A Chula Vista plastic surgeon, Dr. Carlos Chacon, appeared in court Thursday facing charges of second-degree murder after the death of one of his patients.
Meghan Espinosa, a mother and teacher from El Cajon went into cardiac arrest and died during breast augmentation surgery in 2018. The San Diego County District Attorney’s office alleges that Dr. Chacon and his medical staff were incompetent.
The preliminary hearing, which ultimately decides whether the case will proceed to trial, lasted all day at the South Bay courthouse. As scheduled due to later scheduling conflicts, expert witness and plastic surgeon Dr. John Shamoun was the only one to testify Thursday. The DA’s office hired Shamoun, who described the operating room during Espinosa’s operation as a “circus.”
Judge Maryann D’Addezio presided over the hearing and had to frequently interrupt the witness, prosecution and defense counsel for corrections and clarifications. Both the medical board and the prosecutor ordered Shamoun to review all evidence, including charts, reports, depositions and video of the surgery at Divino Surgery Center in Bonita.
Shamoun believes the registered nurse improperly and incompetently administered anesthesia and was initially hired to dispense with an anesthesiologist to save money. He also testified that neither Chacon nor the nurse intubated Espinoza, which could have saved her life, because they didn’t know how, were out of practice and didn’t have the tools to do it.
“Testimonies from people that she was shocked. Others said there was no shock. CPR for 10 seconds, no pulse for 10 seconds, use of epinephrine on several occasions when there was a pulse. I mean, this was a circus. None of this makes sense,” Shamoun said.
Shamoun testified on multiple occasions that Chacon was the captain of the ship and even if the registered nurse accidentally oversedated the patient, Espinosa was his fault. Shamoun also stated that in his career, he estimated he had performed more than 5,000 breast augmentations, but never under conscious sedation like Espinosa’s surgery. He also said he never used a registered nurse in these procedures, but did perform less serious surgeries.
Shamoun ultimately discussed that several factors could have contributed to Espinosa’s death: a pneumothorax (a leak of air into the space between the lungs and the chest wall causing the lung to collapse) caused by a puncture, medication that exacerbated the effects of anesthesia, and the failure to call emergency services in time; He described how Espinosa’s operation was an incision around the nipple to place the prosthesis under the pectoral muscle. He described it as dangerous because of its proximity over the heart and lungs.
“No one even bothered to put a stethoscope on this lady’s chest, as far as I can tell, to determine if she had a pneumothorax,” Shamoun said.
But as for Chacón’s defense team, attorney David Rosenberg focused on the nurse’s role in this tragic case and aggressively disputed her failure to report the various medications in Espinosa’s system at the time that included birth control, antidepressants that may have come with the administered fentanyl and other drugs administered during the procedure.
Rosenburg seemed intent on undermining Shamoun’s credibility by pointing out that Shamoun provided inaccurate statements, that Chacon, his staff and the surgery center were authorized to use general anesthesia, and that Espinoza was probably conscious at some point. Espinoza also signed consent forms and knew the risks of the operation. Shamoun disputed this and often cited conflicting reports from interviews of the medical staff he judged.
Rosenberg also claimed that Shamoun’s analysis of the medical reports and evidence was inconsistent and unclear, citing his connection to the hired jobs he did for the medical board as an expert in other trials. However, Shamoun testified that he was acting as an expert pro bono in Espinosa’s case.
Shamoun concluded that Espinosa’s cause of death was excessive sedation that stopped her breathing. It also said Chacon had made two calls to an anesthesiologist during the three hours he and his staff failed to call emergency services, which they were expected to do once CPR was briefly attempted.
“A drug-induced respiratory depression is the most likely cause of her death,” Shamoun said.
Several times, the defense team objected and characterized the details as hearsay as interpreted by Shamoun from the reports and evidence he reviewed.
The medical board is investigating Chacon, but his medical license is still active. May perform surgery or procedures only in an accredited location, using an anesthetist or licensed medical personnel. As part of his bail deal, Chacon must also inform patients of his pending charges.
Chacon is due back in court on October 9.
