Antonio Craig v. Oakwood Hospital

Michigan Supreme Court
Lansing, Michigan

Opinion
Chief Justice Justices
Maura D. Corrigan Michael F. Cavanagh
Elizabeth A. Weaver
Marilyn Kelly
Clifford W. Taylor
Robert P. Young, Jr.
Stephen J. Markman

FILED JULY 23, 2004

ANTONIO CRAIG, by his next
friend, KIMBERLY CRAIG,

Plaintiff-Appellee,

v Nos. 121405
121407-09
OAKWOOD HOSPITAL, HENRY FORD 121419
HOSPITAL, doing business as HENRY FORD
HEALTH SYSTEM, ASSOCIATED
PHYSICIANS, P.C., and ELIAS
G. GENNAOUI, M.D.,

Defendants-Appellants,

and

AJIT KITTUR, M.D.,

Defendant.
________________________________

YOUNG, J.

Plaintiff, now an adult, suffers from cerebral palsy,

mental retardation, and a number of other neurological and

physical ailments. He argues, through his mother as next

friend, that these conditions are the proximate results of

defendants’ negligence in treating his mother during her

labor leading to his delivery. Specifically, plaintiff

maintains that defendants administered an excessive amount

of a contraction-inducing medication to his mother and were

unable to detect signs of fetal distress because they

failed to make appropriate use of fetal monitoring devices.

The trial court denied defendants’ request to hold a Davis-

Frye hearing on expert testimony that purported to draw a

causal connection between these breaches of the standard of

care and plaintiff’s present neurological and physiological

condition.

Following a five week trial, the jury returned a

verdict in plaintiff=s favor. The trial court thereafter

determined that defendant Henry Ford Health System was

liable as a successor corporation to defendant Associated

Physicians, P.C. The trial court denied the defendants=

motions for judgment notwithstanding the verdict or for a

new trial. The Court of Appeals affirmed the judgment of

liability, but ordered remittitur on lost wage earning

capacity.1 We reverse and remand the matter for entry of

judgment in defendants= favor.

I. FACTS AND PROCEDURAL HISTORY

This appeal arises out of the events surrounding

plaintiff’s birth on July 16, 1980. Plaintiff’s mother,

1
249 Mich App 534; 643 NW2d 580 (2002).

Kimberly Craig, received prenatal care from defendant

Associated Physicians, P.C. Associated Physicians employed

four obstetricians, including defendants Dr. Elias Gennaoui

and Dr. Ajit Kittur.2 Ms. Craig met with each obstetrician

at some point before plaintiff’s birth, but was primarily

attended to by Dr. Gennaoui during plaintiff’s delivery.

Ms. Craig’s amniotic and chorionic membranes ruptured

at approximately 5:30 A.M. on July 16, 1980, and she was

admitted to defendant Oakwood Hospital within a half hour.

The resident doctor on call at the time noted that

plaintiff’s fetal heart tones were within a normal range.

Dr. Kittur, who was the attending physician on staff when

Ms. Craig was admitted, requested that Ms. Craig be given

an intravenous (IV) “keep open” line to maintain hydration

and to establish a channel for the intravenous

administration of medication, should the need arise.

Nurses applied an external fetal-uterine monitor to Ms.

Craig at approximately 9:30 A.M., at which time she still

had not experienced contractions. At 10:00, Ms. Craig

began to receive 1000 cc of a 5% Ringer’s lactate solution

through the “keep open” IV line.

Dr. Gennaoui, who had taken over for Dr. Kittur

2
Dr. Kittur is not a party to this appeal because the
jury determined that he was not negligent.

sometime after Ms. Craig was admitted, met with Ms. Craig

at approximately 11:00 A.M. He was concerned that Ms. Craig

and her child had been exposed to infection since her

membranes burst earlier that morning,3 and concluded that

Ms. Craig should be given ten units of Pitocin4 in order to

induce labor.5 From 11:30 A.M. to 6:00 P.M., Ms. Craig was

given doses of Pitocin in increasing amounts.

One of the central issues at trial was the precise

amount of Pitocin administered to Ms. Craig and whether, as

plaintiff argued, she had mistakenly received a double

dosage. Plaintiff’s standard of care expert, Paul

Gatewood, M.D., testified that Ms. Craig’s medical records

reveal that she was inadvertently given two doses of

Pitocin. The first was administered shortly after 11:00

a.m. upon Dr. Gennaoui’s order. Nurse Quinlan wrote a

check on Dr. Gennaoui’s order for Pitocin to indicate,

according to Dr. Gatewood, that she had performed Dr.

Gennaoui’s request and had administered Pitocin through the

3
Dr. Gennaoui testified that amniotic fluid, which was
discharged when plaintiff’s amniotic and chorionic
membranes burst, protected the fetus from infection.
4
“Pitocin” is a brand name for synthetic oxytocin.
5
Plaintiff contends that records from a fetal uterine
monitor show that Ms. Craig was, in fact, experiencing
contractions before Dr. Gennaoui’s decision to administer
Pitocin.

5% Ringer’s lactate solution.

Dr. Gatewood noted, however, that another nurse, Tyra,

had written in Ms. Craig’s records that she had

administered Pitocin through D5W,6 a solution other than the

5% Ringer’s lactate Ms. Craig was already receiving

intravenously. Thus, according to Dr. Gatewood’s

testimony, Dr. Gennaoui had given a single order for

Pitocin that had been filled twice—once by Nurse Quinlan

through the 5% Ringer’s lactate solution, and once by Nurse

Tyra through the D5W solution.

Also contested at trial was whether Ms. Craig’s labor

presented any complications. Medical records compiled

after plaintiff’s birth show that Ms. Craig began

experiencing contractions of “moderate” strength after

receiving Pitocin and that “moderate” contractions

continued until plaintiff’s delivery.

Plaintiff contends, however, that the records from a

fetal uterine monitor tell a different story. These

records, according to Dr. Gatewood, show that plaintiff

experienced recurrent decelerations of his heart rate, or

bradycardia, after Ms. Craig began to receive Pitocin. Dr.

Gatewood explained at trial that the decelerations occurred

6
Dr. Gatewood described this solution as a mix of
dextrose and water.

because the Pitocin administered to Ms. Craig caused

contractions of excessive intensity and duration.

Plaintiff’s umbilical cord became compressed because of

these contractions, thereby decreasing the amount of blood

flowing to plaintiff. The result was the pattern of

decelerations in heart rate shown by the fetal uterine

monitor and a decrease in the amount of oxygen flowing to

plaintiff’s brain, or “hypoxia” in medical parlance.

Plaintiff was born shortly before 7:00 P .M . that day.

His Apgar scores, 8 and 9 (on a one to ten scale), were

well within the typical range,7 indicating that plaintiff

appeared to be a normal, healthy baby. Plaintiff also

contests this Apgar assessment, maintaining that a picture

of plaintiff taken shortly after his birth depicts an

infant who had recently suffered head trauma.

Specifically, plaintiff points to a “large ridge” across

his forehead as evidence of “facial or brow molding,” and

argues that the photograph clearly reveals bruising and

7
An Apgar score represents an evaluation of a newborn
infant=s physical condition immediately after birth. An
infant is evaluated at one and five minutes after birth on
five criteria: heart rate, respiratory effort, muscle tone,
skin color, and response to stimuli. Each criterion is
assigned a value between zero and two, with a score of ten
indicating the best condition. Attorney=s Dictionary of
Medicine Illustrated, vol 1, p A-475.

edema,8 both sure signs of trauma. In addition, plaintiff

contends that the postdelivery picture shows him “gazing”

to the right while holding his left hand in a cortical

position and that these “are indicative of acute brain

injury.”

Two days after his birth, plaintiff was examined by

pediatrician Dr. Carolyn Johnson, who concluded that

plaintiff seemed to be healthy and displayed normal

cognitive functions. Plaintiff received a vastly different

diagnosis approximately one year later. On June 6, 1981,

Ms. Craig had plaintiff examined by Dr. Michael Nigro, a

pediatric neurologist, after noticing that plaintiff began

to seem developmentally slow after his third month. Dr.

Nigro diagnosed plaintiff with nonprogressive

encephalopathy9 with global developmental delay and mild

spasticity. He concluded at the time and maintained

throughout this trial that the etiology or cause of

plaintiff’s condition was unclear.10

8
An “edema” is an “effusion of serious fluid into the
interstices of cells in tissue spaces or into body
cavities.” Random House Webster’s Unabridged Dictionary
(2d ed, 2001).
9
“Encephalopathy” is a general term for any disease of
the brain. Random House Webster’s Unabridged Dictionary
(2d ed, 2001).
10
Dr. Nigro gave a slightly different diagnosis later,

Plaintiff initiated the present lawsuit in 1994

through his mother, Kimberly Craig, as next friend. He

alleged that Drs. Gennaoui and Kittur committed medical

malpractice in failing to monitor plaintiff’s heartbeat

with an internal uterine catheter until 2:30 P .M . on July

16, 1980. Further, he alleged that Dr. Gennaoui and his

colleagues negligently administered Pitocin to Ms. Craig

despite the fact that she presented physical symptoms

indicating that Pitocin was unnecessary and potentially

harmful. As a result, plaintiff alleged, plaintiff

sustained brain damage either through hypoxia or through

the pounding of plaintiff’s head against his mother’s

“pelvic rim” before birth.

Plaintiff also named Associated Physicians, P.C., the

employer of Drs. Kittur and Gennaoui, under a theory of

vicarious liability. In addition, plaintiff named Oakwood

Hospital, where plaintiff was delivered, and named Henry

on October 30, 1981, when he opined that plaintiff had
chronic, nonspecific encephalopathy with retardation or
psychomotor delay, cerebral palsy, and epilepsy. When
plaintiff was in his early teens, Dr. Nigro diagnosed him
with profound encephalopathy, spastic quadriplegia, mental
retardation, and aphasia. “Aphasia” is “the loss of a
previously held ability to speak or understand spoken or
written language, due to injury of the brain.” Random
House Webster’s Unabridged Dictionary (2d ed, 2001).

Ford Hospital under a successor liability theory.11

On January 21, 1997, defendant asked the Court to

exclude the testimony of Dr. Ronald Gabriel, plaintiff’s

proposed causation expert, or, in the alternative, to

conduct a Davis-Frye hearing.12 This motion was denied.

Henry Ford filed a successful motion to sever.

However, the trial court found after conducting a bench

trial that Henry Ford was liable to plaintiff as a

successor to Associated Physicians, P.C.

After the jury found in plaintiff’s favor, the court

entered judgment of $21 million, reflecting the present

value of the $36 million awarded by the jury. The trial

court denied defendants’ motion for judgment

notwithstanding the verdict or a new trial.

On February 1, 2002, the Court of Appeals affirmed the

jury verdict in plaintiff’s favor, but ordered remittitur

because of the jury’s overestimation of plaintiff’s lost

11
Henry Ford had purchased the administrative portion
of Associated Physicians Medical Center, Inc., a business
corporation created from the professional corporation that
had employed defendants Dr. Gennaoui and Dr. Kittur at the
time of the alleged malpractice. The relationships between
the corporate entities are discussed in greater detail
below.
12
See People v Davis, 343 Mich 348; 72 NW2d 269
(1955); Frye v United States, 54 App DC 46; 293 F 1013
(1923).

wage earning capacity.13 The panel also affirmed the trial

court’s conclusion that Henry Ford was liable to plaintiff

as a successor corporation.

We granted defendants’ applications for leave to

appeal on September 12, 2003, limiting the parties to the

following issues: “(1) Whether the witnesses' testimony was

based on facts not in evidence and whether the trial court

erred in permitting the testimony of plaintiff's expert

witnesses; (2) Whether the trial court erred in finding

defendant Henry Ford Hospital liable on a successor

liability theory.”14 We denied plaintiff’s application for

leave to appeal the decision of the Court of Appeals.

II. STANDARD OF REVIEW

We review a trial court’s decision to admit or exclude

evidence for an abuse of discretion.15 A court necessarily

abuses its discretion when it “admits evidence that is

inadmissible as a matter of law.”16 However, any error in

the admission or exclusion of evidence will not warrant

appellate relief “unless refusal to take this action

13
249 Mich App 534, 544.

14
469 Mich 880 (2003) (citations omitted).

15
People v Katt, 468 Mich 272, 278; 662 NW2d 12

(2003).
16
Id.

appears . . . inconsistent with substantial justice,”17 or

affects “a substantial right of the [opposing] party.”18

We review de novo a trial court’s decision to grant or

deny a motion for judgment notwithstanding the verdict.19

In conducting this review de novo, we “’review the evidence

and all legitimate inferences in the light most favorable

to the nonmoving party.’”20 Only when “the evidence viewed

in this light fails to establish a claim as a matter of

law” is the moving party entitled to judgment

notwithstanding the verdict (JNOV).21

The doctrine of successor liability is “’derived from

equitable principles.’”22 Its application is therefore

subject to review de novo.23

17
MCR 2.613(A).

18
MRE 103(a).

19
Sniecinski v Blue Cross & Blue Shield, 469 Mich 124,

131; 666 NW2d 186 (2003).
20
Id., quoting Wilkinson v Lee, 463 Mich 388, 391; 617
NW2d 305 (2000).
21
Id.
22
Stevens v McLouth Steel Products Corp, 433 Mich 365,
376; 446 NW2d 95 (1989), quoting Musikiwamba v ESSI, Inc,
760 F2d 740, 750 (CA 7, 1985).
23
Stachnik v Winkel, 394 Mich 375, 383; 230 NW2d 529
(1975).

III. IMPROPER ADMISSION OF EXPERT TESTIMONY

We turn, first, to the trial court’s erroneous

conclusion that defendant Oakwood Hospital was not entitled

to a Davis-Frye hearing before the admission of Dr. Ronald

Gabriel’s expert testimony. Defendant contends that the

trial court erred when it denied its motion to exclude the

expert opinion testimony of Dr. Gabriel or, in the

alternative, to hold a Davis-Frye hearing. We agree.

A. MRE 702 AND DAVIS-FRYE ANALYSIS

Expert testimony is admitted pursuant to MRE 702,

which provided, at the pertinent times:

If the court determines that recognized
scientific, technical, or other specialized
knowledge will assist the trier of fact to
understand the evidence or to determine a fact in
issue, a witness qualified as an expert by
knowledge, skill, experience, training, or
education, may testify thereto in the form of an
opinion or otherwise . . . .

In construing this rule of evidence, we must apply “’the

legal principles that govern the construction and

application of statutes.’”24 When the language of an

evidentiary rule is unambiguous, we apply the plain meaning

of the text “’without further judicial construction or

24
CAM Constr v Lake Edgewood Condo Ass’n, 465 Mich
549, 554; 640 NW2d 256 (2002), quoting Grievance
Administrator v Underwood, 462 Mich 188, 193; 612 NW2d 116
(2000).

interpretation.’”25

The plain language of MRE 702 establishes three broad

preconditions to the admission of expert testimony.26 First,

the proposed expert witness must be “qualified” to render

the proposed testimony.27 Generally, the expert may be

qualified by virtue of “knowledge, skill, experience,

training, or education.”28 In a medical malpractice action

such as this one, the court’s assessment of an expert’s

“qualifications” are now guided by MCL 600.2169(2):

In determining the qualifications of an
expert witness in an action alleging medical
malpractice, the court shall, at a minimum,
evaluate all of the following:

(a) The educational and professional
training of the expert witness.

(b) The area of specialization of the expert
witness.

(c) The length of time the expert witness
has been engaged in the active clinical practice
or instruction of the health profession or the
specialty.

(d) The relevancy of the expert witness’s
testimony.

Second, the proposed testimony must “assist the trier

25
Id.
26
People v Beckley, 434 Mich 691, 710-711; 456 NW2d
391 (1990) (opinion of BRICKLEY, J.).
27
MRE 702.
28
Id.

of fact to understand the evidence or to determine a fact

in issue . . . .”29 In other words, the expert opinion

testimony “must serve to give the trier of fact a better

understanding of the evidence or assist in determining a

fact in issue.”30

Finally, under MRE 702 as it read when this matter was

tried, expert testimony must have been based on a

“recognized” form of “scientific, technical, or other

specialized knowledge.”31 The Court of Appeals properly

construed this language in Nelson v American Sterilizer Co

(On Remand):

The word “recognized” connotes a general
acknowledgement of the existence, validity,
authority, or genuineness of a fact, claim or
concept. The adjective “scientific” connotes a
grounding in the principles, procedures, and

29
MRE 702.
30
Beckley, supra at 711 (opinion of BRICKLEY, J.).
31
MRE 702. This rule was amended effective January
1, 2004, and now provides:

If the court determines that scientific,
technical, or other specialized knowledge will
assist the trier of fact to understand the
evidence or to determine a fact in issue, a
witness qualified as an expert by knowledge,
skill, experience, training, or education may
testify thereto in the form of an opinion or
otherwise if (1) the testimony is based on
sufficient facts or data, (2) the testimony is
the product of reliable principles and methods,
and (3) the witness has applied the principles
and methods reliably to the facts of the case.

methods of science. Finally, the word
“knowledge” connotes more than subjective belief
or unsupported speculation. The word applies to
any body of known facts or to any body of ideas
inferred from such facts or accepted as truths on
good grounds.[32]

Continuing along these lines, the word “technical”

signifies grounding in a specialized field of knowledge, or

a particular “art, science, or the like.”33 Similarly,

“specialized” suggests a foundation in a specific field of

study or expertise.34

When this case was tried, the admission of expert

testimony was subject not only to the threshold

requirements of MRE 702, but also to the standard

articulated in People v Davis,35 now generally known in

Michigan as the Davis-Frye test.36 In Davis, we held that

expert opinion based on novel scientific techniques is

admissible only if the underlying methodology is generally

32
223 Mich App 485, 491; 566 NW2d 671 (1997)
(citations and quotation marks omitted).
33
Random House Webster’s Unabridged Dictionary (2d ed,
2001).
34
Id.
35
343 Mich 348; 72 NW2d 269 (1955).
36
See Frye v United States, 54 App DC 46; 293 F 1013
(1923).

accepted within the scientific community.37 Thus, in

determining whether the proposed expert opinion was

grounded in a “recognized” field of scientific, technical,

or other specialized knowledge as was required by MRE 702,

a trial court was obligated to ensure that the expert

opinion was based on accurate and generally accepted

methodologies.38 The proponent of expert testimony bears

the burden of proving general acceptance under this

standard.39

B. THE RIAL COURT’S FAILURE TO
T PERFORM ITS
GATEKEEPING ROLE UNDER MRE 702

In this case, defendant Oakwood Hospital moved in

limine to exclude the testimony of Dr. Ronald Gabriel on

the basis that Dr. Gabriel’s theory of how plaintiff

sustained brain damage was not generally accepted within

the medical community, as required by Davis-Frye. Dr.

Gabriel’s etiological theory, as summarized by defendant in

arguing its motion, was that “hyperstimulat[ion]” of the

uterus caused the head of the fetus (plaintiff) to pound

37
Davis, supra at 370.
38
Id. at 372. See also People v Young, 418 Mich 1,
24; 340 NW2d 805 (1983) (“The Davis-Frye standard is the
means by which the court can determine that the novel
evidence offered for admission here enjoys such
recognition.”).
39
People v Young (After Remand), 425 Mich 470, 475;
391 NW2d 270 (1986).

against his mother’s pelvic anatomy, thereby producing

permanent brain damage. This theory, according to

defendant, was novel enough to be excluded and, at best,

was admissible only once it passed through the crucible of

Davis-Frye analysis.

In response to this motion, plaintiff’s attorney

produced several articles and authorities that were meant

to demonstrate a link between the use of Pitocin and the

type of injury sustained by plaintiff. But while some of

these articles described a correlation between the use of

Pitocin and generalized brain injury, none of these

authorities supported the theory of causation actually put

forth by Dr. Gabriel. That is, none supported a causal

connection between Pitocin and brain injury incurred

through repeated pounding of the fetal head against

maternal anatomy.

However, the court did not rely on authorities

proffered by plaintiff in denying defendant’s motion for a

Davis-Frye hearing. Instead of consulting plaintiff’s

proffered scientific and medical literature, the court

erroneously assigned the burden of proof under Davis-Frye

to defendant—the party opposing the admission of Dr.

Gabriel’s testimony—and held that defendant was not

entitled to a hearing because it failed to prove that Dr.

Gabriel’s theory lacked “general acceptance.”40

When the MRE 702 principles described above are

properly applied, it is evident that the trial court abused

its discretion in denying defendant’s motion for a Davis-

Frye hearing. This abuse of discretion was predicated on

two fundamental legal errors.

First, the trial court erred in concluding that it had

no obligation to review plaintiff’s proposed expert

testimony unless defendant introduced evidence that the

expert testimony was “novel.” Under MRE 702, the trial

court had an independent obligation to review all expert

40
Indeed, the trial court was explicit in this regard:

[Allocating the burden of proof to the
proponent of novel scientific testimony] would
mean that everybody can come in here and allege
that whatever everybody’s expert is saying is not
supported by scientific data, and I would have to
hold a Davis-Frye hearing in every single case
where any expert had to testify. And that’s not
the standard. You have to submit some evidence
to me that I need a Davis-Frye hearing, other
than you just saying it.

The dissent makes the same error. See post at 2-4.
But compare Young (After Remand), supra at 475 (allocating
the burden of proof under Davis-Frye to the proponent of
novel scientific evidence).

The position advocated by the trial court and the
dissent is not only at odds with our Davis-Frye
jurisprudence, but it also defies logic. The trial court’s
rule would require the party opposing expert testimony to
prove a negative—that the expert’s opinion is not generally
accepted. This is an unreasonable and thoroughly
impractical allocation of the burden of proof.

opinion testimony in order to ensure that the opinion

testimony satisfied the three Beckley preconditions noted

above—that it was rendered by a “qualified expert,” that

the testimony would “assist the trier of fact,” and, under

the rules of evidence in effect during this trial, that the

opinion testimony was rooted in “recognized” scientific or

technical principles. These obligations applied

irrespective of the type of expert opinion testimony

offered by the parties.41 While a party may waive any claim

of error by failing to call this gatekeeping obligation to

the court’s attention, the court must evaluate expert

testimony under MRE 702 once that issue is raised.

Second, the trial court erred in concluding that there

was no justification for a Davis-Frye hearing. At issue

was Dr. Gabriel’s opinion that Pitocin administered to Ms.

Craig produced contractions of excessive duration and

force, that these contractions caused plaintiff’s head to

be repeatedly ground against Ms. Craig’s pelvic anatomy,

and that the resulting head trauma caused plaintiff’s

cerebral palsy. This causal sequence, defendant argued,

has “never been described in medical literature” and was at

odds with the testimony of plaintiff’s other expert

41
See MRE 702.

witnesses.

Plaintiff failed to introduce a single authority that

truly supported Dr. Gabriel’s theory in response to

defendant’s motion. Instead, plaintiff repeatedly stressed

that medical literature amply supported the proposition

that Pitocin could cause brain damage—a proposition

defendant did not contest—and supplied the court with

literature to that effect. But this literature had little

to do with Dr. Gabriel’s causal theory and therefore did

not counter the proposition that his expert opinion was

based on novel science.

Therefore, a Davis-Frye hearing was more than

justified in light of the information before the trial

court when it ruled on defendant’s motion in limine. The

proponent of expert opinion testimony bears the burden of

proving that the contested opinion is based on generally

accepted methodology.42 Because there was no evidence to

indicate that Dr. Gabriel’s theory was anything but novel,

the trial court was required to conduct the Davis-Frye

inquiry requested by defendant.

Had the trial court conducted the assessment

requirement by MRE 702, it might well have determined that

42
Young (After Remand), supra at 475.

Dr. Gabriel’s theory was not “recognized” as required by

our rules of evidence. Indeed, the evidence plaintiff

offered in support of Dr. Gabriel should have provided

sufficient notice to the trial court that his theory lacked

general acceptance in the medical community. For one

thing, Dr. Gabriel was unable to cite a single study

supporting his traumatic injury theory during a voir dire

conducted at trial. The only authorities he offered for

the proposition that excessive amounts of Pitocin may cause

cerebral palsy through the traumatic mechanism he described

at trial were studies he cited in which Pitocin caused

cerebral palsy in animals when given in excessive amounts.

These studies did not involve the “bumping and grinding”

mechanism on which Dr. Gabriel’s expert testimony relied.

In fact, Dr. Gabriel expressly distinguished the mechanism

to which he attributed plaintiff’s injuries from those at

work in the animal studies. It would appear, then, that

there was little evidence that Dr. Gabriel’s theory was

“recognized,” much less generally accepted, within

pediatric neurology.

Second, had the court conducted the MRE 702 inquiry

requested by defendant, it might have discovered that Dr.

Gabriel’s theory lacked evidentiary support. Dr. Gabriel

was unable to identify the specific part of Ms. Craig’s

anatomy with which, according to his theory, plaintiff’s

head repeatedly collided during labor. Indeed, Dr. Gabriel

pointedly refused to identify this anatomical structure on

a chart, contending that such testimony was beyond his

expertise. This failure to root his causal theory in

anything but his own hypothetical depiction of female

anatomy indicates that Dr. Gabriel’s testimony may have

been too speculative under MRE 702 to assist the trier of

fact.

Finally, a Davis-Frye/MRE 702 hearing should have

alerted the court to the error described in part IV. At no

point did Dr. Gabriel opine that the traumatic and vascular

mechanisms he described could cause cerebral palsy, or that

those mechanisms might produce the asymmetrical development

shown in plaintiff’s MRI. Thus, Dr. Gabriel’s testimony

supported plaintiff’s medical malpractice claim only if the

jury was permitted to assume, without supporting evidence,

that a causal connection existed between these elements.

As shown in part IV, this is not a permissible inference.

Consequently, the court again had reason to conclude that

Dr. Gabriel’s testimony could not have “assist[ed] the

trier of fact” given the yawning gap between Dr. Gabriel’s

testimony and the conclusions plaintiff hoped the jury

would draw from it.

Although the trial court clearly erred in declining to

review Dr. Gabriel’s testimony before its admission, we

need not determine whether reversal on this basis alone is

warranted under the “substantial justice” standard of our

court rules.43 For the reasons stated below, remand for a

Davis-Frye hearing is unnecessary given plaintiff’s failure

to establish the causation element of his medical

malpractice claim.

IV. JUDGMENT NOTWITHSTANDING THE VERDICT

Even if plaintiff were able to show upon remand that

Dr. Gabriel’s testimony was properly admitted, defendants

would nevertheless be entitled to JNOV. The record reveals

that the proofs submitted by plaintiff do not support the

verdict rendered by the jury because of plaintiff’s failure

to establish that defendants’ breach of the applicable

standard of care proximately caused his cerebral palsy. We

therefore reverse and remand for entry of judgment

notwithstanding the verdict.

A. STATUTORY AND COMMON LAW BACKGROUND

In order to establish a cause of action for medical

malpractice, a plaintiff must establish four elements: (1)

the appropriate standard of care governing the defendant’s

43
MCR 2.613(A).

conduct at the time of the purported negligence, (2) that

the defendant breached that standard of care, (3) that the

plaintiff was injured, and (4) that the plaintiff’s

injuries were the proximate result of the defendant’s

breach of the applicable standard of care.44 These common-

law elements have been codified in MCL 600.2912a, which

requires a plaintiff alleging medical malpractice to show

that

[t]he defendant, if a specialist, failed to
provide the recognized standard of practice or
care within that specialty as reasonably applied
in light of the facilities available in the
community or other facilities reasonably
available under the circumstances, and as a
proximate result of defendant failing to provide
that standard, the plaintiff suffered an injury.

Furthermore, the plaintiff in a medical malpractice case

must establish the proximate causation prong of his prima

facie case by a preponderance of the evidence.45

“Proximate cause” is a legal term of art that

incorporates both cause in fact and legal (or “proximate”)

cause.46 We defined these elements in Skinner v Square D

44
Weymers v Khera, 454 Mich 639, 655; 563 NW2d 647
(1997).
45
See MCL 600.2912a(2) (stating that “the plaintiff
has the burden of proving that he or she suffered an injury
that more probably than not was proximately caused by the
negligence of the defendant or defendants”).
46
Skinner v Square D Co, 445 Mich 153, 162-163; 516

Co:

The cause in fact element generally requires
showing that “but for” the defendant’s actions,
the plaintiff’s injury would not have occurred.
On the other hand, legal cause or “proximate
cause” normally involves examining the
foreseeability of consequences, and whether a
defendant should be held legally responsible for
such consequences.[47]

As a matter of logic, a court must find that the

defendant’s negligence was a cause in fact of the

plaintiff’s injuries before it can hold that the

defendant’s negligence was the proximate or legal cause of

those injuries.48

Generally, an act or omission is a cause in fact of an

injury only if the injury could not have occurred without

(or “but for”) that act or omission.49 While a plaintiff

need not prove that an act or omission was the sole

catalyst for his injuries, he must introduce evidence

permitting the jury to conclude that the act or omission

was a cause.50

It is important to bear in mind that a plaintiff

NW2d 475 (1994).
47
Id. at 163 (citations omitted).
48
Id.
49
Id. See also Prosser, Torts (4th ed, 1971), p 239.
50
Jordan v Whiting Corp, 396 Mich 145, 151; 240 NW2d
468 (1976).

cannot satisfy this burden by showing only that the

defendant may have caused his injuries. Our case law

requires more than a mere possibility or a plausible

explanation.51 Rather, a plaintiff establishes that the

defendant’s conduct was a cause in fact of his injuries

only if he “set[s] forth specific facts that would support

a reasonable inference of a logical sequence of cause and

effect.”52 A valid theory of causation, therefore, must be

based on facts in evidence.53 And while “'[t]he evidence

need not negate all other possible causes,’” this Court has

consistently required that the evidence “’exclude other

reasonable hypotheses with a fair amount of certainty.’”54

In Skinner, for example, we held that the plaintiff

failed to show that the defendant’s negligence caused the

decedent’s electrocution. Skinner was a product liability

action in which the plaintiff claimed that the decedent was

killed because an electrical switch manufactured by the

defendant had malfunctioned.55 The plaintiff’s decedent had

51
Skinner, supra at 172-173.
52
Id. at 174.
53
Id. at 166.
54
Id. at 166, quoting with approval 57A Am Jur 2d,
Negligence, § 461, p 422.
55
Skinner, supra at 157.

built a tumbling machine that was used to wash metal parts,

and had used the defendant’s switch to turn the machine on

and off.56 Wires from the defendant’s switch were attached

to the tumbling machine with alligator clips.57 Immediately

before his death, the plaintiff’s decedent was found with

both alligator clips in his hands while electricity coursed

through his body.58

In order to find that a flaw in the defendant’s

product was a cause in fact of that electrocution, the jury

would have had to conclude, in effect, that the decedent

had disconnected the alligator clips and that the machine

had somehow been activated again, despite being

disconnected from its power source.59 Not only was this

scenario implausible, but there was no evidence to rule out

the possibility that the decedent had been electrocuted

because he had mistakenly touched wires he knew to be live.

There was no evidence to support the plaintiff’s theory of

causation.60 Consequently, we concluded that the trial

court had properly granted summary disposition to the

56
Id.

57
Id.

58
Id.

59
Id.

60
Id.

defendant.

Mulholland v DEC Int’l,61 provides a useful factual

counterpoint to Skinner. In Mulholland, the plaintiffs’

herd of milking cows contracted mastitis, a bacterial

infection of the udder, after the plaintiffs began to use a

milking system built by the defendants.62 Key expert

testimony was provided by Sidney Beale, an expert in

agriculture and dairy science. Mr. Beale had observed a

milking at the plaintiffs’ farm and deduced that the

mastitis was related to the improper configuration of the

milking system.63 He suggested that the plaintiffs

implement certain changes, and, indeed, once these were put

into practice, the plaintiffs noticed “a decrease in

mastitis and an increase in milk production in the herd.”64

We held, on the basis of this expert testimony, that

the trial court improperly granted a directed verdict to

the defendant.65 Because Mr. Beale’s testimony was based on

his direct observation of the milking machinery, its use on

the plaintiffs’ herd, and teat inflammation in the

61
432 Mich 395; 443 NW2d 340 (1989).
62
Id. at 399.
63
Id. at 400.
64
Id.
65
Id. at 398.

plaintiff’s herd following milking, a jury could have

reasonably concluded, on the basis of this testimony, that

the milking machinery caused mastitis.66 While Mr. Beale’s

testimony did not rule out every other potential cause of

mastitis, this fact merely related to the credibility of

his testimony; his opinion was nevertheless admissible and

sufficient to support a finding of causation.67

B. PLAINTIFF’S FAILURE TO ESTABLISH CAUSATION

The statutory and common-law background provided above

makes it clear that a plaintiff’s prima facie case of

medical malpractice must draw a causal connection between

the defendant’s breach of the applicable standard of care

and the plaintiff’s injuries. In this case, the evidence

adduced at trial cannot support the jury’s verdict because

plaintiff has failed to make the necessary causal links.

Even if plaintiff had shown that defendants breached the

standard of care, the jury had no basis in the record to

connect this breach to the cerebral palsy, mental

retardation, and other injuries now presented by plaintiff.

At trial, plaintiff attempted to connect defendants’

purported violations of the applicable standard of care to

66
Id. at 413.

67
Id.

plaintiff’s injuries through the expert testimony of Drs.

Paul Gatewood and Ronald Gabriel. Dr. Gatewood testified

principally as a standard of care witness, interpreting the

medical records of plaintiff and Ms. Craig, and opining

that defendants breached the applicable standard of care by

administering excessive amounts of Pitocin and by failing

to use an internal uterine pressure catheter. Dr. Gatewood

also testified that records from fetal and uterine monitors

indicated that Ms. Craig experienced excessive and severe

contractions, and that these reduced the flow of oxygenated

blood to plaintiff both by compressing the umbilical cord

and by reducing the periods of oxygenation between

contractions. Dr. Gatewood testified that, as a result,

plaintiff suffered from hypoxia and correlated

decelerations in his heart rate.

While Dr. Gatewood’s testimony connected defendants’

alleged breach of the standard of care to physiological

symptoms displayed by plaintiff before his birth, he

specifically declined to connect these prebirth conditions

to the particular injuries for which plaintiff sought

compensation. Indeed, Dr. Gatewood denied he had the

requisite expertise to make the causal linkage and

expressly refused to testify to a causal relationship

between plaintiff’s neurological diseases and his prenatal

care. He insisted instead that “what happened to the

baby’s brain” was “[within] the purview of a neurologist.”68

Plaintiff contended that the link between defendants’

negligence and plaintiff’s injuries was to be supplied

instead by the expert testimony of Dr. Ronald Gabriel. Dr.

Gabriel opined that plaintiff’s injuries were attributable

to two mechanisms that affected plaintiff’s brain before

delivery; he referred to these mechanisms as “traumatic”

and “vascular.” According to Dr. Gabriel’s testimony,

plaintiff sustained “traumatic” injuries when excessive

uterine contractions induced by Pitocin caused plaintiff’s

head to be “pounded or grinded [sic] into [his mother’s]

pelvic rim” during her labor. Because of this pounding,

68
This is a critical fact; the dissent’s analysis
suffers for paying insufficient heed to Dr. Gatewood’s
disclaimer of expertise regarding the etiology of cerebral
palsy. See post at 11-12.

Indeed, the dissent seems to conflate the testimony of
plaintiff’s two principal experts by concluding that Dr.
Gabriel’s “bumping and grinding” theory of causation was
somehow supported by Dr. Gatewood’s testimony about the
dangers of excessive doses of Pitocin. In reality, there
was a fundamental gap between the theories proffered by
these experts. Dr. Gabriel testified that excessive doses
of Pitocin caused plaintiff’s head to be ground against his
mother’s pelvic anatomy and that this grinding, in turn,
led to hypoxia. Dr. Gabriel did not testify that an
excessive dosage of Pitocin alone—that is, without head
compression injuries sustained from repeated contact with
maternal anatomy—could have caused plaintiff’s cerebral
palsy.

plaintiff’s brain sustained compression injuries, which

resulted in elevated venous “pressures” and impeded

“arter[ial] blood flow.” Dr. Gabriel analogized this

“venous component” to the distribution of water through a

lawn sprinkler system, explaining that increased pressure

in certain areas of the brain reduced the flow of

oxygenated blood to outlying, “watershed” regions of the

brain just as “the last sprinkler who [sic] gets the

pressure is the least able to provide water for that area

of the lawn.” The crux of Dr. Gabriel’s theory, then, was

that plaintiff suffered traumatic head injury during labor

and was detrimentally affected by that trauma and the

accompanying vascular effects.

Even if we accept Dr. Gabriel’s testimony in full, a

fatal flaw remains in plaintiff’s prima facie case: Dr.

Gabriel never testified that the injuries stemming from

this pounding and its accompanying vascular effects could

cause cerebral palsy, mental retardation, or any of the

other conditions now presented by plaintiff.

Dr. Gabriel began his testimony by explaining that an

MRI image showed that plaintiff’s brain tissue had developed

asymmetrically. He failed, however, to trace this

asymmetric development either back to the traumatic and

vascular mechanisms he described or forward to the specific

neurological conditions presently displayed by plaintiff.

Thus, how exactly the mechanisms he described led to

cerebral palsy (as opposed to any other neurological

impairment) and how they were connected to the asymmetric

brain development depicted in plaintiff’s MRI was never

explained.69

It is axiomatic in logic and in science that

correlation is not causation.70 This adage counsels that it

is error to infer that A causes B from the mere fact that A

and B occur together. Given the absence of testimony on

causation supplied by Dr. Gabriel, the jury could have

found for plaintiff only if it indulged in this logical

error—concluding, in effect, that evidence that plaintiff

may have sustained a head injury, combined with evidence

that plaintiff now has cerebral palsy, leads to the

conclusion that the conduct that caused plaintiff’s head

69
Compare 1st of America Bank, Mid-Michigan v United
States, 752 F Supp 764, 765 (ED Mich, 1990) (finding that
the negligence of Air Force physicians proximately caused a
child’s cerebral palsy where the plaintiff and the
defendant presented extensive testimony on the etiology of
cerebral palsy); Bradford v McGee, 534 So 2d 1076 (Ala,
1988) (holding that the plaintiffs presented evidence
sufficient for the jury to determine that the defendant’s
negligence proximately caused their son’s cerebral palsy);
Dick v Lewis, 506 F Supp 799 (D ND, 1980).
70
United States v O’Hagan, 521 US 642, 691 n 7; 117 S
Ct 2199; 138 L Ed 2d 724 (1997) (Thomas, J., concurring in
part and dissenting in part).

injury also caused his cerebral palsy.

Such indulgence is prohibited by our jurisprudence on

causation. We have long required the plaintiff to show

“that ‘but for’ the defendant’s actions, the plaintiff’s

injury would not have occurred.”71 Where the connection

between the defendant’s negligent conduct and the

plaintiff’s injuries is entirely speculative, the plaintiff

cannot establish a prima facie case of negligence.72

Here, any causal connection between plaintiff’s

cerebral palsy and the events described by Dr. Gabriel had

to be supplied ex nihilo by the jury. Therefore, the trial

court erred as a matter of law in denying defendants’

motion for JNOV. We reverse the judgment of the Court of

Appeals and remand for proceedings consistent with this

opinion.

V. SUCCESSOR LIABLITY

Although we have established that plaintiff has failed

to state a valid claim of medical malpractice, we must also

correct an erroneous legal conclusion in the published

opinion of the Court of Appeals.

The panel held that Henry Ford Health Care Corporation

71
Skinner, supra at 163 (emphasis added).

72
See id. at 174.

(Henry Ford)73 was liable as a corporate successor to

Associated Physicians, P.C. To the contrary, we conclude

that the trial court erroneously imposed successor

liability on Henry Ford.

At the time of the alleged malpractice in 1980,

defendant Drs. Kittur and Gennaoui were employees of

Associated Physicians, P.C., which was a medical

professional corporation organized under the Professional

Service Corporation Act.74

Six years after plaintiff’s birth, Associated

Physicians, P.C., began to consider the possibility that

Henry Ford might take over its administrative and

bookkeeping services. While Henry Ford was interested in

pursuing this arrangement with Associated Physicians, the

latter’s corporate form posed an obstacle. As a

professional corporation, Associated Physicians, P.C.,

could neither legally merge with nor sell its shares to

Henry Ford, given that Henry Ford=s shareholders were not

physicians.75

73
Henry Ford Health Care Corporation became Henry Ford
Heath System in 1989. For the sake of clarity, we refer to
both as “Henry Ford.”
74
MCL 450.221 et seq.
75
See generally Professional Services Corporation Act,
MCL 450.221 et seq. The shares of a professional

Consequently, Associated Physicians, P.C., split into

two entities. Its administrative portion was incorporated

Associated Physicians Medical Center, Inc., a business

corporation in which nonphysicians could legally share

ownership and control. Its medical practice, however,

became APMC, P.C., a new professional corporation.

Henry Ford purchased all the shares of Associated

Physicans Medical Center, Inc., in accordance with the

Business Corporation Act.76 Henry Ford thereby became the

parent corporation of Associated Physicians Medical Center,

Inc. As the parties intended before the sale, APMC, P.C.,

entered into an agreement with Associated Physicians

Medical Center, Inc., in which the latter controlled

corporation may not be

sold or transferred except to an individual who
is eligible to be a shareholder of the
corporation or to the personal representative or
estate of a deceased or legally incompetent
shareholder or to a trust or split interest
trust, in which the trustee and the current
income beneficiary are both licensed persons in a
professional corporation. [MCL 450.230.]

An individual may not become a shareholder in a
professional services corporation unless he or she is a
“licensed person.” MCL 450.224. A “licensed person” is
“an individual who is duly licensed or otherwise legally
authorized to practice a professional service by a court,
department, board, commission, an agency of this state or
another jurisdiction, or any corporation all of whose
shareholders are licensed persons.” MCL 450.222(a).
76
MCL 450.1101 et seq.

billing, record keeping, and other administrative aspects

of the medical practice. This arrangement ended in 1993,

when APMC, P.C., dissolved before the initiation of the

present lawsuit.

Henry Ford argued that, because it assumed the

ownership of only the administrative portion of Associated

Physicians, P.C. (which was vicariously liable to

plaintiff), the equitable concerns that justify the

imposition of successor liability are not present in this

case. The trial court severed the issue of Henry Ford’s

successor liability. After a one-hour bench trial, the

trial court held that Henry Ford was liable as a successor

corporation to Associated Physicians, Inc. The Court of

Appeals agreed. Both courts relied in part on the factors

listed in Turner v Bituminous Cas Co77 as supporting the

imposition of successor liability.78

77
397 Mich 406, 430; 244 NW2d 873 (1976).
78
See Turner, 397 Mich 430:
(1) There was basic continuity of the
enterprise of the seller corporation, including,
apparently, a retention of key personnel, assets,
general business operations, and even the
[corporate] name.
(2) The seller corporation ceased ordinary
business operations, liquidated, and dissolved
soon after distribution of consideration received
from the buying corporation.

We recently described the scope of successor liability

in Foster v Cone-Blanchard Machine Co.79 There, we observed

the “traditional rule” that successor liability requires an

examination of “the nature of the transaction between

predecessor and successor corporations.”80 In a merger in

which stock is exchanged as consideration, the successor

corporation “generally assumes all its predecessor’s

liabilities.”81 When the successor purchases assets for

cash, however, the successor corporation assumes its

predecessor’s liabilities only

(1) where there is an express or implied
assumption of liability; (2) where the
transaction amounts to a consolidation or
merger;[82] (3) where the transaction was
fraudulent; (4) where some of the elements of a
purchase in good faith were lacking, or where the
transfer was without consideration and the

(3) The purchasing corporation assumed those
liabilities and obligations of the seller
ordinarily necessary for the continuation of the
normal business operations of the seller
corporation.
(4) The purchasing corporation held itself
out to the world as the effective continuation of
the seller corporation.
79
460 Mich 696; 597 NW2d 506 (1999).
80
Id. at 702.
81
Id.
82
See Turner, supra at 419-420 (“It is the law in
Michigan that if two corporations merge, the obligations of
each become the obligations of the resulting
corporation.”).

creditors of the transferor were not provided
for; or (5) where the transferee corporation was
a mere continuation or reincarnation of the old
corporation.[83]

Plaintiff has not alleged that the sale of Associated

Physicians Medical Center, Inc., was fraudulent, in bad

faith, or lacking in consideration. Likewise, plaintiff

has adduced no evidence that Henry Ford expressly or

impliedly assumed the liabilities of Associated Physicians

Medical Center, Inc. Our inquiry therefore must focus on

whether (1) the transaction was a consolidation or merger

(either de jure or de facto), and (2) whether Henry Ford is

a “mere continuation”84 of Associated Physicians.

Plaintiff’s claim fails on both accounts. First,

plaintiff does not allege that a de jure merger took place,

and he has not demonstrated that a de facto merger

occurred. A de facto merger exists when each of the

following requirements is met:

(1) There is a continuation of the
enterprise of the seller corporation, so that
there is a continuity of management, personnel,
physical location, assets, and general business
operations.
(2) There is a continuity of shareholders
which results from the purchasing corporation
paying for the acquired assets with shares of its
own stock, this stock ultimately coming to be

83
Id. at 702 (citations omitted).

84
Id.

held by the shareholders of the seller
corporation so that they become a constituent
part of the purchasing corporation.
(3) The seller corporation ceases its
ordinary business operations, liquidates, and
dissolves as soon as legally and practically
possible.

(4) The purchasing corporation assumes those
liabilities and obligations of the seller
ordinarily necessary for the uninterrupted
continuation of normal business operations of the
seller corporation. [85]

This transaction is not a de facto merger simply because

Henry Ford, the purchasing corporation, paid in cash rather

than stock. Thus, there is no “continuity of shareholders

which results from the purchasing corporation paying for

the acquired assets with shares of its own stock. . . .”86

We also conclude that Henry Ford is not a “mere

continuation” of Associated Physicians Medical Center, Inc.

As the history recited above shows, Associated Physicians

split into two entities immediately before Henry Ford’s

purchase of Associated Physicians Medical Center, Inc. The

professional corporation—Associated Physicians’ medical

practice—became APMC, Inc. Henry Ford was therefore able

to purchase only the administrative aspects of the former

85
Turner, supra at 420 (citations, quotation marks,
and emphasis deleted), quoting Shannon v Samuel Langston
Co, 379 F Supp 797, 801 (WD Mich, 1974).
86
Id.

professional corporation. The core functions of the entity

that originally became vicariously liable to plaintiff were

carried on exclusively by APMC, Inc., a professional

corporation, rather than the business corporation purchased

by Henry Ford. Having analyzed the “nature of the

transaction,”87 we can only conclude that the only company

even arguably liable as a successor to Associated

Physicians, P.C., is that which continued its medical

practice—namely, APMC, Inc.

Moreover, we have never applied successor liability in

the medical malpractice context. Plaintiff has adduced no

reason why we should do so in this case. Not only are the

Turner/Foster requirements not met here but, more

important, the policies that justify the imposition of

successor liability are noticeably inapplicable here. We

stated in Foster that

[t]he thrust of the decision in Turner was to
provide a remedy to an injured plaintiff in those
cases in which the first corporation “legally
and/or practically becomes defunct.” . . . The
underlying rationale for the Turner Court's
decision to disregard traditional corporate law
principles was to provide a source of recovery
for injured plaintiffs.[88]

87
Foster, supra at 702.

88
Foster, supra at 705-706.

Here, plaintiff has already sought and obtained a judgment

from Drs. Gennaoui and Kittur, from Associated Physicians,

P.C., and from Oakwood Hospital. Because plaintiff

obtained a judgment against other sources, there was no

need to impose successor liability on Henry Ford, even if

the Turner/Foster factors had justified such liability.

The trial court erred in imposing successor liability on

Henry Ford and the Court of Appeals erroneously affirmed

this ruling.

V. CONCLUSION

We conclude that the trial court erred when it refused

to grant defendants’ motion for judgment notwithstanding

the verdict. Plaintiff failed to present any evidence from

which the fact-finder could reasonably conclude that any

breach of the applicable standard of care by defendants

proximately caused his cerebral palsy, mental retardation,

and other neurological conditions. In addition, the trial

court improperly denied defendant Oakwood Hospital’s motion

to compel an evidentiary hearing regarding the

qualifications and theories propounded by one of the

plaintiff=s expert witnesses. Finally, the trial court

erred in concluding that Henry Ford Health Care Corporation

was a corporate successor to the professional medical

corporation that employed Dr. Gennaoui. For those reasons,

we reverse the judgment of the Court of Appeals and remand

the matter for entry of judgment in defendants= favor.

Robert P. Young, Jr.
Maura D. Corrigan
Elizabeth A. Weaver
Clifford W. Taylor
Stephen J. Markman

S T A T E O F M I C H I G A N

SUPREME COURT

ANTONIO CRAIG, by his next
friend, KIMBERLY CRAIG,

Plaintiff-Appellee,

v Nos. 121405
121407-121409
121419
OAKWOOD HOSPITAL, HENRY FORD
HOSPITAL, doing business as
HENRY FORD HEALTH SYSTEM,
ASSOCIATED PHYSICIANS, P.C.,
and ELIAS G. GENNAOUI, M.D.,

Defendants-Appellants,

and

AJIT KITTUR, M.D.,

Defendant.

_______________________________

CAVANAGH, J. (concurring).

I concur with the majority in this case. I write

separately, however, because I do not agree with some of

the rationale regarding successor liability articulated by

the majority in part V. Therefore, as it pertains to

successor liability, I concur in the result only.

Michael F. Cavanagh
S T A T E O F M I C H I G A N

SUPREME COURT

ANTONIO CRAIG by his next
friend, Kimberly Craig,

Plaintiff-Appellee,

v Nos. 121405
121407-121409
OAKWOOD HOSPITAL, HENRY FORD 121419
HOSPITAL, doing business as
HENRY FORD HEALTH SYSTEM,
ASSOCIATED PHYSICIANS, P.C.,
and ELIAS G. GENNAOUI, M.D.,

Defendants-Appellants,

and

AJIT KITTUR, M.D.,

Defendant.
_______________________________

KELLY, J. (concurring in part and dissenting in part).

I dissent from the majority's decision that the trial

court abused its discretion in denying a Davis-Frye1

hearing. I also disagree that there was insufficient

evidence of causation. I agree with the conclusion that

Henry Ford Hospital is not liable under the theory of

successor liability. Therefore, with respect to the

1
People v Davis, 343 Mich 348; 72 NW2d 269 (1955), and
Frye v United States, 54 App DC 46; 293 F 1013 (1923).
defendants other than Henry Ford Hospital, I would affirm

the rulings of both lower courts for plaintiff.

The Davis-Frye Hearing

Defendant Oakwood Hospital failed to present any

substantiation for its motion asserting that the testimony

of plaintiff's causation expert, Dr. Ronald Gabriel, was

inadmissible because it was not recognized in the

scientific community. Rule 2.119(A)(1)(b) of the Michigan

Court Rules requires that a motion state with particularity

the grounds and authority on which it is based. All that

defendant stated was a conclusory and overbroad statement

that

[t]he testimony and opinions regarding
plaintiff's condition and the causes for it that
were offered by Dr. Ronald Gabriel in deposition
are groundless in the extreme and, by his own
admission, without support or even mention in
modern medical literature.

To this statement, defendant attached several pages of

Dr. Gabriel's deposition testimony. After reviewing them,

I find that Dr. Gabriel's only relevant admission is that

few recent studies regarding fetal head compression exist

because it occurs rarely. The reason it occurs rarely is

that fetal heart monitors and other medical technology help

detect the conditions associated with it so that head

compression is averted.

A lack of recent studies does not necessarily indicate

that a scientific theory has been abandoned or has fallen

into disrepute. It may indicate that the theory has become

generally accepted. For instance, although there are no

recent scientific studies showing the shape of the earth,

the statement, "The earth is round," would be accepted in

the scientific community.

In its response to defendant's motion, plaintiff cited

the Physician's Desk Reference and quoted a textbook

describing the effects of labor on a fetus. Defendant

offered nothing in response. Had it set forth specific

grounds and authority to support the motion, a Davis-Frye

hearing would have been appropriate.

Under the majority's relaxed standard articulated

today, whenever in the future a party claims that a theory

is "groundless in the extreme," it appears that party will

be entitled to a Davis-Frye hearing. This effectively

removes from the trial court the discretion to decide

whether a hearing is needed, making it automatic. Criminal

defendants questioning proffered testimony regarding the

psychological effect their actions had on a child victim

could receive a Davis-Frye hearing on the bald assertion

that the testimony is unacceptable in the scientific

community.

Defendant's written motion was vague. Attached to it

was some of Dr. Gabriel's deposition testimony in which he

stated that a compression injury occurred and that it

resulted from the administration of excessive Pitocin. The

court heard oral argument on the motion. In focusing on

the expert testimony that it believed was inadmissible,

defendant referred to Dr. Gabriel's testimony that

plaintiff had experienced a traumatic head injury during

childbirth. It asked for a hearing at which it might

present an expert to testify that there is no scientific

support for this theory. Defendant did not have an expert

nor did it provide an affidavit signed by an expert

indicating that Dr. Gabriel's theory is not recognized in

the scientific community.

In denying the motion, the judge noted:

The problem with your [defendant's] motion
is you don't have any Affidavits. You don't have
any evidence in there that -- I mean, that there
should be a Davis Frye Hearing. I mean, it's just
you as an attorney saying that . . . .[granting a
hearing without any support for defendant's
argument] would mean that everybody can come in
here and allege that whatever everybody's expert
is saying is not supported by scientific data,
and I would have to hold a Davis Frye Hearing in
every single case where any expert had to
testify. And that's not the standard. You have to
submit some evidence to me that I need a Davis
Frye Hearing, other than you just saying it.[2]

2
As did the judge in this case, others have noted the

The judge indicated a willingness to revisit the motion

should defendant provide support for its contention: "[Y]ou

can submit anything additional. I will take a look at it.

But that's my ruling today." Defendant never renewed the

motion.

difference between the burden of persuasion, which is on
the proponent of the evidence, and the initial burden of
production. "Because of judicial economy and the 'liberal
thrust' of the rules pertaining to experts, it seems
reasonable to place the initial burden of production on the
opponent for purposes of [a] hearing." Gentry v Magnum, 195
W Va 512, 522; 466 SE2d 171 (1995). Appellate decisions in
the area offer "little guidance on how trial courts should
procedurally accomplish their gatekeeping responsibilities
without frustrating" the policy of liberal admissibility of
expert evidence. Alberts v Wickes Lumber Co, 1995 US Dist
LEXIS 5893 (ND Ill, 1995).

Commentators have also addressed the problem. They
have noted that allocating the initial burden of production
to the opponent of the evidence "furthers the []
gatekeeping objective without hampering the 'liberal
thrust' of the [rules of evidence]." Accordingly, the
opponent's burden is merely to go forward with evidence
showing that the plaintiff's expert proof is inadmissible.
"Plaintiff bears the burden of showing by a preponderance
of the evidence that the expert's opinion is admissible."
Berger, Procedural paradigms for applying the Daubert test,
78 Minn L Rev 1345, 1365-1366 (1994). See, also, Brown,
Procedural issues under Daubert, 36 Hous L Rev 1133, 1140-
1141 (1999). While these decisions and articles deal with
the newer Daubert test, the inquiry about who bears the
burden of production is not affected. See Daubert v
Merrell Dow Pharmaceuticals, Inc, 509 US 579; 113 S Ct
2786; 125 L Ed 2d 469 (1993). The change occasioned by the
adoption of the Daubert test relates only to what the
proponent must show to prove admissibility once the
determination is made that a hearing is warranted.

The Michigan Rules of Evidence grant considerable

deference to a trial judge in ruling on motions. With

regard to preliminary questions, MRE 104(a) provides that

questions regarding the qualification of a person to be a

witness and the admissibility of evidence "shall be

determined by the court . . . . In making its

determination, it is not bound by the Rules of Evidence

except those with respect to privileges." Contrary to the

majority's assertions and in accordance with this rule, the

trial court was not bound by MRE 702, which governs the

testimony of expert witnesses, when it ruled on defendant's

motion.

It is without question that, once a defendant shows

that a genuine issue exists with regard to a theory's

acceptance, the theory's proponent must prove its

acceptance in the medical community. But before that, the

party raising the issue must present more than a conclusory

allegation that an issue exists.

Defendant failed to make the necessary showing in this

case. It never provided support for counsel's proposition

that Dr. Gabriel's traumatic injury theory lacked

recognition in the scientific community. Even given the

opportunity to provide support to the court, defendant was

either unwilling or unable to do so. Hence, the trial

court did not abuse its discretion when it refused to hold

a Davis-Frye hearing.

The Evidence of Causation

Defendants assert that plaintiff failed to present

sufficient evidence that his damages were caused by

defendants' medical malpractice to allow the case to go to

the jury. In presenting its evidence of a prima facie case,

a plaintiff must show causation but need not use any

particular formulation of words.

In this case, plaintiff's expert did not say "Antonio

Craig's cerebral palsy was caused by hypoxia resulting from

defendants' breaches of the standard of care." Although

desirable, such precision is simply not mandated. "[T]he

plaintiff's evidence is sufficient if it 'establishes a

logical sequence of cause and effect, notwithstanding the

existence of other plausible theories . . . ." Skinner v

Square D Co, 445 Mich 153, 159-160; 516 NW2d 475 (1994),

quoting Mulholland v DEC Int'l Corp, 432 Mich 395, 415; 443

NW2d 340 (1989).

The trial court ruled found that plaintiff presented

sufficient evidence. After the jury found for plaintiff,

defendants moved for judgment notwithstanding the verdict.

The motion was denied, and on appeal defendants challenge

that ruling. They question the sufficiency of the evidence

only with respect to the element of causation.

The standard for reviewing a decision on a motion for

judgment notwithstanding the verdict is deferential to the

nonmoving party:

If reasonable jurors could disagree, neither
the trial court nor this Court has the authority
to substitute its judgment for that of the jury.
[Matras v Amoco Oil Co, 424 Mich 675, 682; 385
NW2d 586 (1986).]

The trial court found:

Dr. Donn testified that Pitocin can cause
both trauma and hypoxia. Dr. Gatewood testified
that Pitocin can cause compression, and
compression can cause head injury. Dr. Dombrowski
testified that Pitocin can cause trauma and
hypoxia. Dr. Gabriel testified that Antonio
suffered a brain injury during labor and
delivery, based on the character of the labor and
delivery, based on the fetal monitoring, based on
the positioning of the head, based on the MRI
findings, it was caused by the use of Pitocin. He
testified that there was compression of the head
in the pelvic ridge. There was elevation of the
venous pressure and loss of blood flow and the
loss of oxygen and fusing the brain.

Testimony was also presented that an excessive dose of

Pitocin causes cerebral palsy in animals. The majority

notes that animal experiments are the only authority that

plaintiff offered showing a correlation between excessive

amounts of Pitocin and cerebral palsy. The implication is

that animal studies are insufficient evidence upon which to

base medical expert testimony. That is incorrect.

Dr. Gabriel's authority was sufficient for a jury

reasonably to infer that the same effects occur in humans.

Dr. Gabriel also testified that the animal studies were the

types "upon which the American Medical Establishment

formulated their warnings on the use of oxytoxic drugs."

These warnings appear in medical reference materials

discussing the effects of Pitocin. Defendants did not

refute these statements.

Dr. Gabriel testified that he believed that excessive

Pitocin caused plaintiff's condition. He testified that the

drug affected plaintiff in two ways. It produced both a

vascular effect and a traumatic effect. At trial, Dr.

Gabriel used the terms "pounding and grinding" to explain

the traumatic component of the injury. He testified:

In part, what happened to Antonio I think is
more complicated because I think there is a
traumatic component as well as a vascular
component. Those studies showed the vascular
component, that is to say the reduced blood flow.

Antonio also suffered from the trauma of the
head being pounded or grinded [sic] into the
pelvic rim with successive uterine contractions
which were of a high pressure and which resulted
in marked decelerations. So I think it's a
combination of vascular and trauma.

Dr. Gabriel testified that what happened to Antonio Craig

would not have happened without the administration of

Pitocin.

The majority focused attention on Dr. Gabriel's

"pounding and grinding" theory as if it were the only

theory that plaintiff presented. It was not. Dr. Gabriel

testified that there were two different contributors to

plaintiff's injuries. He claimed that plaintiff suffered

from both a decreased blood flow and from a traumatic

compression injury.3

In addition to Dr. Gabriel, Dr. Paul Gatewood

testified for plaintiff regarding the standard of care. He

stated that an excessive dosage of Pitocin was given to

plaintiff's mother. In his expert opinion, this was a

deviation from the standard of care. Dr. Gatewood also

explained that the administration of excessive Pitocin was

3
The majority maintains that "Dr. Gabriel did not
testify that an excessive dosage of Pitocin alone . . .
could have caused plaintiff's cerebral palsy." Ante at 31
n 68 (emphasis in original). Yet, the majority begins its
causation discussion by noting that "[e]ven if plaintiff
were able to show upon remand that Dr. Gabriel's testimony
was properly admitted, defendants would nevertheless be
entitled to JNOV." Ante at 23. Thus, for purposes of its
causation discussion, the majority assumes both theories
were admissible. Were this not the case, the proper outcome
should be a remand for a Davis-Frye hearing, not an
appellate ruling that the defendants were entitled to JNOV.
The testimony of Dr. Gabriel indicates that excessive
Pitocin causes reduced blood flow ("the vascular
component"). The studies showed a link between this
vascular component and cerebral palsy. There was sufficient
evidence of causation, regardless of the majority's reading
of the record.

the proximate cause of Antonio's injuries.4

After Dr. Gatewood established a breach of duty, Dr.

Gabriel testified that excessive Pitocin causes fetal brain

damage and cerebral palsy in animals. In Dr. Gabriel’s

opinion, the excessive Pitocin caused the fetal brain

damage that led to Antonio’s cerebral palsy.5 In all, there

was sufficient evidence to establish the element of

causation. The jury was entitled to decide the case on the

evidence presented.

Conclusion

The failure to hold a Davis-Frye hearing was not an

abuse of discretion under the facts of this case. Defendant

Oakwood had an obligation to provide support for the claim

that Dr. Gabriel's traumatic injury theory was not accepted

within the scientific community.

Moreover, plaintiff presented sufficient evidence to

establish the element of causation. Both Dr. Gabriel and

4
When plaintiff's counsel asked whether these
deviations "were the proximate causes of the reduced
oxygen, reduced blood flow to the fet[us] here Antonio
Craig," the doctor answered "[T]hese deviations are a
result in the hypoxic episodes . . . all of these factors
contributed to the development and prolongation of the
interim hypoxia that this baby's brain suffered."
5
When asked whether Antonio’s cerebral palsy was
related to the administering of Pitocin, the doctor
testified that “without Pitocin this would not have
happened.”

Dr. Gatewood testified effectively that an excessive dosage

of Pitocin gave rise to the conditions that caused the

baby's injuries.

Therefore, I would affirm the decision of the Court of

Appeals on all issues except that Henry Ford Hospital is

liable under a theory of successor liability. In that

regard, I agree with the majority's conclusion that the

Court of Appeals was incorrect. With that exception, the

decision of the Court of Appeals should be affirmed.

Marilyn Kelly