Title: Moates v. Hyslop
Citation: N/A
Docket Number: 960933
State: Virginia
Issuer: Virginia Supreme Court
Date: January 10, 1997

Present:  All the Justices 
 
ROBERT COURTLAND MOATES 
 
OPINION BY JUSTICE ROSCOE B. STEPHENSON, JR. 
v.  Record No. 960933 
                                      January 10, 1997 
JOHN W. HYSLOP, ET AL. 
 
 
FROM THE CIRCUIT COURT OF CHESTERFIELD COUNTY 
 
Timothy J. Hauler, Judge 
 
 
In this medical malpractice action, the patient-plaintiff 
alleged that the physician-defendant (1) failed to inform him of 
the risks attendant to the medical procedure involved, and (2) 
failed to give him any discharge instructions.  The issue in this 
appeal is whether the patient was required to present expert 
testimony to show whether and to what extent such information 
should have been disclosed by the physician to the patient. 
 
I 
 
Robert Courtland Moates filed a motion for judgment against 
John W. Hyslop, M.D., and others, seeking damages for injuries 
Moates allegedly sustained as a result of Hyslop's negligence.  
Moates claimed, inter alia, that Hyslop negligently failed to 
provide him with adequate preoperative and postoperative 
information and that such failure proximately caused his 
injuries.  Hyslop filed a motion for summary judgment based upon 
responses to requests for admissions, and, by final order entered 
February 7, 1996, the trial court sustained the motion and 
granted summary judgment in favor of Hyslop.  The trial court 
ruled that Moates was required to provide expert testimony in 
order to establish a prima facie case of negligence.  We awarded 
Moates this appeal. 
 
 
 
 
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II 
 
The record contains a written statement of facts, filed 
pursuant to Rule 5:11(c).  In 1991, Moates was having severe and 
recurrent pain in his chest, abdomen, and upper back.  Moates 
went to his family doctor, Kevin A. Keller, M.D.  Dr. Keller 
diagnosed the cause of Moates' problem as either an inflamed 
gallbladder or gallstones and made arrangements for Moates to be 
seen by Hyslop, a general surgeon affiliated with Surgical 
Associates of Richmond, Inc. 
 
Hyslop examined Moates and discussed generally the risks 
inherent in the performance of a laparoscopic cholecystectomy, a 
less invasive surgical excision of the gallbladder.  Hyslop, 
however, did not discuss with Moates the option of conventional 
surgery.  Hyslop has admitted that at no time did he inform 
Moates that the carbon dioxide that would be used to inflate 
Moates' abdomen could leak into his scrotum causing great 
swelling or that a deep vein thrombosis could result from the 
insufflation. 
 
On October 2, 1991, Hyslop performed a laparoscopic 
cholecystectomy on Moates at Johnston-Willis Hospital.  During 
the surgery, carbon dioxide escaped into Moates' scrotum causing 
it to swell "to a huge and painful size."
1
 
     
1Moates conceded that he had no expert witness to show that 
the surgery was performed improperly.  Therefore, his claim that 
Hyslop negligently performed the surgery was stricken and 
dismissed and is not a subject of this appeal. 
 
 
 
 
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Moates claims that, before he was discharged from the 
hospital, neither he nor his wife was given any instructions by 
Hyslop regarding postoperative care.  Hyslop has no recollection 
of what he told Moates, but he assumes that he gave Moates the 
usual discharge instructions. 
 
Moates developed a deep vein thrombosis in his right leg.  
As a result, he is unable to perform his work as a gunsmith to 
the same extent that he could prior to the surgery because his 
work requires constant standing. 
 
Dr. Keller has given his professional opinion that Moates' 
swollen scrotum and subsequent deep vein thrombosis were caused 
by the insufflation. 
 
III 
 
In granting summary judgment, the trial court relied upon 
Bly v. Rhoads, 216 Va. 645, 222 S.E.2d 783 (1976), an informed 
consent case.  The physician-defendant in Bly had performed a 
hysterectomy on Bly.  Following the surgery, Bly developed 
complications, and further hospitalization and surgery were 
required to correct her problems. 
 
Bly sued her doctor, claiming, inter alia, that the doctor 
failed to give her sufficient information to make an informed 
choice about her treatment.  Specifically, Bly claimed that the 
doctor failed to advise her that there were alternatives to the 
surgery and to explain to her the risks involved in a 
hysterectomy.  Id. at 645-47, 222 S.E.2d at 784-85. 
 
 
 
 
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In Bly, we adopted the rule that, in order for a patient to 
recover against the physician for failure to adequately inform 
the patient of the alternatives to and the risks of a particular 
treatment, the patient is required "to show by qualified medical 
experts whether and to what extent information should be 
disclosed."  Id. at 650-51, 222 S.E.2d at 787.  We also said, 
however, that we could "envision situations, albeit relatively 
infrequent, where from ordinary human knowledge and experience 
the necessity of disclosure is so obvious that expert testimony 
should not be required."  Id. at 650, 222 S.E.2d at 787.  Moates 
contends that this statement in Bly applies to the facts of his 
case.  We do not agree.   
 
With respect to the issue of informed consent, we think the 
facts in Bly and those in the present case are indistinguishable, 
and, therefore, the rule in Bly controls.  Consequently, we 
conclude that the trial court correctly ruled that Moates was 
required to show by qualified medical experts whether and to what 
extent information should have been disclosed to him by Hyslop 
prior to the surgery.  Moates did not have an expert in the field 
of laparoscopic cholecystectomy surgery, and, therefore, he could 
not pursue the claim. 
 
IV 
 
As previously stated, Moates also claimed that Hyslop 
negligently failed to give him any postoperative instructions.  
The trial court, relying on the Bly rationale, likewise granted 
 
 
 
 
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summary judgment in favor of Hyslop, ruling that Moates was 
required to establish Hyslop's negligence by qualified expert 
testimony.
2
 
The record before us suggests that Hyslop did not give 
Moates any postoperative instructions, and, following the 
operation, Moates developed a deep vein thrombosis in his right 
leg.  Moates argues that "[i]t doesn't take an expert to 
establish that Moates should have been given discharge 
instructions."  We agree that it should be obvious, even to a lay 
person, that a physician who has performed major surgery has a 
duty to give his patient postoperative instructions and that the 
physician's failure to give any instructions constitutes 
negligence per se.  This, however, is only a part of the 
equation.  Moates also has the burden of proving not only that 
Hyslop was negligent but also that Hyslop's negligence was the 
proximate cause of his injury.  To establish causation, Moates 
was required to produce qualified expert testimony about what 
instructions should have been given to him and that Hyslop's 
failure to give such instructions proximately caused Moates' deep 
vein thrombosis.  Consequently, we hold that the trial court did 
not err in granting summary judgment in favor of Hyslop on this 
                     
     
2The trial court established a cut off date for the parties 
to identify their expert witnesses.  Moates named Dr. Keller as 
his expert, but the court, by an order entered January 5, 1996, 
ruled that Dr. Keller was not qualified to testify on "the 
standard of care issue applicable to a general surgeon."  Moates 
did not request leave to identify another expert and has not 
appealed this ruling. 
 
 
 
 
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claim. 
 
V 
 
Accordingly, we will affirm the trial court's judgment. 
 
Affirmed.