Expert Witness Profiler

Tag: Medical

  • Digital Forensics Expert Not Allowed to Opine on Driver Behavior

    Digital Forensics Expert Not Allowed to Opine on Driver Behavior

    This litigation arises from a motor vehicle accident that occurred during the early morning hours of May 10, 2023, on Interstate 20 in Bienville Parish, Louisiana. Ja’Vel Coleman alleged that she sustained injuries when her vehicle struck the rear of a tractor-trailer operated by Saint Fleur.

    According to Defendants, Saint Fleur experienced mechanical issues with his tractor-trailer and pulled onto the shoulder of Interstate 20 prior to the collision.

    During discovery, Defendants retained Dr. Douglas C. Brown and Josh Lorencz.

    Brown examined Coleman on January 15, 2026, and subsequently issued an expert report setting forth his findings and opinions while Lorencz reviewed AT&T Call Detail Records and identified calls and text messages associated with the phone number, the times of those communications, and the cell towers used during those communications.

    Coleman sought to exclude, or alternatively limit, the testimony of Dr. Douglas C. Brown and Josh Lorencz under Federal Rule of Evidence 702 and the Daubert standard.

    Orthopedic Surgery Expert Witness

    Dr. Douglas Coleman Brown has been in private practice in North Louisiana since 1977 and is certified by the American Board of Orthopaedic Surgery and the American Board of Independent Medical Examiners. He also is a member of the American Orthopaedic Foot and Ankle Society.

    Want to know more about the challenges Douglas Brown has faced? Get the full details with our Challenge Study report.

    Digital Forensics Expert Witness

    Josh Lorencz possesses substantial training and experience in the field of cell phone forensics. He spent approximately sixteen years with the Simi Valley Police Department working as a detective and police officer and then subsequently worked in digital forensics for Envista Forensics before joining Rimkus.

    Lorencz has several certifications in digital forensics and has performed numerous digital analyses of this kind. 

    Discover more cases with Josh Lorencz as an expert witness by ordering his comprehensive Expert Witness Profile report.

    Discussion by the Court

    I. Douglas Brown

    a. Future Medical Costs

    Coleman first sought exclusion of Brown’s opinions regarding future medical costs. In their opposition, Defendants expressly stipulate that Brown will not testify or offer opinions regarding Coleman’s future medical costs and represent that they have retained a separate expert to address those issues.

    b. Coleman’s Neurological Condition and the October 2023 EMG

    Coleman challenged Brown’s opinions regarding Coleman’s neurological condition, arguing that Brown failed to adequately account for an October 2023 EMG report showing radial neuropathy and performed an insufficient neurological examination.

    The Court found that these criticisms go to the weight of Brown’s testimony rather than its admissibility. Brown acknowledged the EMG findings during his deposition and provided an explanation for why the study did not alter his clinical conclusions during his January 2026 examination.

    Coleman has not demonstrated that Brown employed an unreliable methodology such that exclusion is warranted under Rule 702. Any alleged shortcomings in Brown’s review of the medical records, interpretation of the EMG, or physical examination may be explored through cross-examination.

    c. Return to Work

    Coleman also sought exclusion of Brown’s opinion that Coleman is capable of returning to her pre-injury sedentary occupation to the extent that opinion relies upon his neurological findings. Because the Court found that Coleman has not established a basis for excluding Brown’s neurological opinions, the Court likewise declined to exclude his opinions regarding Coleman’s functional capacity and work restrictions.

    d. Future Treatment

    Coleman next sought to exclude Brown’s opinions regarding future surgical treatment and the appropriate surgical approach to Coleman’s anticipated hip arthroplasty. Coleman emphasizes that Brown no longer performs orthopedic surgery and testified regarding certain physical limitations.

    The Court found no basis for exclusion of this testimony. The record reflects that Brown is a board-certified orthopedic surgeon who practiced orthopedic surgery for decades, performed the type of procedures at issue during his career, remains licensed, and continues to practice medicine and perform independent medical examinations.

    Any reduction in his surgical practice or disagreement regarding the appropriate surgical approach affects the weight of his testimony rather than its admissibility.

    II. Josh Lorencz

    a. Qualifications

    Based upon Lorencz’s education, training, and professional experience, the Court found that he possesses sufficient qualifications to testify regarding cell site location analysis. Accordingly, the Court found that Lorencz is qualified to offer expert testimony in this matter.

    b. Reliability of Methodology

    Coleman argued that Lorencz’s opinions should be excluded because his CellHawk training occurred in 2016, he has not attended refresher courses since that time, and he cannot explain the software’s internal processes.

    Notably, Coleman did not challenge the general reliability of cell site location analysis itself. Instead, Coleman argued that Lorencz lacked sufficient familiarity with the CellHawk software because he has not received recent training and cannot explain the software’s internal processes.

    Here, the record reflected that Lorencz has extensive experience utilizing CellHawk and performing cell site location analyses. The fact that he cannot explain the software’s back-end functionality did not render his methodology unreliable.

    Any alleged deficiencies in Lorencz’s familiarity with CellHawk’s internal workings can be scrutinized on cross-examination and affect the weight of his testimony rather than its admissibility. Accordingly, the Court rejected Coleman’s argument that Lorencz’s opinions should be excluded based upon his training history or inability to explain CellHawk’s internal processes.

    Coleman also argued that Lorencz failed to reliably apply his methodology because he did not independently verify cell tower locations. During his deposition, Lorencz acknowledged that he has independently verified tower locations in prior matters but did not do so in this case. Instead, he relied upon the AT&T records and CellHawk’s mapping functions.

    The Court found that this criticism goes to the weight of Lorencz’s testimony rather than its admissibility.

    Although Lorencz acknowledged that independent verification through tools like Google Earth may be used to ensure accuracy of the cell tower locations, Coleman has identified no authority finding that such verification is a prerequisite to admissibility under Rule 702.

    Likewise, the Court is aware of no authority suggesting that an expert’s failure to employ every available validation technique renders an otherwise reliable methodology inadmissible. The Court concluded that Lorencz’s decision not to independently verify the tower locations presents an issue appropriately explored through cross-examination.

    c. Scope of Permissible Testimony

    Lorencz was retained to analyze AT&T Call Detail Records associated with a particular telephone number. His report identifies calls and text messages, the timing of those communications, and the cell towers associated with those communications. The record further reflects that Lorencz reviewed the AT&T Call Detail Records and the Louisiana Uniform Crash Report but did not review GPS data, electronic logging device (“ELD”) data, or other location-specific information.

    Lorencz testified that cell site location analysis did not permit him to determine the precise GPS location of a device. Rather, he can only identify the tower and sector utilized during a communication.

    Thus, the fact that a communication utilized a specific tower only indicates that the device was within the serviceable range of that tower at that time; it does not establish the device’s precise location.

    Accordingly, Lorencz may testify regarding the contents of the AT&T Call Detail Records, the timing of the calls and text messages reflected therein, the cell towers and sectors associated with those communications, and the general principles underlying cell site location analysis. Such testimony may assist the jury in understanding the evidence.

    However, the Court finds that the methodology employed by Lorencz does not support testimony concerning the precise location of any vehicle or person, the precise time that Saint Fleur arrived at the accident location, the length of time that any vehicle remained at a particular location, or other conclusions that cannot be reliably derived from the Call Detail Records.

    Likewise, Lorencz may not offer opinions regarding user identity, driver behavior, distraction, causation, or matters beyond the scope of his report and expertise.

    Held

    The Court granted in part and denied in part Coleman’s Daubert motions to exclude and/or limit the testimony of Dr. Douglas Brown and Josh Lorencz.

    Key Takeaway

    Experts routinely rely upon specialized software tools without possessing detailed knowledge of the software’s source code or internal algorithms.

    However, Rule 702 requires not only that expert testimony be reliable, but also that it assist the trier of fact. Thus, even where an expert is qualified and employs a reliable methodology, the testimony must remain within the bounds of what that methodology can reasonably support.

    Case Details:

    Case Caption: Coleman v. Burlington Ins. Co.
    Docket Number: 5:24cv512
    Court Name: United States District Court, Louisiana Western
    Order Date: July 13, 2026
  • Family Medicine Expert’s Standard-of-Care Testimony Excluded

    Family Medicine Expert’s Standard-of-Care Testimony Excluded

    This lawsuit arises out of medical care and treatment Courtney L. Mapes rendered to Plaintiff Bradley Medina on February 8, 2019 at Family Health Care Network. Medina brought a cause of action against Mapes for medical negligence based on the allegation that Mapes misdiagnosed him with a hamstring injury rather than an infection in his leg.

    Defendant filed a motion to exclude or limit “the scope of the opinions from Plaintiff’s designated rebuttal expert, Daria Majzoubi, M.D.,” asserting Majzoubi’s “proposed testimony exceeded the permissible scope of a rebuttal expert witness.”

    Family Medicine Expert Witness

    Daria Majzoubi, M.D. specializes in family medicine, and has been practicing medicine for over 13 years, starting his practice in the Central Valley in 2003. 

    Trained at George Washington University, Majzoubi did his Residency at Northwestern University.

    Fortify your strategy by reviewing a Challenge Study detailing grounds for excluding Daria Majzoubi’s expert testimony.

    Discussion by the Court

    Defendant explained, “Plaintiffs were given leave to designate Majzoubi strictly to rebut the opinions of Defendant’s Infectious Disease expert as it relates to issues of medical causation presented in this case” however, “Majzoubi’s report testimony focuses nearly entirely on the issue of standard of care” and “goes beyond the scope of her designation as rebuttal expert in this case.”

    Plaintiffs contended that Majzoubi’s expert report and causation testimony is essential to its case and precluding it would be unfair.

    Majzoubi spoke to standard of care only, which is an issue Plaintiffs must prove in their case in chief. The fact that he disagreed with the defense experts does not make him a rebuttal expert. Therefore, the Court held that Majzoubi’s designation cannot properly be characterized as rebuttal testimony.

    Plaintiffs also asserted that the Defendant would not suffer any prejudice or unfairness because Defendant has retained an expert. However, the Court granted Plaintiffs several extensions solely for the purpose of designating a rebuttal expert to respond to the opinions of Defendant’s retained infectious disease expert, but they did not do so. Also, Plaintiffs failed to provide the Court any explanation or argument relating to untimely/improper disclosure.

    Held

    The Court granted the Defendant’s motion to exclude or limit the scope of the opinions from Plaintiff’s designated rebuttal expert, Daria Majzoubi, M.D.

    Key Takeaway:

    If a party fails to provide information or identify a witness as required by Rule 26, the party is not allowed to use that information or witness to supply evidence on a motion, at a hearing, or at a trial, unless the failure was substantially justified or is harmless.

    The Court did not find the failure to timely designate Majzoubi to be “substantially justified or harmless.” 

    Case Details:

    Case Caption: Medina Et Al V. Mapes
    Docket Number: 1:21cv844
    Court Name: United States District Court, California Eastern
    Order Date: August 10, 2025
  • Orthopedic Surgery Expert’s Opinion on Future Damages Admitted

    Orthopedic Surgery Expert’s Opinion on Future Damages Admitted

    This case concerns a motor vehicle accident involving the Plaintiffs, Vanessa Rivera and her minor child K.C., and Joseph Giordano, a driver for Defendants Safway Services, LLC and Brand Safway Services, LLC. The Plaintiffs asserted four counts of negligence against the Defendants and sought damages for the physical, emotional, and financial injuries they allegedly suffered from the accident.

    Defendants filed a motion to exclude the opinions of Dr. Nikhil Thakur and Maryanne Cline. Basically, the Defendants contended that Thakur’s opinions are not founded on a satisfactory level of analytical rigor and are not the product of reliable principles and methods.

    Moreover, Defendants added that Thakur’s conclusions regarding future medical treatment were speculative under Massachusetts law governing future damages. Based on these challenges, Defendants argued that excluding the expert testimony would mean Plaintiffs could not establish the necessary amount in controversy, requiring dismissal for lack of subject matter jurisdiction.

    As for Cline, the Defendants’ only justification for moving to exclude her medical cost projections hinges on the preclusion of Thakur’s opinions.

    Orthopedic Surgery Expert Witness

    Dr. Nikhil Thakur is a Board Certified Orthopaedic Spine Surgeon, who specializes in Adult Reconstructive Spine Surgery. Previously, he was an Assistant Professor at SUNY – Upstate in Syracuse NY, where he performed over 300 elective and traumatic spine surgeries at a Level 1 Trauma Center each year. He also developed and ran the spine program at Upstate University at Community General. He continues to hold an adjunct professorship there and is actively involved in his stem cell lab, which he co-directs.

    Thakur completed his spine fellowship at the prestigious Emory Spine Center in Atlanta, where he was involved in the care of the Atlanta Falcons. He also completed an orthopaedic trauma fellowship at Brown University – Rhode Island Hospital.

    Discover more cases with Nikhil Thakur as an expert witness by ordering his comprehensive Expert Witness Profile report. 

    Life Care Planning Expert Witness

    Maryanne Cline began her career in nursing in 1985 and specifically, rehabilitation nursing in 1991. She worked with traumatically injured clients at St. Anthony’s Medical Center in Crown Point, Indiana and in the Physical Medicine and Rehabilitation Inpatient Unit at The Cleveland Clinic.

    Her varied clinical experience includes cardiology, medical/surgical, oncology and hospice. Cline has nearly ten years’ experience in the field of Life Care Planning, first as a research assistant then becoming a Certified Life Care Planner in 2012.

    Get the full story on challenges to Maryanne Cline’s expert opinions and testimony with an in-depth Challenge Study.  

    Discussion by the Court

    Initial Arguments

    Defendants moved to exclude the testimony and opinions of plaintiffs’ experts, Thakur, an orthopedic spine surgeon, and Maryanne Cline, a certified nurse life care planner. They argued Thakur’s opinions were inadmissible under Federal Rule of Evidence 702. Defendants asserted his opinions lacked satisfactory analytical rigor and did not result from reliable methods.

    Methodology

    The Court evaluated Thakur’s methodology for forming his expert opinions. Thakur based his opinions on a physical examination of Rivera. Furthermore, he also took her medical history and interpreted medical records from her other healthcare providers. Ultimately, the Court found this approach constituted a reliable methodology under Federal Rule of Evidence 702.

    The Court addressed the Defendants’ specific challenges to alleged “errors and omissions” in Thakur’s report. Specifically, Defendants argued certain points, like the fact that Thakur described the accident as a slip and fall instead of a motor vehicle accident or that Thakur did not reference any medical records contradicting his description of Rivera’s ongoing complications and his diagnosis of a C4-C5 disc herniation, warranted exclusion. Nevertheless, the Court held that these disputes over the factual underpinnings of the report did not evince a “significant ‘analytical ga[p]’” between Thakur’s opinions and the record evidence.

    The Defendants’ only methodological quibble—that Thakur did not wait until two years after the accident to measure Rivera’s maximum medical improvement—is not a significant enough analytical issue to merit wholesale exclusion of his opinions. 

    The Defendants next argued that Thakur’s conclusions regarding Rivera’s future medical treatment are “speculative and precatory” and must be excluded under Massachusetts law governing recovery for future damages.

    A Plaintiff, however, “is not restricted to compensation for suffering and expense” that “will inevitably follow,” because “suffering and expense following an injury cannot be foretold with exactness.” Instead, a Plaintiff may be compensated for expenses “which by a fair preponderance of the evidence [she] has satisfied the jury reasonably are to be expected to follow.” 

    Relevance

    Under Federal Rule of Evidence 403, the Court determined Thakur’s opinions had significant probative value which was not substantially outweighed by the danger of unfair prejudice or jury confusion. Moreover, the Court rejected the argument that the jury would improperly rely on Thakur’s credentials alone or become confused by the “stark contrast” between Thakur’s report and Rivera’s deposition testimony.

    Since Thakur’s opinions were admissible under Rules 702, 403, and Massachusetts law, the Court likewise found that Maryanne Cline’s medical cost projections should not be excluded. After all, Cline based her opinions on Thakur’s admissible findings and recommendations.

    Held

    The Court denied the Defendants’ motion to exclude the experts, Dr. Nikhil Thakur and Maryanne Cline.

    Key Takeaways:

    • Ultimately, the “errors and omissions” highlighted by the Defendant did not evince a significant analytical gap between Thakur’s opinions and the record evidence.
    • Because the evidentiary value of Thakur’s opinions is not substantially outweighed by the risk of jury confusion or unfair prejudice, exclusion of his report and testimony is unwarranted.

    Case Details:

    Case Caption: Rivera V. Safway Servs., LLC
    Docket Number: 1:23cv12184
    Court Name: United States District Court for the District of Massachusetts
    Order Date: April 23, 2025
  • Defendant Was Not Justified in Failing to Disclose Orthopedic Sports Medicine Expert Witness’ Report Regarding the Plaintiff’s Medical Condition

    Defendant Was Not Justified in Failing to Disclose Orthopedic Sports Medicine Expert Witness’ Report Regarding the Plaintiff’s Medical Condition

    Plaintiff Deana Hosie alleges that, on November 17, 2017, while dining at the Defendant Omni Hotels Management Corporation’s hotel restaurant, she tripped and fell over a box-shaped object on the floor, causing her serious injuries. 

    After disclosing expert Charles DePaolo, M.D., the Defendant indicated that DePaolo would not provide a report until “after his forthcoming independent medical examination of the Plaintiff.” 

    The Plaintiff declined the Defendant’s request to undergo an independent medical examination.

    On June 13, 2024, the Plaintiff filed the present motion, seeking to exclude the expert testimony of DePaolo.

    Orthopedic Sports Medicine Expert Witness

    Charles DePaolo, MD, is a board-certified orthopedic surgeon and sports medicine physician who specializes in joint reconstructive surgery, direct anterior approach total hip arthroplasty, arthroscopic rotator cuff repair, cartilage preservation procedures, osteochondral transfer procedures and the use of platelet rich plasma (PRP) and stem cells. His goal is to relieve pain and return function to his patients’ everyday life. 

    Get the full story on challenges to Charles DePaolo’s expert opinions and testimony with an in-depth Challenge Study. 

    Discussion by the Court

    The Defendant retained DePaolo to offer testimony regarding the “Plaintiff’s past, present, and future medical condition, including . . . whether such pain or limitation is connected to the injuries” the Plaintiff suffered in this case.

    When the deadline passed on January 8, 2024, no report was forthcoming. Since the Rule 26 requirements were not met, the Court decided to exclude the testimony of DePaolo unless the Defendant could show that the failure to produce a report was substantially justified or harmless.

    Plaintiff did not provide an expert report for the Defendant to respond to

    First, the Defendant argued that its nondisclosure was substantially justified because the Plaintiff did not provide an expert report for the Defendant to respond to. A party, however, need not file an expert report for a treating physician. Here, the Plaintiff disclosed that her treating physician would testify at trial. The Court held that the Plaintiff did not need to disclose an expert report, and the Defendant was not substantially justified in failing to disclose its own expert report.

    DePaolo needed to conduct a medical examination of the Plaintiff

    Second, the Defendant asserts that its nondisclosure was substantially justified because DePaolo needed to conduct a medical examination of the Plaintiff, arguing that a review of the Plaintiff’s medical records “did not provide a sufficient basis for him to serve a report that would satisfy Rule 26(a)(2)(C).” In his Order denying the Defendant’s motion to compel an independent medical examination, the Magistrate Judge emphasized the Defendant’s failure to (1) timely and adequately pursue the Plaintiff’s medical records; (2) provide an expert report from DePaolo; (3) seek an extension of its deadline to disclose DePaolo’s report; and (4) move to compel an independent medical examination until March 1, 2024, nearly two months after the Defendant’s expert disclosure deadline. Further, since the Magistrate Judge entered his order denying the Defendant’s motion to compel in April, the Defendant has not supplemented or corrected its initial expert disclosure.

    The Court held that the Defendant’s failure to disclose a report from DePaolo is not substantially justified due to the lack of an independent medical examination.

    Court can “cure” any surprise caused by the Defendant’s failure to provide a report 

    The Defendant argued that allowing DePaolo to testify would be harmless to the Plaintiff.

    The Defendant claimed that the Court can “cure” any surprise caused by the Defendant’s failure to provide a report by permitting DePaolo to listen to and “rebut” the Plaintiff’s treating physician’s trial testimony, then briefly pausing the trial to allow the Plaintiff time to formulate a cross examination. 

    The Court held that the Defendant’s proposal would minimize the Plaintiff’s opportunity to “adequately prepare” for DePaolo’s testimony, leaving the Plaintiff surprised and unequipped to conduct a sufficient cross-examination. This would not be harmless to the Plaintiff; it would disrupt the trial and unfairly surprise the Plaintiff without providing a sufficient cure.

    Finally, the Defendant argued it is important for DePaolo to testify to give the jury “a more complete understanding of the Plaintiff’s injuries” and for the Defendant to “more fairly defend itself against the Plaintiff’s claim for significant damages.” The Court held that this is precisely the kind of information that DePaolo could have and should have rebutted in an expert report. The Defendant has had the Plaintiff’s medical records and has known of the Plaintiff’s claims for damages for some time. The fact that the Defendant has failed to provide a timely rebuttal to the Plaintiff’s evidence does not justify an ambush of the Plaintiff’s treating physician at trial.

    Held

    The Court granted the Plaintiff’s motion to exclude the expert testimony of Charles DePaolo.

    Key Takeaway:

    The Court held that the Defendant’s failure to provide a report from its expert is not substantially justified. Furthermore, disrupting the trial to formulate an expert opinion on the fly—without giving the Plaintiff time to analyze the expert’s opinion, depose the expert, and prepare a cross examination—would not be harmless.

    Case Details:

    Case Caption: Hosie V. Omni Hotels Management Corporation
    Docket Number: 1:22cv265
    Court: United States District Court for the Western District of North Carolina, Asheville Division
    Order Date: October 4, 2024
  • Gastroenterology Expert Witness’ Testimony Is Not Supported By An Explanation Of the Principles and Methods

    Gastroenterology Expert Witness’ Testimony Is Not Supported By An Explanation Of the Principles and Methods

    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.

    Want to know more about the challenges Edwin Miranda-Aponte has faced? Get the full details with our Challenge Study report. 

    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.

    Fortify your strategy by reviewing a Challenge Study detailing grounds for excluding Wilfredo Nieves Colomer’s expert testimony. 

    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

    Get the full story on challenges to Alvaro Reymunde’s expert opinions and testimony with an in-depth Challenge Study. 

    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

  • Correctional Healthcare Expert Witness’ Testimony on the Risks of MOUD in Correctional Settings Excluded

    Correctional Healthcare Expert Witness’ Testimony on the Risks of MOUD in Correctional Settings Excluded

    A district judge in West Virginia barred the Correctional Healthcare Expert from opining that there was no evidence of medical malpractice, deliberate indifference, discrimination, or negligence.

    Joseph Taylor has struggled with opioid addiction for nearly half his life. He is diagnosed with Opioid Use Disorder (“OUD”) and is treating this chronic brain disease with Medications for Opioid Use Disorder (“MOUD”).

    Wexford and the West Virginia Division of Corrections and Rehabilitation (“WVDCR”) denied Taylor access to MOUD while he was detained from January through March at Central Regional Jail. Plaintiff alleged that Defendants had a policy of forced withdrawal from MOUD, which was discriminatory and evinced deliberate indifference to his clear and acute need for MOUD while detained at CRJ.

    Wexford provided an expert report from Dr. Grady Bazzel who testified that the Defendants met the standard of care in their treatment of Taylor. Taylor filed a motion to exclude the testimony of Bazzel as an expert in addiction medicine.

    Correctional Healthcare Expert Witness

    Dr. Grady Judson Bazzel is currently the Patient Safety Officer and Medical Director of Care Management for Wellpath, a company that provides correctional healthcare throughout the United States. He has worked in corrections since 2005 and is licensed to practice medicine in multiple states. In his current role, he investigates patient deaths and other care errors and helps improve quality of care across Wellpath-managed sites. He has familiarity with the Bureau of Prisons (BOP) Clinical Guidelines for the Diagnosis, Evaluation, and Treatment of Opioid Use Disorder (OUD), although he did not review them specifically while compiling his report. 

    Fortify your strategy by reviewing a Challenge Study detailing grounds for excluding Grady Bazzel’s expert testimony. 

    Discussion by the Court

    Bazzel explained that there are risks to the use of MOUD in correctional settings that are not present in the outside world, including the risk that other inmates will target a patient to obtain the medication.

    Bazzel stated that “proper patient selection is the key to a successful Medication Assisted Treatment (MAT) program.” He stated that the “psychological triggers for relapse are less present and the access to substances of abuse is greatly diminished,” during incarceration, reducing the need for treatment. Bazzel suggested that gaps in Taylor’s treatment record, both before and after his period of incarceration, showed a “pattern of spotty follow-up for this medication that he claims to need so badly.”

    He offered the opinion that Taylor was not a good candidate for MAT while incarcerated because of his lack of compliance with Clinical Opiate Withdrawal Scale (COWS) assessments, his urine drug screen results, and his gaps in treatment before and after his incarceration.  He further opined that “the medical staff at CRJ were under no obligation to continue [buprenorphine] until such time that it became clear that it was needed. This need never presented itself,” as demonstrated by “the fact that his first drug screen post-incarceration was negative for illicit drugs.”

    Bazzel lacks experience and specialized training related to OUD, MOUD, and opioid withdrawal

    Taylor conteded that Bazzel lacked the necessary qualifications as per Rule 702. He noted that Bazzel has “never conducted an OUD screening or a Rapid Opioid Dependence Screen and is not sure if he has ever reviewed such a test.”

    Plaintiff added that Bazzel’s opinions were contradicted in key areas by the Federal Bureau of Prisons (“BOP”) Guidelines, a resource that he stated he was familiar with and considered authoritative.

    Absent full exclusion, the Plaintiff argued that several specific opinions offered by Bazzel are improper. He argued that Bazzel should not be permitted to offer opinions on the legal issues of medical malpractice, deliberate indifference, discrimination, and negligence. In addition, he contended that Bazzel’s opinion on the reduction in psychological triggers in jails and prisons should be excluded because it lacks any scientific support, and he is not a psychiatrist or psychologist with any qualification to offer such testimony.

    Since Bazzel’s report did not contain citations or references to medical or scientific sources, the Court looked to his deposition to gain an understanding of how he formed his conclusions.

    When asked what relevant medical literature he relied on in formulating his opinions, he replied, “None.” He stated that he did not review any scientific literature or journal articles related to COWS scores. As to his opinion that some patients who would be appropriate candidates for treatment with MOUD in the community are not good candidates in a correctional setting, he stated that he did not know if any literature or reports existed to support that viewpoint. He did not review any medical or scientific literature to formulate his opinion that there are fewer triggers for opioid cravings or relapse in jail, stating, “I’m sure I could find some. But it’s just commonsensical.”

    Bazzel’s testimony related to incidents of alleged diversion and urine screen results should be excluded 

    The Plaintiff next argued that Bazzel’s testimony and conclusions related to incidents of alleged diversion and urine screen results, all occurring after the Plaintiff’s January — March 2023 detention, should be excluded because medical staff could not have considered future events when determining Taylor’s medical treatment at the time. He further argued that Bazzel’s opinions regarding security concerns in a correctional setting related to MOUD are “pure conjecture.” Bazzel admitted in his deposition that he ‘has no experience in correctional security,’” and cited no scientific or medical sources. Finally, he argued that Bazzel’s testimony opining about Taylor’s credibility should be excluded.

    The Court held that Bazzel’s opinion that the Defendants met the standard of care in their treatment of Taylor was formed based on the analysis of Taylor’s treatment as discussed above, none of which was based on facts, data, or reliable principles or methods. 

    Held

    The Court granted the Plaintiff’s motion to exclude certain opinions of Grady Bazzel.

    Key Takeaway:

    Bazzel’s report lacked citations or references to medical or scientific sources. When asked what relevant medical literature he relied on in formulating his opinions, he replied, “None.”

    The Court held that Bazzel’s opinion that the Defendants met the standard of care in their treatment of Taylor was formed based on the analysis of Taylor’s treatment, none of which was based on facts, data, or reliable principles or methods. 

    Case Details:

    Case Caption: Taylor V. Wexford Health Sources, Incorporated, Et Al
    Docket Number: 2:23cv475
    Court: United States District Court, West Virginia Southern
    Order Date: June 17, 2024