Opinion ID: 2108736
Heading Depth: 1
Heading Rank: 8

Heading: The Evidence of Causation

Text: Defendants assert that plaintiff failed to present sufficient evidence that his damages were caused by defendants' medical malpractice to allow the case to go to the jury. In presenting its evidence of a prima facie case, a plaintiff must show causation but need not use any particular formulation of words. In this case, plaintiff's expert did not say Antonio Craig's cerebral palsy was caused by hypoxia resulting from defendants' breaches of the standard of care. Although desirable, such precision is simply not mandated. [T]he plaintiff's evidence is sufficient if it `establishes a logical sequence of cause and effect, notwithstanding the existence of other plausible theories.... Skinner v. Square D Co., 445 Mich. 153, 159-160, 516 N.W.2d 475 (1994), quoting Mulholland v. DEC Int'l Corp., 432 Mich. 395, 415, 443 N.W.2d 340 (1989). The trial court ruled found that plaintiff presented sufficient evidence. After the jury found for plaintiff, defendants moved for judgment notwithstanding the verdict. The motion was denied, and on appeal defendants challenge that ruling. They question the sufficiency of the evidence only with respect to the element of causation. The standard for reviewing a decision on a motion for judgment notwithstanding the verdict is deferential to the nonmoving party: If reasonable jurors could disagree, neither the trial court nor this Court has the authority to substitute its judgment for that of the jury. [ Matras v. Amoco Oil Co., 424 Mich. 675, 682, 385 N.W.2d 586 (1986).] The trial court found: Dr. Donn testified that Pitocin can cause both trauma and hypoxia. Dr. Gatewood testified that Pitocin can cause compression, and compression can cause head injury. Dr. Dombrowski testified that Pitocin can cause trauma and hypoxia. Dr. Gabriel testified that Antonio suffered a brain injury during labor and delivery, based on the character of the labor and delivery, based on the fetal monitoring, based on the positioning of the head, based on the MRI findings, it was caused by the use of Pitocin. He testified that there was compression of the head in the pelvic ridge. There was elevation of the venous pressure and loss of blood flow and the loss of oxygen and fusing the brain. Testimony was also presented that an excessive dose of Pitocin causes cerebral palsy in animals. The majority notes that animal experiments are the only authority that plaintiff offered showing a correlation between excessive amounts of Pitocin and cerebral palsy. The implication is that animal studies are insufficient evidence upon which to base medical expert testimony. That is incorrect. Dr. Gabriel's authority was sufficient for a jury reasonably to infer that the same effects occur in humans. Dr. Gabriel also testified that the animal studies were the types upon which the American Medical Establishment formulated their warnings on the use of oxytoxic drugs. These warnings appear in medical reference materials discussing the effects of Pitocin. Defendants did not refute these statements. Dr. Gabriel testified that he believed that excessive Pitocin caused plaintiff's condition. He testified that the drug affected plaintiff in two ways. It produced both a vascular effect and a traumatic effect. At trial, Dr. Gabriel used the terms pounding and grinding to explain the traumatic component of the injury. He testified: In part, what happened to Antonio I think is more complicated because I think there is a traumatic component as well as a vascular component. Those studies showed the vascular component, that is to say the reduced blood flow. Antonio also suffered from the trauma of the head being pounded or grinded [sic] into the pelvic rim with successive uterine contractions which were of a high pressure and which resulted in marked decelerations. So I think it's a combination of vascular and trauma. Dr. Gabriel testified that what happened to Antonio Craig would not have happened without the administration of Pitocin. The majority focused attention on Dr. Gabriel's pounding and grinding theory as if it were the only theory that plaintiff presented. It was not. Dr. Gabriel testified that there were two different contributors to plaintiff's injuries. He claimed that plaintiff suffered from both a decreased blood flow and from a traumatic compression injury. [3] In addition to Dr. Gabriel, Dr. Paul Gatewood testified for plaintiff regarding the standard of care. He stated that an excessive dosage of Pitocin was given to plaintiff's mother. In his expert opinion, this was a deviation from the standard of care. Dr. Gatewood also explained that the administration of excessive Pitocin was the proximate cause of Antonio's injuries. [4] After Dr. Gatewood established a breach of duty, Dr. Gabriel testified that excessive Pitocin causes fetal brain damage and cerebral palsy in animals. In Dr. Gabriel's opinion, the excessive Pitocin caused the fetal brain damage that led to Antonio's cerebral palsy. [5] In all, there was sufficient evidence to establish the element of causation. The jury was entitled to decide the case on the evidence presented.