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WETHERILL v. UNIVERSITY OF CHICAGO

United States District Court, Northern District of Illinois, E.D


June 17, 1983

RACHEL WETHERILL, PLAINTIFF,
v.
UNIVERSITY OF CHICAGO AND ELI LILLY AND COMPANY, DEFENDANTS. MAUREEN ROGERS, PLAINTIFF, V. UNIVERSITY OF CHICAGO AND ELI LILLY AND COMPANY, DEFENDANTS.

The opinion of the court was delivered by: Shadur, District Judge.

  MEMORANDUM OPINION AND ORDER*fn*

Both Rachel Wetherill ("Wetherill") and Maureen Rogers ("Rogers") allege they were injured by exposure in utero to diethylstilbestrol ("DES"), manufactured and supplied by Eli Lilly and Company ("Lilly") and administered to plaintiffs' mothers as part of an experiment conducted by Dr. William Dieckmann ("Dieckmann") in the early 1950s at the University of Chicago ("University") hospitals. Each Complaint contains the same three counts:

    1. Count I charges University committed a battery
  by subjecting the plaintiff's mother to the DES
  experiment without her prior knowledge or
  consent.*fn1

    2. Count II sounds in malpractice, asserting
  various acts of negligence by University and its
  hospital employees.*fn2

    3. Count III seeks recovery against University and
  Lilly on strict liability grounds.

All parties have deluged this Court with motions in limine in each case:

    1. Lilly's motion to exclude evidence as to changes
  in Lilly product literature after plaintiffs were
  exposed to DES;

    2. Lilly's motion to exclude cancer-related
  testimony;

    3. University's motion to exclude colposcopic
  photographs;

    4. University's motion to exclude an Abbott
  Laboratories document;

    5. University's motion to bar plaintiffs from
  calling Dr. Vaux as an expert witness;

    6. plaintiffs' motion to exclude cumulative
  testimony of defendants' expert witnesses; and

7. Lilly's motion for separate trial.

This memorandum opinion and order will address each motion in turn.

Changes in Lilly Product Literature After Plaintiffs' Exposure to
                               DES

Wetherill and Rogers intend to introduce four DES publications printed by Lilly after plaintiffs' births (November 16, 1951 and May 26, 1952, respectively):

    1. Lilly's 1954 A-form publication,*fn3 which
  mentions several researchers opposed to the use of
  DES during pregnancy;

    2. Lilly's 1967 A-form, which acknowledges
  "possible adverse reaction on the fetus";

    3. Lilly's 1972 A-form, which says a "statistically
  significant association has been reported between
  material ingestion of DES during pregnancy and the
  occurrence of vaginal carcinoma in the offspring";
  and

    4. Lilly's 1975 A-form, which warns that "vaginal
  adenosis has been reported in 30 to 90 percent of
  post pubertal girls and young women whose mothers
  received DES or a closely related congener during
  pregnancy."

Characterizing those increasingly ominous warnings as "subsequent remedial measures," Lilly moves under Fed.R.Evid. ("Rule") 407 to exclude all evidence of changes in its DES literature after plaintiffs' births. Alternatively Lilly calls for exclusion under Rule 403.

Rule 407 provides:

  When, after an event, measures are taken which, if
  taken previously, would have made the event less
  likely to occur, evidence of the subsequent measures
  is not admissible to prove negligence or culpable
  conduct in connection with the event. This rule does
  not require the exclusion of evidence of subsequent
  measures when offered for another purpose, such as
  proving ownership, control, or feasibility of
  precautionary measures, if controverted, or
  impeachment.

Plaintiffs disclaim any intention of using the post-occurrence
*fn4 Lilly product literature as evidence of Lilly's "negligence or culpable conduct." Rather plaintiffs would introduce all four documents for "another purpose":

    1. Lilly's 1954 A-form would be tendered to
  establish its knowledge of DES's dangers before
  plaintiffs' births — a claimed issue of
  "feasibility" — or alternatively to impeach the
  testimony of Lilly personnel who disavow any such
  knowledge before those dates.*fn5

    2. Three of them — the 1967, 1972 and 1975 A-forms
  — would be offered to prove the causal relationship
  between DES ingestion by a pregnant woman and injury
  to her offspring.*fn6

Lilly's 1954 A-form does not fall within Rule 407's "feasibility" exception, for that issue is not controverted by Lilly. See Oberst v. International Harvester Co., 640 F.2d 863, 866 (7th Cir. 1980) (evidence of subsequent remedial measure not admissible on the issue of feasibility unless it is contested). Lilly does not deny it would have been feasible to place warning language in its pre-occurrence product literature — if it had possessed knowledge sufficient to issue such warnings. On that latter subject — Lilly's knowledge (or the reasonable forseeability) of DES's harmful properties — the parties are in sharp disagreement. But that issue does not implicate the concept of "feasibility" within the meaning of Rule 407. Accord, Werner v. Upjohn Co., 628 F.2d 848, 855 (4th Cir. 1980); Schneider v. Eli Lilly and Co., 556 F. Supp. 809 at 811 (E.D.La. 1983); Keil v. Eli Lilly and Co., No. 75-7099, slip op. at 2 (E.D. Mich. July 3, 1980); Needham v. White Laboratories, No. 76 C 1101, slip op. at 4 (N.D.Ill. Aug. 13, 1979). Contra, McAdams v. Eli Lilly and Co., No. 77 C 4174, slip op. at 5-6 (N.D.Ill. Oct. 6, 1981) (1954 A-form admissible in rebuttal or cross examination on issue of Lilly's knowledge during 1953 because "[f]easibility also embraces the factual basis upon which the [warning] change could have been made").

"Feasibility" of remedial measures, in the normal sense of the word, rather denotes whether it would have been practical to have employed them earlier. That is a matter far different from whether a claimed wrongdoer knew or should have known, but nonetheless did not employ, remedial measures earlier. That latter question concerns Lilly's culpability or negligence.*fn7 And Rule 407 by its very terms precludes the use of the 1954 A-form for that purpose.*fn8

As for the other three post-1953 publications, Rule 407 surely does not foreclose their introduction as admissions by Lilly that prenatal DES exposure causes the type of injury suffered by plaintiffs. Because causation is analytically distinct from fault ("negligence or culpable conduct"), it is plainly "another purpose" for which evidence of subsequent remedial measures can be offered under Rule 407.*fn9

In an effort to escape that conclusion, Lilly invokes Werner's exposition of the policy underlying the exceptions to Rule 407 (628 F.2d at 857):

  Of course, exceptions must arise where the defendant
  attempts to make offensive use of the exclusion of
  this evidence. Thus, if the defendant denies
  ownership or control, contends that no such repair or
  improvement was possible, or makes statements
  conflicting with the fact of repair, then the
  plaintiff should be allowed to make use of subsequent
  remedial measures. As previously noted, the list of
  exceptions in Rule 407 is illustrative, not
  exhaustive, but each of the listed exceptions deals
  with situations where the defendant might gain a
  direct benefit over and above the fact of exclusion
  and it seems to us that new exceptions to the rule
  should follow this rationale if the policy behind the
  rule is to be protected.

But recognition of the added exception here is entirely consonant with the Werner analysis: Were Lilly to escape plaintiffs' use of an admission regarding causation — a non-fault issue — Lilly would (not merely might) "gain a direct benefit over and above the fact of exclusion." It would surely realize such a "direct benefit" were its post-1953 literature rendered inadmissible as to causation as well as fault.

It might perhaps be urged Werner's "direct benefit" and "offensive use" language was intended to cover only situations in which the subsequent repair evidence convincingly disproves defendant's position on a non-fault issue. But in effect that would convert Rule 407 into a crude version of Rule 403, balancing the probative value of the evidence on that particular issue against the risk of prejudice (the impermissible inference of fault). Even apart from the obvious superiority of Rule 403 for making that comparison,*fn10 two policy reasons militate convincingly against any such approach:

    1. As the Rules are structured, Rule 402 says "All
  relevant evidence is admissible," in conjunction with
  which any specifically applicable Rule or Rules
  determine admissibility of evidence. Only when that
  has been done (independently of any countervailing
  factor) does Rule 403's comparative analysis come
  into play. It would distort the drafters' scheme of
  things to engraft another level of comparison into
  one specific Rule on admissibility.

    2. Rule 403 mandates a major showing of prejudice
  ("substantially outweighs") to overcome the low
  threshold

  of admissibility represented by Rule 401's broad
  definition of "relevance." Rule 407, in its suggested
  application, would turn the balancing process on its
  head, requiring a major showing of probative value to
  overcome a merely possible degree of prejudice.

It is true plaintiffs will undoubtedly offer evidence of scientific clinical studies on the causation issue. But they are also entitled to seek the potentially greater effect a jury may give an admission on the same topic by Lilly. If Lilly expects to contest the causation issue, it cannot complain of any probative value the A-forms may have on that score. And as for any claimed prejudice, appropriate jury instructions can guard against any possible consideration of the A-forms as evidence of Lilly's failure to give adequate pre-occurrence warnings.

In sum the 1954 A-form is out while the other three A-forms are in. If the situation develops differently at trial as to any of them, either party may seek reconsideration.

Cancer-Related Testimony

Though neither plaintiff now suffers from any cancerous or pre-cancerous condition, each believes her prenatal exposure to DES will significantly enhance the likelihood of contracting cancer in the future. Each seeks damages for her fear of developing cancer, not for the increased cancer risk itself. To establish the reasonableness of those fears, each intends to introduce expert and lay medical evidence confirming the causal relationship between cancer and DES.

Lilly objects strenuously to admissibility of cancer-related testimony for two reasons. First and most important, Lilly contends plaintiffs' anxiety is not compensable under Illinois law. It therefore seeks exclusion of that evidence on relevancy grounds (under Rule 402). Specifically, Lilly argues:

    1. Plaintiffs have failed to satisfy the two
  prerequisites to recovery for negligent infliction of
  fear of future injury. Lilly says the feared future
  injury (cancer) must be (a) reasonably certain to
  develop from (b) a present injury (a cancerous or
  pre-cancerous condition).

    2. Plaintiffs' "cancer phobia" does not state an
  action for intentional infliction of emotional
  distress.

    3. As defendant in a strict liability action, Lilly
  is not liable for emotional injury under Illinois
  law. See Woodill v. Parke Davis & Co., 58 Ill. App.3d 349,
  354-55, 58 Ill.Dec. 349, 354-355,
  374 N.E.2d 683, 687-88 (1st Dist. 1978), aff'd, 79 Ill.2d 26,
  38, 37 Ill.Dec. 304, 310, 402 N.E.2d 194, 200 (1980).

Alternatively Lilly seeks exclusion of the evidence under Rule 403, claiming its inflammatory nature outweighs its probative value.

Lilly's first contention as to relevancy misperceives both preconditions to recovery for emotional distress. Neither reasonable certainty nor present injury is required.

As for "reasonable certainty," such a stringent requirement would distort traditional notions of proximate cause. That concept's touchstone — reasonable foreseeability of the claimed injury (in this case emotional distress) — merely demands a reasonable fear, not a high degree of likelihood, that the feared contingency be likely to occur. Such a lesser showing of reasonableness is borne out by the few cases on point. See, e.g., Baylor v. Tyrrell, 177 Neb. 812, 131 N.W.2d 393, 402 (1964) (anxiety about possibility of developing cancer "must have reasonable basis"); Ferrara v. Galluchio, 5 N.Y.2d 16, 19-20, 176 N YS.2d 996, 997-998, 152 N.E.2d 249, 251 (1958) (to recover for emotional anguish, victim of excessive radiation treatment must establish a "basis for her mental anxiety" but need not prove cancer will develop). And the distinction is meaningful, for fears of future injury can be reasonable even where the likelihood of such injury is relatively low. See Murphy v. Penn Fruit Co., 274 Pa. Super. 427, 418 A.2d 480, 482, 485 (1980) (upholding damage award for psychic injury even though plaintiffs' doctors were certain her fears of cancer, heart attack and premature death were medically unfounded); Heider v. Employers Mutual Liability Insurance Co. of Wisconsin, 231 So.2d 438, 441-42 (La.App. 1970) (emotional distress arising from 2% to 5% risk of becoming epileptic compensable); Baylor (fear that wound "might" develop into cancer is reasonable); Ferrara, 5 N.Y.2d at 22, 176 N.Y.S.2d at 1000, 152 N.E.2d at 253 (same).

As for the claimed need to prove "present injury," Illinois case law requires only a causal link between the fear of future injury and the physical impact (as distinct from injury) of defendant's tortious conduct.*fn11 For example Rosenberg v. Packerland Packing Co., 55 Ill. App.3d 959, 962, 13 Ill.Dec. 208, 211, 370 N.E.2d 1235, 1238 (1st Dist. 1977) said in denying recovery for emotional trauma negligently precipitated by defendant, who nearly collided with plaintiffs' car:

  Plaintiffs failed to state a cause of action under
  Count I for the negligent infliction of severe
  emotional distress since they failed to allege bodily
  injury and since there was no physical impact between
  the vehicles or upon the plaintiffs' persons.

As the conjunctive "and" suggests, a showing of physical impact will suffice. Accord, Benza v. Shulman Air Freight, 46 Ill. App.3d 521, 523, 5 Ill.Dec. 91, 92, 361 N.E.2d 91, 92 (1st Dist. 1977) (denying recovery for emotional distress in circumstances virtually identical to Rosenberg on basis of defendants' contention "that Illinois does not permit recovery to a plaintiff who suffered emotional harm accompanied by bodily injury, absent a physical impact, as a result of negligence").*fn12

Plaintiffs' claim of emotional injury meets both preconditions. First, their anxieties are assertedly reasonable because (1) empirical studies have found a causal relationship between DES and cancer and (2) any ordinary person (one regularly bombarded with DES information from a variety of scientific and lay sources) would harbor such fears. Indeed, plaintiffs intend to adduce the very evidence at issue to establish the reasonableness of their apprehensions. Second, their fears stem from their prenatal exposure to DES — the "physical impact" of defendants' allegedly tortious conduct.*fn13

Lilly's second relevancy contention — plaintiffs' failure to state a claim for intentional infliction of emotional distress — is beside the point. Plaintiffs do not assert their cancer fears as the predicate for such a tort. Rather they seek recovery for their anxiety as an element of the damages flowing from a wholly different (and concededly well-pleaded) tort: the alleged inadequacy of Lilly's DES warnings.

Lilly's last relevancy assertion once again misapprehends the applicable law. No Illinois court has ever precluded a strict liability plaintiff from recovering damages for emotional harm arising from the physical impact of defendants' actions. Woodill, 58 Ill.App.3d at 355, 58 Ill.Dec. at 354-55, 374 N.E.2d at 687-88, the only case cited by Lilly, simply refused to extend strict liability to include recovery for emotional distress arising from physical injury to another.*fn14 Even if recovery for mental anguish might be inappropriate in other strict liability cases, failure-to-warn cases couched in strict liability terms really require the same showing of fault as warning cases brought under negligence theories. There is no sound reason to bar recovery for emotional distress in strict liability warning actions while permitting such recovery in their negligence counterparts.

Finally, Lilly's attempted resort to Rule 403 as an alternative ground for exclusion fares no better. Plaintiffs' cancer-related evidence is obviously highly probative as to the reasonableness of their fears of developing cancer. As for the prejudice side of the scale, there is no real risk of a jury drawing an inappropriate factual inference. Contrary to Lilly's assertion, a causal link between DES and cancer may permissibly be inferred from such evidence, and the inference bears directly on the reasonableness issue. Any danger that a jury might award damages as compensation for the heightened risk of cancer rather than the ensuing emotional distress can be minimized by appropriate instructions.

Accordingly Lilly's motion to exclude cancer-related testimony must be denied.*fn15

Colposcopic Photographs

Wetherill intends to introduce at trial the January 22, 1982 videotape deposition of Dr. John Marlow ("Dr. Marlow"), a gynecologist who has examined Wetherill and diagnosed her injuries. In a two-minute segment of that deposition Dr. Marlow described one of Wetherill's claimed injuries (adenosis, an abnormality in the vaginal wall) by referring to a colposcopic*fn16 photograph depicting the condition in an unidentified woman.*fn17 That photograph, from Cartier's Practical Colposcopy textbook,*fn18 magnifies the actual subject matter to ten times its actual size.

University has moved to exclude both the photograph and the two-minute portion of the Marlow deposition under Rule 403, claiming their probative value is substantially outweighed by the danger of unfair prejudice and jury confusion because:

    1. With no notion of what is "normal" vaginal
  tissue, the jury cannot determine the degree of
  "abnormality" portrayed in the photograph.

    2. Ten-fold enlargement of the deformed cell
  structures gives a distorted impression of
  Wetherill's physical condition and the degree of her
  pain.

On the other side of the coin, the University depreciates the probative value of the photograph because it does not reflect Wetherill's own vaginal tissues.

Judges McMillen and Grady recently admitted colpophotographic evidence in two other DES cases, Gwendolyn Mink v. University of Chicago, No. 77 C 1432 (N.D.Ill. Mar. 8, 1983) (McMillen, J.) (reversing earlier ruling excluding such photographs); Patsy Mink v. University of Chicago, No. 77 C 1431, Tr. 255 (N.D.Ill. Feb. 16, 1982). Having reviewed the relevant authorities (as discussed in the rest of this section), this Court concurs with their determinations.

As a general proposition, courts and commentators support admissibility of photographs of another person's injuries when used for illustrative purposes, provided competent evidence is adduced to confirm the similarity of the depicted injuries to plaintiff's. See Kershaw v. Sterling Drug, Inc., 415 F.2d 1009, 1111 (5th Cir. 1969) (upholding admissibility of photographs and slides as demonstrative evidence in action for injuries sustained from drugs manufactured by defendant); Thornburg v. Perleberg, 158 N.W.2d 188, 192-93 (N.D. 1968) ("Where a proper foundation is laid by the witness's testifying that a picture portraying [sic] the same conditions which he found in the plaintiff's case, it should be admitted in evidence for illustrative purposes even though it does not portray the plaintiff's own injuries"); McCormick on Evidence, Demonstrative Evidence § 214, at 530-31 (2d ed. 1972). Cf. Georgia Southern & Florida Railway Company v. Perry, 326 F.2d 921, 924 (5th Cir. 1964) ("posed photograph is admissible when it is shown that it represents a correct likeness of the scene, object or person that it purports to represent, and the sufficiency of the preliminary showing rests largely in the discretion of the trial judge"). Dr. Marlow has testified the photograph "represents precisely" the adenosis condition he observed in Wetherill's vagina (Marlow Dep. 62), so that the requisite evidentiary foundation for admissibility has been laid.

Rule 403 does not render the evidence inadmissible. Its probative value is considerable, given Dr. Marlow's testimony it "represents precisely" Wetherill's injuries:

    1. Only through such photographic evidence can the
  jury visually observe the condition from which
  Wetherill allegedly suffers.

    2. It also facilitates the jury's understanding of
  Dr. Marlow's technical explication of Wetherill's
  complex gynecologic disorders.

By contrast, the spectre of prejudice and confusion raised by University is wholly unfounded:

    1. Magnification of the photograph on the
  videoscreen will enhance the picture's utility as a
  visual aid, rather than inflame the jury.

    2. Nor will the photograph likely induce the jury
  to exaggerate the degree of abnormality it portrays,
  for Dr. Marlow's accompanying testimony lucidly
  identifies the deformed cell structures appearing in
  the depicted vaginal wall.*fn19

University's motion to exclude the colposcopic photograph is therefore denied.

Abbott Laboratories Document

Plaintiffs seek to introduce the Minutes of a January 19, 1950 Abbott Laboratories Medical Department Meeting (the "Minutes"), stating in pertinent part:

  Dr. Dieckann [sic], of the University of Chicago, is
  somewhat skeptical of the report of Dr. Smith on the
  use of stilbestrol in complicated pregnancies. He
  would like to check this work on 1,000 cases to be
  treated with stilbestrol and 1,000 with a placebo. He
  has inquired as to our interest in supplying this
  medication and a grant.

University advances three grounds for excluding the Minutes from evidence:

    1. They are inadmissible hearsay, qualifying
  neither under the ancient document (Rule 803(16)) nor
  the business records (Rule 803(6)) exception because
  their trustworthiness is suspect.

2. They are irrelevant.

    3. Their probative value (if any) is outweighed "by
  the danger of unfair prejudice, confusion of the
  issues, or misleading the jury . . ." (Rule 403).

University's third objection, which moots the second, has merit. Any probative value of the Minutes is slight for two reasons. First, their relevance hinges entirely on plaintiffs' strained reading of the quoted excerpt. If (as plaintiffs urge) the passage is to be viewed as expressing Dr. Dieckmann's skepticism over the efficacy of DES, it arguably bears on whether plaintiffs' mothers received (1) his best medical judgment and (2) enough disclosure for an informed consent to an experimental regime of DES administration.*fn20 But plaintiffs appear to read too much into this excerpt. To this Court the far more plausible sense of the Minutes is as reflecting Dr. Dieckmann's qualms as to "the report of Dr. Smith" (that is, its reliability) — hence the desire of Dr. Dieckmann to undertake his own scientifically valid DES study. To jump to the inference that Dr. Dieckmann doubted DES's beneficial qualities requires a leap of faith, not logic.

Second, a lack of assurance as to the Minutes' trustworthiness further detracts from their probative significance. Too many unanswered questions surround this 33-year-old document. Its author cannot be ascertained. More importantly, the Minutes do not reveal the basis for the comment as to Dr. Dieckmann's skepticism. Were such sentiments expressed by Dr. Dieckmann himself or merely surmised by some other unidentified person at Abbott? If the latter is the case, the probative value of the Minutes — even as interpreted by plaintiffs — is appreciably diluted.

Precisely because of their intrinsic ambiguity and lack of trustworthiness, the Minutes risk substantial prejudice and jury confusion. In Mink v. University of Chicago, 77 C 1432 (N.D.Ill. Feb. 16, 1982), a battery claim brought by plaintiffs' mothers, Judge Grady recognized this grave danger (Tr. 248):

  Skepticism, I suppose, can range from slight to
  extreme, and I just do not think that this memorandum
  is probative.

  On the other hand, simply because it is something
  that is capable of meaning all things to all people,
  it can be highly prejudicial. You could stand there
  in final argument and wave that memorandum and ask
  for $2 million, and maybe some people on the jury
  would think you are entitled to have it. But I do not
  think that that is the kind of evidence that would
  justify such a result.

  So because the prejudicial value or prejudicial
  impact of the document or the possible prejudicial
  impact in my view far outweighs its probative value
  for the reasons I have indicated, I am going to
  exclude it under Rule 403.

Because the Minutes' arguable probative value is so far overshadowed ("substantially outweighed" in Rule 403 terms) by their tendency to prejudice and confuse the jury, this Court too will exclude them under Rule 403.
*fn21

Dr. Vaux's Testimony

Each plaintiff intends to call Dr. Kenneth L. Vaux ("Dr. Vaux") as an expert witness to testify as to Illinois' informed consent standard: whether "the reasonable medical practitioner of the same school, in the same or similar circumstances, would have told the patient of such [foreseeable] risks" of the challenged treatment. Green v. Hussey, 127 Ill. App.2d 174, 184, 262 N.E.2d 156, 161 (1st Dist. 1970). University contends Dr. Vaux cannot provide the requisite "expert medical evidence" (Green, 127 Ill.App. at 184, 262 N.E.2d at 161) because:

    1. He was too young to have had personal knowledge
  of what reasonable physicians would have disclosed to
  a participant in University's DES experiment.

2. He is not a licensed physician.

Neither objection disqualifies Dr. Vaux as an expert witness.

Though bound by Illinois' requirement of "expert medical evidence," this Court looks to federal law — to the Rules — to determine Dr. Vaux's eligibility as an expert witness.*fn22 Rule 702 defines the test:

  If scientific, technical, or other specialized
  knowledge will assist the trier of fact to understand
  the evidence or to determine a fact in issue, a
  witness qualified as an expert by knowledge, skill,
  experience, training, or education, may testify
  thereto in the form of an opinion or otherwise.

That language reveals the poverty of University's first argument. By recognizing expertise gained through "training or education" as well as "experience," Rule 702 expressly permits expert witnesses to form their opinions by studying the work of others rather than through first-hand empirical observation. See Grindstaff v. Coleman, 681 F.2d 740, 742-43 (11th Cir. 1982) (medical expert need not have been licensed at time of event at issue under Rule 702's disjunctive test); cf. Mahr v. G.D. Searle & Co., 72 Ill. App.3d 540, 572-73, 28 Ill.Dec. 624, 657, 390 N.E.2d 1214, 1237 (1st Dist. 1979) (confirming the same proposition under Illinois law).

University's second line of attack has slightly more substance but also fails to discredit Dr. Vaux's expertise. Whether University breached its disclosure obligation to plaintiffs' mothers involves three distinct inquiries:

    1. whether its DES study was experimental or
  therapeutic;

2. whether there were undisclosed risks; and

    3. if there were, whether then-prevailing ethical
  standards required their disclosure.

Because he is not a medical practitioner, Dr. Vaux concededly lacks the "specialized knowledge" to testify as an expert on the first two issues. But he is eminently qualified to speak to the ethical concerns raised by the third — and most important — issue:

    1. Dr. Vaux is an Associate Professor of Ethics in
  the University of Illinois Department of Internal
  Medicine.

    2. He is also a member of the Institutional Review
  Board of the School of Medicine, an oversight body
  that regulates the ethical aspects of medical
  experiments involving human participants.

    3. He has written extensively in the field of
  medical ethics and experimentation.

With that impressive background (and assuming his testimony will address the relevant time period), Dr. Vaux certainly has the qualifications to testify as to the prevalent disclosure policies of hospitals that conducted medical studies similar to Dieckmann's at that time. See Greenberg v. Michael Reese Hospital, 83 Ill.2d 282, 292-93, 47 Ill.Dec. 385, 390, 415 N.E.2d 390, 395 (1980) (prevailing custom is but one of several determinants of the applicable standard of care in suits against hospitals, though it may carry dispositive weight in suits against individual doctors). Most significantly, Dr. Vaux is particularly well-suited — more so than the vast majority of physicians — to testify as to alternative sources of disclosure standards.*fn23 See Darling v. Charleston Community Memorial Hospital, 33 Ill.2d 326, 332, 211 N.E.2d 253, 257 (1965) (state administrative regulations and hospital standards and bylaws are evidence of appropriate standard of care).*fn24 Consequently University's motion to bar Dr. Vaux from testifying as an expert is denied.

Cumulative Testimony of Defendants' Expert Witnesses

Plaintiffs have moved under Rules 104(a) and 403 to exclude cumulative testimony by defendants' expert witnesses. They rely heavily on footnote 5 of this Court's Final Pretrial Order: "Only one expert witness on each subject for each party will ordinarily be permitted."*fn25

1. Lilly's Expert Witnesses

Lilly intends to use three medical experts: Drs. Don Carlos Hines ("Hines"), Edith L. Potter ("Potter") and Joseph W. Goldzieker ("Goldzieker").*fn26 In the Pretrial Memorandum Lilly describes each expert's background and anticipated testimony:

    1. Hines was a physician in Lilly's Medical
  Department during the relevant time period. In that
  capacity, he monitored Lilly's clinical investigation
  of DES, evaluated other available DES literature and
  prepared Lilly's application to the FDA for
  permission to market the drug. He is expected to
  testify as to (a) Lilly's clinical DES
  investigations; (b) the DES medical literature
  available during the period in question; (c) the
  then-prevailing medical opinion "about the relevancy
  of the animal experience with estrogens to the
  experience in humans"; and (d) the foreseeability of
  DES's impact on the human fetus.

    2. Potter is an expert in the field of fetal
  pathology who worked with patients involved in
  University's experimental DES project. She is
  anticipated to testify that (a) she never associated
  any anomaly of the female reproductive tract with
  intrauterine DES exposure; (b) prevailing medical
  opinion prior to 1952 regarded DES as a safe
  estrogenic substance; and (c) animal experimentation
  with estrogen has no relevance to human medicine.

    3. Goldzieker is an expert in the field of
  endocrinology and personally conducted animal DES
  studies. He will testify as to (a) "the state of
  animal testing during the relevant time periods . . .
  and the necessity of using a physiologically
  meaningful animal model in attempting to predict the
  effects of a drug in humans"; (b) the adequacy of DES
  testing; and (c) the foreseeability in 1952 of any
  causal link between DES and plaintiffs' claimed
  injuries.

Lilly's own summary of its experts' testimony thus reveals considerable redundancy. For example, all three witnesses are expected to testify as to (1) the relevance of animal DES studies and (2) the state of medical knowledge as to DES's cancer-related effects during the early 1950's.

Lilly's responsive memorandum glosses over this problem of cumulativeness by characterizing its experts' testimony more narrowly:

    1. Because Hines was the physician primarily
  responsible for Lilly's R & D program concerning DES,
  "the basic thrust of his testimony will relate to
  Lilly's awareness and understanding of DES and the
  medical literature concerning it" (Mem. 3-4).

    2. Potter's "testimony will be predicated to a
  substantial degree upon her extensive first-hand
  review of pathological material at the University of
  Chicago" (id. at 5). Such "pathological material" was
  described earlier as "abortuses, fetuses, stillbornes
  and neonates who had died, many of whom had been
  exposed to DES" (id. at 4).*fn27

    3. As the only Lilly witness who personally
  conducted animal studies, Goldzieker "will testify
  concerning the state of animal testing during the
  relevant time periods and the necessity of using a
  physiologically meaningful animal model in attempting
  to predict the effects of a drug in humans . . .
  [and] also will testify that DES was adequately
  tested" (id. at 6).

  Plaintiffs concede the danger of cumulative testimony would be averted should Lilly's revised synopsis of their experts' testimony prove accurate at trial. They have therefore submitted a draft order incorporating those restrictive characterizations.

Plaintiffs' draft order is an eminently reasonable solution to the potential for duplicative testimony disclosed in the Pretrial Memorandum. By definition Lilly's ability to present its defense would not be impaired by confining its experts' testimony to the areas as to which Lilly intends them to testify.

2. University's Expert Witnesses

University will rely on two expert witnesses, Drs. Mark H. Lepper ("Lepper") and Richard L. Landau ("Landau"). Here the Pretrial Memorandum indicates:

    1. Lepper is an internal medicine practitioner in
  Chicago. He "will testify as to the practices for
  conducting medical studies in Chicago in 1950 to
  1952."

    2. Landau, also an internal medicine specialist,
  has taught at the University since 1946. He too "will
  testify as to the practices for conducting medical
  studies in Chicago in 1950 to 1952."

There is thus no doubt of largely repetitive testimony, a conclusion reinforced by University's failure to respond to plaintiffs' motions.

To eliminate such cumulative testimony, plaintiffs' proposed order would limit:

    1. Lepper's testimony "to the practice in Chicago
  with regard to obtaining consent from persons being
  administered medication as part of a medical study"
  and

    2. Landau's testimony "to the practice of obtaining
  informed consent at the University of Chicago when
  the Dieckmann study was conducted."

Even though such a division of testimony seems reasonable, it is neither plaintiffs' nor this Court's function to devise the allocation of testimonial responsibilities. University will be restricted to one expert for each area but will be allowed to make the selection itself.

Motion for Separate Trial

Lilly has moved under Fed.R.Civ.P. 42(b) to be tried separately on Count III. It seeks to avoid possible prejudice from exposing the jury to certain evidence admissible as to University but inadmissible as to Lilly:

    1. evidence as to plaintiffs' fears of contracting
  cancer, admissible against University on a battery
  theory;

    2. evidence bearing on University's liability for
  punitive damages on the battery count; and

    3. depositions of expert witnesses Drs. Arthur L.
  Herbst ("Herbst") and Dr. Kenneth L. Noller
  ("Noller"), taken in a different proceeding to which
  University but not Lilly was a party.

Potential prejudice is indeed one of Rule 42(b)'s three independent grounds for invoking separability:

  The court, in furtherance of convenience or to avoid
  prejudice, or when separate trials will be conducive
  to expedition and economy, may order a separate trial
  of any claim, cross-claim, counterclaim, or
  third-party claim, or of any separate issue or of any
  number of claims, cross-claims, counterclaims,
  third-party claims, or issues, always preserving
  inviolate the right of trial by jury as declared by
  the Seventh Amendment to the Constitution or as given
  by a statute of the United States.

Because a single trial generally fosters judicial efficiency,
*fn28 courts have ordered separate trials only when "clearly necessary." 5 Moore's Federal Practice ¶ 42.03[1], at 42-37 to 42-38 & n. 4 (1982). Lilly's speculative assertion of prejudice falls far short of that stringent test.

Certainly the first two categories of evidence pose no discernible risk of prejudice:

    1. Because plaintiffs' apprehensions of developing
  cancer are relevant under Count III, evidence on that
  issue is admissible against Lilly in any case.

    2. Evidence bearing on University's intentional
  misconduct (in connection with its DES experiment) is
  unlikely to mislead the jury in determining Lilly's
  culpability on Count III. Such evidence is obviously
  irrelevant to Lilly's liability, and any arguable
  risk of jury confusion can be defused through
  cautionary instructions.

True enough, some risk of prejudice may be posed by the Herbst and Noller depositions. Their testimony would be relevant to at least two issues raised in Count III:

    1. whether prenatal DES exposure is causally linked
  to cancer; and

    2. whether that causal relationship was foreseeable
  in the early 1950's,

but it is inadmissible against Lilly under Rule 804(b)(1).

Despite that theoretical possibility of prejudice, the degree of danger is clearly not sufficiently grave to warrant a separate trial. In both qualitative and quantitative terms, the two depositions are a comparatively minor part of the evidence plaintiffs will marshal on the issues. Live testimony by plaintiffs' expert witnesses will be the bulk of such evidence. In practical terms it is likely to carry far more weight with any jury than an impersonal reading of the deposition transcripts. And again cautionary instructions can be fashioned to avert any possible prejudice.

Lilly's arguments to the contrary really prove too much. They would effectively preclude any trial involving multiple defendants whenever a relatively small amount of evidence admissible as to one defendant is both inadmissible and relevant as to another defendant's. That approach would emasculate the liberal federal approach to joinder of parties. As the court put it in United States v. Kennedy, 564 F.2d 1329, 1334 (9th Cir. 1978) (affirming the denial of a motion for a separate trial under Fed.R.Crim.P. 14, the criminal counterpart of Rule 42(b)):

  It is not surprising that a defendant might prefer to
  be tried separately so that the only evidence
  admissible strictly against him would be heard by the
  jury. However, if this formed the only basis for
  prejudice required for severance, the consequent
  volume of separate trials of multiple actions in a
  series of similar and connected illegal transactions
  would create an intolerable burden on the trial
  courts. Serious consideration is properly to be given
  to the factor of judicial economy by the trial court
  in the exercise of its discretion when severance is
  sought.

Kennedy then concluded the trial court's careful use of limiting instructions minimized the risk of prejudice.

Finally Lilly's contention ignores the more serious potential for prejudice to plaintiffs were the two alleged joint tortfeasors tried separately. 9 Wright & Miller, Federal Practice and Procedure § 2389, at 290-93 elaborates:

  If plaintiff has sued two or more defendants for the
  same injuries, motions by the defendants that the
  claims against each of them be separately tried have
  usually been denied, even if the basis of liability
  was different so that there was a possibility of
  confusion. Indeed in this situation a state court,
  construing a rule based on Rule 42(b), held it error
  to grant a separate trial for each of the defendants,
  pointing out that "plaintiff should not, in a forced
  separation, be put to the hazard of two juries, each
  believing the absent tort-feasor the wrongdoer."

Every relevant factor thus dictates the same result. Lilly's motion for separate trial is denied.

Conclusion

To obviate the need to leaf through this opinion for its disposition of the several motions, the results will be recapitulated here:

    1. Lilly's motion to exclude post-occurrence
  changes in its product literature is granted as to
  the 1954 A-form but denied as to the 1967, 1972 and
  1975 A-forms.

    2. Lilly's motion to exclude cancer-related
  testimony is denied.*fn*

    3. University's motion to exclude colposcopic
  photographs is denied.

    4. University's motion to exclude the Abbott
  Laboratories document is granted.

    5. University's motion to bar Dr. Vaux from
  testifying as an expert witness is denied.

    6. Plaintiffs' motion to exclude cumulative
  testimony of defendants' expert witnesses is granted.
  Lilly's experts will be limited as Lilly itself has
  most recently stated. University's experts will
  divide their duplicative testimony as University
  determines.

7. Lilly's motion for separate trial is denied.


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