Hart v. Secretary of the Department of Health & Human Services

60 Fed. Cl. 598, 2004 WL 1119955
CourtUnited States Court of Federal Claims
DecidedMay 3, 2004
DocketNo. 01-357 V
StatusPublished
Cited by10 cases

This text of 60 Fed. Cl. 598 (Hart v. Secretary of the Department of Health & Human Services) is published on Counsel Stack Legal Research, covering United States Court of Federal Claims primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hart v. Secretary of the Department of Health & Human Services, 60 Fed. Cl. 598, 2004 WL 1119955 (uscfc 2004).

Opinion

OPINION

ALLEGRA, Judge.

“It is vain to do with more what can be done with fewer.”

So said the medieval philosopher William of Occam, known for his popular razor, which can lead medical doctors to choose parsimoniously from a set of otherwise equivalent diagnoses the simplest one.2 But, is this simplest diagnosis always the right one — under the law?

In this vaccine case, before the court on petitioner’s motion for review, the diagnosis accepted by the Special Master hinged on probabilistic statistics that appeared to show that it was more likely that the tragic death of a young boy was not the result of the measles, mumps and rubella (MMR) vaccine, but an unrelated virus. Because the Special Master’s reliance on such statistics was not only incompatible with the decisional law, but particularly inapropos given the shortcomings of the statistics themselves, the court believes that a razor of a different sort must be plied here — one that transects from the factual findings here any taint attributable to the statistics in question. This matter accordingly is remanded to allow the Special Master, in the first instance, to perform this task in rendering new findings.

[599]*599I. FACTUAL AND PROCEDURAL BACKGROUND

On January 1, 1998, Manasseh Miclea was born to Emma Hart and, by all accounts, was a normal, healthy boy for the first fifteen months of his life. On April 10,1999, Manasseh received several vaccinations, including a measles, mumps, rubella (MMR) immunization. During the next several days, Manasseh’s mother called his pediatrician once or twice because he was not feeling well and had begun to develop a rash. On April 22, 1999, Manasseh was brought to his pediatrician’s office. Fever and rash are common reactions to the measles vaccine and usually appear one or two weeks post-vaccination and, apparently for that reason, Manasseh’s treating pediatrician recorded on April 22, 1999, that his symptoms likely constituted either a “viral exanthem,” ¿a, a rash due to a virus, or an “MMR reaction.” During the ensuing two weeks, his parents made several calls to the pediatrician, and he was taken into the office on May 2 and May 5, 1999, with symptoms including crying, fever, vomiting, red throat, rash, and swollen gums. More symptoms developed, prompting additional physician visits on May 6, 7, 8 and 9, 2000. Finally, Manasseh was hospitalized on May 9,1999, and would remain so, except for a brief release on May 20, until his untimely death on June 20, 1999. It was determined, and it is not disputed, that Manasseh’s death was the result of a condition known as hemophagocytic lymphohistiocystosis (HLH).

Certain basic facts regarding HLH are undisputed. HLH is a rare, and generally fatal, disease primarily affecting infants. The disease is not fully understood, but appears to result from the defective, overreactive operation of the victim’s immune system. Cases of HLH appear to be related to some stimulus such as an active infection. Such infections produce “cytokines,” a type of hormone which is strongly suspected as the trigger for the disease.

On June 14, 2001, petitioner filed a claim under the National Childhood Vaccine Injury Act of 1986, 42 U.S.C. §§ 300aa-l to 300aa-34 (the Vaccine Act), contending that Manasseh’s death was caused by his vaccinations of April 10,1999. The Secretary of Health and Human Services (respondent) contested that claim. An evidentiary hearing was held on November 8, 2002; following posthearing briefs, a second hearing to clarify various expert opinions was held on September 2, 2003. Special Master Hastings issued two opinions denying relief: the first on October 1, 2003, and the second, responding to petitioner’s motion for reconsideration, on November 24, 2003. In these opinions, he concluded that petitioner had failed adequately to establish that Manasseh’s MMR shot triggered the HLH and found instead that it was likely that the HLH was triggered by an infection caused by the Epstein-Barr virus (EBV). In reaching this conclusion, the Special Master noted that because petitioner’s claim did not involve a so-called “table injury,”3 petitioner was required to show that the MMR vaccine “actually caused,” or “caused-in-fact,” Manasseh’s death. 42 U.S.C. § 300aa-13(a)(l), § 300aa-ll(e)(l)(C)(ii). As the Special Master further explained, petitioner did not need to prove that the vaccine was the only cause, or even the predominant cause, of Manasseh’s death, but only that the MMR shot was at least a “substantial factor,” and a “but for” cause. See Shyface v. Sec’y of Health & Human Servs., 165 F.3d 1344, 1352 (Fed.Cir.1999).

In analyzing this case, Special Master Hastings began by noting that there was evidence that a vaccine like the MMR could trigger HLH and that the nature and timing of the symptoms experienced by Manasseh were consistent with a reaction to the measles or rubella vaccinations. The Special Master, indeed, indicated that were there not evidence that Manasseh had EBV, he likely would have awarded compensation, stating “based upon the HLH literature and the expert testimony contained in the record of [600]*600this ease, if there were no indication that Manasseh was infected by the Epstein-Barr virus, then I likely would conclude that Manasseh’s HLH was probably triggered by one of his vaccinations received on April 10, 1999.” Hart v. Sec’y of Health & Human Servs., 2003 WL 23218077, at *3 (Fed.Cl. Spec.Mstr. Nov. 24, 2003) (emphasis in original). He noted that in two other vaccine cases, special masters had found that vaccinations triggered cases of HLH, and that one of these eases specifically involved the MMR vaccine. See Ackley v. Sec’y of Health & Human Servs., 2002 WL 985435 (Fed.Cl. Spec.Mstr. Apr. 29, 2002) (MMR vaccination); Gall v. Sec’y of Health & Human Servs., 1999 WL 1179611 (Fed.Cl.Spec.Mstr. Oct. 31, 1999) (DPT and/or OPV vaccinations). The Special Master held, however, that those cases were sui generis because, unlike the case sub judice, there was no proof that the children in those cases were infected with Epstein-Barr.

In concluding that, at the time of the onset of his fatal HLH, Manasseh was infected with EBV, the Special Master relied on statistics indicating that EBV “is by far the most common cause of HLH.” He first relied on these statistics independently, observing:

First, I note that the medical literature introduced by both parties, along with the testimony of the experts, indicates that one particular virus, the Epstein-Barr virus, ... has been identified as by far the most common trigger for HLH. Dr. Byers acknowledged that, as Dr. Berger indicated, Epstein-Barr virus has been the most commonly identified trigger. Dr. Byers seemed to estimate that, based upon her review of the literature, in about 50% of HLH cases Epstein-Barr virus is identified as the trigger. One article submitted by petitioner’s reviewed 219 cases and found the Epstein-Barr virus to be the trigger in 121 cases (55%), with another virus identified as the trigger in 28 cases, non-viral triggers identified in 14 eases, and no trigger identified in 56 cases. Dr.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
60 Fed. Cl. 598, 2004 WL 1119955, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hart-v-secretary-of-the-department-of-health-human-services-uscfc-2004.