Shortly after he was born in May 2013, an echocardiogram revealed that Antonio Ray Seals Jr. (Seals) had a number of medical complications. These included a patent foramen ovale (PFO) with a left to right shunt—a hole in Seals’s heart. Seals also had a congenital diaphragmatic hernia (CDH), which occurs when there is a defect in the diaphragm that allows the abdominal organs to move into the chest, limiting the space for the lungs and heart to develop.
Infants with CDH may require extracorporeal membrane oxygenation (ECMO) to allow their lungs to recover. ECMO is a circuit in which a portion of a patient’s blood is removed through a plastic tube—a “cannula”—that is placed in the patient’s right jugular vein. The patient’s blood flows through an ECMO oxygenator, which adds oxygen and removes carbon dioxide. The blood is then pumped back into the patient’s body through a cannula in the right carotid artery. One common risk of ECMO is that blood flowing through the circuit is prone to forming clots, which can break off, enter the patient’s bloodstream, and cause permanent injury. To prevent clots from developing and entering a patient’s bloodstream, ECMO circuits can be changed. And to reduce the risk of clotting, patients on ECMO can be treated with heparin, which simultaneously reduces the risk of clotting and increases the risk of bleeding.
While on ECMO, Seals was treated with heparin and the ECMO circuit was monitored for the development of clots. While Seals was on ECMO, he had been sedated. As Seals was weaned off the sedation medications, he began to show signs of neurologic injury. Doctors determined that Seals had suffered a stroke likely caused by a blood clot. Seals later developed “severe neurodevelopmental disabilities as a result of the stroke.”
Over nine years later, Seals—by and through his mother—brought an action for medical malpractice and negligent non-disclosure against the defendants. Seals claimed that the defendants were negligent in their care by failing to monitor the progressive clot and that, as a result of that alleged negligence, Seals had suffered a stroke. As for the negligent nondisclosure claim, Seals asserted that the defendants knew or should have known of the risks associated with their interventions vis-à-vis Seals’s medical conditions and should have disclosed those risks. Seals’s experts stated that the defendants’ failure to change out the circuit—thereby leaving the progressive clot in the circuit—was the cause of Seals’s stroke.
In granting respondents’ motion to exclude the opinions of Seals’s experts, the district court determined that, “[b]ecause [defendants] have identified several plausible alternative causes for [Seals’s] injury, which [Seals’s] experts have failed to rebut, [Seals’s] differential diagnosis methodology is inherently unreliable as a matter of law.”
The Minnesota Court of Appeals held in its nonprecedential opinion filed on July 14, 2025: “Because Seals’s experts did not “rule out all other hypotheses, or at least explain why the other conceivable causes [were] excludable, [the] differential diagnosis [was] not sufficiently reliable to be used for the purpose of proving causation,” id. at 695, and the district court acted within its discretion by excluding the causation opinions of Seals’s experts.”
Source Seals v. Childrens Health Care d/b/a Childrens Minnesota, A24-1772.
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