Opinion ID: 1936466
Heading Depth: 1
Heading Rank: 14

Heading: Alleged Concessions Made by Einspahr

Text: In arguing that Einspahr's opinion was not admissible, the appellants also rely on what they claim are concessions made by Einspahr during cross-examination. During the trial, the following exchanges occurred between Einspahr and counsel for the appellants: [Counsel]. You told me in your deposition that it is impossible to say what the cause of [Dean's] bladder condition is; correct? [Einspahr]. Yes. .... Q. You are aware of no overt injuries that [Dean] may have suffered in the motor vehicle accident; correct?
Q. That would A. That's correct. Q. You can't describe how thethe injury could've occurred. A. No. Q. Or what part of his body was injured. A. No. Q. And you agree with the Mayo Clinic that it would be conjecture to explain how [Dean] developed a problem with his bladder after the motor vehicle accident. A. I agree. Q. And conjecture to you means what? A. It's anyone's guess. The appellants claim that in these exchanges, Einspahr effectively conceded that his opinion that the collision caused Dean's injuries was sheer speculation. The interpretation of Einspahr's cross-examination testimony proffered by the appellants is not unreasonable, and if it were the only interpretation, we would agree that the district court erred in admitting Einspahr's opinion. Cf. Pipitone v. Biomatrix, Inc., 288 F.3d 239, 245 (5th Cir.2002) (stating that perfectly equivocal opinion does not make any fact more or less probable and is irrelevant under the Federal Rules of Evidence). But after reviewing the record, we conclude that another reasonable interpretation for Einspahr's testimony exists. Given our abuse of discretion standard, we are bound to accept this second interpretation. It is plausible that Einspahr and the appellants' counsel were talking about different levels in the chain of medical causation. A physician, independent of legal issues, typically uses the term causation ... to refer to the various levels of underlying abnormality that have substantially led to the next higher level of abnormality, disease, or diagnosis. This chain, or web, of causation is considered the pathogenesis or pathophysiology of a disease. Mary Sue Henifin et al., Reference Guide on Medical Testimony, in Reference Manual on Scientific Evidence 439, 451 (Federal Judicial Center 2d ed.2000). As we understand Einspahr's testimony, he claims that the collision is the ultimate causative agent. The collision caused a trauma injury to Dean's nervous system, which in turn caused Dean's bladder condition. As we read Einspahr's cross-examination answers, he was not conceding that he was uncertain whether the ultimate causative agent was the trauma Dean suffered in the collision. Rather, he meant that he could not fully trace the other steps in the web of causation, i.e., the pathogenesis of Dean's bladder condition. Specifically, he could not pinpoint where Dean's nervous system had been injured in the collision or describe the exact manner in which that injury was causing Dean's bladder to malfunction. Thus, this second interpretation of Einspahr's cross-examination testimony is not inconsistent with his ultimate conclusion that the collision caused Dean's bladder condition. The inability to trace the exact pathogenesis of Dean's bladder condition does not make Einspahr's opinion per se unreliable so long as other reliable factors supported his opinion that the collision was the ultimate causative agent. Cf. Daubert v. Merrell Dow Pharmaceuticals, Inc., 43 F.3d 1311, 1314 (9th Cir.1995) ([n]ot knowing the mechanism whereby a particular agent causes a particular effect is not always fatal to a plaintiff's claim. Causation can be proved even when we do not know precisely how the damage occurred, if there is sufficiently compelling proof that the agent must have caused the damage somehow ). Here, even though he could not trace the exact pathogenesis of Dean's bladder condition, a number of other factors make Einspahr's testimony reliable: (1) trauma is a recognized cause of neurogenic bladder, (2) the close temporal connection between the collision and the onset of symptoms, and (3) the medical testing and physical examinations which ruled out several other plausible causes for Dean's bladder condition.