Hampton v. Hearn ( 2020 )


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  •                 IN THE COURT OF APPEALS OF NORTH CAROLINA
    No. COA19-378
    Filed: 21 January 2020
    Alamance County, No. 14 CVS 418
    DEBBIE THOMPSON HAMPTON; as Executrix of the Estate of Delacy Beatrice
    Thompson Miles, Deceased,
    v.
    ANDREW TAYLOR HEARN, M.D., Defendant.
    Appeal by plaintiff from judgment entered 25 April 2018 by Judge A. Graham
    Shirley, II in Alamance County Superior Court. Heard in the Court of Appeals 29
    October 2019.
    Wake Forest University School of Law Appellate Clinic, by John J. Korzen, for
    plaintiff-appellant.
    Nelson Mullins Riley & Scarborough LLP, by G. Gray Wilson, Linda L. Helms,
    and Lorin J. Lapidus, for defendant-appellee.
    BERGER, Judge.
    Debbie Thompson Hampton (“Plaintiff), as Executrix of the Estate of Delacy
    Beatrice Thompson Miles (“Ms. Miles”), appeals from a judgment entered after a jury
    returned a verdict finding Dr. Andrew Taylor Hearn (“Dr. Hearn”) not liable for
    negligence. Plaintiff contends the trial court erroneously instructed the jury on
    intervening negligence and erroneously admitted expert witness testimony. We
    disagree and find no error.
    HAMPTON V. HEARN
    Opinion of the Court
    Factual and Procedural Background
    On March 8, 2011, Ms. Miles was treated by Dr. Hearn at Alamance Regional
    Medical Center for angioplasty and stent placement in her innominate vein related
    to her dialysis treatments. Angioplasty is “the dilatation [sic] of a vessel.” The
    innominate vein runs from the collarbone across the chest and then “enters the
    superior vena cava, which is the main blood vessel entering the heart on the right
    side.” Dr. Hearn inserted the stent to unblock the vein, which was likely blocked from
    previous catheter placements in dialysis treatments.
    Dr. Hearn first performed the angioplasty, or “balloon” insertion, to expand the
    vein. He then implanted a stent. The stent was about 60 millimeters, or about 2.5
    inches, in length. The manufacturers put metallic markers on the ends of the stents
    so its location can be easily identified radiologically. In Ms. Miles’ case, the stent was
    to be placed at the junction of the left innominate vein and the superior vena cava.
    Three days later, on March 11, 2011, Ms. Miles needed a “permacath
    placement” in her right internal jugular vein to establish new access for her ongoing
    dialysis. In order to establish access, Dr. Gregory Schnier (“Dr. Schnier”), passed a
    catheter from the right jugular vein through the superior vena cava to the right
    atrium of the heart. No evidence tended to show Dr. Schnier knew or had been
    informed that the stent Dr. Hearn placed on March 8 was obstructing the superior
    vena cava.
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    HAMPTON V. HEARN
    Opinion of the Court
    During the procedure, Ms. Miles experienced ventricular tachycardia.
    Providers at Alamance Regional Medical Center placed Ms. Miles on medication for
    the arrhythmia, and discovered there was a “foreign body” in the right ventricle. Ms.
    Miles was transferred to Duke Hospital on March 12, 2011, and the foreign stent was
    removed on March 14, 2011. The Duke pathology report revealed that “a foreign
    body” was found in the right ventricle. The foreign body was determined to be a 30
    millimeter “self-expanding stent which had a fracture on one portion of it.” It was
    part of the stent that Dr. Hearn had placed in Ms. Miles.
    Ms. Miles remained in the hospital from March 14, 2011 until March 23, 2011.
    She returned to Duke from March 29 to April 3, 2011 due to bleeding from the dialysis
    site. After her release from Duke Hospital, Ms. Miles entered a nursing home in
    Georgia. Ms. Miles subsequently died from other causes.
    Plaintiff filed a complaint against Hearn Vascular Surgery, P.A.; Alamance
    Regional Medical Center, Inc.; Dr. Hearn; and Dr. Schnier. Plaintiff alleged her
    complaint was “an action for medical negligence resulting in severe and permanent
    disabling injuries to [Ms. Miles] as a result of injuries sustained when a stent
    improperly placed in [Ms. Miles’] vein for better dialysis access, was broken during a
    subsequent procedure and went into [Ms. Miles’] heart causing severe, permanent
    and disabling injuries.” At trial, before the opening statements, Plaintiff took a
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    HAMPTON V. HEARN
    Opinion of the Court
    voluntary dismissal without prejudice against Dr. Schnier, leaving Dr. Hearn as the
    sole defendant in the suit.
    During trial, Plaintiff’s expert witness regarding the standard of care, Dr.
    Michael Dahn (“Dr. Dahn”), testified Defendant had placed the stent “too far into the
    superior vena cava.” He acknowledged that it was acceptable medical practice for a
    vascular stent to extend into the superior vena cava, but he testified that extending
    “beyond one to two millimeters” is problematic. He further opined that Dr. Hearn’s
    final positioning of the stent “set the stage for it . . . being sheared in half causing it
    to migrate.” Dr. Dahn concluded that Dr. Hearn’s placement of the stent breached
    the applicable standard of care. Dr. Dahn also testified that Dr. Schnier’s failure to
    recognize the position of the stent when he performed his procedure breached the
    standard of care.
    Two expert witnesses retained by Dr. Hearn, Dr. Steve Powell (“Dr. Powell”)
    and Dr. Ray Workman (“Dr. Workman”), testified that Dr. Hearn had complied with
    the standard of care when he performed the angioplasty and stent placement
    procedures. Dr. Hearn also presented deposition testimony by Dr. Jack Dawson and
    Dr. Michel Rinaldi (“Dr. Rinaldi”). Dr. Rinaldi was specifically retained to testify as
    an expert witness on causation.
    During the charge conference, the trial court informed the parties of the
    proposed jury instructions, which included Dr. Hearn’s requested instruction on
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    HAMPTON V. HEARN
    Opinion of the Court
    intervening negligence.      Plaintiff’s objection to the instruction on intervening
    negligence was overruled. The intervening negligence instruction stated in pertinent
    part:
    In this case, the defendant, Dr. Hearn, contends that, it
    [sic] he was negligent, which he denies, such negligence
    was not a proximate cause of the Plaintiff’s injury because
    it was insulated by the negligence of Dr. Gregory S[c]hnier.
    You will consider this matter only if you find that Dr.
    Hearn was negligent. If you do so find, Dr. Hearn’s
    negligence would be insulated and Dr. Hearn would not be
    liable to the Plaintiff, if the negligence of Dr. S[c]hnier, was
    such to have broken the causal connection or sequence
    between Dr. Hearn’s negligence and the Plaintiff’s injury;
    thereby excluding Dr. Hearn’s negligence as a proximate
    cause.
    After deliberation, the jury determined that Dr. Hearn was not negligent.
    Plaintiff appeals, contending the trial court erred by instructing the jury on
    intervening negligence, and that the jury likely would have reached a different result
    but for the instruction. She further contends the trial court erred by allowing one of
    Dr. Hearn’s expert witnesses on causation to opine on standard of care. We disagree
    and find no error.
    Analysis
    I. Jury Instructions on Intervening Negligence
    Plaintiff first contends the trial court erred when it instructed the jury on
    intervening negligence because that instruction was not supported by the evidence.
    Plaintiff’s main argument asserts an instruction on intervening negligence should
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    HAMPTON V. HEARN
    Opinion of the Court
    not have been given because no expert witness directly established the standard of
    care Dr. Schnier owed; that he breached that standard of care; and that his breach of
    the standard of care was the proximate cause of Ms. Miles’ injury. As a result, she
    argues insufficient evidence that Dr. Schnier’s negligence insulated Dr. Hearn’s
    negligence, thereby rendering an instruction on intervening negligence erroneous.
    We conclude direct expert testimony establishing those elements against Dr.
    Schnier was not required for an instruction on intervening negligence to be given.
    When charging a jury in a civil case, the trial court
    has the duty to explain the law and apply it to the evidence
    on the substantial issues of the action. The trial court is
    permitted to instruct a jury on a claim or defense only if
    the evidence, when viewed in the light most favorable to
    the proponent, supports a reasonable inference of such
    claim or defense.
    Estate of Hendrickson ex rel. Hendrickson v. Genesis Health Venture, Inc., 
    151 N.C. App. 139
    , 151-52, 
    565 S.E.2d 254
    , 262 (2002) (citations and quotation marks omitted).
    “This Court is required to consider and review jury instructions in their entirety.
    Under the applicable standard of review, the appealing party must show not only that
    error occurred in the jury instructions but also that such error was likely, in light of
    the entire charge, to mislead the jury.” Id. at 150-51, 
    565 S.E.2d at 262
     (citation
    omitted).
    “A plaintiff asserting medical negligence must offer evidence that establishes
    the following essential elements: (1) the applicable standard of care; (2) a breach of
    such standard of care by the defendant; (3) the injuries suffered by the plaintiff were
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    HAMPTON V. HEARN
    Opinion of the Court
    proximately caused by such breach; and (4) the damages resulting to the plaintiff.”
    Hawkins v. Emergency Med. Physicians of Craven Cnty., PLLC, 
    240 N.C. App. 337
    ,
    341, 
    770 S.E.2d 159
    , 162 (2015) (internal citations and quotation marks omitted).
    Proximate cause is defined as:
    a cause which in natural and continuous sequence,
    unbroken by any new and independent cause, produced the
    plaintiff’s injuries, and without which the injuries would
    not have occurred, and one from which a person of ordinary
    prudence could have reasonably foreseen that such a
    result, or consequences of a generally injurious nature, was
    probable under all the facts as they existed.
    Id. at 341-42, 770 S.E.2d at 162-63 (citation and quotation marks omitted).
    Proximate cause is an inference of fact, to be drawn
    from other facts and circumstances. If the evidence be so
    slight as not reasonably to warrant the inference, the court
    will not leave the matter to the speculation of the jury.
    It is only when the facts are all admitted and only
    one inference may be drawn from them that the court will
    declare whether an act was the proximate cause of an
    injury or not. But that is rarely the case. Hence, “what is
    the proximate cause of an injury is ordinarily a question for
    the jury. . . . It is to be determined as a fact, in view of the
    circumstances of fact attending it.”
    Conley v. Pearce-Young-Angel Co., 
    224 N.C. 211
    , 214, 
    29 S.E.2d 740
    , 742 (1944)
    (citation omitted).
    Proximate cause is “an established element of negligence, the burden rests
    upon a plaintiff to prove ‘by the greater weight of the evidence’ that a defendant’s
    conduct was the proximate cause of the injuries alleged in an action for negligence.”
    Clarke v. Mikhail, 
    243 N.C. App. 677
    , 686, 
    779 S.E.2d 150
    , 158 (2015) (citation
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    HAMPTON V. HEARN
    Opinion of the Court
    omitted). “The doctrine of insulating negligence is an elaboration of a phase of
    proximate cause.” Id. at 686, 779 S.E.2d at 158 (purgandum). “The burden of proof
    does not shift to the defendant when an instruction on superseding negligence is
    requested.   Superseding or insulating negligence is an extension of a plaintiff’s
    burden of proof on proximate cause.” Id. at 686, 779 S.E.2d at 158.
    Although “intervening negligence” is also referred to as “superseding or
    insulating negligence” in our case law, Barber v. Constien, 
    130 N.C. App. 380
    , 383,
    
    502 S.E.2d 912
    , 914 (1998), “negligence” in any of those three names originates from
    “cause.” In Harton v. Tel. Co., 
    141 N.C. 455
    , 
    54 S.E. 299
     (1906), our Supreme Court
    explained the concept of intervening cause as follows:
    An efficient intervening cause is a new proximate cause
    which breaks the connection with the original cause and
    becomes itself solely responsible for the result in question.
    It must be an independent force, entirely superseding the
    original action and rendering its effect in the causation
    remote. It is immaterial how many new elements or forces
    have been introduced, if the original cause remains active,
    the liability for its result is not shifted. . . . If, however, the
    intervening responsible cause be of such a nature that it
    would be unreasonable to expect a prudent man to
    anticipate its happening, he will not be responsible for
    damage resulting solely from the intervention. The
    intervening cause may be culpable, intentional, or merely
    negligent.
    
    141 N.C. at 462-63
    , 
    54 S.E. at 301-02
     (citation omitted) (emphasis added); Balcum v.
    Johnson, 
    177 N.C. 213
    , 216, 
    98 S.E. 532
    , 534 (1919) (noting that the new independent
    cause “must be in itself negligent or at least culpable” (emphasis added)).
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    HAMPTON V. HEARN
    Opinion of the Court
    In order to warrant an instruction on intervening negligence, there needs to be
    evidence tending to show an intervening cause, whether culpable, intentional, or
    negligent, broke the connection of the original wrongdoer and that the original
    wrongdoer had no reasonable ground to anticipate it.
    In a medical malpractice case, a prima facie evidentiary showing of the
    standard of care, breach of the standard of care, proximate causation, and damages
    is required. Clark v. Perry, 
    114 N.C. App. 297
    , 305, 
    442 S.E.2d 57
    , 61 (1994); Purvis
    v. Moses H. Cone Mem’l Hosp. Serv. Corp., 
    175 N.C. App. 474
    , 477, 
    624 S.E.2d 380
    ,
    383 (2006); Hawkins, 240 N.C. App. at 341, 770 S.E.2d at 162. However, intervening
    negligence is an extension of proximate cause. Plaintiff points to no case that states
    a separate and heightened evidentiary showing is required regarding an alleged
    insulating cause. Instead, our case law demonstrates that if the evidence at trial,
    whether plaintiff’s own evidence or other evidence, reveals that a cause may have
    been a sufficient intervening cause of the injuries alleged, an instruction on
    intervening negligence is proper. As long as the intervening cause is “an independent
    force, entirely superseding the original action and rendering its effect in the causation
    remote,” an instruction may be warranted.
    In Clarke v. Mikhail, the plaintiff filed a wrongful death and medical
    malpractice action against Dr. Mikhail, Ms. Hardin, and Coastal Carolina
    Neuropsychiatric Center on behalf of Ms. Bohn. 243 N.C. App. at 678-79, 779 S.E.2d
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    HAMPTON V. HEARN
    Opinion of the Court
    at 153. Ms. Bohn was first seen by Dr. Mikhail, who diagnosed her with paranoid
    schizophrenia and generalized anxiety disorder. Id. at 679, 779 S.E.2d at 154. Ms.
    Hardin, under Dr. Mikhail’s supervision was responsible for Ms. Bohn’s direct
    treatment thereafter. Id. at 679, 779 S.E.2d at 154. In April 2010, Ms. Hardin
    prescribed Lithium, a mood stabilizer for her depression and anxiety, to Ms. Bohn.
    Id. at 680, 779 S.E.2d at 154. In a subsequent appointment, Ms. Hardin prescribed
    Lamictal, which had a warning stating the drug carries the risk of a severe rash, to
    Ms. Bohn. Id. at 680-81, 779 S.E.2d at 154-55. Ms. Bohn continued to see Ms. Hardin
    until June 2010. Id. at 681, 779 S.E.2d at 155.
    In June 2010, Ms. Bohn went to Onslow Urgent Care with a sore throat, yeast
    infection, blisters on her lips, and a rash. Id. at 681, 779 S.E.2d at 155. Onslow
    Urgent Care did not advise Ms. Bohn to stop taking Lamictal and diagnosed her with
    herpes simplex 2, bacterial conjunctivitis, leukoplakia of her oral mucous membrane,
    yeast infection, and canker sores. Id. at 682, 779 S.E.2d at 155. Two days later, she
    was transported to the hospital from her home and treated for the rash she had
    developed. Id. at 682, 779 S.E.2d at 155. Ms. Bohn eventually passed away two
    months later of ventilator-acquired pneumonia. Id. at 682, 779 S.E.2d at 156.
    In her complaint, the plaintiff “alleged Ms. Hardin was negligent in prescribing
    and dosing a drug, Lamictal, to treat [Ms. Bohn’s] severe mental illness.” Id. at 679,
    779 S.E.2d at 153. At trial, defendants presented two experts whom both “opined
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    HAMPTON V. HEARN
    Opinion of the Court
    Lamictal was an appropriate medication for Ms. Bohn’s condition.” Id. at 683, 779
    S.E.2d at 156. The defendants also presented two causation experts who testified
    that “in their expert opinion, if Ms. Bohn had been properly diagnosed on the date
    she sought care at Onslow Urgent Care and had discontinued the Lamictal, more
    likely than not the rash would have resolved and she would have survived.” Id. at
    683, 779 S.E.2d at 156. The trial court instructed the jury on intervening negligence
    and stated it should consider Onslow Urgent Care’s negligence as superseding and
    intervening. Id. at 685, 779 S.E.2d at 157-58. The jury returned a verdict in favor of
    the defendants. Id. at 685, 779 S.E.2d at 157-58.
    On appeal, the plaintiff argued, among other things, the trial court erred by
    “submitting the issue of superseding and intervening negligence to the jury” and
    “submitting a jury instruction on superseding and intervening negligence, which was
    unsupported by the evidence and misstated the law.” Id. at 684, 779 S.E.2d at 157.
    This Court, concluded:
    The trial court’s instruction to the jury did not
    require Plaintiff to disprove superseding or intervening
    negligence by Onslow Urgent Care. The trial court’s jury
    instruction properly informed the jury of the following: (1)
    Plaintiff carries the burden “to prove by the greater weight
    of the evidence” that Defendants’ negligence was a
    proximate cause of Ms. Bohn’s injury and death; (2)
    Defendants did not carry the burden of proving their
    negligence, if any, was insulated by Onslow Urgent Care’s
    negligence; and, (3) the issue of superseding negligence was
    to be addressed only if the jury first found Defendants were
    negligent in the course of Ms. Bohn’s medical treatment.
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    HAMPTON V. HEARN
    Opinion of the Court
    Id. at 687, 779 S.E.2d at 159.
    This Court did not state an expert witness was required to establish a separate
    and heightened evidentiary showing of Onslow Urgent Care’s standard of care, that
    it had breached its standard of care, or that its breach was the proximate cause of
    Ms. Bohn’s injuries. The trial court relied on the evidence presented at trial in
    determining whether an instruction on intervening negligence was proper. Based on
    the evidence, this Court determined that the defendants’ conduct and Onslow Urgent
    Care’s conduct could be the proximate causes of Ms. Bohn’s injuries. This Court
    emphasized: “The burden of proof remained with Plaintiff to prove Defendants’
    negligence, if any, was a proximate cause of Ms. Bohn’s injury and death. The trial
    court’s jury instruction did not improperly shift the burden of proof or misstate the
    law.” Id. at 688, 779 S.E.2d at 159.
    Thus, it follows to reason that, even if a third-party is not a party at trial, an
    instruction on intervening negligence may be given if the evidence at trial shows that
    the third-party’s conduct was a sufficient “intervening cause.” Id. at 688, 779 S.E.2d
    at 159; see Barber, 130 N.C. App. at 382, 
    502 S.E.2d at 914
    . Therefore, Plaintiff’s
    contention that an expert witness was required to first establish Dr. Schnier’s
    standard of care and whether he breached that standard of care in order to warrant
    an instruction on intervening negligence is without merit.
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    HAMPTON V. HEARN
    Opinion of the Court
    Our task on appeal is to determine whether sufficient evidence was presented
    for the jury to decide whether any negligence on Dr. Hearn’s part was insulated by a
    superseding cause.
    The test by which the negligent conduct of one is to be
    insulated as a matter of law by the independent negligent
    act of another, is reasonable unforeseeability on the part of
    the original actor of the subsequent intervening act and
    resultant injury. Put another way, in order for the conduct
    of the intervening agent to break the sequence of events
    and stay the operative force of the negligence of the original
    wrongdoer, the intervening conduct must be of such nature
    and kind that the original wrongdoer had no reasonable
    ground to anticipate it.
    Adams v. Mills, 
    312 N.C. 181
    , 194, 
    322 S.E.2d 164
    , 173 (1984) (citation omitted).
    However,
    the law of proximate cause does not always support the
    generalization that the misconduct of others is unforeseeable.
    The intervention of wrongful conduct of others may be the
    very risk that defendant’s conduct creates. In the absence of
    anything which should alert him to the danger, the law does
    not require a defendant to anticipate specific acts of
    negligence of another.
    Hairston v. Alexander Tank & Equip. Co., 
    310 N.C. 227
    , 234, 
    311 S.E.2d 559
    , 565
    (1984) (citation omitted).
    “[R]easonable unforseeability is the critical test for determining when
    intervening negligence relieves the original tortfeaser of liability.” Barber, 130 N.C.
    App. at 385, 
    502 S.E.2d at 916
     (awarding new trial after first determining the trial
    court’s instruction on intervening negligence was supported by the evidence but
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    Opinion of the Court
    erroneously failed to reference foreseeability); see Pope ex rel. Pope v. Cumberland
    Cnty. Hosp. Sys., Inc., 
    171 N.C. App. 748
    , 752, 
    615 S.E.2d 715
    , 718 (2005) (reversing
    entry of directed verdict for the medical negligence claims relating to the defendant
    hospital’s labor and delivery nurses because the plaintiff’s evidence, that the
    intervening cause alleged by the defendants was foreseeable in causing the decedent’s
    injuries, was “sufficient to create an inference of causation for the jury”).
    Here, sufficient evidence demonstrates that Dr. Hearn could not anticipate Dr.
    Schnier’s subsequent conduct. Two of Dr. Hearn’s witnesses were tendered as experts
    in vascular surgery, and both testified that Dr. Hearn complied with the statutory
    standard of care. Both expert witnesses opined that the fracture of the stent was
    unforeseeable. Dr. Powell testified that it was “totally not foreseeable in any way”
    that the stent placed by Dr. Hearn would be fractured during a subsequent procedure
    performed by Dr. Schnier. Dr. Workman testified that after Dr. Hearn performed his
    surgery it was not reasonably foreseeable that a stent fracture would occur during
    the subsequent procedure performed by Dr. Schnier.
    While Dr. Dahn testified that Dr. Hearn could anticipate subsequent
    procedures being needed or performed on a patient like Ms. Miles, who was receiving
    dialysis treatment, it was not foreseeable that the stent Dr. Hearn placed would be
    fractured. Dr. Dahn testified it was permissible for the stent to extend one or two
    millimeters into the superior vena cava. After being asked the significance of the
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    HAMPTON V. HEARN
    Opinion of the Court
    stent extending beyond one to two millimeters, he replied, “I think it’s problematic.
    The likelihood that it’ll result in a major problem is low, but, I think it’s [a]
    problematic situation because now it sets the patient up for subsequent complication
    with the passage of any other device.”
    Although Dr. Dahn testified that Dr. Hearn’s “final positioning of the stent set
    the stage for it’s being sheared in half causing it to migrate,” this statement merely
    opines the stent created a risk for some subsequent injury. It is not a concession Ms.
    Miles’ injury could not have been the result of some insulating cause.
    Moreover, on re-cross, Dr. Dahn affirmed his pre-trial deposition testimony
    that Dr. Schnier breached the standard of care by failing to recognize the position of
    the stent during his procedure. Dr. Dahn also opined that “the likelihood of having a
    sheared off stent is low, but, still significant.” Dr. Dahn further testified that had Dr.
    Schnier performed his procedure properly, “the likelihood of having a sheared off
    stent is low.”
    Dr. Hearn’s expert witnesses and Plaintiff’s own expert witness provided
    sufficient testimony demonstrating that Dr. Schnier’s intervening conduct was of
    such nature that Dr. Hearn “had no reasonable ground to anticipate it.” Adams, 
    312 N.C. at 194
    , 
    322 S.E.2d at 173
    . Moreover, viewing the evidence in the light most
    favorable to Plaintiff, “[t]he well-settled rule in this jurisdiction is that except in cases
    so clear that there can be no two opinions among men of fair minds, the question
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    Opinion of the Court
    should be left for the jury to determine whether the intervening act and the resultant
    injury were such that the author of the original wrong could reasonably have expected
    them to occur as a result of his own negligent act.” Hairston, 
    310 N.C. at 238
    , 
    311 S.E.2d at 567
    ; Floyd v. McGill, 
    156 N.C. App. 29
    , 41, 
    575 S.E.2d 789
    , 797 (2003) (“The
    trial court properly permitted the jury to draw inferences from these facts and decide
    the issue of proximate cause. Since more than one inference could be drawn from the
    evidence, submission of the issue to the jury was appropriate.”). Because two theories
    of proximate cause were presented at trial, the trial court did not err in instructing
    the jury to determine whether Dr. Schnier’s intervening conduct insulated Dr.
    Hearn’s alleged original negligence.
    Plaintiff also contends she was prejudiced by the trial court’s instruction on
    intervening negligence. Plaintiff specifically argues the trial court’s “heavy emphasis
    on intervening negligence in its instructions” likely influenced the jury’s decision in
    finding Dr. Hearn not negligent. We disagree.
    The use of the North Carolina Pattern Jury Instruction is “the preferred
    method of jury instruction” unless a pattern instruction misstates the law. Barber,
    130 N.C. App. at 385, 
    502 S.E.2d at 915
     (citation and quotation marks omitted). In
    the present case, the trial court utilized N.C.P.J.I. 102.65, insulating/intervening
    negligence, and did not alter it substantively when it instructed the jury. “It cannot
    be said that it was error for the judge to state the law correctly to the jury . . . .”
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    Opinion of the Court
    Boykin v. Kim, 
    174 N.C. App. 278
    , 286, 
    620 S.E.2d 707
    , 713 (2005). Accordingly,
    Plaintiff’s argument regarding prejudice is overruled.
    II. Evidentiary Rulings
    Plaintiff also argues the trial court erred when it allowed Dr. Hearn’s expert
    witness on causation of permanent injury to opine on the applicable standard of care.
    Plaintiff specifically contends Dr. Rinaldi’s testimony about placement of the stent
    was not admissible as a matter of law and, even if it were, the trial court’s admission
    of his testimony was prejudicial. We disagree.
    In reviewing evidentiary rulings by the trial court, “we defer to the trial court
    and will reverse only if the record shows a clear abuse of discretion.” Gray v. Allen,
    
    197 N.C. App. 349
    , 352, 
    677 S.E.2d 862
    , 865 (2009). “A court has abused its discretion
    where its ruling is manifestly unsupported by reason or is so arbitrary that it could
    not have been the result of a reasoned decision.” Id. at 353, 
    677 S.E.2d at 865
    (internal citation and quotation marks omitted).         “[A]dmission of incompetent
    evidence, even though it is not withdrawn, is no ground for a new trial unless
    prejudice is shown.” Smith v. Perdue, 
    258 N.C. 686
    , 690, 
    129 S.E.2d 293
    , 297 (1963).
    Here, a videotape of Dr. Rinaldi’s deposition was played at trial. Plaintiff
    contends the following colloquy between defense counsel and Dr. Rinaldi “was
    inadmissible because it clearly went to the standard of care issues of whether [Dr.
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    Opinion of the Court
    Hearn] improperly placed the stent, an issue on which Dr. Rinaldi was not
    designated”:
    Q. And where was the stent placed in this case as you
    understand it from your review of the medical records?
    A. Yes. It was extending from the innominate vein or
    brachiocephalic vein into the superior vena cava.
    Q. Okay. And is there anything unusual about the
    placement of that stent in that location?
    A. I don’t think so. That is done frequently. And, in fact,
    stents can be placed in the superior vena cava when people
    have narrowings [sic] in the superior vena cava. I’ve
    personally done it myself, and it is a normal procedure.
    Plaintiff’s main contention is that the jury likely attached great significance to
    Dr. Rinaldi’s testimony because the position of Dr. Hearn’s placement of the stent
    was the crux of the issue at trial. However, providing a limiting instruction to the
    jury following the admittance of erroneous testimony may cure an alleged error in
    the admittance of such testimony. See Chamberlain v. Thames, 
    131 N.C. App. 705
    ,
    711, 
    509 S.E.2d 443
    , 447 (1998).         “A jury is presumed to follow the court’s
    instructions.” Nunn v. Allen, 
    154 N.C. App. 523
    , 541, 
    574 S.E.2d 35
    , 46 (2002).
    The trial court provided the following limiting instruction prior to playing the
    remainder of Dr. Rinaldi’s testimony on the videotape:
    All right, members of the jury, before we go on, I want to
    instruct you and remind you that this witness is not
    offering any opinion as to whether Dr. Hearn’s conduct
    adhered to or failed to adhere to the standard of care and
    you are not to consider his testimony for that purpose.
    - 18 -
    HAMPTON V. HEARN
    Opinion of the Court
    Any purported error in the admission of Dr. Rinaldi’s testimony on standard of
    care did not prejudice Plaintiff because it was cured by the trial court’s limiting
    instruction. Plaintiff has failed to show the trial court abused its discretion.
    Conclusion
    The trial court did not err in instructing the jury on intervening negligence.
    Plaintiff was not prejudiced by the admittance of Dr. Hearn’s expert witness
    testimony.
    NO ERROR.
    Judges TYSON and INMAN concur.
    - 19 -