Stephanie Dubois v. Radwan Haykal, M.D.

Citation: Not availableDocket: W2003-01549-COA-R3-CV

Court: Court of Appeals of Tennessee; November 1, 2004; Tennessee; State Appellate Court

Original Court Document: View Document

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The appeal in the case of Stephanie Dubois v. Radwan Haykal, M.D. et al. arises from a medical malpractice action in which the trial court granted summary judgment to the Appellees, determining that Dubois could not sufficiently establish the necessary elements of her claim, particularly causation. After presenting expert testimony on causation, the trial court ruled in favor of the Appellees, leading Dubois to appeal. The Court of Appeals of Tennessee reversed the trial court’s judgment and remanded the case for further proceedings.

The facts indicate that Dubois began treatment with Dr. Radwan Haykal in March 1996 for post-traumatic stress disorder and bipolar disorder, following her hospitalization. During her treatment, she was prescribed Wellbutrin and later Tegretol for her bipolar condition. Dubois informed Haykal of her use of Norinyl 135, an oral contraceptive. Despite this, after transitioning to a new gynecologist, Dr. Robert Sauter, her prescription was changed to Ortho-Tricyclen. Dubois discovered she was pregnant in December 1996, despite consistent contraceptive use, and was informed by another gynecologist, Dr. John Austin, that Tegretol could cause birth defects if taken during pregnancy.

On December 28, 1996, Dubois underwent an abortion to prevent having another child with birth defects. The abortion clinic staff informed her that Tegretol could reduce the effectiveness of oral contraceptives. On December 18, 1997, Dubois initiated a medical malpractice lawsuit against Haykal, Sauter, and Walgreen’s, claiming they failed to warn her about the interaction between Tegretol and her contraceptives. After discovery, the defendants filed for summary judgment. On May 27, 2003, the trial court granted their motions, concluding Dubois did not establish causation, finding her expert witnesses’ testimony unreliable and inadmissible. Dubois appealed, questioning the trial court's reliability assessment of her experts’ testimony.

The appellate court reversed and remanded for further proceedings, applying an abuse of discretion standard to the trial court’s decision. It noted that the trial court had conducted a Daubert/McDaniel hearing to evaluate the admissibility and reliability of the expert opinions. Dubois argued that her experts, Dr. Donald Block and Dr. Richard Brown, provided adequate evidence of causation based on trustworthy data. The ruling referenced Tennessee Rules of Evidence 702 and 703, which govern the admissibility of expert testimony, emphasizing that expert opinions must be based on reliable facts and data to be admissible.

Tennessee courts, when evaluating the reliability of expert opinions, may consider several factors including: the testing and methodology of scientific evidence, peer review status, known error rates, general acceptance within the scientific community, and whether the expert's research was conducted independently of litigation. Courts are not mandated to apply these factors or limit their assessment to them. Scientific evidence deemed invalid will not assist the trier of fact, and there is no necessity for such evidence to be generally accepted. A trial court must verify that scientific opinions are rooted in relevant methods and data rather than speculation. 

In medical malpractice cases, a claimant must prove: the standard of care in the relevant community, the defendant's deviation from that standard, and that the injuries were proximately caused by the defendant's negligence. The Tennessee Code outlines the elements of negligence: duty, breach, causation, proximate cause, and damages; all elements must be present for a claim to succeed. Causation requires proof beyond mere possibility, necessitating a demonstration of probability to a reasonable medical certainty. 

In the case at hand, the trial court granted summary judgment favoring the Appellees due to the Appellant's failure to prove that a Tegretol prescription affected her oral contraceptives. The Appellant presented two expert witnesses, including Dr. Brown, a clinical pharmacist, who argued that research indicated Tegretol induces liver enzymes that metabolize oral contraceptives, despite his lack of personal experience with the drug. Upon review, the court disagreed with the summary judgment ruling.

Brown testified that the prescribed oral contraceptives could remain effective despite the presence of Tegretol, provided the oral contraceptives had a higher estrogen concentration. However, he indicated that Tegretol, also known as Carbamazepine, is generally accepted in medical literature to decrease the efficacy of oral contraceptives. After excluding factors such as pill failure and gastrointestinal issues that could impair absorption, Brown concluded that Tegretol compromised the contraceptive's effectiveness. Dr. Block, an OB/GYN, corroborated this by explaining the primary functions of oral contraceptives and their low failure rate. He affirmed that the medical community recognizes Tegretol's interaction with oral contraceptives and stated that it likely caused the Appellant's unplanned pregnancy. The trial court originally excluded the testimonies of Brown and Block, ruling they did not sufficiently assist in establishing causation. However, the appellate court found this exclusion to be an error, reaffirming that the scope of a pharmacist's duty is a factual question and remanding the case for further proceedings. The appellate court reversed the summary judgment awarded to Walgreen’s and ordered that costs of the appeal be taxed to the Appellees.