Opinion ID: 6330205
Heading Depth: 4
Heading Rank: 2

Heading: Michael Carter’s Testimony

Text: At trial, the government called Michael Carter as an expert witness. Carter had been a nurse practitioner for 45 years, and he held multiple advanced degrees in nursing, including a Doctor of Nursing Science. He testified about the standard of care for nurse practitioners; how nurses formulate diagnoses and develop therapeutic plans; Tennessee legal requirements for nurse practitioners prescribing drugs; and registered nurses’ general knowledge of controlled substance prescriptions. Carter also reviewed 90 patient files from the clinics and assessed their adequacy in terms of patient history, family history, medical history, description of the medications prescribed, and notes regarding examinations, practitioners’ findings, treatment goals, and follow-up. Hofstetter moved to strike Carter’s testimony, arguing that he lacked expertise in pain management and therefore could not assess whether the prescriptions were issued for legitimate medical purposes. The district court denied the motion, concluding that Carter’s testimony was properly confined to his area of expertise. The district court later evaluated the same challenge again when it ruled on Hofstetter’s motion for judgment of acquittal. Federal Rule of Evidence 702 governs the admissibility of expert testimony and permits “[a] witness who is qualified as an expert by knowledge, skill, experience, training, or education [to] testify in the form of an opinion or otherwise[.]” Fed. R. Evid. 702. Rule 702 “should be broadly interpreted on the basis of whether the use of expert testimony will assist the trier of fact.” United States v. L.E. Cooke Co., 991 F.2d 336, 341 (6th Cir. 1993). We apply a fourprong test to determine the admissibility of expert testimony: “(1) a qualified expert (2) testifying on a proper subject (3) which is in conformity to a generally accepted explanatory theory (4) the probative value of which outweighs its prejudicial effect.” Id. (quoting Sterling v. Velsicol Chem. Corp., 855 F.2d 1188, 1208 (6th Cir. 1988)). On appeal, Hofstetter challenges only the first two prongs—i.e., that Carter was not qualified and that he testified on an improper subject— but she does not identify an erroneous factual finding or an improper use of legal standards. Regarding the first prong, the district court carefully analyzed Carter’s qualifications and concluded that Carter’s five degrees in nursing and his extensive clinical and professional Nos. 20-6245/6426/6427/6428 United States v. Hofstetter, et al. Page 28 experience qualified him “to testify to the standard of care for nurse practitioners across specialties.” (Order, R. 794, PageID 38776.) The district court recognized that Carter did not qualify as a pain-management expert. Regarding the second prong, Hofstetter argues Carter should not have been allowed to opine on whether the prescriptions were issued for legitimate medical purposes because such testimony required pain-management expertise that he did not have. The district court, however, found that Carter did not testify to the ultimate issue of whether there was a legitimate medical purpose for the various prescriptions in the files he reviewed. Instead, the district court concluded that Carter testified about whether the content of the files offered a basis for a legitimate prescription: While the government did repeatedly ask the witness whether there was a legitimate medical purpose for prescriptions in certain medical files, . . . [t]he context of these questions and responses makes clear that the government was not eliciting opinions from the witness as a pain management expert, which he admittedly is not, but rather asking him to testify to whether he could identify a legitimate medical purpose for the prescription based on the content of the files. Each exchange took place immediately after the government took the witness through a specific file and asked him questions about the file’s adherence to the standard of care. Thus, by testifying that he could not identify such a legitimate purpose for the prescription, the witness was testifying to a failure of the standard of care, i.e., an inadequate history, inadequate physical, inadequate assessment and an inadequate plan. (Id. at PageID 38778–79 (internal modifications omitted).) The record supports the district court’s conclusion that Carter limited his assessments to the content of the files and the extent to which the files demonstrated that the clinics’ nurse practitioners adhered to the standard of care, which fell within his area of expertise. Accordingly, Carter did not testify as a pain-management expert, and the district court did not abuse its discretion by refusing to strike his testimony.