General Surgery Expert Fails to Consider Crucial Evidence Related to Biopsy Complications

    Court: United States District Court for the Western District of Texas, San Antonio Division
    Jurisdiction: Federal
    Case Name: Matosky v. Manning
    Citation: 2010 U.S. Dist. LEXIS 49030


    The plaintiffs, a woman along with her husband, filed a medical malpractice lawsuit claiming that the defendant, a doctor, was incompetent in performing her fine needle aspiration (FNA) breast biopsy. This incompetency allegedly led to the plaintiff suffering a pericardial effusion and cardiac tamponade. Pericardial effusion is extra blood between the heart and the membrane that protects the heart, known as the pericardium. Though this condition is mostly nondangerous, it can cause the heart to function poorly. Cardiac tamponade is a cardiac compression caused by fluid in the sac that protects the muscle. This places weight on the heart, which stops it from filling correctly. The effect is a sudden reduction in blood pressure that may be catastrophic. The plaintiffs retained a general surgery expert witness to support their case. The defense, however, challenged the expert’s testimony.

    The General Surgery Expert Witness

    The defendant claimed that the plaintiff’s expert, a general surgeon, did not have the adequate expertise, qualifications, training, or experience to provide expert testimony on the cause of the plaintiff’s pericardial effusion and cardiac tamponade. The general surgery expert witness testified that he observed only one or two pericardial effusions a year, and perhaps less than 10% of those pericardial effusions were caused by overt damage to the heart rather than by disease. He also disclosed that a cardiologist or a cardiothoracic surgeon typically managed these cases. Although the expert did occasionally see a pericardial effusion patient, the defendant argued he did not have enough expertise in the care and management of pericardial effusion and cardiac tamponade. The general surgery expert’s experience in gastrointestinal or abdominal surgery was demonstrated in his curriculum vitae and his published papers, however, the defendant asserted this was not relevant to the issues at hand.

    The general surgery expert opined that the pericardial effusion and cardiac tamponade were caused by the defendant’s negligence in performing the FNA biopsy. The expert claimed that the defendant had somehow overlooked the lesion found through a real-time ultrasound and that the 1.5-inch needle punctured the plaintiff’s chest wall and the pericardium covering her neck, which in effect induced pericardial effusion and cardiac tamponade.


    The court noted that the expert’s opinions tended to be based on nothing more than a casual relationship between the FNA biopsy and the pericardial effusion and cardiac tamponade occurring 11 days later. Firstly, the court explained that the expert’s rationale for the defendant’s alleged malpractice was a clear statement made in favor of the plaintiff’s claim of the plaintiffs. In fact, the court ruled that there was no evidence to support the conclusion that the needle ended up in the pericardium or that the ultrasound imaging was misinterpreted in real-time. Instead, the court asserted that it seemed like the expert leaped to this conclusion merely to suit his beliefs on causation.

    The court noted the complete failure of the expert to offer due consideration to other natural, possible causes consistent with the plaintiff’s symptoms cast significant doubt on the credibility of his opinion. Though the expert may disagree with other experts, his concluding opinion that there was no other etiology indicated in the medical reports represented an utter disregard for crucial evidence and basic medical standards to consider other causes.


    The motion to exclude the general surgery expert witness’s testimony was granted.