Creekmore v. Maryview Hosp.

• Decision Date: 08 December 2011
• Docket Number: No. 10–1183.,10–1183.
• Citation: 662 F.3d 686
• Parties: Latarsha CREEKMORE, Plaintiff–Appellee, v. MARYVIEW HOSPITAL, Defendant–Appellant,andUnited States of America, Defendant.
• Court: U.S. Court of Appeals — Fourth Circuit

662 F.3d 686

Latarsha CREEKMORE, Plaintiff–Appellee,

v.MARYVIEW HOSPITAL, Defendant–Appellant,andUnited States of America, Defendant.

No. 10–1183.

United States Court of Appeals, Fourth Circuit.

Argued: Sept. 22, 2011.Decided: Dec. 8, 2011.

Brewster Stone Rawls, Rawls & McNelis, PC, Richmond, Virginia, for Appellant. Kim Michelle Crump, Norfolk, Virginia, for Appellee.

Before WILKINSON, WYNN, and FLOYD, Circuit Judges.

Affirmed by published opinion. Judge WYNN wrote the opinion, in which Judge WILKINSON and Judge FLOYD joined.

OPINION

WYNN, Circuit Judge:

Plaintiff Latarsha Creekmore sued Defendant Maryview Hospital (“Maryview”),¹ alleging that its negligent care following the Caesarean section delivery of her baby injured her. After a three-day bench trial, the district court found Maryview liable for medical malpractice and entered a judgment awarding Creekmore nine hundred thousand dollars ($900,000.00) in damages.

Maryview appeals, arguing that the district court abused its discretion by allowing an obstetrician-gynecologist (“OB–GYN”) to testify as an expert regarding the standard of care for a nurse's postpartum monitoring of a high-risk patient with preeclampsia. Maryview maintains that Creekmore failed to make her prima facie case for negligence because the testimony of the OB–GYN did not meet the expert testimony requirements of Virginia Code § 8.01–581.20. Because neither the statute nor Virginia case law precludes the expert testimony in question, we find no abuse of discretion and affirm.

I.

On February 25, 2005, Creekmore was admitted to Maryview's Labor and Delivery Unit for the delivery of her fourth child. She had a history of pregnancy-induced high blood pressure, known as severe preeclampsia. Around 7:00 p.m., Creekmore gave birth to a baby boy via a Caesarean section (“C-section”) performed by Dr. Sidath Jayanetti, an OB–GYN. She was then taken to a recovery room and attached to a machine that automatically monitored and recorded her blood pressure and heart rate every ten minutes.

Sandra Sutliff, an obstetrics nurse, was assigned to attend to Creekmore, who was the only patient in Sutliff's care for the night. Dr. Jayanetti gave Sutliff orders to check Creekmore's incision site and uterus for bleeding initially every half-hour and then every hour. Hospital records and testimony from Creekmore's partner, Whitt Johnson, indicate that over the next several hours, Creekmore's blood pressure and heart rate were erratic, and that her urine output and general physical condition declined. According to Dr. Richard Stokes, Creekmore's expert OB–GYN, these three symptoms—falling blood pressure, rising pulse rate, and lack of urine output—are “classic signs of blood loss shock,” which can be a result of excessive bleeding, a significant and well-known risk to patients with preeclampsia such as Creekmore.

Around midnight, Johnson noticed that Creekmore had begun to have hot flashes and to sweat; he paged the nurse twice but got no response. Sutliff checked on Creekmore at 1:00 a.m. and recorded only that she was resting comfortably, despite readings from the monitors showing low blood pressure and a high heart rate. Over the next hour and a half, Creekmore's blood pressure continued to drop, and her heart rate increased gradually. Johnson paged the nurse again, still with no answer.

At 2:26 a.m., in response to a significant difference between Creekmore's systolic and diastolic arterial blood pressures, or pulse pressure, nurse Christine Weber directed Sutliff to administer a large quantity of intravenous fluid, or bolus, to raise Creekmore's low diastolic pressure. However, less than twenty minutes later, at 2:45 a.m., an alarm on Creekmore's monitor sounded when her blood pressure descended precipitously. Sutliff responded to the alarm and recorded that Creekmore was clammy and unresponsive, sweating profusely, and had gone into hypovolemic shock from low blood volume. Sutliff also noted that Creekmore's urine output had dropped dramatically. She administered another bolus.

Three minutes later, at 2:48 a.m., Weber called Dr. Jayanetti to inform him of Creekmore's blood pressure and urine output. Another nurse called Dr. Jayanetti again at 3:07 a.m., and Sutliff called him at 3:08 a.m. and told him that Creekmore was unresponsive. On Dr. Jayanetti's instructions, Sutliff summoned the house resident, who arrived in Creekmore's room at 3:10 a.m. At that point, Johnson recalled being awoken and asked to move out of the way, as he watched several people come into the room, move Creekmore into another bed, and wheel her out. He noticed a significant amount of blood on Creekmore's sheets and gown.

Creekmore was transferred to the surgical intensive care unit at 3:28 a.m. Upon evaluation, it was determined that she had lost approximately half of her blood volume, causing oxygen deprivation to the brain and a massive stroke. Dr. Stokes testified that he believed Creekmore had suffered from hemolysis low platelets (HELLP) syndrome, a severe form of preeclampsia that can result in a loss of the ability to clot one's blood, or disseminated intravascular coagulopathy (DIC). Creekmore underwent additional surgery as well as transfusions of clotting factors and blood.

As a result of her stroke, Creekmore suffered severe and painful physical and cognitive impairments that continue to impact her life today. On February 5, 2009, Creekmore filed a complaint against, among others, Maryview, seeking three million five hundred thousand dollars ($3,500,000). Following dismissal of the United States as a party, Creekmore filed a motion to remand the remaining claims against Maryview to state court in Virginia. On November 16, 2009, the district court denied that motion and retained jurisdiction pursuant to its discretionary authority under 28 U.S.C. § 1367(c), identifying convenience and fairness to the parties and considerations of judicial economy as the key factors in its decision. The matter proceeded to a bench trial on December 9, 10, and 11, 2009, and the district court entered judgment in favor of Creekmore on January 10, 2010. Maryview appealed.

II.

On appeal, Maryview contends that the district court should have barred Dr. Stokes, an OB–GYN, from testifying as an expert with respect to the standard of care for a nurse's postpartum monitoring of a high-risk patient with preeclampsia. We review the trial court's determination of this issue for abuse of discretion. See United States v. Grimmond, 137 F.3d 823, 831 (4th Cir.1998) (“A district court's evidentiary rulings are reviewed under the narrow abuse of discretion standard.”); Hinkley v. Koehler, 269 Va. 82, 91, 606 S.E.2d 803, 808 (2005) (“[A]scertaining whether a proffered witness is qualified to testify as an expert is a determination lying within the sound discretion of the trial court” that will not be reversed “ ‘unless it appears clearly that [the expert] was not qualified in the field in which he gives evidence.’ ” (quoting Swersky v. Higgins, 194 Va. 983, 985, 76 S.E.2d 200, 202 (1953))).

It is worthwhile to point out that because this case was heard by a federal district court, the Federal Rules of Evidence would generally control the admissibility of expert witness testimony. See, e.g., Bryte ex rel. Bryte v. Am. Household, Inc., 429 F.3d 469, 475–76 (4th Cir.2005) (noting that in diversity cases, federal evidentiary law governs the procedural question of the admissibility of expert testimony, while state law controls substantive matters concerning the sufficiency of evidence).

Nevertheless, because the testimony at issue here was required for a medical malpractice claim under Virginia law, the sufficiency of its substance to meet plaintiff's prima facie case is governed by state law. See Hottle v. Beech Aircraft Corp., 47 F.3d 106, 110 (4th Cir.1995) (“[T]here are circumstances in which a question of admissibility of evidence is so intertwined with a state substantive rule that the state rule ... will be followed in order to give full effect to the state's substantive policy.” (internal quotation marks omitted) (quoting DiAntonio v. Northampton–Accomack Mem'l Hosp., 628 F.2d 287, 291 (4th Cir.1980))).

Under either the Federal Rules of Evidence or the Virginia Rules of Evidence, the district court's decision to allow Dr. Stokes to testify as an expert was discretionary and is reviewed as such. Thus, our analysis and conclusion remain the same regardless of which evidentiary rules control.

In an action for medical malpractice under Virginia law, the standard of care by which the acts or omissions are to be judged shall be that degree of skill and diligence practiced by a reasonably prudent practitioner in the field of practice or specialty in this Commonwealth, and the testimony of an expert witness, otherwise qualified, as to such standard of care, shall be admitted.

Va.Code § 8.01–581.20(A) (2010) (emphasis added). A witness shall be qualified as an expert in the applicable standard of care

if he demonstrates expert knowledge of the standards of the defendant's specialty and of what conduct conforms or fails to conform to those standards and if he has had active clinical practice in either the defendant's specialty or a related field of medicine within one year of the date of the alleged act or omission forming the basis of the action.

Id. Both requirements—the so-called “knowledge requirement” and the “active clinical practice requirement”—must be satisfied before an expert may testify regarding the standard of care. Hinkley, 269 Va. at 88, 606 S.E.2d at 806.

The knowledge requirement does not demand an identical level of education or degree of specialization; rather, it can be shown by “evidence that the standard of care, as it relates to the alleged negligent act or treatment, is the same for the proffered expert's specialty as it is for the defendant doctor's specialty.” Jackson v. Qureshi, 277 Va. 114, 122, 671 S.E.2d 163, 167...