We granted the petition for a writ of certiorari to review the Court of Appeals’ opinion in
Fields v. Regional Medical Center Orangeburg,
FACTUAL AND PROCEDURAL BACKGROUND
Vergie Fields (Plaintiff) brought this -wrongful death action against Physician and Regional Medical Center Orangeburg (RMC), alleging negligence and medical malpractice in failing to diagnose a heart condition suffered by her husband, Thomas Edison Fields (Decedent), and admit him to RMC. The Court of Appeals reversed the jury verdict for Physician and RMC and granted Plaintiff a new trial. 1
Plaintiff took Decedent, age 49, to RMC’s emergency room when he began suffering chest pain which radiated into both arms on the afternoon of September 14, 1994. Decedent was examined, his history and past records were reviewed, he was placed on a heart monitor, and an electrocardiogram (EKG) test of his heart revealed no abnormalities. Decedent suffered from previously diagnosed conditions of chronic back pain, caused by a 1976 employment-related injury which left him totally disabled, and a hiatal hernia and gastrointestinal reflux. Decedent was given medication to relieve pain, told to follow up with his physician and sent home.
Plaintiff again took Decedent to RMC’s emergency room at about 3 a.m. on September 18, 1994, after he awoke with severe chest pain radiating into both arms. Physician, who *24 was on duty in the emergency room, testified he examined Decedent and reviewed past records which showed Decedent’s history as a smoker, complaints of chest pain in past years, and past hospital admissions for mental health issues. Physician reviewed previous EKG and heart test results, including a heart catheterization in 1993 and the visit four days earlier, none of which revealed any heart condition.
Physician testified he placed Decedent on a heart monitor and performed an EKG which showed no abnormalities. Decedent stated his chest pain was similar to past instances, but worse. He was crying and upset. Physician gave Decedent the same pain medications he had received previously for the hiatal hernia and reflux, conditions which also may cause chest pain. Physician diagnosed Decedent with histrionics 2 and chronic pain, told him to follow up with his doctor, and discharged him at 3:50 a.m. Physician denied his diagnosis was substantially affected by an emergency room nurse who told him Decedent, her uncle, was “crazy” and possibly seeking drugs, but instead was based primarily on Decedent’s medical history, the current exam and normal EKG test.
Plaintiff testified Decedent’s chest pains worsened after leaving RMC and she drove her husband to a Columbia hospital. There, Decedent suffered a documented heart attack about an hour after leaving RMC. Decedent was transferred to another Columbia hospital the same day, where he underwent an emergency heart catheterization. Decedent died after his right coronary artery was dissected during the operation, which is a known risk of the procedure. An autopsy revealed Decedent suffered from severe coronary artery disease.
Plaintiff alleged that, had Physician properly diagnosed Decedent with potential coronary artery disease and realized a heart attack might be imminent, Decedent would have been admitted to RMC, probably would have been given thrombolytic (“clot-busting”) medications when he suffered his heart attack, and would not have undergone the emergency proce *25 dure which resulted in his death. Plaintiff presented evidence, including the testimony of two expert witnesses, of Physician’s medical malpractice in failing to have Decedent examined by a heart specialist and admitted to RMC; in failing to adequately investigate and consider Decedent’s medical and family history and past episodes of similar chest pain; in failing to perform additional tests and monitoring; and in concluding Decedent was simply hysterical or exaggerating his symptoms.
Physician contended his examination and treatment of Decedent met the requisite standard of care. Physician and his expert in emergency medicine testified Physician adequately reviewed Decedent’s medical history, which included several instances in which Decedent had complained of chest pain and undergone heart-related tests which did not reveal any heart disease or impairment. Physician presented evidence Decedent had suffered from a variety of physical and psychiatric ailments and made numerous trips to RMC’s emergency room. Physician also presented the testimony of Decedent’s regular physician, his psychiatrist, and the cardiologist who performed the 1993 heart catheterization which revealed no significant abnormalities.
ISSUES
I. Did the Court of Appeals err in denying Physician’s motion to dismiss Plaintiffs appeal as untimely?
II. Did the Court of Appeals err in reversing the jury’s verdict based on the trial court’s exclusion of testimony regarding the qualifications of Plaintiffs expert witness?
III. Did the Court of Appeals err in reversing the jury’s verdict based on the trial court’s refusal to allow Plaintiff to use a medical treatise to cross-examine Physician?
STANDARD OF REVIEW
Qualification of an expert and the admission or exclusion of his testimony is a matter within the sound discretion of the trial court. Similarly, the admission or exclusion of evidence in general is within the sound discretion of the trial court. In both instances, the trial court’s decision will not be disturbed on appeal absent an abuse of discretion.
Pike v.
*26
S.C. Dept. of Transp.,
To warrant reversal based on the admission or exclusion of evidence, the appellant must prove both the error of the ruling and the resulting prejudice, i.e., that there is a reasonable probability the jury’s verdict was influenced by the challenged evidence or the lack thereof.
Hanahan v. Simpson,
LAW AND ANALYSIS
I. MOTION TO DISMISS APPEAL
Physician contends the Court of Appeals lacked jurisdiction to consider Plaintiffs appeal because Plaintiff failed to timely serve the notice of appeal on the opposing parties. We disagree.
At the end of the trial on March 30, 2000, Plaintiff requested ten days to file a new trial motion, as provided in Rule 59(b), SCRCP. The trial judge denied the request, stating he would prefer to consider any motions immediately while the case and issues were still fresh in his mind. Plaintiff then asserted, in a one-sentence statement, that the trial court’s previous evidentiary rulings constituted reversible error. The trial judge denied the oral motion.
Seven days later, Plaintiff filed a written motion for a new trial, citing Rule 59, SCRCP. Plaintiff asserted that, inter alia, the trial judge erred in excluding testimony about her *27 expert witness’s qualifications on the ground of hearsay, and in refusing to allow Plaintiff to use a medical treatise to cross-examine Physician on the ground the treatise had not been listed by Plaintiff in discovery responses. The trial judge denied Plaintiffs post-trial motion July 14, 2000, after a hearing. Plaintiff filed and served a notice of appeal August 8, 2000.
Physician filed a motion to dismiss the appeal for lack of jurisdiction after the Court of Appeals issued an opinion reversing the jury’s verdict. The Court of Appeals denied the motion.
Physician contends, as he did to the Court of Appeals, that the trial judge denied Plaintiffs request to file a written new trial motion. Thus, Plaintiffs written new trial motion, which followed the oral new trial motion made at the end of the trial, was an improper successive motion akin to those condemned in
Quality Trailer Products, Inc. v. CSL Equipment Co.,
We conclude Plaintiffs written motion is properly viewed as a motion for reconsideration under Rule 59(e), SCRCP to the extent it addressed the trial court’s evidentiary rulings which Plaintiff challenged in her briefly stated oral motion at the end of the trial.
See e.g. C.A.H. v. L.H.,
Moreover, we recently clarified the limits and rationale of
Quality Trailer
and
Collins Music
in
Elam v. South Carolina Department of Transportation,
However, in Elam we held that
a party usually is free to file an initial Rule 59(e) motion, regardless of whether the previous JNOV/new trial motions were made orally or in writing, without unnecessary concern the repetition of an issue or argument made in a previous motion will result in a subsequent appeal being dismissed as untimely. In essence, we view the use of oral or written JNOV/new trial motions, followed by an initial Rule 59(e) motion, as part and parcel of a party’s “single bite at the apple” in presenting his case to the trial court. Again, we caution a party who files post-trial motions to note carefully the exceptions to this general rule as expressed in Coward Hund. 3 Quality Trailer and Collins Music.
*29
Elam,
II. EXCLUSION OF TESTIMONY ABOUT EXPERT’S QUALIFICATIONS
Physician argues the Court of Appeals erred in reversing the jury’s verdict and remanding for a new trial because the trial court excluded part of the explanation of Plaintiffs expert for not being board-certified in emergency medicine. We agree.
Physician’s expert witness in emergency medicine, Dr. Robert Bartlett, testified a physician may seek board certification in emergency medicine after eight years of training. A physician must pass a written and oral examination, and is recertified every ten years.
The expert witnesses of both parties were routinely asked if they were board-certified in emergency medicine or another specialty. Physician’s witness, Bartlett, testified he was board-certified in emergency medicine. One of Plaintiffs expert witnesses, Dr. Alfred Frankel, also testified he was board-certified in emergency medicine. Physician testified he was board-certified in family medicine; but had failed the emergency medicine exam for board certification by one point.
Plaintiff presented Dr. George Podgorny as an expert in emergency medicine. Podgorny testified by video deposition that he had practiced emergency medicine for more than twenty-five years. In explaining why he was not board-certified in the specialty, Podgorny testified, “The reason is that I was the first president of the board of emergency medicine and was instrumental in development of the examination, and then served for many years as the editor of both the written and the oral exam.”
The trial court sustained Physician’s objection to the remainder of Podgorny’s explanation on the ground it was inadmissible hearsay. The jury did not hear this statement:
*30 “And the opinion of legal counsel was that there may be a conflict of interest if I will take the exam, which it was perceived that I knowed (sic) all the answers.”
In closing arguments, Plaintiffs counsel mentioned the board certification of the expert witnesses. He noted Podgorny was not board certified “because he’s the one that writes the test that they use” and described Podgorny as “the guru in this part of the country on emergency rooms.” Physician’s counsel, in closing, emphasized Bartlett’s qualifications as a “true expert” who “knows what he’s talking about. Dr. Podgorny; what evidence is there that Dr. Podgorny writes the test? Ridiculous! Dr. Podgorny never took the test to be board certified.”
The Court of Appeals held Plaintiff demonstrated both error and resulting prejudice in the trial court’s exclusion of a portion of Podgorny’s explanation. The Court of Appeals stated
[u]sually, if opinion testimony is offered by a physician or surgeon, his competency to testify as an expert is sufficiently established by the fact that he has been duly licensed to practice medicine or surgery. State v. Moorer,241 S.C. 487 ,129 S.E.2d 330 (1963), overruled on other grounds by State v. Torrence,305 S.C. 45 ,406 S.E.2d 315 (1991); Hill v. Carolina Power Light Co.,204 S.C. 83 ,28 S.E.2d 545 (1943). A physician or surgeon is not incompetent to testify as an expert merely because he is not a specialist in the particular branch of his profession involved in the case. Creed v. City of Columbia,310 S.C. 342 ,426 S.E.2d 785 (1993). The fact that the physician is not a specialist in the particular area affects only the weight of the witness’s testimony and affords no basis for completely rejecting it. Hill,204 S.C. at 109 ,28 S.E.2d at 555 ; Brown v. LaFrance Indus.,286 S.C. 319 ,333 S.E.2d 348 (Ct.App.1985)....
Hearsay is “a statement, other than one made by the declarant while testifying at the trial or hearing, offered in evidence to prove the truth of the matter asserted.” Rule 801(c), SCRE. Proof of a statement introduced to show a party heard and acted upon information is not objectionable hearsay. Webb v. Elrod,308 S.C. 445 , 449,418 S.E.2d 559 , 562 (Ct.App.1992); 31A C.J.S. Evidence 259 (1996) (“[T]esti *31 mony is not hearsay where it relates to what the witness himself did in reliance on, or in response to, a statement, facts upon which action was taken, personal observations, explanation of conduct, the effect of statements on the listener, the fact that something was said, or identifying what was said.”).
Podgorny’s statement is a classic example of showing an action based upon information and is not offered for the truth of the matter asserted. The statement was not offered to prove that the counsel was correct in showing that there would be a conflict of interest if Podgorny took the test, but rather explained why Podgorny did not take the test and therefore, was not board-certified.
Fields,
We conclude the Court of Appeals correctly found error in the trial court’s ruling, and the trial court abused its discretion in excluding the “legal counsel” testimony. The testimony was not hearsay because it was not admitted to prove the truth of the matter asserted.
However, the Court of Appeals erred in concluding Plaintiff has shown prejudice. When evidence is erroneously excluded by the trial court, the appellate court usually engages in the following analysis to determine whether prejudice has occurred. First, the court considers, inter alia, whether the error may be deemed harmless because equivalent or cumulative evidence or testimony was offered; 4 the aggrieved party still managed to accomplish his primary objective, such *32 as eliciting testimony about an issue or effectively cross-examining a witness; 5 the jury’s verdict or a proper court ruling rendered the wrongly excluded evidence moot because it was relevant to an issue that did not have to be reached; 6 the aggrieved party failed to establish a claim or defense even when both the admitted and excluded evidence are considered; 7 or the wrongly excluded evidence involved a generally known fact. 8
Second, the appellate court considers whether, viewing a case as a whole, the wrongly excluded evidence or *33 testimony was so crucial and important in proving the aggrieved party’s claim or defense that its exclusion constitutes prejudicial error, i.e., the aggrieved party demonstrates there is a reasonable probability the jury’s verdict was influenced by the lack of the challenged evidence. 9
It certainly is true that the credentials of both parties’ expert witnesses were crucial in the present case. Both parties medical experts were routinely asked whether they were board-certified. Both parties’ mentioned the experts’ board certification in closing arguments while praising their own expert and criticizing their opponent’s.
Plaintiff did not present evidence that was equivalent or cumulative to the wrongly excluded “legal counsel” testimony. Plaintiff did, however, accomplish her primary objective in demonstrating Podgorny was well-qualified to render an opinion on Physician’s actions. Podgorny testified he had practiced emergency medicine for more than twenty-five years and had helped edit the board certification test for years. In addition, Plaintiffs other expert, Frankel, was board-certified in emergency medicine.
Viewing the case as a whole, we are not persuaded the “legal counsel” testimony was so crucial and important in proving Plaintiffs malpractice claim that its exclusion constitutes prejudicial error. Plaintiff has not shown a reasonable *34 probability the jury was influenced by the absence of a portion of Podgorny’s explanation regarding his lack of board certification. This case differs, for example, from the Elledge; Senn, or Sellers cases described in footnote 9, where the aggrieved party was prejudiced by the wrongful exclusion of crucial and important evidence.
In short, both parties presented experienced, well-qualified experts who offered opposing opinions about the propriety of Physician’s actions. Whether Physician’s actions met the requisite standard of care was a question for the jury and the jury decided it in favor of Physician. Accordingly, we affirm the Court of Appeals’ finding of error in the trial courts ruling, but reverse the finding of prejudice.
III. USE OF MEDICAL TREATISE TO CROSS-EXAMINE PHYSICIAN
Physician contends the Court of Appeals erred in reversing the jury’s verdict and remanding for a new trial because the trial court refused to allow Plaintiff to use a medical treatise during cross-examination of Physician. Although this issue presents a closer question than Issue II, we agree.
Plaintiff attempted to use an emergency medicine textbook written by Tintinalli, Krome, and Ruiz while cross-examining Physician. Physician testified he was familiar with the treatise, considered an authoritative source by emergency room doctors. Physician’s counsel objected to use of the treatise because Plaintiff had failed to list it in her responses to Physician’s discovery requests.
Plaintiffs counsel stated he intended to use the treatise to “ask [Physician] if what he’s testified to is different from what’s in the text.” Counsel did not proffer any specific questions or information from the textbook. The trial court sustained the objection and instructed the jury to disregard all references to the treatise. In an affidavit which accompanied Plaintiffs written motion for a new trial, Plaintiffs paralegal testified Physician’s counsel, apparently realizing Plaintiffs counsel had seen the treatise on defense counsel’s table while cross-examining Physician, instructed an assistant to put it away. The assistant placed the treatise on the floor and covered it up with several notebooks.
*35
The Court of Appeals, relying on Rule 37(b), SCRCP, held the trial court abused its discretion by disallowing use of the treatise -without weighing the nature of the interrogatories, the discovery posture of the case, the willfulness of the offending party, and the degree of prejudice to the objecting party. The Court of Appeals held Plaintiff had been prejudiced by the error.
Fields,
We conclude the Court of Appeals correctly held the trial court abused its discretion in preventing Plaintiff from using the treatise to challenge Physician’s assertion that his examination and treatment of Decedent was appropriate. There was no evidence Plaintiff willfully failed to disclose the treatise, and Physician was not prejudiced or surprised by the use of an admittedly authoritative treatise lying on defense counsel’s table. Disallowing use of the treatise for a discovery violation under these facts did not further the primary purpose of the civil procedural rules at issue, i.e., preventing or limiting ambush tactics at trial.
However, the Court of Appeals erred in concluding Plaintiff has demonstrated prejudice under the analysis set forth in Issue II. Plaintiff has failed to explain persuasively at trial or on appeal how she would have used the treatise to challenge Physician’s testimony. The treatise evidence likely would have been cumulative to the testimony of Plaintiffs two experts, who testified Physician failed to perform additional tests and monitoring of Decedent’s condition. Viewing the case as a whole, Plaintiff has not shown the treatise was so crucial and important that its wrongful exclusion constitutes prejudicial error. Plaintiff has failed to establish a reasonable probability the jury was influenced by the lack of cross-examination of Physician with information from the medical treatise.
As explained in Issue II, both parties presented experienced, well-qualified experts who offered opposing opinions about the propriety of Physician’s actions. Whether Physician’s actions met the requisite standard of care was a question for the jury and the jury decided it in favor of Physician.
*36 CONCLUSION
We affirm the Court of Appeals’ denial of Physician’s motion to dismiss the appeal. On Issues II and III, we affirm the Court of Appeals’ findings of error in the trial court’s evidentiary rulings, but reverse the findings of prejudice. Accordingly, we affirm the jury’s verdict in favor of Physician.
AFFIRMED IN PART; REVERSED IN PART
Notes
. RMC is not a party on appeal.
. Plaintiff's expert defined histrionics as “[a]n unofficial term sometimes used by doctors referring to a behavioral pattern of an individual when it is loud, crying, disorganized, that to an average individual appears to be not appropriate to the situation on hand.”
. The case of
Coward Hund Constr. Co. v. Ball Corp.,
.
E.g. Recco Tape Label Co. v. Barfield,
.
E.g. Goudelock v. Prudential Ins. Co. of America,
.
E.g. First State Sav. and Loan v. Phelps,
.
E.g. Triple “F," Inc. v. Gerrard,
.
E.g. Coffee v. Anderson County,
.
E.g. Elledge v. Richland/Lexington School Dist. Five,