--- title: "Radiology Expert Allowed to Opine on Emergency Care" meta: "og:description": "The radiology expert was not testifying outside his specialty because he is not providing an opinion on the standard of care" "og:title": "Radiology Expert Allowed to Opine on Emergency Care" author: "Expert Witness Profiler" description: "The radiology expert was not testifying outside his specialty because he is not providing an opinion on the standard of care" --- # Radiology Expert Allowed to Opine on Emergency Care Posted on April 17, 2026 by Expert Witness Profiler On September 19, 2023, Rita C. Peyton was seen at a local hospital by a physician employed by Blue Ridge Radiology, P.C. for an outpatient CT-guided biopsy of a lesion on her lung. The biopsy required that the doctor insert a biopsy needle into Mrs. Peyton’s lung to reach the lesion. But after nine unsuccessful attempts to reach the lesion, Mrs. Peyton was hemorrhaging so severely that she began coughing up blood. The physician then instructed her to sit upright, an event that is subject to dispute in the case. After her oxygen saturation dropped, she was transferred to the Emergency Department and subsequently went into cardiac arrest. Ultimately, her condition deteriorated, and she suffered a stroke. On September 21, 2023, Mrs. Peyton died. The Plaintiff, Larry K. Peyton (Mr. Peyton), as her executor, asserted that she died as a direct and proximate result of the physician’s negligence. However, Blue Ridge responded that the physician did not violate the standard of care applicable to the procedure and that she would have survived had she been treated properly in the Emergency Department. Blue Ridge has filed motions to exclude or limit the testimony of two of the Plaintiff’s expert witnesses, Dr. [Peter Bream](https://expertwitnessprofiler.com/expert-witness/Peter-Bream/1574011) and Dr. [Matthew Fulton](https://expertwitnessprofiler.com/expert-witness/Matthew-Fulton/1574036). Mr. Peyton has filed a motion to exclude or limit the testimony of one of Blue Ridge’s expert witnesses, Dr. [Michael Mistretta](https://expertwitnessprofiler.com/expert-witness/Michael-Mistretta/1574012). ## **Radiology Expert Witness** Dr. [Peter R. Bream](https://expertwitnessprofiler.com/expert-witness/Peter-Bream/1574011), Jr., M.D. is a board certified Interventional Radiologist with over 25 years experience. He has worked as Clinical Professor in Radiology at The University of North Carolina at Chapel Hill, where he served as the Diagnostic Radiology Program Director. [Discover more cases with Peter Bream as an expert witness by ordering his comprehensive Expert Witness Profile report](https://expertwitnessprofiler.com/order/add?eId=1574011&pId=3). ## **Anesthesiology Expert Witness** [Matthew B. Fulton](https://expertwitnessprofiler.com/expert-witness/Matthew-Fulton/1574036), D.O. is a board-certified anesthesiologist practicing in Roanoke, Virginia. Fulton has been practicing continuously since 2006. [Get the full story on challenges to Matthew Fulton’s expert opinions and testimony with an in-depth Challenge Study](https://expertwitnessprofiler.com/order/add?eId=1574036&pId=3). ## **Pulmonary Disease Expert Witness** [Michael A. Mistretta](https://expertwitnessprofiler.com/expert-witness/Michael-Mistretta/1574012) is board-certified in pulmonary disease and critical care medicine. He is licensed to practice in the Commonwealth of Virginia. [Want to know more about the challenges Michael Mistretta has faced? Get the full details with our Challenge Study report](https://expertwitnessprofiler.com/order/add?eId=1574012&pId=3). ## **Discussion by the Court** ### **A.Testimony by Dr. Peter Bream** To begin with, Blue Ridge took issue with a statement in Bream’s report that the emergency care Mrs. Peyton received after the biopsy was reasonable and appropriate. Blue Ridge argued that because Bream is not an expert in emergency or critical care, he is not qualified to provide an opinion regarding the reasonableness or necessity of the emergency care that was provided to Peyton. The Plaintiff responded that Bream is not providing an opinion on the standard of care relevant to emergency and critical care. Rather, he argued that Bream was stating his opinion that it was medically necessary to transfer Mrs. Peyton to the Emergency Department for additional treatment given her condition. Given the Plaintiff’s stated intention to offer Bream’s opinion on emergency care to show that a radiologist would transfer someone in Mrs. Peyton’s condition to the Emergency Department, the Court found that Bream is not testifying outside his specialty. ### **B. Testimony by Dr. Matthew** **Fulton** Fulton is an anesthesiologist and expresses in his report that the performing physician did not undertake appropriate airway management when he instructed Mrs. Peyton to sit up after she began coughing up blood. Blue Ridge argued that because Fulton is not a radiologist and did not perform CT-guided lung biopsies, he should not be permitted to render a standard of care opinion regarding the approach to airway management. There is no indication that the standard of care applicable to pneumothorax, hemorrhage, or hemoptysis is different if those complications emerged after a procedure performed by an interventional radiologist, rather than a physician of another specialty. As an anesthesiologist, Fulton basically has knowledge of and experience with the relevant complications that emerge in surgical contexts. He is not disqualified because he did not perform CT-guided lung biopsies. ### **C. Testimony by Michael Mistretta** Mistretta opined that Peyton’s death was caused by the emergency treatment she received, not the procedure performed. Mr. Peyton therefore claimed that Mrs. Peyton’s death is an aggravation of the initial injuries the physician caused, making the alleged negligence of the Emergency Department irrelevant. Here, whether Mrs. Peyton’s death was an aggravation of injuries inflicted during her biopsy or a separate and distinct injury is a question best left to the jury, after proper instructions by the Court. According to the Court, the evidence regarding Peyton’s emergency treatment would not unfairly prejudice or confuse the jury. Rather, the jury is best positioned to consider the credibility of experts and evidence in their determinations of causation. ## **Held** - As a result, the Court denied Blue Ridge’s motions to exclude or limit the testimony of two of the Plaintiff’s expert witnesses, Dr. Peter Bream and Dr. Matthew Fulton. - The Court denied Peyton’s motion to exclude or limit the testimony of Blue Ridge’s expert witness, Dr. Michael Mistretta. ## **Key Takeaway** Whether the physician’s negligent acts cause a mere aggravation of the original injury or cause instead a separate and distinct injury should be left to the determination of a jury, guided by ordinary principles of proximate cause. ## **Case Details:** --- ## **You Might Also Like** ![Radiology Expert was Allowed to Opine on the Extent of the Injuries](https://ewp-blog.expertwitnessprofiler.org/wp-content/uploads/2026/04/blog-pic-640X480-2026-04-17T212119.557.jpg) [**Radiology Expert was Allowed to Opine on the Extent of the Injuries**](https://expertwitnessprofiler.com/radiology-expert-allowed-to-opine-on-emergency-care/radiology-expert-was-allowed-to-opine-on-the-extent-of-the-injuries)![Radiology Expert Allowed to Opine on Emergency Care](https://ewp-blog.expertwitnessprofiler.org/wp-content/uploads/2026/04/blog-pic-640X480-2026-04-17T151703.135.jpg) [**Radiology Expert Allowed to Opine on Emergency Care**](https://expertwitnessprofiler.com/radiology-expert-allowed-to-opine-on-emergency-care/radiology-expert-allowed-to-opine-on-emergency-care)![Human Factors Expert Not Allowed to Opine on Warning Cues](https://ewp-blog.expertwitnessprofiler.org/wp-content/uploads/2026/04/blog-pic-640X480-2026-04-17T191943.820.jpg) [**Human Factors Expert Not Allowed to Opine on Warning Cues**](https://expertwitnessprofiler.com/radiology-expert-allowed-to-opine-on-emergency-care/human-factors-expert-not-allowed-to-opine-on-warning-cues)![Accident Reconstruction Expert's Testimony on Design Defects Excluded](https://ewp-blog.expertwitnessprofiler.org/wp-content/uploads/2026/04/blog-pic-640X480-2026-04-16T184712.490.jpg) [**Accident Reconstruction Expert’s Testimony on Design Defects Excluded**](https://expertwitnessprofiler.com/radiology-expert-allowed-to-opine-on-emergency-care/accident-reconstruction-experts-testimony-on-design-defects-excluded)![Architecture Expert Allowed to Opine on Storm Damage](https://ewp-blog.expertwitnessprofiler.org/wp-content/uploads/2026/04/blog-pic-640X480-2026-04-14T214142.934.jpg) [**Architecture Expert Allowed to Opine on Storm Damage**](https://expertwitnessprofiler.com/radiology-expert-allowed-to-opine-on-emergency-care/architecture-expert-allowed-to-opine-on-storm-damage)