Opinion ID: 610623
Heading Depth: 2
Heading Rank: 2

Heading: Sufficiency of Medical Evidence Regarding the Aggravation of a Pre-existing Condition

Text: 16 The defendants challenge a second instruction. The district court told the jury that when they determined the proper amount to award Mr. Stutzman they could consider, inter alia, the aggravation of a previous injury. The defendants argue that this charge constitutes reversible error because the plaintiffs failed to show that Mr. Stutzman's pre-existing condition, a congenital back problem called spondylolisthesis, was aggravated by his car accident injury. Further, the defendants claim that the error was not harmless because it resulted in a higher damages award. 17 It is prejudicial error for a trial court to give instructions which find no support in the evidence, unless the record shows the error is clearly harmless. Kirschner v. Broadhead, 671 F.2d 1034, 1040 (7th Cir.1982). Consequently, the issue before us is whether the plaintiffs offered sufficient competent evidence that Mr. Stutzman's previous medical condition was aggravated by the accident. It is argued that no competent evidence supported the instruction because the only evidence on aggravation was improperly admitted. 18 At trial, the plaintiffs called two expert medical witnesses. Dr. Schaffer testified, via deposition, that trauma could aggravate spondylolisthesis and that he thought Mr. Stutzman's spondylolisthesis was aggravated by the car accident. However, during cross-examination in response to a series of questions concerning the aggravation of Mr. Stutzman's spondylolisthesis, Dr. Schaffer qualified his earlier testimony: 19 A [ ] Just that it might have exacerbated the problem and it may not have. [ ] And I cannot correlate for sure that it did or didn't. 20 Q So you can't say with any medical certainty at all that that's the cause of any low back pain? 21 A That's correct. 22 In addition to Dr. Schaffer, Dr. Klaassen testified at trial via a videotaped deposition. He stated that spondylolisthesis could be aggravated by a car accident like the one Mr. Stutzman had. This exchange followed: 23 Q Assuming Mr. Stutzman never had any problems with his low back as far as we can tell before the accident of April 5th, 1990, and has had problems since that date, do you have an opinion based upon a reasonable degree of medical certainty whether the accident aggravated or worsened that condition making it symptomatic? 24 A Well, here's where it gets to be very difficult to split the two apart. I mean how do you determine what symptoms in his lower legs are caused by his cervical spine compression [the accident injury] and his lumbar problem [the pre-existing condition]. 25 The defendants argue that the foregoing testimony was improperly admitted because, under Indiana law, expert physician testimony must be based on a reasonable medical probability and these doctors testified to only possibilities. The defendants, however, are relying on the wrong body of law. Indiana law does not govern the admissibility of expert testimony in a federal forum; rather, the Federal Rules of Evidence govern. Consequently, the proper question is whether the physicians' testimonies were properly admitted under Federal Rules of Evidence. Before we reach that question, however, a brief explanation of why federal law applies is necessary. 26 Federal courts exercising diversity jurisdiction apply state law to substantive issues and federal law to procedural issues. Hanna v. Plumer, 380 U.S. 460, 85 S.Ct. 1136, 14 L.Ed.2d 8 (1965); Erie Railroad Co. v. Tompkins, 304 U.S. 64, 58 S.Ct. 817, 82 L.Ed. 1188 (1938). The question before us is whether the admission of expert testimony should be governed by state or federal law; in other words, is it a procedural issue or a substantive issue? In the past we have not specifically answered this question. See Kirschner, 671 F.2d at 1040. We do so today. 27 We have held that the Federal Rules of Evidence generally apply in federal diversity actions. See Pincus v. Pabst Brewing Co., 893 F.2d 1544, 1553 (7th Cir.1990); Rosenburg v. Lincoln American Life Ins. Co., 883 F.2d 1328, 1333 (7th Cir.1989); Lovejoy Electronics, Inc. v. O'Berto, 873 F.2d 1001, 1005 (7th Cir.1989). See also Pieters v. B-Right Trucking, Inc., 669 F.Supp. 1463 (N.D.Ind.1987). On some occasions, however, we have addressed the applicability of specific Federal Rules and reached various results. Compare Flaminio v. Honda Motor Co., Ltd., 733 F.2d 463, 471-72 (7th Cir.1984) (Federal Rule 407, not state rule, applies in diversity action), with Monetti, S.P.A. v. Anchor Hocking Corp., 931 F.2d 1178, 1182 (7th Cir.1991) (whether oral evidence is admissible to show that an ambiguous document satisfies the statute of frauds is governed by state law); Lovejoy, 873 F.2d at 1005 (state's dead man statute governs admissibility of certain evidence where state law supplies rule of decision). 28 In addition to establishing the general rule that the Federal Rules apply to determine the admissibility of evidence, these cases show that there are exceptions to the general rule: express exceptions contained in the Federal Rules and substantive rules masquerading as evidence rules. Id. In Lovejoy, we found an exception based on language contained in the Federal Rules themselves. Id. Rule 601, governing the competency of witnesses, sweeps away the traditional objections to competency of witnesses, but with the following exception: preservation of the state dead man's statutes when state law supplies the rule of decision. Id. 1 In Monetti, we concluded that state law should apply because the issue was essentially one of parole evidence--a substantive contract law issue. 931 F.2d at 1182. 29 To decide whether the general rule applies to the admissibility of expert testimony we first look to whether there is an express exception in the Federal Rules themselves. There is not. Second, we explore whether the Federal Rules governing expert testimony are really substantive, rather than procedural. The test must be whether a rule really regulates procedure,--the judicial process for enforcing rights and duties recognized by substantive law and for justly administering remedy and redress for disregard or infraction of them. Sibbach v. Wilson & Co., 312 U.S. 1, 14, 61 S.Ct. 422, 426, 85 L.Ed. 479 (1941). 30 The rules at issue regulate process rather than establish substantive rights. The rules delineate what evidence may be used to prove the essential elements of a claim; they do not alter what has been determined by state law to constitute those elements. In examining Rule 407 and its mandate that evidence of subsequent remedial measures be excluded, we noted: 31 Congress's judgment that juries are apt to give too much weight to such evidence is a procedural judgment ... that is, a judgment concerning procedures designed to enhance accuracy or reduce expense in the adjudicative process. 32 Flaminio, 733 F.2d at 471. Similarly, the Federal Rules governing expert testimony reflect a procedural judgment that juries are aided by hearing expert testimony and that assistance enhances the accuracy of the entire process--even in situations where an expert is not absolutely certain about his conclusion. This judgment does not dictate the parties' substantive rights, but merely controls the method of enforcing those rights established by the state. 33 We hold that the Federal Rules of Evidence govern the admissibility of expert testimony in federal diversity cases. Further, we note that our conclusion is consistent with those of other circuits that have addressed this issue. See Scott v. Sears, Roebuck & Co., 789 F.2d 1052 (4th Cir.1986); Dawsey v. Olin Corp., 782 F.2d 1254 (5th Cir.1986). 34 Having concluded that federal law applies, we also believe that the testimony of both doctors in this case was properly admitted. The decision to admit expert testimony is committed to the broad discretion of the trial court and its determination will be affirmed unless it is 'manifestly erroneous.'  Bob Willow Motors, Inc. v. General Motors Corp., 872 F.2d 788, 797 (7th Cir.1989). See also Carroll v. Otis Elevator Co., 896 F.2d 210, 212 (7th Cir.1990). 35 In United States v. Cyphers, 553 F.2d 1064, 1072-73 (7th Cir.), cert. denied, 434 U.S. 843, 98 S.Ct. 142, 54 L.Ed.2d 107 (1977), we specifically held that Rule 702 does not require that an expert's opinion testimony be expressed in terms of a reasonable scientific certainty in order to be admissible.... We adhere to the rule that an expert's lack of absolute certainty goes to the weight of his testimony, not to its admissibility. Similarly, in Kirschner we concluded that [t]he admissibility of an expert medical opinion, of course, should not turn on whether the testifying physician characterizes a particular potential cause of injury as 'conceivable,' 'possible,' or 'probable.'  671 F.2d at 1039. 36 In Kirschner, however, we also suggested that something more than a mere possibility was required. Id. at 1040. Since Kirschner, several cases have aptly explained the correct criteria that district courts should examine in deciding whether to admit expert testimony. 37 The district court ruled that plaintiff had established an adequate foundation, and that any questions regarding [the expert's] methodology or particular area of expertise were more appropriately addressed during cross-examination. This was hardly error. Experience and knowledge establish the foundation for an expert's testimony; the accuracy of such testimony is a matter of weight and not admissibility. 38 Liquid Air Corp. v. Rogers, 834 F.2d 1297, 1308 (7th Cir.1987), cert. denied, 492 U.S. 917, 109 S.Ct. 3241, 106 L.Ed.2d 588 (1989). See also Sheldon v. Munford, Inc., 950 F.2d 403, 410 (7th Cir.1991); Bob Willow, 872 F.2d at 797; Bright v. Land O'Lakes, Inc., 844 F.2d 436, 441 (7th Cir.1988). 39 The foregoing supports our conclusion that the Federal Rules do not contain any threshold level of certainty requirement. As long as a medical expert's qualifications are proper and the expert relies on appropriate types of information under Rule 703, the district court does not abuse its discretion by admitting the medical expert's testimony. 40 In the instant case, the defendants do not argue that inadequate foundations were laid for the doctors' testimonies. They do not challenge Dr. Schaffer's and Dr. Klaassen's qualifications. They do not claim that the doctors based their opinions on improper bases. In fact, the testimonies are clearly based on medical opinions--trauma can aggravate spondylolisthesis--and examinations of Mr. Stutzman. The defendants' sole quarrel with the doctors' opinions is the doctors' levels of certainty. Under the Federal Rules, certainty is an issue for the jury and does not affect admissibility. Cyphers, 553 F.2d at 1072-73. 41 The district court properly admitted both doctors' testimonies and such evidence amply supported the instruction permitting the jury to consider the aggravation of a pre-existing condition in determining its award of damages.