United States: Causation Testimony Excluded As "Unhelpful" And "Unreliable" In Heart-Lung Machine Death Case

Last Updated: July 31 2017
Article by Rachel B. Weil

One of the wonders of parenthood is its ability to deliver interludes so sublime in their exquisite simplicity that they provoke smiles long after they end. Such was an evening last week when we journeyed to New York to celebrate the birthday of the Drug and Device Law Rock Climber, now a waxing college senior completing a summer internship at an insanely cool company in Lower Manhattan.  We were treated to a tour of the office and to the comments that colleagues and mentors reserve for interns' mothers.  We had perfect saltimbocca at a beloved Italian bistro.  We saw Waitress (again – we love this show).  We stayed overnight on the Climber's couch, joined at some point by a four-pound Chihuahua.  And we relished every moment with this child-now-adult.  We were awash in happiness for the entire train ride home.

We were also happy (yet another suspect segue) with the court's evidentiary rulings in today's case, but decidedly not with the case's very sad facts—an all-too-frequent dichotomy in our line of work. Because we spend vast amounts of our professional time struggling to achieve the exclusion of plaintiffs' causation experts, we are always pleased to read a Daubert opinion that layers tidy analytical segments to reach a satisfying conclusion that correctly applies the Rules of Evidence and controlling case law.

In Smith v. Terumo Cardiovascular Systems Corp., et al., 2017 U.S. Dist. LEXIS 108205 (D. Utah July 12, 2017), the plaintiff's decedent underwent open-heart surgery in which a heart-lung machine was used to circulate oxygenated blood through the patient's body while his heart was being repaired.  At some point during the surgery, the machine stopped working for approximately ten minutes.  The plaintiff's decedent never left the hospital after the surgery.  Eleven months later, he suffered a heart attack and died.

The plaintiff sued the hospital and the heart-lung machine's manufacturer, asserting the usual claims. She hired a cardiologist as her causation expert, and he opined that the malfunction of the heart-lung machine caused the decedent to suffer physical and mental deterioration and ultimately caused his heart attack and his death.  The defendants moved to exclude the expert's testimony, arguing that: 1) his causation opinions were unhelpful and unreliable; 2) he was not qualified to opine on neurological injuries; and 3) he should not be allowed "to provide a narrative of events that can and should be provided by other witnesses and records." Smith, 2017 U.S. Dist. LEXIS 108205 at *5 (citation omitted).

Explaining that , "to be helpful, [the expert's] opinion . . . that the . . . surgery and related complications had any causal . . . relationship to Mr. Smith's injuries and ultimate death must be based on a 'valid scientific connection,' the court held that that the expert's own deposition testimony demonstrated that his opinion would not be helpful to a jury. To wit, in his deposition, the expert admitted that he could not testify with certainty that there was a connection "between the surgery, the ten-minute lack of flow, and the heart attack that caused" the decedent's death. Id. at *10-11 (citations omitted).   Instead, he could only go as far as concluding that "the events that happened at the time of surgery simply made it more likely" that the decedent would die as the result of a heart attack, although the decedent's own risk factors –hypertension, smoking, diabetes, family history – were generally considered to be "the main contributors" to the development of the plaque that narrowed the decedent's arteries and caused his myocardial infarction.  As such, the expert concluded, "[While] I think that what happened . . . played a role in his having a heart attack and made it less likely that he would survive a heart attack, but I cannot say that it caused his heart attack." Id. at *11-12 (emphasis in original, citation omitted).

While this is refreshing (and uncommon) candor for a plaintiff's expert, it is obviously not "helpful" to the establishment of causation. Moreover, the court held, even if the testimony had been helpful, it was not reliable, because the expert did not "provide a basis to conclude that the relationship [was] causal and not merely corollary," leaving too large a gap between his premise and conclusion, and because he failed to account for obvious alternative explanations for the decedent's death.   Id. at *15-16.

The expert also concluded, contrary to the results of the decedent's autopsy, that the decedent had suffered an earlier heart attack, around the time of the surgery, before the one that ultimately killed him eleven months later. The court held that this opinion was also inadmissible because the expert's diagnostic methods were not generally accepted.  As such, the court concluded, "To allow the jury to hear [the expert's] opinion on this point would be to allow the jury to hear conclusions based on inferior diagnostic metrics.  This will not be permitted." Id. at *20.

Next, the court addressed the expert's opinion that the decedent "suffered an injury to the brain due to prolonged lack of oxygenated blood flow to the brain." Id. at *20-21.  The court held that the expert lacked the "knowledge, skill, training, or education that would qualify him to diagnose neurologic injuries." Id. at 21 (internal punctuation and citation omitted).  Moreover, the opinion lacked any scientific basis, as the autopsy revealed no sign of hypoxic encephalopathy.   The court concluded, "[The expert] is not being as careful as he would be in his regular professional work outside his paid litigation consulting.  A jury has no use for [this type of speculation], especially from someone whose expertise lies elsewhere." Id. at *24.

The court did not exclude the expert's entire report, permitting him to testify that the decedent's heart was injured during his surgery and to indicate what he relied upon to form his opinions. It held, however, that the expert would not be permitted "to give a general narrative of Mr. Smith's health before, during, and after the surgery." Id.

We like this opinion. It draws the correct lines, and it does so in clear and logical fashion.  It also reinforces the oft-apparent conclusion that plaintiffs' lawyers disserve their clients when they hire the wrong people, and pay them to say the wrong things, in their quests for big settlement paychecks.   We will continue to keep you posted on judges who properly bar the courtroom doors against such experts, and those who don't.

This article is presented for informational purposes only and is not intended to constitute legal advice.

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