Court Opinion

ID: 9786264
Source: CourtListenerOpinion
Date Created: 2023-08-30 23:51:59.026872+00
Date Added: 2024-06-11T07:36:43.601645
License: Public Domain

ARMSTRONG, J.,
concurring in part, dissenting in part.
The majority concludes that the trial court properly excluded plaintiffs proffered expert evidence on medical causation because the evidence did not meet the standard for its admission. I respectfully disagree with that conclusion. Although the question is close, I believe that the evidence was admissible and that the trial court erred in excluding it.
Plaintiffs expert, Dr. Williamson, diagnosed plaintiff as suffering from Raynaud’s syndrome in her left hand. Raynaud’s syndrome is a condition in which arteries in the hand become unduly constricted when the hand is exposed to cold. There is no dispute that plaintiff established an adequate foundation for Williamson to testify that plaintiff suffers from that condition. The dispute concerns the adequacy of the foundation for Williamson to give his opinion about the cause of the condition in plaintiffs left hand.
Williamson testified that, in his opinion, an extravasation of gadolinium that occurred in plaintiffs left hand during an MRI that she received from defendants was a substantial causal factor in her development of Raynaud’s syndrome in her left hand. He identified a number of factors that led him to that conclusion. They were, first, the temporal relationship between the extravasation of gadolinium and the development of Raynaud’s syndrome in plaintiffs left hand; second, that plaintiff had Raynaud’s syndrome in only her left hand when most conditions associated with the development of the syndrome cause people to have the syndrome in both hands; third, that gadolinium was shown in a study involving mice to be toxic to tissue, that is, to kill tissue, when exposed to tissue outside of blood vessels; and, fourth, that tests and studies involving plaintiff had led him to rule out *194all known conditions associated with the development of Raynaud’s syndrome in people.
It is important to note, as well, that Williamson is a well-regarded member of a medical research team at Oregon Health and Science University that may be the most experienced and knowledgeable team in the world about Raynaud’s syndrome and other vasospastic disorders. As a member of that team, he applied scientific knowledge and techniques to reach a scientific conclusion about the causal contribution of the extravasation of gadolinium in plaintiffs left hand to the development of Raynaud’s syndrome in that hand.
Nevertheless, the majority concludes that the trial court properly excluded Williamson’s testimony about the scientific conclusion that he had reached about the cause of plaintiffs condition because his testimony failed to meet the standard established in State v. Brown, 297 Or 404, 687 P2d 751 (1984), and State v. O’Key, 321 Or 285, 899 P2d 663 (1995), for the admission of scientific evidence. That standard requires a court to determine whether proffered scientific evidence is based on "scientifically valid” principles, that is, whether the evidence is legitimately scientific, and to exclude evidence that lacks such a basis.
In reaching its conclusion, the majority principally relies on distinctions that it sees between the excluded evidence in this case and the scientific evidence that the Oregon Supreme Court held to be admissible in Jennings v. Baxter Healthcare Corp., 331 Or 285, 14 P3d 596 (2000). With respect, the distinctions that the majority sees are not scientifically significant distinctions. Moreover, the majority’s focus loses sight of the core feature of science, which is falsifiability. Both the excluded evidence in this case and the evidence that the court held admissible in Jennings involve scientific conclusions that can be shown to be false using recognized scientific techniques. The evidence in both cases is equally scientific.
The core distinction — in fact, the only distinction— that the majority sees between the evidence in this case and the evidence in Jennings is the basis on which the two experts placed a disputed causal factor into their differential diagnoses of the plaintiffs’ conditions. The condition in *195Jennings was said to be a unique combination of neurological problems involving the inner ear and a loss of sensation in fingers and toes. The plaintiffs expert in Jennings, Dr. Grimm, put silicone breast implants into his differential diagnosis as a potential cause of that condition. He did so based on the fact that he had found the same condition in 43 women whom he had examined in his practice who had had silicone breast implants. In other words, he included silicone breast implants in his differential diagnosis as a cause of plaintiffs condition on the basis of 43 cases. Here, in contrast, Williamson put gadolinium extravasation into his differential diagnosis as a cause of Raynaud’s syndrome in plaintiffs left hand on the basis of one case, plaintiffs.
In the majority’s view, approximately 50 cases in which Grimm found a “unique pattern” of neurological conditions in women with silicone breast implants made it scientifically appropriate for Grimm to include silicone breast implants in his differential diagnosis as a cause of the condition. Because Williamson had only a single case of a person with Raynaud’s syndrome that arose in a hand soon after the person had experienced an episode of gadolinium extravasation in the hand, the majority reasons that it was not scientifically appropriate for Williamson to include gadolinium extravasation in his differential diagnosis as a cause of the condition. While the difference in number, 43 cases versus one, seems intuitively significant, it is not scientifically significant.
As the court recognized in Jennings, case reports can play an important role in establishing a cause of a condition, but they must be used with caution:
“An opinion [on causation] drawn from only case reports can be troublesome, because it involves post hoc, ergo propter hoc (after this, therefore because of this) reasoning:
“ ‘[S]ome children who live near power lines develop leukemia; but does exposure to electrical and magnetic fields cause this disease? The anecdotal evidence is not compelling because leukemia also occurs among children who have minimal exposure to such fields. It is necessary to compare disease rates among those who are exposed and those who are not. If exposure causes the *196disease, [then] the rate should be higher among the exposed, lower among the unexposed.’ ”
331 Or at 306 (citation omitted).
“ ‘However, case reports are often all that is available on a particular subject because they usually do not require substantial, if any, funding to accomplish, and human exposure may be rare and difficult to study. Causal attribution based on case studies must be regarded with caution. However, such studies may be carefully considered in light of other information available, including toxicological data.’ ”
Id. (citation omitted; emphasis in original).
The Jennings court ultimately concluded that Grimm’s reliance on case reports to put silicone breast implants into his differential diagnosis as a cause of the plaintiffs condition was acceptable because the hypothesis that he derived from the reports could be shown to be false:
“Any scientist can check Grimm’s testing methods and the clinical history of each of his patients [to determine whether they had the neurological conditions that Grimm identified and had had silicone breast implants]. Moreover, Grimm’s results also can be tested (another neurologist could test women with silicone breast implants to see if they had the same neurological conditions identified by Grimm). Grimm’s hypothesis is capable of being falsified; that is, evidence may be introduced to disprove his hypothesis. See O’Key, 321 Or at 303 (science is based on testing hypotheses to see if they can be falsified).”
Id. at 307.
The same scientific principles apply to Williamson’s reliance on a case report to put gadolinium extravasation into his differential diagnosis as a cause of plaintiffs condition. Scientists can check Williamson’s testing methods and plaintiffs clinical history to determine whether plaintiff suffers from Raynaud’s syndrome in only her left hand and whether the condition arose soon after the gadolinium extravasation episode. In fact, on cross-examination during the OEC 104 hearing in this case, one of the defendants sought to establish that plaintiff suffered restricted blood flow in arteries in both of her hands.
*197Williamson’s hypothesis also can be falsified by evidence about the physiological processes by which arteries in the hand constrict or go into vasospasm. According to the record, there currently are various hypotheses about why arteries constrict in the manner that causes Raynaud’s syndrome. One hypothesis is “that there is some type of malfunction within the vessel or the vessel wall” of the arteries that causes them to constrict. Another is that interference with the sympathetic and parasympathetic nerves in the hand can cause or contribute to the constriction seen in Raynaud’s syndrome. If evidence is developed that establishes that the first hypothesis is correct and the second is not, then that evidence presumably would undermine if not render false the hypothesis that led Williamson to put gadolinium extravasation into his differential diagnosis, because it relied on a study involving the death of tissue outside the walls of blood vessels from gadolinium that had been placed outside the vessels. In fact, one of the defendants sought on cross-examination to get Williamson to agree that nerve impairment was no longer considered to be a cause of the type of vasospasm seen in Raynaud’s syndrome.
Although it may be less likely that epidemiological evidence could be developed to disprove the hypothesis in this case than it could to disprove the one in Jennings, that should not make a difference to the admissibility of the evidence. Grimm’s hypothesis was new and untested, which means that there were no extant epidemiological studies or evidence on the causal relationship between silicone breast implants and the neurological conditions that Grimm had identified. Epidemiological evidence could, in theory, be developed to disprove the hypotheses in both cases, which means that the hypotheses meet the “falsifiability’ standard that scientific evidence must meet.
As I noted at the outset, and as the majority recognizes, the admissibility question in this case is close. I believe, however, that we must err in favor of admitting scientific evidence that meets the criterion that the relevant scientific community would consider to be valid evidence. I am confident that the disputed scientific evidence in this case *198meets that standard and that the trial court erred in excluding it.1
Because of my conclusion about the admissibility of Williamson’s opinion about the causal contribution of the gadolinium extravasation episode to the development of Raynaud’s syndrome in plaintiffs left hand, I also disagree with the majoritys decision to affirm the grant of a directed verdict on plaintiffs informed consent claim. I believe that it should be reversed as well. I agree, however, with the majoritys disposition of the remaining assignments of error.

 The majority contends that I fail to recognize that Brown and O’Key require more than abstract falsifiability in order to satisfy the foundation for admission of scientific evidence. 215 Or App at 189 n 12. The majority misunderstands my position. A court properly can reject a scientific hypothesis that has been established to be false, e.g., that the sun and planets revolve around the earth. However, a court should not reject a hypothesis of a preeminent medical expert that is based on recognized scientific techniques, that is not inconsistent with current scientific knowledge, and that can be falsified. Williamson’s opinion about the cause of Kaynaud’s syndrome in plaintiff’s left hand is such a hypothesis.