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In re Canavan8/17/2000
conducted the employee has symptoms "highly suggestive of . . . environmental sensitivity." However, Dr. LaCava did not identify any specific studies that show the existence of MCS based on specific symptoms and did not identify tests that can be performed to prove that a patient suffers from MCS. On cross-examination, he admitted that there is a dispute in the medical community regarding the existence of MCS. Thus, the only evidence on this record tending to show that the employee suffers from MCS is Dr. LaCava's assertion. The purpose of the Lanigan test is to prevent an expert from offering testimony to a fact finder that is not based on reliable methodology. Commonwealth v. Lanigan, supra at 26. We cannot conclude that the expert's mere assertion that a methodology is reliable is sufficient to pass the Lanigan test absent any other evidence showing its reliability. See Kumho Tire Co. v. Carmichael, supra at 157, quoting General Elec. Co. v. Joiner, 522 U.S. 136, 146 (1997) ("nothing in either Daubert or the Federal Rules of Evidence requires a district court to admit opinion evidence that is connected to existing data only by the ipse dixit of the expert"). We conclude that on this record it was an abuse of discretion for the judge to admit Dr. LaCava's diagnosis testimony.
b. Causation.
Our conclusion that the diagnosis testimony was improperly admitted disposes of this case; however, because of the importance of the question, we address the hospital's contention that it was an error to admit the causation testimony. The judge concluded not only that the employee suffered from MCS but that it was caused by her work at the hospital. Specifically, Dr. LaCava agreed that "to within a reasonable degree of medical certainty" it was his opinion that her condition was "caused by the exposures of multiple chemicals that she has been exposed to at the [hospital] during the course of her employment." Dr. LaCava admitted during cross-examination that there is medical uncertainty as to the cause of MCS. He acknowledged that MCS may be caused by many factors including genetics, metabolism, physical stress, or toxic exposures and that causation may differ depending on the person. The Appeals Court concluded that Dr. LaCava's causation opinion was properly admitted because he was aware of the chemicals present at the hospital and diagnostic tests confirmed that the employee had been exposed to these chemicals. Canavan's Case, supra at 300-301. There is no suggestion that the judge conducted a Lanigan analysis to determine whether Dr. LaCava used a reliable methodology to conclude that the chemical exposures to which the employee was subjected caused her to suffer from MCS. This was an error.
Because understanding medical causation is "beyond the . . . knowledge of the ordinary layman . . . proof of if it must rest upon expert medical testimony." Hachadourian's Case, 340 Mass. 81, 85 (1959). Opinions regarding medical causation are classic examples of testimony that must be subject to Lanigan analysis. Both the Daubert and Joiner cases involved the admissibility of medical causation testimony. In Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579 (1993), the issue was whether there was reliable methodology to show that the drug Bendectin caused birth defects; in General Elec. Co. v. Joiner, supra, the Court addressed whether there was reliable methodology to show that polychlorinated biphenyls (PCBs) caused small cell lung cancer. Similarly, the causation question in this case is whether exposure to a variety of chemicals including ethylene, diesel fuel, and formaldehyde caused the employee to be "highly reactive to low levels of environmental chemicals." Because the judge below did not
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