Contreras v. Secretary of Health and Human Services, 121 Fed. Cl. 230

Background

Petitioner Jessie Contreras (age 13 at vaccination in 2003) alleged transverse myelitis (TM) and Guillain-Barré syndrome (GBS) within ~24 hours of hepatitis B and Td vaccines.
Case underwent multiple proceedings: special master denied relief (Contreras I); this court vacated and remanded (Contreras II); revised denial (Contreras III); court remanded to address newly disclosed misconduct by respondent’s expert Dr. John Sladky and to require (1) clarity on Sladky’s credibility, (2) comparison to petitioner’s experts, and (3) an alternative ruling excluding Sladky (Contreras IV).
On remand the special master (Contreras V) found Sladky ‘‘minimally credible’’ and retained his opinions but also provided an alternative entitlement ruling that entirely excluded Sladky’s evidence and again denied compensation.
This Court reviewed: (a) whether the special master abused discretion in relying on Sladky given post-trial disclosures of misrepresentations and license discipline; (b) whether credibility and reliability are separable; and (c) the remaining substantive Althen analysis (plausibility of mechanism and timing).
Court held that the special master manifestly erred and abused discretion by failing to exclude or significantly discount Sladky’s evidence and by treating credibility and reliability as separable; but upheld the special master’s alternative timing (Althen prong three) ruling excluding Sladky, which independently supported denial of compensation.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether special master abused discretion by relying on Dr. Sladky after discovery of his misrepresentations and license suspension	Sladky’s pattern of misrepresentations made him untrustworthy; his evidence should be excluded or heavily discounted	Respondent: Sladky’s substantive opinions remain reliable despite credential misstatements; retain in record	Abuse of discretion: special master manifestly erred in relying on Sladky without excluding or materially discounting his testimony
Whether credibility (candor) can be separated from reliability (weight of opinion)	Credibility problems materially undermine reliability and weight	Respondent contended they are distinct and Sladky’s scientific methodology could still be reliable	Credibility and reliability are closely linked; cannot be treated as severable in this way; special master’s separation was erroneous
Althen prong one (medical theory — molecular mimicry): was petitioner’s burden properly applied?	Dr. Steinman’s molecular mimicry theory is biologically plausible and meets Althen prong one’s threshold	Respondent argued petitioner failed to show sufficient indicia of reliability under Daubert-like scrutiny	Court: special master applied an overly demanding standard; plausibility/viability of the mechanism sufficed for Althen prong one (error but harmless because of timing failure)
Althen prong three (timing): did onset within ~24 hours meet a medically-acceptable timeframe?	Petitioner argued onset within 24 hours is possible and evidence should be reweighed without Sladky	Respondent relied on Dr. Whitton and literature showing molecular-mimicry-mediated injury is unlikely in 24 hours	Special master’s alternative ruling (excluding Sladky) that 24 hours is too short was rational and is sustained; denial of entitlement stands

Key Cases Cited

de Bazan v. Sec’y of Health & Human Servs., 539 F.3d 1347 (Fed. Cir. 2008) (standard of review for special-master decisions under Vaccine Act)
Althen v. Sec’y of Health & Human Servs., 418 F.3d 1274 (Fed. Cir. 2005) (framework for proving causation in Vaccine Act cases)
Munn v. Sec’y of Dep’t of Health & Human Servs., 970 F.2d 863 (Fed. Cir. 1992) (standards of review for fact, law, and discretion)
Porter v. Sec’y of Health & Human Servs., 663 F.3d 1242 (Fed. Cir. 2011) (special masters must consider expert credibility)
Broekelschen v. Sec’y of Health & Human Servs., 618 F.3d 1339 (Fed. Cir. 2010) (weighing credibility and persuasiveness of competing expert theories)
Moberly ex rel. Moberly v. Sec’y of Health & Human Servs., 592 F.3d 1315 (Fed. Cir. 2010) (plausibility and indicia of reliability discussion)
Hibbard v. Sec’y of Health & Human Servs., 698 F.3d 1355 (Fed. Cir. 2012) (permissible threshold diagnosis inquiry when outcome turns on intermediate diagnosis)
LaLonde v. Sec’y of Health & Human Servs., 746 F.3d 1334 (Fed. Cir. 2014) (distinguishing plausibility of theory from preponderance on causation)
United States v. Shaffer Equip. Co., 11 F.3d 450 (4th Cir. 1993) (appropriate remedies and factors when a key witness has fabricated credentials)
In re Unisys Sav. Plan Litig., 173 F.3d 145 (3d Cir. 1999) (a judge in a bench trial may exclude testimony he finds not believable)