Zeman et al v. Williams et al

Filing 86

Judge George A. OToole, Jr: OPINION AND ORDER entered granting 33 Motion to Dismiss; granting in part and denying in part 9 Motion to Dismiss (Lyness, Paul)

UNITED STATES DISTRICT COURT
DISTRICT OF MASSACHUSETTS
CIVIL ACTION NO. 11-10204-GAO
ROBERT ZEMAN and JULIA ZEMAN,
Plaintiffs,
v.
ZIV WILLIAMS, M.D., EMAD ESKANDAR, M.D., HINA ALAM, SARY F. ARANKI, M.D.,
RHONDA BENTLEY-LEWIS, M.D., SUSAN BURNSIDE, RICHARD D’AUGUSTA,
ASHWIN DHARMADHIKARI, M.D., DEBORAH ECKER, MELISSA FRUMIN, M.D.,
ROBERT J. GLYNN, ELIZABETH L. HOHMANN, M.D., DAVID A. JONES, M.D.,
THOMAS KOLOKOTRONES, KEITH A. MARCOTTE, FRANCISCO MARTY, M.D.,
ELINOR A. MODY, M.D., JOAN RILEY, ANDREW P. SELWYN, ARTHUR C. WALTMAN,
M.D., SJIRK WESTRA, M.D., SEAN R. WILSON, M.D., and NEUROLOGIX, INC.,
Defendants.

OPINION AND ORDER
July 7, 2014
O’TOOLE, D.J.
This action arises out of an unsuccessful clinical trial of an innovative therapy to treat
Young-Onset Parkinson’s Disease. The plaintiffs, Robert Zeman and Julia Zeman, bring claims
against Neurologix, Inc., the clinical trial sponsor, for negligence, breach of warranty, and loss of
consortium. They allege that Neurologix negligently drafted and approved the informed consent
form used in the clinical trial. They also claim that Neurologix negligently designed and
manufactured the medical equipment which was used in the procedure. Neurologix has moved to
dismiss the plaintiffs’ claims for failure to state a claim pursuant to Federal Rule of Civil
Procedure 12(b)(6).
In addition, the plaintiffs claim that members of the Institutional Review Board at the
Massachusetts General Hospital 1 (“IRB members”) were negligent in drafting and approving the
1

Each member of the Institutional Review Board is being sued in his or her individual capacity.

informed consent documents used to obtain Mr. Zeman’s consent to participate in the clinical
trial. The IRB members have also moved to dismiss the plaintiffs’ negligence claim for failure to
state a claim under Federal Rule of Civil Procedure 12(b)(6). The central question presented by
the motion is whether the IRB members owed the plaintiffs a legally cognizable duty of care
under the common law of Massachusetts.
I.

The Amended Complaint
The Amended Complaint alleges the following facts. In late 2008, Mr. Zeman presented

to Massachusetts General Hospital (“MGH”) to participate in a clinical trial to treat Young-Onset
Parkinson’s Disease. The clinical study was a single blind placebo study, whereby only half of
the study participants underwent the actual procedure. Mr. Zeman received the real therapy, not
the placebo.
The clinical study involved a procedure called bilateral gene transfer, by which healthy
genes were to be injected into both sides of the brain in the sub-thalamic nucleus using a viral
vector. Together, the viral vector and healthy genes made up the study agent. Medtronic, Inc.,
previously dismissed from this action, designed and manufactured the experimental Acute Brain
Infusion Delivery (“ABID”) System used to introduce the study agent into Mr. Zeman’s brain.
The clinical study predicted that the injected healthy genes would produce an enzyme called
glutanic acid decarboxylase, which in turn would produce a neurotransmitter, gammaaminobutyric acid, a deficiency of which is common in Parkinson’s patients. The clinical trial
was being conducted under the Investigational Device Exemption (“IDE”) to the normal Food
and Drug Administration pre-market approval requirements.
Prior to enrolling in the clinical trial, Mr. Zeman received and signed an informed
consent form. The Amended Complaint alleges that both Neurologix and the IRB members

2

“engaged in the drafting of and gave approval for” the informed consent form. (See Am. Compl.
¶¶ 125, 132 (dkt. no. 4).) They “knew or should have known that said document did not
adequately and reasonably present the alternatives to and risks and potential consequences of the
experiment.” (Id. ¶¶ 128, 135.)
The procedure was performed on December 4, 2008, and Mr. Zeman became the first
human subject to have a bilateral gene transfer. Unfortunately for Mr. Zeman, the procedure
proved unsuccessful. Under the study design, the ABID System utilized two catheters to
introduce the study agent into Mr. Zeman’s brain. According to the procedure’s protocol, one
catheter was to be placed in the left side of the brain and one in the right side. In error, the
operating surgeon placed both catheters in the left side of Mr. Zeman’s brain, an error which
caused him serious harm.
II.

Standard of Review
To withstand a motion to dismiss pursuant to Federal Rule of Civil Procedure 12(b)(6), a

complaint must “state a claim to relief that is plausible on its face.” Bell Atl. Corp. v. Twombly,
550 U.S. 544, 570 (2007). When evaluating the plausibility of a plaintiff’s claim, the court must
accept the factual allegations in the complaint as true and draw all reasonable inferences in favor
of the plaintiff. Maldonado v. Fontanes, 568 F.3d 263, 266 (1st. Cir 2009) (quoting Ashcroft v.
Iqbal, 556 U.S. 662, 678 (2009)); Coyne v. City of Somerville, 972 F.2d 440, 442-43 (1st Cir.
1992). The complaint must be supported by more than “mere conclusory statements,” Iqbal, 556
U.S. at 678, but “detailed factual allegations” are not required. Twombly, 550 U.S. at 555.

3

III.

Motion to Dismiss by Neurologix
A.

Count XI: Negligence (Informed Consent)

The plaintiffs allege that Neurologix negligently drafted and approved the informed
consent form. Neurologix contends that this claim fails because the plaintiffs fail to establish that
Neurologix owed Mr. Zeman a legally cognizable duty with respect to the content of the consent
form. See Afarian v. Mass. Elec. Co., 866 N.E.2d 901, 905 (Mass. 2007) (stating that an
“essential element of every negligence claim is the existence of a legal duty”). The existence of a
legally cognizable duty is a question of law, and courts look to social values, customs, and
policies to determine whether a legal duty exists. See Remy v. MacDonald, 801 N.E.2d 260,
262-63 (Mass. 2004); Tobin v. Norwood Country Club, Inc., 661 N.E.2d 627, 632-33 (Mass.
1996); Yakubowicz v. Paramount Pictures Corp., 536 N.E.2d 1067, 1070-71 (Mass. 1989).
The plaintiffs allege that Neurologix, as the sponsor of the clinical trial, had a duty to
draft and approve the clinical trial protocol and informed consent form with reasonable care to
ensure Mr. Zeman’s safety. The plaintiffs allege further that Neurologix knew or should have
known that the informed consent form was inadequate because the form did not advise Mr.
Zeman of all reasonable risks and alternatives to the clinical procedure.
Federal regulations covering experimental clinical trials articulate a general policy to
protect human subjects in clinical trials. See 45 C.F.R. § 46.101(e)-(f). 2 Under regulations issued
by the Food and Drug Administration, participants in Investigational New Drug (“IND”) clinical
trials such as the one involved in this case are classified to include both “sponsors” and
“investigators.” An “investigator” is an “individual who actually conducts a clinical investigation

2

A “subject” is “a human who participates in an investigation, either as a recipient of the
investigational new drug or as a control. A subject may be a healthy human or a patient with a
disease.” 21 C.F.R. § 312.3(b).
4

(i.e., under whose immediate direction the investigational drug is administered or dispensed to a
subject).” 21 C.F.R. § 312.3(b). The defendant Dr. Eskandar was the principal investigator in this
case. A clinical trial “sponsor” is “a person who takes responsibility for and initiates a clinical
investigation.” Id. A sponsor “does not actually conduct the investigation unless the sponsor is a
sponsor-investigator,” and a sponsor-investigator must be an “individual.” Id. Under the
regulations the term “individual” refers to a human being, while the term “person” includes a
“pharmaceutical company, governmental agency, academic institution, private organization, or
other organization.” Id. Here, Neurologix was a sponsor, and neither an investigator nor a
sponsor-investigator.
Both the investigator and the sponsor have responsibilities under the regulations
regarding obtaining a subject’s informed consent. An investigator is responsible for the conduct
of the trial according to the applicable protocol. 21 C.F.R. § 312.60. An investigator must
“obtain the informed consent of each human subject to whom the drug is administered.” Id. A
sponsor is “responsible for selecting qualified investigators” and (among other things)
“providing them with the information they need to conduct an investigation properly.” Id. §
312.50.
It is a plausible understanding of these provisions that both investigators and sponsors
have a role in the obtaining of informed consent from a clinical trial subject. It is the investigator
who is responsible for actually interacting with the subject to obtain his consent, but the sponsor
must “provid[e] . . . the information [the investigator] need[s],” id., to obtain a properly informed
consent.
The sponsor’s obligation to provide the necessary information in one sense is owed to the
investigator, but it also may be owed to the subject. The subject obviously has a great stake in

5

whether the investigation is conducted “properly.” That certainly includes the subject’s being
provided adequate information to give a properly informed consent. It is plausible that in a given
case that will not happen unless the investigator obtaining the consent himself has adequate
information bearing on the risks of the procedure. Under the regulations, the sponsor is obliged
to provide the investigator sufficient information so that an informed consent is properly given
by the subject.
I agree with Neurologix that the federal regulations do not themselves authorize a cause
of action by a subject such as Mr. Zeman against a sponsor such as Neurologix. But the plaintiffs
fashion their claim as one arising under the Massachusetts common law of torts. That there is no
case law directly in point does not necessarily answer the question whether such a claim is
viable.
Neurologix argues that the responsibility for obtaining an informed consent rests
exclusively with the investigator. It is certainly true that the investigator has a major, if not the
major, role in obtaining a properly informed consent. But that does not foreclose the possibility
that some other persons, including particularly the trial’s sponsor, might also have a
responsibility to help assure that the investigator actually gets a properly informed consent. After
all, even under the “learned intermediary” rule, a pharmaceutical company will not be held liable
to injury to a patient only if it has given adequate information to the intermediary physician so
the physician can adequately inform the patient. See Garside v. Osco Drug, Inc., 976 F.2d 77,
80-81 (1st Cir. 1992). See also MacDonald v. Orthos Pharm. Corp., 475 N.E.2d 65, 69-70 (Mass.
1985). If the investigator fails to inform a subject about some substantial risk because the
sponsor has failed adequately to inform the investigator about the risk, the sponsor may be liable
in tort.

6

The Amended Complaint alleges that Neurologix approved the protocol for the clinical
trial, including the informed consent form, and that it knew or should have known that the form
“did not adequately and reasonably present the alternatives to and risks and potential
consequences of” the trial. It further enumerates specific omitted information. (Am. Compl. ¶
135.) The claim that Neurologix negligently failed in a duty owed to Mr. Zeman is adequately
pled under the Twombly and Iqbal standard. Whether the claim can be proved is a matter for
another day.
B.

Count XII: Negligence (Product Liability)

The plaintiffs allege that Neurologix negligently designed and manufactured the ABID
System, which includes the catheters used to inject the study agent into Mr. Zeman’s brain. The
allegations are, however, entirely general and conclusory. (Am. Compl. ¶¶ 142-144.) For
example, it is alleged that the ABID System “was manufactured in violation of the Federal Food,
Drug and Cosmetic Act (“Act”) and regulations promulgated pursuant to said Act” (Am. Compl.
¶ 142), but there are no specifics about which provisions of the Act or regulations were violated
or how. The plaintiffs similarly allege that Neurologix “negligently manufactured and/or
designed the ABID System,” but no details are alleged. Instead there is a catalog of summary and
conclusory assertions, such as the allegation that Neurologix was negligent by “designing,
manufacturing, and/or distributing a product in a defective condition.” (Am. Compl. ¶ 144.a.)
Such generalities do not come close to satisfying the Twombly-Iqbal standard.
Neurologix also argues that the plaintiffs’ negligence claim for product liability is
preempted by the Food, Drug, and Cosmetic Act (“FDCA”) and its 1976 Medical Device
Amendments (“MDA”). The MDA expressly preempts state requirements for medical devices
“different from, or in addition to, any requirement applicable under this chapter to the device,

7

and . . . which relates to the safety or effectiveness of the device . . . .” 21 U.S.C. § 360k(a); see
also Reigel v. Medtronic, Inc., 552 U.S. 312, 321 (2008). In general, state law negligence claims
that “impose requirements [different from or in addition to the federal requirements] [are] preempted by federal requirements specific to a medical device.” Reigel, 552 U.S. at 323-24
(internal quotation marks omitted). The plaintiffs respond that a state negligence claim is not
preempted to the extent that it is premised on a violation of federal law because in such a case
the state-imposed duties “parallel, rather than add to, federal requirements.” Id. at 330 (internal
quotations omitted) (citing Medtronic, Inc. v. Lohr, 518 U.S. 470, 495 (1996)).
Because of the absence of specific allegations, it is impossible to tell whether the
plaintiffs’ product liability claim parallels federal law or not. It is not necessary to resolve the
preemption question, however, because of the inadequacy of the pleading.
C.

Count XIII: Breach of Warranty

The plaintiffs also allege breach of warranty. The same pleading inadequacy exists as to
this claim. All the complaint says is that the “ABID System was defective in design and/or
manufacture, was unreasonably dangerous, and was in breach of . . . implied warranties.” (Am.
Compl. ¶ 150.) Without any allegation has to how the system was “defective in design and/or
manufacture,” the claim is not pled to the Twombly-Iqbal standard.
IV.

Motion to Dismiss by the IRB Members
The IRB members argue that they do not stand in such a relationship to a subject in a

clinical trial such as Mr. Zeman as to give rise to a duty of care with respect to the obtaining of
informed consent, and that consequently the complaint fails to state a claim against them. I agree.
The sponsor and investigator of a clinical trial both participate in the clinical treatment of
the subject by designing and implementing the treatment protocol. The IRB, in contrast, does not

8

participate in either the design or implementation of the protocol. Its role is more like a
regulatory body, than a treating medical professional or designer of the clinical trial protocol. .
The doctrine of informed consent has been developed in actions for malpractice by
medical professionals who are treating a patient. See Harnish v. Children’s Hosp. Med. Ctr., 439
N.E.2d 240 (1982). It has been applied where a treatment relationship has been established, most
classically, but not necessarily exclusively, a doctor-patient relationship. Id. The Supreme
Judicial Court has declined, however, to apply the doctrine to medical professionals who are only
associated with the treatment in a tangential or limited way. So, for example, a neurosurgeon
who was consulted but was not otherwise responsible for the patient’s treatment was held outside
the kind of relationship that would give rise to a duty to the patient regarding informed consent.
Halley v. Birbiglia, 458 N.E.2d 710, 715-16 (Mass. 1983).
The IRB members stand outside any treatment relationship with Mr. Zeman. Under the
Massachusetts cases, they do not have any duty to him (or any other specific patient) with
respect to the obtaining of informed consent.
V.

Conclusion
Based on the reasons set forth above, Neurologix’s Motion (dkt. no. 9) to Dismiss is

GRANTED as to Counts XII and XIII, and those claims are DISMISSED. It is DENIED as to
Counts XI and XIV (to the extent it rests on the claim in Count XI).
The IRB members’ motion (dkt. no. 33) to dismiss the claims against them is
GRANTED, and those claims, in Counts X and XIV, are DISMISSED.
It is SO ORDERED.
/s/ George A. O’Toole, Jr.
United States District Judge

9