Source: https://docs.justia.com/cases/federal/district-courts/arizona/azdce/2:2012cv02583/743923/230
Timestamp: 2016-10-25 12:35:54
Document Index: 85926539

Matched Legal Cases: ['art 97', '§ 12', '§ 12', '§ 12', '§ 12', '§ 12', '§ 12', '§ 12', '§ 12', '§ 12', '§ 12', '§ 12', '§ 12', '§ 12']

ORDER AND OPINION granting in part and denying in part 97 Motion to Exclude or Limit Plaintiff's Experts Testimony and Opinions for Amrani v. United States of America :: Justia Dockets & Filings Log In
Jacob Amrani,
2:12-cv-2583 JWS
[Re: Motion at Docket 97]
At docket 97 defendant United States of America (“United States”) asks to
exclude or limit the testimony and opinions of several of plaintiff Jacob Amrani’s
(“Dr. Amrani”) experts. Dr. Amrani opposes at docket 109. United States replies at
docket 119. Oral argument was requested but would not assist the court.
Dr. Amrani is a board certified orthopedic surgeon who specialized in spine
surgery. Dr. Amrani’s practice in Phoenix was conducted at his own clinic, the Deer
Valley Spine Center. Because he is a veteran, Dr. Amrani is eligible to receive his own
medical care from the Veteran’s Administration (“VA”). Some time after he suffered a
severe injury to his right should while weightlifting, Dr. Amrani sought treatment at the
VA hospital in Phoenix. Dr. Amrani was placed under the care of Dr. Cranford, a board
certified orthopedic surgeon who performed right shoulder rotator cuff surgery on
Dr. Amrani. The surgery included excision of a soft tissue mass in the shoulder.
Dr. Amrani claims that, as a result of the medical negligence of Dr. Cranford, he has
experienced a substantial loss of function in his right shoulder and right arm which has
negatively affected his ability to practice surgery and thus reduced his income. In this
lawsuit Dr. Amrani seeks more than $6 million in damages.
Among others, Dr. Amrani has named Dr. Corrie Yablon (“Dr. Yablon”), Dr. Scott
Nelson (“Dr. Nelson”), Dr. David Mohler (“Dr. Mohler”), and Alan Burke as expert
witnesses.1 These witnesses’ testimony and opinions are at issue in the motion at
Dr. Yablon
Dr. Yablon is a board certified radiologist with a subspecialty in “Musculoskeletal
(MSK) Imaging.”2 Dr. Yablon has prepared an expert report regarding the MRI findings
on Dr. Amrani’s right shoulder and the subsequent care he received for the soft tissue
mass found on his pre-operative MRI.3 The United States seeks to exclude Dr. Yablon
as an expert witness or, alternatively, limit her testimony, because: (1) Dr. Yablon does
not meet the criteria of A.R.S. § 12-2604; (2) Dr. Yablon’s opinions regarding what may
have happened if the mass had been malignant are irrelevant; (3) Dr. Yablon’s
testimony would be duplicative of Dr. Stephen Kay; and (4) Dr. Yablon is not competent
to testify as to whether Dr. Amrani’s axillary nerve was injured, how it was injured, or the
cause of that injury.
Doc. 97-5 at 8-9, 11, 13, 15.
Doc. 97-3 at 2.
Dr. Yablon may not testify regarding the appropriate standard of care
In pertinent part A.R.S. § 12-2604 provides that if a party in a medical
malpractice action against whom expert testimony on “the appropriate standard of
practice or care” is offered “is or claims to be a specialist who is board certified, the
expert witness shall be a specialist who is board certified in that specialty or claimed
specialty.”4 The Arizona legislature enacted this statute to ensure that “only physicians
with comparable training and experience may provide expert testimony regarding
whether the treating physician provided appropriate care.” 5
The parties agree that because Dr. Yablon is not a specialist in orthopaedic
surgery, A.R.S. § 12-2604 forbids her from testifying regarding the standard of care
applicable to Dr. Cranford. The United States argues that Dr. Yablon opines on the
appropriate standard of care, however, with her following three conclusions: (1) “it was
standard operating procedure for an orthopedic surgeon to refer a mass such as
[Dr. Amrani’s] to an orthopedic oncologist for evaluation and treatment;” (2) “[i]t was a
grave error on the part of the treating orthopedic surgeon to assume that the soft tissue
mass was benign and that the etiology was secondary to the rotator cuff tear;” and
(3) “[b]ecause the assumption was made that the mass was benign, it was not
approached with the care that would be taken if the mass had been suspected to be
malignant.”6 Dr. Amrani argues that “Dr. Yablon is not providing a standard of care
opinion against Dr. Cranford; she is providing a causation opinion that a radiologist
would have recommended a referral to an orthopedic oncologist.”7
A.R.S. § 12-2604 does not preclude Dr. Amrani from offering Dr. Yablon’s
testimony to show causation—that Dr. Cranford’s breach of the appropriate standard of
A.R.S. § 12-2604(A)(1).
Baker v. Univ. Physicians Healthcare, 296 P.3d 42, 46 (Ariz. 2013).
Doc. 119 at 3-4.
Doc. 109 at 4.
care resulted in injury. Thus, Dr. Yablon may testify about how a radiologist may have
prevented injuries caused by Dr. Cranford’s alleged breach. The court agrees with the
United States, however, that Dr. Yablon’s report goes beyond this, and express her
opinion of what a prudent orthopedic surgeon would have done under the
circumstances. Such opinions, including the three opinions identified above, are
inadmissible pursuant to A.R.S. § 12-2604. W ith regard to these opinions, the United
States’ motion is granted.
Dr. Yablon’s opinion regarding what may have happened if the mass
had been malignant is irrelevant
The United States argues that “Dr. Yablon’s opinions as to what may have
happened during surgery had the mass been malignant are irrelevant” because the
mass was benign, an undisputed fact.8 Specifically, the United States objects to
Dr. Yablon’s following three opinions: (1) that “it was not possible, based on the limited
imaging pre-operatively, to know that the right shoulder mass was benign;”9 (2) “a core
needle biopsy should have been performed prior to resection of the tumor so that
appropriate pre-operative planning could be performed;”10 and (3) Dr. Cranford erred by
removing the mass without first consulting with the radiologist or an orthopedic
oncologist “as to the proper approach and the important anatomic structures to avoid.”11
Dr. Amrani responds by arguing that the United States is missing the point of
Dr. Yablon’s testimony—her testimony is not being offered to show whether the mass
was benign or malignant, but rather, whether his axillary nerve would have been injured
if Dr. Cranford had not breached the appropriate standard of care.
Doc. 97 at 9.
Doc. 97-3 at 11.
The United States is correct that Dr. Yablon’s opinion about how Dr. Amrani
would have been treated if a core needle biopsy had yielded a malignant result is
irrelevant to this case. 12 But the specific opinions to which the United States objects do
not pertain to what might have happened if the mass were malignant. Instead,
Dr. Yablon states what might have happened if Dr. Cranford had suspected that the
mass was malignant. Although Dr. Yablon may not testify whether Dr. Cranford
breached his standard of care by not suspecting as much, Dr. Yablon’s testimony about
how consultation with a radiologist might have prevented Dr. Amrani’s injury would go to
causation, and would therefore be relevant.
Dr. Yablon’s testimony would not be duplicative of Dr. Kay’s
The United States argues that Dr. Yablon should be excluded as an expert
witness because her testimony would be duplicative of Dr. Kay’s. The premise of this
argument is that Dr. Yablon would be merely offering her opinion on whether
Dr. Cranford breached the appropriate standard of care. This premise is faulty.
Dr. Yablon will not be permitted to offer standard of care testimony, so her testimony is
not duplicative.
Dr. Yablon’s qualification to testify regarding the alleged nerve injury
and anterior deltoid muscle atrophy
Dr. Yablon’s expert report concludes that Dr. Amrani “suffered axillary nerve
injury, which caused atrophy of his anterior deltoid muscle.”13 The United States
objects to this opinion as unreliable, because nothing in Dr. Yablon’s curriculum vitae
establishes her competency to testify as to whether the axillary nerve was injured, how
the nerve may have been injured, or what caused the alleged atrophy of Dr. Amrani’s
anterior deltoid muscle. The United States’ argument does not reference Rule 702 of
the Federal Rules of Evidence, but this is the authority upon which it relies. Rule 702
Doc. 97-3 at 11 (“If the core specimens yielded a malignant result, then appropriate
pre-treatment discussion and planning with the patient could have ensued.”).
Doc. 97-3 at 12.
witness’s opinion is relevant and reliable. 14 Expert opinion testimony is relevant “if the
knowledge underlying it has a valid connection to the pertinent inquiry” and it is reliable
“if the knowledge underlying it has a reliable basis in the knowledge and experience of
the relevant discipline.”15 Under Daubert v. Merrell Dow Pharmaceuticals, Inc.,16 and its’
progeny, “a district court’s inquiry into admissibility is a flexible one.”17 The purpose of
the district court’s inquiry is not to “exclude opinions merely because they are
impeachable,” but rather to “screen the jury from unreliable nonsense opinions.” 18
In opposition, Dr. Amrani argues that Dr. Yablon is qualified to testify regarding
whether and how the axillary nerve was injured because “she can show on the
pre-operative MRI that the ‘normal expected course of the axillary nerve is interrupted
by the mass, as the mass appears to encase the axillary nerve.’”19 Interpreting a pre-
operative MRI is within a radiologist’s qualifications. Dr. Yablon’s testimony regarding
her interpretation of the pre-operative MRI will therefore be helpful to the trier of fact.
Dr. Amrani does not, however, explain how Dr. Yablon is qualified to testify that the
nerve injury caused the alleged atrophy of Dr. Amrani’s anterior deltoid muscle.
Dr. Yablon is precluded from offering such testimony at trial.
See City of Pomona v. SQM N. Am. Corp., 750 F.3d 1036, 1043 (9th Cir. 2014), cert.
denied sub nom. SQM N. Am. Corp. v. City of Pomona, Cal., No. 14-297, 2014 WL 4542540
(U.S. Dec. 15, 2014).
Id. at 1044 (citation and internal quotation marks omitted).
Pomona, 750 F.3d at 1043.
Doc. 109 at 5 (quoting Doc. 97-3 at 6).
Dr. Nelson is a board certified pathologist.20 According to Dr. Amrani, Dr. Nelson
will testify that a reasonable and prudent pathologist could have examined a needle
biopsy specimen and reported his findings to the orthopedic surgeon, the radiologist,
and an orthopedic surgical oncologist.21 The United States seeks to exclude Dr. Nelson
as an expert witness or, alternatively, limit his testimony, because: (1) Dr. Nelson does
not meet the criteria of A.R.S. § 12-2604; (2) Dr. Nelson’s testimony would be
duplicative of Dr. Kay; and (3) Dr. Nelson is not competent to testify that a branch of
Dr. Amrani’s axillary nerve was cut.
Dr. Nelson may not testify regarding the appropriate standard of care
As with Dr. Yablon, the parties agree that because Dr. Nelson is not a specialist
in orthopaedic surgery, A.R.S. § 12-2604 forbids him from testifying regarding the
standard of care applicable to Dr. Cranford. Dr. Amrani asserts that Dr. Nelson will not
testify as to Dr. Cranford’s standard of care, but rather, whether Dr. Amrani’s axillary
nerve was severed, whether Dr. Amrani’s treatment required a multidisciplinary
approach, and whether such a multidisciplinary approach could have prevented
Dr. Amrani’s injury.
As the United States points out, Dr. Nelson’s report explicitly states that it
contains his opinions regarding the manner in which Dr. Cranford “failed to meet the
applicable standard[] of care.”22 Dr. Nelson states that “the plan for the surgery and the
surgery performed by Dr. Cranford . . . falls well below the standard of care.”23 And
Dr. Nelson concludes his report by stating that “if Dr. Cranford . . . had followed the
principles of orthopedic oncology, and treated this patient and the tum or with the care
Doc. 97-5 at 11.
Doc. 109 at 2.
Doc. 97-6 at 3. See also Doc. 97-6 at 6.
Doc. 97-6 at 8.
and careful consideration deserved,” Dr. Amrani would have been able to continue his
career to completion.24 These opinions of what a prudent orthopedic surgeon would
have done under the circumstances, including whether Dr. Cranford should have
consulted with a multidisciplinary team of physicians, are inadmissible pursuant to
A.R.S. § 12-2604. However, Dr. Nelson may offer his opinion regarding whether and
how Dr. Cranford’s failure to consult with a pathologist or a multidisciplinary team of
physicians prior to surgery may have caused Dr. Amrani’s injury.
Dr. Nelson’s testimony would not be duplicative of Dr. Kay’s
The United States argues that Dr. Nelson should be excluded as an expert
witness because his testimony would be duplicative of Dr. Kay’s. The premise of this
argument is that Dr. Nelson would be merely offering his opinion on whether
Dr. Cranford breached the appropriate standard of care. Because this premise is faulty,
it provides no basis for excluding Dr. Nelson’s opinion relating to causation.
Dr. Nelson’s qualification to testify regarding the alleged nerve injury
Dr. Nelson’s expert report states that a branch of Dr. Amrani’s axillary nerve was
“severed during surgery, as evidenced by the immediate, long standing and likely
permanent loss of motor function of the deltoid muscle, and the microscopic presence
of nerves in the pathology specimen removed during surgery.”25 The United States
concedes that Dr. Nelson is qualified to testify that the presence of nerves in the
pathology specimen is evidence of axillary nerve damage, but argues that Dr. Nelson is
not qualified to testify that Dr. Amrani’s loss of motor function in his deltoid muscle is
additional evidence of this fact. The court agrees that Dr. Amrani has not sufficiently
explained how Dr. Nelson is qualified to draw this conclusion. Dr. Nelson is therefore
prohibited from testifying that Dr. Amrani’s loss of motor function in his deltoid muscle is
evidence of axillary nerve damage.
Doc. 97-6 at 9.
Doc. 97-6 at 6.
Dr. Mohler is a board certified orthopedic surgeon.26 According to Dr. Amrani,
Dr. Mohler will testify as to “what a reasonable and prudent orthopedic oncolog ist would
have done had one been consulted, and how that consult would have changed
plaintiff’s outcome.”27 The United States seeks to exclude Dr. Mohler as an expert
witness or, alternatively, limit his testimony, because: (1) what a reasonable orthopedic
oncologist would have done is irrelevant to this case; and (2) Dr. Mohler does not meet
the criteria of A.R.S. § 12-2604(A)(2).
What a reasonable orthopedic oncologist would have done may be
relevant causation evidence
Dr. Mohler’s expert report states that if Dr. Armani had been referred to an
orthopedic surgical oncologist for evaluation of the tumor, “it is more likely than not the
loss of axillary nerve function would have been avoided.”28 This is because, among
other reasons, prior to removal an orthopedic surgical oncologist would have mapped
out the location of “the abnormal tissue as it relates to the axillary nerve and its major
branches.”29 Assuming that Dr. Amrani can establish that Dr. Cranford breached the
appropriate standard of care, Dr. Mohler’s testimony regarding how a referral to an
orthopedic oncologist might have prevented Dr. Amrani’s injury would go to causation,
and would therefore be relevant.
Dr. Mohler will not offer standard of care testimony
The United States argues that Dr. Mohler should be excluded as an expert
witness because he does not meet the criteria of A.R.S. § 12-2604(A)(2). In response,
Dr. Amrani does not argue that Dr. Mohler is qualified to offer standard of care
Doc. 97-5 at 8.
Doc. 109 at 7.
Doc. 97-7 at 3.
testimony and represents that Dr. Mohler will not be called to do so. 30 A.R.S. § 12-2604
does not preclude Dr. Mohler from offering the causation testimony described above.
But Dr. Mohler is precluded by A.R.S. § 12-2604 from testifying regarding his opinion of
what a prudent orthopedic surgeon would have done under the circumstances.
Dr. Amrani intends to call Alan Burke, President of Insurance Reimbursement
Specialists LLC,31 to testify about Dr. Amrani’s damages caused by the surgery. The
United States objects to his testimony under Rule 702 and Daubert, arguing that it is
based on unsupported speculation and subjective beliefs instead of scientific, technical,
or other specialized knowledge. Specifically, the United States asserts that Mr. Burke is
not qualified to testify “as to the revenue trends of a medical practice or to identify the
single cause of variations in the amount of income.”32 Dr. Amrani responds by noting
that Mr. Burke has experience with the “business of medical practices in general, and of
plaintiff’s medical practice in particular,” including providing “billing and practice
management services to physicians for 23 years,” “conduct[ing] plaintiff’s business
electronic payor billing and collection responsibilities, and provid[ing] plaintiff with
financial and practice analysis.”33
Mr. Burke’s expert report does not describe his educational background in any
way. Also, it is not immediately apparent why his experience qualifies him as an expert
on the causes of fluctuations in a surgeon’s income. Dr. Amrani has not established
that Mr. Burke’s testimony will be helpful to the trier of fact. Mr. Burke will not be
allowed to offer opinion testimony under Rule 702.
Doc. 109 at 8.
Doc. 97-8 at 2.
Doc. 97 at 13.
Doc. 109 at 16.
For the reasons above, the motion at docket 97 is GRANTED IN PART and
Dr. Yablon may offer expert testimony, which may include her interpretation of
Dr. Amrani’s pre-operative MRI. Dr. Yablon may not testify on the appropriate
standard of care, how Dr. Amrani would have been treated if a core needle
biopsy had yielded a malignant result, or whether Dr. Amrani’s alleged axillary
nerve injury caused atrophy of his anterior deltoid muscle.
Dr. Nelson may offer expert testimony, including whether and how consultation
with a pathologist or a multidisciplinary team of physicians might have prevented
Dr. Amrani’s injury. Dr. Nelson may not testify on the appropriate standard of
care or whether Dr. Amrani’s alleged loss of motor function in his deltoid muscle
is evidence of axillary nerve damage.
Dr. Mohler may offer expert testimony, which may include whether and how
consultation with an orthopedic surgical oncologist might have prevented
Dr. Amrani’s injury. Dr. Mohler may not testify on the appropriate standard of
Mr. Burke may not offer expert testimony.
DATED this 6th day of January 2015.