Krizek v. Queen's Med. Ctr.

HELENA KRIZEK, Birth Mother ofBIANCA HELEN KRIZEK (DECEDENT), Plaintiff, v. THE QUEEN'S MEDICAL CENTER; HAWAII RESIDENCY PROGRAM;DR. MATTHEW DUMOUCHEL; DR. NOBUHIRO ARIYOSHI; DR. ITTIKORN SPANUCHART;DR. WENDY W. HSU; DR. HAO CHIH HO;and DR. T. SCOTT GALLACHER, Defendants.

CIV. NO. 18-00293 JMS-WRP

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF HAWAII

September 21, 2020

ORDER: 1) GRANTING DEFENDANT DUMOUCHEL'S DAUBERT MOTION, ECF NO. 249; AND 2) DENYING IN PART AND GRANTING IN PART OTHER DEFENDANTS' DAUBERT MOTIONS, ECF NOS. 250 & 251

I. INTRODUCTION

Before the court in this wrongful death lawsuit are three motions brought pursuant to Daubert v. Merrell Dow Pharm., Inc., 509 U.S. 579, 597 (1993) ("Daubert I"). All Defendants challenge the admissibility of the opinions of Plaintiff Helena Krizek's ("Plaintiff") causation expert, Dr. David Systrom ("Dr. Systrom"). ECF Nos. 249, 250, 251. For the foregoing reasons, the court GRANTS Defendant DuMouchel's motion, ECF No. 249 in its entirety; and DENIES in part and GRANTS in part the other Defendants' motions, ECF Nos. 250 & 251.

II. BACKGROUND

A. Factual Background

Dr. Systrom submitted his three-page expert report on January 17, 2020. ECF No. 249-3. That report outlines the following timeline of events:

On December 28, 2015, at 3:43 p.m., Bianca Helen Krizek ("Bianca"), Plaintiff's adult daughter, was admitted to Honolulu's Queen's Medical Center's ("QMC") Emergency Room ("ER") "with a chief complaint of weakness x3 days, left leg pain, erythematous skin, chills, cough and nausea." Id. at PageID #2268. At the time of her admission, Bianca had a history of alcoholism, cirrhosis, withdrawal seizures, hypokalemia, anorexia, and severe protein energy malnutrition. Id. Prior to her arrival at the ER, Emergency Medical Services ("EMS") had administered one ampule of dextrose without thiamine (vitamin B1). Id. At 11:50 p.m., Bianca was assigned to the Medical Intensive Care Unit ("ICU") with a "presumptive diagnosis of septic shock/severe sepsis due to cellulitis." Id. Beginning around 8:00 a.m. on December 29, 2015, Bianca was recorded as exhibiting periods of confusion, which started escalating over the hours. Id. at PageID #2269. She was later given a nasogastric feeding tube. Id.After she was given sedative drugs, at approximately 8:55 p.m., Bianca was intubated. Id. Bianca's progress notes "mention Wernicke's encephalopathy in the differential diagnosis," but heart failure and sepsis were ruled out. Id. Bianca passed away, while still at QMC, on February 5, 2016. Id.

B. Dr. David Systrom's Qualifications and Opinions

1. Dr. Systrom's Qualifications

Dr. Systrom is a medical doctor in the Pulmonary and Critical Care Medicine Unit at Brigham and Women's Hospital in Boston, Massachusetts. Systrom Curriculum Vitae, ECF No. 249-5 at PageID #2294. Over the past 30 years, Dr. Systrom "made contributions to clinical research, teaching and clinical care at Massachusetts General Hospital, Brigham and Women's Hospital and Harvard Medical School." Id. at PageID #2310. His research focuses on "the exercise limit in chronic heart and lung disease, with particular attention paid to interactions between the skeletal muscle mitochondrion and an abnormal pulmonary vasculature." Id.

Dr. Systrom's scholarship is extensive. He has written approximately 100 peer-reviewed articles, along with various non-peer-reviewed scientific or medical publications. See id. at PageID #2302-09. Many of these articles center on the topics of pulmonary or respiratory diseases. See id. He has not written anyarticles, nor spoken, on Wernicke's encephalopathy or thiamine deficiency. Systrom Dep., ECF No. 285 at PageID #2852-53.¹

In addition to his research, Dr. Systrom also teaches medical students, residents, and Harvard pulmonary and critical care fellows on consult services and in the ICU. ECF No. 249-5 at PageID #2310. He also teaches various courses on pulmonary physiology. See id.

Clinically, Dr. Systrom is currently board certified in internal (1983) and pulmonary medicine (1986). Id.; see also ECF No. 285 at PageID #2819. He was board certified in critical care medicine (1987), but that certification has lapsed. ECF No. 249-5 at PageID #2309; ECF No. 285 at PageID #2819. He was never board certified in emergency medicine. ECF No. 285 at PageID #2821. For the past nine years, for four to five months out of the year, Dr. Systrom works with patients in the ICU. Id. at PageID #2950. He serves as a "consultant" in this capacity, where he "co-manage[s]" the patients. Id. He does not serve in an attending capacity. Id.

2. Dr. Systrom's Opinions

Dr. Systrom's January 17, 2020,² letter contains his opinions as to the medical care provided to Bianca. He rendered these opinions after reviewing Bianca's medical records, including records from the Waikiki Health Clinic in 2013, 2014, and 2015, along with the records pertaining to Bianca's 2015 stay at QMC. See ECF No. 249-3 at PageID #2268; ECF No. 285 at PageID #2826-27. Based on this review, Dr. Systrom opines that two standards of care were violated.

First, Dr. Systrom opines that Bianca's clinical course "was indicative of Wernicke's encephalopathy," which is "known to occur in malnourished alcoholics" and is "prevented and/or treated by B vitamins." ECF No. 249-3 at PageID #2269. Bianca was administered "[o]ngoing intravenous D5 (glucose) . . . during the first 14 hours of admission with less than 100 mg of [intravenous] thiamine [which] led to Wernicke's encephalopathy, increased confusion and ultimately aspiration pneumonia." Id. at PageID #2270. "Preventive therapy and treatment of patients at risk for thiamine deficiency mandates at least 1500 mg ofIV thiamine for the first 2 days of hospitalization and before any glucose administration. Standards of care were violated [by] not providing larger doses of IV thiamine[.]" Id.

Second, Dr. Systrom opines that a standard of care was violated because "nausea and vomiting" was not controlled, "gastric residuals" were not checked, and Bianca was not protected from "aspiration pneumonia." Id.

Per Dr. Systrom, the violation of these standards of care led to Bianca's death. Id.

Important to the instant motions, Dr. Systrom's report does not purport to explain how each individual ICU Defendant violated either standard of care. In other words, he opines that the standards of care were violated without explaining the role each individual physician played in violating that standard.³

In a March 9, 2020 deposition, Dr. Systrom further explained his opinions. In order to diagnose Wernicke's encephalopathy, there is a "clinical and radiographic diagnosis," and the combination of both "can support [the] diagnosis." See ECF No. 285 at PageID #2882. Dr. Systrom last diagnosed Wernicke's encephalopathy ten years ago. Id. at PageID #2944. In so doing, hereviewed the MRI imaging with the radiologists and combined it with his own clinical findings to arrive at the diagnosis. Id. at PageID #2944-45. At that time, the patient was in the ICU and not in the ER. Id. at PageID #2865. In total, Dr. Systrom has treated "probably half a dozen" patients with Wernicke's encephalopathy over the course of thirty years, and his experience with Wernicke's encephalopathy appears to be limited to the ICU setting. Id. at PageID #2864; see also Pl.'s Opp'n., ECF No. 252 at PageID #2453 ("Moreover, Dr. Systrom has personal experience with the diagnosis and treatment of Wernicke's encephalopathy in the critical care setting.").

Dr. Systrom's opinion, in part, is based on a chapter discussing Wernicke's encephalopathy in UpToDate, an online medical textbook. ECF No. 285 at PageID #2864.

C. Procedural Background

Plaintiff's Second Amended Complaint ("SAC") names as Defendants: QMC; Dr. Wendy W. Hsu, the Supervising Attending Physician at QMC's ICU; Dr. Hao Chih Ho, the admitting doctor at QMC's ICU; and Dr. T. Scott Gallacher, the Chief Physician at QMC's ICU (collectively, "QMC Defendants"). ECF No. 190 at PageID #1536-37. She also names the Hawaii Residency Program ("HRP"), and Drs. Nobuhiro Ariyoshi and Ittikorn Spanuchart,who were the resident physicians assigned to the ICU (collectively "HRP Defendants"). See id. Lastly, she names Dr. Matthew C. DuMouchel, the ER physician charged with Bianca's care during her time in the ER. Id. at PageID #1536.

On February 5, 2020, QMC Defendants filed a motion for summary judgment. ECF No. 205. HRP Defendants and Dr. DuMouchel joined in the motion. ECF Nos. 209, 212.

During a May 8, 2020 status conference, the court determined that these motions "raised arguments pertaining to the qualification of Plaintiff's causation expert and the admissibility of his opinions" but they failed to "properly bring forth a motion pursuant to Daubert"; instead, Defendants "raise[d] arguments on admissibility in a joinder and/or replies." See ECF Nos. 240 & 243. With agreement of the parties, the court then set a briefing schedule for Defendants to file Daubert motions. See ECF No. 243.

On June 15, 2020, Defendant DuMouchel, the QMC Defendants, and the HRP Defendants filed separate Daubert motions. ECF Nos. 249, 250 & 251. Plaintiff filed her opposition to Dr. DuMouchel's motion, ECF No. 252, and a single opposition to the motion filed by QMC Defendants and HRP Defendants,ECF No. 253. Defendants filed their replies on July 10, 2020. ECF Nos. 260, 261 & 262.

On August 26, 2020, the court held an evidentiary hearing by video. ECF No. 277. Dr. Systrom was the only witness.

III. STANDARD OF REVIEW

Federal Rule of Evidence 702 states:

A witness who is qualified as an expert by knowledge, skill, experience, training, or education may testify in the form of an opinion or otherwise if:

(a) the expert's scientific, technical, or other specialized knowledge will help the trier of fact to understand the evidence or to determine a fact in issue;

(b) the testimony is based on sufficient facts or data;

(c) the testimony is the product of reliable

...