## In the



# U n ited S ta tes Co urt o f Ap p ea ls

F o rth eS e v e n th C ir cu it
N o. 08

- 1648 D AV ID B . G ICLA, Plai nt i f f

-Appe l l ant, v. U NIT ED S TATE S OF A MERI CA, D efend a nt-A pp ellee.

A pp eal from the United S t ates Di strictC ourt fo r the N o rthernDi stricto f Illino is, Eas tern Divisi on. No . 03 C7236

— Sid ney I . Schenkier , Magis trate Judge
.
A RGUED J AN UA RY 13, 2009

— D ECIDED J UL Y 15, 2009

Befo re B AUER, P OSNER, a nd R OV NER, C ircu it Judges . R OV NER, Cir cu i tJudg e . P lain tiff-a p p ella n t D av id B . G icla had his r i ght-a n kl e j oi nt r epl aced with an i m pla nt ata Veteran ’s Ad m i ni str ati on M edi calCenteri n Chicag o. Aft er th e i m pl an t f ai l ed to r el i ev e th e ch r o ni c pain a nd sw el l i ng tha t Gi cl a w as exp er i enci ng, a ser i es offi ve a d d i t i o n a ls u r g e r i e s f o l l o w e d , c u l m i n a t i n gi n th e a mp u ta tio n of h is rig h t le g b elo w th e k n ee . G icla fil e d th is su i t f o rmal pr ac ti ce a g ains t th e Uni te d S ta te s an d v ar i o us2 N o. 08

- 1648 V A m ed ical p erson ne l p urs ua nt to th e F e d eral Tort C laim s A c t, 28 U .S.C . § 26 71 , ets eq . The i ndi vi dualde fen dants were dism i sse d from t h e s uit, and the case was tr i ed to the bench. The m agi str ate j ud ge, pre si ding w i th th e p ar ti es ’ c o ns en t, e nt er ed j udg m en t i n f av o ro fthe U ni ted S tat es, fi nd i ng tha t the VA m edi calpers onnel w ho t re ate d G i cl a di d not br each the duty o fcar e that they owed to hi m . Gic l a a pp eal s. H e pr i m ar i ly chal l enges the dis tr ict cour t’ s r efusalto excl ud e the te sti m ony of a defense expertf or a purporte d vi ol ati on o fFe deral Rule ofCi vi lPro cedure 2 6, afterthe expertdi scl ose d on cro ss- exam i na tion that j ust be f or e t aking the witnes s st an d h e loo k e d a t x -ra ys th at h e h ad n otp re vio u sly r ev i ewe d in r en der i nghi s o pi ni o n o n b eh al fo fthe U nite d S t ates. Gicla also conten d s tha t the district cou rt er re d in c re d itin g th e U n ite d Sta te s’ w itn es se s o ve r h is own . Find i ng no er ro r, we affi rm the j ud gm ent. I n 1 999, Gic l a co nsul ted with Dr. J ohn Grady, di re cto r oft he podi atr y s er vi ce a t the W est si de VA M edi cal C en te r inC h ica go . G icla h ad s e ve re art h rit is in h is r i g ht an kle s te m m i ngfr o m a fr ac tu r e he s uffer ed i n a m o to r cy cl e ac ci den t so m e twe nty y ea r s earl ier, whi l e he w as s er vi ng in the U
. S. N avy. The ar thri ti s ca used him to e xpe r i en ce e xt r eme pa i n a nd s well ing. Aft erno nsurg i caleff or ts at re l i eving hi s s ym ptom s pro ve d unsuccess ful, and afterdi scussing hi s o pti ons w i th Dr. Grady, Gi cl a ag r ee d t o ha ve hi s a nk l e j o i ntr epl ac ed us i ngthe DePu y Agi l i ty® TotalA nkl e S yst em , an i m p lan t which ha d o nl y r ec en tly b ee n a ppr o ve d b y the U. S
. F o od a nd Drug A dm i ni str ati on. Gic l a was 40 ye ar s o l d at that t i m e.N o. 08

- 1648 3 The surg er y, per f or m ed i n A pri l19 99, was the fi rs t o cc as i o n on w hi chVA phy si ci an s ha d us ed th e DeP uy Agi l i ty ® i m pl an t. Dr
. Gr adype r f o r m ed th e su r g er y wi ththe a ss i st an ce o fr es i den t Dr
. J o na th anN orto n. Du ring the pro cedure, theyr em ov ed a scr ew thathad been use d t o rep air th e factu re G icl a ha d suffered years be f o r e. The he ad o fthe s cr ew b r oke offas the s ur g eo ns tr i ed to r em ove i t. Because they lac ke d an appropri ate l ysi ze d t r eph i ne t o holl ow o utthe b o ne a r o und the screw and f ac ili t a te th e screw ’s rem oval, they w ere f or ced to use an o ste oto m e a nd m al l et, wh ich m ay have r es ul te d i n the r emov alo fmor e bo ne s ur r o undi ngthe screw th an a treph ine w ou ld h ave. A lso du ring the su rg ery, e i th erwhenthe i m pl ant was i ns er te d o rwhenthe a nk l e wa s fl e xe d f o l l o wi ng the i mpl a nt a t i o n, the l ower po r ti o n o f Gi cl a’ s fibul a ( ca l fb o ne ) , a l so kno wn as the l a t e r a lma l l e o l u s , c r a c k e d

. S u c h fr a c tu r e s a r e a kn o wn r i sk o fi m pl an t su r g ery . The s ur g ery was o th er wi se unev en tfu l. T h e i mpl a n td i d n o ti mpr o v e Gic l a’ s d i s c o mf o r t, h o wev er, a nd a s er i es o ff o l l o w-u p s ur g i ca lpr o ce dur es e nsu ed. In J ul y 1 99 9, Drs
. Gra dy a nd N o r to n r emov ed a bo ny re gr owth fr om hi s ri ght ankl e and l engthe ned hi s Achil l es te n d on to inc re as e t h e r a n ge of m ot ion in h is foo t. In A u gu st20 00 , D r. G ra d y rem ov ed th e im p lan t a n d th e a n kle j o i ntwas fus ed. One y ea ra fte rtha t, much o fthe r emai ni ng ha rd w are in the an kle w as r e m o ved

. Th e fol low ing year, yetano thersur gery w as perf or m ed i n an e ff or t t o sal vage th e fus i o n. S ti l l, Gi cl a co nt i nue d t o e xpe r i en ce pa i n a nd diffi cul ty usi ng hi s r i ght l eg. U ltim ate l y, i n Octobe r 2003 , Gicl a had h i s ri ght l eg am putated eight to ten i nches be l ow4 N o. 08

- 1648 th e k n ee . Th e fin al th re e s u rg er ies w er e p er for m ed in M i l wa uk e e , wh e r e the Gi c l a s h a d r e l o c a t e d. Gicl a fi l ed thi s s u it in Octobe r 2003 co m pla i ni ng o f m edi ca lmal pr ac ti ce . Gi cla a ll eg ed th athe was t o o y o ung f o rthe i m pl an t pr o ce dur e per f o r m ed i n 1 99 9 ( g i ve n the expected l i fe of the i m pla nt) and that he w as not proper l y a dvis ed ofthe ri sks attendant to an a nkl e r epla cem ent. H e a l so al leg ed thatDrs. Grady a nd N or ton m ad e certain m istakes in p erform ing the i nitial su rgery i n A pri l19 99 and the fol l ow-up surge ryi n J ulywh i ch c on tr ibu te d to th e fa ilu re of t h e im p lan t t o re so lve h is disc om f or t, i ncl ud i ng usi ng the wron g-si zed i m pla nt, r e m o vi ngt o o mu c h b o n e i n e x t r a c t i n gth e b r o k e n s c r e w, fai lingt o us e bo ne wax to pr ev en t bo ne g r o wth in un w an ted areas (e.g ., the area aroun d the rem oved screw ), fra c tu ring hi s fibul a, f ai l i ng to st abi l i ze the i m pla nt, f ai l i ng to use a bo ne s tim ula torto hast en bo ne r egr owth ind es ire d are as , an d d am ag in g o r d isp lac in g h is del toi d l i gam ent during the f ol l ow-up surge ry . A t t ri al, D r. G eorge Vi to tes ti fi ed as an exper t witness on the go vernm ent’ s be hal f . F ed er alRule o fCi vi lPro ced ure 26(a)( 2)(B) requ ires the p arty w ho p roffers an exp ert to make c er ta i n pr e- tr i aldi sc l o su r es , i nc l udi ng, a m ong oth er things , ( i) a st a t e m e nt of th e op inions th e exp ert w i l lexpre ss, al ong w i th the bas es and re as ons f ortho se opi ni o ns , ( i i ) a nyda t a o ro the ri nfo r mat i o n c o ns i de r ed by th e ex per t i n f o r m i ng hi s o pi ni o ns , an d ( ii i) a ny exhibi ts that w i l lbe used to sum m ar ize orsupport thos e op inions. I f th e initi al disclosure is i nc o m p le t e , or i f th ere i s a subse qu en t add i ti on t o orchange i n the i nfo rm ati onN o. 08

- 1648 5 disc l ose d, the e xpert’ s p roponent has an obl i gat i on t o s up pl e men ti t s di s c l o s ur e p ur s ua ntt o R ul e s 2 6 ( a) ( 2 ) ( D) and 2 6( e)
. Rule 37( c) ( 1) i n turn cal l s forthe excl usi on o fan expert ’ s t est i m ony i fthe re qu isit e d i scl osur es have not b ee n m ad e, “u n les s t h e fa ilu re w as su b st an tia lly j us tified or is h arm less. ” C ons istentw ith Ru le 26(a) (2)( B ), th e govern m en t in ad van ce of tri a l d is c losed Dr. Vito’s op inions, the rationale for t h o s e opinion s, an d the inform ati on he consi dered in f or m i ng the m . O n e s ourc e o f in for m at ion th at D r. V ito d id n otco n su lt in form in g h is op inions was a s er i es o ft wenty t o thi r tyx- r ay s o fGi cl a’s ankl e that were tak en a t vari ous t i m es bef or e a nd after hi s i m pl an t su rgery i n Apr i l1 99 9. Ra th ertha n r ev i ewing th e x-r ays hi m sel f, Dr. Vi to re l i ed on the r adio l ogi cal fi nd i ngs a s t o w hat those x- ra ys re veal ed. Thi s was known to G icla ’s co unsel, pre sum abl y a s a r esul t o fbo th th e g o ve r nm en t’ s Rul e 26 di sc l o su r es a nd f oll ow-u p disc ove ryas to Dr. Vi to’ s o pinion s. Gic l a’ s co unsel p lanned to dr i ve ho m e th i s po i nti n c r o ss - ex ami ni ng Dr
. Vi to at t rial a nd t o s ug g es t to the c o ur t th athi s o pi ni o n s s h o u l d b e g i ve n l e s s we i g h tth a n G i c l a ’ s o wn ex per t, who ha d e xa m i ne d the x- r ay s. Butwhenthe tim e ca m e t o cro ss- exam i ne Dr. Vi to, Gic l a’ s co unsel w as surpri sed to l earn fro m Dr. Vit o that he hadr evi ew ed the x- ra ys ear l i erthatday, befor e he too k the witnes s sta nd

. Tr. 39 1. Dr. V i to confi rm ed that he had not l oo ked at th e x -ra ys in fo rm in g h is op in ion s p r i o r to tria l; h is fi rs t and o nl y re vi ew of the x-r ays had t ak en p lace ea r l i er tha t day

. Tr
. 3 91

- 92
. Dr
. Vi to a l so t es ti fi ed th atthe x-ray s h ad notal ter ed hi s v i ew s. “M y o pini on has not changed. ” Tr. 39 1. W hen ask ed i ftheyhad confi rm ed or6 N o. 08

- 1648 ai ded hi s a nal ysi s, Dr. Vi to sai d that “ i fa n ythi ng, they he lped m e exp an d up on m y testim ony ri gh t now
. . . . ” Tr. 392. But Dr. Vit o neverexpl ai ned how the x-r ays hel ped hi m t o e l ab o r a t e o n hi s o pini o ns , a s Gi c l a ’ s co unsel el ecte d not t o ques ti on hi m furthero n that subj ect. I ns tead , he m oved to stri ke D r. Vito’s te stim ony altogethe r. Gicl a’ s co un se l t ook the posi ti on that i t was a vi ol ati on ofthe go vernm ent’ s obl i gat i ons und erR ule 26 f orDr. Vi to to t es ti fy a s ane xpe r t when hi s o pi ni o ns wer e no w i nfor m ed b y h i s re vie w of th e x -ra ys , an d w h en h is bel ate d rev i ew o ftho se x-r ays h ad n ot bee n dis cl ose d to Gicl a in accord ance with the rul e. Gic l a was prej ud i ced by th e vi ol ati on, hi s a tto rneyar gued, bec ause counsel had pl anned Dr. Vit o’ s cro ss- exam i nati on bel i eving that Dr
. Vi to ha d r en der ed hi s o pi ni o ns wi th o utr ev i ewing the x

- ra ys. Dr. Vi to’ s unexpected di scl osur e that he had tak ena l o o ka tthe x - r a y s a nd tha tthe y di d n o tc ha nge hi s o pin i on bl ock ed the l i ne o fat tackthatGic l a’ s co unsel ha d int e nd e d t o p ur s ue a nd l e fth i m un pr e pa r ed to qu es tio n D r. V ito ab ou t w h at h e s aw or d id n ’t s ee in the x -ra ys. Counseladded that he w as unabl e t o consul t with Gicl a’ s e xpert ( w h o w as notpre sent at the t ri al ) in o rderto pre pare appropri ate questi ons f or Dr. Vi to now thatDr. Vi to had seen the x- ra ys. The dis tr i ct c ourtdecl i ned to str i ke Dr. Vi to’ s t est i m ony. The c o ur t was c r i ti ca lo fthe g o ve rnm en t f o rha ving shown D r. V i to the x- ra ys on the m or ni ng o fhi s t est i m ony. Tr. 39 7-99. The go vernm ent obvi ousl y had done thi s t o neutra l i ze the a nti ci pated cr oss - exam i nati on o fDr. Vi to, T r. 39 8, an d in t h e c o u r t’s vie w , th e g ov er n m en t s h ou ldN o. 08

- 1648 7 ha ve s ho wn Dr
. Vi to the x -rays a t ane ar l i erda te a nd d isc losed thi s t o the pl ai nti ff, so thatGic l a would have had an opportunity t o questi on Dr. Vi to bef or e t ri alas to w hat the x- ra ys re veal ed, Tr. 39 8-9 9. Bu t the co urt saw an y v iola tio n of R u le 2 6(a )(2) as h ar m les s. T r. 39 6. In re sponse to q u est i ons posed by Gicl a’ s co unsel, Dr. Vi to had adm i tte d that he f or m ed hi s o pini ons w i thout re vi ew i ng the x -rays; m or eov er, l oo ki ng atthe x-r ays ha d not ch an ged Dr. Vito’s opinions
. Tr. 3 9 5 , 3 99. Gicla’s counsel, i n turn, a greed thatDr. Vi to’ s t est i m ony on di r ec t ex ami nati o n di d no t dev i at e fr o m the o pi ni o ns d isclosed prior to trial in accord an ce w ith Ru le 26(a) (2). Tr. 39 9. T h e c ou rto ffer ed Gicl a’ s a tto rneya re cess so that Gicla c oul d determ i ne wh at parti cul arx- ra ys Dr. Vi to ha d r e v i e we d a nd c o ns i de r wha t qu e s t i o ns he mi g htl i ke to as kDr
. V i t o ab o utthe m be f o r e r e s umi ngh i s c r oss ex a m i n at ion . Tr . 394 , 399 -40 0. T h e c ou rtad d ed th at “if you have som ethi ng el se that you w ant, I ’ m w illing to l i st ent o y o u. ” Tr
. 3 96
. Howev er, c o uns elde cl i ne d the offer, Tr. 4 0 0 , and i ns tead elected to com p lete Dr. Vito’s c ro ss -ex am in at ion w ith ou t d elv in g in to th e x -ra ys . O n ap p eal, Gicla renew s his co n t en tion th at D r. Vito’s be l at e d r e v i e w o fth e x - r a y s , wi th o u twa r n i n gt o the p la in t if f, w a s a v io la t io n ofR u le 2 6 (a )( 2 ) th a tw a s p r ejud i ci al to hi s case . H e conte nd s that the on ly p ro per w ay to a d d ress th is vi olation w as to strike Dr. Vito’s te st i m o ny pur su an t to Rul e 37 ( c) ( 1)
. In Gi cl a’ s vi ew, the excl usi on o fDr. Vi to’ s t est i m ony w oul d ha ve so al ter ed the b al ance ofthe evi dence as to enti tl e hi m to j ud gm ent. W e r e v i e w the di s t r i c tc o ur t ’ s deci s i o n no tt o e xc l ud e D r. V ito ’s tes tim on y for ab u se of d isc re tio n . See, e . g. , Je nki ns8 N o. 08

- 1648

v. B artl ett, 487F.3d 48 2, 48 8 (7 th C ir. 20 07 ); Salgad o ex rel
. Salgado v. Ge n. M ot ors Corp. , 150 F.3d 735 , 739, 742 ( 7th Cir. 1998 )
. W e fi nd no abuse ofdi scret ion in the m anner i n w hi ch the dist ri ct c ourthandle d thi s i ssue. W e m ay assu m e w ithou t d ecid ing tha t D r. Vito’s el eve nth-ho ur r evi ew o fthe x-r ays am ounted to a vi ol ati on ofRule 26 r ega rdl ess o fw hetherh i s o pini ons changed as a resu lt ofthat re v ie w . By requ iring the p re-tri al disclosure o fa ny e xpe r t t es ti m o ny tha t a par tyi nt en ds to o ffer, a l o ng w i th the bas es f or t h e e xpert’ s o pini ons, Rule 26 i s desig n ed t o av oid su rp ris e a n d giv e t h e o p p os in g p ar ty a fu ll o ppo r tu ni tyt o e va l ua te the e xpe r t’ s m ethod o l o g y a nd c on c lu sio n s a n d to res p on d ap p ro p ria te ly. SeeRule 26 ( a) ( 2) advi sory c om m i tte e’ s no te, 19 93 am endm en ts . D r. Vi to for m ed h is op i n i o n s a s t o th e c ar e p ro vid ed to G icla wi th o utr ev i ewi ngth e x- r ay s; he i ns te ad r el i ed o n the ra dio l ogi calr epor ts. Thi s g av e Gicl a a n openi ng to at tack th e vali d ity of Dr. V ito’ s op inions at trial th at G icl a’s counsel fully intended to explo i t. A t no ti m e in advance o ft r i al, a nd c er ta i nl y no t wi th i n the t i m e se t bythe cour t for Rule 26 di scl osur es, di d the Un i ted S tat es disc l ose an intent to have Dr. V ito r ev i ew the x-r ays bef or e he too k the w i tness stand. Dr. V i to’ s unannounced re vi ew o fthe x-r ays for ecl ose d to Gicl a the l i ne o fat tack h i s co unselhad anti ci pated pursui ng and, m or e pe rt inentl y, gi ven the purposes o fRule 26 , depri ved hi m o f forew arn ing as to the i m p act o f t h e x -rays on D r. Vito’s th i nk i ng, the o ppo r tu ni tyt o que st i o n Dr
. Vi to on th atpo i nt du ring di sco ver y, and t h e abi l i ty to adj ust hi s cr oss exam i nati on a t t ri alacc or dingl y.N o. 08

- 1648 9 St i l l, as the dist ri ct c ourtnot ed, t h er e i s no ev i dence th at G icla w as u n d u ly p rej u d ice d by th e s u rp ri s e. A lthough D r. V i to did sugg estthatse ei ng the x- ra ys enabl ed him to “exp an d up on [his] test im o n y,” T r. 392, th e cou rt foun d , and Gicla’s c ou ns el conce d ed , that Dr. Vito’s tes ti m ony on di re ct e x am inati on di ffer ed i n no r espect fro m the opi ni on s d iscl ose d pri orto tr i al

. Tr. 39 9. A fter hi s mo t i o n t o s tr i k e tha tt e s t i mony wa s de ni e d, Gi cl a’ s co uns el o pte d no t to c r o ss - ex ami ne Dr
. Vi to abo ut th e x-r ays and Dr. Vi to m ade no othe r re fer ence i n h is testim ony to them

. A t m ost, it app ears th at D r. Vito’s re vi ew o fthe x-r ays si m plyco nfi rm ed w hat he had al re ady co ncl ud ed. Tr. 39 1- 92. It is tr ue thatGic l a was depri ved ofhi s a nti ci pated chal l enge to Dr. Vit o’ s opi ni ons, but that i s n ot wh at Rul e 26 was d esigned t o pr o te ct
. Tr i al s se r ve a t r uthsee ki ng functi on, and i fDr. Vi to’ s o pini ons w er e no t al ter ed by hi s r evi ew o fthe x-r ays , then the f actfi nd er w as en tit led to kn ow th at . Th e re al h a rm w as th at G icla and his co unselwere depri ved ofthe opportunity t o kn ow i n advance o fthe tr i althatDr. Vi to’ s o pini on w as unchanged, and to prep ar e to cro ss- exam i ne hi m o n that poi nt. This i s why i t m at te rs thatthe dist ri ct c ourto ffer ed Gicl a’ s co unselthe opportunity t o tak e a b re ak i n or der to deter m in e w hat x- ra ys Dr. Vi to had rev i ew ed and to asce rt ai n w hetherhe wis hed to c ro ss- exam i ne Dr. Vi to on those x- ra ys. Gic l a co uld have used that o pp or tuni ty to deter m i ne w h at q u est i ons he m i ght wis h to as k o f Dr. Vi to knowing that Dr. Vi to had now se en the x- ra ys.10 N o. 08

- 1648

H av ing p rev iou sly qu estion ed G icla ’s e xp ert, D r. D av id 1 Pl otki n ( who s e de po s i t i onwa s l a t e r a dm i t t e d i nt o e vi de nce in lieu of his testim on y at trial), G icla’s a t t or ne y w as w ell aw are ofw hat Dr. Plotk in s a w i n the x- rays thathe bel ie ved w as ind icativ e of neg ligen ce on the p art o f the V A p hy sician s. S ee, e. g. , R. 85 at 35 ( noti ng si gnific ant s pace around rem oved (co n tin u ed ...) W e hav e r eco gni zed the p ropri etyo fsuch m eas ures to c or re c t R u le 2 6 v iola tio n s. See Fid e l i ty Nat’ l Tit l eIns . Co. of N
. Y. v. Int e r co unty Nat’ l Tit l eIns. Co. , 41 2 F
. 3d 745, 75 2 ( 7th Ci r. 20 05)
. Gic l a co ntends thatth is w as an em pty o fferb ec au se hi s o wn ex per t was notpr es en t atthe t r i a l( the de po s i ti on o fGi c l a ’ s e xp e r twa s i ns t e a d a dm itt ed int o e vid en c e b y agr ee m en t) a n d w as n otim m ed iat ely av aila b le for co n su lta tio n , so th er e w as n o p oin t in su ch a b r eak. Yet, so f ar as the record reveals, Gicla’s counselneve r m ade an a tte m pt to r each his exper t. Even if h is ex p er t w as u n av aila b le at th at m om en t, G i c la has no t s how n that hi s cr oss - exam i nati on of D r. Vi to w oul d have be en m ate ri al l y di ffer ent had he not been ca ught b y s ur pr i s e b y the b e l a t e d di s c l o s ur e tha t Dr
. Vi to ha d r ev i ewe d the x- r ay s. As we po i nt ed o uta t o r ala r g um ent, nothi ng w oul d have pre vente d G i cl a’ s l aw yer fro m c o ns ul tingwi ththe e xpe r t ata l at erda te a nd m ak in g a p ro ffer of w h at h e w ou ld h av e d on e d iffer en tly h a d h e r ec ei ve d t i me l y n o t i fi c a t i o n o fth e x - r a y r e v i e w. N o rwas Gi cl a pr ec l ude d fr o m hi g hl i g ht i ng f o rthe c o u r t th e n o t e wo r t h y i n f o r ma t i o n t h a t h i s o wn experthad gl eaned from t h e x- ra ys that Dr. Vi to had (a pp ar en tl y) o ver l oo ked o r disc ounted. I t i s worth 1N o. 08

- 1648 11

(
. . . c on t i nu e d) 1 sc rew), 38- 39 ( noti ng v oid and tr aum a res ulti ng f rom rem oval ofs cre w , w hich, i n D r. Plot kin’ s view , l ed to bone spurs tha t requ ired secon d op era tion , w hich in tu rn resu lted in destabil izat ion ofankle) , 56 ( noti ng “hu ge” s p ace betw een tib ia a n d fib u la, w hich sug g ested tha t sm aller im p lan t sho u ld ha v e b een used ), 57-58 ( no ting d e v i a t i o n a nd lack of stab ility ow ing , in D r. Plotk in’s v i e w , to su rg eo n’s f ailu re to p ro p erly pos i t i on, s uppor t, and pro t ec t l at er al m al l eo l us ) , 64 ( no ting tha tm or e o ffi bu l a wa s r e m ov e d tha n r e c omm e nd e d b y im p lantm anu f ac t ur er )
. W e add thatDr. Gra dy t oo was quest i one d aboutc er t ai n o fthe x - ra ys by both the g ove rn m en tan d G ic la

. S ee, e. g. , Tr. 172- 175, 189- 194, 200- 03. S o G ic la’ s counsel had s om e f a m ili a ri ty with the x- rays thatw ould hav e hel ped h i m to m a k e a sh o w i n g o fp r eju d i c e r e su l t i n g fr o m D r . V i t o ’s surpri se disc los ure. poi nti ng o ut thatthi s was a b ench tr i al, and ther e was an i nter i m of near l y a w eek between the concl u sio n o f th e t ria l an d th e is s u an c e o f th e m ag ist ra te j u d ge ’s d ec isi on. Even afterthe deci si on was r endered, ther e was add i ti onal ti m e i n w hi ch to fi l e an appropri ate p os t-tri al m ot ion
. S o gr an tin g th at it m ay h av e b ee n d ifficu lt f or G icla’s l aw yerto m ake a m or e co ncre te showing of p rej ud ice in th e m idst of trial, tim e rem a in e d a fterw ard i n whi cht o make su ch a s ho wi ng . Had Gi cl a ta k enthe op p ortu nity to d em on s t r a t e how he m ight ha ve m ore effecti vel y c ro ss- ex am i ned Dr. Vi to w i th ti m el y no ti ce th atDr
. Vi to ha d r ev i ewe d the x- r ay s, the cour t m i g ht have re consi dered i ts rul i ng, gi ven Gi cl a the o pp or tuni ty to r e-cal lDr. Vi to to the s tand orr eopen the ev i dence for so m e o th er p u rp os e, or g r a n te d G icla a n ew tria l.12 N o. 08

- 1648 ButGi cl a di d no t at te m pt t o m ake a mor e co nv i nc i ng sh ow ing of p rej ud ice. O n this record , w e can not disce rn an y c o nc r et e har m tha t Gi cl a su ffer ed as a r es ul t o fthe unexp ecte d discl osur e. T h e fa c t t h at th is w as a b en c h tria l al s o s e rv ed to m in im i ze any prej ud i ce to Gicl a. The M agi str ate J ud ge w as aw ar e o f w h a t h ad oc c u rre d , un d er st oo d p er fec tly wel ltha t Dr
. Vi to ha d f o r m ed hi s o p in i o ns wi th o ut l oo ki ng atthe x-r ays , and al so appreci ate d the f act that Gicl a’ s co unsel w as pu t a t a di sadvantag e a t t ri alby the s urpri se disc l osur e. One l ast p oint on thi s s ubj ect: Gic l a pre sum es that had D r. V ito ’s t es tim on y b ee n ex c lu d ed , th e d ep os itio n te st im ony o fh i s o wn e xp e r t, Dr
. Da v i d P l o t k i n, wo ul d h ave st o o d unc hall en g ed, c o m pel l i ngthe di st r i ctc o ur t to fi nd i n hi s f avo r. Fo r that re as on , he conte nd s that the er ro r i n a l l o wi ngDr
. V i t o ’ s t e s t i mony e nt i t l e s h i m to reversal w ith d irections to ent er j ud gm en t in his f avor, or alt er n at ive ly to a n ew tria l. Bu t hi s pre sum pti on i s fl aw ed form ult i ple r eas ons. Fi rs t, e v e n if D r. P lot kin ’s t es tim on y h ad n otbe en ex p re ss ly co nt r adi ct ed bywayof th e g o ve r nm en t’ s ex per t, i n n o sense would the dist ri ct c ourthave bee n com pel l ed to cr edi t hi s o p i ni o ns a nd r en derj udg m en t f o rGi cl a. The cour t co uld have f ound fa ultwith Dr. Plot ki n’s anal ysi s, f or e xa mpl e . Mo r e o v e r, Dr
. P l o t k i n’ s o pini o n wo ul d no t have been the s ol e o pini on con c er ni ng the adequacy of G icl a’s m ed ical care eve n in th e absen ce o f D r. Vito’s te st i m o ny . The V A doc to r s who per f o r m ed th e i m pl an t surg er y on Gicl a al so tes ti fi ed, and o f cour se as h isN o. 08

- 1648 13 tr ea tingphy si ci an s, the y wer e qua l i fi ed to o ffero pi ni o ns as to the pr opri etyo fthe tr eat m ent he r ecei ve d . Li ke Dr. Vi to, Dr. G ra d y w as l ed thr ough m osti fnotal lo f the o pini ons that Dr. Pl otk i n had expres sed ( al though D r. Plotkin w as not cited as the sou rce of those op inions), a nd l i k e Dr
. V i t o , Dr
. Gr a dy di s a g r e e d wi th the m. Ind e e d, th e di st r i ctc o ur t’ s dec isi on i n f av o ro fthe g o ve r nm en t re flec ts th at it did c re d it an d re ly u p on th e tre at in g p h ys ici ans’ te sti m ony i n si gni fi cant re spects
. Whi c h b r i n g s us to th e fi n a li s s u e th a tG i c l a r a i s e s : He ar gu es th at th e d ist ric t c ou rterr ed in c r e d i t in g th e t es tim oni es ofDr. Vi to and the t re ating physi ci ans ove r that ofDr. Plot kin a nd thatthe cour t’ s j ud gm ent in f avo r of th e g o ve r nm en t was a g ains t th e m an i fes t wei g hto fthe ev i den ce . As the b as i s f o rtha t ar g um en t, he r el i es o n a va r i ety o fi nc o ns i st en ci es a m o ngthe t es ti m o ni es o fthe g o ve r nm en t’ s wi tnesses
. F o re xa m pl e, Dr
. Vi to tho ught th at art h ro sc op y m i g h t h av e b ee n an op tio n for G icla in the fi rs t instance , T r. 38 9- 90, but the t est i m oni es of Drs. Grady a nd N or ton re fl ecte d no di scussi on o f ar thro sco py w i th Gi cl a. Tr. 44, 51 , 26 9- 70, 29 7. In other in st an c es , th e p h ys icia n s w er e i n ag re em en t o n ce rt ain poi nts a s t o the l i m i tation s or ri sks o fthe i m pla ntati on pr o ce dur e, b utg av e te st i m o ny tha t r ai se d que st i o ns about w hetherthei r deci si ons w er e in acc or d w i th tho se k no wn l i mi t a t i o ns a nd r i s k s . F o re xa m pl e , Dr
. Gr a dy tes ti fi ed that i fa pati ent’ s a nkl e j oin t had dete ri or ate d b ey on d a c er ta inp oin t, th en an im p lan t w a s n o t a via b le opti on. Tr. 16 8- 69. A nd wh en as ked about w hat Gicl a’ s pre surg er y x- ra ys showed abou t th e condit i on o fhi s a nkl e, Dr. N or ton sta ted t h at “[ h]e di dn ’ t hav e m uch ofan14 N o. 08

- 1648

an k l e j oi ntl eft” : the j o i ntha d no r emai ni ngc ar ti l ag e an d re fl ecte d defo rm ity d u e t o ar thri ti s. Tr. 26 4, 26 5- 66. Both do ct o r s al so ind ica te d tha t Gi cl a’ s hi st o r y o fs m o k i ng an d d r u g a n d alc oh ol ab u se co u ld int er fer e w ith h is abi l i ty to succes sfully heal fro m the i m pla nt sur gery. Tr. 33 , 306, 30 9- 10, 34 4-4 5. Yet, Dr. Grady was notcer tain how m uchthe y kne w ab o utthi s hi st o r y b efore pe r f o r m i ng the i m pla n t, T r. 33

- 34, and al though Dr. N or ton w as aw ar e o fGic l a’ s hi sto ryo fsm ok in g, h e was unaw ar e o f hi s hi sto ryo fsubst ance abuse, Tr. 30 6- 08, 33 6. A s Gi cl a’ s a rgum ent r eco gni zes , the ult im ate deci si on i n th i s c a s e a s t o w h e th e ro rn o tth e V A p h y s i c i a ns c o mm i tte d m al pract i ce turned l ar gely o n the cre dibi l i ty of th e witn esses . The r e wer e di spu te s be twe enM r . a nd M r s. Gi cl a o n the o ne ha nd a nd Gi cl a’ s t r ea tingphy si ci an s on the o theras to som e o fthe und er l yi ng f acts

— i n pa r ti cul a r, a s t o the o pt i o ns the p hy s i c i a ns h a d d i s c us sed w i th Gi cl a pri orto hi s i m pla nt sur gery an d t he warni ngs th ey gave h im abou t the ri sks asso cia ted w ith th at su rgery. Those types of disputes prese nt ed st ra i ghtf or w ar d cre dibi l i ty questi ons f orthe m agi str ate j ud ge to re sol ve as the fi nd erof fact

. But ther e were al so dis p u te s o fo pini on a m ong the par ti es’ exper t witnesse s an d th e t re at in g p h ys icia n s. A lth ou gh t h os e p ro fes sio n als w er e c o mm e nt i ngl a r g e l y o n the s a me b o dyo fe v i dence re l ating to Gic l a’ s co urse o ftr eat m ent, theycam e t o dir ectly c ontr adic tory c oncl usi ons a s t o w hat that ev id en c e re ve ale d ab ou t t h e p ro p rie ty of t h e c ar e G icla received. Thu s, whenDr
. Vi to t es ti fi ed o n b eh al fo fthe govern m en t, he w as w alked th roug h eac h of Dr. Plotkin’s op in ion s a s t o th e m ist ak es h e b elie ve d G icla ’s V A p h ys i-N o. 08

- 1648 15 ci an s ha d m ade , a nd Dr

. Vi to r ej ec te d e ac h of th o se o pi ni o ns . S o th e c a s e a l s o p r e s e n t e d a c l a s s i c b a t t l e o ft he expert s. A nd i n th at r esp ect as w el l, the case cal l ed up o n the f a c t fi nd e rt o de t e r mi ne wh a twe i g hta nd c r e dibi l i tyt o g i ve the t es ti m o ny o fe ac h e xpe r t an d ph y si ci an . Se eU ni t e d Sta tes v
. O l of s on , 563 F.3d 652 , 659 n.6 (7th C ir. 20 09 ); Soria v. O zinga B ros., Inc. , 704 F.2d 99 0, 99 4 n .6 (7t h C ir. 19 83 ); see also Kin etic Concepts , Inc . v. Blu eSky M e di ca l Gr oup , Inc. , 554 F.3d 101 0, 1020 ( Fed

. Cir. 2009); Crowev. M ar ch and, 506 F.3d 13 , 19 (1 stC ir. 20 07 ); U nited St at e s v. Uze ns ki, 434 F.3d 690 , 7 0 3 n.6 ( 4th Cir. 2006); P hil lip s v. C o hen , 400 F.3d 38 8, 39 9 (6 th C ir. 20 05 ); LePa ge’s Inc . v. 3M , 324 F. 3d 141, 165-66 ( 3d C ir. 2003 ) (en ban c); Streber v. H un ter, 2 21 F
. 3d 701, 7 26 ( 5th Ci r . 2 00 0)
. The cr edibi l i tydet er m i na ti o ns tha t a j udg e r en der s as the fin d er of fac t c om m an d a h igh d e g r e e of d efe re n c e. E.g
. , U nited Sta tes v. Lo ng street, ___ F
. 3d.
___, 20 09 W L 15776 92, at * 10 ( 7th C ir. J une 8, 20 09)
. W e wil lnor m al l y hav e n o re as on t o d ist u rb a c ou rt ’s ev alu at ion of w itn es s c re d ib ility u n les s t h e c ou rth as cr ed ite d p at en tl y im p ro b ab le tes ti m ony ori ts cre dibi l i ty ass ess m ents conflict with i ts ot h er fac tu al fin d in gs . E. g. , Ki ddv . Il l
. S t at ePo li ce, 1 67 F
. 3 d 1 0 8 4 , 1 0 9 5 ( 7 th Ci r . 1 9 9 9 ) ( c i t i ng Ande rs on v. Ci ty of Be s s e m erC ity, N. C. , 47 0 U.S
. 56 4, 575, 10 5 S
. Ct. 15 04, 1512 ( 1985 ))
. N o such er ro r occur re d here

. A l though there were, as G icl a em p h a s izes , certain incon sisten cies and vuln erabi l i ti es i n the tes ti m oni es ofth e gove rnm ent’ s wit

n es ses , nothi ng pre cl ud ed the dist ri ct c ourtfro m cred iti ng their opinion s as to the prop riety oft h e care th at Gicl a r ecei ved. The te sti m oni es ofDrs. Vi to, Grady,16 N o. 08

- 1648

an d N or to n w er e c on s i s te n t w ith on e a n ot h er in i m port ant r espect s. Dr. Vi to had si gni fi cant e xp er i ence wi ththe ty pe o fi m plant sur g ery tha t Dr s. Gr adya nd N ort o n perform ed on G icl a, an d of cou rse as G icl a’s tr eat i ng physi ci an the l att ertwo w er e inti m ately f am i l i ar w ith his con d iti on an d th e surge ry they p erform ed

. Dr. Pl otk i n, byco ntra st, had no e xperi ence w i th the ty pe of i m pl an t us ed o n Gi cl a an d i n f ac t di d no t d o i m pl an t surg eri es, and he had neve r exam i ned Gicl a. The di str i ct c ou rtrev iew ed atlen gt h th e t es tim on ies of a ll fo u r p h ys ici an s an d a r ti cul ate d c o g en t r ea so ns f o rr ej ec ting Dr
. Pl o tk i n’s op i ni o ns a nd c r edi tingthe v i ews o fthe g o ve r nm en t’ s wi tn es se s. The co ur t was a war e o fa nd ad d re ss ed m an y of t h e p oin ts th at G icla h as cit ed . I t d id no tc r e di tthe g o v e rn men t ’ s wi tne s s e s a c r o s s the b o a r d, althou gh i t ultim ately did agree w ith th em that Gicla’s physi ci ans di d not pro vi de hi m with s ubstandard ca re . The cour t’ s f actualfin d in gs, i ncl ud i ng i ts cre dibi l i ty a s s e s s men t s , a r e we l ls up po r t e d b y the r e c o r d. Fo r al lo fthes e r eas ons, we rej ect Gicl a’ s a ssi gnm ents oferr o ra nd A FFIRM the j ud gm en t in the gove rnm en t’s favor.

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