Pritchard v. Blue Cross Blue Shield of Illinois

District Court, W.D. Washington·Decided November 21, 2022·No. 3:20-cv-06145·Unknown

Opinion

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6 7 UNITED STATES DISTRICT COURT 8 WESTERN DISTRICT OF WASHINGTON AT TACOMA 9 10 C. P., by and through his parents, Patricia CASE NO. 3:20-cv-06145-RJB 11 Pritchard and Nolle Pritchard, individually and on behalf of others similarly situated; ORDER ON MOTIONS TO 12 and PATRICIA PRITCHARD, EXCLUDE 13 Plaintiffs, v. 14 BLUE CROSS BLUE SHIELD OF 15 ILLINOIS, 16 Defendant. 17 This matter comes before the Court on Defendant Blue Cross Blue Shield of Illinois’s 18 (“Blue Cross”) Motion to Exclude Plaintiffs’ Experts under Daubert (Dkt. 103) and Plaintiffs’ 19 Consolidated Motion to Exclude Expert Testimony of Michael Laidlaw, M.D., Lawton R. Burns, 20 Ph.D., and Scott Carr Ph.D. (Dkt. 107). The Court has considered the pleadings filed regarding 21 the motions and the remaining record. 22 In this class action, Plaintiff C.P., a transgender male and class representative, and his 23 mother, Plaintiff Patricia Pritchard, claim that Defendant Blue Cross violated the anti- 24 1 discrimination provision, Section 1557, of the Affordable Care Act (“ACA”), 42 U.S.C. § 18116, 2 when it administered a discriminatory exclusion of gender-affirming care in self-funded health 3 care plans governed by the Employee Retirement Income Security Act of 1974 (“ERISA”). Dkt. 4 1. Now pending are the parties’ motions to exclude various experts pursuant to Fed. R. Civ. P. 5 (“Rule”) 702 and Daubert v. Merrell Dow Pharms., Inc., 509 U.S. 579 (1993). Dkts. 103 and

6 107. For the reasons provided below, the Blue Cross’s motion (Dkt. 103) should be denied 7 without prejudice and the Plaintiffs’ motion (Dkt. 107) should be denied without prejudice as to 8 Drs. Laidlaw and Burns and granted, in part, as to Dr. Carr. 9 To the extent the motions (Dkts. 103 and 107) are denied without prejudice, these rulings 10 may be revisited at trial, if appropriate, particularly on relevance issues. 11 Background. The Plaintiffs offer the testimony of Dr. Randi C. Ettner, Dr. Dan Karasic 12 and Dr. Loren S. Schechter as evidence that gender-affirming care is medically necessary. The 13 Plaintiffs rely on the opinion of Dr. Frank G. Fox to estimate the number of people in the class. 14 Blue Cross offers the testimony of Dr. Michael Laidlaw as evidence that gender-

15 affirming care is not medically necessary. It relies on Dr. Lawton R. Burns’ testimony for the 16 proposition that, if this Court determines that Blue Cross may not administer gender-affirming 17 care exclusions, it will cost employers and consumers more. Blue Cross offers the testimony of 18 Dr. Scott Carr to contest the testimony of Plaintiffs’ expert, Dr. Fox, regarding the numbers of 19 class members. 20 Standard. Rule 702 provides that, 21 A witness who is qualified as an expert by knowledge, skill, experience, training, or education may testify in the form of an opinion or otherwise if: 22 (a) the expert’s scientific, technical, or other specialized 23 knowledge will help the trier of fact to understand the evidence or to determine a fact in issue; 24 1 (b) the testimony is based on sufficient facts or data; 2 (c) the testimony is the product of reliable principles and methods; 3 and

4 (d) the expert has reliably applied the principles and methods to the facts of the case. 5 “Before admitting expert testimony into evidence, the district court must perform a gatekeeping 6 role of ensuring that the testimony is both “relevant” and “reliable” under Rule 702.” United 7 States v. Ruvalcaba-Garcia, 923 F.3d 1183, 1188 (9th Cir. 2019)(citing Daubert at 597). To be 8 relevant, the expert testimony must “logically advance a material aspect of the party’s case.” Id. 9 (internal quotation marks and citations omitted). Expert’s testimony must also have “a reliable 10 basis in the knowledge and experience of the relevant discipline.” Kumho Tire Co. v. 11 Carmichael, 526 U.S. 137, 149 (1999). As to reliability, this court must examine “whether the 12 reasoning or methodology underlying the testimony is scientifically valid and properly can be 13 applied to the facts in issue, with the goal of ensuring that the expert employs . . . the same level 14 of intellectual rigor that characterizes the practice of an expert in the relevant field.” Ruvalcaba- 15 Garcia at 1189 (internal quotation marks and citations omitted). The party offering the expert’s 16 testimony has the burden of proving admissibility. Lust By & Through Lust v. Merrell Dow 17 Pharm., Inc., 89 F.3d 594, 598 (9th Cir. 1996). 18 BLUE CROSS’S MOTION TO EXCLUDE 19 A. Plaintiffs’ Experts on Medical Necessity – Drs. Ettner, Karasic, and Schechter 20 The Plaintiffs have shown that these witnesses qualify as experts to testify about the 21 medical necessity of gender-affirming care. Dr. Ettner, is a clinical psychologist with over 35 22 years of experience treating over 3,000 people, almost one third of whom were minors, with 23 gender dysphoria and issues related to gender variance. Dkts. 98-1 at 2-5; 116-2 at 4-5. She has 24 1 co-authored medical texts, including portions of the World Professional Association for 2 Transgender Health (“WPATH”) Standards of Care for the Health of Transsexual, Transgender 3 and Gender-Nonconforming People1 (“WPATH Standards”) and published peer-reviewed 4 scientific articles on the standards of care for the health of transgender people. Dkt. 98-1 at 3-5; 5 28-49.

6 Dr. Karasic is a board-certified psychiatrist with over 30 years-experience working with 7 people with gender dysphoria; one-third of which were minors. Dkts. 98-2 at 3; 116-3 at 7. Like 8 Dr. Ettner, Dr. Karasic has co-authored medical texts, including portions of the WPATH 9 Standards and published peer-reviewed scientific articles on the standards of care for the health 10 of transgender people. Dkt. 98-2 at 3-4 and 25-51. 11 Dr. Schechter is a board-certified plastic surgeon with 27 years of experience who 12 specializes in performing gender confirming surgeries; between 10-20% of his patients are 13 minors. Dkts. 104-1 at 57-59; 116-4 at 4-5. Dr. Schechter has authored texts on the standard of 14 care regarding surgical and postoperative care for people having gender-affirming surgery,

15 including portions of the WPATH Standards and “The Surgeon’s Relationship with the 16 Physician Prescribing Hormones and the Mental Health Professional.” Dkt. 104-1 at 57-135. He 17 18 19 1 “Many of the major medical and mental health groups in the United States—including the American Medical 20 Association, the American Medical Student Association, the American Psychiatric Association, the American Psychological Association, the American Family Practice Association, the Endocrine Society, the National Association of Social Workers, the American Academy of Plastic Surgeons, the American College of Surgeons, 21 Health Professionals Advancing LGBTQ Equality, the HIV Medicine Association, the Lesbian, Bisexual, Gay and Transgender Physician Assistant Caucus, and Mental Health America—recognize the WPATH Standards of Care as 22 representing the consensus of the medical and mental health communities regarding the appropriate treatment for transgender and gender dysphoric individuals.” Edmo v. Corizon, Inc., 935 F.3d 757, 769 (9th Cir. 2019). While 23 most courts agree, some do not. Id. (citing Gibson v.

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