Opinion ID: 172194
Heading Depth: 2
Heading Rank: 1

Heading: Dr. Weingarten's Testimony

Text: Mrs. Neiberger contends that the district court erred in allowing Dr. Weingarten to testify because his expert opinion did not satisfy the requirements of Federal Rule of Evidence 702 and because the pretrial report of his opinion, provided by Defendants during discovery, was inadequate disclosure under Federal Rule of Civil Procedure 26(a). We disagree. On October 10, 2005, Dr. Weingarten examined Mrs. Neiberger. He also reviewed various imaging studies of her spine. In a report provided to Mrs. Neiberger's counsel on October 17, he observed that immediately subsequent to the motor vehicle accident [there was no] radiographic evidence of loosening or displacement of the hardware [installed by Dr. Odom during her initial surgery], and concluded that it was highly unlikely that the motor vehicle accident caused a fracture [of Mrs. Neiberger's spine] without evidence of displacement of the hardware. Id. at 121. He also noted that Mrs. Neiberger had told him that she had stopped smoking six months before her first surgery but had then resumed smoking up to half a pack a day for a period of time after the accident. He stated, Clearly the history of smoking does result [in] an increased incidence of pseudoarthrosis, or nonunion. Id. On November 7 Mrs. Neiberger's counsel deposed Dr. Weingarten for 26 minutes. Dr. Weingarten reiterated his view that the accident had not caused any fracture or nonunion in Mrs. Neiberger's spine. He stated that nonunion is a recognized risk even in nonsmokers but that smoking greatly heightened this risk and that it was a likely cause of the nonunion. Mrs. Neiberger's counsel did not ask questions about the scientific bases for Dr. Weingarten's conclusions. Defendants deposed Mrs. Neiberger's surgeon, Dr. Odom, two weeks later. They questioned him about five peer-reviewed studies showing that smoking inhibited spinal fusion and about the position statement of the American Academy of Orthopedic Surgeons (AAOS) adopting that view. Dr. Odom expressed his substantial agreement with this medical literature and acknowledged that he had repeatedly warned Mrs. Neiberger of the risk of nonunion posed by her smoking. These warnings began early in his care of her. His notes of their March 2002 presurgical conference state that [h]er greatest risk, of course, is nonunion because she's been a smoker. Id. Vol. 1 at 58. He testified that he had explained this risk to Mrs. Neiberger and thought that she understood it. He also said that Mrs. Neiberger had agreed to limit this risk by not smoking for at least a year after her initial surgery and that six months after her second surgery, when Mrs. Neiberger told him that she was smoking half a pack a day, he had told her that was not good... [b]ecause she wouldn't grow bone as well as if she didn't smoke. Id. at 67. On January 24, 2007, one month before trial, Mrs. Neiberger filed a motion in limine to limit Dr. Weingarten's testimony. She argued that Defendants had violated Federal Rule of Civil Procedure 26(a)(2) by failing to disclose the data or methodology underlying his conclusion that her smoking was the cause of her spine's failure to heal. She pointed out that Dr. Weingarten had performed no smoking specific tests or procedures on her, id. at 29, and had examined her physically for only 15 minutes. She also argued that the failure to provide such data or methodology rendered his opinion inadmissible under Federal Rule of Evidence 702 and Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 113 S.Ct. 2786, 125 L.Ed.2d 469 (1993). Defendants' response noted the medical literature and Dr. Odom's deposition testimony supporting the view that smoking increases the risk of nonunions. During trial the district court orally denied the motion in limine. Without specifically stating that Defendants' disclosure was inadequate under Rule 26(a), the court said: What we should generally be concerned with is that the opponent has a reasonable opportunity to understand and effectively cross-examine or confront the expert.... [T]he report was dated October of 2005. The deposition was taken, I think, within a month thereafter.... [T]he plaintiffs were aware of the opinion and did not seek any further explanation and, as such, I can see no factor ... that would weigh in favor of the prohibition of the testimony because of disclosure difficulties. If there was a problem or any question about it, it certainly could have been cured much sooner. But I see no problem. Aplts.App. Vol. 2 at 175. With regard to the reliability of Dr. Weingarten's opinions under Rule 702 and Daubert, the court stated: [T]he questions that I have should focus on the reliability and the matters that are listed in Rule 702. And there doesn't seem to be any question but that it's established medical opinion that smoking does harm the union process or is a factor in non-union occurring. The defendants have articulated that and have provided much data over the time of this litigation and, indeed, there is evidence thatwhat I've seen, that the surgeon who performed the operation would agree. I see no real reason to qualify or find that this opinion is not reliable or not based upon sufficient facts or data or reliable principle methods. Id. at 175-76. When asked if he had any questions about the ruling, Mrs. Neiberger's counsel responded that he did not. (Contrary to Mrs. Neiberger's contention on appeal, the court did not base its ruling on the timeliness of the motion in limine.)
Mrs. Neiberger contends that the district court erred in ruling that Dr. Weingarten's testimony was admissible under Rule 702. We review de novo the question whether the district court applied the proper legal standard in admitting an expert's testimony; we then review for abuse of discretion its actual application of the standard. See Miller v. Pfizer, Inc., 356 F.3d 1326, 1335 (10th Cir.2004). [W]e will not overturn the trial court's ruling on admissibility unless it is arbitrary, capricious, whimsical or manifestly unreasonable or ... we are convinced that the district court made a clear error of judgment or exceeded the bounds of permissible choice in the circumstances. Champagne Metals v. Ken-Mac Metals, Inc., 458 F.3d 1073, 1079 (10th Cir.2006) (internal quotation marks omitted). Rule 702 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, if (1) the testimony is based upon sufficient facts or data, (2) the testimony is the product of reliable principles and methods, and (3) the witness has applied the principles and methods reliably to the facts of the case. The Rule is intended to capture the holdings of the Supreme Court in Daubert and Kumho Tire Co., Ltd. v. Carmichael, 526 U.S. 137, 119 S.Ct. 1167, 143 L.Ed.2d 238 (1999). See Fed.R.Evid. 702 advisory committee's note (2000 amend.). The trial judge must ensure that proffered expert testimony is not only relevant, but reliable. Daubert, 509 U.S. at 589, 113 S.Ct. 2786. Thus, where such testimony's factual basis, data, principles, methods, or their application are called sufficiently into question,... the trial judge must determine whether the testimony has a reliable basis in the knowledge and experience of the relevant discipline. Kumho Tire, 526 U.S. at 149, 119 S.Ct. 1167 (brackets and internal quotation marks omitted). Dr. Weingarten's trial testimony tracked his Rule 26 report. First, he said that the x rays taken two weeks after the accident did not show any loosening or displacement of the hardware in Mrs. Neiberger's spine. Second, he opined that it was therefore highly unlikely that the collision caused a fracture in her spine. He explained that the hardware wasn't loosened. It wasn't bent. The spine simply would not have moved. And, consequently, there's no way that this accident caused the spine to fracture or to break. Aplts. App. Vol. 3 at 315. The collision, he concluded, was not the cause of either of the nonunions discovered by Dr. Odom in Mrs. Neiberger's postaccident surgeries. Third, he expressed the view, based on his education, experience, and reading of scientific literature, that smoking is a major cause of nonunion. Finally, he concluded that Mrs. Neiberger's smoking was likely the cause of the nonunions. In her district-court motion in limine, Mrs. Neiberger, although complaining generally about the lack of support for Dr. Weingarten's opinions, addressed specifically only his connecting [her] smoking and her broken back, Id. Vol. 1 at 36. In particular, she raised no concerns about the first two steps in Dr. Weingarten's chain of reasoningthat the accident had not loosened or displaced the orthopedic hardware and that it was therefore highly unlikely to have caused the nonunion. Nor did she raise a concern about those two steps when the district court ruled on the matter during trial. Because the district court was required to rule only with respect to opinions that are called sufficiently into question, Kumho Tire, 526 U.S. at 149, 119 S.Ct. 1167, we need address only the reliability of Dr. Weingarten's opinion regarding the causal effect of her smoking. The district court undoubtedly recognized the proper legal standard under Rule 702; and we hold that the court did not abuse its discretion in applying that standard to admit Dr. Weingarten's testimony. To begin with, the record before the district court included several peer-reviewed articles in medical journals that concluded that smoking greatly increased the risk of nonunions. In addition, a position statement of the AAOS had echoed this view and, perhaps dispositively, Mrs. Neiberger's own expert witness, Dr. Odom, had substantially agreed with the literature, even warning her not to smoke after her surgery. The district court could quite reasonably conclude that there doesn't seem to be any question but that it's established medical opinion that smoking does harm the union process. Aplts. App. Vol. 2 at 175. The next step in Dr. Weingarten's reasoning was to connect this general proposition to Mrs. Neiberger's condition. There was no dispute that she was a smoker. But Mrs. Neiberger complained that Dr. Weingarten had examined her for only 15 minutes and had performed no smoking specific tests or procedures on her. Id. Vol. 1 at 29. Dr. Weingarten explained, however, why such a study would be inappropriate, if not impossible: I would have to ask her to smoke and not smoke and measure different parameters. That's not the way these studies are ever done. And what the studies involve, typically, is taking a group of patients who are smokers and who are nonsmokers and seeing what the success rate from a given procedure is.... It takes a lot of people because you need to compare age ranges, comparable operative procedures, and then the ability to follow people for a long time; and that's already been done. Id. Vol. 3 at 318-19. Dr. Weingarten further explained that one cannot say that smoking causes a nonunion because you don't know which patient it's going to cause it in and which one it won't. You... can only say that it increases the risk of a nonunion. So smoking can cause lung cancer in a way, but you don't know in a given patient whether that guy would have developed it anyway. You know that the odds of developing it are much higher if he smokes. And so with spine fusions, the literature, when you just put it in a nutshell, shows the fusion ratethe incidence of pseudarthrosis is two to three times as great in someone who is smoking as in someone who is not. Id. at 319. Dr. Weingarten's methodology was one generally accepted in the medical community and by the courts. He simply considered the possible recognized causes and eliminated those contradicted by the evidence before him. To use somewhat technical language, he began with scientific support for general causationthat smoking can cause nonunionsand concluded that smoking was likely the specific cause in this instance after he had eliminated the possibility that the accident had been the cause. See Goebel v. Denver & Rio Grande W.R.R. Co., 346 F.3d 987, 990 (10th Cir.2003) (distinguishing general and specific causation); Bitler v. A.O. Smith Corp., 400 F.3d 1227, 1237 (10th Cir.2004) (using the term differential diagnosis to describe the reasoning employed). The district court could therefore properly rule that there was a reliable basis for Dr. Weingarten's opinion regarding the effect of Mrs. Neiberger's smoking. In sum, Mrs. Neiberger has failed to point to any shortcoming in the support for Dr. Weingarten's testimony. (As an aside, we note that for Defendants to prevail, it was theoretically necessary only to eliminate the accident as a cause, although the jury might not have accepted that conclusion unless presented with an alternative cause.)
Mrs. Neiberger's motion in limine to limit Dr. Weingarten's testimony was construed by the district court as being based not only on Rule 702 but also on Federal Rule of Civil Procedure 37(c), which authorizes sanctions for failure to comply with the disclosure requirements of Federal Rule of Civil Procedure 26(a)(2). Without explicitly ruling whether Dr. Weingarten's report complied with Rule 26(a)(2), the district court decided to impose no sanctions. Mrs. Neiberger challenges that decision. We reject the challenge. Rule 26(a)(2)(B) states that the disclosure of an expert witness must be accompanied by a written reportprepared and signed by the witness. [2] Among other things, the report must contain a complete statement of all opinions the witness will express and the basis and reasons for them and the data or other information considered by the witness in forming them. Fed.R.Civ.P. 26(a)(2)(B)(i), (ii). This provision imposes a duty to disclose information regarding expert testimony sufficiently in advance of trial that opposing parties have a reasonable opportunity to prepare for effective cross examination and perhaps arrange for expert testimony from other witnesses. Fed.R.Civ.P. 26 advisory committee's note ¶ 2 (1993 amend.). Violation of this duty subjects a party to sanctions under Rule 37(c)(1), which states: If a party fails to provide information or identify a witness as required by Rule 26(a) ..., the party is not allowed to use that information or witness to supply evidence ... at a trial, unless the failure was substantially justified or is harmless. In addition to or instead of this sanction, the court, on motion and after giving an opportunity to be heard: (A) may order payment of the reasonable expenses, including attorney's fees, caused by the failure; (B) may inform the jury of the party's failure; and (C) may impose other appropriate sanctions.... Because [t]he determination of whether a Rule 26(a) violation is justified or harmless is entrusted to the broad discretion of the district court, Woodworker's Supply, Inc. v. Principal Mut. Life Ins. Co., 170 F.3d 985, 993 (10th Cir.1999) (internal quotation marks omitted), we review for abuse of discretion the district court's decision not to impose a Rule 37(c)(1) sanction, see Doctor John's v. Wahlen, 542 F.3d 787, 790 (10th Cir.2008). There was no abuse of discretion here. Mrs. Neiberger has failed to show how she was prejudiced by any deficiency in the Rule 26 report prepared by Dr. Weingarten. As described above, the opinions expressed in Dr. Weingarten's report were the same as those to which he testified in his deposition introduced at trial. The report opined that smoking raises the risk of nonunion, that there was no radiographic evidence that the collision had loosened or displaced any hardware, that it was thus unlikely that the collision caused a fracture, and that Mrs. Neiberger's smoking was likely the cause of the nonunion. Mrs. Neiberger's complaint is that the report did not disclose the bases and data for these conclusions. But the only conclusion that she specifically points to as being unsupported is Dr. Weingarten's linking of smoking to nonunion. In our discussion of her Rule 702 challenge we have already resolved that she has failed to identify any lack of support for his trial testimony on that issue. This leaves only the possibility that the trial testimony included support that was missing from his report. As far as we can tell, however, the only predicate for Dr. Weingarten's trial testimony that is absent from the report is the peer-reviewed literature saying that smoking can cause nonunions (and the resulting position statement of the AAOS). That absence did not prejudice Mrs. Neiberger. Her own expert, Dr. Odom, acknowledged the proposition that smoking increases the risk of nonunions. Indeed, even before this suit was filed, he had repeatedly warned Mrs. Neiberger of the risk. Moreover, medical literature on the subject was presented at Dr. Odom's deposition long before trial. There is a theoretical possibility that the lack of disclosure in Dr. Weingarten's report could have prejudiced Mrs. Neiberger in taking his discovery deposition or in formulating her strategy on calling experts. But Mrs. Neiberger does not argue that point and, given the noncontroversial nature of the link between smoking and nonunion, we see no chance of such prejudice having arisen. [3] As we understand the district court, it ruled that if there was any shortcoming in Dr. Weingarten's report, it did not prejudice Mrs. Neiberger's ability to prepare for trial. We affirm that ruling.