The existence of a professional society gives no assurance that the quality of a physicians work will be closely examined or even scrutinized. There is simply no deterrent for bad surgeons to practice. Unfortunately, Dr. Shamoun has witnessed the pre-textual play by insurance companies, defendant doctors, and defense councils who have tried to tarnish experts reputation in the legal arena. It is unfortunate these attorneys and professional societies are all too happy to do this when a fellow member is called into question or has committed gross malpractice. It is my opinion, after 20 years of expert testimony, that often times many professional societies protect their members over and above the public.

By law a physician has a duty to use the degree of skill and care which is expected of a reasonably competent physician in the same specialty to which he or she belongs. 

• Accidents.
• Inadvertent injury.
• Complication.
• Medical injury.
• Therapeutic misadventure
• Iatrogenic injury
• Adverse drug events.
• Malpractice / negligence.

• Negligence is a failure to act in accordance with a reasonable physician in the community.
• Falls short of reasonable care.
• Negligence includes acts of commission (doing something wrong) or acts of omission (failure to do something).
• A bad result when the effort does not reflect reasonable standards of practice.
• Inexperience or a lack of expertise and training is no excuse for negligence.

• Improper performance.
• Failure to recognize.
• Delay in rx.
• Careless decisions made with obvious ignorance of the situation.
• Refusing to respond.
• Failing to follow accepted practice.
• Making the wrong surgical move.
• Intentional carelessness.
• Lack of knowledge.
• Thoughtless.
• Unethical acts.

• Adverse event caused by preexisting factors that are OUTSIDE the DRs’ CONTROL.
• Health habits, immunity, or healing abilities vary in patients and all have varying influence in complications.
• Using well reasoned choices to tackle a difficult problem and conducting the care properly and carefully yet ending up with a bad result is not malpractice.
  

*If a patient is not warned of possible complication beforehand, the complication then becomes a mistake*

• Bad outcome despite good and reasonable care.
• A misadventure is an incident over which the physician has no control.
• A therapeutic misadventure can be defended in a court of law. However, negligence is indefensible.
• Negligence as defined by the law, is simply the failure to meet the standard of care as stated above.

• Natural
• Accidental
• Homicide
• Suicide
• Undetermined

• A passion for truth and accountability.
• Points out the obvious.
• Sees what everyone else sees but will not admit.
• In giving expert testimony has a passion for what is right, what is most probable. while forensically looking at the most likely scenario.
• Articulates what the science shows, what common sense shows, how surgery should be performed, the anatomy, proper training, etc.
• “Lets it rip“ regardless of political forces or agendas.
• Understands what is reasonable medical probability and what is (more likely than not) a certainty when giving his expert opinion.

Dr. Shamoun  has previous deposition and/or trial – arbitration experience with “standard of care”  civil cases , and criminal cases involving:

• Breast Augmentation
• Breast Implant Surgery
• Revisionary Breast Surgery
• Breast Reconstruction
• Breast Reduction
• Abdominoplasty Surgery
• Arm Lifting (Brachioplasty) Surgery
• Thigh Lifting Surgery
• Liposuction
• Facial Procedures
• Mommy Makeover Surgery
• Death after  numerous Plastic Surgery Procedures
• Blindness after Facial Surgery
• Blindness, Strokes , Necrosis  after filler injections
• Trauma after Assaults
• Motor vehicle injuries
• Dog Bites
• Pediatric Plastic surgery
• Death cases –  Pulmonary emboli, Anesthetic Misadventures, Fat emboli, Bleeding
• Lower Extremity Trauma
• Ethics Violation Review
• Burns from Gas explosions, Electrical Accidents
• Train collisions
• Medical Board Violations
• Attorney Misconduct and Violations of Statutes

It is important to understand that “standard of care” is a legal term with a clear definition that is much more expansive: it is the level at which an ordinary, prudent professional, having the same training, would practice under the same or similar circumstances.

• To benefit humanity by advancing the art and science of plastic and reconstructive surgery.
• To promote the highest standard of professional skill and competence among plastic surgeons.
• To promote the exchange of information among plastic surgeons.
• To promote the highest standard of personal conduct among plastic surgeons and physicians.
• To provide the public with information about the scientific progress in plastic and reconstructive surgery.

A medical expert witness serves an important role in the legal system in helping to determine if there is a deviation from the standard of care.

Regarding medical expert witnesses, it is in the public interest that medical expert testimony be readily available, objective and unbiased. Plastic Surgeons have an obligation to testify as expert witnesses when appropriate.

To help limit possibly misleading testimony, expert witnesses should:

1. Have recent and substantive experience in the area in which they testify.
2. Thoroughly review the medical facts and testify to their content fairly, honestly and impartially.
3. Be familiar with the standards of practice prevailing at the time of the occurrence.
4. Neither condemn performance that clearly falls within generally accepted practice standards nor endorse or condone performance that clearly falls outside of such standards.

The purpose of expert witness testimony in medical malpractice cases is to describe the standard of care relevant to a given case, identify any breaches in those standards, and render an opinion as to whether those breaches of the most likely cause of injury. The expert witness is asked to compare the applicable standards of care with the facts of the case and interpret whether the evidence indicates a deviation from the standards of care. The medical expert also provides an opinion as to whether that breach in care is the most likely cause of the patient’s injury without the experts explanation of the range of acceptable treatment modalities within the standard of care and interpretation of medical facts, juries would not have the technical expertise needed to distinguish malpractice(bad care) from maloccurrence (bad outcome). Ideally expert witnesses should be unbiased, objective and accurate and should provide a truthful analysis of the standard of care.

The standard of care is a formal diagnostic and treatment process a doctor will follow for a patient with a certain set of symptoms or a specific illness. That standard will follow guidelines and protocols that experts would agree with as most appropriate, also called ‘best practice’. In legal terms, a standard of care is used as the benchmark against a doctor’s actual work. ex: in a malpractice lawsuit, the doctor’s lawyers would want to prove that the doctor’s actions were aligned with the standard of care. The plaintiff’s lawyers would want to show how a doctor violated the accepted standard of care and was therefore negligent.

Ideally an expert witness should take all necessary steps to provide thorough, fair, objective, and impartial review of medical facts. Relevant information should not be excluded for any reason. They should be fair and objective. When a variety of acceptable treatment modalities exist, the expert witness should report this candidly and clearly. Expert witness testimony should not condemn performance that clearly falls within generally accepted practice standards or condone performance that clearly falls outside accepted practice standards.

Whenever a medical or surgical procedure is performed, several outcomes are possible: the patient’s situation may be improved, may stay the same, or may worsen. It is important for everyone involved to understand that medical malpractice cannot be concluded solely because there is an unexpected result, a bad result, failure to cure, to recover, or any other circumstances showing merely a lack of success.

In a malpractice case the plaintiff bears the burden of proof and must convince a jury by a preponderance of the evidence (at least 51%) that his or her case is more likely than not based on a reasonable medical probability. This is unlike a criminal case, in which the fact at issue must be proven beyond a reasonable doubt.

According to Black’s Law Dictionary:

• Medical negligence requires that the plaintiff establish the following elements: the existence of the physicians DUTY to the plaintiff, usually based on the existence of the physician–patient relationship.
• The applicable standard of care and its violation or BREECH OF THAT DUTY.
• DAMAGES (a compensable injury).
• A CAUSAL connection between the violation of the standard of care and the harm complained of.

(1) Black’s Law Dictionary. 6th ed. St Paul, MN: West Publishing Co;1991

The US Supreme Court formulated new guidelines on the proper standard for admissibility of scientific evidence in federal courts (adopted by many state courts) in its 1993 ruling on Daubert v Merrell Dow Pharmaceuticals. The Daubert guidelines state that the trial judge is to act as “gatekeeper” to ensure that expert witness testimony is relevant to the case at hand and rests on reliable science. In determining whether expert witness testimony should be admissible in court, trial judges can consider the following:

1. Whether the expert’s opinion has been peer-reviewed.
2. Whether this theory can be and has been tested
3.  The known or potential error rate of the theory.
4. The general acceptance of the theory in the relevant scientific community.

William Daubert v Merrell Dow Pharmaceuticals Inc. 509 US 579 (1993)

The expert must:

1. Have recent and substantiate experience in the area in which they testify, including, without limitation, experience in the relevant subspecialty or the particular procedure performed on the plaintiff.
2. Thoroughly review the medical facts and testify to their content fairly, honestly and impartially.
3. Be familiar with the standards of practice prevailing at the time of the occurrence.

Dr. Shamoun believes “The truth shall set you free” and that one should be able to leave the witness stand with the respect of everyone in the courtroom and most importantly the respect for yourself”.

Dr. Shamoun has unfortunately testified against numerous charter members of plastic surgery society and has made it a point to have no allegiance to any organization. It is his opinion that all to often many of these societies use strong armed tactics to protect its members over the public.

1. ARIZONA
2. CALIFORNIA
3. COLORADO
4. ALASKA
5. ARKANSAS
6. GEORGIA
7. HAWAII
8. SOUTH CAROLINA
9. MASSACHUSETTS
10. NEW YORK
11. WASHINGTON
12. OKLAHOMA
13. OREGON
14. FLORIDA
15. TEXAS
16. MISSISSIPPI
17. UTAH
18. NEVADA
19. TENNESSEE
20. MISSOURI
21. KENTUCKY
22. ALABAMA
23. PENNSYLVANIA

1. Breast necrosis after open heart surgery in past.
2. Sickle cell Patient death after liposuction.
3. Blindness after filler injection.
4. Blindness after fat injection.
5. Bowel injury after liposuction.
6. Liposuction in office on obese 57 bmi patient
7. 12 hour body contouring with no consent for Free Nipple Grafting and patient death.
8. Anoxic Brain injury and death from inadequate monitoring during surgery.
9. Mastopexy with augmentation and necrosis of nipple and breast tissue.
10. Secondary abdominoplasty after previous umbilical float procedure with necrotic umbilicus.
11. J-plasma burns with high definition liposculpture.
12. Retained osteotome fragment after rhinoplasty.
13. Retained needle cap in Breast after augmentation.
14. Drain left in after abdominoplasty.
15. Changing medical records to include consent after patient died from PE.
16. Sexual Battery performing labiaplasty without consent during abdominoplasty.
17. Failure to use any DVT prophylaxis during 8 hour surgery resulting in death from PE.
18. Death after 14 hour body contouring operation with multiple procedures in patient with high BMI.
19. Nail salon infection after manicure.
20. Iliac artery trocar injury during Gall bladder surgery.
21. Death from exsanguination after DVT anticoagulant.
22. Necrosis of breast after Secondary lift with reduction and and implants.
23. Attorney error allowing Statute of limitations to pass.
24.  Liver death necessitating transplant after leukotriene medication.
25. Retained Gossypiboma Sponge after 14 months breast augmentation.
26. Lid retraction after blepharoplasty.
27. Brain injury after endoscopic brow lift.
28. BBL fat injection brain injury and death
29. Infection after rhinoplasty from retained sutures.

1. Body Contouring procedures.
2. Lower Eyelid Blepharoplasty.
3. Augmentation -Mastopexy procedures.
4. Revision Cosmetic Procedures.
5. Injectable fillers.
6. Fat grafting.