Expert witness calls OR during El Cajon woman's deadly breast augmentation procedure a ‘circus'

A Chula Vista plastic surgeon, Dr. Carlos Chacon, appeared in court Thursday facing second-degree murder charges after the death of one of his patients.

Meghan Espinosa, a mother and teacher from El Cajon went into cardiac arrest and died during a breast augmentation surgery back in 2018. The San Diego County District Attorney’s office alleges Dr. Chacon and his medical staff were incompetent.

The preliminary hearing, which ultimately decides if the case continues to trial, lasted the entire day at the South Bay courthouse. As planned per scheduling conflicts later, expert witness and plastic surgeon Dr. John Shamoun was the only one to testify Thursday. The District Attorney’s Office hired Shamoun, who described the operation room during Espinosa’s surgery as a "circus."

Judge Maryann D’Addezio presided over the hearing and had to frequently interrupt the witness, the prosecution and the defense council to make corrections and clarifications. Both the medical board and the District Attorney tasked Shamoun with reviewing all evidence including charts, reports, depositions and video of the surgery at the Divino Surgery Center in Bonita.

Shamoun believes the registered nurse was inappropriately and incompetently administering anesthesia, and was originally hired in order to forego 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 lacked the tools to do so.

“Testimony by people that she was shocked. Others saying there was no shock. CPR for 10 seconds, no pulse for 10 seconds, the use of epinephrine on multiple occasions when there was a pulse. I mean, this was a circus. None of this stuff makes any sense,” said Shamoun.

Shamoun testified in several instances that Chacon was the captain of the ship and even if the registered nurse mistakenly over-sedated the patient, Espinosa was his responsibility. Shamoun also stated that in his career, he estimated he had performed more than 5,000 breast augmentations, but never under conscious sedation as was Espinosa’s surgery. He also said he never used a registered nurse in those procedures, but had in less serious surgeries.

Shamoun ultimately discussed that several factors could have contributed to Espinosa’s death: a pneumothorax (air leaks into space between lungs and chest wall causing lung collapse) caused by a puncture, medication compounding the effects of the anesthesia, and the failure to call for emergency services in a timely manner. He described how Espinosa’s procedure was an incision around the nipple, with the intent to place the prosthesis underneath the pectoral muscle. He described it as risky because of its proximity above 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,” said Shamoun.

But as for Chacón’s defense team, attorney David Rosenberg focused on the nurse’s role in this tragic case and aggressively questioned her failure to report the several medications in Espinosa’s system at the time that included birth control, anti-depressants that may have comingled with the administered fentanyl and other medications administered during the procedure.

Rosenburg seemed to persistently attempt to undermine Shamoun’s credibility by pointing out that Shamoun provided inaccurate statements, that Chacon, his staff and surgery center were authorized to use general anesthesia and that Espinoza was potentially conscious at some point. He also sai Espinoza signed consent forms and was aware of the risks of the surgery. Shamoun disputed that and frequently referenced conflicting reports from medical staff’s deposed interviews.

Rosenberg also claimed that Shamoun’s analysis of the medical reports and evidence was inconsistent and not straightforward, calling on his connection to the hired jobs he performed for the medical board as an expert witness in other trials. Shamoun testified he was executing his role as an expert, pro bono in Espinosa’s case, though.

Shamoun concluded the cause of Espinosa’s death was over-sedation that stopped her breathing. He also reported that Chacon had placed two calls to an anesthesiologist during the three hours he and his staff failed to call for emergency services, which they were expected to do once CPR was attempted briefly.

“A respiratory depression induced by medication is the most likely ideology of her demise,” said Shamoun.

Several times, the defense team objected and called the details hearsay as what Shamoun interpreted from the reports and evidence he reviewed.

The medical board is investigating Chacon, but his medical license is still active. He is only allowed to perform surgery or procedures at an accredited location, using an anesthesiologist or licensed medical staff. As part of his bail release agreement, Chacon also has to notify patients of his pending charges.

Chacon is due back in court Oct. 9.