Opinion ID: 2071483
Heading Depth: 2
Heading Rank: 1

Heading: Levinson's Expert Testimony

Text: Balan argues that Levinson was not qualified to testify as an expert and that his testimony lacked sufficient basis to be admissible in any event. Levinson has impressive credentials as a gynecologist, but no experience or expertise in general surgery. This distinction is important, according to Balan, because there are differences in the way that gynecologists and general surgeons perform laparoscopic procedures. Levinson, himself, testified that surgeons have a different approach and a different focus than gynecologists. The major difference, according to Levinson, is that gynecologists use a steering wheel device, that is inserted in the vagina, to move internal organs out of the way and provide unobstructed vision through the laparoscope. Surgeons, by contrast, use second or third trocars for increased vision. Levinson testified that the use of the steering wheel is the better approach. It is apparent from Levinson's testimony that there are differences in the way that surgeons and gynecologists performs laparoscopies. Those differences, however, do not impact the standard of care. Levinson repeatedly testified that, [t]here are different techniques by different doctors of equal repute in this community. But the basic techniques and the basic no-nos are the same. Balan's focus on the steering wheel testimony is misplaced. Levinson never criticized Balan for using the second trocar instead of a steering wheel. Rather, he opined that Balan was negligent in the way he inserted the second trocar. This Court has recognized that, the diagnosis and treatment of some medical problems may be of concern to doctors of different specialities, and in an area of concurrent expertise, a common standard of care may be shared. [1] The record supports the conclusion that there is a common standard of care with respect to basic laparoscopic procedures. Accordingly, we find no abuse of discretion in the trial court's decision to qualify Levinson as an expert with respect to the performance of laparoscopies by general surgeons. [2] Even if Levinson was qualified to testify, Balan argues that his testimony should have been stricken because Levinson's opinion was unsupported. Levinson testified that, [I do] not know exactly where Balan put [the second trocar]. But I can say that he put it in the wrong place. Levinson explained that, I know it was done incorrectly or we would not be here.... Levinson also testified that, on rare occasions, the insertion of the first trocar causes an injury, but that he has neither experienced nor read about a case where the insertion of a second trocar damaged a major artery. On cross-examination, Levinson admitted that he did not know where Balan inserted or aimed the second trocar. It is settled law that a plaintiff cannot use evidence that a medical procedure had an unusual outcome to create an inference that the proper standard of care was not exercised. [3] Balan argues that Levinson attempted to do just that. Since Levinson did not know any of the details of how or where the second trocar was inserted, he was unable to state how Balan purportedly deviated from the applicable standard of care. Instead, according to Balan, Levinson opined that Balan was negligent simply because of the unusual outcome. In advancing this argument, Balan misconstrues Levinson's testimony. While it is true that Levinson did not know exactly where or how the second trocar was inserted, that information was not critical to his analysis. Levinson opined that, once the first trocar was successfully inserted, Balan was operating under direct vision, and should have been able to control the second trocar as accurately as if Balan were performing open surgery. Since a careful surgeon could have avoided puncturing the iliac artery, Balan's failure to do so constituted a deviation from the applicable standard of care. In sum, Levinson's opinion was based on his analysis of the circumstances of this case, not mere speculation over the cause of a bad result. [4]