Neonatology Expert Witness Not Allowed to Opine on Autism
Posted on January 30, 2025 by Expert Witness Profiler
On July 29, 2022, a minor, Kamila, represented by her mother Keila Robles Figueroa (“Plaintiff” or “Robles”), filed a medical malpractice lawsuit against Dr. Juan C. Castañer (“Castañer”), Presbyterian Community Hospital, Inc. (“the Hospital”) and the Hospital Pediátrico Universitario (collectively “Defendants”). The allegations of negligence in this lawsuit are centered on the medical care providers’ treatment of Robles and her baby during her pregnancy, delivery, and the neonatal care of her premature infant. Robles claimed that the Defendants deviated from the established standards of care.
On August 30, 2024, the Hospital filed a motion in limine to exclude Plaintiff’s neonatology expert witness, Carolyn Crawford. The Hospital argued that Crawford was neither qualified by education, training, and experience, to opine on the topic of autism or its causes, nor did her report or deposition testimony present opinions that could be said to be based on reliable methodology or rested on sufficient factual foundation.
On October 7, 2024, Plaintiff argued that Crawford had the necessary expertise to opine on autism and autistic-like behavior in children, as to assist the fact-finder. She also argued that concerns about Crawford’s qualifications and methodology go to “the weight of the testimony, rather than admissibility, which is properly reserved for the jury.”
Neonatology Expert Witness
Carolyn Stocker Crawford completed her B.S. from Dickinson College in Carlisle, Pennsylvania, in 1962, followed by an M.S. from St. Joseph’s University in Philadelphia in 1964. She then completed her M.D. from Jefferson Medical College in Philadelphia in 1971.
With nearly fifty years of practice in medicine, specifically in the areas of neonatal and perinatal medicine, her experience includes many publications and book chapters in the field of neonatology, including several related to Respiratory Distress Syndrome (RDS).
Discussion by the Court
In her expert report dated December 30, 2022, Crawford provided her analysis of Kamila’s medical history, including alleged deficiencies in the prenatal care received by Kamila’s mother, Robles, and the perinatal and neonatal care Kamila received after birth. Defendants challenged the statements in the expert report that relate specifically with Kamila’s neurological status, including certain “autistic-like behaviors.”
Defendants argued that the Court should exclude these opinions from trial because Crawford was not qualified to make them, and argued that her methodology lacked a reliable basis.
A. Crawford’s Qualifications
Defendants argued that Crawford lacked the qualifications to testify as an expert on issues like autism and autistic-like behaviors in children or its causes.
Defendants stated that Crawford’s expert qualifications are limited by her education, training, experience, and academic appointments to “pediatrics and neonatology.” As her CV is devoid of any publications on autism or neurology, Defendants claimed that Crawford’s experience reflected a “lack of dedicated research or deep knowledge in the field.”
a) Curriculum Vitae
The Court reviewed Crawford’s CV and found that she had practiced medicine for nearly fifty years, specifically in the areas of neonatal and perinatal medicine. Her experience included many publications and book chapters on neonatology, including several related to Respiratory Distress Syndrome (RDS). While the Court agreed that Crawford is an experienced physician in neonatology, it observed that any focus on childhood autism, autistic-like behaviors, or pediatric neurology was notably missing from her CV.
b) Deposition
During her deposition, Crawford was asked if she considered herself an expert in pediatric neurology, and she responded, “Yes. In certain areas, yes.”She elaborated: “the kind of complications that you see in premature infants as they develop and mature and age. The type of interventions, the causation of certain types of problems. Certain types of neurological problems.”
After being asked whether she is qualified to diagnose someone with autism, she responded, “I think I’m qualified to screen and to discuss with parents, but in terms of actually doing the testing, no. I have not been trained to do the actual testing for autism. But in terms of identifying risk factors and evaluating a child for the possibility of autism, I think, yes, I would consider myself reasonably qualified.” Despite admitting she lacks the qualifications to diagnose autism in children, Crawford stated regarding Kamila, “the child does not really have autism. The child may have some autistic-like features related to the brain damage she has.”
Because Crawford’s experience was not related to diagnosing autism and she had not issued or contributed to publications on autism or autistic-like behavior, Plaintiffs had not shown by the preponderance of the evidence that Crawford was qualified to testify in regard to autism in that case. As such, the Court found that Crawford’s testimony shall be limited to her areas of expertise, namely neonatology, and shall not veer into diagnosis and causation for autism or autistic-like behaviors.
B. Crawford’s Methodology
The Court also examined Crawford’s opinions as to Kamila’s autistic-like behaviors and the causal link to brain damage.
a) Expert Report
In drafting her expert report, Crawford reviewed Kamila’s medical records and had a phone interview with Kamila’s mother, Robles. Based on this review, Crawford concluded that “Kamila’s neurological injury is the result of her prematurity ‘Plus.’ The ‘Plus’ is the contribution from sepsis, hypotension, DIC, hypoxia/ischemia from multiple apneic episodes in the context of non-steroid benefitted RDS and delayed surfactant administration. As a result of her episodes of hypoxia and altered perfusion she also suffered irreversible brain damage with resultant developmental delay and abnormal neurological function including autistic-like behavior. No family history of developmental delay, autism or cerebral palsy was identified. Absent her significant RDS and NEC and their sequelae, Kamila would likely have developed normally.”
b) Deposition
At her deposition, Crawford stated that she believed Kamila “has cerebral palsy, has a brain injury, and [she] think[s] her behavior is explainable by the brain damage and not necessarily by some underlying autism.” When asked what evidence she relied on to support her opinion that Kamila has brain damage, Crawford stated, “she can’t do any self-care. She doesn’t eat. She’s non-verbal. I think motor-wise she’s very delayed. I don’t think she walks or runs. She doesn’t talk.” Crawford also stated that she had not seen an MRI for Kamila but that one “would be an appropriate test to assess her.”
It was noted that Plaintiff did not provide any scientific basis for Crawford’s belief that Kamila in fact has brain damage and that there is a scientific link between brain damage and autism or autism-like behaviors.
Plaintiff argued that this was simply a matter in which experts disagreed, thus pertained “to the weight of the testimony, rather than admissibility, which is properly reserved for the jury.”
The Court disagreed. The record before the Court revealed Plaintiff’s failure to demonstrate by a preponderance of evidence that Crawford’s testimony was the product of reliable principles and methods. Consequently, the Court did not allow Crawford to testify about autism, autism spectrum disorder, or autism-like behaviors during the trial.
Held
The Court granted the Defendant’s motion in limine to exclude Plaintiff’s neonatology expert witness Carolyn Crawford’s testimony.
Key Takeaway:
The Court excluded Crawford’s expert testimony regarding autism and autistic-like behaviors for two main reasons:
- Lack of Qualifications: While Crawford’s expert qualifications are limited by her education, training, experience, and academic appointments to “pediatrics and neonatology.” She admitted herself that she has not been trained to do the actual testing for autism. Notably missing from her CV is any focus on childhood autism, autistic-like behaviors or pediatric neurology in general.
- Unreliable Methodology: Plaintiff has not provided any scientific basis for Crawford’s belief that Kamila in fact has brain damage, and that there is a scientific link between brain damage and autism or autism-like behaviors. In this case, there is “too great an analytical gap between the data and the opinion proffered.”
Case Details:
| Case caption: | Robles-Figueroa V. Presbyterian Community Hospital, Inc. Et Al |
| Docket Number: | 3:22cv1361 |
| Court: | United States District Court for the District of Puerto Rico |
| Dated: | January 27, 2025 |
