In its unreported opinion filed on May 20, 2019, the State of Minnesota Court of Appeals (“Minnesota Appellate Court”) overturned the jury’s $2.5 million verdict in favor of the plaintiff in her Minnesota medical malpractice case, holding that the plaintiff’s experts were unqualified to render medical opinions in her case because they lacked “the requisite occupational experience in neurology” and therefore “they were not qualified to testify on ADEM and PRES, or what caused them, creating a gap in [the plaintiff’s] chain of causation.”
The Underlying Facts
The defendant surgeon performed a total knee arthroplasty (TKA) on the plaintiff’s right knee in January 2012. Upon opening the knee joint, the defendant surgeon observed dark, cloudy fluid and necrotic (dead) tissue. The defendant surgeon suspected infection and ordered a Gram stain test and a culture. While he waited for the results of the Gram stain test, he disinfected and removed unhealthy tissue from the joint area.
The Gram stain test came back negative, indicating that the likelihood of infection was very low, so he continued with the surgery. Three days post-surgery, the defendant surgeon learned that the culture sent to the lab produced Methicillin-resistant Staphylococcus Aureus (MRSA), a type of staph infection. The defendant surgeon consulted with an infectious-disease specialist, who advised that the plaintiff be treated with a six-week intravenous administration of vancomycin, consisting of one dose every 12 hours.
On the first day of the plaintiff’s at-home monitoring, a blood test revealed that she had severely high vancomycin levels. She went to the hospital where she was diagnosed with vancomycin toxicity, acute renal failure, anemia, and MRSA. Her condition deteriorated and she began experiencing neurological symptoms, including seizures. She again went to the hospital, where she was diagnosed with acute disseminated encephalomyelitis (ADEM) occurring peri-infecticiously with MRSA. Subsequently, another neurologist diagnosed the plaintiff with posterior reversible encephalopathy syndrome (PRES). The plaintiff continues to suffer from significant neurological injuries affecting her vision, balance, memory, and cognition.
The parties to the plaintiff’s Minnesota medical malpractice lawsuit agreed that her MRSA infection existed prior to the TKA surgery. Because the plaintiff’s experts provided differing testimony as to her final neurological condition, the plaintiff argued two possible theories of causation: (1) relying on the initial ADEM diagnosis, the plaintiff claimed that the defendant surgeon caused her ADEM by continuing with the TKA surgery after discovering her infected knee joint, and this spread the MRSA infection into her bloodstream; or, alternatively (2) if the plaintiff had PRES, then the defendant surgeon caused it by prematurely discharging her from the hospital and failing to properly monitor her vancomycin treatment.
The Minnesota Appellate Court stated that Minn. R. Evid. 702 governs the admissibility of expert testimony and provides that “[i]f scientific, technical, or other specialized knowledge will assist the trier of fact to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training, or education, may testify thereto in the form of an opinion or otherwise.” The Minnesota Appellate Court stated that although education and professional training are important considerations, it is the “occupational experience” of a potential expert witness that is of “controlling importance” when determining qualification. An expert unfamiliar with a procedure cannot testify about it.
The Minnesota Appellate Court held that neither of the plaintiff’s two experts “has the requisite occupational experience in neurology, much less in ADEM or PRES. As a result, they were not qualified to testify on ADEM and PRES, or what caused them, creating a gap in [the plaintiff’s] chain of causation.” Therefore, the Minnesota Appellate Court reversed the jury’s verdict and remanded the case for a new trial.
The dissenting opinion stated, in part: “Neither expert is a neurologist. But not all of the alleged deviations from the standard medical care even require this specialized knowledge. Not the decision to proceed to surgery instead of using the less-invasive approach. Not the alleged premature discharge decision. And where the neurological diagnosis is important, these experts appropriately relied upon their general medical training, research and the opinions of specialists contained in the medical records. These facts further support the district court’s expert admissibility decision … Given this deference to the district court and the impressive credentials and wide range of experiences of these physicians, I conclude the district court did not abuse its discretion in allowing [the plaintiff’s experts] to testify as medical experts on causation … [The plaintiff] alleged three deviations from the standard of care by [the defendant surgeon]. Linking only one of them to [the plaintiff’s] brain damage supports the verdict on causation. And each link in the causal connection need not be explicitly tied to the words of an expert. Rather, if expert testimony “reasonably implie[s]” the necessary chain of causation, the jury verdict stands.”
Source Marquardt vs. Schaffhausen, A18-0968.
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