Proper Consideration of Alternative Causation in Expert Testimony

Introduction

Faison-Williams v. United States is a Second Circuit summary order issued April 1, 2025, addressing two principal issues: (1) the scope of the administrative-presentment requirement under the Federal Tort Claims Act (FTCA), and (2) the district court’s gatekeeping function under Federal Rule of Evidence 702 when evaluating expert testimony on causation. The plaintiff, Natasha Faison-Williams, sued the United States under the FTCA after complications arose from a thoracic microdiscectomy performed by a Department of Veterans Affairs surgeon, Dr. James Stone. The district court excluded the plaintiff’s expert neurologist, Dr. Martin Zonenshayn, on reliability grounds, then granted summary judgment to the government. The Second Circuit vacated and remanded, holding that the district court had applied an overly stringent “rule‐out‐all‐alternatives” standard and had failed to credit Dr. Zonenshayn’s reasoned explanation of why obvious alternative causes were unlikely.

Summary of the Judgment

The Court of Appeals for the Second Circuit reached three key conclusions:

1. Subject-Matter Jurisdiction: The FTCA’s presentment requirement was satisfied because the plaintiff’s one-page administrative claim alleging deviation from the standard of care in “performing” the thoracic surgery necessarily put the VA on notice to investigate both the performance and the decision to schedule the procedure.
2. Expert Testimony Exclusion: The district court abused its discretion under Rule 702 by excluding Dr. Zonenshayn’s causation testimony. Although Rule 702 allows a reliability inquiry into whether an expert has accounted for “obvious alternative explanations,” the district court improperly demanded categorical exclusion of all other potential causes rather than assessing Dr. Zonenshayn’s non-conclusory, experience-based reasons for rejecting each alternative.
3. Remand: Because the expert testimony should have been admitted, the summary judgment for the United States cannot stand. The case was vacated and remanded for further proceedings.

Analysis

Precedents Cited

• McNeil v. United States, 508 U.S. 106 (1993): FTCA claimants must exhaust administrative remedies before suing.
• Collins v. United States, 996 F.3d 102 (2d Cir. 2021): Details FTCA’s presentment specificity requirement.
• Johnson v. United States, 788 F.2d 845 (2d Cir. 1986): Administrative claim need not be a model pleading so long as it triggers an agency investigation.
• Kumho Tire Co. v. Carmichael, 526 U.S. 137 (1999): Daubert gatekeeping applies to all expert testimony, not just “scientific.”
• Amorgianos v. Nat’l R.R. Passenger Corp., 303 F.3d 256 (2d Cir. 2002): District courts have broad discretion in assessing expert reliability; appellate review is for abuse of discretion.
• Fed. R. Evid. 702 Advisory Committee Note (2000): Identifies accounting for “obvious alternative explanations” as a reliability factor.

Legal Reasoning

1. FTCA Presentment: Under 28 U.S.C. § 2675(a), the FTCA requires a claimant to present a “sufficiently specific” claim to the relevant federal agency so it can investigate and value the claim. The court reaffirmed that this requirement is jurisdictional but does not demand pleading-level detail. Investigating a surgeon’s negligent “performance” of a procedure necessarily includes inquiry into whether the procedure was properly scheduled, so jurisdiction was proper.

2. Rule 702 Gatekeeping: Rule 702 requires district courts to evaluate whether an expert’s specialized knowledge is based on reliable methods and reliably applied to the facts. One recognized reliability factor is whether the expert has “adequately accounted for obvious alternative explanations.” The district court here misapplied that factor by requiring Dr. Zonenshayn to rule out every conceivable cause, rather than crediting his years of neurosurgical experience and the detailed, non-conclusory reasons he gave for rejecting each obvious alternative:

• Cervical Myelopathy: Dr. Zonenshayn explained that he would expect objective upper extremity findings if the neck were the source. He saw none, and the MRI evidence at the thoracic level was both dramatic and temporally linked to the hematoma evacuation.
• Preexisting Bladder Problems: Although intermittent incontinence predated surgery, he pointed to post-hematoma urodynamic studies showing a new neurologic pattern, and the sudden, sustained nature of the incontinence after the hematoma contrasted with the earlier transient issues.
• Childbirth-Related Incontinence: He acknowledged multiple births but explained that childbirth-related urinary issues do not produce the radiographic changes in the thoracic cord compression demonstrated here.
• Psychological Overlay (Conversion Disorder): While Dr. Zonenshayn conceded that some later deterioration lacked clear anatomical correlation, he stressed the “acute spinal cord injury” seen on MRI and the classic symptom pattern of leg weakness and bowel/bladder dysfunction linked to the hematoma.

Because Dr. Zonenshayn did precisely what Rule 702 contemplates—identify obvious alternative causes and explain, on the basis of reliable methods and his extensive experience, why they did not account for the plaintiff’s symptoms—the district court’s exclusion was an abuse of discretion.

Impact

This decision clarifies and reinforces the following points:

• Expert Reliability Analysis: District courts must evaluate an expert’s reasoning on alternative causes flexibly—experts need not eliminate every possible hypothesis, but must address and reasonably discard the obvious ones.
• Scope of FTCA Presentment: A concise administrative claim alleging negligent performance of a medical procedure can suffice to encompass claims about scheduling or indication, so long as the agency could reasonably investigate them.
• Lower-Court Gatekeeping: Reminds trial courts to honor an expert’s professional credentials and methodology where properly applied to the facts, reserving questions of persuasiveness for the trier of fact rather than excluding testimony wholesale.

Complex Concepts Simplified

• Daubert/Kumho Gatekeeping: Judges must ensure that an expert’s testimony rests on reliable methods and sound reasoning, but they must not usurp the jury’s role by weighing evidence unless reliability is truly lacking.
• “Obvious Alternative Explanations” Factor: An expert must identify and explain why clear, plausible competing causes do not explain the injury, but need not rule out every remote possibility.
• FTCA Presentment Requirement: Before suing under the FTCA, a claimant must present a claim to the relevant federal agency. The claim must be specific enough to let the agency investigate liability and damages, but the administrative form need not include detailed factual or legal theories.
• Epidural Hematoma: A collection of blood outside the spinal cord that can compress neural tissue, potentially causing weakness, numbness, or bowel/bladder dysfunction. In this case, MRI evidence showed severe compression relieved by emergency surgery.

Conclusion

Faison-Williams v. United States stands for the principle that Rule 702’s reliability inquiry must respect an expert’s professional methods and reasoned explanations of alternative causes. Experts are not required to exclude every imaginable hypothesis; they must fairly consider and rule out obvious alternatives. When an expert does so, courts should admit the testimony, leaving questions of weight and credibility to the factfinder. The decision also reaffirms that a broadly worded medical-malpractice claim to the VA suffices to meet the FTCA’s presentment requirement for related theories of liability. On remand, the district court must admit Dr. Zonenshayn’s testimony and proceed to consider whether genuine issues of material fact preclude summary judgment.