Occupational Medicine Expert Witness’ projection of Plaintiff’s future medical care costs rejected by the Court for lacking sufficient basis in the medical evidence
Posted on November 13, 2023 by ewp_staff_writer
Plaintiff Autumn Brown, who was twenty-two years old at the time, sustained injuries on June 24, 2020 after a vehicle driven by an employee of Defendant BellSouth Telecommunications, LLC struck her vehicle at an intersection in Pascagoula, Mississippi. She was taken to the emergency department at Singing River Hospital where they found she had suffered a broken right wrist, broken bones in her pelvic area, a fractured lumbar vertebra, and a liver laceration. She was transferred to USA Medical Center in Mobile, Alabama for further treatment, where testing revealed she also had a ruptured bladder.
Brown reported having issues controlling her bowel and bladder, back and pelvic spasms, stiffness, decreased range of motion, incontinence, and mental health problems – all of which she attributed to the accident.
Defendant BellSouth filed a motion in limine to limit the testimony of Plaintiff’s retained expert, Dr. Gregory L. Smith, regarding Smith’s life care plan which projected $345,337 in future medical damages for Brown. BellSouth argued the life care plan lacked sufficient factual basis.
Occupational Medicine Expert Witness
Gregory L. Smith, M.D., M.P.H. graduated from Rush Medical College in Chicago and served in the U.S. Army Medical Corp for six years, achieving the rank of Major and completing his residency in Occupational and Preventive Medicine at Walter Reed Army Medical Center. Following his military service, he earned a Master’s of Public Health (MPH) from Harvard University and published numerous research articles in peer-reviewed medical journals.
In 1988, Smith entered private practice, specializing in Occupational Medicine in various states, including California, Georgia, Florida, and Texas. He was recognized as a Fellow of the American Board of Occupational and Preventive Medicine and appointed as an Agreed Medical Examiner (AME) by worker’s compensation judges in two California counties. Additionally, he obtained certification from FIG® in Medical Cost Analysis.
Smith’s extensive experience includes providing expert medical opinions and testimony on numerous cases related to causation, medical necessity, and future medical care. He has authored hundreds of Life Care Plans and Medical Cost Projections for personal injury cases, demonstrating a comprehensive understanding of medical assessments and cost analysis in the legal context.
Discussions by the Court
Smith reviewed Brown’s medical records and conducted an interview, leading to the following conclusions:
Brown had the following diagnoses and associated impairments linked to the injury:
- She experienced pelvis pain resulting from bilateral superior pubic rami comminuted displaced fractures, a right inferior pubic ramus fracture, and a left sacral ala intra-articular fracture. She underwent open reduction internal fixation (ORIF) for bilateral superior ramus fractures and closed reduction percutaneous screw fixation for bilateral sacral fractures on June 25, 2020.
- Brown faced bowel incontinence.
- She reported right wrist pain attributed to a healed impacted fracture of the distal radius and an ulnar styloid process nondisplaced fracture.
- A bladder repair was performed on June 25, 2020, resulting in residual bladder urgency and incontinence.
- Brown struggled with anxiety and depression
Smith, in his future care projections, organized the anticipated needs into four categories: (1) medication; (2) future diagnostic studies and surgeries for the “late sequelae” of Brown’s broken bones and bladder rupture; (3) durable medical equipment (“DME”); and (4) a Functional Restoration Program for pain management.
Regarding medication, Smith opined that Brown had an “ongoing need for prescription medications,” including daily use of cyclobenzaprine, which proved effective for residual symptoms. He projected that Brown would require Cyclobenzaprine (Flexeril) at 10mg per day for 63.9 years, with a total cost of $7,668.
The most substantial projected future care costs were allocated to the “late sequelae” of Brown’s ongoing wrist and pelvic pain from broken bones, as well as for “neurogenic bowel and bladder” problems presumably related to her rupture. Smith predicted that these “late sequelae” would necessitate a comprehensive diagnostic evaluation, along with potential interventional pain injections and/or surgery. The projected future care costs also factored in pre- and post-operative diagnostic studies, perioperative medical and facility costs, and required post-operative therapy.
In terms of durable medical equipment (DME), Smith foresaw Brown’s need for six Neuromuscular Stimulator units throughout her life, each costing $600, along with two sets of supplies per year for these units. The total projected cost for DME amounted to $11,268.
The remaining costs in the life care plan covered a Functional Restoration Program, incorporating a three-day evaluation and 160 hours of programming, with a total cost of $27,000.
In summary, Smith projected Brown’s future medical damages at $345,337.
The Court found that Smith’s testimony failed the Daubert test because his report lacked specificity in linking Brown’s medical records to the projected future care needs and establishing a reasonable degree of medical probability in the causal relationship to the accident.
In the context of future diagnostic studies and procedures for the “late sequelae” of Brown’s injuries, Smith did not identify or describe these sequelae beyond residual pain. The report failed to connect specific instances of projected future medical care to recommendations by any of Brown’s treating physicians. Additionally, the Court noted that Plaintiff’s counsel acknowledged during the hearing on September 21, 2023, that none of the treating physicians would opine on the need for future treatment, leaving the court unconvinced by Smith’s projections.
Furthermore, the Court observed that some of the medical records cited by Smith contradicted his projections. Brown mentioned in her interview with Smith that her orthopedist and urologist had released her, and the report indicated that she was no longer seeing a physical therapist. Despite listing a home exercise program under current treatments, Smith did not mention physical therapy, and no surgeries were scheduled.
Smith projected twelve future neurologist visits, although he provided no records of Brown receiving neurology care after the accident. Moreover, Brown denied a head injury immediately after the accident, and her hospital CT scan revealed “no significant abnormality.”
In essence, the Court concluded that Smith’s assertions were insufficient, emphasizing the need for a more concrete connection between Brown’s medical records, the projected future care needs, and a demonstrated causal relationship to the accident. The Court could not rely solely on Smith’s assertions without a more substantial basis.
Smith’s projections of Brown’s future care needs were deemed insufficient by the Court. In the case of future drug costs, Smith’s assertion that Brown had an “ongoing need” for Flexeril was criticized. The Court noted that simply because she was currently taking the drug and it had been effective did not necessarily mean she would require it for the rest of her life. Smith did not provide detailed explanations for why she would need Flexeril continuously, relying on a broad statement about her “ongoing need.”
Similarly, Smith’s opinion about the Neuromuscular Stimulator unit lacked sufficient justification. While he asserted that Brown would benefit from prolonged use due to chronic pain, he did not explain why she would experience a lifetime of problems with pain and spasms or how the stimulator would address these symptoms adequately.
The last medical care projection, the Functional Restoration Program, was also challenged. Smith referenced “current treatment guidelines (ODG)” to support the prescription, stating that Brown was expected to have long-term issues with bowel and bladder incontinence, anxiety, depression, and significant functional losses. However, the Court noted that no treating physician had recommended this program for Brown, and Smith’s conclusory statements lacked a clear basis in the medical evidence.
The Court emphasized the difference between weak and insufficient bases for expert testimony, asserting that Smith’s life care plan did not demonstrate a sufficient reliance on medical evidence to predict Brown’s future care needs accurately. Despite Smith’s status as a medical doctor, the Court found that he provided projections without an adequate foundation in the available medical evidence, specifically regarding the medical necessity of the predicted future care.
While Brown was undoubtedly injured, the medical records discussed in Smith’s report did not demonstrate an ongoing, specific, permanent injury. These records also lacked any doctor’s recommendations for future care. Smith’s report acknowledged the possibility of future pain, including the “chronic pain syndrome” he attributed to Brown, but he noted that it had not been diagnostically evaluated or treated.
The Court determined that there was a significant analytical gap between the data presented and the opinions Smith proffered. The absence of conclusive evidence supporting ongoing, specific injuries and the lack of doctor-recommended future care contributed to this analytical gap.
Additionally, the Court concluded that the opinions expressed in Smith’s life care plan were inadmissible under Federal Rule of Evidence 403. Based on the reasons discussed earlier, the Court found that the “probative value” of Smith’s life care plan was substantially outweighed by the danger of unfair prejudice, confusion of the issues, and potential to mislead the jury regarding the extent of Brown’s future medical needs and their associated costs.
The Court granted Defendant BellSouth Telecommunications, LLC’s Motion in Limine to Limit Testimony of Plaintiff’s Retained Expert, Gregory L. Smith, M.D., M.P.H., as a result of which he was precluded from testifying at trial to the opinions in his life care plan.
The case was dismissed with prejudice on October 23, 2023 after the parties announced to the Court a settlement of this case.
- An expert’s testimony must be based on sufficient facts and data to be admissible under Rule 702. The Court found Smith’s life care plan lacked a sufficient basis in the medical records.
- An expert cannot simply state conclusions without explaining the underlying facts and analysis. The Court found there was too great an analytical gap between the data and Smith’s opinions.
- An expert should clearly connect their opinions to specific recommendations by treating physicians when possible. Smith did not link his projections to any treating doctor’s recommendations.
- A life care plan should identify ongoing, specific, and permanent injuries as a basis for projections. The Court found Smith did not show Plaintiff had such identifiable permanent injuries.
- Expert opinions can be excluded under both Rule 702 and 403 if unreliable or prejudicial. The Court found admission would be unfairly prejudicial and misleading here.
Posted In: Expert Challenges, Occupational Medicine Expert Witness
Tagged In: Expert Testimony, Life Care, Pain, Projections, Unreliable