of law. In reaching this conclusion, the court notes that the substantive ele ments of a medical malpractice claim—the applicable standard of care, whether the standard was violated, and whether the violation was the proximate cause of Harvey’s injury or death—are questions to be determined by state law. Fitzgerald v. Manning, 679 F.2d 341, 346 (4th Cir.1982). Under Virginia law, expert testimony is ordinarily necessary to establish each of these elements. Webb v. Smith, 276 Va. 305, 661 S.E.2d 457, 459 (4th Cir.2008). “Exceptions to this rule exist only in ‘those rare cases in which a health care provider’s act or omission is clearly negligent within the common knowledge of laymen.’” Id. (quoting Raines v. Lutz, 231 Va. 110, 341 S.E.2d 194, 196 n. 2 (1986)); see, e.g. Webb, supra (<HOLDING>). Having reviewed the record, the court
holding the plaintiff must show that the defendants departure from such generally recognized practices and procedures was the proximate cause of the plaintiffs alleged injuries and damages holding that negligence must be the proximate cause of injury holding where reasonable difference of opinion as to whether the defendants act was the or a proximate cause of the injury the matter is for the jury to decide holding that a physicians negligence need only be a proximate cause not the proximate cause of plaintiffs injury holding that a reasonably intelligent juror did not need an expert to explain why the doctors negligence was the proximate cause of the patients damages where the doctor forgot to perform the second of two planned surgical procedures and as a result the plaintiff had to undergo surgery on a second occasion