Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-5_13-cv-01338/USCOURTS-cand-5_13-cv-01338-12/pdf.json

Nature of Suit Code: 365
Nature of Suit: Personal Injury - Product Liability
Cause of Action: 28:1332 Diversity-Personal Injury

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United States District Court

Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

SAN JOSE DIVISION

SONDRA J ALLPHIN,

Plaintiff,

v.

PETER K. FITNESS, LLC, et al.,

Defendants.

Case No. 13-cv-01338-BLF 

ORDER GRANTING PLAINTIFF'S 

MOTION FOR PARTIAL SUMMARY 

JUDGMENT

[Re: ECF 136]

This is a strict products liability action brought by Plaintiff against several Defendants, 

alleging that a defective exercise resistance band unexpectedly broke while she was properly using 

it, causing her serious injury. Plaintiff has been diagnosed by her treating doctors, resident at 

Stanford Hospitals and Clinics as well as Palo Alto Medical Foundation (“PAMF”), with Complex 

Regional Pain Syndrome Type I (“CRPS-I”), which she describes as “a debilitating condition that 

results in near constant, severe pain that affects a victim’s limbs and makes touching or moving 

those limbs seem intolerable.” Mot. at 1. As a result of her injury, Plaintiff contends that she has 

been unable to return to work as a trusts and estates attorney. See id.

Defendants Fulco Fulfillment (“Fulco”), Peter Kofitsas, and Peter K. Fitness have asserted 

affirmative defenses which allege, among other things, that they are entitled to apportionment of 

responsibility for non-economic damages, if any are found by the jury, caused by Plaintiff’s 

treating doctors’ medical malpractice. Defendants’ affirmative defense is premised on their claim 

that the diagnosis of CRPS-I in Plaintiff, and the treating doctors’ corresponding treatment of 

Plaintiff consistent with that diagnosis, was malpractice. In support of this medical malpractice 

affirmative defense, Defendants have utilized the testimony and reports of an expert, Dr. Jose 

Ochoa, who contends that Plaintiff’s treating doctors have committed malpractice by “failing to 

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properly diagnose Plaintiff with a pseudoneurological condition . . . rather than CRPS-I.” Opp. at 

1. Dr. Ochoa does not believe that CRPS-I is a valid medical diagnosis, despite uniform

endorsement of the diagnosis in the pain management community. 

Plaintiff now seeks summary adjudication on Defendants’ medical malpractice defense, 

and has framed her motion as to a single issue: “Defendants cannot establish that any of 

Plaintiff’s treating healthcare providers committed medical malpractice by a preponderance of the 

evidence and as such, there can be no apportionment of damages to these nonparty healthcare 

providers at trial.” See ECF 151 at 2. Plaintiff argues that Defendants’ evidence, including the 

testimony and expert reports of Dr. Ochoa, fails to make out a prima facie case for medical 

malpractice under California law, and as such that these Defendants cannot seek apportionment of

harm for Plaintiff’s injuries to her treating doctors as joint tortfeasors.1

Plaintiff therefore requests that the Court grant partial summary judgment and thus deny 

Defendants the ability to utilize two jury instructions – CACI 406 regarding “Apportionment of 

Responsibility” and CACI VF-402 regarding “Negligence – Fault of Plaintiff and Others at Issue” 

– with regard to any nonparty healthcare provider. See Reply at 12. 

Having reviewed the briefing and oral argument of the parties, the Court GRANTS

Plaintiff’s motion, for the reasons set forth below. 

I. BACKGROUND

A. Procedural History

Plaintiff filed suit in Santa Clara County Superior Court against Defendants Peter K. 

Fitness, Peter Kofitsas, and Fulco Fulfillment on February 13, 2013, alleging a single cause of 

action for strict products liability.2 On March 21, 2013, Fulco answered. See Fish Decl. Exh. A. 

On March 25, 2013, Peter K. Fitness and Peter Kofitsas answered, and also removed the case to 

 

1

Plaintiff also asserts that Defendants’ discovery responses and Rule 26 disclosures regarding any 

purported affirmative defense of medical malpractice against her treating doctors were inadequate. 

See, e.g., Mot. at 9-12. The Court addresses this argument briefly in Part III of this Order, but 

ultimately finds it unpersuasive. 

2 Defendants have filed various cross-claims and counterclaims against one another and other 

third-parties, which are not germane to Plaintiff’s instant motion. 

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this district. See ECF 1, 2; see also Fish Decl. Exh. B.

Fulco’s sixth and twelfth affirmative defenses are at issue in Plaintiff’s motion. See Mot. at 

9. Fulco’s sixth defense contends that Plaintiff’s injuries were “negligently caused by persons . . . 

other than that (sic) this answering defendant,” while its twelfth defense contends that Plaintiff’s 

injuries “resulted from an independent, intervening cause over which this answering defendant had 

no control.” See Fish Decl. Exh. A. 

Similarly, Peter Kofitsas and Peter K. Fitness’ fifth, fourteenth, and sixteenth affirmative 

defenses are challenged by Plaintiff. See Mot. at 9-10. Their fifth defense states that Plaintiff’s 

injuries were “caused solely by the actionable conduct of persons, parties or entities other than 

these answering Defendants.” Fish Decl. Exh. B. Their fourteenth defense states that Plaintiff’s 

“injuries and damages, if any, are attributable to acts of third parties.” Id. Their sixteenth defense 

states that Plaintiff’s injuries were “proximately caused and contributed to by the acts of other

defendants, persons, and entities, and said acts were the intervening and superseding causes of 

injuries and damages, if any.” Id.

Plaintiff filed the instant motion on December 9, 2014. See ECF 136. Fulco, Kofitsas, and 

Peter K. Fitness jointly opposed. See ECF 150. Following briefing, the parties appeared for oral 

argument on January 15, 2015. See ECF 169.

B. Plaintiff’s Undisputed Material Facts

Plaintiff alleges the following material facts in support of her motion, which she submits 

are undisputed. Plaintiff contends that the evidence and testimony provided by Defendants in 

support of the medical malpractice diagnosis is insufficient to make out a prima facie case for 

medical malpractice against Plaintiff’s treating doctors under California law.

3

 

3

In their joint opposition, Defendants submit two objections to evidence offered by Plaintiff. First, 

they object to the declaration of Dr. Steven Feinberg on the grounds that Plaintiff did not 

previously disclose him as an expert on the issue of medical malpractice pursuant to Rule 26. See

Defs.’ Opp. at 8. They further object to the webpages referred to in Exhibits B, C, D, and E of the 

Feinberg Declaration as hearsay, pursuant to Federal Rule of Evidence 802. See id. Plaintiff does 

not in her Reply substantively respond to either objection. See generally Reply. 

Having reviewed the subject matter of the Feinberg Declaration, the Court finds that it is not 

relevant to its determination of the instant motion, therefore, the Court will not consider the 

Feinberg Declaration or the attached evidence in exhibits B, C, D, and E. 

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Plaintiff states that all pain management doctors recognize CRPS-I as a valid medical 

diagnosis, a point she contends Dr. Ochoa concedes. See Ochoa Depo., Fish Decl. Exh. F at 46:7-

11. Despite this uniform recognition in the pain management community, Plaintiff cites to a 

number of statements made by Dr. Ochoa in which he describes his belief that CRPS-I is a 

“mythical diagnosis.” See Ochoa Depo. 45:18-21. For example, Dr. Ochoa has stated that he 

believes that CRPS-I is a “purely nonsense diagnosis,” id. at 44:24-45:1, and that treating someone 

for CRPS-I amounts to the practice of “false medicine,” id. at 45:10-12. He describes pain 

management doctors who believe in CRPS-I as “flat earth people,” id. at 75:20-76:1, “cult-driven, 

folk medicine believers,” id. at 131:3-14, and “pain aficionados,” id. at 120:23-25, who are 

“amateurs” and “not professional.” Ochoa Depo. 120:23-121:23. Dr. Ochoa further has stated that 

the doctors who diagnosed Plaintiff with CRPS-I and thereafter treated her pursuant to that 

diagnosis committed malpractice. See, e.g., id. at 129:12-130:9; see also ECF 152-5 at 10 

(statements regarding only Plaintiff’s treating doctors at Stanford). Dr. Ochoa believes that any 

doctor who diagnoses a patient with CRPS-I is “lost and unaccountable.” Ochoa Depo. 123:10-20. 

Plaintiff further notes that Dr. Ochoa is not board certified in the United States in pain 

management, anesthesiology, neurology, psychiatry, or any other medical field. See, e.g., Ochoa 

Depo. 6:25-7:3, 89:12-15 (in which Dr. Ochoa testifies “I’m not board certified in anything”).

4

She cites deposition testimony in which Dr. Ochoa states that he “stay[s] away from the 

mainstream of pain practicing doctors who don’t understand medicine.” Id. at 121:11-122:2. 

II. LEGAL STANDARD

Federal Rule of Civil Procedure 56 governs motions for summary judgment. Summary 

judgment is appropriate “if the pleadings, depositions, answers to interrogatories, and admissions 

on file, together with the affidavits, if any, show that there is no genuine issue as to any material 

fact and that the moving party is entitled to a judgment as a matter of law.” Celotex Corp. v. 

Catrett, 477 U.S. 317, 322 (1986) (citing Fed. R. Civ. P. 56(c)). The Court draws all reasonable 

 

4

This does not mean Dr. Ochoa lacks relevant medical education and training. On the contrary, 

Dr. Ochoa himself has three doctorate degrees, including his M.D. from the Catholic University of 

Chile. See Lompa Decl. Exh 10 at 3, 8. 

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inferences in favor of the party against whom summary judgment is sought. See, e.g., Matsushita 

Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986). 

The moving party “bears the burden of showing there is no material factual dispute,” Hill 

v. R+L Carriers, Inc., 690 F. Supp. 2d 1001, 1004 (N.D. Cal. 2010), by “identifying for the court 

the portions of the materials on file that it believes demonstrate the absence of any genuine issue 

of material fact.” T.W. Elec. Serv., Inc. v. Pac. Elec. Contractors Ass'n, 809 F.2d 626, 630 (9th 

Cir. 1987). In judging evidence at the summary judgment stage, “the Court does not make 

credibility determinations or weigh conflicting evidence, and is required to draw all inferences in a 

light most favorable to the nonmoving party.” First Pac. Networks, Inc. v. Atl. Mut. Ins. Co., 891 

F. Supp. 510, 513–14 (N.D. Cal. 1995) (citing T.W. Elec. Serv., Inc., 809 F.2d 626, 630).

A material fact is one that could affect the outcome of suit under the governing substantive 

law. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). For a court to find that a genuine 

dispute of material fact exists, “there must be enough doubt for a reasonable trier of fact to find for 

the [non-moving party].” Corales v. Bennett, 567 F.3d 554, 562 (9th Cir. 2009). The court 

“determines whether the non-moving party's specific facts, coupled with disputed background or 

contextual facts, are such that a reasonable jury might return a verdict for the non-moving party.” 

E.piphany, Inc. v. St. Paul Fire & Marine Ins. Co., 590 F. Supp. 2d 1244, 1250 (N.D. Cal. 2008). 

If the court finds that a reasonable jury could find for the non-moving party, summary judgment is 

inappropriate. See, e.g., Anderson, 477 U.S. 242, 248. 

 III. DISCUSSION

Both parties agree that, in order to defeat Plaintiff’s summary judgment motion, 

Defendants must put forth sufficient evidence to establish a prima facie case that Plaintiff’s 

treating physicians have committed medical malpractice. See Mot. at 5-8; see also Opp. at 1 

(“Defendants do not dispute that it (sic) must establish a prima facie case of medical malpractice 

in order to have Plaintiff’s treating physicians included on the verdict form [as joint tortfeasors].”). 

Defendants state that this prima facie case has been established through the testimony and 

evidence provided by Dr. Ochoa, through his independent medical examination (“IME”) of 

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Plaintiff, his expert reports, and his deposition testimony. See id.5

A claim for medical malpractice against Plaintiff’s treating physicians requires Defendants 

to show four elements: “(1) a duty to use such skill, prudence, and diligence as other members of 

the profession commonly possess and exercise, (2) a breach of the duty, (3) a proximate causal 

connection between the negligent conduct and the injury, and (4) resulting loss or damage.” 

Chakalis v. Elevator Solutions, Inc., 205 Cal. App. 4th 1557, 1571 (2012) (citing Johnson v. 

Superior Court, 143 Cal. App. 4th 297, 305 (2006)); see also Wilson v. Ritto, 105 Cal. App. 4th 

361 (2003). Where, as here, Defendants seek to reduce their liability by apportioning fault to a 

nonparty joint tortfeasor who is a treating physician, the Defendants must show “substantial 

evidence” that the physician is also at fault. See Wilson, 105 Cal. App. 4th 361, 367, 369 

(“Apportionment among doctors under Civil Code section 1431.2 requires evidence of medical 

malpractice . . . as to nonparty doctors. The same burden of proving fault applies regardless of 

whether a joint tortfeasor is a defendant or nonparty.”). For purposes of establishing breach of 

duty in a medical malpractice case, the moving party must show that the physician’s performance 

fell before the “care ordinarily possessed and exercised by members of the medical profession 

under similar circumstances.” Avivi v. Centro Medico Urgente Med. Cntr., 159 Cal. App. 4th 463, 

470 (2008) (citing Mann v. Cracchiolo, 38 Cal.3d 18, 36 (1985)) (emphasis in original). Case law 

is clear that specialists are “held to the standard of learning and skill normally possessed by such 

specialists.” Quintal v. Laurel Grove Hosp., 62 Cal.2d 154, 159-60 (1964) (emphasis added).

Plaintiff focuses on three arguments regarding the insufficiency of Defendants’ evidence in 

stating a prima facie case for medical malpractice. See Mot. at 12-20. First, she argues that 

 

5 Defendants clearly state in their joint opposition that their prima facie case of medical 

malpractice “would be accomplished by way of the testimony of Jose L. Ochoa [], the expert 

retained by defendants.” Opp. at 1. Nonetheless, Defendants also cite as evidence a report and 

letter by Dr. Mark Strassberg, a board certified neurologist and psychiatrist, in support of their 

opposition. See ECF 152-1 Exh. 2 (Dr. Strassberg report); ECF 152-5 Exh. 7 (Dr. Strassberg 

letter). Dr. Strassberg’s report, however, states that he “[a]ccept[s] Dr. Ochoa’s conclusions [as to 

Plaintiff’s diagnosis] as correct,” because Dr. Ochoa is “an expert in the field of CRPS.” ECF 152-

1 Exh. 2 at 33. Dr. Strassberg himself does not provide any evidence as to the standard of care that 

Plaintiff’s physicians should have exercised, in this report or his letter. See ECF 152-5 Exh. 8 at 1 

(merely stating that “[a]s noted in my prior report, Dr. Ochoa found no physical/neurologic 

disturbance in this woman to explain her complaints”). 

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Defendants have not specifically shown how Plaintiff’s treating physicians breached the relevant 

medical standard of care. Second, she argues that, even if this breach were shown, Defendants 

have not established that the physicians’ actions were a substantial factor in causing Plaintiff 

harm. Third, she argues that Dr. Ochoa’s opinions are insufficient as a matter of law to establish a 

triable issue of fact as to any alleged medical malpractice, because they are not credible or reliable 

under Federal Rule of Evidence 702. 

In response, Defendants contend that, reading Dr. Ochoa’s testimony and expert reports in 

their entirety, he sets forth enough evidence to make a prima facie case for medical malpractice –

arguing that, even if Dr. Ochoa did not use the specific phrases “medical standard of care” or 

“substantial factor,” he still set forth enough information such that, making all inferences in favor 

of Defendants, his testimony amounts to a prima facie case for malpractice. Additionally, though 

they concede that Dr. Ochoa falls outside the mainstream in believing that CRPS-I is a mythical 

diagnosis, Defendants argue that his opinions are nonetheless reliable under FRE 702. Finally, 

they argue that any issue of bias with regard to Dr. Ochoa’s belief that CRPS-I is an invalid 

diagnosis is properly addressed through cross-examination. 

The Court reviews the entirety of Dr. Ochoa’s deposition testimony, his IME of Plaintiff, 

and his expert reports in order to determine whether Defendants have demonstrated a prima facie 

case for medical malpractice. Defendants are undoubtedly correct that there is no requirement an 

expert use certain “magic words” in his opinions in order to provide sufficient evidence to show 

malpractice. For example, an expert does not need to specifically say the words “medical standard 

of care” if he clearly, and specifically, describes what care a doctor, operating under similar 

circumstances as the plaintiff’s treating physicians, would have exercised in treating a similarly 

situated plaintiff. Cf. Wilson, 105 Cal. App. 4th 361, 369 (“Defendant [is] required to establish 

[that the doctors were] at fault, and fault is measured by the medical standard of care.”). The 

ultimate problem that Defendants cannot overcome in this case is not the failure of Dr. Ochoa to 

use specific words in support of his opinion regarding medical malpractice, it is his failure to set 

forth sufficient evidence to support that claim for medical malpractice against Plaintiff’s treating 

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physicians.6 

Based on the Court’s consideration of all of Dr. Ochoa’s reports and testimony, his opinion

regarding whether Plaintiff’s treating doctors committed medical malpractice lacks foundation. 

First and foremost, Dr. Ochoa never identifies or defines the proper standard of care that 

Plaintiff’s doctors should have exercised. Instead, he asserts that the mere diagnosis of CRPS-I in 

Plaintiff by her treating doctors constitutes malpractice. Dr. Ochoa does not believe that CRPS-I is 

a valid medical diagnosis. See, e.g., Ochoa Depo. 45:7-12 (stating that “[p]erforming as a 

professional doctor and supporting the concept of CRPS-I really is ignorant” and answering “yes” 

to the question “Would you say that treating someone for CRPS type I is practicing false 

medicine?”). However, he concedes that CRPS-I is recognized as a valid diagnosis by all pain 

management doctors. See id. at 46:6-11 (responding to the question “There are, correct, many 

medical books and other literature that do recognize CRPS type I as a valid diagnosis, correct?” 

with “The majority, I mean, all pain management doctors, all of them.”) (emphasis added). 

Further, he concedes that that National Institute of Neurological Disorders and Stroke (“NINDS”), 

a division of the National Institute of Health, recognizes the validity of a CRPS-I diagnosis. See id.

at 53:9-56:14 (describing as “pathetic” a fact sheet put out by NINDS describing CRPS-I, though 

recognizing that NINDS is “one of the world’s foremost medical research centers”). In his IME of 

Plaintiff, he states clearly that “CRPS (1) [] is unanimously accepted as a neurological 

symptomatic condition,” but states unequivocally that he believes CRPS-I “does not amount to a 

valid medical diagnosis.” See Ochoa IME, ECF 152-1 Exh. 1 at 5 (emphasis added). 

Dr. Ochoa essentially argues that any pain management doctor who diagnoses any patient 

with CRPS-I is per se committing malpractice. See id. at 10-11 (stating that, in diagnosing 

 

6

Plaintiff’s arguments that Defendants did not properly disclose Dr. Ochoa’s testimony, and that 

Defendants failed to provide sufficient discovery responses regarding their affirmative defenses, 

see Mot. at 5-9, are unpersuasive. Dr. Ochoa’s review of Dr. Feinberg’s IME, produced to Plaintiff 

more than a month prior to the November 13, 2014 expert discovery cut-off, clearly indicates that 

Dr. Ochoa believed Plaintiff’s treating physicians at Stanford committed malpractice. See ECF 

152-5 Exh. 9 at 10. Plaintiff had the opportunity to depose Dr. Ochoa regarding his malpractice 

allegations. See Fish Decl. Exh. F. Though the evidence and testimony provided by Dr. Ochoa 

failed to set forth a prima facie case for malpractice, Defendants’ disclosures with regard to Dr. 

Ochoa’s testimony were not inadequate. 

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Plaintiff with CRPS-I, Plaintiff’s treating physicians “trespassed their legitimate professional 

qualifications,” and that “those providers unintentionally harmed the patient iatrogenically” 

because of that diagnosis). Dr. Ochoa does not argue that Plaintiff was misdiagnosed with CRPS-I 

because she does not show the proper symptoms of CRPS-I. Rather, he states that Plaintiff was 

misdiagnosed with CRPS-I, a diagnosis he concedes all pain management doctors recognize, 

because he believes CRPS-I does not exist. See id. at 4-10. Dr. Ochoa seems to go even further in 

his IME, calling into question the entire medical specialty of pain management. See id. at 10 

(“These flawed standards of practice of ‘pain management’ has (sic) been well recognized and 

powerfully challenged through scientific evidence,” to which he cites an article that he himself 

wrote). 

Even making every inference in favor of Defendants, the Court finds that Dr. Ochoa fails 

to identify the standard of care that these treating physicians should have exercised, and thus 

Defendants offer no evidence of breach of their duty of care. At most, Dr. Ochoa critiques the 

treating physicians’ ultimate diagnosis, and states that Plaintiff should have received an alternative 

diagnosis. He states that Ms. Allphin’s symptoms “reflect[] psychoneurological dysfunction,” id.

at 10, and that she should instead have received “[p]sychiatric therapies” in order to treat her 

condition, id. at 12.Though a differential diagnosis can be used in this circuit by an expert to prove 

causation in a medical malpractice case, see, e.g., Clausen v. M/V New Carissa, 339 F.3d 1049, 

1058 (9th Cir. 2003), it is not sufficient by itself to show that a physician fell below the relevant 

standard of care, particularly when the expert explicitly recognizes that all doctors within the 

specialty in question recognize the validity of the diagnosis the patient ultimately received from 

her treating doctors. See Ochoa Depo. 46:6-11.

The dearth of Defendants’ evidence regarding the relevant standard of care was made even 

clearer by the attorneys for Defendants at the January 15, 2015 hearing on the instant motion. In 

response to the Court’s statement that Dr. Ochoa “doesn’t define the standard of care . . . there’s 

no foundation for his malpractice assertions,” counsel stated that “I think it was clear [Dr. Ochoa] 

was critical of [the treatment], . . . they just went to CRPS without considering other diagnos[es], 

didn’t have her examined by mental health practitioners, didn’t do the [right] type of neurological 

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exam.” ECF 169 at 10-11. Much like Dr. Ochoa, counsel for Defendants was unable to explicate 

exactly what Plaintiff’s treating physicians should have done, apart from the cursory statement 

that the treating physicians did not “do the [right] type of neurological exam.” Id. at 11. Dr. 

Ochoa’s IME, however, clearly concedes that Plaintiff was provided with neurological 

examinations. See ECF 152-1 Exh. A at 9 (where he states that Plaintiff’s “occasional neurological 

exams by her appointed providers were shallow and incomplete”). Even giving Dr. Ochoa’s 

testimony the benefit of all doubts, his statement is factually devoid. He does not articulate what 

other types of neurological exams Plaintiff should have received above and beyond those she was 

given by her treating doctors, nor does he explain any defects in the exams performed. 

Without a description of the appropriate standard of care, Dr. Ochoa’s purported medical 

malpractice claims lack any relevant context. Dr. Ochoa clearly believes that CRPS-I is not a valid 

diagnosis. He has expressed this opinion in courts and tribunals across the United States. See, e.g., 

Claimant v. Employer & Liberty Mut. Fire Ins. Co., 2003 WL 1092570 (2003 Idaho Indus. 

Comm.); Vaughn v. Envir. Health Sciences Alaska, Inc., 2004 WL 1294502, at *17 (2004 Alaska 

Work. Comp. Bd.) (in which the Board found Dr. Ochoa “not credible” and “assesse[d] no weight 

to Dr. Ochoa’s testimony”); see also Aponte v. Weitz Co., 2002 WL 34453158 (S.D. Fla. Apr. 1, 

2002) (where a court found that Dr. Ochoa met the Daubert threshold to testify as an expert, but 

had not been provided with a copy of his expert report). But this belief, by itself, is not sufficient 

to bring an affirmative case for medical malpractice against Plaintiff’s treating doctors. 

Defendants contend that the Court should not preclude Dr. Ochoa’s testimony at summary 

judgment because any question of his “bias[] against CRPS-1 . . . is properly addressed during 

cross-examination to discredit his testimony.” Opp. at 9. Plaintiff is correct, however, that there is 

“a clear and substantial difference between having an expert criticize a plaintiff’s nonparty 

healthcare providers at trial and having an expert prove a prima facie case of malpractice against a 

nonparty healthcare provider.” Reply at 2.

The Court does not exclude Dr. Ochoa’s testimony under the standards set forth in Daubert 

v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 590 (1993), but rather excludes his opinions 

as to medical malpractice more narrowly under Federal Rule of Evidence 702(b). As discussed in 

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detail above, Dr. Ochoa’s opinions on this ultimate issue are based on nothing more than his 

opinion that CRPS-I is a “mythical diagnosis.”

7 Defendants cannot attempt at trial to apportion 

comparative fault to Plaintiff’s treating, nonparty physicians without first making out at least a 

prima facie case for medical malpractice. See Wilson, 105 Cal. App. 4th 361, 369. They have not 

done so. In Wilson, the Court declined to allow a defendant to apportion fault to a nonparty 

treating physician because “evidence merely showing that [the physician’s] treatment affected 

plaintiff’s condition was not sufficient to add [the physician] as a joint tortfeasor. Defendant was 

required to establish [that the physician] was at fault, and fault is measured by the medical 

standard of care.” Id. Here, Defendants fail to set forth a prima facie case for medical malpractice 

because they fail to produce evidence that defines the relevant standard of care, and cannot show 

that Plaintiff’s treating physicians fell below the standard of care that similar practitioners in their 

specialty would have exercised. See Quintal, 62 Cal.2d 154, 159-60.

In sum, Dr. Ochoa’s opinion that he would have diagnosed Plaintiff differently is not 

sufficient, standing alone, to support a prima facie showing of medical malpractice. Coupled with 

his flamboyant personal views regarding the integrity of the pain management medical 

community, his reliance on his own publications and little more to support his unorthodox and 

admittedly outside-the-mainstream view that a CPRS-I diagnosis constitutes per se medical

malpractice is simply not enough to allow Defendants’ medical malpractice claim to survive.

Though Defendants’ failure to show these two elements of a medical malpractice claim –

the relevant medical standard of care and breach of that standard – is fatal to Defendants’ attempt 

to prove an affirmative case of medical malpractice, Plaintiff makes one additional argument that 

the Court briefly addresses here: Plaintiff contends that Defendants also fail to put forth sufficient 

evidence to show causation, as required under Chakalis. See 205 Cal. App. 4th 1557, 1571-72 

(extending the holding of Wilson to all four elements of a medical malpractice claim, not merely

breach of duty). 

 

7 Whether Dr. Ochoa will be permitted at trial to testify more generally that CRPS-I is a false or 

mythical diagnosis will be deferred to the pre-trial hearing, where the Court can consider the 

reliability of his opinions under Daubert. At this juncture, the Court is simply considering whether 

Defendants have made a prima facie showing of medical malpractice. 

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In support of its causation argument, Plaintiff contends that Defendants have not “proven 

[causation] within a reasonable medical probability based on competent expert testimony.” 205 

Cal. App. 4th 1557, 1572 (citing, among others, Miranda v. Bomel Constr. Co, Inc., 187 Cal. App. 

4th 1326, 1336 (2010)) (emphasis added). In Chakalis, a jury had been presented with evidence 

that certain therapies and treatments prescribed by the plaintiff’s treating physician were 

“unnecessary and painful,” that “plaintiff feared the therapy,” that the physician’s “diagnosis was 

incorrect,” and that “many of plaintiff’s health problems had a very strong psychiatric basis to 

them.” Id. The Court found this evidence insufficient, stating:

The fatal flaw with defendants’ argument is that there was no expert 

testimony regarding the element of causation. While defendants’ 

experts were critical of [the doctor’s] treatment and discussed the 

dangers and risks associated with it, they did not actually offer an 

expert opinion that it was a substantial factor in causing plaintiff’s 

injuries within a reasonable medical probability. Defendants 

therefore failed to meet their burden.

Id. at 1572-73 (emphasis added). 

Plaintiff argues that this case and Chakalis are virtually indistinguishable, because Dr. 

Ochoa did not “offer an expert opinion in his reports that said mistreatment [by Plaintiff’s doctors] 

was a substantial factor in causing Plaintiff’s injuries within a reasonable degree of probability.” 

Reply at 4. Defendants, in response, point to expert reports and deposition testimony in which Dr. 

Ochoa states that he believes Plaintiff’s treating doctors committed malpractice. See Opp. at 3-4 

(“[T]he Stanford Pain faculty working on Sondra Allphin have caused iatrogenic harm [] by

commission and [] by omission.”); id. at 4 (“[Plaintiff’s doctors] have committed iatrogenic harm. 

. . . [T]hey have trespassed a specialty. . . . [T]hey have misdiagnosed the patient. Through the 

misdiagnosis, they have given her the wrong treatment, so they have harmed her iatrogenically.”). 

Plaintiff’s arguments regarding causation are ultimately unpersuasive. First, Dr. Ochoa 

does state that Plaintiff’s treating physicians caused her harm, through their diagnosis of CRPS-I 

and their subsequent treatment of Plaintiff consistent with that diagnosis. See ECF 152-5, Exh. 9 at 

10; see also Lompa Decl. Exh. 1 at 10 (stating that the physicians “harmed the patient 

iatrogenically” through the use of four “ineffective, invasive, potentially dangerous treatments,” 

including sympathetic blocks and Ketamine infusions). In Chakalis, which was decided following 

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a jury trial and not, as is the case here, at summary judgment, the Court found that there was “no 

expert testimony regarding the element of causation” for the plaintiff’s nonparty treating 

physician, and thus held that Defendants had failed to meet their burden to prove comparative 

fault. 205 Cal. App. 4th at 1572. Here, Defendants do present some such evidence regarding 

causation. Drawing all inferences in favor of Defendants, Dr. Ochoa’s expert reports and 

testimony suffice, at summary judgment, to make a prima facie case that the treatment regimen of 

Plaintiff’s treating physicians caused her harm. 

Much as a court would be required to grant summary judgment for defendant if a plaintiff 

failed to set forth a prima facie case for medical malpractice, cf., e.g., Avivi, 159 Cal. App. 4th 463 

(2008), the Court similarly must hold a defendant to that same standard when attempting to prove 

an affirmative defense of medical malpractice against a patient’s nonparty physicians. See, e.g., 

Perez v. Gordon & Wong Law Grp., P.C., 2012 WL 1029425, at *7 (N.D. Cal. Mar. 26, 2012)

(noting that the defendant bears the same burdens in proving an affirmative defense that a plaintiff 

bears in proving a claim for relief) (citing Kanne v. Conn. Gen. Life. Ins. Co., 867 F.2d 489, 492 

n.4 (1998)). Even after the Court pieced together the statements made by Dr. Ochoa in all of his 

various reports, testimony, and his IME of Plaintiff, it finds that Dr. Ochoa fails to adequately set 

forth the relevant standard of care or show how the performance of Plaintiff’s physicians fell 

below that standard. He thus fails to make out a prima facie case for medical malpractice. 

IV. ORDER

For the foregoing reasons, Plaintiff’s motion for partial summary judgment is GRANTED. 

Defendants shall not be permitted to instruct the jury as to “CACI 406: Apportionment of 

Responsibility” and shall not be given “CACI VF-402: Negligence – Fault of Plaintiff and Others 

at issue” regarding any nonparty health provider. 

IT IS SO ORDERED.

Dated: January 28, 2015

______________________________________

BETH LABSON FREEMAN

United States District Judge

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