Opinion ID: 149189
Heading Depth: 2
Heading Rank: 1

Heading: Characterizing G.P.'s Neurologic Impairments

Text: As a preliminary matter, we must address Hendrix's argument that the district court erred by asking whether the experts had established that traumatic brain injury could ever cause ASD. Hendrix argues that, instead, the district court should have determined whether traumatic brain injury could ever cause one or more of the individual neurologic deficits that led to G.P.'s ASD diagnosis. As the experts in this case testified, ASD is a disorder that is recognized and diagnosed based on its underlying impairments. The district court, however, did not discuss G.P.'s underlying neurologic deficits separately. Instead, the court noted that [a]ccording to Hendrix, [G.P.] suffers from ASD and then went on to analyze the experts' testimony in terms of that ASD diagnosis generally. Hendrix, 255 F.R.D. at 577. Hendrix argues that the district court was required to assess the reliability of the expert testimony regarding causation of each of G.P.'s neurologic impairments. Because ASD is defined by its underlying deficits and behaviors, it might be difficult to isolate the deficits underlying G.P.'s ASD diagnosis and determine whether traumatic brain injury could have caused each deficit individually. After a thorough review of the record, however, we conclude that the district court was not required to undertake that complicated task because Hendrix herself failed to fairly present this issue to the district court. Hendrix's experts both referred to G.P.'s individual deficits, but opined only that there was a causal link between traumatic brain injury and G.P.'s ASD. Neither expert described whether or how traumatic brain injury could cause G.P.'s individual deficits. For example, Dr. Hoffman refers in passing to G.P.'s multiple neurodevelopmental impairments; however, in describing his theory of how the accident contributed to G.P.'s injuries, Dr. Hoffman stated the following: abnormalities in the cerebellum, and in the connections between the cerebellum and the cortex, are strongly linked to autism ... the perinatal and neonatal intensive care follow-up literature does support the association between injury to the developing brain, including traumatic brain injury, and later occurrence of autism spectrum disorder ... the sequence of the injury to the brain, spinal cord, and surrounding tissues at that time then resulted in changes to CSF flow in the cervical spinal cord and around the foramen magnum with ... impaired subsequent development of the cerebellum and cerebellar connections to the cerebral cortex resulting in autism spectrum disorder ... there is no evidence in the medical record of any specific genetic disorder as a cause for [G.P.]'s autism Thus, Dr. Hoffman applied his elaborate causation theory explicitly and unambiguously to G.P.'s ASD diagnosis generally and not to G.P.'s impairments individually. Similarly, Dr. Suhrbier notes G.P.'s underlying impairments but refers exclusively to ASD and autism when discussing causation. Dr. Suhrbier stated during his deposition that he had diagnosed G.P. with autism and that there is a high probability given the severe nature of [G.P.]'s injury and his subsequent development of other neurologic sequela, that the accident had caused G.P.'s ASD. In his affidavit, Dr. Suhrbier said he had diagnosed [G.P.] with [a]utism (which is on the spectrum of [a]utistic [s]pectrum [d]isorder), and that we can reasonably conclude that it is more likely than not that [G.P.] suffered damage to his brainparticularly the posterior regionswhich was, in turn, a substantial factor in causing his autism. Dr. Suhrbier also stated that [t]rauma of various kinds is a known cause for ... autism.... as part of my treatment of [G.P.], I concluded that the most likely cause of G.P.'s autism ... was the trauma that he sustained in that motor vehicle accident in April of 2002. Not only did Hendrix's two medical experts opine only about the cause of GP's ASD diagnosis taken as a whole, Hendrix's arguments to the district court also did not attempt to parse the causation issue with respect to any of GP's individual impairments. Accordingly, we cannot conclude that the district court abused its discretion in focusing on the issue which was fairly presented to iti.e., the reliability of Dr. Hoffman's and Dr. Suhrbier's testimony that traumatic brain injury caused G.P.'s ASD. Moreover, in her initial brief before this Court, Hendrix did not argue that it was appropriate to focus on causation of G.P.'s neurologic impairments separately. Therefore, we conclude that she has abandoned this argument on appeal. We now turn to the issue of whether the district court properly excluded testimony from Hendrix's experts that traumatic brain injury caused G.P.'s ASD.