Title: John v. Im
Citation: N/A
Docket Number: 010759
State: Virginia
Issuer: Virginia Supreme Court
Date: March 1, 2002

PRESENT:  Carrico, C.J., Lacy, Keenan, Koontz, Kinser, and 
Lemons, JJ., and Compton, S.J. 
 
SARAH A. JOHN, M.D. 
 
v.  Record No. 010759   OPINION BY JUSTICE BARBARA MILANO KEENAN 
 
 
                           March 1, 2002 
WONG SHIK IM 
 
FROM THE CIRCUIT COURT OF FAIRFAX COUNTY 
Marcus D. Williams, Judge 
 
 
 
In this appeal, we consider whether the trial court abused 
its discretion in excluding evidence of a quantitative 
electroencephalogram (QEEG test) and the testimony of expert 
witnesses that was based on this evidence. 
 
In July 1998, Sarah A. John, M.D., was a passenger in an 
automobile that was struck from behind by a vehicle driven by 
Wong Shik Im, an uninsured motorist.  John filed a motion for 
judgment against Im and obtained service of process on uninsured 
motorist carriers State Farm Mutual Automobile Insurance Company 
and United Services Automobile Association Casualty Insurance 
Company (collectively, State Farm).  John alleged, among other 
things, that as a result of the collision she "suffered severe 
permanent physical injury." 
 
In support of her claim, John proffered expert testimony 
that was based on an analysis of a QEEG test performed on her 
after the accident.  In a QEEG test, the electrical activity of 
the brain is measured and converted into a digital format to 
facilitate analysis of and to detect deviations from normal 
brain functioning. 
 
John offered into evidence the de bene esse deposition 
testimony of Robert W. Thatcher, who holds a doctorate in 
psychology and was program director of QEEG testing at the Bay 
Pines Veterans Administration Hospital in Florida.  Thatcher is 
a colleague of John's father, Dr. E. Roy John, and collaborated 
with him in developing QEEG testing and in writing several books 
and articles on this subject. 
 
Based on the results of the QEEG test performed on John, 
Thatcher concluded that there was "very clear evidence" that 
John suffered an injury to her brain that was caused by a "rapid 
acceleration/deceleration" trauma.  Thatcher stated that he was 
unable to determine when the injury occurred, and that the 
"rapid acceleration/deceleration" trauma was not necessarily 
caused by an automobile accident, but could have been caused by 
an assault or by "[a]ny number of events." 
 
Thatcher also stated that he did not observe the QEEG test 
performed on John, but reviewed the test results he received 
from a person he identified as "Dr. Sitar."  Thatcher was 
unaware of Sitar's occupation, including whether Sitar was a 
medical doctor or a physical therapist.  Thatcher did not know 
anything regarding Sitar's training, how long Sitar had 
 
2
conducted QEEG tests, or whether Sitar personally performed the 
QEEG test on John or employed a technician for that purpose. 
 
Thatcher testified that there are no "control conditions" 
required for accurate performance of a QEEG test, other than 
having a patient sit "with her eyes closed," and that the 
testing data indicated that John's eyes were closed when the 
test was conducted.  Although Thatcher was aware that John was 
taking the medications Neurontin and Ritalin, he did not know 
when she had last taken them before the QEEG test.  He stated 
that medications such as Neurontin can "globally affect" a 
patient's QEEG test results, and that John's QEEG test results 
demonstrated "a very specific pattern" indicating a particular 
type of brain injury. 
 
Thatcher also acknowledged that drowsiness in a patient can 
affect QEEG test results.  However, when asked if John was 
drowsy during her QEEG test, Thatcher initially replied, "You 
would have to ask Dr. Sitar."  Thatcher later stated that he 
knew "with certainty" that John had not been drowsy at the time 
of the test based on his review of John's QEEG test results. 
 
In addition to Thatcher's deposition testimony, John also 
offered into evidence the de bene esse deposition testimony of 
John K. Nash, Ph.D., a licensed psychologist.  Nash testified 
that during his examination of John, she informed him that she 
had developed several symptoms after the accident, including 
 
3
slowed thinking and difficulty organizing her thoughts and 
concentrating. 
 
Based on these symptoms, and on Thatcher's analysis of 
John's QEEG test results, Nash concluded that John had sustained 
a "mild traumatic brain injury that she suffered as a result of 
the impact and the sudden acceleration-deceleration of her head 
in [the] car accident."  Nash further testified that he was not 
a forensic psychologist or a medical doctor, and that the 
medications John was taking at the time of her QEEG test should 
be "taken into account" in analyzing her test results. 
 
State Farm filed a motion in limine seeking to exclude the 
testimony of Thatcher and Nash.  State Farm asserted that the 
expert testimony should be excluded because, among other 
reasons, it lacked a proper foundation.  State Farm also argued 
that the expert testimony was inadmissible because QEEG testing 
had not been established as reliable scientific evidence under 
the evaluation criteria set forth in Daubert v. Merrell Dow 
Pharmaceuticals, Inc., 509 U.S. 579 (1993). 
 
The trial court entered an order excluding the testimony of 
both Thatcher and Nash.1  Relying on our decision in Tittsworth 
v. Robinson, 252 Va. 151, 475 S.E.2d 261 (1996), the trial court 
held that "there were potential testing variables, including, 
                     
 
1The judge who rendered this decision was the Honorable R. 
Terrence Ney. 
 
4
but not limited to, the medication that Dr. John was taking at 
the time of the test, which could affect the outcome of the test 
. . . that . . . cannot be appropriately accounted for."  The 
order further stated that the QEEG testing technique relied on 
by Thatcher did not meet the criteria for scientific reliability 
set forth in Daubert. 
 
The trial court also held that Nash's testimony was 
inadmissible because it was based on Thatcher's analysis of the 
QEEG test results.  The court excluded Nash's testimony on the 
additional ground that Nash was not qualified to make a medical 
diagnosis or to state a medical opinion that John's injury was 
related to the automobile accident. 
 
Upon trial of the case, the jury awarded John $10,700 in 
damages, and the trial court entered judgment on the jury 
verdict.  John appeals from this judgment. 
 
John argues that the trial court abused its discretion in 
excluding the testimony of Thatcher and Nash on the grounds that 
the evidence lacked a sufficient foundation.  John contends that 
the QEEG test, on which this testimony was based, is an 
"objectively verifiable" physical test, and that the effect of 
any testing conditions on the results obtained was a matter 
subject to cross-examination. 
 
In response, State Farm asserts that the trial court 
properly excluded the disputed expert testimony because the 
 
5
testimony lacked a sufficient factual basis, did not take into 
account all testing variables, and did not assess the effect of 
those variables on the test results.  State Farm also argues 
that the trial court properly ruled that Nash was not qualified 
to render a medical diagnosis or to give a medical opinion 
regarding the cause of John's injuries.  We agree with State 
Farm's arguments. 
 
In civil cases, expert testimony generally is admissible if 
it will assist the trier of fact in understanding the evidence.  
See Code §§ 8.01-401.1 and –401.3; Keesee v. Donigan, 259 Va. 
157, 161, 524 S.E.2d 645, 647 (2000); Tittsworth, 252 Va. at 
154, 475 S.E.2d at 263.  However, the admission of expert 
testimony is subject to certain basic requirements, including 
the requirement that the evidence be based on an adequate 
foundation.  Id.; Tarmac Mid-Atlantic, Inc. v. Smiley Block Co., 
250 Va. 161, 166, 458 S.E.2d 462, 465 (1995).  The decision 
whether to admit such testimony is a matter committed to the 
trial judge's sound discretion, and we will reverse a trial 
court's determination in this regard only when the court has 
abused its discretion.  Lockheed Info. Mgmt. Sys. Co. v. 
Maximus, Inc., 259 Va. 92, 111, 524 S.E.2d 420, 430 (2000); 
Virginia Power v. Dungee, 258 Va. 235, 258, 520 S.E.2d 164, 177 
(1999); Tarmac, 250 Va. at 166, 458 S.E.2d at 465. 
 
6
 
Expert testimony is inadmissible if it is speculative or 
founded on assumptions that have an insufficient factual basis.  
Keesee, 259 Va. at 161, 524 S.E.2d at 648; Tittsworth, 252 Va. 
at 154, 475 S.E.2d at 263; Tarmac, 250 Va. at 166, 458 S.E.2d at 
466.  Such testimony is also inadmissible when an expert has 
failed to consider all variables bearing on the inferences to be 
drawn from the facts observed.  ITT Hartford v. Virginia 
Financial Assoc., 258 Va. 193, 201, 520 S.E.2d 355, 359 (1999); 
Tittsworth, 252 Va. at 154, 475 S.E.2d at 263; Tarmac, 250 Va. 
at 166, 458 S.E.2d at 466. 
 
In reviewing a trial court's ruling on the admissibility of 
expert testimony, we are limited to an examination of the record 
before us.  Greater Richmond Transit Co. v. Wilkerson, 242 Va. 
65, 68 n.2, 406 S.E.2d 28, 31 n.2 (1991); see McDonald v. 
National Enterprises, Inc., 262 Va. 184, 195, 547 S.E.2d 204, 
211 (2001); Commonwealth v. Williams, 262 Va. 661, 669, 553 
S.E.2d 760, 764 (2001).  Thus, in deciding this appeal, we 
decline John's request that we consider several articles 
concerning QEEG testing that she failed to submit to the trial 
court. 
 
We hold that the record before us supports the trial 
court's determination excluding the challenged testimony.  The 
initial deficiency in the foundation evidence was Thatcher's 
inability to identify the person who actually performed the QEEG 
 
7
test on John.  Without this information, the testing conditions 
and procedures could not be ascertained. 
 
A second deficiency in the foundation evidence was 
Thatcher's inability to account for the testing variables 
involving John's use of certain medications.  In testifying 
concerning a prior study he had conducted on QEEG testing, 
Thatcher stated that the possible effects of medication on such 
tests should be considered with caution.  However, Thatcher 
conceded that he did not know when John had last taken her 
Ritalin and Neurontin medications prior to the QEEG test.  He 
also failed to state whether John's use of Ritalin could have 
had any effect on her QEEG test results.  Finally, Thatcher 
testified that Neurontin can "globally affect" test results, but 
did not specify whether he observed such an effect in the 
results of the test performed on John. 
 
A third deficiency in the foundation evidence concerned 
Thatcher's conflicting responses when asked about the testing 
variable of drowsiness.  After acknowledging that drowsiness in 
a patient can affect some portions of QEEG test results, 
Thatcher first stated that he did not know whether John had been 
drowsy when the test was conducted, but later stated that he was 
certain that John was not drowsy at the time of the test.  Based 
on these omissions and inconsistencies in the evidence, we hold 
that the trial court did not abuse its discretion in concluding 
 
8
that the evidence was insufficient to lay a foundation for the 
testimony of Thatcher and Nash involving the QEEG test performed 
on John and their conclusions based on the results of that test. 
 
We also hold that the trial court properly excluded Nash's 
opinion testimony that John sustained a mild traumatic brain 
injury as a result of the automobile accident.  An opinion 
concerning the causation of a particular physical human injury 
is a component of a diagnosis, which is part of the practice of 
medicine.  Combs v. Norfolk & W. Ry. Co., 256 Va. 490, 496, 507 
S.E.2d 355, 358 (1998).  Nash was a licensed psychologist, not a 
medical doctor.  Therefore, since Nash was not a medical doctor, 
he was not qualified to state an expert medical opinion 
regarding the cause of John's injury.2  See id. at 496-97, 507 
S.E.2d at 359. 
                     
 
2We note that in Velazquez v. Commonwealth, 263 Va. 95, 557 
S.E.2d 213 (2002), we recognized an exception to the general 
rule that only a medical doctor may render an opinion regarding 
the cause of a physical human injury.  There, in a trial on an 
indictment alleging rape, a Sexual Assault Nurse Examiner (SANE) 
qualified as an expert witness on the subject of sexual assault 
injuries.  The record showed that the SANE had been a registered 
nurse for 26 years, had received special training to qualify as 
a SANE, and had examined approximately 500 victims of sexual 
assault.  We held, in relevant part, that although the SANE was 
not a medical doctor, she was qualified under the facts 
presented to render an expert opinion concerning the “causation 
of injuries in the context of an alleged sexual assault.”  Id. 
at 104, 557 S.E.2d at 218.  Because our holding in Velazquez is 
limited to the unique context of a SANE's expert opinion 
concerning the causation of injuries in a sexual assault case, 
that holding does not change the general rule stated above that 
only a medical doctor may give an expert opinion about the cause 
 
9
 
Because the testimony of Thatcher and Nash was inadmissible 
for the reasons stated above, we do not reach the merits of the 
issue whether that evidence also failed to meet the criteria for 
scientific reliability articulated in Daubert, 509 U.S. at 589.  
We note, however, that we have not previously considered the 
question whether the Daubert analysis employed by the federal 
courts should be applied in our trial courts to determine the 
scientific reliability of expert testimony.3  Therefore, we leave 
this question open for future consideration. 
 
For these reasons, we will affirm the trial court's 
judgment. 
Affirmed.
                                                                  
of a physical human injury.  See Combs, 256 Va. at 496-97, 507 
S.E.2d at 358-59. 
 
3Prior to Daubert, however, we discussed the trial court's 
role in making a threshold finding of scientific reliability 
when unfamiliar scientific evidence is offered.  See Satcher v. 
Commonwealth, 244 Va. 220, 244, 421 S.E.2d 821, 835 (1992), 
cert. denied, 507 U.S. 933 (1993); Spencer v. Commonwealth, 240 
Va. 78, 97-98, 393 S.E.2d 609, 621, cert. denied, 498 U.S. 908 
(1990). 
 
10