The opinion of the court was delivered by: John F. Grady, United States District Judge
The defendants have moved to bar the proposed testimony of plaintiff's medical expert, Dr. Howard Adelman, concerning the cause of May Molina's death. The motion is made pursuant to Daubert v. Merrell, Dow Pharmaceuticals, Inc., 509 U.S. 579 (1993), and defendants' position is that Dr. Adelman's proffered opinion as to the cause of death is not reliable.
Dr. Adelman's position has varied somewhat over time, but his final opinion is expressed in the conclusion of his report of March 6, 2007:
THE OUTCOME: Without evidence to the contrary, it is my opinion, to a reasonable degree of medical probability, that Ms. Molina, deprived of her diabetic and thyroid medications fell into a diabetic coma and died. Had she been brought to a hospital even as late as when her lawyer visited with her; [sic] the outcome would, to a high degree of medical probability, [have] been much different. In the first place, treatment of her diabetes in the form of monitoring her blood sugar and titrating her insulin would probably have prevented her fatal coma. Even if -- and this is a big "if" she did lapse into coma on the basis of a narcotic overdose, this would, mostly likely, have been discovered at the hospital because it is one of the differential diagnoses of coma, and would have been treated.
My conclusion is and remains, to a high degree of medical probability and virtual certainty, that the proximate cause of May Molina's death was not being put in a hospital where she belonged.
(Pls.' Resp. To Defs.' Mot. To Bar Pls.' Expert Adelman Report, Ex. D, at 10.)
There are three elements to Dr. Adelman's opinion:
(a) because Ms. Molina was deprived of her diabetic and thyroid medications, she fell into a diabetic coma and died;
(b) there is also a small possibility that Ms. Molina lapsed into a coma "on the basis of a narcotic overdose"; and
(c) in either event, had she been taken to a hospital, her blood sugar would have been monitored and she would have been appropriately treated with insulin, preventing the fatal diabetic coma; or, if the coma was the result of a narcotic overdose, that, too, would have been diagnosed and treated at the hospital.
We will examine Dr. Adelman's basis for each of these three elements of his opinion.
Whether the Death Was the Result of a Diabetic Coma
The evidence is that Ms. Molina had Type II diabetes. There is no evidence as to how serious the condition was, nor does it appear that Dr. Adelman made any effort to determine whether Ms. Molina had been under treatment for the condition, and, if so, what the treatment was and for how long she had received it. There is evidence that Ms. Molina did not have her "diabetes medication" with her at the lockup; her daughter brought it to her at the lockup, only to be told by the lockup personnel that it could not be accepted. There is no indication as to what the diabetic medication was. It was not insulin, but some unspecified kind of "pills." The evidence does not show when Ms. Molina had last taken a pill, or what the effect of not having the pills available in the lockup was, if any, on Ms. Molina's diabetic condition. Dr. Adelman's simple reference to Ms. Molina's being "deprived of her diabetic and thyroid medications" is not a medical explanation of how her not having access to the pills from the time of her arrest would have caused her to lapse into a diabetic coma.
In his deposition, Dr. Adelman had to admit that most of the medical evidence is inconsistent with a diagnosis of diabetic coma. For one thing, Ms. Molina was a Type II diabetic, and diabetic ketoacidosis, the cause of diabetic coma, does not normally occur in ...