158 So. 3d 318
Miss. Ct. App.2014Background
- Elizabeth King suffered a stroke and was treated at Ocean Springs Hospital ER; doctors allegedly misdiagnosed and treated the stroke; King’s experts included Dr. James E. Gebel (neurologist) and Dr. Bryan P. Barrileaux Sr. (internist); trial court excluded Gebel as unqualified and found his causation opinion not supported by medical literature; trial court granted summary judgment to defendants; on appeal, King argues the exclusion was error; Mississippi Supreme Court affirms the judgment.
- King’s stroke occurred September 7, 2009; initial ER assessment suggested benzodiazepine intoxication/altered mental status; MRI later revealed a rare basilar artery occlusion (BAO); King’s condition was severe with little chance of recovery; she died in 2013; the record discusses tPA and mechanical retrieval options and their perceived applicability to BAO.
- Standard of review and admissibility of expert testimony are at issue, focusing on Dr. Gebel’s qualifications and the reliability of his opinions in light of literature; the court considered whether the expert could testify to the ER/internist standard of care and whether his causation opinion had a reliable basis in literature; the decision rests on Daubert/Kumho standards and Mississippi Rule of Evidence 702.
- The court ultimately held the trial court did not err in excluding Gebel’s testimony and in granting summary judgment based on lack of proof of causation, given the absence of credible support in medical literature for a greater than 50% chance of better outcome from tPA or retrieval devices in King’s BAO stroke.
- The majority notes the need for some support in medical literature when an expert’s theory contradicts published data; personal experience alone is insufficient to sustain the opinion under Rule 702.
- The judgment of the Circuit Court of Jackson County is affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Qualified to testify on standard of care | Gebel is highly qualified; familiarity with ER/hospitalist care suffices | Gebel lacks sufficient familiarity with ER/internist standard of care | Affirmed exclusion; lack of reliable basis for standard of care opinion |
| Reliability of causation opinion | Gebel’s 70% better-outcome claim supported by literature and experience | No literature supports >50% better outcome; Helsinki/NINDS/ECASS studies do not support his view | Held that causation opinion not reliably supported by medical literature; exclude opinion |
| Reliance on literature vs. personal experience | Personal experience can support opinion where literature is lacking | Expert must rely on credible medical literature to be admissible | Opinion invalid without credible literature support; Daubert gatekeeping applied |
| Standard for appellate review of expert testimony rulings | Trial court abused discretion; Dr. Gebel’s qualifications were sufficient | Abuse-of-discretion review supports trial court ruling | De novo review for summary judgment; upheld admissibility ruling based on reliability |
Key Cases Cited
- Poole v. Avara, 908 So.2d 716 (Miss. 2005) (importance of literature support, not absolute requirement)
- Hill v. Mills, 26 So.3d 322 (Miss. 2010) (reliability challenged when literature contradicts expert)
- Patterson v. Tibbs, 60 So.3d 742 (Miss. 2011) (lack of literature support requires exclusion of expert)
- Sherwin-Williams Co. v. Gaines ex rel. Pollard, 75 So.3d 41 (Miss. 2011) (expert opinions excluded absent scientific authority)
- Ladner v. Campbell, 515 So.2d 882 (Miss. 1987) (greater-than-50% causation standard; proof required)
- Kumho Tire Co. v. Carmichael, 526 U.S. 137 (U.S. 1999) (Daubert gatekeeping; broad discretion to evaluate reliability)
- Daubert v. Merrell Dow Pharms., Inc., 509 U.S. 579 (U.S. 1993) (reliability standards for expert testimony)
- McGee v. River Region Med. Ctr., 59 So.3d 575 (Miss. 2011) (expert must articulate standard and causation)