Title: Barrow, et al. v. Abramowicz
Citation: N/A
Docket Number: 486, 2006
State: Delaware
Issuer: Delaware Supreme Court
Date: August 7, 2007

IN THE SUPREME COURT OF THE STATE OF DELAWARE 
 
KATHLEEN MARIE BARROW,  
) 
individually and as the Personal 
 
)  No. 486, 2006 
Representative of the Estate of  
) 
Robert J. Barrow, JAMES 
 
)  Court Below:  Superior Court 
GREGORY BARROW, JENNIFER )  of the State of Delaware in 
KATHLEEN BARROW,  
 
)  and for New Castle County 
CHRISTINE MARIE BARROW 
) 
and NICOLE ELIZABETH  
 
)  C.A. No. 04C-01-151 
KAZENSKE, 
 
 
 
) 
 
 
 
 
 
 
) 
 
 
Plaintiffs Below,  
) 
 
 
Appellants,  
 
) 
 
 
 
 
 
 
) 
v. 
 
 
 
 
 
) 
 
 
 
 
 
 
) 
CARL ABRAMOWICZ, M.D. and 
) 
SOUTHERN DELAWARE 
 
) 
IMAGING ASSOCIATES, LLC, 
) 
 
 
 
 
 
 
) 
 
 
Defendants Below, 
 
) 
 
 
Appellees.  
 
) 
 
Submitted:  May 9, 2007 
Decided:  August 7, 2007 
 
Before STEELE, Chief Justice, BERGER and JACOBS, Justices. 
 
Upon appeal from the Superior Court.  REVERSED and REMANDED. 
 
 
Richard A. Zappa, Young Conaway Stargatt & Taylor, LLP, Wilmington 
Delaware for appellants. 
 
 
Dennis D. Ferri (argued) and Amy A. Quinlan, Morris James LLP, 
Wilmington, Delaware for appellees. 
 
STEELE, Chief Justice: 
 
2
 
Plaintiff-appellant, Kathleen Barrow, individually and as the personal 
representative of the estate of Robert J. Barrow et al., appeals a Superior Court jury 
verdict in which the jury found Defendant-appellee, Carl Abramowicz, M.D., 
negligent in his care of Barrow, but not liable for Barrow’s death because his 
negligence was not a proximate cause of harm to  Barrow.   
The Barrows focus their arguments on two errors the trial judge allegedly 
made.  They claim that the trial judge erred when he did not permit the testimony 
of Dr. Abramowicz’ medical expert that was favorable to the Barrows and erred 
again when he permitted Dr. Abramowicz to opine on issues of causation without 
providing proper notice to the Barrows.  Because we agree with the Barrows that 
the trial judge erred in these two respects, we reverse and remand this case to the 
Superior Court for a new trial. 
FACTS AND PROCEDURAL HISTORY 
On November 19, 2001, Dr. Abramowicz viewed x-rays of Robert Barrow’s 
chest.  Doctors diagnosed Barrows with lung cancer in April 2002.  Metastatic lung 
cancer caused his death on January 4, 2003.  The Barrows allege that Dr. 
Abramowicz negligently interpreted and reported Barrow’s November 19, 2001 
chest x-rays and that his failure to detect and report discoverable cancer at that 
early stage in 2001 resulted in a curable lung cancer metastasizing and becoming 
an end stage, incurable cancer by the time of its diagnosis in 2002.  Specifically, 
 
3
the Barrows contend that Dr. Abramowicz (i) failed to report that abnormalities in 
the upper left lobe of Barrow’s left lung could be cancer; and, (ii) failed to 
recommend a follow up chest CT scan which would have led to the diagnosis of 
lung cancer while it was confined to the left upper lobe in 2001. 
From the outset of the case, Dr. Abramowicz has denied that he misread 
Barrow’s November 19, 2001 chest x-ray.  Dr. Abramowicz also contends that 
Barrow’s lung cancer was at an advanced stage on November 19, 2001, and that, 
because of the cancer’s rapid growth, treatment would not have made a difference.  
Dr. Abramowicz maintains, arguably inconsistently, that no discernable cancer 
could be detected in the left upper lobe of his lung as of November 19, 2001. 
In accordance with deadlines established by the trial scheduling order, the 
Barrows identified their trial experts.  They identified two radiologists, Dr. 
Konerding and Dr. Magid, to testify on standard of care issues and two cancer 
specialists, Dr. DeNittis and Dr. Martin, both oncologists, to testify on causation 
issues.  Dr. Abramowicz, after receiving a deadline extension, identified two 
oncologists, Dr. Krasnow and Dr. Creech, whose opinions were limited to 
causation issues.  Dr. Abramowicz did not disclose any standard of care experts.  
Moreover, in response to Rule 26(e) expert witness interrogatories, Dr. 
Abramowicz did not list himself, or any other radiologist, as an expert who would 
be offering expert opinion testimony on any issue at trial.   
 
4
The parties deposed pretrial all of the designated expert witnesses.  For the 
Barrows, both Dr. Konerding and Dr. Magid opined that Dr. Abramowicz violated 
the applicable standard of care and that those violations caused a material delay in 
the diagnosis of Barrow’s lung cancer.  They also testified that the abnormalities 
shown in the November 19, 2001 chest x-rays were consistent with the presence of 
lung cancer and that Dr. Abramowicz should have identified the abnormalities as a 
potential malignancy and recommended that a chest CT scan be performed to 
further evaluate the abnormalities in order to facilitate a definitive diagnosis.  
On medical causation issues, both Dr. DeNittis and Dr. Martin testified that 
the failure to recognize and report the abnormalities in November of 2001, caused 
a delay in the diagnosis and treatment of Barrow’s lung cancer, which resulted in 
no treatment plan for lung cancer, and allowed the cancer to advance and 
metastasize from its primary site in the left upper lobe.   As a result, by the summer 
of 2002 when the cancer was eventually diagnosed, it had become incurable.  
These oncology experts also opined that the radiographic abnormalities on 
Barrow’s November 19, 2001 chest x-rays and July 22, 2002 chest CT scans were 
cancerous, and that the primary site of Barrow’s lung cancer was in the left upper 
lobe.   
For Dr. Abramowicz, Dr. Krasnow opined in a written report, and again at 
his pretrial deposition, that Barrow’s primary lesion was located in the left upper 
 
5
lobe of his left lung and that the abnormalities on the November 19, 2001 chest x-
ray were cancerous to a “reasonable medical certainty.”  Dr. Krasnow further 
testified that the cancer in that location already had metastasized by November of 
2001.  In his pretrial deposition, Dr. Creech contested the malignant nature of 
Barrow’s abnormalities and the location of the primary site of his lung cancer.  He 
also testified that (i) he could not locate the primary tumor; and, (ii) that the tumor 
was not in the left upper lobe because the radiographic abnormalities in the left 
upper lobe were benign. 
The Barrows moved to strike that portion of Dr. Krasnow’s opinion that 
related to whether Barrow’s lung cancer had metastasized by November 2001, as 
“unreliable.”  The trial judge agreed, while emphasizing that his ruling did not 
affect Dr. Krasnow’s other proffered medical opinions, including his opinion that 
the location of Barrow’s primary lung tumor was in the left upper lobe. 
The trial judge entered the final pretrial order signed by all parties that 
identified all of the parties’ expert witnesses on February 1, 2006.  The Barrows 
designated as experts the doctors they previously had disclosed pursuant to the 
pretrial scheduling order.  The Barrows expressly reserved the right to call Dr. 
Abramowicz’s experts, including Dr. Krasnow, without objection from Dr. 
Abramowicz.  Dr. Abramowicz similarly reserved the right to call the Barrows’ 
designated expert witnesses.  The Barrows also expressly reserved the right to 
 
6
introduce the pretrial discovery deposition of witnesses who could not attend the 
trial.  Although Dr. Abramowicz objected to other matters affecting the trial, he did 
not object to the Barrows introducing the pretrial discovery depositions of 
witnesses that would be unavailable at trial.1  
The trial was scheduled to begin on February 6, 2006.  A few days before 
trial, Dr. Abramowicz’s counsel requested a continuance because of illness.  The 
trial judge granted the continuance and rescheduled the trial to begin August 21, 
2006, and later ruled that the parties were to remain in the same position at the 
rescheduled trial as they would have been had the case proceeded to trial as 
originally scheduled.   
Shortly before trial, Dr. Abramowicz’s counsel informed the Barrows that he 
would not be calling Dr. Krasnow as a trial witness.  The Barrows then identified 
relevant portions of Dr. Krasnow’s pretrial discovery deposition testimony that 
they intended to introduce at trial.  The proffered testimony related to Dr. 
Krasnow’s opinions that the location of Barrow’s primary lung tumor was in the 
left upper lobe and the radiographic abnormalities on the November 19, 2001 chest 
x-rays were cancerous.  Dr. Abramowicz objected. 
                                                 
1  
Whether or not the Barrows properly identified their intent to use Dr. Krasnow’s 
discovery testimony at trial is an issue on appeal.  Dr. Abramowicz argues that the general 
language on which the Barrows rely could not have provided sufficient notice to Dr. 
Abramowicz of their intent to use Dr. Krasnow’s discovery testimony given their attempt to 
exclude a portion of his pretrial deposition testimony. 
 
7
The Barrows argued to the trial judge that the pretrial order had properly 
identified Dr. Krasnow as an expert witness that the Barrows could call in the case-
in-chief or in rebuttal on an issue that went to the heart of the Barrows’ claims.  
The Barrows contended that they had properly reserved the right to introduce the 
deposition testimony of Dr. Krasnow in the pretrial order and Dr. Abramowicz had 
not objected.  Moreover, they asserted, the deposition testimony was admissible 
pursuant to Superior Court Civil Rule 32.  Finally, the Barrows argued that our 
opinion in Green v. Alfred A.I. DuPont Institute of the Nemours Foundation2 was 
persuasive, if not controlling, authority for their position.   
With the trial underway, the trial judge ruled that the Barrows would not be 
permitted to introduce Dr. Krasnow’s pretrial deposition testimony.3  The judge 
distinguished Green on the basis that the Green court admitted the expert’s 
deposition testimony because it was designated as a trial deposition, as opposed to 
a pretrial discovery deposition, as was the case here.  The trial judge also alluded to 
                                                 
2  
759 A.2d 1060 (Del. 2000). 
 
3  
The trial judge ordered: 
  
“In this case, the proposed deposition of Krasnow was not a trial 
deposition, it was a discovery deposition, and, in fact, although I believe 
one party was present, I’m not sure how many questions the defense 
actually asked in that deposition.  So I think the whole posture was quite 
different.  And, more importantly, I have eliminated or had some problems 
with Dr. Krasnow’s testimony.  So because of those factors, I am not 
going to allow the plaintiff to use part of the discovery deposition.”   
 
Barrow v. Abramowicz, Del. Super., Civ. A. No. 04C-01-151, Scott, J. (Aug. 21, 2006). 
 
 
8
a “general bar against parties calling opposing standard of care experts” in 
Delaware.4 
 
The trial judge also permitted Dr. Abramowicz to give a causation opinion 
by testifying at trial that Barrow’s radiographic abnormalities in the left upper lobe 
were benign and that there was no cancer in the left upper lobe of his lung.  The 
trial judge permitted this testimony over the Barrows’ objections made shortly 
before the start of trial and again at trial during Dr. Abramowicz’s direct 
examination.  The Barrows objected to the testimony because Dr. Abramowicz had 
not properly disclosed his medical causation opinion before trial and because the 
opinions he gave at trial contradicted those he had given under oath at his pretrial 
deposition.5  
                                                 
4  
Id. 
 
5  
Dr. Abramowicz stated the following, under oath, at his pretrial deposition:   
 
Q: 
Are we in agreement that in looking at the CAT scan [July 22, 2002], that that 
abnormality is in the same area which you circumscribed by markings on the 
chest x-rays done in November of 2001? 
A: 
Yes. 
 
* 
* 
* 
* 
* 
Q: 
What I’m trying to get a good fix on, though, is the parameters of that area [on the 
July 22, 2002 CT scan] that you felt was the mass.  Can you with the red marker 
circle of fill in the area where the mass is located …[witness complied] … That is 
the lung cancer, in your opinion? 
A: 
Suspicious.  That’s how I said it in my report [on the July 22, 2002 CT scan]. 
 
Q: 
Looked to you like lung cancer? 
 
A: 
He has a diagnosis of nonsmall cell carcinoma.  That’s the most suspicious area. 
Q: 
So in putting two and two together based on other testing that was done, that’s 
where you could identify the presence of the lung cancer? 
 
A: 
Most probable. 
 
 
9
After Dr. Abramowicz testified, Dr. Creech testified that there was no cancer 
in the left upper lobe of Barrow’s lung and that the radiographic abnormalities 
shown on his diagnostic studies in the left upper lobe were benign.  In closing, Dr. 
Abramowicz’s counsel argued that the abnormalities in Barrow’s upper left lobe 
were not cancerous and, therefore, any negligence on Dr. Abramowicz’s part could 
not have been the proximate cause of harm to Barrow because no cancer 
originating from the upper left lobe would have been diagnosed in 2002, even if 
further studies had been conducted in 2001. 
 
The jury, responding to special interrogatories, found Dr. Abramowicz 
negligent, but concluded his negligence did not proximately cause harm to Barrow.   
 
On September 8, 2006, the Barrows appealed, arguing that the trial judge 
erred when he precluded them from introducing relevant portions of Dr. Krasnow’s 
pretrial deposition testimony on medical causation, and again when he permitted 
Dr. Abramowicz to opine on medical causation at trial that he had not properly 
                                                                                                                                                             
At trial, Dr. Abramowicz testified, as follows: 
 
Q: 
Based upon what you have reviewed in this case, taking everything into 
consideration, do you believe that there was any cancer in the left upper lobe of 
Mr. Barrow? 
A: 
I think the medical evidence is overwhelming in this case that this is a scar.  On x-
ray, the lesion has decreased in size.  On four CT scans, if you compare the first 
with the last, there’s no change in size.  The shape of the lesion is much more 
linear than it is round.  Usually cancers are almost always round which also is 
very suggestive that this is more likely to be a scar.  The PET is completely 
negative in this area.  It shows no cancer at all.  The patient had surgery, had two 
bronchoscopies, and had a thoracotomy where the surgeon went looking for this 
lesion and this lesion, I believe, would have been easy to find if it was a cancer.   
 
 
10
disclosed and that were inconsistent with opinions he expressed in his pretrial 
deposition. 
DISCUSSION 
I.  The trial judge’s decision to bar pretrial discovery  
deposition testimony 
 
The Barrows allege that the trial judge erred when he ruled that they could 
not introduce Dr. Krasnow’s pretrial deposition testimony on causation – an issue 
that went to the very heart of their case.  “When the excluded evidence goes to ‘the 
very heart’ of plaintiffs’ case and ‘might well have affected the outcome’ of the 
trial, the exclusion of the evidence warrants a new trial.”6  We review a trial 
judge’s evidentiary rulings for abuse of discretion.7  If we find the trial judge 
abused his discretion, we must then determine whether the mistake “constituted 
‘significant prejudice so as to have denied the appellant a fair trial.’”8 
Here, Dr. Krasnow’s medical opinion on the location of Barrow’s primary 
tumor focused on the most important disputed causation issue in the case.  In order 
to determine causation, the jury needed to decide whether the radiographic 
abnormalities in Barrow’s left upper lobe were benign.  If they were, the follow up 
diagnostic testing required by the standard of care, which included the surgical 
                                                 
6  
Green, 759 A.2d at 1063 quoting Watts v. Delaware Coach Co., 58 A.2d 689, 696 (Del. 
Super. 1948). 
 
7  
Id. at 1063. 
 
8  
Id. (quoting Eustice v. Rupert, 460 A.2d 507, 510 (Del. Super. 1983)). 
 
11
removal of the abnormal tissue in the left upper lobe, would not have revealed 
Barrow’s cancer.  Any negligence on Dr. Abramowicz’s part, therefore, could not 
have proximately caused Barrow’s death.   
Dr. Krasnow’s opinion was relevant, highly probative evidence that 
contradicted the testimony of Dr. Abramowicz’s expert, Dr. Creech.  Indeed, the 
jury’s finding of negligence but no proximate cause strongly suggests that the 
exclusion of this evidence had a bearing on the trial’s outcome.  As a result, we 
find that Dr. Krasnow’s pretrial deposition testimony on causation issues went to 
“the very heart” of the Barrows’ case. 
Dr. Abramowicz argues, and we agree, that Dr. Krasnow’s causation 
testimony echoed the opinions of the Barrows’ other medical experts, Dr. 
Konerding, Dr. DeNittis, and Dr. Martin, and, thus, was cumulative.  But, the fact 
that evidence may be cumulative does not render it inadmissible.  The Barrows cite 
to Green’s proposition that a trial judge should only sparingly limit a party’s 
presentation of evidence on the ground that it is cumulative.9  Indeed, Green 
dictates that the exclusion of important evidence “warrants a new trial, even if 
                                                 
9  
“While a trial judge may limit a party’s presentation of evidence on the ground that it is 
cumulative, such authority should be exercised sparingly so as not to deprive a litigant of the 
right to manage the presentation of her evidence.” Id. at 1065. 
 
 
12
there was other evidence ‘of the same general character’ or ‘the rejected evidence 
was cumulative.’”10   
Furthermore, it is clear to us that a medical opinion favorable to the 
Barrows’ case from the lips of one of Dr. Abramowicz’s experts is potentially 
more persuasive to a jury than the testimony of an additional plaintiff’s expert.  
Underlying our ruling in Green is the principle that a litigant has the right to 
introduce all relevant evidence, even if generated by an adverse party, which goes 
to “the very heart” of a case and could affect the outcome of the trial.11    
We next consider whether the Barrows properly reserved their right to 
introduce Dr. Krasnow’s pretrial deposition testimony at trial.  The Barrows posit 
that, on February 1, 2006, Dr. Abramowicz’s counsel signed, and the trial judge 
approved, a pretrial order in which the Barrows expressly reserved the right to call 
Dr. Abramowicz’s witnesses, including Dr. Krasnow.12 “Under Superior Court 
Civil Rule 16, the trial judge enters a trial scheduling order which governs pretrial 
                                                 
10  
Id. at 1063 (quoting Watts v. Delaware Coach Co., 58 A.2d 689, 696 (Del. Super. 1948) 
(“When the excluded evidence goes to ‘the very heart’ of the plaintiffs’ case and ‘might well 
have affected the outcome’ of the trial, the exclusion of the evidence warrants a new trial, even if 
there was other evidence ‘of the same general character’ or ‘the rejected evidence was 
cumulative.”)).  
 
11  
  Id. at 7-8. 
 
12  
Barrow, Del. Super., Civ. A. No. 04C-01-151. 
 
 
13
conferences, scheduling, and trial management.”13  Rule 16 “mandates that parties 
follow the trial judge’s scheduling order,” thus assuring that the parties conduct 
predictable discovery.14  “Parties must be mindful that scheduling orders are not 
merely guidelines but have full force and effect as any other order of the [Superior] 
Court.”15  The Barrows claim that the trial judge disregarded the agreed upon terms 
of the pretrial order, and, thus, abused his discretion when he prohibited them from 
introducing Dr. Krasnow’s pretrial deposition testimony.   
The Barrows allege that Green v. A.I. DuPont controls.16  In Green, we 
found that the trial judge abused his discretion when he precluded the plaintiff, 
who properly reserved her right in the pretrial order, from introducing relevant 
portions of the trial deposition testimony of a defense expert who the defendants 
decided not to call as a trial witness.  Attempting to distinguish Green, Dr. 
Abramowicz argues that the witness testimony at issue in Green was trial 
deposition testimony, as opposed to the pretrial discovery deposition testimony, 
and points to how this distinction affected the parties’ expectations regarding the 
depositions’ use at trial.  Arguing that the parties in Green anticipated the use of 
                                                 
13  
Sammons v. Doctors for Emergency Services, P.A., 913 A.2d 519, 530-33 (2006). 
 
14  
Id.   
 
15  
Id. 
 
16  
Green, 759 A.2d 1060. 
 
 
14
the expert’s deposition, and here, did not, Dr. Abramowicz cites to the Green 
court’s reasoning that the pretrial order reflected “an understanding, shared by the 
parties as well as the expert, that the deposition was to be shown to a jury who 
would give it the same weight as live testimony.”17 
Dr. Abramowicz also cites to Hambleton v. Christiana Care Health 
Services, Inc.,18 a Superior Court case with similar facts that diverged from 
Green’s precedent.  Distinguishing Hambleton’s facts from those of Green, the 
Hambleton court focused on the designated purpose of the deposition at the time it 
was taken and whether the parties had sufficient notice of the parties’ intent to use 
the content at trial.  The Hambleton court concluded that the deposition was a 
“discovery deposition and neither party intended or contemplated when taking it 
that it would be used at trial.”19  Indeed, the trial judge here relied on Hambleton’s 
distinction between a trial deposition and a discovery deposition when he 
prohibited the Barrows from using Dr. Krasnow’s pretrial deposition testimony.20   
                                                 
17  
Id. at 1065. 
 
18  
2002 WL 183851 (Del. Super. Jan. 31, 2002). 
 
19  
Hambleton at 4-5. 
 
20  
The trial judge reasoned as follows:  
 
In this case, the proposed deposition of Krasnow was not a trial 
deposition, it was a discovery deposition, and, in fact, although I believe 
one party was present, I’m not sure how many questions the defense 
actually asked in that deposition.  So I think the whole posture was quite 
different.  And, more importantly, I have eliminated or had some problems 
 
15
Dr. Abramowicz here touts that the parties did not agree to use the discovery 
deposition at trial, did not notice it as a deposition for “use at trial” and, therefore, 
created no expectation it would be used at trial.   
We agree with the Barrows that Green controls and find the distinction 
between a trial deposition and a discovery deposition superfluous on the facts here.  
While Dr. Abramowicz’s argument makes practical sense in the abstract, given that 
the pretrial order is tantamount to a contract between the parties for conducting 
pretrial preparation, we find that rationale inapplicable here.21  Dr. Abramowicz 
clearly intended to use Dr. Krasnow’s pretrial deposition testimony at trial and had 
notice of the Barrows’ intention to do the same.  On February 1, 2006, Dr. 
Abramowicz’s counsel signed, and the trial judge approved, a pretrial order in 
which he expressly reserved the right to call Dr. Krasnow and specifically 
identified “[d]eposition and interrogatory answers” as exhibits he intended to use at 
trial.22  The Barrows similarly expressed their intent to use the same material and 
witnesses when they “reserve[d] the right to introduce any exhibit identified by the 
defendants” which, by Dr. Abramowicz’s own denotation, included Dr. Krasnow’s 
                                                                                                                                                             
with Dr. Krasnow’s testimony.  So because of those factors, I am not 
going to allow the plaintiff to use part of the discovery deposition.   
 
Barrow, Del. Super., Civ. A. No. 04C-01-151. 
 
21  
Sammons, 913 A.2d at 530-33. 
 
22  
Barrow, Civ. A. No. 04C-01-151. 
 
 
16
pretrial deposition testimony.  While he objected to other evidence proffered, Dr. 
Abramowicz did not object to the Barrows’ proposal to introduce the witness’ 
pretrial deposition testimony and he also reserved the right to call the Barrows’ 
trial witnesses.  Indeed, it appears to be common practice for parties to designate 
each other’s witnesses for use at trial and inconceivable that Dr. Abramowicz 
would think that the Barrows would not affirmatively elicit opinions from Dr. 
Krasnow on favorable matters, particularly on the important issue of causation.   
Moreover, the Barrows informed Dr. Abramowicz that they intended to 
introduce portions of Dr. Krasnow’s testimony at trial promptly after Dr. 
Abramowicz confirmed that he no longer intended to call Dr. Krasnow.  Similarly, 
those portions of Dr. Krasnow’s deposition testimony were part of the very 
causation opinion upon which Dr. Abramowicz designated Dr. Krasnow to opine.   
Thus, we conclude that the pretrial order and the Barrows’ later indication 
that they intended to introduce pretrial discovery deposition testimony of witnesses 
at trial gave Dr. Abramowicz full and fair notice of their intentions.  The Barrows 
had a right to rely on the pretrial order to govern the course of trial, unless 
“modified … to prevent manifest injustice.”23  The trial judge never modified the 
pretrial order.  Therefore, we hold that the trial judge erred when he chose not to 
                                                 
23  
Del. Super. Ct. Civ. R. 16(e): a pretrial order “shall control the subsequent course of the 
action unless modified by a subsequent order…to prevent manifest injustice.” 
 
 
17
give effect to the pretrial order of February 1, 2006, thereby preventing the 
Barrows from presenting important evidence that went to the “very heart” of their 
case at trial.  Dr. Abramowicz “cannot now be heard to complain about living with 
the record [he] had a hand in creating.”24 
Dr. Krasnow’s opinion was relevant, highly probative evidence that went to 
“the very heart” of the Barrows’ case, and all parties had reason to believe and 
were on notice that the pretrial depositions of expert witnesses may be introduced 
at trial.  For those reasons we hold that the trial judge erred when he prevented the 
jury from considering Dr. Krasnow’s opinion testimony in order to resolve an issue 
central to the trial’s outcome.25 
II.  The trial judge’s admission of unnoticed defendant  
witness expert testimony 
 
Next, the Barrows allege that the trial judge erred when he failed to limit the 
scope of Dr. Abramowicz’ trial testimony to opinions disclosed at his pretrial 
deposition.  We review a trial judge’s evidentiary rulings for abuse of discretion.26  
If we find the trial judge abused his discretion, we must then determine whether the 
                                                 
24  
Vandenbraak v. Alfieri, 2005 U.S. Dist. LEXIS 9882 at *17 (D. Del. May 25, 2005). 
 
25  
We note that Dr. Krasnow’s testimony also rebutted Dr. Creech’s opinions.   
26  
Sammons, 913 A.2d at 535; Green, 759 A.2d at 1063. 
 
 
18
mistakes “constituted ‘significant prejudice so as to have denied the appellant a fair 
trial.’”27 
Over the Barrows’ timely objections, the trial judge permitted Dr. 
Abramowicz to testify that Barrow’s radiographic abnormalities were benign, that 
there was no cancer in the left upper lobe of his lung, and that, therefore, a failure 
to report a negative finding could not have contributed to the patient’s death from 
incurable cancer.  The Barrows claim the trial judge abused his discretion by 
permitting this testimony because (i) Dr. Abramowicz was never identified as an 
expert who would be giving causation opinions at trial; and, (ii), Dr. Abramowicz’s 
trial testimony on causation contradicted his pretrial testimony.  The Barrows 
argue that Dr. Abramowicz’s testimony went beyond mere factual observations 
and included an opinion on cause of death.  The Barrows further contend that the 
trial judge’s ruling that permitted this testimony rendered the expert witness 
disclosure requirements of Superior Court Civil Rules 16(e) and 26(e) 
meaningless.28  Specifically, they contend that Dr. Abramowicz’s failure to 
identify himself pretrial as an expert who would opine on causation at trial, and to 
disclose the substance of his causation opinions when identifying his experts for 
use at trial did not comply with the Rule 16(e) trial scheduling order.  Moreover, 
                                                 
27  
Green, 759 A.2d at 1063 (quoting Eustice v. Rupert, 460 A.2d 507, 510 (Del. Super. 
1983)). 
 
28  
Del. Super. Ct. Civ. R. 16(e); Del. Super. Ct. Civ. R. 26(e). 
 
 
19
they argue, he failed to comply with Rule 26(e)29 by not identifying himself as a 
trial expert and disclosing his opinions in response to expert witness 
interrogatories. 
In Rogers v. Case,30 the authority upon which the trial judge relied when he 
allowed Dr. Abramowicz’ testimony, the trial judge allowed a defendant doctor in 
a medical malpractice case to give un-noticed expert testimony.  The Rogers court 
reasoned that the distinction between a defendant doctor’s role as a fact witness 
and an expert witness is blurred in medical malpractice cases: 
 
It seems to me that any Defendant in a malpractice case is going to 
give mixed testimony involving medical opinion and factual 
recitation. The Plaintiff's testimony is customarily stronger at trial 
than at deposition, and something qualitatively different is inevitably 
raised which calls for rebuttal. The Defendant physician must have a 
fair opportunity to defend himself. Of all the physicians, the 
Defendant is usually the one most familiar with the facts and 
diagnosis in the case and his opinion is inevitably admitted in some 
form. In this case, the Plaintiff was certainly not surprised that the 
defense would counter the testimony connected with the X-rays.31  
 
While we understand the trial judge’s reasoning, we cannot overlook the 
requirement that a defendant doctor wishing to so testify must give notice to an 
                                                 
29  
Rule 26(e) states that “[a] party is under a duty seasonably to supplement the response 
with respect to any question directly addressed to… the identity of each person expected to be 
called as an expert witness at trial… the subject matter on which the person is expected to testify, 
and the substance of the person’s testimony.” 
 
30  
1998 WL 437145 (Del. Super. June 30, 1998). 
 
31  
Id. 
 
 
20
opposing party to give that party a fair opportunity to meet that “expert” opinion 
on the same basis as any other expert opinion from a nonparty witness.   
Bush v. HMO of Delaware requires that a party comply with discovery 
directed to the identification of experts and the disclosure of the “substance of their 
expected opinions” as a precondition for admitting that expert testimony at trial.32    
When a healthcare defendant takes the stand as an expert witness for trial, he must 
satisfy the same requirements as any other expert witness.  These requirements 
include: (i) a timely identification of his role as an expert; and, (ii), a timely 
disclosure of his opinions and the bases for his opinions.  Without this notice, the 
other party cannot properly prepare for trial. 
Dr. Abramowicz claims that the Barrows should not have been surprised that 
he expressed the causation opinion he expressed, given his deposition testimony, as 
well as Dr. Creech’s testimony to the same effect at his deposition and at trial.  
Moreover, he asserts, the issue of whether there was incurable cancer in the upper 
lobe was in the case from the beginning and was addressed to some degree by all 
four of the Barrows’ experts.   
Although that position is factually unassailable, Dr. Abramowicz failed to 
disclose that he himself would be offering opinion testimony that there was no 
cancer in Barrow’s left upper lobe but that, if there were, a failure to so report 
                                                 
32  
Bush v. HMO of Delaware, 702 A.2d 921, 923 (Del. 1997). 
 
21
could not have produced a timely, life saving diagnosis and treatment plan.  
Therefore, he should not have been permitted to give that opinion at trial.33  The 
trial judge abused his discretion by permitting Dr. Abramowicz’ testimony because 
the defense never identified Abramowicz as an expert who would be giving 
causation opinions at trial.  “Parties must comply with the discovery rules by 
identifying expert witnesses and disclosing the substance of their expected 
opinions as a precondition to the admissibility of expert testimony at trial.”34 
The significance of Dr. Abramowicz’s noncompliance is enhanced because 
his pretrial testimony on the underlying causation issue contradicted his trial 
testimony.  At his pretrial deposition Dr. Abramowicz stated the following, under 
oath:   
 
Q: 
Are we in agreement that in looking at the CAT scan [July 22, 2002], 
that that abnormality is in the same area which you circumscribed by 
markings on the chest x-rays done in November of 2001? 
A: 
Yes. 
 
* 
* 
* 
 
Q: 
What I’m trying to get a good fix on, though, is the parameters of that 
area [on the July 22, 2002 CT scan] that you felt was the mass.  Can 
you with the red marker circle of fill in the area where the mass is 
                                                 
33  
Indeed, Dr. Abramowicz’ Answering Brief on appeal conceded that “… Dr. Abramowicz 
… testif[ied] regarding the standard of care and causation.” Appellee’s Ans. Br. at 29 (emphasis 
added). 
 
34  
Sammons, 913 A.2d at 530-33. 
 
 
22
located …[witness complied] … That is the lung cancer, in your 
opinion? 
A: 
Suspicious.  That’s how I said it in my report [on the July 22, 2002 
CT scan]. 
 
Q: 
Looked to you like lung cancer? 
A: 
He has a diagnosis of nonsmall cell carcinoma.  That’s the most 
suspicious area. 
Q: 
So in putting two and two together based on other testing that was 
done, that’s where you could identify the presence of the lung cancer? 
 
A: 
Most probable. 
 
At trial, Dr. Abramowicz gave contradictory testimony, as follows: 
 
Q: 
Based upon what you have reviewed in this case, taking everything 
into consideration, do you believe that there was any cancer in the left 
upper lobe of Mr. Barrow? 
A: 
I think the medical evidence is overwhelming in this case that this is a 
scar.  On x-ray, the lesion has decreased in size.  On four CT scans, if 
you compare the first with the last, there’s no change in size.  The 
shape of the lesion is much more linear than it is round.  Usually 
cancers are almost always round which also is very suggestive that 
this is more likely to be a scar.  The PET is completely negative in this 
area.  It shows no cancer at all.  The patient had surgery, had two 
bronchoscopies, and had a thoracotomy where the surgeon went 
looking for this lesion and this lesion, I believe, would have been easy 
to find if it was a cancer.   
 
Dr. Abramowicz’s trial testimony should have been limited to relevant factual 
matters and opinions disclosed at his pretrial deposition.  Because the Barrows had 
no notice that Dr. Abramowicz – a radiologist, not an oncologist – would offer a 
causation opinion at trial contrary to his pretrial deposition testimony, their experts 
were no longer available to rebut Dr. Abramowicz’s new testimony at trial. 
 
23
Here, the preconditions of Bush v. HMO of Delaware were not satisfied.  
The trial judge’s ruling permitting Dr. Abramowicz to opine that if Barrow had 
cancer in his left upper lobe that it would have been incurable in November 2001, 
was highly prejudicial and denied the Barrows a fair trial.  Indeed, the trial judge’s 
ruling rendered the mandatory expert witness disclosure requirement of Superior 
Court Rules 16(e) and 26(e) meaningless.35   
Moreover, the trial judge’s ruling whipsawed the Barrows by allowing Dr. 
Abramowicz’ opinion testimony on causation after having made a ruling that 
prohibited the Barrows from introducing Dr. Krasnow’s opinions on causation.  In 
effect, Dr. Abramowicz was given an extra expert opinion (his own) to support Dr. 
Creech’s causation opinions and the Barrows were denied an expert opinion (Dr. 
Krasnow’s) which would have directly rebutted both Dr. Abramowicz and Dr. 
Creech’s opinions. 
CONCLUSION 
Dr. Krasnow’s opinion was relevant, highly probative evidence that went to 
“the very heart” of the Barrows’ case, and all parties had reason to believe and 
were on notice that the pretrial depositions of expert witnesses may be introduced 
by either at trial.  Therefore, the trial judge erred when he prevented the jury from 
                                                 
35  
The ruling also contradicted two previous rulings which were entered to prevent a party 
from introducing expert testimony at trial which had not been properly disclosed. 
 
 
24
considering Dr. Krasnow’s opinion testimony in order to resolve an issue central to 
the trial’s outcome.  The trial judge also erred when he failed to limit the scope of 
Dr. Abramowicz’ trial testimony to the observed facts related to standard of care 
that he disclosed at his pretrial deposition.  Accordingly, we REVERSE and 
REMAND the case to the Superior Court for a new trial.