Plaintiffs, Kathian Marie López-Concepción and Lenymar López-Concepción sought to recover damages for the alleged wrongful death of their late father, Angel I. López-Diaz in this medical malpractice action.
Plaintiffs alleged in their complaint that the medical treatment and care provided by CMC, Dr. Benny Nieves Matias, Dr. Iolani Garcia Rosario, and Dr. Cristina I. Ortiz Garcia deviated from the standards of care of the medical professional community and was the cause of the death of Ángel I. López Díaz, after he received treatment and care for what turned out to be ingestion of a toxic substance.
The Defendants jointly moved in limine to exclude the testimony of Plaintiffs’ expert witness, Dr. Edwin Miranda-Aponte (hereinafter “Dr. Miranda”), pursuant to Rule 702 and Daubert V. Merrell Dow Pharmaceuticals (92-102), 509 U.S. 579 (1993).
Plaintiffs, in turn, requested the exclusion of two experts announced, respectively, by Co-Defendants Dr. Cristina Ortiz-García and Dr. Iolani García-Rosario: Drs. Wilfredo Nieves-Colomer (“Dr. Nieves”) and Alvaro Reymunde (“Dr. Reymunde”).
Emergency Medicine Expert Witnesses
Edwin Miranda-Aponte is a licensed Specialist in Emergency Medicine with over 36 years of professional experience in Direct Care, Administrative, Operations Management, Aero-Medical Transport, and Academic Medicine. From 1983 through 2019, he held an unrestricted current permanent license to Practice Medicine and Surgery issued by the Puerto Rico Board of Medical Examiners. His Curriculum Vitae shows that he worked as an emergency room physician from 1994 through 2018 at Centro Médico. For a span of 8 years, he was the emergency room director at that same institution (2001-2009). Miranda was also a Professor at the University of Puerto Rico School of Medicine during the years 1983 through 1994.
Wilfredo Nieves Colomer, MD is an emergency medicine specialist in Carolina and has over 37 years of experience in the medical field. He graduated from Ponce Health Sciences University School of Medicine in 1986.
Gastroenterology Expert Witness
Alvaro Reymunde, MD is a gastroenterologist in Ponce, PR and has over 40 years of experience in the medical field. He graduated from University Central Del Este in 1983. He
Discussion by the Court
Edwin Miranda-Aponte
Defendants argued that Miranda is unqualified to render reliable testimony because he is not a toxicology expert and never treated a glyphosate poisoning while working as an emergency room physician.
Defendants’ contention that he is not qualified because his medical training is limited to the “basic medical training as a General Practitioner” with no academic background or medical experience in toxicology, misses the mark considering his ample experience as an emergency room physician and emergency room director.
The Court held that Miranda does not need to be an expert in toxicology to render an opinion regarding the treatment of López at CMC’s emergency room for ingesting a poisonous substance. Even more so when the allegations in this case all relate to treatment of López in the emergency room, as he was allegedly never admitted to the regular ward or the intensive care unit.
Even though Miranda affirmed in his deposition that he never treated a patient with glyphosate poisoning, his expertise as an emergency room physician qualifies him to testify on whether the Defendants failed to abide by the accepted standards of care in managing López’s condition at the emergency room.
The Court added that the admission of Miranda’s testimony does not prevent Defendants from presenting their own expert to refute his opinion at trial, or from confronting him through cross examination with matters that go to credibility or the weight, if any, that the jury will assign to his opinions. Moreover, Plaintiffs also challenged Miranda’s qualifications because his medical license was expired when he rendered his report. Miranda retired from the practice of medicine in 2018 and his license expired in 2022. However, Plaintiffs have not explained how the expiration of Miranda’s license undermines his credibility or makes his testimony unreliable.
Benny Nieves Matias
Nieves’ report stated that he was asked to review the medical record of López with particular attention to the care provided by Ortiz at CMC’s emergency department in February 2020.
Because there was no list of his qualifications; no mention of other cases where he has testified; and no statement of the compensation he received for the study and testimony in the case, the Court held that Nieves’ three-page report did not fulfill the requirements of Rule 26(a)(2)(B). Moreover, Nieves’ report did not reference any additional data, medical literature, or treatises that he reviewed or considered.
When Nieves stated that the intervention of Cristina Ortiz García with Angel I. López Díaz at the emergency department at Caribbean Hospital on February 27, 2020, was adequate, that Court held that Nieves’ input offered little that could not be obtained from the medical records. The report did not identify a national standard of care, nor did it state how Ortiz adhered to that standard of care. Moreover, Plaintiffs deemed Nieves’ conclusions as ipse dixit.
In conclusion, the report did not guide the Court through Nieves’ analytical process to reach the conclusion that no standard of care was breached.
Alvaro Reymunde
To begin with, Reymunde opined that the mechanism that is triggered with the poison ingestion (“oxidative stress”) was already damaging López’s organs when he was admitted to the emergency room. And that there was nothing the doctors could have done because there’s no antidote for ingesting glyphosates. In fact, he categorically stated that other treatments that could have been attempted, such as dialysis, would have been futile because “the damage was already done.”
Like Nieves’ expert report, Reymunde’s did not comply with all the requisites of Fed. R. Civ. P. 26(a)(2)(B). Also, the report was also missing any reference to medical literature and standards of care. Reymunde admittedly based his opinion on his vast experience but his report, however, does not delve into how his experience led to the conclusions he reached.
Regarding García-Rosario’s care, he states that her decisions and medical criteria did not deviate from the standards of medical practice since she was in constant contact with the in-house physicians even when she wasn’t there in person to check on the patient.
The Court held that Reymunde’s conclusory opinion that nothing could be done by the medical personnel at CMC is not supported by an explanation of the principles and methods he used to arrive at it. Likewise, the Court is left to guess how he estimated the amount of glyphosate López consumed, and the time elapsed between the ingestion of the poison and the arrival at the emergency room.
Held
In conclusion, the Court denied the Defendants’ motion to exclude the testimony of Plaintiffs’ expert witness, Dr. Edwin Miranda-Aponte but granted the motion as to the exclusion of the reports and testimonies of Benny Nieves Matias and Alvaro Reymunde.
Key Takeaways:
- If Nieves was relying solely or primarily on his own experience, he was required to “explain how that experience leads to the conclusion reached, why that experience is a sufficient basis for the opinion, and how that experience is reliably applied to the facts.”
- Concerning the standards of care, Reymunde did not enunciate what that standard is or why he understands that García-Rosario’s actions or medical decisions had no bearing on the outcome of López’ health condition. The Court is left to wonder what the reasoning or the methodology are underlying his conclusions and whether they are scientifically valid and applicable to the facts in issue. An expert’s opinion “must be supported by appropriate validation” and rely on “more than subjective belief or unsupported speculation.”
Case Details:
| Case Caption: | Lopez-Concepcion Et Al V. Caribe Physicians Plaza Corporation Et Al |
| Docket Number: | 3:21cv1360 |
| Court: | United States District Court, Puerto Rico |
| Order Date: | August 07, 2024 |
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