Virginia Appeals Court Vacates $2.5 Million Verdict Over Omitted Jury Instruction
December 1, 2025
By Damian D. Capozzola, Esq., and Jamie Terrence, RN
News
A Virginia appellate court has overturned a $2.5 million medical malpractice verdict after finding that the trial judge erred by refusing to instruct the jury on the doctrine of superseding cause. The opinion underscores how critical jury instructions are in shaping negligence cases and highlights the continuing importance of foreseeability in determining legal causation.
The ruling arose from a delivery-room emergency that resulted in a cesarean delivery performed before anesthesia was administered. The patient alleged that the anesthesiologist failed to provide timely anesthesia, while the defense argued that the obstetrician’s decision to proceed without it was an extraordinary, unforeseeable act. The appellate panel held that the jury, not the judge, should have decided whether that decision broke the chain of causation. The three-judge panel also ruled that the trial court wrongly limited cross-examination of a key witness regarding prior malpractice settlements. Evidence of those settlements, the court found, could have shown potential bias or self-interest affecting the witness’s credibility. Together, the rulings illustrate how the law of causation and trial procedure can determine a case’s outcome. The matter has been remanded for a new trial.
Background
The case arose from a delivery that ended in controversy. The patient, admitted for an induced labor, received an epidural earlier in the day. Later that evening, after several hours of contractions and additional epidural doses, the baby’s heart rate began to fluctuate. The attending obstetrician attempted a vacuum-assisted delivery but abandoned the effort after several unsuccessful attempts. The obstetrician decided to proceed with an emergency cesarean delivery. The anesthesiologist, who had been treating another patient, was notified and responded that he would arrive within minutes. Before he reached the operating room, the obstetrician made the initial incision using only a local anesthetic, a technique he later described as one he had learned during his military service decades earlier. The anesthesiologist entered the operating room moments later, induced general anesthesia, and the baby was delivered within minutes. The newborn was healthy, but members of the operating team were reportedly shaken by the sequence of events. The patient later sued, alleging that she endured unnecessary pain and emotional trauma because the anesthesiologist failed to provide anesthesia in time.
At trial, the anesthesiologist’s defense centered on the argument that the obstetrician’s choice to begin the surgery before anesthesia was administered, and before the anesthesiologist arrived, was a superseding cause. He argued that it was an independent, unforeseeable act that severed the causal link between the alleged negligence and the patient’s injury. He asked the court to instruct the jury on that principle, using Virginia’s model jury instruction defining a superseding cause as an independent, unforeseeable event that breaks the chain of causation. The trial judge refused, finding the concept confusing and unsupported by the evidence. The jury returned a verdict for the plaintiff, awarding $2.5 million in damages.
On appeal, the Court of Appeals disagreed with the trial court. The panel held that the defense was entitled to have the jury consider whether the obstetrician’s decision to begin surgery without anesthesia, despite knowing the anesthesiologist was seconds away, was so unforeseeable and extraordinary as to relieve the defendant of liability. Witnesses, including the plaintiff’s own expert, testified that performing a cesarean delivery without anesthesia was “virtually a never event.” No one involved had ever encountered a similar situation. Given that testimony, the appellate court concluded there was more than a “scintilla” of evidence to support the instruction. By refusing to give it, the trial court deprived the jury of the opportunity to decide the central causation question. The panel also addressed a separate evidentiary issue likely to arise on retrial. During the first trial, defense counsel attempted to cross-examine the obstetrician about prior malpractice settlements, arguing that he had a personal motive to protect himself from further complaints and to avoid triggering a professional review by the state medical board. The trial court barred that questioning as irrelevant and unduly prejudicial. The appellate court held that was error. It explained that while the trial judge retains discretion to limit unduly prejudicial evidence, bias and self-interest are always proper subjects of cross-examination, particularly when the witness’s testimony is pivotal to the outcome. Because the obstetrician’s testimony directly supported the plaintiff’s claim and contradicted the defense experts, evidence of potential bias was probative and should have been permitted within reasonable bounds.
What This Means for You
The opinion illustrates the central role that causation plays in every negligence case and how doctrines like superseding cause can limit liability. Superseding cause is the principle that, even if a defendant was negligent, an extraordinary and unforeseeable intervening act can break the causal chain and make that act the sole proximate cause of injury.
The law recognizes that negligence does not make one liable for every conceivable consequence. Instead, the defendant is responsible only for harms that were reasonably foreseeable. Whether an intervening event was foreseeable or extraordinary usually is a question for the jury. In this case, the appellate court made clear that the jury, not the judge, should have decided whether beginning a cesarean delivery without anesthesia, when the anesthesiologist was seconds away, was an unforeseeable act that superseded any prior negligence.
Foreseeability and superseding cause are closely tied. Negligence requires proof that the defendant’s conduct was both a factual and a legal cause of the injury. Even if the defendant’s negligence set the events in motion, it may not qualify as the legal cause of the harm. Legal causation is broken when another actor intervenes in a manner no reasonable person could have anticipated. Courts often describe this as a “highly extraordinary” event. Whether the intervening act qualifies as superseding depends on its predictability. That makes the doctrine a powerful defense tool. But it also requires careful jury instruction. Without proper instructions explaining the relationship between foreseeability and causation, juries may confuse factual cause with legal responsibility.
The case also underscores how decisive jury instructions can be. Jury instructions are the lens through which jurors view the evidence. They tell the jury what legal standards apply and, in effect, what questions they must answer. Competing sides almost always propose different instructions to tilt the case in their favor. A single omitted instruction can determine a verdict, particularly when causation is disputed. The appellate panel’s reversal here serves as a reminder that denying a properly supported instruction, even if the judge finds it confusing or unnecessary, can be a reversible error. An instruction that correctly states the law and is supported by the evidence must be given so the jury can decide the case under the proper legal framework.
The ruling also provides instruction of probative value and the limits of cross-examination. In the original trial, the defense sought to question the obstetrician about two prior malpractice settlements. The defense argued that those settlements were relevant to the obstetrician’s potential bias. Under state medical board rules, three such settlements within 10 years would automatically trigger a competency review, giving the witness a strong incentive to deflect blame. The trial court excluded the evidence as prejudicial. The appellate court disagreed, emphasizing that the search for truth often requires exploring a witness’s self-interest. Evidence has probative value if it makes a fact of consequence more or less likely, and in this context, the fact at issue was credibility. Showing that a witness had a personal motive to protect his reputation or license could reasonably make the jury more skeptical of his testimony. The court noted that bias is always a proper subject of cross-examination and that trial judges must weigh probative value against potential prejudice under the standard balancing test. While not giving the defense a “blank check” to impugn the witness, the appellate court held that some questioning into prior settlements should have been allowed.
For plaintiffs, the decision highlights how essential it is to ensure that jury instructions accurately reflect the elements of negligence, particularly causation. Plaintiffs must be prepared to oppose superseding cause instructions unless the evidence clearly supports them, because such instructions invite the jury to focus on the conduct of others rather than on the defendant’s breach. Plaintiffs’ counsel also should anticipate that opposing parties will seek to introduce prior settlements or disciplinary history to suggest bias and be ready to argue that such evidence is more prejudicial than probative. When key treating physicians also serve as experts, the risk of such attacks increases.
For defendants, the opinion is an affirmation of the right to present alternative theories of causation. If there is any credible evidence that another actor’s conduct was unforeseeable and independently responsible for the injury, defendants are entitled to have the jury instructed on that theory. The ruling also reinforces that cross-examination on bias is not merely permitted but constitutionally rooted in the right to confrontation. Defense counsel should develop a record showing why the proposed line of questioning is relevant and probative. The appellate court’s discussion provides a roadmap for doing so. A defendant should connect the potential bias directly to the witness’s motivation and to the credibility of testimony central to the case.
At a broader level, the case is a reminder that trials turn as much on how the law is explained as on the facts themselves. Jury instructions are far more than procedural details. They shape how jurors understand the evidence and ultimately decide the case. A single missing instruction can change how jurors conceptualize the story of the case. Consider the circumstances of the attending obstetrician who is faced with the decision on the survivability of negligence. The unborn infant in immediate distress with potential intrauterine damage and life-long neurological injury or death caused by a delay in delivery vs. the possibility of intractable pain and the potential for psychological damage from lack of anesthesia in an adult were the two probable outcomes of the physician’s decision, while doing nothing would possibly mean two victims. Seconds do count, and the jurors now have to determine the propriety of punishing the rather impossible choice this physician had to make.
Damian D. Capozzola, Esq., The Law Offices of Damian D. Capozzola, Los Angeles
Jamie Terrence, RN, President and Founder, Healthcare Risk Services, Former Director of Risk Management Services (2004-2013), California Hospital Medical Center, Los Angeles
Reference
- Decided Oct. 7, 2025, Court of Appeals of Virginia, Docket No. 1792-23-4.
A Virginia appellate court has overturned a $2.5 million medical malpractice verdict after finding that the trial judge erred by refusing to instruct the jury on the doctrine of superseding cause. The opinion underscores how critical jury instructions are in shaping negligence cases and highlights the continuing importance of foreseeability in determining legal causation.
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