This memorandum opinion was not selected for pub lication in the New Mexico Appellate Reports. Please see Rule 12-405 NMRA for restrictions on the citation of unpublished memorandum opinions. Please also note that this electronic memorandum opinion may contain computer-generated errors or other deviations from the official paper version filed by the Court of Appeals and does not include the filing date. IN THE COURT OF APPEALS OF THE STATE OF NEW MEXICO 1 R.R., a minor child, by and through 2 HEATHER STOWELL, as parent 3 and next friend, 4 Plaintiff-Appellant, 5

v. No. 34,998 6 TUSHAR DANDADE, M.D., 7 Defendant-Appellee. 8 APPEAL FROM THE DISTRICT COURT OF SANDOVAL COUNTY 9 Valerie A. Huling, District Judge 10 Law Offices of James P. Lyle, P.C. 11 James P. Lyle 12 Albuquerque, NM 13 for Appellant 14 Rodey, Dickason, Sloan, Akin & Robb, P.A. 15 Jocelyn Drennan 16 Edward Ricco 17 Albuquerque, NM 18 Hinkle Shanor LLP 19 Kathleen Wilson 20 Hari-Amrit Khalsa 21 Albuquerque, NM 222 for Appellee 1 MEMORANDUM OPINION 2 VARGAS, Judge. 3
{1} This is an appeal from the district court’s decision to exclude the opinion 4 testimony of Plaintiff Heather Stowell’s only expert witness, a pharmacologist, as to 5 the cause of her minor child’s neurodegenerative disorder. Plaintiff also appeals the 6 district court’s entry of summary judgment in favor of Defendant Tushar Dandade, 7 M.D., following the exclusion of Plaintiff’s expert. As discusse d below, we conclude 8 that the district court did not err by excluding the testimony of Plaintiff’s expert 9 pharmacologist; and, absent other expert medical testimony on causation, the district 10 court’s entry of summary judgment for Defendant was proper. 11 BACKGROUND 12
{2} After becoming pregnant with her first child in 2008, Plaintiff sought prenatal 13 treatment from Defendant. During the course of her pregnancy, Defendant prescribed 14 Zoloft to Plaintiff. Zoloft is a selective serotonin reuptake inhibitor (SSRI) used to 15 treat disorders such as depression and anxiety. 16
{3} Plaintiff gave birth to a baby girl, (R.R.) in April 2009. At birth, R.R. appeared 17 to be a normal, healthy child with no apparent medical problems. Around age one, 18 however, R.R. began displaying symptoms of neurodegeneration, which have steadily 193 continued. Genetic and metabolic testing have failed toidentify a cause for R.R.’s 1 condition. 2
{4} Plaintiff filed suit against Defendant, clai ming that the Zoloft he prescribed and 3 she took during her pregnancy was the causeof R.R.’s neurode generative disorder. 4 In support of her claim, Plaintiff named Dr. Patrick Ronaldson, Ph.D., as her only 5 expert witness to testify about the medicalcausation of R.R.’s condition and damages. 6
{5} Dr. Ronaldson holds a Ph.D. in pharmacol ogy, but is not a medical doctor and 7 is not licensed to diagnose medical conditions. As part of his testimony, Dr. 8 Ronaldson explained that he did not intend to offer opinions on the medical diagnosis 9 of R.R. Instead, his testimony was limited tothe etiology of R.R.’s neurodegenerative 10 condition, specifically, the biological mechanisms that could have caused the 11 symptoms that are apparent in R.R. 12
{6} In support of his theory that Zoloft wa s the cause of R.R. ’s neurodegenerative 13 disorder, Dr. Ronaldson explaine d, “[T]here is evidence in the scientific literature that 14 hypoxia, including fetal hypoxi a, can be caused by in utero exposure to SSRIs 15 including [Zoloft].” According to Dr. Ronaldson, hypoxia can cause neurological 16 damage; periventricular leukomalacia (PVL) is an established biomarker of hypoxia; 17 and there are three references in R.R.’s very substantial medical records to PVL. 18 These three references, along with Dr. R onaldson’s understanding that board-certified 194 geneticists who had examined R.R. had ruled out a geneticcause for R.R.’s condition, 1 form the basis of Dr. Ronaldson’s opini on. In arriving at his conclusion, Dr. 2 Ronaldson did not review R. R.’s testing images or actual lab results. Instead, he 3 reviewed reports from the geneticists and radiologists who treated R.R. 4
{7} Dr. Ronaldson conceded that none of the studies on which he relied to reach his 5 opinion demonstrate that Zoloft can causea neurodegenerative disorder with the 6 symptoms of those exhibited by R.R. Hefurther admitted that no study to date 7 supports his exact hypothesis. 8
{8} In support of his motion to exclude Dr. Ronaldson’s testimony, Defendant 9 presented evidence from R.R.’s treating pe diatric geneticist and from his own expert 10 geneticist and teratologist that a genetic explanation for R.R.’s neurodegenerative 11 condition had not been ruled out and was th e likely cause of R.R.’s condition. Dr. 12 Randall Heidenreich, Chief of the Division of Pediatric Genetics at the University of 13 New Mexico, evaluated R.R. in an atte mpt to identify a genetic cause for her 14 condition. He was unable to identif y a specific genetic basis for her 15 neurodegeneration; however, Dr. Heidenreich continues to strongly believe that R.R. 16 suffers from a genetic alteration that mi ght be identified using exome or genome 17 sequencing that has not yet been performed on R.R. 185 {9} Dr. Margaret Adam, M.D., a clinical gene ticist and teratologist who testified on 1 behalf of Defendant, agreed with the assessment of Dr. Heidenreich. Dr. Adam 2 testified that, in her opinion, to a reas onable degree of medical probability, the cause 3 of R.R.’s neurodegenerative condition was genetic. According to Dr. Adam, that R.R. 4 was normal at birth but began exhibiting degenerative features around one year of age, 5 that the degenerative features continued to progress, and that R.R.’s whole brain was 6 affected all support her and Dr. Heidenreich’s conclusions that the cause of R.R.’s 7 condition is genetic. Dr. Adam confirmed Dr. Ronaldson’s testimony that there were 8 no studies in the field of genetics, teratol ogy, or pediatrics that support the conclusion 9 that prenatal exposure to Zoloft can cause a neurodegenerative condition such as 10 R.R.’s. Further, Dr. Adam testified that th e well-described effects of Zoloft on a fetus 11 in utero are typically in the form of autonomic dysfunction and respiratory issues, 12 none of which were present in R.R. 13
{10} Finally, Defendant submitted evidence fro m at least three separate sources, 14 concluding that R.R. did not suffer fro m hypoxia or PVL, the conditions relied upon 15 by Dr. Ronaldson to reach his conclusion. Dr . Adam testified that nowhere in R.R.’s 16 medical records had any physician made a diagnosis of PVL inR.R. Another of 17 Defendant’s expert witnesses, Gail McCarver, M.D., a board certified pediatrician, 18 neonatologist, and clinical pharmacologist , submitted an affidavit refuting Dr. 196 Ronaldson’s assumption that hypoxia is the me dical cause of R.R.’s condition, instead 1 concluding that R.R.’s “clinical presentation does not correlate with chronic hypoxia 2 in utero .” Finally, Dr. Marvin Nelson, M.D., a pediatric neuroradiologist submitted 3 his affidavit, concluding “that the head imaging findings [for R.R.] do not suggest 4 hypoxia during the perinatal period and this is not HIE (hypoxic-ischemic 5 encephalopathy) or PVL (periventricular leukomalacia).” 6 STANDARD OF REVIEW 7
{11} The admissibility of expert testimony lies in the sound discretion of the district 8
court. Loper v. JMAR , 2013-NMCA-098, ¶ 18, 311 P.3d 1184. 9 An abuse of discretion standard of review, however, is not tantamount 10 to rubber-stamping the trial judge’s decision, and we are not prevented 11 from conducting a meaningful analysis of the admission of the expert 12 testimony to ensure that the trial judge’s decision was in accordance with 13 the Rules of Evidence and the evidence in the case. 14 Id. (internal quotation marks and citation omitted); see State v. Alberico , 1993-NMSC15 047, ¶ 63, 116 N.M. 156, 861 P. 2d 192. We resolve doubts regarding the admissibility 16 of an expert opinion in favor of admissi on rather than exclusion of the evidence. 17 Parkhill v. Alderman-Cave Milling & Grain Co. of N.M. , 2010-NMCA-110, ¶ 60, 149 18 N.M. 140, 245 P.3d 585 (Vigil, J., specially concurring). 197 DISCUSSION 1 A. Admissibility of Expert Testimony 2
{12} Whether testimony of an expert witn ess is admissible depends on three 3 requirements: “(1) that the expert be qualif ied; (2) that the testimony be of assistance 4 to the trier of fact; and (3) that the expert’s testimony beabout scientific, technical, 5 or other specialized knowledgewith a reliable basis.” State v. Downey , 2008-NMSC6 061, ¶ 25, 145 N.M. 232, 195 P.3d 1244. 7
{13} To be admissible, testimony of a medicalexpert must expl ain both “how and 8 why [the expert] arrives at an opinion that a defendant physician’s conduct has been 9 substandard.” Sewell v. Wilson , 1982-NMCA-017, ¶ 23, 97 N.M. 523, 641 P.2d 1070. 10 The qualifications required of a medical e xpert turn on “the type of negligence 11 claimed and the medical complexity involved.” Lopez v. Reddy , 2005-NMCA-054, ¶ 12 16, 137 N.M. 554, 113 P.3d 377. Testimony from a medical professional who does not 13 specialize in the area of medicine at issu e may be admitted if the professional is 14 qualified and competent to do so. See Sewell , 1982-NMCA-017, ¶ 23. “[T]he mere 15 fact that a medical witness is not a specialist goes to the weight, not to admissibility, 16 of the witness’ expert testimony.” Id. “Nevertheless, to give scientific or specialized 17 opinion testimony, an expert witness must be qualified to do so by knowledge, skill, 18 training or education.” Id. 198 {14} On appeal, Plaintiff first argues that th e district court wrongfully usurped the 1 function of the jury by resolving the divergent opinions regarding medical causation 2 in favor of Defendant’s experts. Plainti ff further argues that the district court 3 committed error when it rejected Dr. Ronaldson’s opinion as untested and 4 unsupported. We reject Plaintiff’s arguments for two reasons and affirm the decision 5 of the district court. 6 1. Dr. Ronaldson’s Opinion Was Based on a Misunderstanding of R.R.’s 7 Medical Diagnosis and He Is Not Qu alified to Offer an Alternative 8 Diagnosis 9
{15} Both in his expert report and in hi s testimony before the district court, 10 Plaintiff’s expert contended that there wa s no dispute between th e parties regarding 11 R.R.’s medical diagnosis. This is not the cas e. Dr. Ronaldson is correct that Plaintiff 12 and Defendant agree that R.R. suffers from a neurodegenerative medical condition of 13 unknown etiology, however, the parties do notagree on the manner in which R.R.’s 14 condition manifested itself. In reaching hi s conclusion, Dr. R onaldson relied on two 15 premises that have been refute d by Defendant’s medical experts. 16
{16} In forming his opinion, Dr. Ronaldson relied on his understanding that R.R. had 17 been diagnosed with PVL, a biomarker of hypoxia. Hypoxi a, Dr. Ronaldson 18 concluded, can cause neurological damage . Dr. Ronaldson’s understanding that R.R. 19 had been diagnosed with PVL was based on three references to PVL in R.R.’s medical 209 records. However, notwithstanding that R. R.’s medical records mention PVL on three 1 instances, we note that Defendant’s medical experts testified that R.R. was never 2 diagnosed with PVL or hypoxia and did not suffer from either condition. 3
{17} Dr. Adam testified that nowhere in her medical records was R.R. diagnosed 4 with PVL. Dr. Nelson, a pediatric neuroradio logist, agreed that R.R.’s head imaging 5 revealed neither PVL nor hypoxia. Finally, Dr. McCarver, Defendant’s expert 6 pediatrician, neonatologist, and clinicalpharmacologist, concluded that R.R.’s 7 “clinical presentation did not correlate with chronic hypoxia in utero .” As Dr. 8 Ronaldson is not a medical doctor, did not review R.R.’s testing images and lab 9 results, and admitted he is not qualified to diagnose medical conditions, he is not 10 qualified to refute the conclusions of De fendant’s three medical experts that R.R. 11 suffers from neither PVL nor hypoxia. Without diagnoses of PVL and hypoxia, the 12 foundational basis of Dr. Ronaldson’s opinion—that Zoloft caused hypoxia 13 (evidenced by PVL) in R.R., whic h resulted in her neurodegenerative 14 condition—lacks any factual or medical support. See Downey , 2008-NMSC-061, ¶ 30 15 (“[T]he reasoning or methodology underlying the testimony must not only be 16 scientifically valid, it also must be properl y applied to the facts in issue.” (omission, 17 alteration, internal quotation marks, and citation omitted)). 1810 {18} Further compromising Dr. Ronaldson’s opi nion is his exclusion of any possible 1 genetic cause for R.R.’s condition. Among the factors cited by Dr. Ronaldson in 2 support of his conclusion was the fact that a genetic cause had not been identified for 3 R.R.’s condition. The absence of a genetic cause, Dr. Ronaldson surmised, made it 4 more likely that the harm to R.R. was cause d by Plaintiff’s ingestion of Zoloft during 5 pregnancy. Both Dr. Adam and Dr. Heidenreich, however, provided testimony that the 6 cause of R.R.’s condition was genetic. Dr. Adam testified that it was her opinion to 7 a reasonable degree of medical probability th at the cause of R.R. ’s neurodegenerative 8 condition was genetic, pointing to the delay in the onset of her degenerative condition, 9 as support. Dr. Heidenreich opined that R. R.’s specific geneticalteration might be 10 identified using exome or ge nome sequencing that has not yet been performed. Dr. 11 Ronaldson has no background, training, or experience in genetics that qualifies him 12 to contradict the conclusions of Dr. Adam and Dr. Heidenreich that the cause of R.R.’s 13 condition was genetic. As Dr. Ronaldson admits he is not qualified to offer a contrary 14 diagnosis of R.R.’s medical condition, we are unpersuaded by Plaintiff’s argument 15 that the district court improperly weighed the opinions of the experts in excluding Dr. 16 Ronaldson’s testimony. 1711 2. Plaintiff Failed to Show That Dr. Ronaldson’s Opinion Was Reliable 1
{19} Plaintiff also argues on appeal that the district court improperly rejected Dr. 2 Ronaldson’s opinion as untested and uns upported. However, Plaintiff failed to 3 establish that the science that forms the ba sis of Dr. Ronaldson’s conclusion is reliable 4 and therefore admissible. To be admissible, expert testimony that is scientific or 5 technical in nature, or that requires speci alized knowledge must have a reliable basis. 6 See id. ¶ 25. “[T]he determination of the external cause of a patient’s disease is a 7 complex process that is unrelated to di agnosis and treatment, and which requires 8 specialized, scientific knowledge regarding the external agents involved.” Parkhill , 9 2010-NMCA-110, ¶ 23. Dr. Ronaldson’s te stimony as to the causation of R.R.’s 10 condition is admissible only if it is reliable. We have adopted several factors, 11 frequently referred to as the Daubert-Alberico factors, to determine whether scientific 12 testimony is reliable. Those factors are: 13 (1) whether a theory or technique can be (and has been) tested; (2) 14 whether the theory or technique has been subjected to peer review and 15 publication; (3) the known potential rateof error in using a particular 16 scientific technique and the existe nce and maintenance of standards 17 controlling the technique’s operation; . . . (4) whether the theory or 18 technique has been generally accepted inthe particular scientific field[; 19 and (5)] whether the scientific technique is based upon well-recognized 20 scientific principle and whether it is capable of supporting opinions 21 based upon reasonable probability rather than conjecture. 2212 State v. Anderson , 1994-NMSC-089, ¶ 15, 118 N.M. 284, 881 P.2d 29 (internal 1 quotation marks and citation omitted). 2
{20} Following an evidentiary hearing to determine whether Dr. Ronaldson’s 3 testimony should be excluded, the district court found that there was no literature in 4 the fields of genetics, teratology, or pedi atrics that concludes that the ingestion of 5 Zoloft can cause a neurodegenerative condition such as R.R.’s. The court further 6 found that there were no cases or other reports of Zoloft exposure during pregnancy 7 causing later neurodegeneration after birth in humans or animals. Finally, the court 8 found that there are no studies demonstrating that Zoloft can cause a 9 neurodegenerative disorder such as that of R.R. or that support Dr. Ronaldson’s 10 opinions that the ingestion of Zoloft by pregnant women can cause the type of 11 condition seen in R.R. 12
{21} In his report and at the hearing on Defendant’s motion to exclude his testimony, 13 Dr. Ronaldson relied on two scie ntific articles. The first, referred to by the parties as 14 the Rurak article, considered the effects of fetal exposure to di fferent types of SSRI 15 medications. See Dan Rurak, et al., Third Trimester Fetal Heart Rate and Doppler 16 Middle Cerebral Artery Blood Flow Veloc ity Characteristics During Prenatal 17 Selective Serotonin Reuptake Inhibitor Exposure , 70 Pediatric Res. J. 96 (2011), 18 http:///www.nature.com/pr/journal/v70/n1/pdf/pr2011139a.pdf. Included in the results 1913 reported in the Rurak artic le were four cases of fetal exposure to Zoloft. 1 Acknowledging that, “[t]o date, very little is known about SSRI effects on the human 2 fetal physiologic functions[,]” the Rurak article concluded, after studying the effects 3 of different SSRIs on twenty-nine subject s, that the observed results suggest possible 4 fetal hypoxia. Rurak, et al., supra , at 96 (emphasis added) . While the Rurak article 5 opined that it was “ conceivablethat [SSRIs] alter early brain development[,]” the 6 study neither discussed nor c oncluded that SSRIs caused neurodegenerative disorders 7 such as the one seen inR.R. Rurak, et al., supra , at 96. In addition to the Rurak article, 8 the only other peer-reviewed article on which Dr. Ronaldson relied was an article 9 reporting the results of a study of the eff ects of high serotonin levels in mouse 10 embryos. SeeChi Chiu Wang, et al., Serotonin Receptor 6 Mediates Defective Brain 11 Development in Monoamine Oxidas e A-deficient Mouse Embryos , 289 J. Biological 12 Chemistry 8252 (2014), http://www.jbc.org/content/289/12/8252.full.pdf. While the 13 Wang study concluded that the presence of an SSRI in mouse embryos can initiate a 14 series of events that impairs the central nervous system of the embryos, the study did 15 not determine the manner in which the impairment manifested itself, as the embryo 16 cultures did not go to term. 17
{22} Rather than support a conclusion that Dr . Ronaldson’s opini on is based on well18 recognized scientific principles, see Anderson , 1994-NMSC-089, ¶ 15, the 1914 peer-reviewed articles on which he relies fail to connect the use of Zoloft with R.R.’s 1 neurodegenerative condition. Dr. Ronaldson provided no other peer-reviewed 2 information to support his hypothesis that R.R.’s condition was caused by in utero 3 ingestion of Zoloft, and Dr. Ronaldson admitted that there are no other studies that 4 support his exact hypothesis. Defendant’s expert, Dr. Adam, confirmed this, testifying 5 there is no medical literature to support the proposition that Zoloft or any prescription 6 medication causes a neurodege nerative condition such as the one suffered by R.R., 7 either in humans or animals. Dr. Adam further testified that studies and case reports 8 she has examined demonstrate that there does not appear to be any significant 9 neurological effects to individuals exposed to Zoloft. In the absence of additional 10 research, Dr. Ronaldson’s testimony and opinion are merely conjecture and do not 11 satisfy any of the Daubert-Alberico factors utilized to determine scientific reliability. 12 See Anderson , 1994-NMSC-089, ¶ 15. 13
{23} Dr. Ronaldson testified and Plaintiff argues on appeal that his education, 14 training, and experience as a pharmacologist render him qualified to testify about the 15 biological mechanisms associated with this case that c ould have caused the symptoms 16 that are apparent in R.R. According to Plaintiff, his opinions are sound, 17 notwithstanding that he doe s not diagnose patients. See Sewell , 1982-NMCA-017, 18 ¶ 23. 1915 {24} Plaintiff urges that our Supreme Court’s ruling in Acosta v. Shell Western 1 Exploration & Production, Inc. , 2016-NMSC-012, 370 P.3d 761, supports the 2 admissibility of Dr. Ronaldson’s testimony. In Acosta , a toxic tort case, our Supreme 3 Court declined to adopt the ruling of the United States Supreme Court in General 4 Electric Co. v. Joiner , 522 U.S. 136, 146 (1997), which allows a judge to “reject 5 expert testimony where the ‘analytical gap’ between the underlying evidence and the 6 expert’s conclusion is ‘too great[.]’ ” Acosta , 2016-NMSC-012, ¶ 27. In declining to 7 adopt the Joiner rule, Acostadetermined it was inconsistent with the policy of our 8 courts to leave credibility determinations and weighing of evidence to the trier of fact. 9 Acosta , 2016-NMSC-012, ¶ 28. Reasoning that it w ould be unfair to bar the claims of 10 the first several victims of a new toxic tort“simply because scientific analysis on a 11 particular chemical cause has not yet beenfully developed[,]” the Court utilized the 12 nonformulaic guidelines of Sir Austin Brad ford Hill to assess whether the plaintiff’s 13 epidemiological study finding an association between exposure to a mixture of 14 benzene and other organic solvents and au toimmune disease supported an inference 15 of causation. Id. ¶¶ 31-32. The Bradford Hill factors, the Court reasoned, “measure 16 the ability of an epidemiological study to determine whether an association found by 17 the study is sufficient to satisfy an ultim ate question of fact regarding causation or 18 whether the association is merely spurious.” Id. ¶ 33. 1916 {25} Initially, we note that unlike Acosta , Plaintiff’s expert, Dr. Ronaldson, has not 1 conducted or participated in any epidemio logical or other studies or done any work 2 on the effects of Zoloft on pregnant women or their fetuses. Cf. Parkhill , 2010- 3 NMCA-110, ¶ 45 (“ ‘One very significant fact to be considered is whether the experts 4 are proposing to testify about matters growi ng naturally and directly out of research 5 they have conducted i ndependent of the litigation, or whether they have developed 6 their opinions expressly for the purpose of testifying[.]’ ” (quoting Daubert v. Merrell 7 Dow Pharms., Inc. , 43 F.3d 1311, 1317 (9th Cir. 1995))). Plaintiff does not ask us to 8 conclude the results of Dr. Ronaldson’s sc ientific study to be sufficiently reliable 9 evidence to prove causation in this case. There is no study to consider. Instead, 10 Plaintiff offers Dr. Ronaldson’s conclusions with regard to a single patient based on 11 the two scientific articles he cites along with his pharmacology education, training, 12 and experience in studying how drugs cro ss biological membranes and accumulate in 13 the body. 14
{26} This case is not akin to Acosta , as the effects of SSRI medications, such as 15 Zoloft have been scientifically studied on pregnant women. Dr . McCarver explained 16 that Defendant’s prescription of Zoloft to Plai ntiff is consistent with its use within the 17 medical community, and the drug is commonly used in pregnancy. Dr. Adam testified 18 that several studies of the effects of Zolo ft have been conducted, and the effects on 1917 fetuses, if any, manifest themselves in the form of autonomic dysfunction and 1 respiratory issues, neither of which aff licted R.R. Notwithstanding Dr. Ronaldson’s 2 significant pharmacology credentials, these de ficiencies, coupled with the inability to 3 satisfy any of the Daubert-Alberico factors, render his opinion unreliable, and 4 therefore inadmissible. The district court did not abuse its discretion by excluding Dr. 5 Ronaldson’s testimony. 6 B. Grant of Summary Judgment 7
{27} Concluding that Plaintiff had not di sclosed a medical expert qualified to 8 establish a causal connection between Defendant’s conduct and R.R.’s injuries, the 9 district court granted Defendant’s moti on for summary judgment. We review, de 10 novo, whether the district court properly granted summary judgment, viewing the facts 11 in the light most favorable to the party opposing summary judgment and indulging all 12 reasonable inferences in favor of a trial on the merits. Acosta , 2016-NMSC-012, ¶ 20. 13
{28} “In any medical malpractice action, the plaintiff has the burden of proving that 14 . . . [the defendant’s] actions complainedof were the proximate cause of [the] 15 plaintiff’s injuries.” Schmidt v. St. Joseph’s Hosp. , 1987-NMCA-046, ¶ 8, 105 N.M. 16 681, 736 P.2d 135. As we noted in Parkhill , a determination of the external cause of 17 a patient’s condition requires specialized , scientific knowledge regarding those 18 external agents involved. 2010-NMCA-110, ¶ 23. Dr. Ronaldson was Plaintiff’s only 1918 expert to testify about the medical causation of R.R.’s condition and damages. With 1 the exclusion of his testimony, Plaintiff has no medical expert to testify about the 2 cause of R.R.’s harm and cannot prove the elements of her medical malpractice claim 3 against Defendant. The district court properly granted summary judgment. 4 CONCLUSION 5
{29} We affirm the district court’s exclus ion of Dr. Ronaldson’s expert causation 6 testimony, as well as summary judgment granted on the basis of that exclusion. 7
{30} IT IS SO ORDERED. 8

9 JULIE J. VARGAS, Judge 10 WE CONCUR: 11

12 JONATHAN B. SUTIN, Judge 13

14 TIMOTHY L. GARCIA, Judge 15