Opinion ID: 2514034
Heading Depth: 2
Heading Rank: 1

Heading: causation testimony

Text: ¶ 15 Denver & Rio Grande first contends that the trial court erred by admitting the expert causation testimony of Dr. Harrison because that testimony was scientifically unreliable and thus inadmissible under State v. Rimmasch, 775 P.2d 388 (Utah 1989). [3] ¶ 16 Trial courts enjoy broad discretion in determining whether expert scientific evidence is admissible, e.g., State v. Crosby, 927 P.2d 638, 642 (Utah 1996); Wessel v. Erickson Landscaping Co., 711 P.2d 250, 253 (Utah 1985), `and such decisions are reviewed under an abuse of discretion standard.' State v. Brown, 948 P.2d 337, 340 (Utah 1997) (quoting State v. Larsen, 865 P.2d 1355, 1361 (Utah 1993)). Indeed, this `exercise of discretion . . . necessarily reflects the personal judgment of the court and the appellate court can properly find abuse only if . . . no reasonable [person] would take the view adopted by the trial court.' Id. (quoting State v. Gerrard, 584 P.2d 885, 887 (Utah 1978)). ¶ 17 Utah Rule of Evidence 702 governs the admission of expert scientific testimony at trial. That rule provides: If scientific, technical, or other specialized knowledge will assist the trier of fact to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training, or education, may testify thereto in the form of an opinion or otherwise. Utah R. Evid. 702. ¶ 18 In Rimmasch, we interpreted the standard for admitting scientific evidence pursuant to Utah Rule of Evidence 702. Under Rimmasch, a court must conduct a three-part analysis to determine the admissibility of scientific evidence. First, Rimmasch requires a threshold showing that the scientific principles and techniques underlying the expert's testimony are inherently reliable. 775 P.2d at 398. If the techniques and principles at issue have been general[ly] accept[ed] . . . in the relevant scientific community, the court may take judicial notice of their inherent reliability. Brown, 948 P.2d at 340 (citing Rimmasch, 775 P.2d at 400). If judicial notice is not appropriate, however, the court must determine whether the party seeking to have the evidence admitted has sufficiently demonstrated the inherent reliability of the underlying principles and techniques. Crosby, 927 P.2d at 641 (citing Rimmasch, 775 P.2d at 400). This foundational assessment must explore such questions as the correctness of the scientific principles underlying the testimony, the accuracy and reliability of the techniques utilized in applying the principles to the subject matter before the court and in reaching the conclusion expressed in the opinion, and the qualifications of those actually gathering the data and analyzing it. Rimmasch, 775 P.2d at 403. ¶ 19 If the proponent of the scientific evidence in question satisfies the threshold requirement of inherent reliabilityeither by judicial notice or through a foundational showingthe trial court must then consider Rimmasch 's second and third requirements. Brown, 948 P.2d at 341; Crosby, 927 P.2d at 641. Rimmasch 's second requirement is a determination that . . . the scientific principles or techniques have been properly applied to the facts of the particular case by qualified persons and that the testimony is founded on that work.' Brown, 948 P.2d at 341 (quoting Rimmasch, 775 P.2d at 398 n. 7). Finally, Rimmasch 's third requirement is a determination of whether the evidence will be more probative than prejudicial as mandated by Utah Rule of Evidence 403. Crosby, 927 P.2d at 641 (citing Rimmasch, 775 P.2d at 398 n. 8). ¶ 20 In this case, Denver & Rio Grande's sole argument on appeal is that Dr. Harrison's causation testimony was inadmissible under the second prong of Rimmasch, i.e., that Dr. Harrison arrived at his opinion by incorrectly applying the methodology he used to assess the cause of Brewer's carpal tunnel syndrome. [4] ¶ 21 In developing his opinion as to the cause of Brewer's carpal tunnel syndrome, Dr. Harrison employed a qualitative observational methodology recommended by the National Institute for Occupational Safety and Health in 1979 (the 1979 NIOSH methodology). Under this methodology, a qualified expert follows five steps to determine whether a medical problem such as carpal tunnel syndrome is work-related: (1) consideration of evidence of the disease and consistency of the diagnosis with the patient's history, (2) assessment of epidemiological data, (3) evaluation of evidence of exposure, (4) appraisal of other potential causes, and (5) evaluation and conclusion. As explained by Denver & Rio Grande's own expert witness, Dr. J. Steven Moore, an expert may follow these steps to systematically collect and evaluate data in determining the cause of a patient's carpal tunnel syndrome: [The first step is] to assure that you're dealing with a correct diagnosis. For example, in this case, does the documentation in the medical records present a compelling case that, in fact, Mr. Brewer did have carpal tunnel syndrome? . . . [T]here's no question [here] that Mr. Brewer had carpal tunnel syndrome. . . . After you've ascertained exactly what the disease condition is, you then go to the epidemiological literature that describe[s] the factors related to the occurrence of that disease. . . . Then step three is where you go to the specific job of concern in this case and determine if those circumstances [that you find in the literature] are present. . . . [Fourth,] you look for a variety of . . . non-occupational factors . . . that may also have contributed or explained the occurrence of this disease. . . . Then finally, based upon the review of the above, you reach a conclusion on work-relatedness. ¶ 22 Here, there is no question about whether Dr. Harrison correctly followed the majority of the steps outlined by the 1979 NIOSH methodology in developing his opinion as to the cause of Brewer's carpal tunnel syndrome. Denver & Rio Grande admitted at trial that it d[id]n't have any objection to Dr. Harrison's qualifications, and it does not raise the issue on appeal. The railroad also concedes that there is no dispute as to whether Brewer has carpal tunnel syndrome, and both Dr. Harrison and Dr. Moore testified that Brewer suffers from the condition, respectively, without doubt and without question. Likewise, never does Denver & Rio Grande challenge on appeal whether Dr. Harrison observed the epidemiological factors he determined relevant to development of carpal tunnel syndrome to be present at Brewer's work station, or whether Dr. Harrison incorrectly disregarded nonoccupational risk factors as potential causes of Brewer's carpal tunnel syndrome. Indeed, Dr. Harrison testified at length about his observation of the risk factors he had identified as present at Brewer's specific job of concern in this case: The risk factors that he has here that I can see from the pictures . . . , from talking to Mr. Brewer is the repetitive keying. [R]epetition is a factor that's well known to cause carpal tunnel syndrome. The second exposure or risk factor is posture. When I look at the pictures, I would describe Mr. Brewer as a leaner, he's kind of leaning forward, perched over the keyboard, and his hands are up . . . . . . . . And if he's doing simultaneously the repetitive keying, and he's in the awkward posture, those two factors combined are synergistic, . . . they're creating more than double the risk factor. . . . Likewise, Dr. Harrison further testified at trial that Brewer d[id]n't have any other reason for developing carpal tunnel syndrome and that there was nothing else that could [have] cause[d] the disease in his wrists. ¶ 23 Rather, Denver & Rio Grande narrowly alleges that Dr. Harrison failed to properly apply the second and fifth steps of the 1979 NIOSH methodology to Brewer's case. Specifically, Denver & Rio Grande contends that Dr. Harrison failed to rely on epidemiological evidence supporting the risk factors he used to assess the cause of Brewer's carpal tunnel syndrome, and that Dr. Harrison formed his opinion as to causation before he examined Brewer's posture at his work station. [5]
¶ 24 To determine whether Brewer's carpal tunnel syndrome was caused by his work as a clerk at Denver & Rio Grande, Dr. Harrison examined two risk factors, repetitive typing and inappropriate posture due to the railroad's furniture. Dr. Harrison explained that repetition is a factor . . . well known to cause carpal tunnel syndrome. Similarly, Dr. Harrison attested that, if combined with other risk factors, poor posture in the form of wrist extension such as that exhibited by Brewer can cause carpal tunnel syndrome by placing stress across the wrist and causing eventual damage to the nerve. Moreover, Dr. Harrison testified, when both of these risk factors are present, they combine to work synergistic[ally], exacerbating the potential effect one factor would have had on the wrist by itself. ¶ 25 In support of his examination of these two risk factors, Dr. Harrison relied on a recent epidemiological literature review conducted by NIOSH, which addressed four risk factors as potential causes of carpal tunnel syndrome: repetition, force, posture, and vibration. That review concludes, There is strong evidence for a relationship between exposure to a combination of risk factors (e.g., force and repetition, force and posture) and CTS [carpal tunnel syndrome]. . . . Based on the epidemiological studies reviewed above, especially those with quantitative evaluation of the risk factors, the evidence is clear that exposure to a combination of job factors studied (repetition, force, posture, etc.) increases the risk for CTS. This is consistent with the evidence that is found in the biomechanical, physiological, and psychosocial literature. Nat'l Inst. for Occupational Safety and Health, U.S. Dep't of Health and Human Services, Publication No. 97-141, Musculoskeletal Disorders and Workplace Factors: A Critical Review of Epidemiological Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back 5a-28 (Bruce P. Bernard ed., 1997) (emphasis in original). In addition to this review, Dr. Harrison testified at trial that he had relied on dozens of other studies finding repetition and posture to be risk factors for carpal tunnel syndrome. For instance, one article co-authored by Dr. Harrison and published in the Journal of the American Medical Association described six potential risk factors connected with carpal tunnel syndrome. That article states, Work-related risk factors associated with [cumulative trauma disorders] include (1) repetition, (2) high force, (3) awkward joint posture, (4) direct pressure, (5) vibration, and (6) prolonged constrained posture. For example, . . . [k]eyboard use often requires wrist extension, ulnar deviation, and sustained localized pressure at the wrist crease. David M. Rempel et al., Work-Related Cumulative Trauma Disorders of the Upper Extremity, 267 JAMA 838, 838 (1992). Likewise, another article authored by Denver & Rio Grande's own expert witness, Dr. Moore, analyzed repetitive forceful exertions, repetitive static exertions, awkward postures, hand-arm vibration, localized mechanical compression, and various combinations of these variables as risk factors for development of carpal tunnel syndrome. See J. Steven Moore, Clinical Determination of Work-Relatedness in Carpal Tunnel Syndrome, 1 J. Occupational Rehabilitation 145, 155 (1991). ¶ 26 Despite this evidence, Denver & Rio Grande argues that because Dr. Harrison also professed to rely on an article entitled Methodological Limitations in the Study of Video Display Terminal Use and Upper Extremity Musculoskeletal Disorders, which found in part that [m]ethodological limitations and inconsistent results have limited conclusions that can be made from . . . studies of the associations between keyboard use and upper extremity disorders, he erred in applying the second step of the 1979 NIOSH methodology by failing to rely on epidemiological evidence supporting his assessment of what risk factors may have influenced the onset of Brewer's carpal tunnel syndrome. Fredric Gerr et al., Methodological Limitations in the Study of Video Display Terminal Use and Upper Extremity Musculoskeletal Disorders, 29 Am. J. Indus. Med. 649, 649 (1996). However, the substance of this article attempts, not to discredit the risk factors a doctor might use to assess the cause of a specific patient's carpal tunnel syndrome, but to establish the need for additional standardized studies to determine more precisely how much exposure to video display terminal use may lead to repetitive disorders such as carpal tunnel syndrome generally. See id. at 654-55 (Research to determine associations between VDT [video display terminal] use and upper extremity disorders will contribute maximally to our understanding only if measures of both exposure . . . and adverse health effect . . . are standard, objective, and valid.). More importantly, Dr. Harrison's mere citation to this study cannot now undermine the trial court's determination that he correctly followed step two of the 1979 NIOSH methodology if the court had before it other sufficient foundational evidence upon which it could have determined Dr. Harrison properly assessed the epidemiological risk factors relevant to the facts of this case. As explained above, we review such determinations `under an abuse of discretion standard,' State v. Brown, 948 P.2d 337, 340 (Utah 1997) (quoting State v. Larsen, 865 P.2d 1355, 1361 (Utah 1993)), and we will reverse `only if . . . no reasonable [person] would take the view adopted by the trial court.' Id. (quoting State v. Gerrard, 584 P.2d 885, 887 (Utah 1978)). Accordingly, in light of Dr. Harrison's reliance on the NIOSH literature review study finding strong evidence for a relationship between exposure to a combination of risk factors, such as repetition and posture, and carpal tunnel syndromealong with his reference to two other articles employing the very risk factors he used in determining the cause of Brewer's ailmentwe cannot say that the trial court abused its discretion by rejecting Denver & Rio Grande's arguments that Dr. Harrison failed to properly apply step two of the 1979 NIOSH methodology to the facts of this case.
¶ 27 Denver & Rio Grande also argues that Dr. Harrison did not correctly follow step five of the 1979 NIOSH methodology, which requires that experts form their causation conclusions based upon the review of the information found in the other four steps of the methodology, because he allegedly arrived at his conclusion before adequately examining Brewer's posture at his work station. Specifically, Denver & Rio Grande asserts that Dr. Harrison formed his causation opinion before assessing Brewer's posture because Dr. Harrison issued his report on causation and gave his first discovery deposition before he reviewed a set of photographs of plaintiff's work station with plaintiff actually seated there, and the depositions of plaintiff's ergonomic experts who viewed plaintiff's actual worksite. In support of this argument, defendant correctly cites the proposition that [c]oming to a firm conclusion first and then doing research to support it is the antithesis of [science]. Claar v. Burlington N. R.R. Co., 29 F.3d 499, 502-03 (9th Cir.1994). ¶ 28 However, it is clear from the record that the trial court possessed a sufficient foundation to determine that Dr. Harrison had in fact properly applied the fifth step of the 1979 NIOSH methodology to the facts of Brewer's case by first examining his medical records; assessing and observing the relevant risk factors, including posture; ruling out any possible nonoccupational causes; and then coming to his ultimate conclusion. In fact, Dr. Harrison's so-called report on causation, dated October 20, 1997, demonstrates on its face that it does not represent Dr. Harrison's final conclusion as to causation. That document references Brewer's repetitive use of his hands and fingers as a well-known risk factor for carpal tunnel syndrome, but then specifically hedges when it discusses posture. The document states, In addition, it is likely that Mr. Brewer had an additional ergonomic stressor in the form of prolonged static posture while using a typewriter or keyboard. The medical and scientific literature supports a causal connection between ergonomic stressors and carpal tunnel syndrome. (Emphasis added.) The obvious implication from this statement is, not that Dr. Harrison prematurely assumed Brewer's carpal tunnel syndrome was caused by unobserved and undocumented postural problems, but that inappropriate posture may in part cause carpal tunnel syndrome and that it would be necessary to ascertain whether Brewer in fact suffered from such a risk factor in his position at Denver & Rio Grande. ¶ 29 Importantly, by the time of his first deposition, conducted on February 23, 1998, Dr. Harrison possessed detailed information concerning Brewer's work station at Denver & Rio Grande. Dr. Harrison testified at trial that poor posture and wrist extension are unfortunately common when people work at th[e] kind of furniture Brewer used at the railroad, and it is undisputed that Dr. Harrison had examined seven photographs of Brewer's hands, chair, and work station taken in early October 1997 prior to this first deposition. ¶ 30 Moreover, Dr. Harrison's open-mindedness as to his causation assessment, apparent throughout his first deposition, provided further evidence directly undermining Denver & Rio Grande's argument that he had arrived at his conclusion before assessing Brewer's posture. In his first deposition, Dr. Harrison actually identified three risk factors possibly present at Brewer's work site: repetition, posture, and direct mechanical compression. Later in his analysis, however, Dr. Harrison eliminated direct mechanical pressure from the keyboard on Brewer's wrists as a possible inducement of Brewer's carpal tunnel syndrome, because he did not observe its presence at Brewer's work station. Conversely, Dr. Harrison testified at trial that his subsequent examination of additional information related to Brewer's posture only confirmed what he had previously found. For example, by the time of Dr. Harrison's second deposition, conducted less than two weeks after the first deposition, on March 6, 1998, he had received a second set of photographs showing Brewer seated at his work station at the railroad. Dr. Harrison explained that from these photographs he was able to ascertain that Brewer's wrists were extended approximately thirty degrees, which confirmed his earlier determination from the first set of photographs that Brewer suffered from postural problems while he typed for Denver & Rio Grande. Similarly, Dr. Harrison explained that the reports of ergonomists Dell Felix and Paul France, who measured the angle of Brewer's arms, hands, and wrists while seated at his work station, further corroborated his determination that Brewer's posture while typing was a risk factor for development of his carpal tunnel syndrome. ¶ 31 Consequently, we hold that the trial court possessed a sufficient evidentiary foundation to determine that Dr. Harrison assessed possible postural problems affiliated with Brewer's work station before coming to his conclusion concerning causation and, thus, that the court did not abuse its discretion in dismissing Denver & Rio Grande's argument that Dr. Harrison did not properly apply the fifth step of the 1979 NIOSH methodology to the facts of Brewer's case. A reasonable person clearly could have taken the view of the trial court that Dr. Harrison correctly applied both the second and fifth steps of the 1979 NIOSH methodology to the facts of this case, see State v. Brown, 948 P.2d 337, 340 (Utah 1997), and we therefore further hold that the trial court did not abuse its discretion in admitting the causation testimony of Dr. Harrison.