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Samaan v. St. Joseph Hospital - 670 F.3d 21 (1st Cir. 2012)


The two requirements for expert testimony--a reliable foundation and an adequate fit--are separate and distinct. The reliable foundation requirement necessitates an inquiry into the methodology and the basis for an expert's opinion. Given the nature of this analysis, the expert's methodology is commonly the central focus of a Daubert inquiry. The second requirement has attracted less attention. This requirement seeks to ensure that there is an adequate fit between the expert's methods and his conclusions. This prong of the Daubert inquiry addresses the problem that arises when an expert's methods, though impeccable, yield results that bear a dubious relationship to the questions on which he proposes to opine.


While in a plane, a flight attendant thought that the Plaintiff looked sick, so she sat him down, and recruited health-care professionals from among the passengers. A second-year medical resident examined the plaintiff and concluded that he was probably experiencing an ischemic stroke or transient ischemic attack brought on by the stoppage of blood flow to part of his brain. The pilot detoured to the nearest airport: Bangor, Maine. An ambulance took the plaintiff to St. Joseph Hospital. No intravenous shot of tissue plasminogen activator (t-PA) was administered. The drug is a form of thrombolytic therapy that works by dissolving clots that are occluding arteries. Its efficacy in any given patient is uncertain but its goal is to reduce neurologic injury caused by a stroke. During his time at the Hospital, the plaintiff's condition deteriorated and then stabilized. When he did not improve, an ambulance transported him to an institution in New York. He went from there to a series of other rehabilitation facilities and eventually returned home (albeit still partially paralyzed and unable to work). The plaintiff sued the Hospital and his attending physician there, Dr. David Kaplan. His complaint alleged professional negligence (medical malpractice) and negligent infliction of emotional distress, both relating to a failure to administer t-PA.


Did the Court err in denying the offer by the Plaintiff of presenting Dr. Tikoo’s testimony?




Although only the doctor signed a notice of removal, removal was proper because the hospital manifested its consent to removal when it vigorously opposed the patient's motion to remand. The district court did not err in requiring the patient to prove that the alleged negligence more likely than not brought about his injuries. The court rejected the claim that the appropriate standard for causation in Maine was the lost chance doctrine. The district court did not abuse its discretion in determining that the testimony of the patient's medical expert was not admissible because the results of the expert's statistical analysis did not sufficiently ground his conclusion that the patient's condition likely would have improved had t-PA been administered. Also, the district court did not abuse its discretion in precluding the testimony of two of the patient's fact witnesses on the issue of causation because the patient did not adequately identify either one as a causation expert.

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