In a major opinion for Virginia medical malpractice law, the Court of Appeals has reversed a $2.5 million jury verdict against an anesthesiologist — clarifying that the concept of “superseding cause” turns on foreseeability, not negligence. The case, Reston Anesthesia Associates, P.C. v. Bandy (Oct. 7, 2025), reaffirms that defendants are entitled to have the jury instructed on superseding cause whenever there is evidence that another actor’s unforeseeable conduct — even if not negligent — may have broken the causal chain.
Background: An Emergency C-Section Gone Wrong
The case arose from an emergency cesarean delivery at Reston Hospital Center. The patient, Elizabeth Bandy, was in labor when the on-duty anesthesiologist, Dr. Mirza Baig, was called to administer anesthesia. While Dr. Baig was on his way to the operating room, the attending obstetrician, Dr. Wesley Hodgson, decided to begin the C-section without anesthesia, using only a small amount of local lidocaine because he feared delay might endanger the baby.
Dr. Baig arrived within a minute, but Dr. Hodgson had already made the incision. When anesthesia was administered, Dr. Hodgson did not wait the brief 30 seconds typically required for it to take effect before delivering the baby. The mother sued Dr. Baig and his practice, alleging pain, emotional distress, and negligent delay in providing anesthesia. A Fairfax County jury awarded $2.5 million in damages.
The Defense: An Unforeseeable, Independent Act
At trial, Dr. Baig requested a standard jury instruction on superseding cause, arguing that Dr. Hodgson’s extraordinary decision to begin surgery without anesthesia — a procedure even the obstetrician later called a “never event” — broke the chain of causation. The trial court refused to give that instruction, concluding it would “confuse” the jury. The Court of Appeals disagreed.
The Court’s Holding: Foreseeability Is the Key
Writing for a unanimous panel, Judge Frank K. Friedman held that the jury should have been instructed on superseding cause. The court reaffirmed that:
“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.”
In other words, a defendant is not responsible for consequences arising from an unforeseeable and extraordinary act by another professional — even if that act was not negligent. The court emphasized that the obstetrician’s choice to perform a C-section without anesthesia, while knowing the anesthesiologist was seconds away, was “virtually unprecedented” and therefore unforeseeable as a matter of law
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Superseding Cause Does Not Require Negligence
The opinion clarified an important point that many practitioners overlook: a superseding cause does not have to be negligent. It may be “an act of God, a heroic act, or any other unforeseeable event” that independently causes the injury. What matters is not whether the intervening actor was at fault, but whether their conduct was reasonably foreseeable under the circumstances.
The “Never Event” and the Causal Chain
Here, the court found more than a scintilla of evidence that the events were unforeseeable. None of the medical experts — for either side — had ever seen an obstetrician proceed with a C-section without anesthesia. The hospital’s staff were reportedly “upset” and required debriefing after the incident. These facts, the court said, were enough to let the jury decide whether the obstetrician’s actions constituted a superseding cause that severed any causal connection between Dr. Baig’s alleged delay and the patient’s injuries
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Implications for Virginia Malpractice Law
The Bandy decision strengthens the ability of defendants in complex medical cases to argue that a co-treating provider’s unforeseeable and extraordinary conduct can interrupt the chain of causation — even when both providers were involved in the same course of care. The opinion also makes clear that the superseding cause doctrine applies equally in medical malpractice as in other negligence contexts.
Cross-Examination on Bias: Another Important Ruling
The appellate court also found error in the trial court’s refusal to allow the defense to cross-examine Dr. Hodgson about prior malpractice settlements that might suggest bias or self-protection. The panel called this a “classic battle of the experts” and held that evidence of potential bias was probative and should be allowed, subject to the usual Rule 2:403 balancing test. This aspect of the decision reinforces a party’s right to expose a key witness’s motive or self-interest when credibility is central to the case.
The Case Going Forward
The Court of Appeals reversed the judgment and remanded the case for a new trial. On remand, a jury will again determine whether Dr. Baig was negligent — but this time, the jury will also be instructed on whether Dr. Hodgson’s actions were an unforeseeable superseding cause.
Why This Matters for Future Cases
For Virginia practitioners — especially those handling hospital-based malpractice cases — Reston Anesthesia v. Bandy underscores the importance of properly framing jury instructions on causation. Where the facts show an unusual, independent act by another provider, defendants are entitled to argue that the act broke the causal chain. For plaintiffs, the case is a reminder that foreseeability must be carefully developed through expert testimony to preserve liability when multiple medical actors are involved.
Stay ahead of Virginia medical malpractice law. Contact the Law Offices of Dr. Michael M. Wilson, M.D., J.D. & Associates to understand how the Reston Anesthesia v. Bandy decision may affect your case strategy and jury instructions on causation. Call 202-223-4488 or complete our online form. We are located in Washington, D.C.
