## Facts

- Betty Pat Ingram sued Charlotte Sofley McCuiston for negligence after an automobile collision in Charlotte, North Carolina.
- The collision occurred on March 16, 1961, when Ingram was driving west on Woodlawn Road near the South Tryon Street intersection and McCuiston’s car struck Ingram’s vehicle from the rear, pushing it into the car ahead.
- Ingram claimed physical injury from the crash, including a five percent permanent disability to her neck and thoracic spine.
- Ingram also claimed serious emotional and psychological problems allegedly caused by the collision, including depression and suicidal tendencies.
- To prove medical causation and permanency, Ingram presented testimony from her orthopedic specialist, Dr. Robert E. Miller.
- On direct examination, Ingram’s attorney posed an extended hypothetical fact pattern to Dr. Miller that included Ingram’s physical and emotional history and the accident circumstances.
- The hypothetical included assumed, embellished, or inaccurate matters, including that Ingram had been in excellent physical and emotional health before the accident; that she developed suicidal tendencies afterward; and that she suffered disability in additional spinal areas not supported by the evidence referenced in the question.
- The hypothetical also included unnecessary narrative material (such as background details and why Ingram was on the road) that was not needed for a medical opinion.
- Dr. Miller responded that the accident could have produced the physical and emotional conditions described, and he indicated he was basing his comments about the emotional condition on the testimony/diagnosis of Ingram’s psychiatrist, Dr. Wright.
- Defendants objected that the hypothetical assumed facts not in evidence, contained irrelevant and one-sided material, and improperly incorporated another physician’s conclusions; the trial court overruled the objections.
- The jury returned a verdict for Ingram, and defendants appealed, challenging the admission of Dr. Miller’s opinion testimony based on the hypothetical.

## Issues

1. Whether it is error to admit an expert’s opinion elicited by a hypothetical question that includes assumed facts not supported by the evidence (or reasonable inference), contains unnecessary and prejudicial narrative, and treats another doctor’s diagnosis as an assumed fact for the testifying expert.
2. If error occurred, whether it was prejudicial so as to require a new trial.

## Decision

- The Supreme Court of North Carolina reversed the judgment for the plaintiff and awarded a new trial.
- The court held the hypothetical question (and a follow-up question incorporating it) was improper because it assumed facts not supported by the evidence, included irrelevant and argumentative matter likely to bias the jury, and incorporated another physician’s diagnostic conclusions as part of the assumed “facts.”
- Because the challenged testimony went to causation and the extent of damages, the error was prejudicial.

## Legal Principles

- A hypothetical question to an expert is competent only if it is limited to facts already in evidence or facts the jury could logically infer from the evidence.
- A hypothetical question should not be used as a vehicle to place before the jury assumed, exaggerated, or inaccurate factual claims not supported by the record.
- A hypothetical may be excluded when it includes extended, unnecessary, or one-sided narrative that functions as advocacy rather than a fair statement of assumed facts for an opinion.
- An expert’s opinion generally cannot be built on the opinion or diagnosis of another expert embedded as an assumed fact, rather than on underlying facts established by evidence.
- When improper expert testimony bears directly on causation and damages in a personal-injury case, its admission may constitute prejudicial error requiring a new trial.

## Conclusion

The court granted a new trial because the plaintiff’s orthopedic surgeon was allowed to answer an extended, slanted hypothetical that assumed unsupported facts and incorporated a psychiatrist’s diagnosis, creating a substantial risk that the verdict rested on an opinion formed from matters not properly established in evidence.


Ingram v. McCuiston, 134 S.E.2d 705 (1964)