Expert Witness Profiler

Tag: Sedate

  • Emergency Medicine Expert Was Not Allowed to Opine on Sedation

    Emergency Medicine Expert Was Not Allowed to Opine on Sedation

    This litigation stems from the death of Charles Lamar Vanlandingham in September of 2019. Plaintiff alleged that Vanlandingham suffered a medical episode with seizure activity in the early morning hours of September 15, 2019, and Vanlandingham’s girlfriend called 911. According to Plaintiff, Vanlandingham started to improve in the time it took EMS to arrive. Following the seizure activity, Vanlandingham had apparently transitioned to a “postictal state” that can cause confusion.

    Although Vanlandingham was initially compliant with EMS upon their arrival, Plaintiff alleged that “EMS providers tried to force Vanlandingham onto their medical cot,” and when Vanlandingham did not comply, “[EMT] Tuttle ultimately tackled Vanlandingham onto the medical cot.”

    Once members of the Oklahoma City Fire Department arrived, Plaintiff alleged that the Firefighters used their body weight to pin Vanlandingham in the prone position for approximately three minutes before Oklahoma City Police Officer Brandon Lee arrived. Officer Lee then put handcuffs on Vanlandingham—still in the prone position—and placed his knee across Vanlandingham’s back.

    Plaintiff alleged that Vanlandingham was in this position, handcuffed, for approximately four minutes, during which time “no one checked Vanlandingham’s vitals or advocated for a position change despite Vanlandingham’s clear signs of respiratory distress.” “Without knowing Mr. Vanlandingham’s vitals and without performing any kind of medical assessment,” EMT Tuttle then administered midazolam (a sedative), and Vanlandingham went limp. CPR efforts were unsuccessful, and Vanlandingham died at the scene.

    Plaintiff’s claims are against Defendants City of Oklahoma City, Officer Brandon Lee, and American Medical Response Ambulance Service, Inc. (AMRAS). During discovery, AMRAS disclosed an expert report prepared by Molly A. Furin, M.D., M.S., who is board certified in both Emergency Medicine and Emergency Medical Services.

    In the present motion, Plaintiff contended that Furin’s offered opinions should be excluded under Fed. R. Evid. 702.

    Emergency Medicine Expert Witness

    Molly Ann Furin is board-certified in both Emergency Medicine and Emergency Medical Services (EMS) and has obtained a Master of Science in Disaster Medicine and Management.

    She has worked at a level 1 trauma center for the past 17 years as well as community Emergency Departments.

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

    Discussion by the Court

    I. Timeliness of Furin’s Supplement

    Furin supplemented her expert report on May 20, 2025. In it, Furin did not expand the opinions listed in her initial report, but she did provide supplemental explanation of her education and experience in the emergency medicine field. Plaintiff contended that Furin’s supplement is untimely under Fed. R. Civ. P. 26(e)(2).

    Furin issued her supplemental report. However, Rule 26(a)(3) also refers to the deadline to file deposition designations, which has yet to expire. Accordingly, the Court found that Furin’s supplement of May 20, 2025, is timely under Rule 26(e)(2).

    II. Daubert Motion

    • Paramedic Tuttle and EMT Barnes performed an appropriate rapid assessment of Vanlandingham upon arrival, including checking blood glucose, and could not proceed with further evaluation and treatment because it became unsafe to do so. Evaluating for scene safety is one of the first skills taught in Emergency Medical Services, and the crew appropriately called for additional resources in a timely manner. Physical restraint of Vanlandingham was necessary at the time in order to prevent harm or injury to himself or crew members.
    • Upon the arrival of OCFD personnel, including Paramedic Morton, care was correctly transitioned to Paramedic Morton.
    • Paramedic Tuttle assisted the OCFD by drawing up and administering midazolam IM as requested. Sedation was paramount in order to further evaluate and treat Vanlandingham. Midazolam is a benzodiazepine, utilized for both sedation and treatment of seizures, and when administered intramuscularly takes a minimum of several minutes to take effect. Given the very brief time interval after administration, the midazolam had no causative role in Vanlandingham’s subsequent cardiac arrest.
    • When Vanlandingham sustained cardiac arrest, he was efficiently treated with high quality [Advanced Cardiovascular Life Support] care.

    Analysis

    First, the Court found that Furin’s initial report failed to clearly identify the basis for her opinions or explain how certain standards or her experience lead to the conclusions reached. Furin did not identify how her experience in the emergency medicine field led to her specific opinions.

    Next, Furin’s supplemental expert report did little to expand on the basis for her four opinions. Rather, Furin focuses on her qualifications to issue opinions regarding emergency medicine.

    Furin has largely failed—even after supplementing her report—to provide a basis for her opinions. Furin’s experience in emergency medicine, standing alone, is not sufficient to support her opinion that EMS “could not proceed with further evaluation because it became unsafe to do so.” Apart from explaining her experience in emergency medicine and providing examples of transitions of care, Furin’s supplemental report does not sufficiently explain how her experience (or knowledge of the industry standard) led her to opine that the transition of care in this case was “correct.”

    Next, Furin’s supplement did not provide a basis for her opinion that “sedation was paramount in order to further evaluate and treat Vanlandingham.”

    Although Furin stated that she “reviewed the patient care reports and documents provided to me, and is qualified to opine as to the quality of care provided when Vanlandingham sustained cardiac arrest,” Furin failed to provide any basis or reasoning for her opinion that the care provided to Vanlandingham was efficient and high quality.

    A portion of Furin’s third opinion was admissible under Rule 702 and Daubert because Furin has provided a sufficient basis for it. Furin can opine that—given her firsthand knowledge and experience with the administration and onset of midazolam—the midazolam could not have taken effect before Vanlandingham’s cardiac arrest.

    Held

    The Court granted in part and denied in part Plaintiff’s motion to exclude the opinions of Dr. Molly Furin.

    Key Takeaway

    It is fundamental that, if the basis for an expert’s opinions is to be tested for reliability, that basis must be identified in some fashion. Absent some identification of the basis for the expert opinion, there is little or no way to test it against any of the guidelines or factors involved in a Daubert analysis or to otherwise determine its reliability.

    Case Details:

    Case Caption: Vanlandingham V. City of Oklahoma City
    Docket Number: 5:22cv209
    Court Name: United States District Court, Oklahoma Western
    Order Date: March 18, 2026
  • Dentistry Expert’s Testimony on Conscious Sedation Admitted

    Dentistry Expert’s Testimony on Conscious Sedation Admitted

    This case stems from allegations by the U.S. Department of Justice that Dr. Eli Jarjoura, a licensed dentist, illegally prescribed Schedule IV controlled substances without a “legitimate medical purpose . . . in the usual course of his professional practice.” 

    Jarjoura instructed the patient to take one 0.25 mg tablet of triazolam and one 0.5 mg or 1.0 mg tablet of alprazolam—both Schedule IV sedatives used in conscious sedation dentistry—one hour before the procedure, and to return any remaining tablets to Jarjoura for administration, if needed, or for disposal.

    Dr. Bruce D. Horn is DOJ’s expert witness on dentistry and sedation practice. Horn’s report, submitted pursuant to Rule 26, opines on “whether prescriptions written and issued by [Defendant] . . . were (i) issued for a legitimate medical purpose; and/or (ii) issued within the ordinary course of professional practice.” 

    Horn concluded that Defendant’s prescription practices regarding certain sedation drugs had no “legitimate medical purpose and were outside the course of usual professional practice.”

    Defendant filed a motion to exclude Horn’s opinions under Rule 702.

    Dentistry Expert Witness

    Dr. Bruce D. Horn is a dentist in a private practice setting and has been practicing since 1981. He holds an active permit with the Oklahoma Board of Dentistry for parenteral conscious sedation and has served on the Oklahoma Board of Dentistry in a variety of roles.

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

    Discussion by the Court

    Specifically, Horn made three related contentions. First, Horn noted that Defendant prescribed abnormally high quantities of the benzodiazepines Triazolam and Alprazolam despite no “reliable, accepted publication supporting the combined use of these two sedatives in sedation dentistry.” Second, Horn contended that Defendant’s recordkeeping was deficient. In his words, “sedation dental practice . . . should be based on the individual characteristics of each patient,” and patient records should contain these details to ensure “safe dosing” but Defendant’s records lacked the requisite detail.  Third, Horn asserted that Defendant could not have effectively monitored his patients given the amount of sedation medication administered. Such levels of sedation medication, Horn argued, would have placed Defendant’s patients in physical danger.

    The Defendant argued that Horn’s expert opinion should be thrown out under Rule 702, claiming he wasn’t qualified to speak on prescription drug safety or drug interactions. Their reasoning? Horn was trained as a dentist—not a pharmacist—so he allegedly lacks the expertise required for that kind of analysis.

    Defendant further argued that certain portions of Horn’s report were either irrelevant or prejudicial. Defendant cited to portions of the report in which Horn commented on the following topics: (1) the presence of expired sedative antagonists in Defendant’s office stock; (2) Defendant’s practice of intravenously administering the benzodiazepine Midazolam; (3) the accuracy of Defendant’s medical recordkeeping; (4) appropriate dosing of prescriptions kept in Defendant’s office stock; (5) the application of the Oklahoma Board of Dentistry statutes and regulations to Defendant’s practice; and (6) the proper monitoring of patients during conscious sedation.

    Analysis

    Qualifications

    Defendant challenged Horn’s qualifications, asserting that Horn is unqualified “regarding safety of prescriptions and drug interactions” because he is not a pharmacist.

    The Court found that Horn is qualified to offer opinions regarding the safety and adverse effects of the medications at issue in this case. Horn has served as the President of the Oklahoma Board of Dentistry, has practiced dentistry for over 40 years, and has extensive experience working with various sedation techniques. His experience provides the foundational knowledge necessary to compare Defendant’s prescription practice to the professional dental practice at large.

    The fact that Horn is a dentist, and not a pharmacist, is not a barrier to admissibility.

    Reliability

    Defendant did not challenge the reliability of Horn’s methodology.

    Upon review of the expert report, the Court held that Horn’s methods were reliable. Horn’s opinions were derived from a comparison of Defendant’s practices as observed from medical records and deposition testimony with industry standards as identified by Horn and promulgated by the Oklahoma Board of Dentistry. 

    Relevance of Expert Testimony

    Defendant challenged the relevance of certain portions of Horn’s report. Specifically, Defendant argued that Horn’s comments on the following topics are irrelevant to the ultimate issue of Defendant’s prescription practices:

    1. The presence of expired sedative antagonists in Defendant’s office stock;

    2. Defendant’s intravenous application of Midazolam;

    3. The accuracy of Defendant’s medical records;

    4. The appropriate dosing of certain prescriptions kept in Defendant’s office stock;

    5. Purported violations of Oklahoma Board of Dentistry statutes and regulations; and

    6. The failure to properly monitor patients during conscious sedation.

    Defendant asserted that each of the above comments go beyond the scope of this case—whether “prescriptions written by Defendant were issued for a legitimate medical purpose or within the ordinary course of professional practice.”

     The Court had no trouble finding that each of the contested portions of Horn’s report was relevant. Item 3—medical record inaccuracies—inform how medication should be prescribed and in what quantity.  The remaining items—all of which relate to appropriate dental practice (i.e. the intravenous use of Midazolam, appropriate dosing, etc.)—are not only relevant, but central to the issue in this case. Each matter presents the fact finder with the background necessary to evaluate Defendant’s overall practice, including the appropriateness of prescription decisions.

    Thus, the challenged testimony will be helpful to the trier of fact in determining whether Defendant’s prescriptions had a legitimate medical purpose in the usual course of professional practice.

    Held

    The Court denied the Defendant’s Daubert motion to exclude certain opinions of Bruce D. Horn.

    Key Takeaway:

    Horn is qualified as an expert by knowledge, skill, experience, training, or education. Furthermore, it is more likely than not that (a) Horn’s scientific, technical, or other specialized knowledge will help the trier of fact because under Rule 401, relevant evidence is that which has “any tendency to make the existence of any fact that is of consequence to the determination of the action more probable or less probable than it would be without the evidence.”; (b) the testimony is based on sufficient facts or data; (c) the testimony is the product of reliable principles and methods; and (d) the expert has reliably applied the principles and methods to the facts of the case.

    Case Details:

    Case Caption: United States Of America V. Jarjoura
    Docket Number: 5:23cv680
    Court Name: United States District Court, Oklahoma Western
    Order Date: July 11, 2025