Case Title: Bunting v. Jamieson

Citation: 

Docket Number: 

State: wyoming

Court: Wyoming Supreme Court

Date: 1999-07-16T00:00:00Z

Document:
Bunting v. Jamieson1999 WY 105984 P.2d 467Case Number: 98-287Decided: 07/16/1999Supreme Court of Wyoming

MARY 
LOU BUNTING and NICHOLAS BUNTING, as guardians and natural) parents of Raef A. 
Bunting, a minor, MARY LOU BUNTING and NICHOLAS BUNTING, Petitioners

v.

 

CHARLES JAMIESON, M. D., 
Respondent.

 

                                  

Original Proceeding Petition 
for Writ of Review.

   

 P. Richard Meyer of Meyer and Williams, Jackson, WY. 
Argument by Mr. Meyer, representing petitioners.

 Robert M. Shively and Amy M. Taheri of Shively Law 
Offices, Casper, WY, Argument by Ms. Taheri, representing 
respondent.

 Donald I. Schultz of Holland & Hart, Cheyenne, 
WY, Defense Trial Counsel representing Amicus Curiae 
.

 

     Before LEHMAN, 
C.J., and THOMAS, MACY, GOLDEN, and HILL, JJ.

 

     HILL, 
Justice.

    
[¶1]     Petitioners, the Buntings, filed a 
medical malpractice action on behalf of themselves and their son, Raef. They 
claim the Respondent's failure to timely refer Raef to a genetic specialist 
delayed a proper diagnosis of Hurler Syndrome. Petitioners allege the delay 
caused a permanent and substantial deterioration in Raef's prognosis. After taking the deposition of the 
Appellant's expert, Respondent Dr. Jamieson filed a motion in limine to preclude 
the expert's testimony. Respondent contends the opinion is not reliable and, 
therefore, inadmissible under Rule 702 of the Wyoming Rules of Evidence. After 
hearing argument by counsel, the district court granted Respondent's motion, 
thereby excluding Petitioners' only proffered causation witness. We granted a 
writ of review, and here adopt the approach propounded by the United States 
Supreme Court in Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 113 S. Ct. 2786, 125 L. Ed. 2d 469 (1993) and its progeny. We find the district court 
abused its discretion, however, in its application of Daubert, and remand this 
case for a proper analysis.

 

                                
ISSUES

 

   [¶2]     Petitioners present the following issue 
for review:

 

1. In a case where treating physicians and scientists 
are unanimous that early treatment produces better outcomes, was it proper for 
the trial court to exclude the opinion of the Plaintiff's treating physician 
concerning Plaintiff's improvement if earlier treatment had been 
rendered?

 

2. Where Plaintiff's treating physician and 
preeminent expert on the disease from which Plaintiff is suffering testified 
that he would have been improved through an earlier diagnosis and treatment, was 
it proper for the trial court to prevent him from testifying to his opinion 
because quantification of the degree of improvement is subject to 
dispute?

 

3. Do Rule 702 or Daubert criteria apply to exclude 
the opinions of treating physicians who are applying medical knowledge which is 
within their expertise?

 

4. Was it proper for the trial court to make factual 
findings in the nature of summary judgment findings in ruling upon a motion in 
limine, when there were no facts presented to the court which would have 
justified them?

 

   Respondent proposes a single 
issue:

 

Did the Honorable Hunter Patrick of the Fifth 
Judicial District abuse his discretion in ruling that plaintiffs' expert's 
causation testimony did not meet the requirements for admissibility of expert 
testimony?

 

   Amicus Wyoming Association of 
Defense Trial Counsel phrase the issues as follows:

   

A. Should the district court's order excluding expert 
opinion testimony be reviewed under an abuse of discretion 
standard?

 

B. Should the proffered medical expert opinions be 
scrutinized under the standards of Daubert v. Merrell Dow Pharmaceuticals, Inc., 
113 S. Ct. 2786 (1993)?

 

C. Given questions raised about reliability of the 
medical expert's conclusions, was it an abuse of discretion for the district 
court to exclude opinions as to how much better off this plaintiff would likely 
have been, assuming an earlier bone marrow transplant?

 

D. Did the district court act within its discretion, 
given the lack of foundation, when it excluded the opinion that this plaintiff 
would have been better off with an earlier bone marrow 
transplant?

 

                                 
FACTS

 

   [¶3]     This case centers on the effect of a 
delayed diagnosis of Hurler Syndrome. The incidence of Hurler Syndrome is 
approximately 1 in 100,000 and is one of about 30 diseases known as "storage 
diseases." Although the infant appears normal at birth, the child lacks the 
ability to produce a specific enzyme, a-L-iduronidase. In the absence of this enzyme, 
deposits of glycosaminglycan accumulate in the body's organs and skeletal 
system, impeding their function. Eventually, the accumulation produces skeletal 
deformities, cardiac problems, neurological dysfunction, mental retardation, 
hearing loss, and corneal opacification. Untreated, the disease causes death at 
a median age of 5 years, and children rarely survive beyond ten 
years.

 

   [¶4]     Hurler Syndrome occurs only when both a 
child's mother and father are genetic carriers. A person who is a carrier 
produces about half the amount of the enzyme that a non-carrier produces, while 
the person afflicted with the disease produces none. Raef's mother, father, and 
younger sister are carriers who produce about 50% of the normal production of 
the enzyme. 

 

[¶5]      The accepted 
treatment for Hurler Syndrome is a bone marrow transplant.  Although always a risky procedure, the 
relative complications and outcome depend in large part on the origin of the 
donor. There are three possibilities: (1) a donor with identical human 
lymphocyte histocompatibility (HLA-identical); (2) a donor related to the 
patient who is HLA similar; and (3) a donor unrelated to the patient who is HLA 
similar. The object of the bone marrow transplant is to provide the recipient 
with a new blood system containing the capability of producing the absent 
enzyme. The transferred capability is roughly equivalent to the production found 
in the donor. Thus, a successful bone marrow transplant from a carrier donor 
(heterozygous donor) would provide the capability to produce about 50% of normal 
levels of production, while a successful transplant from a noncarrier donor 
(homozygous donor) would theoretically allow 100% production.  Research indicates that the blood marrow 
transplant, if successfully engrafted without major complications, will halt the 
usual progression of the disease and may, in some cases, improve the recipient's 
condition. Prior to a bone marrow transplant, the recipient is provided 
preparatory treatment, including chemotherapy, to enhance the chances of 
successful engraftment and reduce the risks associated with the procedure. This 
involves a period of approximately 14 weeks from diagnosis to transplant for 
recipients of unrelated donors. Some of the serious risks to the recipient are 
surgical trauma, post-surgical pneumonia, and graft versus host disease (GVHD). 
These risks are more common when the donor is not 
HLAidentical.

 

   [¶6]     Raef Bunting was born on February 28, 
1994. As his physician, Dr. Jamieson treated Raef for continuous medical 
problems, and on June 27, 1996, Dr. Jamieson wrote a letter referring Raef to a 
geneticist for evaluation. A genetic counselor from Shodair Hospital in Montana 
diagnosed Raef as having Hurler Syndrome.  
Following his diagnosis, Raef was transferred to the care of Dr. Krivit 
at the University of Minnesota Medical School for a bone marrow transplant. At 
that time, it was discovered that Raef's then nine-month-old sister, born when 
Raef was 21 months old, was a compatible carrier donor. Dr. Krivit performed a 
bone marrow transplant from Raef's sister in September 1996.  The transplant has successfully 
engrafted, and Raef now produces approximately 50% of the 
enzyme.

 

   [¶7]     Petitioners filed suit against Dr. 
Jamieson on January 9, 1997, claiming that Respondent's untimely referral 
significantly compromised Raef's recovery ability. They offered Dr. Krivit's 
expert testimony to establish that, had Raef received a transplant following an 
accurate diagnosis at approximately 12 months, rather than allowing the disease 
to progress until he received his transplant at 31 months old, Raef would have 
higher intelligence and fewer physical problems in the future. Dr. Jamieson 
objected to this testimony, claiming Dr. Krivit's opinion was based on a program 
experimental in nature, that it lacked scientific foundation, and it 
contradicted his own published statements and research. After hearing the motion 
on June 15, 1998, the district court held Dr. Krivit's testimony inadmissible. 
We granted a petition for writ of review of the district court's order.

 

                          
STANDARD OF REVIEW

 

   [¶8]   Petitioners contend that the 
standard of review should be akin to that of summary judgment, since the trial 
court made findings of fact which disposed of the case. This is similar to the 
"hard look" approach formerly utilized in some federal jurisdictions where the 
exclusion of expert testimony was dispositive. In re Paoli, 35 F.3d 717, 733 (3rd Cir. 1994). This 
approach, however, has been rejected by the United States Supreme Court in 
General Electric Company v. Joiner, 522 U.S. 136, 118 S. Ct. 512, 517 
(1997).

 

   [¶9]     The standard when reviewing the 
application of Daubert was recently clarified by the United States Supreme 
Court:

 

The trial court must have the same kind of latitude 
in deciding how to test an expert's reliability, and to decide whether or when 
special briefing or other proceedings are needed to investigate reliability, as 
it enjoys when it decides whether or not that expert's relevant testimony is 
reliable. Our opinion in Joiner [General Electric Co. v. Joiner, 522 U.S. 136 
(1997)] makes clear that a court of appeals is to apply an abuse-of-discretion 
standard when it "review[s] a trial court's decision to admit or exclude expert 
testimony." 522 U.S.  at 138-39, 115 S. Ct. 512. That standard applies as much to 
the trial court's decisions about how to determine reliability as to its 
ultimate conclusion. . . . Thus, whether Daubert's specific factors are, or are 
not, reasonable measures of reliability in a particular case is a matter that 
the law grants the trial judge broad latitude to 
determine.

 

Kumho Tire Company, Ltd. v. 
Carmichael, 526 U.S. 137, 119 S. Ct. 1167, 1176, 143 L. Ed. 2d 238 (1999). "In 
determining whether there has been an abuse of discretion, the ultimate issue is 
whether or not the court could reasonably conclude as it did." Campbell v. 
Studer, 970 P.2d 389, 392 (Wyo. 1998).

 

"`[D]ecisions of the trial court with respect to the 
admissibility of evidence are entitled to considerable deference and, as long as 
there exists a legitimate basis for the trial court's ruling, that ruling will 
not be reversed on appeal.'" It is also 
well established that a district court judgment may be affirmed on any proper 
legal grounds supported by the record. However, where the law imposes a duty on 
the district court to make findings on the record, we will not speculate as to 
the reasons for the decision.

 

   
English v. State, 982 P.2d 139, 143 (Wyo. 1999) (internal citations 
omitted).

 

                              
DISCUSSION

 

   [¶10]  The trial court correctly anticipated 
our adoption of the analysis set forth in Daubert supra, to a trial judge's 
determination to admit or exclude expert testimony. The admissibility of expert 
testimony is derived directly from W.R.E. 702, which 
states:

 

If 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.

   

   Our traditional analysis is found 
in Springfield v. State, 860 P.2d 435, 443 (Wyo. 1993), where we 
stated:

 

[I]n ruling upon the offer of such evidence in 
Wyoming, our trial courts need only be concerned with the requisite foundation. 
Because it does appear the possibility of an erroneous result is more likely to 
arise from the testing techniques than from the procedure, it is important for 
the trial court to be satisfied about the manner in which the testing was 
performed, and the qualifications of the individual who accomplished the 
scientific technique.

 

(Quoting Rivera v. State, 
840 P.2d 933, 942 (Wyo. 1992)). We noted that our approach parallels the United 
States Supreme Court's decision in Daubert, and reiterated several of the 
"general observations" listed by that Court to be considered by the trial court. 
Id. We now expressly adopt the analysis provided by Daubert and its progeny as 
guidance for the Wyoming courts' determination whether to admit or exclude 
expert testimony. In doing so, however, we do not abandon our own precedent 
regarding the admissibility of expert testimony, but as in Springfield, supra, 
find the case law of the several jurisdictions essentially compatible on this 
subject.

 

   [¶11]  Petitioners maintain that even if 
Daubert is the analysis used in Wyoming, it is not applicable to the opinions of 
a treating physician based on medical knowledge within the physician's specific 
area of expertise. Again, this contention has been rejected. In Kuhmo, supra, 
the United States Supreme Court stated:

 

We conclude that Daubert's general holding - setting 
forth the trial judge's general "gatekeeping" obligation  applies not only to 
testimony based on "scientific" knowledge, but also to testimony based on 
"technical" and "other specialized" knowledge. See Fed. Rule Evid. 702. We also 
conclude that a trial court may consider one or more of the more specific 
factors that Daubert mentioned when doing so will help determine that 
testimony's reliability. But, as the Court stated in Daubert, the test of 
reliability is "flexible," and Daubert's list of specific factors neither 
necessarily nor exclusively applies to all experts or in every case.  Rather, the law grants a district court 
the same broad latitude when it decides how to determine reliability as it 
enjoys in respect to its ultimate reliability 
determination.

 

   
Kumho, 119 S. Ct.  at 1171.

 

   [¶12]  The primary goal of Daubert's 
gatekeeping requirement "is to ensure the reliability and relevancy of expert 
testimony. It is to make certain that an expert, whether basing testimony upon 
professional studies or personal experience, employs in the courtroom the same 
level of intellectual rigor that characterizes the practice of an expert in the relevant field." 
Black v. Food Lion, Inc., 171 F.3d 308, 311 (5th Cir. 1999); Kumho, 119 S. Ct.  at 
1176.

 

   [¶13]  In Daubert, the Supreme Court provided an 
analysis consisting of a two-part test. First, the district court must determine 
whether the methodology or technique used by the expert to reach his conclusions 
is reliable. If so, the court must determine whether the proposed testimony 
"fits" the facts of the particular case. Daubert, 509 U.S. at 592-93; Kennedy v. 
Collagen Corporation, 161 F.3d 1226, 1227-28 (9th Cir. 
1998).

 

    [¶14] It is important to 
note, however, that Daubert recognized "[v]igorous cross-examination, 
presentation of contrary evidence, and careful instruction on the burden of 
proof are the traditional and appropriate means of attacking shaky but 
admissible evidence." Daubert, 509 U.S.  at 596. As one court has 
stated:

 

Clearly, the Court envisioned cases in which expert 
testimony meets the Daubert standard yet is "shaky," and cases in which 
admissible expert testimony provides only a "scintilla" of support for a claim 
or defense. Put differently, an expert opinion must be based on reliable 
methodology and must reliably flow from that methodology and the facts at issue 
- but it need not be so persuasive as to meet a party's burden of proof or even 
necessarily its burden of production.

 

Heller v. Shaw Industries, 
Inc., 167 F.3d 146, 152 (3rd Cir. 1999). Thus, while the burden is on the party 
offering the testimony to show that the testimony is admissible, Graham v. 
Playtex Products, 993 F. Supp. 127, 129 (N. D. N. Y. 1998), a ruling on a motion 
in limine does not impose the same burden on the party offering the evidence as 
would be applied on a motion for summary judgment. Rather, the focus is on the 
admissibility of the testimony, not its ultimate sufficiency in establishing the 
case.

 

   [¶15]  In the first prong of the Daubert 
analysis, the district court must determine whether the reasoning or methodology 
underlying the testimony is scientifically valid. Daubert, 113 S. Ct.  at 2795. 
Daubert provided a non-exclusive list of four criteria to guide the trial 
court's determination: 1) whether the theory or technique in question can be and has been tested; 2) 
whether it has been subjected to peer review and publication; 3) its known or 
potential rate of error along with the existence and maintenance of standards 
controlling the technique's operation; and 4) the degree of acceptance within 
the relevant scientific community. Daubert, 509 U.S.  at 593-94, f. n. 12, 113 
S.Ct. at 2796-97;1 see also, Springfield, 860 P.2d  at 
443. Later courts have endeavored to refine the gatekeeping role of the trial 
judge by identifying additional factors to assess reliability. These include: 
the extensive experience and specialized expertise of the expert, Ambrosini v. 
LaBarraque, 101 F.3d 129, 140 (D.C. Cir. 1996); whether the expert is proposing 
to testify about matters growing naturally and directly out of research they 
have conducted independent of the litigation, Daubert, (on remand), 43 F.3d 1311, 1317 (9th Cir. 1995), cert. denied, 516 U.S. 869, 116 S. Ct. 189, 189, 133 L. Ed. 2d 126; Ambrosini, 101 F.3d  at 139-40 (D.C. Cir. 1996); and the 
non-judicial uses to which the method has been put, In re Paoli R. R. Yard PCB 
itigation, 35 F.3d 717, 742 n. 8 (3rd Cir. 1994) L.Ed.2d 
126.

 

   [¶16]  The second part of the Daubert approach 
requires the trial court to determine whether the testimony "fits" the disputed 
issues of fact. Daubert, 113 S. Ct.  at 2796.

 

[W]hether the expert testimony will assist the trier 
of fact in understanding or determining a fact in issue - essentially asks 
whether the expert's testimony "fits" the facts of the case. This is a relevance 
standard. Moreover, the `helpfulness' standard incorporated in [F. R. E.] 702 
means that the expert's opinion must relate to an issue that is actually in 
dispute and must provide "a valid scientific connection to the pertinent 
inquiry."

 

Graham, 983 F. Supp. 127 at 
130 (N. D. N. Y. 1998) (quoting Margaret A. Berger, Procedural Paradigms for 
Applying the Daubert Test, 78 Minn. L. Rev. 1345, 1351 
(1994)).

 

   [¶17]  We are aware that the application of the 
Daubert approach to exclude evidence has been criticized as a misappropriation 
of the jury's responsibilities. See, Report of the 1997 Forum for State Court 
Judges, Scientific Evidence in the Courts: Concepts and Controversies, paper 
presented by Professor Michael H. Gottesman, pp. 41-53, sponsored by The Roscoe 
Pound Foundation, (1998).

 

The most difficult question concerning the 
application of Rule 702's "assist" requirement is whether the reliability of the 
expert opinion is a factor in deciding admissibility. On the one hand, the 
admission of unreliable expert testimony can hardly be said to "assist" since it 
undermines accurate factfinding, the basic policy goal of Rule 702. On the other 
hand, the court's exclusion of evidence on this basis can be inconsistent with 
the jury's power to evaluate witness credibility and give testimony its proper 
weight.

 

29 Charles Alan Wright & 
Victor James Gold, Federal Practice and Procedure § 6264 (1997). We, too, have 
recognized that, "it is imperative that the jury retain its fact-finding 
function."  Springfield, 860 P.2d  at 
443 (citing United States v. Jakobetz, 955 F.2d 786, 796 (2d Cir. 
1992)).

 

   [¶18]  To alleviate this potential conflict, 
Daubert admonished that methodology should be distinguished from the conclusion 
of the expert. Daubert at 595. Thus, a trial judge need not and should not 
determine the scientific validity of the conclusions offered by an expert 
witness. Rather, to decide admissibility, the trial judge should only consider 
the soundness of the general scientific principles or reasoning on which the 
expert relies and the propriety of the methodology applying those principles to 
the specific facts of the case. Charles Alan Wright & Victor James Gold, 
supra, at § 6233; see also Springfield, supra, quoting Jakobetz, 755 F.2d  at 797 
("In other words, the court need not make the initial determination that the 
expert testimony or the evidence proffered is true before submitting the 
information to the jury.").

 

The ultimate question for the trial judge is whether 
both sides will have a fair opportunity to test the validity of scientific 
results; if not, those results should not be admissible.

 

. 
. . [E]xpert testimony should be admitted so long as it can be adequately tested 
by an adversary.

 

   Daniel J. Capra, The Daubert 
Puzzle, 32 Georgia Law Rev. No. 3, 699, 705 (Spring 1998).

 

   [¶19]  With these principles in mind, we turn 
to the case before us.  Petitioners 
designated Dr. Krivit as an expert whose proposed testimony would "discuss his 
research and the differences in prognosis which early diagnosis and treatment 
provide for patients such as Raef." Petitioners also stated Dr. Krivit would 
relay his opinion regarding "the degree 
of improved prognosis which would have occurred in this case with earlier 
diagnosis and/or referral."

 

   [¶20]  At his deposition, Dr. Krivit testified 
that the optimum age for transplant is as early as possible, but before 24 
months of age. This is because a delay in receiving treatment allows the disease 
to progress, thus causing increased developmental dysfunction. Dr. Krivit opined 
that due to the delay in Raef's diagnosis, he will most likely require extensive 
surgical intervention and a lowered intelligence quotient (20-30 points lower 
than 80-100) which would not have occurred with timely diagnosis and treatment. 
This opinion was based on studies conducted by teams in Great Britain and the 
United States, Krivit's extensive first-hand experience with Hurler patients, 
and his first-hand knowledge of Raef's condition.

 

   [¶21]  Dr. Jamieson challenged this testimony, 
claiming that Dr. Krivit's opinion was inconsistent with medical literature 
authored by Dr. Krivit and his team, and that the research is incomplete and 
ongoing. Dr. Jamieson concluded that "the experimental nature of Dr. Krivit's 
opinions and conclusions fail to satisfy the Daubert criteria." Petitioners 
responded that the defense did not dispute that children are better off if 
treated earlier, but were attacking the credibility of Dr. Krivit's 
quantification of the amount of improvement. These objections, contend 
Petitioners, are the proper subject of cross-examination and not grounds for the 
exclusion of the evidence.

 

   [¶22]  The district court began its analysis by 
recounting two portions of Dr. Krivit's deposition testimony which it found 
significant. The first question and response is as 
follows:

 

Q. [W]ould it be fair to say that you cannot say, to 
a reasonable degree of medical probability, which child . . . is going to reach 
an above-average IQ, and which will stay in the normal range of the low 
80s?

 

            . . . 
.

 

[A.] You guys got me on the ropes now. It's a good 
question if we refine the question a little better. If we say, in the 
future, what will be the ones that will make you feel like you're doing a 
shiny, glory job in making them totally normal.  And the answer is, the earlier, the 
better, the better the transplant process, the less trauma during the bone 
marrow transplant process, the better will be the outcome.

 

We anticipate, and talk to parents 
about expectations afterwards, depending upon how early they are, how much 
involvement there is, and what kind of a transplant we're going to be 
doing.
 

At the present time I warrant to the 
parents - this is Bill Krivit now - 
I warrant to the parents that with an early age and a good marrow, and a good 
engraftment process, like we have here, I warrant them an IQ that should be 
close to 100.

 

My colleagues wince when I do that. But I do this so that the parents can have a point 
of view. Because I think a hundred is approximately correct for what they're 
going to be at.

 

   (Emphasis supplied.) The second 
portion which the district court found to be important 
reads:

 

Q. Do you have any recollection in Raef Bunting's 
case about having a particular desire to have his sister be the donor, either on 
the part of the medical team or on the part of the 
parents?

 

A. It was a - everybody should explained (sic) to 
them and told them what's going on, and a decision left to the parents and Dr. 
Peters. It was a 50/50 question.

 

Our data is being gathered and it's in this article 
that homozygosity is better than heterozygosity. . . . It's the carrier 
question.

 

And we don't have enough data to exclude one way or 
the other. So we provided them the expertise that a carrier may not give us 
enough enzyme, but it may be a safer marrow transplant. And so they and Dr. 
Peters chose this.  Subsequently 
we've done others the same way.

 

            Q. All 
right.

 

A. It has not been settled yet as to what a 
carrier level could do, and what a half of a carrier level could do, and what a 
fourth of a carrier level could do, How low we can go in replacing the enzyme to 
get betterment out of the patient.  
How quality of life can we do better.

 

   (Emphasis 
supplied.)

 

   The court then analyzed this 
testimony as applied to the facts of the case. It found:

 

11. Dr. Krivit's (sic) testified that there are three 
considerations concerning bone marrow transplants. They are (1) how early the 
transplants are; (2) how much involvement there is; and (3) what kind of a 
transplant is going to be done (related or unrelated 
donor).

 

12. If the transplant to Plaintiff, Raef Bunting, 
were within the time frame recommended by Dr. Krivit, it would be a transplant 
from an unrelated donor, acknowledged by Dr. Krivit to carry substantially more 
risk than a transplant from a related donor.

 

13. Going by Dr. Krivit's standards, even if Dr. 
Krivit could have done the transplant on the very day Raef's sister and donor 
was born, Raef Bunting was already on the verge of being too old to benefit from 
the transplant. It is fair to assume that there would have been additional delay 
for testing of both donor and donee. Furthermore, according to Dr. Krivit's 
testimony, after a donor is found, the donee has to undergo chemotherapy before 
the transplant can take place.

 

14. Accepting Dr. Krivit's testimony about the time 
delays in performing the transplant as true, too much time expired before a 
donor was available. In other words, the transplant could not have been achieved 
at the time Dr. Krivit now recommends without incurring the substantial 
additional risk of using an unrelated donor.

 

15. The opinion testimony of Dr. Krivit on the 
subject of causation does not satisfy the peer review requirements of Daubert v. 
Merrell Dow Pharmaceuticals, 509 U.S. 579 (1993), which this Court believes will 
be followed by the Wyoming Supreme Court.

 

16. THIS COURT will, therefore, not permit Dr. Krivit 
to testify that had the transplant been done earlier Raef Bunting's current 
condition would have been better. As a consequence of the foregoing findings, it 
is ordered that the motion of Defendant to exclude, in limine, all causation 
testimony of Dr. Krivit is GRANTED.

 

   [¶23]  We find the district court abused its 
discretion in its application of the Daubert approach. The district court's 
order applies but one of the Daubert factors - peer review - in a conclusory 
manner. We do not know what other factors were considered by the trial court, 
nor are we told why the district court concluded that this one factor outweighed 
all others. Indeed, Daubert underscored that peer review was only a single 
factor in considering the admissibility of expert testimony, and its absence was 
not dispositive. Daubert, 509 U.S. 593 (relevant, though not dispositive). 
Moreover, this factor appears to be unconnected to the remainder of the district 
court's factual analysis, which assumes the reliability of Dr. Krivit's 
statements.

 

   [¶24]  As we have said in the context of the 
trial court's discretionary duties in determining the best interests of a child, 
"an abuse of discretion is present "`when a material factor deserving 
significant weight is ignored.'" Reavis v. Reavis, 955 P.2d 428, 431 (Wyo. 
1998); Triggs v. Triggs, 920 P.2d 653, 657 (Wyo. 1996) (quoting Vanasse v. 
Ramsay, 847 P.2d 993, 996 (Wyo. 1993)).

 

To determine whether a district court has abused its 
discretion, we must rely on the district court's articulation of the factors 
which were considered and how those factors support its 
conclusions.

 

To 
play fair, a trial judge relying on discretionary power should place on record 
the circumstances and factors that were crucial to his determination. He should 
spell out his reasons as well as he can so that counsel and the reviewing court 
will know and be in a position to evaluate the soundness of his 
decision.

 

Reavis, 955 P.2d  at 431-432 
(quoting Maurice Rosenberg, Judicial Discretion of the Trial Court, Viewed From 
Above, 22 Syracuse L. Rev. 635, 665-66 (1971)). Recently, in English, 1999 WL 
333104, at *5, we recognized that the abuse of discretion standard, when applied 
to the admission of testimony under the catch-all exception to the hearsay rule, 
requires the district court to set forth its reasoning in more detail than may 
be required under other circumstances. See also, Betzle v. State, 847 P.2d 1010, 
1021 (Wyo. 1993). The catch-all exception imposes stringent restrictions on its 
use, as compared to Rule 702, which is intended to promote admissibility of 
trustworthy evidence.  However, we 
believe that the trial court's decision to dispose of a case by precluding 
expert testimony requires the same level of judicial explanation supporting its 
discretionary decision as the admission of testimony under the catch-all 
exception. A single conclusory statement applying one nondispositive Daubert 
factor is insufficient. Because we remand this matter to the district court for 
a full analysis of admissibility under the Daubert approach, as refined by later 
decisions, we take a moment to discuss those factors as applied to this 
case.

 

   [¶25]  The initial step in reviewing the 
admissibility of expert testimony is the determination whether the Daubert 
factors apply to the specific testimony at issue. Where they are reasonable 
measures of reliability, these factors should be considered.  Here, the question is not whether, 
generally, a more favorable prognosis 
results from the earliest possible treatment of Hurler Syndrome. Dr. Jamieson's 
expert clearly agreed with Dr. Krivit that this is so. The only issue is whether 
the quantification offered by Dr. Krivit as to Raef's prognosis is grounded on 
something other than "subjective belief or unsupported speculation." Joiner, 118 S. Ct.  at 516.

 

   [¶26]  Dr. Krivit testified that his 
conclusions can be validly extrapolated from the studies which have been done, 
his direct experience with 75% of all Hurler patients, and his treatment of 
Raef. Under the Daubert approach, it is not the conclusion but the method of 
extrapolation on which it is based which must be examined. Consequently, while the peer review factor 
is applicable to the underlying studies, it is not relevant to the method used 
by Dr. Krivit to reach his conclusions from those studies.

 

   [¶27]  The testimony cited by the district 
court does little to illuminate the problem. We are not told why Dr. Krivit's 
colleagues wince when he guarantees parents an IQ level of approximately 100 
with the proper conditions. Are his colleagues bothered by the IQ level he 
promises, the idea that he is guaranteeing anything, or the minimization of the 
problems associated with the transplant itself? Similarly, even though Dr. 
Krivit admitted that "it is not settled" as to what a carrier level could do or 
how low an increase in the enzymatic production will be beneficial, this does 
not answer whether his conclusions constitute a reasonably probable outcome 
based on the research already accomplished.

 

   [¶28]  Dr. Krivit's qualifications are not at 
issue. He is regarded as one of the most knowledgeable persons in this field and 
has extensive clinical experience with this particular disease. Thus, the 
analysis must be whether Dr. Krivit's opinion "employs in the courtroom the same 
level of intellectual rigor that characterizes the practice of an expert in the 
relevant field."  Black v. Food 
Lion, Inc., 171 F.3d 308, 311; Kumho, 119 S. Ct.  at 1176. It appears that the 
methods employed by Dr. Krivit are commonly used in clinical work to arrive at a 
medical opinion:

 

The textbook, Medical Decision Making, identifies the 
following information available to physicians making medical decisions: personal 
experience, published experience, and attributes of the patient. According to 
the text, a physician's opinion is guided by personal experience with similar 
events or by the experiences of 
colleagues. . . .

 

In addition, physicians rely upon published 
experience, in the form of reports quantifying the risk or success associated 
with a certain procedure. . . . Finally, attributes of the patient are important 
to alert the physician for "unusual characteristics of the patient that put him 
at higher or lower risk than the average."

 

J. Conard Metcalf, A Primer 
on Principles of Scientific and General Causation, Colorado Trial Lawyers 
Association Trial Talk (1998) (reprinted in Wyoming Trial Lawyers Association 
CoffeeHouse, p. 4 at 20 (Spring 1999)), quoting H. C. Sox, M. A. Blatt, M. C. 
Higgins, K. L. Martin, Medical Decision Making, 33-34 (1988). On remand, the 
district court must explain why Dr. Krivit's conclusions are not a reasonable 
extrapolation based on this method.

 

   [¶29]  In Dr. Jamieson's expert's deposition, 
the expert stated that his disagreement with Dr. Krivit's conclusions are due to 
Dr. Krivit's tendency to optimism, while he gravitates toward a skeptical view 
of the data. However, he agreed that "[t]here is room for the kind of scientific 
disagreement that [he] and Dr. Krivit, as professionals, men in [his] 
profession, have." Again, the district court must state why Dr. Krivit's 
testimony should be precluded, even though another expert in the field finds his 
opinion to be within the parameters of professional 
disagreement.

 

   [¶30]  We also find the district court 
misapplied the second prong of the Daubert test. Many of the facts assumed by 
the district court, in particular that an earlier donor would necessarily have 
been unrelated, were not in the record. There is nothing which demonstrates that 
a relative other than Raef's sister could not have been a donor, or that a 
relative would necessarily be a carrier. In addition, Raef's sister was born in 
November 1995, three months before Raef's second birthday. Dr. Krivit testified 
that the better outcomes were derived from children transplanted before the age 
of two. Since Raef was diagnosed in June of 1996, and his transplant was in 
September, the record illustrates that only three months passed between 
diagnosis and transplant.  
Therefore, had the diagnosis been made prior to his sister's birth, Raef 
would still have been within the preferred age category given a three-month 
delay. The district court also ignored testimony of both experts which qualified 
the benefit of a transplant with the individual and the progression of the 
disease, as well as age.

 

   [¶31]  As we stated above, in determining 
whether the expert testimony "fits" the facts of a case, the determination is 
not a substitute for summary judgment. In this case, Dr. Krivit's testimony is 
based on studies of patients with the same condition as Raef's and is directly 
relevant to whether a delay in diagnosis caused Raef harm - an issue hotly 
disputed in this case. Thus, there is definitely a "fit" between the facts and 
the testimony.  The trial court 
erred in extending the motion in limine to include a dispositive determination 
based on facts assumed by the trial court. Rather, the task before the trial 
court on remand is simply to determine the scientific validity of the methods 
and reasoning used by the expert.

 

                              
CONCLUSION

 

   [¶32]  The application of the Daubert approach 
requires the district court to consider all factors relevant to the reliability 
of a proposed expert's testimony, with a focus on the methodology of the expert 
- not his or her conclusions. In so doing, the district court must clearly state 
its reasoning on the record. Because the district court failed to fully explain 
the factors considered and how they were weighed, we reverse and remand for 
further proceedings consistent with this opinion.

    

FOOTNOTES

1Footnote 
12 contains direction to sources relating other factors which may be relevant to 
the inquiry, citing United States v. Downing, 753 F.2d  at 1238-39, and several 
treatises and law review articles.