Opinion ID: 2321184
Heading Depth: 3
Heading Rank: 1

Heading: The Expert Opinion

Text: Dr. Fellows inferred (his term) that the surgery had caused Ms. Sherwood's neurological dysfunction, and he explained that certain missteps could have led to that resultif they in fact occurred. However, he agreed that, when performing a sympathectomy, you don't even normally go in the area where the femoral or sciatic or obturator nerves are involved[.] He also acknowledged that there's no indication from the operative report that Dr. Giordano went into or came close to any of those areas.... Dr. Fellows also agreed that, if Dr. Giordano did the operation exactly the way it was described in his operative report and did not go into the area by way of retraction or anything else, didn't come close to it ..., the results of the EMG and the complaints by Ms. Sherwood would then have to be based logically on some other explanation. One would then have to look to other specialties, such as neurology, for an explanation. Dr. Fellows acknowledged that he would have to defer to the opinions of a neurologist; he did not hold himself out as an expert in the field of neurology. He agreed, moreover, that RSD is a disease process, it's an insidious process that is not and never has been well understood by the medical profession[.] Nevertheless, in his view, [t]he disease state, RSD, did not cause the dysfunction identified on the EMG nerve conduction study. Dr. Fellows' opinion was based upon his conclusion that, after surgery, Ms. Sherwood had the new onset of a problem involving the nerves to her upper part of her leg that had not been defined prior to surgery. And I inferred that some standard had been breached to cause that neurological dysfunction. But the expert may not base such an opinion merely on `a proximate temporal association' between a medical procedure and an injury. Derzavis, 766 A.2d at 522 (quoting Lasley v. Georgetown University, 688 A.2d 1381, 1387 (D.C.1997)). In a medically complicated case such as this, contemporaneity between a medical procedure and an injury is too weak a foundation upon which to infer causation. Lasley, 688 A.2d at 1387. Moreover, it is far from clear that a new problem affecting Ms. Sherwood's upper leg arose after, let alone as a result of, the surgery. As mentioned above, a post-surgery EMG provided objective evidence that something had injured nerves affecting her upper leg. Dr. Fellows acknowledged, however, that the pre-surgery EMG/nerve conduction study was directed primarily to the lower leg. It was not directed to the upper leg. See note 6, supra. Now, that's a problem[,] he admitted, because everybody now is comparing a little bit apples to oranges.... He resolved that problem in his own mind by making certain assumptions about our personalities: We, in the medical field, have different personalities for each different specialty that we enter. The neurologists are the most careful people, do detailed exams and order more exams than most other specialists. By inference if that neurologist who saw her did not order on that extremity examination in the upper leg, I have to feel 99 percent confident that either something that was there was so trivial that the specialist couldn't even identify it or it wasn't there at all. This sort of pop-psychology does not come close to supporting Dr. Fellows' inference (or assumptionsee note 8, supra ) that the nerves were free of injury before the surgery. Indeed, there was a great deal of conflicting evidence on that question.