Williams v. Hedican
| Decision Date | 23 April 1997 |
| Docket Number | No. 95-2172,95-2172 |
| Citation | 561 N.W.2d 817 |
| Parties | Melissa WILLIAMS and Adam Williams, Individually and as Next Friend of Maxwell Williams, a Minor, Appellants, v. Robert E. HEDICAN and Ob-Gyn Specialists, P.C., Appellees. |
| Court | Iowa Supreme Court |
Tom Riley and Mark E. Liabo of Tom Riley Law Firm, P.C., Cedar Rapids, for Appellants.
Glenn Goodwin and Steven Scharnberg of Finley, Alt, Smith, Scharnberg, May & Craig, P.C., Des Moines, for Appellees.
Considered by McGIVERIN, C.J., and LARSON, LAVORATO, NEUMAN, and ANDREASEN, JJ.
Melissa and Adam Williams brought this medical malpractice action against Robert E. Hedican and Ob-Gyn Specialists, P.C. They alleged that the defendants negligently failed to treat Melissa for chicken pox while she was pregnant and as a result her child was born blind in one eye. In a pretrial ruling, the district court excluded expert testimony on causation from the plaintiffs' medical expert. The court concluded the testimony lacked a sufficient foundation under the test suggested in Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 113 S.Ct. 2786, 125 L.Ed.2d 469 (1993). Employing the same test, we conclude the district court abused its discretion in excluding the testimony. We reverse and remand for further proceedings consistent with this opinion.
Melissa and Adam Williams are husband and wife and parents of Maxwell Williams. Robert E. Hedican and Ob-Gyn Specialists, P.C. delivered prenatal care for Melissa in the spring of 1992.
Melissa claims that on April 30, 1992 she reported to one of Hedican's employees that she had been exposed to chicken pox while working at a day care center. At the time, Melissa was seventeen weeks pregnant with Maxwell. Melissa also claims the employee told her that it was not a matter of significance. Melissa received no testing, treatment, or other follow-up and thereafter developed a severe case of chicken pox.
On October 5 Melissa gave birth to Maxwell. Maxwell was born with various maladies including blindness in one eye and skin lesions.
On April 21, 1994, Melissa and Adam brought this action individually and on behalf of Maxwell against Hedican and Ob-Gyn Specialists, P.C. The petition alleged that the defendants were negligent in Melissa's care and treatment when she contracted chicken pox while she was pregnant with Maxwell.
The petition also alleged that because of the defendants' negligence Melissa did not receive medication that could have alleviated her symptoms and substantially improved Maxwell's chance of avoiding harm from the chicken pox virus. The petition further alleged that because of the defendants' failure to provide Melissa with proper antiviral therapy, Maxwell was born with congenital varicella syndrome, which has left him blind in one eye.
Congenital varicella syndrome occurs when mothers have been exposed to the varicella-zoster virus and transmit the virus through the placenta to their unborn children. Varicella-zoster virus is the scientific name for the chicken pox virus. Varicella-zoster immune globulin (VZIG) is an antibody that may destroy the chicken pox virus.
As mentioned, chicken pox is a virus. A virus is a particle smaller than the nucleus of a cell and consists of one or sometimes more strands of genetic material enclosed in a protein shell. The genetic material in the chicken pox virus is deoxyribonucleic acid or DNA.
Because viruses are not living organisms, they cannot reproduce on their own. Once a virus enters the body, the virus' genetic programming directs the virus to healthy cells that make up certain tissues of the body. The viral particles next attach themselves to the walls of the individual cells, penetrate the cell wall, and ultimately enter the cell nucleus. Once inside the cell nucleus, the viral particles take over the reproductive genetic machinery of a cell and reproduce other viral particles. Eventually, the viral particles break out of these cells and spread to other healthy cells, where they repeat the process. Fever, aching, and the outbreak of skin lesions occur after the viral particles have reproduced in sufficient numbers and have invaded enough tissue in a particular part of the body for symptoms to develop.
The body has an elaborate and complex immune system to combat viruses. Antibodies are part of this system and are carried by the blood. Antibodies attack viruses and either destroy or disable them. Once the body produces antibodies in response to a particular type of virus, the antibodies remain part of the body's immune system and are available to attack the same viral type in the event of reinfection. If a person has never been exposed to a particular viral disease, the person may not have as part of the person's immune system the antibodies necessary to respond to that virus. Such persons are inoculated (deliberately injected) with attenuated virus to stimulate the body's own immune response so that if they are exposed to a virulent strain of that virus, they will have antibodies to combat the disease.
A person may also be given an injection of antibodies, or immune globulin, acquired from another person. Once in the body, the immune globulin performs the role that the body's own antibodies would have performed in attacking and destroying or disabling the viral particles. Eventually, the body's immune system manufactures its own antibodies that aid in combating the disease and that will provide protection if there is future exposure to the virus.
The chicken pox virus enters the body through the nose or mouth. For a period of three days following this invasion, the viral particles locate in the respiratory area of the head and upper neck. After four to six days of initial exposure and reproduction, the viral particles spread to the liver, spleen, and other organs of the body. This is the primary viremia stage. Once having spread, the viral particles continue to reproduce. About fourteen days after exposure, the secondary viremia stage begins and the viral particles spread to the skin causing rashes and vesicles that are the outward manifestations of chicken pox.
The chicken pox virus can spread to the fetus of a mother who has been exposed to the virus by crossing the placental barrier to reach the fetus. Fetal infection may occur when the chicken pox disease reaches either the primary viremia or secondary viremia stages but may be more likely to occur in the secondary viremia stage.
Both medical experts--the plaintiffs' and the defendants'--agree that VZIG (the immune globulin for the chicken pox virus) should be given to susceptible pregnant women who are exposed to chicken pox within ninety-six hours of exposure. Doing so can prevent or lessen the effects of chicken pox in the mother. Such treatment is important because pregnant women are at a heightened risk for potentially fatal complications from chicken pox, such as viral pneumonia and encephalitis. The obstetrical literature supports this recommended treatment and the reasons for it.
After ninety-six hours, the viral particles will have become too numerous and diffusely spread for VZIG to be successful in preventing the disease. Early treatment is vital when the viral particles are fewer in number and concentrated near the point of entry in the upper respiratory area.
The two experts, however, disagree on whether VZIG can prevent or lessen the effects of chicken pox in the fetus. According to the plaintiffs' expert, Dr. James Balducci, "it is a matter of common sense and sound scientific reasoning that if VZIG successfully neutralizes the varicella zoster particles in the mother, the fetus will be protected from those particles as well." In reaching that conclusion, he points to several factors. First, a viral particle that is disabled from attacking the mother is disabled from attacking the fetus. Second, the varicella particles do not begin to cross the placental barrier and infect the fetus until four to six days after the mother's exposure, which is the primary viremia stage. Third, if VZIG is administered before this stage it will be able to attack the disease before the viral particles begin to spread to the fetus. Fourth, VZIG can cross the placental barrier to the fetus. Last, by crossing the placental barrier to the fetus, VZIG can provide a direct benefit to the fetus by attacking viral particles that did make it across the placental barrier. Balducci bases this reasoning on "the physiology of the way immune globulin works."
The defendants' expert, Dr. Charles Grose, takes the opposite position, although he acknowledges that it is theoretically possible for VZIG to prevent chicken pox in the fetus. According to Grose, it has never been scientifically demonstrated that VZIG can prevent chicken pox in the fetus.
Balducci is certified by the American Board of Obstetrics and Gynecology. He is the Chief of the Obstetrics Department and the division head of the Maternal Fetal Medicine Unit at Lehigh Valley Hospital in Pennsylvania. He has published numerous articles, including a study of outcomes after first trimester varicella infection.
To support his opinion, Balducci relies on his own experience and a study performed by a well-known researcher in the area, Dr. Gisela Enders.
Balducci's hospital serves an area 120 miles in radius and regularly treats pregnant women who have been exposed to chicken pox. Balducci personally treats as many as four to five women per month who have been exposed to the disease. He has treated or been involved in the treatment of about 150 women who received VZIG while they were pregnant. In his experience, none of these women gave birth to a baby showing signs of congenital varicella syndrome.
In addition, Balducci's hospital has been involved in the delivery of 12,000 to 14,000 babies. He is unaware from his direct clinical experience or from anecdotal...
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