Opinion ID: 2516122
Heading Depth: 1
Heading Rank: 6

Heading: The Causation Opinions

Text: We next set out a summation of the causation opinions expressed by plaintiffs' three experts in their reports and depositions. Our ultimate inquiry is, how do the opinions play at the procedural stage of summary judgment? Dr. Gould opined in her report that Jennifer had been in an unrecognized, unstable, preeclamptic state characterized by elevated blood pressure, proteinuria, and hyperreflexia, a condition that had been markedly exacerbated by the administration of Parlodel, setting off a chain of events consisting of vasospasm, exacerbation of hypertension, seizures, and resulting cerebral edema. In Dr. Saade's opinion Parlodel increased peripheral and intracranial pressures in a patient who already had preeclampsia and precipitated the cerebral edema and its consequences. Dr. Davies emphasized that there was sufficient time for the bromocriptine [Parlodel] to have participated in exacerbating [Jennifer's] pregnancy-induced hypertension, concluding that in reasonable medical probability, Parlodel contributed to Ms. Bishop's death. The plaintiffs assert that the conclusions of Drs. Gould, Saade, and Davies were based upon the standard medical methodology of differential diagnosis. Differential diagnosis is defined as [t]he determination of which of two or more diseases with similar symptoms is the one from which the patient is suffering, by a systematic comparison and contrasting of the clinical findings. Stedman's at 474. According to plaintiffs, each of the three experts compared symptoms of different conditions and excluded alternative causes of the cerebral edema during their depositions. Dr. Gould compared symptoms of various conditions and ruled out various bacteria as the likely cause of Bishop's death, including pneumonia, uterine infection, and infectious meningitis. She reported that: (1) stains revealed no bacteria capable of causing disease, (2) minor signs of an infection were more likely attributable to the respirator than to pneumonia, (3) evidence of a uterine infection was inconsistent with the sort of infection that is usually the cause of a patient's death, and (4) the existence of pinpoint hemorrhages in the meninges ruled out the possibility of infectious meningitis. Dr. Saade compared symptoms of different conditions and excluded both eclampsia and infection from his differential diagnosis. He noted that eclampsia will usually look different from the type of seizure suffered by Jennifer, while the presence of an infection was doubtful because her uterus (the likely source of an infection) evidenced no signs of an infection. Finally, Dr. Davies compared symptoms from different diseases and ruled out bacteremia, sepsis, meningitis, an alternative medication, and a preexisting seizure disorder as the causes of Jennifer's death.