In its lengthy opinion issued on February 14, 2014, the Supreme Court of the State of Idaho (“Idaho Supreme Court”) discussed establishing causation in Idaho medical malpractice cases where there are several potential causes of symptoms and there is insufficient scientific basis to conclusively establish any one potential cause. In some medical malpractice cases, it may be appropriate to employ “differential diagnosis” analysis in establishing causation.
Where differential diagnosis analysis is appropriate to prove causation in medical malpractice cases, the expert first identifies all of the potential causes of symptoms and then engages in a process of eliminating hypotheses in order to reach a conclusion as to the most likely cause. When using differential diagnosis analysis, an expert’s testimony is excluded if the expert fails to offer an explanation why an alternative cause is ruled out. In the context of medical malpractice cases, the Idaho Supreme Court defined “diagnosis” as the determination of a medical condition (such as a disease) by physical examination or by study of its symptoms.
In the case that it was deciding, the plaintiff had suffered injuries due to MRSA and pseudomonas that she had acquired. The lower court had employed the differential diagnosis method of establishing causation and determined that expert medical testimony was necessary in order to establish how and where the plaintiff was infected with MRSA and pseudomonas. The lower court held that the plaintiff’s experts were required to rule out possible sources of the infection, other than the defendant’s care. The lower court determined that the plaintiff’s experts’ opinions were inadmissible because they did not address the other possible sources of the infections that were suggested by the defendant’s experts (e.g., the possibility that the plaintiff may have been a carrier of MRSA, the possibility that the culture of her left leg wound may have produced a false negative, or the other factors that could have been a substantial factor in causing the infections).
The Idaho Supreme Court vacated the lower court’s decision, holding that the lower court had erroneously employed differential diagnosis analysis in this case (“Where a specific cause of a patient’s symptoms can be stated to a reasonable medical certainty, there is no place for this alternate means of establishing causation”). The Idaho Supreme Court held that expert testimony can be of assistance to the trier of fact in establishing that a disease is infectious and how it might be spread or contracted; however, expert testimony is not necessary in determining how a particular person contracted the disease, which is largely a factual matter (“Once the experts have opined as to the potential sources of an infection, it does not take expert testimony to establish exactly how a particular person contracted a particular infection. Fact witnesses can provide the necessary details about sanitary conditions, contact by or with the infected person, wound care received by the infected person, and the like in order to fill in the details … the medical experts lay the groundwork for how these infections can spread. It is not necessary to have expert testimony to establish how the infections may actually have been acquired by a particular patient”).
The Idaho Supreme Court therefore held, “the district court erred here in holding that expert medical testimony was required in order to establish how and where [the plaintiff] was infected. This Court’s concept of the differential diagnosis methodology does not require such a holding.”
Source Judy Nield v. Pocatello Health Services, Inc., 2014 Opinion No. 20.
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