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Fourth Circuit Vacates Maryland District Court Judgment for Defendants Where Injury Did Not Present Complicated Medical Question Requiring Expert Testimony to Prove Causation

Arthur Galloway v. Horne Concrete Construction
United States Court of Appeals for the Fourth Circuit, No. 11-1879 & 11-1898 (4th Cir. May 1, 2013)

by Jhanelle Graham, Law Clerk
Semmes, Bowen & Semmes (

In Arthur Galloway v. Horne Concrete Construction, the United States Court of Appeals for the Fourth Circuit was asked to determine whether the Maryland district court erred by excluding a substantial portion of damages evidence for Plaintiff, Arthur Galloway, including his medical bills and the depositions of his treating physicians, along with additional proof that he suffered permanent injuries and lost future earnings. In a per curiam decision, the appellate court was “satisfied that expert testimony was not required under Maryland law, that the court’s error of law caused it to abuse its discretion by excluding Galloway’s evidence, and that the erroneous rulings were prejudicial.” Accordingly, the court vacated the damages award against Defendant, Horne Concrete Construction (“Horne”), and remanded the case for a new trial exclusively on that issue.

At the time of the accident, Galloway was a resident of Alabama and the owner-operator of a Volvo tractor used for long-distance trucking. He worked primarily as a contract hauler for K.C. Transport, LLC (“K.C.”), of Newton, Alabama. On September 28, 2006, Galloway was driving his tractor-trailer south on Interstate 95 in Harford County, Maryland, when Galloway came to a stop in the center lane of the highway, behind a tractor-trailer operated by Apollo Incorporated. Sasa Djuric, also driving an eighteen (18)-wheel tractor-trailer, then came to a stop behind Galloway. Djuric’s rig, however, was struck in the rear by a dump truck driven by Horne’s employee, who failed to stop in time. As a result, a chain-reaction collision occurred, and Djuric’s tractor-trailer was pushed into Galloway’s rig, which was in turn pushed into Apollo’s. Badly damaged and later declared a total loss by the insurer, Galloway’s tractor-trailer was towed from the multiple-vehicle crash.

Galloway did not receive medical treatment at the accident scene but he began to experience severe lower back pain on the night of the accident. Galloway informed K.C.’s insurance adjuster early the next morning that he needed to go to the hospital. The adjuster, however, advised Galloway to instead return to Alabama for a job assignment before seeking medical treatment. As a result, Galloway travelled to Alabama on September 30, 2006, and soon after returning home, he sought medical treatment from his primary care physician, Dr. Smith. When Galloway’s pain did not subside, Dr. Smith noted that Galloway was suffering from “[b]ack Strain. Work Related. Happened two weeks ago,” and ordered an MRI of Galloway’s lower back. The MRI revealed a herniated disc, and Dr. Smith promptly referred Galloway to Dr. Cezayirli, a neurosurgeon.

Upon reviewing Galloway’s MRI and conducting his own physical examination, Dr. Cezayirli confirmed that Galloway was suffering from a herniated disc. Before considering surgery, however, Dr. Cezayirli referred Galloway to Dr. Kelsey, a pain management specialist. Dr. Kelsey administered a regional anesthetic to Galloway’s lower back and prescribed physical therapy sessions twice a week for one (1) month, before recommending that Galloway return for back surgery. On June 14, 2007, Dr. Cezayirli surgically removed Galloway’s herniated disc and inserted a piece of bone into the disc space in Galloway’s lower back, by a procedure known as a spinal fusion. After performing the spinal fusion, Dr. Cezayirli again referred Galloway to Dr. Kelsey for post-operative physical therapy.

On August 27, 2009, Galloway filed his single-count complaint in the District Court of Maryland against Horne, Djuric, and Apollo. Galloway alleged that the defendants’ negligence had caused his back injuries, as well as other injuries, and he sought damages of not less than one (1) million dollars. On January 25, 2011, the court awarded summary judgment to Apollo, but denied summary judgment to Horne and Djuric. Because Galloway’s treating physicians were in Alabama, he prepared for trial by conducting evidentiary depositions of Drs. Kelsey and Cezayirli on June 21, 2011. The two (2) treating physicians were not designated as expert witnesses, but were identified as fact witnesses in Galloway’s discovery responses. Soon thereafter, Horne moved in limine to exclude from trial the testimony of Galloway’s three (3) treating physicians on grounds that their evidence was inadmissible because the physicians had never causally linked Galloway’s injuries, or his need for the spinal fusion, to the September 2006 accident.

Relying on the decision of the Court of Special Appeals of Maryland in Desua v. Yokim, 768 A.2d 56, 60 (Md. Ct. Spec. App. 2001), the magistrate judge determined that Galloway’s back injuries and treatments presented a complicated medical question for which expert testimony was necessary to prove causation, but that no such testimony had been proffered. The magistrate judge then ruled that Dr. Cezayirli’s evidence would be excluded in its entirety for lack of proof of causation; deferred ruling on the in limine motion as to Dr. Kelsey’s pre-surgery treatments; but granted the motion entirely as to Dr. Cezayirli. Additionally, the court denied Horne’s motion in limine as to Dr. Smith, advising that it would not be clear until trial whether he could testify regarding causation. Having barred from trial the admission of all evidence relating to the spinal fusion surgery, the magistrate judge concluded that Galloway was not entitled to claim damages for permanent injuries, could neither seek nor recover future lost wages, and could not testify regarding any of his medical treatments, including the spinal fusion. Galloway could, however, advise the jury that he suffered back pain from the accident and that he had sought medical care for the pain. The jury found Horne liable to Galloway on his negligence claim — thereby finding that Horne had caused Galloway’s injuries — but found in favor of Djuric. Despite the evidentiary limitations imposed at trial, the jury assessed $125,000 in damages against Horne, and on July 15, 2011, judgment was entered accordingly. Galloway appealed to the United States Court of Appeals for the Fourth Circuit on August 13, 2011.

On appeal, the Fourth Circuit was asked to determine whether a personal injury dispute presents a “complicated medical question” necessitating expert testimony. Wilhelm v. State Traffic Safety Comm’n, 185 A.2d 715, 719 (Md. 1962). Citing to Maryland law under Wilhelm, the Fourth Circuit stated that when a personal injury claim involves a “complicated medical question” that “falls within the province of medical experts,” expert testimony must be presented to the fact-finder to connect the injuries to the alleged negligent act. Id. Nonetheless, the appellate court also noted that “[t]here are . . . many occasions where the causal connection between a defendant’s negligence and a disability claimed by a plaintiff does not need to be established by expert testimony.” Id. Specifically, the Fourth Circuit explained that, under Wilhelm, expert testimony is not required if the case falls into one (1) of three (3) categories: (1) if “a disability develops coincidentally with,” or within a “reasonable time after,” the subject act; or (2) if the proof of causation is “clearly apparent” from the nature and circumstances of the injury; or (3) if “the cause of the injury relates to matters of common experience, knowledge, or observation of laymen.” Id.

Applying Wilhelm to the instant case, the appellate court determined that Galloway’s case qualified under each of Wilhelm’s three (3) categories of cases where experts are unnecessary. First, Galloway’s back injuries developed coincidentally with and immediately after Horne’s negligence. Second, causation was “clearly apparent” from the nature and circumstances of his injuries. Third, under the evidence, the cause of Galloway’s back injuries was shown to be the wreck on I-95, and a reasonable jury could so find by using its “common experience, knowledge, [and] observation.” Wilhelm, 185 A.2d at 719. Thus, the Fourth Circuit concluded that no experts were needed to establish that being rear-ended by an eighteen (18)-wheel tractor-trailer in a multi-vehicle interstate accident could cause lower-back injuries. For these reasons, the Fourth Circuit vacated the judgment of the district court, remanded the case for a new trial on damages only, and dismissed the cross-appeal by Horne.