This litigаtion involves claims asserted by Roderic McDowell against government and medical defendants resulting from the delayed treatment of his illness while detained as an inmate at Dekalb County Jail in June 1997. The district court granted summary judgment in favor of Dekalb County, Georgia, on Mr. McDowell’s § 1983 claims. The district court also granted summary judgment to defendants Wexford Health Sources, Inc., and Pernell Brown on his state law medical negligence claims. No other claims were left pending before the district court. Mr. McDowell’s appeal raises the following issues: (1)
*1286
whether Mr. McDowell demonstrated a § 1983 claim against a municipality under
Board of County Commissioners v. Brown,
I. Facts
The Dekalb County Sheriffs Office maintains the Dekalb County Jail (the “Jail”). This appeal involves two divisions at the Jail: the jail division, which manages the daily operations, and the field division, which handles medical transports to Grady Memorial Hospital (“Grady”). Additionally, the Jail contracted its health services out to Wexford Health Sources, Inc. (“Wexford”). Wexford, in turn, employed doctors and nurses to attend to the inmates’ medical needs. The Jail’s policy required its staff to call an Emergency Medical Services ambulance should medical personnel determine an inmate’s condition to be an emergency.
Plaintiff, Roderic McDowell, was detained as an inmate at the Dekalb County Jail in May and June 1997 pending disposition of a warrant for failure to report to his probation officer. Two weeks into his detention, at the end of May 1997, Mr. McDowell began to suffer pain in his lower back. Over the course of several days, Wexford’s nurses treated Mr. McDowell’s condition. On June 5, 1997, the Jail’s field division transported Mr. McDowell to Grady to evaluate his back pain and other symptoms. Mr. McDowell was treated and returned to the Jail the same day.
At 9:30 p.m. the following day, June 6, 1997, Mr. McDowell reported that he could not urinate and had difficulty walking. Pernell Brown (“Nurse Brown”), a Wex-ford nurse in the Jail’s medical clinic, examined Mr. McDowell, and determined that he needed to return to Grady for treatment. Nurse Brown completed a referral form directing the Jail to send Mr. McDowell to Grady in order to rule out pneumonia or “acute abdomen.” At 9:50 p.m., Nurse Brown gave the referral form to Sergeant Hutchinson with the Sheriffs Office. There is some dispute as to whether Nurse Brown informed Sergeant Hutchinson of either the urgency of Mr. McDowell’s condition or the time frame in which Mr. McDowell needed medical attention. Sergeant Hutchinson testified during his deposition that Nurse Brown gave no such instructions, while Nurse Brown maintained in her deposition that she told Sergeant Hutchinson to transport Mr. McDowell to Grady “within the hour.” Nurse Brown did not inform the Wexford doctor on call of the situation, and left the Jail shortly after seeing Mr. McDowell.
Sergeant Hutchinson and another officer moved Mr. McDowell from the Jail’s clinic to its intake area to await transport by field division officers because the transport area was closed. Sergeant Hutchinson then distributed copies of Mr. McDowell’s referral form to various Sheriffs Office staff, communications personnel, and the intake area nurse. The communications officer reported that dispatch had sent a field division unit to handle Mr. McDowell’s transport to Grady. At the end of his shift, Sergeant Hutchinson informed the following shift’s supervisor that Mr. McDowell was waiting in the intake area for transport to Grady by the field division.
A nurse monitored Mr. McDowell’s condition while he waited in the intake area, and provided care for his infirmities. When a field division deputy arrived, another inmate, suffering severe facial trau *1287 ma from an altercation, also required transport to Grady. The transport deputy could only take one inmate because policy mandated that the deputy wait with the inmate at Grady. The deputy consulted the intake nurse and took the other inmate to Grady. Jail staff then took Mr. McDowell back to the medical clinic so he could lie down, and to allow Wexford nurses to monitor his condition and arrange for ambulance transport if Mr. McDowell’s condition deteriorated.
In the early morning hours of June 7, 1997, the field division performed several mental health transports. Mr. McDowell’s condition was not considered аn emergency, and the Jail’s policy places priority on mental health transports over non-emergency transports. The morning watch commander notified the Jail that his shift could not transport Mr. McDowell to the hospital; Mr. McDowell’s transport would be accomplished by the day shift, which began at 8:00 a.m. When the day watch deputy arrived to take Mr. McDowell to Grady, he was no longer in the intake area. The field division sergeant told the Jail to inform him when Mr. McDowell was ready for transport. At 9:00 a.m. that morning, Mr. McDowell told an officer that he had no feeling in his legs. A doctor and nurse examined Mr. McDowell and determined his condition to be emergent. An ambulance was called to take Mr. McDowell to Grady. He arrived there at 12:20 p.m.
By the time he arrived at Grady Hospital, Mr. McDowell was experiencing paralysis in his legs. Mr. McDowell was first examined by Grady doctors at 1:38 p.m. One doctor noted Mr. McDowell’s symptoms and diagnosed him as needing to “rule out” spinal cord compression and epidural abscess. For the rest of the day, a battery of tests were performed on Mr. McDowell. By 6:45 p.m., doctors diagnosed Mr. McDowell with spinal cord compression, and transferred him back to the emergency room at 9:20 p.m. Emergency physicians then admitted Mr. McDowell to the neurosurgical department. Mr. McDowell entered surgery for a spinal epidural abscess 1 at approximately 10:20 p.m., more than twenty-four hours after he first visited Nurse Brown. The surgery ultimately reversed Mr. McDowell’s total paralysis, however, Mr. McDowell remains an incomplete paraplegic. 2
II. Proceedings Below
Mr. McDowell filed this case in Georgia state court on June 1, 1999, alleging medical malpractice and constitutional violations against: Dekalb County (the “County” or “Dekalb”), Wexford and Nurse Brown, 3 Grady Memorial Hospital, and several doctors and nurses who treated Mr. McDowell at Grady. Mr. McDowell sued Dekalb under 42 U.S.C. § 1983 for violation of his Eighth Amendment rights and asserted state-law medical negligence claims against Wexford and Grady. 4 The County removed the case to federal district court on September 16,1999.
On September 25, 2001, the district court determined that McDowell failed to establish that the County’s policy, practice or custom resulted in the violation of his Eighth Amendment rights, as required by
Monell v. Department of Social Services,
*1288
In March 2003, with the case against the County dismissed, the district court reopened discovery to permit McDowell to develop further expert testimony on causation, but it did not permit additional expert discovery with regard to Nurse Brown’s negligence. As a result of the district court’s prior exclusion of McDowell’s medical experts and its determination that they could not testify as to the proper standard of care for a nurse, McDowell was left with no expert testimony regarding the standard of care or causation with respect to Wexford. Therefore, the district court granted summary judgment in favor of Wexford on March 23, 2003.
McDowell’s case prоceeded against the Grady Defendants, eventually reaching a settlement in August 2003. McDowell dismissed his claims against the individual Grady nurses and doctors and against Grady itself. As such, none of the Grady Defendants are part of this appeal. Therefore, the claims pertinent to this appeal concern the § 1983 claim against the County, and the state law medical negligence claims against Wexford. McDowell challenges the district court’s grant of summary judgment to the County, and the exclusion of his medical experts against Wexford. We will address each issue as it pertains to the particular defendant in turn.
III. Summary Judgment for Dekalb County
We review a district court’s grant of summary judgment to DeKalb County
de novo,
and apply the same legal standards used by the district court.
See O’Ferrell v. United States,
We resоlve all issues of material fact in favor of the plaintiff, and then determine the legal question of whether the defendant is entitled to judgment as a matter of law under that version of the facts.
Durrwthy v. Pastor,
Mr. McDowell argues that Dekalb County’s custom of understaffing the Sheriffs Office (and the Jail) delayed the treatment of his condition and thereby violated his rights under the Eighth Amendment. Title 42 U.S.C. § 1983 provides that:
Every person who, under the color of any statute, ordinance, regulation, custom or usage, of any State or Territory or the District of Columbia, subjects, or causes to be subjected any citizen of the United States or other person within the jurisdiction thereof to the deprivation of any rights, privileges, or immunities secured by the Constitution and laws shall be liable to the party injured in an action at law, suit in equity, or other proper proceeding for redress.
Although the Supreme Court has held that counties (and other local government entities) are “persons” within the scope of § 1983, and subject to liability, McDowell cannot rely upon the theory of
respondeat superior
to hold the County liable.
7
See Monell v. Dept. of Soc. Servs.,
No party challenges that McDowell had a severe medical condition that required urgent care and treatment, which he did not receive. This resulted in a violation of McDowell’s constitutional rights.
8
Our
*1290
first inquiry, then, is whether Dekalb’s policy or custom was to understaff the field division so as deny McDowell’s constitutional rights. In
Wayne v. Jarvis,
This threshold identification of a custom or policy “ensures that a municipality is held liable only for those deprivations resulting from the decisions of its duly constituted, legislative body or of those officials whose acts may fairly be said to be those of the municipality.”
Brown,
The Sheriff and the Sheriffs Office of Dekalb County are responsible for the County’s law enforcement functions. The Board of Commissioners of Dekalb County (the “Board”) approves the Sheriffs Office budget. To demonstrate the Jail’s routine understaffing practices, McDowell points to the testimony of numerous Sheriffs Office employees claiming that the Jail laсked adequate manpower. Indeed, the chief of jail operations, Dennis Cheatham, testified in his deposition that despite Sheriffs Office requests for additional personnel, other priorities often took precedent. Moreover, the Jail’s former health services coordinator explained that transporting inmates between the Jail and Grady was a “continual problem,” which he “constantly [tried] to correct and amend.”
Although McDowell produced evidence that the Jail had staffing problems, the record provides no evidence that the field division consistently failed to transport non-emergency eases to Grady. Additionally, the field division’s policy was to call an ambulance to take the inmate to Grady if it could not accomplish the transport itself. While McDowell’s case is tragic, he cannot point to another occasion when the Jail’s understaffing, and resulting inability to transport, contributed to or exacerbated an inmate’s medical condition. Simply put, this isolated incident, however unfortunate, *1291 does not demonstrate evidenсe of the County’s “persistent” or “widespread” policy of understaffing the Jail so as to delay the transfer of inmates to Grady.
Our next inquiry requires that a municipality’s that the municipality’s action was “taken with the requisite degree of culpability ... with deliberate indifference to its known or obvious consequences.”
Davis ex rel. Doe v. Dekalb County Sch. Dist.,
In
Brown,
the Supreme Court refined the culpability requirement for municipal liability cases. The Court set forth a scheme whereby a governing body’s own intentional acts that violate constitutionally protected rights amount to “per se” § 1983 liability. In such cases, where the “municipal action
itself
violates federal law, or directs an employee to do so ... issues of fault and causation [are] straightforward,” and “present no difficult questions.... ”
Id.
at 405-06,
At the other end of the § 1983 liability spectrum, is where the plaintiff claims that a municipality’s facially valid actions violated his constitutional rights. In such a case, “rigorous standards of culpability and causation must be applied to ensure that the municipality is not held liable solely for the actions of its employee.” Br
own,
Mr. McDowell traces the County’s liability to its failure to properly fund the resources necessary to staff the Jail. The Supreme Court has recognized that inadequate training may impose § 1983 liability on a municipality in “limited circumstances.”
See Canton,
*1292
McDowell cannot establish that a reasonable member of the Board would conclude that the County’s budget decisions would lead to events that occurred here.
See Davis,
Our final inquiry examines causation. A plaintiff must prove causation by demonstrating that the municipality’s
“deliberate
conduct ... was the ‘moving force’ behind [his] injury....”
Brown,
We heed the Court’s caution and apply it here. While it may be true that the Board’s budget decision would make a violation of his constitutional rights “more
likely,”
that alone cannot “give rise to an inference that a policy maker’s failure to scrutinize the [budget] ... produced a specific constitutional allegation.”
Brown,
To “test the link” between McDowell’s injury and the County’s conduct, we look to whether a complete review of the budget decision (and the resulting understaffed Jail) reveals that the Board should have known that McDowell’s injuries were a “plainly obvious consequence” of that decision.
Brown,
As a final matter, McDowell insists that
Anderson v. City of Atlanta,
The facts in
Anderson
demonstrated a complete departure from operating procedure whereby the jail was required to staff healthcare personnel at all times. The jail never hired a nurse for the 11:00 P.M. to 7:00 A.M. shift, when Anderson arrived and later died at the jail.
Anderson,
In the instant case, the record is barren of any evidence of implementation of an intentionally malevolent or impermissible policy by the Board so as to authorize a cause of action against Dekalb County under 42 U.S.C. § 1983. The fact that the Board’s budget practices resulted in un-derstaffing does not amount to a purposeful disregard which would violate any citizen’s constitutional rights. McDowell “may not infer a policy merely because harm resulted from some interaction with a governmental entity.”
Colle v. Brazos County, Texas,
TV. Exclusion of Expert Testimony 9
We review a district court’s ruling on the admissibility of expert testimony for abuse of discretion.
General Elec. Co. v. Joiner,
The only claims McDowell has remaining against Wexford involve Georgia state medical malpractice claims. Because the district court exercised supplemental jurisdiction over these claims when it was removed from state court, state law governs substantive issues аnd federal law governs procedural issues.
Erie R.R. Co. v. Tompkins,
Some state evidentiary rules are substantive in nature, and transcend the substance-procedure boundary, creating a potential
Erie
conflict.
See Bradford v. Bruno’s, Inc.,
We agree. Here, the “law .of Georgia as it pertains to medical malpractice actions is applicable.”
Smith v. Am. Transitional Hosps., Inc.,
*1296 Accordingly, for McDowell’s claim against Wexford to succeed, he first needed to present “competent expert testimony” that Wexford’s nursing staff proximately caused his injuries. Smith, 330 F.Supp.2d at 136L “This requisite subsumes the burden of providing expert testimony as to what the applicable standard of care is.” Id. In its competency determination, the district court excluded McDowell’s experts, finding them unqualified to render an opinion as to the standard of cаre applicable to nurses. Indeed, McDowell’s three experts, Drs. Merikangas, Darouiche, and Gower are all experts in the field of neurology, and the district court found them qualified to testify about McDowell’s spinal epidural abscess as well as causation on the part of Grady’s doctors. Although the district court did not initially consider the experts’ testimony as it pertained to nursing and specifically Nurse Brown’s actions, it later extended its findings to include Wexford when it granted summary judgment.
For a witness to “constitute an ‘expert competent to testify,’ ” his realm of expertise must encompass “knowledge of the standard of care applicable to the defendant-professional as to at least one of the matters on which the plaintiffs malpractice claim is based.”
Lee v. Visiting Nurse Health Sys. of Metro. Atlanta,
In McDowell’s case, Wexford argues that McDowell’s experts do not possess the education, training, or experience that would qualify them to testify against a jail nurse. Wexford points with specificity to Dr. Dariouche’s deposition, and asserts that he his lack of experience in working in a jail renders his opinion unqualified. To the contrary, Dr. Dariouche stated he had not reviewed the hospital nurses’ testimony and that he could not provide an opinion regarding those nurses. Dr. Dar-iouche did, however, testify as to the standard of care applicable to Wexford nurses, and opined that while she may have acted reasonably, Nurse Brown should have called an ambulance for McDowell. Dr. Darouiche’s opinion stems from a knowledge of medical care, not jail policies.
The standard of care applicable to nurses is universal, and does not diminish when the setting is a jail rather than hospital. Wexford has not given us a reason to differentiate between jail nurses and hospital nurses. A physician’s area of expertise necessarily encompasses the standard of care applicable to nurses.
See Crook,
The district court disqualified all of McDowell’s experts on the issue of the standard of care applicable to emergency room medicine, but did not conduct a similar inquiry with regard to Wexford’s nurses in the jail. Instead, the district court dropped a footnote in its order excluding McDowell’s experts against Grady stating that “each of McDowell’s experts testified that he is not qualified to opine as to the proper actions or the applicable standard of care for nursing.” Only later did the district court rule that because it had closed discovery on the issue of the standard of care and causation with respect to Nurse Brown and Wexford, McDowell had no expert testimony, as Georgia requires for medical malpractice claims.
See, Pilzer v. Hones,
We find this broad ruling to be in error. “The proffered physician need not be a specialist in the particular medical discipline to render expert testimony relating to that discipline.”
See Gaydar v. Sociedad Instituto Gineco-Quirurgico y Planifacacion,
A review of the record demonstrates that all three of McDowell’s experts testified as to the applicable standard of care with regard to Wexford’s nurses. Only Dr. Dariouche explicitly stated that he was “not an expert on the standard of care for nurses working in the emergency room.” Dr. Dariouche, however, made this statement with regard to the Grady nurses and their emergency rоom treatment of McDowell. This opinion did not encompass the Wexford nurses and the delay in transporting McDowell to Grady. Moreover, Dr. Merikangas clearly included a discussion on the nurses’ standard of care in his deposition testimony, and Dr. Gower offered that the “standard of care really should have elected the most rapid transport” to Grady. It is true that Drs. Daro-uiche and Merikangas explained that Nurse Brown may well have acted reasonably, but an opinion that is incompatible with a plaintiffs case alone does not render that expert unqualified. In accordance with Georgia law, we find the experts competent to render opinions as to the applicable standard of care for Wexford’s nurses.
Our inquiry, however, does not end at the competency determination. In order to survive summary judgment, McDowell’s experts must establish both a breach of the standard of care and that Wexford’s actions were a proximate cause of his injuries. Smith,
McDowell bears the burden of demonstrating that each of his proffered experts is qualified to render an expert opinion, that the opinion is reliable, and that the opinion would assist the trier of fact in resolving a disputed issue of material fact — here, causation. Fed.R.Evid. 702;
see, e.g., Daubert v. Merrell Dow Pharm.,
The district court found all of McDowell’s experts qualified to testify as to the issue of causation, i.e., the nature of the spinal epidural abscess and McDowell’s resulting paralysis. Nevertheless, a “supremely qualified expert cannot waltz into the courtroom and render opinions unless those opinions are based on some recognized scientific method.”
See Clark v. Takata Corp.,
Federal Rule of Evidence 702 states:
If scientific, technical, or other 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, оr education, may testify thereto in the form of an opinion or otherwise, if (1) the testimony is based upon 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.
In
Daubert v. Merrell Dow Pharmaceuticals, Inc.,
Daubert
put forth a two-pronged analysis, used to determine the admissibility of the proffered expert testimony on scientific issues under Rule 702. First, the expert testimony must be reliable, so that it must be “scientific,” meaning grounded in the methods and procedures of science, and must constitute “knowledge,” meaning something more than subjective belief or unsupported assumptions.
Daubert,
Daubert’s
reliability prong sets out four guideposts that a district court may consider in assessing the reliability of the expert testimony, which include, but are not limited to: (1) whether the expert’s methodology has been tested or is capable of being tested; (2) whеther the technique has been subjected to peer review and publication; (3) the known and potential error rate of the methodology; and (4) whether the technique has been generally accepted in the proper scientific community.
See Daubert,
The second prong of the
Daubert
analysis requires that the proposed testimony be relevant. To meet this requirement, the expert testimony must be “ ‘relevant to
*1299
the task at hand,’ ... i.e., that it logically advances a material aspect” of the case.
Daubert
at 591,
A district court is thus required to act as a gatekeeper “to make certain that an expert, whether basing testimony upon professional studies or personal experience, employs in the courtroom the practice of an expert in the relevant field.”
Kumho Tire Co. v. Carmichael,
A district court has “considerable leeway in deciding in a particular case how to go about determining whether particular expert testimony is reliable,” and we give that discretion a large degree of deference.
Kumho Tire,
A. Doctor James Merinkangas
Mr. McDowell claims that the delay in treating his spinal epidural abscess caused or worsened his condition. To support this, Dr. Merinkangas proposed that early treatment of a patient with spinal epidural abscess reduced neurological damage. The district court labeled this theory as “the earlier, the bеtter.” Additionally, Dr. Merinkangas also opined that the four-hour delay (on the part of the Grady defendants) caused Mr. McDowell’s injuries. Dr. Merinkangas based his theory on the common sense and “universal” axiom that expedited treatment is preferable to delayed treatment. Dr. Merinkangas also pointed to a study in SPINAL CORD COMPRESSION, which analyzed the effects of 48-hour delays in treatment. The district court determined that Merinkangas’s theory lacked testing, peer review, a potential error rate, and general acceptance. We agree.
The district court was correct in finding that “the earlier, the better” theory was “too vague” • to assist the trier the fact. Indeed, the notion' of early treatment is well within common knowledge that would be obvious to the average juror, but has *1300 nothing to do with causation. Dr. Merin-kangas himself stated that “the sooner, the better” is “just simply common understanding, and doesn’t rise to the level where someone would bother reporting that because everyone knows that.” As such, this “the earlier, the better” theory adds nothing absent some testimony connecting the delay tо the causation or aggravation of an injury.
We also agree with the district court’s conclusion that Dr. Merinkangas’s contention that McDowell’s injury could have been prevented had he entered surgery four hours earlier failed the
Daubert
analysis.
13
Dr. Merinkangas could not identify any empirical data, survey, study, or literature to support his theory, save the study in SPINAL CORD COMPRESSION, which dealt with a delay of 48 hours, which is more than twice the delay here. Notwithstanding his lack of support, Dr. Mer-inkangas further opined that had McDowell been treated 24 hours earlier, then he would have no resulting paralysis. Taking either of Dr. Merinkangas’s propositions (a four-hour delay or twenty-four delay), there is no support addressing anything less than a 48-hour delay. There is a considerable gap between a 24-hour to a 48-hour delay, and even more so with a 4-hour delay. This runs afoul of Allison’s admonition that a theory should not “leap” from an accepted scientific premise to an unsupported one.
Finally, Dr. Merinkangas has not tested his own theory nor determined any error rate associated with it.
See Daubert,
B. Dr. Rabih Darouiche
Like Dr. Merinkangas, Dr. Darouiche concluded that McDowell would have suffered less injury had he been treated earlier. Also like Dr. Merinkangas, Dr. Dar-iouche’s theory specifically related to the delay in surgery rather than the delay at the Jail. Dr. Darouiche based his theory on his past experience and training with spinal patients and on his observation that a more rapid progression of neurological damage indicated that earlier treatment would be successful. Dr. Darouiche frequently explained that his causation theory lacked empirical evidence or scientific support, and he acknowledged an absence of studies which assess surgery at the four, eight, twelve, eighteen, or twenty-four hour time intervals. Instead, and in accord with Dr. Merinkangas, Dr. Darouiche relied upon “medical logic” to suggest that *1301 early treatments effects an improved condition.
Dr. Darouiche also admitted that his “logic” theory lacked proof, and he could not quantify what McDowell’s condition would have been had surgery occurred at an earlier point. Additionally, Dr. Daro-uiche made no attempt to refute, test, or falsify his theory, and did not identify whether the actions of one or many caused McDowell’s injury. Instead, Dr. Daro-uiche pointed out the condition’s rarity and that it lacked observable patients. Complicating this expert’s theory further is the fact that it has never been published or subjected to peer review. Dr. Darouiche further testified that McDowell may very well have suffered the same injuries had he been treаted within six hours. We agree with the district court that Dr. Daro-uiche’s proffered testimony was more of a guess than a scientific theory.
Daubert
would permit an expert to draw conclusions from existing data, but in this case the expert drew conclusions where there was no existing data.
See Joiner,
C. Dr. David Gower
Dr. Gower’s proffered testimony reiterated that of Drs. Merinkangas and Daro-uiche; namely, that if McDowell had been treated earlier, his recovery would have been faster. Dr. Gower could not, however, measure the level that McDowell’s improvement might have been, only stating that “instead of taking years, [recovery] might have only taken a couple of months.” Dr. Gower acknowledged that there were no scientific studies that bolstered his theory, but explained that there were significant reports and case studies demonstrating that extеnded paralysis reduced the possibility of a full recovery. Dr. Gower, however, could not specifically identify any such articles, case studies or reports to support this premise. Even -more telling is that Dr. Gower opined that when compared to other patients who experienced 24-36 hour paralysis, McDowell “seem[ed] better than most,” and Gower expressed surprise at McDowell’s degree of recovery. In effect, McDowell himself did not fit Dr. Gower’s theory. Without any support, Dr. Gower’s opinion failed to meet Daubert’s reliability requirement, as it had not been tested, subjected to peer review, or assigned a rate of error. We agree with the district court’s decision to exclude Dr. Gower’s testimony.
In sum, although we find that the district court erred in excluding the experts’ testimony as to the applicable standard of care, we hold that the district court did not abuse its discretion in barring the causation testimony against Nurse Brown and Wexford. As the Supreme Court wrote in
Daubert,
scientific evidence must “fit” the plaintiffs theory of causation.
More importantly, McDowell does not argue that the doctors’ causation theories are sound. Instead, McDowell complains that the district court abused its discretion by extending its ruling that the evidence was inadmissible against Grady to the Wexford defendants. Such action by the district court is well within the ambit of its discretion, and McDowell has not demonstrated why the testimony is reliable and admissible under Daubert, Kumho Tire, and Fed.R.Evid. 702. We agree with the district court that the testimony “essentially boils down to an opinion that earlier surgical intervention would be preferable.”
*1302 The experts then made the leap from this “presumably accepted scientific principle... to an unsupported scientific principle...that a delay of more than four hours caused Plaintiffs injury.” This “leap of faith” was supported by little more than the fact that early treatment begets improved recovery. The experts, however, provided no existing research detailing the extent of injury or recovery at different time intervals.
McDowell has offered no reliablе evidence that earlier medical intervention would have prevented or diminished his injury. We hold that the district court did not abuse its discretion in concluding that McDowell’s evidence is legally unreliable and inadmissible under the standards set by Daubert and its progeny.
V. Conclusion
Although Mr. McDowell’s circumstances are unfortunate, he has no remedy here. Having held first that Mr. McDowell cannot establish a genuine issue of material fact as to any Dekalb County policy causing or contributing to his injury, the district court’s grant of summary judgment to Dekalb County was proper. Second, we hold that the district court did not abuse its discretion in concluding that McDowell’s experts simply failed to meet the requirements of the law. Summary judgment in favor of Wexford and Brown was proper. Therefore, we affirm the decisions of the district court.
AFFIRMED.
Notes
. A spinal epidural abscess is a pocket or collection of pus which develops in or around the epidural space in the spinal cord.
. Mr. McDowell needs assistance to walk, but can expel without catheterization.
. The medical malpractice claims against Wexford were based on respondeat superior liability for thе negligence of Wexford's nurses, including Nurse Brown.
. Mr. McDowell also asserted a § 1983 claim against Wexford, but later dismissed that claim.
. Pursuant to Federal Rule of Civil Procedure 54(b), McDowell requested a certification from the district court, that its ruling was a final judgment with respect to Dekalb. The district court denied that motion.
. Neither McDowell nor Wexford briefed the admissibility of the experts' testimony with regard to Wexford's negligence. In granting Grady's motion, the district court explained that it only considered the question of whether the expert testimony was admissible as it pertained to the “doctor Defendants.” The district court noted, however, that the experts did state that they were not qualified to render an opinion as to the nurses' standard of care.
. Mr. McDowell conceded that the sheriff's deputies he named in his suit were entitled to qualified immunity in their individual capacities. The district court, therefore, only assessed the liability of Dekalb County resulting from deputies acting in their official capacities.
See Pompey v. Broward County,
. As a pre-trial detainee, MсDowell’s rights exist under the due process clause of the Fourteenth Amendment rather than the Eighth Amendment, which McDowell alleges in this case.
See City of Revere v. Massachusetts Gen. Hosp.,
.It is necessary to point out that the district court’s original order excluding Mr. McDowell's experts applied to the Fulton-Dekalb Hospital Authority and individual doctors and nurses and Grady. The district court's order did not encompass Wexford or Pernell Brown. Nonetheless, the district court stated that each of McDowell's experts testified that he was not qualified to opine as to the proper actions or the applicable standard of care for nursing.
This issue was reexamined at a hearing on the motion for summary judgment as to Wex-ford and Nurse Brown. The district court noted again thаt there was simply no expert testimony with respect to the standard of care for nursing or to show causation.
. We review a district court's grant of summary judgment de novo, but here the grant of summary judgment to Wexford was based on the district court's exclusion of McDowell's expert testimony against Wexford, and its subsequent determination that McDowell had no competent expert to testify against Wexford, as required for medical negligence claims under Georgia state law. Mr. McDowell concedes that he does not challenge the grant of summary judgment should we uphold the exclusion of his experts.
. In
Bonner
v.
City of Prichard,
. The Sixth Circuit noted in
Legg,
that the two Rules, 601 and 702, work in "tandem” because Rule 601 addresses a witness's
"competency,"
making it a substantive rule, while Rule 702 measures an expert's
"qualifications,"
and is "directed at the science and methodology behind the witness's testimony."
Legg,
. The district court excluded Dr. Merinkan-gas’ theory after evaluating it in terms of the Grady defendants. Specifically, the district court weighed the theory as to the delay in surgery at Grady rather than the delay in transport at the Jail, which is the issue here. Nonetheless, the district court's conclusions are pertinent to our inquiry because the issue, delay in treatment as the cause of injury, is the same.