Ligon v. Southside Cardiology Associates

519 S.E.2d 361, 258 Va. 306, 1999 Va. LEXIS 99
CourtSupreme Court of Virginia
DecidedSeptember 17, 1999
DocketRecord 982467
StatusPublished
Cited by8 cases

This text of 519 S.E.2d 361 (Ligon v. Southside Cardiology Associates) is published on Counsel Stack Legal Research, covering Supreme Court of Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ligon v. Southside Cardiology Associates, 519 S.E.2d 361, 258 Va. 306, 1999 Va. LEXIS 99 (Va. 1999).

Opinions

JUSTICE KEENAN

delivered the opinion of the Court.

In this medical negligence case, we consider whether the trial court erred in admitting “habit” evidence from medical personnel ,to prove that a patient did not complain of pain on a specific occasion, and that the defendant’s treatment of the patient conformed to his routine practice.

Jane V. Ligón, administrator of the estate of Pearl V. Vaughan, filed a wrongful death action in the trial court against Dr. Girish Purohit and his medical practice, Southside Cardiology Associates, P.C. (collectively, the defendant). Ligón alleged, among other things, that the defendant was negligent in failing to provide a proper diagnosis and treatment of Vaughan’s heart disease.

The following evidence was presented in a jury trial. In May 1995, Vaughan experienced chest pains and received three days of treatment at the Southside Community Hospital (Southside) in Farmville. Five days after her release, she returned to Southside’s Cardiac Diagnostic Unit (CDU) as an outpatient to take a Persantine stress test. In this test, the drug Persantine is administered to place additional stress on the patient’s heart so that abnormalities can be detected and evaluated.

Vaughan’s daughter, Audrey Johnson, took Vaughan to the hospital for the Persantine stress test and remained there during the course of the procedure. Under the standard protocol for this test, Vaughan completed a medical history form in the CDU and an intravenous “saline lock” was placed in her arm. Vaughan then went to the hos[309]*309pital’s Nuclear Medicine Department where she received an injection of a radioactive medicine. A medical technician took photographic images, commonly referred to as a “nuclear scan,” of Vaughan’s resting heart.

After three hours, Vaughan returned to the CDU where another medical technician connected her to vital sign monitors and obtained various electrocardiograms (EKGs). Dr. Purohit supervised the injection of the Persantine and the administration of the stress test. The stress test took 14 minutes to complete. During the stress test, Vaughan experienced tightness and pain in her chest. At Dr. Purohit’s direction, Vaughan was given nitroglycerin, and her chest pain stopped. After Vaughan completed the stress test, the heart monitor and EKG connections were removed and she returned to the Nuclear Medicine Department where a technician took a second nuclear scan of her heart.

Vaughan left the hospital with Johnson and went to Johnson’s home. That night, Vaughan died in her sleep. All three medical experts who testified at trial agreed that Vaughan probably died from an arrhythmia that resulted in cardiac arrest. One of these three witnesses, Dr. James T. Rittelmeyer, a cardiologist, stated that Vaughan also had experienced a “heart attack” during the stress test administered by Dr. Purohit. The other two medical experts disagreed with that conclusion.

Johnson testified that as she waited in the CDU reception area while her mother was undergoing the stress test, she heard Vaughan call her name. Johnson stated that she went to the area where the test was being administered and found Vaughan lying on a gurney, dressed in her own clothes and not connected to any monitors. Johnson said that Vaughan was crying, trembling, and complaining that she could not breathe and that she had pain in her chest and arm.

Johnson testified that Dr. Purohit was standing nearby, along with two female technicians or nurses. Johnson stated that when she asked Dr. Purohit whether Vaughan’s condition was normal, he assured her that it was and said that her mother would be fine once she went home and rested.

Dr. Purohit testified that he had no independent recollection of Vaughan’s condition in the CDU. Debora S. Hurt, the CDU technician who cared for Vaughan, also had no independent recollection of Vaughan. However, Courtney Gates, the nuclear technologist who obtained the final nuclear scan of Vaughan’s heart after the stress test, testified that she remembered Vaughan. Gates stated that Vaughan complained of indigestion or “stomach upset” at that time, [310]*310but that she never complained of chest pain. At trial, all three medical experts testified that a violation of the standard of care would occur if a patient, complaining of chest and arm pain under the circumstances described by Johnson, were released from the hospital without further evaluation. Thus, a critical factual issue in the trial was whether Vaughan complained of chest and arm pain after completing the stress test.

Over Ligon’s objection, the defendant was permitted to present evidence of the routine or “habit” of Dr. Purohit, Hurt, and Gates in responding to other patients who complained of chest pain after completing stress tests. Dr. Purohit testified that he had administered one or two stress tests per day over the last ten years, and that at least a dozen of those patients had complained of chest pain after completing the test and changing into their own clothes. He stated that whenever this occurred, he re-evaluated the patient by obtaining another EKG and performing a physical examination. Dr. Purohit testified that he had never failed to re-evaluate a patient who complained of chest pain on completion of a stress test.

Hurt testified that she had worked as a cardiac diagnostic technician for ten years. When asked how many times she had observed patients develop complaints similar to those described by Johnson, Hurt responded that such complaints had occurred more than ten times. She testified that when these complaints were brought to her attention, she reconnected the patients to an EKG monitor and had them re-evaluated by a physician.

Gates testified that during the 30 years she had worked as a nuclear technologist, patients had complained of chest pain “more than ten” times. Gates stated that she immediately responded to those complaints by requesting assistance from the cardiac unit or the emergency room.

At the conclusion of the evidence, the jury returned a verdict in favor of the defendant. The trial court entered judgment in accordance with the jury’s verdict.

On appeal, Ligon argues that the trial court erred in admitting the defendant’s “habit” evidence. Ligon asserts that the challenged testimony permitted the jury to speculate that because Dr. Purohit, Hurt, and Gates provided proper medical care to other patients, they provided the same care to Vaughan. Ligon argues that under our holding in Jackson v. Chesapeake & Ohio Ry. Co., 179 Va. 642, 20 S.E.2d 489 (1942), evidence of a defendant’s habitual conduct is inadmissible to prove that the defendant acted in conformance with such conduct on a particular occasion.

[311]*311In response, the defendant argues that the witnesses’ testimony concerning their responses to other patients’ complaints of chest pain was not evidence of general habit such as that addressed in Jackson, but was evidence of “specific responses to a specific situation.” The defendant asserts that in a medical negligence action, when a defendant physician has no memory of a patient, evidence of the physician’s routine or habit is relevant to establish his conduct with regard to that particular patient.

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Ligon v. Southside Cardiology Associates
519 S.E.2d 361 (Supreme Court of Virginia, 1999)

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Bluebook (online)
519 S.E.2d 361, 258 Va. 306, 1999 Va. LEXIS 99, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ligon-v-southside-cardiology-associates-va-1999.