Title: Pavey, et al. v. Kalish, et al.

State: delaware

Issuer: Delaware Supreme Court

Document:

IN THE SUPREME COURT OF THE STATE OF DELAWARE 
 
SCOTT PAVEY and VIRGINIA P.  
§ 
PUSPOKI, individually and as The  
§ 
 
Executors of the Estate of TSURU  
§ 
PAVEY, 
§ 
No. 628, 2009 
 
 
§ 
 
Plaintiffs Below, 
§ 
 
Appellants, 
§ 
Court Below:  Superior Court 
 
 
§ 
of the State of Delaware in and 
v. 
 
§ 
for New Castle County 
 
 
§ 
ERIC D. KALISH, M. D., MICHAEL 
§ 
C.A. No. 05C-09-190 
K. CONWAY, M. D., DELAWARE  
§ 
SURGICAL GROUP, P. A. 
§ 
 
 
§ 
 
 
Defendants Below, 
§ 
 
Appellees. 
§ 
 
Submitted:  July 7, 2010 
   Decided:  August 23, 2010 
 
Before STEELE, Chief Justice, HOLLAND, BERGER, JACOBS, and 
RIDGELY, Justices, constituting the Court en Banc. 
 
O R D E R 
This 23rd day of August 2010, upon consideration of the briefs of the parties 
and their contentions at oral argument, it appears to the Court that: 
(1) 
This is a medical negligence and wrongful death action in which the 
Superior Court entered judgment in favor of Defendants1 after excluding the 
                                          
 
1 The Defendants are Eric D. Kalish, M.D., Michael K. Conway, M.D., and Delaware Surgical 
Group, P.A.. 
 2
testimony of Plaintiffs’2 medical expert.  Appellants contend that the trial court 
erred when it concluded their expert witness, Neil Novin, M.D., lacked sufficient 
experience to form a reliable opinion.  Appellants further contend that the trial 
court erred when it granted summary judgment without a written motion and 
adequate notice.  The record reveals that Dr. Novin was an experienced surgeon 
who had sufficient expertise to form an opinion meeting the threshold for 
admissibility.  Accordingly, we reverse the Superior Court’s decision to exclude 
Dr. Novin’s testimony and enter summary judgment for Defendants.3 
(2) 
Tsuru Pavey was admitted to Christiana Hospital on June 19, 2003, 
for treatment of multiple myeloma and sepsis.  A central venous catheter (the 
“Hickman catheter”), used to administer chemotherapy and infuse fluids, was 
inserted on June 25, 2003, by Eric D. Kalish, M.D.  When inserted, the catheter 
pierced the superior vena cava causing bleeding into the pleural space.  The 
catheter remained plugged in the hole in the vein, preventing further bleeding. 
(3) 
Following the insertion of the Hickman catheter, Ms. Pavey 
experienced difficulty breathing.  Chest x-rays revealed a pneumothorax, which 
resisted treatment with nasal oxygen.  A transesophageal echocardiogram showed a 
large right pleural effusion and that the Hickman catheter was non-functional.  A 
                                          
 
2 The Plaintiffs-below are Scott Pavey and Virginia Puspoki, individually and as the Executors of 
the Estate of Tsuru Pavey (collectively, the “Appellants”). 
3 It is therefore unnecessary to address Appellants’ second argument. 
 3
chest tube was inserted, and blood and body fluid were drained.  Michael Conway, 
M.D., determined that the catheter was improperly inserted in the right pleural 
space and required removal.  Dr. Conway consulted the attending thoracic surgeon, 
Allen Davies, M.D., and they determined that the catheter would be removed in a 
monitored setting. 
(4) 
On June 27, 2003, Dr. Conway directed and supervised the removal of 
the Hickman catheter in a monitored room with Dr. Kraut, a thoracic surgeon, 
assisting.  Upon removal of the catheter, Ms. Pavey became lightheaded, lost 
consciousness and could not be resuscitated.  Ms. Pavey’s death certificate 
identified “massive intrapleural hemorrhage” as the cause of death. 
(5) 
Plaintiffs’ expert, Dr. Neil Novin, opined that the removal of the 
Hickman catheter should have been performed in an operating room with a 
thoracic surgeon present, and that Defendants, through their negligence, caused the 
death of Ms. Pavey.  The Defense experts were prepared to testify that the catheter 
was appropriately removed, that it was appropriate to do so in the monitored 
setting which was used and that a thoracic surgeon would not have been able to 
intervene and prevent the patient’s death in the manner contended by Dr. Novin.  
The trial court announced its ruling excluding Dr. Novin as an expert witness with 
the following explanation: 
 
The Court: The issue before this Court is whether the 
witness’s testimony that a – that a thoracic surgeon should have been 
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present in the operating room to do immediate open chest surgery in 
the event that there was any untoward event is what is at issue here.  
The witness is a former – is a general surgeon who has not practiced 
surgery since 1988, almost 20 years, and in formulating his opinion he 
aggressively states that he didn’t consult any literature or conduct any 
research to determine what the standard of care was with regard to the 
procedure in question here.  He also states that he didn’t even discuss 
the situation with any other surgeon.  And he arrives at a conclusion 
that the Court finds totally surprising; namely, that he expected that if 
something happened in the operating room, the standby thoracic 
surgeon would immediately open the patient’s chest without any 
anesthetic.  And that is just too startling.  Before the Court can allow 
that opinion to be placed before the jury there has to be some 
scientific support for it, and this witness provides none.  The motion 
will be granted. 
 
Plaintiffs’ Counsel:  Your Honor, I just note –  
 
The Court:  Is that the only expert you have, [counsel]? 
 
Plaintiffs’ Counsel:  That is the expert.  And I’d ask Your 
Honor to reconsider that ruling.  This is a situation that there is no 
literature on because –  
 
The Court:  I’m not formulating it basically on the literature.  I 
based it one, number one – not number one in particular.  That’s part 
of it. 
 
Secondly, this doctor’s removal from direct surgical practice for 
nearly 20 years and the nature of his opinion, which just clashes with 
all reason and common sense.  Before the Court can have that put 
before the jury I would expect that there would be some better basis 
than this doctor who just says, “I think that’s the way it should have 
been done.”  And that’s basically all he says.  “I think this is the way 
it should have been done and there should have been a doctor there 
who could have cut this lady’s chest open as soon as soon as she lost 
consciousness.”  That makes no sense to this Court.  
(6) 
The record in this case shows the experience, medical practice, 
hospital privileges, and present tenure of Dr. Novin as a clinical associate professor 
of surgery at the University of Maryland Medical School.  Dr. Novin graduated 
from State University of New York, Downstate Medical Center in 1955.  He 
 5
interned in Baltimore, Maryland for one year prior to joining the United States Air 
Force.  He attended Flight Surgeon School, and worked as a flight surgeon with 
300 hours flying time.  He was Chief of Professional Services at the 18th Tactical 
Hospital in Okinawa.  He was discharged at the rank of Major and returned to 
Baltimore where he spent four years in a general surgical residency at the 
University of Maryland, completing the program in 1963.  For the next few years, 
he worked as a professor of anatomy and surgery while he started his own  
practice. 
(7) 
In 1966, Dr. Novin became Chief of Surgery of South Baltimore 
General Hospital, now known as Harbor Hospital.  He remained Chief of Surgery 
for more than twenty-one years, and had a full surgical residency.  He was 
responsible for one-third of the general surgical classes’ clinical experiences.  
During this time, Dr. Novin successfully completed the American Board of 
Surgery examination. 
(8) 
Because of an injury, Dr. Novin stopped performing surgery himself 
in 1988, but continues to provide surgical consultations, second surgical opinions, 
care for people with injuries that don’t require hospitalization, and consultations on 
Social Security disability determinations.  He retains hospital privileges at the 
University of Maryland, Mercy Hospital, and Maryland General Hospital.  Dr. 
 6
Novin is on the honorary staff at Harbor Hospital, and on the consultant staff at 
Sinai Hospital. 
(9) 
Dr. Novin is currently a clinical associate professor of surgery at the 
University of Maryland Medical School.  At various times during his tenure at the 
University of Maryland, Dr. Novin was president of the Baltimore Academy of 
Surgery, president of the University of Maryland Surgical Society, president of the 
Maryland Chapter of the American College of Surgeons, vice chairman for the 
Committee on Trauma for the State of Maryland for the American College of 
Surgeons, and coordinating communicator for the Cancer Commission for the 
American College of Surgeons. 
(10) Dr. Novin is board certified in general surgery, and is a certified 
specialist in vascular surgery in the State of Maryland.4  Dr. Novin is a surgical 
consultant for J. Gaber & Associates, P.A., a medical practice in Baltimore.  He 
also continues to read medical journals.  Dr. Novin testified in his deposition that 
in the course of his career, he estimated that he has opened a patient’s chest on an 
emergent basis six times.  In one of these instances, the patient’s chest was opened 
because of a suspected injury to the superior vena cava. 
                                          
 
4 Balan v. Horner, 706 A.2d 518, 520 (Del. 1998) (reiterating this Court’s holding in Baoust v. 
Kraut, 377 A.2d 4, 7 (Del. 1977), that “the diagnosis and treatment of some medical problems 
may be of concern to doctors of different specialties, and in an area of concurrent expertise, a 
common standard of care may be shared.”). 
 7
(11) When a party offers expert testimony, the court must determine 
whether the proffered expert’s knowledge will assist the trier of fact.5  If the 
witness is qualified by knowledge, skill, experience, training or education, he may 
testify in the form of an opinion or otherwise.6  The proponent of the expert 
testimony bears the burden of establishing that the testimony is relevant and 
reliable by a preponderance of the evidence.7  There is a “strong and undeniable 
preference for admitting any evidence having some potential for assisting the trier 
of fact.”8  “Expert opinions are appropriate where they will assist the jury in 
understanding the facts or the evidence.”9 
(12) The trial court relied on its finding that Dr. Novin lacked sufficient 
experience to form a reliable opinion, and its assessment of the merit of Dr. 
Novin’s opinion.  The duty of the trial court is not to determine “which theory is 
stronger” but instead to act as a “gatekeeper” who determines whether the 
testimony is based on sufficient facts or data and on reliable principles and 
                                          
 
5 D.R.E. 702 (“If scientific, technical or other specialized knowledge will assist the trier of fact to 
understand the evidence or to determine a fact in issue, a witness qualified as an expert by 
knowledge, skill, experience, training or education may testify thereto in the form of an opinion 
or otherwise, if (1) the testimony is based upon sufficient facts or data, (2) the testimony is the 
product of reliable principles and methods, and (3) the witness has applied the principles and 
methods reliably to the facts of the case.”). 
6 Id. 
7 Sturgis v. Bayside Health Ass’n Chartered, 942 A.2d 579, 584 (Del. 2007). 
8 DeLuca v. Merrell Dow Pharmaceuticals, Inc., 911 F.2d 941, 956 (3d Cir. 1990). 
9 Ward v. Shoney’s, Inc., 817 A.2d 799, 803 (Del. 2003). 
 8
methods that have been reliably applied to this case.10    We review the Superior 
Court’s decision to exclude Dr. Novin’s expert testimony for abuse of discretion.11  
The duty to exercise discretion “generally includes the duty to make a record to 
show what factors the trial judge considered and the reasons for the decisions.”12 
(13) In light of Dr. Novin’s experience and credentials, we conclude that 
the Superior Court abused its discretion in excluding his testimony which met the 
threshold for admissibility under D.R.E. 702.  Although Dr. Novin did not conduct 
a literature search prior to formulating his opinion in this matter, all experts in this 
case have agreed that there is no medical literature directly addressing the standard 
of care for removal of the Hickman catheter under the circumstances of this case.  
Further, Appellants presented sufficient evidence to establish that Dr. Novin was 
qualified by knowledge, skill, experience, training or education to offer an opinion 
on the issue of the standard of care for the removal in an operating room of a 
Hickman catheter that has punctured a patient’s superior vena cava.  In his 
deposition, Dr. Novin was asked to “identify each breach of the standard of care 
that you contend occurred starting with the first one and ending with the last one.”  
He testified in response:  
                                          
 
10 D.R.E. 702; .G. Bancorporation v. Le Beau, 737 A.2d 513, 521-23 (Del. 1999); accord Kumho 
Tire Co. v. Carmichael, 526 U.S. 137 (1999). 
11 M.G. Bancorporation, 737 A.2d at 522. 
12 Storey v. Camper, 401 A.2d 458, 466 (Del. 1979). 
 9
 
My basic criticism is that this young lady had a misadventure 
when the catheter inadvertently traversed the vena cava and was free 
in the pleural cavity, an accident that’s rare, and I don’t consider that a 
breach of the standard of care.  It’s an accident that happened, it was 
recognized, it was somewhat delay [sic] in the recognition, but again, 
I don’t think that had a deleterious effect.  It just delayed the proper 
removal, it resulted in her bleeding into her chest and getting excess 
fluid in her chest.   
 
A chest tube was properly placed.  There was [sic] some 
problems with that getting loose, but that, too, my main criticism is 
that the catheter went through a major blood vessel and was 
functioning as a plug in a hole or a finger in the dike.  We knew that 
there was massive bleeding into the chest and removing that catheter 
ran a significant risk of what ultimately happened.  She bled to death. 
 
She should have been taken to an operating room with a 
competent orthopedic surgeon – correction – competent thoracic 
surgeon present so that when the catheter was removed and the plug 
removed and she bled, she could have been operated on, had a finger 
put in, a stitch put in, and she would have probably been with us 
today. 
 
So, my criticism is that she was put in a monitored bed to 
monitor that which was unnecessary to monitor.  She belonged in an 
operating room so that when the catheter was removed and the 
possible and significant probable bleeding would occur, proper care 
could have been rendered.  It was not, and she died. 
(14) As an experienced general and vascular surgeon and as a clinical 
associate professor of surgery, Dr. Novin addressed the standard of care for 
removal of the Hickman catheter where it is known that the catheter pierced the 
superior vena cava and the patient had already lost two liters of blood prior to the 
removal of the catheter.  After reviewing the facts of this case, Dr. Novin formed 
an opinion based on his knowledge and experience that such removal should have 
been done in an operating room with a thoracic surgeon present to prevent her 
 10
from bleeding to death.  Because his testimony satisfied the threshold for 
admissibility under D.R.E. Rule 702, the Superior Court abused its discretion in 
excluding Dr. Novin’s testimony and in entering summary judgment for 
Defendants. 
NOW, THEREFORE, IT IS ORDERED that the judgment of the Superior 
Court is REVERSED and this matter is REMANDED for further proceedings 
consistent with this Order. 
 
BY THE COURT: 
 
 
 
 
 
 
 
/s/ Henry duPont Ridgely 
 
 
 
 
 
 
 
 
 
Justice