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    PUBLISHED
    

    UNITED STATES COURT OF APPEALS
    

    FOR THE FOURTH CIRCUIT
    

    ------------------------------------------------*

    AMERICAN CYANAMID COMPANY,

    Plaintiff-Appellee,

              v.No. 02-1235
    

    ST. LOUIS UNIVERSITY,

    Defendant-Appellant.

    ------------------------------------------------*

    Appeal from the United States District Court
    for the District of Maryland, at Baltimore.
    J. Frederick Motz, District Judge.
    (CA-99-1316-JFM)
    

    Argued: January 22, 2003
    

    Decided: July 16, 2003
    

    Before NIEMEYER, LUTTIG, and TRAXLER, Circuit Judges.
    

    ____________________________________________________________

    Affirmed by published opinion. Judge Traxler wrote the majority

    opinion, in which Judge Niemeyer joined. Judge Luttig wrote a con-

    curring opinion.

    ____________________________________________________________

    COUNSEL
    

    ARGUED: Marc Simon Moller, KREINDLER & KREINDLER,

    New York, New York, for Appellant. David Patrick Donovan, WIL-

    MER, CUTLER & PICKERING, McLean, Virginia, for Appellee.

    ON BRIEF: Mark R. Dunn, HERZOG, CREBS & MCGHEE,

    L.L.P., St. Louis, Missouri; Stanley P. Kops, Bala Cynwyd, Pennsyl-

    vania; Rex Carr, CARR, KOREIN, TILLERY, KUNIN, MONTROY

    & GLASS, East St. Louis, Missouri, for Appellant. Roger W. Yoer-

    ges, WILMER, CUTLER & PICKERING, Washington, D.C., for

    Appellee.

    ____________________________________________________________

    OPINION
    

    TRAXLER, Circuit Judge:

    St. Louis University ("SLU") paid a $16 million Missouri state-

    court judgment to the family of a boy who became paralyzed after

    receiving Orimune, an oral polio vaccine, and SLU now seeks contri-

    bution from American Cyanamid Company, the parent company of

    the vaccine manufacturer. The district court granted summary judg-

    ment in favor of Cyanamid, and SLU appeals. We affirm.

    I.
    

    Much of the factual and procedural background relevant to this

    case is set out in our opinion in St. Louis University v. United States,

    No. 02-1351, which is also filed today. To the extent possible, we will

    not repeat that information in this opinion.

    After SLU paid the judgment in the state court case, it filed various

    federal and state-court actions against Cyanamid. These actions were

    dismissed for procedural reasons. SLU ultimately filed a contribution

    action against the United States government in federal district court

    in Maryland (the "Government Contribution Action"). The district

    court in that action granted summary judgment in favor of the govern-

    ment in 1999. Cyanamid thereafter filed a declaratory judgment

    action in the same federal district court, seeking a declaration that the

    summary judgment order in the Government Contribution Action col-

    laterally estopped SLU from seeking contribution against Cyanamid.

    The district court agreed with Cyanamid, gave collateral estoppel

    effect to its order in the Government Contribution Action, and granted

    summary judgment in favor of Cyanamid. SLU appealed the rulings

    in the declaratory judgment action and the Government Contribution

    Action. This court reversed and remanded both cases for further pro-

    ceedings. See St. Louis Univ. v. United States, No. 99-2227 (4th Cir.

    2
    

    March 1, 2001); American Cyanamid v. St. Louis Univ., No. 99-2224

    (4th Cir. March 1, 2001). On remand, the district court concluded that

    the government could be held liable in contribution to SLU, but that

    Cyanamid was not liable in contribution.1

    II.
    

    The district court concluded that SLU failed to establish that a

    defect in the vaccine proximately caused the injuries in the underlying

    state-court case. SLU's arguments on appeal largely track those it

    made in response to the government's appeal in St. Louis University

    v. United States, No. 02-1351. That is, SLU contends that the opin-

    ions of the district court and this court in the Sabin cases2 are determi-

    native of this case. The Sabin courts concluded that the government

    violated the neurovirulence regulations and that the government's

    actions proximately caused the injuries suffered by the Sabin plain-

    tiffs, and SLU contends that the "rationale" of the Sabin opinions

    applies to Cyanamid as well as the government. Reply Brief at 6. SLU

    also contends that Cyanamid bears ultimate responsibility for the reg-

    ulatory violations found in Sabin, and that these regulatory violations

    alone make Cyanamid liable in contribution to SLU.

    As to SLU's reliance on the Sabin cases, we again find it to be mis-

    placed. As we explained in our decision in No. 02-1351, the Sabin

    ____________________________________________________________

    1 SLU's argument that there is no live case or controversy involving

    Cyanamid because Cyanamid did not amend its complaint after our

    remand is wholly without merit. The post-remand conduct of the parties

    clearly indicated the question of whether Cyanamid could be held liable

    in contribution was tried by consent. See People for the Ethical Treat-

    ment of Animals v. Doughney, 263 F.3d 359, 367 (4th Cir. 2001) ("A

    party's failure to amend will not affect a final judgment if the issues

    resolved were tried by express or implied consent of the parties. Even

    without a formal amendment, a district court may amend the pleadings

    merely by entering findings on the unpleaded issues." (citations and

    internal quotation marks omitted)).

    2 In re Sabin Oral Polio Vaccine Prods. Liab. Litig., 743 F. Supp. 410

    (D. Md. 1990); In re Sabin Oral Polio Vaccine Prods. Liab. Litig., 763

    F. Supp. 811 (D. Md. 1991); In re Sabin Oral Polio Vaccine Prods. Liab.

    Litig., 774 F. Supp. 952 (D. Md. 1991), aff'd In re Sabin Oral Polio Vac-

    cine Prods. Liab. Litig., 984 F.2d 124 (4th Cir. 1993) (per curiam).

    3
    

    cases involved questions of Maryland and Florida law. Because this

    case is governed by Missouri law, the Sabin decisions are not control-

    ling. Thus, the issue we must resolve is whether, without regard to the

    Sabin decisions, SLU has carried its burden of demonstrating that

    Cyanamid can be held responsible for the injures suffered by Danny

    Callahan. We agree with the district court that SLU did not carry this

    burden.

    Under Missouri law, SLU is entitled to contribution from Cya-

    namid only if Cyanamid can be held liable for Danny's injuries. See

    Gramex Corp. v. Green Supply, Inc., 89 S.W.3d 432, 442 (Mo. 2002)

    (en banc). Liability is grounded in Missouri's product liability law,

    which follows the approach set forth in the section 402A of the

    Restatement (Second) of Torts. See Keener v. Dayton Elec. Mfg. Co.,

    445 S.W.2d 362, 364 (Mo. 1969).

    The essential elements of a strict product liability claim are

    (1) the defendant sold a product in the course of its business;

    (2) the product was then in a defective condition, unreason-

    ably dangerous when put to a reasonably anticipated use; (3)

    the product was used in a manner reasonably anticipated;

    and (4) the plaintiff was damaged as a direct result of such

    defective condition as existed when the product was sold.

    Lay v. P & G Health Care, Inc., 37 S.W.3d 310, 325 (Mo. Ct. App.

    2000); see Restatement (Second) of Torts § 402A(1) (1965) ("One

    who sells any product in a defective condition unreasonably danger-

    ous to the user or consumer or to his property is subject to liability

    for physical harm thereby caused to the ultimate user or consumer

    . . . ."). Assuming that the first three elements are satisfied, SLU has

    not satisfied the fourth element, causation.

    SLU has simply failed to present any competent evidence showing

    that the defect in the vaccine - excessive neurovirulence - proxi-

    mately caused Danny's injuries.3 SLU insists, however, that the mere

    ____________________________________________________________

    3 The record does include an article discussing a particular genetic

    mutation in the vaccine that might be connected to cases of vaccine-

    associated poliomyelitis, but SLU offered no expert testimony to inter-

    pret the findings and explain the relevance of the findings to this case.

    The article, therefore, is insufficient to satisfy SLU's burden of showing

    proximate cause. The expert testimony in the record is likewise insuffi-

    cient. As explained in our opinion in 02-1351, none of SLU's experts tes-

    tified that increased neurovirulence led to increased incidence of

    vaccine-associated polio, nor were any qualified to render such an opin-

    ion.

    4
    

    fact that the neurovirulence regulations were violated entitles it to

    recovery. As we explained in No. 02-1351, SLU is simply wrong on

    this point. Even in cases where the violation of a statute amounts to

    negligence per se, Missouri law is unambiguous in its requirement

    that the plaintiff must still prove that the violation proximately caused

    his injuries. See Sill v. Burlington No. R.R., 87 S.W.3d 386, 392 (Mo.

    Ct. App. 2002) ("If a submissible case is made under a negligence per

    se cause of action, a plaintiff could recover if a jury concluded that

    a statute was violated and the violation was the proximate cause of

    the injury."); Friend v. Yokohama Tire Corp., 904 S.W.2d 575, 579

    (Mo. Ct. App. 1995) ("One of the elements of a negligence per se

    action is that the violation of a statute was the proximate cause of the

    injury.").

    SLU presented no expert testimony showing that Danny Callahan

    would not have contracted polio or would have contracted a less

    severe case of polio had he been given a vaccine complying with the

    neurovirulence regulations. The district court, therefore, properly

    rejected SLU's claim against Cyanamid. See Klein v. General Elec.

    Co., 714 S.W.2d 896, 900 (Mo. Ct. App. 1986) ("To prevail under the

    doctrine of strict liability in tort, the plaintiffs must prove that the

    product was defective and dangerous . . . that the plaintiff sustained

    damage as a direct result of the defect.").

    Accordingly, for the foregoing reasons, the district court's grant of

    summary judgment in favor of Cyanamid is hereby affirmed.4

    AFFIRMED
    

    ____________________________________________________________

    4 Proximate cause is an element of the plaintiff's cause of action.

    Because SLU failed to establish this essential element of its claim, SLU's

    argument that Cyanamid failed to prove its entitlement to the affirmative

    defense set forth in comment K to section 402A of the Restatement is

    irrelevant. See, e.g., Farm Bureau Town & Country Ins. of Missouri v.

    Hilderbrand, 926 S.W.2d 944, 948 (Mo. Ct. App. 1996) ("An affirmative

    defense seeks to defeat or avoid the plaintiff's cause of action. It avers

    that even if the petition is true, the plaintiff cannot prevail because there

    are additional facts that permit the defendant to avoid legal responsibil-

    ity." (citation omitted)). Also irrelevant is SLU's pre-emption argument.

    The district court did not reject SLU's claim on pre-emption grounds, nor

    do we. Instead, the district court held, and we agree, that SLU failed to

    prove proximate cause, as required by Missouri law.

    5
    

    LUTTIG, Circuit Judge, concurring:

    I concur in the judgment of the court. I do not fully join the major-

    ity opinion, however, for the same reasons that I dissent from the

    companion case in 02-1351. Again, the majority would have it that

    Sabin IV does not present binding law for this appeal. Again, I dis-

    agree. However, I join the judgment of the court in this case for the

    straightforward reason that SLU failed to proffer evidence of proxi-

    mate causation sufficient to satisfy the Missouri tort standards.

    In contrast to the companion case, the defendant here is being sued

    not for its conduct as an alleged defective product-approver, but for

    its conduct as an alleged defective product manufacturer. The

    straightforward defective product manufacturing proximate cause

    analysis therefore applies to this case. See Nesselrode v. Executive

    Beechcraft, Inc., 707 S.W.2d 371, 375-76 (Mo. 1986) (en banc)

    (holding that the plaintiff in a product manufacturing defect case must

    prove the defect caused his injuries by proving that had the product

    been defect-free he would not have been injured).

    Here, the defect in question is the defective manufacture of the vac-

    cine. As the majority well points out, SLU proffered no evidence that

    the vaccine, had it been defect-free, would not have caused Danny

    Callahan's injuries. As such, SLU failed to create a genuine issue as

    to that central proximate cause question, without which it cannot sur-

    vive appellee's summary judgment motion.

    For these reasons I too would affirm the district court's judgment

    in this case.

    6
    

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