5 Şubat 2013 Salı

Silver Linings Casebook: Getting Happy with a Bad Discovery Ruling

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You have to hand it to the Academy of Motion Pictures. Byexpanding the number of Best Picture nominees, it ended up selling lots moretickets. Like many people we know, we try to see all the Best Picture nomineesso as to earn the right to grouse about the Academy’s inevitable injustices(e.g., Oliver! over 2001?! Gandhi over ET?!! Art Carney over Jack Nicholson, Al Pacino, and Dustin Hoffman?!!!). In past years, that meant seeing fivefilms. This year, we need to see nine. So that's almost twice as many movietickets, popcorns, nachos, snowcaps, and slushees.  Last weekend we sawSilver Linings Playbook.  It is weird that it took us so long,considering the Philly-centric nature of the story. Brad Cooper plays a bipolarpatient who has trouble coping with life, especially the disintegration of hismarriage. He keeps telling himself that he needs to find the silver linings intough situations. His father seems to have a serious case of OCD, especiallywhen it comes to rooting for and betting on the Philadelphia Eagles. (If onewants to make the point that the enterprise of life is rescuing the good bitsfrom a failure pile, it’s hard to come up with a better metaphor thancheering for a Philadelphia sports team.) A psychiatrist tells the Coopercharacter that he needs a “strategy” (presumably that is the “Playbook” of thetitle) to pluck out the glories from the dismal parade of life's indignities.Nevertheless, it’s not clear what sort of strategy would work – beyond, maybe,just being open to the possibility of happiness.
 
A week ago, we were watching one of our favorite sitcoms,Modern Family. For the first twenty or so minutes, it seemed like a whole lotof nothing. The episode was disappointing.  It was flat.  But itturned out that it was setting us up for a concluding couple of minutes thatare as brilliant as anything we’ve seen in a while. Levitan et al served up aparody of the conclusion of The Godfather. See it for yourself here. More thana few of our lawyer buddies have a running gag about how the most valuablelessons for life and litigation are contained in The Godfather. What welearned from the Modern Family reenactment of The Godfather is that humancleverness is endless, a long set-up can prepare the way for a sublime punchline, that even in our dotage we can laugh ourselves to tears, and that TyBurrell (again) can make us giddy with stonefaced genius.  It soundsoverblown and frivolous, but a tv show managed to amplify our delight in being alive.  
 
For some reason, that excellent television show andexcellent movie put us in mind of a New Yorker article we read many years agoabout a corporate coach named Marshall Goldsmith.  Companies invitedGoldsmith to help executives who were smart, driven, and completely successful,save for the fact that they were utterly obnoxious.  Goldsmith applied hismodified Zen Buddhism to organizational dynamics and emerged with threerules:  (1) Life is Good; (2) Be Happy Now; and (3) Let it Go.  Hewas convinced that those three rules are the key to happiness.  Stopcomplaining and, instead,  appreciate how gorgeous existence is.  Donot play the game of 'I'll be happy when' [e.g., when I get that promotion,when I make enough money, when I get that certain someone to love meback].  And if something wrong is done to you, or, perhaps moreimportantly, if you have done something you regret, learn from it, and thenstop obsessing over it.  To this day, we think more about that New Yorkerarticle than any other we've read over the past (gulp) 35 years.
 
Armed with this wisdom and joy and openness, let's dance in the rain of dodgy legal analysis.  The case is from the Pradaxa MDL, Inre Pradaxa, 2013 U.S. Dist. LEXIS 7979 (S.D. Illinois January 18, 2013).  Theplaintiffs brought a product liability claim against Boehringer IngelheimPharmaceuticals, Inc. ("BIPI") relating to Pradaxa.  As we all know, discovery inmass tort cases is a grim slog. There are way too manycustodial files, way too many databases, and way too many things to do with this stuff, including reviews for responsiveness, privilege, and confidentiality. Even then, we haven't scratched the surface of tasks associated with thismountain of documents and terabytes.  (De-duplication, anyone?) Responding to this discovery costs a company more money than most civillitigation defendants must pay after being found liable -- yet when we talkabout mass tort defendants responding to discovery, we are talking aboutdefendants who have not yet been found liable for anything.  The Americandiscovery regime is, not to put too fine a point on it, insane.
 
Now consider how much more insane it gets when the plaintiffasks for documents relating to drugs that are not at issue in thelitigation.  The Pradaxa MDL plaintiffs asked for documents relating toany lawsuit alleging that BIPI engaged in off-label promotion of any medicineor that BIPI paid kickbacks to induce doctors to prescribe any BIPImedicine.  The plaintiffs also asked BIPI to identify witnesses relatingto such lawsuits, and employees who participated in the alleged wrongfulactivities.  When the plaintiffs inquired about earlier lawsuits, theywere focusing on a qui tam suit alleging off-label marketing of four products, none of them Pradaxa.  As part of thesettlement of that qui tam action, BIPI entered into a Corporate IntegrityAgreement ("CIA").  That CIA governed BIPI's conduct as itrelates to all of BIPI's drugs, including Pradaxa. 
 
BIPI objected to the non-Pradaxa discovery requests ongrounds of relevance and burden.  That is not surprising in theleast.  Nor are the grounds asserted by BIPI surprising:  (a) Pradaxais the only drug at issue in the Pradaxa MDL; (b) the sought-for discovery mostly antedates the conduct atissue in the Pradaxa litigation; and (c) obtaining the non-Pradaxa informationwould "impose a great expense and an undue burden."  2013 U.S.Dist. LEXIS 7979 at *9.  The plaintiffs, you will be shocked to learn,disagreed.  They argued that the non-Pradaxa materials might lead toother acts evidence admissible under Fed. R. Evid. 404(b), that impeachment ammo might surface,and that evidence of improper conduct would be relevant on the issue ofpunitive damages. 
 
We are displeased to report that Chief Judge Herndon bought more arguments from theplaintiffs than the defendant.  The court begins by observing how"federal discovery rules are liberal in order to assist in the preparationfor trial and settlement of litigated disputes."  Id. at *11-12.  Sometimes the beginning gives you a clear idea of the end. Think of Reservoir Dogs.  Or Citizen Kane.  Sometimes you just knowyou're not headed for a happy ending.  In this case, the unhappy ending is the virtual disappearance of any notion ofproportionality in discovery.  Okay, so the rules ofdiscovery are liberal.  Boy,  are they ever liberal.  But theyare not limitless ... are they?  The court cites Fed. R. 26(b)(1). Remember that. 
 
The court reads the Pradaxa MDL complaint to assert"allegations related to the manner in which Pradaxa wasmarketed."  Id. at * 13.  Then here's the kicker:  "Itis entirely possible that the marketing policies and strategies at issue in thequi tam action extended to BIPI's marketing of Pradaxa."  Id. at *15.  Later, in addressing the issue of undue burden, the court ... well,the court does not really seem to care about that issue very much.  First,the court "finds that this evidence is extremely probative." Id. at *19.  Really?  That information the relevance of which is "entirelypossible"?  Anyway, that is not a burden point.  What the courtdoes say about burden is that the "identity of witnesses and documentationsought is not that extensive in relative terms."  Id.  Sorry,but that conclusion (and it really is nothing more than a conclusion; there isn’teven a smidgen of factual support) seems profoundly wrong. The information relating to the earlier lawsuit may be, as the courtsays, "obtainable," but we'd make a wager bigger than any wager theDeNiro character makes in Silver Linings Playbook that production of thosematerials will be massive and expensive.  What are the "relativeterms" that the court alludes to? Relative to an ordinary case? Relative to the rest of the massive production in the case?  Relative toall the paper and data in the world?  Relative to our nation’s GDP?
 
Remember when we mentioned how the court mentioned Rule26(b)(1)?  What about 26(b)(2) (Limitations on Frequency and Extent) or26(g)(1)(B)(iii) (signing a request for discovery is a certification that thediscovery sought is "neither unreasonable nor unduly burdensome orexpensive, considering the needs of the case, prior discovery in the case, theamount in controversy, and the importance of the issues at stake in theaction")?  We do not see how the non-Pradaxa discovery requestssatisfy a rigorous application of the benefit vs. burden balancing test. Yes, as any former federal prosecutor will tell you, Rule 404(b) is a rule ofinclusion not exclusion.  But "other acts" evidence is usuallyfairly unnecessary, tangential stuff and it is still hemmed in by Rule 403(undue prejudice).  Accordingly, if production of the 404(b) materialinvolves significant time, effort, and expense (and please do not ignore theexpense issue just because the defendant is a large corporation, because thatis not part of the balancing test nor should it be), then we think the sideshowof other acts evidence should be shut down.
 
There is a scene in Silver Linings Playbook where Cooper,disgusted with the unhappy ending in A Farewell to Arms, heaves the bookthrough the bedroom window.  Hemingway's book streaks through the nightand plops on the middle of an Upper Darby street.  It lays there, no doubtstunned at the insult.  Poor thing.  It’s not such a bad book. We were tempted to treat the Pradaxa opinion with similar belligerence. But it is only six pages long, so it would merely bounce off our officewindow.  Then we thought about Silver Linings.  And we thought aboutlaughter.  And we thought about Marshall Goldsmith and his threerules.  Is there a way to fend off our unhappy feelings about the battydiscovery ruling in Pradaxa?
 
There are a couple of things.  We've been on panelswith Chief Judge Herndon and we like and respect him.  He has a good senseof humor.  We are not saying that the Pradaxa opinion is a joke (wishfulthinking, that), but we should pay attention to the nice parts of the opinion,especially understanding how difficult and enervating it is to resolvediscovery disputes.  There are some things in the opinion you might evenwant to cite in the face of overreaching plaintiffs.  In seeking aprotective order, BIPI attached a sealed document. Ever the opportunists, theplaintiffs requested that the document be unsealed.  The court denied theplaintiffs' motion without breaking a sweat.  Id. at * 12.  The courtalso narrowed the non-Pradaxa discovery by timeframe -- it had to be 1990 orlater.  Not great, but it's something.  The court also did not get tothe plaintiffs' punitive damages justification for the discovery, so we dodgeda bad law bullet there.
 
Life is still good.  In our experience, when plaintiffsget broad-ranging, additional discovery of things that should not matter, thethings discovered seldom help their case much.  Meanwhile,plaintiff-specific discovery inevitably reveals that a huge chunk of the MDL inventory ispure, unmitigated junk.  Can we be happy now?  Of course we can(though we are still grieving over that last episode of Downton Abbey).  Abad discovery ruling does not diminish the delight we experience from a jobthat surrounds us with smart, engaging people, or from the Drug and Device LawSon bringing home an A on his latest French test, or from a praline dessert wecannot stop thinking about.  Can we let the Pradaxa ruling go?  Sure. It is annoying and wrong, but it is, “in relative terms,” a minorskirmish.  There is more day to dawn.   We look forward toreporting on the silver lining.     
 
                   

Spherical Error Revisited

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Every now and then we run into a decision that wethink is wrong in so many different ways that we call it an example of“spherical error” – that is, error no matter how one looks at it.  We only do that rarely.  Back in May, 2010 we first applied that descriptionto In re Gadolinium-Based Contrast Agents Products Liability Litigation,2010 WL 1796334 (N.D. Ohio May 4, 2010). Then in September of that year we likewise identifiedspherical error in Sheet Metal Workers Local 441 Health & Welfare Planv. GlaxoSmithKline, PLC, 737 F. Supp.2d 380 (E.D. Pa. 2010) – or at leastthe Pennsylvania part of it, which dealt with the law we knew best.
That’s it – two cases earned that sobriquet in theblog’s six-plus years of existence.
Make that three.
The recent decision in Arters v. Sandoz Inc.,2013 WL 308768 (S.D. Ohio Jan. 25 2013), likewise bollixed up the law in somany different ways that we think it rises (falls?) to the level of sphericalerror.
Arters involved a question that a lot of courtshave considered lately with almost (but not quite) uniformly good results –preemption in the context of generic drugs following PLIVA v. Mensing, 131 S. Ct. 2567 (2011).  As in many generic preemption cases, thedefendant sought to have the case dismissed under Rule 12.
That – Rule 12 – is the first error in Arters.  The decision states:
A motion for judgment on the pleadings pursuant to Rule12(c) should not be granted “unless it appears beyond doubt that the plaintiffcan prove no set of facts in support of his claim which would entitle him torelief.”  Conley v. Gibson, 355U.S. 41, 45–46, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957).
Arters, 2013 WL 308768, at *1.
Umm….  No.
Someone must have been the second coming of Rip VanWinkle and slept through the last five years. In a rather well-publicized decision, back in 2007, the Supreme Courtexpressly overruled Conley on specifically this “no set of facts”point.  See Bell Atlantic Corp.v. Twombly, 550 U.S. 544, 561-63 (2007). Twombly?  Maybe you’veheard of it.  If so, you’re already oneup on Arters.  Anyway, the SupremeCourt in Twombly explicitly “retired” the Conley standard reliedupon in Arters:
On such a focused and literal reading of Conley’s“no set of facts,” a wholly conclusory statement of claim would survive amotion to dismiss whenever the pleadings left open the possibility that aplaintiff might later establish some set of undisclosed facts to supportrecovery. . . .  It seemsfair to say that this approach to pleading would dispense with any showing of areasonably founded hope that a plaintiff would be able to make a case; Mr.Micawber’s optimism would be enough.
Seeing this, a good many judges and commentators havebalked at taking the literal terms of the Conley passage as a pleadingstandard.  [many citations omitted]  We could go on, but there is no need to pileup further citations to show that Conley’s“no set of facts” language has been questioned, criticized, and explained awaylong enough. . . . [A]fter puzzling the profession for 50 years, this famous observationhas earned its retirement.  The phrase isbest forgotten as an incomplete, negative gloss on an accepted pleadingstandard.
Twombly, 550 U.S. at 561-63 (emphasisadded).  Then, a couple of years later,the Court made clear that Twombly’s interrment of the Conleylanguage cited in Arters applies across the board to all types of cases.  See Ashcroft v. Iqbal, 556 U.S.662, 684 (2009).
So that’s where the spherical error in Artersgets rolling.  The opinion starts offwith the wrong basic standard for review.
And it’s downhill from there.  Spherical error keeps rolling.
As we mentioned, Arters is a preemptioncase.  So where does the decision gonext?  Why, straight to that old saw, thepurported “presumption against preemption”:
In considering whether these claims are preempted by theFDCA, some deference to state law is appropriate:  “[I]n all preemption cases, and particularlyin those in which Congress has legislated in a field which the States havetraditionally occupied, we start with the assumption that the historic policepowers of the States were not to be superseded by the Federal Act unless thatwas the clear and manifest purpose of Congress.”  Levine, 555 U.S. at 565 (internalquotations omitted).
Arters, 2013 WL 308768, at *4.
Wrong again. Arters is a generic drug case – it’s governed by Mensing,not Levine.  And it’s safe to saythat the presumption against preemption was a major bone of contention in Mensing– and a 5-4 majority of the Court chose not to apply any such presumption.  Four justices in Mensing went fullbore the other direction:  rejecting anysuch presumption and expressing the opposite view, that the Supremacy clause issomething called a “non obstante” provision, and consequently, if anything,there should be a presumption in favor of preemption:
[T]he provision suggests that courts should not strain to find ways to reconcilefederal law with seemingly conflicting state law. . . .  A non obstante provision thus was a usefulway for legislatures to specify that they didnot want courts distorting the new law to accommodate the old.
Mensing, 131 S. Ct. at 2580 (emphasisadded) (plurality opinion).  Now, this piece of Mensingwasn’t a majority opinion (Justice Kennedy did not join this section), but onlyfour justices wanted to apply a positive presumption against preemption of thesort invoked in Arters – and that’s a minority.
So, before we even get to the merits, Artershas directly contradicted three controlling Supreme Court opinions – taking anerroneous pro-plaintiff position as to each.
Why are we not surprised that the merits aren’t anybetter?
The plaintiff in Arters asserted a “designdefect”/“remove from the market” claim à la Bartlett v. MutualPharmaceutical Co., 678 F.3d 30 (3d Cir.), cert. granted, 133 S.Ct.694 (U.S. 2012).  2013 WL 308768, at*4.  Of course, the vast majority ofprecedent is to the contrary.  AnotherOhio case, Fulgenzi v. PLIVA, Inc., 867 F. Supp.2d 966 (N.D. Ohio 2012),held, first, that design defect claims were improperly pleaded under the OhioProduct Liability Act (“OPLA”), id. at 972-73, and further that plaintiffcouldn’t replead because there was no way to construct an unpreempted “designdefect” claim:
Even if the pleading deficiencies could be remedied,dismissal of these claims would still be appropriate because, regardless of howPlaintiff attempts to cast these claims, they are, at the core, failure-to-warnclaims that are clearly preempted. . . .  [A] generic pharmaceutical product must bethe same as the referenced listed drug in active ingredients, safety and efficacyand hence, as was the case with labeling, federal law pre-empts state laws imposingthe duty to change a drug’s design upon generic manufacturers.
867 F. Supp.2d at 973-74 (citations and quotationmarks omitted).  Fulgenziexemplifies decisions reached by many other courts.  See Demahy v. Schwarz Pharma, Inc.,702 F.3d 177, 186 (5th Cir. 2012) (design defect claims are “failure-to-warnclaims under different names” and preempted) (applying Louisiana law); Frazierv. Mylan Inc., ___ F. Supp.2d ___, 2012 WL 6641626, at *5-6 (N.D. Ga. Dec.18, 2012) (“a generic drug is designed to be a copy of a reference listed drugand it must be identical in active ingredients and efficacy” rejecting Bartlettbecause generic “was not free to unilaterally pursue a safer alternative design. . . to comply with state law while also being in compliance withfederal law”); Strayhorn v. Wyeth Pharmaceuticals, Inc.,  ___ F. Supp.2d ___, 2012 WL 3261377, at *10,12 9-10 (W.D. Tenn. Aug. 8, 2012) (“design claim is “at [its] core” a warningclaim; Bartlett “offered little explanation for accepting the failure towithdraw theory”); Lashley v. Pfizer, Inc., 877 F. Supp.2d 466, 478, 480(S.D. Miss. 2012) (design defect claim without alternative design is really apreempted warning claim; Bartlett “unpersuasive and not a proper basisfor relief”); Metz v. Wyeth, 872 F. Supp.2d 1335, 1341 (M.D. Fla. 2012)(generic drug “was required to be the bioequivalent to the reference listeddrug”); Eckhardt v. Qualitest Pharmaceuticals, Inc., 858 F. Supp.2d 792,801 (S.D. Tex. 2012) (“Generics were required to produce a drug that wasequivalent to the brand-name drug and were not free to unilaterally pursue asafer alternative design in order to comply with state law”); In rePamidronate Products Liability Litigation, 842 F. Supp. 2d 479, 484(E.D.N.Y. 2012) (“the federal duty of ‘sameness’’’ also applies in the contextof generic drug design, and federal law preempts state laws imposing a duty tochange a drug’s design on generic drug manufacturers”); Jacobsen v. Wyeth,LLC, 2012 WL 3575293, at *9 (E.D. La. Aug. 20, 2012) (“federal law requiresa generic drug to be of the same design as its brand name counterpart”); Inre: Accutane Products Liability Litigation, 2012 WL 3194952, at *2 (M.D.Fla. Aug. 7, 2012) (“defective design claims are similarly preempted underMensing because the generic drug was required to be the bioequivalent to thereference listed drug”); Aucoin v. Amneal Pharmaceuticals, LLC, 2012 WL2990697, at *8-9 (E.D. La. July 20, 2012) (“federal law requires a generic drugto be of the same design as its brand name counterpart”); Fullington v.PLIVA, Inc., 2012 WL 1893749, at *5 (E.D. Ark. May 23, 2012) (design defectclaim based on inherent risk really a preempted warning claim); Johnson v.Teva Pharmaceuticals USA, Inc., 2012 WL 1866839, at *4 (W.D. La. May 21,2012) (design defect claims preempted because plaintiff “cannot show that analternative drug design was available to the Generic Defendants”); Cooper v.Wyeth, Inc., 2012 WL 733846, at *6 (M.D. La. March 6, 2012) (“if state lawcould require a generic drug manufacturer to wholly withdraw from the marketbased on the unreasonable danger of the product . . . it necessarilymust repudiate the label approved by the FDA”); In re Darvocet, Darvon &Propoxyphene Products Liability Litigation, 2012 WL 718618, at *3 (E.D. Ky.March 5, 2012) (failure to withdraw claim was “based on the allegedly defectivedesign of the drug, which the Generic Defendants, bound by their ‘ongoingfederal duty of sameness,’ were powerless to change”); Lyman v. Pfizer, Inc.,2012 WL 368675, at *4 (D. Vt. Feb. 3, 2012) (design defect claims “arepreempted as well by Mensing’s logic,” since the “ ‘federal duty ofsameness’ . . . applies to the design or composition of the drug aswell as to its labeling”); In re Fosamax (Alendronate Sodium) ProductsLiability Litigation, 2011 WL 5903623, at *6 (D.N.J. Nov. 21, 2011) (“FDArequires generic Fosamax to have the same active ingredient as Fosamax”); Stevensv. PLIVA, Inc., 2011 WL 6224569, at *2 (Mag. W.D. La. Nov. 15, 2011) (“genericpharmaceutical product must be the same as the referenced listed drug . . .in active ingredients”), adopted, 2011 WL 6224556 (W.D. La. Dec. 2,2011).
Arters’ response to this massive opposing precedent?  First, they’re not binding, so theycan be ignored.  2013 WL 308768, at *5(“[n]one of the cases . . . bind this Court on the issue of whetherdesign defect claims are preempted by the FDCA”).  Second, if it’s not a failure to warnclaim, it’s distinguishable.  Id.(“other district courts within the Sixth Circuit have reached the oppositeconclusion. . . .  TheseCourts have considered different state laws and different factual situations.Here, plaintiffs' design-defect claim rests on the alleged violation of anentirely different duty than their failure to warn claim”).
Well, although the first is true, one would expect Artersat least to address the other courts’ reasoning – that bioequivalence means the“same” design as well as warnings – but no, not one word about how there isn’t“sameness” in design claims.  As for thesecond, that’s just false.  While someother Sixth Circuit district courts (Strayhorn (Tennessee) and Darvocet(Kentucky)), were under other states’ laws, Fulgenzi – which Artersnotably fails to cite – simply isn’t.  Fulgenzianalyzed the identical question under identical state law.  Arters sweeps the mostdirectly-on-point precedent silently under the rug.
But the scope of the error in Arters is evenworse than ignoring uncomfortable precedent. Rather, Arters should never have been out on that limb, and thusruling contrary to both Mensing and the great weight of precedent, in the firstplace.  The decision puts the cart beforethe horse.  There has to be a state lawclaim first – before it can be preempted. See Purvis v. Teva Pharmaceuticals, USA, Inc., ___ F.Supp.2d ___, 2012 WL 5364392, at *4 (M.D. La. Oct. 30, 2012) (design defectclaim without alternative design not viable; Bartlett not persuasive); Grinagev. Mylan Pharmaceuticals, Inc., 840 F. Supp.2d 862, 870 (D. Md. 2011)(plaintiff failed to allege a proper design defect claim under state law; noneed to reach preemption); Fisher v. Pelstring, 817 F. Supp.2d 791, 817-18(D.S.C. 2011) (design defect failed when plaintiff failed to demonstrate analternative feasible design).  This iswhat “failure to state a claim” is all about.
Unlike Bartlett, where (non-drug) NewHampshire law could at least be plausibly read as allowing a “design defect”based on pure risk/utility balancing without an alternative design, Artersarose under Ohio law.  2013 WL 308768, at *5.  Ohio simply does not recognize a designdefect without a feasible alternative design:
A product is notdefective in design or formulation if,at the time the product left the control of its manufacturer, a practical and technically feasiblealternative design or formulation was not available that would haveprevented the harm for which the claimant seeks to recover compensatory damageswithout substantially impairing the usefulness or intended purpose of theproduct.
Ohio Rev. Code §2307.75(F) (emphasis added).  That goes double for prescription medicalproducts:
An ethical drug or ethical medical device is not defective in design orformulation because some aspect of it is unavoidablyunsafe, if the manufacturer of the ethical drug or ethical medicaldevice provides adequate warning and instruction . . . concerningthat unavoidably unsafe aspect.
Ohio Rev. Code §2307.75(D) (emphasis added).  While Arters cites §2307.75 generally,2013 WL 308768, at *5, it inexplicably ignores the two most directly on-pointsubsections that establish the unavailability of an OPLA design defect cause ofaction in the absence of any alternative design.  Nor is there any conceivable otheravenue open in Arters.  OPLA is “intendedto abrogate all common law product liability claims or causes of action.”  Ohio Rev.Code §2307.71(B).
In short, the “design defect” claim purportedly atissue in Arters does not exist under relevant state law.  A “design defect” claim absolutely, bystatute, requires an alternative design in Ohio.  Plaintiff cannot assert an Ohio claim that aproduct – particularly a prescription medical product – can simply be removedfrom the market.  Because there is no Bartlettrationale under Ohio law, it was error for Arters even to consider preemptionof that claim.  “[W]e do not ordinarilydecide constitutional issues if a case can be resolved on non-constitutionalgrounds.”  Sistrunk v. City ofStrongsville, 99 F.3d 194, 197 (6th Cir. 1996).
In reaching and resolving this constitutional issue, theDistrict Court ignored the basic and longstanding rule of construction thatwhen two questions are raised, and resolution of the non-constitutionalquestion makes unnecessary a decision on the constitutional question, only thenon-constitutional question should be decided.
Nagy v. Farmers Insurance Exchange, 758 F.2d189, 192 (6th Cir. 1985).
And that’s not the end of it.  Arters goes on to hold that somethingit calls “off-label promotion” also survives preemption.  2013 WL 308768, at *6.  Arters states that there’s some sortof “duty not to promote a dangerous use of [the drug] that is inconsistent withthe FDA-approved label.”  Id.  Where does this novel duty come from?  Arter cites no law at all, statingonly that the defendant allegedly “promoted a use of [the drug] that was inviolation of Ohio law.”  Id.
Wrong again.
Off-label use isn’t illegal in Ohio.  The only off-label use ever banned in Ohiohas to do with (you guessed it) abortion. See Planned Parenthood Southwest Ohio Region v. DeWine,696 F.3d 490, 496 (6th Cir. 2012) (discussing Ohio Rev. Code §2919.123(A)).  Otherwise, off-label use is perfectly legalunder Ohio common law.
[A]lthough the FDA regulates, among other things, drugsand medical devices, the FDA does not regulate the practice of medicine. . . .  [C]ourts addressing issues of FDA-regulateddrugs have determined that physicians are permitted to use federally approveddrugs as they, in their medical judgment, see fit. . . .  FDA approved indications were not intended tolimit or interfere with the practice of medicine nor to preclude physiciansfrom using their best judgment in the interest of the patient  The Food, Drug and Cosmetic Act does notlimit the manner in which a physician may use an approved drug.  Once a product has been approved formarketing, a physician may prescribe it for uses or in treatment regimens orpatient populations that are not included in approved labeling.  Thus, the decision whether to use a drug foran off-label purpose is a matter of medical judgment, not of regulatoryapproval.
Klein v. Biscup, 673 N.E.2d 225, 231 (OhioApp.) (citations and quotation marks omitted), review denied, 667 N.E.2d987 (Ohio 1996).
It is well established that the U.S. Food and Drug Administrationneither regulates the practice of medication nor restricts uses of those of the“official” approval, but merely approves or disapproves the use and marketingof medical devices and drugs.  The OhioState Medical Association has taken the position that “off-label use” isneither “experimental” nor “investigational.” The off-label use of a medical device is merely a matter of medicaljudgment . . . is not barred by the U.S. Food and Drug Administration.
State ex rel. Bax Global, Inc. v. Industrial Com’n,2007 WL 512529,  at *5 (Ohio App. Feb. 20,2007).
So if not off-label use itself, what could be a“violation” of the law?  Off-labelpromotion?  For one thing, no federalstatute or regulation prohibits that, as the Second Circuit pointed out  recently in United States  v. Caronia, ___ F.3d ___, 2012 WL 5992141,at *3 (2d Cir. Dec. 3, 2012) (“[t]he FDCA and its accompanying regulations donot expressly prohibit the 'promotion' or 'marketing' of drugs for off-labeluse”).  For another, assuming a plaintiffcould nonetheless tease a “plausible” violation out of various FDA regulations:  (1) off-label promotion is not inherentlyfalse or fraudulent, as we discussed at length here; and (2) there’s not a scrap of Ohio precedent holding that off-labelpromotion also somehow violates state tort law. It’s not the role of federal courts sitting in diversity to dream up newstate-law tort claims.
[F]ederal courts must proceed with caution when makingpronouncements about state law.  Sittingin diversity, we are not commissioned to take a position regarding theadvisability or fairness of the state rule to be applied, but must determinethe issue as would the highest court of the state.  This Court’s proper reluctance to speculateon any trends of state law applies with special force to a plaintiff in adiversity case. . . .  Whengiven a choice between an interpretation of state law which reasonablyrestricts liability, and one which greatly expands liability, we should choosethe narrower and more reasonable path.
Combs v. International Insurance Co., 354 F.3d568, 577 (6th Cir. 2004) (citations and quotation marks omitted); see Ventas, Inc. v. HCP, Inc., 647 F.3d291, 328 n.15 (6th Cir. 2011 (quoting and following Combs); Kurczi v. Eli Lilly & Co., 113F.3d 1426, 1429 (6th Cir. 1997) (“A federal court in a diversity case is notfree to engraft onto ... state rules exceptions or modifications which maycommend themselves to the federal court, but which have not commendedthemselves to the State in which the federal court sits”) (quoting Day &Zimmermann, Inc. v. Challoner, 423 U.S. 3, 4 (1975)).
Moreover, there’s another United States SupremeCourt case holding, in the specific context of off-label use, that supposed state-law claims asserting FDA regulatoryviolations are in fact nothing more than improperattempts to sue over alleged violations of a statutory scheme that doesn’tpermit private enforcement.  See21 U.S.C. §337(a) (reserving FDCA enforcement exclusively to the federalgovernment).  However far Buckman Co.v. Plaintiffs Legal Committee, 531 U.S. 341 (2001), might or might nototherwise extend, it forbids state-law claims such as those in Artersthat allege improprieties involving off-label use:
[Plaintiff’s claims would ] delay health careprofessionals’ ability to prescribe appropriate off-label uses. . . . [I]t is clear that the [Lohr]claims arose from the manufacturer’s alleged failure to use reasonable care inthe production of the product, not solely from the violation of FDCArequirements.  In the present case,however, the [plaintiffs’] fraud claims exist solely by virtue of the FDCAdisclosure requirements. . . . [W]ere plaintiffs to maintain their fraud-on-the-agency claims here,they would not be relying on traditional state tort law which had predated thefederal enactments in questions.  On thecontrary, the existence of these federal enactments is a critical element intheir case.
531 U.S. at 351-53 (numerous citations omitted).  Without the FDA-approved label, there’s nosuch thing as “off-label” use – let alone “promotion” – which is anotherregulatory term.  Thus, a tort claim for“off-label promotion” as discused in Arters necessarily runs afoul of Buckman’s“critical element” test.
If that weren’t enough, the Ohio Supreme Court hasalso banned this sort of disguised statutory enforcement claim where, as withthe FDCA, the statute in question bars private enforcement.  In Hernandez v. Martin Chevrolet, Inc.,649 N.E.2d 1215 (Ohio 1995), the court considered the effect of a claimedviolation of OSHA, a federal statute that, like the FDCA, explicitly barred itsuse (the so-called “disclaimer”) in private civil litigation.  The court, in a rare unanimous decision, said“no” to the claim:
This statutory disclaimer clearly indicates thatCongress did not intend OSHA to affect the duties of employers owed to thoseinjured during the course of their employment. . . .  Negligence per se decreases the elements thata plaintiff must prove in a negligence action.  Thus, a plaintiff's case is significantlyaided if negligence per se is established.  If we held that a violation of OSHAconstitutes negligence per se, we would allow OSHA to affect the duties owed byindividuals to those injured in the course of their employment. Such a holdingwould be contrary to the intent of the legislation. Accordingly, we hold that aviolation of OSHA does not constitute negligence per se.
Id. at 1216-17 (citations omitted).  As for "intent" in the FDCA context, as Buckman held, §337(a) is “clearevidence that Congress intended that the MDA be enforced exclusively by theFederal Government.”  531 U.S. at352. And finally, while it only makesthe rubble of Arters bounce, as Caronia, supra, pointed out, there is nothing in the FDCA itself aboutoff-label promotion (or, indeed, off-label use).  Ohio law also prohibits violations of meregovernmental regulations from being the basis of an negligence per se claim.  See Chambers v. St. Mary’s School,697 N.E.2d 198, 203 (Ohio 1998) (“we hold that the violation of anadministrative rule does not constitute negligence per se”).
Spherical error. In one relatively short opinion (seven Westlaw pages), the Artersdecision manages to:
(1)        employa “retired” standard for deciding a rule 12 motion, directly contrary to two ofthe most-widely cited Supreme Court decisions in recent years;
(2)        applya presumption against preemption directly contrary to the holding in a third controllingSupreme Court decision;
(3)        holdthat a design defect/failure to withdraw claim was not preempted when thatclaim cannot possibly exist under the controlling state (OPLA) statute;
(4)        holdthat a design defect/failure to withdraw claim was not preempted ignoring (andin some cases not even acknowledging) the reasoning of the vast weight ofcontrary precedent;
(5)        holdthat an off-label promotion claim is not preempted, directly contrary to theholding of a fourth controlling Supreme Court decision;
(6)        entertainan off-label promotion claim that no Ohio court has permitted, contrary to thecourt’s limited role when sitting in diversity; and
(7)        entertainan off-label promotion claim that’s barred by two Ohio Supreme Court decisionsthat limit the scope of negligence per se claim under controlling state law.

Second Circuit - Fosamax Plaintiff's Expert Testimony a Sham

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Schadenfreude - That probably best describes how we felt when we read Secrest v. Merck, Sharp & Dohme Corp., No. 11-4358, slip op. (2d Cir. Jan. 30, 2013).  We've seen time and time again how plaintiffs attempt to manipulate treating physician testimony, usually but not always cloaked by biased judicial rulings that prevent one side - our side - from talking to treaters informally, while giving plaintiffs full reign to subject treaters to all manner of persuasion.

That evidently happened in Secrest, and produced contradictory treater testimony so grotesque that the Second Circuit recoiled, calling it a "sham" in a for-publication decision.

Here's an outline.  Plaintiff took Fosamax over a period of years prescribed by Dr. X and then Dr. Y.  Dr. Y apparently did not testify, or at least his testimony was considered irrelevant by both sides.  Dr. X testified as a fact witness that at the time plaintiff suffered her injury (bone deterioration in the jaw - "ONJ") he (Dr. X) "was not aware" that plaintiff continued to take Fosamax (then being prescribed by Dr. Y).  Secrest, slip op. at 5.

Then the defendant moved for summary judgment against the warning claim on causation grounds - because if Dr. X didn't know about plaintiff's Fosamax use, he couldn't have been affected by an allegedly inadequate warning.  Why would a treater say anything about the risks of a drug that s/he didn't know that the plaintiff was taking?

After the motion was filed, up popped Dr. X again - this time serving as the plaintiff's expert.

To any naif out there, that means Dr. X was now on the plaintiff's payroll.

Predictably, Dr. X has changed his tune, offering utterly contradictory testimony in a second expert deposition that he actually did know about plaintiff's Fosamax use during the critical time.  Specifically:

By contrast, in his [second]  deposition, Dr. [X] testified that he “knewshe was on [Fosamax]” in [the critical time] and that, had [defendant] warned him about therisk of ONJ, he would have recommended that [plaintiff] stop taking Fosamax.Secrest, slip op. at 5.  As the court pointed out "[o]nly after he was designated as plaintiff's expert" did Dr. X experience an epiphany of recollection that led to this contradictory testimony.

Neither the district court (which granted summary judgment anyway) nor the Second Circuit was having any part of Dr. X's changed testimony.

It was a "sham."

[C]onsidering Dr. [X]’s clearly contradictory testimony . . .we hold that the District Court was entitled to disregard Dr. [X]’s new testimonyrelating to his knowledge based on the “sham issue of fact” doctrine, whichprohibits a party from defeating summary judgment simply by submitting anaffidavit that contradicts the party’s previous sworn testimony.  Although we have typically applied the shamissue of fact doctrine where a party submits an affidavit that contradicts theparty’s own prior statements, it may also apply when a party attempts to useevidence from an expert witness to defeat summary judgment.Secrest, slip op. at 7.  The subsequently procured "expert" testimony could be disregarded "where the relevant contradictions between the first and second depositions are unequivocal and inescapable, unexplained, arose after the motion for summary judgment was filed, and are central to the claim at issue."  Id. at 8.


 Moreover, the plaintiff "ha[d] not proffered a plausible explanation" for Dr. X's testimonial gymnastics, but only argued that "credibility determinations are left to the jury."  Id. at 9.  The timing - after the filing of a summary judgment motion - was also extremely suspect.  Id. at 10.  Thus summary judgment was affirmed. That's as close as you'll see an appellate court come to calling a witness a liar without actually doing so. Schadenfreude - it feels good.
For the record, after summary judgment was granted on the warning claims in Secrest, non-warning claims (design defect) were tried to a jury and plaintiff lost again.  The Second Circuit also summarily affirmed the jury verdict in a second, unpublished opinion, here.

The Learned Intermediary Doctrine Applied Learnedly

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In our business, it’s good to have intermediaries, particularly learned ones.  They add a dose of reality to cases that are otherwise conjecture.  They shift the focus from dramatic accusations about profits and hidden risks to tangible realities such as science and medicine and the professionals who know a thing or two about both.  Hidden risks become standard knowledge, and statements in labeling sections with titles such as Warnings or Precautions actually become, you know, warnings and precautions. 
So, while we’ve at times railed against courts that have failed to recognize the importance of what these learned intermediaries say or don’t say, it’s also important – maybe more important – that we highlight courts that do recognize it.  One of them is the court in Carr-Davis v. Bristol—Myers Squibb Co., No. 07-1098 (FLW), 2013 U.S. Dist. LEXIS 10914 (D.N.J. Jan. 28, 2013.  It’s one thing to apply the learned intermediary doctrine.  It’s a whole other thing to apply it correctly.  Here’s how that’s done.
The decedent in Carr-Davis had a quadruple bypass and other heart problems and procedures.  His cardiac surgeon placed him on Plavix and aspirin.  Id. at *6-8.  The Plavix label discussed an increased risk of bleeding in its Precautions, Adverse Reactions and Information For The Patient sections.  Id. at *4-7.  Three days after his last heart-related procedure, the decedent had a cerebral hemorrhage (bleeding in the brain) and died.  Id. at *9.  He had stopped taking Plavix five days before the procedure, and his cardiac surgeon had instructed him not to resume Plavix after the procedure.  Id.  Moreover, the neurosurgeon who treated the cerebral hemorrhage testified that the hemorrhage could have resulted from the procedure itself and the decedent’s platelet levels and bleeding did not point to Plavix.  Id. at *10.  Nonetheless, the decedent’s spouse brought failure to warn, defect and other claims, pointing the finger at Plavix and the alleged inadequacy of the warnings about its risk of increased bleeding. 
From this point onward, the court – applying Missouri law – crafts an opinion that reads like an instruction manual on how to properly apply the learned intermediary doctrine.  As an important starting point, it addressed two things that many courts conflate or simply miss.  The plaintiff’s failure to warn claim would fail if the manufacturers satisfied their duty to warn or there was no proximate cause – say, because the doctor knew of the risk:
The learned intermediary doctrine is a corollary to the rule that a manufacturer of prescription drugs or products discharges its duty to warn by providing the physician with information about risks associated with those products. . . . The physician acts as a “learned intermediary” between the manufacturer and the patient and any warning given to the physician is deemed a warning to the patient. . . . The learned intermediary doctrine provides that the failure of a drug manufacturer to provide the physician with an adequate warning of the risks associated with a prescription product is not the proximate cause of a patient's injury if the prescribing physician had independent knowledge of the risk that the adequate warnings should have communicated.
Id. at *14. 
Plaintiff’s claims had both problems.  First, the statements in the label about an increased risk of bleeding were adequate.  Moreover, the studies that plaintiff used to argue that they weren’t had nothing to do with the decedent: “virtually none of these studies are relevant to Decedent’s medical situation.”  Id. at 16.  Better yet, in a juicy bit of spot-on reasoning, the court explained that even the study that might actually have been relevant to the decedent’s medical situation didn’t matter because it addressed Plavix’s “efficacy,” not its “risk.”  The claim is about a failure to warn of a risk of increased bleeding, not an efficacy claim: 
Plaintiff's efficacy arguments are not relevant in the context of a failure-to-warn analysis. Plaintiff's claim is essentially premised on the fact that [the decedent] suffered substantial bleeding as a result of taking both Plavix and aspirin at the same time - not that Plavix did not work. As the Court has previously noted, in Missouri, a drug manufacturer is required to provide an adequate warning of its product if it knows of any potential harm that may result from the use of its product. In other words, a proper warning should adequately alert any danger or harm that may result from ingesting the drug.  Permitting Plaintiff to pursue her failure-to-warn claim on an efficacy theory would, as has been found in other jurisdictions with similar laws, impermissibly expand liability . . . .
Id. at 19-20.  (This isn’t the first time that the court in the Plavix litigation has explained the futility of arguing efficacy studies in a failure to warn case.) 
Second, the court addressed proximate cause.  The prescriber knew about the risk of increased bleeding.  How could he know?  This is where hidden risks become standard knowledge.  He knew because he was a learned intermediary.  He knew because he followed the “medical literature and other available information regarding his prescription decisions” and looked to “guidelines from the medical community and his colleagues’ opinions.”  Id. at 24.  That’s what learned intermediaries do.  That’s why they’re learned.  That’s also why they’re intermediaries.  And given this knowledge, “any alleged failure to warn could not be the proximate cause of [the decedent’s] injuries.”  Id. at *24-25.
The plaintiff, undaunted, pointed to the heeding presumption.  Surely the case must go forward because the court must presume that the prescriber would have heeded a proper warning if one was given.  We’re sure you see the problem with this argument.  The court did.  The manufacturers had given an adequate warning.  There was no “other” proper warning containing the supposedly missing information for a prescriber to heed: “the Court has already concluded that Plaintiff has failed to demonstrate the inadequacy of the current warning, and therefore that Plaintiff has not demonstrated that the warning failed to impart the necessary information.”  Id. at 27.  The court granted defendants judgment on the failure to warn claim and all other claims, which simply restated the failure to warn claim. 
That’s how it’s done.  That’s how the learned intermediary doctrine is applied learnedly. 

An Off-Label Conundrum

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            The legal community is still buzzing about the Second Circuit’s decision in United States v. Caronia, ___ F.3d ___, 2012 WL 5992141 (2d Cir. Dec. 3, 2012) and what it bodes for the future.  Whatever its eventual implications, today, it is important to remember that the FDA bans off-label promotion and that there remains a lot of litigation about “illegal” off-label promotion.  That’s right, illegal.  Off-label promotion, even if scientifically sound, useful or even critical to physicians, is still breaking the law (at least outside the Second Circuit).  So our clients get sued, a lot, for allegedly doing it.              Fortunately, defendants have been fairly successful in defeating product liability claims based solely on off-label promotion because off-label promotion, while perhaps unlawful, is not a tort.  Without something more, such claims are simply an attempt to bring a private cause of action for off-label promotion violations of the FDCA.  Numerous courts have so held.  But it is still illegal.   So, even if private litigants can’t recover for off-label promotion, drug and device companies are still subject to suit by the government.  So, in general our clients are very sensitive and extremely cautious when it comes to saying or doing anything not FDA-approved.  And while that may protect against FDCA-based criminal actions, it leaves open the door to failure to warn claims.            Then the plaintiff’s allegation isn’t “you said too much” (off-label promotion) – it’s “you’ve said too little” (failure to warn).  Talk about walking a fine line.  Drug and device manufacturers are like Nik Wallenda balancing above Niagara Falls.  Harnessed or not, a fall from that height is heart-stoppingly scary.  So, what to do?  How much can you say to provide an adequate warning about an off-label use while not violating the FDCA?  That was precisely the conundrum faced by the defendant in Wells v. Allergan Inc., 2013 U.S. Dist. LEXIS 13191 (W.D. Okla. Jan. 31, 2013).  And the court left them damned if they do and damned if they don’t.            The product at issue was Botox that was used to treat pediatric limb spasticity – an off-label use.  Id. at *2.  The labeling history is important so here are a few details.  Based on studies and reports concerning the link between Botox and botulism, especially in pediatric use cases, Allergan twice proposed to FDA labeling that included a warning that in pediatric trials for cerebral palsy, “doses greater than 8 U/kg have not been adequately studied.”  Id. at 2-3.  The FDA rejected Allergan’s proposed warning because cerebral palsy “is not an approved use in the United States.”  Id.  at *3.  About one year later, the FDA began requiring a black box warning on Botox and distribution of a medication guide for patients.  “Neither the FDA’s new label warning nor the medication guide included Allergan’s previously suggested 8 U/kg language.”  Id. at *4.  The black box did provide a warning about the possibility of botulinum toxin effects, including that “[t]he risk of symptoms is probably greatest in children treated for spasticity . . . [and] have occurred at doses comparable to those used to treat cervical dystonia and at lower doses.”  Id.  This warning was in effect at the time Botox was prescribed to the plaintiff.  Id. at *5.              Years before the black box warning and before this plaintiff was ever treated with Botox, his prescriber requested information from Allergan about “maximum dosing levels for pediatric spasticity and information on cases of botulism following Botox use in children.”  Id. at *6.  In its response, Allergan did not include information about the 8 U/kg dosing level but did provide two post-marketing reports of pediatric botulism.  Id.   This is the crux of plaintiff’s failure to warn claim.            Not surprisingly, Allergan pointed to the FDA-required black box warning addressing the very risk sustained by plaintiff as proof that they provided an adequate warning.  But the court didn’t agree that that was enough.  Instead the court found that the adequacy of the warning was a fact issue for the jury based on “Allergan’s evasive response to Dr. Wright’s direct inquiry in 2007.”  Id. at 15.  Evasive?  What the court found as evasive, we would argue is more accurately a manufacturer attempting to comply with the FDA’s ban on off-label promotion.  Remember that tightrope – well how about this for a balancing act:  “Because this case involves an off-label use, Allergan should have been particularly forthcoming when asked information relating to a specific question by an individual doctor.”  Id. at *15-16.  Particularly forthcoming about an off-label use.  How is a manufacturer supposed to reconcile his FDCA obligations to not promote off-label uses with a state law requirement to discuss off-label uses in detail?  Sounds like conflict preemption to us, but we’ll get to what the court said about that in a minute.            Before we leave the adequacy of the warning discussion, we have to point out that the court and plaintiff are relying on information that was provided to the prescriber three years before he treated the plaintiff.  To the extent that information may have been lacking, it was superseded by an FDA-mandated black box warning about the very risk at issue.  In fact, the prescriber changed his informed consent to include the box warning about botulinum toxin.  Id. at *8.  It is difficult to understand how such a warning is not adequate as a matter of law.       So, we think on that point the court simply got it wrong and then went on to muddy the waters as to how much a manufacturer should say about off-label uses.            Now on to preemption.  While Wyeth v. Levine, 555 U.S. 555 (2009), doesn’t leave brand defendants a lot to work with, there are still arguments to be made.  Such as the fact that the FDA specifically rejected Allergan’s proposed warning that included 8 U/kg dosing information.  So any state law requirement that Allergan provide such information to doctors is in conflict with federal law and therefore preempted.  Not so says Wells, which distinguished this case from an earlier case from the same court – Dobbs v. Wyeth Pharmaceuticals, 797 F. Supp.2d 1264 (W.D. Okla. 2011).  We’ve discussed Dobbs here.  In Dobbs, the proposed warning was rejected because it lacked scientific support.  In Wells, the court rejected conflict preemption finding that the “FDA clearly explained that it rejected Allergan’s proposal [not because of science, but] because of fears of back-door off-label promotion.”  Wells, at *19-20.              How does that get around conflict preemption?  The FDA said you can’t discuss the dosing information because it is off-label promotion.  Off-label promotion violates federal law.  This court’s ruling would require Allergan to provide information that they have already been told by the FDA is impermissible off-label promotion.   There’s your conflict.   There’s your conundrum.              It is quite conceivable that the very language this court would require to defeat a failure to warn claim would give rise to criminal allegations by the FDA – regardless of the truth and accuracy of the statements.  That can’t be the answer.  Which  brings us full circle back to Caronia.  One of the possible implications of Caronia, as we’ve previously suggested, is that the FDA will have to abandon its off-label promotion ban in favor of First Amendment-compliant “time, place and manner” restrictions.  The hope is that this will help with conflict preemption – more requirements, more opportunities for common-law claims to conflict with them.  We certainly think that would help in this situation, at least to provide the manufacturers with true procedures for communicating accurate information to physicians.  Until then, we may be stuck with damned if you do, damned if you don’t.

3 Ocak 2013 Perşembe

P2K and Dr. Parisian

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It probably won’t surprise you to know that Bexis keeps a scorecard of the number of posts we’ve done over the years.  Bexis likes scorecards. This post will be a big one.  It’s the 2000th in Drug and Device Law Blog history.  It’s taken a lot of law – and a lot of other silly stuff – to get us here.  We’ve rehashed good preemption decisions and blasted bad ones, explained fraudulent joinder and complained that plaintiffs get away with it way too much, attached in limine decisions and explained what’s right and wrong with them, dissected Daubert decisions and pointed out the good experts, the bad ones and, even worse, Dr. Parisian.  We’ve gone round and round on the learned intermediary doctrine, heeding presumptions, Linsanity (which Bexis later described as Temporary Linsanity), good movies, bad movies, doomed personal injury class actions, and good barbecue.
That’s all taken us to here: post 2000.  And as P2K approached, we at the blog worried greatly about what might happen when we click the “publish” button and the scorecard flips over to 2000.  Would all the posts disappear?  Maybe just the really good ones, like the cheat sheets, the scorecards or heaven forbid the Parisian transcript list?  Would Mensing suddenly vanish, never actually having happened?  Or Buckman?  Or Caronia?  Would we lose Yeary’s invaluable posts on fraudulent joinder?  Would we unlearn what we’ve learned about McConnell’s admiration of Diane Keaton?  Would Bexis become a plaintiff’s lawyer?  All too terrifying to consider.  So we decided to just come out swinging and discuss one of our favorite topics: Dr. Parisian.  In some sense it’s appropriate.  Dr. Parisian’s seemingly unending expert witness career has provided constant material for this blog.  Plus, like the blog, we bet that Dr. Parisian is likely approaching her 2000th expert report. 
The recent decision on Dr. Parisian in the Aredia litigation – Jenkins v. Novartis Pharmaceuticals Corp., 2012 U.S. Dist. LEXIS 176697 (E.D. Tn. December 13, 2012) – is a good one.  Like many courts before it, the Eastern District of Tennessee decided that Dr. Parisian can’t talk about a lot of the stuff that she usually puts in her expert reports.  We’ll focus on two aspects of the opinion: Dr. Parisian’s proposed testimony about Novartis’s knowledge; and her proposed testimony about causation.  The court excluded both. 
Dr. Parisian almost always tries to tell juries what the defendant company knew.  She will usually go further and try to tell juries what the company intended, but the plaintiffs gave up on that opinion here even before the court had the chance to exclude it.  Id. at *15 (“the parties have agreed that Dr. Parisian cannot testify to . . . . the intent and/or motives of Novartis”).  But the plaintiffs still claimed that she was a “company knowledge” expert.  Of course, she isn’t.  She has no particular expertise that would allow her to know what Novartis, or really any company other than maybe her own, knows.  She certainly has no more expertise than a jury.  And the court said so:
She may not, however, decide what Novartis knew and did not know at various times during the relevant period. Novartis's knowledge is an issue for the jury. Dr. Parisian has no specialized knowledge or scientific/medical expertise that provides her with a superior ability to judge Novartis's knowledge, and there is no basis for finding that the jury needs her assistance in evaluating Novartis's knowledge.
Id. at *16.
What’s even more heartening is that the court saw that Dr. Parisian, who does not appear to have practiced medicine for decades, did not have the expertise to opine on causation.  The majority of her career has been spent addressing regulations, mostly while in litigation, not while practicing medicine.  And even the practical medical experience that she had years ago didn’t involve the type of medical issues involved in the Aredia litigation:
The Court finds that Dr. Parisian is not qualified to testify as to the mechanism by which Zometa and Aredia, or bisphosphonates generally, cause ONJ. While Dr. Parisian holds a doctor of medicine, she testified that the vast majority of her career has been spent in the field of medical regulation rather than the practice of even general medicine. Moreover, the Plaintiff has not presented any evidence indicating that Dr. Parisian has any special experience treating bisphosphonate-related disorders, jaw conditions, or bone conditions. Further, there is no evidence in the record to indicate that Dr. Parisian has either treated ONJ or studied ONJ in an academic setting.
Id. at *17.
Now, the court did allow Dr. Parisian to testify about certain FDA requirements, including the labeling process and requirements.  Id. at *16.  And, while we’d challenge even that expertise given that Dr. Parisian’s FDA experience was two decades ago, for barely 3 years, and on the device not the drug side, we’re happy with this decision.  Much of the bad stuff was ruled out by the court or conceded away by plaintiffs.  That’s a victory.   
Well, that’s all we have to say today.  So this is it.  We’re ready to click the “publish” button.  We hope everything’s still intact when we’re done and that Bexis is still on our side.  Alright.  Hold your breath.  Here goes . . . . . .

The Bottom Ten – The Worst Prescription Drug/Medical Device Decisions Of 2012

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Do we have to? That depends on whether we mean “must” or should.”  There’s relatively little that’s really a“must,” but quite a bit that’s a strong “should.”  So yes, we have to.  It’s that time of year again, and we’re lookingback over the past twelve months for the decisions that, in this instance, weliked the least.  Because we like to endthe year on a high note, we always examine the bad decisions before the good ones, and thisyear’s no exception.
This post thus goes to show that you – that is, we– can’t win them all.  So for our fifthstraight year we’re looking at the coal that has found its way into ourChristmas stockings, specifically the ten worst prescription medical productliability decisions of 2012.  There's no particular pattern, these blots on the law are from all over, both in federal andstate court.  While we’ve seen ATRA’slatest list of hellhole jurisdictions, our bottom ten doesn’t particularly correspond, probably since ATRA’s latest listhas less to do with drugs and medical devices than the in some prior years.
Yeah, we’re procrastinating.  Like most lawyers, we’d rather focus on winsthan losses – that and 2012 still has a week and a half left for still morebottom-dwelling decision to come down. That said, we can’t delay any longer. Here are the jurisprudential dregs of 2012.
1.                 Bartlett v. Mutual Pharmaceutical Co., 678 F.3d30 (1st Cir. 2012).  Terrible result andworse reasoning, on several levels. After the plaintiff lost his warning claims for the prescriber’s failureto read the warning, he pursued a design defect claim with no alternative design thatamounted to a demand that an FDA-approved generic drug should be removed fromthe market altogether.  All that wasbefore Mensing.  After Mensingwe couldn’t see how the plaintiff could retain this $20 million+ verdict, butthe First Circuit found a way – a bad way, but a way.  Even though the opinion all but conceded that designclaims would fail under the “sameness” analysis used by the SupremeCourt in Mensing, the First Circuit decided that reasoningdidn’t matter, dug in its heels, and ruled that, no matter what, it wasn’tgoing to preempt the plaintiff’s solesurviving claim.  Period; full stop.  The decision's rationale was that nothing requires amanufacturer actually to sell a drug that the FDA has approved, but argument that (likethe lobbying argument rejected in Mensing) proves way too much.  The same thing could be said about any product in any case. Moreover, nothing could more directly conflict with the FDA’sauthority over drug approval than a state-law claim that says, “So what?  You can’t sell that here.”  "Yes" directly conflicts with "no." Finally, to the extent that Hatch Waxman wassupposed to promote the availability of generic drugs, banning them outright isthe antithesis of that purpose.  We bloggedabout this stinker here and here.  The only good thing we can say about Bartlettis that the Supreme Court recently accepted the challenge and granted certiorari.  So we’re hopeful that the worstdecision of 2012 might produce the best of 2013.  Fingers crossed.
2.                 Caldwell ex rel. State v. Janssen Pharmaceutical,Inc., ___ So.3d___, 2012 WL 3761900 (La. App. Aug. 31, 2012).  What do you get when a state hirescontingent fee counsel and lets that counsel pick the most pro-plaintiff county(called “Parishes” in Louisiana) in the state to sue over alleged failures towarn that were never actually hurt anybody?  How about an eye-popping $257 million verdictalong with an extra $73 million fee and cost award for said counsel.  Most ginned up state false claims suits like this oneget thrown out, at least on appeal, but not in Louisiana (at least not yet).  On appeal, the court found no error in thetrial court’s allowing the plaintiff to proceed on an absolute liability theory from West Virginia that (unmentioned in Caldwell) the West Virginia Supreme Court later threw out as a matter of law.  The language of the relevant statute wasoutright ignored in Caldwell, and both injury and causation were effectuvekt presumed (the “materials inand of themselves cause harm and injury”). The opinion also affirmed total exclusion of evidence (includingstatistics) that the defendant’s supposedly false statements were in factscientifically valid.  The opinion itself is an embarrassment, consisting mostly of the court quoting the trial court’s barely coherent rulingsand reciting that there was no “manifest error.”  Theonly saving grace is that the Louisiana Supreme Court might think so too.  We excoriated Caldwell here.
3.                 Dolan v. Hilo Medical Center, 278 P.3d 382 (Haw.App. 2012).  In this absurd medicaldevice decision, the manufacturer was found liable where:  (1) the hospital never inventoried the devicekit that it received, and (2) the surgeon used a screw driver as a substitutefor a spinal rod when he couldn’t find the right part during surgery.  The screw driver, of course, broke almostimmediately, since it was not designed (let alone FDA approved) for implantation.  Oh ... and the defendantmanufacturer produced an undisputed packing slip indicating that it had shipped all theproper parts to the hospital.  And there's more:  the doctors andhospital concealed from the patient what they had done.  The jury got it right – hammering themalpractice defendants and excusing the manufacturer.  Inexplicably, however, the appellate courtreversed, on the lame excuse that the judge used an outdated juryinstruction on substantial change.  Sowhat?  This wasn’t a substantial changecase, rather it involved blatant and outrageous product misuse.  It may not be the worst decision of the year,but it sure is the dumbest.  We dissentedhere.
4.                 In re Chantix Varenicline Products LiabilityLitigation, ___ F. Supp.2d ___, 2012 WL 3871562 (N.D. Ala. Aug. 21,2012).  A really, really bad Daubert decision.  Seven causation experts were allowed totestify that the drug caused suicide (of all injuries, one of the hardest to prove) despite lacking even one medicalstudy (at least none were cited) to support their opinions.  Basically, the decision holds thatqualifications are enough and everything else is cross-examination fodder.  Daubert?  What Daubert?  Opinions based on statistically insignificantdata?  That’s OK.  Adverse reactions that the FDA itself saysaren’t to be used for drawing causation conclusions?  That’s OK, too.  Extrapolation from animal studies with hugedosages?  You bet.  Ditto for cherry-picked data.  The defendant’s labeling mentioning therisk also supported causation.  Damned if you do; damned if youdon’t – even though FDA regulations outright specify that “a causalrelationship need not have been proven.”  Also, any decision that favorablycites the pre-Daubert Wells v. Ortho decision raises our hackles.  Even the good rulings (corporate intent,misleading the FDA), were precluded on a lame “speculative” basis rather thanfor being blatantly improper subjects of expert testimony.  We found this opinion largely indigestiblehere.
5.                 Cornett v. Johnson & Johnson, 48 A.3d 1041 (N.J.2012).  Usually adverse state supremecourt cases rank pretty high on our list. Cornett isn’t ranked higher because all of it isn’t bad –specifically the court blew out the lead plaintiff’s case on unrelated statute oflimitations grounds, whichought to count for something (not all that much), and placedsome decent summary judgment limits on the claims it permitted to go forward (somewhat better).  But those good points can’t make up formessing up two of our favorite issues, preemption and off-label use, in thesame opinion.  In a PMA medical devicecase, the court allowed a plaintiff to get by the pleading stage with a“parallel claim” based on off-label promotion, even though there’s not any FDAregulation that bars such promotion (the regs call it no more than “evidence”),and the FDA guidance that enunciates an outright ban doesn’t have force of law and thusshouldn’t support any negligence per se action at all. The off-label promotion claim was nothing more than an ill-disguisedinadequate warning claim (preempted under Riegel), but the court went along with the plaintiffs' ruse of renaming the claim.  Still,the court did impose some decently strong restrictions on the claim before itcould survive summary judgment.  If thetrial courts enforce these, there may not be all that many claims.  But the tough nut remains, how can a statelaw claim be “genuinely equivalent” to anything when it’s based on a document that the FDAitself does not give legal force?  Cornettends up with a “parallel” claim that in fact isn’t parallel to anything, sinceessential elements of fraud/misrepresentation such as reliance are simply notpresent in the FDA’s scheme of things (that’s still true even after Caronia.  For setting such a claim loose on the law, Cornettmakes our bottom ten.  We scratched ourheads over Cornett here.
6.                 Hawkins v. Medtronic, Inc., ___ F. Supp. ___, 2012WL 4364171 (S.D. Ohio Sept. 24, 2012), interlocutory certification denied,2012 WL 6059361 (S.D. Ohio Dec. 6, 2012).  Ugly times two on medical device preemptionand TwIqbal.  It’s a PMA device,so there’s Riegel preemption.  Theplaintiff’s attempt to plead a parallel claim was pathetic.  The complaint simply listed a bunch of statutory andregulatory sections and alleged, without any explanation, that they were“violated” − classic boilerplate conclusions of law that aren’t allowed anymore, except in Hawkins.  Theopinion mentions “precise contours” but from the indefinite “contours” in this complaint,Cleveland might as well still be part of Connecticut.  On this flimsy pleading, the opinion allowed claimssuch as warning, design defect and warranty, that other decisions almost uniformlydismiss on the pleadings, to survive.  Then,on a second motion, the fact that Lohr preceded TwIqbal waslikewise ignored.  Hawkins is a goodcandidate for the worst PMA device preemption decision of the year.  It’s only saving grace is that, on summaryjudgment, the plaintiff will have to back up these vague allegations (after thedefendant, of course, has to spend lots of time and money).  We sounded off on Hawkins here.
7.                 Whitener v. PLIVA, Inc., 2012 WL 39487974 (E.D.La. Sept. 10, 2012).  There’s expresspreemption and there’s implied preemption. As the Supreme Court has held repeatedly, these two forms of preemptionoperate independently.  Whitenerdidn’t get the memo from the Supreme Court. The case involved generic drug preemption under Mensing.  The plaintiffs alleged illegal off-labelpromotion.  Even putting aside theproblem (highlighted in recent opinions) that neither the FDCA nor any FDAregulation prohibit off-label promotion, the proper response is, so what?  Assuming there was an FDCA violation, thatdoesn’t matter in an implied preemption case. The notion of a “parallel violation claim” is wholly a consequence ofthe particular language of an express preemption clause applicable only tomedical devices.  It has nothing to dowith generic drugs or implied impossibility preemption.  For completely messing up fundamental preemptionconcepts and giving generic drug plaintiffs an out they are not entitled tounder Mensing, this decision makes our list.  We tried to put a stop to things here.
8.                 Bonander v. Breg, Inc., 2012 WL 4128386 (D.Minn. Sept. 18, 2012).  Reading thisdecision, you wouldn’t believe that the plaintiff had the burden of proving causationin warning cases.  These facts – that thedoctor never read the allegedly defective warning and didn’t listen to salesreps – have resulted in summary judgment in innumerable cases, but not in Bonander.  Instead, the decision allowed rank speculationunsupported by any affirmative testimony to substitute for proof.  The prescriber changed his practice based ona medical journal article years after the fact. Maybe something from the manufacturer (whom the prescriber already testified he didn’t pay attention to) would have done the trick.  “Foreclosing a possibility” simply isn’t thesame as testimony that would meet the burden of proof.  As Carl Sagan was fond of saying, “absence ofevidence is not evidence of absence.”  Atbest, Bonander was an absence of evidence case, which the plaintiffshould have lost, and that’s being charitable. The most vacuous warning causation case of 2012.  We analogized it to monkeys at a typewriterhere.
9.                 Shiff v. Hurwitz, 2012 WL 1971320 (W.D. Pa.June 1, 2012); Shiff v. Hurwitz, 2012 WL 1828035 (W.D. Pa. May 18, 2012); andShiff v. Hurwitz, 2012 WL 1355613 (W.D. Pa. April 18, 2012).  Three differently situated defendants movedto dismiss this oddball case alleging that the plaintiff was injured during thecourse of an allegedly underground, totally unauthorized clinical trial.  The result was a troika of opinions thatdisregarded multiple settled principles of federal and/or Pennsylvania law –those being:  (1) no separate duty totest; (2) no private FDCA causes of action are permitted (3) no strictliability against manufacturers (except maybe manufacturing defect); (4) nostrict liability, ever, against doctors or hospitals; (5) no consumer fraudclaims involving medical treatment; (6) hospitals don’t obtain informedconsent; (7) informed consent is limited to risks, benefits, and alternativesto medical procedures; and (8) federal courts sitting in diversity aren’tsupposed to make up novel claims and call them predictions of state law.  We described exactly how all this doesn't fit together here.  Shiff would have ranked higherbut for only one state’s law being impacted.
10.             Murthy v. Abbott Laboratories, 2012 WL 6020157 (S.D.Tex. Dec. 3, 2012).  This case is arepeat performer.  Last year, a decisionon payments to investigators and the (non-existent) direct-to-consumer exception made thebottom 10 at #8 (the DTC ruling now being overruled under Texas law – see ourupcoming Top 10).  Murthy’s latestmangling of Texas law misreads the state’s immunity statute to allow theplaintiff to amend to allege a claim under the exceptions for off-labelmarketing.  The exception, however, is worded to apply where the“defendant prescribed” off-label, so that obviously is intended to preserveclaims against physicians.  The opinionpounds the square peg of a claim against a manufacturer into this very roundhole by asserting that the prescriber could be the manufacturer’s “agent.”  Thus, Murthy appears to be doublingdown on the investigator payments = non-independence rationale of last year’slump of coal.  This case might rank higher, exceptfor it being so state specific.  We calledout this “bad penny” of a case here.
So there they are. We hope none of these not-just-wrong-but-loud-wrong losses were yours –if they were, we sympathize.  We didconsider several other candidates; those that came closest to making the cutwere:  Schilf v. Eli Lilly & Co.,687 F.3d 947 (8th Cir. 2012) (the facts were arguably squishy); Bass v.Stryker Corp., 669 F.3d 501 (5th Cir. 2012) (the bad parts were tempered byaffirmance of the dismissal of so much of the case); Winter v. NovartisPharms. Corp., 2012 WL 827305 (Mag. W.D. Mo. March 8, 2012) (it’s a badParisian decision, but the worst was excluded – and the defendant later won (verdict less than the costs of trying the case) attrial); and the reconsideration in Fisher v. Pelstrung, 817 F. Supp.2dat 830-40 (D.S.C. Jan. 11, 2012) (while it was bad, it was only areconsideration).
Now that our unpleasant and masochistic exercise inrecapitulating our side’s worst defeats is over, stay tuned for next week (orpossibly the following Monday) when we have fun – reviewing and celebrating thetop ten best drug/device decisions of 2012.