Robles-Figueroa v. Presbyterian Community Hospital, Inc. et al
Filing
169
OPINION AND ORDER granting 88 Motion In Limine To Exclude Dr. Carolyn Crawford's Testimony as an Expert on Autism and Her Causation Opinions Regarding Autism or Autistic-Like Behaviors. See attached. Signed by Judge Gina R. Mendez-Miro on 1/27/2025. (GMN)
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF PUERTO RICO
Keila Robles-Figueroa
on behalf of her minor daughter
Kamila
Civil. No. 22-cv-01361 (GMM)
Plaintiff,
v.
Presbyterian Community Hospital,
Inc., et al.,
Defendants
OPINION AND ORDER
On July 29, 2022, a minor, Kamila, represented by her mother
Keila Robles Figueroa (“Plaintiff” or “Mrs. Robles”), filed a
Complaint against Dr. Juan C. Castañer, Presbyterian Community
Hospital,
Inc.
(“the
Hospital”)
and
to
Hospital
Pediátrico
Universitario alleging claims of medical malpractice under Puerto
Rico state law. (Docket No. 1). Pending before the Court is the
Motion In Limine To Exclude Dr. Carolyn Crawford’s Testimony as an
Expert on Autism and Her Causation Opinions Regarding Autism or
Autistic-Like Behaviors (“Motion in Limine”. (Docket No. 88). For
the reasons stated below, the Motion in Limine is GRANTED.
I.
RELEVANT FACTUAL AND PROCEDURAL HISTORY
This is a medical malpractice case in which Plaintiff alleges
that Dr. Juan C. Castañer (“Dr. Castañer”), the Hospital and the
Hospital
Pediátrico
Universitario
(collectively
“Defendants”)
deviated from the standards of care. The allegations of negligence
Civil. No. 22-cv-01361(GMM)
Page -2-
are centered on the medical care provided to Mrs. Robles and her
baby during her pregnancy, delivery, and the neonatal care of her
premature infant.
On August 30, 2024, the Hospital filed Motion In Limine
(Docket No. 88). The Hospital argues that Dr. Carolyn Crawford
(“Dr. Crawford”) is neither qualified by education, training, and
experience, to opine on the topic autism or its causes, nor does
her report or deposition testimony present opinions that can be
said to be based on reliable methodology or rest on sufficient
factual foundation. On September 10, 2024, Dr. Castañer filed a
Motion for Joinder as to the motions in limine filed by the
Hospital at Docket Nos. 86, 87 and 88. (Docket No. 102).
On October 7, 2024, Plaintiff filed Plaintiff’s Opposition to
Codefendant’s Motion in Limine at Docket No. 88 & 90. Plaintiff
argues that Dr. Crawford has the necessary expertise to opine on
autism and autistic-like behavior in children, as to assist the
fact-finder. See (Docket No. 127). She also argues that concerns
about Dr. Crawford’s qualifications and methodology go to “the
weight of the testimony, rather than admissibility, which is
properly reserved for the jury.” (Id. at 11). The Hospital filed
a Reply to Plaintiff’s Opposition To The Hospital’s Motion In
Limine at Docket No. 88 on November 18, 2024. (Docket No. 141). On
November 25, 2024, Dr. Castañer filed a Motion for Joinder as to
Civil. No. 22-cv-01361(GMM)
Page -3-
motions filed by the Hospital at Docket Nos. 139, 140, 141, 142
and 143. (Docket No. 149).
II.
APPLICABLE LAW
Federal Rule of Evidence 702 permits testimony by experts
qualified
by
“knowledge,
skill,
expertise,
training,
or
education,” to testify “in the form of an opinion or otherwise”
based on “scientific, technical, or other specialized knowledge”
if that testimony will “assist the trier of fact to understand the
evidence or to determine a fact in issue.” Fed. R. Evid. 702. The
expert's testimony must be based on “sufficient facts or data,” it
must be “the product of reliable principles and methods,” and the
expert must have “applied the principles and methods reliably to
the facts of the case.” Id.
The
proponent
establishing
by
a
of
expert
testimony
preponderance
of
bears
the
the
evidence
burden
of
that
the
admissibility requirements are met. See id., Advisory Committee
Notes. Although there is a presumption of admissibility, Daubert
v. Merrell Dow Pharms., Inc., 509 U.S. 579, 588 (1993), the trial
court is obliged to act as a “gatekeeper” regarding the admission
of expert scientific testimony under Rule 702. See id. at 597.
“This entails a preliminary assessment of whether the reasoning or
methodology is scientifically valid and of whether that reasoning
or methodology properly can be applied to the facts in issue.” Id.
Civil. No. 22-cv-01361(GMM)
Page -4-
at 592-93. The Court possesses broad discretion to determine
whether proffered expert testimony meets Daubert’s requirements
for admissibility. See Carballo Rodriguez v. Clark Equip. Co., 147
F.Supp.2d 81, 83 (D.P.R. 2001) (“When assessing the reliability of
technical
or
specialized
expert
testimony,
as
opposed
to
scientific testimony, the trial judge exercises ‘broad latitude’
both in how it determines the reliability of the testimony, and in
the ultimate reliability determination.” Citing Kumho Tire Co. v.
Carmichael, 526 U.S. 137, 149 (1999)).
“The focus, of course, must be solely on principles and
methodology, not on the conclusions that they generate.” Daubert,
509 US at 595. “So long as an expert's scientific testimony rests
upon good grounds, based on what is known, it should be tested by
the adversarial process, rather than excluded for fear that jurors
will not be able to handle the scientific complexities.” LopezRamirez v. Toledo-Gonzalez, 32 F.4th 87, 94 (1st Cir. 2022)
(quoting Milward v. Acuity Specialty Prods. Grp., Inc., 639 F.3d
11, 15 (1st Cir. 2011)) (internal quotations omitted).
In determining whether an expert's reasoning or methodology
is scientifically valid, the district court can consider “many
factors,”
including:
(1)
whether
the
scientific
theory
or
technique can be (or has been) tested; (2) whether the theory or
technique has been subjected to peer review and publication; (3)
Civil. No. 22-cv-01361(GMM)
Page -5-
whether a particular technique has a known potential rate of error;
and (4) whether the theory or technique is generally accepted in
the relevant scientific community. Daubert, 509 U.S. at 593-94.
To be sure, “[t]rained experts commonly extrapolate from
existing data. But 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.” General Electric Co. v. Joiner, 522 U.S. 136, 146 (1997).
Accordingly, expert testimony may be excluded when there is “too
great
an
analytical
gap
between
the
data
and
the
opinion
proffered.” Id. at 146.
The Supreme Court has indicated that the test of reliability
is “flexible,” and Daubert’s list of specific factors neither
necessarily nor exclusively applies to all experts or in every
case. Rather, the law grants a district court the same broad
latitude when it decides how to determine reliability as it enjoys
in respect to its ultimate reliability determination. See Kumho
Tire Co., 526 U.S. at 141-42.
III. ANALYSIS
In her expert report dated December 30, 2022, Plaintiff’s
expert, Dr. Crawford, provided her analysis of Kamila’s medical
history,
including
alleged
deficiencies
in
the
prenatal
care
received by her mother, Mrs. Robles, and the perinatal and neonatal
Civil. No. 22-cv-01361(GMM)
Page -6-
care she received after her birth. See (Docket No 88-2). Defendants
challenge
the
statements
in
her
expert
report
that
relate
specifically with Kamila’s neurological status, including certain
“autistic-like
behaviors.”
(Id.
at
8-10).
Specifically,
Dr.
Crawford writes, [Kamila] is developmentally delayed, nonverbal,
and recently a diagnosis of autism has been suggested. . .Her
neurological injury is the result of her prematurity ‘Plus.’ The
‘Plus’
is
the
contribution
from
sepsis,
hypotension,
DIC,
hypoxia/ischemia from multiple apneic episodes in the context of
non-steroid benefitted RDS and delayed surfactant administration.”
(Id.). Further, Dr. Crawford writes, “[a]s a result of her episodes
of hypoxia and altered perfusion she also suffered irreversible
brain
damage
with
resultant
developmental
delay
and
abnormal
neurological function including autistic-like behavior. No family
history of developmental delay, autism or cerebral palsy was
identified. Absent her significant RDS and NEC and their sequelae,
Kamila would likely have developed normally.” (Id. at 9-10).
Defendants argue that testimony of these opinions should be
excluded from trial because Dr. Crawford is not qualified to make
them, and her methodology lacks a reliable basis.
A.
Dr. Crawford’s Qualifications
Defendants first argue that Dr. Crawford is not qualified to
testify as an expert specifically on issues regarding autism and
Civil. No. 22-cv-01361(GMM)
Page -7-
autistic-like behaviors in children or its causes. See (Docket No.
88 at 5). Pointing to her CV, Defendants state that Dr. Crawford’s
expert qualifications are limited by her education, training,
experience,
and
academic
appointments
to
“pediatrics
and
neonatology.” Because her CV is devoid of any publications on
autism or neurology, Defendants posit, Dr. Crawford’s experience
reflects a “lack of dedicated research or deep knowledge in the
field.” (Id.).
Dr. Crawford’s CV reflects nearly fifty years of practice in
medicine, specifically in the areas of neonatal and perinatal
medicine. See (Docket No. 88-1 at 3-5). Her experience includes
many publications and book chapters in the field of neonatology,
including several related to Respiratory Distress Syndrome (RDS).
(Id.
at
11).
Dr.
Crawford
is
an
experienced
physician
in
neonatology. Notably missing from her CV is any focus on childhood
autism, autistic-like behaviors or pediatric neurology in general.
During her deposition, Dr. Crawford was asked if she would
consider herself an expert in pediatric neurology, to which she
responded, “Yes. In certain areas, yes.” (Docket No. 88-3 at 2).
She
elaborated:
“the
kind
of
complications
that
you
see
in
premature infants as they develop and mature and age. The type of
interventions, the causation of certain types of problems. Certain
types of neurological problems.” (Id.). After being asked whether
Civil. No. 22-cv-01361(GMM)
Page -8-
she is qualified to diagnose someone with autism, she responded,
“I think I’m qualified to screen and to discuss with parents, but
in terms of actually doing the testing, no. I have not been trained
to do the actual testing for autism. But in terms of identifying
risk factors and evaluating a child for the possibility of autism,
I think, yes, I would consider myself reasonably qualified.” (Id.).
Despite admitting she lacks the qualifications to diagnose autism
in children, Dr. Crawford stated regarding Kamila, “the child does
not really have autism. The child may have some autistic-like
features related to the brain damage she has.” (Id. at 6).
The Court also has the benefit of the analysis from a similar
case in this District in which the Court examined Dr. Crawford’s
qualifications specifically as to her opinions related to autism.
See Arrieta v. Hosp. Del Maestro, No. CV 15-3114 (MEL), 2018 WL
3425295 (D.P.R. July 13, 2018). From her testimony at a Daubert
hearing, the Court in Arrieta relayed that Dr. Crawford, “as part
of
medical
legal
reviews,
[]
has
evaluated
situations
where
autistic like behavior has been a manifestation of brain damage.”
Arrieta, 2018 WL 3425295, at *4. She also testified that autism
could not be diagnosed at the newborn stage. See id. Magistrate
Judge
Marcos
E.
Lopez
concluded
that
because
Dr.
Crawford’s
experience was not related to diagnosing autism and she had not
issued or contributed to publications on autism or autistic-like
Civil. No. 22-cv-01361(GMM)
Page -9-
behavior, Plaintiffs had not shown by the preponderance of the
evidence that Dr. Crawford qualified to testify in regard to autism
in that case. See id.
Here, Plaintiff presents the same expert, Dr. Crawford, to
testify to the same matter she was found unqualified to testify on
in Arrieta.
Although Dr. Crawford is clearly qualified as an
expert in neonatology, as her CV and expert report reflects, she
may not testify as to matters that fall outside of her expertise.
See Friedman v. Cent. Maine Power Co., No. 2:20-CV-00237-JDL, 2024
WL 1327344, at *2 (D. Me. Mar. 28, 2024) (“a witness qualified as
expert on certain topics ‘does not mean that he or she is qualified
to express expert opinions as to other fields.’” quoting Levin v.
Dalva Bros., Inc., 459 F.3d 68, 78 (1st Cir. 2006)); but see PagesRamirez v. Ramirez-Gonzalez, 605 F.3d 109 (1st Cir. 2010) (finding
the District Court erred in excluding Dr. Carolyn Crawford’s
testimony as to “obstetrical standards of care” based on her
qualifications; “[t]he court mistakenly relied on Dr. Crawford’s
lack
of
board
certification
in
obstetrics
and
gynecology
to
preclude her from testifying.”).
In Pages-Ramirez, the First Circuit was able to point to
relevant
book
chapters
published
by
Dr.
Crawford
on
the
administration of Pitocin during childbirth, the fact that she
participated
in
peer-reviewed
evaluations
on
obstetrics
and
Civil. No. 22-cv-01361(GMM)
Page -10-
delivery care, and her work drafting guidelines for perinatal
emergencies to conclude that Dr. Crawford was qualified to testify
on causation and the standards of care for obstetrics. See PagesRamirez, 605 F.3d at 116. The record here does not similarly
reflect
Dr.
Crawford’s
qualifications
to
opine
on
Kamila’s
diagnosis and causation of autistic-like behavior. As such, the
Court finds that Dr. Crawford’s testimony shall be limited to her
areas of expertise, namely neonatology, and shall not veer into
diagnosis and causation for autism or autistic-like behaviors.
B.
Dr. Crawford’s Methodology
The Court has also examined Dr. Crawfords opinions as to
Kamila’s autistic-like behaviors and the causal link to brain
damage and has determined that Plaintiff has not demonstrated that
her opinions rest on reliable foundations.
In drafting her expert report, Dr. Crawford reviewed Kamila’s
medical records, see (Docket No. 88-2 at 1), and had a phone
interview with Kamila’s mother, Keila Robles Figueroa, see (id. at
8-9). Based on this review, Dr. Crawford concluded that “[Kamila’s]
neurological injury is the result of her prematurity ‘Plus.’ The
‘Plus’
is
the
contribution
from
sepsis,
hypotension,
DIC,
hypoxia/ischemia from multiple apneic episodes in the context of
non-steroid benefitted RDS and delayed surfactant administration.”
(Id. at 8). She further states, “[a]s a result of her episodes of
Civil. No. 22-cv-01361(GMM)
Page -11-
hypoxia and altered perfusion she also suffered irreversible brain
damage
with
resultant
developmental
delay
and
abnormal
neurological function including autistic-like behavior. No family
history of developmental delay, autism or cerebral palsy was
identified. Absent her significant RDS and NEC and their sequelae,
Kamila would likely have developed normally.” (Id. at 9-10). At
her deposition, Dr. Crawford stated that she believes Kamila “has
cerebral palsy, has a brain injury, and [she] think[s] her behavior
is explainable by the brain damage and not necessarily by some
underlying autism.” (Docket No. 88-3 at 5-6). When asked what
evidence she relied on to support her opinion that Kamila has brain
damage, Dr. Crawford stated, “[s]he can’t do any self-care. She
doesn’t eat. She’s non-verbal. I think motor-wise she’s very
delayed. I don’t think she walks or runs. She doesn’t talk.” (Id.
at 6). Dr. Crawford also stated that she had not seen an MRI for
Kamila but that one “would be an appropriate test to assess her.”
(Id.).
Daubert directs the Court to assess whether an expert’s
testimony is the product of reliable principles and methods. Some
factors that Court may consider include (1) whether the scientific
theory or technique can be (or has been) tested, (2) whether the
theory
or
technique
publication,
(3)
has
whether
been
a
subjected
particular
to
peer
technique
review
has
a
and
known
Civil. No. 22-cv-01361(GMM)
Page -12-
potential rate of error, and (4) whether the theory or technique
is
generally
accepted
in
the
relevant
scientific
community.
Daubert, 509 U.S. at 593-94. Here, Plaintiff has not provided any
scientific basis for Dr. Crawford’s belief that Kamila in fact has
brain damage, and that there is a scientific link between brain
damage and autism or autism-like behaviors. In this case, there is
“too great an analytical gap between the data and the opinion
proffered.” Joiner, 522 U.S. 142.
Plaintiff argues that this is
simply a matter in which experts disagree, thus pertains “to the
weight of the testimony, rather than admissibility, which is
properly reserved for the jury.” (Docket No. 127 at 11). The Court
disagrees. The record before the Court reveals Plaintiffs failure
to demonstrate by a preponderance of evidence that Dr. Crawford’s
testimony is the product of reliable principles and methods.
Consequently,
Dr.
Crawford’s
testimony
specifically
regarding
autism, autism spectrum disorder or autism-like behaviors will not
be allowed during trial.
IV.
CONCLUSION
For the foregoing reasons, the Motion in Limine is GRANTED.
IT IS SO ORDERED.
In San Juan, Puerto Rico, January 27, 2025.
s/Gina R. Méndez-Miró
GINA R. MÉNDEZ-MIRÓ
UNITED STATES DISTRICT JUDGE
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