### INTHE UNI TED S TATESCOU RT OFAPPEALS FORTHE FIFTH CIRCU IT

N o. 04- 60962

BA RB AR A H U SS; RO D N EYH U SS P l ai n t i f fs - A pp el l ees v. J OHN OV ER T ON G AY DE N, M. D. ; MEM P HI S OB S T ET RI CS A ND GYNECOLOGI CAL AS S OCI AT I ON PC D efen da n t s - A pp el l an t s

Appe alf

r o m t he U ni t e d St at e s D i s t r i c tCour tf o rt he N o r th e r n D is tr ic t o f M is s is s ip p i

B ef ore H IG G IN B O T H A M , D eM O S S , an d O W E N , C i rcui tJu dg es . D eM O S S , C i rcui tJu dg e: In th is m e d ic a l m a lp r a c tic e d iv e r s ity s u it, d e fe n d a n ts a p p e a l a ju r y ’ s $ 3 .5
m illio n a w a r d to p la in tiff B a r b a r a H u s s . W e re v e r s e a n d re m a n d fo r a n e w tr ia l.

I. W e begi n w i t h a bri ef overvi ew of

t h i s l i t i gation

. B arbara H u ss an d h er h u sban d R odn ey H u ss f i l ed thi s l aw sui ton Ju n e 30, 200 0. T h e pa rt i es c on sented t o ha ve t h e case h eard bef ore a m agis t rat e j u dg e. T ri al w as h el d i n G reenvil l e, M is s is s ip p i o n A u g u s t 1 7

– 2 0 , 2 0 0 4 . Aju r yo f e ig h t r e tu r n e d a g e n e r a l v e r d ic t in fav o ro f Bar ba r a H us s a nd a w ar de d he r$ 3, 50 0, 00 0. The j ur y al s o r e t ur ne d a verdi cti n favor of

R odn ey H u ss, bu taw arded hi m nothi n g. Adi vi ded pan elof United States Court of App eals

Fifth Circuit 

### F I L E D June 10, 2 009 Cha rl es R. F ulb ru g e II I ClerkN o. 04- 60962

T erbutaline sulfate i s thegeneric name for Brethin e. We refer to th e drugthroughout 1 as T erbutaline. 2 t h i s C ou rtconc l ude d t hatt he a ppli c able M i ssi ssi pp ist atute of l i m i t ati on s barred th e H u s s e s ’cla im s a s a m a tt e ro f la w . H u ss v. G ayd en (H u ss I ), 4 6 5 F
. 3d 201, 208- 09 ( 5t h C i r . 2006)

. Th e H uss es r eques t ed r ehear i ng en banc

. Apol lw as t ak en an d a m aj ori t y of t h e j u dg es i n act ive servi ce an d not di squ al i f i ed d i d n ot
v o te in fa v o ro f g r a n tin gre h e a r in ge n b a n c . H u ss v. G ayd en (H u ss II ) , 2 0 0 6 WL 501 319 5, at *1 ( 5th C i r. D ec. 2 7, 2 006 ) ( per curi am )

. H ow ever, t h i s pan elgran t ed rehea ri n g bef

ore t h e pan el

. In l i gh t of t h e M i ssi ssi pp i S u prem e C ou rt ’ s opi n i on i n S u t h erlan dv. R i t t er , 959 So. 2d 1004 (M i ss . 2007) , a panelm aj or i t y su asp o n te requ e s t e d t hatt he M i s s i s s i ppiSupr e m e Cour ta c c e pta c e r t i f i e d q ue s t i on
r e g a r d in gth e s ta tu te o f lim ita t io n s . H u ss v. G ayd en (H u ss III ) , 508 F. 3d 240, 24 5- 48 ( 5 t h Ci r . 2 0 0 7 )

. T h e M i s s i s s i p p iS u p r e m e Co u r ta c c e p t e d t h e q u e s t i o n, a n d h e ld th a t d e fe n d a n ts ’ lim ita tio n s d e fe n s e fa ils a s a m a tt e ro f la w . S ee H u ss v . G ay de n (H u ss IV

) , 991 So. 2d 16 2, 1 65 (M i ss. 2 008 )

. W e now vacate our pri or deci si on an d ad dress t h e rem ai n i n g i ssues. II. Th i s i s a m edi c al m al pra c t i c e sui t agai nst a physi c i an and a pr of es si onal
c o r p o r a tio n o f p h y s ic ia n s . B a r b a r a a n d R o d n e yH u s s , cit iz e n s o f M is s is s ip p i, al l ege t hatdefendant s John G ayden and M em phi s O bs t et r i c s and G ynec ol ogi c al A s s o c ia tio n P C (“M e m p h is O B /G Y N ”), c itiz e n s o f T e n n e s s e e , n e g lig e n tly adm i ni st er ed t he drug Terbut al i ne sul fat e t o B ar bar a duri ng h er p r egnanc y. 1 The m anufac t ur e ro f Te r but al i ne w as no ts ue d. T h e H u sses argu ed at t ri alt h at defen da n t s breach ed the st an da rd of care bya dm i ni s t e r i ng s ubc ut ane o us Te r but al i ne t o Bar ba r a as a t o c o l yt i c ( an ag e nt to s lo w o rh a l t p r e m a tu r e la b o rco n tr a c tio n s ), th e p r e s c r ip tio n o f a to c o ly tic
w ith o u t p h y s ic a l e x a m in a tio n b ya p h y s ic ia n , th e p r e s c r i p t io n o f a n yto c o ly tic
w h en B arbara w as n otact u al l y i n l abor, an d the prescr i pti on of T erbu t al i n e f

orN o. 04- 60962

The terms “c ardiomyop at hy,” “po stpartu m car diomyopathy,” “perip artu m 2 cardiomyo pathy,” and “perip artal c ardiomyo pathy” allrefer toth e sa me co nditionfor p urposes of this litigatio n. 3 f ou r w eeks w h en t h ere w as no i n di cat i on t h at B arbara w as i n l abor. T h e H u sses al so sa i d B ar bar a w oul d nothave c ons ent ed t o t r eat m entw i t h T erbut al i ne had sh e b ee n i n form ed of th e risks

. T h e H u sse s sa y T erb u tali n e cau sed B a rb a ra to dev el op cardi om yop athy, pu l m on ary edem a, an d cong est i ve h eartfai l u re. 2 A. B a r b a r a b e c a m e th e p a tie n t o f D r . A n d r e a G id d e n s , a m e m b e ro f M e m p h is O B/ G YN , o n Feb r uar y 17 , 19 98
. At t hatt i m e , Bar ba r a w as t w e nt y- s e ve n wee ks pregn an t , an d h ad a du e date of M ay 17. B arbara i n f orm ed D r. G i dd en s t h at her
m edi calhi st ory i n cl u ded on e chi l db i rt h by C esari an sec t i on , t h ree m i scarr i ages, pri or ovari an cyst s, an d h yp ert en si on . B arbara’ s m edi cal cond i t i on s an d fact ors on F ebr uary 17 i ncl uded: w ei ghtgai n of for t y t o f

i f t y po und s duri ng pr egnanc y, s w ell i n g, ne a r-con stan t na u sea an d vo m i ti n g, gesta ti on a ldiab etes (i

. e ., pr e gna nc y- i nduc e d d i ab e t e s ) , a nd c o nt i nue d c i ga r e t t e s m o ki ng t hr o ugh o ut p r e g n a n c y . D r . G id d e n s b e lie v e d th a t t h e “e x c e s s iv e ” w e ig h t g a in w a s d u e in pa rtt o ret en t i on of

excess f

l u id , or edem a, as w el las exces sive eati n g. D r. G i dd en s c on cl u ded t h at B arbara h ad a “ h i gh

- ri sk pregn an cy” a n d di rect ed h er t o c e a s e w o r k i n gf

o rt h e r e ma i n d e ro f

h e rt e r m. O n M a rch 8 , 1 9 9 8 , w h en B a rb a ra w a s th i rty w ee k s p reg n a n t, sh e fe lt i n c r e as i ng c r am pi ng andpr e s s ur e . She e xp e r i e nc e d c o nt r ac t i o ns f i ve t o t en
m i n u t es apart, an d sh e t h ou gh tshe w as i n l a b o r. S h e sough tt reat m en tf rom M em ph i s O B / G Y N ’ s em ergency room at 11: 15 p
. m . T h e on-c al lph ysi ci an , D r. J o h n A lb r itt o n , a tt e m p te d to s to p th e co n tr a c tio n s . H e d id n o t p e r s o n a lly
e xa m i ne Bar ba r a, b utco m m uni c at e d byt e l e pho ne w i t h a nur s e , f i r s to r de r i ng in t raven ou s hyd rat i on an d the dru g S t ad ol

. W h en contr act i on s c on t i n u ed, D r. Alb r i t t o n o r d e r e d s ub c ut a ne o us i nj e c t i o ns o f T e rb u t a l i n e . B a rb a r awa s g iv e n t woN o. 04- 60962

4 i nj ec t i ons , and the co n tract i ons c eas ed w i t hi n a f ew hour s. Th e ne xtm or ni ng, M ar c h 9 , 1 99 8, de fe nda ntD r . J o hn Gayd e n, a M e m phi s O B/ G YN phy s i c i an, prescr ibed adm i n i st rat i on of 2. 5 m i l l i gra m o ra lT erbu t al i n e t ablet s. B arbara i n i t i al l y received 30 pi l l s, an d w as t o t ak e a pi l l every si x h ou rs. T h e prescr i pti on
w as ref i l l ed three t im e s, m e an i n g B arbara received 120 pi l l s, or a sup pl y f or ap proxi m atel y f

ou r w eeks. A l t h ou gh contr act i on s had ce a se d , D r. G ayd en prescr ibed T erbu t al i n e p roph yl act i cal l y t o preven tt h e rec u rrence of pre- t erm c ont r ac t i ons and t o f or es t al lpr em at ure l aborand del i ver y. B ar bar a w as di sc harge d f

r om t he hos pi t alon t he m or ni ng of M ar c h 9. O n M ar c h 1 0, 1 99 8, Bar ba r a r e t u r n e d t o M e m phi s O B/ G YN f o ra f o l l o w - up e xa m i nat i o n b y D r . G i dde ns . Bar ba r a w as e xp e r i e nc i ng o c c as i o nalc o nt r ac t i o ns att hatt i m e. D r . G i ddens c onc urr ed i n t he pr ophyl ac t i c pr es c r i pt i on o f or al T e r b u ta lin e a s a to c o ly tic . A t t r ia l, D r . G id d e n s w a s re c o g n iz e d a s a n e x p e r t in
o b s t e t r ic s a n d g y n e c o lo g y . S h e t e s t if ie d th a ts h e w a s c o n c e r n e d w it h B a r b a r a ’s pa s tCes ar i an s e c t i o n. D r . G i dde ns s ai d: “ I w as c o nc e r ne d ab o uthe rc o nt r ac t i ng at hom e an d the ri sk f or c on t ract i on s . . . w i t h a pri or s ect i on i s uter i n e rupture,
w h i ch can be d e v a sta tin g . T h e bab y can di e. T h e m ot h er c an di e. So I di d n ot
w anthert o have c ont r ac t i ons r egul ar l y. ” M or eo ver , D r . G i ddens t es t i f i ed t hat pr e m at ur e de l i ve r y w o ul d ha ve s e ve r e a dv e r s e i m pa c t s o n t he he al t h of t he
c hi l d. D r . G i dde ns s ai d s he b e l i e ve d i tw as m e di c al l y pr o pe r , a nd wi t hi n t he st an da rd of

care, t o p resc ribe T erbu t al i n e proph yl act i cal l y as a t ocol yti c. T erb u tali n e is l a b eled f or trea tm en t of

asth m a , bu t D r. G i d d en s i n d i ca ted tha t,
w h en p resc ribed off

- l abel as a t ocol yti c, i ti s s afe, ef fect i ve, an d ap propri ate. D r. G i dd en s i n di cat ed that because B arbara had n ot show n an y si gn s of hi gh bl ood pressure or h eartprobl em s, i tw as n otn ecess ary t o condu ctcardi ac t est s pri or t o pr es c r ibi ng t he dr ug. A si de f r om hert r eat m e ntf

o rp r e m a t ur e c o nt r a c t i o ns on M ar c h 8–10, 1998, B arbara exp eri en ced ot h er c om pl i cat i on s t h at c au sed h e r to seek em ergencyN o. 04- 60962

5 t r eat m enton s eve r aloc c as i ons b efore h erdaught erH annah M ar i e H uss w as del i ve r e d o n M a y6 , 1 9 9 8
. Al t ho ug h d i s p ut e d b yd e fe nd a nt s a tt r i a l , Ba r b a r a,
m em bers of

h er fam i l y, an d an acqu ai n t an ce t est i f i ed that B arbara exp eri en ced
severe s h ort n ess of

breath. B arbara test i f i ed that f

or t w o an d on e- h al f

t o t h ree
m ont hs be f

or e de l i ver y, s he had s eve r e s hor t nes s of br eat h. O n M ar c h 20, 1998, d u ri n g a fa m i l y o u ti n g, Barb a ra feltl ea k i n g a n d con traction s f i ve m i n u tes a p a rt. S h e t h ou gh tt h at h er w ater h ad broken

. Sh e t est i f i ed that she al so experi en ced sho r t nes s of

br eat h. B ar bar a w as pl ac ed o n oxyg en by em er genc y m edi c al te c h n ic ia n s a n d tr a n s p o r te d t o a h o s p ita l. O n A p r il 5 , 1 9 9 8 , B a r b a r a fe lt
un c o n t r o l l a b l e l e a k i n ga n d s o u g h tt r e a t me n ta ta l o c a le me r g e n c yr o o m. On Eas t e rSund ay , Apr i l1 2, 1 99 8, Bar ba r a e xp e r i e nc e d s ho r t ne s s o f b r e at h du r i ng a fa m i l y d i n n er a n d o n ce m ore s ou gh t trea tm en t a t an em erg en cyroom . In l a te A pri l , B arbara w as prescr ibed an t ibi ot i cs f or an ear i n fect i on . B arbara test i f i ed t h at i n th e w eeks precedi n g H an n ah ’ s bi rt h , she exp eri en ced such severe s ho r t ne s s o f

b r e at h t hats he ha d t r o ubl e s pe ak i ng ands l e pts i t t i ng up. B a r b a r a co n tin u e d to s e e D r . G id d e n s a n d th e p h y s ic ia n s a t M e m p h is O B / G Y N un t i lt h e del i very of H an n ah

. Sh e t est i f

i ed that she di d n otrem em ber, ho w e ve r , w he n s he o bt ai ne d he rl as t Terbut al i ne r e f i l l

. W he n a s ke d whet he rt he d a t e A p r il6 , 1 9 9 8 w a s c o r r e c t , B a r b a r a s a id : “ I t w a s in A p r ils o m e t im e . I d o n ’t kn ow t h e exactdate. ” Sh e rec al l ed that she rec ei ved 30 pil l s, o r a one-w eek suppl y. W hi l e t es t i f

ying, B ar bar a r evi ew ed herow n m edi c alr ec or ds. She w as as ke d w h e t h e ri twa s n o t e d t h a ts h e wa s s t i l lo n T e r b u t a l i n e o n Ap r i l1 5
. S he i ndi c at e d t hatt he r e c o r ds s ai d a s m u ch. W he n a s ke d i f s he c o nt i nue d t o t ak e Terbut al i ne af

t ert hi s poi nt , B ar bar a s ai d ye s. W hen as ked w het hers he w as t ak i ng Terbut al i ne o n Apr i l2 8, s he a l s o a ns w e r e d y e s . Ba rb a r a ’ s medi c alr e c o r ds i n di cat e, how ever, t h at t h e drug w as di sconti n u ed on A pri l21, 199 8. Arec ord f r o m Bar ba r a’ s t r e at m e ntf o re ari nfe c t i o n, f

i l l e d o uto n Apr i l23, 199 8, l i s t s t he
me d i c a t i o n s B a r b a r a wa s t a ki ng ; Te r b u t a l i n e i s n o tl i s t e d

. W h e n a s k e d h o w aN o. 04- 60962

6 f ou r- w eek su pp l y t h at s h ou l d h ave ru n out i n m i d-A pri ll asted so l on g, a n d h ow th e fin a l w e e k ’ s re fill la s te d w e ll o v e rt w o w e e k s , B a r b a r a e x p la in e d th a t s h e d id notal w ays t ake f

ourpi l l s perday a s i nst r uct ed, buts k i p p ed a do se i f s he w as sl eepi n g w el l

. B u tshe i n si st ed that thi s sel dom occurred, a n d sh e gen eral l y t ook Terbut al i ne a s s he w as t o l d. Bar ba r a al s o t e s t i f i e d t hataf

t e rH anna h’ s bi r t h s he
s till h a d o n e o rtw o T e r b u ta lin e ta b le ts “le ft o v e r .” B y M ay 5, 199 8, B arbara w as experi en ci n g severe s w el l i n g i n her l egs. D r. Gi d d e n s t e s t i f

i e d t h a ta tt h a tt i me , B a r b a r a h a d t o x e mi a . T o x e mi a i s a l s o k n o wn as pr ee c l am psi a; t hi s i s hi gh bl oo d pr es sur e dur i ng pr egnanc y. Toxem i a c an l ead t o e c l a m p s i a , a s e i z u r e o f p r e g n a n c y , i n wh i c h t h e b a b y c a n l o s e o xy ge n a nd
su ff er retard a ti on , cere b ra lpa l sy , or d ea th

. D r. G i d d en s i n stru cted B a rb a ra to go to t h e h osp i tal f

or d elive ry . B a rb a ra ’ s O B A sse ssm en t R eco rd from th e d a te
o f he r ad m i t t anc e , M ay 5, 19 98 , do e s no t i ndi c at e t hat s he w as t ak i ng T erb u tali n e a t t h a t t i m e. A t t h e h osp i tal on M a y 5 , attem p ts w ere m a d e to i ndu c e l ab o r . The y w e r e uns uc c e s s f ul

. The ne xtda y, M ay6 , 1 99 8, D r . G us G i ddens, t he h usband of D r . A ndre a G i ddens, succ es sf ul l y pe r f

or m ed a C es ar i an s e c t i on , a n d H anna h was b o r n he al t hy. Bar ba r a w as di s c har ge d f r o m t he ho s pi t alo n M ay9, 199 8. H e rm e di c alre c o r ds f r o m t he fo urday s B arba r a s pe nt i n t he hos pi t al i ndi c at e t hat she w as br eat hi ng nor m al l y and w i t houtdi f f i c ul t y. Af t e rr e t ur ni ng ho m e o n M ay 9, Bar ba r a e xp e r i e nc e d s ho r t ne s s o f b r e at h. S h e t ook one of t h e T erbu t al i n e t ablet s t h at she had “ l ef tover. ” Sh e ha d h eard t hatTe r but al i ne i s us e d t o o pe n t he br o nc hi al t ube s o f as t hm a s uf fe r e r s , ands he bel i eve d t he Ter but al i ne w oul d am el i or at e t he sho r t nes s of br eat h. H ow eve r , at
s o m e po i ntl at e rt hat e ve ni ng, Bar ba r a l e ane d b ac k a nd c o ul d no tb r e at he

. I n t he earl y m orni n g h ou rs of M ay 10 , she w a s tak en t o t h e em ergency room of M et h odi st S ou t h i n M em ph i s. T h i s faci l i t y i s not a defend an tan d i s not af f i l i ated
w i t h defen da n t s.N o. 04- 60962

7 O n M ay 10 , 199 8, B arbara w as di agn osed by three phy s i c i ans a tM e t h odi st S ou t h w i t h peri pa rt um c ar di o m yo pa t hy, pul m o nar y e de m a, a nd c o nge s t ive hea rt fai l ure . C ar di om yopat hy r ef er s t o a w eak hea r tm usc l e. Th e c ond i ti on c an be t e m po r ar y o rc hr o ni c . D r . G ar y M ur r ay , Bar ba r a’ s t r e at i ng cardi o l o gi s ta tt he t i m e o f t r i al , t e s t i f

i e d t hat peri par t um c ar di o m yo pa t hy “ i s de f i ne d a s t he d ev elop m en t of

con ge sti ve h ea rt fa i l u re i n a w om a n occu rringw i th i n on e m on th
o f de l i ve r y o rb y f

i ve m o nt hs a f

t e rdel i very, ” w he r e t he r e i s “ no o t he ro bv i o us cau se” f or t h e di sord e r. D r. M u rray sai d that peri pa rt u m cardi om yop athy i s a rare c on di t i on occ u rri n g in on e i n t h ree t h ou san d to f i f t een t h ou san d bir t h s. C onges t i ve hear tfai l ure i s th e i nabi l i t y o f t he hear tt o c ont r ac tnor m al l y, ca u singa b a ck u p of fl u i d in the h ea rt an d thro u gh ou t t h e b od y. C a rd i ologists
m e a s u r e it s s e v e r it yb yth e eje c t io n fr a c t io n , w h ic h i s th e m e a s u r e o f t h e h e a r t ’s
a b i l i t yt o p u mp . T h i s c o n d i t i o n c a n b e t e mp o r a r yo rc h r o n i c . P u l mo n a r ye d e ma i s t h e presence of

f l u i d seepi n g f

rom t h e vessel s of

t h e l u n gs i n t o t h e ai r s acs of th e lu n g s . T h e co n d itio n in h ib its b r e a th in ga n d ca n b e life -th r e a te n in g o rfa ta l. I ti s no r m al l y a t e m po r ar y cond i t i o n whi c h c an be c o m pl e t e l y r e m e di e d. T estim on y w a s p rese n ted tha t con ge sti ve h ea rt fa i l u re ca n be ass ociated w i th p u l m o n a r y e d e m a , a s t h e p r e s e n c e o f e x c e s s f l u i d i n t h e l u n g s m a y i n h ib i t t he hear t ’ s abi l i t y t o m ove f l ui d t hro ughout t he bo dy e f fec t i vel y. An E R phys i c i an, w ho i s no ta de fen da n ti n t hi s c as e , a nd Dr

. Al br i t t o n,
w ho w as a m e m be rof M e m phi s O B/ G YN , sa w B arba r a atM e t ho di s tSout h a nd
eac h d i a g no s e d h e rc o nd i t i o ns . Dr
. Alb r i t t o n r e q ue s t e d t ha tBa r b a r a be t r ans fe r r e d t o M e t ho di s tH o s pi t alin G erm ant o w n ( al s o no ta de fe nda nt) a nd t h a t Dr
. Mc D o n a l d , a c a r d i o l o g i s t , c o n s u l tw i t h h e r , w h i c h h e d i d

. T h a ts a me day, D r . M c D onal d di agnos ed Barbar a as havi ng c a r d i o m y o p a t hya ndc onges t i ve h eartf ail ur e . H e rm e di c alr e c o r ds f rom t h ese adm i ssi on s r ef l ectsevere shortness of breath a n d B arbara’ s stat em en ttha tsh e h ad b een com pl ai n i n g of short n ess of breath f

or t h e l ast t h ree m on t h s.N o. 04- 60962

8 B arbar a c on t i n u ed to see D r. M cD on al d as h er t reat i n g cardi ol ogi st th rou gh the fa l lo f 1 9 9 8
. In O ctob er of tha t yea r, h e relea sed h er to retu rn to l i gh tw ork. B arbara test i f i ed that sh e fe lt w orse af t er t h i s and t h at her gr and pa r e nt s r e fe r r e d he rt o a no t he rc ar di o l o gi s t , D r . M ur r ay, w ho m s he
consu l t ed i n N ovem ber of 199 8. H e concurred i n t h e di agn osi s of cardi om yo pa t hy
a n d co n tin u e d to tr e a t B a r b a r a th r o u g h th e tim e o f tr ia l. A t t h e tim e o f tr ia l, B ar bar a h ad m ade so m e pro gr es s, bu tcont i nued t o s uf ferf r om c ar di om yopat hy. T h rough t reat m en tby D r. M u rray, B arbara’ s ej ect i on f ract i on i n creased f

rom t he l ow r ange ( ar ound 30% ) i n l at e 1 998, t o t he l ow - nor m alr an ge (50–55% ) at t he t i m e o f

D r . M urr ay’ s depos i t i on o n Jul y 31, 2004. H ow eve r , B ar bar a had de ve l o pe d o r t ho s t at i c hy po t e ns i o n, w hi c h i s a dr o p i n b l o o d p r e s s ur e w hi l e t he pat i enti s st andi ng. B ec ause of t hi s c ondi t i on, w hi c h D r . M urr ay c oul d nots ay
w a s r e l a t e d t o c a r d i o m y o p a t hy , Ba r b a r a h a d t o s t o p t a ki ngt he d r ugCo r eg. C ore g h a d h elpe d to ra i se B a rb a ra ’ s ejecti on fracti on . D r. M u rra y t estif i ed tha t,
a lth o u g h h e h a d o b s e r v e d “ a s u b s ta n tia l im p r o v e m e n t in h e reje c tio n fr a c tio n ,” B a r b a r a ’ s ca r d io m y o p a th ya n d a s s o c ia te d c o n g e s tiv e h e a r t fa ilu r e w o u ld lik e ly
rem ai n l i f

e- l on g probl em s. D r. M u rray bel iev e d th a t th e se co n d iti o n s e n d a n g e red B a rb a ra ’ s l i fe an d n ece ssit a ted con ti n u a lm ed i ca ti on an d freq u en t t rea tm en t. H o w e v e r , B a rb a r a n o lo n g e rh a d p u lm o n a r ye d e m a a t t h e tim e o f tr ia l. B. In Ju n e of

199 9, B arbara a n d R odn ey H u ss sued D r. A n drea G i dd en s f or
m edi c alm al pra c t i c e. D r . G i ddens w as B ar bar a’ s pri m ar y t r eat i ng physi c i an at M e m phi s O B / G YN unt i lH anna h’ s b i r t h a nd Barba r a’ s di s c har ge f r o m t he h ospi t alon M ay 9, 199 8. T h e sui tag a in stD r. G i dd en s w as di sm i ssed on j u ri sdi ct i on algroun ds. B arbara t est i f

i ed t h at i t w as n ot u n t i l “ shortl y” or “ l ess t h an a year” bef ore t h e present s u i tw as f i l ed on Ju n e 30, 200 0, t h at s h e beca m e aw are t h at her
m edi c alr ec or ds had bee n re vi ew ed byex per t s and t hatt hos e e xper t s hadN o. 04- 60962

9 c onc l uded t hatthe adm i ni st r at i on of T erbut al i ne and t he c our se of t r eat m entby th e d efen d a n ts con sti tu ted n eg l i ge n ce w h i ch m a y h a ve ca u sed o r con trib u ted to h er devel op m e n tof

cardi om yop athy, congestive h eartfai l u re, an d p u l m on ary edem a. Sh e di d n otexpl ai n w h y o r h ow she obtai n ed these expert opi n i on s or
w h y she d i d n otor coul d n otha ve obtai n ed them earl i er. Th e j ury hear d conf

l i c t i ng evi denc e re gar di ng t he s t andard o f ob st et r i c al
c ar e and w het her i tw as br eac hed. Th e H uss es pr es ent ed e vi denc e t hatal t hough T erbu t al i n e i s u se d “o ff l abel” by obstet ri ci an s t o sl ow or h al tpret erm c o n tr a c tio n s , it s h o u ld n o t b e u s e d w h e n th e ce r v ix h a s n o t d ila te d a n d th e r e is
n o p ret erm labor, a n d t h at i tsh ou l d n oth ave been a dm i n i st ered f or f ou r w eeks. I n co nt r as t , D r . G i ddens t es t i f i ed t hati ti s s afe t o use Terbut al i ne f orob st et r i c al pa t i e nt s , a nd t hatt hi s w as a c o m m o n a nd ac c e pt e d pr ac t i c e am o ng o bs t e t r i c i ans i n cases l i ke B arbara’ s. W h et h er Terbu t al i n e can cau se cardi om yop athy, a n d w h et h er i tdi d cau se B a r b a r a ’s c a r d io m y o p a t h y , w a s h e a v il yd is p u t e d a ttr ia l. D r . M u r r a y , B a r b a r a ’s trea t i ng c ar di ol ogi st , agr ee d i n hi s depos i t i on, w hi c h w as subm i t t ed i n to evi denc e , t hatpe r i pa r t um c ar di o m yo pa t hy i s i di o pa t hi c , m e ani ng t he

“ pat hogene si s i s notknow n. ” I n ot her w or ds, i di opat hi c m eans t hatt he e t i ol ogy o rm e d ic a l ca u s e o f th e c o n d itio n is u n k n o w n . D r . M u r r a ya g r e e d th a t d ia g n o s is of t he c ondi t i on res ul t s f r om a “ di agnos i s of

exc l usi on, ” w hi c h he s ai d m eans t hat

“ o ne c an f

i nd no o t he r r e as o n f

o rt he c ar di o m yo pa t hy o t he rt han t he fac tt hatt he
w om an w as pregn an t
. ” I n contr ast, t h e H u sses ’pri m ary cau sati on e x p e rt, D r. Frede r i c k C ar l t on, Jr
. , t es t i f i ed t hatTer but al i ne i s know n i n t he m edi c al
c om m uni t y to c ause c ar di om yopat hy. D r . C ar l t on o pi ned t hati f B ar bar a had
e x p e r ie n c e d s h o r tn e s s o f b r e a th o u t o f p r o p o r t i o n to w h a t a p h y s ic ia n w o u ld
e x p e c t in a la te -te r m p r e g n a n c y “b e g in n in g a c o u p le o f m o n th s b e fo r e [d e liv e r y ],”
s uc h a fac t“ m o ve s i tl e s s a nd l e s s f rom j u st t he i di o pa t hi c pe r i pa r t um cardi om yop athy” and l ed h i m t o bel i eve t h at Terbu t al i n e caused or contribu t edN o. 04- 60962

Other ri sk factors whi c h Ba rba r a did not exhibit include age over 3 0 years, and 3 African -Americanrace. 10 t o Bar ba r a’ s he ar ta nd l ungc o ndi t i o ns . I tw as s i gni f i c antt o hi m t hatt he
m edi calrec ords f

rom B arbara’ s r ead m i ssi on on M ay 10 , 199 8, ref l ect ed h er s t a t e me n t s t h a ts h e h a d s u f fe r e d f r o m s e v e r e s h o r t n e s s o f b r e a t h f

o ra b o u tt wo
m o nt hs b e f

o r e t he b i r t h o f

H anna h. O t he re xp e r t s t e s t i f i e d t hat , w hi l e t he c aus e s o f pe r i pa r t um cardi om yop athy are u n kn ow n , ri sk fact ors i n cl u de m u l t i pl e pregn an ci es, exc e ss ive w ei gh tgai n du ri n g pregn an cy, sm oking, an d toxem i a. B arbara
e x h ib ite d a ll o f th e s e b yt h e e n d o f h e rp r e g n a n c y . D e fe n d a n ts s o u g h t t o e lic it 3 t es t i m ony f

r om t hei r expe r t , D r . R eddi x, t hatm edi c all i t er at ure r el i ed upon by D r . C a r lto n in fo r m in gh is o p in io n d o e s n o t s h o w a ca u s a tiv e re la tio n s h ip b e tw e e n T e r b u ta lin e a n d c a r d io m y o p a th y . T h e m a g is tr a te ju d g e d id n o t p e r m it D r . R e d d ix to s ta te th is o p in io n , a s th is w a s “o u ts id e th e a r e a o f h is e x p e r tis e .” O n t h e f

i n alday of

t ri al , f ol l ow i n g t h e cr oss- exam i n ati on of defend an t s’l ast exp ertw i t n ess, D r. M art i n T u cker, t h e m agis t rat e j u dg e qu i pp ed i n t h e presence o f th e ju r y : “R e d ir e c t? H is m e te ris ru n n in g .” Th e par t i es a gr ee d t hatTenness ee ’ s subs t ant i ve l aw of m edi c al
m a lp r a c tic e g o v e r n e d . T h e H u s s e s s o u g h t t o re c o v e ro n th e o r ie s o f n e g lig e n c e in
a d m in is te r in gT e r b u ta lin e a n d a la c k o f in fo r m e d co n s e n t— r e a s o n in gth a t if B ar bar a had bee n i nf or m ed of t he r i sks of Terbut al i ne, she w oul d n ot h a ve consen t ed to t reat m en tw i t h t h at drug. D efen d a n ts ob j ect ed to t h e i n f orm ed
c o n s e n t in s tr u c tio n o n th e b a s is th a t in T e n n e s s e e , th e th e o r yd o e s n o t a p p ly betw een a ph ysi ci an prescr ibi n g t h erapeu t i c drugs an d a pa t i en t
. T h e obj ect i on
w as ov er r ul ed, and t he i nst r uct i on w as given t o t he j ury. D u ri n g cl o s i ng ar gu m en t , t h e H u sses ’att orney sai d the defenda n t s di d n ot produ ce m edi call i t erat u re t o sup port t h ei r argum e n ts. D efen da n t s’coun sel ob je c te d t o this as a m i s-ch a ra cterization of ev en ts at tri a l

. T h e m a gistrateN o. 04- 60962

Th e partie s co n se nte d tohave thisc a setri edb yama gis tr atej u dge. See2 8U .S .C

. § 4 6 3 6 (c). We h ave app ellatej uri sdictionp urs u a nt to2 8U .S .C

. § 1 2 9 1 an d § 6 3 6 (c)( 3). 11 o v e r r u le d th e o b je c tio n b e c a u s e “[t ]h is is co u n s e l’ s v ie w o f th e m a tt e r .” U l ti m a tel y, t h e j u ryren d ere d a g en era lve rd i ct. O n a h a n d -w ri tten piece of n ote pa per, t h e j u ry f

ou n d f or B arbara H u ss an d aw arded her $3, 500 , 0 0 0. T h e j u ry al so f ou n d f or R odn ey H u ss bu taw a rd e d h i m no d am ages. T h e courtentered j u dg m en ton the verdi ct
. T h e defen da n t s f i l ed a m ot i on f

or j u dg m en tas a m att er o f l aw, o ri n t he a l t e r nat i ve , f o ra ne w t r i al

. Thi s w as de ni e d. T h e d efen da n t s ap pea l ed, a rguing t h at: (1) the H u sses ’cl ai m s are barred by t he s t at ut e o f

l i m i t at i ons , ( 2) t her e i s i nsuf f i c i entev i denc e t o pr ove t hat T e r b u ta lin e ca u s e d B a r b a r a H u ss’ s i nj u r ie s , (3 ) th e m a g is tr a te ju d g e im p r o p e r ly excl u ded port i on s of

D r. R edd i x’ s t est i m on y regardi n g cau sati on , ( 4) t h ere w ere error s i n t h e j u ry charge, (5 ) th e j u dg e’ s c om m en tabou tD r. T u cker’ s “ m et er”
w as pr ej udi c i al , a nd ( 6) t he j udg e fai l e d t o c o r r e c ta m i s c har ac t e r i z at i o n of t he evi den ce by t h e H u sses ’coun seldu ri n g cl osi n g argu m en t s. III. The ba s i s o f

t he t r i alc o ur t ’ s j ur i s di c t i o n was dive r s i t y o f c i t i z e ns hi p. The H us s e s a r e c i t i z e ns of M i s s i s s i ppi , de fe nda nt s a r e c i t i z e ns o f Te nne s s e e , a nd t he
a m o u n t in co n tr o v e r s ye x c e e d s $ 7 5 ,0 0 0
. S ee2 8 U
. S

. C

. § 1332

. I n di versi t y cases, 4
w e app l y federalprocedu rala n d evi den t i ary rul es, a n d the sub st an t i ve l aw s of th e fo r u m s ta te
. Er i e R. R. Co

. v . To mpk i ns , 3 04 U
. S. 6 4, 7 8 ( 19 38 )

. U nde rt he E rie do ctri n e, fede ra l cou rts a p p l y t h e st a tu te of l i m i tati on s th a t t h e foru m state
w o u ld a p p ly

. S ee G u ar. TrustCo. v. Y ork , 3 2 6 U
. S

. 99, 109

- 10 (1945). W e al so a p p l y t h e fo r u m s ta te ’ s ch o ic e o f la w ru le s . S ee D e nm an v. Sn apperD i v. , 131 F
. 3d 546 , 548 ( 5th C i r. 199 8)

. T h i s m ay requ i re app l yi n g on e s ta te ’ s stat u t e of lim ita tio n s a n d a n o th e rs ta te ’ s s u b s ta n tiv e la w . See , e . g. , B oard m an v. Un i t ed S v c s . A u to . A s s ’n , 47 0 S o. 2d 1 0 2 4 , 1 0 3 1 (M i ss. 1 9 8 5 ) (“ [T ]he l a w of a si n gle state d o e s n o t n e c e s s a r ilyco n tr o l e v e r yis s u e in a g iv e n c a s e .”). T h is c a s e w a s t r ie d inN o. 04- 60962

Mis sis sip pi co urt s tr eat f ore igns tat utes of rep os e as subst antive , and obs erve 5 li mitation s i mp os edb ysuchst atute s. See Wayne v. Tenn . Valley Auth. , 73 0 F .2d 3 92, 400 -02 (5thC ir. 1 984) (holdin g that, while Mississippi courts typicallyapp lydomestic statute s of li mitation s, T enn es se e’ s 1 0 -year st atute of re po se app li ed toc ut of f pl aintiff

s’right of

actio n). Bec auseth e Husses file d suit within the thre e-year perio d of T enn essee’s medical malpractice re po sestatute , thisexce ptio ni s noti mp licate d. SeeT E NN . C O D E ANN . § 2 9–2 6–1 16(a)(3) (2 006 supp .)

. 12 M i ssi ssi pp i

. T h e courtapp l i ed M i ssi ssi pp i ’ s m edi ca l m al practi ce s t atute of l i m i t ati on s, an d i n st ructed t h e j u ry accor di n g t o T en n essee m edi calm al practi ce l aw . T he part i es n eve robj ec t ed t o t hi s c hoi c e o f l aw . O n appeal , t he par t i es have bri efed l i m i t ati on s un der M i ssi ssi pp ilaw , a n d bri efed su f f i ci en cy of

t h e evi den ce a n d p r o p r i e t yo f

t h e j u r yi n s t r u c t i o n s u n d e rT e n n e s s e e l a w. E ven h ad ei t h er pa rt y preserved an obj ect i on t o t h i s c h oi ce of l aw , w h i ch th e p a r tie s p la in lyd id n o t, seeKu celv. W alt er E
. Hel ler & Co. , 813 F. 2d 67, 74 (5th C i r. 19 8 7 ), w e are con fi d en t th a t i t w a s p rop er to a p p l y M i ssissi p p i ’ s statu te of l i m i tati on s an d T en n ess ee ’ s l a w of m ed i ca lm a l p ra cti ce. M i ssissi p p icou rts g e n e r a llytr e a t s ta tu te s o f lim ita tio n s a s p r o c e d u r a l a n d th u s a p p l yd o m e s tic lim ita tio n s p e r io d s . S ee Al l i s o n v . ITEImpe r i alCor p. , 92 8 F
. 2 d 1 3 7 , 1 4 4 ( 5 th C ir . 1 9 9 1 ); cf. Wi l l i am s v. T aylorMach

. , I

n c. , 5 2 9 S o . 2 d 6 0 6 , 6 0 9 (M iss

. 1 9 8 8 ),
sup er se d ed on oth erg ro u n d s by sta tu te , M is s . L a w s , ch . 4 8 6 , § 1 7 .0 5 (1 9 8 7 ), as re cog n ize din S

. Pac. Tran sp. Co. v. F ox , 60 9 S o. 2 d 35 7 , 36 1 -62 (M i ss. 19 9 2 ). In 5
m att ers of

substanti ve t ort l aw , M i ssi ssi pp if ol l ow s t h e “ center of gravi t y” t est
o f t he Res t at e m e nt( Se c o nd) o f Conf l i c t s o f Law, und e rw hi c h a c o ur ta ppl i e s t he l aw of t he s t at e w i t h the m ost s ubs t ant i alc o nt ac t s w i t h t he pa r t i e s a nd t he
s u b je c t m a tt e ro f th e a c tio n . S ee Mitch ell v. C raft , 211 So. 2d 50 9, 515 (M i ss. 196 8) ( ci t i n g R est atem en t( S econd ) of C on f l i ct s of L aw § 145). Acourtm u st
c o ns i de rt he pl ac e of

i nj ur y, t he pl ac e w he r e t he ne gl i ge ntc o nduc to c c ur r e d, t he d o m ic ile o rre s id e n c e o f th e p a r tie s , a n d th e p la c e w h e r e th e p a r tie s ’re la tio n s h ip is ce n te r e d

. P ri ce v. L i t t on S ys. , I n c. , 7 84 F. 2d6 00 , 6 03 ( 5t h Ci r . 1 986 ) ( c i t i ng Mitch ell , 2 1 1 S o . 2 d a t 5 1 5 ).N o. 04- 60962

13 Th e de fendant s reside i n T ennes se e, and t he par t i es ’r el at i ons hi p w as c e nt e r e d i n M e m phi s . T he br e ac h of t he s t and ar d o f

c ar e , i f a ny, o c c ur r e d a tt he M e m p h i s OB/ GYN c l i n i c , wh e r e Ba r b a r a wa s a d m i n i s t e r e d s u b c u t a n e o us T erbu t al i n e an d p resc ribed oralT erbu t al i n e. O n t h e ot h e r h an d, t h e H u sses
r e s i d e i n Mi s s i s s i p p i , a n d B a r b a r a h a s s u f fe r e d h a r m c h i e f

l yi n t h a ts t a t e . On ba l anc e , w e be l i e ve t hatt he “ c e nt e rof gr av i t y” i n t hi s ca s e i s i n Te nne s s e e , a nd th a t M is s is s ip p i d o e s n o t h a v e a m o r e s ig n ific a n t r e la tio n s h ip t o th e ca s e . S ee, e . g. , B l edsoe v. C row l ey , 8 49 F. 2d6 39 , 6 42

- 43 ( D
. C. Ci r. 198 8) ( ap pl yi ng R est atem en tan d h ol di n g t h at w h ere pati en t
- ph ysi ci an rel ati on shi p w as based i n M aryl an d, M aryl an d l aw app l i ed to D
. C

. res id en t ’ s m edi calm al practi ce c la im ); cf. D e nm an , 131 F. 3d at 549 ( “ U nderM i ss i ss i ppil aw , t he s ubst ant i ve l aw o f t he pl ac e o f

i nj ur y c o nt r o l s unl e s s a no t he rs t at e ha s a m o r e s i gni f i c ant
re la tion sh ip to th e oc cu rr e n ce a n d th e p a rtie s.”) (cita tion om itted ). I V. B ecau se t h e l i m i t ati on s i ssue w as pote n tia l l y di sposi t i ve, t h i s pan el i ni t i al l y addr es se d t hati ss ue. Apanelm aj or i t y hel d t hat , as a m at t erof fede r al procedu rall aw , defen da n t s had preserved t h e argu m en t t h at t h ey w ere enti t l ed to ju d g m e n t a s a m a tt e ro f la w . H u ss I, 465 F .3d a t 2 05 (“ T h ere w as no j u ry que s t i o n s ubm i t t ed c o nc e r ni ng t he da t e t he H us s e s ’c aus e o f a c t i o n a c c r ue d; th e r e fo r e , d e fe n d a n ts ca n p r e v a il o n th e ir s ta tu te o f lim ita tio n s d e fe n s e o n lyif t h e H u sses ’cl ai m s acc rued bef ore Jun e 30, 199 8 as a m att er of l aw . ” )

. T h e pan el t h en hel d that, un der M i ssi ssi pp il aw , B arbara k n ew or shou l d h ave k n ow n of
a c o nne c t i o n b e t w e e n t he de fe nda nt s ’c o ndu ct a nd h e ri nj ur i e s o n t he da y s he
w a s d ia g n o s e d w ith c a r d io m y o p a th y , M a y 1 0 , 1 9 9 8
. I d. at207- 08 (c i t i ng Wr ight
v. Q u esnel , 876 So. 2d 36 2, 367 (M i ss. 2 004 ) )

. In l i gh tof t h e factt h at t h e H u sses f i l e d s ui t t w o y e ar s a nd f o r t y da ys a f

t e rt hi s t i m e , t he m aj o r i t y he l d t hatt he H uss es ’c l ai m s w er e t i m e- bar r ed as a m at t erof l aw under M i ss i ss i ppi ’ s m edi c alN o. 04- 60962

Th e statuteprovi des in relevant part: 6 [N] o c l ai m in t o rt m ay b e b ro u ght a gain s t a lic e n s e d p hy s ic i a n [o r] h o s p it al

. . . for inj uri es orwron gful de atharisin g out of th e course of med ic al , s urgicalor other professio nalservices unl ess it is file d within two (2) ye ars from th e date the all eged act, omissionor ne gl ect shall or with reasonablediligencemight have b eenfir st knownor discovered. § 1 5–1 –36 (1), (2). Whilea statutory change took effect for clai ms accruin g on or after July 1, 1 9 9 8 , th e ch a n ge do esnotaff ect th e is su esp re se nte d inthisc a se . See id.

14 m a l p ra cti ce sta tu te of l i m i tati on s. I d. ; see M IS S
. C ODE A NN . § 1 5– 1– 36
. The 6
m aj ori t y vacated t h e j u ry’ s verdi ctan d rend ered j u dg m en ti n defen da n t s’favor. H u ss I, 4 65 F. 3da t2 08

- 09
. J udg e H i gg i nbo t ham di s s e nt e d. The H us s e s r e que s t e d r e he ar i ng e n b anc . Thi s fai l e d: a m aj o r i t y o f t he j udg e s i n a c t i ve s e r vi c e a nd n o tdi s qua l i f i e d d i d no tv o t e i n fav o ro f g r ant i ng
r e h e a r in ge n b a n c . H u ss II, 2 0 0 6 W L 5 0 1 3 1 9 5 , a t * 1 . H o w e v e r , th e p a n e l s ua sp o n teg r a n te d re h e a r in gb yth e p a n e l. I d. T h e M i ssi ssi pp iSu prem e C ou rt
s ubs e que nt l y i s s ue d i t s o pi ni o n i n S u t h erlan dv. R i t t er , 959 So. 2d 10 04 (M i ss. 20 07 )

. A m aj o r i t y o f t hi s pa ne lc o nc l ude d t hatno c as e o f t he M i s s i s s i ppi S u p r e m e C o u r t w a s cle a r lyco n tr o llin g . S ee H u ss III, 5 08 F. 3da t2 45

- 48
. The pa ne lm aj o r i t y r e que s t e d t hatt he M i s s i s s i ppiSupr em e C o ur ta c c e ptt he f o l l o w i ng c e r t i f

i e d q ue s t i o n: W hen t he al l ege d negl i genc e i s ( 1) adm i ni st r at i on o f a d ru g b y a ph ysi cia n , or ( 2) fai l u re t o di scl ose w h at a r eason able practi t i on er w ou l d h ave di scl osed abou t t h e ri sks of a dru g, an d exp ert s di sagree a s to w h eth er t h e dru g cau sed th e plaintif f’ s i nj u ri es, is th e d a te th a t t h e a l l eg ed act, om i ssion or n eg l ect m i gh t, w i th rea s o n a b le di l i ge nc e , ha ve b e e n f i r s tkno w n o rdi s c o ve r e d by t h e pl ai nt i f f t he da t e he rc on di t i o n o ri l l ne s s i s di ag no s e d b y no n- de fe nda nt p h y s ic ia n s o re x p e r ts , o rth e d a te th e p e r tin e n t fa c ts a r e a v a ila b le i n m edi calrec ords, or is li m i t ati on s t ol l ed u n t i lone i n a ser i es of physi c i ans o rot herex per t s t he pl ai nt i f f c ons ul t s f

i r stt el l s hert hat t h e drug caused her cond i t i on or i l l n ess? I d. at 24 1 -42
. Ju d ge H i gg i n b oth a m dissen ted f rom certi fi ca tio n . I

d. at248- 55 (H igg in b o th a m , J ., d iss e n tin g).N o. 04- 60962

The parti es’ b riefingof adm is sibilityof expert testimony under T enn essee law i s 7 thereforenot relevant
. 15 The M i ss i s s i ppiSupr e m e Cour ta c c e pt e d t he c e r t i f i e d q ue s t i o n. The S u prem e C ou rt ’ s r espon se— t h at t h e H u sses ’cl ai m s are n otp resc ribed a m att er of l aw — h as res ol ved t h e l i m i t ati on s i ssue, an d w e vacate our pri or di sposi t i on of t h i s and hol d that t h e m agis t rat e j u dg e properl y den i ed d efen da n t s’m ot i on f o rdi r e c t e d v e r di c to n l i m i t at i o ns g r o unds

. The pa ne lne c e s s ar i l y r e t ai ns ju r is d ic tio n o f

t h e re m a in d e ro f th e is s u e s ra is e d b yth e d e fe n d a n ts in th is ap pea l

. T h e f

i ve ot h er poi n t s of

err or ass ert ed by defen da n t s are: suf f i ci en cy of evi denc e t o e st abl i sh c ausat i on, t he r ul i ng on D r . R eddi x’ s expe r tt es t i m ony, prej u di ci alcom m en t s by t h e m a gi st rat e j u dg e, t h e cor rect n ess of t h e j u ry i n stru cti on s, an d m i s-ch a ra cterization of ev i d en ce d u ri n g closing arg u m en t. V. W e no w t ak e up t he a r gum e ntt hatt he m ag i s t r at e j udg e e r r e d i n s t r i ki ng p o r tio n s o f th e te s tim o n yo f t h e d e fe n d a n ts ’ca u s a tio n e x p e r t, D r . R e d d ix . W e ho l d t hat t he m ag i s t r at e j udg e e r r e d i n pr o hibi t i ng D r . Red di x f r o m e xp r e s s i ng opi n i on s on m edi calcausati on , an d that such errorw as not harm l ess. A. S t ate l aw governs th e substance of t h i s c ase, bu t“ t h e F ederalR u l es of E vid en ce co n trol th e a d m i ssion of ex p ert testi m on y.” Mat hi s v . Exx o n Cor p. , 302 F
. 3d4 4 8 , 4 5 9 (5t h C ir. 2 0 0 2 ). E x p e rts q u a li fied b y“k n o w led g e , sk il l, ex p e rien ce, 7 tr a in in g o r e d u c a tio n ” m a y p r e s e n t op in io n te s tim o n y to th e ju r y . F ED . R. E VID . 70 2. “A par t y s e e ki ng t o i nt r o duc e e xp e r tt e s t i m o ny m us ts ho w ‘ ( 1) t he t e s t i m o ny is b a s e d u p o n s u ffic ie n t fa c ts o r d a ta , (2 ) th e te s tim o n y is th e p r o d u c t o f r e lia b le pr i nc i pl e s a nd m e t ho ds , a nd ( 3) t h e w i t ne s s ha s a ppl i e d t he pr i nc i pl e s a nd
m eth od s reli a b l y t o t h e fa cts of th e ca se.’” S m i t h v. G oodyear Ti re & R u bber Co. , 495 F
. 3d 224, 227 ( 5t h C i r . 2007) ( quot i ng F ED . R. E VID . 702 )

. T h e t ri alcourt s act
as “ ga t e - ke e pe r s ” w hi c h m ak e a “ pr e l i m i nar y as s e s s m e nto f w he t he rt heN o. 04- 60962

16 reasoni n g or m et h odol ogy u n derl yi n g t h e t est i m on y i s s ci en t i f i cal l y vali d an d of
w h e th e rth a t r e a s o n in go rm e th o d o lo g yp r o p e r lyca n b e a p p l i e d t o t h e fa c ts in i ssu e.” P i

pit on e v. B i om atr ix, I n c. , 2 88 F. 3d2 39 , 243

- 44 ( 5t h Ci r . 2 00 2) ( quo t i ng D au bertv. Merr el lD ow Ph arm . , I n c. , 5 0 9 U .S

. 5 7 9 , 5 9 2 -9 3 (19 9 3 )). W h et h er an i n di vi du ali s qua l i f i ed to t est i f

y as an ex pert i s a questi on of la w . Ma th is , 302 F. 3d at459 ( c i t i ng F ED . R. E VID . 104 ( a) )

. H ow ever, w e revi ew th e a d m is s io n o re x c lu s io n o f e x p e r t t e s tim o n yfo ra n a b u s e o f d is c r e tio n . S ee S t. Mart i n v. Mobi l Explor ati on & P rodu ci ng U
. S

. I n c. , 2 24 F
. 3d 402 , 405 ( 5th C i r. 2 0 0 0 ). “Ad i s t r i c t c o u r t s h o u ld re fu s e to a llo w a n e x p e r t w itn e s s to te s tify if it f i n ds t h at t h e w i t n ess i s not qu al i f i ed to t est i f

y i n a parti cul ar f

i el d or on a gi ven su b j ect. ” Wi ls o n v . W o o ds , 1 63 F
. 3d 9 35, 937 ( 5th C i r. 199 9)

. R u l e 702 does not
m an da t e t h at an exp ertbe highl y qu al i f i ed i n order t o t est i f y abou ta gi ven i s s ue . D i f

fe r e nc e s i n e xp e r t i s e b e arc hi e f l y o n t he w e i ght t o be a s s i gne d t o t he te s tim o n y b y th e tr ie r o f fa c t, n o t it s a d m is s ib ility

. S ee D au bert , 509 U
. S. at596 ( “Vi go r o us c r o s s - exam i nat i o n, pr e s e nt at i o n o f c o nt r ar y e vi de nc e , a nd c ar e f ul i n st ructi on on the bu rden of proof are t h e t radi t i on alan d ap propri ate m ean s of
a tt a c k in gs h a k yb u t a d m is s ib le e v id e n c e .”); Ho lb r o o k v . Ly k e s B r o s . S .S . Co ., Inc. , 80 F. 3d 777, 782 ( 3d C i r . 1996) ( r eas oni ng t hat“m os targum ent s aboutan e x p e r t ’s q u a li fi c a t io n s r e la t e m o r e to th e w e ig h tto b e g iv e n th e e x p e r t ’s te stim on y t h an t o i t s adm i ssibi l i t y”)

. R u l i n gs are s u bj ectt o ha rm l ess error ana l y s i s , u n d e r wh i c h a n i n c o r r e c t r u l i n g wi l l b e a f f i r m e d u n l e s s i t a f

fe c t e d a
s u b s ta n tia l rig h t o f th e co m p la in in gp a r ty
. S ee S t. Ma rtin , 224 F. 3d at405. B. D ef endant s des i gnat ed D r . R eddi x as an expe r t w i t nes s. D r . R eddi x h as a m e d ic a l d e g r e e , a m a s te r ’ s d e g r e e in p u b lic h e a lth , a n d is b o a r d -c e r tifie d in i nt er nalm edi c i ne. A t th e ti m e o f t r i alhe had f

i f t ee n year s of

ex per i enc e a s an i nt er ni st
. H e s t at ed t hat he had know l edge of c ar di ac c ondi t i ons and t oxi c ol ogy f r o m m e di c als c ho o la nd h i s t r ai ni ng as a n i nt e r ni s t
. H e ha d t r e at e d p r e gna ntN o. 04- 60962

C ontr aryto the obj ectio n made by the Husses’ coun sel, Dr. Red dix said in his expert 8 reportth at Barbara’s cardiomyo pathy “cannot be said to h ave b eencaused

. . . byth e administrationof oralT erbutaline.” Th e report has detailed criticism of th e medical literature on whic h t heplaintiffs’ experts relie d. Dr. Reddixal so attach es astudyinvolving 9,0 00 pat ient s in which fe w, if any, had car dio myop athy. 17 pa t i e nt s , a nd h adt r e at e d p at i e nt s w i t h he ar tdi s e as e s , c ar di o m yo pa t hy, a nd pul m onar y e dem a. D ef end a n ts’ c ounse las ked D r . R eddi x w het herhe had
s t udi e d Barba r a’ s m e di c alre c o r ds and t he m e di c all i t e r at ur e r e l i e d up o n b y t he H uss es ’ex per t s; D r . R eddi x s ai d he had. C ounse l t hen as ked w het herhe had an
o pi ni o n, “ba s e d up o n r e as o nab l e m e di c alpr o ba bi l i t i e s a nd y o ure duc at i o n, tr a in in g , a n d e x p e r ie n c e a s a p h y s ic ia n , a s w e ll a s y o u rre v ie w o f th e m a te r ia ls I j us tr e ad , a s t o w he t he ro rno tTe r but al i ne cau sed or c o nt r ibut e d t o t he cardi om yop athy s u f

fered by B arbara H u ss? ” T h e H u sses ’att orney ob j ect ed on t h e basi s t h at D r. R edd i x h ad stat ed i n h i s R u l e 26 reportt h at he di d n otkn ow t h e cause of

B arbara’ s c ardi om yop athy becau se t h e condit i on i s i di opa t h i c. 8 T h e m agis t rat e j u dg e requested t h at t h e att orneys dis cuss t h e obj e cti on o ut s i de t he pr e s e nc e of t he j ur y. I n ch am be r s , t he fo l l o w i ng e xc hang e o c c ur r e d: The Co ur t : N o w , o n whatb as i s i s t hi s w i t ne s s qual i f i e d t o o f fe r any opi n i on abou t w h e th e r a d m in iste ri n g T erbu t al i n e di d or di d n otcause cardi om yop athy h ere? D e fe nd ant s ’ Couns e l : H e ’ s a n i nt e r nalm e di c i ne phy s i c i an w ho

t reat s pati en t s w i t h cardi om yop athi es. H e ha s a degree f r o m H ar va r d i n P ubl i c H e al t h, i nc l udi ng s t udy i ng s t at i s t i c s . H e ’ s re vi e w e d t he m e di c all i t e r at ur e . I m e an, he has pat i ent s al l t he t i m e w ho have c ar di om yopat hy. H e kn ow s t h e drug i n t eract i on s. T h e C ou rt: I do n ’ t k n ow a b ou t th a t l a st statem en t. I’ m i n cl i n ed to

t h i n k thi s i s outs i de the area of hi s expert i se. F o cu sin gon D r. R e d d ix’s la ck o f “e x p e rie n ce o r tra in in g” w h ich w o u ld “en a b le[] h i m t o say t h at t h e adm i n i st rat i on of t h i s drug d i d or di d n otp ro b a b l y cau se ca rd i om yo p a th y,” the m a gistrate jud ge su stain ed the ob j ection

. T h e m a gistrateN o. 04- 60962

Dr. Reddixtestified in part: 9 [M]anyof the articles that th eytalk about werevery , very s mallstudi es. And the possibilityof chance occurrences wereveryhigh. Whenyou had four peopl e o ut [of] 1 6, where ito nlyo c c ur sino n ein5 , 0 0 0to1 0 , 0 0 0p ati e nt s . S oalo tof ti m e sth ej ourn als that wereli sted [by the Husses’ experts] also confu sed what was said about pulmo nary ed em aa s ap artof th e prob le m, whichwouldle a d toa cardio myop athyinanyof thos e stu di es . 18 j udg e di d no tf

o c us o n whet he rt he o pi ni o n w as be yo nd t he s c o pe o f t he o pi ni o ns set forth in D r. R ed d i x’ s R u l e 2 6 rep ort. Fol l o w i ng t hi s rul i ng, de fe nda nt s ’c o uns e la s ke d Dr

. Red di x o ut s i de o f t he pre se nce of

t he j ury t o s t at e i n n a r r at i ve f or m t he bas i s f

orhi s opi ni on t hat T erbu t al i n e di d n otcause or c on t ribu t e to B arbara H u ss’ s cardi om yop athy. D r. Redd i x s ai d: “ Bas i c al l y, t he r e ’ s no e s t ab l i s he d e vi de nc e t hatha s b e e n t e s t e d a nd pu bl i shed i n m aj or j ou rna l s or t h e [ P h ysi ci an ’ s D esk R eference] t h at i t ca u ses cardi om yop athy. ” C ou n selt h en asked “ w h at i n t h e m edi calrec ords caused you to b e lie v e th a t T e r b u ta lin e is n o t th e c a u s a tiv e a g e n t? ” D r . R e d d ix s a id o n e co u ld
n otded u ce a c au sative rel ati on shi p becau se t h e art i cl es r el i ed on by the H u sses ’ expe r t s had ver y s m al ls am pl e si ze s, an d addi t i onal l y, s om e a r t i c l es m ay have
c onf use d pul m onar y e dem a w i t h c ar di om yopat hy. B y co nt r as t , D r . R eddi x w as pr e pa r e d t o t e s t i f

y ba s e d up on a s t udyo f 9 , 00 0 pa t i e nt s w ho t o o k Te r but al i ne and di d not deve l op c ar di om yopat hy. Th e t hrus t of t he pro f fer ed t es t i m ony w as 9 t hatTer but al i ne c oul d not be sa i d t o b e t he c ause of B ar bar a’ s c ar di om yopat hy,
a n d th a t t h e ca u s e o f h e rco n d itio n co u ld n o t b e d e te r m in e d , i
. e. , t h e condit i on i s i di o pa t hi c . Fo l l o w i ng t he pr o f fe r , t he j ur y r e t ur ne d t o t he c o ur t r o o m . The
m a g i s t r a t e j u d g e e x p l a i n e d t o t h e j u r y : “ I h a v e s u s t a i n e d a n o b j e c t i o n t o t he
o pi ni o n Dr. Red di x w as re que s t e d t o ex pr e s s on t he gr o und t hati tw as o ut s i de t h e f i el d of hi s expert i se. ” D efen da n t s t h en cal l ed thei r next w i t n ess. A fte rtr ia l, d e fe n d a n ts m o v e d fo r a n e w tr ia l in p a r t d u e to th e a lle g e d ly
e r r o n e o u s e x c lu s io n o f D r . R e d d ix ’ s te s tim o n y . T h e m a g is tr a te ju d g e d e n ie d th is
m ot i on i n a w r i t t en o r der , r eas oni ng:N o. 04- 60962

19 D r . R e d d ix ’s r e s u m e . . . r e v e a ls th e d e fi c ie n c ie s in D r . R e d d ix ’s back groun d an d exp eri en ce i n sofar as a causati on experti n t hi s c ase i s c on cerned. D r. R edd i x h as vi rt u ally n o e xp eri en ce i n obst et ri cs a n d g yn ecol ogy an d n o experi en ce w h atsoeverw i t h T erbu t al i n e. S in ce 1 9 9 1 , D r. R e d d ix’s e m p loy m e n t h a s p rim a rily b e e n a s a sta ff ph ysi ci an f

or t h e Job C orp [ si c] , t h e S tu den tH eal t h C en t er of Jack son S t ate U n i versi t y, an d the H i n ds C ou n t y D et en t i on C en t er. T h ere i s s i m pl y n ot h i n g i n D r. R edd i x’ s ba ckgrou n d w h i ch en t i t l ed hi m t o e xp r e s s o pi n i on s a s t o w he t he rTe r but al i ne c aus e d t he pl ai nt i f f ’ s c ar di om yopat hy orw het hert he c ar di om yopat hy w as i di opa t h i c. D efen da n t s note t h at D r. R edd i x h ad am e di c alde gr ee, w as board-c ert i f i ed i n i n t erna lm edi ci n e, pract i ced i n t erna lm edi ci n e f or f i f t een years, t reat ed pat i ent s w i t h hear tc ondi t i on s— som e of w hom w er e pr egnant , w as “ fam i l i ar
w i t h t h e ter m c ar di o m yo pa t hy, ” t r e at e d p at i e nt s w i t h e nl ar ge d he ar t s a nd cardi om yop athy, an d p resc ribed drug s s i m i l ar t o T erbu t al i n e . M oreover, “ D r. R e d d ix ’ s a n tic ip a tedtes tim o n yw a s a n a tu r a l e x te n s io n o f h is m e d ic a l a n d p u b lic h e a lth tr a in in ga n d h is e x p e r ie n c e a s a p r a c tic in gp h y s ic ia n o f fift e e n y e a r s .” D efendant s pos i tt hatt hi s qual i f i ed D r . R eddi x t o o pi ne t hatt he m edi c al l i t e r at ur e a nd Barba r a’ s rec o r ds di d no ta l l o w o ne t o i nfe rt hatTe r but al i ne c ause s ca rdi om yopat hy, ort hati tc ause d i ti n B ar bar a’ s c as e. D ef endant s sa y D r. R edd i x w as at lea stas qua l i f i ed to gi ve cau sati on t est i m on y as w as D r. Car l t o n, t he H us s e s ’m ai n e xp e r to n ca us at i o n. D e fe nda nt s ar gue t hatt he r ul i ng
w as prej u di ci albecau se it preven t ed them f rom chal l en gi n g t h e H u sses ’
cau sati on t est i m on y an d D r. C arl t on ’ s c h aract eri zati on of t he m e di c all i t erat u re. T h e H u sses note th a tD r. R edd i x w as neit h er a c ardi ol ogi stnor a t o xi c o l o gi s t
. R el yi ng o n T an n er v. W

est brook , 1 7 4 F .3d 5 4 2 (5t h C ir. 1 9 9 9 ),
s upe r s e de d i n pa r tby r ul e o n o t he rg r o unds , F ED . R. E VID . 1 0 3 ( a ) (2 0 0 0 ), as re cog n ize din Ma th is , 3 0 2 F .3 d a t 4 5 9 n .1 6 , th e H u s s e s a r g u e th a t D r . R e d d ix coul d n otha ve provi ded com petent t est i m on y abou tw h et h er a part i cul ar hea rt
c ondi t i on ( c ar di om yopat hy) c an be, ori n B ar bar a’ s c as e, w as c ause d by aN o. 04- 60962

20 par t i c ul ardr ug ( Terbut al i ne)

. T he H uss es al so ave rt hatev en i f t he r ul i ng w as w rong, defen da n t s di d n otsuf fer prej u d ice b e ca u se ot h er expert s presented
s i m i l aro pi ni o ns t o t ho s e D r . Red di x w as p repared t o e xp r e s s , e xc e ptf o rt he
c la im th a t t h e s tu d ie s re lie d o n b yD r . C a r lto n a r e illo g ic a l. C. W e b el i eve t hatt he e xc l usi on o f D r . R eddi x’ s opi ni on te st i m ony w as an abuse of

di sc r et i on. D r . R eddi x r evi ew ed Barba r a’ s r ec or ds and t he m edi c al l i t e r at ur e r e l i e d o n b y t he H us s e s . Thr o ugh D r . Red di x’ s t e s t i m o ny, t he defenda n t s s ou gh tpri m aril y to di scr edi tt h e contenti on t h at Terbu t al i n e i s a k n o w n ca u s e o f c a r d io m y o p a th y , a n d c o n s e q u e n tly , t h a t T e r b u ta lin e m o r e lik e ly t han no tc aus e d Barba r a’ s c ar di o m yo pa t hy. D r . Red di x di d no t ne e d t o b e b o ar dc e r t i f i e d i n c ar di o l o gyo rt o xi c o l o gyt o e xp l ai n t hat t he s t udi e s r e l i e d o n b y t he H u s s e s d o n o t p r o v e a ca u s a tiv e re la tio n s h ip

— e s p e c ia llyg iv e n th e v e r ys m a ll
n u m ber of

pati en t s in those st u di es. D r. R edd i x’ s t rai n i n g an d exp eri en ce as a
m edi calprofessi on alqu al i f y h im t o t el lt h e j u ry w h y t h e l i t erat u re does not
es t abl i sh a c ausa l li n k

. M or eo ver , D r . R eddi x i dent i f i ed a st udy of

ov er9, 000 p e o p le w h ich ten d e d to u n d e rm in e th e H u ss e s’ cla im s. In sh o rt, D r. R e d d ix ’s edu cat i on a n d kn ow l edg e a l l ow ed h i m to for m a rel i able opi n i on as t o w h et h er, as a g ener alm at t er , Ter but al i ne c ause s c ar di om yopat hy. W e t hi nk t hatt he m o r e ge ne r alnat ur e of D r . Red di x’ s c o nc l us i o ns he l ps t o d i s t i n g u i s h t h e p r e s e n t c a s e f r o m T an n er . T h ere, al lexperts agreed as a gener alm at t ert hatbi r t h asphyxi a c an c ause c er ebr alpal sy . 174 F. 3d at548. T h e issu e w a s m ore sp ecif i c: w h eth er t h e defen d a n ts’fa i l u re to p rop erly trea t a
ne w bo r n b ab y’ s b i r t h as phy xi a c aus e d t he ba by ’ s c e r e br alpa l s y, o rw he t he rt he
c e r e b r a l p a ls yw a s ca u s e d b ya n o th e re v e n t. S ee i d. a t 5 4 7 -4 8 . W e h e ld th a t it
w a s e r r o n eo u s to ad m i t an ex p ert’ s op i n i on tha t t h e d efen d a n ts’action s l ed to t h e bab y’ s cerebralp al sy w h en the m edi calli t erat u re d i d n otsu pp ortthis t h eoryN o. 04- 60962

21 o f c aus at i o n, t he e xp e r tha d no tex am i ne d t he bab y, and t he e xp e r ta l s o ha d no p e r s o n a l e x p e r ie n c e th a t w o u ld v a lid a te h is th e o r y . I d. at548. In t h i s c ase, the pa rt i es f ou gh tm ai n l y over w h et h er Terbu t al i n e can cau se ca rd i om yo p a th y. T h e H u sse s’ex p ert, D r. C a rl ton (w h o is a tox ic o lo g i st, n ot a
ca r di o l o gi s t ) , r e l i e d o n t hi s g e ne r alpr e m i s e w he n o pi ni ng t hatTe r but al i ne c a u s e d B a r b a r a ’ s ca r d io m y o p a th y . D r . C a r lto n e x p la in e d th a t h e fo r m e d h is
o p i n i o n in p a r tb ye x c l u s i o n . S p e c i f i c a l l y , h e b e l i e v e d T e r b u t a l i n e w a s t h e c u l p r it b e c a u s e h e co u ld n o t id e n tify o rth in k o f a n yo th e rre a s o n th a t B a r b a r a w o u ld de ve l o p c ar di o m yo pa t hy. T he m ai n pu r po s e o f D r . Red di x’ s o pi ni o n was t o r e but
an un t en able concl u si on . D r. R e d d i x’ s kn ow l edg e qu al i f i ed h i m t o t el lt h e j u ry t hatD r . C ar l t o n’ s i nfe r e nt i all e ap w as uns upp o r t e d b y m e di c all i t e r at ur e , a nd th a t in h is ju d g m e n t, B a r b a r a ’ s p e r ip a r tu m c a r d io m y o p a th yw a s id io p a th ic . W e do nott hi nk t hatD r . R eddi x n ee ded t o be s pec i al i ze d i n ca r di ol ogyort oxi c ol ogy t o actas a coun t erpoi n tt o t h e H u sses ’experts
. The m ag i s t r at e j udg e f o c us e d o n t he fac tt hatD r . Red di x hadl e s s t r ai ni ng an d exp eri en ce w i t h T erbu t al i n e t h an D r. C arl t on . T h i s m i ssed t h e pu rpose f or
w h i ch defend an t s s ou gh tt o el i ci tD r. R edd i x’ s opi n i on . M oreover, t h e D au bert
s t and ar ds a r e f

l e xibl e , a nd t h e m o s ti m po r t antq ue s t i o n i s no tw he t he ro ne p a r t y ’s e x p e r tis m o r e q u a li fi e d th a n th e o t h e r ’s , b u tr a t h e r , w h e t h e ra n e x p e r t ’s te s tim o n yis re lia b le

. S ee i d. a t 5 4 7
. W e b e lie v e th a t th e r e w e r e s u ffic ie n t in d ic ia i n t h i s c ase t h at D r. R edd i x w ou l d p rovi de a rel i able opi n i on i n rebutt alt o D r. C arl t on ’ s opi n i on . W e di sagree w i t h t h e m agis t rat e j u dg e’ s c on cl u si on t h at t h ere i s “ no t hi ng i n Dr. Red di x’ s b ac kg r o und w hi ch en t i t l e d hi m t o e xp r e s s o pi ni o ns as t o w he t he r Terbut al i ne c aus e d t he pl ai nt i f f ’ s c ar di o m yo pa t hy o rw he t he rt he
ca rd i om yo p a th y w a s i d i op a th i c. ” Cf. Hol brook , 8 0 F .3 d a t7 8 2 (“ T h e c o u r t ’s
m i s t ak e n a ppr o ac h r e s t r i c t e d Dr

. Car pe nt e r ’ s t e s t i m o ny ba s e d o n a r e qui r e m e nt th a t t h e w itn e s s p r a c tic e a p a r tic u la rs p e c ia l ty to te s tify co n c e r n in gce r ta in
m a tt e r s .”). T h e ru lin gw a s a n a b u s e o f d is c r e tio n .N o. 04- 60962

22 W e a ls o b e lie v e t h a t th is e r r o rp r eju d ic e d th e d e fe n d a n ts . T h e cr u x o f th is
c a s e w a s w h e t h e rT e r b u t a li n e c a u s e s c a r d io m y o p a t h y . T h e m a g is t r a t e ju d g e ’s rul i n g preven t ed the defenda n t s f rom dem on st rat i n g t h at t h e H u sses rel i ed on
m edi call i t erat u re w h i ch w as un rel i able, an ecdotal , an d co n t radi ct ed by ot h er s t udi e s . The H us s e s i ns i s tt he de fe nda nt s w e r e no tpr ej u di c e d b e c aus e t he de fe nda nt s ’o t he rw i t ne s s e s di s c l ai m e d a c aus all i nk b e t w e e n t he dr ug and B a r b a r a ’ s co n d itio n . H o w e v er, n on e o f th e o th e rw itn e s s e s g a v e th e le v e l o f d e ta il t hatD r . Red di x w o ul d ha ve pr e s e nt e d, no rdi d t he w i t ne s s e s t e s t i f y ab o ut st u di es s h ow i n g n o l i n k be t w e e n Te rbut ali ne a nd c ar di o m yo pa t h y. T h e excl u si on w as no tha r m l e s s e r r o r . I n a cl ose c as e s uc h a s t hi s , D r . Red di x’ s t e s t i m o ny
w oul d “ have adde d i nf or m at i on that , i f

the j uro r s f

ound i tc r edibl e, m i ghthave b e e n d e te r m in a tiv e ” o f th e d iffic u lt c a u s a tio n q u e s tio n s . S ee B a tt l e v . Me m ’l Hosp. atG u lf

port , 228 F
. 3d 5 44, 5 53 ( 5th C i r. 2 000 )

. W e hol d that t h e excl u si on
w as revers ibl e err or, an d d efen da n t s are en t i t l ed to a n ew t ri alon thi s basi s. V I. W e no w t ur n t o def

e nda nt s ’ar gum e ntt hatt he y ar e e nt i t l e d t o j udg m e nt
as a m at t e ro f

l aw ora ne w t r i alb e c aus e t he H us s e s di d no te s t ab l i s h t he
ca u sa ti on elem en t of the i r m ed i ca lm a l p ra cti ce claim

. A ft er tri a l , de fen d a n ts
m o ve d f o rj udg m e nta s a m at t e ro f l aw, o ri n t he a l t e r nat i ve , f o r a ne w t r i al

. The
m agi st r at e j udge de ni ed t he m ot i on be c ause t he H uss es ’ex per t s t es t i f i ed t hat

“ T erbu t al i ne i s r e po r t e d i n s o m e m e di c all i t e r at ur e a s a c aus e of cardi om yop athy. ” A f t er r evi ew i n g t h e rec ord, w e ha ve m i sgi vi n gs abou tw h et h er t h e evi den ce al l ow s a r eason able t ri er of factto f

i n d that Terbu t al i n e caused or con trib u ted to B a rb a ra H u ss’s co n d i ti on s. H ow ev er, d efen d a n ts fa i l ed to
a d e q u a te lyp r e s e r v e th is a r g u m e n t. B e c a u s e w e c a n n o t r e n d e rju d g m e n t o n th is basi s, w e pret erm i ta f u l ldi scussi on of

t h e suf

f i ci en cy of

t h e evi den ce. N ev erth eless, som e ob serv a ti on s ab ou t t h e ca u sa ti on e v i d en ce a re inten d ed to
a id th e p a r tie s a n d co u r t o n re tr ia l.N o. 04- 60962

23 A.

“A di rect ed verdi ct i s ap propri ate on l y i f, af t er c on si deri n g al lt h e evi den ce an d draw i n g al linferences theref rom in favor of t h e non - m ovi n g pa rt y, t h e court is co n v i n c e d t h a t n o re a s o n a b le ju r yco u ld fin d in fa v o ro f th e n o n -m o v a n t.” Pi m e nt al v . LTD Canadi an Pa c . Bul , 9 6 5 F .2 d 1 3 , 1 5 (5 th C ir . 1 9 9 2 ); seeF ED . R. C IV . P
. 50(a)

. W h en revi ew i n g t h e den i alof a m ot i on f

or a di rect ed verdi ctor f or j u dg m en tnotw i t h st an di n g t h e verdi ct , w e reverse on l y i f “ t h ere w as no con f

l i ct i n su b stan ti a lev i d en ce su ch tha t reas on a b l e m i n d s cou l d d iffe r . ” Hor t on v. B u h rke, D i v. of

Kl ei n T

ools, I n c. , 9 2 6 F .2 d 4 5 6 , 4 5 9 (5 th C ir . 1 9 9 1 ); see also D au bert , 5 09 U
. S. a t5 96 ( “ [ I ] n t he e ve ntt he t r i alc o ur tc o nc l ude s t hatt he
s c i n t i l l a o f

e v i d e n c e p r e s e n t e d s u p p o r t i n ga p o s i t i o n i s i n s u f f i c i e nt t o al l o w a
r e as o nab l e j ur o rt o co nc l ude t hatt he po s i t i o n m o r e l i ke l y t han no ti s t r ue , t he
c o u r t r e m a in s fr e e t o d i r e c t a ju d g m e n t[.]” ). W e re v ie w s u ffic ie n c yd iffe r e n tly d e p e n d in go n w h e th e rth e is s u e w a s p r e s e r v e d a t t r ia l. S ee Pol an co v. C i ty of A u stin , 78 F
. 3d 9 6 8 , 9 7 3 ( 5th C i r. 199 6)

. I f t h e i ssue w as preserved, w e ask
w h e th e r s u b s ta n tia l e v id e n c e s u p p o r te d th e v e r d ic t. S ee McC a n n v. T ex a s C ity R ef i n i ng, I n c. , 9 84 F. 2d6 67 , 6 71 ( 5t h Ci r . 1 99 3)

. I f t he i s s ue w as no tpr e s e r ve d,
w e a s k w h e th e ra n ye v id e n c e s u p p o r te d th e v e r d ic t. S ee Pol an co , 78 F. 3d at 974. Suf f i c i e nc y o f

t he e vi den ce i s pr e s e r ve d b y r ai s i ng t he i s s ue i n a m o t i o n a tt he
c lo s e o f a ll o f th e e v id e n c e . S ee i d. a t 9 73. “ Eve n i f no e vi de nc e s upp o r t s t he
ve r di c t , t hi s Cour tl ac ks t he po w e rt o e nt e rj udg m e ntf o rt he a ppe l l ant
. I ns t e ad , a p p ell a te reli ef i s l i m i ted to ord erin g a n ew tri a l

. ” Mc Cann , 984 F. 2d at671. D e fe nda nt s fai l e d t o r ai s e c aus at i o n a tt he c l o s e o f al lo f t he e vi de nc e . The H u s s e s u r g e u s t o c o n s id e rt h e is s u e fo r fe ite d . D e fe n d a n ts co n c e d e th a t t h e yd id
n o t ra i se t h e i ssu e at th e cl ose of a l l of th e evide n ce, b u t a rg u e t h a t w e s h o u ld
e xc us e t he i rfai l ur e a nd d e t e r m i ne w he t he rs ubs t ant i ale vi de nc e s upp o r t e d t he
v e r d ic t. In th e p a s t, w e h a v e co n s tr u e d th e p r e s e r v a tio n re q u i r e m e n ts o f R u le 5 0 lib e r a lly

— b u t w e h a v e in s is te d th a t w e m a yn o t s im p lyig n o r e th e R u le

. S ee,N o. 04- 60962

24 e . g. , T aylorP u bl ’

g Co. v. Jost ens, I

n c. , 2 1 6 F .3 d 4 6 5 , 4 7 2 -7 3 (5 th C ir . 2 0 0 0 ). W e as k whet h ert he de pa r t ur e f r o m t he Rul e w as “ de m i ni m i s ” a nd whet he rt he R u le ’ s p u r p o s e s w e r e fu lfille d

. S ee Pol an co , 78 F
. 3d at 974

- 75. T h e pu rposes are t w o- f ol d: “ t o en able t h e t ri alcourtt o re- exam i n e t h e suf f i ci en cy of

t h e evi den ce as a m at t e r o f l aw i f, af t e r ve r di c t , t he c o ur tm us ta ddr e s s a m o t i o n f o rj udg m e nt
as a m att er of

law , a n d t o a l ertt h e opp osi n g pa rt y t o t h e i n suff i ci en cy of

hi s c ase b e fore b ein g su b m i tted to th e j u ry . ” Ma cAr t h u r v . Uni v . of Tex . He a l t h Ct r . at T yl er , 4 5 F .3d 8 9 0 , 8 9 7 (5t h C ir. 1 9 9 5 ). D e fe nda nt s c hal l e nge d t he s uf f i c i en cy of t he e vi de nc e a tt he c l o s e o f t he H u s s e s ’ p r i m a fa c i e c a s e . Th e m a g i s t r a t e d i d n o t r e s e r v e j u d g m e nt , b ut i m m e di at e l y de ni e d t he m o t i o n. Appr o xi m at e l y o ne da y e l ap s e d b e t w e e n t he
c l o s e o f t he H us s e s ’ev i de nc e and t he cl o s e o f t he de fe nda nt s ’e vi de nc e . D ur i ng t h at t i m e, defen da n ts e li ci t ed cau sati on t est i m on y ( al bei tw i t h port i on s of D r. R ed d i x’ s op i n i on erro n eo u sly ex cl u d ed ). A t t h e close of the i r cas e, d efen d a n ts fa i l e d t o r e ne w t h e mo t i o n f o ra d i r e c t e d v e r d i c t
. I n s i mi l a rc i r c u ms t a n c e s , we h a ve n ot ex cu sed n on -com p l i a n ce of this kin d as “d e m i n i m i s. ” S ee Mc Cann , 984 F .2 d a t 6 7 2 . T h e r e fo r e , d e fe n d a n ts w o u ld a t m o s t b e e n tit le d to a n e w tr ia l. S ee i d. at671
. B e c aus e w e ha ve a l r e ad y c o nc l ude d t hata ne w t r i ali s ne c e s s ar y due to th e e rr o n eou s excl u si on of t est i m on y, w e need not r u l e on the suff i ci en cy of t he e vi de nc e . H o w e ve r , s o m e o bs e r va t i o ns a bou t the e vi de nc e m aya i d t he p a r tie s o n re tr ia l. B. T o est abli sh a cl ai m form edi calm al practi ce i n T en n essee, a pl ai n t i f f m u st show , by a prepon deran ce of evi den ce, t h at t h e defenda n tbreached t h e st an da rd
o f c a r e , a n d th a t t h e b r e a c h p r o x im a te lyca u s e d th e p la i n t iff’s inju r ie s . T ENN . C ODE A NN . § 2 9

– 2 6

– 1 1 5 (a ) (S u p p . 2 0 0 6 ); Ki l pat r i c k v . Bry ant , 868 S. W
. 2d 594, 5 9 8 -9 9 ( T e n n . 1 9 9 3 ). T h e T e n n e s s e e S u p r e m e C o u r t c o u n s e ls t h a t c a u s a tio n “is
a m att er of

probab i l i t y, not possibi l i t y, an d i n a m edi cal m al practi ce case, suchN o. 04- 60962

25 m u st be sh ow n to a rea son a b l e d eg ree of m ed i ca lcert a in ty
. ” Ki l pa t ri ck , 868 S. W
. 2d at602. Th us, a pl ai nt i f f m usts how t hat : ( 1) t her e i s a k n ow n m edi c al
n e x u s b e t w e e n t h e c o n d u c t a n d t h e h a r m s u ffe r e d , a n d (2 ) t h e p h y s ic ia n ’s
c onduct

— and notan i n d ep en d en t fa ctor— m ore l i k ely th a n n ot c ause d t he i nj ury. Se e i d. I n toxi c t ortan d n egl i gen tprescr i pti on cases , t h ese t w o facet s of
c aus at i o n a r e o f

t e n r e fe r r e d t o , r e s pe c t i ve l y, as ge ne r ala nd s pe c i f i c c aus at i o n. S ee McC l ain v. Met ab ol if e I n t ’l, I n c. , 4 0 1 F .3d 1 2 3 3 , 1 2 3 9 ( 1 1 t h C ir. 2 0 0 5 ); R uggie ro v. W

arn er- L am bertCo. , 424 F
. 3 d 2 49, 252 n. 1 ( 2d C i r . 2005) ( e xp l ai ni ng t he di s t i nc t i o n b e t w e e n “ ge ne r al” a nd “ s pe c i f i c ” c aus at i on a nd
re co g n izin gth a t a failu re to p ro v e eith e r u n d e rm in e s a n e g li g e n ce cla im ). T h e H u sse s reli ed pr i m a ri l y o n the ex p ert testi m on y o f D r. C a rl ton to
e s t a b l is h ca u s a tio n . S ee St o ke s v . Le ung , 6 5 1 S

. W
. 2 d 7 0 4 , 7 0 6 ( Te n n . Ct

. App. 1 9 8 2 ) (“[ I] n m e d ic a l m a lp r a c tic e c a s e s , n e g lig e n c e a n d c a u s a tio n a r e o r d in a r ily
r equi r ed t o b e p r o v e d b ye x p e r tm e d i c a lt e s t i m o ny . ” )

. Dr
. Ca r l t o n o p i ne d t hat Terbut al i ne i s a “ know n ca use ” of c ar di om yopat hy, and t hati t m or e l i kel y t han
n otcaused or contribu t ed to B arbara’ s dev el opm en t of cardi om yop athy. In ot h er w o r ds , he t e s t i f

i e d t o b o t h “ ge ne r al” a nd “ s pe c i f i c ” c aus at i on . Thi s t e s t i m o ny l a ck ed an ad eq u a te ba sis i n sci en ce or fa ct. M ajo rs o u r c e s o f m e d ic a l lite r a tu r e , e . g. , t he Phys i c i ans ’D e s k Ref e r e nce an d reports f

rom T e rb u ta li n e m an u fact u rers , provi de a l i stof ri sks associ ated
w i t h Te r but al i ne ; ca r di o m yo pa t hy i s no ta m o ng t he m . D r . Car l t o n’ s s t at e m e nt th a t T e r b u ta lin e is a “ k n o w n c a u s e ” o f c a r d io m y o p a th yr e lie s m a in lyo n a s in g le
s tu d y . S eeJu d i th U
. H ib b a rd , M .D ., Chro ni cTe r but al i ne The r apy and Pe r i par t um Car di o m y o

pat hy :A Cas e - Cont r o lSt udy , 1 5 (2 ) H Y PER TEN SIO NIN P RE GNANC Y183 ( 1996) ( “ t he H ibbar d st udy” )

. Th e H ibbar d s t udy obs er ved t hat f ouroutof

f i f t ee n per i par t um c ar di om yopat hy pat i ent s, or26. 7% , ata Ch i c ago h osp i tal received T erb u tali n e a s a toco l ytic. T h e s t udy show s tem p ora lpr ox i m i ty b e tw e e n a d m in is tr a tio n o f T e r b u ta lin e a n d d e v e lo p m e n t o f c a r d io m y o p a th yinN o. 04- 60962

The women who develope d cardiomyopathy were more likelyto have smoked, drunk 10 alc ohol , ab u se d co cain e, and u se d n arc otic s durin gp re gn a ncy . Id

. at18 5-86 . Of th e cardiomyo pathy patie nts, 1 4 of 15 (or 93.3 %) were African -American . One wa s Hispanic. The average a gewas over 3 0. Whil e 2 0.0% of the cardiomyo pathy patie nts had pre ecla mpsia, o nly 3 .3 % of th e co ntrolgro u p di d. Id

. As noted above, smoking, African -Americanrace, a geover 30, andtoxem ia/pr eec lam ps ia are rec ognizedriskfact orsof peripartumcardiom yopathy. 26 fou r w om en . T h e stu d y co m p a res th ese fou r w om en w i th a co n trol gro u p o f sixty
w om en w h o di d not dev el op c ardi om yop athy. O n l y t h ree pa t i en t s i n t h e contr ol g r o u p to o k T e r b u ta lin e . T h e s tu d yd id n o t in v e s tig a te h o w fr e q u e n tly
c a r d io m y o p a th yo c c u r r e d in a ll T e r b u ta lin e u s e r s . A s D r . R e d d ix n o te d in h is prof fered t est i m on y, t h e st u dy ’ s s m al lsam pl e si ze creates a ri sk that unj u st i f i ed concl u si on s w ere draw n f rom scant da t a an d cha n ce oc currences. D r. C arl t on 10 i n sist ed tha t t h e H ib b a rd stu d y’ s ca se-con tro l m e th od w a s “t h e b est w a y to
a r r iv e a t a n a n s w e r .” T h e s tu d y c o n c lu d e s th a t lon g -te r m u s e o f T e r b u ta lin e is “po sit i ve l y a sso ci a ted w i th pe ri p a rtu m card i om yo p a th y.” I d. a t1 89
. The s t udy
w arn s: “ C au t i on shou l d be exerci sed in u n derst an di n g t h at t h e case- control de s i gn d o es n o t p ro v id e a ca u sa tive re la tion sh ip be t w ee n t he use of or al [T erb u tali n e] t h era p y a n d card i om yo p a th y.” Id

. (em p h a sis a d d e d ). D r . Car l t o n t e s t i f

i e d a bo uto t he rr e po r t s , no ne o f w h i ch say Terbut al i ne c aus e s c a r d i o m y o p a t hy

. Va g ue s t a t e m e nt s t ha ta d r ugl e d t o “ c a r d i o v a s c ul ar c om pl i c at i ons ” orev en dea t h do nots how gener al c ausat i on f or t he c ondi t i ons at i s sue. L i kew i se, an ec do t e s de t ail i ng i ndivi dua lpa t i e nt s ’e xp e r i e nc e s w he n t ak i ng th e d r u g , su c h a s ch e s t p a in , fa ll s h o r t o f p r o v id in gs c ie n tific a llyre lia b le evi den ce app l i cabl e t o al lot h er pati en t s. D r. C arl t on d rew a n a n al ogy betw een Terbut ali ne a nd o t he rdr u gs i n i t s fam i l y, cal l ed sym pa t h om i m et i cs. C ocai ne a nd
am phet am i nes ar e i n t hi s fam i l y, an d to som e ext ent , “ t hey al lt end i n one w ay oranot hert o r ev t he i ndi vi dual up. ” D r . C ar l t on sa i d t hat one “ c an as sum e t hat drugs i n a p a r t i c ul a rc l a s s h a v e s i m i l a re f fe c t s a nds i d e e f

fe c t s , ” a ndt hat
s y m p a th o m im e tic s ca n le a d to ca r d io m y o p a th ya s a “p o te n tia l co m p lic a tio n .”N o. 04- 60962

27 H o w e v e r , D r . C a r lto n d id n o t in d ic a te w h e th e r th is th e o r y h a s b e e n a c c e p te d in t h e sc i en t i f

i c c om m u n i t y or te ste d vi a the sc i en t i f i c m et h od. O n cr ossexam i nat i on he ac know l edge d t hat sy m pat hom i m et i c s c an hav e d i ss i m i l ar e f fe c t s . D r . Car l t o n’ s t he o r y r e gardi ng s i m i l ar i t i e s b e t w e e n c o c ai ne a nd T e r b u ta lin e p r o v id e s n o s u p p o r t fo rw h a t is in e s s e n c e a s c ie n tific a llyu n te n a b le t h esi s. The m e di c all i nk be t w e e n Terbut al i ne a nd c ar di o m yo pa t hy i s t o o t e nuo us to su p p ort ca u sa ti on “t o a rea son a b l e d eg ree of m ed i ca l certa i n ty. ” S ee Ki l pa t ri ck , 8 6 8 S .W .2 d a t 6 0 2 ; cf. D ubo i s v . Hay ka l , 165 S. W
. 3d 634, 638- 39 &
n . 3 ( T en n . C t
. A pp . 200 4) (h ol di n g t h at defen da n t s w ere n otenti t l ed to sum m ary ju d g m e n t o n ca u s a tio n b e c a u s e p la in tiff p r e s e n te d p e e r -r e v ie w e d s c ie n tific st udi es sho w i ng t hat drug pre sc r ibed t o her r educ ed ef f i ca cy of or al
c o nt r ac e p t i ve s )

. As t he El e ve nt h Ci r c ui t ’ s de c i s i o n i n McC la in cogentl y exp l ai n s, cou rts m u st n ot all ow ev i d en ce of tem p ora lco rrelation to serv e a s a su b sti tu te f or s ci en ce- based causati on evi den ce: [ S ] i m pl y becau se a person t ak es drugs an d then suf fers an i nj u ry doe s nots how c ausat i on. D r aw i ng s uch a c onc l usi on f r om t em por al rel ati on shi ps l ead s t o t h e bl u n der o f th e posthoc ergo propterhoc fal l acy. T h e posthoc ergo propterhoc fal l acy assum es c au sal i t y f rom te m p o r a l s e q u e n c e . I t lit e r a llym e a n s “a fte rth is , b e c a u s e o f th is .” B LAC K’ S L AW D I CT I ONARY118 6 ( 7th e d . 1 9 99). I ti s c al l ed a fal l acy b eca u se i t m a k es a n a ssu m p ti on b a sed o n the fa l se infere n ce th a t a t e m po r alr e l at i o ns hi p p r o ve s a c aus alr e l at i o ns hi p. 401 F
. 3d at 124 3. H ere, t h e H u sses presented evi den ce of st ati st i calcor rel ati on betw een use of

T erbu t al i n e an d p eri pa rt u m cardi om y o p a t h y. A n y sci en t i stor s t at i s t i c i an m us ta ckn ow l e dg e , ho w e ve r , t hatc o r r e l at i o n i s no tc aus at i o n. M o r e o v e r , p e r ip a r tu m ca r d io m y o p a th yis ty p ic a llyre g a r d e d a s a n id i o p a th ic
con d i ti on : the m ed i ca lcom m u n i ty h a s a po or un d ersta n d i n g of w h a t ca u ses i t. Cons e que nt l y, a pl ai nt i f f w ho i ns i s t s t hata dr ug, no ta no t he rfac t o r , c aus e d t he di sease faces a hi gh bu rden i n provi n g gen eralcausation . A p lai n t i f f m u stN o. 04- 60962

I n Richardsonv. Miller , 44S.W.3 d 1 (Tenn. C t. Ap p . 2 00 0), th e C ourtof Appe als 11 de clin edto dire ctaver dictinfavorof phy sici a n s su edfora dm inis tr ationof T erb utalin e a s a to colytic. Id

. at30 -31. Th e pl aintiff’s expert o pine d that Terbut aline cau sed an artery to split in th e pl aintiff

’s h eart , cau sin g ah eartatt ack

. Id

. at31 . The court accepte d this te stimonyat face v alu e, a s it wa s b a se d on th e expe rt’s me dical expe ri ence a n d exa min ation of th e pl aintiff

. Id

. I n t hi s c ase, however, Dr. Carltondid not ex amin e B arb ara , an d h e te stifiedba sed on me dical literaturewhichdoe s notp rove th e cau sal link. I n th e only re po rt ed T enn es se e ca se 28 pr e s e ntm ore t h an a si n gl e st u dy show i n g corr el ati on , accom pa n i ed by un rel ated
ane c do t e s a nd q uas i

- s c i e nt i f i c m us i ngs a bo utho w a c l as s of dr ugs a f

fe c t s t he h u m a n b o d y . H o w e v e r , th a t is w h a t t h e H u s s e s p r e s e n te d a t t r ia l. Iti s axi om ati c t h at c au sati on t est i m on y i s i n ad m i ssibl e i f an expert rel i es u p on stu d i es o r p u b l i ca ti on s, the au th ors of w h i ch w ere th em selve s u n w i l l i n g to
c o n c lu d e th a t c a u s a tio n h a d b e e n p r o v e n . See , e . g. , G en. E lec. Co. v. Joiner , 522 U. S

. 1 3 6 , 1 4 5

- 4 6 ( 1 9 9 7 ) ( s t udi e s d i d n o ts u p p o r te x p e r t s ’c o n c l u s i o n t h a tP CB exp osure caused cancer because the doctor s w h o condu cted t h e st u di es w ere u n w illin gt o d r a w th a t c o n c lu s io n ); V arga s v. L ee , 317 F
. 3d 498 , 501

- 02 (5t h C i r. 2 0 0 3 ) (tw o s tu d ie s d id n o t s u p p o r t c o n c lu s io n t h a t tr a u m a c a u s e s fib r o m y a lg ia b e ca u se a u th o rs o f b o th stu d ies d e te rm in e d th a t ca u sa tion w a s n o t es ta b li sh e d ); McC la in , 401 F. 3d at1247- 48 ( st udi es di d notaut hor i ze c onc l usi on t hat
com bi n ati on of eph edri n e an d c af fei n e i s da n gerous because au t h ors of st u di es i n d i ca ted tha t cau sa ti on w a s n ot p rov en ). S tran ge l y, th e p a rti es d i d n ot req u est, and t he cour tdi d notc onduct , a D au berth e a r in g . H o w e v e r , D au bert“ assi gn ed t he t r i alc o ur ta g at e ke e pe rr o l e t o e ns ur e [ e xp e r t ] t e s t i m o ny i s bo t h r e l i ab l e a nd relev a n t. ” Hodges v. Mack Trucks, I n c. , 474 F
. 3d 188 , 194 ( 5th C i r. 200 6)

. U pon
r e t r i al , s uc h a hea r i ng w i l lbe es s e nt i alt o t he c o ur t ’ s “ pr e l i m i nar y as s e s s m e nt
o f w h e th e rth e re a s o n in go rm e th o d o lo g yu n d e r ly in gth e te s t i m o n yis
sc i ent i f i c al l y val i d and of

w het hert hatr eas oni ng orm et hodol ogypr ope r l y c an b e a p p l i ed to t h e facts i n i ssu e.” S ee D au bert , 509 U
. S. at592- 93. T h e H u sses ha ve i den t ifi ed n o case, an d w e ha ve f ou n d n on e, f

rom Tenn es se e o rel se w her e, f i ndi ng t hatTer but a l i n e caus es c ar di om yopat hy. 11N o. 04- 60962

in whicha plaintiff all eged th at Terbut alinel edto car diomyopathy, the TennesseeC ourtof App ealsaff

ir me d th e trial c ourt’sdis mi ssal onlim it ation s gro un ds

. Crawfor d v. Bea tty , 10 8 S. W. 3 d 8 7 7 , 8 7 9 -8 0(T enn . C t. App . 2 0 0 3). The jury was onlyasked to return a ge neral verdict. It maymake more sense upon 12 retri al to po se separatequ estion s to the jury regarding each of the condition s allegedlycaused byT erbutaline: peripartum cardiomyo pathy, congestive heart failure, and pulmo nary edema. 29 C o u r ts m u s t b e a r b ite r s o f tr u th , n o t ju n k s c ie n c e a n d g u e s s w o r k

. S ee i d. at596- 97. T h e gen eral cau sati on evi den ce m arsha l ed att ri alsugg est s s pecu l ati on , not
a r e as o nab l e de gr e e o f m e di c alc e r t ai nt y. The pa r t i e s a nd t he t r i alc o ur tm u st
c a r e fu llyco n s i d e ro n re tr ia l w h e th e rth e H u s s e s ’a s s e r tio n s a r e s c ie n tific a lly rel i able, or w h et h er th e irt h eory of causati on i s s u pp ort ed by ot h er evi den ce
w hi c h was no tpr e s e nt e d o rw as no ta va i l ab l e a tt he t i m e o f t he f i r s tt r i al

. The court m u stal so not confl ate ‘ ad m i ssibl e’w i t h ‘ suff i ci en t ’ : t h e say- so of

an expert is n o t n e c e s s a r ilyg r o u n d s t o d e n yju d g m e n t a s a m a tt e ro f la w . S ee id

. at596; cf. G u i l e v. Un i t ed S t ate s , 422 F
. 3d 221 , 227 ( 5th C i r. 200 5) ( “A cl aim ca n n ot st an d or fal lon t h e m ere ip se d ixitof a cr e d e n tia led w itn e ss .”) (cita tion om itted ). H ad def

e nda nt s a de qua t e l y pr e s e r ve d o bj e c t i o ns t o t he a dm i s s ibi l i t y and
s u ffic ie n c yo f c a u s a tio n e v id e n c e , ju d g m e n t c o u ld b e e n te r e d o n t h is b a s is

. S ee Hodges , 474 F
. 3d at 193 ( “A n appel l at e co urt , i n dec i di ng w het her[j udgm entas a m a tt e ro f la w ] s h o u ld h a v e b e e n a w a r d e d , m u s t fir s t e x c i s e in a d m is s ib le evi den ce; such evidence ‘ contribu t es nothi n g to a l egall y suff i ci en tevi den t i ary bas i s. ’” ) ( quot i ng W

ei sgram v. Marl ey , 5 28 U
. S

. 4 40 , 4 54 ( 20 00 ) )

. G i ve n t he procedu ralpost u re of t h i s c ase, onl y a n ew t ri ali s avai l able. Eve n i f Te r but al i ne w as a “ kno w n c aus e ” o f c ar di o m yo pa t hy, t he r e i s s c ant
e v id e n c e o f s p e c ific ca u s a tio n , i
. e. , t h a tT e r b u t a li n e c a u s e d B a r b a r a ’s cardi om yop athy an d rel ated cond i t i on s. S ee Ki l pa t ri ck , 868 S. W
. 2d at598- 99. 12 D r . C ar l t on di d not per so nal l y exam i ne B ar bar a at any t i m e, butbe l i eve d t hat t h e drug caused her cardi om yop athy becau se “s h e w a s on T erbu t al i n e. Terbut al i ne i s a kno w n c aus e . And yo u do n’ tha ve a ny o t he re xp l ana t i o n f o rw hyN o. 04- 60962

30 sh e w ou l d h a ve de ve l op ed i t. ” Po s t h o c e rg o p r o p te rh o c . D r. C arl t on al so bel i eved th a t B a r b a r a w a s ta k in g T e r b u ta lin e “b a s ic a lly u p u n til d e liv e r y .” S h e a c tu a lly
c e as e d t aki n g t he dr ug w e e ks b e f o r e de l i ve r y. Bar ba r a’ s m e di c alr e c o r ds dem on st rat e a conspi cuou s absence of breathi n g probl em s i n t h e w eeks befor e del i very an d d u ri n g t h e f ou r d a y s she spen ti n t h e hosp i t alat t h e t i m e of H anna h’ s b i r t h. Bel ab o r e d b r e at hi ng i s a s ym pt o m o f c ar di om yopat hy and
c o nge s t i ve he ar t fai l ur e , bo t h o f w hi c h t he H us s e s s ayBar ba r a de ve l o pe d wee ks
or m on t h s bef

ore H an n ah ’ s bi rt h

. M oreover, B arbara’ s hi st ory i n cl u ded at t r ibut es r ec ogni ze d by m edi c all i t er at ure as r i sk fac t or s f orc ar di om yopat hy: f o urpr i o rpr e gna nc i e s , s m o ki ng, s e ve r e w e i ght ga i n, ge s t at i o nal di ab e t e s , a nd t oxem i a. I f

D r. C arl t on t h ou g h t t h at B arbara d i d n otpossess t h ese cha ract eri st i cs, hi s opi n i on w as based on i n accurate fact s. I f he d isre gard ed th e s e ch a r a c te r is tic s a n d co n c lu d e d th a t T e r b u ta lin e m u s t h a v e b e e n th e s o le

“ c ul pri t , ” hi s opi ni on bo r der s on fant as y. The o bs e r va t i o ns a bo utg e ne r ala nd s pe c i f i c c aus at i o n a r e no ta pa r to f t he ho l di ng t o da y. H o w ever, iti s i m po r t antt o i de nt i f y pr o bl e m at i c a s pe c t s i n t he
sc i ent i f i c and fac t ualproo f

n ec es sa r y t o t hi s c as e s o t hatany s hor t c om i ngs c an b e p r o p e r lya d d r e s s e d u p o n re tr ia l. V II. W e now t u rn to defenda n t ’ s argum en tt h at t h e j u ry shou l d n otha ve been i nst r uct ed o n a t heor y o f l ac k of i nf orm ed c ons ent
. B ec ause t hi s c as e m ustbe
r e m and e d f

o ra ne w tri al , ou rr e s o l ut i o n o f t hi s i s s ue w i l la i d t he pa r t i e s a nd court i n cr af

t i n g t h e proper j u ry i n st ru ctio n s. “ W e revi ew chal l en ges t o j u ry i n stru cti on s f

or a b u se o f d i scre ti on . ” B a ttle , 228 F
. 3d at554 ( c i t i ng Un i t ed S t ate s v. Mon roe , 1 7 8 F .3 d 3 0 4 , 3 0 7 (5 th C ir . 1 9 9 9 )). “A ju d g m e n t w ill b e r e v e r s e d o n ly i f t he c har ge a s a w ho l e c r e at e s s ubs t ant i ala nd i ne r ad i c ab l e doub tw he t he rt he j u ryh a s be en pr op erly g u i d ed i n i ts de l ib era ti on s. ” I d. (cita tion om itted ).N o. 04- 60962

31 O ver defen da n t s’obj ect i on , t h e j u ry w as i n st ructed on the i ssue of i nf o r m e d c o ns e ntund e rTe nne s s e e l aw. Rel yi ng o n C a ry v. A rr o w sm ith , 777 S. W
. 2d 8 (Tenn
. C t
. A pp. 1989) , def endant s avert hatt he i nst r uct i on w as im p r o p e rb e c a u s e a “d o c to ris n o t li a b l e fo r la c k o f in fo r m e d co n s e n t in
conn ect i on w i t h t h era pe ut i cdr ug t r e at m e nt
. ” The na t ur e o f de f e nda nt s’obj ect i on t o t hi s i ns t r uc t i o n i s t hatt he j ur y l i ke l y c o ns t r ue d i nf o r m e d c o ns e nta s a s t and

al on e cl ai m , i n st ead of f ocusi n g on t h e H u sses ’ m edi cal m al practi ce cl ai m , w h i ch pr o vi de s a s uf

f i c i e ntr e m e dy

. The H us s e s di s ag r e e d. I n s upp o r to f t he in s tr u c tio n , th e H u s s e s ’a t t o r n e ycit e d a t t r ia l Mi t chel lv. E n sor , 2 0 0 2 WL 31730908 ( Tenn
. C t
. A pp. N ov. 1 8 , 2 002) ( notr epo r t ed)

. D ef endant s i nsi st ed t hat Mitch ellw a s n ot d esign a ted f or p u b l i ca ti on an d i s n ot bin d i n g p rece d en t. D efen da n t s m oved post
- verdi ctf or a new tri alon the basi s t h at t h e i n f orm ed
consen ti n st ructi on w as prej u di ci al error . T h e m agis t rat e j u dg e di d n otconsi der C ary bi ndi ng aut ho r i t y, a nd c i t e d B u rrough s v. Mag ee , 118 S. W
. 3d 323, 332- 33 ( Tenn
. 2003) , a nd P i t t m an v. U pj oh n Co. , 8 9 0 S .W .2 d 4 2 5 , 4 3 0 ( T e n n . 1 9 9 4 ), in h o ld i n g t h at an i n f

orm ed consen ti n st ructi on i s proper i n m edi calm al practi ce cases. O n app eal , t h e H u sses st i l largu e t h at t h e i n f orm ed co n sent i n st ructi on
w as c ons i st entw i t h t hei rm al pra c t i c e c l ai m , c i t i ng A s he v

. R adi at i on O nco logy A ssoc s. , 9 S .W .3d 1 1 9 (T e n n . 1 9 9 9 ). To pr e va i l i n a l ac k o f i nf o r m e d c o ns e ntc as e , a pa t i e ntm us tpr o ve t hatt he d o c to r“d id n o t s u p p lya p p r o p r ia te in fo r m a tio n to th e p a ti e n t i n o b ta in in gh is i n f orm ed consen tt o the procedu re ou tof w h i ch pl ai n t i f f ’ s cl ai m al l eged l y arose

. . . . ” T ENN . C ODE A NN . § 29–26–118 ( 2006 supp. )

. T he pl ai nt i f f m ustal so pr ove th a t s u c h fa ilu r e to d is c lo s e co n s tit u te d m a lp r a c tic e . S ee Ash e , 9 S. W
. 3d at121 (ci ti ng T ENN . C ODE A NN . § 2 9– 26 –1 15 )

. I n C ary , reli ed on b y de fen d a n ts, a Tenn e s s e e Cour to f

Appe al s r e as o ne d: T h e d octrine o f l a ck of i n form ed con sen t i s ba sed u p on “ba ttery.” “I f in fo r m e d c o n s e n tis n o te ffe c t iv e ly o b t a in e d , t h e d e fe n d a n t ’sN o. 04- 60962

32 d ep a rtu re from th e stan d a rd ca re i s n ot n eg l i ge n ce b u t ba t t ery . . . .” C ard w el lv. B echt ol , 7 2 4 S .W .2 d 7 3 9 , 7 5 0 (T e n n . 1 9 8 7 ) (e m p h a s is s u p p lie d ). “[I ]f n o b a tt e r yca n b e s h o w n , th e n th e is s u e cle a r ly e m e r ge s as on e of m a l p ra cti ce.” I d. a t 7 5 1 . Ab a tt e r yn e c e s s a r ily r e qui r e s a n unpe r m i t t e d t o uc hi ng o f t he pl ai nt i f

f b y t he de fe nda nt or b y so m e ob j ect set i n m oti on by the de fen d a n t. 7 7 7 S .W .2 d a t 2 1 (c ita tio n o m itt e d ). T h e c o u r t t h e n d is c u s s e d a P e n n s y lv a n ia S u p e r io rC o u r t c a s e , B oy erv. S m ith , 497 A

. 2d 6 46 (Pa

. Su per. C t
. 198 5) , bef ore con cl u d i n g th a t: t h e b e t t e r r u le is t h a t a t r e a t in g p h y s ic ia n m u s to b t a in th e p a t ie n t ’s i n f orm ed c on sent f

or t h e m edi cal t reat m en t of t h e pa t i en ta n d n ot f orea c h co m ponentpar tof t he t r eat m entpr oc es s. Th e pat i enthas a n a d e q u a te le g a l re m e d y , i
. e. , a m a lp r a c tic e a c t i o n s o u n d in gin ne gl i ge nc e , f

o rt he i nj ur i o u s cons e que nc e o f t he r ap e ut i c dr ug trea tm en t. C ary , 777 S. W
. 2d at21. H o w e ve r , i n Ash e , t h e T en n essee S u prem e C ou rtm ore r ecentl y cl ari f i ed t h at i n f orm ed consen tcases an d m edi calbatt ery cases are not t h e sam e: Am edi c albat t er y m ay t ypi c al l y o c c ur w hen: ( 1) a pr of es si onal perf orm s a procedu re t h at t h e pa t i en t w as u n aw are t h at t h e doct or w as goi n g t o perf

orm ; or ( 2) t h e procedu re w as perf orm ed on a part o f th e bo d y o th er th a n tha t pa rt exp l a i n ed to t h e p a ti en t ( i
. e. , a m p u ta tio n o f th e w r o n gle g). A l a c k o f in fo r m e d co n s e n t c la im t ypi c al l y o c c urs w hen t he pat i entw as aw ar e t hatt he pr oc edur e w as g o in g to be perf

orm ed bu tt h e pati en tw as un aw are of t h e ri sk associ ated w i t h t h e procedu re. 9 S. W
. 3d at121 ( c i t i ng Bl anc har d v

. Kel l um , 9 7 5 S .W .2d 5 2 2 , 5 2 4 (T e n n . 1 9 9 8 )). Th e T ennes se e Su pre m e C our tn ot ed t hatthe pl ai nt i f f cont ended t hats he w as no ta ppr i s e d o f

r i s ks i nhe r e nti n hert r e at m e nt , a nd t hi s r e nde r e d he rc o ns e nt t o tr e a tm e n t in v a lid

. I d. T h e p le a d in ga n d p r o ffe ro f s u c h a fa c tu a l s c e n a r io
r e n d e r e d a n in fo r m e d c o n s e n t in s tr u c tio n p r o p e rin th a t c a s e . I d. N o t ab l y, t he C ou rtdi d not l i m i ti t s hol di n g t o cases i n vol vi n g surgi calprocedu res, as opposedN o. 04- 60962

33 to th e r a p e u tic d r u gtr e a tm e n ts , s e e i d. , n or d o w e see reason to read a l i m i t ati on i n t o t h e C ou rt ’ s hol di n g t h at i s s i m pl y n ott h ere. I n l i ghto f

t hi s s t at e m e nto f

t he l aw byTe nne s s e e ’ s hi ghe s tc o ur t , w e do
n otbel i eve t h at i t w as an abu se of di scr et i on f

or t h e m agis t rat e j u dg e t o i n st ruct t h e j u ry on i n f

orm ed consen tal on g w i t h m edi calm al practi ce. T h e H u sses rai sed l ack of consent i n t h e pret ri alorder. B arbara test i f i ed at t ri alt h at s h e w as not i nf or m ed o f

t he r i sks as so c i at ed w i t h T erbut al i ne, and t hats he w oul d nothave
c o ns e nt e d t o t o c o l ys i s w i t h Te r but al i ne t he r ap y hads he b e e n a ppr i s e d o f t he
r is k s o f t a k in gth e d r u g . T h e i n s t r u c t io n a ls o c o m p o r t e d w it h T e n n e s s e e ’s “o b je c tiv e a p p r o a c h ” t o in fo r m e d co n s e n t. S ee i d. at123. I n sum , t he phys i c i an
m u st w a rn the p a ti en t of “all sign i fi ca n t pe ri l s. ” I d. a t 1 2 4
. T h e co u rt m a ycr a ft th e p r o p e rin s tr u c tio n to th e ju r yu p o n re tr ia l. V III. L astl y, defen da n t s argued on ap pea lt h a tt h e m agis t rat e j u dg e m ad e a pr ej udi c i alc o m m e nta bo utt he i rex pe r t ’ s “ m e t e r ” i n t he pr e s e nc e o f t he j ur y, a nd t hatc o uns e lf

or the H us s e s m ad e a pr ej udi c i alm i s - c har ac t e r i z at i o n o f t he
ev i d en ce d u ri n g closing arg u m en t. W e p erce i ve n o n ee d to discu ss th e m erit vel
n on o f s uc h i s s ue s , a s t he c as e m us tb e r e t r i e d. I X. W e hol d that t h e H u sses ’cl ai m s are n otbarred a s a m att er of l aw on lim ita tio n s g r o u n d s ; th a t t h e m a g is t r a t e ju d g e co m m itt e d re v e r s ib le e r r o rin st r i ki ng por t i ons of

def endant s’ex per tt es t i m ony; and t hatt he m agi st r at e j udge di d n otabu se hi s di scr et i on i n i n st ructin g th e ju ry on a theory of l ack of i nf o r m e d c o ns e nt
. A ne w t r i ali s o r de r e d. RE VE RS ED a n d R EMANDE D.N o. 04- 60962

34 PR I SC I LL AR
. O W E N , C i r c ui tJudge, c onc urr i ng. I jo in in a ll b u t p a r t V I( B ) o f th e fo r e g o i n g o p i n i o n . W h ile th e s c ie n tific
r e lia b ility o f th e e v id e n c e p e r ta in in gto cau sa tio n p r e s e n te d b yth e H u s s e s w o u ld
m erit scru ti n y o n rem a n d i f ch a l l en ge d , the i ssu e w a s n ot p u rsu ed i n this cou rt.N o. 04- 60962

Two matters maybeq uickly put aside. Judge DeMoss writin g for himself instructs 1 the trial c ourtonremand. I do not think thi s on e j udge exe ge sis is soun d. Nor canIj ointh e panel ma

jority’s stat ementth at it nee d not de cide the que stion of sufficie ncyof the evidence sinceth e ca se i s being

remanded. The testimo ny of the Husses’ expert witnesses was admitted without obje ctionattri al. To question the suffici ency , onthis re cord, is inexplicable

. 35 PA TR I C KE
. H I G G I N B O TH A M , C i r c ui tJudge, di ss ent i ng.
Th er e i s onl y o ne r ealissue i n t hi s c as e— w het hert he t r i alj udge
c o m m i t t e d r e ve r s ibl e e r r o ri n e xc l udi ng a pa r to f t he t e s t i m o ny o f

o ne o f t he defenda n t ’ s expertw i t n esses . 1 I c anno ta gr e e t hatt he m ag i s t r at e j udg e a bus e d hi s di s c r e t i o n i n r e f us i ng t o a l l o w D r . M i c hae lRed di x t o e xp r e s s hi s o pi ni o n a s t o w h et h e rTe r but al i ne cau sed B arbara H u ss’cardi om yop athy. Plai n t i f fs att ri alobj ect ed that defen se c o u n s e l’ s q u e s tio n in v ite d D r . R e d d ix to e x c e e d h is d is c lo s u r e file d u n d e rR u le 2 6 . L o o k in gto a c o ll o q u yw it h t h e j u d g e d u r in ga p r o ffe ro f D r . R e d d ix ’s t e s t i m o ny andt o a pos t
- ve r di c tdeni alof a new t r i al , t he m aj o r i t y ho l ds t hatt he
ru l in g r e s te d on a b roa d er a sse ssm en t of qu a l i fi ca ti on s. P erh a p s, bu t both g r o u n d s w e r e s o u n d

. T h e r e w a s n o a b u s e o f d is c r e tio n in e x c lu d in gth is par t i c ul arex pre ss i on o f opi ni on o n ei t hergr ound, and one so l i d gr ound f oran e v id e n tia r yd e c is io n is s u ffic ie n t fo ro u rd e fe r e n tia l re v ie w .
I O urde c i s i o n i n T

an n erbin d s th i s p a n el. Itw ou l d h a ve be en e rror to al l o w D r . Red di x t o e xp r e s s a n o pi ni o n r e ga r di ng s pe c i f i c c aus at i o n. The
m aj ori t y f

l i ps confor m i t y t o T

an n eri nt o r e ve r s ibl e e r r o r . I n T an n er w e revers ed a j udgm entf

orpl ant i f

fs w her e t he t r i alc our tov erobj ec t i on al l ow ed a m edi c al docto rw i t h g e ne r alm e di c alt r ai ni ng t o v e nt ur e a n o pi ni o n t hatdo ct ors a tt e n d in ga ch ild b ir th ca u s e d th e ch ild to co n tr a c t c e r e b r a l p a ls y .N o. 04- 60962

Tan ner v. Wes tb rook , 17 4 F .3d 542 , 547 (5th Cir. 1 999) (reversin g on ground s that a 2 doctor’s expert testimony was errone ously admitte d, whenitwentbeyo nd ge neral standar d of ca re andinto sp ecif ic caus atio n iss ueson whic h he lack ed relevant backgr oundknow led ge orexpe ri ence). Tannerwasdem andi ng of qualif icat ionsfor pl aintiff

s’e xp ertwit nes se s. It cann otb e relax edf

ord ef en dants
. Th e ma jority’s co unt er argu ment to the magistrat e j udge e ssentiallyamo unt s to 3 pointing out that Reddix was “familiar with the term cardiomyopathy,” and had “prescribed drugs simil ar to T erbutaline.” Pl ainly , th ese are inade quate challen ge s to a trialj udge’s exerci seof di scretion . 36 A s i n T an n er , R eddi x so ught t o m ove i n t he l at t er par t of hi s t es t i m on y to
m at t e r s t hat“ hi nge [ d] o n . . . t he de pth of [hi s ] kno w l e dg e o f

a c o m pl i c at e d, sp eci al i zed m edi calsubj ectm att er. ” I tw as t h i s m ove t o w h i ch the pl ai n t iff 2 ri gh t f u l l y obj ect ed. U n der T an n er it w o u ld h a v e b e e n re v e r s ib le e r r o rto a d m it R e d d ix ’s o p in io n th a t T e r b u t a li n e w a s n o t t h e c a u s e . A ft e r q u o t in gth e ju d g e ’s
ex p l a n a ti on s f

or ex cl u d i n g th i s p a rt of R ed d i x’ s testi m on y, th e m aj ority rep ea ts defense- sup pl i ed p rot est s of R edd i x’ s c om petence, bu tt h ese a rgum en t s do not unde r m i ne t he j udg e ’ s s al i e nt o bs e r va t i o ns r e ga r di ng Redd i x’ s t hi n t r ai ni ng and exp eri en ce on t h e rel evan tsu bj ect s. Th e w eak n ess of t h e m aj ori t y’ s posi t i on sp ea k s f

rom the pa ge s of i ts de ci sion

. E ve n i f th e m a tter cou l d be arg u ed bo th 3
w ays, t h ere i tm u stl i e.
I I D r. R edd i x’ s expertreportf i l ed u n der R u l e 26 st ated t h at hi s opi n i on
w ou l d be that cardiom yop athy w as idi opa t h i c. H e gave thi s opi n i on t o t h e j u ry w i t houtany o bj ec t i on. Thi s ac c or ds w i t h t he c or e def ens e as se r t ed att r i al

— t hat
s c i e nc e di d no t kno w t he c aus e o f c ar di o m yo pa t hy and he nc e t h e pres c r ibi ng d o c to r s co u ld n o t h a v e k n o w n . T h e tr ia l co u r t w a s w e ll w ith in its d is c r e tio n in
n otal l ow i n g t h e w i t n ess t o exp an d hi s t est i m on y over pl ai n t i f fs’obj ect i on , f

rom

“ i tw as not kn ow able” t o “ i t w a s not a cau se of i nj u ry. ” N or di d the obj ect i on c o m e a s a s u r p r is e . D e fe n d a n t s h a d o n t h e e v e o f t r ia l s o u g h tto e x p a n d R e d d ix ’sN o. 04- 60962

Th e defe n se co u n se l said , in ch a mb er s: “Plaintiff s h ave b ro u ght u p pulm on arye de ma 4 and tried to put it in the same intelle ctual wastebasket as cardiomyopathy and act like they’re th e sa methin g . It’ s i mp ortant th at h e expl ain s to th e j uryth at th eyar e notth e sa methin g .” Th e j udge’s ruling , in reply , was: “Well, he did so . It to ok him forever to get aroun d to it. B ut I ’ m n o t go in g t o l e t hi m e xp r e s s a n o p ini o n a s t o wh e th e r th e a d m ini s tr ati o n of this drug caused or did not c auseth e cardiomyopathy here .” 37 ant i c i pa t e d t r i alt e s t i m o ny be yo nd t he f i l e d R ul e 26 R e po r tbuta tt he s t ar to f t he t ri alt h e j u dg e sust ai n ed p l ai n t i f fs’obj ect i on t o the ef

f ort
. Iti s not h ap pen st an ce t hatde fe n s e c o u n s e l l e d t h e d i r e c t t e s t i m o n y f i r s t o v e r t h e g r o u n d wi t h i n t he R ul e 2 6 di sc l os ure . Thi s put be f ore th e j u r y D r . R eddi x’ s opi ni ons t hat cardi om yop athy i s i dio p a th ic, t h e hea rtof t h e defen se. O n l y t h en di d d efen se cou n sel pu sh the en ve l op e of the tri a lcou r t r e fu sa lto all ow a last m i n u te
e x p a n s io n o f th e re p o r t. H u ss’condit i on , R e d d i x’ s r eport opi n ed, “ can n otbe sai d to h ave been
c aus ed, t o a r e as o nab l e o f [ s i c ] m e di c alc e r t ai nt y/pr o ba bi l i t y, b y t he ad m i ni s t r at i o n o f

o r alTe r but al i ne . Po s t pa r t um c ar di o m yo pa t hy o c c ur s i n a s m a ll n u m b e ro f w o m e n w h o a r e p r e g n a n t. S u c h co n d itio n is id io p a th ic in
n ature. ” A tt ri alhe sou gh tto go f u rt h er, to b ri dg e the gap b y el i ci t i n g an opi n i on t hatTe r bul at i ne w as no tt he c aus e . Thi s c r uc i al di s t i nc t i o n und e r l i e s t he g r o u n d fo rth e o b je c tio n , rig h tly s u s ta in e d , a t t r ia l. The m aj o r i t y c l ai m s t hatD r . Red di x’ s “ r e po r thas det ai l e d c r i t i c i s m o f t he
m edi call i t erat u re, ” bu tt h e f u l lext en tof

t h is cr iti ci sm i s t h at t h e st u di es are “o u td a te d ,” th a t th e y “o fte n c o n fu s e p u lm o n a r y e d e m a w it h c a r d io m y o p a th y ,” and t hatt hey us e dat a f r om I Vadm i ni st r at i on o f Ter but al i ne w hen or al
a d m in is tr a tio n w a s a t is s u e in H u s s ’ca s e . Im p o r ta n t p o in ts , b u t th e cr itiq u e is
e mp h a t i c a l l yn o td e t a i l e d , n o ri s i td a mn i n g . Mo s ti mp o r t a n t l y , t h e l a t t e rt wo poi n t s w ere abu n da n t ly te stified t o at t ri al

— an d the f orm er poi n tw as nev er prof fered. N ow h ere does R edd i x’ s r eport m en t i on sam pl e si zes orot h er

4 st ati st i calchal l en ges to th e gen eralcausati on cl ai m s of t h e pl ai n t i f

f ’ s art i cl es;N o. 04- 60962

Even if it h ad b eendiscu ssed inth e report or in testimony, it would have affected 5 littl e. Th e articl e i s byno means adecisive refutationof the caus alconnectionbetween cardiomyo pathy and Terbut aline under the circu mstance s presented by Huss. The article did not involve acontroll ed experiment, nor were t hefac t or s rel evantto Huss’ ca se a dequ ately acc ounte d fo r inth e dataan alysi s.

Dr. Tucker was a manuscript reviewer for the AmericanC oll ege of Obstetricians and 6 Gyne colo gi sts, an d h e b oasts an extensivelist of research publication s over the cour se of his care er. He woul d thus h ave b eenimmin ently more qualif ie dt o c ritique the plaintiff’ s cau sationstu di es , h a d th e defe n seactu allyb ee nintere st edinmountin gsuchach all en ge. 38 a s f or th e “stu d y in vo l vin g 9 , 0 0 0 pa ti en ts, ” i t w a s m ere l y a ttach ed to t h e rep ort,
a n d t h e rep ort off

ers n o refere n ce to i t, com m en tary on i t, or d escr i p ti on of it
w h atsoever
. 5 F u r th e r , th e d e fe n s e n e v e ro ffe r e d i n t o e v id e n c e th e a r tic le th a t R e d d ix ref erred t o i n hi s prof

fer, despi t e m an y poi n ts a t w h ich itcoul d h ave d on e so. T h e defen se di d n oteven t ry t o seek adm i ssio n . D e fen se expertD r. T u cker,
va s t l y m o r e q ual i f

i e d t han Redd i x as t o pe e r - r e vi e w e d m edi cal l i t e r at ur e a nd t est i f yi n g i m m edi atel y af t er t h e al l eged l y erroneou s excl u si on , w as not asked aboutt he ar t i c l e. Thi s des pi t e t he fac tt hatD r . Tu c ker di d t es t i f y t o a poi nt at 6
w h i ch t h e art i cl e w ou l d be rel evan t , i f t h e m aj ori t y h ere w ere c orrec t : “ I’ve n ever be e n a bl e t o f

i nd a ny r e l at i o ns hi p, a c aus alr e l at i o ns hi p b e t w e e n Te r but al i ne and ca rdi om yopat hy. G r ant ed, Ter but al i ne has ot hers i de e f fec t s, and w e’ ve t al ke d a bo utt ho s e . But as far as c ar di o m yo pa t hy, I ’ ve ne ve rb e e n a bl e t o f i nd
an y cau salrel atio n sh ip betw een t h e t w o. ” Th e defen se never cr oss- exam i n ed p la in tiff

’ s w itn e s s e s u s in gth e a r t i c l e a s th e b a s is fo rch a lle n g e , e v e n w h e n it rep ea ted l y w ou l d h a ve b ee n a p p rop ri a te to do so. T h ey did con fron t t h em w i th ot h er art i cl es an d oth e r m e d ica l l iter a tu re on th e sp e cific ca u sa tion a n d stand ard
o f c a r e a r g u m e n t s , b e c a u s e t h e s e we r e t h e s i t e s o f a c t u a lc o n f

l i c ta tt r i a l

. The defenda n t D r. G a y den w as di rect l y cha l l en ged on cau sati on , bu the too n ever
m en t i on ed thi s art i cl e.N o. 04- 60962

Pucket v. U.S. , 55 6 U .S. __ _ (2 009) (“If a liti gant believes that an error has occurred 7 (to his detriment) durin g a fe deralj udicialpro ceeding , he must obj ect in orderto preserve the 39 I n s um , t he def

e ns e di d noto f

fe rf r e e s t and i ng s t at i s t i c alc hal l e nge s , a nd R eddi x’ s st at i st i c alob se r vat i ons w er e t o s upporta c ausa ti on c onc l usi on t hat R edd i x w as ri gh t l y rest ri ct ed f rom ren deri n g. R edd i x’ s part i alexcl u si on w as not
an e r r o r , a nd c e r t ai nl y no a bus e of d i scr et i o n. Eve n i f t he r e w e r e e r r o r , a ny reasona bl e vi ew of

t h e defen se c ase at t ri aly ield s the i n si gh tt h at i tw as not pr ej udi c i alt o t he de fe ns e c as e , w hi c h r e c ei ved a m pl e a i r i ng att r i al

. The pro f fer ed t es t i m ony l ac ks c oher enc e s uf f i c i entt o pe r suade t hati t s exc l usi on w as pr ej udi c i al

. The j ur y w as a l r e ad y awas h wi t h t e s t i m o ny o f b o t h s i de s r e ga r di ng s p e c ific ca u s a tio n , a ll a d m i t t e d w ith o u t o b je c tio n a n d e x p la in e d a t le n g th in di rectan d cross exam i n ati on . A n d D r. R edd i x w as f ol l ow ed by an ot h er defen se e x p e r t w h o te s tifie d a t le n g th to co n c lu d e th e ca s e .
III A ft e re r a s in gth e H u s s e s ’ ju r yv e r d ic tb a s e d o n th e d is t r ic tc o u r t ’s excl u sion o f a p ort i on of D r. R edd i x’ s t est i m on y, Ju dg e D eM oss t h en i n cl u des
n i n e pag es of

di ct a “m ak i n g observati on s” abou tt h e adm i ssibi l i t y of t h e H u sses ’
e xp e r t e v i d e n c e , a n i s s u e p l a i n l yn o tb e f o r e t h i s c o u r t ; t h i s wh i l e f i n di ng reversibl e err or i n t h e d istr ict court’ s r ef u salt o adm i tpart of t h e t est i m on y of a defense ex pert— w h i ch som eh ow esc ap es i t s vol u n t eer D au berte xa m i nat i o n. N ei t herJudge O w en norm ys el f j oi n t hi s par tof

t he o pi ni on o n adm i ss ibi l i t y. Jud ge D e M o s s ’ opi ni o n i t s e l f a c kno w l e dg e s t hatt he de fe nda nt s w aive d a ny cha l len g e to th e a d m iss ib il ityof th e H u ss ’ex p e rt e v id e n ce b yn o t ob jec tin gb ef ore o rd u r in gtr ia l, d e s p ite th e e x p lic i t w a r n in gin th e p r e tr ia l o r d e rth a t a ll ob je c tio n s to d ep ositi on s n ot su b m i tted to th e tri a lj u d ge ten da ys pr i or to t r i al

— i nc l udi ng t he v i de o de po s i t i o n o f D r . M ur r aytha t w as pl ay e d f o rt he j ury— ar e w ai ved. I tal so ac know l edge s t hatt he def endant s fai l ed t o pr es er ve 7N o. 04- 60962

is su e. I f h e fail s to do so inatim elymann er , th e cl aimf orr elief fromth e error isf orfeit ed

. .

. . If an erroris not properly preserved, appell ate-court au t ho rityto remedyth e error (by rever sin gth e j u dgme nt, f orex a mp le , oro rd erin gan ewtri al) i s s trictlycircu mscrib ed .”). P olan cov . Cit

y of A ust in , 7 8F .3 d 9 6 8 , 9 7 4( 5 thC ir

. 1 9 9 6). 8 40 a ch a lle n g e to th e s u ffic ie n c yo f t h e e v id e n c e , b u t n e v e rm e n tio n s th a t t h is fai l ur e re s t r i c t s t hi s co ur t ’ s re vi e w of t he H us s ’e xp e r te vi de nc e t o “ w he t he rt he pl ai nt i f f ha s pr e s e nt e d any evi denc e i n suppor tof h i s c l ai m ”

— a s t andard t hat

8 b e y o n d p e r a d v e n tu r e th e H u s s e s s u r p a s s e d

.N o. 04- 60962

U.S. v. Mo rnan , 41 3 F .3d 3 72, 379(3d Cir. 2005) (“Where a defen dantfails toobje ct 9 to the admissio n of evide nce (inclu ding expert testi mony) during trial, thi s Court reviews th e de ci sionto a dm itth at evidencef orp laine rror .”); U. S

. v. Gask in , 36 4 F.3d 43 8, 460n.8 (2d C ir. 200 4) (“Where a party que stion s wheth er soun d scientificmethodology provides a b asis for an expert opinion , it may move to preclude the admissio n of th e o pinion. Gaskinmadeno such motion ; in s tead, he stipul ated to the admissib ility of th e expert o pinion. Un der such c irc u m s t a nc e s , h e c a nno t c o m p l ain o n ap p e al th at th e o p ini o n l ac ks f o u n d ati o n . ”) (intern al citationo mitt ed); Mascent i v. Becker , 23 7 F .3d 1 223 , 1231 (10th Cir. 2001 ) (“[W]efin d no pl ain err or su ch as toexcusea timely Daubertobjection to pl a i n t i f f M a sc enti ’sexperttes tim ony. We are convinc ed th at Defendant forfeited the opportunity to subj ect the expert testimony of Dr. Sullivan an d plaintiff’s otherexperts to a Da uber t challe nge b y failure to make a timely obj ection b ef

ore th at te stim ony was adm itte d. ”) ; C.B. F leetC o. v. Smithkline Beecham C onsu me r Heal t h ca re, L.P. , 13 1 F .3d 4 30, 437(4th Cir. 1 997) (“Fleetmadeno Daubert obj ectio n to a dmissionof the extensivetesti monyof SmithKline’s expert witnesses about the blu e-dye te sts’ methodology, conduct, and results. Fleetcontends that it n eed not have: th at its challen geh ere is not to th e a dmissibilityof this evidence b ut to its in suffici encywhen tes tedby Daubert principle s to support the district court’s finding of the t es t s ’scie ntific reli ab ility . Th at cann otb e ri ght. ”) ; Ma rbled Mur relet v. Bab bitt , 83 F .3d 1 060 , 10 67 (9thC ir. 1 9 9 6) (“Wec onclu deP acific Lu mb erwaivedits Daubertobje ction s to EPI C’s scientificevidence of i mpaire d breedingbyfailin g to requ est arulin g on theadmi ssibilityof the evidence in the di strictc ourt .”); Ch ristopher v. Cut te r Labs. , 53F .3d 1 184 , 11 92 (11thC ir. 1 995) (“If Armour believed th at Dr. Robin son’s testimony was stati sticallyinvalid, it should h ave obj ected to that testimony, givinghim th e ch anc e toexplain his answer. . . . A bs en tanobje ction , we c an review th e ch all enged evi denceonlyfor plain error .”) ; McKnight v. Joh nsonC ont rols, Inc. , 36 F.3 d 13 96, 140 6–0 7 (8th Cir. 199 4) (“We nee d not reach this issue, however, because JC I fail ed to obj ect to J acob son’s testimony on the basi s that h e was n ot qualifi ed a s anexpert or that h e lack edascie ntific b a si s f orhiso pinio n s.”). See H.E. Ste venso n v. E.I. DuPo ntDe Ne mours and C o. , 32 7 F .3d 4 00, 406–07(5th 10 C ir

. 2 0 0 3) (DeMo ss, J .) ; SE C v. Snyder , 29 2 F . App’x391, 400n .1 (5 th Cir. 2 008) (“Many of Sny der’s arguments appe ar to b e b elated attempts tochall enge th e a dmissibilityof Hoffman’s opinion s under Fed. R. Evid. 702an d Daubert , ratherth an challe nges toth e sufficie ncyof the evidence. Bec auseSnyder di d not obj ect to the admis s ibilityof Hoffman’s testimony conc erningth e accountin g practices at issue, that issue has bee n forfeited.”) (internalcitation om itte d) ; U.S. v. Bates , 240 F.3d 10 73, *3 (5thCir. 200 0) (unpubli shed) (“If the defen dantfails to obj ect to the expert’s testimony, then the defen dant ‘waives appell ate review absent pl ain error. ’”). Cons ide r hears ay whi c hi s gener ally inadm iss ible on groun dsof unrel iabili ty.

11 However , if hearsayevidence i s admitted into testimony without an obj ectio n, it i s treated a s 41 T h e u n i form la w of th e circu i ts, the F i ft h i n cl u d ed , i s th a t w i th ou t a 9 1 0 t i m el y obj ect i on t o t h e ad m i ssi on of exp ert evi den ce, ap pel l ate revi ew i s w ai ved ab s e nt pl ai n e r r o r . The uno bj e c t e d- t o e vi de nc e i s c o m pe t e nta nd p as s e s t o t he j u ry f or c redibi l i t y an d w ei gh tdeter m i n ati on s. 11N o. 04- 60962

c o m p e t e nt evi d e nc e f

o r th e j ury t o w e i gh a n d o n which t o r e s t it s ve r dict
. SeeGo ch icoav . Joh nson , 11 8 F .3d 4 40, 448n .7 (5thC ir. 1 997) (“Otherwise inadmi ssibleh earsay admitte d without obje ctionis treated the same as anyoth er evi dence , an d maybecon sidere d byth e j ury in supp ort of it s ver dict .”) (interp retin g T exa s l aw); U.S. v. S pletzer , 53 5 F .2d 9 50, 955n .7 (5 th C ir

. 1 9 7 6). 42 I V T h i s c ase an sw ers n o sc i en t i f i c questi o n s a n d sh eds l i t t l e of t h e l i gh tof sci en ce on i t s d i f

f i cul tm edi calp robl em s. A bl e law yers tr i ed thi s c ase. T h i s j u ry a n s w e r e d th e q u e s tio n s th e co u r t a n d th e la w y e r s p u t t o it. D e fe nda nt s ha ve ha d t he i rda y i n t hr e e c o ur t s a nd, a c c e pt i ng as w e do t he
ans w e rb y t he Supr e m e Cour t o f M i s s i s s i ppi t o o ur c e r t i f i e d que s t i o n r e ga r di ng l i m i t ati on s, ha ve rai sed n o ot h er groun ds of err or w h i ch persu ad e m e t o di st u rb th is ju r yv e r d ic t. T o th e s e e y e s t h e c o u r t to d a yo v e r s te p s its ju d ic ia l ro le a n d in d o in gs o p ro d u ce s g ra v e er ro r. In low e rin gth e h u rd le o f T an n er for de fen d a n ts i tfai l s t o t reatpl ai n t i f fs and defen da n t s w i t h an even ha n d an d i n t h e process p e r v e r s e lyin v ite s th e ju n k s c ie n c e it d e c r ie s . I w o u l d a f

f i r m.