Opinion ID: 4528536
Heading Depth: 2
Heading Rank: 1

Heading: The Contested Expert Testimony at Trial

Text: ¶18 The Barneys' case depends upon the conclusion that Dr. Mickelson's continued use of an external monitor was not among the reasonable alternative methods of treatment to continuously and accurately measure London's heart rate. A review of the record shows that the parties' experts disputed whether the external monitor was continuously and accurately measuring London's heart rate in the last 90 minutes of labor and, consequently, whether Dr. Mickelson's use of the external monitor continued to be a reasonable alternative method. ¶19 The experts disputed the extent to which, in the last 90 minutes of labor, the external monitor missed London's heart rate or traced Mrs. Barney's heart rate instead. Dr. Blackwell, one of Dr. Mickelson's experts, testified that [m]y interpretation is the bulk of the continuous tracing is fetal, meaning the external monitor was predominantly monitoring London's heart rate. While Dr. Blackwell admitted that it is a known phenomenon that a monitor can misinterpret a fetal heart and a maternal heart sometimes, he testified: I don't believe that it happened here. As I continuously watch the tracing, as we saw, we've seen hours and hours of tracing, a baby's heart rate like our heart rate changes quite a bit based on what's going on. I just 9 No. 2017AP1616 don't see those - - I don't over-interpret some of those isolated findings. You have to look at the overall continuous pattern. ¶20 Additionally, in responding to the contention that for substantial periods of time the fetal heart rate was being missed and instead the maternal heart rate was being traced, Dr. Blackwell said the following: [Defense counsel]: Was there any reasonable possibility, in your opinion, that for substantial periods of time the real fetal tracing was being missed and maternal was being traced, and you were missing the status of this fetus during this labor? [Dr. Blackwell]: Other than the period of the epidural, I'd say no.[11] In Dr. Blackwell's view, when all of the external monitor strips were read together, and in context, there was nothing to suggest that London's heart rate was being missed. ¶21 Dr. Worthington, another one of Dr. Mickelson's experts, testified that it was fairly easy to distinguish the fetal heart rate from the maternal heart rate on the external monitor strips.12 Dr. Mickelson herself testified that she could rule out that the entire tracing was the maternal and that she was confident that 11The epidural was given to Mrs. Barney 12 hours prior to London's delivery. 12The Barneys assert that Dr. Worthington's deposition testimony was different than his trial testimony in regard to whether the tracings on the external monitor were fetal or maternal. However, this inconsistency was raised at trial and we defer to a jury's credibility determinations. See Meurer v. ITT Gen. Controls, 90 Wis. 2d 438, 450, 280 N.W.2d 156 (1979) (The credibility of witnesses and the weight given to their testimony are left to the judgment of the jury . . . .). 10 No. 2017AP1616 the majority of the tracing except for a few small spots was the baby . . . . ¶22 The Barneys' expert, Dr. Bryan, was the only expert to testify that there was a concerning discontinuity in the tracings by the external monitor and indications that the monitor was tracing the maternal heart rate rather than the fetal heart rate, which should have prompted action by Dr. Mickelson.13 Dr. Bryan testified that, starting in the morning on February 16th, there was discontinuity in the external monitor readings, which meant that Dr. Mickelson could not accurately assess fetal well-being. However, he admitted that the failure to switch to an alternative earlier in the day did not cause London any harm and that the previous fetal tracings had been decent.14 He ultimately opined 13It was undisputed at trial that there were periods of time where the external monitor showed discontinuity. All of the experts agreed that this was not automatically concerning, as it was common to see this discontinuity or drop out during maternal movement or repositioning. Dr. Bryan testified as follows: [Defense counsel]: So you agree that every time there's a difficult read or a sketchy tracing, the standard of care does not require putting in an internal scalp electrode, true? [Dr. Bryan]: That's correct. 14 Dr. Bryan was asked the following questions: [Defense counsel]: The fact that there was no fetal scalp electrode on through 17:21, 5:21 for us civilians, did not cause any harm, true? [Dr. Bryan]: True. [Defense counsel]: And we even extended it further at your deposition, did we not? [Dr. Bryan]: Yes. 11 No. 2017AP1616 that, at the very least, Dr. Mickelson missed signs of fetal distress by not having an accurate fetal heart rate reading in the 90 minutes prior to London's delivery. ¶23 The experts further disputed whether, in the last 90 minutes of labor, Dr. Mickelson's continued use of the external monitor to measure London's heart rate was a reasonable alternative method to the use of a pulse oximeter or fetal scalp electrode to monitor fetal heart rate. Dr. Bryan was the only expert to testify that since the external monitor was not accurately tracing London's heart rate, Dr. Mickelson had to switch to one of two methods to more accurately monitor the fetal heart rate and fetal well-being: a pulse oximeter or a fetal scalp electrode. ¶24 Dr. Mickelson's experts did not dispute that the pulse oximeter and fetal scalp electrode were reasonable alternatives to monitor fetal heart rate.15 However, they testified that those alternatives were not necessary in this case because continuing [Defense counsel]: You said that the baby was fine, and you've said that today through 18:10 or 6:10 . . . . [Dr. Bryan]: I remember that. That's what I said. [Defense counsel]: Okay. So as of 18:10 or 6:10, the fact that a fetal scalp electrode had not been placed did not cause any harm, true? [Dr. Bryan]: True. 15Dr. Blackwell and Dr. Mickelson both voiced concern that Mrs. Barney's infection could have spread to London if a fetal scalp electrode had been attached. 12 No. 2017AP1616 with an external monitor was a reasonable alternative that fell within the standard of care. Dr. Worthington testified: [Defense counsel]: Let me ask you this, if you have brief switches from fetal to maternal or drop-out due to position change, is it required by the standard of care to switch your monitoring of an infected mother to the invasive scalp electrode from what had been working with the external monitor? [Dr. Worthington]: I think if you feel comfortable with your recording and can interpret the fetal heart rate, there's no reason to switch. ¶25 Dr. Blackwell similarly testified that the most common and the most reasonable thing, if your tracings have been good before then, is to continue to watch the tracing and that it was very reasonable to continue to follow and watch in this case. He further testified on this point: [Plaintiff's counsel]: Am I correct, Doctor, that all they had to do to confirm whether they were really watching London or watching [Mrs. Barney] was take [Mrs. Barney's] pulse during a contraction and see how that compared to the rate -- the rate that's being traced. That is one way, correct? [Dr. Blackwell]: That is one way. There are other ways. That is one way. [Plaintiff's counsel]: And the other way is to put on a pulse oximeter? [Dr. Blackwell]: That is another way, and another way is to watch the continuous fetal heart rate tracing. [Plaintiff's counsel]: No, Doctor. Watching it continuously may not tell you whether you're really watching mom or watching baby, correct? 13 No. 2017AP1616 [Dr. Blackwell]: I believe that it did, and I believe it can, and I believe it's within the standard of care.[16] ¶26 Dr. Worthington also answered a question that precisely tracked the language in the alternative methods instruction: [Defense counsel]: One final question. Was utilizing an external monitor a recognized alternative method to monitor this fetus? [Dr. Worthington]: Yes. [Defense counsel]: And in administrating and applying that method of the external monitor, did Dr. Mickelson use reasonable care, skill, and judgment in administering that method? [Dr. Worthington]: Yes. ¶27 The trial testimony demonstrates that the experts disputed whether the external monitor was continuously and accurately tracing London's heart rate. Further, there was a dispute about whether continuing with the external monitor in the last 90 minutes of Mrs. Barney's labor was a reasonable alternative to a pulse oximeter or a fetal scalp electrode. Since there was substantial testimony that Dr. Mickelson's continued use of the external monitor was a reasonable method to continue to assess London's heart rate and was within the standard of care, the alternative methods instruction was properly given by the circuit court in this case.