Opinion ID: 146762
Heading Depth: 2
Heading Rank: 4

Heading: The Decision to Limit Dr. Crawford's Testimony

Text: After hearing the evidence outlined above, the district court issued an order precluding Dr. Crawford from providing her opinion as to obstetrical standards of care, departures from these standards, or causation in this case. The court agreed with Ramírez-González's argument that because Dr. Crawford's experience and training is not in obstetrics and gynecology, she cannot provide expert testimony regarding the alleged departures in the standards of care committed by Defendant [], an obstetrician-gynecologist. Citing Dr. Crawford's lack of board certification in obstetrics and gynecology and her statement that it is typically an obstetrician/gynecologist who makes the final decisions regarding a woman in labor, the court ruled that Dr. Crawford would not be permitted to testify as to the events that occurred before and during the cesarean section, and that she could not provide any testimony pertaining to the cause of [G.P.P.]'s injuries. Dr. Crawford proceeded to testify only about G.P.P's medical conditions and the testing that he underwent immediately following his birth. We review a trial court's decision to admit or exclude expert testimony for abuse of discretion. Gaydar, 345 F.3d at 24. A district court enjoys substantial discretion to decide whether to admit or exclude relevant expert testimony. Mitchell, 141 F.3d at 14. As we described above, the judge's task is to ensure that the expert's testimony `both rests on a reliable foundation and is relevant to the task at hand.' Mooney, 315 F.3d at 62 (quoting Daubert, 509 U.S. at 597, 113 S.Ct. 2786). In carrying out this responsibility, the trial court must bear in mind that an expert with appropriate credentials and an appropriate foundation for the opinion at issue must be permitted to present testimony as long as the testimony has a tendency to make the existence of any fact that is of consequence to the determination of the action more probable or less probable than it would be without the evidence. Fed.R.Evid. 401. An unduly restrictive review of the relevant expertise of a physician is incompatible with what we have characterized as a liberal standard of relevance. Mitchell, 141 F.3d at 14 (quoting Daubert, 509 U.S. at 587, 113 S.Ct. 2786) (noting that Rule 401's `basic standard of relevance [] is a liberal one'). In light of these standards, we conclude that the district court abused its discretion when it refused to permit Dr. Crawford to testify on the relevant standard of care and causation. The court mistakenly relied on Dr. Crawford's lack of board certification in obstetrics and gynecology to preclude her from testifying. In its Opinion and Order granting Ramírez-González's motion for judgment as a matter of law, the court explained: Dr. Crawford testified that she was not board-certified in OB/GYN, and that she had no privileges to administer [P]itocin to a patient or to perform a cesarean section. She further testified that although she serves as a consultant at high-risk[] births, it is the OB/GYN who actually delivers the baby and makes the final decisions regarding the delivery. Accordingly, the Court rule[s] that Dr. Crawford's testimony be limited to exclude any testimony regarding OB/GYN standards of care, departures from OB/ GYN standards of care, and causation. The court thus found that because Dr. Crawford herself is not certified to administer Pitocin or perform c-sections, she would not be qualified to opine on the alleged departures from the standards of care committed by Ramírez-González, an obstetrician-gynecologist. That logic is flawed. The dispositive question is not whether an expert is board certified in a particular medical specialty. Rather, the Rules of Evidence require that the judge admit expert testimony relevant to the disposition of the case when it will assist the trier of fact in understanding a fact in issue and rests on a reliable foundation. See Fed.R.Evid. 702; Mooney, 315 F.3d at 62; Gaydar, 345 F.3d at 24. Dr. Crawford's credentials easily meet and, indeed, surpass the standard for admissibility of expert testimony. She is board-certified in, and practices, perinatal and neonatal medicine. As enumerated above, she has published book chapters that deal with the administration of Pitocin. She has served as a consultant at high-risk deliveries and has recommended that c-sections be performed. She conducts peer review evaluations that involve taking into account the obstetrical and delivery care that a patient is given, and she has worked on guidelines for responding to perinatal emergencies. She has scientific, technical, [and] other specialized knowledge that will assist the trier better to understand a fact in issue. Gaydar, 345 F.3d at 24 (citation omitted). Her knowledge rests on a reliable foundation, Mooney, 315 F.3d at 62, i.e., her medical education and many years of experience in the field. Her testimony is relevant to the task at hand. Id. Indeed, without Dr. Crawford's testimony on causation and the standard of care, the plaintiffs were unable to present evidence on two elements of their case. Trying to defend the district court's ruling on a different ground, Ramírez-González argues that, whether or not she was properly credentialed to serve as an expert, Dr. Crawford's testimony was correctly excluded because the plaintiffs did not disclose her prior to the trial as an expert in the appropriate standard of care and causation. In making this argument, Ramírez-González attempts to analogize the district court's limitation on Dr. Crawford's testimony in this case to the district court's preclusion of expert testimony that we recently upheld in Martínez-Serrano v. Quality Health Services of Puerto Rico, Inc., 568 F.3d 278 (1st Cir.2009). In that case, the plaintiffs attempted to reformulate their theory of liability (and, thus, dramatically shift the focus of their expert's opinion testimony). Id. at 283. We found that the substantive change in the opinion being offered by an expert for the plaintiffs amounted to a failure to meet the district court's deadline for identification of experts and the disclosure of their opinions. Id. We refused to find an abuse of discretion when the trial court precluded that expert from offering testimony because of the untimeliness of the disclosure of his opinions. Id. at 284. We noted that the plaintiffs had flouted a clearly expressed discovery deadline without any apparent justification and under circumstances redolent of strategic behavior. Id. Ramírez-González's effort to cast the events in this case into the mold of Martínez-Serrano is unavailing. Although there may be some merit to Ramírez-González's contention that Dr. Nathanson was to be the plaintiffs' principal witness on causation and the standard of care, the record shows that Dr. Crawford was set to testify on those issues as well. The pretrial order stated that Dr. Crawford would testify as an expert in neonatology regarding her review of the pertinent records, the standards of care within her field of expertise applicable to this case, the defendants' departures from such standards, about [G.P.P.]'s condition as it relates to her field of expertise, and the estimated cost of his life care. [4] Moreover, her report, which was provided to Ramírez-González well in advance of the trial, [5] dealt extensively with G.P.P.'s treatment and concluded with a section entitled, Causation: Opinions. There is no support in the record for Ramírez-González's claim that he would have been surprised and unfairly prejudiced if Dr. Crawford had been allowed to testify on the standard of care and causation. [6] Moreover, it is noteworthy that the district court does not mention a failure to disclose the substance of Dr. Crawford's testimony in its opinion and order limiting Dr. Crawford's testimony. It is clear that the district court instead based its decision to limit Dr. Crawford's testimony on its erroneous assessment of her credentials after hearing her testify in the Daubert hearing. Judgment vacated. Remanded for further proceedings consistent with this opinion. Costs are awarded to the appellants. So ordered.