Nursing Expert Witness’s Testimony Limited

Nursing expert was qualified to testify on risk management procedures and quality control in hospitals, but not qualified to testify on issues regarding nephrology or dialysis.

Facts: The case (Morris v. Davita Healthcare – U.S. District Court of Colorado – May 28th, 2015) concerns the ongoing monitoring and quality control of patient data after receiving hemodialysis treatment at one of defendant Davita’s clinics. The plaintiffs claim that defendants did not notice changes in blood ph levels caused by ingredients in the dialysate solution, or did notice the changes but chose not to reveal the information.

Nursing Expert Barbara J. Youngberg, also a licensed attorney, was called on to assess the defendant’s quality improvement standards, patient safety, and risk management programs on the use of the ingredients in the solution and how they relate to the standard of care in the industry. In addition, two nephrology experts (both MDs) from both sides we called to discuss their medical opinions on the medical standards of care with hemodialysis treatments. After declaration and deposition, defendant moved to exclude the nurse’s testimony, as well as the nephrology experts, under Rule 702 of the Federal Rules of Evidence.

Ms. Youngberg testified that, based on the documents she reviewed, Davita collects patient data during and after the hemodialysis treatments. However, she found that they did not review the data across their centers. If Davita had done so, they would have seen the risks in patients who had received the treatments containing the detrimental ingredients. In addition Ms. Youngberg testified that even though the FDA recalled the two ingredients in the dialysate solution (albeit not prohibit their use) in 2012 and further, a warning issued by the manufacturer in the same year, Davita would have identified the issues if they had tracked and reviewed the data more efficiently.

Based on the documents she reviewed, plaintiff’s expert testified that Davita did not review the patient data collected after the hemodialysis treatments across their centers. If Davita had done so, they would have seen the risks in patients who had received the treatments containing the detrimental ingredients.

Discussion: In the Daubert hearing, the court noted that plaintiffs’ nursing expert had impressive credentials in teaching and developing quality control and risk management procedures in hospitals. Davita, in its motion, explained that Ms. Youngberg did not look at important records of the defendant and did not have knowledge of how the company tracked patient data, improved quality, or kept up to date with the medical literature in this area. The court agreed. In addition, the court mentioned that Ms. Youngberg, in her testimony, flipped back and forth between Davita’s having no risk management and patient safety procedures to stating that they did not follow the written procedures that they had.

In addition, the court noticed that Ms. Youngberg continued to evade questions pertaining to special knowledge of nephrology and dialysis and possibly signed a declaration with such opinions that were outside her purview and experience. Also, in her reply declaration, she answered standard of care questions that only an expert in nephrology or dialysis could provide.

Held: The court concluded that Ms. Youngberg is not qualified to testify on issues of the case that vary from her expertise in quality control and risk management (for example, on nephrology and dialysis). She is qualified to testify about the documents she reviewed for Davita and any monitoring done of the data from the treatments. Thus, the court denied this motion in part and granted it in part.