Title: Bitar v. Rahman
Citation: N/A
Docket Number: 051891
State: Virginia
Issuer: Virginia Supreme Court
Date: June 8, 2006

Present:  All the Justices 
GEORGE BITAR, M.D. 
v.  Record No. 051891  OPINION BY JUSTICE CYNTHIA D. KINSER 
 
 
 
 
 
 
 
 
June 8, 2006 
WAFA RAHMAN 
 
FROM THE CIRCUIT COURT OF FAIRFAX COUNTY 
David T. Stitt, Judge 
 
 
In this medical malpractice action, we address two 
issues: (1) the fact that the plaintiff’s only medical 
expert witness did not state his opinion to a reasonable 
degree of medical probability; and (2) the sufficiency of 
the evidence.  Because the defendant did not make a 
contemporaneous objection when the medical expert’s 
testimony was introduced, the defendant’s motion to strike 
the expert’s testimony made at the close of the plaintiff’s 
evidence was not timely, and the objection was therefore 
waived.  Thus, the jury properly considered the expert’s 
opinion.  With regard to the sufficiency of the evidence, 
we conclude that the plaintiff presented sufficient 
evidence establishing that the defendant breached the 
standard of care and that the breach was a proximate cause 
of the plaintiff’s injury.  Thus, the circuit court’s 
judgment in favor of the plaintiff was neither plainly 
wrong nor without evidence to support it.  We will 
therefore affirm that judgment. 
 
2
RELEVANT FACTS AND PROCEEDINGS 
 
The appellee, Wafa Rahman, underwent an 
abdominoplasty, a surgical procedure commonly known as a 
“tummy tuck.”1  The appellant, Dr. George J. Bitar, 
performed the surgery in March 2003.  During an office 
visit on the day prior to the scheduled procedure, Dr. 
Bitar made pre-operative markings on Rahman’s abdomen in 
preparation for the surgery.  According to Dr. Bitar, he 
used those markings as points of reference or guidelines 
during the surgery so that he would know if he was cutting 
approximately the same amount of skin from the right and 
left sides of Rahman’s abdomen.  Dr. Bitar indicated that 
the markings were necessary because tissue moves around 
when a patient lies on the operating table. 
 
The day following the surgery, Dr. Bitar noted in 
Rahman’s chart that the “[a]bdominal incision [was] healing 
well.”  Two days after the surgery, Dr. Bitar again noted 
that the “[a]bdominal incision [was] healing well,” but he 
observed a “[s]mall two-by-one centimeter of ischemia” on 
                     
1 Rahman also underwent a breast reduction surgical 
procedure, but this medical malpractice action pertains 
solely to complications that resulted from the 
abdominoplasty. 
 
 
3
Rahman’s mid-abdomen.2  During the first post-discharge 
examination, Dr. Bitar stated that the “[i]ncision looked 
good with [a] small area [of] ecchymosis.”3  In several 
follow-up appointments, however, Dr. Bitar had to perform a 
“minor debridement” of dead or necrotic tissue in order for 
the wound to heal.  The area of the necrotic tissue 
eventually measured 18 by 8 centimeters and was caused by a 
loss of blood supply to Rahman’s abdominal flap.  Because 
of the necrosis, Rahman’s wound did not heal until 
approximately nine months after the surgery.4 
As a result of the complications Rahman suffered 
following the abdominoplasty, she filed an amended motion 
for judgment against Dr. Bitar alleging negligence and lack 
of informed consent.5  Rahman alleged that Dr. Bitar 
breached the standard of care and was negligent in his 
                     
2 Expert witnesses defined the term “ischemia” as a 
“decrease in blood supply,” thereby indicating “signs of 
blood insufficiency to the tissues.” 
 
3 Expert witnesses defined the term “ecchymosis” as  
“bruising when [there is] blood under the skin that can 
cause a bluish, purple area which is sometimes 
indistinguishable from ischemia” and as “a harbinger of 
potential skin damage due to loss of blood supply.” 
 
4 The term “necrosis” is defined as the “death of 
living tissue” that is “affected by loss of blood supply.”  
Webster’s Third New International Dictionary 1511 (1993). 
 
 
4
treatment of her, thereby causing, among other things, “a 
non-healing abdominal wound, swelling, . . . mutilation, 
large irregular scarring and scar tissue.” 
 
At trial, Rahman presented testimony from Dr. Elliot 
W. Jacobs, who qualified as an expert in the field of 
plastic surgery.  Dr. Jacobs had reviewed Rahman’s medical 
records with regard to the abdominoplasty as well as pre-
operative and post-operative photographs of Rahman.  He had 
also examined her on two occasions after the surgery.  Dr. 
Jacobs described how an abdominoplasty is performed and 
discussed the planning and monitoring of the procedure.  He 
explained that, in performing an abdominoplasty, “there is 
a limit as to how much tissue you can remove or how much 
you can tighten it before the blood supply to the remaining 
tissues is compromised.  And then, as occurred in this 
case, the tissues left in place will die due to lack of 
blood supply.”  Based on the photographs of Rahman, Dr. 
Jacobs concluded that Dr. Bitar’s pre-operative markings 
“turned out to be the place where he made his final 
determination of how much tissue would be removed.”  Dr. 
Jacobs explained, however, that a plastic surgeon should 
not pre-determine how much tissue to remove because an 
                                                             
5 The circuit court dismissed the count alleging lack 
of informed consent.  That issue is not before us in this 
 
5
abdominoplasty “is an operation in which basically you cut 
as you go. . . . [T]he proper way to do it is not to draw a 
line but basically to pull it down [and] cut off what [the] 
patient gives you.” 
 
With regard to Rahman’s abdominoplasty, Dr. Jacobs 
testified that the ecchymosis noted on the second day after 
surgery was the first warning of a potential problem.  The 
ecchymosis occurred in the area below the “belly button,” 
which is the area “furthest from the predictable blood 
supply.”  According to Dr. Jacobs, the subsequent 
appearance of ischemia in the same area was a “red flag.”  
Once the ischemia manifested, Dr. Jacobs indicated that 
certain remedial efforts were possible, such as cutting 
some of the stitches free, but that such efforts were not 
made with regard to Rahman.  Dr. Jacobs did describe how 
Dr. Bitar had gradually removed the dead tissue by cutting 
it away until he reached “healthy bleeding tissue.” 
During cross-examination, Dr. Jacobs was asked whether 
he believed that Dr. Bitar had removed too much tissue 
because Dr. Bitar had pre-planned the amount of tissue he 
would take out during the abdominoplasty.  Dr. Jacobs 
answered, “[y]es,” explaining that “[Dr. Bitar] could have 
resected less tissue; and, in my opinion, I believe 
                                                             
appeal. 
 
6
[Rahman] would not have had this problem.”  Continuing, Dr. 
Jacobs testified that, in his 31 years of practice as a 
plastic surgeon, he had never seen an area of necrosis as 
large as that sustained by Rahman.  Finally, Dr. Jacobs 
clarified his opinion in the following exchange of 
questions and answers: 
A: 
What I am saying is that the apparent 
predetermination of tissue was a deviation.  It 
should not have been predetermined, at least 
according to this marking. 
 
Number two, I believe that too much tissue 
was removed leading to the suturing of the flap 
under such tension that the blood supply was 
compromised and the tissue eventually died.  
That’s what I’m saying. 
 
Q: 
And if that was not a predetermination of what 
tissue would be removed but simply a guideline for him 
and what he did was to undermine it, as you indicated, 
and he brought the tissue down and trimmed off what 
was excess over the lower side of the cut, that’s what 
you do, isn’t it? 
 
 
A: 
Yes. 
 
Q: 
And if he did that, then he didn’t breach the 
standard of care, even if it did break down 
thereafter? 
 
A: 
I believe, again, with a – with a result of this 
magnitude something went horribly wrong.  And it’s a 
matter of judgment as to . . . how much tissue you can 
safely remove.  That comes with experience. 
 
At the close of Rahman’s evidence, Dr. Bitar moved to 
strike Dr. Jacobs’ testimony and to enter judgment in favor 
of Dr. Bitar.  He argued that Dr. Jacobs failed to express 
 
7
an opinion to a reasonable degree of medical probability 
that Dr. Bitar had breached the standard of care and that 
the breach was the proximate cause of Rahman’s injuries.  
Dr. Bitar emphasized the point that Dr. Jacobs never 
expressed an opinion to a reasonable degree of medical 
probability.  The circuit court took Dr. Bitar’s motion 
under advisement. 
At the close of all the evidence, Dr. Bitar renewed 
his motion to strike Rahman’s evidence and enter judgment 
in his favor.  In support of his motion, Dr. Bitar argued 
the following: 
[A]t no time was Dr. Jacobs ever asked to express 
an opinion with reasonable medical certainty with 
respect to the standard of care. 
 
 
There is no doubt that he stated that in his 
opinion Dr. Bitar erred because he planned to 
remove more tissue and, therefore, preplanned it 
and did, in fact, upon the execution remove more 
tissue than he should have removed thereby 
creating a situation where excess tension was 
placed upon the abdominal flap resulting in 
inadequate blood supply to what I guess has been 
termed as area two or the area below the navel 
and that as a result . . . that area suffered 
from ischemia and the death of that tissue 
leaving a cosmetically displeasing appearance to 
her lower abdomen. 
 
 
If he had coupled that with the statement 
that – with reasonable medical certainty or 
reasonable medical probability . . . he would 
have perhaps met the standard of care; but he 
didn’t do that. 
 
 
8
The circuit court denied the motion, explaining that 
although “the general rule is that medical expert opinion 
must be rendered to a reasonable degree of medical 
probability[,] . . . the appropriate time for [the motion] 
was at the time the witness offered the opinion[,] . . . 
not after the opinion is in the record.”  The circuit court 
also denied Dr. Bitar’s motion to reconsider the denial of 
his motions to strike Dr. Jacobs’ testimony and to strike 
Rahman’s evidence. 
The jury then returned a verdict in favor of Rahman 
and awarded damages in the amount of $20,000.  Following 
the verdict, Dr. Bitar filed a written motion to set aside 
the jury verdict and to enter judgment as a matter of law 
in his favor.  Dr. Bitar argued that Rahman failed to 
present expert testimony in three areas: (1) what the 
standard of care required Dr. Bitar to do with regard to 
Rahman’s surgery; (2) that Dr. Bitar breached the standard 
of care; and (3) that any such breach was a proximate cause 
of Rahman’s damages.  Dr. Bitar also asserted that, to the 
extent Dr. Jacobs offered an opinion, he did not do so to a 
reasonable degree of medical probability.  The circuit 
court acknowledged that Dr. Jacobs had not been asked 
whether his opinion was to a reasonable degree of medical 
probability.  Nevertheless, the circuit court again 
 
9
concluded that an objection on that basis was untimely.  
The court also stated Dr. Jacobs had testified that Dr. 
Bitar had breached the standard of care and that his 
testimony went beyond “mere possibilities.”  Thus, the 
circuit court denied the motion and entered judgment for 
Rahman in accordance with the jury verdict.  Dr. Bitar now 
appeals to this Court. 
II.  ANALYSIS 
Dr. Bitar raises two issues on appeal.  He asserts 
that the circuit court erred by permitting the jury to 
consider Rahman’s medical malpractice claim and by 
thereafter failing to set aside the jury verdict because: 
(1) Rahman’s expert witness failed to state an opinion to a 
reasonable degree of medical probability; and (2) Rahman’s 
expert witness failed to present sufficient evidence to 
establish that Dr. Bitar had breached the standard of care 
and that the breach was a proximate cause of Rahman’s 
injury.  We will address the issues in that order. 
In doing so, we are guided by well-established 
principles of appellate review.  Armed with a jury verdict 
approved by the trial court, Rahman stands in “the most 
favored position known to the law.”  Ravenwood Towers, Inc. 
v. Woodyard, 244 Va. 51, 57, 419 S.E.2d 627, 630 (1992).  
She is entitled to have the evidence, and all inferences 
 
10
that may reasonably be drawn from it, viewed in the light 
most favorable to her.  Norfolk S. Ry. Co. v. Rogers, 270 
Va. 468, 478, 621 S.E.2d 59, 65 (2005); Evaluation Research 
Corp. v. Alequin, 247 Va. 143, 147, 439 S.E.2d 387, 390 
(1994).  The judgment of the circuit court will not be set 
aside unless it is “plainly wrong or without evidence to 
support it.”  Code § 8.01-680; see also Norfolk Southern, 
270 Va. at 478, 621 S.E.2d at 65. 
In a medical malpractice action, “a plaintiff must 
establish not only that a defendant violated the applicable 
standard of care, and therefore was negligent, the 
plaintiff must also sustain the burden of showing that the 
negligent acts constituted a proximate cause of the injury 
or death.”  Bryan v. Burt, 254 Va. 28, 34, 486 S.E.2d 536, 
539-40 (1997); see also King v. Sowers, 252 Va. 71, 76, 471 
S.E.2d 481, 484 (1996) (“[t]he relevant issue . . . is 
whether the treatment rendered violated the applicable 
standard of care and whether any such breach of the 
standard of care was a proximate cause of the plaintiff’s 
injury”).  “ '[E]xpert testimony is ordinarily necessary to 
establish the appropriate standard of care, to establish a 
deviation from the standard, and to establish that such a 
deviation was the proximate cause of the claimed 
damages.’ ”  Perdieu v. Blackstone Family Practice Ctr., 
 
11
Inc., 264 Va. 408, 420, 568 S.E.2d 703, 710 (2002) (quoting 
Raines v. Lutz, 231 Va. 110, 113, 341 S.E.2d 194, 196 
(1986)); see also Rogers v. Marrow, 243 Va. 162, 167, 413 
S.E.2d 344, 346 (1992).  To be admissible, such medical 
expert testimony must be rendered to a “reasonable degree 
of medical probability.”  Pettus v. Gottfried, 269 Va. 69, 
78, 606 S.E.2d 819, 825 (2005); see also Spruill v. 
Commonwealth, 221 Va. 475, 479, 271 S.E.2d 419, 421 (1980) 
(“[a] medical opinion based on a ‘possibility’ is 
irrelevant, purely speculative and, hence inadmissible”). 
 
This last principle is central to our consideration of 
the first issue, whether the circuit court erred by 
allowing the jury to consider the medical malpractice claim 
since Dr. Jacobs never expressed his opinion to a 
reasonable degree of medical probability.  Dr. Bitar argues 
not only that Dr. Jacobs’ testimony was based on 
possibilities instead of probabilities but also that his 
opinion lacked an adequate factual foundation and did not 
take into account all the variables that could bear upon 
the inferences to be drawn from the facts.6  It is correct 
                     
6 According to Dr. Bitar, the variables that Dr. Jacobs 
did not take into account were other possible causes for 
the loss of tissue such as hematoma and/or seroma, and the 
effect of flexing the operating table, Rahman’s sleeping 
and standing positions after surgery, releasing sutures 
post-operatively, and Rahman’s smoking. 
 
12
that Dr. Jacobs never stated his opinion was based on a 
reasonable degree of medical probability.  Rahman, however, 
contends that Dr. Bitar’s argument premised on this 
omission in Dr. Jacobs’ testimony is actually an objection 
that should have been raised contemporaneously with the 
introduction of Dr. Jacobs’ testimony rather than at the 
close of Rahman’s evidence, after her other witnesses had 
testified.7  We agree with Rahman’s position. 
 
In Mueller v. Commonwealth, the defendant argued that 
portions of a forensic pathologist’s testimony should not 
have been admitted because the pathologist expressed 
opinions that were not stated to a “reasonable degree of 
medical certainty.”  244 Va. 386, 410, 422 S.E.2d 380, 395 
(1992), overruled in part on other grounds by Morrisette v. 
Warden of Sussex I State Prison, 270 Va. 188, 202, 613 
S.E.2d 551, 562 (2005).  Because the defendant failed to 
make a contemporaneous objection during the pathologist’s 
testimony to the admission of objectionable opinions, we 
refused to consider the argument on appeal.  Mueller, 244 
Va. at 410, 422 S.E.2d at 395. 
 
Similarly, in Spruill, a psychiatrist testified that 
there was a “possibility” that the defendant was insane on 
                     
7 Dr. Jacobs was Rahman’s first witness.  She called 
four other witnesses after Dr. Jacobs testified before 
 
13
the day the crimes at issue were committed.  221 Va. at 
479, 271 S.E.2d at 421.  We upheld the trial court’s 
decision refusing to admit the testimony.  Id.  We stated, 
“[a] medical opinion based on a ‘possibility’ is 
irrelevant, purely speculative and, hence, inadmissible.”  
Id. (emphasis added); accord State Farm Mut. Auto. Ins. Co. 
v. Kendrick, 254 Va. 206, 208-09, 491 S.E.2d 286, 287 
(1997); Fairfax Hosp. Sys. v. Curtis, 249 Va. 531, 535, 457 
S.E.2d 66, 69 (1995).  We reached the same conclusion in 
Pettus, when a doctor’s answer to a question “offered an 
expert opinion that was speculative in nature and 
inadmissible because it was not stated to a reasonable 
degree of medical probability.”  269 Va. at 78, 606 S.E.2d 
at 825 (emphasis added); see also Vasquez v. Mabini, 269 
Va. 155, 160, 606 S.E.2d 809, 811 (2005) (expert testimony 
founded upon assumptions having no factual basis is 
inadmissible, and failure of the trial court to strike such 
testimony upon a timely motion is error); Countryside Corp. 
v. Taylor, 263 Va. 549, 553, 561 S.E.2d 680, 682 (2002) 
(“expert testimony is inadmissible if the expert fails to 
consider all the variables that bear upon the inferences to 
be deduced from the facts observed”); John v. Im, 263 Va. 
315, 319-20, 559 S.E.2d 694, 696 (2002) (expert testimony 
                                                             
resting her case. 
 
14
is inadmissible if it is based on an inadequate foundation, 
is speculative, or is founded on assumptions lacking a 
sufficient factual basis). 
 
In sum, these cases demonstrate that an objection 
based on the fact that a medical expert’s opinion is not 
stated to a reasonable degree of medical probability, lacks 
an adequate factual foundation, or fails to consider all 
the relevant variables challenges the admissibility of 
evidence rather than the sufficiency of evidence.  As this 
Court, however, has stated, “[a]n objection to the 
admissibility of evidence must be made when the evidence is 
presented.  The objection comes too late if the objecting 
party remains silent during its presentation and brings the 
matter to the court’s attention by a motion to strike made 
after the opposing party has rested.”  Kondaurov v. 
Kerdasha, 271 Va. 646, ___, ___ S.E.2d ___, ___ (2006). 
In some circumstances, a defect in an expert witness’ 
testimony may not be apparent until the testimony of that 
witness is completed.  Hence, an objection raised at that 
first opportunity is timely.  See Vasquez, 269 Va. at 162, 
606 S.E.2d at 812-13 (objection was timely made at the end 
of a witness’ testimony when his reliance on unfounded 
assumptions became clear); Countryside Corp., 263 Va. at 
553, 561 S.E.2d at 682 (objection at the conclusion of an 
 
15
expert’s testimony when reliance on erroneous factual 
premise became apparent was timely raised).  In the present 
case, however, as is true in most instances, the omission 
rendering Dr. Jacobs’ testimony inadmissible was apparent 
as specific questions were posed and Dr. Jacobs failed, in 
answering those questions, to express his opinion to a 
reasonable degree of medical probability as required by 
established law.  This defect certainly was obvious by the 
end of the direct examination.  Consequently, an objection 
could have, and should have, been made at that time.8 
 
The general standards for timely motions to strike the 
evidence for insufficiency are inapplicable to objections 
regarding the admissibility of evidence.  As we have 
previously held: “[a] litigant may not, in a motion to 
strike [the evidence], raise for the first time a question 
of admissibility of evidence.  Such motions deal with the 
sufficiency rather than the admissibility of evidence.”  
Woodson v. Commonwealth, 211 Va. 285, 288, 176 S.E.2d 818, 
821 (1970); see also Poole v. Commonwealth, 211 Va. 258, 
260, 176 S.E.2d 821, 823 (1970). 
 
Since Dr. Bitar did not move to strike Dr. Jacobs’ 
testimony or raise any objection to its admissibility until 
                     
8 In some instances, an objection to the admissibility 
of evidence can be raised in a pre-trial motion. 
 
16
after Dr. Jacobs was excused and had returned to New York, 
and the testimony of several other witnesses was presented, 
the objection was too late.  Although Dr. Bitar couches the 
first issue as a challenge to the sufficiency of the 
evidence, it presents only a question regarding the 
admissibility of Dr. Jacobs’ testimony, which was waived 
because the objection was not timely raised during the 
trial.9  See TransiLift Equip., Ltd. v. Cunningham, 234 Va. 
84, 91-92, 360 S.E.2d 183, 187-88 (1987) (if a party does 
not timely object to the admission of evidence, the 
objection is waived). 
 
Thus, with regard to the first issue, we conclude that 
the circuit court did not err by allowing the jury to 
consider Rahman’s medical malpractice claim merely because 
Dr. Jacobs did not express his opinion to a reasonable 
degree of medical probability.  Dr. Jacobs’ testimony, 
having been admitted without objection, was properly 
considered by the jury. 
                     
9 Dr. Bitar argues on brief that, if he had to object 
to the admissibility of Dr. Jacobs’ testimony 
contemporaneously with its introduction, he would be 
presented with “[a]n untenable dilemma with ethical 
implications.”  He contends that such a rule would alert a 
plaintiff that the opinion of her only expert was not 
admissible and that, as a defendant, he would lose the 
opportunity to move to strike the plaintiff’s evidence on 
the basis that she had not proven a prima facie case.  This 
argument has no merit. 
 
17
 
[I]f a litigant sits by and permits evidence 
to go to the jury which the court, if it had been 
objected to, would have excluded, the jury have 
the right and it is their duty to consider it 
along with all the evidence and give it such 
weight as they think it is entitled to. 
 
Id. (quoting Newberry v. Watts, 116 Va. 730, 736, 82 S.E. 
703, 705 (1914)). 
We now consider the second issue, whether the evidence 
was sufficient to establish that Dr. Bitar breached the 
standard of care and that such breach was a proximate cause 
of Rahman’s injury.  Our resolution of that issue turns on 
the testimony of Dr. Jacobs, who was Rahman’s only medical 
expert witness. 
 
In addressing the issue, we are mindful that Dr. Bitar 
challenged the sufficiency of the evidence at the close of 
Rahman’s evidence, at the close of all the evidence, and in 
a motion to set aside the jury verdict.  The standard of 
appellate review, however, is the same in each instance. 
[W]here the trial court has declined to strike 
the plaintiff’s evidence or to set aside a jury 
verdict, the standard of appellate review in 
Virginia requires this Court to consider whether 
the evidence presented, taken in the light most 
favorable to the plaintiff, was sufficient to 
support the jury verdict in favor of the 
plaintiff. 
 
County of Giles v. Wines, 262 Va. 68, 76 & n.*, 546 S.E.2d 
721, 725 & n.* (2001) (Lacy, J., dissenting); see also 
Lumbermen’s Underwriting Alliance v. Dave’s Cabinet, Inc., 
 
18
258 Va. 377, 380-81, 520 S.E.2d 362, 364-65 (1999); 
Claycomb v. Didawick, 256 Va. 332, 335, 505 S.E.2d 202, 204 
(1998); Austin v. Shoney’s, Inc., 254 Va. 134, 138, 486 
S.E.2d 285, 287 (1997). 
Dr. Jacobs opined that Dr. Bitar, in planning and 
performing the abdominoplasty, breached the standard of 
care because Dr. Bitar pre-determined the amount of tissue 
to be removed.  Continuing, Dr. Jacobs stated that “too 
much tissue was removed leading to the suturing of the flap 
under such tension that the blood supply was compromised 
and the tissue eventually died.”  This testimony 
established a breach of the standard of care by Dr. Bitar 
and that such breach was a proximate cause of Rahman’s 
injury.  See Brown v. Koulizakis, 229 Va. 524, 532, 331 
S.E.2d 440, 446 (1985) (in a medical malpractice action, 
the plaintiff must establish that the defendant breached 
the applicable standard of care and that the negligent acts 
were a proximate cause of the injury).  In other words, Dr. 
Jacobs’ testimony provided credible evidence that supports 
the jury verdict.  “A trial court is authorized to set 
aside a jury verdict only if it is plainly wrong or without 
credible evidence to support it.”  Bussey v. E.S.C. Rests., 
Inc., 270 Va. 531, 534, 620 S.E.2d 764, 766 (2005). 
 
19
Contrary to Dr. Bitar’s argument, Dr. Jacobs did not 
base his opinion on the fact that Rahman suffered 
complications after her surgery.  Instead, in responding to 
a question whether Dr. Bitar would have breached the 
standard of care if he had merely used the pre-operative 
markings on Rahman’s abdomen as a guideline, Dr. Jacobs 
stated, “I believe . . . with a result of this magnitude 
something went horribly wrong.”  Furthermore, in arguing 
his motion to strike Rahman’s evidence at the close of all 
the evidence, Dr. Bitar acknowledged that Dr. Jacobs opined 
that Dr. Bitar erred because he pre-planned the amount of 
tissue to remove and then took out more tissue than he 
should have, thereby causing excess tension upon the 
abdominal flap, which resulted in inadequate blood supply, 
death of the tissue, and “a cosmetically displeasing 
appearance to [Rahman’s] lower abdomen.” 
Thus, we conclude that the circuit court did not err 
in refusing to strike Rahman’s evidence or to set aside the 
jury verdict in her favor.  We cannot say the judgment was 
“plainly wrong or without evidence to support it.”  Code 
§ 8.01-680. 
CONCLUSION 
 
Since Dr. Bitar failed to raise a timely objection to 
the admission of Dr. Jacobs’ testimony, the circuit court 
 
20
did not err in allowing the jury to consider Rahman’s 
medical malpractice claim even though Dr. Jacobs never 
stated his opinion to a reasonable degree of medical 
probability.  Viewing the evidence in the light most 
favorable to Rahman, we conclude that Rahman presented 
sufficient evidence to establish that Dr. Bitar breached 
the standard of care and that the breach was a proximate 
cause of her injury. 
 
For these reasons, we will affirm the judgment of the 
circuit court. 
Affirmed.