Opinion ID: 746887
Heading Depth: 1
Heading Rank: 9

Heading: Refutation Of Inapposite Arguments

Text: 120 The argument by the the defendants-appellees and the dissenting opinion that the proffer of Dr. Jenkins's testimony as to clinical medical knowledge should be assessed for reliability according to whether it is grounded in hard scientific dosage or exposure level methodology begs the question. First, it assumes without demonstration that this case involves a proffer of hard scientific, not clinical medical, evidence. Next, from that unproven assumption, it infers that the proffer must be tested for reliability as hard scientific evidence by the hard scientific methods set forth in Daubert, also known as the Daubert factors. Finally, it concludes that the proffered evidence is unreliable because it was not attained by use of the hard scientific methodology. 121 The argument relies on a misapplication of the Daubert factors. In Daubert, the Supreme Court clearly indicated that the proffer of an expert's testimony must be tested for evidentiary reliability by determining whether the expert's opinion is soundly grounded in the principles and methodology of the proffered expert's discipline. The court derived the hard scientific methods, now called Daubert factors, from the methodology of the discipline of hard science. The court advised trial judges to use these hard scientific methods or factors in determining whether proffers of testimony as to hard scientific knowledge are well grounded in hard scientific methodology. The Daubert court plainly did not intend to require trial judges to use hard scientific methods to test the reliability of proffers outside the sphere of hard science. The hard scientific methods generally are inappropriate for determining whether an expert's opinion is soundly grounded in the principles and methodology of the discipline of clinical medicine. Only a brief comparison of the disciplines of hard science and clinical medicine is needed to see that they have quite different and disharmonious goals, principles and methodology. See infra., pp. 688-90. 122 The proffer at issue in the present case is that of an expert's testimony based on clinical medical knowledge. Consequently, under Rule 702, as explained by Daubert, the proffer must be tested for evidentiary reliability by determining whether the expert's opinion is soundly grounded in the principles and methodology of the discipline of clinical medicine. When the proffer of Dr. Jenkins' testimony based on clinical medical knowledge is properly analyzed, as we have shown above, it is evident that his opinion was soundly grounded in his discipline of clinical medicine, was evidentiarily reliable and should have been admitted. 123 The trial court erroneously failed to assess Dr. Jenkins cause of disease opinion by reference to the principles and methodology of his discipline of clinical medicine. The trial court assumed that Dr. Jenkins' opinion, in order to be evidentiarily reliable under Rule 702 and Daubert, must have been attained by hard scientific methods, such as air samples comparing the ratio of contaminated parts per million with safe dosage or exposure level standards derived from epidemiological studies or experimentation with animals. Dr. Jenkins' opinion, that Moore's exposure to the mixture of chemicals caused his disease, was derived by clinical medical methods and not by use of hard scientific methods. Therefore, the trial court mistakenly concluded that Dr. Jenkins' opinion was not reliable because it was not attained by the use of hard scientific methods. 124 Inexplicably, the trial court did not test the reliability of Dr. Alvarez's cause of disease opinion, which used the identical basis to reach the identical conclusion, by whether or not he used such hard scientific methods. Instead, the court said that Dr. Alvarez's use of clinical medical methodology instead of hard scientific methods, and his lack of precise information as to exposure levels and standards, would merely go to the weight of his testimony. The trial court acted arbitrarily and abused its discretion by not judging Dr. Jenkins' proffered testimony by clinical medical principles and methodology as it did Dr. Alvarez's testimony. 125 The argument of the dissenting opinion and the defendants-appellees' brief follows the same erroneous path as the trial court's reasoning. Consequently, in support of their arguments they point only to inapposite cases involving primarily the proffers of experts' testimony based on professed hard scientific knowledge relative to the surreptitious causation of insidious diseases; and they disregard entirely the many pertinent decisions approving the introduction of experts' opinions as to the causation of episodic traumatic injuries and disorders based on well established clinical medical methodology such as the clinical physician's examination, testing, differential diagnosis, and history taking of the patient or victim. 126 The dissenting opinion relies primarily on Allen v. Penn. Engineering Corp., 102 F.3d 194 (5th Cir.1996), but that case is not persuasive here because it is markedly distinguishable from the present case. Allen was a products liability suit against the manufacturer of ethylene oxide sterilizers by the widow and child of a hospital maintenance worker who died of brain cancer after 20 years on the job in which he occasionally replaced cylinders containing the sterilizers. The plaintiffs proffered expert scientific testimony that there is a causal link between human brain cancer and ethylene oxide exposure. The plaintiffs' experts based their opinions on evidence developed with hard scientific methods, viz., epidemiological studies, animal studies, cell biology, and health organization conclusions. The defendants responded with numerous reputable epidemiological studies indicating there is not a correlation between the ethylene oxide exposure and cancer of the human brain. The trial court found the plaintiffs' experts to be unqualified and also excluded their testimony for lack of sufficient scientific grounding. This court of appeals affirmed, holding that under Rule 702 the scientific data relied on by the experts did not furnish a scientifically valid basis for their conclusions, due to the paucity of epidemiological evidence, the unreliability of animal studies, and the inconclusiveness of cell biology. Id. at 198. In expressing an opinion on an issue not reached by the trial court, this court stated that the evidence was also excludable under Rule 703 because [i]n this case, there is no direct evidence of the level of Allen's exposure to EtO. The [experts'] opinion relies principally on the affidavit of a coworker and on extrapolations concerning EtO handling at the hospital where Allen worked based on conditions in other hospitals in the 1970's. Id. at 198. 127 Because of its dissimilarities the Allen case does not control or even help to understand or to decide the present case. Allen was purely a scientific evidence case, in which the proffer of hard scientific expert testimony was not soundly grounded in scientific principles or methodology, and in which there was no evidence that the deceased was ever actually exposed to the substance that his widow and child alleged had caused his brain cancer. Also, the experts never examined the deceased before or after his death, there was no evidence of his medical history, there was no indication that he had any relevant symptoms or signs during his life, and apparently no tests were ever performed on his body or brain. Thus, the case involved a proffer of hard scientific testimony, not clinical medical testimony, and it had not been shown that the proffered scientific evidence was reliably grounded in scientific principles and methodology. 128 The present case is purely a clinical medical evidence case. A live plaintiff gave histories to doctors and testified without contradiction that he was in good health until he was exposed to a mixture of chemical gases in and around an enclosed 28 foot trailer for approximately one hour; and that within an hour thereafter he developed severe coughing, wheezing and tightness of the chest. Unlike the Allen case in which there was no evidence of exposure to the dangerous substance, the fact that Moore inhaled a mixture of toxic gases escaping from leaking drums for approximately one hour was not disputed in the instant case. The doctors who examined, tested and took histories from him found that he had signs and symptoms consistent with reactive airways disease. The doctors arrived at opinions that the plaintiff suffered from reactive airways disease caused by his exposure to the mixture of chemicals. Their opinions were soundly grounded in their discipline of clinical medicine. The defendants did not respond with scientific evidence but with the testimony of a third clinical physician who, without ever examining the plaintiff or developing any new data, reinterpreted the facts and data developed by the first two doctors to arrive at a contrary opinion. 129 The dissenting opinion strays farther afield in its reliance on Wright v. Willamette Industries, Inc., 91 F.3d 1105 (8th Cir.1996). The Eighth Circuit's decision was based largely on Arkansas negligence and proximate cause law. The divided panel held that a family who lived near the defendant's plant at which wood particles were treated with formaldehyde could not recover for their claims of minor afflictions, such as headaches, sore throats, watery eyes, running noses, dizziness, and shortness of breath, because they failed to produce evidence that they were exposed to a hazardous level of formaldehyde from the fibers emanating from the plant. The part of the first passage of Wright which the dissenting opinion quotes does not pertain to the admissibility of evidence but to minimum standards of proof and proximate cause. Id. at 1107. Also, the dissenting opinion omits the remainder of that passage, which reads: We do not require a mathematically precise table equating levels of exposure with levels of harm, but there must be evidence from which a reasonable person could conclude that a defendant's emission has probably caused a particular plaintiff the kind of harm of which he or she complains before there can be a recovery. Id. The Eighth Circuit stated, however, that the trial court should have excluded Dr. Peretti's testimony, as Willamette requested it to do, because it was not based on scientific knowledge. Id. at 1108 (citing Daubert and Rule 702). This certainly indicates that Dr. Peretti purported to present hard scientific testimony. The opinion does not state what kind of doctor Peretti was or upon what he said his opinion was based. Two other doctors mentioned by Wright were Dr. Fred Fowler, an industrial hygienist, and Dr. Jimmie Valentine, a pharmacologist. There is no indication that Peretti was a clinical physician or that he based his opinion on the methodology of clinical medicine. 130 The Seventh Circuit decision relied upon by the dissenting opinion, Rosen v. Ciba-Geigy Corp., 78 F.3d 316 (7th Cir.1996), is also a scientific evidence case that is clearly distinguishable from the present case involving the proffer of a clinical medical opinion. A 60 year old smoker with a history of coronary artery disease, previous heart attack, high blood pressure, cholesterol count, and continued smoking, who suffered another heart attack after using a nicotine patch for three days, brought a products liability action against the manufacturer of the patch. The court of appeal affirmed a summary judgment based on the trial court's conclusion that the plaintiff's scientific expert's opinion concerning the role of the nicotine patch in Rosen's heart attack, was inadmissible. Id. at 318. The Seventh Circuit affirmed because the scientific evidence supplied nothing but a bottom line offering neither a theoretical reason to believe that wearing a nicotine patch for three days, or removing it after three days, could precipitate a heart attack, or any experimental, statistical, or other scientific data from which such a causal relation might be inferred or which might be cause to test a hypothesis founded on theory. Id. at 318-319. The scientific expert was Dr. Fozzard, a distinguished cardiologist and department head at the University of Chicago. Id. at 318. His testimony was proffered, however, as hard scientific evidence, not as clinical medical evidence. Id. at 318. The court of appeal opinion is devoid of any indication that the scientific expert had ever seen, examined, tested or taken a history from the plaintiff. Consequently, the Rosen decision deals solely with the proffer of hard scientific testimony insufficiently grounded in scientific methodology and not the proffer of clinical medical testimony soundly grounded in the principles and methodology of that discipline, as in the present case. 131 Finally, the defendants-appellees contend that Texas state practice on jury instructions is controlling in this case and that the plaintiffs waived their argument that Dr. Jenkins' testimony was not cumulative. We have considered the arguments and find them to be clearly without merit. In view of our disposition of this case, we do not reach the parties' cross-appeals relative to costs of court assessed by the trial court.