Opinion ID: 164099
Heading Depth: 2
Heading Rank: 1

Heading: examination of dr. mccauley

Text: Ms. Gray claims the trial court committed a number of evidentiary errors during her examination of her treating physician, Dr. McCauley. Ms. Gray hoped to prove Roche should have warned Dr. McCauley of Accutane’s alleged psychological side effects “[a]nd, in turn, these warnings should have been given by Dr. McCauley to [Ms. Gray].” To establish Roche proximately caused her alleged injuries, Ms. Gray needed to demonstrate that “had [Roche] issued a proper warning to [Dr. McCauley], he would have altered his behavior and the injury would have been avoided.” Eck v. Parke, Davis & Co., 256 F.3d 1013, 1018 (10th Cir. 2001). Ms. Gray believes the trial court prevented her from making this showing by: (a) sustaining objections during her examination of Dr. McCauley, and (b) granting (in part) Roche’s motion in limine to exclude “evidence regarding changes made to Accutane product warnings and communications after the conclusion of Ms. Gray’s treatment with Accutane.”
First, Ms. Gray claims the trial court erred in sustaining Roche’s “asked and answered” objections. Ms. Gray described two specific warnings she believes Roche should have issued, and asked Dr. McCauley whether he would have followed them. Dr. McCauley responded, “it depends.” He went on to explain: -4- “[W]e don’t rotely just follow instructions from drug companies. There are a lot of other things that go into evaluation of drugs with known and unknown side effects. So we would have taken this into account, but we also temper it with the experience that the patient is relating to us; also in regards to what other, what our own experience is with other patients.... And also in regard to other literature that we may be reading, and the experiences that we have, our shared experiences that we had with colleagues. So we don’t just rote do what the drug companies tell us. We do it, we take this certainly into consideration, and we put it into the rest of the equation in regards to the information that we visit with our patients about and also counsel them in regards to the medications. Apparently dissatisfied with his response, Ms. Gray immediately repeated her question. Roche objected on grounds the question had been asked and answered, and the trial court sustained. Throughout the remainder of her examination of Dr. McCauley, Ms. Gray repeatedly asked slight variations of this same question. The trial court sustained a number of Roche’s objections on grounds the question had been asked and answered. 2 Trial courts may prohibit litigants from asking witnesses repetitive 2 In the instances the trial court allowed Dr. McCauley to respond to Ms. Gray’s question, he indicated he “may or may not have done anything differently,” he was “not sure that at this particular point it would have made any difference in the way that [he] would have advised [Ms. Gray],” and he “may or may not have acted upon this any differently.” -5- questions. Fed. R. Evid. 611(a) (instructing courts to “exercise reasonable control ... so as to ... avoid needless consumption of time”); Fed. R. Evid. 403 (recognizing courts’ discretion to exclude evidence “if its probative value is substantially outweighed ... by considerations of undue delay, waste of time, or needless presentation of cumulative evidence”). See, e.g., Bragg v. Foretravel, Inc., 652 F.2d 39, 40 (10th Cir. 1981) (holding a “trial court properly exercised its discretion in order to prevent repetitive questioning and needless consumption of judicial time”). Here, Dr. McCauley obviously did not provide the answer Ms. Gray hoped to elicit. However, he did reply to the question with an appropriate answer. The trial court did not abuse its discretion by prohibiting the repetitive questions. Ms. Gray next complains the trial judge should have permitted her to ask Dr. McCauley, in regard to part of a warning she asserts Roche should have issued, “what those two sentences mean to him.” The sentences state: “Followup visits during Accutane treatment should include specific questioning regarding psychiatric signs and symptoms. Patients should be specifically warned to immediately discontinue Accutane use and seek medical evaluation if depression -6- or mood change occurs.” 3 The district court excluded the question on the ground it called for Dr. McCauley to interpret the sentences. We have held, “where ... expert testimony is offered on an issue that a jury is capable of assessing for itself, it is plainly within the trial court’s discretion to rule that testimony inadmissible.” Thompson v. State Farm Fire & Cas. Co., 34 F.3d 932, 941 (10th Cir. 1994). Although Dr. McCauley testified as a lay witness, the same reasoning applies here. Lay opinions, like expert opinions, are only admissible if they are helpful to the jury. Fed. R. Evid. 701, 702. The sentences Ms. Gray asked Dr. McCauley to interpret were not technical or confusing; the jury was capable of understanding them without Dr. McCauley’s assistance. The trial court did not abuse its discretion in sustaining Roche’s objection. 3 Ms. Gray also asked Dr. McCauley whether he disagreed with these two sentences. Dr. McCauley responded he would like to see the rest of the document to view the sentences in their context. Ms. Gray immediately repeated the question, and the trial court sustained Roche’s objection on the ground it had been asked and answered. Ms. Gray believes the court erred in sustaining the objection because Dr. McCauley did not answer her question. Again, we see no abuse of discretion. Although Dr. McCauley may not have provided the answer Ms. Gray hoped for, his response was within the realm of appropriate answers. Thus, the trial court did not abuse its discretion in sustaining Roche’s objection. -7- Ms. Gray next argues the trial court improperly interrupted her when she asked Dr. McCauley if he would have altered her treatment had he “received a warning from Roche that he considered to constitute a significant change in the warnings involving side effects for Accutane.” Troubled by the word “significant,” the trial court ruled it would only allow Dr. McCauley to answer if Ms. Gray clarified “what changes.” Ms. Gray argues “[i]t is up to the witness to inform the Court if he cannot answer the question.” We disagree. Trial courts bear the responsibility of “mak[ing] the interrogation ... effective for the ascertainment of the truth.” Fed. R. Evid. 611(a)(1). Here, the court found Ms. Gray’s question vague, thus not helpful to the jury. We see no abuse of discretion in its sua sponte interruption. See, e.g., United States v. Head, 697 F.2d 1200, 1210 (4th Cir. 1982) (noting trial court’s prerogative to interrupt witness examinations sua sponte). Moreover, the court gave Ms. Gray the opportunity to clarify her question. Finally, Ms. Gray complains the trial court erroneously limited her redirect examination of Dr. McCauley, finding her questions unrelated to Roche’s crossexamination. She points out Roche had asked whether Dr. McCauley’s other patients taking Accutane reported depression. Accordingly, Ms. Gray argues the -8- court should not have prevented her from asking if “whether [his] patients report psychiatric side effects ... [has] anything to do ... with whether the patient understands that Accutane might cause the psychiatric side effects,” because this question was related to Roche’s questioning on reported depression of other patients. “The scope of redirect examination is committed to the sound discretion of the trial court” and is normally limited to the scope of cross-examination. United States v. Hodges, 480 F.2d 229, 233 (10th Cir. 1973). Here, the trial court reasonably determined Ms. Gray’s question went beyond the scope of crossexamination. Roche’s inquiry was limited to whether any of Dr. McCauley’s other Accutane patients reported depression. Ms. Gray’s question, on the other hand, delves into what factors might motivate his patients to report side effects. The trial court acted within its discretion by curtailing this line of questioning.
Ms. Gray also asserts the trial court erred by excluding evidence Roche changed Accutane’s warnings after she stopped taking the drug. Ms. Gray sought to introduce Roche’s revised “informed consent/patient agreement” form through Dr. McCauley. This form, modified after Ms. Gray discontinued treatment, -9- addresses possible psychological side effects associated with Accutane, and requires patients to initial the form acknowledging their understanding of the possible side effects. The trial court granted (in part) Roche’s motion in limine to exclude the form as evidence of a subsequent remedial measure. In diversity actions involving a products liability claim, the admissibility of subsequent remedial measures is a matter of state law. Wheeler v. John Deere Co., 862 F.2d 1404, 1410 (10th Cir. 1988). Under Oklahoma law, “evidence of subsequent measures” taken after an “event” is inadmissible “to prove negligence or culpable conduct.” Okla. Stat. Ann. tit. 12, § 2407 (1993). However, we found no Oklahoma law indicating whether this exclusion applies to products liability suits. We must therefore turn to Rule 407 of the Federal Rules of Evidence. Herndon v. Seven Bar Flying Serv., Inc., 716 F.2d 1322, 1326 (10th Cir. 1983) (holding where no state rule of evidence is available, the federal rule should be applied). Federal Rule of Evidence 407’s subsequent remedial measures exclusion applies to products liability cases. See Fed. R. Evid. 407 advisory committee’s note. In relevant part, it excludes evidence of measures taken after “an injury or harm” occurred “that, if taken previously, would have made the injury or harm -10- less likely to occur ... to prove ... a need for a warning and instruction.” Fed. R. Evid. 407. However, such evidence may be admitted for other purposes, notably for impeachment and for proving the “feasibility of precautionary measures, if controverted.” Id. Roche’s revised patient informed consent form fits squarely within the category of evidence Rule 407 bars. Therefore, the trial court properly excluded the form as evidence Roche should have issued a stronger warning. Because Rule 407 does not exclude subsequent remedial measures taken by non-parties, Mehojah v. Drummond, 56 F.3d 1213, 1215 (10th Cir. 1995), Ms. Gray asserts the trial court should have admitted the evidence because she offered it to show Dr. McCauley, a non-party, took the remedial measure of using Roche’s revised form. We disagree. Evidence admissible under Rule 407 still faces Rule 403 scrutiny. Courts must exclude evidence if “the dangers of prejudice or confusion substantially outweigh the probative value of the evidence.” Fed. R. Evid. 407 advisory committee’s note (1997 Amendments). Here, the form’s danger of prejudice to Roche ran high. Because the form not only established Dr. McCauley’s subsequent remedial measure, but Roche’s, as well, the jury might have used the form against Roche for the very purpose Rule 407 prohibits – as evidence there -11- was “a need for a warning.” Additionally, the form’s probative value was minimal. As to Dr. McCauley’s remedial action, the form merely bolstered his testimony that he now specifically questions his Accutane patients about psychiatric side effects. The form’s potential for prejudice thus substantially outweighed its probative value. The trial court acted within its discretion by ordering it excluded. 4
Ms. Gray next argues the trial court should have allowed her to introduce the form to impeach Dr. McCauley’s testimony. As discussed above, Dr. McCauley testified he “may or may not have” followed instructions had Roche issued them during Ms. Gray’s treatment. Ms. Gray contends she could have impeached this testimony with the form because she claims Dr. McCauley’s deposition testimony indicates, “as soon as he received the revised informed patient consent form from [Roche], he immediately began using it.” (Emphasis 4 Ms. Gray also believes the court should have allowed her to introduce Roche’s revised consent form because Roche failed to cite Oklahoma law mandating its exclusion. She claims Meller v. Heil Co., 745 F.2d 1297 (10th Cir. 1984) places the burden of demonstrating the evidence’s inadmissibility under state law upon the party seeking its exclusion. However, the principle in Meller Ms. Gray refers to is our interpretation of a Colorado statute excluding post-injury scientific advancements. Id. at 1302. The statute in Meller does not apply to this case. -12- added.) According to Ms. Gray, the deposition testimony shows Dr. McCauley “responds directly and immediately to such warnings and instructions from the drug manufacturer.” She believes she could have proved Dr. McCauley would have altered her treatment had the trial court permitted her to introduce the form. Both Oklahoma law and Rule 407 permit litigants to introduce subsequent remedial measures evidence for impeachment purposes. Fed. R. Evid. 407; Okla. Stat. Ann. tit 12, § 2407 (1993). Here, the informed consent form itself did not contradict Dr. McCauley’s testimony that he does not “rotely” follow instructions from drug companies, or that he would have altered Ms. Gray’s treatment had Roche issued warnings while she was taking Accutane. Furthermore, we are unconvinced the form would have allowed Ms. Gray to elicit further testimony to impeach Dr. McCauley. First, and contrary to Ms. Gray’s assertions, we found no indication in Dr. McCauley’s deposition testimony that he began using the consent form immediately after receiving it. On the contrary, Dr. McCauley testified he could not remember when he received the informed consent form or when he began using it. Second, the informed consent form differs in both form and content from the warning Ms. Gray claims Roche should have issued years earlier. The -13- fact he currently uses the form does not prove he would have followed a different warning several years earlier. Indeed, Dr. McCauley’s deposition testimony indicates he attained new information about Accutane’s possible side effect around the time Ms. Gray stopped taking Accutane and before he adopted the form. In light of these facts, we doubt Ms. Gray could have used the form to demonstrate that, contrary to his testimony, Dr. McCauley would have proceeded differently had Roche issued the two warning sentences. The trial court properly excluded the form for impeachment purposes.
Next, Ms. Gray argues the trial court should have admitted the form under the feasibility exception to the rules barring subsequent remedial measures. She believes feasibility was controverted at trial. Ms. Gray first explains she controverted feasibility when she attempted to show Roche’s former method of informing doctors about Accutane’s possible side effects was infeasible, whereas the revised patient informed consent form would have been feasible. Ms. Gray also claims Roche controverted feasibility when its representative testified the company “didn’t think to put” warnings on patient brochures and blister packs, and testified it would not have been easy for Roche to revise the informed consent form. -14- Neither the Oklahoma statute nor Rule 407 bars subsequent remedial measures to prove the “feasibility of precautionary measures, if controverted.” Fed. R. Evid. 407; Okla. Stat. tit. 12, § 2407 (emphasis added). The “if controverted” requirement “allows the opposing party to lay the groundwork for exclusion by making an admission.” Fed. R. Evid. 407 advisory committee’s note. Here, in a pretrial brief, Roche stated it did not contest feasibility. Although the trial court indicated its order excluding the form was “subject to reconsideration at trial,” during the trial Ms. Gray never argued Roche’s representative’s testimony controverted feasibility. Because she raises this argument for the first time on appeal, we decline to review it. See TeleCommunications, Inc. v. Commissioner, 12 F.3d 1005, 1007 (10th Cir. 1993). In addition to waiving appellate review, Ms. Gray’s omission also deprived Roche of the opportunity to make an admission regarding feasibility. Ms. Gray further suggests her efforts to controvert feasibility satisfy the “if controverted” requirement irrespective of Roche’s response. We believe the advisory committee’s note to Rule 407 forecloses this argument by reiterating the parties must present a “genuine issue,” and by recognizing the opposing party’s opportunity to “lay the groundwork for exclusion by making an admission.” Fed. R. Evid. 407 advisory committee’s note. We affirm the trial court’s exclusion of -15- the form to prove feasibility.
Finally, Ms. Gray argues the form was admissible to demonstrate she was not guilty of contributory negligence. We have upheld the admission of subsequent remedial measures to demonstrate a plaintiff was not contributorily negligent. See, e.g., Rimkus v. Northwest Colo. Ski Corp., 706 F.2d 1060, 106566 (10th Cir. 1983). However, because Roche did not raise contributory negligence as a defense at trial, the trial court properly excluded the evidence. In sum, the trial court did not abuse its discretion in excluding evidence pertaining to Roche’s subsequent remedial measure under Oklahoma law and Rule 407.