Sawyer v. Comerci
undisclosed (2002)
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Rule of Law:
A defendant in a medical negligence action is not entitled to a jury instruction on contributory negligence unless they present more than a scintilla of evidence to establish a prima facie case that the patient failed to act reasonably for their own safety, which includes showing the patient was adequately informed of and understood the severity of their condition and the consequences of their actions.
Facts:
- On April 2, 1997, Norman Plogger went to the Stonewall Jackson Hospital emergency room with continuous pain on the right side of his abdomen.
- Dr. Cathy Comerci, the emergency room physician, examined Plogger and concluded he needed to be admitted to the hospital due to blood in his stool and an elevated white blood count.
- Dr. Comerci consulted Dr. Robert Irons, the hospital's on-call surgeon, who disagreed that Plogger had an 'acute surgical abdomen' and recommended Plogger see his family physician instead.
- While Dr. Comerci was consulting other doctors, Plogger and his wife expressed their desire to leave the hospital, stating they had an appointment in another city the next day.
- Dr. Comerci tried to persuade Plogger to stay and instructed him to follow up with his family physician, but did not secure his signature on an 'against medical advice' form or explicitly tell him that leaving could be fatal.
- Plogger left the hospital with instructions to see his family physician, Dr. Hamilton, on April 4, but he failed to make or keep an appointment.
- Plogger returned to the same emergency room on April 5 with a sore throat, at which time Dr. Comerci reiterated that he needed to see his family doctor about his abdominal condition.
- On April 7, Plogger was transported to the emergency room by ambulance in acute distress; he was admitted to the hospital and died the following day.
Procedural Posture:
- Norma J. Sawyer, as administrator of the estate of Norman Lee Plogger, filed a medical negligence action against Dr. Cathy Comerci and Stonewall Jackson Hospital in a Virginia circuit court (the court of first instance).
- At the beginning of the jury trial, Sawyer took a voluntary nonsuit against the hospital.
- The trial court granted Dr. Comerci's request for a jury instruction on contributory negligence over Sawyer's objection.
- The trial court also limited the scope of Sawyer's cross-examination of Dr. Comerci's expert witness.
- The jury returned a verdict in favor of the defendant, Dr. Comerci.
- Sawyer (plaintiff-appellant) appealed the resulting judgment to the Supreme Court of Virginia.
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Issue:
Does a patient's act of leaving a hospital emergency room constitute contributory negligence sufficient to warrant a jury instruction when the patient was not explicitly informed by a physician with admitting privileges that he needed to be admitted and was not made aware of the potentially fatal consequences of leaving?
Opinions:
Majority - Justice Hassell
No. A patient's departure from an emergency room does not constitute contributory negligence sufficient for a jury instruction if the defendant fails to present a prima facie case that the patient was adequately informed of and understood the severe risks. The defendant has the burden of proving contributory negligence by more than a scintilla of evidence. Here, Dr. Comerci failed to meet that burden because no physician with admitting privileges ever told Mr. Plogger he needed to be admitted, and the on-call surgeon actually disagreed with admission. Crucially, the record is devoid of evidence that Dr. Comerci explained the potentially fatal consequences of leaving to Mr. Plogger. Therefore, a jury could not reasonably infer that a layman like Mr. Plogger was negligent for leaving under such circumstances. The court also held that the instruction on mitigation of damages was proper, as Plogger failed to follow instructions to see his family doctor. However, the trial court erred by improperly limiting the cross-examination of the defendant's expert witness regarding his prior testimony for the same defendant, as this line of questioning is relevant to show potential bias.
Analysis:
This decision clarifies the evidentiary standard for a contributory negligence defense in Virginia medical malpractice cases, setting a higher bar for defendants. It establishes that for a patient's actions to be considered negligent, the physician must prove the patient received and understood clear warnings about the serious risks involved, especially when medical advice is conflicting. The ruling protects patients from being blamed for non-compliance when they were not adequately informed. Additionally, the decision reinforces the broad latitude given to litigants in cross-examining expert witnesses to expose potential bias, solidifying that an expert's history of testifying for a particular party is a relevant and permissible area of inquiry.
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