Faison-Williams v. United States: Rule 702’s Requirement to Adequately Address Alternative Explanations in Expert Causation Testimony

Introduction

In Faison-Williams v. United States, 24-1404 (2d Cir. Apr. 1, 2025), the Second Circuit confronted two central issues in a Federal Tort Claims Act (FTCA) medical-malpractice suit against the United States. Natasha Faison-Williams, a veteran who underwent thoracic spinal surgery at a Veterans Affairs hospital, claimed negligent scheduling and supervision by her surgeon, Dr. James Stone. After discovery, the district court excluded her causation expert’s testimony under Federal Rule of Evidence 702 and granted summary judgment for the government. On appeal, the Second Circuit addressed (1) whether the administrative‐exhaustion requirement barred Faison-Williams’s “scheduling” claim, and (2) whether the district court abused its gatekeeper role by excluding expert testimony that, while acknowledging alternative causes, explained why they were not plausible in this case.

Summary of the Judgment

Jurisdiction upheld: The court held that Faison-Williams’s one‐page administrative claim alleging deviation from the standard of care in her thoracic procedure was specific enough to prompt any reasonable investigation into the decision to perform the surgery.
Rule 702 analysis: The district court applied the “obvious alternative cause” factor too strictly, demanding that the expert rule out every possible cause rather than reasonably explain why the most plausible causes other than the surgical hematoma were unlikely.
Abuse of discretion: The Second Circuit found it “manifestly erroneous” to exclude the expert’s testimony in its entirety, because the expert—Dr. Martin Zonenshayn—drew on extensive clinical experience and imaging evidence, and offered non‐conclusory explanations for rejecting cervical myelopathy, preexisting bladder dysfunction and psychological overlays.
Disposition: The district court’s judgment was vacated, and the case was remanded for further proceedings consistent with the correct application of Rule 702 and the summary Judgment standard.

Analysis

1. Precedents Cited

McNeil v. United States, 508 U.S. 106 (1993) – FTCA’s administrative‐exhaustion requirement is jurisdictional.
Collins v. United States, 996 F.3d 102, 119 (2d Cir. 2021) – Presentment must give the agency “sufficiently specific information” for investigation and valuation.
Johnson v. United States, 788 F.2d 845, 848–49 (2d Cir. 1986) – The one‐page Form must be specific enough to achieve Congress’s goals of early settlement and administrative review.
Kumho Tire Co. v. Carmichael, 526 U.S. 137, 153 (1999) – A court may exclude expert testimony on methodology grounds, even if the expert’s qualifications are unchallenged.
Amorgianos v. National Railroad Passenger Corp., 303 F.3d 256, 265 (2d Cir. 2002) – District courts have broad discretion as Daubert gatekeepers under Rule 702.
Fed. R. Evid. 702 Advisory Committee Notes (2000) – One reliability factor is consideration of “obvious alternative explanations.”

2. Legal Reasoning

Subject‐Matter Jurisdiction: The court reaffirmed that under 28 U.S.C. § 2675(a) a plaintiff may proceed only if she “first present[s]” a claim with sufficient detail to the agency. Here, any inquiry into Dr. Stone’s “performance of the thoracic discectomy” necessarily encompasses the scheduling decision. Hence the FTCA claim was properly exhausted.

Rule 702 Gatekeeping: Under Federal Rule of Evidence 702, an expert must (a) have specialized knowledge that will assist the trier of fact, (b) base opinions on sufficient facts or data, (c) apply reliable principles and methods, and (d) reliably apply those principles. The district court found Dr. Zonenshayn’s methodology unreliable because, in its view, he did not “rule out” all alternative causes of Faison-Williams’s neurological and bladder symptoms.

Abuse of Discretion: The Second Circuit clarified that experts need not “categorically exclude” every conceivable cause. Rather, they must offer reasoned, non‐conclusory explanations for rejecting “obvious” alternatives. Dr. Zonenshayn:

Examined pre‐ and post‐hematoma MRIs showing acute thoracic cord compression not present earlier;
Explained that cervical myelopathy would have manifested different upper‐extremity symptoms;
Distinguished prior intermittent bladder issues (which were mild and inconsistent with chronic incontinence) from the acute neurogenic bladder dysfunction documented after the hematoma;
Addressed childbirth‐related incontinence and conversion disorder by pointing to objective imaging and urodynamic tests.

That analysis satisfied Rule 702’s reliability criteria, so excluding his testimony in toto was manifestly erroneous.

3. Impact

This decision refines the lower‐court approach to Daubert reliability challenges in medical-malpractice and other FTCA cases:

It emphasizes that Rule 702 does not require hyper-technical elimination of every hypothetical cause, but rather a reasoned professional judgment backed by data and experience.
It discourages district courts from conflating “failure to rule out” with “failure to address” alternative explanations.
It reaffirms that jurors, not judges, should weigh the persuasiveness of expert testimony once it meets the minimal thresholds of reliability and relevance.

As a result, accurately reasoned expert opinions—especially those grounded in comparative imaging, physical findings and recognized clinical patterns—must be heard rather than excluded.

Complex Concepts Simplified

FTCA Exhaustion: Before suing the federal government, claimants must detail their injury and its cause in an administrative claim so the agency can investigate and settle if appropriate.
Daubert/Rule 702: District judges act as “gatekeepers” to ensure expert testimony is both reliable (solid methodology) and relevant (fits the facts). They may exclude testimony if the method is junky, not just because they doubt the expert’s credentials.
“Obvious Alternative Explanations”: One reliability factor. Experts need not eliminate every possibility—just the foreseeable, competing causes—by explaining why those causes don’t fit the evidence.
Summary Judgment Standard: If a party lacks admissible evidence to support essential elements of their claim (here, causation), the court may grant summary judgment. But disputed expert testimony should survive unless it is demonstrably unreliable.

Conclusion

Key Takeaways: The Second Circuit’s decision in Faison-Williams v. United States sets out two important rules:

An FTCA plaintiff’s broad allegation of “negligent care” can suffice for administrative exhaustion if it reasonably alerts the agency to both the performance and scheduling of a procedure.
Under Rule 702, expert testimony should not be excluded merely because it does not “rule out” every conceivable alternative cause; it must, however, supply reasoned and evidence-based explanations for rejecting the most plausible alternatives.

This ruling ensures that well‐supported expert opinions reach jurors, preserves the integrity of Daubert’s gatekeeping function, and promotes fair adjudication of medical‐malpractice claims against the United States.