Leeanne Y. Patterson, Esq.
Michael J. Preovolos, Esq.
For the defense

J. Niley Dorit, Esq.
For the plaintiff

Harold M. Schneidman, M.D.
Expert witness for the plaintiff

Examination by Ms. Patterson
Comments in brackets are assessments of the testimony by Dr. Ackerman

Q. Okay. Would you state your full name for the record, please.
A. Harold M. Schneidman.
Q. And Dr. Schneidman, you are physician licensed to practice medicine in the state of California?
A. Correct.
Q. What is your current area of specialty?
A. Of specialty?
Q. Correct.
A. Dermatology and dermatopathology…


Q. In looking at this CV, it looks as though you received your undergraduate degree from University of Minnesotta in 1946?
A. Correct.
Q. And then you attended medical school at the University of Minnesota also, graduating in 1947?
A. Correct.
Q. You then did a rotating internship at University of Oklahoma, completing that in 1948?
A. Correct.
Q. And then you did a residency in dermatology at Michael Reese Hospital in Chicago. And then—well, you have here, “Herbert Ratner, M.D., Chief,” and then you have “Steven Rothman, M.D., Chief.” And then you completed that in 1951. And then it says that you did a residency in dermatology at Stanford under Eugene Farber, completing that in 1956. And it looks as though there’s a break between 1951 and 1954.
A. Correct.
Q. Explain that break for me.
A. I went into the Army. The Korean War was on.
Q. Did you do a fellowship in any specific area of specialty?
A. No.


Q. You indicated that you were a specialist in not only dermatology but dermatopathology as well, correct? A. Correct.
Q. Did you do a residency or fellowship in dermatopathology?
A. No.
Q. Did you do any special training whatsoever in dermatopathology?
A. Yes.
Q. And where was that?
A. Stanford.
Q. And when was that?
A. That was during my residency at Stanford.
Q. During your dermatology residency?
A. At Stanford, correct.
Q. So that would have been in the mid-‘50s?
A. It would have been—correct. 1954 to 1956.
Q. And you are board certified in both dermatology and dermatopathology?
A. Correct.
Q. You received your board certification in dermatology in 1956?
A. Correct.
Q. And then in dermatopathology 1978?
A. Correct…


Q. Do you currently hold any academic positions?
A. Clinical professor of dermatology.
Q. And is that at UCSF?
A. No, that’s at Stanford.
Q. And for how long have you held that position?
A. I think it’s in there. I think it’s 1968.
Q. To the present?
A. To the present, yes.
Q. Do you hold any other academic positions?
A. No.
Q. What percentage of your professional time would you say is dedicated to the private practice of medicine?
A. At the present, 100 percent…


Q. What is your current practice?
A. I currently practice three half days a week.
Q. And when did you start that schedule, working three half days a week?
A. Approximately four years ago…


Q. What percentage of your practice currently would you say consists of patients who are being treated for melanoma?
A. I would say approximately six to ten melanomas a year. So out of the total patient load that I see, I will see six to ten. It may even be as high as 12…

Q. You brought a copy of your file with you to the deposition this morning. Can you tell me what’s located within your file, what you’ve reviewed in preparation for offering opinions in this case?
A. I have references here from Allen’s book, Arthur Allen’s book. It’s a dermatopathology book, which I think is one of the first dermatopathology books. It goes back many years. There are a number editions. This is probably the first edition [1953].
Q. Was it your understanding that you were asked to offer opinions with regard to standard of care?
A. Yes…

MR. DORIT: I have not asked Dr. Schneidman to review the slides or give opinions as to the appropriate diagnosis. He’s giving his opinions as to the dermatologist, and because there was some interplay between the dermatologist and the dermatopathologist, there may be some crossover opinions. But primarily from the perspective of what the dermatologist should have been done…
Q. Mr. Dorit has indicated in an expert disclosure that you will be offering testimony as to liability (reading), “standard of care, causation and damages, including, but not limited to, respondents acts of negligence, the cause of claimant’s injuries, his diagnosis, his prognosis, his work life expectancy, his work employment capacity, and related issues.” Do you have an understanding that you’re going to be offering opinion testimony as to all of those issues?
A. Yes.
Q. Let’s start with the first issue, and that would be standard of care. What opinions—well, first of all, how do you define standard of care?
A. It’s the minimum amount of care required for cure or management of a medical problem…[The actual definition of “Standard of care” in regard to medicine is the degree of prudence and caution required of a physician who is under the duty of providing care, the measuring stick of that responsibility being established by the community of physicians].
Q. And have you formed an opinion in this case that there was a breach of the standard of care?
A. Yes.
Q. And your opinion pertains to whom?
A. To the dermatologist who saw Mr. Y in ’94.
Q. And what is your opinion as to the ’94 care? In what way was the standard of care not met?
A. I felt that the minimum amount of care would have been to do an excision with an adequate margin, and that adequate margin could have been 3 millimeters, 5 millimeters, because the lesion in question was in an area where this could easily be done. [The diagnosis histopathologic received first by the dermatologist was “Spitz nevus arising in a compound nevus with congenital features,” it having been provided by a general pathologist. A dermatopathologist was then sent the sections of tissue in consultation and made a diagnosis of “Spitz nevus,” advising further in writing that “re-excision is not indicated.” Armed with the diagnosis of a neoplasm wholly benign, i.e., a Spitz’s nevus, and cautioned against any further surgery for the lesion, the dermatologist did nothing more, which was fully in accordance with the standard of care.]
Q. And in your opinion, the dermatologist should have performed this excision? A. Correct.
Q. And you base that opinion on what?
A. I base it on what I myself would have done and what I think, again, the minimum of care should have been. [What he, himself, would have done is irrelevant. What was done conformed precisely to the standard of care.]
Q. Right. But what is your understanding as to the information that the dermatologist had as to that lesion at that time?
A. Well, he had a Spitz nevus in a patient who was 16, 17 years old. And a Spitz nevus can behave a little differently in an adult compared to its behavior in a child. [There is not a jot of evidence for that contention.]
Q. Describe the differentiation for me.
A. Well, the Spitz nevus is more likely to be a more serious lesion, more likely to be a melanoma in an adult than it is in a child. [There is no basis in fact for that assertion.]
Q. And what’s your definition of an adult?
A. Over puberty. Over 13 years old….[Puberty not uncommonly begins before age 13.]
A. There seems to be some protective mechanism in a child which is not present in an adult, when you are interpreting what a Spitz nevus is and the outlook. [The statement is pure conjecture without any basis in fact.]
Q. And that’s based on literature that you have read or your own personal experience, or what?
A. Both. It’s based on my own personal experience and also based on the literature.
Q. Was this the thinking back in 1994 or is this the current thinking?
A. It’s the thinking in 1994…[No reference is provided for this assertion because it is mere supposition.]

Q. I’m asking are you going to be offering any standard of care opinion testimony with regard to the pathologist?
A. I think he should have gotten a second opinion, even though he may have been a certified dermatopathologist. [He did get a second opinion.]
Q. Do you have an understanding as to whether or not a second opinion was obtained as to the pathology in 1994?
A. To my knowledge, no second opinion was obtained…[He is dead wrong.]

BY MS. PATTERSON
Q. It’s my understanding there was a second read on this pathology, was there not?
MR. DORIT: Yes. He did get another opinion. [The attorney for the plaintiff is obligated to inform his expert witness about the very rudiments of the case.]
THE WITNESS: By who?
MR. DORIT: There are the initials of other pathologists (indicating)…

BY MS. PATTERSON
Q. But you have not reviewed the slides and you don’t have any personal knowledge as to what the appearance of the slides were, correct?
A. Correct. [He is Board-certified in dermatopathology, yet he failed to “review the slides” crucial to the adjudication fairly of the matter under consideration.]
Q. I mean, I’m looking at the article here, one of the articles that you provided, and it says “differentiation of a Spitz nevus from a nodular malignant melanoma can be difficult and even impossible in some cases.” Would you agree with that?
A. Correct.
Q. So given the hypothetical that the pathologist reviewed the slide and actually had a second opinion and made a recommendation or made a finding that this was a Spitz nevus and recommended against further excision, is it still your testimony that the dermatologist breached the standard of care by not doing a re-excision of this mole in 1994?
A. Well, you’re asking whether the pathologist did a re-excision, which he doesn’t do.
Q. I’m sorry. Let me restate the question. Given the fact that the pathologist diagnosed this as a Spitz nevus in 1994, that there was a second read of the pathology which was not in disagreement, and that in his report he recommended against re-excision at that time, is it your testimony that the dermatologist breached the standard of care by not relying upon or following the recommendations of the pathologist?
A. Yes. My answer is yes. [Without a word of justification for an answer that flies in the face of logic elementary.]
Q. So is it your opinion that a dermatologist cannot rely upon the findings in a pathology report—reasonably rely upon the findings in a pathology report?
MR. DORIT: That’s argumentative. I think the opinion is different, that he makes an independent judgment. But you can answer the question.
THE WITNESS: A dermatologist has to rely on the pathology report, number one. And number two, the question is, who is controlling the total care of a patient. The dermatologist has to take into account what the pathologist tells him and incorporate it into the entire accumulation of data and occurrences that are taking place. [That is precisely what the dermatologist did. For the dermatologist to have done otherwise could have been construed as negligent.]

BY MS. PATTERSON
Q. So it’s your testimony that in 1994 the standard of care required a dermatologist to do a complete excision of a Spitz nevus--
A. Correct…[Although some authors in 1994 advised complete excision of Spitz’s nevus solely because of misdiagnosis episodically of melanoma as Spitz’s nevus by a pathologist and, at times, with an outcome grievous, that surely was not the standard of care in 1994 for management of Spitz’s nevus. The term “nevus” denotes benignancy and a Spitz’s nevus is benign. That being so, there is no reason to excise completely a benign neoplasm. In theory, a neoplasm that is obviously benign clinically need not even be biopsied.]
Q. Did you ever have patients, teenage patients, in the mid-90s that you treated for Spitz nevus?
A. I can’t recall. I would think no.
Q. Have you ever treated an adolescent patient or a teenager that was diagnosed with a Spitz nevus?
A. Yes.
Q. And when was the last time?
A. I can’t remember. I can’t remember the last time, the direct answer.
Q. Approximately how many patients have you had with this diagnosis in this approximate age group?
A. I would say approximately a half dozen, in my experience.
Q. Over the past 30, 40 years?
A. Correct.
Q. And did you always treat those patients with excision of the lesion?
A. If they were in an area that was amenable to a wide excision, yes. [“Wide excision” of Spitz’s nevus falls below the standard of care.]
Q. And if they were—if it was in an area that was not amenable to wide excision, what did you treat?
A. I have one patient where it was left alone.
Q. And why did you leave it alone?
A. It was on the nose.
Q. On the nose?
A. Correct.
Q. Do you know what the standard practice was of dermatologists back in the mid-1990s as far as treatment of a Spitz nevus?
A. Wide excision. [Nothing could be further from the truth.]
Q. Always?
A. Correct. Say that again. In the 1990s?
Q. In the 1990s.
A. Oh. I have to—okay. If you ask the question, I will—the standard would have been or the minimum care would have been to do a re-excision with an adequate margin.
Q. Of 3 to 5 millimeters?
A. Correct…

BY MS. PATTERSON
Q. Okay. Doctor, going back to some of the questions I was asking you earlier, we were talking about the fact that it’s your opinion that the standard of care required excision—wide excision of the lesion in 1994, correct?
A. Correct….
MR. DORIT: …And the question is, what is there in the clinical presentation and what is there in the pathology that leads you to having an opinion that the lesion should have been widely excised in 1994….
THE WITNESS: …In reading this [pathology report], it leads me to the point that his isn’t an atypical lesion. It is an atypical Spitz nevus.

BY MS. PATTERSON
Q. It’s an atypical Spitz nevus or an atypical lesion?
A. An atypical Spitz nevus. It’s a borderline lesion which requires, in my opinion, a second pathology opinion, and second—[Irrespective of how the term Spitz’s nevus is modified, e.g., “atypical” or “borderline,” the diagnosis remains “Spitz’s nevus.” Furthermore, a “second pathology opinion” was obtained—and from a Board-certified dermatopathologist—who agreed with the diagnosis of Spitz’s nevus.]
Q. Which was obtained.
A. Okay. I did not know that. [He was obligated to know that.] And which would require the recommendation of an excision with adequate margins….[When a diagnosis of “Spitz’s nevus” is issued by a pathologist, there is no need whatsoever for “recommendation of an excision with adequate margins”; the lesion is benign and, therefore, does not mandate any further surgery.]

BY MS. PATTERSON
Q. So there’s nothing in the clinical notes that supports your opinion that his lesion should have been excised?
A. Nothing in the two notes that I am reading. [No support for his own opinion.]
Q. So your opinion that the standard of care required excision of the alleged Spitz nevus in 1994 is strictly based on the pathology report, correct?
A. Correct….[The two pathology reports were in synchrony, to wit, a neoplasm benign, i.e., a Spitz’s nevus.]

BY MR. PREOVOLOS
Q. So it’s your assumption that the patient had melanoma in 1994?
A. Yes….

Q. And in your opinion what type of follow-up did the standard of care require, given his diagnosis of Spitz nevus?
THE WITNESS: The standard of care would have been to see the patient at least in three months, and following that second follow-up visit in approximately six months after the first follow-up visit. And then possibly a third follow-up visit in six months after that…[There is no justification at all for such “follow-up” of a Spitz’s nevus and, moreover, no source is cited, or could be cited, that would give legitimacy to such a schedule.]

BY MS. PATTERSON
Q. Have you changed your treatment regimen at all in the treatment of patients who have Spitz nevus over the last 15 years?
A. No….


Q. You’re not recommending that anything other than a wide excision should have been done in 1994; is that correct?
A. That is correct….[For which there is no basis according to the “standard of care.”]

Q. Let’s talk about Spitz nevus first.
A. I think that treatment of Spitz nevus in an adult is approached with great caution. Has the treatment changed, I would say no. The treatment, I would say, continues to be a wide [Untrue, unfounded, and uncorroborated. Let him provide a single reference circa 1994 for “wide excision” of Spitz’s nevus]—an adequate excision, plus follow-up.
Q. And that was the treatment in the mid ‘90s, correct?
A. Correct.

The suit was settled.


On May 23, 2008, Betsy Peare, Managing Editor of Dermatopathology: Practical & Conceptual, invited Dr. Schneidman to respond in writing, ad lib, to the issues raised by his testimony in the case of Bloom vs. Kaiser. This is what she wrote:
-----Original Message-----
From: Betsy Peare [mailto:betsy@derm101.com]
Sent: Friday, May 23, 2008 9:00 AM
To: 'mschnei448@aol.com'
Subject: Testimony re: Bloom v. Kaiser

Dear Dr. Schneidman,

Accompanying you will find a manuscript that pertains to your testimony in the case of Bloom v. Kaiser. As you will see, Dr. Ackerman has taken issue with some of the statements you made under oath. I write to you now to invite you to respond, as fully as you wish, to any of the comments made by him. Your words will be printed in Dermatopathology: Practical & Conceptual and on TruthfulTestimony.org just as you have written them.

Do let me know if you choose to reply.

Sincerely,

Betsy Peare
Managing Editor
Dermatopathology: Practical & Conceptual

BP/jd

No reply was received from Dr Schneidman