Neurosurgery Experts Permitted to Discuss Cumulative Pain Without Formally Quantifying Causation

Court: United States District Court for the District of Maryland, Northern Division
Jurisdiction Federal
Case Name: Ripple v. Yalamanchili
Citation: 2013 U.S. Dist. LEXIS 163121


The plaintiff filed a negligence suit against the defendants alleging that they caused her post-operative pain and misrepresented it as a recurring problem secondary to her original condition. The plaintiff claimed this misrepresentation required her to undergo additional surgery. The plaintiff retained a neurosurgery expert witness to support her case, whose testimony was challenged by the defendants.

The Neurosurgery Expert

The plaintiff’s neurosurgery expert had 30 years of professional experience. He completed his internship and residency in neurosurgery at the Wake Forest University Medical Center and subsequently worked as a neurovascular fellow at a neurological institute in Arizona. At the time of the case, the neurosurgery expert served as an adjunct clinical professor of health education in the neurosurgery department of a university. Before these appointments, the neurosurgery expert witness served as a clinical associate and as a clinical assistant professor in the neurosurgery department of the same institution. His research work focused on the efficacy of neurosurgical procedures, particularly carotid endarterectomy, and strategies for cerebrovascular attack prevention.

The neurosurgery expert witness testified that the discrepancies between the MRI report and the treating surgeon’s medical report made it more probable that the treating doctor had breached a standard of care by misleading the plaintiff. The expert further opined on causation, claiming that to a reasonable degree of medical certainty, the combined effect of the plaintiff’s two surgeries, rather than only one, had resulted in her suffering from more pain.


The court noted that the neurosurgery expert’s testimony about the inaccuracy of the treating surgeon’s medical records was relevant. The court determined that even if the expert did not show how incorrect records harmed the plaintiff (as the defendants argued), the expert’s testimony demonstrated a high probability that the treating doctor had breached a standard of care. The court further noted that the defendants had failed to show how admitting this testimony would have been unfairly prejudicial.

The court was of the opinion that the neurosurgery expert’s opinion on causation was based on his extensive education, training, background, and experience as a neurosurgeon, along with a review of the plaintiff’s MRI reports and her medical records. The court observed that the neurosurgery expert had further opined that the plaintiff’s records indicated how she had developed certain symptoms related to the first surgery. The court held that the neurosurgery expert’s inability to quantify the plaintiff’s current pain based solely on the first surgery did not render his testimony about the cumulative painful effect of both surgeries speculative. The court noted that “a reliable expert opinion must be based on scientific, technical, or other specialized knowledge and not on belief or speculation, and inferences must be derived using scientific or other valid methods,” citing Oglesby v. Gen. Motors Corp.


The defendants’ motion for exclusion of the testimony offered by the plaintiff’s neurosurgery expert witness was denied.

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