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Neurologist Who Googled Term Unqualified to Testify that Heart Caused Death; Cranioplasty


A five-month-old girl suffered a skull fracture. As the fracture expanded over time, a cyst formed in the area. The fracture and cyst did not become a cause for concern until, at the age of 17, she was hit in the head and suffered a loss of consciousness, blurred vision, and dizziness. CT and MRI scans confirmed the extent of the fracture and the cyst.

 

The girl underwent cranioplasty surgery, a neurosurgical procedure designed to repair or reshape irregularities or imperfections in the skull, to repair the fracture and the area of the dura, the thick membrane surrounding the brain where the cyst had formed. The girl was discharged the day after the surgery. She was found dead in her bed three days later.

 

The medical examiner, a forensic pathologist, examined the girl’s body and was unable to identify a cause of death. The medical examiner asked a neuropathologist to examine the girl’s brain. The neuropathologist found that the surgery damaged the dura and surface of the girl’s brain. Based on this finding, a forensic pathologist concluded that the girl had died from a seizure brought about by the surgical damage. Neither the forensic pathologist nor the neuropathologist were aware of or had reviewed the presurgery CT and MRI scans when they made their findings.

 

The girl’s mother sued the hospital and the surgeons. The complaint alleged that the surgery caused the child to suffer a seizure and die, and that the surgeons should have prescribed antiseizure medication as part of the girl’s post-operative care plan.

 

The hospital and surgeons argued that no seizure had occurred and that a heart-related ailment was likely the cause of death. In support of this argument, the hospital and surgeons submitted the testimony of a pediatric neurologist.

 

The mother filed a motion in limine to bar the expert pediatric neurologist from denying that the girl’s death was caused by a seizure. The motion argued that the expert pediatric neurologist was not qualified through education or experience to give an opinion to a reasonable degree of medical certainty as to the girl’s forensic cause of death. In addition, the motion argued that the expert pediatric neurologist had failed to offer any scientific explanation for his opinion that the girl had not died from a seizure.

 

Over the mother’s objections, the United States District Court for the Southern District of Illinois permitted the hospital and surgeons’ expert pediatric neurologist to opine about the child’s likely cause of death.

 

At trial, the defense expert pediatric neurologist testified that the girl’s death was not brought about by seizure and opined that focal interstitial chronic inflammation of the girl’s heart (i.e., thickening of the heart’s connective tissue) was the likely cause of death. The mother objected. The trial compared the expert’s testimony to the pretrial disclosures and found that the expert’s testimony had been previously disclosed. On that basis, the trial court overruled the mother’s objection and allowed the expert pediatric neurologist to testify.

 

After a trial, the jury found in the hospital and surgeons’ favor.

 

The Seventh Circuit United States Court of Appeals reversed. The court held that the hospital and surgeons’ expert pediatric neurologist lacked the requisite qualifications to opine that the child’s heart ailment was the likely cause of death and there was a significant chance that the erroneous admission of this expert testimony affected the outcome of the trial.

 

The hospital and surgeons’ expert pediatric neurologist lacked the requisite qualifications to opine that the child’s heart ailment was the likely cause of death. The trial court did not apply the Rule 702/Daubert framework to assess the admissibility of the hospital and surgeons’ expert pediatric neurologist’s testimony. When the mother’s motion in limine argued that the hospital and surgeons’ expert pediatric neurologist offered cause of death opinions without being qualified and without the requisite scientific explanation, the trial court should have conducted a Daubert inquiry, even though the mother did not expressly reference to Daubert or Rule 702 by name. When the mother objected at trial, the trial court was squarely faced with the need to determine if the expert pediatric neurologist was qualified as an expert on the girl’s heart, even if the word Daubert was not spoken. The judge erroneously focused solely on whether the challenged opinions had been previously disclosed. While the expert pediatric neurologist was qualified to opine on the girl’s surgery and the possibility of seizure, the court found that this qualification did not extend to his opinion that the girl’s heart-related issue was the likelier cause of death. The expert pediatric neurologist acknowledged at trial that when he read the inflammation finding in the girl’s autopsy report he did not know what it was. He conducted a Google search and found papers explaining it. Based on a Google search, he opined that focal interstitial chronic inflammation made more sense as a cause of death. The court found that the record lacked sufficient evidence demonstrating that this knowledge and the related experiences rendered the expert pediatric neurologist qualified to opine about the girl’s heart.

 

There was a significant chance that the erroneous admission of the expert pediatric neurologist’s testimony affected the outcome of the trial. The girl’s cause of death was a critical issue at trial. Generally, a finding of a seizure-related cause of death is difficult to prove because it is made only by ruling out all other possible alternatives. The expert pediatric neurologist played a critical role supporting heart troubles as an alternative cause of her death. The expert pediatric neurologist testified about multiple studies he had read that linked the heart condition that the girl had to the circumstances under which she passed away. The expert pediatric neurologist was the only expert to opine about the purportedly numerous papers that identify young athletes who died suddenly of heart-related illnesses. The court found it was a distinct possibility that the expert pediatric neurologist’s discussion of those publications played a key role in the jury’s verdict. The court concluded that because the hospital and surgeons failed to satisfy the harmless error standard, a new trial was warranted.

 

The Seventh Circuit United States Court of Appeals reversed the district court’s decision to admit the expert pediatric neurologist’s heart related cause of death testimony and remanded for a new trial.

 

See: Sandra Hall, special administrator of the estate of Chelsea Weekley, Plaintiff-Appellant, v. Ann Flannery, et al., Defendants-Appellees., 2016 WL 6543513 (C.A.7 (Ill.), November 4, 2016) (not designated for publication).

 

See also Medical Law Perspectives, August 2015 Report: Pediatrician Liability for Childhood Disease Complications

 

See also Medical Law Perspectives, February 2014 Report: Congenital Heart Conditions: How Infants, Adults, and Healthcare Providers Handle the Risks

 

See also Medical Law Perspectives, May 2012 Report: Repeat Brain Trauma That Is More Than a Bump on the Head: Multiple Concussion Injury and Second Impact Syndrome 

 

 

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