Court of Appeals Permits Vascular Surgeon’s Expert Testimony In MRI Injection Case

    Vascular Surgery Expert

    Court: Supreme Court of Oregon
    Jurisdiction: Federal
    Case Name: Marcum v. Adventist Health System/West
    Citation: 345 Ore. 237


    In this medical malpractice case, the plaintiff went in for an MRI ordered by her physician. The defendant MRI technician injected the patient with gadolinium, a contrast chemical, to enhance the MRI image. The MRI technician was unable to inject the plaintiff’s arm and instead injected the gadolinium into the back of the patient’s left hand. The patient experienced discomfort, which she expressed to the defendant. Following the injection, the plaintiff’s hand swelled up, turning orange and purple.

    This case arose out of the plaintiff’s appeal against the trial court’s ruling that the plaintiff’s expert witness did not meet the legal standard under Rule 702.

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    The plaintiff’s retained a vascular surgery expert witness to perform a differential diagnosis to rule in the various causes which could have caused the visible symptoms.The expert was a member of the Department of Vascular Surgery at Oregon Health and Sciences University who specialized in hand disorders. In the absence of scientific studies linking gadolinium exposure to the symptoms experienced by the plaintiff, the expert referred to studies done on mice to support his opinion that gadolinium exposure could have been a probable cause for the plaintiff’s injury.

    The court of appeals accepted the differential diagnosis but rejected the expert’s testimony regarding gadolinium exposure being the proximate cause of the plaintiff’s injury because of an absence of scientifically-accepted evidence linking the two.


    The court held that the mere absence of a scientifically proven link between probable cause and injury does not mean the expert’s testimony falls short of the standard under 702. It is difficult to find studies and tests on rare diseases and injuries, such as the one suffered by the plaintiff. Moreover, in cases where the injury was caused by a single incident, a medical doctor could “rule in” probable causes even without prior studies laying them down as such. The court accepted the expert’s process of performing a differential diagnosis to identify gadolinium poisoning as a probable cause, and it also accepted his argument that there was no literature that said gadolinium did not cause necrosis.

    Thus, the court of appeals order was set aside and the expert’s testimony allowed.

    What We Can Learn From This Case

    For immediate and localized injuries caused by a single, sharp incident, differential diagnosis to find proximate cause is a valid method even in the absence of medical literature linking the cause and injury.