At its meeting on November 22, 2024, the Board of Directors of the American Association of Neurological Surgeons approved the recommendation of the Professional Conduct Committee to discipline a member for unprofessional conduct while serving as an expert witness in a medical malpractice lawsuit. The disciplinary action is as follows:
Nancy E. Epstein, MD, FACS – Expulsion. The Board concluded that Dr. Epstein of Garden City, New York, violated Sections A.2, A.3 and A.4 of the AANS Rules for Neurosurgical Medical/Legal Expert Opinion Services concerning impartial testimony. The case involved a patient who injured her back from heavy lifting and presented to the emergency department (ED) six days later with leg weakness, bilateral leg numbness and groin pain. Upon examination in the ED, the patient had a distended painful abdomen and decreased bowel sounds. An MRI scan revealed a lumbar spine epidural abscess. Although the consulting neurosurgeon recognized that the size and location of the abscess were not consistent with the patient’s neurological deficits, plans were made to perform lumbar decompression the following morning after the patient’s medical condition was treated overnight. Two hours after antibiotics were administered later that evening, the patient’s condition deteriorated, eventually requiring endotracheal intubation, laparotomy and colostomy. The PCC and the Board each concluded that it was reasonable to assess the patient as not stable enough for a lumbar spine decompression until the following day under the circumstances. The patient was eventually transferred for rehabilitation and recovered sufficient function to ambulate with a walker despite persistent right leg weakness and less severe left leg weakness. Dr. Epstein testified that the patient would not have had such neurological deficits, developed the degree of sepsis or undergone the colostomy or intubation if the neurosurgeon did not wait until the following day to perform surgery.
The Board concluded that this testimony violated Section A.2 because Dr. Epstein did not acknowledge differing viewpoints and that a prudent neurosurgeon might very well wait a day before proceeding with a decompression and drainage, given this patient’s overall clinical picture. The Board similarly found that Dr. Epstein did not identify when her personal opinions varied significantly from generally accepted neurosurgical practice in violation of Section A.3. The Board also determined that Dr. Epstein violated Section A.4 when she testified that the decision to wait until morning to operate violated the standard of care. The Board voted in favor of expulsion of membership given the nature of the violations and the fact that Dr. Epstein had been suspended for six months in 2019 for violation of the AANS Rules for Neurosurgical Medical/Legal Expert Opinion Services, including certain of the same sections involving impartial testimony.
