Opinion ID: 746887
Heading Depth: 1
Heading Rank: 7

Heading: Analysis of Trial Court's Ruling

Text: 95 A. The trial court's ruling was based on numerous clearly and manifestly erroneous findings of facts. 96 The trial court clearly erred in several preliminary factual findings concerning the admissibility of Dr. Jenkins' testimony under Rule 104(a), viz., (1) that Dr. Jenkins did not consider the results of the allergy test performed by Dr. Alvarez; (Dr. Jenkins testified that he reviewed the allergy test results in determining his final diagnosis and etiology. Moreover, the test results tended to rule out allergies, thus confirming Dr. Jenkins' opinion that Moore's disease stemmed from his exposure to the chemical mixture.) (2) that Dr. Alvarez expressed a number of statements and opinions in his deposition that were distinguishable from those of Dr. Jenkins; (Except for Dr. Jenkins' more impressive qualifications and experience, there was no material difference between the bases of medical knowledge underlying the doctors' opinions because Dr. Alvarez relied almost totally on the work, analysis and opinions of Dr. Jenkins. The trial court clearly erred in its single attempt to point to a specific difference, i.e., in its erroneous statement that Dr. Jenkins had not reviewed or considered the results of Dr. Alvarez's allergy test.) (3) that Moore was exposed to toluene only, rather than to a mixture of chemicals; (The MSDS introduced into evidence at the beginning of the trial clearly listed the mixture of chemicals to which Moore had been exposed. Dr. Jenkins' and Dr. Alvarez testified that, according to the histories taken from Moore and the MSDS, Moore was exposed to a mixture of chemicals, not merely to toluene. Moreover, attorneys for both sides expressly and tacitly agreed to this established fact during the pre-trial in limine hearing.) (4) that at the second proffer hearing Dr. Jenkins said he relied entirely on the MSDS; (Dr. Jenkins, in both his live and deposition testimony, stated that he based his opinion on his examinations, history taking, testing and reviewing other doctors' work on Moore's illness, and only partly on the MSDS. Dr. Jenkins's testimony before the court was clearly supplementary to the proffer of his testimony by way of deposition and affidavit and not in lieu thereof.) 97 Additionally, the trial court clearly misunderstood the lack of relevance of the fact that Dr. Jenkins' candidly acknowledged that he did not know how the manufacturer assessed the dangers of its product for purposes of affixing the MSDS warnings. Dr. Jenkins did not propose to testify to any knowledge or opinion based on the MSDS warnings, much less to base his opinion as to cause of disease on the warnings. Dr. Jenkins, in arriving at his opinion, used the MSDS only as a source of information as to the types of chemicals that Moore had inhaled. The MSDS was introduced into evidence without objection at the commencement of trial. Moreover, Dr. Alvarez referred to the MSDS for this purpose during his deposition, affidavit and live testimony proffer without any protest by the court or the defendants-appellees. During the trial Dr. Alvarez and Dr. Robert Jones, the defendants-appellees' expert witness on causation, referred to the MSDS for this purpose without objection from the court or the parties. There was no evidence that Dr. Alvarez or Dr. Jones had any knowledge of the research techniques that the manufacturer used in formulating the MSDS warnings. The absence of such knowledge was totally irrelevant to the proposed or actual testimony of any of the expert medical witnesses, including that of Dr. Jenkins. 98 Hence, the trial court manifestly erred, clearly erred and abused its discretion by relying on these plainly erroneous facts and understandings. 99 B. Erroneous determinations of mixed questions of law and fact, legal inferences from the facts, and applications of law to the facts; and abuse of discretion in such determinations, inferences and applications. 1. Under Rule 702 100 The trial court erred in applying Rule 702 to exclude Dr. Jenkins' testimony that Moore's inhalation of the mixture of chemical gases caused his reactive airways disease. Rule 702, as illumined by Daubert, requires that an expert's opinion or inference be soundly grounded in the principles and methodology of his or her discipline. The opinion of Dr. Jenkins was well grounded in the principles and methodology of his field of clinical medicine. Because Dr. Jenkins did not use any novel technique, method or principle, but employed only the traditional medical knowledge within his field, we conclude that the opinion of Dr. Jenkins was soundly grounded in the principles, experience and methodology of his discipline. 101 As we noted above, most of the trial court's reasons for excluding Dr. Jenkins' testimony as to cause of disease under Rule 702 were invalid because they were based on the court's clearly erroneous factual findings and its misunderstanding of the relevance of facts clearly established by the record. The single remaining reason assigned by the trial court for its ruling, i.e., that Dr. Jenkins had no scientifically precise information concerning the level of exposure, amount of exposure, and duration of exposure, reflects the trial court's error and abuse of discretion in applying Rule 702 to the proffer of Dr. Jenkins' opinion based on clinical medical knowledge. By this statement, of course, the trial court did not mean that Dr. Jenkins had no information whatsoever concerning the levels of exposure that could be harmful to a person susceptible to reactive airways disease or the amount and the duration of Moore's exposure to the mixture of chemicals. From Moore's history that Dr. Jenkins had taken, he had information that before the exposure Moore was in good health, that two 400 pound drums of the chemicals had begun leaking in the back of Moore's truck at some time before his arrival at Ashland, that Moore's rig consisted of a diesel tractor and a 28 foot enclosed trailer, that after the discovery of the leakage upon arrival at Ashland the drums were allowed to continue to leak inside the trailer with the doors shut for another 45 minutes until the Ashland supervisor told Moore to remove them, that at this point the 400 pound drums had become light enough to allow Moore and others to roll them manually out onto the dock, that Moore and a co-employee worked in and around the trailer for about 45 to 60 minutes sprinkling Absorbo over the contaminated areas, sweeping the saturated material into shovels, removing the materials from the trailer, and shoving the leaking drums into salvage drums, that Moore finished the cleanup at Ashland about 11:00 a.m., that Moore began to experience shortness of breath, wheezing, and tightness of chest at about 11:45 a.m., that as his symptoms were continuing to worsen Moore consulted the company doctor who put him on oxygen and inhalants. 5 Obviously, the trial court meant that because no one had taken any air samples or timed Moore's encounter with the mixture of chemicals with a stop watch, Dr. Jenkins did not have scientifically precise exposure information in terms of parts per million and exact minutes and seconds; and that because there had been no known experiments on humans or animals with the particular mixture of chemicals involved, Dr. Jenkins could not have had precise scientific information as to the safe or unsafe exposure levels for average or hypersensitive persons with respect to the risk of reactive airways disease. Plaintiffs' exhibit 7, pp. 1-4. 102 The goals, principles and methodology of clinical medicine do not require or permit a clinical physician to determine by hard scientific testing the precise amount of a deleterious substance that an accident victim inhaled or the exact duration during which he breathed it in before the doctor must make the interrelated decisions as to diagnosis, cause and prognosis of a pulmonary or airways disease. Likewise, a clinical physician cannot ethically or practicably delay decisions as to diagnosis-etiology until she conducts experiments with humans or animals to determine the safe level of exposure for average or highly susceptible persons with respect to substances that previously have not been tested or addressed by medical literature. Consequently, as Dr. Jenkins, Dr. Alvarez, and even Dr. Jones, the defendant-appellees' expert, testified, scientifically exact information as to the level of exposure, amount of exposure, and duration of exposure is virtually never available to a clinical physician after an inhalation accident or episode. When assessing the basis of Dr. Alvarez's opinion, the trial court correctly ruled that the lack of precise exposure data will go to the weight of his testimony rather than to its admissibility. Yet the trial court inexplicably reversed field and made crucial the importance of precise exposure data in incorrectly and arbitrarily excluding Dr. Jenkins' opinion on cause of disease. Because of the trial court's allusions to lack of scientific support and to scientific speculation when discussing the proffer of Dr. Jenkins' opinion, we infer that the trial court may have misapplied the Daubert factors, hard scientific methods appropriate for testing proffers of hard scientific evidence, to the proffer of Dr. Jenkins' opinion based on clinical medical knowledge. The trial court's error in this regard, of course, was compounded by its erratic failure to apply the same reasoning to the proffer of Dr. Jenkins' opinion as it had to Dr. Alvarez's testimony. Accordingly, we conclude that the trial court manifestly erred and abused its discretion in deciding that the lack of precise, hard scientific exposure data prevented Dr. Jenkins' opinion from being soundly grounded in the principles and methodology of his discipline and therefore based on a reliable foundation. 103 Watkins v. Telsmith, Inc., 121 F.3d 984, 991 (5th Cir.1997) explicitly makes clear that Rule 702, as elucidated by Daubert, authorizes a qualified expert in a realm outside of hard science to testify to an opinion or inference based on his knowledge, skill, experience, training, or education if it is soundly grounded in the principles and methodology of his discipline and is relevant to a fact in issue or to an understanding of the evidence. Even prior to Watkins, however, this circuit and others had at least implicitly understood this to be part of Daubert lore. See United States v. 14.38 Acres of Land, 80 F.3d 1074 (5th Cir.1996)(engineer's opinion of potential for floods; real estate appraiser's opinion of value of land affected); Hopkins v. Dow Corning Corp., 33 F.3d 1116, 1124-25 (9th Cir.1994)(doctors' opinions of silicone breast implants' cause of autoimmune disease); Berry v. City of Detroit, 25 F.3d 1342, 1350 (6th Cir.1994)(former sheriff's opinion of inadequate police discipline's cause of unjustifiable use of deadly force) (Although ... Daubert dealt with scientific experts, its language relative to the 'gatekeeper' function of federal judges is applicable to all expert testimony offered under Rule 702. Id.); Marcel v. Placid Oil Co., 11 F.3d 563, 567 (5th Cir.1994)(economist's opinion of work-life expectancy); Cf. United States v. Murphy, 996 F.2d 94, 98-99 (5th Cir.1993), cert. denied, 510 U.S. 971, 114 S.Ct. 457, 126 L.Ed.2d 389 (1993)(expert's opinion that tools could have made marks on stolen cars' ignitions admitted). 104 Furthermore, as one commentator has recognized, simply because a non-scientific expert's testimony touches on evidence that theoretically could be tested by Newtonian science methodology, Daubert should not be interpreted so as to permit an advocate to put his or her opponent to the burden of establishing hard scientific reliability-validity upon demand. See 2 GRAHAM, HANDBOOK OF FEDERAL EVIDENCE § 702.5, at 79 (4th ed. 1996) (For example, it would be ludicrous to require the proponent of a doctor's testimony to introduce evidence that every test the doctor conducted or reasonably relied upon under Rule 703 is scientifically reliable-valid. While 'widespread acceptance' is stated to be merely a factor in a judicial determination of reliability-validity, testimony by the expert that the 'scientific' evidence has received 'general acceptance' ... should be sufficient alone to support admissibility of 'scientific' evidence unless the opponent presents evidence creating a genuine issue as to the reliability-validity of the 'scientific' evidence ....)(footnotes omitted). See also G. Michael Fenner, The Daubert Handbook: The Case, Its Essential Dilemma, And Its Progeny, 29 CREIGHTON L. REV. 939, 968 (1996)(Fenner). Cf. Edward J. Imwinkelried, The Next Step After Daubert: Developing A Similarly Epistemological Approach To Ensuring The Reliability Of Nonscientific Expert Testimony, 15 CARDOZO L. REV. 2271, 2283-94 (1994). 105 In the field of clinical medicine, courts generally agree that, under Daubert, the methodology and data that diagnosing and treating physicians reasonably consider good grounds for opinions or inferences in medical practice are sufficiently reliable to form the basis of a qualified medical expert's testimony in court. See 3 WEINSTEIN & BERGER, WEINSTEIN'S EVIDENCE p 703, p. 703-24 et seq. (Rel.47-7/93 Pub.803); 2 GRAHAM, HANDBOOK OF FEDERAL EVIDENCE § 702.5 at 79 (4th ed.1996); Fenner at 1009. 106 For example, this court in Carroll v. Morgan, 17 F.3d 787, 790-791 (5th Cir.1994), concluded that a cardiologist's testimony was ground[ed] in the methods and procedures of science and was not mere unsupported speculation, citing Daubert, 509 U.S. at 590, 113 S.Ct. at 2795 despite his refusal to accept, as authoritative, either a single source or a collection of textbooks and journals in toto, because his testimony was based on thirty years of experience as a practicing, board-certified cardiologist, on his review, among other things, of [the deceased plaintiffs'] medical records and the coroner's records, and on a broad spectrum of published materials.The Fourth Circuit in Benedi v. McNeil-P.P.C., Inc., 66 F.3d 1378, 1383 (4th Cir.1995), held that the testimony of experts who found a causal link between the plaintiff's liver failure and a combination of alcohol and Extra-Strength Tylenol was reliable although they did not use epidemiological data. Instead, they relied on the plaintiff's history, personal examinations of plaintiff, plaintiff's lab and pathology data, and peer-reviewed literature. In other words, the experts relied on the kind of data the medical community uses regularly in diagnosing patients. The court stated that it would not declare such methodologies invalid in light of the medical community's daily use of the same methodologies in diagnosing patients. Id. 107 The Second Circuit in McCullock v. H.B. Fuller Company, 61 F.3d 1038, 1043 (2d Cir.1995), held that the district court properly admitted the testimony of a medical doctor as to the causal link between glue vapors and plaintiff's injury, rejecting defendant's contentions that the doctor's methodology was flawed because he could not point to a single piece of medical literature that says glue fumes cause throat polyps and because  'differential etiology,' [does not] qualif[y] as scientific under Daubert. Id. However, the basis of the doctor's opinion included his care and treatment of the plaintiff, her medical history, review of her medical and surgical reports, pathological studies, review of defendant's MSDS, his medical training and experience, use of differential etiology, and reference to scientific and medical treatises. Id. The court found that [d]isputes as to the strength of his credentials, faults in his use of differential etiology as a methodology, or lack of textual authority for his opinion, go to the weight, not the admissibility, of his testimony. Id. at 1044.  'Vigorous cross examination, presentation of contrary evidence, and careful instruction on the burden of proof are the traditional and appropriate means of attacking shaky but admissible evidence.'  Id.,(citing Daubert, 509 U.S. at 596, 113 S.Ct. at 2798). See also Becker v. Nat'l. Health Prods., Inc., 896 F.Supp. 100 (N.D.N.Y.1995)(admitting one expert's opinion based, in part, on over 30 years experience as a physician, and a second expert's opinion based, in part, on clinical experience with 10,000 patients solely in gastroenterology); Cantrell v. GAF Corp., 999 F.2d 1007, 1014 (6th Cir.1993)(Nothing ... prohibits an expert witness from testifying to confirmatory data, gained through his own clinical experience, on the origin of a disease or the consequences of exposure to certain conditions). 2. Under Rule 403 108 The trial court clearly abused its discretion in excluding the testimony of Dr. Jenkins under Rule 403. The only reason the trial court gave was that it would be highly prejudicial and misleading to have the jury accept from Dr. Jenkins's history and credentials that his opinion as to causation is other than scientific speculation, because that's what I heard him testify to. The trial court's reason was not clearly expressed and suggests several meanings. 109 The fact that an expert witness is highly credentialed cannot create a danger of unfair prejudice. Unfair prejudice, as used in Rule 403 does not exist simply because the evidence is adverse to the opposing party. Virtually all evidence is prejudicial or it is not material. There must be a danger of unfair prejudice in order for the discretion to exclude to arise. Dollar v. Long Mfg., N.C., Inc., 561 F.2d 613 (5th Cir.1977); United States v. McRae, 593 F.2d 700 (5th Cir.1979). 110 The trial court's reference to history was ambiguous. If the court referred to Dr. Jenkins' own history or experience, this, of course, was part of his credentials or qualification, which could not be unfairly prejudicial for the reason we have stated. If the court was referring to the medical history of Moore taken by Dr. Jenkins, it is equally difficult to see how any unfair prejudice could have been caused. By admitting the testimony of Dr. Jenkins as to his diagnosis of Moore's reactive airways disease, the court also allowed Dr. Jenkins to refer to the history taken as part of the clinical diagnostic process. In fact, Dr. Jenkins specifically stated at trial, without objection before the jury, that he had relied on the history he took of Moore in making his diagnosis as to Moore's condition. Furthermore, by admitting the testimony of Dr. Alvarez as to both diagnosis and cause of disease, the court allowed Dr. Alvarez to refer to the history and other work by Dr. Jenkins used by him as the basis for his own opinion. 111 The trial court's characterization of Dr. Jenkins' opinion as to causation as scientific speculation was essentially a repetition of its reason for excluding that evidence under Rule 702, i.e., for lack of a reliable evidentiary basis. The trial court's exclusion of the evidence as unreliable under Rule 702 was itself manifestly erroneous and an abuse of discretion. Therefore, it cannot serve as a ground for excluding the evidence under Rule 403. 112