The Virginia Supreme Court held in its opinion filed on February 13, 2020 in a Virginia medical malpractice wrongful death case, “On a motion to strike at the conclusion of Shareef’s case-in-chief, the circuit court was required to view all of his evidence in the light most favorable to him, presuming that the jury would believe it all and draw all logical inferences from it in his favor. The court erred by failing to do so … we hold that Shareef’s evidence that the defendants departed from the standard of care and caused Jaclyn’s death was sufficient to establish a prima facie case and survive a motion to strike at the conclusion of his case-in-chief. We will reverse the circuit court’s judgment and remand for a new trial.”
The Underlying Facts
Jaclyn Tahboub was diagnosed with an incompetent cervix during her first pregnancy in 2011. Siva Thiagarajah, M.D. surgically placed a cervical cerclage to prevent a premature birth. Jaclyn later successfully delivered by Caesarean section and the cerclage was left in place.
In December 2013, Jaclyn was five months into her second pregnancy. Dr. Thiagarajah could not locate the original cerclage during an ultrasound, so he surgically placed a new one on December 12.
Jaclyn subsequently complained on numerous occasions of symptoms that were consistent with infection. The Virginia medical malpractice wrongful death complaint alleged that Dr. Thiagarajah negligently failed to properly diagnose and treat Jaclyn over a period of time, leading to heavy bleeding, fever, ruptured membranes, pus discharge, and multiple organ dysfunction when she arrived at the hospital. Physicians immediately suspected chorioamnionitis and feared placental abruption and disseminated intravascular coagulopathy (“DIC”). Jaclyn was treated for sepsis and chorioamnionitis by administering a triple-antibiotic “cocktail” of ampicillin, gentamicin, and clindamycin, and a blood transfusion. Blood cultures later confirmed bacterial infection with E. coli.
Hospital staff performed an emergency delivery by Caesarean section, after which Jaclyn suffered major hemorrhaging. She was admitted to the intensive care unit, where she remained in critical condition until she died on December 31.
At the conclusion of the plaintiff’s case-in-chief, the defendants moved to strike the plaintiff’s evidence, asserting that it was insufficient to prove causation. The trial court granted the motion and entered a final order awarding judgment to the defendants. The plaintiff appealed.
Virginia Supreme Court Opinion
The Virginia Supreme Court stated “we accept as true all factual allegations expressly pleaded in the complaint and interpret those allegations in the light most favorable to the plaintiff” when reviewing a ruling on a demurrer to a complaint … we review “the evidence and all reasonable inferences fairly deducible therefrom in the light most favorable to the plaintiff” when reviewing a motion to strike at the conclusion of the plaintiff’s case-in-chief … “Any reasonable doubt as to the sufficiency of the evidence must be resolved in the plaintiff’s favor.””
The Virginia Supreme Court further stated, “Consequently, even if the plaintiff’s evidence has been discredited or impeached by the defendant during his cross-examination of the plaintiff’s witnesses, the court must accept it as true at this phase of trial. The court must rule based on the presumption that the jury will believe all the evidence that the plaintiff adduced. To do otherwise would invade the province of the jury and assess the weight of the evidence.”
The Virginia Supreme Court concluded: “Shareef’s evidence of causation was sufficient to survive a motion to strike. As noted above, Dr. Sajadi testified that based on the progression of her symptoms, Jaclyn probably had an infection on December 22 and that if Dr. Thiagarajah had diagnosed and treated it then, “she would have survived.” In addition, Shareef asked Dr. Gonzalez, “do you have an opinion within a reasonable degree of medical probability and certainty that the breaches of the standard of care that you’ve described by Doctors Levit and Thiagarajah resulted in [Jaclyn’s] tragic death?” The witness testified that, “[t]he fact that . . . they didn’t even think of infection, and they did nothing to treat this infection, was a departure from good and accepted standards of medical care, and was a direct cause of her death” … the expert witnesses’ testimony in this case establishes what the standard of care required-a physical examination including cervical examination and blood tests—and stated how those actions would have affected Jaclyn’s health: they would have revealed the infection that Dr. Sajadi testified was present on December 22, and led to treatment that would have saved her life, either on that day or the morning of December 26 … causation is established when “the plaintiff presented testimony to establish the nature of the treatment the decedent could have undergone . . . and the probability that such treatment would have extended the decedent’s life” … Shareef’s experts’ testimony satisfied the requirements in Dixon because it specifically identified what the defendants should have done, which would have led to prompt diagnosis and treatment of the otherwise fatal condition.”
The Virginia Supreme Court held: “Shareef’s evidence in this case established that the standard of care required a physical examination and specifically identified diagnostic procedures to detect Jaclyn’s infection. According to his experts, prompt diagnosis and treatment on December 22 would certainly, and on December 26 would likely, have saved her life. Accordingly, his evidence was sufficient to defeat the defendants’ motion to strike … On a motion to strike at the conclusion of Shareef’s case-in-chief, the circuit court was required to view all of his evidence in the light most favorable to him, presuming that the jury would believe it all and draw all logical inferences from it in his favor. The court erred by failing to do so.”
Source Tahboub v. Thiagarajah, Record No. 190019.
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