Court Opinion

ID: 9927957
Source: CourtListenerOpinion
Date Created: 2024-01-30 16:17:03.868142+00
Date Added: 2024-06-11T09:32:31.906445
License: Public Domain

COURT OF APPEALS OF VIRGINIA

            Present: Chief Judge Decker, Judges Beales and Raphael
PUBLISHED

            Argued at Norfolk, Virginia

            TINA C. RODRIGUE, M.D., ET AL.
                                                                                     OPINION
            v.      Record No. 1521-22-1                                     JUDGE STUART A. RAPHAEL
                                                                                 JANUARY 30, 2024
            LORETTA BUTTS-FRANKLIN

                              FROM THE CIRCUIT COURT OF THE CITY OF NORFOLK
                                            Jerrauld C. Jones, Judge

                            Ronald P. Herbert (Harman, Claytor, Corrigan & Wellman, PC, on
                            briefs), for appellants.

                            Paul L. Warren (Warren PLC, on brief), for appellee.

                    Following a four-day trial in this medical-malpractice case, the jury awarded Loretta

            Butts-Franklin $1,183,000 in damages against Tina C. Rodrigue, M.D., Chelsea Baker Smith, and

            Hampton Roads Neurosurgical Associates, P.C. (collectively, “defendants”). Defendants seek a

            new trial on the ground that the trial judge refused to instruct the jury on Butts-Franklin’s duty to

            mitigate her damages. Because defendants failed to show when Butts-Franklin’s alleged failure to

            mitigate occurred, let alone that it happened after defendants committed the medical malpractice

            alleged, we find no error and affirm the judgment.

                                                        BACKGROUND

                    When reviewing a trial court’s refusal to grant a jury instruction, we view the evidence in

            the light most favorable to the proponent of the instruction—here, the defendant medical

            professionals. See Watson v. Commonwealth, 298 Va. 197, 207 (2019); Holmes v. Commonwealth,

            76 Va. App. 34, 52-53 (2022).
       On January 7, 2016, Dr. Rodrigue performed surgery on Butts-Franklin’s right wrist as a

treatment for carpal tunnel syndrome. The surgery involved making an incision to the wrist,

performing the procedure, and then closing the incision with four sutures. There were no

complications during the surgery, and Butts-Franklin was discharged from the hospital the same

day.

       Before discharging Butts-Franklin, Dr. Rodrigue instructed her to return to the hospital in

ten days to get her sutures removed. Dr. Rodrigue further instructed her to refrain from soaking her

hand in water to reduce the risk of infection. A nurse provided Butts-Franklin with written

discharge instructions that said, “Keep hand clean and dry until sutures removed; no soaking hand

in water.”

       Butts-Franklin testified that within three or four days of the surgery, her wrist was “warm”

to the touch and red around the incision area. She said she called Dr. Rodrigue’s office and spoke to

Chelsea Smith, Dr. Rodrigue’s medical assistant, but because Butts-Franklin had an upcoming

appointment, nothing happened. Smith testified that Butts-Franklin called multiple times, “every

couple of days” between the surgery and the suture removal, asking for more or different pain

medications, which Dr. Rodrigue refused to prescribe. Smith said that, although she did not record

a note for each call, she reported each one to Dr. Rodrigue.1 Smith testified that Butts-Franklin

never reported during those calls that the wound was “red, hot, foul smelling [or] swollen,” or

       1
         One of Smith’s notes reflects that Butts-Franklin called on January 7 (the same day as
the surgery), requesting that she be prescribed a different pain medication; Butts-Franklin denied
making that call. According to the note, after being denied the prescription, Butts-Franklin told
Smith “that she would just take her complaint elsewhere and go to the ER to get something else.”
An exhibit introduced by Butts-Franklin at trial included a medical record appearing to show that
Butts-Franklin went to Sentara Leigh Hospital on January 8, where she received an injection of
ketorolac for pain relief.
                                                -2-
anything else that would suggest infection. No follow-up visit was scheduled before the suture-

removal visit.

        About seven to ten days after the surgery, Butts-Franklin went to Dr. Rodrigue’s office to

have the sutures removed.2 Smith removed the sutures, noting that the wound was not infected or

swollen. Smith saw “[n]othing out of the ordinary.” Smith removed all the sutures, though Butts-

Franklin claimed there was still one suture left. Smith then got a physician’s assistant, Jamie

Rogalla, to look at Butts-Franklin’s wrist. Rogalla did not find any remaining sutures,3 nor did she

see any infection or redness. Butts-Franklin denied that anyone other than Smith saw her that day.

Butts-Franklin left the office without a follow-up appointment scheduled.

        Butts-Franklin testified that she called the next day and asked to see Dr. Rodrigue, but Smith

told Butts-Franklin she did not need to see the doctor because her wrist was “fine.” In the following

days, Butts-Franklin said that she continued to experience pain, increased swelling, and redness.

She also noticed that her wrist “started to ooze at the incision and it didn’t smell right.”

Butts-Franklin said that she called Dr. Rodrigue’s office a couple more times over the following

days, but again no follow-up visit was scheduled by Dr. Rodrigue. For her part, Smith testified that

Butts-Franklin never mentioned any redness or pain symptoms during any call with Smith after the

sutures were removed. Had Butts-Franklin mentioned those symptoms, Smith said she “would have

immediately brought her in and told Dr. Rodrigue.”

        2
         Defendants did not make a record of the visit on the date it occurred, and no witness
claimed to remember the exact date. Smith testified that Butts-Franklin came in “seven to ten
days after her surgery,” so the visit “would have been either the 15th [a Friday] or the 18th [a
Monday].”
        3
         When performing surgery on Butts-Franklin’s wrist the following week, Dr. Rodrigue
likewise found no leftover sutures.
                                            -3-
        On January 22, Butts-Franklin went to the Chesapeake Regional Medical Center emergency

room seeking treatment for pain in her wrist. The doctors there diagnosed Butts-Franklin with an

infection, prescribed antibiotics, and told her to follow up with Dr. Rodrigue. Butts-Franklin was

discharged from Chesapeake Regional Medical Center the next morning.

        On January 25, Butts-Franklin called Dr. Rodrigue’s office to inform her of the emergency-

room visit, spoke to Smith, and scheduled a follow-up appointment for the next day. Upon

examining Butts-Franklin’s wrist, Dr. Rodrigue recommended immediate surgery to treat the

infection. In a note dated January 26, Dr. Rodrigue wrote that Butts-Franklin “has had excessive

pain complaints since the time of surgery,” and “[l]ast week, she had her sutures removed which

was unremarkable and no problems were noted at the time of the suture removal.” Dr. Rodrigue

added that Butts-Franklin “remarked that she had been soaking her hand at home.” Dr. Rodrigue

testified that she wrote that note because Butts-Franklin told Dr. Rodrigue she had been soaking her

hand to relieve her pain. Butts-Franklin denied soaking her hand in water during the 14 days after

the surgery.

        Butts-Franklin underwent surgery that night and stayed in the hospital for 11 days, during

which she underwent 2 additional surgeries to clear the infection. Butts-Franklin ultimately

recovered, but she lost significant use of her right hand. Her medical bills for the post-operative

care totaled approximately $183,000. Butts-Franklin brought this medical malpractice action

against defendants seeking to recover damages for her medical bills, pain and suffering, and loss of

mobility in her wrist. The jury trial lasted four days.

        Butts-Franklin argued at trial that the delay in diagnosing the infection between January 7

and January 26 resulted in the infection’s progressing to the point where she needed 3 additional

surgeries and an 11-day hospital stay. Two expert witnesses for defendants testified, relying on

Dr. Rodrigue’s January 26 note, that Butts-Franklin’s soaking her hand sometime between January
                                                  -4-
7 and January 26 caused or increased the severity of her infection. Neither pinpointed during that

period, however, when the alleged soaking occurred. Dr. John Reavey-Cantwell, a neurosurgeon,

explained that healthcare providers commonly instruct patients not to get surgical wounds wet

because doing so increases the likelihood of infection. He concluded that Butts-Franklin increased

the risk of her suffering the infection by soaking her hand in disregard of her post-operative

instructions. Dr. John Sampson, also a neurosurgeon, testified that assuming Dr. Rodrigue’s

January 26 note was correct and that Butts-Franklin had been “soaking her hand before that second

surgery . . ., then that dramatically increased the risk of infection and also probably dramatically

increased [the] . . . severity of the infection.”4

        At the close of evidence, defendants requested the following jury instruction relating to

Butts-Franklin’s duty to mitigate her damages: “Plaintiff has a duty to minimize her damages. If

you find that the Plaintiff did not act reasonably to minimize her damages and that, as a result, they

increased, then she cannot recover the amount by which they increased.” Defendants argued that

the evidence relating to Butts-Franklin’s soaking her hand supported the theory that Butts-Franklin

failed to mitigate her damages, meriting the proposed instruction.

        The trial judge denied the instruction. The court explained, “I think the theory of

[defendants’] case is that [Butts-Franklin] contributed to her own injury by her alleged submersion

of her wound, and I think it more relates to causation and proximate cause than it does to damages.”

The trial judge further noted, “The theory that you’re arguing, I think, is more of a causation issue.”

        4
         Butts-Franklin introduced the deposition testimony of Dr. Paul Kaloostian, a
neurosurgeon, who said that he could not “rule out” that the infection resulted from soaking the
hand. He said, “I don’t know if soaking the hand in the water, if that happened, caused the
infection,” noting that Butts-Franklin was diabetic and that “other hygiene things” may have
contributed to the infection, given that it was her right (dominant) hand. Dr. Kaloostian, when
shown a January 22 picture of Butts-Franklin’s wrist infection, opined that the infection was
about four or five days old.
                                                 -5-
        The jury returned a verdict for Butts-Franklin and awarded her damages in the amount of

$1,183,000, with prejudgment interest from February 1, 2016. Defendants moved to set aside the

verdict, arguing that the trial court committed reversible error by refusing their mitigation

instruction. At the posttrial hearing, defendants argued that they were entitled to a mitigation

instruction because there was some evidence of plaintiff’s failure to mitigate; they claimed that the

trial court acknowledged as much by saying it was more of a proximate cause issue than a damages

issue. Butts-Franklin responded that “[t]here is nothing temporally whatsoever as to when any

alleged mitigation could have/should have occurred” and that the trial court correctly refused the

instruction.

        The trial court denied defendants’ motion and entered final judgment for Butts-Franklin on

the jury verdict. Defendants noted a timely appeal.

                                              ANALYSIS

        Defendants argue that the trial court erred by refusing their proposed mitigation instruction

because there was more than a scintilla of evidence that Butts-Franklin failed to mitigate her

damages when she soaked her hand sometime after the January 7 surgery. “A trial court’s decision

whether to grant or refuse a proposed jury instruction is generally subject to appellate review for

abuse of discretion.” Howsare v. Commonwealth, 293 Va. 439, 443 (2017); Conley v.

Commonwealth, 74 Va. App. 658, 675 (2022). But “[a] litigant is entitled to jury instructions

supporting his or her theory of the case if sufficient evidence is introduced to support that theory.”

Hancock-Underwood v. Knight, 277 Va. 127, 130 (2009) (alteration in original).

        The evidence is sufficient to support a theory of the case if it “amount[s] to more than a

scintilla.” Id. at 131 (quoting Holmes v. Levine, 273 Va. 150, 159 (2007)). “We have declined to

define the term ‘scintilla,’ but instead [have] held that it should be ‘“resolved on a case-by-case

basis” by assessing the evidence in support of a proposition against the “other credible evidence that
                                                  -6-
negates” it.’” Edwards v. Commonwealth, 65 Va. App. 655, 662-63 (2015) (quoting Woolridge v.

Commonwealth, 29 Va. App. 339, 348 (1999)).

        “One who is injured by the wrongful or negligent acts of another, whether as the result of a

tort or of a breach of contract,5 is bound to exercise reasonable care and diligence to avoid loss or to

minimize or lessen the resulting damage . . . .” Monahan v. Obici Med. Mgmt. Servs., Inc., 271 Va.

621, 636 (2006) (quoting Lawrence v. Wirth, 226 Va. 408, 412 (1983)). Thus, “to the extent that

[the plaintiff’s] damages are the result of his active and unreasonable enhancement thereof or are

due to his failure to exercise such care and diligence, he cannot recover.” Id. (quoting Lawrence,

226 Va. at 412). “[T]he party asserting [a failure-to-mitigate] defense . . . b[ears] the burden of

proof on that issue.” Forbes v. Rapp, 269 Va. 374, 380 (2005). “Generally, whether a plaintiff

acted reasonably to minimize his damage is a question for the jury.” Evans v. Evans, 280 Va. 76, 85

(2010) (quoting Sawyer v. Comerci, 264 Va. 68, 77 (2002)).

        Although a plaintiff’s obligation to use reasonable care to mitigate damages is sometimes

called a “duty” to mitigate damages, Monahan, 271 Va. at 636, phrasing that obligation as a duty

can be “misleading.” Kent Sinclair, Sinclair on Remedies § 3-6[A], at 3-58 (5th ed. 2016). “[A]

failure to mitigate does not expose a party to any liability. What the failure to mitigate does do is

result in a limitation on the amount of damages the party who failed to mitigate can recover.” Id. at

3-58 to 3-59.

        The duty to mitigate damages serves an important function. “[W]ithout a mitigation rule,

plaintiffs would have a perverse incentive to sit back and let their damages mount, even though they

could stanch the loss by exercising reasonable care.” Id. at 3-59. “Mitigation doctrine—by forcing

        5
         The formulation of the mitigation-of-damages defense is generally the same for claims
sounding in tort and in contract. Compare Model Jury Instrs.—Civ. No. 35.110 (“Patient’s Duty
to Mitigate Damages”), with Model Jury Instrs.—Civ. No. 45.550 (“Damages: Duty to
Mitigate”).
                                              -7-
plaintiffs to act as if their losses were not insured—encourages plaintiffs to reduce the societal costs

of their injuries.” Id. “It is only incumbent upon [the plaintiff], however, to use reasonable exertion

and reasonable expense . . . .” Haywood v. Massie, 188 Va. 176, 183 (1948).

        Critical to resolving this case is the temporal element that distinguishes the plaintiff’s duty

to mitigate damages from the doctrine of contributory negligence. Those two defenses are based on

“separate and distinct tort principles.” Diehl v. Butts, 255 Va. 482, 491 (1998). “The basis for the

distinction results from the differing times when the plaintiff’s duty to avoid unnecessary harm

arises under each doctrine.” Sinclair, supra, § 3-6[A], at 3-62 (emphasis added).

        If the plaintiff’s injury occurs because the plaintiff failed to exercise reasonable care

contemporaneously or concurrently with the negligent act of the defendant, it constitutes

contributory negligence that bars the plaintiff’s recovery. See Chandler v. Graffeo, 268 Va. 673,

681 (2004) (“To constitute contributory negligence in a medical-malpractice case, a plaintiff’s

negligence must be contemporaneous with the claimed defendant’s negligence.”); Sawyer, 264 Va.

at 75 (“[I]n order for contributory negligence to bar a plaintiff’s recovery in a medical negligence

action, the plaintiff’s negligence must be concurrent with the defendant’s negligence.”). “[I]n the

medical malpractice context, this requirement means that the patient’s negligent act must be

contemporaneous with the main fact asserted as the negligent act of the physician.” Sawyer, 264

Va. at 75 (quoting Ponirakis v. Choi, 262 Va. 119, 125 (2001)).

        By contrast, and “[u]nlike contributory negligence, the plaintiff’s duty to mitigate damages

arises only after the defendant’s tortious conduct.” Sinclair, supra, § 3-6[A], at 3-62 (emphasis

added). Our Supreme Court has described the patient’s duty to mitigate damages as arising “after

receiving negligent medical care,” or “‘following his physician’s negligent treatment.’” Monahan,

271 Va. at 636 (emphases added) (quoting Sawyer, 264 Va. at 77). See also Model Jury Instrs.—

Civ. No. 35.110, at 35-42 (2022-2023) (advising that the mitigation instruction “is applicable where
                                                  -8-
there is evidence that a patient, after an act of malpractice, failed to exercise ordinary care for his

own health and thus increased his damages” (emphasis added)).6

        Another difference is in the rules for pleading the affirmative defenses of contributory

negligence and failure to mitigate damages. “Contributory negligence will not constitute a defense

unless pleaded or shown by the plaintiff’s evidence.” Rule 3:18(c). By contrast, even though the

plaintiff’s failure to mitigate damages is “an affirmative defense,” Forbes, 269 Va. at 380, the

defendant need not plead that defense in the answer, Monahan, 271 Va. at 631-32.

        A jury instruction—whether on contributory negligence or duty to mitigate—“may be given

only if there is evidence to support the instruction.” Monahan, 271 Va. at 636 (quoting Pollins v.

Jones, 263 Va. 25, 28 (2002)). The proponent of the instruction must show that “more than a

scintilla” of evidence supports it. Id. (quoting Schlimmer v. Poverty Hunt Club, 268 Va. 74, 78

(2004)); Sawyer, 264 Va. at 75 (“Hence, a defendant who asserts a defense of contributory

negligence is not entitled to a jury instruction on contributory negligence if that defendant only

adduces a mere scintilla of evidence of the plaintiff’s purported contributory negligence.”).

        The more-than-a-scintilla requirement has teeth. Numerous Virginia decisions have held

that it was error for the trial court to grant a contributory-negligence or duty-to-mitigate instruction

when the evidence was lacking. See, e.g., Monahan, 271 Va. at 636-37 (holding that a mitigation

instruction was not appropriate where the patient’s decision to go home, rather than to the

emergency room, was consistent with the doctor’s advice); Chandler, 268 Va. at 681 (holding that

        6
         Some courts in other jurisdictions have held that a defendant asserting a failure-to-
mitigate defense must show “both how [the plaintiff] could have taken action to mitigate his
damages and the amount of damages that might have been avoided by his proper mitigation.”
Henry v. Mitchell, 428 S.W.3d 454, 462 (Ark. 2013); Eskenazi v. Mackoul, 905 N.Y.S.2d 169,
171 (N.Y. App. Div. 2010) (same); Hygeia Dairy Co. v. Gonzalez, 994 S.W.2d 220, 226 (Tex.
Ct. App. 1999) (“[T]here must be some evidence in the record from which the jury can make a
reasoned calculation about losses from failure to mitigate.”). Our disposition of this appeal does
not require that we decide if Virginia law imposes that additional requirement.
                                               -9-
the trial court erred in granting a contributory-negligence instruction when the physician negligently

discharged the patient by failing to recognize that his condition was “life threatening” and the

patient, “a layman, c[ould not] be expected to know otherwise”); Sawyer, 264 Va. at 76 (finding

evidence insufficient to support the contributory-negligence instruction, explaining that when the

patient declined to be admitted to the hospital, the physician failed to explain that if the patient

“chose to leave the hospital without being admitted . . . he could die”).

        Defendants here have intermixed the concepts of contributory negligence and failure to

mitigate. Defendants argue that the post-operative infection that Butts-Franklin suffered occurred

because Butts-Franklin soaked her hand in violation of her post-operative instructions. Dr. Reavey-

Cantwell, for instance, testified that Butts-Franklin’s alleged hand-soaking “certainly increase[d] the

risk of infection.” In their motion to set aside the verdict, defendants posited that “the majority of

the damages plaintiff claimed - both the $183,000 in medical bills and the pain and suffering from

the subsequent surgeries - resulted arguably after the plaintiff soaked her hand against medical

advice.” At oral argument here, defendants asserted that the jury might have awarded “zero”

damages had a mitigation instruction been given.

        But that argument sounds in contributory negligence, not mitigation of damages. To

defendants, Butts-Franklin’s alleged hand-soaking in violation of her post-operative instructions

was a proximate cause of the infection, preventing her from recovering against them even if they

had committed malpractice by failing to see her more quickly and to recognize the brewing

infection. Yet defendants chose not to plead contributory negligence. Their answers merely

“reserve[d]” the right to plead it, “should the facts so dictate.” They did not ask to amend their

answers to plead contributory negligence. Nor did they request that the jury be instructed on

contributory negligence. It would have been improper for the trial court to permit defendants to

                                                  - 10 -
argue that Butts-Franklin’s claims were barred by contributory negligence after defendants

themselves gave up that defense.

       Having intentionally abandoned a contributory-negligence defense, defendants cannot

recover it through the backdoor of a mitigation instruction. True, a mitigation-of-damages defense

need not be pleaded in the answer. But the facts here, even in the light most favorable to

defendants, did not show that Butts-Franklin failed to mitigate damages that were caused in the first

instance by defendants’ malpractice.

       Defendants concede there is no evidence in the record to show when Butts-Franklin soaked

her hand during the period in question. Defendants thus fail to explain how Butts-Franklin’s

supposed hand-soaking aggravated or exacerbated damages caused by their own negligence.

Defendants do not claim, for instance, that their delay in recognizing and treating the infection may

have caused some injury, but the injury was made worse because Butts-Franklin soaked her hand.

Defendants’ theory of the case simply does not map onto a failure-to-mitigate scenario.

       Defendants also overlook the critical importance of when the alleged soaking occurred in

relation to the suture removal. Dr. Rodrigue performed the initial surgery on January 7, and the

post-operative instructions warned Butts-Franklin, “Keep hand clean and dry until sutures

removed.” (Emphasis added).7 The sutures were removed seven to ten days later. The infection

came to light on January 22, when Butts-Franklin sought treatment for pain at Chesapeake Regional

Medical Center. And Dr. Rodrigue did not record Butts-Franklin’s statement that “she had been

soaking her hand at home” until January 26, when Butts-Franklin presented with the infection.

       7
         Butts-Franklin conceded that Dr. Rodrigue did not make a mistake in the original
surgery on January 7 and that the treatment Butts-Franklin received to treat the infection on
January 26 was “within the standard of care.”
                                              - 11 -
        Defendants acknowledged at oral argument that the record does not tell us whether the

alleged hand-soaking occurred before or after the sutures were removed. But if Butts-Franklin had

soaked her hand after the sutures were removed, it “c[ould not] be the basis for a mitigation of

damages instruction” because she “did not act contrary to the advice given.” Monahan, 271 Va. at

637.

        Without knowing when the soaking occurred, it would be “speculative and conjectural,”

Sawyer, 264 Va. at 76, whether such soaking was the initial cause of the infection, which could

have supported a contributory-negligence defense had one been pleaded; whether the soaking

occurred after defendants’ malpractice, an essential element of the failure-to-mitigate defense; or

whether it occurred after the sutures were removed, thereby barring a failure-to-mitigate defense

under Monahan. In short, defendants’ concession that the record does not permit the Court to

determine when Butts-Franklin soaked her hand is fatal to their appeal.

                                             CONCLUSION

        We conclude that there was not “sufficient evidence in this record t[o] . . . permit the jury to

find as a matter of fact that [Butts-Franklin] failed to mitigate h[er] damages.” Sawyer, 264 Va. at

77. Thus, the trial court did not abuse its discretion by refusing to grant defendants’ duty-to-

mitigate instruction.

                                                                                              Affirmed.

                                                 - 12 -