Title: Martin v. Lahti
Citation: N/A
Docket Number: 170524
State: Virginia
Issuer: Virginia Supreme Court
Date: February 22, 2018

PRESENT:  All the Justices 
 
WANDA S. MARTIN, EXECUTOR OF THE 
ESTATE OF MARGARET McDANIEL STARR, 
DECEASED 
 
 
 
OPINION BY 
v.  Record No. 170524 
JUSTICE STEPHEN R. McCULLOUGH 
 
 
 
February 22, 2018 
GARY LAHTI, ET AL. 
 
 
FROM THE CIRCUIT COURT OF THE CITY OF DANVILLE 
James J. Reynolds, Judge 
 
 
Wanda S. Martin, the executor of her mother’s estate, challenges the trial court’s 
exclusion of evidence.  She contends the trial court erred in excluding certain proffered 
statements that, in her view, should have been admitted as lay opinion under Rule 2:701 of the 
Virginia Rules of Evidence.  She also challenges the trial court’s exclusion of a statement the 
decedent made after the surgery.  She asserts that this statement should have been admitted under 
Code § 8.01-397, often referred to as the “Deadman’s Statute.”  We conclude the trial court did 
not abuse its discretion in excluding these items of evidence and, accordingly, we affirm. 
BACKGROUND 
 
On March 21, 2011, Margaret Starr was diagnosed with acute pancreatitis during a visit 
to the emergency room of the Danville Regional Medical Center.  Abdominal ultrasound 
imaging indicated that Starr’s gallbladder “contain[ed] a small amount of sludge and tiny stones.  
Tiny amount of pericholecystic fluid.”  Dr. Gary Lahti, who had previously operated on the 
patient, recommended removal of Starr’s gallbladder. 
 
The record contains a consent form, which provides, in relevant part, “[a]lternative 
methods of treatment and the risks and benefits of these alternatives have also been explained to 
 
2 
me, including the possibility of, and risks and benefits of, no treatment at all.”  Because Starr’s 
hand was shaky, Martin signed the consent form on her behalf. 
 
Dr. Lahti performed the surgery on March 24, 2011.  Martin testified that the operation 
was to proceed laparoscopically, but because Dr. Lahti nicked a bowel during the surgery, Dr. 
Lahti had to “open her up.”  Starr died approximately one week after the operation due to 
complications from the surgery. 
 
Martin brought a medical malpractice action against Dr. Lahti and the Danville Surgical 
Center.1  One of the counts alleged that Dr. Lahti did not obtain Starr’s informed consent to the 
procedure.  Specifically, the plaintiff alleged that the defendants “failed to explain that a 
conservative non-operative medical course was a reasonable option.”  The complaint further 
alleged that “[i]f the patient had been properly advised of her options, relative risks, and/or 
benefits, and the alternatives to surgery, she would not have undergone the procedure on March 
24, 2011.” 
 
The defendants filed a demurrer to the informed consent count on the basis that the 
plaintiff’s allegations were not sufficient for the plaintiff “to proceed on a claim for lack of 
informed consent.”  The defendants also asked for a bill of particulars.  The trial court denied the 
demurrer but granted the bill of particulars.  In response, the plaintiff submitted a bill of 
particulars in which she amplified her allegations of lack of informed consent.  This bill of 
particulars stated that Dr. Lahti testified at his deposition that he had informed Starr that waiting 
could lead to a life-threatening recurrence of pancreatitis. 
                     
 
1 The plaintiff originally brought an action alleging multiple counts against several 
defendants.  The plaintiff later nonsuited all claims save for the informed consent claim. 
 
3 
 
The defendants then filed a motion to dismiss the informed consent count.  The 
defendants argued that the plaintiff “ha[d] not adduced a single piece of admissible evidence to 
support” the contention that she would not have undergone the surgery.  And, “[w]ithout 
testimony or like evidence from the decedent that she would have refused the surgery [upon full 
disclosure of her options, relative risks, benefits, and the alternatives to surgery] . . . Plaintiff’s 
claim for lack of informed consent fails as a matter of law.”  The court granted the motion to 
dismiss.  Following a motion to reconsider filed by the plaintiff, the court held a hearing at which 
the plaintiff presented her evidence of proximate causation.2  The evidence consisted of 
testimony from Martin and Rachel Meeks, Starr’s sister. 
 
Martin testified that she was very close to her mother, who would “talk to her about 
anything.”  Martin would see her mother “about twice a day.”  It was Martin’s practice to take 
her mother to the doctor.  Martin would talk to her mother about what the doctor had said, and 
the two would discuss her health care decisions. 
 
Starr had gone through a number of surgeries.  In 1980, she underwent a hysterectomy 
and treatment for cancer.  In 2001, Dr. Lahti performed a surgery to address Starr’s colon cancer.  
In addition, Starr had several operations on her eye.  Starr initially told Martin she did not want 
to go through the surgeries on her eye, that she did not want “more cutting on her.”  Despite this 
initial reluctance, Starr agreed to go through with the operations on her eye.  Martin testified that 
her mother did not want more surgeries, “just only necessary.  She was tired of being cut up.” 
                     
 
2 The unusual way the court addressed the issue – a motion to dismiss followed by a 
hearing, which the plaintiff characterizes as a “hybrid between a demurrer and a motion for 
summary judgment” – is not before us.  The plaintiff, on appeal, expressly notes that she does 
not object on this ground. 
 
4 
 
Martin took her mother to the emergency room on March 21, 2011.  Doctors discovered 
that she was suffering from pancreatitis and that she had gallstones.  Starr stayed at the hospital 
for several days so doctors could conduct additional tests.  During her mother’s stay at the 
hospital, Martin visited her and spent hours in her company.  Starr steadily improved and she 
regained her appetite. 
 
Several doctors told Martin that her mother “need[ed] her gallbladder out.”  Martin 
remembered that her mother was nervous and unsure she wanted to have the surgery.  Starr 
relayed to Martin that “Dr. Lahti told [Starr] that she needed this surgery.”  Martin 
acknowledged that her mother felt comfortable with Dr. Lahti because of her past experience 
with him. 
 
Just before taking Starr into surgery, Dr. Lahti came in the room and made a brief 
statement to Martin about the need for surgery.  He did not mention a non-surgical alternative to 
Martin.  Likewise, Starr did not mention to Martin anything about alternatives to the surgery.  In 
Martin’s view, her mother “would have discussed that with” her.  Plaintiff’s counsel asked 
Martin the following question: 
Based on your personal experience and observations, based on 
your years of having conversations with your mother about her 
health care needs, based on Dr. Lahti’s conversations with you in 
the presence of your mother prior to surgery, based on your 
knowledge of your mother’s general feelings about surgery, do you 
have an opinion as to whether your mother would have agreed to 
the proposed gallbladder surgery if she had been given the type of 
information contained in the first five pages of that Bill of 
Particulars? 
 
Martin responded “if the doctor would have told her about the alternatives, she would not have 
had that surgery.”  She also testified that if her mother had known about alternatives to the 
surgery, she would have accepted the alternatives rather than undergo the surgery. 
 
5 
 
Martin agreed that Dr. Lahti consulted with her mother on the morning of the surgery, 
and that neither Martin nor other family members were present during the 35- to 40-minute 
conversation between Dr. Lahti and her mother. 
 
Rachel Meeks, Starr’s sister, also testified.  She described her relationship with Starr as 
very close.  Meeks spoke with Starr almost every day.  She stated that Starr did not want to have 
surgery and “didn’t believe in that.”  Starr also told her that she “believed in [Dr. Lahti] and 
didn’t want nobody else operating on her.”  Meeks testified that Starr trusted Dr. Lahti “[a]ll the 
way.”  Meeks spoke with her sister about the surgery, but Starr did not mention anything to her 
about “Dr. Lahti having given her any alternatives or options.”  Meeks believed Starr would not 
have agreed to the surgery had she known about alternatives to the procedure.  Starr told Meeks 
that “she did not want to have surgery, but she had so much faith and confidence in Dr. Lahti” 
that she was going to go forward with the surgery. 
 
The trial court excluded as irrelevant the following statement Starr made to Martin 
following the surgery:  “I thought that this would be an easy operation.” 
 
Following the hearing, the trial court dismissed the informed consent count.  The court 
reasoned that although the patient “is not here to testify about what was or was not explained to 
her and whether or not she would have decided differently with more or different information,” 
the plaintiff could prove her case through circumstantial evidence.  The court concluded, 
however, that the plaintiff’s proffered evidence was “undeniably hearsay and . . . is, at its heart, 
speculative.”  After the plaintiff nonsuited her remaining claims, the court entered a final order 
of dismissal and this appeal followed. 
 
 
 
6 
ANALYSIS 
 
“To succeed on an informed consent claim, the plaintiff must establish that the physician 
breached the standard of care by failing to disclose the material risks associated with the 
treatment or procedure, or the existence of alternatives if there are any, thereby precluding the 
plaintiff from making an informed decision about whether to undertake a particular procedure or 
course of treatment.”  Allison v. Brown, 293 Va. 617, 628-29, 801 S.E.2d 761, 768 (2017).  In 
addition, “the patient must prove that she would not have agreed to the treatment or procedure 
had the physician made a proper disclosure of the risks and alternatives associated with the 
treatment or procedure.”  Id. at 629, 801 S.E.2d at 768.3  In the present appeal, we focus our 
attention on this second point. 
 
I. 
THE LAY OPINION TESTIMONY CONCERNING WHAT WAS DISCLOSED TO THE PATIENT 
AND WHAT THE PATIENT MAY HAVE DONE WAS SPECULATIVE AND INADMISSIBLE. 
 
 
Martin sought to prove lack of informed consent via circumstantial evidence.  She argues 
that her testimony and that of her aunt was admissible under Rule 2:701, which permits lay 
opinion testimony.  That rule provides as follows: 
Rule 2:701 OPINION TESTIMONY BY LAY WITNESSES 
 
Opinion testimony by a lay witness is admissible if it is reasonably 
based upon the personal experience or observations of the witness 
and will aid the trier of fact in understanding the witness’ 
                     
 
3 Although this case does not call upon us to decide the question, we note that this Court 
has not affirmatively examined the merits of the objective or subjective approaches to proving 
causation in an informed consent case.  See, e.g., Ashe v. Radiation Oncology Assocs., 9 S.W.3d 
119 (Tenn. 1999) (discussing the approaches employed by other states).  Under the subjective 
approach, “[c]ausation . . . is established solely by patient testimony.  Patients must testify and 
prove that they would not have consented to the procedures had they been advised of the 
particular risk in question.”  Id. at 122.  Under the objective approach, courts address causation 
“in terms of what a prudent person in the patient’s position would have decided if suitably 
informed of all perils bearing significance.”  Id. (quoting Canterbury v. Spence, 464 F.2d 772, 
791 (D.C. Cir. 1972)).  Under that view, the patient’s testimony is relevant but not controlling.  
Id. 
 
7 
perceptions.  Lay opinion may relate to any matter, such as -- but 
not limited to -- sanity, capacity, physical condition or disability, 
speed of a vehicle, the value of property, identity, causation, time, 
the meaning of words, similarity of objects, handwriting, visibility 
or the general physical situation at a particular location.  However, 
lay witness testimony that amounts only to an opinion of law is 
inadmissible. 
 
 
We review a circuit court’s admission or refusal to admit lay opinion testimony for an 
abuse of discretion.  See Harman v. Honeywell, 288 Va. 84, 97-100, 758 S.E.2d 515, 523-24 
(2014). 
 
Like statutes, we construe rules of evidence based on their plain language.  See BBF, Inc. 
v. Alstom Power, Inc., 274 Va. 326, 331, 645 S.E.2d 467, 469 (2007).  Precedent, both before 
and after the rules were adopted, also guides our interpretation of the rules of evidence.  “The 
Virginia Rules of Evidence are intended to state in clear, succinct and readily understood form, 
the core concepts of evidence that have previously been applicable in Virginia—they do not 
‘change’ evidence principles, but are intended to state them clearly.”  Charles E. Friend & Kent 
Sinclair, The Law of Evidence in Virginia § 1-2 (7th ed. 2017). 
 
We agree with the plaintiff’s general proposition that a plaintiff may prove her case by 
adducing circumstantial as well as direct evidence.  See, e.g., Etherton v. Doe, 268 Va. 209, 
212-13, 597 S.E.2d 87, 89 (2004) (“[I]t is axiomatic that any fact that can be proved by direct 
evidence may be proved by circumstantial evidence.”). 
 
Although there are textual variations between Virginia’s Rule 2:701 and the comparable 
rule adopted by other states and the federal courts, it is common ground that the rule permitting 
lay opinion testimony does not open the door to opinions that are not based on the perception of 
 
8 
the witness or on the witness’s personal knowledge.4  See, e.g., Harman, 288 Va. at 98-99, 758 
S.E.2d at 523-24.  Such an opinion is speculative.  See, e.g., United States v. Marshall, 173 F.3d 
1312, 1315 (11th Cir. 1999) (holding that admitting lay opinion was an abuse of discretion 
because “the opinion of a lay witness on a matter is admissible only if it is based on first-hand 
knowledge or observation . . . .  In this case, [a DEA Agent]--who was not present at any of the 
meetings between [the informant] and the defendants--had no personal knowledge regarding the 
origin of the cocaine given to him by [the informant]”); Jacobs v. General Electric Co., 880 A.2d 
151, 158 (Conn. 2005) (concluding trial court abused its discretion by admitting lay opinion 
about the defendant’s motivation for firing the plaintiff when “neither witness participated in the 
layoff decision” or  had “firsthand knowledge of the basis for the decision”); Chesser v. State, 30 
So. 3d 625, 628 (Fla. Dist. Ct. App. 2010) (“Opinion evidence of matters perceived by one of the 
senses, such as distance, time, size, weight, form, or identity, have usually been admitted.  Non-
expert witnesses have been allowed to give opinion testimony of these matters when they have 
knowledge based upon their personal perception . . .  However, if the opinion is nothing more 
                     
 
4 We acknowledge that there are instances when lay opinion testimony is permissible 
despite a lack of, or minimal, personal knowledge of the witness.  For example, “[i]t is generally 
recognized that the opinion testimony of the owner of property, because of his relationship as 
owner, is competent and admissible on the question of the value of such property, regardless of 
his knowledge of property values.  It is not necessary to show that he was acquainted with the 
market value of such property or that he is an expert on values.  He is deemed qualified by 
reason of his relationship as owner to give estimates of the value of what he owns.”  Crowder v. 
Commonwealth, 41 Va. App. 658, 664 n.3, 588 S.E.2d 384, 387 n.3 (2003) (quoting King v. 
King, 40 Va. App. 200, 212-13, 578 S.E.2d 806, 813 (2003), in turn quoting Haynes v. Glenn, 
197 Va. 746, 750, 91 S.E.2d 433, 436 (1956)).  Consequently, an owner of personal property 
“whether he is generally familiar with such values or not, ought certainly to be allowed to 
estimate its worth; the weight of his testimony (which often would be trifling) may be left to the 
jury, and courts have usually made no objections to this policy.”  Haynes, 197 Va. at 750-51, 91 
S.E.2d at 436 (quoting 3 Wigmore on Evidence § 716, at 48).  Nothing in this opinion should be 
read as disturbing those settled precedents.  This case, however, involves a leap of a different 
magnitude, into the thought processes of another. 
 
9 
than speculation, it is not admissible.”); Barbie v. Minko Constr., Inc., 766 N.W.2d 458, 462 
(N.D. 2009) (excluding lay opinion testimony because “a full review of their . . . testimony 
indicates there is no sustainable basis for their opinions and they were merely guessing or 
speculating”); State v. Davis, 261 P.3d 1197, 1210 (Or. 2011) (“[O]pinions based on speculation 
or conjecture generally are not based on the perception of the witness or on the witness’s 
personal knowledge.”).  See also MCI Telecomms. Corp. v. Wanzer, 897 F.2d 703, 706 (4th Cir. 
1990) (“The modern trend favors the admission of opinion testimony [under Rule 701], provided 
that it is well founded on personal knowledge as distinguished from hypothetical facts,” and the 
opinion is offered “on the basis of relevant historical or narrative facts that the witness has 
perceived.”) (alteration omitted). 
 
The rule expressly permits a lay witness to offer an opinion about the sanity or mental 
capacity of another.  Va. R. Evid. 2:701.  Such opinions are properly admitted when they are 
based on the witness’s personal experience or observations, for instance when the witness has 
observed erratic behavior, heard incoherent statements, and the like.  Lay opinions about a 
condition like sanity or mental capacity are one thing; an opinion from a witness concerning 
whether another person would or would not have made a specific decision is a different matter 
altogether. 
 
Martin and Meeks spoke with Starr extensively over the years and talked with her 
immediately before the surgery.  They knew of Starr’s aversion to surgery based on her difficult 
experience with prior surgeries.  In the past, Starr had overcome her reluctance to undergo 
surgery and had proceeded anyway.  As to the specific decision to undergo the surgery in 
question, neither Martin nor Meeks was present when Dr. Lahti consulted with Starr and neither 
knows what he may or may not have told her about the risks of, and alternatives to, the surgery.  
 
10 
Moreover, Starr did not convey to either Meeks or Martin what Dr. Lahti said to her about 
alternatives to surgery or what he may have omitted.  In addition, according to the plaintiff’s 
evidence, Starr had great confidence in Dr. Lahti.  Martin and Meeks assumed that Starr would 
have mentioned alternatives to surgery had Dr. Lahti communicated them, and because of this 
silence, they reasoned, Dr. Lahti must not have informed Starr of these alternatives.  In essence, 
Martin and Starr seek to extrapolate a decision their mother and sister would have made, despite 
the complete absence of evidence from Starr and from the doctor about the discussion that 
actually transpired between them and, specifically, whether surgical alternatives were or were 
not mentioned.  Their lay opinion about what Starr’s decision would have been was not rooted in 
their “personal experience or observations” as required by Rule of Evidence 2:701.  On these 
facts, Martin and Meeks’s testimony is nothing but speculation about what Starr’s thought 
process might have been if various items of information had been provided to her with respect to 
this specific surgery. 
 
Finally, we note that the standard on appeal is one of abuse of discretion.  “In contrast to 
the de novo standard of review, the abuse of discretion standard requires a reviewing court to 
show enough deference to a primary decisionmaker’s judgment that the court does not reverse 
merely because it would have come to a different result in the first instance.”  Lawlor v. 
Commonwealth, 285 Va. 187, 212, 738 S.E.2d 847, 861 (2013) (internal quotation marks and 
citation omitted).  “[W]hen a decision is discretionary . . . . the court has a range of choice, and 
. . . its decision will not be disturbed as long as it stays within that range and is not influenced by 
any mistake of law.”  Landrum v. Chippenham & Johnston-Willis Hosps., Inc., 282 Va. 346, 352, 
717 S.E.2d 134, 137 (2011) (quoting Kern v. TXO Prod. Corp., 738 F.2d 968, 970 (8th Cir. 
1984)).  The trial court in the present case did not abuse its discretion in excluding this evidence.  
 
11 
Without this evidence, the plaintiff could not establish causation on her informed consent claim.  
Therefore, the trial court properly dismissed the complaint. 
 
II. 
THE COURT PROPERLY EXCLUDED AS IRRELEVANT A STATEMENT THE PATIENT 
MADE FOLLOWING THE SURGERY. 
 
 
According to Martin, after the surgery, Starr said “I thought that this would be an easy 
operation.”  Dr. Lahti objected on relevance grounds.  The court agreed and excluded this 
statement as irrelevant.  Martin argues that this statement was admissible under the “Deadman’s 
Statute,” Code § 8.01-397.  According to Martin, this statement was relevant to show that her 
mother “was misled into believing her operation was easy, when according to the plaintiff’s 
evidence, the operation was extraordinarily dangerous.”  She also argues the statement was 
relevant to show that Starr must not have been properly informed about a safer non-surgical 
alternative, and that had she been so informed, she would not have gone forward with a 
dangerous operation.  The assignment of error, however, does not address relevance – the basis 
upon which the trial court excluded the statement.5  Instead, plaintiff’s assignment of error is that 
the trial court “erred in ruling that Plaintiff’s proffered evidence was inadmissible hearsay and 
speculation.”6  “An assignment of error that does not address the findings or rulings in the trial 
court . . . is not sufficient.”  Rule 5:17(c)(1)(iii).  The trial court ruled that this statement was not 
                     
 
5 In its letter opinion of July 5, 2016, the trial court wrote that the plaintiff was 
“attempting to use evidence which is undeniably hearsay and which is, at its heart, speculative.”  
At the hearing that followed the plaintiff’s motion to reconsider, held on December 16, 2016, at 
which the plaintiff offered the specific statement into evidence, the court excluded it on 
relevance grounds. 
 
 
6 The complete assignment of error reads: 
 
The trial court erred in ruling that Plaintiff’s proffered evidence 
was inadmissible hearsay and speculation when Virginia’s 
Deadman’s Statute, Section 8.01-397, and other exceptions to the 
rules prohibiting hearsay testimony, permit such testimony. 
 
12 
relevant.  Failure to assign error to the trial court’s ruling means that the issue is waived.  Covel 
v. Town of Vienna, 280 Va. 151, 163, 694 S.E.2d 609, 616 (2010). 
CONCLUSION 
 
We will affirm the judgment below. 
Affirmed.