Opinion ID: 2370675
Heading Depth: 2
Heading Rank: 2

Heading: Causation of Vascular Injuries

Text: Dr. Kleeman next argues that the trial court erred by allowing Dr. Golding to opine that Dr. Kleeman more likely than not caused at least one of Goudreault's vascular injuries. Dr. Kleeman points out that Dr. Golding also testified that either Dr. Nepomnayshy or Dr. Kleeman could have caused Goudreault's vascular injuries. He contends that Dr. Golding's opinion on causation had no foundation under RSA 516:29-a, I, because of insufficient facts or data and a lack of reliable principles reliably applied to the facts of th[is] case. Goudreault argues that Dr. Golding's opinion was admissible because he based it upon the records, depositions and testimony coupled with his experience as a surgeon. Goudreault maintains that any inconsistent testimony given by Dr. Golding should go the weight of his opinion, not its admissibility. To make out a prima facie case of medical negligence, a plaintiff must introduce, by expert testimony, evidence sufficient to warrant a reasonable juror's conclusion that the causal link between the negligence and the injury probably existed. Bronson v. The Hitchcock Clinic, 140 N.H. 798, 801, 677 A.2d 665 (1996); see RSA 507-E:2, I(c). The plaintiff need only show with reasonable probability, not mathematical certainty, that but for the defendant's negligence, the harm would not have occurred. Bronson, 140 N.H. at 802-03, 677 A.2d 665. A medical expert's competent opinion that the defendant's negligence probably caused the harm establishes the quantum of expert testimony necessary. See id. at 802, 677 A.2d 665; see also N.H. R. Ev. 704; Emerson v. Bentwood, 146 N.H. 251, 256, 769 A.2d 403 (2001). However, such an opinion is admissible only after it has been shown to the satisfaction of the court that the testimony is based upon sufficient facts or data; ... is the product of reliable principles and methods; and ... [that t]he witness has applied the principles and methods reliably to the facts of the case. RSA 516:29-a, I; see also N.H. R. Ev. 702. Thus, an expert's testimony must rise to a threshold level of reliability to be admissible under New Hampshire Rule of Evidence 702. Emerson, 146 N.H. at 254, 769 A.2d 403 (quotation omitted). The proper focus for the trial court is the reliability of the expert's methodology or technique. The trial court functions only as a gatekeeper, ensuring a methodology's reliability before permitting the fact-finder to determine the weight and credibility to be afforded an expert's testimony. Baker Valley Lumber v. Ingersoll-Rand, 148 N.H. 609, 616, 813 A.2d 409 (2002). The facts or data in the particular case upon which an expert bases an opinion or inference may be those perceived by or made known to the expert at or before the hearing. If of a type reasonably relied upon by experts in the particular field in forming opinions or inferences upon the subject, the facts or data need not be admissible in evidence. N.H. R. Ev. 703. The trial court permitted Dr. Kleeman to explore the basis for Dr. Golding's opinion in the jury's presence before allowing him to render an opinion on causation. Dr. Golding testified that [t]he basis is when I reviewed the records and some depositions and testimony that I heard here yesterday and forty years of experience in surgery. Dr. Golding conceded that the records he reviewed did not expressly identify which doctor caused the vascular injuries, but he elaborated that [i]n reviewing the operative records, there was a progression of major bleeding episodes coupled with his sense of how dissection in the retro-peroneal space is done, and how vessels get injured in the retro-peroneal space. He added that the use of blunt and sharp dissection ... requires traction and counter-traction performed by two sets of hands, which occurred here in an area of blood vessels that can easily be damaged by either traction or counter-traction. Dr. Golding testified that two vascular injuries were [c]ertainly caused by traction and a third could be from the traction. The trial court recessed to examine the record outside of the jury's presence in response to Dr. Kleeman's objection. Dr. Golding was then allowed to give his opinion that more likely than not that Doctor Kleeman caused at least one of these vascular injuries. The trial court did not expressly rule as to the reliability of Dr. Golding's methodology. He appears to have relied upon something akin to differential etiology, Baker Valley Lumber, 148 N.H. at 616, 813 A.2d 409, a standard scientific technique of identifying the cause of a medical problem by eliminating the likely causes until the most probable one is isolated. Westberry v. Gislaved Gummi AB, 178 F.3d 257, 262 (4th Cir.1999). We find no error in admitting this testimony because admissibility of expert opinions turns upon the reliability of the expert's methodology or technique, Baker Valley Lumber, 148 N.H. at 616, 813 A.2d 409, and not upon the expert's conclusion, see id. at 615, 813 A.2d 409; see also Baxter v. Temple, 157 N.H. 280, 285, 949 A.2d 167 (2008). To the extent there were gaps in Dr. Golding's explanations, these omissions concern the relative weight and credibility of competing expert testimony rather than the basic reliability of such testimony, and are the province of the fact-finder, not the trial court. Baker Valley Lumber, 148 N.H. at 615, 813 A.2d 409. [O]bjections to the basis of an expert's opinion go to the weight to be accorded the opinion evidence, and not to its admissibility. Id. (quotation omitted). The appropriate method of testing the basis of an expert's opinion is by cross-examination of the expert. Id. at 615-16, 813 A.2d 409 (quotation omitted).