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Zuchowicz v. United States

Citation. 140 F.3d 381 (2d Cir. 1998)
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Brief Fact Summary.

Mrs. Zuchowicz was prescribed Danocrine at double the maximum authorized dosage for one month and the maximum authorized dosage for two months. Four months after, she developed a rare heart disease that caused her death. Her husband sued for her Estate, relying heavily on two expert witnesses because research on excess dosages of Danocrine were not readily available.

Synopsis of Rule of Law.

When use of a drug results in a negative side effect and the drug was wrongly prescribed in an unapproved and excessive dosage, the injured plaintiff has generally shown enough to permit the finder of fact to conclude that the excessive dosage was a substantial factor in producing the harm and it is up to the defendant to produce an explanation for why the wrongful conduct was not a substantial factor in producing the plaintiff’s injury.


Doctors and pharmacists at a naval hospital prescribed Mrs. Zuchowicz a drug called Danocrine to treat her endometriosis (a disease found in the uterus). The doctors prescribed Mrs. Zuchowicz double the maximum authorized dosage of Danocrine for one month and then the maximum authorized dosage for two months after that. They then directed her to stop taking Danocrine.

Four months later, Mrs. Zuchowicz—a healthy, active woman with no history of cardiovascular problems—was diagnosed with a fatal heart disease called primary pulmonary hypertension, resulting in weight gain, swelling of hands and feet, fatigue, and shortness of breath. The disease is extremely rare, occurs predominantly in young women, and can be caused by select other exogenous agents, such as birth control pills or appetite suppressants.

The disease was worsened by her new pregnancy, and it also made her ineligible for a lung transplant. One month after Ms. Zuchowicz gave birth, she died. Her husband sued on behalf of her estate.

At trial, Dr. D’Mowski, one of Mrs. Zuchowicz’s expert witnesses, testified that Danocrine was safe and effective when properly used but that very few women had received doses in this high of a setting. Because no formal studies of excess doses had been conducted, Mrs. Zuchowicz was unable to provide epidemiological or anecdotal evidence linking the disease to Danocrine overdoses. Therefore, her case rested primarily on the testimony of two expert witnesses in pulmonary diseases and pharmacology respectively.

Dr. Matthay, the pulmonary disease expert witness, considered a detailed history of the progression of Mrs. Zuchowicz’s disease, her medical history, and the timing of the Danocrine overdose and her symptoms. He testified that he was confident to a reasonable medical certainty that the Danocrine caused Mrs. Zuchowicz’s disease. While he could not rule out all other possible causes of pulmonary hypertension generally, he did rule out causes of secondary pulmonary hypertension, as well as drug-related causes of primary pulmonary hypertension.

Dr. Tackett, the pharmacology expert witness, testified that, to a reasonable degree of scientific certainty, he believed that the overdose of Danocrine more likely than not produced hormonal factors to cause Mrs. Zuchowicz’s disease.


Was the district court’s decision to admit the evidence of Mrs. Zuchowicz’s two expert witnesses was an abuse of discretion?


No. Affirmed.

The district court’s decision to admit the testimony of Mrs. Zuchowicz’s expert witnesses was not an abuse of discretion.


Was the Admission of the Plaintiff’s Experts’ Testimony Manifestly Erroneous?

The district court’s decision to admit or exclude expert testimony is reviewed under a highly deferential abuse of discretion standard on appeal.

Here, the district court’s decision was not erroneous. The facts of this case are similar to those of McCullock v. H.B. Fuller Co., where we similarly found proper the district court’s decision to admit the testimony of an engineer and a medical doctor in a case involving a worker’s exposure to glue fumes and her subsequent development of throat polyps because the district court carefully fulfilled its role in making the evaluation under the Daubert test.

Were the District Court’s Factual Findings with Respect to Causation Clearly Erroneous?

A district court’s factual findings are reviewed for clear error.

In Connecticut, a plaintiff can prove that an action or omission to act constituted a substantial factor in producing the injury by showing that: (a) the defendant’s negligence was a “but for” cause of the injury; (b) that the negligence was causally linked to the harm; and (c) the defendant’s negligence was proximate to the resulting injury.

If a negligent act increases the chance that the accident will occur and that accident then does occur, this is enough to support a finding by the trier of fact that the negligent behavior caused the harm.

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