Opinion ID: 40779
Heading Depth: 2
Heading Rank: 2

Heading: The Evidence of Causation

Text: 64 Gomez was not required to eliminate every possible alternative cause of her injuries to raise an inference that a defective Angio-Seal caused her injuries. Instead, under Louisiana law, Gomez had to eliminate alternative causes with reasonable certainty. Pipitone, 288 F.3d at 243 n. 5 (applying Louisiana law); Wheat v. Pfizer, Inc., 31 F.3d 340, 342-43 (5th Cir.1994) (same). 65 As noted, Dr. Bilazarian, Dr. Eidt, and Dr. Jones testified that the anchor prevents the collagen used in the Angio-Seal from moving to the inside of the artery. They testified that a positive anchor extension on the Angio-Seal used on Gomez could have caused the anchor to be pushed out of position when it passed through the hemostasis valve into Gomez's artery and not sit flush against the inner artery wall. Dr. Jones testified that a positive anchor extension could cause the Angio-Seal anchor to stick into the wall of the artery instead of lining up flush against the artery wall. (Tr. at 522). Once the anchor is stuck against the artery wall, and the surgeon goes to tamp the collagen down, there is room, there is a space there for collagen to get into the artery and, of course, come into contact with the blood. ( Id. ). Jones and other witnesses testified that an angled or improperly-positioned anchor could allow collagen from the Angio-Seal plug to escape into the artery itself. ( Id. ). Such testimony, if found credible, could support an inference that the positive-anchor defect in the Angio-Seal caused Gomez's injuries. 66 Dr. Bilazarian and Dr. Eidt testified about the medical evidence supporting the conclusion that collagen from the Angio-Seal caused the blood clot to form in Gomez's femoral artery after the March 1999 surgery. Dr. Gilmore performed the surgery to relieve a 99% blockage from Gomez's femoral artery one month after her initial surgery. The jury heard Dr. Gilmore's testimony that the mass she removed from Gomez was inside the femoral artery. (Tr. at 753). Dr. Gilmore testified that she agreed with the pathology report, which stated that the injury and the extracted lump were consistent with a collagen plug. (Tr. at 754). The pathology report also showed suture fragments inside Gomez's artery. ( See Testimony of Dr. Jerry Hudson, Tr. at 455-56). 67 Dr. Bilazarian and other medical witnesses rejected alternative causes for the presence of collagen inside Gomez's artery. They testified that artery dissection or physician error were unlikely explanations for the presence of collagen and suture fragments inside the artery. Dr. Bilazarian examined the report from Dr. Gilmore and could not think of any alternative as to how ... that stuff [parts of the Angio-Seal] was in there and shouldn't have been in there. ( Id. ). Dr. Bilazarian and other medical witnesses, including Dr. White, testified that they could eliminate other causes for the formation of the blood clots, such as a tendency to form clots or Gomez's history of smoking. (Tr. at 181-82, 195-96, 577, 726, 848). Dr. White conceded that Gomez's injuries were not caused by preexisting plaque in her right femoral artery, an artery dissection, or vasospasm. (Tr. at 842-45). Dr. Bilazarian also provided testimony from which the jury could have concluded that the injuries did not result from a vasospasm. ( See Tr. at 186). 68 Kendall argued that there was no evidence that the collagen found inside Gomez's femoral artery was bovine collagen, the substance used in the Angio-Seal. The pathologist did not screen for bovine collagen, only human. As a result, there was no evidence that collagen inside Gomez's bloodstream was, or was not, bovine. Kendall contends that this contributed to Gomez's failure to meet her burden of proof that the Angio-Seal was defective or caused her injuries. Because Angio-Seal contains bovine collagen, a definitive result one way or the other would have provided significant evidence. The lack of that evidence required Gomez to demonstrate defect and causation through other evidence. Gomez introduced evidence that there should not have been any collagen inside her bloodstream at all. She introduced evidence eliminating causes for the presence of collagen inside her femoral artery other than the failure of the Angio-Seal's anchor to prevent that from occurring. 69 Kendall presented evidence that an external clot pressing on the artery from the outside caused the femoral artery narrowing. Dr. White testified that a recognized complication of a properly-manufactured and deployed Angio-Seal is that the collagen will cause a large clot to form on the outside of the artery wall, which can compress and narrow the artery. This conflicted with Gomez's evidence that a clot inside the artery caused her femoral artery narrowing because the Angio-Seal's anchor failed to prevent the externally-deposited collagen from coming inside the artery itself. The jury should have resolved this conflicting evidence as to causation. Gomez did not, as Kendall asserts, simply rely on the fact that she suffered injuries after the surgery and blame it on the use of a medical device no longer available for inspection. Cf. Todd v. State, 699 So.2d 35, 43 (La.1997) (Proof which establishes only possibility, speculation, or unsupported probability does not suffice to establish a claim.) (citing Coon v. Placid Oil Co., 493 So.2d 1236 (La.App. 3 Cir. 1986)). As with the defect issue, Kendall put forward substantial conflicting testimony and evidence, but under the Rule 50 standard, the court must draw all reasonable inferences in favor of the nonmoving party, Gomez, and may not weigh the evidence or the credibility of the witnesses. The district court erred in granting the Rule 50 motion on the basis of insufficient evidence as to causation.