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Sample Medical Expert Report

Expert Report

A. Materials Reviewed

I have review the following materials in developing my opinions in this case:

  1. Medical records, medical bills, operative pictures, and radiology films from Mandy Anthony’s admission at Midtown Hospital from February 28, 2019 until March 7, 2019.
  2. Medical records, medical bills, and radiology films from Mandy Anthony’s treatment at Memorial University Hospital from March 7, 2019 until June 2019.
  3. Deposition testimony of David Earnest, M.D. from her deposition on 5/25/16.
  4. Deposition testimony of William J. Evans, M.D. from his deposition on 6/15/16.
  5. Answers to Interrogatories and Response to Requests for Admissions of David Earnest, M.D.
  6. Answers to Interrogatories and Response to Requests for Admission of William J. Evans, M.D.

As discovery is ongoing, I reserve the right to supplement the materials I have reviewed in rendering my opinions. In particular, I understand that Plaintiff’s counsel is currently obtaining additional records and bills from several providers, including, but not limited to Eastern Maryland Hospital. Therefore, I reserve the right to supplement this report to include opinions about those bills and that treatment.

B. Qualifications, List of Cases, and Fee Schedule

I am a physician licensed to practice medicine in the state of Kansas and Texas. I am a surgeon and the Director of the Chicago Institute of Minimally Invasive Surgery. I am also the Director of the Laparoscopic and Bariatric Fellowship Program at St. John Hospital and a Professor of Surgery at the University of Kansas Chicago. I am currently a staff surgeon at St. John Hospital in Evanston, Kansas. I have substantial experience performing surgical procedures such as laparoscopic cholecystectomies and hepatobiliary surgery, including Roux-En-Y bile duct reconstruction procedures. I have published extensively on the subject of hepatobiliary surgery in peer reviewed journals and medical books.

I am familiar with the standard of medical care applicable to hospitals and medical providers such as Dr. Evans, individually; and Midtown Hospital and William J. Evans, III, M.D., PLLC acting through its employees, servants, agents and/or ostensible agents, including, but not limited to, Dr. Evans who examine, evaluate, and treat patients for conditions similar to Mandy Anthony in the District of Columbia.

A copy of my CV including my last 10 years of publications is attached to this report as Exhibit A. A list of the cases I have testified in as a witness for the last 4 years is attached as Exhibit B. My fee schedule is attached as Exhibit C. I charged $500 per hour to review medical charts and $7,500 per one day deposition.

C. Summary of Records and Testimony

Mandy Anthony presented to Midtown Hospital on February 28, 2019 with signs and symptoms consistent with cholelithiasis. This included a positive murphy’s sign, a history of nausea and vomiting, and right upper quadrant abdominal pain. An ultrasound was performed, which showed gall stones. Based upon this information, the patient was admitted to the hospital and scheduled for a laparoscopic cholecystectomy with Dr. Evans.

The surgery took place on March 3, 2019. Initially, the dissection was performed by the resident, David Earnest, who admittedly had little to no experience performing the procedure. However, after approximately 20 minutes of attempted dissection, the operation was taken over by Dr. Evans. The operative note indicates Dr. Evans found extensive adhesions and inflammation. According to his deposition and discovery responses, Dr. Evans used the infundibular technique in conjunction with a critical view of safety framework to identify the patient’s anatomy prior to clipping and cutting structures to remove her gall bladder. Initially, Dr. Evans used the Ethicon endo-dissector to expose the cystic duct. He then placed two Covidien clips on the duct and transected it. Next, Dr. Evans dissected around the cystic artery. Three clips were placed on the artery. It was then transected. After these two structures were transected, Dr. Evans started to dissect the gall bladder off of the liver bed.

Approximately halfway up with the dissection, Dr. Evans noticed a small spurt of bile near the location of the cystic duct clip and stump. This was confirmed by direct visualization. At this point, Dr. Evans used the dissector to remove the laparoscopic clip, which did not appear to grasp cleanly. He then placed one additional clip on the cystic duct. Seeing that there was still a bile leak, he placed a second clip behind the first clip closer to the common bile duct. At his deposition, he testified that he knew the location the clips in relation to the common bile duct because he could see it under direct visualization.

At this point, Dr. Evans completed his dissection of the gall bladder. In his operative note, he states that intraoperatively, the decision was made to have a consultation with Gastroenterology to possibly do an ERCP and a retrograde cholangiogram to check for a leak at the cystic duct considering the fact that the cystic duct clips had to be removed and reseated.

At his deposition, Dr. Evans also noted that the patient had a “short cystic” duct. A pathology report for the gall bladder removed from the patient revealed that the portion of the cystic duct removed was .6 x .3 x .3 cm.

Following her operation, the patient’s clinical condition rapidly deteriorated. She underwent numerous radiological studies between March 4 and March 7, including, a HIDA scan, an ERCP, and an MRI. The results of these tests in addition to the patient’s lab work overwhelming confirmed that she had sustained a severe injury to her common hepatic and/or common bile duct. Despite this evidence, the patient was not transferred to a higher level of care at Memorial University Hospital until March 7, 2019. At that point, she was septic and required two months of treatment, including drains and antibiotic therapy, until she was able to undergo her Roux-En-Y reconstruction surgery on May 1, 2019.

D. Expert Opinions

I hold the following opinions regarding Ms. Anthony’s care to within a reasonable degree of medical certainty:

  1. Ms. Anthony was not suffering from extensive adhesions or inflammation. I have personally examined the photographs taken by Dr. Evans during the operation and Ms. Anthony had a pristine gall bladder. In addition, the pathology report of the gall bladder did not reveal an inflamed gall bladder.
  2. It is unlikely that Mr. Anthony had a “short cystic duct.” The pathology report examining the gall bladder after the operation measured the removed portion of the duct to be .6 cm. Given the extent of the duct removed, it seems highly unlikely that the original duct was abnormally short.
  3. The standard of medical care in performing a laparoscopic cholecystectomy required Dr. Evans to: 1) use a medically accepted technique to properly identify Ms. Anthony’s anatomy prior to clipping and cutting structures to remove her gall bladder; 2) properly executing a medically accepted technique to identify Ms. Anthony’s anatomy prior to clipping and cutting structures to remove her gall bladder; and 3) refraining from clipping, cutting, and injuring Ms. Anthony’s common hepatic and common bile ducts.
  4. It is my opinion that Dr. Evans breached the standard of medical care by failing to properly execute a medically accepted technique to properly identify Ms. Anthony’s anatomy prior to clipping and cutting structures to remove her gall bladder.
  5. In particular, Dr. Evans failed to clear the triangle of Calot of all fat and fibrous tissue; failed to separate the lowest part of the gall bladder from the cystic plate; and failed to identify that there were two and only two structures entering the gall bladder prior to clipping and cutting structures to remove Ms. Anthony’s gall bladder.
  6. Instead, he clipped and cut the cystic duct without properly identifying the anatomy.
  7. He also failed to properly identify Ms. Anthony’s anatomy prior to placing two new clips in the location of the potential bile duct leak.
  8. As a direct and proximate result of these breaches of the standard of medical care, Dr. Evans placed a clip directly across Ms. Anthony’s common hepatic duct thereby causing a permanent injury to that structure.
  9. In addition, the standard of medical care required that Dr. Evans identify an injury to Ms. Anthony’s common hepatic and common bile duct once it occurred.
  10. According to the records and testimony, Dr. Evans knew during the operation that he might have injured the common hepatic and/or common bile duct.
  11. There is also evidence that Dr. Evans knew he caused a leak from the cystic duct.
  12. Given these concerns (as well as the allegation that the Plaintiff had inflammation and abnormal anatomy), the standard of care required Dr. Evans to perform an intraoperative cholangiogram.
  13. If an intraoperative cholangiogram had been performed, it would have revealed a clip placed across the common hepatic duct.
  14. If this clip had been identified during the operation, it could have been removed without causing permanent damage.
  15. Moreover, the standard of medical care required Dr. Evans to timely diagnose Ms. Anthony’s bile duct injury and transfer her to a higher level of care.
  16. Dr. Evans breached the standard of care by failing to timely diagnose Ms. Anthony’s bile duct injury and transfer her to a high level of care.
  17. There are several notes in the medical records indicating that Dr. Evans was concerned during the operation and immediately thereafter that Ms. Anthony had suffered a common bile duct injury.
  18. In addition, Ms. Anthony had several diagnostic tests performed that overwhelmingly confirmed that she was suffering from a common hepatic and/or common bile duct injury.
  19. A HIDA scan performed on March 4, 2019 indicated there was a bile duct obstruction.
  20. An ERCP performed on March 5, 2019 once again demonstrated a bile duct obstruction.
  21. On March 5, 2019, Dr. Evans also ordered a Stat MRI. For some reason, this MRI was not performed until the afternoon of March 6, 2019. Once performed, it also demonstrated a bile duct obstruction.
  22. It is my opinion that these breaches of the standard of medical care by Dr. Evans substantially delayed Ms. Anthony’s treatment and proximately caused her to undergo additional treatment for two months until she was able to obtain her Roux-En-Y reconstruction.
  23. I have reviewed all the medical records for the treatment Ms. Anthony received at Memorial University Hospital from March 7, 2019 until June 2019. Based upon a reasonable degree of medical certainty, all the treatment, including the Roux-En-Y reconstruction operation, was proximately caused by Dr. Evans’s breaches of the standard of medical care.
  24. Based upon a reasonable degree of medical certainty all of the treatment Ms. Anthony received at Memorial University Hospital was fair, reasonable, and medically necessary. All of the bills she received for this treatment was fair, reasonable, and medically necessary.
  25. Based upon a reasonable degree of medical certainty all of the treatment Ms. Anthony received from Midtown Hospital after March 3, 2019 until March 7, 2019, is proximately caused by Dr. Evans’s breaches of the standard of medical care. The bills for the treatment are fair and reasonable.

As discovery is ongoing, I reserve the right to supplement and/or amend my opinions. In particular, I understand that Plaintiff’s counsel is currently obtaining additional records and bills from several providers, including, but not limited to Eastern Maryland Hospital. Therefore, I reserve the right to supplement this report to include opinions about those bills and that treatment.

E. Exhibits to be Used at Trial

At trial, I intend to rely upon all the medical records and films from Midtown Hospital, Memorial University Hospital, and Eastern Maryland Hospital. In addition, I may use medical illustrations, medical animations, demonstrative videos, power point slides, charts of the Plaintiff’s medical records, summaries of the Plaintiff’s medical records, diagrams of the Plaintiff’s medical records, photographs of the Plaintiff, and anatomical models of the human body illustrating the anatomy of the gall bladder, cystic duct, and visual representations, including animations and surgical videos of the medical procedures involved in this case including laparoscopic cholecystectomies and Roux-En-Y procedures.

I hereby certify that this report is a complete and accurate statement of all of my opinions, and the basis and reasons for them, to which I will testify under oath.

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