ELHER v MISRA
Docket No. 150824
Supreme Court of Michigan
February 8, 2016
499 Mich 11
Docket No. 150824. Decided February 8, 2016.
Paulette Elher brought a medical malpractice action in the Oakland Circuit Court against Dwijen Misra, Jr., and others, seeking damages after Misra accidentally clipped her common bile duct while performing a laparoscopic cholecystectomy. Plaintiff sought to admit expert testimony stating that clipping a patient‘s common bile duct during an otherwise uncomplicated laparoscopic cholecystectomy was a breach of the applicable standard of care. Plaintiff also claimed that negligence could be inferred from the improperly clipped bile duct under the doctrine of res ipsa loquitur. Defendants moved to exclude plaintiff‘s proposed expert testimony on the ground that, because it was not supported by peer-reviewed literature or the opinions of other physicians, it did not meet the standards for reliability set forth in
In an opinion per curiam signed by Chief Justice YOUNG and Justices MARKMAN, ZAHRA, MCCORMACK, and VIVIANO, the Supreme Court, in lieu of granting leave to appeal and without hearing oral argument, held:
The proponent of expert testimony in a medical malpractice case must satisfy the court that the expert is qualifiеd under
Judgment of the Court of Appeals reversed; trial court order excluding the testimony of plaintiff‘s expert and granting summary disposition in favor of defendants reinstated.
Justice BERNSTEIN, dissenting, would have affirmed for the reasons stated in the Court of Appeals majority opinion.
Justice LARSEN took no part in the decision of this case.
EVIDENCE - EXPERT TESTIMONY - MEDICAL MALPRACTICE - STANDARD OF CARE - RELIABILITY - STATUTORY FACTORS.
Speaker Law Firm, PLLC (by Steven A. Hicks), and DeNardis & Miller, PC (by Ronald F. DeNardis), for plaintiff.
PER CURIAM. In this medical malpractice case, we must determine whether the circuit court abused its discretion by excluding plaintiff‘s expert medical testimony under
We hold that, under the facts of this case, in which Priebe admitted that his opinion was based on his own personal beliefs, there was no evidence that his opinion was generally accepted within the relevant expert community, there was no peer-reviewed medical literature supporting his opinion, plaintiff failed to provide any other support for Priebe‘s opinion, and defendant submitted contradictory, peer-reviewed medical literature, the circuit court did not abuse its discretion by excluding Priebe‘s testimony. The Court of Appeals clearly erred by concluding otherwise. We therefore reverse the judgment of the Court of Appeals and reinstate the opinion and order of the Oakland Circuit Court.
I. FACTS AND PROCEEDINGS
Plaintiff, Paulette Elher, underwent a laparoscopic cholecystectomy (removal of the gallbladder) per
On February 3, 2011, plaintiff filed suit in Oakland Circuit Court, alleging that Misra breached the applicable standard of care by clipping the common bile duct.2 Plaintiff‘s sole standard-of-care expert was Priebe, a board-certified general surgeon and professor at Case Western Reserve University. At his deposition, Priebe testified that, in his opinion, it is virtually always malpractice to injure the common bile duct during a laparoscopic cholecystectomy, absent extensive inflammation or scarring. He considered plaintiff‘s injury in this case to be a breach of the standard of care, but did not provide any suрporting authority for his opinion.
A. Correct.
Q. You cannot cite to any medical literature whatsoever that supports that opinion, true?
A. Medical literature doesn‘t discuss standard of care.
Q. So is that true, sir?
A. It‘s true. But medical literature does not discuss standard of care.
Q. Well, you know, there are a host of colleagues of yours, national and local, who would disagree with you in terms of the only caveats being a breach of the standard of care being extensive scarring or inflammation; isn‘t that correct?
A. They‘re entitled to their opinion. In my opinion, that is a breach of the standard of care and malpractice.
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Q. Can you cite one current general surgery colleague at Case Western University who agrees with your position, to your knowledge, that other than these caveats of extensive scarring or inflammation, it is always a breach of the standard of care to cause injury to the common bile duct during a laparoscopic cholecystectomy?
A. I‘ve never discussed this with any of them. I have no idea what their opinions are.
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Q. And as it relates to [your standard-of-care] opinion, you cannot cite to a shred of medical literature, a medical authority, to support that opinion other than your own belief system, true?
A. There is no authority that exists to do that, so that‘s true. But there is no authority that does that. So the answer is true.
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A. I‘ve never discussed it with them. I wouldn‘t know.
Q. Can you cite to one colleague in the general surgery field, a board certified general surgeon, who agrees with your position that the only caveats to injury to the common bile duct with laparoscopic cholecystectomy would be extensive scarring or inflammation?
A. I wouldn‘t know. I‘ve never asked any of my other surgical colleagues, so I would have no idea what thеir opinion is.
Defendants moved for summary disposition under
The circuit court concluded that plaintiff had failed to address whether her expert‘s testimony was reliable under
Plaintiff appealed the circuit court‘s decision in the Court of Appeals, which reversed the circuit court in a split opinion.3 The majority held that the circuit court incorrectly applied
First, the majority concluded that no evidence of testing or replication supported either side‘s expert opinions. The majority failed to understand how such standard-of-care opinions could ever be tested or replicated. Because Priebe‘s opinion did not implicate any possible testing or replication, the majority concluded that the circuit court abused its discretion by using this factor to exclude his testimony.
Second, with regard to peer-reviewed publication, the majority stated that Priebe testified that there was no peer-reviewed literature addressing whether clipping the common bile duct quаlified as a breach of the standard of care and concluded that defendants’ article submissions did not rebut Priebe‘s statement. The majority concluded that the article authored by Dr. Josef E. Fischer and submitted by defendants was an editorial expressing an opinion that supported rather than refuted Priebe‘s thesis that common bile duct injuries can represent standard-of-care violations. The article authored by Dr. Lawrence Way and submitted by defendants similarly acknowledged that some bile duct injuries are the product of negligence, said the majority. The majority concluded that the circuit court abused its discretion by relying on the lack of peer-review to exclude Priebe‘s testimony because no evidence supported that the standard-of-care issue debated by the experts had been tested, analyzed, investigated, or studied in peer-reviewed articles.
Finally, the majority concluded that no widespread acceptance of a standard-of-care statement could be found. The majority reasoned that the record reflected no disagreement about the standard of care, only
The Court of Appeals dissent would have affirmed the grant of summary disposition, concluding that the circuit court did not аbuse its discretion by excluding the expert testimony of Priebe. The dissent stated that Priebe provided no basis for his understanding regarding what the standard of care required or the manner in which it was breached. Priebe conceded that his views were based on his own “belief system,” for which he failed to provide any supporting authority. Quoting Priebe‘s testimony, the dissent concluded that Priebe offered no basis for his asserted knowledge of the standard of care or his opinion that there was a breach in this case. The dissent stated that it may be that Priebe held himself to a higher, or different, standard than that practiced by the medical community at large and thаt Priebe‘s experience alone, without any supporting literature, was insufficient to allow him to testify that Misra committed malpractice. In a footnote, the dissent pointed out that while the majority characterized Priebe‘s opinion as consistent with the “purists” referred to in the Fischer and Way articles, there is no indication that these articles, or the thinking of other “purists,” informed Priebe‘s opinion.
II. STANDARD OF REVIEW
We review the circuit court‘s decision to exclude evidence for an abuse of discretion.4 “An abuse of discretion occurs when the trial court chooses an outcome falling outside the range of principled outcomes.”5 We review de novo questions of law underlying evidentiary rulings, including the interpretation of statutes and court rules.6 The admission or exclusion of evidence because of an erroneous interpretation of law is necessarily an abuse of discretion.7
III. ANALYSIS
Defendants contend that the circuit court did not abuse its discretion by excluding Priebe‘s testimony. We agree.
A plaintiff in a medical malpractice action must establish “(1) the applicable standard of care, (2) breach of that standard of care by the defendant, (3) injury, and (4) proximate causation between the alleged breach and the injury.”8 “Generally, expert testimony is required in a malpractice case in order to establish the applicable standard of care and to demonstrate that the professional breached that standard.”9 An exception exists when the professional‘s breach of the standard of care is so obvious that it is within the common knowledge and experience of an
“The proponent of expert testimony in a medical malpractice case must satisfy the court that the expert is qualified under
If the court determines that scientific, technical, or othеr specialized knowledge will assist the trier of fact to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training, or education may testify thereto in the form of an opinion or otherwise if (1) the testimony is based on sufficient facts or data, (2) the testimony is the product of reliable principles and methods, and (3) the witness has applied the principles and methods reliably to the facts of the case.
This rule requires the circuit court to ensure that each aspect of an expert witness‘s testimony, including the underlying data and methodology, is reliable.13
- (a) Whether the opinion and its basis have been subjected to scientific testing and replication.
- (b) Whether the opinion and its basis have been subjected to peer review publication.
- (c) The existence and maintenance of generally accepted standards governing the application and interpretation of a methodology or technique and whether the opinion and its basis are consistent with those standards.
- (d) The known or potential error rate of the opinion аnd its basis.
- (e) The degree to which the opinion and its basis are generally accepted within the relevant expert community. As used in this subdivision, “relevant expert community” means individuals who are knowledgeable in the field of study and are gainfully employed applying that knowledge on the free market.
- (f) Whether the basis for the opinion is reliable and whether experts in that field would rely on the same basis to reach the type of opinion being proffered.
(g) Whether the opinion or methodology is relied upon by experts outside of the context of litigation.
At the outset, we reject plaintiff‘s contention that this is a case in which the breach of the standard of care is so obvious to a layperson that no expert testimony is required. Priebe himself conceded that some professionals believe that clipping the common bile duct, absent extensive scarring or inflammation, is not necessarily a breach of the standard of care. Accordingly, expert testimony was required to prove the applicable standard of care and a breach of that standard of care in this case.19
There is no doubt that Priebe, plaintiff‘s sole expert regarding the standard of care, was qualified to testify as an expert based on his extensive experience. On the basis of this experience, he opined that, absent extensive scarring or inflammation, it is virtually always a breach of the standard of care to clip the common bile duct. In Priebe‘s opinion, because there was no evidence of scarring or inflammation, Misra breached the standard of care in this case. The question is whether this opinion was sufficiently reliable under the principles articulated in
The Court of Appeals viewed this case as one in which the experts’ opinions were outside the realm of scientific methodology and in which Priebe‘s opinion was reliable given his specialized experiеnce and knowledge. The United States Supreme Court has recognized, as did the circuit court, that the Daubert factors may or may not be relevant in assessing reliability, depending on the nature of the issue, the expert‘s expertise, and the subject of the expert‘s
We conclude that the circuit court did not abuse its discretion by relying on two of the factors listed in
The circuit court also did not abuse its discretion by relying on the lack of evidence regarding the degree to which Priebe‘s opinion was generally accepted.25 The
We do, however, agree with the Court of Appeals majority that all the factors in
IV. CONCLUSION
We hold that the circuit court did not abuse its discretion by concluding that Priebe‘s background and experience were not sufficient to render his opinion reliable in this case when Priebe admitted that his
YOUNG, C.J., and MARKMAN, ZAHRA, MCCORMACK, and VIVIANO, JJ., concurred.
BERNSTEIN, J. (dissenting). I would affirm for the reasons stated in the Court of Appeals majority opinion. I believe the Court of Appeals reached the right result for the right reasons.
LARSEN, J., took no part in the decision of this case.
