McBride v. Houston Cnty. Health Care Auth., CIVIL ACTION NO. 1:12cv1047-MHT (WO)

• Decision Date: 11 June 2015
• Docket Number: CIVIL ACTION NO. 1:12cv1047-MHT (WO)
• Parties: COURTNEY McBRIDE, Plaintiff, v. HOUSTON COUNTY HEALTH CARE AUTHORITY d/b/a Southeast Alabama Medical Center, et al., Defendants.
• Court: U.S. District Court — Middle District of Alabama

COURTNEY McBRIDE, Plaintiff, v. HOUSTON COUNTY HEALTH CARE AUTHORITY d/b/a Southeast Alabama Medical Center, et al., Defendants.

CIVIL ACTION NO. 1:12cv1047-MHT (WO)

DISTRICT COURT OF THE UNITED STATES FOR THE MIDDLE DISTRICT OF ALABAMA, SOUTHERN DIVISION

June 11, 2015

OPINION AND ORDER

Plaintiff Courtney McBride developed a rare skin disease after receiving treatment at a county hospital followed by her subsequent discharge to a local jail. She brings this civil action against the following defendants: Houston County Health Care Authority; Drs. Dinesh Karumanchi and Rajendra Paladugu; the City of Dothan; and Dothan City Jail Correctional Officers Mamie McCory and Stephanie Johnson. She asserts thatthe Health Care Authority and the doctors committed medical malpractice in violation of Alabama law, and she further claims that the City of Dothan and its correctional officers were deliberately indifferent to her medical needs in violation of the United States Constitution and were negligent in violation of Alabama law. The court has jurisdiction pursuant to 28 U.S.C. § 1343(a)(3) (civil rights) and § 1367 (supplemental).

The case is before the court on defendant Karumanchi's motion to exclude the expert opinions of Dr. Robert Auerbach, Dr. Carla Rodgers, and Dr. Allan Nineberg. The motion will be denied.

Relying on Daubert v. Merrell Dow Pharm., Inc., 509 U.S. 579 (1993), Karumanchi challenges Drs. Nineberg and Auerbach's qualifications and methodology; he also challenges Dr. Rodgers's qualifications to testify under Alabama medical-malpractice law. At the outset, the court notes that the magistrate judge already issued an opinion denying Karumanchi's earlier motionto exclude the expert opinions of Auerbach, Rodgers, and Nineberg, in which he discussed each experts' qualifications as well as Auerbach's methodology for determining causation. See McBride v. Houston Cnty. Health Care Auth., 2014 WL 4373187 (M.D. Ala. 2014) (Moorer, M.J.). Because Karumanchi did not object to the magistrate judge's opinion, the decision is binding, as "a party may not assign as error a defect in the order not timely objected to." Fed. R. Civ. P. 72(a). Because his motion therefore is not properly before this court, it is due to be denied. Indeed, if Karumanchi could bring successive Daubert motions, he would lack an incentive to complete his due diligence before filing and to make timely objections to the magistrate judge.

Nevertheless, the court will address Karumanchi's arguments on the merits below, as an alternative basis for denying his motion. Because the court agrees with the magistrate judge's opinion, it will not rehash whathas already been covered but rather will focus on Karumanchi's arguments based on the new information not available at the time of the magistrate judge's opinion.

I. DAUBERT CHALLENGES TO

DOCTORS NINEBERG AND AUERBACH

The court first will lay out the legal standard for evaluating expert testimony. It will then address two general arguments made against Drs. Nineberg and Auerbach and last will move to specific criticisms of each expert's opinion.

A. Legal Standard

The Federal Rules of Evidence govern the admissibility of expert testimony. See Daubert, 509 U.S. at 587. Rule 702 provides:

"A witness who is qualified as an expert by knowledge, skill, experience, training, or education may testify in the form of an opinion or otherwise if:

a. The expert's scientific, technical, or other specialized knowledge will help the trier of fact to understand the evidence or to determine a fact in issue;

b. The testimony is based on sufficient facts or data;

c. The testimony is the product of reliable principles and methods; and

d. The expert has reliably applied the principles and methods to the facts of this case."

Fed. R. Evid. 702. The trial court must serve as a gatekeeper for expert-witness testimony. Daubert, 509 U.S. at 597. Doing so requires the court to make both a "relevance" and a "reliability" determination, disallowing expert testimony that is either unreliable or unhelpful to the trier of fact. Id. at 589.

The Supreme Court has provided a non-exclusive list of factors to guide the trial judge's Rule 702 determination, including: whether a theory or technique can be or has been tested; whether a theory or technique has been subjected to peer review orpublication; whether a theory or technique has gained widespread acceptance within the relevant community of experts, or, rather, has been unable to garner more than minimal support; and the known or potential rate of error of a technique. Id. at 593-94. These factors are not a "definitive checklist," but are considerations that may shape the trial judge's "flexible inquiry" under Rule 702. Id. at 594; see also United States v. Brown, 415 F.3d 1257, 1267-68 (11th Cir. 2005) (citing Kumho Tire Co. v. Carmichael, 526 U.S. 137, 149 (1999) and explaining that "Daubert's list of specific factors neither necessarily nor exclusively applies to all experts or in every case" and that "the question of whether Daubert's specific factors are, or are not, reasonable measures of reliability in a particular case is a matter that the law grants the trial judge broad latitude to determine" (internal citations omitted)). Consistent with this understanding, the Rule 702 advisory committee notesexplain that, while the Rule's current iteration endorses the Daubert conception of the trial judge as a gatekeeper, Rule 702 was not intended to "codify" the specific factors mentioned in Daubert.

Therefore, Rule 702 makes clear that this court is "obliged to screen expert testimony to ensure it stems from, not just a reliable methodology, but also a sufficient factual basis and reliable application of the methodology to the facts." Rudd v. Gen. Motors Corp., 127 F. Supp. 2d 1330, 1337 (M.D. Ala. 2001) (Thompson, J.) (emphasis in original). In doing so, however, trial judges must avoid several pitfalls. First, they should not confuse this sufficiency-of-basis inquiry under Rule 702 with the sufficiency-of-the-evidence inquiry in summary-judgment analysis. Id. at 1336 n.5. Indeed, the two inquiries are "formally quite distinct ... that is, Rule 702 mandates a determination of whether the expert had sufficient evidence (evidence which itself may or maynot be admissible) to support his or her testimony, not a determination of whether that testimony standing alone provides sufficient evidence to allow a reasonable fact-finder to find for the plaintiff on an issue of substantive law." Id. Relatedly, in carrying out their gate-keeper obligation under Rule 702, trial judges must not usurp the role of the trier of fact:

"[Rule 702] is not intended to authorize a trial court to exclude an expert's testimony on the ground that the court believes one version of the facts and not the other.... [T]he rejection of expert testimony is the exception rather than the rule. Daubert did not work a seachange over federal evidence law, and the trial court's role as gatekeeper is not intended to serve as a replacement for the adversary system. Vigorous cross-examination, presentation of contrary evidence, and careful instruction on the burden of proof are the traditional and appropriate means of attacking shaky but admissible evidence."

Fed. R. Evid. 702, advisory committee notes, 2000 amendment (internal citations omitted).

To meet this obligation, the Eleventh Circuit Court of Appeals has instructed trial courts to "engage in a rigorous three-part inquiry," in which the trial court considers whether: "(1) the expert is qualified to testify competently regarding the matters he intends to address; (2) the methodology by which the expert reaches his conclusions is sufficiently reliable... ; and (3) the testimony assists the trier of fact, through the application of scientific, technical, or specialized expertise, to understand the evidence or to determine a fact in issue." Rosenfeld v. Oceania Cruises, Inc., 654 F.3d 1190, 1193 (11th Cir. 2011) (internal citations omitted). The burden is on the proponent of expert testimony to establish that those requirements have been met by a preponderance of the evidence. See Kilpatrick v. Breg, Inc., 613 F.3d 1329, 1335 (11th Cir. 2010).

B. Defendant Karumanchi's General Arguments

Defendant Karumanchi presents two sweeping criticisms of Drs. Nineberg's and Auerbach's opinions: that they failed to show the exact mechanism of how a higher dosage of Lamictal causes Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN) and that they failed to present a double-blind scientific study proving causation. Neither argument comports with the dictates of Daubert or the realities of modern science.

First, Karumanchi emphasizes that neither Nineberg nor Auerbach can describe the mechanism by which Lamictal or a higher dosage of Lamictal causes SJS or TEN and that their opinions should therefore be excluded. This argument is wrong as a matter of law. See, e.g., In re Chantix (Varenicline) Products Liab. Litig., 889 F. Supp. 2d 1272, 1301-02 (N.D. Ala. 2012) (Johnson, J.) ("Absent is any argument that the plaintiff must prove the biological means of injury,because no such requirement exists. ... Although the plaintiffs must prove specific causation, to the satisfaction of the trier of fact, this is not analogous to proving the specific bodily interaction or mechanism which underlies that causation."); In re Traylsol Products Liab. Litig., 2010 WL 4102247, at *4 (S.D. Fla. 2010) (Middlebrooks, J.) (same); In re Seroquel Products Liab. Litig., 2009 WL 3806435, at *8 (M.D. Fla. 2009) (Conway, J.) (same). Indeed, such a stringent standard would eliminate testimony on even well known cause-effect relationships. For example, Nineberg testified: "In my field, we basically don't know much of anything about why antidepressants or antipsychotics work. But if you look at thousands of patients and you do these placebo-controlled studies, there's no question that some groups get better and some...