Case Title: Sturgis v. Bayside Health

Citation: 

Docket Number: 146, 2007

State: delaware

Court: Delaware Supreme Court

Date: 2007-12-26T00:00:00Z

Document:
IN THE SUPREME COURT OF THE STATE OF DELAWARE 
SHAKIYA STURGIS a/n/f of  
) 
DARNAYA STURGIS,  
 
)  No. 146, 2007 
 
 
 
 
 
 
) 
 
 
Plaintiff Below, 
 
)  Court Below:  Superior Court 
 
 
Appellant,  
 
)  of the State of Delaware in 
 
 
 
 
 
 
)  and for New Castle County 
v. 
 
 
 
 
 
) 
 
 
 
 
 
 
)  C.A. No. 04C-06-139 
BAYSIDE HEALTH 
 
 
) 
ASSOCIATION CHARTERD and 
) 
MACKIE BANKS, C.N.M., 
 
) 
 
 
 
 
 
 
) 
 
 
Defendants Below, 
 
) 
 
 
Appellees.  
 
) 
 
Submitted:  November 14, 2007 
Decided:  December 26, 2007 
 
Before STEELE, Chief Justice, HOLLAND and RIDGELY, Justices. 
 
 
Upon appeal from the Superior Court.  AFFIRMED. 
 
 
Kenneth M. Roseman, Kenneth Roseman, P.A., Wilmington, Delaware, for 
plaintiff below appellant. 
 
 
Mason E. Turner, Jr., Prickett, Jones & Elliott, Wilmington, Delaware, for 
defendant below Bayside Health Association Chartered. 
 
 
Gilbert F. Shelsby, Jr., Shelsby & Leoni P.A., Stanton, Delaware for 
defendant below Mackie Banks, C.N.M. 
 
 
STEELE, Chief Justice: 
 
 
 
 
2
 
Shakiya Sturgis, as next friend of Darnaya Sturgis, appellant, alleged that 
nurse-midwife, appellee Mackie Banks,1 along with other non-party assistants 
negligently delivered and injured Darnaya with excess traction (i.e. pulling on the 
baby’s head) in January 2002.  After a jury trial, the jury found for the defendants.  
Sturgis’s appeal focuses on two pretrial rulings on two motions in limine by Sturgis 
and by the defendants.  In the first motion, Sturgis asked the trial judge to bar the 
defendants’ expert from testifying that Darnaya’s injury could have occurred under 
three circumstances – in utero, in the birth canal, and by excess traction.  The trial 
judge ruled that the defense expert could testify that two reasonably certain causes 
of Darnaya’s injury existed—in utero and by excess traction.  Based on that ruling 
by the trial judge, Sturgis’s expert then sought to opine that in utero and by excess 
traction were the only two possible causes of Darnaya’s injury.  In the second 
motion in limine, the defendants moved to bar Sturgis’s expert from testifying that 
they were the only two possible causes.  The defendants argued that other, 
unknown, causes of Darnaya’s injury were possible.  The trial judge ruled that, 
even though only two reasonably certain causes exist for expert testimony 
purposes, other less certain and potential causes of Darnaya’s did exist.  Thus, the 
trial judge barred Sturgis’s expert from testifying that in utero and excess traction 
were the only two possible causes of Darnaya’s injury.   
                                                 
1  
Bayside Health Assc. was also included as a defendant and is included in this appeal. 
 
3
Sturgis argues on appeal that the trial judge improperly limited her expert’s 
testimony about the only two possible causes of Darnaya’s injury.  However, 
Sturgis never introduced any scientific evidence that supported her expert’s 
opinion that in utero and the use of excess traction were the only two causes.  
Sturgis cannot simply rely on the trial judge’s ruling that limited the defendants’ 
expert testimony.  In order for her expert to testify that there are only two possible 
causes of Darnaya’s injury, that expert must have proffered reliable verifiable 
scientific evidence supporting the claim that in utero and the use of excess traction 
were the only two possible causes of her injury.  In the absence of any evidence 
supporting that theory, the trial judge properly excluded Sturgis’s expert’s 
testimony.  Therefore, we AFFIRM. 
FACTS 
Shakiya gave birth to Darnaya in January 2002.  During delivery, some 
unexpected complications arose.  As nurse-midwife Banks attempted to deliver 
Darnaya, Banks discovered that one of Darnaya’s shoulders lodged against her 
mother’s pubic bone, a complication known as shoulder dystocia.  This rare 
complication jeopardized Darnaya’s life.  If Banks did not deliver Darnaya within 
five to seven minutes, Darnaya would be deprived of oxygen for a long enough 
period of time to damage her vital organs. 
 
4
 
Although Banks needed to act quickly, she still needed to proceed with great 
care.  In order to free Darnaya for delivery, Banks needed to ensure that she did not 
apply undue force, known as excess traction, on Darnaya’s head.  If the nurse-
midwife applied excess traction, she might separate the nerves in Darnaya’s 
shoulder and cause a brachial plexus injury.  A brachial plexus injury could 
potentially limit Darnaya’s use of her arm for the rest of her life.  
 
To reduce excess traction, obstetricians have developed a number of 
procedures to dislodge the baby from the pubic bone for delivery and to minimize 
the likelihood of a brachial plexus injury.  According to the medical literature, 
when the nurse-midwife discovers shoulder dystocia, she could apply suprapubic 
pressure, i.e. push above the mother’s pubic bone, in an attempt to dislodge the 
baby without pulling on her head.  The nurse-midwife might follow that by 
performing the McRoberts maneuver, where, with the help of an assistant, the 
nurse-midwife positions the mother’s legs to maximize the potential opening for 
the baby to pass through.  Finally, the nurse-midwife could apply the Woods 
corkscrew maneuver to reposition the baby and potentially free her for delivery.  
These procedures attempt to eliminate excessive traction or pressure on the baby’s 
head and limit the possibility of a brachial plexus injury. 
 
After Darnaya’s delivery, her mother, Shakiya, discovered that Darnaya had 
suffered a brachial plexus injury.   Shakiya, as next friend of Darnaya, sued the 
 
5
hospital and Brown and alleged that Brown had negligently breached her duty of 
care by applying excess traction on Darnaya’s head during delivery. 
 
Both plaintiff and defendants sought to introduce expert testimony on the 
delivery of Darnaya and brachial plexus injuries.   
 
The defendants’ expert, Dr. Johnson, sought to opine that brachial plexus 
injuries could occur under three circumstances.  Dr. Johnson, in her deposition, 
testified that brachial plexus injuries could occur (1) in utero, (2) during the 
descent through the birth canal, or (3) during delivery.  Dr. Johnson also testified at 
her deposition that she ruled out any possibility of an in utero brachial plexus 
injury in this case.  Darnaya’s attorney filed a motion in limine to preclude Dr. 
Johnson from testifying at trial that brachial plexus injuries could occur during the 
descent through the birth canal. 
 
The plaintiff’s expert witness, Dr. Mollick, sought to testify that only two 
possible cause of brachial plexus injuries exist, (1) in utero and (2) as a result of 
excess traction during delivery.  Further, the plaintiff wanted Dr. Mollick to testify, 
based on Dr. Johnson’s finding that the injury did not occur in utero, that the 
brachial plexus injury must have been the result of excess traction applied by 
Banks during delivery.    
 
The trial judge considered the motion and ruled that: 
With regard to Dr. Johnson, who is the Defendant’s expert, I find the 
theory that the injury might have occurred in the birth canal is indeed 
 
6
a possibility.  It’s not a theory which can be expressed to a reasonable 
degree of medical probability, at least not at this time, and therefore, 
that opinion does not comply with Daubert.  I do, however, think that 
Dr. Johnson can testify that there was no excess traction, and she can 
state the basis for her opinion. 
 
The trial judge also ruled: 
My ruling with regard to Dr. Mollick is that he may testify as to why 
he believes there has been medical negligence and that must be based 
on what happened or did not happen, whether there were certain 
maneuvers that were properly performed or other maneuvers which 
perhaps should not [sic] have been performed.  I am not going to 
permit him to opine that it either must be an in-utero opinion [sic] or it 
must be excess traction.  I don’t think that’s supported by current 
literature, and he certainly didn’t support that unequivocally in the 
literature based upon Mr. Roseman’s representation.  The current 
literature is somewhat equivocal on that.  And I don’t think he needs 
to express that opinion in order for a plaintiff to establish a prima 
facia case.  
 
 
At trial, Dr. Johnson testified that Brown performed all of the appropriate 
maneuvers and opined that even when all of the techniques are applied correctly 
during delivery “[i]t is that the squeeze can just be too tight for the baby, and 
there’s, you know, with all the caution in the world, you can’t always avoid that[, 
i.e. a brachial plexus injury.]”   
 
Dr. Mollick testified that Brown did not attempt the correct delivery 
procedures, that she violated the applicable professional standard of care, and that 
her negligence caused Darnaya’s brachial plexus injury.  On cross-examination, 
Dr. Mollick testified that he believed that a brachial plexus injury could only occur 
 
7
as a result of excess traction.  The jury deliberated and returned a verdict for the 
defendants. 
 
After the jury verdict, Sturgis filed a Motion for a New Trial asserting that 
the trial judge should have admitted Dr. Mollick’s testimony that excess traction 
was the only possible cause of Darnaya’s injury.  The trial judge denied that 
motion based on her pre-trial ruling.  Sturgis appeals the trial judge’s rulings.  
DISCUSSION 
We review a trial judge’s decision to exclude expert testimony for abuse of 
discretion.2  “This deferential standard of review is simply a recognition that trial 
judges perform an important gatekeeping function and, thus, ‘must have 
considerable leeway in deciding in a particular case how to go about determining 
whether particular expert testimony is reliable’”3 
 
Delaware Rule of Evidence 702 governs the admissibility of expert 
testimony.  D.R.E. 702 provides: 
[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, if (1) the testimony is based upon sufficient facts or data, 
(2) the testimony is the product of reliable principles and methods, 
                                                 
2  
M.G. Bancorporation v. Le Beau, 737 A.2d 513, 522 (Del. 1999) (citing General Electric 
Co. v. Joiner, 522 U.S. 136, 141–42 (1997)). 
 
3  
Garden v. State, 815 A.2d 327, 338 (Del. 2003), superseded by statute on other grounds, 
11 Del. C. § 4209(d) (2003), as recognized in Starling v. State, 882 A.2d 747 (Del. 2005), 
quoting (Kumho Tire Co., Ltd. v. Carmichael, 526 U.S. 137, 152 (1999)) 
 
8
and (3) the witness has applied the principles and methods reliably to 
the facts of the case.  
 
Because of substantial similarities between D.R.E. 702 and Federal Rule of 
Evidence 702, we have chosen to follow the United States Supreme Court’s 
decision in Daubert v. Merrell Dow Pharmaceuticals, Inc.4  
 
As a gatekeeper, the trial judge must assess an expert’s testimony to 
determine whether his testimony “has a reliable basis in the knowledge and 
experience of [the relevant] discipline.”5  In Daubert, the United States 
Supreme Court identified four factors that the trial judge, as gatekeeper, may 
consider to determine, under F.R.E. 702 and thus D.R.E. 702,  whether the 
“principles and methodology” underlying the expert’s testimony have a basis 
“rooted in science and derived from the scientific method.”6   Those four 
factors include: 
(1) whether a theory or technique has been tested, 
(2) whether it has been subjected to peer review and publication 
(3) whether a technique had a high known or potential rate of error 
and whether there are standards controlling its operation, and 
(4) whether the theory or technique enjoys acceptance within a 
relevant scientific community.7 
                                                 
4  
509 U.S. 579 (1993). 
 
5  
Le Beau, 737 A.2d at 523.  
 
6  
Daubert, 509 U.S. at 595; Bowen v. E.I. DuPont de Nemours & Co., Inc., 906 A.2d 787, 
795 (Del. 2006). 
 
7  
Id. 
 
 
9
 
We, based on the D.R.E., require, in addition to Daubert, a five-step 
test to determine the admissibility of scientific or technical expert testimony.  
Before admitting expert testimony, the trial judge must determine that: 
(1) the witness is qualified as an expert by knowledge, skill, 
experience, training, or education, 
(2) the evidence is relevant, 
(3) the expert’s opinion is based upon information reasonably relied 
upon by experts in the particular field,  
(4) the expert testimony will assist the trier of fact to understand the 
evidence or determine a material fact in issue, and 
(5) the expert testimony will not create unfair prejudice or confuse or 
mislead the jury.8 
 
“The party seeking to introduce the expert testimony bears the burden of 
establishing its admissibility by a preponderance of the evidence.”9 
 
In order to determine the admissibility of Dr. Mollick’s opinion, we 
will first describe, in detail, the different testimony that the parties proffered 
about the causes of brachial plexus injuries and the trial judge’s ruling on 
that testimony.  Sturgis attempts to base her appeal on an inconsistency in 
the trial judge’s decisions on both motions in limine.  As we illustrate below, 
the trial judge’s decisions are entirely consistent. 
                                                 
8  
Tolson v. State, 900 A.2d 639, 645 (Del. 2006); Eskin v. Carden, 842 A.2d 1222, 1227 
(Del. 2004). 
 
9  
Bowen, 906 A.2d at 795 (string citations omitted).  
 
10
1. 
Dr. Johnson’s Expert Testimony 
 
Dr. Johnson initially sought to opine that three potential known causes 
of brachial plexus injuries exist.  The diagram below helps explain Dr. 
Johnson’s deposition testimony and proposed trial testimony. In the diagram, 
the large circle represents the universe of possible brachial plexus injuries.  
The smaller circles identify the specific causes about which Dr. Johnson 
sought to testify.  The individual circles do not represent the entire area of 
the large circle because Dr. Johnson only sought to testify about known 
causes of brachial plexus injuries and left open the possibility for other 
potential unknown causes.  Any area in the large circle not encompassed by 
a smaller circle represents an unknown cause of brachial plexus injuries. 
Causes of Brachial Plexus Injuries 
 
11
 
2. 
Dr. Mollick’s Expert Testimony 
Alternatively, Dr. Mollick sought to testify that only two possible 
causes of brachial plexus injuries exist.  Because Dr. Johnson ruled out any 
possibility of an in utero injury, Sturgis argues that the brachial plexus injury 
must be a result of excess traction.  In the diagram below, Dr. Mollick’s two 
causes represent the entire circle of causes of brachial plexus injuries 
because he sought to opine that these were the only two possible causes. 
Causes of Brachial Plexus Injuries 
 
 
 
 
 
Unknown  
 
 
In Utero 
During 
descent 
through birth 
canal 
 
Excess 
traction at 
birth 
 
12
 
 
3. 
The Trial Judge’s Ruling on Expert Testimony 
In her rulings on the two motions in limine, the trial judge found that 
neither experts’ testimony, in its entirety, met the Daubert standards.  The 
trial judge decided that Dr. Johnson could not testify that brachial plexus 
injuries could occur on the descent through the birth canal.  Although the 
trial judge believed that the descent through the birth canal could cause a 
brachial plexus injuries, she excluded Dr. Johnson’s testimony as a 
recognized cause of brachial plexus injuries because it was not sufficiently 
supported by the medical literature.  The trial judge also excluded part of Dr. 
Mollick’s testimony.  The trial judge reasoned that Dr. Mollick could not 
 
 
 
 
In Utero 
Excess 
traction at 
birth 
 
 
13
testify that the only two possible causes of brachial plexus injuries were (1) 
in utero and (2) as a result of excess traction because descent through the 
birth canal could potentially cause the injury.  The trial judge found that the 
medical literature simply did not support Dr. Mollick’s conclusion.10   
Under the trial judge’s ruling, Dr. Mollick could testify that two 
recognized, but non-exclusive, causes of brachial plexus injuries exist.  
Thus, Dr. Mollick could not opine that excess traction must have caused the 
injury based on Dr. Johnson’s admission that the injury did not occur in 
utero.  Nevertheless, the trial judge did permit Dr. Mollick to opine that 
Brown failed to perform all of the appropriate maneuvers to avoid the injury; 
breached the applicable standard of care; and, thus caused Darnaya’s 
brachial plexus injury by using “excess traction.”  Alternatively, she allowed 
Dr. Johnson to testify that Brown did execute the correct maneuvers, acted 
consistently with the applicable standard of care and that, even when one 
flawlessly performed the appropriate maneuvers, a brachial plexus injury 
might still result.   
The final diagram below helps illustrate the trial judge’s ruling.  In the 
diagram, the excess traction circle and the in utero circle do not cover the 
                                                 
10  
Of the two possible causes for the brachial plexus injury, Dr. Johnson had already 
excluded in utero injury and, thus, excess traction would have remained as the only potential 
cause of Darnaya’s injury. 
 
14
entire area of the large circle, which represents the universe of potential 
causes, because the trial judge ruled that other possible causes of brachial 
plexus injuries, including the descent through the birth canal and other 
unknown reasons, exist. 
Causes of Brachial Plexus Injuries 
 
 
4. 
The Trial Judge Did Not Abuse Her Discretion 
On appeal, Sturgis asserts that the trial judge should have permitted 
Dr. Mollick’s testimony that only two possible causes of brachial plexus 
injuries exist.  However, Sturgis fails to point to any scientific basis for that 
position.  In the absence of any reliable scientific basis to support that 
testimony, D.R.E. 702 and Daubert required the trial judge to limit Dr. 
 
 
 
 
 
 
 
 
 
 
Unknown  
 
 
In Utero 
 
 
Excess 
Traction 
 
15
Mollick’s testimony.  Sturgis, as the party seeking admission of that expert 
testimony, bears the burden to establish that the expert’s testimony meets the 
strictures of Delaware law.11   
Sturgis did not sustain the burden of proving the cause of the injury.12  
Dr. Mollick testified that, in his opinion, Brown violated the applicable 
standard of care, used excess traction and thereby caused the injury.  In stark 
contrast to Dr. Mollick’s testimony, Dr. Johnson testified that Brown acted 
diligently and within the applicable standard of care and that for some 
unknown reason, despite Brown meeting the standard of care, Darnaya still 
suffered a brachial plexus injury.  Based on Dr. Johnson’s testimony, the 
jury could find that Brown did meet the standard of care and that nothing 
Brown did or failed to do proximately caused Darnaya’s injury.   
Sturgis’ contention here is that any brachial plexus injury not caused 
in utero must therefore be a result of excess traction, thus obviating her 
burden to establish causation, and shifted the burden to the defendants to 
establish any alternative cause.  However, Sturgis introduced no scientific 
evidence to support that proposition.  Instead, Sturgis wants us to draw the 
inference from the trial judge’s ruling – which barred Dr. Johnson from 
                                                 
11  
See Bowen, 906 A.2d at 795. 
 
12  
Frio v. Du Pont Hosp. for Children, 816 A.2d 784, 786 (Del. 2003); see 18 Del. C. § 
6853. 
 
16
testifying that the injury could have occurred during descent – that the only 
two remaining possible causes of brachial plexus injuries were in utero and 
from excess traction at delivery.  Since Dr. Johnson opined that the injury 
did not occur in utero, then “by default,” excess traction is “the last man 
standing.”  In effect, despite Dr. Johnson’s conflicting opinion, Sturgis 
would have us conclude that Dr. Mollick’s opinion should be controlling and 
should be admitted.  To the contrary, both experts’ opinions were properly 
and fairly constrained and the jury chose which opinion to believe.  The jury 
heard Dr. Johnson’s opinion that Banks did not violate the standard of care 
and that injuries of the kind Darnaya suffered occured without negligence.  
The jury chose to believe that testimony rather than Dr. Mollick’s.   
The trial judge specifically ruled that more than two possible causes 
exist but only two of causes meet the criteria under Daubert to support 
expert testimony that they resulted in Darnaya’s injuries.  Through our 
diagrams above, we show that the trial judge’s decisions are entirely 
consistent.   
As the gatekeeper, the trial judge sits in the best position to decide 
whether an expert’s testimony should be admitted.  Sturgis provides no 
evidence that supports an inference that brachial plexus injuries can only 
occur in utero or as a result of excess traction at birth.  In order for Dr. 
 
17
Mollick’s testimony to be admitted, D.R.E. 702 requires that the expert’s 
“testimony is based upon sufficient facts or data, the testimony is the product 
of reliable principles and methods, and the witness has applied the principles 
and methods reliably to the facts of the case.”  Without an articulable reason 
explaining why, based on scientific literature in the record, the trial judge 
erred in excluding expert testimony, we must, on appeal, defer to the 
expertise of the trial judge as gatekeeper.  Accordingly, the trial judge 
appropriately barred Dr. Mollick from testifying that excess traction could 
be the only cause of the brachial plexus injury. 
 
18
CONCLUSION 
 
Now, therefore, it is ordered that the judgment of the Superior Court is 
AFFIRMED.