Plaintiff Sabrina Zaragoza appealed from the summary judgment entered in favor of defendant Dr. Nadir Adam in a California medical malpractice action. Plaintiff contended that Dr. Adam was not entitled to summary judgment because his medical expert failed to provide a reasoned explanation for his opinions that Dr. Adam did not negligently perform gallbladder removal surgery on plaintiff or cause her injuries.
Based on his review of plaintiff’s medical records, Dr. Adam’s expert offered the following statements and opinions: (1) plaintiff was an appropriate candidate for the cholecystectomy performed by Dr. Adam; (2) plaintiff consented to the
procedure after Dr. Adam explained the recognized risks of injury, including injury to the bowel or bile duct, with possible bile leak; (3) the cholecystectomy was performed by Dr. Adam “without apparent complication” and “within the standard of care expected of a general surgeon performing this surgery”; (4) a bile leak is “a recognized risk of
cholecystectomy” and “is a relatively minor complication” that “can occur even when the procedure is performed with due care by the surgeon. In this case the bile leak was not due to any negligence or inappropriate surgical technique on the part of Dr. Adam”; (5) in most circumstances, an ERCP allows a bile leak to resolve and the patient has no further complications,” but “in this case, the ERCP was not successful,” as “the procedure note by Dr. Uppal . . . indicated that the procedure was ‘incomplete,’ ” and “[s]ubsequent medical records confirmed that the attempted ERCP procedure resulted in a retroperitoneal duodenal perforation. The duodenum is part of the small intestine, also referred to as the bowel. In short, the attempt to perform the ERCP resulted in a perforated bowel. This is a serious complication. It allowed the abdominal cavity to be contaminated, resulting in infection and sepsis.” Dr. Morse concluded that the attempted ERCP by Dr. Uppal “set off a cascade of ongoing medical complications, hospitalizations, additional surgeries, and other procedures,” and plaintiff’s resulting injuries and disabilities were caused by the bowel perforation from the ERCP, not the bile leak from Dr. Adam’s cholecystectomy.”
The Court of Appeal of the State of California First Appellate District Division Three stated in its opinion published on February 27, 2025: “Dr. Morse concluded, based on his review of plaintiff’s medical records, that Dr. Adam performed the cholecystectomy “within the standard of care expected of a general surgeon performing this surgery,” but critically, he did not elaborate or explain the basis for this conclusion. For instance, Morse did not explain what acts constitute due care when performing a cholecystectomy, particularly as they relate to avoiding or preventing a bile leak. Morse also concluded, without adequate explanation or elaboration, that plaintiff’s bile leak “was not due to any negligence or inappropriate surgical technique on the part of Dr. Adam.” To the extent Dr. Morse offered this conclusion based
on the premise that a bile leak is a recognized and relatively minor complication of a cholecystectomy that can occur “even when the procedure is performed with due care,” his conclusion “does not follow” (McAlpine, supra, 51 Cal.App.5th at p. 941) because he did not explain how he ruled out a negligent cause for the bile leak in this case. Instead, Dr. Morse attempted to attribute plaintiff’s injuries and complications to a bowel perforation purportedly caused by Dr. Uppal during the ERCP. But setting aside for now its adequacy and admissibility, this particular opinion simply does not tend to prove the absence of negligence by Dr. Adam in performing the cholecystectomy that led to the bile leak. Furthermore, and in any event, we conclude Dr. Morse did not provide a reasoned explanation for his opinion that Dr. Uppal’s performance of the ERCP caused a bowel perforation. “
“Dr. Morse’s opinions in this regard were conclusory, and furthermore, he did not state to a reasonable medical
probability that the ERCP, rather than Dr. Adam’s actions, was the sole cause of plaintiff’s complications and injury.
Strictly scrutinizing Dr. Adam’s evidence, as we must, we conclude Dr. Morse failed to support his opinions with sufficient factual detail and reasoned explanation to show the absence of a triable issue of material fact.”
Source Zaragoza v. Adam, M.D., A168100.
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