Elizabeth Bandy was admitted to Reston Hospital Center on August 13, 2021, for an induced delivery of her first child. Her regular physician recommended they induce her labor because she was past her due date. On Sunday, August 15, 2021, as Ms. Bandy’s labor progressed, Dr. Mirza Baig, the only anesthesiologist on duty in the hospital, placed an epidural catheter for pain management around 12:11 p.m., 13 minutes after he was requested to do so. Ms. Bandy was moved to the operating room at 6:49 p.m. The fetal heart rate had improved and was in the 90s at 6:51 p.m. At 6:52 p.m., Dr. Baig was informed he was needed immediately in Ms. Bandy’s operating room; he responded that he was in the main operating room and would arrive in two to three minutes. His impending arrival was made known. Dr. Baig subsequently informed the nurse he was in the elevator, and he arrived in the room at 6:55 p.m.
According to Dr. Hodgson, he initiated the first C-section incision at 6:55 p.m. He was concerned that the fetal heart rate had dropped—and he asserted that, by 6:55 p.m., the fetus had experienced 17 minutes of fetal distress. This period of distress, Dr. Hodgson testified, could lead to fetal disability or death. And although Dr. Baig was only a minute away, Dr. Hodgson was concerned the lead time to set up for and administer anesthesia would be too long. Dr. Hodgson therefore decided to begin the caesarean operation without the benefit of Dr. Baig’s anesthesia services. Thus, seconds before Dr. Baig arrived, Dr. Hodgson made the abdominal incision at 6:55 p.m., employing a “procedure [he] learned in the Navy called caesarian section under local anesthesia” using lidocaine “to prepare to be able to do the surgery if we did not have anesthesia.”
Once Dr. Hodgson got Ms. Bandy’s permission to proceed with the lidocaine delivery, he determined that “we didn’t have [the lidocaine on hand] that [he] had been trained in,” or “at least we didn’t have that in the operating room to be provided to me. We didn’t have syringes I needed.” Dr. Hodgson stated, “unfortunately, the staff were not able to give me more lidocaine that I was asking for.” He injected Ms. Bandy using 10 cc syringes rather than the necessary “50 cc syringe[s].” He then made the initial incision at 6:55 p.m. Dr. Hodgson said that Dr. Baig arrived “about when I was going through the peritoneal,” which he described as a stretchy layer of tissue between the muscles before he incised the uterus.
Dr. Baig arrived when Dr. Hodgson was “looking at the uterus,” and Dr. Hodgson instructed Dr. Baig to put Ms. Bandy to sleep. Dr. Baig promptly attached required monitoring devices to the patient and administered sevoflurane and propofol to place Ms. Bandy under general anesthesia. However, Dr. Hodgson did not wait the estimated “30 seconds” typically observed to allow the anesthesia to take effect before making the final incision into the uterus and delivering the baby. Dr. Hodgson entered the uterus at 6:56 p.m., and delivered the baby at 6:58 p.m. Dr. Hodgson recalled Ms. Bandy “yelling” that “it hurt” once, but that he had patients communicate with him similarly during caesarian births.
After a six-day medical malpractice trial, a Virginia medical malpractice jury awarded Elizabeth Bandy $2,500,000 in
damages against Reston Anesthesia Associates, P.C. and Mirza Baig, M.D. On appeal, Dr. Baig argued it was error for the trial court to refuse to give a superseding cause jury instruction.
Superseding Cause
The Restatement (Second) of Torts § 440 provides: “A superseding cause is an act of a third person or other force which by its intervention prevents the actor from being liable for harm to another which his antecedent negligence is a substantial factor in bringing about.” There is no requirement that the intervening act be negligent for a superseding cause to exist; rather, a defendant must establish that the intervening act in question was not foreseen or reasonably foreseeable. In sum, it is the foreseeability of the intervening act that determines whether it severs the causal nexus between the defendant’s negligent act and the injuries.
The Court of Appeals of Virginia stated in its October 7, 2025 Opinion: “Here, viewing the evidence in the light most favorable to the proponent of the refused instruction, there was ample evidence that performing a caesarian delivery without anesthesia was not reasonably foreseeable. Dr. Hodgson, himself, testified that he had never begun a caesarian delivery without anesthesia present … The decision to begin the surgical procedure was Dr. Hodgson’s alone, and the evidence —viewing it in the light most favorable to Dr. Baig—was that the anesthesiologist had been caring for another patient but was now headed to Ms. Bandy and was only seconds away when Dr. Hodgson decided to proceed with a C-section. Similarly, competent evidence also suggested that no genuine emergency existed to require such a drastic course. Under these circumstances, we find that the trial court erred in refusing to instruct the jury on superseding cause, so that the jury—as the factfinder—could assess the factual questions related to causation and whether Dr. Hodgson’s actions were reasonably foreseeable.”
“The trial court erred in refusing to grant Dr. Baig’s requested superseding cause instruction. This instruction error necessitates reversal and a new trial.”
Source Reston Anesthesia Associates, P.C. v. Bandy, 1792234.
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