Court Opinion

ID: 9897695
Source: CourtListenerOpinion
Date Created: 2023-11-14 19:23:50.21163+00
Date Added: 2024-06-11T09:15:59.732122
License: Public Domain

COURT OF APPEALS OF VIRGINIA
UNPUBLISHED

              Present: Judges Malveaux, Ortiz and Friedman
              Argued at Norfolk, Virginia

              MID-ATLANTIC WOMEN’S CARE, P.L.C.
                                                                               MEMORANDUM OPINION* BY
              v.      Record No. 1319-22-1                                     JUDGE FRANK K. FRIEDMAN
                                                                                   OCTOBER 31, 2023
              GLORIA KONTARATOS

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

                               Nicholas J.N. Stamatis (Michael E. Olszewski; Michael B. Sylvester;
                               Rodney S. Dillman; Brett M. Saunders; Hancock, Daniel & Johnson,
                               P.C., on briefs), for appellant.

                               Randy D. Singer (Rosalyn K. Singer; Kevin A. Hoffman; Singer
                               Davis, LLC, on brief), for appellee.

                      Mid-Atlantic Women’s Care, P.L.C. appeals the circuit court’s judgment following a jury

              trial, awarding Gloria Kontaratos $2,125,000 in a medical malpractice action. On appeal,

              Mid-Atlantic argues the circuit court erred in denying its motions for a mistrial and for a new trial,

              based on the prejudice caused due to the “unavoidable absence” of one of the treating physicians,

              Dr. Colleen Connor, during part of the jury trial. Mid-Atlantic also contends that the circuit court

              erred in failing to provide the jury with a cautionary instruction regarding Dr. Connor’s absence.

              We find no error and affirm the decision of the circuit court.

                                                        BACKGROUND

                      In March 2019, Dr. Connor, an employee of Mid-Atlantic, performed a total abdominal

              hysterectomy on Kontaratos, with assistance from Dr. Seifeldin Sadek, a medical resident. At

                      *
                          This opinion is not designated for publication. See Code § 17.1-413(A).
approximately 11:00 a.m. on the day following surgery, Kontaratos reported pain, numbness, and

tingling in her lower extremities. Kontaratos underwent a veinous study that afternoon that revealed

no blood clots but showed that Kontaratos had no arterial blood flow to her lower extremities. After

Dr. Sadek received the results of the veinous study, he ordered an arterial scan but did not have the

authority to request a vascular consult without first consulting with the attending physician.

Dr. Sadek relayed Kontaratos’ symptoms to Dr. Connor, who did not visit Kontaratos or order

additional testing before she left the hospital for the evening.

        Kontaratos’ symptoms continued to worsen throughout the day, and Kontaratos’ nurse

found no pulse in her lower extremities. The nurse contacted Mid-Atlantic’s on-call physician,

Dr. Frank Morgan, who decided to wait for a pending arterial scan before requesting a vascular

consult. At this point, six hours had passed since the initial onset of Kontaratos’ symptoms.

Kontaratos’ arterial scan confirmed that she had no pulses flowing to her lower extremities, at

which time Dr. Morgan ordered a vascular consult, at approximately 7:55 p.m. A vascular surgeon

evaluated Kontaratos that evening and determined that she had acute limb ischemia and needed

immediate surgery. During the surgery, the vascular surgeon found the ischemia to be significant

and found clots in multiple blood vessels. The vascular surgeon made several incisions on both of

Kontaratos’ legs, attempting to remove the clots, and then followed with fasciotomies in both legs.

Following this procedure, Kontaratos had an “exceedingly painful and difficult” recovery.

Kontaratos later required many additional surgeries and amputations of toes and part of her foot.

        In September 2020, Kontaratos filed a complaint alleging medical malpractice against

Dr. Connor and Dr. Frank Morgan, as well as their employer, Mid-Atlantic, based on a theory of

respondeat superior for the care Kontaratos received after complaints of severe leg pain and

numbness that arose following her total abdominal hysterectomy.1 The parties convened for a

        1
            Kontaratos also named other defendants but dismissed them before trial.
                                               -2-
jury trial on April 25, 2022. Dr. Connor attended the first two days of trial, during which the

parties completed jury selection, presented opening arguments, and heard testimony from three

of Kontaratos’ witnesses. On the third day of trial, however, Mid-Atlantic informed the circuit

court that Dr. Connor was ill and unable to attend the trial. Mid-Atlantic asked the circuit court

to instruct the jury that “Dr. Connor had an important matter to attend to” and that the circuit

court had “excused Dr. Connor from trial” on the first day. The circuit court advised the jury

that Dr. Connor had “a very important personal matter and the [circuit court had] authorized her

absence from today’s proceedings.” The circuit court advised the jury that they were “not to

make any assumptions or draw any inferences due to her absence.” The trial proceeded

following this instruction.

       The following day, Mid-Atlantic informed the circuit court that Dr. Connor had “taken a

turn for the worse.” Mid-Atlantic argued that “given what has developed with Dr. Connor’s

health situation,” the earlier instruction was “no longer a sufficient explanation to the jury

because it invites too much speculation on their part and possible prejudice against Dr. Connor.”

Mid-Atlantic asked the circuit court to instruct the jury that “the important personal matter

Dr. Connor had to attend to yesterday was her own health because she was sick,” that “her illness

ha[d] gotten worse and her intention [wa]s to go to the hospital,” and, for that reason, the circuit

court excused Dr. Connor from attending trial. After hearing arguments from the parties

regarding the instruction, the circuit court informed the jurors that “Dr. Connor had been excused

from court due to an important matter” and that “Dr. Connor became ill with an undiagnosed

illness. Dr. Connor is still ill today and in fact is seeking medical treatment.” The circuit court

instructed the jury to “not make any assumptions or draw any inferences due to her absence.”

The circuit court proceeded with trial, and the jury heard testimony from several more witnesses.

                                                -3-
       Later that day, Mid-Atlantic informed the circuit court that Dr. Connor was being

admitted to the hospital for “[a]scites, severe bowel inflammation,” and was awaiting a surgical

consultation. Based on this, Mid-Atlantic moved for a mistrial. Mid-Atlantic argued that

Dr. Connor deserved the opportunity to participate in her case, but was being denied that

opportunity through no fault of her own. Mid-Atlantic’s counsel stated that he had had “no

meaningful discussion” about trial strategy with Dr. Connor since she became ill. The circuit

court discussed less drastic ways to address the issue, such as suspending the trial “for a

reasonable time to allow her to recover” and therefore “minimiz[ing] the harm” to the parties.

The circuit court ultimately took Mid-Atlantic’s motion under advisement, but asked for more

information on Dr. Connor’s condition.

       The next day, the fifth day of trial, Mid-Atlantic made a new motion for a mistrial.

Mid-Atlantic informed the circuit court that Dr. Connor was receiving medical treatment, but she

still did not have a specific diagnosis. In support of the motion for mistrial, Mid-Atlantic argued

“[t]here [wa]s no substitute for Dr. Connor as the main named defendant for being in th[e]

courtroom.” Kontaratos advised the circuit court that she was considering nonsuiting both

individual defendants, Dr. Connor and Dr. Morgan, depending on Dr. Connor’s progress. The

circuit court again took the motion for mistrial under advisement until it could learn more about

Dr. Connor’s “ability to participate by way of presence and/or presentation of evidence in the

case.” Before testimony continued, the circuit court informed the jury that Dr. Connor was still

ill and receiving medical treatment. The circuit court instructed the jury to “not make any

assumptions or draw any inferences due to her absence” and that the circuit court approved her

absence.

                                                -4-
        Kontaratos filed a motion that Dr. Connor be required to produce, under seal, a complete

copy of her hospital records from her admission. Dr. Connor was released from the hospital on

Sunday, May 1, 2022.

        The following day, on the sixth day of trial, Mid-Atlantic moved for a mistrial on behalf

of itself, Dr. Connor, and Dr. Morgan. Mid-Atlantic argued the circuit court had “broad

discretion to determine whether declaring a mistrial was necessary to prevent great injustice to

either party.” Mid-Atlantic provided the circuit court with selected “screenshots from

Dr. Connor’s medical records from her hospital admission.” Mid-Atlantic asserted that through

her absence and illness, Dr. Connor missed the ability to observe the testimony of the expert

witnesses and had been unable to review any transcripts from the testimony due to her

hospitalization. Mid-Atlantic argued that Dr. Connor suffered prejudice due to her illness, as she

was unable to participate in her trial, warranting mistrial.

        In response, Kontaratos moved to nonsuit Dr. Connor and Dr. Morgan, which the circuit

court granted. Kontaratos argued that the motion for a mistrial was “moot” because Dr. Connor

was no longer a party to the suit, arguing “[t]hat motion for a mistrial is no longer pending in

front of the court and rightfully so, because there can be no verdict entered against her.” The

circuit court made no ruling on the motion for mistrial, and the trial continued. Before testimony

started, the circuit court instructed the jury that Dr. Connor was “still ill today and is receiving

medical treatment” and that the jury “should not make any assumptions or draw any inferences

due to her absence.”

        The following day, Mid-Atlantic provided the circuit court with a note from a registered

nurse with a “return to work” date for Dr. Connor of May 5, 2022. Mid-Atlantic also asked the

circuit court to rule on the pending motion for mistrial. The circuit court considered the argument

of the parties. The court stated that it had carefully reviewed all the authorities provided by the

                                                  -5-
parties, had considered their arguments, had done its own research, and was “very, very cautious in

making the decision.” The circuit court denied Mid-Atlantic’s motion for a mistrial.

        Mid-Atlantic requested the circuit court offer a curative instruction to the jury to explain

Dr. Connor’s absence due to her illness and hospitalization. Kontaratos objected to the instruction,

arguing that it would bias the jury towards Dr. Connor. The circuit court called the jury into the

courtroom and informed it that Dr. Connor had been diagnosed with gastroenteritis and had been

hospitalized from April 28, 2022, until May 1, 2022. The circuit court informed the jury that

Dr. Connor would testify the next day. The circuit court reiterated that “Dr. Connor was not present

in trial due to her illness and hospitalization” and that the jury “should not make any assumptions or

draw any inference due to her absence. Her unforeseen absence was excused.” The circuit court

also informed the jury that Kontaratos voluntarily dismissed Dr. Connor and Dr. Morgan and that

the trial would proceed against Mid-Atlantic.

        The trial resumed the following day, during which Dr. Connor was in attendance and

testified, after which the defense rested. Relevant to this appeal, Dr. Connor testified about her

illness and that she had been hospitalized for three days during the trial.

        At the close of the evidence and after deliberations, the jury returned a verdict in

Kontaratos’ favor in the amount of $3,100,000.2 Following the trial, Mid-Atlantic filed a motion to

set aside the jury’s verdict, which the circuit court denied. Mid-Atlantic appeals.

                                              ANALYSIS

        On appeal, Mid-Atlantic challenges the circuit court’s denial of its motion for a mistrial.

Mid-Atlantic asserts that Dr. Connor’s absence from the trial caused prejudice because, during

testimony, “she was accused of being improperly absent during medical care.” Mid-Atlantic

        2
         Upon Mid-Atlantic’s motion, the circuit court reduced Kontaratos’ damages to
$2,125,000, based on the statutory limit and a separate settlement between Kontaratos and
another defendant. Code § 8.01-581.15.
                                               -6-
reasoned that the jury could have taken her absence at trial as being “similar to the actions that lie at

the heart of the litigation,” creating a “manifest probability of prejudice . . . necessitating a mistrial.”

Mid-Atlantic also challenges the circuit court’s refusal to inform the jury about Dr. Connor’s

hospitalization and the medical procedures she underwent until the eighth day of trial, one day

before the defense rested.

                                          I. Motion for Mistrial

        The circuit court’s “ruling denying a motion for mistrial will be set aside on appellate

review only if the ruling constituted an abuse of discretion.” Gross v. Stuart, 297 Va. 769, 774

(2019) (quoting Allied Concrete Co. v. Lester, 285 Va. 295, 308 (2013)). “A reviewing court can

conclude that ‘an abuse of discretion has occurred’ only in cases in which ‘reasonable jurists

could not differ’ about the correct result.” Bethea v. Commonwealth, 68 Va. App. 487, 506-07

(2018) (quoting Commonwealth v. Swann, 290 Va. 194, 197 (2015)). “‘[B]y definition,’

however, a trial court ‘abuses its discretion when it makes an error of law.’” Id. at 507

(alteration in original) (quoting Coffman v. Commonwealth, 67 Va. App. 163, 166 (2017)). “To

properly review the trial court’s application of the law to the facts, ‘[w]e give deference to the

trial court’s factual findings and view the facts in the light most favorable to . . . the prevailing

part[y] below.’” Stone v. Commonwealth, 297 Va. 100, 102 (2019) (alterations in original)

(quoting Kim v. Commonwealth, 293 Va. 304, 311 (2017)).

        “When a motion for mistrial is made, based upon an allegedly prejudicial event, the trial

court must make an initial factual determination, in . . . light of all the circumstances of the case,

whether the defendant’s rights are so ‘indelibly prejudiced’ as to necessitate a new trial.” Green

v. Commonwealth, 266 Va. 81, 102 (2003) (quoting Spencer v. Commonwealth, 240 Va. 78, 95

(1990)). “The trial court must also find a probability of prejudice, with the ‘burden of

establishing that probability . . . upon the party moving for a mistrial.’” Green v.

                                                   -7-
Commonwealth, 26 Va. App. 394, 401 (1998) (alteration in original) (quoting Robertson v.

Metro. Wash. Airport Auth., 249 Va. 72, 76 (1995)). “Hence, we will not overturn ‘the denial of

a motion for a mistrial . . . unless there exists a manifest probability that [the ruling] was

prejudicial.’” Id. (alterations in original) (quoting Taylor v. Commonwealth, 25 Va. App. 12, 17

(1997)).

        Mid-Atlantic argues that this case presents a “unique scenario” under which the circuit court

should have granted a mistrial. Specifically, Mid-Atlantic argues that “an incurable prejudice arises

when a litigant is seen by the jury, through no fault of its own, doing exactly what the litigant has

been accused of doing.”3 Mid-Atlantic compares the facts of this case to Miller v. Commonwealth,

7 Va. App. 367, 371 (1988), in which the trial court denied a motion for a mistrial after a criminal

defendant, who was accused of a non-violent crime, was brought into the courtroom in front of the

jury wearing shackles. This Court reversed the denial of the defendant’s motion for a mistrial,

holding that the defendant was “effectively denied that presumption of innocence by being

unnecessarily shackled and viewed by the jury.” Id. Mid-Atlantic argued that it suffered a

“manifest probability of prejudice” because Dr. Connor was unable to attend the trial through no

fault of her own, and therefore “was forced to appear exactly as . . . Kontaratos claimed she was

during her medical care—absent.”4

        3
          In Jack v. Booth, 858 N.W.2d 711 (Iowa 2015), a health care provider defendant leapt
into action to provide aid to a juror who fainted during the trial. The trial court denied the
plaintiff’s subsequent motion for a mistrial. A defense verdict ensued. On appeal, the Iowa
Supreme Court reversed, finding a mistrial should have been granted. Mid-Atlantic argues that
just as a mistrial was appropriate in Jack, because trial events painted the doctor in an overly
flattering light, here Dr. Connor’s absence necessitated a mistrial because it cast her in an
unflattering light. The jury here, however, was told of Dr. Connor’s illness, instructed not to
draw any inferences from her absence, and, ultimately, the doctor was permitted to testify about
her illness. We find Jack a very different situation than the setting here.
        4
          Notably, Mid-Atlantic argued repeatedly below that a mistrial was warranted because
Dr. Connor was unavailable to assist in the defense of the case or contribute to challenging
plaintiff’s experts. On appeal, Mid-Atlantic suggests that Dr. Connor’s absence added fuel to
                                               -8-
        Mid-Atlantic’s argument ignores the impact of the circuit court’s repeated instructions to the

jury not to “make any assumptions or draw any inference due to [Dr. Connor’s] absence.” “A jury

is presumed to follow the court’s instructions, and an appellant who challenges a verdict bears the

burden of rebutting that presumption.” Centra Health, Inc. v. Mullins, 277 Va. 59, 81 (2009). In

this case, there is no indication that the jury failed to follow the circuit court’s instructions and

Mid-Atlantic offers no evidence to rebut the presumption. Moreover, the repeated instructions were

generally given at Mid-Atlantic’s request, despite Kontaratos’ expressed frustration that the

instructions could cause the jury to look upon Dr. Connor with sympathy.

        Mid-Atlantic also suggests that “the circuit court erred by giving weight to factors that were

not proper for its decision” with respect to the mistrial motion. Mid-Atlantic takes issue with the

circuit court’s statements that “it believed it needed to balance interests regarding what would be

fair to both sides in how it addressed this situation,” specifically, Kontaratos’ counsel’s claim that he

had advanced, and would lose, $100,000 in costs for preparation for trial. Mid-Atlantic alleges

“mistrial analysis does not involve balancing prejudices” and should not be “guided by the opposing

party’s advanced litigation costs.”5

        We agree with Mid-Atlantic that the proper consideration for deciding a motion for a

mistrial is whether “the defendant’s rights are so ‘indelibly prejudiced’ as to necessitate a new trial.”

Green, 266 Va. at 102 (quoting Spencer, 240 Va. at 95). It was, however, Mid-Atlantic’s burden to

prove its rights were so “indelibly prejudiced” as to require a mistrial. Id. (quoting Spencer, 240 Va.

at 95). We find that Mid-Atlantic did not meet this burden here. The record does not reveal signs of

plaintiff’s narrative that Dr. Connor was absent when Kontaratos needed care. Kontaratos
asserts that this latter emphasis by the defense was not expressly raised below and has been
waived under Rule 5A:18. We will assume without deciding that the argument is preserved.
        5
          Kontaratos counters that her arguments relating to the long delay in obtaining a trial
date and the costs expended in the trial were factors relevant to suspending the trial, if necessary,
rather than granting a mistrial.
                                                -9-
prejudice—and we find the circuit court’s instructions were adequate to eliminate the threat of

prejudice to the defense caused by Dr. Connor’s absence. Centra Health, 277 Va. at 81 (we

presume the trial court’s instructions were followed); Stump v. Doe, 250 Va. 57, 62 (1995) (same);

Medici v. Commonwealth, 260 Va. 223, 229 (2000) (same).

        Finally, Mid-Atlantic argues that Kontaratos’ nonsuit of Dr. Connor and Dr. Morgan did not

cure the prejudice that arose from Dr. Connor’s absence from trial because the judgment against

Mid-Atlantic was based only on its responsibility for its employees’ actions. Mid-Atlantic contends

that Dr. Connor remained an “important material witness” following the nonsuit and that

“Mid-Atlantic should have had the benefit of having its agent, Dr. Connor, present during trial.”

Mid-Atlantic concludes that Kontaratos’ mid-trial nonsuit of Dr. Connor did not cure “the manifest

probability of prejudice that arose due to Dr. Connor’s unpreventable absence from trial.”

        As Kontaratos notes, after she nonsuited Dr. Connor, the circuit court’s analysis “shifted

because Dr. Connor became a material witness for Mid-Atlantic, not a party.” Mid-Atlantic still

had access to Dr. Morgan throughout the trial, and Mid-Atlantic offers no authority to support its

proposition that the circuit court should have halted the trial in the absence of its “preferred”

material witness.6

        Ultimately, Dr. Connor was able to attend the beginning and ending of the trial. She was

able to testify before the jury. In fact, she was permitted to explain her sickness and absence from

        6
         We do not downplay the hardship faced by Mid-Atlantic in these circumstances.
However, even Mid-Atlantic does not suggest that the unavailability of a preferred material
witnesss or representative at trial mandates a per se entitlement to a mistrial. Since such an
absence is not a per se grounds for a mistrial, we are left to analyze these matters on a case-by-
case basis. Here, again, Dr. Connor was nonsuited, the jury was instructed not to draw
inferences from her unavailability, and the jury was ultimately informed that she had been
hospitalized. In the end, she, herself, testified to the jury about her illness. Under these
circumstances, the circuit court did not abuse its discretion in denying the motion for mistrial.
                                                 - 10 -
the trial. Considering the totality of the circumstances, we find that the circuit court did not abuse

its discretion by denying Mid-Atlantic’s motion for mistrial.

                                       II. Cautionary Instruction

        Where the “circuit court has determined that a defendant’s rights have not been prejudiced

and has denied his motion for a mistrial,” this Court’s review “is confined to an inquiry whether the

circuit court abused its discretion and, thus, was wrong as a matter of law.” Lewis v.

Commonwealth, 269 Va. 209, 214 (2005). “The decision whether to give a cautionary instruction

is a matter lying within the trial court’s discretion and will not be disturbed on appeal unless the

record shows an abuse of discretion.” Andrews v. Commonwealth, 280 Va. 231, 268-69 (2010)

(quoting Goins v. Commonwealth, 251 Va. 442, 465 (1996)).

        Mid-Atlantic argues that, even if the prejudice could have been cured by an instruction to

the jury, this Court should find that the instructions the circuit court provided to the jury here were

“inadequate to cure the prejudice that arose.” The circuit court first informed the jury that

Dr. Connor was absent due to “a very important personal matter” and subsequently informed the

jury that Dr. Connor had an undiagnosed illness and was seeking medical attention. Mid-Atlantic

twice asked the circuit court to instruct the jury about Dr. Connor’s hospitalization, but the circuit

court again told the jury that Dr. Connor was ill and seeking medical attention, without mentioning

her hospitalization. The circuit court informed the jury of Dr. Connor’s hospitalization on the

eighth day of trial.7 Mid-Atlantic argues that “by this time, the prejudice against Mid-Atlantic had

already accrued,” because by being unaware of Dr. Connor’s hospitalization until the eighth day of

        7
         While Mid-Atlantic complains of the delay, the circuit court repeatedly asked for
medical confirmation of Dr. Connor’s medical condition. Such confirmation was slow in
arriving. We do not fault the circuit court for requiring medical verification of Dr. Connor’s
condition and prognosis.
                                                - 11 -
trial, “the jury was poised to think the worst of Dr. Connor and use that as a basis for determining

that she was impermissibly absent during . . . Kontaratos’ medical care.”

        We disagree. The circuit court provided the jury with daily instructions, building upon the

information it received regarding Dr. Connor’s condition. The circuit court’s final instruction

informed the jury that Dr. Connor had been hospitalized. The circuit court consistently reminded

the jury not to make any assumptions or draw any inferences from Dr. Connor’s absence and that it

had approved of Dr. Connor’s absence. Again, as the cautionary instructions piled up, day after

day, Kontaratos noted that the instructions were evoking sympathy from the jury in favor of the

stricken doctor—but the circuit court persevered with the instructions. Once Dr. Connor returned to

trial, the circuit court permitted her to testify about the circumstances of her absence. As noted

above, we presume the jury followed the circuit court’s instructions not to draw inferences from

Dr. Connor’s unavailability. Centra Health, Inc., 277 Va. at 81. Based on the facts of the case, we

find that the circuit court did not abuse its discretion in issuing its cautionary instructions.

                                             CONCLUSION

        For the foregoing reasons, the circuit court’s judgment is affirmed.

                                                                                                   Affirmed.

                                                   - 12 -