Title: Perdieu v. Blackstone Family Practice Center
Citation: N/A
Docket Number: 012008
State: Virginia
Issuer: Virginia Supreme Court
Date: September 13, 2002

PRESENT: All the Justices 
 
HORACE E. PERDIEU, AS ADMINISTRATOR 
 OF THE ESTATE OF LUCILLE P. OVERTON, 
 DECEASED 
 
 
 
OPINION BY 
v.  Record No. 012008 
JUSTICE DONALD W. LEMONS 
 
 
 
September 13, 2002 
BLACKSTONE FAMILY PRACTICE CENTER, 
 INC., ET AL. 
 
 
FROM THE CIRCUIT COURT OF NOTTOWAY COUNTY  
James A. Luke, Judge 
 
 
In this appeal, we consider whether the trial court erred 
in refusing to qualify three of the plaintiff’s proposed expert 
witnesses.  We further consider whether the trial court erred in 
granting the defendants’ motions to strike at the conclusion of 
the plaintiff’s case-in-chief when the plaintiff did not present 
essential expert testimony. 
I. Facts and Proceedings Below 
 
According to well-settled principles of appellate review, 
when the evidence has been struck at the conclusion of the 
plaintiff’s case-in-chief, we will recite the facts in the light 
most favorable to the plaintiff.  Bryan v. Burt, 254 Va. 28, 30-
31, 486 S.E.2d 536, 537 (1997). 
 
On January 4, 1995, Lucille P. Overton (“Overton”) was 
admitted as a patient to Heritage Hall Health Care (“Heritage 
Hall”), a nursing home facility in Blackstone, Virginia.  Upon 
her admission, she entered into an agreement entitled “Heritage 
Hall Admission Agreement” (the “contract”), in which HCMF 
Corporation (“HCMF”), t/a Heritage Hall Health Care, agreed to 
provide Overton with such care as her condition reasonably 
required.  Overton had a history of “mental confusion, dementia 
and disorientation.”  Charles I. Rosenbaum, M.D. (“Dr. 
Rosenbaum”) and Blackstone Family Practice Center, Inc. (“BFPC”) 
were listed on Overton’s chart as her medical care providers.  
The Heritage Hall staff performed an evaluation of Overton’s 
condition and needs upon her arrival to the facility, which 
indicated that Overton was “ambulatory only with assistance, was 
confused, and only sometimes oriented to place and time.”  As a 
result of the evaluation, the Heritage Hall staff categorized 
Overton as subject to a high risk for falls. 
 
On January 20, 1995, Overton fell from her bed onto the 
floor of her room.  A member of the staff at Heritage Hall 
contacted BFPC and Dr. Rosenbaum to inform them of Overton’s 
fall.  Overton was then examined by Dr. Josephine R. Fowler 
(“Dr. Fowler”), a resident physician in training at the Medical 
College of Virginia/Virginia Commonwealth University, who was 
conducting a family practice rotation under the supervision of 
BFPC.  Dr. Fowler did not diagnose any injuries resulting from 
Overton’s fall. 
 
The next day, January 21, 1995, Overton fell again, this 
time in the dining room at Heritage Hall.  Again, Dr. Fowler 
 
2
examined Overton and did not diagnose any injury resulting from 
the fall. 
 
After the second fall, Overton’s physical and psychological 
condition “severely deteriorated.”  Overton’s son, Horace E. 
Perdieu (“Perdieu”), visited her on January 30 or 31, 1995, 
observed her condition, and requested medical attention for his 
mother from the Heritage Hall staff.  The staff notified BFPC, 
and as a result Overton was examined by Dr. George P. Damewood 
(“Dr. Damewood”), another resident physician associated with 
BFPC.  During a physical examination, Dr. Damewood determined 
that Overton appeared to have sustained a hip fracture and he 
ordered x-rays of Overton’s hip.  Dr. Rosenbaum viewed the x-
rays and confirmed the hip fracture and Dr. Barry W. Burkhardt 
(“Dr. Burkhardt”) subsequently performed surgery on Overton to 
replace her fractured hip with a prosthesis.   
 
On April 30, 1999, Overton filed a four-count motion for 
judgment against BFPC, Dr. Rosenbaum, and HCMF, seeking one 
million dollars in “compensatory and exemplary damages.”  In 
Count I, Overton alleged that HCMF breached its contract with 
her when it failed to provide her with reasonable care, failed 
to direct the development of a suitable care plan related to her 
personal health needs, and failed to protect her with adequate 
safety measures. 
 
3
 
In Count II, Overton alleged that BFPC and Dr. Rosenbaum 
committed medical malpractice because Dr. Rosenbaum failed to 
personally examine Overton and allowed her to be examined by Dr. 
Fowler, a “completely unsupervised” resident physician.  Overton 
further alleged that BFPC and Dr. Rosenbaum failed to properly 
“examine, diagnose, and treat” her, in violation of the 
applicable standard of reasonable care, and failed to implement 
adequate safety measures to prevent her from falling. 
 
In Count III, Overton alleged that all three defendants 
engaged in “negligent and careless acts and omissions” when they 
failed to “properly attend, restrain, assist, examine, diagnose 
and treat” her.  She further alleged that the three defendants 
“negligently failed to supervise their employees.” 
 
Finally, in Count IV, Overton alleged that HCMF violated 
Code § 32.1-138, which enumerates certain requirements for 
nursing homes in Virginia, and that HCMF, Dr. Rosenbaum, and 
BFPC violated 42 U.S.C. § 1395i-3, which provides requirements 
for “skilled nursing facilities.” 
 
Overton died of unrelated causes on October 16, 1999, and 
Perdieu qualified as the administrator of her estate.  On March 
7, 2000, Perdieu, as Administrator of the Estate of Lucille P. 
Overton, was substituted as the plaintiff in the case. 
 
Prior to trial, Perdieu designated eight experts, including 
the three at issue in this appeal: Dr. John O. Martin (“Dr. 
 
4
Martin”), Dr. Reinald Leidelmeyer (“Dr. Leidelmeyer”), and 
Phylis Corrigan, R.N. (“Corrigan”).  Dr. Martin proposed to 
testify that the lack of a suitable care plan and safety 
measures in place to prevent Overton’s falls violated the 
appropriate standard of care.  He would have opined that this 
failure directly and proximately caused Overton’s physical 
injury and continued pain and suffering. 
 
Dr. Leidelmeyer was designated to testify about the same 
matters as Dr. Martin, and was further designated to testify 
that Overton’s medical records, including the records of Dr. 
Fowler’s examinations, were “not sufficiently detailed.”  As a 
result of Dr. Fowler’s “grossly inadequate records” and her 
failure to report the falls, as required, Dr. Leidelmeyer would 
have testified that it took approximately ten or more days to 
diagnose Overton’s hip fracture.  Dr. Leidelmeyer would also 
have testified that Dr. Rosenbaum’s conduct, in failing to 
consult with Dr. Fowler, “consitute[d] a serious aberration of 
accepted standards and protocol of resident physician training 
programs.”     
 
Corrigan was designated to testify “as to the standard of 
care which [Overton] should have received” from HCMF.  Corrigan 
would have opined that proper care, which was “reasonably 
necessary to prevent the falls and resulting injury” sustained 
by Overton, was not provided.  Corrigan would further have 
 
5
testified that a patient-specific care plan should have been 
instituted immediately upon Overton’s admission to Heritage 
Hall. 
 
Dr. Rosenbaum and BFPC filed motions in limine to exclude 
the testimony of Dr. Leidelmeyer and Dr. Martin.  HCMF filed a 
similar motion in limine to exclude the testimony of Dr. Martin 
and Corrigan.  On the day before trial, the court heard 
arguments on the motions to exclude the various expert 
witnesses.  The court first considered the qualifications of Dr. 
Leidelmeyer and viewed a videotape of his deposition.  Dr. 
Leidelmeyer testified that he had served as the head of the 
emergency department of medicine at Fairfax Hospital in Fairfax, 
Virginia, from approximately 1961 until 1982.  While at Fairfax 
Hospital, Dr. Leidelmeyer was in a “supervisory capacity over 
all the physicians,” including interns and residents in 
training.  After leaving that position, he “opened a walk-in 
clinic for primary care,” and operated the clinic for “[a]bout 
ten years,” until approximately 1992.  Dr. Leidelmeyer testified 
that after leaving his employment with the “walk-in clinic,” he 
worked approximately one day per week for a private family 
practice clinic owned by two doctors who had previously worked 
for him at Fairfax Hospital.  He held this employment until 
1998.  Dr. Leidelmeyer testified that from 1990 until 2001, he 
also worked approximately one day per week at the Fairfax County 
 
6
Health Department (“Health Department”), where he performed pre-
employment physicals and interpreted tuberculosis tests.  He 
testified that he did not diagnose or treat fractures, nor did 
he treat nursing home patients, while working at the Health 
Department. 
 
BFPC and Dr. Rosenbaum argued that Dr. Leidelmeyer did not 
satisfy the requirements of Code § 8.01-581.20 because his part-
time employment at the Health Department did not qualify as an 
“active clinical practice,” as required by the statute.  They 
argued that Dr. Leidelmeyer “was not treating patients therefore 
he was not actually a clinician at that point.”  Furthermore, 
BFPC and Dr. Rosenbaum maintained that Dr. Leidelmeyer did not 
practice in the same specialty as Dr. Rosenbaum, who was a 
family practice physician.  They argued that Dr. Leidelmeyer was 
not diagnosing and treating fractures, was not treating nursing 
home patients, and was not supervising interns or residents 
within a year of the alleged malpractice, which occurred in 
1995.  Accordingly, BFPC and Dr. Rosenbaum maintained that Dr. 
Leidelmeyer could not qualify as an expert pursuant to Code 
§ 8.01-581.20. 
 
Perdieu argued that Dr. Leidelmeyer satisfied the 
requirements of Code § 8.01-581.20.  He emphasized Dr. 
Leidelmeyer’s testimony “that he’s been engaged in the clinical 
practice of primary care which treats all members of the 
 
7
family.”  Perdieu argued that the statute did not address how 
many work days each week were required to constitute a “clinical 
practice,” and he maintained that Dr. Leidelmeyer’s employment 
at the Health Department satisfied the statutory requirements. 
 
The trial court ruled that Dr. Leidelmeyer could not 
testify as an expert witness, observing: 
 
[T]here’s a very great question as to whether 
he has any clinical practice during the period 
of time [required by Code § 8.01-581.20].  He 
worked for this health department, he filled in 
a day a week, he says, for a couple of doctors. 
. . . 
 
 
The [court is] of the opinion that he did 
not have a clinical practice and I might add he 
never had any, testifies to no experience 
treating and diagnosing fractures.  He must 
have seen some in his practice, but I don’t 
hear much from him about that.  I can’t allow 
his testimony. . . . 
 
 
The trial court next considered Corrigan’s qualifications 
and viewed a videotape of her deposition, wherein Corrigan 
discussed her work experience.  She testified that while working 
in a hospital from 1991 to 1997, her “area of expertise was 
dealing with primarily elderly, critical patients who came in 
from either home or . . . from nursing homes . . . because of an 
acute problem.”  Corrigan further testified that she assisted 
the hospital social worker in providing nursing homes with 
information they would need to care for the patient after his or 
her release from the hospital, and she prepared discharge 
 
8
summaries for patients moving to nursing homes.  All of 
Corrigan’s nursing experience was “hospital based.” 
 
HCMF argued that Corrigan did not qualify as an expert 
witness pursuant to Code § 8.01-581.20, because her only 
experience was in an acute-care setting and she had never worked 
in a nursing home or long-term care facility.  Accordingly, HCMF 
maintained that Corrigan did not work in a field of medicine 
“related” to the defendant’s field, as required by the statute.  
HCMF further argued that Corrigan had never devised a care plan 
in a long-term care facility, and she had never made decisions 
regarding the use of restraints in a nursing home, which was one 
of the issues to which she proposed to testify.  Finally, HCMF 
asserted that the standard of care in a nursing home is 
different from the standard of care in a hospital.  For these 
reasons, HCMF maintained that Corrigan failed to qualify as an 
expert witness pursuant to Code § 8.01-581.20. 
 
Perdieu argued that Corrigan was qualified as an expert 
witness based on her experience working with elderly patients as 
a nurse and formulating care plans for them.  He further argued 
that Corrigan worked with nursing home patients while they were 
in the hospital and he emphasized that her experience included 
transferring patients to nursing homes with the necessary 
documentation and care instructions. 
 
9
 
The trial court ruled that Corrigan was not qualified to 
testify as an expert witness.  The court explained: “I can’t see 
that she has any experience in this specific field which is 
caring for patients in a nursing home and I don’t think she’s 
qualified to testify.”   
 
Perdieu called Dr. Martin as a witness at trial.  Dr. 
Martin testified that he was a licensed physician in Virginia 
from 1956 until 2000.  He explained that since 1987, his work in 
the medical field consisted of serving as the “medical officer” 
for a senior citizen softball league.  Dr. Martin testified that 
during his years of practice, he worked in the field of general 
practice and he “treated quite a few fractures”; furthermore, he 
also treated patients in nursing homes.  On cross-examination, 
Dr. Martin testified that he retired from treating patients on a 
“regular, full time basis” in 1987, and that he had not worked 
in a nursing home since 1965. 
 
Dr. Rosenbaum, BFPC, and HCMF argued that Dr. Martin did 
not qualify as an expert witness because he had been retired 
since 1987, he did not have an active clinical practice at the 
relevant time period as required by Code § 8.01-581.20, and he 
did not have knowledge of the standard of care in a nursing 
 
10
home.1  Perdieu maintained that Dr. Martin was qualified pursuant 
to Code § 8.01-581.20, based on his “long-standing 
qualifications in the general practice of medicine.”  
 
The trial court refused to qualify Dr. Martin as an expert 
witness.  The court explained: 
 
The question here is whether Dr. Martin can be 
qualified as an expert in the defendant’s 
specialty.  Dr. Martin testifies to having been 
a [general practice physician] and still is 
without an active clinical practice. . . .  
 
**** 
 
 
The [c]ourt cannot qualify Dr. Martin . . . to 
offer an opinion as to the standard of care 
involved in this case, the standard of care for 
treatment of geriatric patients in a nursing 
home for he’s never done it except perhaps a 
year back in the ‘60s and that won’t do in this 
case.  I cannot let him testify. 
 
 
Perdieu presented the expert testimony of Dr. Burkhardt, 
the surgeon who performed Overton’s bipolar hip prosthesis.  Dr. 
Burkhardt testified by audio-visual deposition that while 
performing Overton’s surgery, he discovered dark fluid in the 
capsule around her hip joint.  According to Dr. Burkhardt, the 
presence of dark fluid “was a clear indication that it was an 
older fracture.”  He estimated that the fracture was 10 to 14 
days old. 
                     
 
1 Dr. Martin testified that his definition of the standard 
of care was “to do the best care that’s available to give that 
patient.” 
 
11
 
At the conclusion of Perdieu’s case-in-chief, Dr. 
Rosenbaum, BFPC, and HCMF each moved to strike the evidence.  
Dr. Rosenbaum and BFPC argued that in a medical malpractice 
case, the plaintiff is required to use expert testimony to 
establish the standard of care, a breach of the standard of 
care, and causation.  They maintained that Perdieu failed to 
present expert testimony on these three required elements. 
 
HCMF joined Dr. Rosenbaum’s and BFPC’s motion to strike the 
evidence and further argued that in order to establish proximate 
cause, pursuant to Bryan v. Burt, 254 Va. 28, 486 S.E.2d 536 
(1997), Perdieu was required to state “what should have been 
done.”  HCMF maintained that Perdieu failed to present any 
evidence as to what measures should have been taken to prevent 
Overton’s falls.  Furthermore, HCMF noted the absence of 
evidence that any deviation from the standard of care caused 
Overton’s falls, and the lack of evidence that Overton’s falls 
caused her fracture. 
 
Perdieu argued that jurors are able to make judgments on 
matters within their common knowledge without the need for 
expert testimony.  He asserted that the lack of safety 
precautions in place, Overton’s two separate falls, the lack of 
supervision over Dr. Fowler, the failure to diagnose the 
fracture, and Overton’s deteriorating health following the falls 
were all facts and circumstances within the common knowledge and 
 
12
understanding of jurors.  Accordingly, he maintained that expert 
testimony was not required and that the defendants “just missed 
[the fracture], and it’s up to the jury to determine whether or 
not [the defendants] should have exercised the standard of care 
necessary to detect [the fracture].” 
 
The trial court granted both motions to strike, and 
explained: 
 
 
I don’t think there is any question in 
this case but that Mrs. Overton’s hip was 
broken while she was a patient at Heritage 
Hall.  I don’t think there’s any question . . . 
that her condition deteriorated some and I 
quite understand the upset to anyone closely 
associated with her.  I also don’t think there 
is any question [that] it is necessary in this 
case for the plaintiff to be able to show a 
breach of the standard of care and I think that 
can only be done through expert testimony, 
which as I’ve said, was not able to be 
produced. 
 
 
. . . The [c]ourt has no choice in this 
matter but to grant both motions to strike. 
 
On June 8, 2001, the trial court entered its final judgment 
order from which Perdieu appeals. 
 
On appeal, Perdieu argues that the trial court erred in 
refusing to qualify Dr. Leidelmeyer, Dr. Martin, and Corrigan as 
expert witnesses.  Perdieu maintains that the trial court 
misinterpreted Code § 8.01-581.20 because the statute is not 
exclusionary, but is only intended to give guidance as to when 
an expert shall be qualified to testify.  He asserts that 
experts can qualify even if they do not specifically meet all of 
 
13
the criteria enumerated in the statute.  Nevertheless, Perdieu 
maintains that the three excluded experts were qualified to 
testify, even pursuant to the trial court’s interpretation of 
the statute.  Perdieu further argues that the trial court erred 
in striking the evidence at the conclusion of his case-in-chief.  
He maintains that the negligence at issue in the case was “so 
blatant” that the determination of a violation of the standard 
of care was within the common knowledge of the jury.  
Accordingly, he asserts that expert testimony was not required. 
 
Dr. Rosenbaum, BFPC, and HCMF argue that the trial court 
properly interpreted the requirements of Code § 8.01-581.20 to  
determine that Dr. Leidelmeyer, Dr. Martin, and Corrigan were 
not qualified to testify as experts pursuant to the statute.  
They further argue that expert testimony was required in this 
case to establish the standard of care, a breach, and causation.  
Because Perdieu failed to present expert testimony on each of 
the required elements, they maintain that the trial court 
properly granted their motions to strike Perdieu’s evidence at 
the conclusion of his case-in-chief. 
II. Standard of Review 
 
The question whether a witness is qualified to testify as 
an expert is “largely within the sound discretion of the trial 
court.”  Noll v. Rahal, 219 Va. 795, 800, 250 S.E.2d 741, 744 
(1979) (citing Swersky v. Higgins, 194 Va. 983, 985, 76 S.E.2d 
 
14
200, 202 (1953)).  In the context of a medical malpractice 
action, this determination must be made with reference to Code 
§ 8.01-581.20.  “A decision to exclude a proffered expert 
opinion will be reversed on appeal only when it appears clearly 
that the witness was qualified.”  Noll, 219 Va. at 800, 250 
S.E.2d at 744, (citing Landis v. Commonwealth, 218 Va. 797, 800, 
241 S.E.2d 749, 751 (1978)). 
 
When a defendant challenges the sufficiency of a 
plaintiff’s evidence by a motion to strike, “the trial court 
should resolve any reasonable doubt as to the sufficiency of the 
evidence in plaintiff’s favor and should grant the motion only 
when ‘it is conclusively apparent that plaintiff has proven no 
cause of action against defendant.’ ”  Williams v. Vaughan, 214 
Va. 307, 309, 199 S.E.2d 515, 517 (1973) (quoting Leath v. 
Richmond, F. & P. R.R., 162 Va. 705, 710, 174 S.E. 678, 680 
(1934)). 
III. Analysis 
 
Perdieu first argues that the trial court misinterpreted 
Code § 8.01-581.20 when it refused to qualify three of his 
proposed expert witnesses.  Perdieu maintains that the word 
“shall” included in the statute is not exclusionary; instead, he 
argues that the statute is meant to provide guidance and general 
requirements to the trial court, which, if met, will generally 
qualify an expert to testify.  He asserts that proposed experts 
 
15
are not required to satisfy the statutory criteria in order to 
qualify as expert witnesses.  However, we have previously held 
that the requirements of Code § 8.01-581.20 are mandatory.  See 
Fairfax Hosp. Sys., Inc. v. Curtis, 249 Va. 531, 536, 457 S.E.2d 
66, 70 (1995) (holding that a trial court properly excluded a 
proposed expert when “he failed to maintain an active clinical 
practice in [the relevant] field of medicine or a related field 
within one year of the date of the alleged medical malpractice 
as required by Code § 8.01-581.20”). 
 
 
Perdieu next argues that his three proposed expert 
witnesses were qualified to testify pursuant to Code § 8.01-
581.20.  Code § 8.01-581.20(A) provides, in pertinent part: 
A witness shall be qualified to testify as 
an expert on the standard of care if he 
demonstrates expert knowledge of the 
standards of the defendant’s specialty and 
of what conduct conforms or fails to 
conform to those standards and if he has 
had active clinical practice in either the 
defendant’s specialty or a related field 
of medicine within one year of the date of 
the alleged act or omission forming the 
basis of the action. 
 
 
The trial court stated its reason for excluding each of 
Perdieu’s three proposed experts.  The court excluded Dr. 
Leidelmeyer because he did not have an active clinical practice 
within a year of the alleged malpractice.  The court excluded 
Corrigan because she did not have experience in the relevant 
field of nursing home care.  Finally, the court excluded Dr. 
 
16
Martin because he did not have an active clinical practice 
during the relevant time period, and because he had not treated 
nursing home patients for over 30 years. 
 
We have held that the purpose of the requirements in Code 
§ 8.01-581.20 is “to prevent testimony by an individual who has 
not recently engaged in the actual performance of the procedures 
at issue in a case.”  Sami v. Varn, 260 Va. 280, 285, 535 S.E.2d 
172, 175 (2000).  In light of the record, the statute’s purpose 
and the trial court’s stated reasons for refusing to qualify the 
three proposed experts, we cannot say that the trial court 
abused its discretion in disqualifying any of the three proposed 
expert witnesses. 
 
This medical malpractice action involved Dr. Rosenbaum’s 
treatment of nursing home patients, which included the 
diagnosing of fractures.  During the relevant time period, Dr. 
Leidelmeyer was working one day per week in a private clinic and 
one day per week at the Health Department, where he did not 
treat fractures or work with nursing home patients.  Dr. Martin 
retired in 1987, and during the relevant time period, he was 
volunteering as the “medical officer” for a senior citizen 
softball league.  He did not testify to treating any fractures 
or nursing home patients during the relevant time period.  
Finally, although Corrigan demonstrated some experience working 
with nursing home patients in hospitals, the entirety of her 
 
17
experience involved treatment in an acute-care setting.  Neither 
Dr. Leidelmeyer, Corrigan, nor Dr. Martin had “recently engaged 
in the actual performance of the procedures at issue” in the 
case.  Id.  Accordingly, the trial court did not abuse its 
discretion in refusing to qualify these proposed experts. 
 
Finally, Perdieu asserts that the trial court erred in 
striking the evidence at the conclusion of his case-in-chief.  
He maintains that the issues involved in the case were within 
the common knowledge and understanding of the jury; therefore, 
expert testimony was not required to establish the standard of 
care, a breach, or causation.      
 
In Raines v. Lutz, 231 Va. 110, 113, 341 S.E.2d 194, 196 
(1986), we recognized that “expert 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.”  See also Rogers v. Marrow, 243 Va. 162, 167, 413 
S.E.2d 344, 346 (1992).  Perdieu argues that this case falls 
within the exception recognized in Beverly Enterprises-Virginia, 
Inc. v. Nichols, 247 Va. 264, 267, 441 S.E.2d 1, 3 (1994), 
wherein we held that “[i]n certain rare instances . . . expert 
testimony is unnecessary because the alleged act of negligence 
clearly lies within the range of the jury’s common knowledge and 
experience.”   
 
18
 
Beverly Enterprises involved a medical malpractice action 
wherein we considered whether the plaintiff was required to 
present expert testimony to prove the defendant’s negligence.  
Blanche Nichols (“Nichols”) was a resident in a nursing home, 
and the nursing home staff was aware that Nichols had previously 
choked on food and was unable to eat without assistance.  Id. at 
266, 441 S.E.2d at 2.  Nevertheless, an employee of the nursing 
home delivered a tray of food to Nichols, who then attempted to 
feed herself without assistance, choked on a piece of food, and 
died of asphyxia.  Id. at 266-67, 441 S.E.2d at 2.  At trial, a 
licensed practical nurse employed by the nursing home testified 
that if someone left a tray of food in Nichols’ room, “that 
‘would have been a mistake.’ ”  Id. at 267, 441 S.E.2d at 2.  
The plaintiff did not present expert testimony on the standard 
of care and the jury found for the plaintiff.  Id. at 265, 441 
S.E.2d at 2. 
 
Based on the unique facts of the case, we held that the 
evidence was sufficient to support the jury’s finding of 
negligence without the aid of expert testimony on the standard 
of care.  Beverly Enterprises, 247 Va. at 268, 441 S.E.2d at 3.  
The defendant knew of Nichols’ physical condition and her prior 
choking incidents, and despite this knowledge, the defendant’s 
employee left a tray of food in front of Nichols and failed to 
provide her with the required assistance.  Id.  We held: “[T]he 
 
19
question whether a reasonably prudent nursing home would permit 
its employees to leave a tray of food with an unattended patient 
who had a history of choking and who was unable to eat without 
assistance is certainly within the common knowledge and 
experience of a jury.”  Id. at 269, 441 S.E.2d at 4.  
 
The negligence alleged in the present case is of a 
different nature than the negligence involved in Beverly 
Enterprises.  Perdieu advanced two separate theories of 
negligence against Dr. Rosenbaum and BFPC.  First, he alleged 
that both were negligent when they failed to timely diagnose 
Overton’s hip fracture.  The issue whether a fracture was 
diagnosed in a timely manner is a medical issue not within the 
common knowledge and experience of a jury.  Therefore, expert 
testimony was required to establish the relevant standard of 
care, a breach, and causation, and Perdieu failed to present 
this required testimony.  Although he presented expert testimony 
through Dr. Burkhardt, who testified that Overton’s fracture was 
sustained approximately 10 to 14 days prior to the diagnosis, no 
evidence was presented that the fracture could have been 
diagnosed earlier, or that a delay in diagnosis constituted a 
breach of the standard of care.  Furthermore, Perdieu presented 
no expert testimony that any breach by Dr. Rosenbaum or BFPC 
caused the claimed damages. 
 
20
 
Perdieu also alleged that Dr. Rosenbaum and BFPC were 
negligent in failing to properly supervise Dr. Fowler, a 
resident physician.  The issue whether a resident physician was 
appropriately supervised is not within the common knowledge of a 
jury; therefore, expert testimony was required to establish the 
standard of care for supervising resident physicians and this 
required expert testimony was not presented.  Taking the 
evidence in the light most favorable to Perdieu, as we must, we 
hold that Perdieu failed to present required expert testimony on 
the elements of the standard of care, breach, and causation, 
with respect to either of the theories of negligence against Dr. 
Rosenbaum and BFPC.  Accordingly, the trial court did not err in 
granting Dr. Rosenbaum’s and BFPC’s motion to strike the 
evidence because it was “conclusively apparent” that Perdieu had 
not proven a cause of action against them.  Williams, 214 Va. at 
309, 199 S.E.2d at 517. 
 
Perdieu also advanced two theories of negligence against 
HCMF.  First, he alleged that HCMF was negligent in failing to 
implement a care plan that would have prevented Overton’s falls. 
Perdieu conceded during oral argument that he did not present 
evidence of causation at trial.  Specifically, he failed to 
present evidence that any specific care plan would have 
prevented Overton’s falls.  Furthermore, the appropriate 
standard of care required by a nursing home to prevent falls by 
 
21
residents is not within the common knowledge or understanding of 
a jury.  Therefore, Perdieu was required to present expert 
testimony to establish the relevant standard of care, a breach 
by HCMF, and causation.  He failed to meet this burden. 
 
Perdieu further alleged that HCMF was negligent in failing 
“to adhere to applicable standards of care . . . when [it] 
failed to properly attend, restrain, assist, examine, diagnose 
and treat” Overton, which “evince[d] a conscious disregard for 
[her] well-being.”  The appropriate standard of care for 
treating nursing home residents is not within the common 
knowledge of the jury; therefore, expert testimony was again 
required to establish the standard of care.2  Perdieu failed to 
present expert testimony on the standard of care, a breach, or 
causation.  Again, viewing the evidence in the light most 
favorable to Perdieu, we hold that the trial court did not err 
in granting HCMF’s motion to strike the evidence because without 
the required testimony, Perdieu had not proven a cause of action 
against HCMF.  Id.
 
In summary, the trial court did not abuse its discretion in 
excluding the testimony of the proposed expert witnesses, and 
the trial court did not err in striking the plaintiff’s 
                     
 
2 Furthermore, the record establishes that HCMF notified 
BFPC after each of Overton’s falls, and on each occasion, 
Overton was examined by a physician. 
 
22
evidence.  Accordingly, the judgment of the trial court will be 
affirmed. 
Affirmed. 
 
23