Opinion ID: 163939
Heading Depth: 2
Heading Rank: 6

Heading: Appellate Review of Adequate Scientific Support.

Text: 58 The dissent contends that this court has failed to take the correct approach by not considering whether adequate scientific support exists for Dr. Teitelbaum's opinion. The dissent concludes that the scientific support is inadequate to demonstrate that the HACE experienced by Mr. Goebel could cause permanent brain damage and that the episode in the Moffat Tunnel could have caused HACE. The trial court, having been alerted to these gaps, should have insisted that Dr. Teitelbaum explain these gaps, or excluded his testimony. 59 The key to this case is the deferential standard of review — under the abuse of discretion standard, the district court's decision to admit the evidence must be characterized as manifestly erroneous to warrant reversal. See Joiner, 522 U.S. at 142-43, 118 S.Ct. 512. The lack of scientific literature directly addressing the confluence of all of the factors at issue in the tunnel is hardly surprising because such tests could not be run with human subjects. Though the review was for plain error due to a belated Daubert objection, in Macsenti v. Becker, 237 F.3d 1223 (10th Cir.2001), this court upheld the use of an expert's opinion of brain injury from diffusion hypoxia where the plaintiff had been administered multiple drugs in combination with nitrous oxide. 237 F.3d at 1231. Just as here, the defendant challenged the absence of professional literature to support [the expert's] opinion and asserted conflicts between portions of [the expert's] reasoning and principles which do find support in the professional literature. Id. We concluded that admission of the expert's opinion on the specifics of the case, in the absence of published studies on this precise combination of medications and prolonged use of nitrous oxide, was not plain error. Id. at 1234. 60 In Macsenti, the [d]efendant's positions disputing [the expert's] opinions were energetically developed at trial through cross-examination of [the expert] and through the testimony of defendant's own experts, inter alia.  Id. at 1231. Contrast that with this case where the Railroad did not appeal the lack of an evidentiary hearing on remand, it never deposed Dr. Teitelbaum, and at trial it did not put on its own expert to directly refute Dr. Teitelbaum's testimony. The Railroad's theory is that exposure to diesel smoke and depression accounted for Mr. Goebel's condition, and that we as lawyers and judges on appeal can determine what the medical literature says and its import as well as any expert, let alone the trial court. Joiner did not go that far, nor did it invest this court with plenary review that would displace the discretion of the district court. 61 Here, adequate support for the HACE diagnosis exists, based upon the disorientation and the AMS diagnosis. Even the dissent's review of the literature contains self-limiting terms about symptoms, and quotes statements that support Dr. Teitelbaum's conclusions. Dissent at 6-7. Though the dissent faults the supporting literature as not being verifiable, it is a little far afield for this court (not the experts) to refute the validity of the underlying data in support. 62 The dissent also contends that Dr. Teitelbaum did not adequately prove the onset of HACE given a one-hour exposure to the tunnel episode. Nothing in this record is categorical about the amount of time it takes for HACE to develop, particularly given that medical science is unsure how HACE develops. Dissent at 10 n.2. Mr. Goebel spent more than one hour at elevations above 8,000 feet, and as noted above Dr. Teitelbaum is claiming that a combination of factors, some not present in the studies, resulted in the onset of HACE. True, these factors result in hypoxia, but a permissible reading of Dr. Teitelbaum's position is that the entire transition from Denver's altitude to the Moffat Tunnel apex was sufficient to cause AMS and HACE in combination with the other factors.