Title: Washburn v. Klara
Citation: N/A
Docket Number: 011034
State: Virginia
Issuer: Virginia Supreme Court
Date: April 19, 2002

Present:  All the Justices 
 
JANICE WASHBURN 
 
v. Record No. 011034  OPINION BY JUSTICE CYNTHIA D. KINSER 
 
 
 
 
 
 
 
APRIL 19, 2002 
PETER KLARA, M.D., ET AL. 
 
FROM THE CIRCUIT COURT OF THE CITY OF NORFOLK 
Joseph A. Leafe, Judge 
 
 
In this claim of battery, the issue is whether the 
evidence raises a reasonable inference that the defendant 
surgeon intentionally performed a surgical procedure 
exceeding the scope of the plaintiff’s consent.  Because we 
conclude that the plaintiff presented sufficient evidence 
to create a factual dispute on this issue, which a jury 
must resolve, we will reverse the circuit court’s judgment 
striking the plaintiff’s evidence and remand the case for a 
new trial. 
FACTS AND MATERIAL PROCEEDINGS 
 
In September 1997, Britt M. Borden, M.D., performed a 
surgical procedure known as an anterior cervical diskectomy 
on Janice L. Washburn.  At the time of the operation, Dr. 
Borden was training in a fellowship program at Eastern 
Virginia Medical School, with Peter Klara, M.D., acting as 
Dr. Borden’s supervising faculty member.  The surgery took 
place at the Virginia Beach General Hospital (the 
Hospital). 
 
Dr. Borden had diagnosed Washburn with C6-7 
pseudoarthrosis1 after a bone scan revealed dense scar 
tissue at the C6-7 level of her spine.  That scar tissue 
resulted from a previous surgical fusion that Washburn had 
undergone in 1994.  To relieve pain in Washburn’s neck and 
left arm, Dr. Borden recommended the anterior cervical 
diskectomy procedure.  He described the procedure as 
“removing the bone and fibrous tissue that are in the area 
of the old fusion that didn’t take and replacing it with 
another graft, and then placing a plate on the spine to 
hold it together while it heals.”  Dr. Klara agreed that 
Washburn was likely to benefit from the surgery. 
 
Prior to surgery, Washburn executed a written consent 
form.  The form specified authorization for a “C67 Anterior 
Cervical Diskectomy” and described the operation in 
layman’s terms as “remove bone & fibrous tissue and replace 
graft[.]”  The consent form also authorized “the 
performance of such operation(s) and procedure(s) in 
addition to or different from those now contemplated . . . 
which the . . . physician . . . consider[s] necessary or 
                     
1 Pseudoarthrosis is the “failure of spinal fusion to 
occur following surgery.”  Taber’s Cyclopedic Medical 
Dictionary 1583 (18th ed. 1997). 
 
 
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advisable in the exercise of his[] professional [judgment] 
in accordance with reasonable medical standards.” 
 
Because the surgery allegedly caused Washburn to 
suffer “permanent laryngeal and/or recurrent nerve damage,” 
Washburn filed the present action against Drs. Borden and 
Klara, Peter Klara, M.D., P.C., and the Hospital.2  Washburn 
asserted theories of recovery based upon medical 
malpractice, emotional distress, battery, lack of informed 
consent, fraud, and receiving money under false pretenses.  
Prior to trial, the circuit court sustained demurrers to 
Washburn’s claims of emotional distress and receiving money 
under false pretenses.3  During the trial, Washburn 
                     
2 This is the second action filed by Washburn against 
these defendants.  In the first case, the trial court 
sustained Dr. Borden’s plea of sovereign immunity with 
regard to all claims based on negligence.  The court also 
granted the Hospital’s motion for summary judgment.  
Washburn then nonsuited her remaining claims and appealed 
from the trial court’s judgment on the issue of sovereign 
immunity.  While that appeal was pending, Washburn filed 
the present action.  In an order dated November 3, 2000, we 
affirmed the trial court’s judgment that Dr. Borden was 
entitled to sovereign immunity on the negligence claims. 
 
3 The circuit court also sustained the Hospital’s 
demurrer to Washburn’s claim of vicarious liability and its 
special plea of res judicata with regard to the other 
claims asserted against it.  Although Washburn assigned 
error to the circuit court’s ruling with regard to the 
Hospital, we granted the Hospital’s motion to dismiss 
Washburn’s petition for appeal in an order dated November 
8, 2001.  Thus, the Hospital is not a party to this appeal.  
Hereinafter, references to “the defendants” do not include 
the Hospital. 
 
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voluntarily dismissed her claim of medical malpractice and 
presented evidence to the jury only with regard to the 
remaining counts. 
 
As pertinent to the issue in this appeal, Dr. Borden 
testified at trial that he performed the surgery at the C6-
7 level, as specified in Washburn’s written consent.  He 
denied that he operated, either intentionally or 
unintentionally, at the C7-T1 level of Washburn’s spine.  
However, post-operative radiology reports indicated 
evidence of a fusion at the C7-T1 level, in addition to a 
fusion at the C6-7 level.  One of the radiology readings 
admitted into evidence by Washburn stated that a “screw is 
projecting over the inferior aspect of the T1 vertebral 
body.”  Although Dr. Borden acknowledged that Washburn’s 
cervical fusion in 1994 did not involve the use of any 
hardware and that he was the first person to place any 
screws and plates in Washburn’s spine, he maintained that 
he did not operate at the C7-T1 level.  Dr. Borden also 
stated that there was no medical reason to operate at the 
C7-T1 level. 
 
At the close of Washburn’s case-in-chief, the circuit 
court granted the defendants’ motion to strike the 
evidence, specifically finding, as pertinent to the claim 
of battery, that there was no evidence that the surgery 
 
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exceeded the scope of Washburn’s consent.  The court 
subsequently entered a final order granting judgment for 
the defendants.  We awarded Washburn this appeal, limited 
solely to the issue whether the circuit court erred in 
striking the evidence with regard to the count alleging 
battery.4
ANALYSIS 
 
We have stated that 
[w]hen the sufficiency of a plaintiff’s evidence 
is challenged upon a motion to strike the 
evidence at the conclusion of the plaintiff’s 
case-in-chief, the trial court should in every 
case overrule the motion where there is any doubt 
on the question. 
 
Rizzo v. Schiller, 248 Va. 155, 159-60, 445 S.E.2d 153, 156 
(1994) (quoting Brown v. Koulizakis, 229 Va. 524, 531, 331 
S.E.2d 440, 445 (1985) (citation omitted)).  The trial 
court must also “give the plaintiff ‘the benefit of all 
substantial conflict in the evidence, and all fair 
inferences that may be drawn therefrom.’ ”  Hadeed v. 
Medic-24, Ltd., 237 Va. 277, 285-86, 377 S.E.2d 589, 593 
(1989) (quoting Walton v. Walton, 168 Va. 418, 423, 191 
S.E. 768, 770 (1937)); see also Powell v. Margileth, 259 
                     
4 The defendants filed separate motions to dismiss 
Washburn’s petition for appeal, asserting that Washburn had 
failed to file transcripts material to the consideration of 
her assignments of error.  Those motions were denied by an 
order of this Court dated November 8, 2001. 
 
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Va. 244, 246, 524 S.E.2d 434, 435 (2000).  Applying these 
principles, we conclude that the evidence in this case, 
when viewed in the light most favorable to Washburn, is 
open to the reasonable inference that Dr. Borden performed 
a cervical diskectomy at two levels of Washburn’s spine, 
thereby exceeding the scope of her consent.  Thus, we find 
that the circuit court erred by striking Washburn’s 
evidence with regard to the claim of battery. 
 
This Court has recognized that the physician-patient 
relationship is a consensual one.  See, e.g., Pugsley v. 
Privette, 220 Va. 892, 899, 263 S.E.2d 69, 74 (1980); Lyons 
v. Grether, 218 Va. 630, 633, 239 S.E.2d 103, 105 (1977).  
Thus, unless an emergency or unanticipated problem arises, 
a physician or surgeon must first obtain the consent of a 
patient before treating or operating on that patient.  See  
61 Am. Jur. 2d Physicians, Surgeons, and Other Healers 
§ 175 (1981).  “An unauthorized operation is a wrongful and 
unlawful act for which the surgeon will be liable in 
damages.”  Pugsley, 220 Va. at 899, 263 S.E.2d at 74. 
A written consent, such as the one executed by 
Washburn, “does not constitute consent to an operation 
other than the one to be performed when there is no 
evidence that a necessity arose during the authorized 
operation.”  Lloyd v. Kull, 329 F.2d 168, 170 (7th Cir. 
 
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1964).  Consequently, in the absence of such necessity, an 
operation without consent or the extension of an operation 
beyond the scope of the patient’s consent constitutes what 
is sometimes referred to as a “‘technical’ assault and 
battery.”  See Lane v. United States, 225 F. Supp. 850, 852 
(E.D. Va. 1964); Hively v. Higgs, 253 P. 363, 365 (Ore. 
1927); Nolan v. Kechijian, 64 A.2d 866, 868 (R.I. 1949).  
We discussed this form of “technical” battery in Pugsley, 
where we stated that “[i]t is well established that, given 
the proper factual conditions and circumstances, a patient 
can maintain against a physician an action based on assault 
and battery for acts arising out of the physician’s 
professional conduct” and that “ ‘[a] surgical operation on 
the body of a person is a technical battery or trespass 
unless he or some authorized person consented to it.’ ”  
Pugsley, 220 Va. at 899, 263 S.E.2d at 74 (quoting what is 
now 61 Am. Jur. 2d Physicians, Surgeons, and Other Healers 
§ 197 (1981)). 
 
Later, in Woodbury v. Courtney, 239 Va. 651, 391 
S.E.2d 293 (1990), we again addressed the tort of battery 
in the context of medical malpractice.  In Woodbury, a 
patient gave her consent for a breast biopsy.  When the 
surgeon performed a partial mastectomy, the patient brought 
an action against the surgeon, alleging, among other 
 
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things, battery.  In defense, the surgeon asserted that the 
terms “biopsy” and “partial mastectomy” are synonymous and 
that, therefore, the patient consented to the partial 
mastectomy.  With respect to the claim of battery, we held 
that the trial court erred in granting summary judgment in 
favor of the defendant surgeon, because the plaintiff was 
not required to present expert medical testimony in order 
to prove her allegations of battery.  We concluded that 
“[a] factual issue was created and the jury should have 
been allowed to determine the extent of the permission [the 
patient] granted to [the surgeon] and whether he exceeded 
the scope of that permission.  If [the surgeon] exceeded 
the scope of that permission, then he committed a battery.”  
Id. at 654, 391 S.E.2d at 295 (citing Pugsley, 220 Va. at 
899, 263 S.E.2d at 74). 
 
In the instant case, Washburn’s claim of battery is 
predicated on her allegations that Dr. Borden exceeded the 
scope of her consent by performing a cervical diskectomy at 
the C7-T1 level of her spine, in addition to the diskectomy 
at the C6-7 level to which Washburn had consented.  
According to Washburn, the evidence, primarily the post-
operative radiology reports, established a prima facie case 
of battery and, in light of Dr. Borden’s insistence that he 
did not, either intentionally or unintentionally, fuse the 
 
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vertebrae at the C7-T1 level, created a factual question 
for the jury to decide. 
 
Dr. Borden, however, contends that Washburn failed to 
establish a prima facie case of battery because there was 
no evidence that he intentionally exceeded the scope of 
Washburn’s consent.  On brief, Dr. Borden acknowledged that 
Washburn presented some evidence that he operated beyond 
the C6-7 level and that her consent was limited to surgery 
at that level.  While Dr. Borden maintains that he operated 
only at the C6-7 level, he nevertheless argues that, if a 
fusion of Washburn’s vertebrae at the C7-T1 level occurred 
during the surgery, it resulted from his negligence or lack 
of skill and not because he intentionally operated at that 
level.  Thus, he contends that he did not commit a battery 
on Washburn. 
 
In granting the defendants’ motion to strike 
Washburn’s evidence, the circuit court concluded that there 
was no evidence that the surgery exceeded the scope of 
Washburn’s consent.  However, the radiology reports 
indicating fusion at the C7-T1 level are at least some 
evidence that Dr. Borden may have operated at a level other 
than that specified in Washburn’s written consent.  
Although the consent authorized additional operations or 
procedures deemed necessary or advisable, Dr. Borden 
 
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admitted that there was no medical reason to operate at the 
C7-T1 level. 
 
Thus, we conclude that evidence presented by Washburn 
was sufficient to present a factual issue, for the jury’s 
determination, whether Dr. Borden intentionally performed a 
cervical diskectomy at two levels of Washburn’s spine, thus 
exceeding the scope of her consent.  As we stated in 
Woodbury, if a surgeon exceeds the scope of a patient’s 
consent, then the doctor has committed a battery.  239 Va. 
at 654, 391 S.E.2d at 295.  Accordingly, we will reverse 
the judgment of the circuit court and remand for a new 
trial on Washburn’s claim of battery.5
Reversed and remanded.
                     
5 We remand the case as to all the defendants.  When 
the circuit court granted the motion to strike Washburn’s 
evidence, the court stated from the bench that the 
vicarious liability question necessarily followed the 
battery claim and that, since there was no issue to go to 
the jury on the battery claim, the motion to strike with 
regard to Dr. Klara’s vicarious liability was also granted.  
Thus, the court never addressed the merits of the question 
whether Dr. Klara and his professional corporation can be 
held vicariously liable for Dr. Borden’s actions.  Hence, 
we will not address the arguments presented on appeal 
regarding that question. 
 
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