The Georgia Court of Appeals affirmed the exclusion of two expert witnesses in a case involving the alleged failure to diagnose severe malaria. The patient presented to the emergency department following a trip to Africa with concerns that he may have contracted malaria. Lab tests confirmed this. The emergency department consulted an infectious disease specialist, who ordered an oral antimalarial drug for treatment. The patient was admitted for observation and he was described as stable. The following day, the infectious disease specialist consulted on the patient and agreed with the initial diagnosis of uncomplicated malaria. The specialist downloaded the diagnostic criteria for severe malaria and put it into the chart.

The same day, a hospitalist assumed the care of the patient. The hospitalist reviewed the infectious disease specialist’s notes and ordered additional blood tests, which showed worsening kidney and liver function. The hospitalist did not specifically notify the infectious disease specialist, even after the patient experienced hypotension and other symptoms. The patient continued to worsen and a second infectious disease specialist was consulted, who diagnosed severe malaria (which is treated differently from uncomplicated malaria). The patient died of multi-organ failure a day later.

The family sued the first infectious disease specialist and the hospitalist. In discovery, Plaintiffs identified two experts, a hospitalist on standard of care and causation, and an internist on “general causation.” The hospitalist testified that she is not an infectious disease specialist or malaria expert. The internist, who also works as a hospitalist, also testified that she is not an infectious disease expert or malaria expert. The second expert testified she could not say whether an alleged failure to call an ID specialist sooner impacted the outcome. The defense moved to exclude the witnesses and the trial court granted the motion.

The Court of Appeals affirmed. In particular, the Court held that the experts were not qualified and the standard of care opinions of the second expert (IM) were not reasonably reliable under a Daubert analysis. The first expert had never diagnosed or treated a patient with severe malaria or taught about it and thus could not testify to the standard of care. On causation, the first expert did not rely on any peer-reviewed literature, but obtained “information from Internet searches.”

For the second expert, the “general causation” opinions were that IV malarial drugs are generally highly effective at reducing mortality in severe malaria cases. But, the expert did not opine on the efficacy of the treatment, only that uncomplicated malaria and severe malaria are treated differently and that treating severe malaria as uncomplicated malaria is going to have a “worse” outcome. The Court held that this was not helpful to the jury and would not have assisted the trier of fact.

Take-home: the courts are becoming much more nuanced on Daubert motions, so each case needs to be examined carefully on the facts and testimony. The case is Humphrey v. Emory Clinic, Inc., __ S.E.2d __ 2023 WL 5737342 (Ga.Ct.App. Sept. 6, 2023).