Pathologist Stopped Short of Offering Could-Have, Should-Have Opinions

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In personal injury and wrongful death cases, the plaintiff bears the burden of proving medical causation, which almost universally requires testimony from a competent expert.  Some plaintiffs offer testimony from forensic pathologists—also known as medical examiners, or physicians specializing in postmortem cause-of-death determinations—to prove causation.  These forensic pathologists (or the parties proffering their testimony) may push evidentiary boundaries with respect to opinions corollary to their cause of death determinations. While some courts have allowed juries to hear these questionable corollary opinions, relying on cross examination to level the playing field, others have excluded such testimony on the basis of insufficient qualifications or lack of reliable methodology.  Recently, the Southern District of Georgia excluded a forensic pathologist’s opinions on both grounds in a wrongful death action. Although not a product liability case, the court’s well-reasoned holding is sure to affect product cases going forward.

In Griffin v. Coffee County et al., 2022 WL 2045650 (S.D. Ga. June 7, 2022), a man in custody at a county jail in Georgia died from a methamphetamine overdose. His estate brought claims for deprivation of rights and medical malpractice against the jail, the hospital, and various individuals associated with those entities. In support of its claims, the estate proffered testimony from a forensic pathologist who offered opinions about medical treatment.

The defendants sought to exclude the pathologist’s opinion that the decedent would have survived the overdose had he been transported to the hospital when he first disclosed his methamphetamine consumption for lack of qualifications or reliable methodology. The pathologist had testified that the defendants’ failure to immediately transport the decedent to the hospital was the actual and proximate cause of his death. If the decedent made it to the hospital sooner, the pathologist opined, a physician would have initiated lifesaving treatment available in the emergency room.  The defendants argued that the pathologist, who conceded he would defer to others on treatment, was not qualified to opine on these issues. Moreover, he had no experience on which to base his opinions.

The estate responded that its pathologist’s testimony was admissible because he was well-credentialed, experienced and had testified as an expert in other matters. The estate also emphasized the consistency between the pathologist’s opinions and those of other physicians who had examined the medical records and literature.

The court granted the defendants’ motion to exclude. Although the pathologist was qualified to offer testimony on the decedent’s undisputed cause of death—including the indicators of methamphetamine toxicity and the mechanism by which it can cause death—based on his specialization in forensic pathology, his testimony exceeded his expertise in touching on what could have or should have been done to treat the decedent.

The court determined that the pathologist lacked sufficient qualifications to opine on the appropriate treatment for methamphetamine overdose or the effect of treatment on patient outcome. The court emphasized that the pathologist had never trained or practiced as an emergency room physician, nor had he treated a patient in an emergency room setting since the early 1980s. Moreover, the pathologist’s review of relevant medical literature could not make him qualified to offer these opinions. The court specifically rejected the estate’s consistency argument, explaining that such consistency had no bearing on an expert’s qualifications or methodology.  Accordingly, the court held that the pathologist was not qualified to offer opinions about treatment or the effect of treatment on the patient’s outcome.

Even putting aside the issue of qualifications, the court determined it was unreliable and speculative due to faulty methodology. The pathologist’s testimony was borne out of a review of medical literature and the application of his experience. Such testimony is only reliable if the proponent can demonstrate a sufficient connection between the experience and the testimony, and the estate’s pathologist could not make such a connection.

Because the forensic pathologist was not qualified to offer the disputed opinions, nor were the opinions reliable, the court excluded them. As the court aptly stated: “Whether [an expert] is qualified is a threshold question, and vigorous cross-examination is no substitute.”

This order reinforces that an expert’s qualifications and experience must specifically relate to the opinions offered. Put simply, general qualifications and a literature review are not enough.

About the Author: Adrienne Franco Busby

Adrienne Franco Busby puts science and strategy to work for companies facing product liability litigation. She is an experienced litigator in product liability, commercial, employment, class action and mass tort matters.

About the Author: Emily D. Steeb

Emily advises local, national and international product manufacturers on resolving complex disputes in and out of court at the state and federal levels. She focuses her practice on pharmaceuticals and medical devices, and she has represented manufacturers of orthopedic implants, pelvic mesh, laser therapy systems, inferior vena cava filters, and heater-cooler devices. Emily has supported these types of manufacturers in all phases of product liability litigation, from pre-suit negotiations through trial. Her experience includes strategic analysis; drafting written discovery and facilitating document production; expert witness procurement and development; taking and defending depositions of fact, expert and corporate witnesses; briefing dispositive and other pre-trial motions; oral argument; mediation; and settlement negotiations.