Opinion ID: 419222
Heading Depth: 1
Heading Rank: 1

Heading: dr. johnson's testimony

Text: 22 Because the cause of GBS is unknown, both parties placed considerable emphasis on epidemiologic evidence. The principal epidemiologic study is reported in Schonberger, et al., Guillain-Barre Syndrome Following Vaccination in the National Influenza Program, United States, 1976-1977, 110 Am.J. Epidemiology 105 (1979) (CDC study). The CDC study consisted of a nationwide surveillance of GBS cases conducted by the Center for Disease Control in Atlanta, Georgia during and after the national swine flu program. 23 The CDC study presents an analysis of the data received by the CDC on cases of GBS with onset between October 1, 1976 and January 31, 1977. The study analyzed data extending six weeks beyond the end of the swine flu program on December 16, 1976. The number of cases of GBS rose sharply between mid-October and mid-December, peaking the week ending December 18, 1976. Thereafter, the incidence of GBS decreased rapidly and eventually leveled out at a point approximately equal to the normal occurrence for GBS in the unvaccinated population. 24 The data further revealed that the greatest risk of GBS occurred in the second and third weeks after vaccination. The risk remained significantly above the norm up to the tenth week after vaccination. After the tenth week, there was no significantly greater risk of contracting GBS. The authors of the CDC study concluded that there is no relation between swine flu vaccine and the onset of GBS more than ten weeks after vaccination. 25 One of plaintiff's primary arguments in support of causation was that statistical data regarding the number of cases of GBS in Colorado showed an increase above the norm in March of 1977 (the month in which plaintiff was diagnosed as having GBS). To compile these statistics, plaintiff undertook his own survey of Colorado hospitals. Plaintiff sought information regarding the number of GBS cases treated from approximately 1976 to 1978, the onset date of each case, the hospital admission date and whether the patient had been vaccinated. Plaintiff also obtained statistical data on GBS cases from the Colorado Department of Health. The result of these compilations was plaintiff's Exhibit 57, which consisted of the replies from the hospitals and plaintiff's summary of the data. 26 Carl Johnson, M.D., a specialist in epidemiology, testified on behalf of plaintiff's statistically-based analysis. Defendant objected on the ground that Dr. Johnson's testimony would be based in part on plaintiff's Exhibit 57, which had just been provided to the defendant on the morning of the trial. The court decided, in response to this objection, that it would hear the testimony, reserving any ruling on whether the testimony would be admitted. The court indicated that the testimony of Dr. Johnson might be stricken at a later time. 27 Exhibit 57 consists primarily of letters from medical records technicians of hospitals in Colorado regarding the number of cases of GBS that each hospital had treated from 1976 to 1978. This information was then summarized by plaintiff's attorney to determine whether there had been an increase in the number of GBS cases in March of 1977. 28 Dr. Johnson testified that, in his opinion, the underlying data found in Exhibit 57 were of a type which would be reasonably relied upon by an expert in the field. The data contained in Exhibit 57, according to Dr. Johnson, indicated that there had been an increase in GBS cases in Colorado in March of 1977. Dr. Johnson further testified that the information received for preparation of Exhibit 57 was based on the International Classification of Diseases Adapted, which designates a specific code for various types of illnesses. The code which would include GBS is commonly referred to as ICDA Code 354. In deciding what to report in response to plaintiff's request, medical technicians apparently relied on the ICDA Code 354. 2 29 Dr. Johnson admitted on cross-examination that he did not evaluate the length of time between immunization and the onset of GBS. Indeed, an examination of Exhibit 57 reveals that the date of the vaccination is unknown in certain instances. Dr. Johnson further acknowledged that the exhibit contained cases that (a) were not GBS; (b) were counted twice; (c) were from persons inoculated in states other than Colorado; (d) had questionable diagnoses; and (e) were recorded as being during a time when the national moratorium on the immunization was in effect. 30 At the close of Dr. Johnson's testimony, defendant objected to the entire testimony as being based on Exhibit 57, which was inherently unreliable and not of the type reasonably relied on by experts in the field. The court overruled defendant's objection and permitted the testimony to stand. 31 Later in the trial, during presentation of defendant's case, Steven Ringel, M.D., testified that plaintiff's Exhibit 57 contained cases of illnesses other than GBS. Dr. Ringel stated that Exhibit 57 was not the type of information that he, as an expert in neurology, would rely on in formulating an opinion. According to Dr. Ringel, the information contained in plaintiff's Exhibit 57 was provided by a clerk rather than a neurologist. These clerical personnel did not consider the clinical picture, nor were they qualified to do so, in deciding whether all of the cases were in fact GBS. Dr. Ringel noted that the responses from the various clerks indicated that some cases were possible GBS, some were polyneuropathies, and that there was uncertainty with regard to these cases as to whether they were GBS at all. 32 After the trial, defendant renewed its objection to Dr. Johnson's testimony. The trial court granted defendant's motion to strike on the basis that Dr. Johnson's opinion did not reach the threshold standards for admissibility as set forth under Fed.R.Evid. 703. The trial court found that the data (Exhibit 57) upon which Dr. Johnson relied were inadmissible hearsay and were not of the type reasonably relied on by experts in epidemiology and neurology. In re Swine Flu Immunization Products Liability Litigation, 508 F.Supp. at 904. 33 Plaintiff contends on appeal that it was an abuse of discretion for the trial court to strike Dr. Johnson's testimony after previously admitting it. It is plaintiff's position that additional evidence was available to buttress the data contained in Exhibit 57 and would have been presented had the trial court not initially admitted Dr. Johnson's testimony. Plaintiff contends that it is fundamentally unfair for crucial evidence to be deemed admissible during the trial and then stricken when the time for presenting additional evidence has passed. 34 The issue, therefore, is not whether the trial court's ruling was proper from an evidentiary standpoint, for even plaintiff acknowledges that [i]t may have been error to admit Dr. Johnson's testimony in the first place. Initial Brief for Appellant at 30. The question on appeal is whether prejudicial error lies in the striking of the crucial evidence after the court had initially ruled it admissible. 35 We are persuaded, however, that the testimony of Dr. Johnson is not crucial evidence in this case. The trial court concluded its discussion on the evidentiary ruling with the following statement. [A]ssuming [Dr. Johnson's testimony] is admissible, the testimony has limited persuasive effect. It clearly does not tip the scales in favor of causation. 508 F.Supp. at 904. This indicates that the trial court did consider and evaluate the testimony. The trial court's factual findings are presumptively correct and the appellate court will not disturb them unless they are clearly erroneous. Fed.R.Civ.P. 52(a); Gutierrez v. Denver Post, Inc., 691 F.2d 945, 946 (10th Cir.1982). In order to conclude that the trial court's findings are clearly erroneous, we must be left with the definite and firm conviction that a mistake has been committed. Zenith Radio Corp. v. Hazeltine Research, Inc., 395 U.S. 100, 123, 89 S.Ct. 1562, 1576, 23 L.Ed.2d 129 (1969) (quoting United States v. United States Gypsum Co., 333 U.S. 364, 395, 68 S.Ct. 525, 542, 92 L.Ed. 746 (1948)). Moreover, the appellate court is to give due regard to the opportunity of the trial court to judge the credibility of the witnesses. Fed.R.Civ.P. 52(a). There is substantial evidence in the record to support the district court's finding of limited persuasive effect with regard to Dr. Johnson's testimony. In light of the trial court's careful consideration of the testimony, we cannot say that its finding is clearly erroneous.