Lasley v. Georgetown University

KING, Associate Before FARRELL GALLAGHER, Judge. Judges, and Senior GALLAGHER, Judge: Senior question we answer a certified this case Ap Court of of law from the United States Circuit. peals for the District of Columbia pres plaintiff must The issue is whether on causation ent medical negligence. prima facie case of establish a Appeals has certified The Circuit Court in accordance with the of law statute. District certification of Columbia (1995). generally § 11-723 See D.C.Code Abramson, v. Penn Mut. Ins. Co. Life (D.C.1987) (describing 1205-08 statutory for certification our scheme law). authorizes questions of This statute certify ques Appeals to the Circuit Court when, in that to this court tions of local law estimation, controlling we have no court’s pending precedent determinative ll-723(a). Although the § cause. D.C.Code complaint filed his plaintifiyappellant for the District District Court United States Columbia, provide the law must our local appeal because the for this rule of decision District of Co arises under the claim itself generally negligence. See lumbia’s law 64, 58 Tompkins, 304 U.S. R.R. Erie Co. (holding fed- 82 L.Ed. S.Ct. eral apply geon. courts must local law to Caputy nonfederal Dr. confirmed the existence of actions). by inspecting the AVM an angiograph of Lasley’s brain. He also learned that several The Circuit Court of certified the branches of middle and anterior ce- following question of law: rebral arteries fed blood into the AVM. Dr. malpractice plaintiff, Must a medical Caputy Lasley further referred to Dr. Alfred order to presented jury, his claim a have Luessenhop, J. the chief of neurosurgery at present opinion testimony medical on the hospital. 15,1989, On June Dr. Luessen- (whether, issue of causation to a reason- hop Lasley met with to discuss treatment degree able certainty, medical it is more options 20, 1989, for his AVM. On June Dr. probable than procedure not that the was a Deveikis, John P. neuroradiologist, head causing injury), substantial factor in Lasley also met with to discuss treatment. (1) during injury where Lasley go particu- decided to forward with a itself, procedure the evidence treatment, Lasley, lar and eighteen who was resulting injury establishes that the is a old, years and his signed mother both recognized procedure, risk of such a and authorizing consent form Dr. per- Deveikis to (3) the evidence establishes that there is procedure form despite the acknowl- risk, some in this case less than a five- edged Lasley alleges risks. that neither Dr. chance, percent-per-year that Luessenhop adequately nor Dr. Deveikis ex- spontaneously would occur in the absence plained the risks of the There- procedure? of the fore, although consenting he admits Law, Question Certification of No. 94-7168 procedure, Lasley claims his consent was (D.C.Cir. 1995) Sept. (emphasis in origi- uninformed. nal). We hold that plaintiff in this medi- Dr. Deveikis treated AVM em- cally complex case must establish causation bolizing procedure, it. an embolization testimony. placed artery catheter is into the carotid History I. Factual and Procedural the neck. A second catheter is then intro- artery duced via the first into the feeder complex

This case involves both a leaving frag- diverts blood the brain into the complicated condition and a medical treat- (chemical ile AVM vessels. An emboli mix- Appellant ment. Lasley Michael A. first vis- ture) artery is then inserted into physician, Wheeler, the feeder ited his Dr. Ronald when inside, via the catheters. Once the emboli experienced frequent headaches, he intense (obstructs) supply occludes the blood from tingling numbness and body’s right on his AVM, side, artery the feeder facilitating impaired right eye. vision in his A subsequent surgical tangled removal of the presence CAT scan conge- revealed the (AVM) may AVM vessels. The be re- nital arteriovenous ap- malformation peated for each of the discrete feeder proximately arter- adjacent four centimeters size carrying ies blood into the AVM. While the the anterior left lobe brain. preoperative performed and was An tangle fragile AVM is an abnormal angiogram operat- suite rather than an blood vessels. These substantially vessels room, ing proce- is nonetheless an invasive disturb cerebral blood flow. exiting After surgical operation. akin dure large arteries, normally cerebral blood trav- AVM, however, els to small An veins. di- principal pro- risk leaving verts the blood the brain. The accu- cedure is identical to that of the AVM condi- mulation of the diverted blood inside the tion itself. Both the AVM condition and the dangerous fragile AVM is because the AVM’s procedure pose danger embolization of ves- easily rupture, vessels can causing severe rupturing sel hemorrhaging. Dr. De- hemorrhaging. hemorrhaging Cerebral in veikis testified “the risk of the AVMs is damage turn causes brain that can be fatal. bleed, you you that it could if nothing, do AVM, Upon discovering the Dr. Wheeler According risk.” to the various doctors, Lasley Anthony Caputy, referred to Dr. treating probability J. of a natural Georgetown University Hospital hemorrhage approxi- neurosur- AVM mately percent year present per judge explained three to five for failed to anyone with an AVM. testified any expert Dr. Deveikis causation ele- presented higher himself “a judge concluded ment of his claim. trial hemorrhage.” An treat- required Las- that District Columbia law dangerous is same ment AVM for the expert testimony the em- ley present to that stated, Dr. “Anytime reason. As Deveikis Lasley’s to procedure AVM bolization you anything AVM, possi- to an do there’s a hemorrhage. Lasley rupture appealed and bility fragile it could cause the to vessels Appeals for the to the United States Court of burst, bleeding, and that could and the cause Circuit, subse- District of Columbia which bleeding damage could cause to the question the this court. quently certified to major doing the brain.... That’s fear of Analysis II. AVM, anything to the kind of and it’s also trying thing ironic that that’s the are to certified The Circuit Court has prevent.” precisely The evidence not does whether, the cir- the narrow under severity indicate the risk that the the cumstances of District of Columbia procedure might the embolization itself cause testimony requires opinion to law rupture hemorrhage. to and AVM The rec- specifically causation. We examine therefore, ord, to comparative fails reveal the Lasley’s to whether it was fatal claim that Lasley purportedly faced between the explicitly none of his witnesses asserted AVM condition and the treat- embolization procedure caused his AVM ment. rupture hemorrhage. and rule is that Our normally re- is Lasley’s Dr. Deveikis When embolized sec- medically quired complicated cases. We feeder, artery ond this risk materialized. have, however, acknowledged excep- certain artery ruptured feeder and hemor- expert requirement tions to witness rhaged, causing a severe intracerebral hema- negligence the types other cases where (blood clot). Lasley immediately toma complicated. conclude issues are less room, operating to the Dr. taken where requiring testimony ap- that the rule Luessenhop performed emergency surgery, plies particular to this case. saving Lasley’s Luessenhop life. Dr. suc- cessfully removed both hematoma and the Appellant’s Arguments A. did, Lasley however, inju- the AVM. sustain Lasley urges adopt us to his view that is ries, including aphasia (speech difficulty) and unnecessary for an witness to weakness). right-sided hemiparesis (body explain the causation of his informed element Lasley negligence filed a claim under Dis- Although consent claim. he concedes trict of Columbia law in the United States complicated general, he neuroscience is District Court for the District of Columbia. pertinent the issue of causation contends Lasley complaint, premised In his his claim quite simple. negligence claim his negligent Luessenhop failure Drs. Lasley argues that in this case Deveikis to obtain and informed simple obvious. He because causation is Lasley, however, consent. not claim that did only possibilities Ei- two exist: stresses that negligent performing Dr. Deveikis was while procedure embolization or the AVM ther the procedure. Lasley’s negligence con- sole rupture and caused his blood vessels to itself Luessenhop that neither nor tention was Dr. Moreover, hemorrhage. rupture properly Dr. him of the Deveikis advised bleeding during the embolization Lasley procedure. of the embolization risks estimation, tem- despite consenting proce- asserts poral coincidence dure, had he would withheld his consent link between rupture reveals causal fully explained doctors him the risks them. and the alternatives. granted implicitly the issue argues District Court the defense also judgment simple the unlikeli-

motion for as matter of law after of causation is because of hood, Lasley presented impossibility, his The trial or indeed the evidence. is not the cause of C. Discussion rupture. He reiterates the trial statistic beginning analysis, Before our we make procedure, that absent the there is mere preliminary some observations. Lasley’s percent three to five chance that an AVM complaint alleges negligent the doctors’ fail rupture hemorrhage will on its own ure to obtain his informed consent. Such a any given year. He also declares that it is initially requires proof claim of nondisclosure medically impossible for an Neviaser, of material risks. Gordon v. spontaneously proce- once an embolization (D.C.1984). Whether underway. dure persuasive of nondisclosure was at trial fact, in the District Court is an issue of reasons, upon Based these posits offer no assessment here of the sufficien that the completely capable was of infer- cy of in regard. the evidence A claim of ring the relevant causal relation without reli- requires proof uninformed consent also of opinion testimony. Lasley ance on medical causation. “Once there has been a breach of additionally states that doctors themselves disclose, duty patient to must demon puzzled by are precise of causes vessel strate a causal relation physi between the rupture, expert testimony provide so could cian’s failure to disclose the material infor nothing supposition. more than mation and (citing sustained.” Id. Appellee’s Counter-arguments B. Canterbury Spence, v. U.S.App. 150 D.C. 263, 281, 772, 790, denied, 464 F.2d cert. 409 Georgetown Lasley’s simplicity counters 1064, 560, U.S. 93 S.Ct. 34 L.Ed.2d 518 argument by emphasizing complexity (1972)). parties stipulated here have Georgetown causation issue this case. Lasley’s injuries ultimate —such argues lay jury that a ill equipped is to speech difficulty the adverse conse —are medically evaluate which of the compli- two quences bleeding. only the cerebral explanations persuasive. cated causal is more issue, therefore, disputed causation is the opinion testimony necessary, Medical is specific question of whether the embolization contends, Georgetown because of the over- procedure rupture to whelming complexity of this evaluation. hemorrhage. Georgetown concurs with medically complicated Our rule for cases is only there are two causal candidates: Either proof normally requires of causation spontane- the vessels AVM burst opinion testimony. “Ordinarily, medical in a ously, or procedure was the malpractice expert testimony medical Georgetown’s cause. view a sufficient required prove in order to ... causation.” understanding possibility requires of each Pre-Term, (quoting Sponaugle at Id. 295 v. specialized insight jurors typi- medical do not Inc., 366, (D.C.1980) (citations 411 A.2d 368 cally possess. Furthermore, since either ex- omitted)). requirement This in medical mal planation plausible, it is burden practice generally applies cases also to that rather than the malpractice specifically class of cases claim preexisting condition is the actual cause. ing example, lack of informed consent. For Georgetown contends the cannot mean- proof of causation remains an element of ingfully sophisticated judgment make this malpractice such claim. actions “[A]s evaluating without medical reasons described generally, relationship there must be a causal experts. medical physician’s adequately between the failure Georgetown argues divulge also damage patient.” it is insufficient to Canter solely rupture dining bury, supra, U.S.App. show that the 150 D.C. at 464 (citations procedure. They omitted); Gordon, approxi- reason that an at F.2d 790 su temporal overlap pra, (citing Canterbury). mate establishes a mere 478 A.2d at 294 Furthermore, requires experts correlation when the law are still re Finally, Georgetown quired causation. that if conjecture.” Washington, speculation or su obvious procedures are neither explains A.2d at 181. This rationale

pra, 579 of ordi- subjects the realm causes nor within why acknowledged excep limited we have knowledge experience. nary human Expert testimony not tions to the rule. Second, jury each if a could understand even required if of causation can be the issue alternatives, medi- without of the two causal wholly ordinary “resolved within the realm of testimony, rational basis it has no cal Gordon, knowledge experience,” human possible evaluating of the two which supra, (quoting at 478 A.2d 295-96 Canter rup- actually the AVM to causes did cause 282-83, bury, supra, U.S.App. 150 D.C. at jury to make A is unable ture and bleed. 791-92), proof if is so 464 F.2d at or “the own it has this determination on its because as to lie within the ken of the aver obvious logical choose one over the no reason to juror,” age lay Washington, supra, 579 A.2d to relevant medical access other. Without (citations omitted). have summa 181 We facts, jury reasoned basis for the has no exceptions rized the as follows: or the emboli- concluding whether prevent jury engaging from in To rupture. “To allow a zation caused the speculation, we have held that in the ab- science, to laymen, in medical unskilled may expert testimony, a not sence of a attempt to answer such the causal connection between a consider guesswork, specu- permit the rankest kind of negligence plaintiffs defendant’s Baltimore, supra, conjecture.” lation and disability claimed unless: Wilhelm, supra, (quoting 1231 545 A.2d at (1) disability emerged first coinciden- 719). A.2d at 185 tally very negligent with or soon after the presented plaintiff never In this ease the act, or jury precisely how explain (2) disability type by its was of a which procedure rather why the embolization or cause, very nature reflected its or injury. itself caused than the AVM (3) injury to mat- the cause of the related deficiency to fatal to this find Lasle/s knowledge, experience, ters of common evidentiary error was fatal This exact claim. laymen. observation of un- prima proof facie plaintiff’s Co., previous District Court consent B.F. 545 A.2d informed Baltimore v. Goodrich Luessenhop, 669 (D.C.1988) v. 1228, Early Blincoe (relying on v. case. See 1231 (D.D.C.1987). nearly 513, In a 252, (D.C.1978); F.Supp. 517 Wagner, 254 Jones 391 suffering Miller, (D.C.1972); setting, patient factual identical v. 290 A.2d 590-91 opin- Comm’n, present medical faded to Safety 230 from an AVM Wilhelm State Traffic (1962)). testimony that an embolization It ion 185 A.2d Md. court ana- injury. The Blincoe caused her

Laslejfs that his case falls within these view lyzed significance Williams, of this omission David W. Louisell & Harold Malpractice 8.05, § follows: at 8-71 Medical (footnotes omitted) added). (emphasis To establish the medical fact of the caus recognized difficulty prior al link between Mrs. Blincoe’s March We have Gordon, proce supra, appellant injured cases. “stroke” dures, plaintiffs skiing. proffer must his shoulder while 478 A.2d at 293. medical testi twice, mony, Canterbury, surgically operated After his doctor see 464 F.2d at 792.... his patient Id. worsened. sued for negligent nondisclosure of the risks of the Plaintiffs refer court portion to no We, however, surgery. Id. affirmed a direct- indicating the record a causal link between him, against explaining ed verdict as follows: February embolizations and March was neces- court, addition, 4 “stroke.” This can sary to establish both that there awas find no medical evidence in the medical surgery involved and that the condi- records, depositions or the affidavits appellant’s tion of shoulder deteriorated as establishing relationship a causal between surgery a result of the .... February embolizations and the stroke Appellant through faded to establish ex- any competent of March 4. Without medi- however, pert testimony, surgery that the link, cal evidence to establish a causal aggravated disability. was the cause of his must conclude as a matter law that no causality This lack on the issue of relationship causal exists between the Feb- malpractice fatal to his medical claim. ruary embolizations and the March 4 added). (emphasis Id. at 296 We reached stroke. Baltimore, supra, the same conclusion in added). (emphasis Id. at 516-17 The District employee where an fell five or six feet be- Court reached the conclusion in same this negligent operation hydrau- cause of the judge case. The trial confirmed that “no- employee lic lift. 545 A.2d at 1230. The where in the record” did evidence physical psy- suffered from “numerous “establish a causal link between the emboli- chological ailments” before the accident. Id. bleeding.” zation and the discussing exceptions expert After to the tes- It is not uncommon to encounter this in- rule, timony we nonetheless concluded that difficulty evaluating herent of between an multiple preexisting because of “the and con- subsequent ailment and medical treatment as possible current causes ... this case falls injury. malprac- the cause of an In medical category ‘medically within that complicat- of tice cases it is often unclear whether an requiring expert testimony.” ed’ cases Id. injury by preexisting malady is caused the 1231. also note that case bears procedure performed the medical to alleviate McQueen, no resemblance to a case where principle recognized: it. This is well legitimate exception we did find a to the every person Almost who receives the rule. International Sec. physician McQueen, Corp. Virginia services of a is sick or disabled 497 A.2d 1076 (D.C.1985). Thus, goes physician. personal when he first That case involved in- malpractice in a malpractice, rather than medical there there ever-present possibility 'pa- preexisting that it was the was no condition original injuries, tient’s might rather than the and the actu- affliction physician’s negligence injuries readily apparent. which caused al cause damage. (according plaintiff, security ultimate Id. Malpractice cases often at 1078 a present room, problem guard “pushed the difficult of distin- me ... back into the guishing neg- banged my the effects of the defendant’s karated me to the floor and I ribs wall”). ligence against against from the natural results of the the metal bench plaintiff’s disease. unpersuaded by Lasley’s argu- areWe

Typically, expert testimony compel will be re- ments that the facts of this case quired application exception to establish causation in fact for the to the tes- jury. timony requirement. Having explained why (2d Honoke, the two causal alter- the evaluation between in the Law Causation ed.1987) (if causes, details of possible two complicated, we now turn natives is unknown, proof not burden of why causa- actual cause reasons it is insufficient the charac- “evidence of solely evidence that met without at least tion dif- immediately teristically processes after the which during or different effects”). In- produce their ferent causes condition, conjunction of a only of the formed medically complicated In a case such injury, lay jury could procedure, this, contemporaneity between a medical pinpointed the cause of not have injury a foun procedure and an is too weak blindly guessing. rupture without vessel causation. Corre upon dation which to infer hardly synonymous. lation and causation are conclude otherwise —that If we were to proximate temporal “a associa We find that proved causation —we contemporaneity a causal alone does not suffice to show tion plaintiffs might inappropriately shift temporal link” a mere coincidence because defendant. Instead burden of onto the necessarily en between two events does not why the plaintiff to indicate requiring between tail a substantial causal relation occurred, forcing effect be Secretary Dep’t Hodges v. them. See causality. For exam- disprove defendants Servs., 958, 960 & Human 9 F.3d Health easily tempted to con- ple, could (Fed.Cir.1993) Secretary (quoting Grant v. during any injuries sustained clude that Sews., 956 Dep’t Health & Human necessarily result from the surgery brain (Fed.Cir.1992)). 1144, 1148 Conse F.2d surgery in- brain operation itself because quently, required. “With more evidence here herently risky. a conclusion Such more, proximate temporal out relation application an unreasonable would constitute support finding ship will not of causation.” loquitur ipsa of res because of the doctrine States, Hosier v. 718 F.2d United always an parties agree that there was both (6th Cir.1983), denied, 817, 105 cert. 469 U.S. might rupture appreciable risk that the AVM (plaintiff failed S.Ct. 83 L.Ed.2d 31 its even if the embolization own immunological reaction to a to show that her Blincoe, supra, performed. See were never flu inoculation caused the auto-immune swine (“res ipsa loquitur is F.Supp. at 517 suffered). The need disease irom which she inapplicable”). especially for further is clear here be pre- disagree that the evidence We also rup possible cause it is alterna- improbability of the sented on the during spontaneously tured the embolization prove causation. sufficient to tive cause is procedure. possibility complicates This not Lasley is correct that he need While issue, and this added dimension must explanation, he disprove the alternative complexity only for clari increases the need affirmatively ex- prove that his nevertheless ty. right one. This planation is indeed complete impressed are absence We showing simply by proof is not established during trial. of clarification the District Court AVM, suffering an everyone from that for stated, no one judge As the trial “We have everyday life is sta- rupture in spontaneous likely not ... that the saying it’s more than unlikely any given year. We tistically in by the part into that of the AVM intrusion proof that this require particularized instead doing the embolization caused doctors likely than not procedure more embolization bleed, opposed it because it was as bled rupture substantially this AVM to anyway_” ever going to No doctor bleed exchange following hemorrhage. The exactly why Lasley’s rupture or how detailed clearly illus- trial during the District Court actually Lasley’s doctors failed to occurred. insufficiency Lasley’s proposed trates the or identify specific causal mechanism comparative from of causation inference sequence of cause and any precise articulate risks alone: Blincoe, supra, F.Supp. 669 effect. See you Capu- [Dr. ask (insufficient PLAINTIFF: Let me a caus- evidence to establish Tony in an hemorrhage greater ty], risk of is the link); H.L.A. Haet & generally al see just that, view, presenting my or in natural in a cluster of facts history? permit jury would a reasonable to find causa- opinion tion without a medical on which to Objection, DEFENDANT: Your Honor. rest the conclusion. I would reverse and Yes, objec- THE I’ll COURT: sustain the go jury allow the case to to a on the funda- brought tion. He in wasn’t here as an dispute parties— in mental issue between the expert testify. hospital adequately whether doctors opinion Without such a crucial medical identi- Lasley dangers warned of the of the emboli- fying potential the relative risks of the two procedure.1 zation causes, jury reliably could not determine solely probabilities. the actual cause from only possibilities: There were two causal Moreover, Easley’s we discount declaration rupture hemorrhaging either the oc- in spontaneous rupture his brief that a is naturally though curred as were at medically impossible during an embolization television, watching they home expert A may unique- operation legal a result of sense ly competent propo- to assert such a medical likely that the intrusion into the brain more sition, pre- but this trial no ever bring- than not factor in “was substantial opinion. sented this ing about the result.” District Columbia Freeman, (D.C. reject 477 A.2d 716 n. 9 reliability argu- We also Lasle/s 1984) (quoting W. PROSSER, ment. He opinion maintains that medical Law of Torts (4th ed.1971)). § majority at 241 As the unnecessary because the exact correctly testimony, prin- recounts the “The why reasons AVM embolization can cause cipal risk of the embolization rupture vessel are unknown even to the ex- identical to that of the perts. agree AVM condition itself.” Georgetown if so, Testifying through deposition, in court and this is then the is foreclosed from performed making the doctors who guess appear it. It about procedures uniformly explained and related they the care with which advised plaintiffs if the cannot form family danger operation his of the so opinion certainty with sufficient so as to very rupture that it sensitive could cause the judgment, nothing make a medical there bleeding keep intended to from the record with which a can make And, fact, happening naturally. the ar- certainty a decision with sufficient so as to tery ruptured during oper- feeder either legal judgment. make a immediately Assuming ation or after it. Young, McMahon v. 442 Pa. 276 A.2d grim statistics on AVM’swere so that of 100 (1971). persons having roughly the condition Consequently, we conclude that in expect could to suffer a natural medically complex tes- year, the course that would still leave it timony necessary on causation was to survive highly improbable rupture occurring that a judgment a motion for as a matter of law. just causally it when did here was unrelated certify The clerk shall this answer to the operation. might agree Yet I well United States Court of for the Dis- contempo- the court in that with that case trict of Columbia Circuit. raneity and the conceded risks of the sur- So ordered. gery inadequate proxy were an for medical probabil- on causation. here But FARRELL, Judge, dissenting: Associate ities become insurmountable when the testi- was, general is no mony by Caputy There that our Dr. court as the states, require expert opinion probability spontane- decisions “[t]he tes- [ie., timony naturally occurring] causation in medical mal- ous AVM practice unique hemorrhage percent year cases. But this case is per is five point, judge wisely given 1. On that the trial refused to had dan- whatsoever been him about the verdict, although Lasley’s direct a gers unrelieved operation of the taxes belief. any warning succession of one-word denials that very I prevent, doubt testimony carefully harm it is intended I read that less.” (as an could state with much that Luessenhop’s as Dr. corroborative well opposite conclusion confidence testimony people that “of all who But, at rupture happened spontaneously. bleeders,” a hun- three or four out of [are] least, recognize generis I the sui would hemorrhage spontaneous dred “will have a it to the de- of this case and leave nature per year”); supports a reasonable infer- inference of negate the reasonable fense ence, purposes, Las- for directed verdict testimony by expert or otherwise. rup- ley spontaneous had a would not have here, exception By acknowledging the or, surgery ture at or around the time of general not weaken the rule. indeed, Put- for some time into the future.2 testimony togeth- ting probabilities as to hemorrhage oc-

er with the fact that very I operation, time of the

curred

do not know what other required on which to

would need base Indeed,

opinion. given danger the conceded very can cause the mony presenting Lasley presented 2. Dr. Deveikis’ and circumstances hemorrhaging higher hemorrhage,” that occurred "a besides not stat- issue as to whether risk, yet ing higher surely simultaneously operation unre- with the how much does not weight overcome the combined of the other testi- lated to it. notes to establish the causal link. Even experts cases, they are ... “[i]n unable discern the non-disclosure are nor cause, jurors may try mally true not even to do so. needed on issues as to the cause of 1385 exceptions rather than the Gordon, readily apparent at 295 injury_” supra, 478 A.2d disagree. rule itself. We U.S.App. Canterbury, supra, 150 (quoting 792). Experts F.2d at are D.C. that the issue are of the view alleging negligence cases in medical essential medically compli in this case is so causation because the issue of nondisclosure required to introduce cated science, profes “distinctly to some related precise testimony explaining sion, Washington v. occupation....” ly why the embolization how and Ctr., 177, 181 Washington Hosp. 579 A.2d vessels his AVM caused the (D.C.1990) (quoting District Columbia that a agree Georgetown bleed. We (D.C.1987)). Peters, As rationally determin jury may incapable of commented, the Circuit Court of has rupture without ing cause of the the actual experts.” are for medical “medical facts expert testimony. the assistance Canterbury, U.S.App. D.C. at supra, our conclusion. Two reasons motivate omitted). (citations 464 F.2d at 792 First, thorough understanding of each yet is essential diffi- possible causes the two expert opinion testi purpose of “The of medical to attain without the benefit cult jury findings on mere mony is to avoid based ruptures and expertise. Spontaneous AVM

Case Details

Case Name: Lasley v. Georgetown University

Court Name: District of Columbia Court of Appeals

Date Published: Feb 6, 1997

Citation: 688 A.2d 1381

Docket Number: 95-SP-1341

Court Abbreviation: D.C.