Healthcare Law, Litigation & Public Policy   Medical Licensure & Discipline ♦ Employment Board of Registration

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In medical malpractice cases, both plaintiffs and defendants rely on expert testimony to establish whether the standard of care was met.  Expert testimony regarding scientific methodology in Massachusetts has generally been admitted into evidence if the offering party could show that the scientific evidence was generally excepted by the scientific community or that the evidence was otherwise reliable and valid.  The Supreme Judicial Court has recently considered the issue of whether expert opinion testimony alone is sufficient to establish that a scientific methodology is reliable and valid enough to be admitted into evidence.   

            In the case of Theresa Canavan, Ms. Canavan was claiming to be disabled from her employment due to a controversial diagnosis known as multiple chemical sensitivity due to chemical poisoning.  Ms. Canavan was a registered nurse who began working at Brigham & Women’s Hospital in the recovery room in 1983.  Beginning in June of 1990, Ms. Canavan began working in the operating room.  Her duties as an OR nurse included preparing the room for surgery, caring for the surgical instruments and assisting the surgeons with procedures.  In performing these duties, Ms. Canavan claimed she was exposed to various chemicals including ethylene oxide, formaldehyde and diesel fuel. 

            On August 6, 1993, after a ten hour day in the operating room, Ms. Canavan experienced a severe headache, nasal congestion, and dizziness. Although she returned to work on August 9, she continued to experience symptoms including a fever, headache, and swelling of her nose and right cheek.  In light of these continued symptoms, Ms. Canavan was referred to see Dr. Arthur Laurentano who diagnosed her with chronic sinusitus and prescribed a course of antibiotics.  Since the antibiotic was only marginally effective, Dr. Laurentano referred Ms. Canavan to Dr. LaCava, who became her treating physician. 

            Dr. LaCava is board certified in pediatrics and in a field known as environmental medicine which is not recognized by the American Board of Medical Specialties.  Dr. LaCava concluded that Ms. Canavan suffered from arthritis, paresthesias, organic brain syndrome, chemical induced headaches, immunodeficiency, and multiple chemical sensitivities (MCS) secondary to chemical poisoning, which he believed was caused by Ms. Canavan’s exposure to chemicals during the course of her employment at the hospital.  Ms. Canavan applied for worker’s compensation benefits for her alleged injury from the exposure to chemicals and Dr. LaCava testified on her behalf at the worker’s compensation hearing. 

            At the hearing, Dr. LaCava testified that the laboratory tests he conducted on Ms. Canavan provided evidence that she suffered from MCS.  Dr. LaCava testified that he believed her MCS was caused by chemical poisoning at her work environment and that MCS rendered her totally disabled.  To treat Ms. Canavan’s condition, Dr. LaCava prescribed a course of intravenous fusion vitamins in high doses of vitamin C, oral nutrient supplements, antibiotics, and heat and sauna therapy. 

            The Hospital presented Dr. Accetta, who is board certified by the American Board of Allergy and Immunology, to refute Ms. Canavan’s claim that she had MCS which was contracted from her job.  Dr. Accetta testified that MCS is not accepted as a diagnostic disease by mainstream allergists/immunologists and occupational medicine physicians.  He also testified that the course of treatment prescribed by Dr. LaCava was not accepted and not appropriate for the symptoms she exhibited.  Dr. Accetta testified that Ms. Canavan suffered from chronic nonallergic rhinitis caused by nonspecific stimuli that exist in every day environment, and that her symptoms had a psychogenic component. 

            The hospital argued that the methodology used by Dr. LaCava to reach his opinion regarding the MCS and its cause was not generally accepted in medical field and was not otherwise reliable, and therefore, not admissible.  The worker’s compensation court did not conduct an analysis to assess whether the medical opinion was generally accepted or otherwise reliable and allowed Dr. LaCava to render his expert opinions at the hearing.  The Court then ruled in favor of Ms. Canavan and the hospital appealed.  The appeals court upheld the admissibility of the evidence and the case was appealed to the Supreme Judicial Court of Massachusetts. 

            The Supreme Court determined that the judge at the worker’s compensation court erred by not conducting an analysis to determine whether Dr. LaCava relied on a  reliable methodology to determine that the chemical exposures caused the employee’s MCS.  The Court explained that before such scientific evidence is presented by an expert witness a preliminary finding of reliability must be made.  The fact that Dr. LaCava was qualified as an expert physician did not automatically make his opinions about Ms. Canavan’s alleged MCS reliable enough to be admitted into evidence.  

            This decision clarifies the issue of what type of evidence is required to show that a given scientific methodology is reliable enough to present to a jury.  The Court has made it clear that the fact that an expert witness is presenting the methodology is simply not enough to meet the test of admissibility.  By strengthening the requirements of admissibility, this decision is likely to discourage plaintiff’s lawyers from retaining experts to present scientifically unreliable methodologies. It is no longer enough for an expert to testify that they have seen a certain condition enough times to make a diagnosis.  The expert will need to explain why he has reached a certain diagnosis and what studies have been done in other cases to support his diagnosis. Defense lawyers will likely to look to the Canavan decision to foreclose hired-gun experts from testifying in medical malpractice cases in an effort to circumvent the costs of a full blown trial. 

Trial Judge to Block Bad Science

by Attorney Frank E. Reardon

October 2000