Opinion ID: 2832576
Heading Depth: 4
Heading Rank: 3

Heading: Testimony of Dr. Gary Leroy Towle (“Dr. Towle”)

Text: Plaintiffs called Dr. Towle to testify as an expert on the standard of care and the material risks of Reglan. Dr. Towle testified that “Reglan is not recommended for use in children except for very specific circumstances” not present in 7 Defendant testified that although he had not read the version of the manufacturer’s insert admitted at trial, he had known of the information it contained at the time he administered Reglan to Minor. In addition, another expert, Dr. Gary Leroy Towle, explained that the version admitted at trial was substantially similar to the Physicians’ Desk Reference or manufacturer’s package insert for Reglan. 9  FOR PUBLICATION IN WEST’S HAWAII REPORTS AND PACIFIC REPORTER  this case. Interpreting the manufacturer’s insert, Dr. Towle testified that the manufacturer could not say Reglan was safe to treat pediatric patients, but was not saying it was unsafe either. Rather, Reglan’s safety in pediatric patients was undetermined. Dr. Towle testified that “one of the ways Reglan works is that it gets the pylorus, or the sphincter between the stomach and small intestines, to relax and open up and allow the contents of the stomach to pass through to the small intestine.” He stated that “[t]he problem with Reglan is it increases the motility of the stomach and small intestine. In other words, it gets it going, it gets things flowing through it.” Dr. Towle also testified that the contraindications section in the Reglan insert states that Reglan should not be used whenever stimulation of gastrointestinal motility might be dangerous. Dr. Towle stated that in Minor’s case, although Reglan did not directly cause diarrhea in and of itself, “if you’re emptying the stomach and you’re dumping things into the small intestine, it kind of gets the intestines going and diarrhea is one of the more common side effects with Reglan.” Dr. Towle testified that he would have started with other anti-emetics, such as Phenergan and Zofran, which the FDA has specifically approved to treat pediatric patients, and which were safer for use in children with nausea and vomiting. He 10  FOR PUBLICATION IN WEST’S HAWAII REPORTS AND PACIFIC REPORTER  testified that one of the more common side effects of Reglan was increased diarrhea, and while Zofran or other “anti-emetics theoretically can increase diarrhea[,] Reglan is more likely to” have this effect. Dr. Towle also testified that Zofran was an “excellent anti-emetic. It’s used in chemotherapy patients, in cancer patients, and also for people with gastroenteritis. It works very well. It has a relatively low side effect profile. It’s very popular and it could be the most popular one now replacing even Tigan and Phenergan.” Dr. Towle stated, however, that he could not testify to a reasonable degree of medical probability that Reglan increased Minor’s nausea and diarrhea, nor that it had any side effects that were of consequence to Minor. Dr. Towle also stated that he could not say whether Defendant should have warned Parents about any risks because “[i]t’s like asking what’s the dose of some medicine you’re not supposed to give. I can’t answer that.”