Defense Challenges Cardiology Expert’s Testimony on Chemotherapy Drug

In this medical malpractice case, the plaintiff claimed the decedent died from a cardiogenic shock caused by an excessive administration of a chemotherapy drug.

Wendy Ketner, M.D.

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— Updated on April 27, 2022

Defense Challenges Cardiology Expert’s Testimony on Chemotherapy Drug

Court: Court of Appeals of Michigan
Jurisdiction: Federal
Case Name: Estate of Leblanc v. Agnone
Citation: 2017 Mich. App. LEXIS 1091

The plaintiff claimed the treating doctors were negligent in managing the decedent’s condition. The cardiology expert witness, retained by the plaintiff, opined on the standard of care concerning chemotherapy drugs. However, the defendants argued that the expert lacked specialized knowledge on the chemotherapy drug in question. 

Facts

The plaintiff claimed the plaintiff’s decedent died as a result of a cardiogenic shock. According to the plaintiff, an excessive and inappropriate administration of a chemotherapy drug called Novantrone caused the cardiogenic shock. The administration was not appropriate according to her body surface and cardiogenic symptoms.

The defendant neurologist diagnosed an irreversible worsening of multiple sclerosis. Then, the defendant directed her to an oncologist for intravenous administration of Novantrone as a type of MS treatment. The defendant neurologist also referred the decedent to a cardiologist for heart examination in conjunction with Novantrone administration. The plaintiff alleged that the treating doctors were negligent in managing her condition. Furthermore, the plaintiff claimed the doctors failed to pay attention to changes in her cardiogenic function. Changes in her ejection fraction—a percentage of blood a filled ventricle pumps out with each beat of the heart—indicated the changes in her cardiogenic function. The alleged negligence resulted in the decedent suffering from cardiogenic shock, respiratory failure, and multiple organ failure.

The Plaintiff’s Cardiology Expert Witness

The cardiology expert witness was a cardiologist for 27 years. His expertise of cardiology stems from completing medical school and continuing education. The expert’s continuing education included researching new studies, evaluating clinical trials, and reviewing peer-reviewed literature. The cardiology expert witness had no prior experience with Novantrone prior to his work in this trial. However, the expert testified that he had experience testing patients with other cardiotoxic chemotherapy drugs. He also testified that his experience with other chemotherapeutic drugs and his work as a cardiologist laid sufficient foundation to evaluate the administration of Novantrone as determined by the changes in physiological conditions of a patient.

The expert stressed that he wouldn’t use medical literature he collected from the Internet to assess the standard of care. Instead, he used the literature to decide the criteria by which a cardiologist would test a patient taking Novantrone.

The first allegation was based on the defendant’s evidence that, at the time of the assessment, he had no understanding of Novantrone. Furthermore, the defendant allegedly had no understanding of the parameters to be measured by a patient taking the drug. However, in the expert’s view, the defendant breached the standard of care by giving a prescription in light of the fact that he had no knowledge of the drug. The expert’s next critique was that the defendant failed to recognize that the victim had a cardiotoxic impact from Novantrone. The defendant did not recognize the possible adverse consequences of Novantrone treatment when the decedent was tested. This included a reduction in ejection fraction from 76% to 62%, which suggested that the medication had a cardiotoxic effect.

Discussion

Initially, the defendants argued that the expert was not competent to appear as an expert. According to the defendants, the expert lacked specialized knowledge on the medical issues that he intended to address. The defendants stressed the expert’s assertion that he was not a specialist in the use of Novantrone. The expert had never seen a patient take Novantrone. Furthermore, the expert had no familiarity with Novantrone other than the work he did in this trial. The defendants noted the expert’s statement that he did research on the Internet to learn more about Novantrone in preparation for his expert testimony in this trial. The defendants argued that his testimony was inadmissible because he simply parroted what he had learned from the internet.

The court concluded that the expert was sufficiently qualified to appear as an expert in cardiology. His vast knowledge and experience in the field of cardiology, including cardiac assessments of patients who are taking cardiotoxic chemotherapy drugs, reinforced the conclusion that he was eligible to testify about the correct standard of care for a cardiologist who is asked to perform a cardiac assessment of a patient who is taking a chemotherapy medication such as Novantrone. The court noted that the lack of peer-reviewed citations affected the weight of his testimony and not its admissibility.

Ruling

The court denied the defendants’ motion to exclude the expert testimony.

Key Takeaways for Experts

The case illustrates the importance of medical experts having sufficient knowledge and experience in the field they’re opining on. The cardiology expert did not have experience with Novantrone. However, he had experience with other cardiotoxic chemotherapy drugs. It’s critical for medical experts to have the appropriate experience treating patients that aligns with the case topic. Having an educational background and experience that aligns with the case helps build your testimony.

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