In a recent medical malpractice case, Scottoline v. Women First, LLC, the Delaware Supreme Court affirmed the Superior Court’s decision to exclude expert testimony regarding the causation of a child’s neurological and neurodevelopmental disabilities and autism spectrum disorder (ASD). The plaintiffs, parents of J.S.S., alleged that the defendants’ negligence during labor and delivery caused J.S.S.’s hypoxic-ischemic encephalopathy (HIE), which in turn led to his disabilities.

The Court focused on the reliability of Dr. Daniel Adler’s causation opinion under Delaware Rule of Evidence 702. Dr. Adler, a pediatric neurologist, opined that J.S.S.’s HIE caused his disabilities, including those falling within the autism spectrum. The Superior Court initially excluded this opinion, finding it lacked a reliable scientific basis and was not the product of a reliable methodology. Specifically, the court noted that the literature Dr. Adler relied upon only identified an association between HIE and ASD, not causation, and that Dr. Adler failed to adequately rule out other potential causes of ASD.

On appeal, the Delaware Supreme Court upheld this exclusion. The Court distinguished the case from prior rulings like Norman v. All About Women and Wong v. Broughton, which allowed medical experts to rely on training and experience for standard of care opinions. In contrast, Dr. Adler’s opinion ventured into the scientific inquiry of etiology (the cause of a disease), requiring a more rigorous demonstration of scientific basis and methodology. The Court emphasized that while Dr. Adler was qualified to diagnose, his expertise in diagnosis did not automatically extend to etiology. The Court found that Dr. Adler’s opinion lacked a scientific basis because he acknowledged no studies showed HIE causes ASD, only an association. Furthermore, he failed to perform a reliable differential etiology by not adequately ruling out other known causes of ASD, such as genetic disorders or maternal history factors, even though he admitted their potential relevance.

The Court also affirmed the exclusion of Dr. Adler’s opinions in his third report, which largely reiterated his previous conclusions without sufficiently supporting them with anything beyond his ipse dixit (unsupported assertion). The Court rejected the plaintiffs’ argument for an evidentiary hearing, stating that the plaintiffs had ample opportunity to develop the record through reports and depositions. Finally, the Court affirmed the exclusion of Jody Masterson’s life-care planning testimony as it was derivative of Dr. Adler’s excluded causation opinion.

The decision includes a dissent from Justice Valihura, observing that the Court mischaracterized the plaintiffs’ claim and Dr. Adler’s expert opinion and improperly applied controlling case law from Norman and Wong. Justice Valihura asserts that the plaintiffs’ claim was not that HIE caused autism, but rather that negligent care led to HIE, causing J.S.S.’s neurological and neurodevelopmental disabilities, some of which presented as ASD-consistent symptoms. The dissent emphasizes that Dr. Adler, a well-qualified expert, based his opinion on extensive experience and examination of J.S.S.’s medical records, which should be considered reliable under Norman and Wong, where medical experts could rely on training and experience, not just literature, for causation opinions. Valihura concludes that the Superior Court improperly acted as a factfinder by excluding Dr. Adler’s nuanced opinion, preventing a jury from weighing the evidence.

Key Take Away

For medical malpractice attorneys, this case underscores the critical importance of a robust and scientifically reliable methodology when presenting expert opinions on causation, particularly when a condition has multiple potential etiologies. The majority opinion indicates that an expert’s training and experience, while valuable for diagnosis or standard of care, may be insufficient to establish causation if the expert fails to provide a reliable scientific basis and methodology, including a thorough differential etiology that actively rules out alternative causes.

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