Potter v. US Department of Health and Human Services

Background

Vincent Potter brought a medical-malpractice action against the United States under the Federal Tort Claims Act. Potter alleged that care provided through Callen-Lorde Community Health Center caused his spinal injury after a September 8, 2015 sleep-related incident. His claims included medical malpractice, lack of informed consent, and lack of supervision. The Department of Health and Human Services and Callen-Lorde were later dismissed because the Federal Tort Claims Act provides that the United States is the exclusive defendant for these claims. Potter later withdrew his informed-consent and supervision claims, leaving only medical malpractice for decision.

Potter’s medical-malpractice theory relied on expert testimony from psychiatrist Dr. Ross DeLeonardo and neurologist Dr. David Rosenbaum. DeLeonardo identified four alleged departures from the community standard of care: failing to diagnose and treat Potter’s Bipolar II Disorder; prescribing Trazodone without first evaluating him for that disorder; prescribing Trazodone after an earlier serious sleep-related incident; and failing to refer Potter to a more specialized or qualified provider. Both experts offered opinions that these alleged departures, particularly Potter’s use of Trazodone, caused the sleep-related behavior that led to his injury.

Motion and legal standards

The Government moved for summary judgment under Federal Rule of Civil Procedure 56. Summary judgment is entered when the evidence shows no genuine dispute over a fact important to the claim and the moving party is entitled to judgment as a matter of law. The Government argued that the experts’ causation opinions were inadmissible under Federal Rule of Evidence 702, which requires expert testimony to be helpful, based on sufficient facts or data, produced by reliable methods, and reliably applied to the case.

Because the alleged tort occurred in New York, the court applied New York law. Under that law, a medical-malpractice plaintiff generally must prove both a departure from the community standard of care and that the departure was a direct, or legally sufficient, cause of the injury. The court stated that expert testimony was required here because the alleged medical departures and their connection to Potter’s injury were not matters an ordinary juror could evaluate without expert assistance.

Court’s analysis

The court assumed, for purposes of its Rule 702 analysis, that both experts were qualified. It nevertheless excluded their causation opinions because their reasoning was not sufficiently reliable.

For Dr. DeLeonardo’s first opinion, the court found inadequate support for the assertion that Potter’s complex sleep-related behavior was a symptom of untreated Bipolar II Disorder. DeLeonardo testified that the relevant Bipolar II sleep symptom was a decreased need for sleep, not complex sleep-related behavior. His suggested connection between the two conditions relied mainly on the fact that the behavior stopped after Potter began treatment for Bipolar II Disorder. The court held that timing alone was not a reliable scientific method.

The court also excluded DeLeonardo’s second opinion, which connected Potter’s injury to prescribing Trazodone without screening for Bipolar II Disorder. DeLeonardo relied on the possibility that Trazodone could worsen symptoms in people with Bipolar Disorder, but he did not identify a manic or mixed episode or a symptom that Trazodone caused and that led to Potter’s injury. The court found too large a gap between the supporting information and the opinion.

The court excluded DeLeonardo’s third opinion that Trazodone itself caused the complex sleep-related behavior. DeLeonardo acknowledged that such behavior was not a known side effect of Trazodone and based his conclusion largely on Potter’s having taken the medication when the events occurred and not having the events when he was off it. The court found that reasoning speculative and inadequate under Rule 702. It also excluded DeLeonardo’s fourth opinion about the failure to refer Potter to another provider because that opinion depended on the unsupported conclusion that Trazodone caused the behavior. Any combined-cause opinion was likewise inadmissible because its individual components were inadmissible.

Dr. Rosenbaum opined that Potter experienced a disorder involving complex behavior during rapid-eye-movement sleep and that Trazodone caused it. The court found that opinion unreliable for similar reasons. Rosenbaum relied on the fact that the known episodes occurred while Potter was taking Trazodone, cited general literature about antidepressants without identifying or specifically applying it to Trazodone, and did not explain how his clinical experience reliably supported his conclusion. He also acknowledged that complex sleep-related behavior can begin in midlife without being caused by Trazodone.

Disposition

The court held that both experts’ causation testimony was inadmissible under Rule 702 and the reliability principles associated with Daubert. It did not reach the Government’s other grounds for excluding the testimony. Because expert evidence was required to prove causation and Potter had no admissible expert evidence on that element, the Government was entitled to judgment as a matter of law on the remaining medical-malpractice claim.

Judge Alison J. Nathan granted the Government’s motion for summary judgment. The court directed the Clerk to enter judgment and close the case. The opinion did not state that the judgment was with or without prejudice.