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Coleman v. Medtronic, Inc.

California Court of Appeals, Second District, Fifth Division

January 27, 2014

JOHN COLEMAN, Plaintiff and Appellant,
MEDTRONIC, INC., et al., Defendants and Respondents.

Order Filed Date 2/3/14

APPEAL from a judgment of the Superior Court of Los Angeles County No. SC112290, Cesar C. Sarmiento, Judge.

Law Offices of Martin N. Buchanan, Martin N. Buchanan; Girardi & Keese and James G. O’Callahan for Plaintiff and Appellant.

Mayer Brown LLP, Andrew E. Tauber, Scott M. Noveck; Reed Smith LLP, Michael K. Brown, James C. Martin and Lisa M. Baird for Defendants and Respondents.


It is ordered that the opinion filed herein on January 27, 2014, and, be modified in the following particulars:

On page 14, line 4 of the second full paragraph, the citation: (James v. State (2013) 219 Cal.App.4th 1265, fn. 7) is removed and replaced with the following citation: (Elliott v. Albright (1989) 209 Cal.App.3d 1028, 1034.)

On page 22, the heading letter “G.” should be replaced with the letter “F.” so that it reads: F. Manufacturing Defect.

On page 24, line 8 of the disposition paragraph, delete the word “design” and replace it with the word “manufacturing” so that it reads: (3) manufacturing defect.

There is no change in the judgment.


Plaintiff and appellant John Coleman sued defendants and respondents Medtronic, Inc., and Medtronic Sofamor Danek USA, Inc. (collectively, Medtronic), alleging he suffered painful complications after a spinal surgery in which Infuse, Medtronic’s federally-approved bone fusion medical device, was used in an “off-label” manner. Coleman’s seven causes of action are generally based upon allegations that Medtronic defectively manufactured Infuse, promoted off-label uses of Infuse without adequately warning of the associated risks, and failed to take available steps to warn Coleman of the risks of such uses. The trial court sustained Medtronic’s demurrer to Coleman’s third amended complaint without leave to amend on the grounds that each cause of action was preempted by federal law. We conclude that Coleman may allege causes of action for negligence and strict liability in a manner that avoids federal preemption but has waived any claim of error with respect to the remaining causes of action. We therefore affirm in part, reverse in part, and remand to the trial court for further proceedings.


Medtronic manufactures and sells Infuse, a medical device used in surgery to strengthen the spines of individuals with degenerated vertebral discs. Infuse consists of an absorbable collagen sponge, rhBMP-2 (a manufactured version of a protein found in small quantities in the human body), and a titanium threaded fusion cage. During surgery, the doctor infuses the collagen sponge with liquid rhBMP-2 and inserts the sponge into the cage to both stabilize the spine and maintain spacing between the vertebrae during the fusion process.

Under the Federal Food, Drug, and Cosmetic Act of 1938 (FDCA), as amended by the Medical Device Amendments of 1976 (MDA), the Federal Drug Administration (FDA) granted Infuse premarket approval for use in certain types of spinal fusion surgeries, including Anterior Lumbar Interbody Fusion (Anterior Fusion), where the surgical incision is on the patient’s abdomen. Posterior Lumbar Interbody Fusion (Posterior Fusion) is an alternate form of spinal fusion surgery that approaches the spine through an incision in the patient’s back. Posterior Fusion is considered an off-label use of Infuse because the FDA has only approved Infuse for use in Anterior Fusion.[1]

Coleman’s third amended complaint alleges Medtronic promoted the off-label use of Infuse while downplaying the risk of complications, violating both state and federal laws. Medtronic sponsored a clinical trial in 1999 to explore the use of Infuse in Posterior Fusion but halted the trial because early results showed unwanted and uncontrolled bone growth in more than 70 percent of patients. Between 1998 and 2011, Medtronic entered into consulting and royalty agreements with “Key Opinion Leaders” who were physicians touting Infuse through presentations and medical journal articles. Studies funded by Medtronic omitted discussion of bone growth in the spinal canal as an adverse event and instead reported no adverse events. Medtronic, however, was aware that adverse events or complications had been reported in between 20 and 70 percent of cases where Infuse was used in Posterior Fusion. Medtronic also provided information and instructions for off-label surgeries by placing sales personnel in hospital operating rooms. Medtronic’s promotional activities increased the use of Infuse in Posterior Fusion. At the same time, various investigations by media, the Department of Justice, and the Congress raised questions about the safety of Infuse and about payments from Medtronic to physicians.

In April 2009, Coleman underwent Posterior Fusion surgery of his L3–L5 vertebrae. His surgeon used Infuse in an off-label manner. Coleman began suffering numbness and pain after the surgery. CT scans showed the collagen sponge had leaked rhBMP-2 and unwanted bone growth had encased the nerves in Coleman’s spine.

In April 2011, Coleman filed suit against Medtronic. The trial court sustained Medtronic’s demurrers to Coleman’s complaint and first amended complaint with leave to amend. Medtronic filed a demurrer to Coleman’s second amended complaint. Coleman’s opposition to the demurrer attached a third amended complaint. On April 12, 2012, the court sustained the demurrer to the second amended complaint but found the proposed third amended complaint sufficient, with the exception of Coleman’s manufacturing defect claim. The court ordered Coleman to file a third amended complaint without the manufacturing defect claim and ordered Medtronic to file an answer.

Four days later, a three-judge panel of the Ninth Circuit Court of Appeals held that a state law negligence cause of action based on a failure to report adverse information about an FDA-approved medical device as required by federal regulations was preempted by federal law. (Stengel v. Medtronic, Inc. (9th Cir. 2012) 676 F.3d 1159 (Stengel I).) Based on the decision in Stengel I, Medtronic demurred to Coleman’s third amended complaint. The trial court sustained Medtronic’s demurrer without leave to amend on June 13, 2012.

On July 25, 2012, the Ninth Circuit agreed to rehear Stengel I en banc. (Stengel v. Medtronic, Inc. (9th Cir. 2012) 686 F.3d 1121 (Stengel II).) On August 27, 2012, Coleman filed a timely notice of appeal. On January 10, 2013, the Ninth Circuit issued a unanimous 11-judge en banc decision holding that the plaintiff’s state law negligence claims for failure to warn were not preempted by federal law. (Stengel v. Medtronic, Inc. (9th Cir. 2013) 704 F.3d 1224 (Stengel III).)

Medtronic petitioned the United States Supreme Court for a writ of certiorari in Stengel III on May 10, 2013. On October 7, 2013, the Supreme Court issued an order stating: “The Solicitor General is invited to file a brief in this case expressing the views of the United States.” (Medtronic, Inc. v. Stengel (Oct. 7, 2013, No. 12-1351) __ U.S. ___ [134 S.Ct. 375].)


In his timely appeal, Coleman contends his failure to warn, negligence, and manufacturing defect claims are not preempted because they are based on state law duties that parallel requirements under federal law.[2] Medtronic contends that Coleman’s state law claims cannot ...

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