While most civil litigation settles I would bet that most medical malpractice cases in Virginia actually go to trial. There are several reasons for this.
1. The insurance companies are protected by Virginia's cap on medical malpractice damages. they know that on their worst day what their losses will be and if there are multiple defendants found guilty of malpractice each will share in the total loss. This reduces the risk to take cases to trial. Why settle a bad case when it may turn out that you can greatly reduce your payment by bringing other doctors down with you?
2. Insurance companies will spend any amount of money to defend a case. They will search high and low for experts to defend the care of their doctors. At the beginning of my career I helped the insurance companies defend doctors. When we got a new case in to defend we might send the case out to five or six doctors for reviews. We might get five negative reviews but then choose the doctor who is willing to go out on a limb to defend the case. Insurance companies have a limitless amounts of money that enables them to expert witness shop.
3. These cases are much more difficult than you can imagine. Even when other local doctors have pulled you that another doctor messed up most will never say that in public at a trial or deposition. This is because the medical profession and medical societies and insurance companies put a tremendous amount of pressure on doctors who say anything bad in public about other doctors. They will find themselves shunned at medical meetings or perhaps unable to get insurance themselves. In some cases other doctors have brought professional ethics charges against doctors who testified for patients.
All of this means that it doesn't matter, in Virginia, how badly you were treated or how clear the malpractices... your case is likely going to trial and it will require hundreds of hours of work and tens of thousands of dollars in expenses.