EXHIBIT C 

Case 2:15-md-02641-DGC Document 9878-4 Filed 01/26/18 Page 1 of 4
IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

IN RE: Bard IVC Filters Products No. 2:15-MD-02641-DGC

Liability Litigation,

 EXPERT REPORT OF DANIEL COUSIN, MD

Sherr Una Booker

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Case 2:15-md-02641-DGC Document 9878-4 Filed 01/26/18 Page 2 of 4
x On CT abdomen 2/28/2008, the tip of one of the filter prongs of the IVC filter 

is again seen extending outside of the inferior vena cava and into the wall of 

the abdominal aorta. 

x On Lumbosacral Spine radiograph of 3/26/2009, one of the medial filter 

prongs extends towards the abdominal aorta. 

x On CT abdomen and pelvis of 12/2/2011, one of the prongs of the inferior 

vena cava filter is clearly noted extending outside the inferior vena cava wall 

and with its tip in the center of the abdominal aorta. 

x On CT of the abdomen and pelvis of 12/2/2011, one of the filter prong tips is 

again seen located in the center of the abdominal aorta. 

Some of these radiology reports did comment on the presence of an inferior vena cava 

filter, but did not describe an abnormal appearance. For example, on CT abdomen and 

pelvis 2/20/2008 interpreted by Dr. Stephen Kardon, it was noted that “an inferior vena 

cava filter is in place.” On Lumbosacral Spine radiograph of 3/26/2009 by Dr. Sarwat 

Kamal Amer, it was described “IVC filter is noted.” 

The CT of the abdomen and pelvis 6/26/2014 ultimately reported the abnormality of the 

inferior vena cava filter findings. The impression of this report states “IVC filter is in place. 

One of the legs of the IVC filter appears to extend into the lumen of the abdominal aorta 

infrarenal portion.” 

On the chest xray of 7/3/2014, findings correctly report that a “filter fragment is seen in 

the region of the right ventricle.” This finding confirmed that one of the prongs of the filter 

had actually broken off and travelled through the vasculature and into the right side of the 

heart. 

It is my opinion that abnormality of the inferior vena cava filter was clearly present during 

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Report for Sherr-Una Booker Page 5 

all of the above studies from 2/20/2008 until 6/26/2014 when it was formally identified. 

Furthermore, it is my opinion within a reasonable degree of medical certainty that the 

standard of care for practice of a diagnostic radiologist is to identify findings such as this 

abnormal device appearance during reporting of these examinations. The facts that the 

examinations were requested for other indications and that the findings would have been 

incidental do not impact that duty to report the abnormal device appearance. The standard 

of care requires that a diagnostic radiologist report all findings of significant abnormality 

even those unrelated to the reasons for the examination performed. 

By failing to identify and report the abnormal appearance of the inferior vena cava filter, 

the diagnostic radiologists prevented Ms. Booker’s treating physicians from having 

information to assess her medical condition pertaining to the IVC filter. 

My opinions herein are based on the available medical records and I expressly reserve the 

right to alter my opinions if and when new records are provided to me for review and 

analysis. 

 6/29/2017 

 Daniel Cousin, M.D. 

cousin@post.harvard.edu 

646-303-3125 (cell) 

www.RADSURITY.com 

“Be sure with Radsurity” 

 

My rate is $500 per hour for chart review, $150 per hour for travel and $875 per hour for testifying.

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