Title: N & W Ry. v. Keeling
Citation: N/A
Docket Number: 020834
State: Virginia
Issuer: Virginia Supreme Court
Date: February 28, 2003

PRESENT:  Hassell, C.J., Lacy, Keenan, Koontz, Kinser, and 
Lemons, JJ., and Carrico,1 S.J. 
 
NORFOLK AND WESTERN RAILWAY COMPANY 
 
v. Record No. 020834 
 OPINION BY JUSTICE ELIZABETH B. LACY 
 
 
 
 
 
             February 28, 2003 
RAYMOND P. KEELING 
 
FROM THE CIRCUIT COURT OF THE CITY OF ROANOKE 
Clifford R. Weckstein, Judge 
 
 
In this case brought under the Federal Employers' 
Liability Act, 45 U.S.C. §§ 51-60 (FELA), Norfolk and Western 
Railway Company (N&W) appeals a judgment in favor of its 
employee, Raymond P. Keeling, Jr., asserting that Keeling 
failed to present evidence that N&W was negligent and that 
Keeling's injury was foreseeable.  N&W also argues that the 
trial court improperly excluded certain expert testimony.  
Based on our review of the record, we conclude that the issues 
of negligence and foreseeability were properly submitted to 
the jury and that the trial court did not abuse its discretion 
in excluding the testimony of N&W's expert. 
FACTS 
 
Keeling was employed by N&W as an electrician.  In his 
position, Keeling had to wear a respirator at times and, under 
federal regulations, was required to take pulmonary function 
tests (PFTs). 
                     
1 Chief Justice Carrico presided and participated in the 
hearing and decision of this case prior to the effective date 
N&W contracted with T.K. Group, Inc., and Quality 
Services, Inc., to administer PFTs to N&W's employees.  N&W's 
internal protocol provided that prior to administering a PFT 
the blood pressure of employee will be monitored 
and determined to be within the acceptable range 
(lower than 200/115).  If above this level, testing 
will not be performed and the supervisor and 
medical doctor will be advised. 
 
Before administering a PFT to Keeling in August 1994, N&W's 
agent, a technician employed through T.K. Group, Inc., and 
Quality Services, Inc., measured Keeling's blood pressure.  
That measurement showed that Keeling's blood pressure was 
greater than 200/110.2  After waiting five or ten minutes, the 
technician again took Keeling's blood pressure, which then 
measured 158/102.  Based on this reading, the technician 
proceeded to administer the test to Keeling. 
 
The test required Keeling to breathe through a device 
that measures the airflow generated by the patient's lungs.  
The patient is instructed to inhale as deeply as possible and 
then exhale that air as quickly as possible.  The technician 
administering the test felt Keeling's first test was 
insufficient and told Keeling to "blow hard" into the device 
again.  When he repeated the test, Keeling started sweating 
                                                                
of his retirement on January 31, 2003. 
2 The record does not indicate the exact measured reading 
but established that Keeling's blood pressure was greater than 
200/110.  
 
2
and experiencing chest pain and dizziness.  At that point, the 
technician stopped further testing.  After checking with his 
superior, Keeling was driven home by a co-worker. 
Keeling's symptoms continued at home, and his wife took 
him to a hospital emergency room.  The emergency room 
physician determined that Keeling had a hole in his ear and 
referred him to Dr. Kurt Chen, an otolaryngologist.  Dr. Chen 
performed surgery on Keeling's ear two days later. 
Keeling's condition improved following his surgery and 
rehabilitation, but in 1995, he lost his balance and fell.  
Dr. Chen referred Keeling to Dr. Robert I. Kohut, another 
otolaryngologist, who diagnosed Keeling's condition as 
"recurrent perilymphatic fistula" and determined that Keeling 
required another surgery on his eardrum.3  Keeling experienced 
some improvement after this second surgery but was never 
released by a physician to return to his former employment. 
Keeling filed an action against N&W under FELA, alleging 
that N&W violated FELA because it negligently failed to 
provide a safe workplace by, inter alia, not properly 
determining whether he was physically fit to undergo or 
                     
3 A perilymphatic fistula is an opening between the inner 
ear and middle ear allowing perilymph fluid to permeate the 
middle ear from the inner ear. 
 
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continue pulmonary function testing.4  This negligence, Keeling 
claimed, resulted in a perilymphatic fistula when he blew into 
the testing mechanism.  Following a five day trial, the jury 
returned a verdict in Keeling's favor for $350,000.  N&W 
appeals from the judgment entered on the jury verdict. 
DISCUSSION 
1.  Negligence and Foreseeability 
We awarded N&W an appeal on three assignments of error.  
In its first two assignments, N&W asserts it was entitled to a 
judgment in its favor as a matter of law because Keeling 
presented no evidence of negligence in the administration of 
the PFT and no evidence that Keeling's injury was foreseeable. 
 
The legal principles applicable to these two assignments 
of error are well settled.  Whether negligence has been 
established in a FELA claim is a matter of federal law.  
Norfolk S. Ry. v. Trimiew, 253 Va. 22, 24, 480 S.E.2d 104, 106 
(1997).  Under FELA, the railroad has a nondelegable duty to 
exercise reasonable care in providing a safe work place for 
its employees.  Id. at 25, 480 S.E.2d at 106.  The employer 
breaches this duty if its negligence causes, even in the 
slightest way, an injury to its employee.  Reasonable 
foreseeability of harm is an essential element of negligence 
                     
4 Keeling also named T.K. Group, Inc. and Quality Services 
Inc. as defendants.  Orders non-suiting T.K. Group and 
 
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under FELA.  Id. at 24, 480 S.E.2d at 106.  Both 
foreseeability and negligence must be shown by more than a 
scintilla of evidence, and these issues are normally issues 
for the jury.  Id. at 27, 480 S.E.2d at 108. 
 
The standard of review applicable to the first two 
assignments of error is also well established.  The evidence 
and all inferences fairly made from that evidence must be 
considered in the light most favorable to Keeling.  Austin v. 
Shoney's, Inc., 254 Va. 134, 138, 486 S.E.2d 285, 287 (1997).  
Further, this Court will not set aside the trial court's 
judgment unless it is plainly wrong or without evidence to 
support it.  Code § 8.01-680. 
 
N&W asserts that the record "simply does not support" 
Keeling's theory that the failure to excuse him from PFT 
testing when he received the initial higher blood pressure 
reading was negligent.  N&W argues that Keeling was given the 
PFT only after his blood pressure reading was 158/102 and that 
there was no evidence to support the conclusion that 
administering a PFT following such a blood pressure reading 
was negligent.  "The heart of" Keeling's allegation of 
negligence, N&W argues, is that the technician, N&W's agent, 
failed to follow N&W's internal protocol. 
                                                                
dismissing Quality Services were entered prior to trial. 
 
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The record does not support N&W's position.  Rather, the 
record contains expert testimony that administering the PFT 
test following his initial blood pressure reading exposed 
Keeling to a greater risk of injury.  Dr. Kirk E. Hippensteel, 
Keeling's expert in the field of pulmonology, testified that, 
in his expert medical opinion, no patient should be asked to 
perform a PFT following a blood pressure reading in excess of 
200/110 or 200/115.  Dr. Hippensteel explained that blood 
pressure is dynamic and that performing a PFT would likely 
cause a patient's blood pressure to increase.  Such increase 
in blood pressure would decrease the autoregulation of the 
cardiovascular system and autoregulation of pressure in the 
brain.  He opined that administering the PFT following the 
initial blood pressure reading in this case created the risk 
that Keeling's blood pressure, even following a rest period, 
would be as high or higher than the original blood pressure 
reading and that the test should not have been given. 
This evidence of negligence in administering the test 
after receiving the initial higher blood pressure reading is 
not related to an allegation that the negligence consisted of 
a  violation of N&W's internal protocol.  Dr. Hippensteel's 
opinion is an independent determination that the initial blood 
pressure level itself, regardless of the relationship of that 
level to the protocol, provided the basis to conclude that the 
 
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PFT should not have been administered, regardless of 
subsequent blood pressure levels. 
We conclude that the record contains more than a 
scintilla of evidence that N&W was negligent when its agents 
administered a stressful PFT test to an employee with a blood 
pressure reading in excess of 200/110 or 200/115.  See 
Trimiew, 253 Va. at 27-28, 480 S.E.2d at 108. 
We also agree with the trial court that sufficient 
evidence was produced to support a jury finding that injury 
was foreseeable as a result of administering the PFT under an 
elevated blood pressure level.  An employee raising a FELA 
claim does not have to show that the employer's negligence 
would inevitably cause injury, had resulted in past injury, or 
would cause a specific kind of injury.  See Gallick v. 
Baltimore & Ohio R.R., 372 U.S. 108, 120-21 (1963).  N&W 
produced testimony that the blood pressure screening was done 
prior to administration of PFTs for general health purposes.  
Nevertheless, under N&W's protocol, the administration of a 
PFT was contingent upon an employee's blood pressure level.  
Thus, the jury was entitled to conclude that N&W believed 
there was a risk of harm associated with taking a PFT while 
experiencing certain blood pressure levels. 
 
Considering the evidence in a light most favorable to 
Keeling, we conclude that Keeling presented more than a 
 
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scintilla of evidence that N&W knew or should have known that 
an injury was likely to occur if a PFT was given to an 
employee with a blood pressure level in excess of 200/110 or 
200/115.  Accordingly, the trial court properly submitted the 
issues of negligence and foreseeability to the jury and did 
not err in refusing to set aside the jury verdict on those 
issues. 
2.  Expert Testimony 
N&W's final assignment of error relates to the testimony 
of Dr. J. Wallace Grant, Ph.D.  We begin by briefly reviewing 
the testimony in question. 
N&W offered Dr. Grant as an expert in biomechanical 
engineering with a specialization in vestibular mechanics.  
The trial court found that Dr. Grant was qualified to offer 
opinion testimony in those areas.  In his direct examination, 
Dr. Grant was asked "what is it that causes one of these 
fistulas to become symptomatic?"  As part of the response to 
this question, Dr. Grant stated that "[t]he creation of the 
fistula is usually the result of an infection or something 
that causes the tissue or the bone to deteriorate."  Keeling 
objected, asserting that the questions and answers went beyond 
the area of biomechanical engineering because they addressed 
the medical cause of the fistula, an area "reserved for the 
medical profession." 
 
8
Out of the presence of the jury, counsel for Keeling and 
N&W presented arguments regarding the admissibility of this  
testimony.  Following a dialogue with the trial court as to 
whether N&W planned to ask Dr. Grant questions involving 
"cause," Dr. Grant was questioned further by N&W and Keeling.  
This questioning was submitted by N&W as a proffer of Dr. 
Grant's testimony.  N&W's counsel summarized the testimony as 
describing "the relationship between blood pressure and 
cerebral spinal fluid as they interact in pressure within the 
vestibular area . . ." which "merely explains the mechanics of 
what goes about in the inner ear when there is a perilymphatic 
fistula which allows the communication of pressure between an 
inner ear and the middle ear." 
Relying on Combs v. Norfolk and Western Railway Co., 256 
Va. 490, 507 S.E.2d 355 (1998), the trial court concluded that 
Dr. Grant's testimony about the relationship between arterial 
blood pressure and perilymphatic fistula, was, in the court's 
view, "the functional equivalent of Doctor Schneck testifying 
to the relationship between various physical factors and the 
rupture of a human disk [in Combs]." 
Following this ruling, N&W told the trial court that it 
intended to limit its questioning of Dr. Grant to "the 
relationship between blood pressure and the pressure that you 
see in the cerebral spinal fluid."  The court proceeded to 
 
9
examine Dr. Grant to determine whether the nature of his 
testimony would be biomedical or biomechanical.  Following 
this exchange, the trial court again commented that the 
testimony at issue was "biophysical as well as biomechanical" 
and that N&W did not want to question Grant solely about 
"pressures in the inner ear."  The trial court concluded that, 
under Combs, Grant could not "offer testimony in those areas." 
In its final assignment of error, N&W complains that because 
Dr. Grant's testimony did not address medical causation 
issues, it was error to exclude the testimony on the basis 
that Dr. Grant was not a medical doctor. 
 
In considering questions of procedure and evidence, 
including the admissibility of expert testimony, we apply 
state law, Chesapeake v. Ohio Rwy. Co. v. Kelly, 241 U.S. 485, 
491 (1916), and review the trial court's ruling to exclude 
expert testimony for an abuse of discretion.  John v. Im, 263 
Va. 315, 320, 559 S.E.2d 694, 696 (2002). 
In Combs, we held that only a medical doctor could give 
expert testimony about the cause of a human physical injury.  
256 Va. at 496, 507 S.E.2d at 358.  We reiterated that rule in 
Im, 263 Va. at 321, 559 S.E.2d at 697.  The testimony given by 
Dr. Grant in the presence of the jury – that fistulas were 
generally caused by infections that caused bone or tissue to 
deteriorate – clearly came within the prohibition recited in 
 
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Combs and Im.  The trial court did not abuse its discretion in 
excluding this testimony. 
The testimony presented out of the presence of the jury 
in N&W's subsequent proffer did not include questions as to 
the cause of the fistula.  However, we cannot say that the 
trial court abused its discretion in disallowing this 
testimony based on its conclusions that N&W did not intend to 
limit its questions to pressure in the inner ear and that the 
proffered testimony involved opinions based on both medical 
and biomechanical matters. 
Furthermore, as N&W predicted at trial and Keeling argues 
here, other medical doctors presented by N&W testified 
"essentially, about the same issues."  The testimony that N&W 
argues was improperly excluded was Dr. Grant's opinion that 
cerebral spinal fluid pressure is independent of arterial 
blood pressure and that a straining movement could increase 
both cerebral spinal fluid pressure and venous pressure but 
that there was no relationship between such a straining 
movement and arterial blood pressure. 
Dr. Paul R. Lambert and Dr. C. Edward Rose, medical 
doctors testifying on behalf of N&W, stated that there was no 
relationship between arterial blood pressure and cerebral 
spinal fluid pressure.  These doctors also testified that a 
straining effort could increase cerebral spinal fluid pressure 
 
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and venous pressure but not arterial blood pressure.  This 
information was put before the jury, and, thus, Dr. Grant's 
testimony as to these matters would have been cumulative. 
For the above reasons, we will affirm the judgment of the 
trial court. 
Affirmed.
 
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