Faison-Williams v. United States

Background

Natasha Faison-Williams brought a medical-malpractice action against the United States under the Federal Tort Claims Act. The case arose from a May 2, 2017 thoracic microdiscectomy performed at the Manhattan Veterans Affairs medical center. Faison-Williams’s remaining claim was that Dr. James Stone committed malpractice by recommending, scheduling, and supervising that surgery. She had voluntarily dismissed her separate claim that the surgery was negligently performed.

Faison-Williams alleged that the surgery caused an epidural hematoma, which compressed her spinal cord and led to pain, weakness, numbness, walking difficulties, and bowel and bladder symptoms. The Government disputed both liability and causation. It argued that the surgery complied with the applicable standard of care and that Faison-Williams’s symptoms had other possible causes, including cervical spine disease, preexisting conditions, and psychological conditions.

Motions and governing standards

The Government moved to exclude the opinions of Faison-Williams’s retained neurosurgeon, Dr. Martin Zonenshayn, under Federal Rule of Evidence 702 and Daubert v. Merrell Dow Pharmaceuticals, Inc. Rule 702 requires expert testimony to be based on sufficient facts or data, reliable methods, and a reliable application of those methods. The court acts as a gatekeeper by deciding whether proposed expert testimony is reliable and relevant.

The Government also moved for summary judgment. Summary judgment is appropriate when the evidence shows that there is no genuine dispute about a material fact and the moving party is entitled to judgment as a matter of law. Under New York law, which applied to the Federal Tort Claims Act claim, a medical-malpractice plaintiff generally must prove that the defendant violated the medical standard of care and that the violation proximately caused the injury. Because spine surgery is outside ordinary lay knowledge, the court stated that reliable expert testimony was required on both liability and causation.

Exclusion of causation testimony

Zonenshayn opined that Dr. Stone should not have recommended or scheduled the thoracic microdiscectomy because, among other reasons, the disc herniation allegedly did not compress the spinal cord, the surgery followed too soon after an earlier cervical surgery, and medical providers should have ruled out psychiatric or non-neurological causes. He also opined that the surgery caused the epidural hematoma and resulting injuries.

The court found Zonenshayn’s causation opinions unreliable because he did not adequately address obvious alternative causes. First, his testimony acknowledged that cervical spinal disease could cause lower-extremity symptoms, weakness, gait problems, and bowel and bladder issues, but he did not reliably rule out cervical disease as the cause of Faison-Williams’s symptoms.

Second, Zonenshayn did not adequately address preexisting conditions. The record showed that Faison-Williams had neck and back pain before the thoracic surgery, and Zonenshayn described her thoracic disc bulge as a degenerative condition. He also testified that he highly doubted the thoracic spine was the only cause of her bowel and bladder issues and could not estimate how much of those symptoms was attributable to the thoracic spine rather than her childbirths.

Third, the court found that psychological causes, including conversion disorder or malingering, were obvious alternative explanations in this case. Zonenshayn recognized Faison-Williams’s psychological history and testified that some symptoms might be psychological, but he did not explain why those conditions did not cause her later symptoms. The court also found that his statement that a thoracic spinal cord injury can cause the reported symptoms did not reliably establish that the surgery actually caused them.

The court concluded that Zonenshayn had multiple opportunities, including through supplemental reports, to explain why the alternative causes did not account for Faison-Williams’s symptoms. Because he failed to do so, the court held that his causation opinions were unreliable and excluded them. The court did not reach the Government’s separate argument that Zonenshayn’s liability opinions lacked a reliable methodology.

Summary judgment and disposition

Faison-Williams conceded that summary judgment necessarily followed if the Government’s motion to exclude was granted. Because the court excluded her expert testimony, it granted the Government’s motion for summary judgment. In its conclusion, the court also granted the Government’s motion to exclude the expert testimony, directed the Clerk to close the pending motion, and directed the Clerk to close the case.