Moriarty Ex Rel. Moriarty v. Secretary of Health & Human Services
130 Fed. Cl. 573
| Fed. Cl. | 2017Background
- Eilise Moriarty received MMR vaccine on Jan. 2, 2001; five days later she began having seizures and was hospitalized multiple times over the next six months.
- Johns Hopkins treated Eilise with a ketogenic diet that controlled her seizures; she was diagnosed with static encephalopathy of unknown etiology and intractable atonic seizures.
- Over subsequent years Eilise displayed persistent cognitive, language, and motor deficits and treating clinicians noted a history attributing her seizures to an MMR reaction.
- Petitioners filed a Vaccine Act claim seeking compensation for seizure disorder/encephalopathy allegedly caused by the MMR; the case proceeded through multiple special masters and appellate review.
- The Federal Circuit vacated an earlier denial and remanded for the special master to consider the entire record (including the Weibel article and Dr. Shafrir’s second report); on remand the special master again denied relief, finding Althen prong two unmet.
- The Court of Federal Claims vacated the special master’s remand decision, holding the special master had imposed an improperly high burden on prong two and remanded for damages determination.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Petitioners proved Althen prong one (a medical theory linking MMR to encephalopathy) | Weibel article and expert reports provide a plausible medical theory that MMR can cause autoimmune encephalopathy | Respondent questioned the sufficiency/reliability of the medical-theory evidence | Court found prong one established (special master on remand also found possible causation) |
| Whether Petitioners proved Althen prong two (actual sequence showing MMR caused Eilise’s injury) | Clinical picture, temporal proximity, treating clinicians’ attributions, and overlapping evidence satisfying prong one and three support causation | Special master emphasized lack of contemporaneous immunologic testing and treated physicians’ records that did not document a vaccine reaction | Court held the special master set too high a standard; resolved in favor of Petitioners on liability and remanded for damages |
| Whether lack of contemporaneous immunologic testing defeats causation proof | Petitioners: absence of old testing is not dispositive given then-limited diagnostics and available later opinions/evidence | Respondent: absence of antibody or specific tests undermines a definitive causal finding | Court agreed with Petitioners that absence of early testing did not bar causation and that special master erred in imposing that burden |
| Proper standard of review for allocation of burdens under the Vaccine Act | Petitioners: special master must apply Althen and resolve close causation calls for petitioners | Respondent: special master’s factual weighing entitled to deference | Court reviewed legal allocation of burdens de novo and found special master’s legal approach to prong two legally erroneous |
Key Cases Cited
- Althen v. Sec’y of Health & Human Servs., 418 F.3d 1274 (Fed. Cir. 2005) (establishes three-prong test for causation under the Vaccine Act)
- Moriarty ex rel. Moriarty v. Sec’y of Health & Human Servs., 844 F.3d 1322 (Fed. Cir. 2016) (vacated prior decision and remanded for consideration of full record including Weibel article)
- Capizzano v. Sec’y of Health & Human Servs., 440 F.3d 1317 (Fed. Cir. 2006) (evidence used to satisfy one Althen prong may overlap to satisfy another)
- Knudsen v. Sec’y of Health & Human Servs., 35 F.3d 543 (Fed. Cir. 1994) (close causation decisions are resolved in favor of claimants)
- Moriarty v. Sec’y of Health & Human Servs., 120 Fed. Cl. 102 (Fed. Cl. 2015) (prior Court of Federal Claims decision affirming special master, later vacated by Fed. Cir.)
- Heinzelman v. Sec’y of Health & Human Servs., 98 Fed. Cl. 808 (Fed. Cl. 2011) (allocation of burdens under the Vaccine Act is a legal issue reviewed de novo)