F I L E D
United States Court of Appeals
Tenth Circuit
PUBLISH
MAY 10 2002
UNITED STATES COURT OF APPEALS
PATRICK FISHER
Clerk
TENTH CIRCUIT
DEE HOLLANDER and DON
HOLLANDER,
Plaintiffs - Appellants,
v. No. 00-6135
SANDOZ PHARMACEUTICALS
CORPORATION, a New Jersey
corporation; SANDOZ, LTD., a
foreign corporation; and HCA
HEALTH SERVICES OF
OKLAHOMA, INC., an Oklahoma
corporation, d/b/a/ Presbyterian
Hospital,
Defendants - Appellees.
APPEAL FROM THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF OKLAHOMA
(D.C. NO. 96-CV-756-T)
Steven R. Hickman (James E. Frasier with him on the briefs), of Frasier, Frasier
& Hickman, LLP, Tulsa, Oklahoma, for the Plaintiffs-Appellants.
Grant J. Esposito of Mayer, Brown & Platt, New York, New York, for Defendant-
Appellee Sandoz Limited; Joe G. Hollingsworth (Katharine R. Latimer and Kirby
T. Griffis of Spriggs & Hollingsworth, Washington, D. C., for Defendant-
Appellee Sandoz Pharmaceuticals Corporation; Richard M. Eldridge and Thomas
E. Steichen of Eldridge Cooper Steichen & Leach, P.L.L.C., Tulsa, Oklahoma, for
Defendants-Appellees Sandoz Pharmaceuticals Corporation and Sandoz Limited,
with them on the brief).
David A. Branscum (Glenn D. Huff with him on the brief) of Foliart, Huff,
Ottaway & Bottom, Oklahoma City, Oklahoma for the Defendant-Appellee HCA
Health Services of Oklahoma, Inc.
Before EBEL and HENRY , Circuit Judges, and ROGERS , District Judge. *
HENRY , Circuit Judge.
Dee and Don Hollander filed this products liability action in the District
Court for Oklahoma County alleging that Parlodel, a drug manufactured by
Sandoz Pharmaceuticals Corporation (“Sandoz”), now known as Novartis
Pharmaceuticals Corporation, and distributed by HCA Health Services of
Oklahoma, Inc., doing business as Presbyterian Hospital (“Presbyterian
Hospital”), caused Ms. Hollander to suffer an intracerebral hemorrhage shortly
after she gave birth to the Hollanders’ second child. After the Oklahoma County
District Court dismissed the Hollanders’ claim against Presbyterian Hospital, the
remaining defendants removed the case to the federal district court.
The federal district court denied the Hollanders’ motion to remand the case
to state court. It rejected the Hollanders’ arguments that it lacked jurisdiction
over the remaining claims and that the defendants’ removal petition was untimely.
Subsequently, the federal district court dismissed the defendant Sandoz, Ltd. with
*
The Honorable Richard D. Rogers, United States District Judge for the
District of Kansas, sitting by designation.
-2-
prejudice, reasoning that the holding company had its principal place of business
in Switzerland and that the court lacked personal jurisdiction over it.
Finally, applying Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S.
579 (1993), the federal district court ruled that the Hollanders’ expert testimony
regarding the causal connection between Parlodel and intracerebral hemorrhages
lacked the necessary reliability and was therefore inadmissible. See Hollander v.
Sandoz Pharms. Corp., 95 F. Supp. 2d 1230, 1238-39 (W.D. Okla. 2000). As a
result, the court granted summary judgment to Sandoz.
The Hollanders now appeal those rulings, arguing that: (1) the federal
district court lacked subject matter jurisdiction and therefore erred in denying
their motion to remand the case to the Oklahoma state court; (2) the court erred in
dismissing their claim against the defendant Presbyterian Hospital; (3) the court
abused its discretion in ruling that the testimony of their experts was not
sufficiently reliable to be admissible; (4) the court erred in granting summary
judgment to Sandoz; and (5) the district court erred in dismissing their claim
against Sandoz, Ltd., with prejudice.
For the reasons set forth below, we conclude that the federal district court
had subject matter jurisdiction. We further hold that the court did not abuse its
discretion in finding that the Hollanders’ expert testimony was not sufficiently
reliable and that the court did not err in granting summary judgment to Sandoz.
-3-
However, we agree with the Hollanders that the federal district court should have
dismissed their claim against Sandoz, Ltd., without prejudice. In light of these
conclusions, we do not address the Hollanders’ challenge to the dismissal of their
claim against Presbyterian Hospital.
Accordingly, we affirm the district court’s judgment against the Hollanders
and in favor of Presbyterian Hospital and Sandoz. We remand the Hollanders’
claim against Sandoz, Ltd., so that it may be dismissed without prejudice.
I. BACKGROUND
On July 23, 1990, Ms. Hollander gave birth by cesarean section to a healthy
baby boy at Presbyterian Hospital in Oklahoma City. Because Ms. Hollander did
not want to breast feed her son, her obstetrician prescribed a fifteen day course of
Parlodel, to be taken in two 2.5 mg doses per day.
Parlodel is manufactured by Sandoz. The drug’s active ingredient is
bromocriptine mesylate, a compound derived from ergot (a naturally occurring
substance made from a fungus that attacks cereal grains). The compound blocks
the production of prolactin, a hormone that triggers the secretion of milk in
postpartum women. The Federal Drug Administration (FDA) approved Parlodel
for the suppression of post-partum lactation in 1980, and approximately 9 million
women in the United States have taken it for that purpose. See Siharath v.
-4-
Sandoz Pharms. Corp., 131 F. Supp. 2d 1347, 1349 (N.D. Ga. 2001) (discussing
the history of Parlodel). Parlodel is also prescribed for several other disorders,
including acromegaly (a disease caused by hypersecretion of the pituitary growth
hormone), Parkinson’s disease, and various diseases involving the excessive
production of prolactin.
Ms. Hollander received her first dose of Parlodel at 6:00 p.m. on July 23,
1990. About two hours later, her blood pressure increased sharply to 180/90. On
the following day, she received her second and third doses of Parlodel, and her
blood pressure returned to the normal range. She continued to take two 2.5 mg
doses of the drug each day. Presbyterian Hospital discharged her on July 27,
1990.
On the evening of July 28, 1990, Ms. Hollander complained of a severe
headache. By the following morning, she could neither speak nor move her right
side. At Presbyterian Hospital, a CT scan revealed that Ms. Hollander had
suffered an intracerebral hemorrhage in the left basal ganglia area of her brain.
Ms. Hollander’s treating physicians were puzzled as to the cause. One of them
noted that her stroke resembled those caused by hypertension but added that Ms.
Hollander had no history of the disorder. Clinical information revealed no
-5-
pregnancy-related disorders involving hypertension, such as eclampsia or
preeclampsia. 1
On August 1, 1990, Ms. Hollander’s condition deteriorated. As a result,
her physicians performed an emergency left frontal craniotomy and removed an
intracerebral hematoma. Ms. Hollander slowly improved. She remained in the
hospital for over three weeks and then transferred to a rehabilitation center.
The Hollanders filed this action against Sandoz, Sandoz, Ltd., and
Presbyterian Hospital in May 1995 in the District Court for Oklahoma County.
They alleged that Ms. Hollander’s stroke was caused by Parlodel, that the drug
was unreasonably dangerous to the ordinary consumer when used as a lactation
suppressant, and that Sandoz, Sandoz, Ltd., and Presbyterian Hospital had failed
to warn of the dangers of the drug. They further alleged that Ms. Hollander had
suffered permanent injuries.
Presbyterian Hospital filed a motion to dismiss the Hollanders’ claims,
arguing that a hospital could not be held strictly liable for providing a drug
prescribed by a doctor. The Oklahoma County District Court granted Presbyterian
1
Preeclampsia involves the “[d]evelopment of hypertension with
albuminuria or edema between the 20th week of pregnancy and the end of the 1st
week postpartum.” The Merck Manual, § 18 at 2057 (17th ed. 1999).
“Albuminuria” refers to “the presence in the urine of serum albumin.” Dorland’s
Illustrated Medical Dictionary at 42 (28th ed. 1994). Eclampsia involves
“[c]onvlusive seizures or coma without other etiology occurring in the same time
period.” The Merck Manual, § 18 at 2057.
-6-
Hospital’s motion to dismiss in an oral ruling at an August 25, 1995 hearing. It
issued a written ruling on May 10, 1996.
Sandoz filed a notice of removal on May 10, 1996. The Hollanders then
filed a motion to remand the case to the Oklahoma state court, which the district
court denied. See Aplt’s App. vol. I, at 116-17 (District Court Order, filed June
12, 1996). Subsequently, the court dismissed the Hollanders’ claims against
Sandoz, Ltd., reasoning that it was a holding company incorporated in
Switzerland with its principal place of business there, that it had no office,
manufacturing, distribution, or sales facilities in the United States, and that it did
not advertise here. As a result, the court concluded that it lacked personal
jurisdiction over Sandoz, Ltd., and it dismissed with prejudice the claims against
the company. See id. at 354 (District Court Order, filed Dec. 17, 1996).
The dispute between the Hollanders and Sandoz involves issues that have
been raised in other litigation as well as in regulatory proceedings. See Kuhn v.
Sandoz Pharms. Corp., 14 P.3d 1170, 1174 (Kan. 2001) (describing a
“decade-long disagreement between Sandoz and the [FDA] concerning the use of
Parlodel for the prevention of physiologic lactation”). In 1984 (four years after
first approving the drug as a lactation suppressant), the FDA reported that “the
labeling of Parlodel (bromocriptine) is being revised to reflect reports of
postpartum hypertension, seizures, and cerebrovascular accidents.” Aplt’s App.
-7-
vol. IV-B, at 2401-02 (FDA Drug Bulletin, vol. 14, no. 1, at 3-4). The FDA
explained that it had received seven reports of hypertension alone, seven reports
of seizures, and three cases of cerebrovascular accidents (including one fatality).
Because approximately 500,000 women had used Parlodel to suppress postpartum
lactation, however, the significance of those reports was difficult to assess. The
FDA expressly acknowledged that “[a] cause and effect relationship has not been
established.” Id.
Sandoz eventually modified the Parlodel package insert to include
information about these cases. However, the company noted that hypertension,
seizures, strokes, and myocardial infarctions regularly occur in postpartum women
who are not treated with bromocriptine. Thus, it maintained, “the number of
cases reported to Sandoz is less that one would expect even in the absence of any
drug effect.” Id. at 2448 (Letter from Sandoz’s Executive Director of Sales, Aug.
20, 1987).
Over the next few years, the FDA continued to receive reports of adverse
reactions to Parlodel. Sandoz commissioned a study by Epidemiologic Resources,
Inc., regarding the relationship between Parlodel and strokes and seizures (the
“ERI study”). See Aplt’s App. vol. II-D, at 1361-1532 (Kenneth Rothman, et al.,
“An Epidemiologic Evaluation of the Possible Relation Between Bromocriptine,
-8-
Puerperal Seizures and Strokes,” (Sept. 30, 1988)); 2 Siharath, 131 F. Supp. 2d at
1356-57 (discussing the ERI study). Although the ERI study did not find a causal
connection between strokes and seizures, the FDA concluded that the study failed
to allay concerns regarding the drug’s association with seizures and involved too
few individuals to adequately characterize the risk of stroke.
The FDA further concluded that the possibility that Parlodel might cause
serious adverse reactions in some patients outweighed the limited benefits
associated with its use. As a result, it requested all manufacturers to remove the
indication for lactation suppression from the Parlodel label. Initially, Sandoz
refused to comply with the FDA’s request, arguing that Parlodel should not be
used routinely but should be available in specific circumstances recommended by
physicians. Not satisfied with this position, the FDA initiated formal procedures
for withdrawing its prior approval for the labeling of Parlodel. The FDA
explained its position as follows:
FDA now has new information suggesting that therapeutic
use of bromocriptine for the prevention of physiological
lactation may lead to serious adverse experiences,
including death and paralysis, in a small but significant
number of patients. Patients at high risk of experiencing
these serious adverse experiences cannot be adequately
predetermined. In light of the limited benefit of using
2
The purpureum is “the period from the end of the third stage of labor
until the involution of the uterus is complete, usually lasting 3 to 6 weeks.”
Dorland’s Illustrated Medical Dictionary at 1386.
-9-
bromocriptine for the prevention of lactation, and the
effectiveness and lack of serious adverse effects of
conservative treatments such as breast binding with or
without mild analgesics, the risk that bromocriptine may
cause a serious adverse effect in a postpartum woman is
unacceptable.
Accordingly, the Director concludes that the
potential risks associated with the use of bromocriptine for
the prevention of physiological lactation outweigh its
limited benefits and bromocriptine is no longer shown to
be safe for use in preventing physiological lactation.
59 Fed. Reg. 43347, 43351 (Aug. 24, 1994). Sandoz then agreed to FDA’s
proposal to withdraw the indication for the suppression of postpartum lactation.
Following the FDA’s approval of Parlodel as a lactation suppressant,
professional medical journals began to publish reports regarding women who had
suffered heart attacks and strokes after taking the drug. For example, one of the
Hollanders’ expert witnesses described two patients who had suffered from
cardiac dysfunction, seizures, and cerebral vasospasm. See Kenneth Kulig,
“Bromocriptine Associated Headache: Possible Life Threatening
Sympathomimetic Intersection,” Obstetrics and Gynecology, 72: 941(1991)
(Aplt’s App. vol. IV-B, at 2444-46). Another expert published case histories
concerning women who had suffered from heart attacks. See, e.g., Leslie Iffy, et
al., “Acute Myocardial Infarction in the Puerperium in Patients Receiving
Bromocriptine,” American Journal of Obstetrics and Gynecology, vol. 155, No. 2,
at 371-72 (1986) (Aplt’s App. vol. IV-D, at 2976-77). Medical researchers also
-10-
published numerous articles reporting the effects of bromocriptine in animals.
See Siharath, 131 F. Supp. 2d at 1366-69 (discussing animal studies), Glastetter v.
Novartis Pharms. Corp., 107 F. Supp. 2d 1015, 1037-1041 (E.D. Mo. 2000)
(same), aff’d, 252 F.3d 986, 991 (8th Cir. 2001). Some of the studies involved
dogs, rats, and pithed animals. See id.; see also Aplt’s App. vol. I-A, at 369-376
(Sandoz’s statement of material facts, filed July 15, 1999) (discussing animal
studies). Some researchers concluded that, contrary to the Hollanders’ allegations
regarding the effect of bromocriptine on Ms. Hollander, the drug actually
decreases blood pressure. See, e.g, Saad Lahlou & Pierre Demenge,
“Contribution of Spinal Dopamine Receptors to the Hypotensive Action of
Bromocriptine in Rats,” Journal of Cardiovascular Pharmacology, vol. 18, 317-
323 (1991) (Aplt’s App. vol. II-E, at 1646-54).
As the discussion in the scientific literature continued, the controversy over
Parlodel made its way to the courts. In 1994, a Kentucky jury awarded $968,512
in compensatory damages and $1,000,000 in punitive damages to a woman who
alleged that Parlodel had caused her stroke. See Aplt’s App. vol. IV-A, at 2171
(Judgment in Roberts v. Betts, no. 89-CI-653-V, 25th Judicial Dist., Pulaski Cir.
Ct., July 20, 1994). A Kentucky appellate court affirmed that judgment in an
unpublished opinion. See id. at 2175-78. In contrast to the Roberts case, several
recent decisions have rejected claims that Parlodel has caused strokes and heart
-11-
attacks when prescribed as a post-partum lactation suppressant, concluding that
the scientific evidence supporting these claims was not sufficiently reliable under
Daubert. 3 However, several other decisions have reached the opposite
conclusion. 4 See generally Mark Hansen, “When Expert Testimony Fails the Test:
District Courts Disagree on what Defines Causation Evidence in Drug Disability
Cases,” 88 ABA Journal 22 (Jan. 2002) (stating that “[an] Alabama magistrate’s
decision brought to eight the number of products liability suits over Parlodel that
have survived a so-called Daubert challenge to the admissibility of the plaintiffs’
causation evidence [b]ut [an] Illinois judge’s ruling--tantamount to an order of
summary judgment for the defense--marked the seventh trial or appellate decision
to exclude such evidence”).
In support of their contention that Parlodel caused Ms. Hollander’s stroke,
the Hollanders relied primarily on the testimony of three experts: (1) Dr. Kenneth
3
See Glastetter v. Novartis Pharms. Corp., 252 F.3d 986, 989 (8th Cir.
2001); Caraker v. Sandoz Pharms. Corp., 172 F. Supp. 2d 1046 (S.D. Ill. 2001);
Siharath, 131 F. Supp. 2d 1347 (N.D. Ga. 2001); Brumbaugh v. Sandoz Pharms.
Corp., 77 F. Supp. 2d 1153, 1155, (D. Mont. 1999).
4
See Brasher v. Sandoz Pharms. Corp., 160 F. Supp. 2d 1291 (N.D. Ala.
2001); Globetti v. Sandoz Pharms. Corp., 111 F. Supp. 2d 1174 (N.D. Ala. 2000);
Aplt’s App. vol. V, at 3184-3213 (Tr. of unpublished ruling in Kittelson v.
Sandoz Pharms. Corp., No. 98-2277 (D. Minn. March 2, 2000) (denying motion to
exclude scientific testimony as unreliable); Kuhn, 14 P.3d 1179-85 (applying the
test for admissibility set forth in Frye v. United States, 293 F. 1013 (D.C. Cir.
1923) and concluding that there were genuine issues of material fact as to whether
Parlodel caused a patient’s death).
-12-
Kulig, a physician who is board-certified in toxicology and emergency medicine
and who has served as the Chairman of the Pharmacy and Therapeutics
Committee and Director of the Porter Regional Toxicology Center at Porter
Adventist Hospital in Denver, Colorado, and as an associate clinical professor in
the Division of Emergency Medicine and Trauma in the Department of Surgery at
the University of Colorado Health Sciences Center; (2) Dr. Leslie Iffy, M.D., a
professor in the Department of Obstetrics and Gynecology of the University of
Medicine and Dentistry of New Jersey; and (3) Dr. Pedro A. Jose, M.D., Ph.D., a
Professor of Pediatrics, Physiology, and Biophysics at Georgetown University and
an expert on the role of dopamine and dopaminergic drugs on the development of
hypertension.
The parties offered deposition testimony, affidavits, expert reports, and
transcripts of testimony from other cases involving Parlodel. In general, the
experts’ theory was that in certain women, Parlodel causes vasoconstriction (a
narrowing of the blood vessels) and hypertension (high blood pressure).
Vasoconstriction and hypertension, the experts reasoned, can then cause strokes,
as they did in the case of Ms. Hollander.
In his written report, Dr. Kulig explained that he had reviewed Ms.
Hollander’s medical records, medical literature regarding bromocriptine and other
ergot alkaloids, FDA documents, and marketing, promotional and research
-13-
material complied by Sandoz. He concluded that Ms. Hollander suffered “an
intracerebral hemorrhage secondary to ergot induced vasospasm resulting in blood
vessel rupture in her brain.” Aplt’s App. vol. II-A, at 652 (Dr. Kulig’s Sept. 22,
1998 report, at 3). He added, “It is my opinion with a reasonable degree of
medical certainty that Mrs. Hollander’s stroke was caused by the drug
bromocriptine, and had the patient not been taking the drug, she would not have
had a stroke.” Id. at 653. According to Dr. Kulig, the fact that bromocriptine
could cause strokes was well know to Sandoz at the time that Ms. Hollander
began taking the drug. Id. at 652.
In an affidavit in another case involving Parlodel, Dr. Kulig provided a
more detailed explanation as to how he had reached his conclusions. See Aplt’s
App. vol. II-E, at 1742-59 (Dr. Kulig’s affidavit in Railey v. Novartis
Pharmaceuticals Corp., 94-1440 (C.D. Ill.)). He noted that bromocriptine is an
ergot, “a class of drugs with known molecular structures and many common
properties,” including the tendency to cause vasoconstriction. See id. at 1745
(stating that “[o]ne needs only to look at the package inserts from Sandoz
regarding other ergot alkaloids it manufactures to understand that
vasoconstriction is indeed the core property of ergot alkaloids”). Bromocriptine
differs from the naturally occurring ergot alkaloid alpha ergocriptine only in that
-14-
the molecule has an additional bromine atom attached to the second carbon atom
of the basic ergot ring. See id.
Dr. Kulig explained the significance of the structural differences between
bromocriptine and other ergot alkaloids as follows:
Although the adding of a bromine atom to the core nucleus
makes the drug in some patients a vasodilator (the first
dose may cause a precipitous fall in blood pressure,
another fact that makes the drug unsafe in the post-partum
period), it is misleading and inaccurate to suggest that the
drug can never cause vasoconstriction or hypertension in
any person. While the addition of a bromine atom to a
very large organic molecule may change the
pharmacokinetics and pharmacological dynamics of a drug,
it would be unlikely to change the core properties of an
ergot alkaloid from being a vasoconstrictor to a vasodilator
in all cases. Clinical studies, epidemiologic evidence and
adverse drug reaction experience with this drug indicates
that vasoconstriction with bromocriptine unquestionably
occurs, as would be expected based on the fact that it is an
ergot that can cause ergotism.
Id. at 1745-46.
Dr. Kulig also discussed several other categories of evidence on which he
had relied in forming his opinion. These included the pharmacological and
toxicological properties of bromocriptine, studies of the relationship between
bromocriptine and hypertension, and case reports concerning adverse reactions.
As to pharmacology, Dr. Kulig explained that bromocripitne is “a dopamine
agonist.” Id. In other words, the drug stimulates the release of dopamine, a
neurotransmitter. Dr. Kulig added that bromocriptine is also a “dopamine-1
-15-
antagonist,” inhibiting the effects of dopamine at specific “D-1” receptors. Id.
According to Dr. Kulig, dopamine is a well known vasoconstrictor. However,
activation of the “D-1” dopamine receptors results in vasodilation. Thus, the fact
that bromocriptine stimulates the release of dopamine and that it inhibits the D-1
dopamine receptors is consistent with the drug causing vasoconstriction.
Moreover, Dr. Kulig reported that bromocriptine “has a very long beta
elimination half-life of about 50 hours.” Id. at 1747. That means that a steady
state is not achieved in someone taking the drug twice a day until about ten days
after leaving the hospital. As a result, one would not expect women who have
taken the drug to suppress post-partum lactation to develop hypertension and
vasospasm until after their discharge from the hospital.
With regard to hypertension, Dr. Kulig referred to three studies. In the
first, commissioned by Sandoz, nineteen percent of patients demonstrated
increases in blood pressure after taking bromocriptine. In the second study,
published by the FDA in 1984, six out of seven patients who developed
hypertension while on bromocriptine regained normal blood pressure after they
stopped taking the drug. Finally, a study by Dr. Dorothy Watson 5 found that
women with pregnancy-induced hypertension had a higher incidence of post-
5
Watson, D.I., et al., “Bromocriptine Mesylate for Lactation Suppression:
A Risk for Postpartum Hypertension?” Obstetrics and Gynecology, 74(4): 573-
576 (1989) (Aplt’s App. vol. II-D, at 1596-97).
-16-
partum hypertension after taking the drug than those women not receiving
bromocriptine. See id. at 1748-49 (stating that “[t]his case control study provides
important evidence that bromocriptine causes post-partum hypertension in women
who had pregnancy-induced hypertension prior to delivery”).
Finally, Dr. Kulig discussed the adverse reactions to bromocriptine that had
been spontaneously reported to the FDA and Sandoz. These reactions included
hypertension, seizures, strokes, and myocardial infarction. Although he
acknowledged that these reports did not establish causation, he presented them as
an important factor to be considered along with the other scientific evidence.
In addition to Dr. Kulig, the Hollanders also relied on the opinion of Dr.
Leslie Iffy. See Aplt’s App. vol. II-A, at 733-739 (Dr. Iffy’s written report, July
25, 1997). Dr. Iffy concluded that there was “an overwhelming probability” that
Ms. Hollander’s stroke was caused by bromocriptine. Id. at 738. He listed five
factors that supported his opinion: (1) Ms. Hollander had normal blood pressure
during a prior pregnancy but displayed an episode of hypertension when she took
Parlodel during her first childbirth; (2) she suffered episodes of hypertension
during her second pregnancy and immediately after the birth of her second child;
“[t]his being the case, she was predisposed for the hypertensive effect of
bromocriptine”; (3) when she took Parlodel after the second pregnancy, her blood
pressure increased, “in all probability a bromocriptine effect”; (4) “[t]he time of
-17-
occurrence of the cerebral hemorrhage (sixth day postpartum) was highly
characteristic of bromocriptine related catastrophic side effects”; and (5) “[a]part
from her moderate smoking habit, the patient had no identifiable predisposing
factors for cerebral hemorrhage[;] [t]he absence of evidence of congenital defect
at the site of the hemorrhage further emphasizes the lack of predisposing factors
on the part of the patient.” Id. Dr. Iffy added that, in his view, Sandoz was
aware of the dangers of Parlodel at the time that Ms. Hollander suffered her
stroke. See id. at 739.
The third expert on whom the Hollanders relied—Dr. Pedro Jose—set forth
a more specific theory of causation. In his written report, Dr. Jose stated, “I think
that the hypertension (which caused the stroke) is probably due to Parlodel; the
hypertension would not have happened if Parlodel was not prescribed.” Aplt’s
App. vol. II-A, at 842 (Dr. Jose’s report, Jan. 23, 1998). Dr. Jose acknowledged
that bromocriptine often decreases blood pressure. However, in deposition
testimony he explained that in instances in which extra-cellular fluid volume is
increased—as is the case in pregnancy—and in which the activity of the
sympathetic nervous system is decreased, bromocriptine has the “paradoxical
effect of increasing blood pressure.” Id. at 801.
After conducting discovery, Sandoz filed a motion to exclude the opinion
testimony offered by the Hollanders’ experts on the grounds that the testimony
-18-
was insufficiently reliable under Daubert. In the same motion, Sandoz requested
the court to grant summary judgment in its favor. It argued that, in the absence of
the unreliable opinion testimony, the Hollanders could not demonstrate that there
were controverted issues of material fact on the issue of whether Parlodel caused
Ms. Hollander’s stroke.
The federal district court granted Sandoz’s motion to exclude the
Hollanders’ expert testimony as well as its motion for summary judgment. See
Hollander, 95 F. Supp. 2d at 1235-39. The court set forth four reasons in support
of its evidentiary ruling.
First, the court observed that the Hollanders’ experts were unable to
explain the physiological mechanism by which Parlodel caused vasoconstriction
and ensuing hypertension and strokes. The court explained that “Dr. Kulig could
only list possible mechanisms for Parlodel causing hypertension,” that “Dr. Jose
could not cite any studies or tests that proved his hypothesis that bromocriptine
might cause high blood pressure,” and that “Dr. Iffy also classified his opinion
that Parlodel caused Mrs. Hollander’s stroke as being a hypothesis, which is not
held by a medical degree of certainty.” See id. at 1235-36 (internal quotation
marks omitted).
Second, the court reasoned that the kinds of case reports on which the
Hollanders relied have been repeatedly rejected as a scientific basis for
-19-
establishing causation. It stated: “The problems with case reports and adverse
drug experience reports were acknowledged by Dr. Iffy—because they are not
controlled studies and do not eliminate confounding variables, the reported effect
or injury could be due to some other cause than Parlodel.” See id. at 1237.
Third, the court found that the fact that bromocriptine belongs to a class of
compounds (ergot alkaloids) that have been shown to cause hypertension did not
constitute reliable causation evidence. The court observed that the Hollanders
had failed to refute Sandoz’s evidence that “[t]he chemical diversity of ergot
alkaloids corresponds to the diversity of the biological activities of these
compounds.” Id. at 1238 (internal quotation marks and emphasis omitted).
Fourth, the animal studies on which the Hollanders’ experts relied were too
dissimilar to the facts of this case. “The studies relied upon involved different
drugs, did not test the systemic effect of the drug, some of the animals were
anaesthetized, and they were neither pregnant nor post-partum. . . . Doctors Jose
and Kulig were unaware of any controlled animal studies in which bromocriptine
caused an increase in blood pressure.” Id. at 1238 (internal citations omitted).
In light of its conclusion that the Hollanders’ opinion testimony was
insufficiently reliable under Daubert, the district court briefly assessed the state
of the record absent that testimony. It concluded that, without expert opinion
testimony, the Hollanders could not demonstrate that Parlodel caused Ms.
-20-
Hollander’s stroke. The court therefore granted Sandoz’s motion for summary
judgment.
II. DISCUSSION
In this appeal, the Hollanders primarily challenge the district court’s
assessment of their evidence that Parlodel caused Ms. Hollander’s stroke. In
particular, they challenge both the district court’s application of Daubert to
exclude their expert opinion testimony and the district court’s assessment of the
record absent that testimony. They maintain that “[w]hether or not the experts are
allowed to give their ultimate opinion, there is sufficient evidence that a jury
could find in [their] favor on the issue of causation.” Aplt’s Br. at 28. The
Hollanders also present several other challenges to the district court’s rulings.
We begin our analysis by addressing the Hollanders’ argument that the
district court lacked subject matter jurisdiction and therefore erred in denying
their motion to remand the case to the Oklahoma state court. Because we
conclude that the federal district court had subject matter jurisdiction, we then
turn to the Hollander’s arguments regarding scientific evidence. Finally, we
address their argument that the district court erred in dismissing their claims
against Sandoz, Ltd., with prejudice.
-21-
A. Jurisdiction
Focusing on several alleged defects in the removal procedure, the
Hollanders argue that the federal district court erred in denying their motion to
remand. As a result, they contend, that court lacked jurisdiction to adjudicate the
case, and the judgment in favor of the defendants should be vacated so that the
case may be heard in the Oklahoma state court.
In light of the Supreme Court’s decision in Caterpillar, Inc. v. Lewis, 519
U.S. 61 (1996), we need not address the Hollanders’ specific arguments. In
Caterpillar, the Court held that “a district court’s error in failing to remand a case
improperly removed is not fatal to the ensuing adjudication if federal
jurisdictional requirements are met at the time judgment is entered.” Id. at 64;
see also Feichko v. Denver & Rio Grande W. R.R. Co., 213 F.3d 586, 590-91
(10th Cir. 2000) (discussing Caterpillar). The Court reasoned that, despite
deficiencies in the removal process, “[to] wipe out the adjudication postjudgment,
and return to state court a case now satisfying the federal jurisdictional
requirements, would impose an exorbitant cost on our dual court system, a cost
incompatible with the fair and unprotracted administration of justice.”
Caterpillar, 519 U.S. at 77.
Here, as the defendants observe, complete diversity existed between the
remaining parties at the time that the federal district court entered judgment: the
-22-
Hollanders resided in Arkansas and the defendant Sandoz was a Delaware
corporation with its principal place of business in New Jersey. Thus, the alleged
deficiencies in the removal procedure do not divest the district court of subject
matter jurisdiction. We therefore proceed to the merits.
B. Admissibility of the Hollanders’ Experts’ Testimony Under Daubert
Rule 702 of the Federal Rules of Evidence provides:
[i]f 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 upon 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.
Fed. R. Evid. 702.
In Daubert, the Supreme Court concluded that Rule 702 superseded the
“general acceptance” standard for the admissibility of scientific evidence first set
forth in Frye, 293 F. at 1014. 6 Under Daubert, when faced with a proffer of
expert scientific testimony, a district court “must determine at the outset, pursuant
6
The Frye test required district courts to exclude evidence when the
underlying scientific principles were not “sufficiently established to have gained
general acceptance in the particular field in which [they belong].” Frye, 293 F. at
1014.
-23-
to [Fed. R. Evid.] 104(a), whether the expert is proposing to testify to (1)
scientific knowledge that (2) will assist the trier of fact to understand or
determine a fact in issue.” Daubert, 509 U.S. at 592. Thus, under Daubert, the
district court performs an important gatekeeping role in assessing scientific
evidence. See Macsenti v. Becker, 237 F.3d 1223, 1230-34 (10th Cir. 2001)
(discussing the district court’s gatekeeping function under Daubert).
The Daubert standard ensures that the proffered evidence is both “reliable”
and “relevant.” See Daubert, 509 U.S. at 589. Reliability is determined by
assessing “whether the reasoning or methodology underlying the testimony is
scientifically valid.” Id. at 592-93. Relevance depends upon “whether [that]
reasoning or methodology properly can be applied to the facts in issue.” Id. at
593.
We review the district court’s application of Daubert to exclude expert
opinion evidence for an abuse of discretion. See General Electric v. Joiner, 522
U.S. 136, 143 (1997); Mitchell v. Gencorp Inc., 165 F.3d 778, 780 (10th Cir.
1999). Thus, we must afford substantial deference to the district court’s
application of Daubert. See Kumho Tire Co. v. Carmichael, 526 U.S. 137, 152
(1999) (“the trial judge must have considerable leeway in deciding in a particular
case how to go about determining whether particular expert testimony is
reliable”); Joiner, 522 U.S. at 143 (noting that the court of appeals “failed to give
-24-
the trial court the deference that is the hallmark of abuse-of-discretion review”).
Under the abuse of discretion standard, “a trial court’s decision will not be
disturbed unless the appellate court has a definite and firm conviction that the
lower court made a clear error of judgment or exceeded the bounds of permissible
choice in the circumstances.” McEwen v. City of Norman, Okla., 926 F.2d 1539,
1553-54 (10th Cir. 1991); see also Summers v. Missouri Pacific R.R. System, 132
F.3d 599, 603 (10th Cir. 1997) (stating that, under the abuse of discretion
standard, “[w]e will not disturb the trial court’s determination “absent a distinct
showing it was based on a clearly erroneous finding of fact or an erroneous
conclusion of law or manifests a clear error of judgment”).
Here, the Hollanders focus on the district court’s application of the
“reliability” prong of the Daubert inquiry. They invoke two methods of causation
analysis: one promulgated by Sandoz’s Drug Monitoring Center and the other set
forth by a professor of medical statistics, Sir Austin Bradford Hill. See Aplt’s
App. vol. IV-B, at 2378-79 (Sandoz’s classifications of evidence of causation);
vol. IV-D, at 2949-52 (Bradford Hill, “The Environment and Disease: Association
or Causation?,” Proceedings of the Royal Society of Medicine, vol. 58 no. 5 (May
1965)). 7
7
Under the Sandoz scheme, there are four main categories of causation:
(a) not related; (b) remote; (c) probable; and (d) definite. The Hollanders focus
on the standard for “probable” causation.
(continued...)
-25-
Relying primarily on Dr. Kulig’s testimony, the Hollanders maintain that
his opinion that Parlodel caused Ms. Hollander’s stroke comports with these
general standards of causation analysis. Accordingly, they reason, Dr. Kulig’s
testimony is sufficiently scientific to be admissible under Daubert. See Aplt’s Br.
at 24 (“[I]t cannot be gainsaid that Dr. Kulig’s methodology—how he takes the
information available and analyzes it in a scientific manner—is good science and
would be helpful to a jury of laymen.”).
Additionally, the Hollanders note that Dr. Kulig criticized some of
Sandoz’s own evidence on scientific grounds. They point to his testimony that
the studies invoked by Sandoz do not demonstrate that there is an increased risk
of stroke in the post-partum period generally. As a result, they maintain, the
evidence is disputed as to whether Ms. Hollander’s stroke may be explained by
7
(...continued)
An adverse reaction is considered to be “probably related to a drug” if the
reaction: (1) “occurs within a reasonable time interval following the
administration of the drug”; (2) “could not readily be attributed to the patient’s
clinical condition/underlying disease, concomitant therapy, or to environmental or
toxic factors”; (3) “follows a known pattern of response to the drug”; and (4)
“disappears or improves following cessation of treatment or dose reduction.” See
Aplt’s App. vol. IV-B, at 2378-79.
Sir Bradford Hill sets forth nine factors that should be considered
“before deciding that the most likely interpretation [of the association] is
causation.” These factors are: strength, consistency, specificity, temporality,
dose response, biological plausibility, coherence, experimental evidence and
analogy. See Aplt’s App. vol. IV-D, at 2949-52 (Bradford Hill paper); vol. II-E,
at 1751-55 (Dr. Kulig’s affidavit). Dr. Kulig applies the Bradford Hill criteria in
reaching his opinion that Parlodel caused Ms. Hollander’s stroke.
-26-
this generally increased risk during the post-partum period, as Sandoz contends,
rather than by her taking Parlodel.
Finally, the Hollanders contend that Drs. Kulig, Iffy, and Jose applied the
methodology generally employed by experts in the relevant fields. Thus, by
relying on scientific principles, professional publications, animal studies,
differential diagnoses, and case reports, these experts did what Daubert requires:
they grounded their conclusions in “the methods and procedures of science” rather
than “subjective belief or unsupported speculation.” Daubert, 509 U.S. at 590.
In order to assess the Hollanders’ argument, we begin with an overview of
the standards for reliability under Daubert and its progeny. Then we turn to an
examination of the scientific opinion evidence at issue here.
1. Scientific Reliability Under Daubert
Under Daubert’s reliability prong, “an inference or assertion must be
derived by the scientific method . . . [and] must be supported by appropriate
validation--i.e. ‘good grounds,’ based on what is known.” Id. The Supreme
Court listed four nonexclusive factors that the trial court may consider in
assessing reliability: (1) whether the opinion at issue is susceptible to testing and
has been subjected to such testing; (2) whether the opinion has been subjected to
peer review; (3) whether there is a known or potential rate of error associated
-27-
with the methodology used and whether there are standards controlling the
technique’s operation; and (4) whether the theory has been accepted in the
scientific community. See id.
The list is not exclusive, and district courts applying Daubert have broad
discretion to consider a variety of other factors. See Kumho Tire, 526 U.S at 150
(“[W]e can neither rule out, nor rule in, for all cases and for all time the
applicability of the factors mentioned in Daubert, nor can we now do so for
subsets of cases categorized by category of expert or by kind of evidence. Too
much depends upon the particular circumstances of the particular case at issue.”).
Generally, the district court should focus on the experts’ methodology rather than
the conclusions that they generate. See Daubert, 509 U.S. at 595. However, the
experts’ conclusions are not immune from scrutiny: “A court may conclude that
there is simply too great an analytical gap between the data and the opinion
proffered.” Joiner, 522 U.S. at 147 (“[N]othing 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.”). Regardless of
the specific factors at issue, the purpose of the Daubert inquiry is always the
same: “[t]o make certain that an expert, whether basing testimony upon
professional studies or personal experience, employs in the courtroom the same
-28-
level of intellectual rigor that characterizes the practice of an expert in the
relevant field.” 8 Kumho Tire, 526 U.S. at 152. 9
2. The Hollanders’ Scientific Evidence
We assess the Hollanders’ challenge to the district court’s Daubert ruling
by examining the opinions of their three primary experts: Drs. Kulig, Iffy, and
Jose. As to each expert, we must assess the grounds that they provide for their
opinion that Parlodel causes stroke, asking whether those grounds involve “the
8
As Justice Breyer has observed, the requirement that the district court
assess reliability and relevance under Daubert “will sometimes ask judges to make
subtle and sophisticated determinations about scientific methodology and its
relation to the conclusions an expert witness seeks to offer--particularly when a
case arises in an area where the science itself is tentative or uncertain, or where
testimony about general risk levels in human beings or animals is offered to prove
individual causation.” Joiner, 522 U.S. at 147-48 (Breyer, J., concurring). Even
though judges usually do not have the formal scientific training to assist them in
making these decisions, there are Rules of Evidence and Civil Procedure that may
assist them in making the necessary determinations. “Among these techniques are
an increased use of pretrial conference authority [pursuant to Fed. R. Civ. P. 16]
to narrow the scientific issues in dispute, pretrial hearings where potential experts
are subject to examination by the court, and the appointment of special masters
and specially trained law clerks.” Id. at 149 (citations omitted).
9
Judge Posner has expressed a similar view. “When the Supreme Court in
Daubert told judges to distinguish between real and courtroom science, it was not
with the object of discovering the essence of “science,” if there is such an
essence. The object . . . was to make sure that when scientists testify in court they
adhere to the same standards of intellectual rigor that are demanded in their
professional work.” Rosen v. C-G Corp., 78 F.3d 316, 318 (7th Cir 1996).
-29-
methods and procedures of science,” Daubert, 509 U.S. at 590, and “the level of
intellectual rigor of the expert in the field.” Kumho Tire, 526 U.S. at 152.
In doing so, we note that the scope of our review is quite narrow: we may
reverse the district court’s ruling only if we conclude that it abused its discretion
in applying Daubert to exclude opinions of the Hollanders’ experts. Because the
district court has discretion to consider a variety of factors is assessing reliability
under Daubert, and because, in light of that discretion, there is not an extensive
body of appellate case law defining the criteria for assessing scientific reliability,
we are limited to determining whether the district court’s application of the
Daubert manifests a clear error of judgment or exceeds the bounds of permissible
choice in the circumstances. See McEwen, 926 F.2d at 1553-54 (discussing
appellate review for an abuse of discretion). Thus, when coupled with this
deferential standard of review, Daubert’s effort to safeguard the reliability of
science in the courtroom may produce a counter-intuitive effect: different courts
relying on the essentially the same science may reach different results. See
generally Federal Judicial Center, Reference Manual on Scientific Evidence 27
(2d ed. 2000) (observing that, in light of the abuse of discretion standard of
review for Daubert determinations of reliability, “in theory judges are free to
select different procedures and apply different factors to a particular expert or
type of expertise than their colleagues do in the same district or circuit” and that
-30-
“[a]s a consequence, similar cases could be resolved differently on the basis of
inconsistent determinations about admissibility”); see also Brasher, 160 F. Supp.
2d at 1298 n.17 (observing that the Eighth Circuit’s decision in Glastetter, 252
F.3d at 989-92, affirming the exclusion of Parlodel evidence as unreliable “does
not necessarily [establish] that an inconsistent holding by this court would
constitute an abuse of discretion”). 10
a. Similarity to other ergot alkaloids
We begin our analysis with Dr. Kulig’s testimony that bromocriptine is an
ergot alkaloid. According to Dr. Kulig, this fact supports his theory that
bromocriptine causes vasoconstriction.
As the district court observed, neither Dr. Kulig nor the Hollanders’ other
experts disputed the fact that bromocriptine has a different chemical structure
than ergot alkaloids known to cause vasoconstriction. Moreover, neither Dr.
Kulig nor the Hollanders’ other experts disputed the scientific literature stating
that small differences in chemical structure may produce substantial differences in
physiological effects.
10
Conflicting decisions in the district courts regarding the reliability of
opinion testimony about Parlodel further illustrate this point. Compare Siharath,
131 F. Supp. 2d 1347 (evidence regarding Parlodel’s adverse effects unreliable);
and Brumbaugh, 77 F. Supp. 2d 1153 (same); with Brasher, 160 F. Supp. 2d 1291
(Parlodel evidence reliable); and Globetti v. Sandoz Pharms., Corp., 111 F. Supp.
2d 1174 (N.D. Ala. 2000) (same).
-31-
In light of these considerations, several courts have agreed with the district
court’s conclusion that the fact that bromocriptine is an ergot alkaloid does not
constitute reliable scientific evidence that it causes vasoconstriction and
associated adverse reactions like heart attacks and strokes. See Glastetter, 252
F.3d at 990 (“[T]his generic assumption that bromocriptine behaves like other
ergot alkaloids carries little scientific value. Even minor deviations in molecular
structure can radically change a particular substance’s properties and
propensities.”); 11 Brumbaugh, 77 F. Supp. 2d at 1156 (“Testimony extending
general conclusions about similar drugs does not meet Daubert’s requirement of
reliability.”); Siharath, 131 F. Supp. 2d at 1363-65 (finding a lack of reliable
evidence that bromocriptine acts like other ergot alkaloids). Moreover, in a
similar case, this circuit has rejected the argument that one chemical’s
resemblance to another known to have deleterious effects constituted reliable
causation evidence. See Mitchell, 165 F.3d at 782 (“Missing from [the plaintiff’s
evidence] is additional testimony explaining what these similarities are and how
the similarities cause the human body to respond to Defendant’s chemicals in a
manner similar to benzene.”).
11
The Eighth Circuit also noted that “one leading treatise on medical
toxicology concludes that bromocriptine has no vasoconstrictive properties.”
Glastetter, 252 F. 3d at 990 (emphasis in original) (citing Matthew J. Ellenhorn,
Ellenhorn’s Medical Toxicology: Diagnosis and Treatment of Human Poisoning
1879, table 74-23 (2d ed.1997)).
-32-
These decisions support the district court’s analysis. Accordingly, the
district court did not abuse its discretion in finding that bromocriptine’s similarity
to other ergot alkaloids constituted an unreliable basis on which to conclude that
the drug causes vasoconstriction and ensuing adverse effects like Ms. Hollander’s
stroke.
b. Pharmacology of bromocriptine
In important respects, the Hollanders’ experts’ discussion of the specific
pharmacological properties of bromocriptine is similarly speculative. For
example, Dr. Kulig’s affidavit refers to the drug’s known effects on dopamine and
serotonin, and notes that these neurotransmitters are known to trigger
vasoconstriction and vasospasm. However, although he states that the effect of
Parlodel on serotonin receptors “has been demonstrated in company studies,”
Aplt’s App. vol. II-E, at 1747, Dr. Kulig provides no details on the methodology
or conclusions of these studies. Moreover, the mere fact that Parlodel acts on
serotonin and dopamine receptors does not establish that Parlodel itself, as
opposed to some other agent that triggers either the release of these
neurotransmitters or some other physiological mechanism, causes
vasoconstriction, hypertension, and stroke.
-33-
The testimony of Dr. Jose (the expert on peripheral dopamine receptors)
reveals similar deficiencies. Although he presented an elegant theory of the way
in which bromocriptine might have the paradoxical effect of causing
vasoconstriction and increased blood pressure, he acknowledged that there were a
number of animal studies that concluded that bromocriptine decreases blood
pressure. Dr. Jose attempted to distinguish these studies by observing that the
specific conditions that he had posited as necessary to trigger the paradoxical
effects of bromocriptine were not present. However, he acknowledged that his
thesis had not been tested. See Aplt’s App. vol. II-A, at 802 (“I have bits and
pieces proving that bromocriptine can increase sodium reabsorption, bits and
pieces that can show that bromocriptine can decrease blood flow; but to put all of
them together [to demonstrate that bromocriptine can cause high blood pressure]
no, that has not been tested.”). Accordingly, the district court did not exercise
manifestly unreasonable judgment in concluding that the opinions of the
Hollanders’ experts did not meet the Daubert reliability standard insofar as those
opinions were based on the pharmacology of bromocriptine.
c. Studies of hypertension
Both Dr. Kulig and Dr. Iffy relied on studies regarding the relationship
between bromocriptine and hypertension. Dr. Kulig referred to a 1981 study
-34-
commissioned by Sandoz in which women received the drug to treat amennorrhea-
galactorrhea syndrome. 12 Dr. Kulig states that nineteen percent of those women
reported increases in blood pressure. Both experts invoke a study by
D.I. Watson, which concluded that women with pregnancy-induced hypertension
who then took bromocriptine after giving birth had a higher incidence of
postpartum hypertension than women who did not receive the drug. 13
Again, it is not an abuse of discretion to conclude that there is “simply too
great an analytical gap” between these studies and the experts’ conclusion that
Parlodel caused Ms. Hollander’s stroke. See Joiner, 522 U.S. at 146. The studies
in question do not directly address the relationship between Parlodel and stroke.
Moreover, the Hollanders presented no expert analysis as to how one might
extrapolate from bromocriptine’s effect on a small group of women with
amennorrhea-galactorrhea syndrome to determine the effect that the drug would
have on women like Ms. Hollander who took the drug as a postpartum lactation
suppressant.
12
Amenorrhea refers to an “absence or abnormal stoppage of the menses.”
See Dorland’s Illustrated Medical Dictionary 55. Galactorrhea is the “excessive
or spontaneous flow of milk” or the “persistent secretion of milk irrespective of
nursing.” Id. at 672.
13
D.I. Watson, et al., supra, Obstetrics and Gynecology, 74(4): 573-576
(Aplt’s App. vol. II-D, at 1596-97).
-35-
As to the Watson study, Dr. Iffy admitted that it did not claim a “high
degree of reliability.” Aplt’s App. vol. II-A, at 698. Dr. Iffy acknowledged that,
under the study’s criteria for determining which women had pregnancy-induced
hypertension, Ms. Hollander herself would not qualify. Id. Thus, she was not in
the class of patients whose blood pressure increased after taking Parlodel.
d. Animal Studies
According to the Hollanders’ experts, there are certain animal studies that
also provide evidence that bromocriptine may cause vasoconstriction,
hypertension, and stroke. These studies included those performed on isolated
veins, on animals that were unconscious, and on pithed animals. Many involved
large doses of bromocriptine, relatively much greater than the doses taken by Ms.
Hollander.
Several recent decisions considering these studies have agreed with the
district court’s analysis. The studies suggest only that bromocriptine may act as a
vasoconstrictor in very specific circumstances in certain kinds of animals; the
studies do not constitute reliable evidence that bromocriptine causes strokes. See
Glastetter, 252 F.3d at 991 (noting that one of the plaintiff’s experts concluded
that “not a single animal study had ever concluded that [intracerbral hemorrhage]
was associated with bromocriptine”); Caraker v. Sandoz Pharms. Corp., 172 F.
-36-
Supp. 2d 1046, 1050-51 (S.D. Ill. 2001) (noting that “some [studies] involved
animals that had a steel rod injected down their spinal cord to destroy it so the
animal has no intact nervous system, some involved bromocriptine’s reaction
locally (e.g., in a single isolated vein of an animal) as opposed to a systemic
administration; and some were poorly documented”); Siharath, 131 F. Supp. 2d at
1367-69 (discussing three animal studies in detail and concluding that they did
not constitute a reliable basis for experts’ opinions that Parlodel caused the
plaintiff’s stroke).
In light of these characteristics of the animal studies, the district court’s
conclusion that they were unreliable does not “exceed[] the bounds of permissible
choice in the circumstances.” McEwen, 926 F.2d at 1553-54. We therefore
discern no abuse of discretion in the court’s analysis.
e. Case studies and differential diagnosis
The next methodologies employed by the Hollanders’ experts present a
closer question. “Differential diagnosis” refers to the process by which a
physician “‘rule[s] in’ all scientifically plausible causes of the plaintiff’s injury.
The physician then ‘rules out’ the least plausible causes of injury until the most
likely cause remains.” Glastetter, 252 F.3d at 989 (8th Cir. 2001). The remaining
cause is the expert’s conclusion. Id. In conducting a differential diagnosis,
-37-
physicians often use case reports—“a doctor’s account of a particular patients’
reaction to a drug or other stimulus, accompanied by a description of the relevant
surrounding circumstances.” Id.
Here, Drs. Kulig, Iffy, and Jose performed a differential diagnosis,
reviewing Ms. Hollander’s medical history and medical records, excluding other
causes of her stroke, and then attributing the stroke to Parlodel. They relied in
part on case reports, both those filed with the FDA and those published in the
professional literature. Dr. Kulig expressed the view that the onset of Ms.
Hollander’s initial symptom (i.e., developing a headache several days after giving
birth) and the timing of her stroke (several days after her discharge from the
hospital) fit a general pattern seen in patients suffering adverse reactions to
Parlodel and was also consistent with the pharmokinetics of the drug.
With regard to differential diagnoses, courts have reached contrasting
conclusions as to reliability under Daubert. Compare Westberry v. Gislaved
Gummy GB, 178 F.3d 257, 262-66 (4th Cir. 1999) (holding that “[a] reliable
differential diagnosis provides a valid basis for an expert opinion on causation”
and concluding that the district court did not abuse its discretion in admitting a
physician’s opinion testimony based on differential diagnosis) with Glastetter,
252 F.3d at 989 (holding that a district court did not abuse of discretion in
excluding a differential diagnosis that was “scientifically invalid”); see also
-38-
Federal Judicial Center, Reference Manual on Scientific Evidence 34 (2d. ed.
2000) (noting that “[j]udges disagree on whether a physician relying on the
methodology of clinical medicine can provide adequate proof of causation in a
toxic tort action”). Courts have also reached contrasting conclusions as to the
reliability of case reports. Compare Glaser v. Thompson Med. Co., 32 F.3d 969,
975 (6th Cir. 1994) (holding that the district court abused its discretion in
excluding physician’s opinion testimony based in part on case reports) with
Casey v. Ohio Med. Prods., 877 F. Supp. 1380, 1385 (N.D. Cal.1995) (stating that
“case reports are not reliable scientific evidence of causation, because they simply
described reported phenomena without comparison to the rate at which the
phenomena occur in the general population or in a defined control group; do not
isolate and exclude potentially alternative causes; and do not investigate or
explain the mechanism of causation”); see generally Federal Judicial Center,
Reference Manual on Scientific Evidence 475 (noting that “[c]ausal attribution
based on case studies must be regarded with caution” but that “such studies may
be carefully considered in light of other information available, including
toxicological data,” and citing cases reaching contrasting conclusions on their
-39-
admissibility under Daubert). 14 Our circuit does not appear to have addressed the
reliability of differential diagnosis and case reports under Daubert.
In the instant case, the district court made short shrift of the Hollanders’
experts’ differential diagnoses and reliance on case reports. The court stated that
“[b]ecause of their limitations, case reports have been repeatedly rejected as a
scientific basis for a conclusion regarding causation.” Hollander, 95 F. Supp. 2d
at 1237.
Because the Daubert reliability inquiry is case-specific, we need not
address, in general terms, the reliability of differential diagnoses and case reports.
See Kumho Tire, 526 U.S. at 150. Instead, we must only decide whether the
district court abused its discretion by characterizing the specific diagnoses and
case reports at issue here as unreliable under Daubert.
Again, we conclude that the district court did not abuse its discretion. In
many of the decisions in which a differential diagnosis has been deemed reliable,
the party relying on the diagnosis has offered independently reliable evidence that
14
The conflicting views of the reliability of differential diagnosis are
apparent in the Parlodel cases too. Compare Brasher, 160 F. Supp. 2d at 1296
(concluding that differential diagnosis constitutes a reliable methodology under
Daubert) and Globetti, 111 F. Supp. 2d at 1178 (characterizing differential
diagnosis as “a well-recognized and widely-used technique relied on by medical
clinicians worldwide to identify and isolate the causes of disease”) with
Glastetter, 252 F.3d at 1362 (concluding that differential diagnosis and case
reports did not establish reliable proof of causation), and Siharath, 131 F. Supp.
2d at 1361-63 (same).
-40-
the allegedly dangerous drug or substance had harmful effects. See, e.g.,
Zuchowicz v. United States, 140 F.3d 381, 385-87 (2d Cir. 1998) (affirming
admission of differential diagnosis based in part on scientific articles regarding
the effects of a drug); Kennedy v. Collagen Corp., 161 F.3d 1226, 1228-30 (9th
Cir. 1998) (holding that the district court abused its discretion in excluding expert
opinion based on differential diagnosis when the diagnosis was supported by
scientific and clinical studies regarding the connection between collagen and
autoimmune disorders). That is not the case here. In order to “rule in” Parlodel
as a scientifically plausible cause of Ms. Hollander’s stroke, the Hollanders’
experts would need to present reliable evidence that the drug can cause strokes,
and for the reasons we have discussed, the district court did not abuse its
discretion in concluding that the experts did not do so. See Glastetter, 252 F.3d
at 989 (affirming the district court’s exclusion of a differential diagnosis); cf.
Siharath, 131 F. Supp. 2d at 1362-63 (“[A] fundamental assumption underlying
this method is that the final, suspected ‘cause’ remaining after this process of
elimination must actually be capable of causing the injury. That is, the expert
must ‘rule in’ the other suspected cause as well as ‘rule out’ other possible
causes. And, of course, expert opinion on this issue of general causation must be
derived from scientifically valid methodology.”) (internal quotation marks
omitted).
-41-
We take a similar view of the case reports regarding other women suffering
various injuries after taking Parlodel. Many of these case reports contain only
limited information regarding the medical histories of the patients and the nature
of the injuries they suffered. In addition, given the large number of women who
took Parlodel and the variety of possible causes for many of these injuries, it was
not unreasonable for the district court to characterize the reports as unreliable
evidence of causation. See Siharath, 131 F. Supp. 2d at 1361 (noting that “case
reports . . . do not isolate and exclude potentially alternative causes; and do not
investigate or explain the mechanism of causation” and that, as to Parlodel, “the
modest number of case reports associating the drug with stroke or even
postpartum hypertension is not what would be expected if there was a significant
increased risk ”) (internal quotation marks omitted).
In holding that the district court did not abuse its discretion in excluding
the particular differential diagnoses and case reports submitted by the Hollanders,
we emphasize that, in other litigation, there may well be differential diagnoses
and case reports that do not suffer from the same deficiencies noted by the district
court here. For example, if the case reports in this record contained more detailed
information about other women who suffered strokes and heart attacks after
taking Parlodel, and if there were a substantially larger number of such detailed
reports, that information might have provided support for the theories of Drs.
-42-
Kulig, Iffy, and Jose. In that instance, a district court might well be justified in
finding opinion testimony like that of Drs. Kulig, Iffy, and Jose reliable under
Daubert. See Caraker, 172 F. Supp. 2d at 1050 (stating that “an overwhelming
amount of case reports of a temporal proximity between a very specific drug and a
very specific adverse event might . . . be enough to make a general causation
conclusion sufficiently reliable” but adding that “[i]n this case, however, we have
a scant number of case reports”).
Moreover, as the Eighth Circuit has written:
[W]e do not believe that a medical expert must always cite
published studies on general causation in order to reliably
conclude that a particular object caused a particular
illness. The first several victims of a new toxic tort should
not be barred from having their day in court simply
because the medical literature, which will eventually show
the connection between the victims’ condition and the
toxic substance, has not yet been completed. If a properly
qualified medical expert performs a reliable differential
diagnosis through which, to a reasonable degree of medical
certainty, all other possible causes of the victims'
condition can be eliminated, leaving only the toxic
substance as the cause, a causation opinion based on that
differential diagnosis should be admitted.
Turner v. Iowa Fire Equip. Co., 229 F.3d 1202, 1209 (8th Cir. 2000) (internal
quotation marks omitted); see also Westberry, 178 F.3d at 262 (holding that a
reliable differential diagnosis alone may provide a valid foundation for a
causation opinion, even when no epidemiological studies, peer-reviewed
published studies, animal studies, or laboratory data are offered in support of the
-43-
opinion). However, in light of the deficiencies of the particular differential
diagnoses and case reports in this record, the district court’s analysis was not
unreasonable.
f. Rechallenge and dechallenge reports
Ms. Hollanders’ experts also presented several accounts of rechallenge and
dechallenge. Rechallenge occurs when a patient is exposed to the same drug
thought to have previously caused an adverse reaction. Dechallenge occurs when
the drug is removed. As the Eighth Circuit has noted, rechallenge and
dechallenge resemble controlled experiments in some ways, and thus may be more
valuable than typical case reports. Glastetter, 252 F.3d at 990-91. Occasionally
the results may appear quite dramatic. For example, one Sandoz employee
described a rechallenge-dechallenge report as “‘the smoking gun’ we have looked
for so diligently.” Aplt’s App. vol. IV-B, at 2364. 15
Nevertheless, by the Hollanders’ account, there were only three such
reports. See Aplt’s Br. at 31. Of these three, only one involved vasoconstriction
15
A physician reported to Sandoz that he had induced vasoconstriction of
the cerebral blood vessels by administering small doses of Parlodel to a woman
who had previously suffered a stroke after taking the drug. See Aplt’s App. vol.
IV-B, at 2364-65 (memorandum from Dr. William F. Westin, dated Sept 17,
1987). There appears to be no further discussion of this report in the record.
-44-
of the cerebral blood vessels. 16 Moreover, as to that incident, the only
information to which the Hollanders’ have directed us is a second-hand account
by a Sandoz physician. Thus, the district court conclusion here —that there were
too few of these reports for them to constitute reliable evidence of causation
under Daubert—was not unreasonable. Cf. Glastetter, 252 F.3d at 990 (finding
rechallenge and dechallenge data to be more potent proof of causation than did
the district court but further concluding that the district court did not abuse its
discretion in excluding it).
g. The Risks of Stroke in the Postpartum period
A linchpin of Sandoz’s defense was that there is an increased risk of stroke
in the postpartum period generally. Sandoz relied heavily on a study concluding
that there is a 28.3 relative risk of stroke for women in the postpartum period, as
compared with non-pregnant women. See Steven J. Kittner, et al., Pregnancy and
the Risk of Stroke, New Eng. J. Med. 768-74 (1996) (Aplt’s App. vol. II-C, at
1335-41). 17
16
One of the incidents involved the vasoconstriction of a coronary artery
and another involved hypertension.
17
One authority explains the concept of “relative risk” as follows:
[Relative risk] is defined as the ratio of the incidence rate
(often referred to as incidence) of disease in exposed
(continued...)
-45-
17
(...continued)
individuals to the incidence rate in unexposed individuals.
....
The incidence rate of disease reflects the number of
cases of disease that develop during a specified period of
time divided by the number of persons in the cohort under
study. Thus, the incidence rate expresses the risk that a
member of the population will develop the disease within
a specified period of time.
For example, a researcher studies 100 individuals
who are exposed to an agent and 200 who are not exposed.
After one year, 40 of the exposed individuals are
diagnosed as having a disease, and 20 of the unexposed
individuals are also diagnosed as having the disease. The
relative risk of contracting the disease is calculated as
follows:
-The incidence rate of disease in the exposed
individuals is 40 cases per year per 100 persons (40/100),
or 0.4
-The incidence rate of disease in the unexposed
individuals is 20 cases per year per 200 persons (20/200),
or 0.1.
A relative risk of 4.0 indicates that the risk of
disease in the exposed group is four times as high as the
risk of disease in the unexposed group.
....
Although a relative risk is a straightforward concept,
care must be taken in interpreting it. Researchers should
scrutinize their results for error. Error in the design of the
study could yield an incorrect relative risk. Sources of
bias and confounding should be examined. Whenever an
association is uncovered, further analysis should be
conducted to determine if the association is real or due to
an error or bias. Similarly, a study that does not find an
(continued...)
-46-
Thus, according to Sandoz, Ms. Hollander’s stroke could well have been the
result of the increased risk to which all women are exposed during the postpartum
period rather than an adverse reaction to Parlodel.
In the district court proceedings, the Hollanders challenged this argument
primarily through the testimony of Dr. Kulig, who stated that the Kittner study
(and others reaching similar conclusions about the risks of the postpartum period)
did not control for bromocriptine use or for specific conditions that increase the
risk of stroke, such as eclampsia. According to Dr. Kulig, when these factors are
excluded, the Kittner study does not establish that there is an increased risk of
stroke in the postpartum period.
The district court acknowledged Dr. Kulig’s criticisms of the study.
However, the court found that “the postpartum incidence of stroke is a factor that
should be considered.” See Hollander, 95 F. Supp. 2d at 1238 n.21.
17
(...continued)
association between an agent and disease may be
erroneous because of bias or random error.
Federal Judicial Center, Reference Manual on Scientific Evidence 348-49.
Thus, in the instant case, the study cited by Sandoz concluded that women
in the postpartum period were 28.3 times more likely than non-pregnant women to
have suffered a stroke.
-47-
The Hollanders now argue that the district court erred in its qualified
affirmation of the Kittner study in the face of Dr. Kulig’s critique of it. If this
case required Sandoz to prove that there was an increased risk of stroke during
pregnancy, we might agree. However, no such burden is imposed on Sandoz here.
Instead, it is the Hollanders who have the burden of demonstrating the harmful
effect of Parlodel. Accordingly, it was not unreasonable for the district court to
conclude that Dr. Kulig’s attack on the Kittner study did not constitute reliable
evidence that Parlodel caused Ms. Hollander’s stroke.
In summary, we agree with the court’s assessment in Siharath: the
Hollanders have done the best they could with the available data and the scientific
literature. See 131 F. Supp. 2d at 1373. The data on which they rely might well
raise serious concerns in conscientious clinicians seeking to decide whether the
benefits of the drug outweigh its risks. However, in deriving their opinions that
Parlodel caused Ms. Hollander’s stroke from the various sources we have
outlined, Drs. Kulig, Iffy, and Jose all made several speculative leaps. As a
result, the district court did not abuse its discretion in excluding their testimony
under Daubert.
-48-
C. Grant of Summary Judgment to Sandoz
In a related argument, the Hollanders maintain that, even if the district
court did not abuse its discretion in excluding their experts’ testimony, the court
nevertheless erred in granting summary judgment to Sandoz.
According to the Hollanders, the following evidence demonstrates that
there are controverted issues of material fact as to whether Parlodel caused her
stroke: (1) the FDA’s determination that Parlodel had not been shown to be safe
when prescribed as a postpartum lactation suppressant; (2) the judgment entered
against Sandoz in a case in Kentucky involving Parlodel; (3) incidents of
dechallenge and rechallenge; (4) case reports; (5) studies of hypertension; (6) the
fact that bromocriptine is an ergot; (7) animal studies; and (8) epidemiological
studies.
We engage in de novo review of the district court’s summary judgment
ruling, applying the same standard as the district court under Fed. R. Civ. P.
56(c). See Adler v. Wal-Mart Stores, Inc., 144 F.3d 664, 670 (10th Cir. 1998).
Summary judgment is appropriate “if the pleadings, depositions, answers to
interrogatories, and admissions on file, together with the affidavits, if any, show
that there is no genuine issue as to any material fact and that the moving party is
entitled to a judgment as a matter of law.” Rule 56(c). We view the facts and the
-49-
reasonable inferences to be drawn from them in the light most favorable to the
nonmoving party. Adler, 144 F.3d at 670.
Under Oklahoma law, which we apply in this diversity case, see Wood v.
Eli Lilly & Co., 38 F.3d 510, 512 (10th Cir. 1994), “[a] plaintiff seeking recovery
for an injurious side effect from a properly manufactured prescription drug must
prove that the drug caused the injury and that the manufacturer breached a duty to
warn of possible detrimental reactions.” McKee v. Moore, 648 P.2d 21, 23 (Okla.
1982). Causation is established if “in a natural and continuous sequence,
unbroken by an independent cause” the drug produces an injury that would not
have occurred if it had not been administered. See Gaines v. Providence
Apartments, 750 P.2d 125, 126-27 (Okla. 1987) (defining proximate cause).
We need not address the Hollanders’ argument in detail. We have already
ruled that five of the eight categories of evidence on which they rely did not
constitute sufficiently reliable grounds under Daubert for their experts’
opinions. 18 As a result, these categories of evidence do not raise questions of fact
on issues of causation.
Moreover, under Oklahoma law, a plaintiff must introduce expert testimony
if “the fact in issue is not within the realm of ordinary experience of mankind.”
18
These categories of evidence are as follows: incidents of dechallenge and
rechallenge; case reports; studies of hypertension; the fact that bromocriptine is
an ergot; and animal studies.
-50-
Strubhart v. Perry Mem’l Hosp. Trust Auth., 903 P.2d 263, 274 (Okla. 1995).
Here, the alleged effect of Parlodel is not within the realm of ordinary experience:
in order to assess the arguments regarding the alleged effects of the drug, the
factfinder would be required to assess the wide variety of scientific evidence that
we have discussed here. As a result, the Hollanders cannot prove their claim
without expert testimony.
Finally, we consider briefly the three categories of evidence that we have
not yet addressed—the FDA determination, the judgment in the Roberts case, and
the epidemiological studies. None of this evidence provides sufficient support for
the Hollanders’ claims.
As to the FDA determination, this circuit has noted that differing standards
militate against applying regulatory actions to the elements of tort law. See
Mitchell, 165 F.3d at 783 n.3 (10th Cir. 1999). In assessing a district court’s
application of Daubert, we discounted a state agency’s classification of a
substance as a carcinogen, stating that the methodology employed by the agency
“results from the preventive perspective that the agencies adopt in order to reduce
public exposure to harmful substances,”and that “[t]he agencies’ threshold of
proof is reasonably lower than that appropriate in tort law.” Id. (internal
quotation marks omitted).
-51-
Moreover, several courts have concluded that this specific FDA ruling
about Parlodel is not relevant to the causation question. See Glastetter, 252 F.3d
at 991 (noting that the FDA ruling is not reliable evidence of causation for two
reasons: (1) because the FDA “balanced Parlodel’s possible harm against its
limited beneficial use,” an irrelevant consideration in the Daubert inquiry; and (2)
because “[t]he FDA will remove drugs from the marketplace upon a lesser
showing of harm to the public than the standards used to assess tort liability”);
Siharath, 131 F. Supp. 2d at 1366 (rejecting the plaintiff’s reliance on the FDA
ruling). Moreover, the language used in the FDA ruling regarding the withdrawal
of Parlodel indicates that the agency did not make a determination that Parlodel
causes seizures and strokes. 19 Accordingly, we conclude that the FDA ruling does
not establish that there are controverted factual issues as to whether Parlodel
caused Ms. Hollanders’ stroke. 20
19
The FDA ruling states that the evidence received by the FDA “calls into
question bromocriptine’s safety,” that bromocriptine “may be an additional risk
factor in patients who are already at risk for seizures and stroke,” and that the
FDA had obtained new evidence “suggesting that therapeutic use of
bromocriptine for the prevention of physiological lactation may lead to serious
adverse experiences . . . .” 59 Fed. Reg. 43348, 43351 (Aug. 24, 1994) (emphasis
added).
20
Our conclusion about the FDA’s decision to withdraw the indication for
Parlodel as a lactation suppressant should not be read to suggest that, as a general
rule, regulatory decisions lack the intellectual rigor necessary under the Daubert
reliability inquiry. Indeed, some authorities view the review process in the
regulatory area as typically “far more careful and systematic” than the peer review
(continued...)
-52-
As to the judgment in the Roberts case, the Hollanders fail to explain its
relevance. The case was decided under Kentucky law, and our decision is
governed by different law and different facts. Moreover, in light of the district
court’s broad discretion in these matters, the fact that different courts reach
difference conclusions as to reliability under Daubert does not establish that a
legal error has been made by one or the other. See Brasher, 160 F. Supp. 2d at
1299 n.17 (noting that inconsistent rulings Daubert rulings do not necessarily
establish an abuse of discretion).
Finally, the epidemiological studies in question do not support the
Hollanders’ claim. The district court accurately observed that the Hollanders’
own experts did not rely on these studies. Moreover, as the district court further
noted, “[a]though several studies have been conducted regarding Parlodel and
stroke, none has shown a statistically significant link between them.” Hollander,
95 F. Supp. at 1236. See also Siharath, 131 F. Supp. at 1356-59 (discussing four
studies finding no statistically significant association). 21
20
(...continued)
process employed by scientific journals. See Kenneth R. Foster & Peter W.
Huber, Judging Science: Scientific Knowledge in the Federal Courts 174 (1997).
“Regulators require that documents submitted to them contain far more detail than
is typically found in papers submitted to professional journals . . . . [and]
administrative reports—not peer reviewed journals—may provide parties with the
solidest available data.” Id. at 174-75.
21
The Hollanders also suggest that a totality of the circumstances approach
(continued...)
-53-
Accordingly, we conclude that the district court properly granted Sandoz’s
motion for summary judgment.
D. Dismissal of Sandoz, Ltd.
Prior to ruling on the Daubert and summary judgment motions, the district
court dismissed the Hollanders’ claims against the defendant Sandoz, Ltd., a
company incorporated in Switzerland with its principal place of business there.
Prior to January 1, 1990, Sandoz, Ltd. sold Parlodel in bulk to the defendant
Sandoz Corporation. However, after that date, Sandoz, Ltd. became a holding
company, conducting no advertising in the United States and owing no
manufacturing, distribution, or sales facilities here. In granting Sandoz’s motion
to dismiss, the district court reasoned that Sandoz, Ltd. “does not have a bank
account, a telephone number or any employees, officers or directors in this
country; and that it does not actively advertise in the United States.” Aplt’s App.
vol. I, at 344 (Dist. Ct. Order, filed Dec. 10, 1996, at 1). Accordingly, the court
21
(...continued)
establishes that there are controverted issues of material fact. In essence they
maintain that even though each individual category of evidence may be
insufficient, all of the evidence considered as a whole raises factual questions as
to whether Parlodel caused her stroke. The Hollanders cite no legal authority in
support of this approach, and in our view, this argument is inconsistent with
Daubert. To suggest that those individual categories of evidence deemed
unreliable by the district court may be added to form a reliable theory would be to
abandon “the level of intellectual rigor” of the expert in the field. Kumho Tire,
526 U.S. at 152.
-54-
concluded that it lacked personal jurisdiction over Sandoz, Ltd., and it dismissed
the claims against Sandoz, Ltd. with prejudice.
On appeal, the Hollanders argue that, because Sandoz, Ltd. sold Parlodel to
its United States subsidiary (Sandoz) prior to January 1, 1990, Sandoz, Ltd.
should be deemed to have continued to do business in the United
States through July 1990, when Ms. Hollander suffered her stroke. They contend
that it is unlikely that Sandoz, Ltd. would have completely ceased doing business
in the United States in the seven month period beginning in January 1990 (when it
became a holding company) and July 1990 (when Ms. Hollander took Parlodel).
Additionally, the Hollanders argue that the district court erred in dismissing the
claims against Sandoz, Ltd. with prejudice.
The Hollanders’ challenge to the court’s jurisdictional ruling raises a legal
question that we review de novo. See Wenz v. Memery Crystal, 55 F.3d 1503,
1505 (10th Cir. 1995). Their argument is undermined by precedent that imposes
the burden of proof on the party asserting jurisdiction. See id. Because they
have offered no evidence to rebut Sandoz, Ltd.’s evidence that it did not do
business in the United States after January 1, 1990, we conclude that the district
court properly held that it lacked jurisdiction over the company.
However, we further conclude that the district court should not have
dismissed the Hollanders’ claim against Sandoz, Ltd. with prejudice. Its
-55-
jurisdictional ruling did not address the merits of the Hollanders’ allegations as to
Sandoz, Ltd., and, as a result, the claim against Sandoz, Ltd. should have been
dismissed without prejudice to filing in an appropriate forum. See Posner v.
Essex Ins. Co., Ltd., 178 F.3d 1209, 1221 (11th Cir. 1999) (concluding that the
district court erred in dismissing claims against a party with prejudice on
jurisdictional grounds and instructing the district court to dismiss the claims
without prejudice); Arrowsmith v. United Press Int’l, 320 F.2d 219, 221 (2d Cir.
1963) (“A dismissal for lack of jurisdiction . . . does not preclude a subsequent
action in an appropriate forum.”).
III. CONCLUSION
This case illustrates the continuing importance of the Supreme Court’s
observation in Daubert:
[T]here are . . . differences between the quest for truth in
the courtroom and the quest for truth in the laboratory.
Scientific conclusions are subject to perpetual revision.
Law, on the other hand, must resolve disputes finally and
quickly. The scientific project is advanced by broad and
wide-ranging consideration of a multitude of hypotheses,
for those that are incorrect will eventually be shown to be
so, and that in itself is an advance. Conjectures that are
probably wrong are of little use, however, in the project of
reaching a quick, final, and binding legal judgment--often
of great consequence--about a particular set of events in
the past. We recognize that, in practice, a gatekeeping role
for the judge, no matter how flexible, inevitably on
occasion will prevent the jury from learning of authentic
-56-
insights and innovations. That, nevertheless, is the balance
that is struck by Rules of Evidence designed not for the
exhaustive search for cosmic understanding but for the
particularized resolution of legal disputes.
Daubert, 509 U.S. at 596-97. Thus, in Judge Posner’s words, “the courtroom is
not the place for scientific guesswork, even of the inspired sort. Law lags
science; it does not lead it.” Rosen, 78 F.3d at 319.
Here, the district court characterized the Hollanders’ evidence as such
guesswork, and that characterization was not unreasonable. The Hollanders’
evidence provided support for the FDA’s decision to withdraw the indication for
Parlodel as a postpartum lactation suppressant, as well as for the decisions of
experienced clinicians that the apparent risks of Parlodel outweighed the limited
benefits of prescribing the drug as a lactation suppressant. However, the district
court did not abuse its discretion in ruling that the Hollanders’ evidence did not
satisfy the Daubert standard of reliability.
Additionally, the district court did not err in denying the Hollanders’
motion to remand the case to the Oklahoma state courts or in dismissing the claim
against Sandoz, Ltd. However, the court did err in dismissing the claim against
Sandoz, Ltd. with prejudice.
-57-
Accordingly, we AFFIRM the judgment of the district court in all respects
EXCEPT that we REMAND the Hollanders’ claim against Sandoz, Ltd. with
instructions to dismiss that claim without prejudice. 22
22
In light of our conclusion that the federal district court did not abuse its
discretion in concluding that Hollanders’ expert testimony was unreliable under
Daubert, as well as our conclusion that the court did not err in granting summary
judgment to Sandoz, we need not address the Hollanders’ challenge to the
dismissal of their products liability claim against Presbyterian Hospital. Even
assuming that the dismissal was improper, the Hollanders have failed to explain
why the same reliability problems noted by the federal district court do not defeat
the Hollanders’ products liability claim against Presbyterian Hospital.
We do note, as Presbyterian Hospital observes in its response brief, that
an overwhelming majority of jurisdictions have refused to apply strict liability
principles to claims against hospitals and physicians involving the distribution of
allegedly dangerous drugs or medical devices. See, e.g, Royer v. Catholic Med.
Ctr., 741 A.2d 74 (N.H. 1999) (affirming the dismissal of a products liability
claim based on an allegedly defective prosthesis and reasoning that where “a
health care provider in the course of rendering health care services supplies a
prosthetic device to be implanted into a patient, the health care provider is ‘not
engaged in the business of selling’ prostheses for purposes of strict products
liability”); Cafazzo v. Central Med. Health Servs., Inc., 668 A.2d 521, 525 (Pa.
1995) (rejecting products liability claim based on a prosthesis and reasoning that
“hospitals and physicians are not sellers, providers, suppliers, or distributors of
products such as to activate 402A” and that the policy reasons for strict liability
are not present); Ayyash v. Henry Ford Health Sys., 533 N.W.2d 353, 354 (Mich.
Ct. App. 1995) (rejecting products liability claim against a hospital based on an
allegedly defective temporomandibular joint implant and reasoning that when “a
putative defendant uses a defective product in the course of providing a service,
the courts must decide whether the ‘transaction’ is primarily a sale or a service”
and concluding that “[i]n the case of a physician or hospital rendering medical
care courts typically have characterized the ‘transaction’ as a service” and
adopting that characterization for policy reasons); see generally Linda A. Sharp,
Annotation, Liability of Hospital or Medical Practitioner under Doctrine of Strict
Liability in Tort or Breach of Warranty, for Harm Caused by Drug, Medical
Instrument, or Similar Device Used in Treating Patient, 65 ALR 5th 357, 371 §
2(b) (1999) (noting “the continued reluctance by most courts to apply no-fault
(continued...)
-58-
22
(...continued)
products liability principles in actions against medical defendants for injuries
caused by medical products). But see Thomas v. St. Joseph Hosp., 618 S.W.2d
791 (Tex. Civ. App. 1981) (hospital held strictly liable where hospital gown
ignited when lighted match fell on it); Silverhart v. Mount Zion Hosp., 20 Cal.
App. 3d 1022 (Cal. App. 1st Dist. 1971) (hospital would be found liable where
not engaged in activities integrally related to primary function of providing
medical services—selling a defective product in its gift shop).
Although Oklahoma courts do not appear to have answered this particular
question, we have no reason to believe that those courts would disagree with the
majority rule and extend products liability to hospitals in circumstances like those
in the case at bar. Cf. Allenberg v. Bentley Hedges Travel Serv., Inc., 22 P.3d
223, 230-31 (Okla. 2001) (holding that commercial sellers of used products may
not be held strictly liable, “at least if the alleged defect was not created by the
seller, and the product is sold in essentially the same condition as when it was
acquired for resale”). For that reason, and because the Hollanders did not seek
certification in the district court proceedings, we DENY their motion for
certification to the Oklahoma Supreme Court. See Boyd Rosene & Assocs., Inc.
v. Kansas Municipal Gas Agency, 178 F.3d 1363, 1365 (10th Cir. 1999)
(observing that “[c]ertification is never compelled, even when there is no state
law governing an issue”); Massengale v. Oklahoma Bd. of Examiners in
Optometry, 30 F.3d 1325, 1331 (10th Cir. 1994) (stating that “[w]e generally will
not certify questions to a state supreme court when the requesting party seeks
certification only after having received an adverse decision from the district
court”).
-59-