Montgomery Mutual v. Chesson

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Montgomery Mutual Insurance Company v. Josephine Chesson, et al. No. 110, September Term, 2006. EVIDENCE ADMISSIBILITY OF SCIENTIFIC AND MEDICAL EVIDENCE EXPERT MEDICAL TESTIMONY: Where it was unclear whether the medical community generally accepted the theory and testing methods underlying a medical expert s diagnosis that exposure to mold caused certain ailments described as either sick building syndrome or bio toxic illness, that testimony should have been the subject of a Frye-Reed hearing to determine its admissibility. JUDICIAL REVIEW LIMITED REMAND: Limited remand ordered. A limited remand for the purpose of holding a Frye-Reed hearing is appropriate where the issue to be resolved is collateral to the main issues to be resolved at trial. In the Circu it Court for H oward C ounty Case No. 13-C-03-56903 IN THE COURT OF APPEALS OF MARYLAND No. 110 September Term, 2006 MONTGOMERY MUTUAL INSURANCE COMPANY v. JOSEPHINE CHESSON, ET AL. Bell, C.J. Raker Cathell Harrell Battaglia Greene Wilner, Alan M. (Retired, specially assigned), JJ. Opinio n by Rak er, J. Filed: May 23, 2007 This appeal arises from a final judgment in a workers compensation matter in which a jury in the Circuit Court for Howard County returned a verdict in favor of respondents and against the Baltimore Washington Conference of the United Methodist Church and Montgomery Mutual Insurance Company. Respondents claimed that they each had sustained an accidental injury or occupational disease, known as sick buildin g syndro me, 1 arising out of and in the course of th eir employment, due to exp osure to toxic mold. The issue presented in this case is whether the Circuit Court abused its discretion by not holding a Frye-Reed hearing pursuant to our holding in Reed v. Sta te, 283 M d. 374, 3 91 A.2 d 364 ( 1978) , to determine the admissibility of the testimony of respondents expert, R itchie Shoemaker, M.D ., and specifically, to decide whether the doctor s methodologies used for diagnosis and theories regarding the causal connection between mold exposure and certain hum an health effects are g ener ally accepted in the scien tific comm unity for that pu rpose. W e shall hold that the expert s testimony should have been the subject of a Frye-Reed hearing. I. Respondents, Josephine Chesson, Martha Knight, Carole Silberhorn, Linda Gamble, Kenne th Lyons, and Connie Collins, were employees of the Baltimore Washington 1 Sick building syndrome refers to a combination of ailments associated with exposure to modern buildings that lack proper ventilation. The World Health Organization has identified sick building syndrome as an excess of irritation of the skin and mucous membranes and other symptoms, including headache, fatigue, and difficulty concentrating. World Health Organization Regional Office for Eu rope, Indoor air pollutants: exposure and health effects, EUR O Re ports an d Stud ies No . 78, p. 23-26 (1 983), available at http://whqlibdoc.who.int/euro/r&s/EURO_R&S_78.pdf. Conference of the United Methodist Church, and worked at the Church s offices located at 9720 Patuxent Woods Parkway, Columbia, Maryland. On November 18, 2002, several employees work ing in th e offic e buildin g notice d a fou l odor e mana ting fro m the w alls. A maintenance crew broke through an interior wall and discovered two types of mold, Aspergillus and Stachybotrys. Responde nts each filed a claim with the Maryland Worker s Compensation Commission, alleging that they had sustained an accidental injury or occupational disease known as sick building syndrome du e to mo ld expo sure on Nove mber 1 8, 2002 . See Md. Code (1999, 2006 Cum. Supp.) § 9-101 et seq. of the Labor and Employment Article. The Workers Compensation Commission held a hearing and disallowed two of respondents claims and awarded partial compensation to the remaining respondents after finding accidental injury or occupational disease due to mold exposure.2 Each respondent filed a petition for judicial review in the Circuit Court for Howard County, see Md. Code (1999, 2006 Cum. Supp.) § 9-737 et seq. of the Labor and Employment Article, and a joint motion to consolidate the claims. 2 The Work ers Compensation Commission found that respondents Connie Collins and William Lyons suffere d neither an accidental injury nor an occup ational diseas e due to mold exposure. The Commission found that respondents Josephine Chesson, Martha K night, and Carole Silberhorn suffered accidental injury due to mold exposure, and that respondent Linda Gamb le suffered from an o ccupation al disease an d not accid ental injury due to mold exposure. -2- The Circuit Court consolidated the claims.3 Each respondent had been examined and treated by Dr. Ritchie Shoemaker, a licensed medical doctor and board-certified physician in the field of family medicine. Prior to trial, petitioner filed a motion in limine seeking to exclude the testimony of Dr. Shoemaker on the grounds that his theories and methodologies for diagnosis regarding a causal connection between mold exposure and certain human health effects had not been gen erally accepted within the relevant scientific community. Petitioner requested a Frye-Reed hearing, addressing the court as follows: [DEFENSE COUNSEL ]: The diagnosis of sick building syndrome, or bio toxic illn ess, assume s the causal relation ship of the symptoms, to the bio toxic illness. It s the diagnosis in itself, of the bio toxic illness, is that this particular illness exists, as a legitimate illness. Unfortunately, the ICD-9 classifications, which lists all diagnosis, for all illnesses, do not recognize bio toxic illness as an illness. It s also not recognized by the CDC, the Institute of M edicine, and NIOS H, The N ational Institute of Occupational Safety and Health. Arrival at that diagnosis of bio toxic illness, uses techniques not g ener ally ac cept ed by the scien tific com mun ity, which is the Frye-Reed test. Dr. Shoem aker focu ses on a co nstellation of symptoms as being caused by bio toxic illness. This constellation of symptoms is not accepted as an illness from mold. The fundamental principles of differential diagnosis require that you rule out other causes of illnesses from symp toms that are presented from the patient. The first thing you w ould do is ru le out known illnesses, not an illness that you happen to have made 3 The following cases were consolidate d with the present case: 13-C-03-56904, 13-C03-56955, 13-C-03-56956, 13-C-03-57033, 13-C-03-57043, 13-C-04-57483, 13-C-04-57784, and 13-C-04-60173. -3- up yourself, and that is not accepted by the ICD-9 classifications. For example, the symptoms presented by these claimants could inclu de: allergic rhinitis, sinusitis, stress at the belief of being ill; tho se illnesses w ere not even considered by Dr. Shoemaker. He took the constellation THE COURT: Excuse me, wouldn t that go to the weight, rather than the admissibility of his opinion? [DEFENSE COUNSEL ]: No, because you must base your opinion on accepted medical and scientific data. Using a constellation of symptoms, and concluding that it s sick building syndrome, is not a generally accepted method for diagnosis. The generally accepted method for diagnosis is to rule out different illnesses that are a ccepte d as illne sses. In addition, accepting a patient s prior medical history just by having them tell you, without verifying the accuracy of the information, is not a generally accepted form of diagnosis. Dr. Sho emaker, by his own admission, reviewed no medical evidence, w hatsoever, concerning prior illnesses. In addition, he prescribes a drug, Cholestyramine, for the treatment of bio toxic illness, and the FDA has not ap proved C holestyramine for the treatm ent of bio toxic illness becau se, of cours e, they don t recognize bio toxic illness as a legitimate illness. The modifying of the accepted diagnostic tools, also comes under a Frye-Reed evaluation, and that is exactly what Dr. Shoem aker is d oing. He s saying, look there s five thousand tests of the visual-co ntrast sensitivity test. There s, you know, four thousand studies on Cholestyramine, but what he is not telling you, is that those stu dies are bein g modifie d for his use; his use is unique, and new , it s a new sc ientific techn ique and it should be looked at under the Frye-Reed test. When we look at these issues with diagnosis and treatment, we haven t even gotten yet to his expression of causal relationship . If he can separate out where he has diagnosis, and then g oes to caus al relationship , I d sure like to see it, because by the time these people even got to him, he had already diagnosed sick building syndrome. He sent out the -4- questionnaires, they filled them out, and sent them back, or brought them b ack an d, by that time, he found sick building syndrome. He didn t do any differential diagnosis, even though he says he did. He didn t do any testing that is accepted as by the general scientific community for mold related illnesses, such as: allergy test ing, spirometry testing he decides that blood work is the way to go with mold. That visual-contrast sensitivity tests, which are used to tes t the vision of pilots, is what is used for mold. That those techniques, though they may be established for other causes, have been modified for D r. Shoemake r s purposes and, theref ore, they should be under the Frye-Reed evaluation. His tests, and his methods a re complete ly experimen tal. He is the self-proclaimed forerunner in this area of law. He admits that he s the one that developed this *** The problem w ith Dr. Sho emaker s experienc e is it s all anecdotal. The anecdotal evidence that he sees from treating people with Physteria and from what he sees THE COURT: Physteria were the fish dow n in Pocomo ke C ity, or the Pocomoke River, or something? [DEF ENSE COU NSEL ]: That s corr ect THE CO UR T: o r the Che sape ake B ay? [DEF ENSE COU NSEL ]: That s corr ect THE COU RT: Yeah [DEFENSE COUNSEL]: that s right. And he uses that anecdotal evidence and anecdotal evidence from his treatment of mold patients. The prob lem with that is, it assumes that the test he uses to g et to those diagn oses are, gen erally accepted and they re not the gener ally ac cept ed w ay to diagnose a mold related illness, which is to look at the prior medical records, -5- physically look at them, see what these people have been experiencing prior to the mold exposure. It s to do allergy testing, spirometry testing, and then come up with a differential diagnosis by excluding known illnesses, not by au tomatically assuming that this constellation of symptoms means sick building syndrome. *** THE COURT: Well, if I were going to before I could do what you re asking me to do, if indeed, this would have to be submitted to the Frye-Reed analysis, then w ould I not h ave to have a Frye-Reed hearing , as opp osed to just say, oh , well, I agree with you, w ouldn t I be entitled to have a Frye-Reed hearing? [DEFENSE COUNSEL ]: We can bring our experts in, Your Hono r, and D r. Shoe make r is alread y on vide o. Respon dents maintained that because Dr. Shoemaker s opinion was a medical opinion, offered as that of a general practitioner and treating physician, the testimony was admissible and not the proper subject of a Frye-Reed hearing. The Circuit Court agreed with respondents and denied petitioner s request for a FryeReed hearing. The court reasoned as follows: I m prepared to rule on the motion in limine, and I m satisfied, from the evidence. I m going to deny the motion in limine to exclude the testimony of Dr. Ritchie Shoemaker, and I have reviewed the entire submissions and responses, and the cases that you ve cited, and also have revie wed, w ith interest, the deposition of Dr. Shoemaker, and I m satisfied, from the evidence that, regardless of where he starts, that Dr. Shoemaker has people fill out a form, which is not an uncommon practice among physicians, or physician s offices, but he then goes on and he takes a history, and of the patients, and he physically -6- examines them, and then does testing, and the particular tests that he uses are different various and sundry blood tests. *** And he also indicated that h e s spending , app roximate ly, seventy-five percent of his professional time, now, dealing w ith bio toxic related illness. His particular entry into this area, and notoriety, came with the Physteria problem in M aryland, and I noted, in reviewing his deposition, that he had a particular inte rest in wetlands, and causal relationship with that regard. But we re talkin g about a board-certified physician, who has devoted, apparently, in the last five or six years, more than fifty percent of his time to this a rea of spec ialty, and I m satisfied that this is not a Frye-Reed situation, it s diagnosis by a medical p ractitioner, and he, while they have not adopted, or adapted his publications, and things that he has developed ; he s published widely in this field, he s gone to law school, and consulted, and he s indicated he s worked with a number of other doctors in this area; I m satisfied that he s qualified to render opinions in this area, and his opinions would be admissible in the things you mentioned that go to their w eight, rather than their admissibility. So I am going to deny the motion in limine. The case proceeded to trial and Dr. Shoemaker s testimony was admitted on behalf of respondents. The jury returned verdicts in favor of each respondent, finding a causal relationship between mold exposure and certain illnesses claimed by respondents.4 4 The jury found that mold exposure on the date of November 18, 2002 caused a neuro-cognitive condition in Carole Silberhorn, a musculoskeletal and neuro-cognitive condition in Martha Knight, a musculoskeletal and neuro-cognitive condition in Josephine Chesson, an accidental injury that resulted in a respiratory condition in William Lyons, an (contin ued...) -7- Petitioner noted a timely appeal to the Court of Special A ppeals. Be fore that co urt, petitioner raised the arg ument he raises befo re this Cou rt: that the Circuit Court erred when it accepted Dr. Shoemaker as an expert witness without first holding a Frye-Reed hearing to determine whether his medica l opinions and method s of diagn osing patien ts are genera lly accepted within the scientific community. The intermediate appellate court rejected petitioner s argument, stating as follows: As in the case sub judice, we have previously held that expert opinions concerning the cause or origin of an individual s condition are not subject to Frye-Reed analysis. In Myers v. Celotex Corp., 88 M d.App. 442, 460, 594 A.2d 1248 (1991), cert. denied, Fibreboard Corp. v. Myers, 325 Md. 249, 600 A.2d 418 (1992), we reversed the trial court s exclusion of appellant s expert causation opinion regarding asbestos exposure and cancer. In distinguishing the facts of Myers from a case that would invoke a Frye-Reed analysis, we explained that the fact that exposure to asbestos may cause cancer . . . is not a novel or controversial assertion, nor is it a conclusion person al to Dr. Schep ers. Id. at 458, 594 A.2d 1248. We also stressed that the Reed holding h ad not been extended to medical opinion evidence which [was] not presented as a scientific test [,] the results of which were controlled by inexorable, physical laws. Id. at 458-59, 391 A.2d 364 (citation and quotation marks omitted). *** We revisited Myers in the case of CSX Transp., Inc. v. Miller, 159 M d.App . 123, 85 8 A.2d 1025 ( 2004) , cert. granted, 384 Md. 581, 865 A.2d 589 (2005 ), cert. dismissed, 387 Md. 4 (...continued) accidental injury that r esulted in a neu ro-cog nitive co ndition in Lind a Gam ble, and an accidental injury that resulted in a respiratory an d neuro-c ognitive co ndition in C onnie Collins. -8- 351, 875 A.2 d 702 (20 05), in which we affirmed the trial court s acceptance of expert medical opinion testimony. Referring to our opinion in Myers, Judge Moylan reiterated: A doctor s op inion as to the etiology of his patient s arthritis is simply not the type of thing contemplated by the phrase new and novel scientific technique [required by the Frye-Reed test]. What is contemplated are new, and arguably questionable, techniques such as lie detector tests, breathalyzer tests, paraffin tests, DNA identification , voiceprint ide ntification, as in the Reed case itse lf, and the use of polarized light mic roscop y to identif y asbesto s fibers . . . Id. at 187, 8 58 A.2 d 1025 . Montgomery Mutual v. Chesson, 170 Md. App. 551, 569-70, 907 A.2d 873, 884 (2006). The Court of Specia l Appeals concluded that a Frye-Reed hearing was not necessary to address Dr. Shoemaker s theory of causation because that was part of his medical diagnosis, and that the Circuit Court committed no error in denying the motion in limine because Dr. Shoemaker utilized medical tests that are gen erally accepted in the scientific com mun ity. Id. at 560, 907 A.2d at 878. Montgom ery Mutual Insurance Company filed a petition for writ of certiorari before this Court. We granted that petition to address the following question: Whether the Court o f Special A ppeals erred in holding that Dr. Ritchie Shoem aker s ow n, unsupp orted, testimo ny about his practices and expertise renders his opinions concernin g mold related illnesses admissible without the necessity of a Frye-Reed analysis. Montgomery Mut. v. Chesson, 396 Md. 12, 91 2 A.2d 648 (2 006). -9- II. Before this Court, petitioner argues that the Circuit Court should have held a FryeReed hear ing to determ ine th e adm issib ility of Dr. S hoemak er s t estim ony. Petitioner states that under a proper Frye-Reed analysis, Dr. Shoemaker s testimony should have been excluded from trial because his method ologies, tech niques, and tests used to fo rmulate his opinions rega rding mo ld ex posu re an d sick buildin g syndrome have not b een gene rally accepted in the scientif ic community.5 Petitioner argues that it was, at a very minimum, entitled to demon strate at an evidentiary hearing before the Circuit Co urt the basis f or its argu men t that Dr. S hoemak er sh ould not h ave b een p ermitted to tes tify. Respon dents contend th at Frye-Reed applies only to the appropriateness of new scientific techniques, and that there was no need for a Frye-Reed hearing in this case because Dr. Shoemaker based his diagnosis on techniques which are generally accepted in the scientific community. Respondents argue that Dr. Shoemaker s medical opinion concerning causation i.e., that exposure to mold caused sick building syndrome in respondents was not a proper topic for a Frye-Reed hearing. 5 Petitioner s two main contentions in this regard are as follows: (1) although some of the tests used by Dr. Shoemaker may be accepted in and of themselves for other purposes in the scientific community as a who le, e.g., visual-contra st sensitivity testing, they are not accepted as reliable or relevant in the diagnosis of sick building syndrome or all of the particular symptoms c laimed by resp ondents, an d (2) Dr. Sh oemake r s use of p atient histories and administration of a certain drug , Cholestyramine, which he employed in his earlier work diagnosing human disease allegedly caused by Physteria, is not accepted as either reliable or relevant to diagnosis of sick building syndrome. -10- III. Maryland Rule 5-702 addresses the testimony of expert witnesses at trial. The Rule provides as follows: Expert testimony may be admitted, in the form of an opinion or otherwise, if the court determines that the testimony will assist the trier of fact to understand the evidence or to determine a fact in issue. In making that determination, the court shall determine (1) whether the witness is qualified as an expert by knowledge, skill, experience, training, or education, (2) the appropriateness of the expert testimony on the particular subject, and (3) whether a sufficient factual b asis exists to suppo rt the exp ert testim ony. A trial judge has wide latitud e in determ ining wh ether expe rt testimony is suf ficiently reliable to be admitted into evidence, and his sound discretion will not be disturbed on appeal unless the decision to admit the exp ert testimony was clearly erroneous or constituted an abuse of disc retion. See Wilson v. State, 370 Md. 191 , 200, 803 A.2d 1 034, 1039 (200 2); Massie v . State, 349 Md. 834 , 850-51, 709 A .2d 1316, 1324 (1 998). Maryland adheres to the standard set forth in Frye v. United States, 293 F. 1013 (D.C. Cir. 1923), fo r determinin g the adm issibility of scientific e vidence and expert scien tific testim ony. Reed, 283 Md. at 389, 391 A.2d at 372 (adopting the Frye standard). Under the Frye-Reed test, a party must es tablish first that any novel scientific method is reliable and accepted generally in the s cientific commu nity before the court will admit expert testimony based upon the app lication o f the qu estione d scien tific tech nique. Wilson, 370 Md. at 201, -11- 803 A.2d at 1039. A trial court m ay take judicial n otice of the re liability of scientific techniques and meth odologies that are wid ely accepted w ithin the scientif ic co mmunity. Reed, 283 Md. at 380, 391 A.2d at 367. A trial court also m ay take notice th at certain scientific theories are viewe d as un reliable, b ogus, o r exper imenta l. Id. Howe ver, when it is unclear w hether the sc ientific com munity accepts the validity of a novel scientific theory or methodology, we have noted that before testimony based on the questioned technique may be admitte d into ev idence , the reliab ility must be demo nstrated . Wilson, 370 Md. at 201, 803 A.2d at 10 39-40. W hile the most common practice will include witness testimony, a court may take judicial notice of journal articles from reliable sources and other publications which may shed light on the degree of acceptance vel non by recognized experts of a particular process or view . Reed, 283 Md. at 380, 391 A.2d at 367. The opinion of an expert witness should be admitted only if the court finds that the basis of the opinion is generally accepted as reliable within the expert s particular scientific field. Wilson, 370 Md. at 201, 803 A.2d at 1040. Where evidence is subject to challenge under Frye-Reed, it is the better practice for a court to address the issue pre-trial and ou t of the p resenc e of the jury. Clemo ns v. State, 392 Md. 3 39, 347 -48 n.6 , 896 A .2d 105 9, 1064 n.6 (20 06). Frye-Reed hearings are best held before trial in order to p reclude jury m embers f rom con sidering irrelev ant eviden ce and to ensure that the verdict is derived from evidence which is before the jury pr operly. Id. at 348 n.6, 896 A.2d at 1064 n.6. As we noted in Reed, Frye was delib erately intended to interpose -12- a substantial ob stacle to the unrestrained admission of eviden ce based u pon new scientific princip les. Reed, 283 Md. at 386, 391 A.2d at 370 (quoting People v . Kelly, 549 P.2d 1240, 1245 (Cal. 19 76)). In a ddition , Frye-Reed generally involves matters collateral to the substantive issues at trial, and for that reason alone is better resolved outside of the presence of the ju ry. Clemons, 392 Md. at 348 n.6, 896 A.2d at 1064 n.6. In the case sub judice, the Court o f Special A ppeals held that it was unnecessary for the Circuit Court to hold a Frye-Reed hearing, reasoning (1) that Dr. Shoemaker s medical diagnosis was not a prope r subject for Frye-Reed analysis, and (2) that the tests Dr. Shoemaker used in reaching his medical diagnoses are generally accepted in the medical com mun ity, and are therefore not subject to Frye-Reed analysis. Montgomery Mutual, 170 Md. App. at 5 60, 907 A.2d at 878. We disagree and hold that, based on this record, the Circuit Court should have held a Frye-Reed hearing to determine whether the medical commu nity generall y accepts the theory that mold exposure causes the illnesses that responde nts claimed to have suffered, and the propriety of the tests Dr. Shoemaker employed to reach his medical conclusions. This Co urt has em phasized re peatedly that Frye-Reed is meant to apply to evidence based on scie ntific op inion. See Clemons, 392 Md. at 364, 896 A.2d at 1073; Wilson, 370 Md. at 20 1, 803 A .2d at 1040 ; Reed, 283 M d. at 381 , 391 A .2d at 36 8. The proper test for determining admissibility under Frye-Reed is whether the basis of the opinion is g enerally accepted as reliable within the expert s particular scientific field. Wilson, 370 Md. at 201, -13- 803 A.2d at 1040 . Dr. Shoemaker s testimony was based on scientific opinion regarding the causal link between mold exposure and sick building syndrome. As such, both his theories regarding causation and the tests he employed to diagnose respondents were subject to FryeReed analysis. Our decision in Wilson helps to dem onstrate this p oint. In Wilson, we found that the trial court erred in permitting the State to use statistical data and a product rule computation to prove the improba bility o f two Su dden Inf ant D eath Synd rome dea ths in a single f amil y. Id. at 195, 803 A.2d at 1036. While admitting that Frye-Reed often w ill not apply to statistical calculations b ecause the choice be tween alternative statistical techniques, although subjective, is often merely a choice between equally valid methods of describing the same underlying scientific data, id. at 202, 803 A.2d at 1040 (quoting Armstea d v. State, 342 Md. 38, 80 n.33, 673 A.2d 221, 242 n.33 (1996)), we noted that there are instances where the use of generally accepted statistical techniques will nonetheless be subject to Frye-Reed analysis. Wilson, 370 Md. at 203, 803 A.2d at 1041. We used the following example to explain: [S]uppose that a new species of flower is d iscovered. W hen it is discovered, a white-flowered variety and a red-flowered variety are observ ed. It would be incorrect to calculate the probability of a new plant havin g white flowers based on a normal distribution, because this would depend on whether flower colors varied along a continuum fro m white to pink to red, or whether there were only discrete possibilities for the flower color, i.e., white or red. Un der this scenario, the correct choice of probability calculations would depend on the underl ying gen etics of the plan t. -14- Wilson, 370 Md. at 203, 803 A.2d at 1041 (quoting Armstead, 342 Md. at 80 n.33, 673 A.2d at 242 n.33) (internal citations omitted). We held that in cases in which the proper choice of statistical techniques was dependent on an underlying scientific phenomenon or principle, a court must engage in Frye-Reed analysis to determine whether that phenomenon or principle is generally acce pted in the sc ientific com munity and w hether the p roper scien tific tests were u sed to re ach the expert s concl usions . Wilson, 370 Md. at 203, 803 A.2d at 1041. In the instant case, the expert witness offered a medical opinion that was based on an underlying scientific principle. The question b efore the Circuit Cou rt was whether D r. Shoemake r s theory regarding mold exposure and illness, and the techniques he employed to reach his m edical conc lusions, we re generally acc epted in the medical co mmun ity. Petitioner s request for an evidentiary hearing was not a frivolous motion. Courts across the United States have applied either the Frye test or the test set ou t in Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 113 S. Ct. 2786, 125 L. Ed. 2d 469 (199 3) to determine the admiss ibility of expert medical testimo ny that mold exposure causes illness. See e.g., Roche v . Lincoln Property Co., 278 F. Supp. 2d 744 (E.D. Va. 2003) (applying the Daubert test to determine the admissibility of a physician s tes timony that mo ld exposure caused v arious ailme nts); Flores v. Allstate Texas Lloyd s Company, 229 F. Supp. 2d 697 (S.D. Tex. 2002) (applying the Daubert test to a medical expert s testimony regarding mold exposure and illness); Mondelli v. Kendel Homes Corp., 631 N.W.2d 846 (Neb. 2001) (applying the Frye test to determine the admissibility of medical expert testimony regarding -15- mold exposure and resp iratory illness); Geffcken v. D Andrea, 41 Cal. Rptr. 3d 80 (Cal. App. 2006) (applying California s Kelly-Frye test, derived from People v. Kelly, 549 P.2d 1240, to testimony regarding the relationship between mold exposure and sick building syndrom e); Allison v. Fire Ins. Exchange, 98 S.W.3d 227 (Tex. App. 200 2) (applying Texas RobinsonDaubert test to address a medical expert s theory that mo ld exposu re led to adv erse health effects); Centex-R ooney C onst. v. Ma rtin Coun ty, 706 So. 2d 20 (Fla. App. 1997) (applying the Frye standard to expert opinion evidence regarding the link betw een expo sure to toxic mold and ce rtain adv erse he alth eff ects). See also D ANIEL J. P ENOFSKY, Litigating To xic Mold Cases, in 92 A M J UR. T RIALS 113 at § 87, p. 325 (2004, 2006 Cum. Supp.) (noting that admissib ility of expert medical or scientific testimony on the trial of the toxic mold case on such key issues as exposure to toxic mold and causation of illness . . . will typically be resolved pursuant to an in limine h earing con ducted prio r to trial or during trial but out of hearing by the jury ); K ATHLEEN L. D AERR-B ANNON, Cause of Action by Residential Owners and Tenants for Persona l Injury and Property Dama ge Due to Toxic M old, in 26 C AUSES OF A CTION 2d 529 at § 20, p. 562 (2006, 2007 Cum. Supp.) (noting that in toxic mold cases, the court is likely to serve as gatekeeper and make a threshold determination on admissibility of scientific or medical testimony. Courts will usually schedule a separate hearing before or during trial as to whether the requisite standard for such testimony has been met, often referred to as a Daubert or Frye hearing. ). As h ave the co urts that have considered this -16- issue, we think it clear that expert medical testimony, such as that offered by Dr. Sho emaker, is the proper subject of a Frye-Reed hearing. The Court of Special Appeals relied upon CSX v. Miller, 159 Md. App. 123, 858 A.2d 1025, and Myers v. Celotex Corp., 88 Md. App. 442, 594 A.2d 1248, to support the conclusion that Dr. Shoemaker s medical opinion testimony was not subject to analysis under Frye-Reed. In both of those cases, the Court of Special Appeals held that a Frye-Reed hearing was unn ecessary to adm it a medical e xpert s opin ion regardin g the origin of a patient s illness. See CSX, 159 M d. App. at 1 87, 858 A .2d at 1062 ; Myers, 88 Md. App. at 458-59, 594 A.2d at 1256 -57. Myers involved a med ical expert s testimony that exposure to asbesto s cause d canc er. Simil arly, CSX involved a medical opinion regarding the etiology of a patient s arthritis. In both cas es, the interm ediate appe llate court fou nd that Frye-Reed analysis was unnecessary because Reed v. Sta te has not be en extend ed to medical opinion evidence which is not presented as a scientific test the results of which were controlled by inexorable, physical laws. 6 CSX, 159 Md. App. at 188, 858 A.2d at 1063 (quoting Myers, 88 Md. A pp. at 458-59, 594 A .2d at 1256-57) (em phasis in original). 6 In Myers v. Celotex Corp., 88 Md. App. 442, 594 A.2d 1248 (1991), the Court of Special Appeals cited our opinion in State v. Allew alt, 308 M d. 89, 517 A .2d 741 (1 986), to support its position that Frye-Reed has not been extended to medical opinion evidence. Myers, 88 Md. App. at 458-5 9, 594 A .2d at 12 56-57 . Allewalt differs from the present case significantly. In Allewalt, we noted specifically that the medical expert s opinion was accepted in the rel evant m edical c omm unity. Allewalt, 308 M d. at 99, 517 A.2d at 746 (stating that there is no issue in this case ov er the fact tha t psychiatrists and p sychologists recognize PTSD [p ost-traumatic stress disorder] as an anxiety disorder ). The primary issue in the case sub judice is whether the medical expert s opinion has been generally accepted in the rele vant med ical c omm unity. -17- The instant case differs from both CSX and Myers. It involves m ore than a g enerally accepted medic al opinio n and d iagnos is. Dr. Shoemaker employs medical tests to reach a conclusion that is not so widely accepted as to be subject to judicial notice of reliability.7 7 While we offer no opinion on the general acceptance of Dr. Shoem aker s medical conclusions, we think it clear that his theories are not the proper subject of judicial notice. The debate on toxic mold and sick building syndrome has become increasingly pre valent in American courtroo ms, a nd courts across the co untry have reached differing conclusions regarding the causal relationship between mold e xposu re and s ick build ing syndr ome. See e.g., Mond elli v. Kendel Homes Corporation, 631 N.W.2d 846, 858 (Neb. 2001) (holding that under the Frye standard, expert testimony was permissible on the subject o f mold exposu re and respiratory illness); Geffcken v. D Andrea, 41 Cal. Rptr. 3d 80, 89 (Cal. App. 2006) (finding that under California s Kelly-Frye standard, ex pert testimon y was inadm issible because appellants failed to show that the relationship between mold exposure and sick building syndrome has gained general acceptance in th e relevant scientific comm unity); Centex-Rooney Const. v. M artin Cou nty, 706 So. 2d 20, 26 (Fla. App. 1997) (finding that under the Frye standard, the scientific community recognizes the link betwe en expos ure to toxic mold and certain a dverse health effects). The General Assembly has taken notic e of the inc reasing claim s linked to toxic mold exposure, and during the 200 1 Session , established a task force o n indoor a ir quality to address the sub ject. See S.B. 283 (2001). The task force issued a lengthy report on indoor air quality, reaching the following conclusions: Some molds have also been shown to produce toxins (termed mycotoxins) which have been shown to have significant health effects in animals when given in high doses. While there is considerable scientific debate about the potential for these molds to cause toxic effects in people in concentrations typically seen in office buildings, there is consensus among the Task Force and most health profession als that: (1) Mold growth in buildings ca n have ad verse hea lth consequences; (2) Norma l backgrou nd levels of mold can be found in all buildings; (3) There is an inadequate base of scientific knowledge at this time to set health-based mold standards for buildings because of uncertainties about levels of exposures, the rela tionship between exposure and differen t health effects, and differen ces in susceptibility from person to person; (contin ued...) -18- Further, as we noted in Reed, novel medical theories regarding the causes of medical conditions have been subject to Frye analysis. Reed, 283 Md. at 383, 391 A.2d at 369 (noting that the Frye test has been applied to medical te stimony regard ing the cau se of birth defects ). See also Pasteur v. Skevofilax, 396 Md. 405, 431 n.18, 914 A.2d 113, 128-29 n.18 (2007) (noting that an expert s medical opinion will not be admissible u nless it is gene rally accepted as reliable in the exp ert s particular field). The Circuit Co urt erred w hen it allowed Dr. Shoemaker s testimony without first holding a Frye-Reed hearing to determine whether his theories and methodologies are generall y acce pted in the me dica l com mun ity. IV. The question arises as to the proper remedy for the trial court s error and whether the judgmen t should be vacated and a new trial ordered, or whether this matter is better suited 7 (...continued) (4) While background levels of mold and mo ld exposu res in buildings cannot be complete ly eliminated, exp osures du e to indoor mold contamination can and should be minimized; and (5) Mold g rowth and contamination in office buildings can and should be prevented or controlled th rough the use of ad equate and ongoing maintenance of the building and building systems, as well as throu gh goo d hous ekeep ing. Marylan d State T ask Fo rce on I ndoor Air Q uality, Final Report, p. 11 (2 002), available at http://www.dllr.state.md.us/labor/indoorairfinal/iaqfinalreport.pdf (emphas is added). B oth the findings of the task force and our analysis of cases across the country lead us to believe that Dr. Shoemaker s theories should be subject to a Frye-Reed hearing and not taken as reliable through judicial notice. -19- to a limited remand pursuant to Maryland R ule 8-604 (d), with direc tions to the trial co urt to hold a Frye-Reed hearing. This case fits well within the Maryland rule permitting and providing for a limited remand. Maryland Rule 8-604(d) provides, in pertinent part, as follows: (d) Remand. (1) Generally. If the Court concludes that the substantial merits of a case will not be determined by affirming, reversing or modifying the judgment, or that justice will be served by permitting further proceedings, the Court may remand the case to a lower court. In the order remanding a case, the appellate court shall state the purpose for the remand. The order of remand and the opinion upon w hich the order is based are conclusive as to the points decided. Upon remand, the lower court shall conduct any further proceedings necessary to determine the action in accordance with the opinion and order of the a ppellate court. A limited re mand is ap propriate in various circumstances, in both civil and criminal cases, and most notably when the purposes of justice will be advanced by permitting further procee dings. Southern v. State, 371 Md. 93, 104, 807 A.2d 13, 19-20 (2002). A remand may be limited if the erro r occur red in a p roceed ing colla teral to th e trial itself , and the limited purpose o f the rema nd is to corre ct the error that occurred during the collateral procee ding. Lipinski v. Sta te, 333 Md. 582 , 591, 636 A.2d 9 94, 998 (1994). Our jurisprudence is replete w ith exam ples w here a lim ited rem and is p roper. See e.g., Edmo nds v. State , 372 Md. 314, 812 A.2d 1034 (2002) (ordering a limited rema nd to hold a new Batson hearing to address the credibility of prosecutor s race-neutral explanations for the use of perem ptory strikes); In re Adoption No. A91-71A, 334 Md. 538, 640 A.2d 1085 -20- (1994) (ordering a limited remand to appoint independent counsel to represen t the interests of a child invo lved in a co ntested ado ption proce eding); Patrick v. Sta te, 329 Md. 24, 617 A.2d 215 (1992) (ordering a limited remand to determine whether a criminal defendant was prejudiced by the State s failure to disclose p olygraph test res ults); Scheve v. Shudder, 328 Md. 363, 614 A.2d 582 (1992) (ordering a limited remand so that the trial court could determine whether to dismiss an action purs uant to M aryland Rule 2-506); Warrick v . State, 326 Md. 696, 607 A.2d 24 (1992) (ordering a limited remand to hold an in camera hearing to determine whether the defendant was entitled to the name of a confidential State informan t, and if so, whether he suffered prejud ice due to the State s failure to provide the name of that info rmant); Reid v. State , 305 Md. 9, 501 A.2d 436 (1985) (ordering a limited remand to hold an e videntiary hear ing regardin g the authe nticity of character letters offered by defenda nt during se ntencing p roceeding s); Bailey v. Sta te, 303 Md. 650, 496 A.2d 665 (1985) (ordering a limited rema nd to permit the State to provide discovery material regarding statements made by the defendant to an out-of-state police trooper and to allow the trial court to determine the appropriate sanction for the disco very violation); Wiener v. S tate, 290 Md. 425, 430 A.2d 588 (1981) (ordering a limited remand to reconsider defendant s motion for dismissal of his indictment du e to ineffective assistance of c ounsel). Other appellate courts addressing Frye or Daubert issues have ordered limited remands. For example, in Brim v. Sta te, 695 So. 2d 268 (Fla. 1997), the Florida Supreme Court ordered a limited remand after determining that DNA population frequency tests were -21- subject to analysis under the Frye test. The cou rt noted that th ere wou ld be no ne ed to overturn the verdict if the trial court found that the methods satisfied the Frye test; a new trial would be necessary only if the trial court reached a contrary conclusion and foun d the tests should have b een ina dmissib le. Id. at 275. Likewise, in People v. Leahy, 882 P.2d 321 (Ca l. 1994), the California Supreme Court ordered a limited remand to hold a Kelly-Frye hearing. In addressing the propriety of certain field sobriety tests, California s highest court noted that retrial of the case might be unnecessary because the questioned scientific evidence could be found admiss ible at the hearing . Id. at 335. See also State v. Harvey, 699 A.2d 596, 683 (N.J. 1997) (recognizing that an appellate court addressing a Daubert issue may remand the matter to the trial court to take additional testimony about the general acceptance of the scientific evidence ). In this ca se, the iss ue to be resolve d, i.e., the threshold question o f the adm issibility of Dr. Sh oema ker s tes timony, is c ollateral t o the issu es to be resolve d at trial. See Clemons, 392 Md. at 348 n.6, 896 A.2d at 1064 n.6 (noting that Frye-Reed hearings generally involve matters collateral to the substantive issues of a case). Verdicts should not be vacated unnecessarily, and in this case, a retrial m ay not be necess ary. Indeed, it would be a grave injustice were we to rev erse the judgment an d vacate the verdict, and then the trial court, after a Frye-Reed hearing , determined properly that Dr. Shoemaker s testimony was generally acce pted within the scientific comm unity. Accordingly, we remand this case for an evidentiary hearing to ascertain whether Dr. Shoemaker s methodologies used for -22- diagnosis and theories regarding the causal connection between mold exposure and certain human h ealth effec ts are genera lly accepted in th e scientific community. The trial court is directed to make factual findings and conclusions and then to issue a Frye-Reed determination. If the trial court finds that Dr. Shoem aker s methods and theories satisfy the Frye-Reed test, the judgment should remain in effect. If the court finds to the contrary, the judgment should be vacated. Our remand is limited solely to this issue. JUDGMENT OF THE COURT OF SPECIAL APPEALS VACATED. CASE REM ANDED TO T H AT COURT WITH DIRECTIONS TO REMAND CASE, WITHOUT AFFIRMANCE OR REVERSAL, TO T H E CIRCUIT COURT FO R HOWARD COUNTY FOR TH E PURPOSE OF HOLD I N G A HEARING PURSUANT TO THE M O T IO N I N L I M I N E . THE JUDGMENTS OF TH E CIRCU IT C OURT REM AIN IN E F F E CT UNLESS VACATED BY THE CIRCUIT COURT IN ACCORDANCE WITH THE PROCEDURES SET FORTH IN THE FOREGOIN G OPINION. COSTS IN THIS COURT AND THE COURT OF SPECIAL A P P E A L S T O B E P A I D BY RESPONDEN TS. -23-

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