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

N o. 06- 20709
RA N D AL L S. YO U N G ; TH ESSA G
. YO U N G , I ndi vi dua l l y and a s ne xtf r i e nds o f A s h to n Y o u n g , P l ai n t i f fs–A pp el l an t s , v. M E M O R I A L H E R M A N N H O SP I TA L S Y ST E M , doi ng busi nes s as M em or i al He r m a n n Ho s p i t a l ; RURAL /M ET RO OF TE XAS L P; M EM ORI AL H E R M A N N H E A L T H C A R E S Y S T E M ; R /M O F T E X A S G P IN C .; RURAL/M ET RO OF TE XAS I NC. ; J OSE M EDI NA, M D; KAT RI N Y. T AK ENA KA , MD; S T AC YMACD ONA L D, R N; A L I E RI ED L E, R N , D efen da n t s–A pp el l ees .

A pp ealf

rom t h e U n i t ed S t ates D i st ri ctC ou rt f or t h e Sou t h ern D i st ri ctof T exas

B ef ore H IG G IN B O T H A M , SM ITH , an d O W E N , C i rcui t Ju dg es . P E R C U R I A M: R an da l lY ou n g, hi s w i fe, an d thei r m i n or chi l d hav e assert ed heal t h care l i abil i t y an d d eri vati ve cl ai m s and app ealt h e di st ri ctcourt ’ s grant of sum m ary j u dg m en t i n favor of t h e defen da n t s ( col l ective l y, M em ori al ) on the el em en tof
c a u s a t i o n . We a f

f i r m. United States Court of App eals Fifth Circuit 

### F I L E D June 29, 2 009 Cha rl es R. F ulb ru g e II I ClerkN o. 06- 20709

2 I Thi r t y- seve n- ye ar - o l d Rand al lYoun g, a Lo ui s i ana r e s i de nt , a t t e nde d a
m o t o c r o s s e ve nta t R e l i antSt ad i um i n H o us t o n, a nd d ur i ng t hate ve nt bystand ers f

ou n d h im w a n d e rin ga im les sly n e a r a co n ce ss ion sta n d
. P a ra m edi cs r e s po nde d t o a c al la t8 : 34 p. m . a nd t r ans po r t e d Yo ungt o M e m o r i alH e r m ann H o s pi t al , w he r e he a r r i ve d a t9 : 20 p. m . I t w as lat e r de t e r m i ne d f r o m a f r i e nd
w ho had ent er ed R el i ant s t adi um w i t h Y oung but w as nots eat ed w i t h hi m t hat t he l as t t i m e Young w as s ee n sy m pt om f r ee w as abo ut 6: 30 p. m . or per haps 6: 45 p . m . W e w i l ln ot d eta i lth e trea tm en t Y ou n g re ceive d at M em orial or t h e res u l ts of vari ou s t est s ot h er t h an t o note t h at a C T sc an w as i n i t i al l y “ n egati ve” f or a st r oke, buta subs equentC T sc an w as perf or m ed af

t er2: 30 a. m . , and Y oung w as d i a g n o s e d w i t h a s t r o k e a t4 : 1 5 a . m. W h et h er M em ori al shou l d or coul d hav e di agn osed Y ou n g’ s s t roke earl i er and t he a ppr o pr i at e c o ur s e o f t r e at m e nta r e hot l y di s put e d. O ne of t he Youn g fam i l y’ s chi ef contenti on s i s t h at M em ori al shou l d hav e i m m edi atel y di agn osed t h e st roke an d sh ou l d h ave ad m i n i st ered an i n t raven ou s t i ssue pl asm i n ogen ac t i vat or , know n as t
- PA
. I n so m e c as es t
- PA c an l ys e o r “bust ” t h e cl ott hat
c a u s e s a s tr o k e . T h e Y o u n g s co n te n d th a t if R a n d a ll Y o u n gh a d re c e iv e d th is dr ug w i t hi n t hr e e ho ur s o f t he o ns e t o f s ym pt o m s , he w o ul d hav e f u l l y or s u b s ta n tia l ly re c o v e r e d
. It is u n d is p u te d th a t Y o u n gis s e v e r e ly a n d to ta lly di sabl ed as a resul tof hi s s t roke. The Young s f

i l e d he al t h c ar e l i ab i l i t y c l ai m s a ga i ns t M e m o r i alH e r m ann H o s pi t ala nd o t he r de fe nda nt s i n t he U ni t e d S t at e s D i s t r i c t Cour t f o rt he So ut he r n Di s t r i c to f Tex as , ba s i ng j ur i s di c t i o n o n dive r s i t y o f c i t i z e ns hi p. The Y ou n gs rel i ed on opi n i on s f rom t h ree expert s t o sup port t h e causati on aspectof t he i r c l ai m s . Af

t e r t he s e e xp e r t s had s ubm i t t e d r e po r t s a nd wer e de po s e d, t he M e m o r i alde fe nda nt s f i l e d m o t i o ns t o e xc l ude t he e xp e r t s ’t e s t i m o ny o n v ar i o us gr o unds a nd f

i l e d a m o t i o n f

o r s um m ar y j udg m e nto n t he e l e m e nto f c aus at i o n.N o. 06- 20709

Cab oni v. Gen. Motors Cor p ., 2 7 8F .3 d 4 4 8 , 4 5 1 ( 5 thC ir
. 2 0 0 2 ). 1 Id
. 2 Kramer v. Lewisville Mem’l Hos p. , 8 5 8S .W .2 d 3 9 7 , 3 9 9 -4 0 0(T ex . 1 9 9 3). 3 Id
. at 4 0 0 ; see alsoProv iden ceHeal t hCt r. v . Do wel l , 26 2 S .W.3d 324 , 32 8 (T ex . 20 08) 4 (exp l ainin g , wh e nf

ailur eto render tre atment was all eged, th at und er the more-likely -than-no t st a n dard , “th e is su e iswh eth er[tr eatm ent] wouldhave ma de[th e de atho r in j ury] u nlike ly”)
. See Merrell Dow P

harms., In c. v. Havner , 95 3 S .W.2d7 06 , 71 5-17(T ex . 19 97) 5 (c onclu din ginap ro duct s liab ilityc a seinvolvin ga dm inis tr ationo f adru gall egedt o cau se birth defects that “th e re quirement of a mo re than50 % prob abilitymeans th at epide miolo gical evidence must show [at least] that the risk of an inj uryor conditioninth e e xpo sed po pulation was more than doub le the risk inth e unexposed or c on t rol popul atio n,” citingnumero us decisions and Judge Wein stein’s semin al decis io n in In re “Age nt Ora nge” Pro duct Lia bil ity 3 U l t i m at el y, t he di st r i c t cou rt gra n ted M em orial’ s m oti on f or su m m a ry j u d gm en t. T h e courtconcl u ded t h at t h ere w as insuff i ci en t evi den ce t o rai se a fact qu est i on as t o w het herYoun g w oul d have suf fer ed l es s se ver e i m pai r m enti f t
- PA had be e n a dm i ni s t e r e d. T h e Y ou n gs ha ve ap pea l ed. W e revi ew t h e di st ri ctcourt ’ s g ra n tof
sum m ary j u dg m en tde n ovo, a pp l yi n g t h e sam e st an da rd t h at t h e di st ri ctcourt ap pl i e d. Sum m ar y j udg m e nt i s i nap pr o pr i at e i f t he r e c o r d c o nt ai ns a g e nui ne 1 i ssu e of m a terialfa ct. 2

II T h e p a rti es a gr ee tha t T ex a s su b stan ti ve l a w go ve rn s. T h e T ex a s cou rts h a v e h e ld th a t p la in tiffs in a m e d ic a l m a lp r a c tic e o r h e a lth ca r e lia b ility s u it
m u stshow a “ reasona bl e m edi ca l proba bi l i t y” t h at “ t h ei r i nj u ri es w ere c au sed b y th e n e g lig e n c e o f o n e o r m o r e d e fe n d a n ts .” T h is “m e a n [s ] s im p ly th a t it is 3

‘ m ore l i kely t h an not’t h at t h e u lt i m ate harm or cond i t i on res u l t ed f rom such
ne gl i ge nc e . ” The Supr e m e Cour t o f Te xa s , l i ke m anyc o ur t s , ha s e qua t e d t he 4 “m ore -l i k ely-t h a n -no t” ca u sa ti on req u i rem en t t o a m ore tha n 50 % pr ob a b i lity t hat a de fendant ’ s w r ongf ulc onductc ause d t he har m ori nj ury. 5N o. 06- 20709

Lit igat ion , 61 1 F . Supp. 12 23, 126 2 (E.D.N.Y. 198 5), in which he hel d that th e pl aintiffs were re quir edt o of

fe r evid enceth at cau sationwa s “‘m or e th an5 0p erce nt prob ab le ’”). See Pro v i de n ceH

e a l t hCtr . , 2 6 2 S .W .3 d at 3 2 8 ; Havner , 95 3 S .W.2d at 716 -17; 6 Kramer , 85 8 S .W.2d at 400
. See Nat’ l I n st
. of

N euro lo gic al Di so rd er s an d Stro kert- PA Strok e Stu dyGroup, Tissue 7 Plasminogen Activator for Acu teI schemic St roke , 33 3 N E W E NG . J. OF M ED . 1 5 8 1 ( 1 9 9 5); NI NDSt -PA

S trok e Stu dyGroup, Generalized Efficacyof t-P A for Acute Stroke: Su bgroup Analysis of the NIN

DS t -PA St rokeTrial , 28S T R OKE 2 1 1 9( 1 9 9 7). 4 It is u n d is p u te d th a t t h e r e is re lia b le s c ie n tifi c e v id e n c e th a t t im e ly ad m i n i st rat i on of

t-P A is b e n ef

i ci alt o som e pati en t s, som e pati en t s do not b e ne f i t f r om t- PA t he r a p y , a nd s o m e s t r o ke v i c t i m s who d o n o t r e c e i v e t
- PA
r ec ove r , w i t h l i t t l e orn o l as t i ng i m pai r m ent
. W e know t hat R andal lYoun g w as n ot t reat ed w i t h t
- P Aan d that t ragi cal l y, h e di d n otrec over si gn i f i can t l y. U n der Texas l aw , the Y oungs m ustpr oduc e r el i abl e e vi denc e t hat i t i s m or e l i kel y t han
n o t t h a t R a n d a ll Y o u n gw o u ld h a v e b e e n a m o n gth o s e p a tie n ts w h o m a te r ia lly be ne f i t f r o m t he a dm i ni s t r at i o n o f t
- PA r at he r t han am o ng t ho s e w ho r e c e i ve t he th era p y a n d do n ot be n efi t. 6 T h e Y ou n gs’bestevi den ce l i es i n T able 3 of a 1 997 “subg roup an al ysi s” of
an e ar l i e r , f

o unda t i o nal 19 95 s t udy o f t
- PA ’ s e f fe c t i ve ne s s . Ass um i ng, w i t ho ut

7 de c i di ng, t hatt hi s s ubg r o up a nal ys i s a c c ur at e l y r e f l e c t s t he ef

fe c t of t
- PA i n t he gener alpopul at i on o f pat i ent s, t he r el evantport i on o f t hi s t abl e s ugges t s t hat in Y o u n g ’ s a g e g ro u p a n d a t h is lev e l o f str o k e se v e rity , Y o u n g ’ s l ik e li h o o d of a
ve ry fa vo ra b l e ou tco m e w a s a p p rox i m a tel y 4 2 % ev en w i th ou t t -P Atreatm en t, wh i l e h i s l i k e l i h o o d o f s u c c e s s w i t h t h e t r e a t me n t w a s a p p r o x i ma t e l y 5 9 %. B u tas w e ha ve recogn ized , t h e l aw of T exas est abli shes t h e st an da rd of
cau sati on as “ m ore- l i kely- t h an - n ot , ” w h i ch m ean s t h at i t i s m ore probable, i
. e. m or e t han 50% l i kel y, thatthe al l ege d w r ongf ulconductc ause d t he i nj ury t han
no t
. The r e qui r e m e ntt hatt he w r o ngf ulc o nduc t m o r e l i ke l y t han no t c aus e d t he i nj ur y i s t he fo unda t i o n fo r t he co nc l us i o n i n B e nde c t i n l i t i ga t i o n i n T e xa s a ndN o. 06- 20709

See Havner , 9 5 3S .W .2 d at 7 1 6(citin gd ecis io n s ino th erj uri sdiction s)
. 8 I d
. at 708
. 9 I d
. at 714
. 10 Id . at71 5. 11 Id . at71 5-18
. 12 Id . at71 6. 13 5 o t he r j ur i s di c t i o ns t hatc aus at i o n ha d no t b e e n s ho w n. The i s s ue i n t he 8 B e n d e c tin ca s e s w a s w h e th e rth e in g e s tio n o f th a t d r u gb y w o m e n w h ile pregn an t caused bi rth d efect s i n t h ei r c h i l dren , speci f i cal l y, l i m b redu ct i on defec ts. I tw as un di spu t ed that l i m b redu ct i on bi rt h defect s oc curred w h en

9
m oth ers h a d n ot tak en B en d ec tin
. T h e S u p rem e C ou rt of T ex a s h eld th a t a 10 pl ai n t i f f m u stshow t h at i tw as m ore l i kely t h an not t h at B en decti n w as a cause of the def ec t s. The m or e t han 50% l i kel i hood c ausat i on s t andard underTexas 11 l aw w as t he bas i s f

or t he Texas c our t ’ s hol di ng t hat ge ner al l y, epi dem i ol ogi c al st u di es m u stshow at l east a dou bl i n g of the ri sk. “ [ T ] h e requi rem en t of a m ore 12 t han 50 % pr o ba bi l i t y m e ans t hatepi de m i o l o gi c alev i de nc e m us t s ho w t hatt he
r is k o f a n inju r y o r co n d it i o n i n th e e x p o s e d p o p u la tio n w a s m o r e th a n d o u b le th e ris k in th e u n e x p o s e d o r co n tr o l p o p u la tio n .” 13 I n t he pr e s e ntc as e , t he “ une xp o s e d orc o nt r o lpo pul at i o n” c o ns i s t s o f t he p a tie n ts w h o w e r e t r e a te d w ith p la c e b o in th e N IN D S s tu d y a n d th e 1 9 9 7 a r tic le
a n a ly z in git. T a b le 3 o f th e 1 9 9 7 a r tic le re fle c ts th a t in th e ca te g o r y a p p lic a b le t o Randa l l Y ou n g, 5 8% t r e at e d wi t h pl ac e bo ha d a n unfav o r ab l e o ut c o m e , a nd 4 1 % treate d w i th t- P Ah a d an u n fav ora b l e ou tcom e. T h e fail u re to trea t w i th tP Adi d n ot resu l tin a m ore than d ou bl i n g of t h e ri sk of

an un favorab l e outcom e. T h u s even our m ost cha ri t able readi n g of t h e Y ou n gs’ evi den ce c an n otsup port
a j ur y f

i ndi ng i n t he i r fav o r . I n a bs enc e o f a fac t i s s ue , w e AFF I RM t he
su m m a ry j u d gm en t.