Court Opinion

ID: 9696193
Source: CourtListenerOpinion
Date Created: 2023-08-25 18:40:46.368874+00
Date Added: 2024-06-11T18:20:19.419031
License: Public Domain

DISSENTING OPINION BY
BENDER, J.:
¶ 1 I agree with the majority’s conclusion that Frye is inapplicable in this case, especially in light of our Court’s recent decision in Track v. Fellin, 817 A.2d 1102 (Pa.Super.2003), which limits the application of Frye to novel scientific evidence. However, I write separately because there are sound and compelling reasons upon which to exclude Dr. Austin’s expert opinion and, consequently, affirm the trial court’s grant of summary judgment in favor of Appellee.9
¶ 2 Summary judgment is properly granted where the evidentiary record contains insufficient evidence to establish a prima facie case and where, consequently, there is no issue to be submitted to the jury. Grandelli v. Methodist Hosp., Ill A.2d 1138, 1143 (Pa.Super.2001) (citing Pa. R.C.P. 1035.2(2)). When summary judgment is granted on this basis, and the non-moving party fails to proffer evidence essential to preserve its cause of action, the moving party is entitled to judgment as a matter of law. Id. at 1143-44. On appellate review of a grant of summary judgment, we are not bound by the trial court’s conclusions of law, rather we may reach our own conclusions. Id. at 1144. However, we will not disturb the trial court’s decision absent an error of law or abuse of discretion. Id. Our scope of review is plenary. Id.
¶3 The trial court granted Appellee’s motion for summary judgment after excluding Dr. Austin’s expert testimony. As with the grant of summary judgment, “[t]he admissibility of evidence is a matter addressed to the sound discretion of the trial court and should not be overturned absent an abuse of discretion.” Education Res. Inst., Inc. v. Cole, 827 A.2d 493, 499 (Pa.Super.2003). Accordingly, my focus in this dissent is on the serious deficiencies in Dr. Austin’s expert report and testimony, which lead me to conclude that the trial court did not abuse its discretion by excluding his opinion. Indeed, despite the inapplicability of Frye, an expert whose opinion is speculative and unsupported by the facts should not have the opportunity to present such opinion to a jury who, because of the expert’s purported status in his field, may tend to impart credence to the expert’s words.
¶4 First, I will address the res ipsa loquitur issue, upon which Appellant’s entire case is premised. Initially, I conclude that Appellant failed to present sufficient evidence to sustain a cause of action even based on res ipsa and, therefore, the trial court did not err by granting summary judgment in Appellee’s favor pursuant to Pa.R.C.P. 1035.2(2).
¶ 5 In note 3 of its opinion, the majority indicates that, at oral argument on the summary judgment motion, the parties discussed the application of res ipsa loqui-tur in the instant case and Appellee noted that Dr. Austin’s “whole opinion was res *985ipsa, so to speak.” Majority Opinion at n. 3 (citing N.T. Oral Argument, 7/10/02, at 22). The majority then dismisses the res ipsa issue by stating that “Appellant has not pursued a res ipsa claim.” Id. at n. 3. Similarly, on page 983 of its opinion, the majority indicates that the disciplinary action taken against Dr. Austin by the American Association of Neurological Surgeons (AANS) involved a medical malpractice case that “bordered on a res ipsa claim, as does his testimony here.” Id. at 983.
¶ 6 I respectfully disagree with the majority’s characterization of res ipsa as a “claim.” “Res ipsa loquitur is neither a doctrine of substantive law nor a theory of recovery; rather, it is a rule of circumstantial evidence.” Toogood v. Rogal, 573 Pa. 245, 824 A.2d 1140, 1146 (2003). Appellant’s case is, in fact, based entirely on res ipsa, as there is no direct evidence of negligence and Dr. Austin’s opinion, as further described below, proceeds on the assumption that Appellee must have been negligent in performance of the surgery merely because there is, in his opinion, no other explanation for Appellant’s symptoms.
¶ 7 Our Supreme Court recently revisited the res ipsa doctrine vis-a-vis medical malpractice litigation in Toogood. As noted in Toogood, a medical malpractice plaintiff must “establish a duty owed by the physician to the patient, a breach of that duty by the physician, that the breach was the proximate cause of the harm suffered, and the damages suffered were a direct result of the harm.” Id. at 1145 (quoting Hightower-Warren v. Silk, 548 Pa. 459, 698 A.2d 52, 54 (1997)). In a medical malpractice case, the alleged negligence of the physician “encompasses matters not within the ordinary knowledge and experience of laypersons,” so the plaintiff must “present expert testimony to establish the applicable standard of care, the deviation from that standard, causation and the extent of the injury.” Id. In other words, the plaintiff must present expert testimony to “establish that the care and treatment of the plaintiff by the defendant fell short of the required standard of care and that the breach proximately caused the plaintiffs injury.” Id. See also Checchio v. Frankford Hasp., 717 A.2d 1058, 1060 (Pa.Super.1998) (“Where the alleged negligence is medical in nature, the plaintiff must present evidence from an expert ‘who will testify, to a reasonable degree of medical certainty, that the acts of the physician deviated from good and acceptable medical standards, and that such deviation was the proximate cause of the harm suffered.’ ” (citation omitted)).
¶ 8 The narrow exception to the expert testimony requirement is conceptualized as the doctrine of res ipsa in which “the matter is so simple or the lack of skill or care so obvious as to be within the range of experience and comprehension of even non-professional persons.” Id. (quoting Hightower-Warren, 698 A.2d at 54 n. 1). As further defined in Toogood:
The doctrine of res ipsa loquitur allows plaintiffs, without direct evidence of the elements of negligence, to present their case to the jury based on an inference of negligence. The key to the doctrine is that a sufficient fund of common knowledge exists within a jury of laypersons to justify raising the inference. Instead of directly proving the elements of ordinary negligence, the plaintiff provides evidence of facts and circumstances surrounding his injury that make the inference of the defendant’s negligence reasonable. “The gist of res ipsa loquitur ... is the inference, or process of reasoning by which the conclusion is reached. This must be based upon the evidence given, together with a sufficient background of human experi*986ence to justify the conclusion. It is not enough that plaintiffs counsel can suggest a possibility of negligence.” Pros-ser & Keeton, The Law of Torts § 39, p. 243 (5th ed.1995). This theory relieves the plaintiff of having to prove causation directly.
Toogood at 1146. However, the doctrine of res ipsa may be applied even in cases where the plaintiff presents an expert, but still requires the inference of negligence to make her case. In Jones v. Harrisburg Polyclinic Hasp., 496 Pa. 465, 437 A.2d 1134 (1981), our Supreme Court stated that there are “two avenues to avoid the production of direct medical evidence of the facts establishing liability.” Toogood at 1148 (quoting Jones, 437 A.2d at 1138). First, as described above, the plaintiff may rely on “common lay knowledge that the event would not have occurred without negligence.” Id. (quoting Jones, 437 A.2d at 1138). In such instances, a conclusion may be drawn based on general knowledge of the layperson, similar to instances where a court takes judicial notice of a fact. Id. (citing Restatement Of ToRts (Second), § 328D, cmt. d (1965)). Second, the plaintiff may rely on expert medical knowledge that an event usually does not occur without negligence in cases where there is no fund of common knowledge which may permit laymen reasonably to draw the conclusion. Id.
¶ 9 In Toogood, our Supreme Court emphasized the critical role of expert testimony in establishing the elements of negligence in medical malpractice cases, thereby limiting the application of res ipsa in such cases. See id. at 1149. The Court stated, inter alia, that “to say whether a particular error on the part of a physician reflects negligence demands a complete understanding of the procedure the doctor is performing and the responsibilities upon him at the moment of injury.” Id. at 1149. The Court further stated that “[t]he cause and effect of a physical condition lies in a field of knowledge in which only a medical expert can give a competent opinion.... [Without experts] we feel that the jury could have no basis other than conjecture, surmise or speculation upon which to consider causation.” Id. (quoting Woods v. Brumlop, 71 N.M. 221, 377 P.2d 520, 523 (1962)).
¶ 10 After providing a detailed explanation of res ipsa and concluding that its application must be limited in medical malpractice cases, our Supreme Court refined the traditional three-prong test that must be met before a plaintiff may invoke res ipsa in a medical malpractice ease:
(a) either a lay person is able to determine as a matter of common knowledge, or an expert testifies, that the result which has occurred does not ordinarily occur in the absence of negligence; (b) the agent or instrumentality causing the harm was within the exclusive control of the defendant; and (c) the evidence offered is sufficient to remove the causation question from the realm of conjecture, but not so substantial that it provides a full and complete explanation of the event. It is only when each of the three conditions is satisfied that an inference of negligence can be drawn from the occurrence of an injurious event.
Id. at 1150 (sometimes hereinafter referred to as “Toogood test”). Prong (c) of the Toogood test is similar to the second prong of the traditional res ipsa test set forth in section 328D(l)(b) of the Restatement (Second) of Torts, which states that an inference of negligence is established when, inter alia, “other responsible causes, including the conduct of the plaintiff and third persons, are sufficiently eliminated by the evidence.”10 See Gran-*987delli, 111 A.2d at 1147 (emphasis added). In my view, and as I describe more fully below, Dr. Austin’s opinion fails to remove the question of causation from the realm of conjecture, and thereby fails to meet the requirement of prong (c) of the Toogood test or the second prong of the traditional res ipsa test.
¶ 11 Of course, a plaintiff in a medical malpractice case need not disprove all other causes of the injury beyond a reasonable doubt; however, the plaintiff must prove that the alleged negligence is the more probable explanation for the injury. Magette v. Goodman, 771 A.2d 775, 779 (Pa.Super.2001). In Magette, we concluded that the plaintiff (who was the administrator of the decedent’s estate) failed to establish the second prong of the traditional res ipsa test such that the issue of res ipsa, i.e., the inference of negligence in the absence of direct evidence, could be submitted to the jury. Specifically, the decedent suffered cardiac arrest and death while under general anesthesia during back surgery. We agreed with the trial court that the plaintiffs expert’s testimony did not sufficiently eliminate possible causes of the decedent’s death other than the defendant’s negligence (i.e., the evidence did not establish that the defendant’s negligence more likely than not caused the decedent’s death) even though the expert testified that, based on the autopsy results, he ruled out three other reasons that could have caused the decedent’s death, specifically, pulmonary embolism, air embolism, and myocardial infarction. Id. We further recognized that the defendant’s evidence “thoroughly rebutted” the plaintiffs expert’s testimony and that the plaintiff failed to challenge the defendant’s rebuttal evidence in any significant fashion. Id. In all, we concluded that the plaintiffs expert’s testimony failed to sufficiently eliminate other possible causes of the decedent’s death.
¶ 12 In the instant case, although Dr. Austin testified that the symptoms Appellant complained of after surgery do not occur absent negligence, see Deposition of Donald C. Austin, MD, 4/16/02, at 189 (hereinafter Dr. Austin’s Deposition), he failed to sufficiently eliminate other possible causes of Appellant’s complaints and thereby failed to remove the question of causation from the realm of speculation and conjecture.
¶ 13 Dr. Austin’s opinion is premised on the fallacious logic of post hoe ergo propter hoc, which translates from Latin into “after this, therefore because of this.” BlacK’s Law Dictionaey 1186 (7th ed.1999). Post hoe describes “the fallacy of assuming causality from temporal sequence; confusing sequence with consequence.” Id. Dr. Austin’s opinion boils down to the bald conclusion that, merely because Appellant had certain alleged injuries approximately two weeks after the surgery performed by Appellee, such alleged injuries must have been caused by Appellee’s negligent performance of the surgery. Consider the following excerpt from Dr. Austin’s deposition testimony:
[Appellee’s attorney]: ... Now, if I understand what you’ve told us in your direct testimony, you’ve concluded that because Mrs. Haney suffered a nerve injury sometime subsequent — being reported sometime subsequent to the operation that [Appellee] performed, that the surgery must have been performed negligently—
*988[Dr. Austin]: Yes.
[Appellee’s attorney]: — isn’t that your conclusion? ■
[Dr. Austin]: Yes, it is.
Dr. Austin’s Deposition at 169. This is a striking example of Dr. Austin’s reliance on faulty logic. Moreover, although Dr. Austin purported to eliminate all other causes of Appellant’s alleged injury, he fails to indicate or describe even in the slightest degree in his report what other potential causes he explored and eliminated. See Magette, 771 A.2d at 779. Accordingly, Appellant has failed to present evidence sufficient to remove the question of causation from the realm of conjecture or, in other words, Appellant has failed to present evidence that sufficiently eliminates other responsible causes of her alleged injuries. See Toogood at 1150; Grandelli 777 A.2d at 1147; Restatement Op ToRts (Second) § 328D(l)(b) (1965). For these reasons, Appellant cannot properly invoke res ipsa to create the inference of negligence and, in turn, she cannot establish a prima facie case of negligence against Appellee. Summary judgment on this basis is, therefore, appropriate.
¶ 14 Dr. Austin’s proffered opinion is troubling also because it is based on facts not warranted by the record but is, rather, based on mere assumptions. It is well settled that “an expert cannot base an opinion on facts which are not warranted by the record.” Kelly v. St. Mary Hosp., 778 A.2d 1224, 1227 (Pa.Super.2001) (concluding trial court properly prevented plaintiffs expert from testifying about facts outside the record). Furthermore, “[n]o matter how skilled or experienced the [expert] witness may be, he will not be permitted to guess or to state a judgment based on mere conjecture.” Kovach v. Central Trucking, Inc., 808 A.2d 958, 959 (Pa.Super.2002) (citation omitted).
¶ 15 Appellant asserts throughout her brief that Appellee deviated from the standard of care by “cutting the dura and associated structures during surgery and, in the process, ‘impacted’ the S2, S3 and S4 nerve[s].” Appellant’s brief at 6 (emphasis added). More specifically, Appellant asserts that Appellee tore the dura and “passed the arachnoid sheath ” thereby causing injury to the sacral nerves. See, e.g., id. at 7, 9 (emphasis added). Appellee indicated in his post operative note that the dura was torn during the surgery and repaired without incident. Indeed, Dr. Austin admitted that the tearing of the dura is a common occurrence, especially if the site had been subject to previous surgery, as in this case. However, there was no indication in the operative note or otherwise, that Appellee tore, cut, or “passed through” the arachnoid sheath. Dr. Austin admitted that Appellee’s operative note did not indicate such an injury, but for purposes of his expert opinion, he assumed that Appellee did “pass through” the arachnoid sheath. The following excerpts from Dr. Austin’s deposition are illustrative:
[Appellee’s attorney]: Doctor, would you agree with me that the primary closure of a dural tear is the most ideal way to repair it?
[Dr. Austin]: Yes.
[Appellee’s attorney]: And would you agree with me, sir, that in addition to the dura surrounding the nerves as they run out below the spinal cord, there’s also a sheath called the arachnoid sheath?
[Dr. Austin]: Yes.
[Appellee’s attorney]: And [Appellee] doesn’t indicate in his operative note that he’s cut the arachnoid sheath, did he?
* *
*989[Dr. Austin]: He doesn’t describe anything. That’s the problem.
[Appellee’s attorney]: Well, he does describe, sir, that he cut the dura; correct?
[Dr. Austin]: Right.
[Appellee’s attorney]: He does not say that he cut the arachnoid sheath, did he?
[Dr. Austin]: No he didn’t say that.
[Appellee’s attorney]: Okay. And in order for there to be leakage of spinal fluid and in order for there to have been damage by [Appellee] to the nerves directly from him cutting down, as you said, with these instruments, he would have had to have gone through the arachnoid sheath as well, would he have not?
[Dr. Austin]: Yes, but we don’t know that he didn’t.
Dr. Austin’s Deposition at 181-182 (emphasis added). Consider also the following excerpt:
[Appellee’s attorney]: So I just want to make sure that I understand your opinions in this case. And I think I understand them to be that because there was no other evidence of a cause of Mrs. Haney’s complaints, it had to have been as a result of the surgery [Appellee] performed?
[Dr. Austin]: Yes.
[Appellee’s attorney]: And that as a result of that, you suspect, although it’s not in his operative note, that he went beyond tearing the dura, passed the arachnoid sheath and injured the nerves?
[Dr. Austin]: Yes. There’s absolutely no other other [sic] explanation.
Id. at 198.
¶ 16 Dr. Austin admitted that he had no direct evidence to believe that Appellee would try to hide the fact that he cut the arachnoid sheath, if he did indeed do so. Id. at 183. Nevertheless, it is clear that Dr. Austin’s opinion relied on the assumption that Appellee “passed through the arachnoid sheath” — a “fact” that is wholly unsupported by the record. See Kelly, 778 A.2d at 1227. The trial court properly excluded Dr. Austin’s opinion on this basis. See id.11
¶ 17 Also of particular concern is Dr. Austin’s admission that his opinion in the instant case is based on the same premise he used to formulate an opinion in an Illinois case in which he testified as a plaintiffs expert, Patricia Ayers, et al. v. Michael Ditmore, M.D., and for which he was subsequently disciplined by the American Association of Neurological Surgeons (AANS). Patricia Ayers, the plaintiff therein, suffered permanent laryngeal nerve injury after Dr. Ditmore performed surgery on the cervical, or neck, area of her spine. In that case, Dr. Austin opined that Dr. Ditmore must have been negligent in performing the cervical surgery because Ms. Ayers’s subsequent laryngeal nerve injury was permanent. See Report of the Professional Conduct Committee of the American Association of Neurological Surgeons [AANS Report], 10/15/95, at 8, 5. He further opined that Dr. Ditmore must have “rushed” the surgery, although there was no evidence to support this assumption. See Austin v. American Assoc. of Neurological Surgeons, 253 F.3d 967, 970 (7th Cir.2001). The jury returned a verdict for Dr. Ditmore. Id.
*990¶ 18 Dr. Ditmore subsequently brought a disciplinary action against Dr. Austin before the AANS. The AANS disciplinary committee concluded that there was “no convincing basis in either literature or logic for [Dr. Austin’s] testimony that permanence of a recurrent laryngeal nerve injury establishes surgical negligence as its cause.” AANS Report at 5. Dr. Austin received a six month suspension from the AANS as a result of his testimony, which the disciplinary committee described as “particularly egregious.” Id.
¶ 19 Dr. Austin sued the AANS, claiming their suspension was retaliatory, violated his due process rights, and resulted in a decrease in his expert-witness income. See Austin, 253 F.3d at 968. After the federal district court granted summary judgment in favor of the AANS, Dr. Austin appealed to the United States Court of Appeals for the Seventh Circuit. In an opinion written by the Honorable Richard Posner, the Seventh Circuit affirmed the trial court’s grant of summary judgment. See id. The Court noted that the AANS rejected Dr. Austin’s opinion in the Ayers case as the view of the majority of neurosurgeons in the country. See id. at 971. The Court further found no basis in literature for Dr. Austin’s “unorthodox” and “irresponsible” opinion and indicated that his opinion, if accepted, would make “the surgeon an insurer against any serious mishaps in an anterior cervical fusion, [and] make the operation exceptionally risky in a financial or liability sense for the surgeon.” Id. Judge Posner wrote:
By becoming a member of the prestigious [AANS] ... Austin boosted his credibility as an expert witness. The Association had an interest — the community at large had an interest — in Austin’s not being able to use his membership to dazzle judges and juries and deflect the close and skeptical scrutiny that shoddy testimony deserves. It is no answer that judges can be trusted to keep out such testimony. Judges are not experts in any field except law_Judges need the help of professional associations in screening experts.
Id. at 972-73. Judge Posner opined that, if Dr. Austin’s “testimony [in the Ayers ] trial was a type of medical service and if the quality of his testimony reflected the quality of his medical judgment, he is probably a poor physician.” Id. at 974.
¶ 20 Judge Posner recognized that the federal courts employ Daubert to screen proposed expert witnesses to ensure that their testimony is reliable, but noted that only federal courts are bound by Daubert. Id. at 973. Indeed, Pennsylvania has not officially adopted the Daubert standards of admissibility and now, with the decision in Track enunciating the limited applicability of Frye, trial courts are left with little guidance in determining the reliability and, hence, admissibility of expert testimony.
¶ 21 Nevertheless, despite the inapplicability of Frye in the instant case, we must preserve the trial court’s broad discretion in determining whether to admit or exclude expert testimony. In addition to the reasons stated above with regard to why the trial court did not err in excluding Dr. Austin’s testimony, I further note that Dr. Austin expressly admitted, in his deposition, that he relied on the same premise in reaching his opinion in the instant case as he used in reaching his opinion in the Ayers case — an opinion that was harshly criticized by his peers and the federal courts. Specifically, he testified as follows:
[Appellee’s attorney]: In [the Ayers ] case ... your opinion was that when the patient underwent cervical surgery to the cervical area of her spine, she suffered a permanent laryngeal nerve injury; correct?
[Dr. Austin]: Yes, I did.
*991[Appellee’s attorney]: And you testified that she suffered a permanent laryngeal nerve injury so, therefore, the surgery that was performed must have been performed negligently?
[Dr. Austin]: Yes.
[Appellee’s attorney]: Isn’t that the same basis or the same premise for your opinion here today? Different levels of the spine, but same premise?
[Dr. Austin]: Yes, the same premise. Dr. Austin’s Deposition at 195. Dr. Austin employed the same faulty post hoc ergo propter hoc logic in the Ayers case as he is employing in the instant case.
¶ 22 In sum, the unreliability and insufficiency of Dr. Austin’s opinion necessary to invoke res ipsa transcends the inapplicability of Frye. A myriad of reasons exist upon which the trial court properly precluded Dr. Austin’s testimony. Essentially, there is no factual basis for Dr. Austin’s opinion, which, if admitted, would only have the effect of making Appellee a guarantor of perfect health. Dr. Austin’s expert opinion provides “no basis other than conjecture, surmise or speculation upon which to consider causation.” See Toogood at 1149 (quoting Woods, 377 P.2d at 523). If we permitted such irresponsible testimony, “few would be courageous enough to practice the healing art, for they would have to assume financial liability for nearly all the ‘ills that flesh is heir to.’” Id. at 1151 (citation omitted). Even where Frye is inapplicable because no novel scientific evidence is proffered by the proposed expert, the trial court still must retain its broad discretion regarding the admissibility of evidence, and the trial court must be able to exclude expert opinions that are unreliable, speculative, and/or unsound and that fail to meet the same level of intellectual rigor characterized by other professionals in the relevant field of practice. See, e.g., Black v. Food Lion, Inc., 171 F.3d 308, 311-312 (5th Cir.1999) (indicating that trial judge has broad discretion to employ some or all of Daubert factors, or even other factors not enunciated in Daubert, as appropriate to facts of specific case in order to ensure overarching goal of scientific reliability of expert testimony).
1123 For these reasons, I would affirm the grant of summary judgment on the basis of Pa.R.C.P. 1035.2(2), since the necessary quantum of causation evidence is lacking in light of Dr. Austin’s unreliable opinion.

. “It is well settled that where the result is correct, an appellate court may affirm a lower court’s decision on any ground without regard to the ground relied upon by the lower court itself.” Boyer v. Walker, 714 A.2d 458, 463 n. 10 (Pa.Super.1998) (affirming trial court order granting summary judgment).

. The first prong of the res ipsa test in the Restatement is "the event is of a kind which *987ordinarily does not occur in the absence of negligence,” and the third prong is “the indicated negligence is within the scope of the defendant's duty to the plaintiff.” Restatement Of Torts (Second) § 328D(l)(a) & (c) (1965). These mirror prongs (a) and (b), respectively, of the Toogood test.

. The majority admits that Dr. Austin’s opinion is not supported by the facts of record. See Majority Opinion at 983.