How Attorney Turned Tables on Plaintiff's Arguments to Clear Doc in Trial Over Fatal Colon Cancer

In closings at trial of a South Florida doctor accused of negligence that led to a patient's colon cancer, Keith Puya used the plaintiff's own arguments on cancer growth rates to help seal a defense win.

Doctors diagnosed Zevan Kazandjian with late-stage colon cancer in 2013, just 18 months after Dr. David Vastola had performed a colonoscopy and declared Kazandjian's free of any problems. Kazandjian claimed Vastola missed the growth while performing the 2011 colonoscopy, and relied on evidence that colon cancer typically takes many years to develop and reach the stage it was at when it was ultimately discovered in 2013.

The defense argued Kazandjian's cancer was a rare, aggressive form that was undetectable during the 2011 colonoscopy, and the nine-day trial centered on whether the cancer could have been seen during Vastola's 2011 procedure. 

In his closing for the doctor, Puya, of The Law Office of Keith J. Puya, first argued it was unrealistic to imagine Vastola igored or failed to see a growth, given the doctor's own experience in performing the procedure and the equipment he was using. "[Vastola] didn't bother to see it? What? With a colonoscope that magnifies lesions 100 times their size?" Puya asked. "On a 30-inch screen that jumps out at you?"

Critically, Puya also noted Kazandjian had undergone a colostomy in 2008, and asked why a growth would not have been discovered then, if it was the type of slow-growing tumor argued in plaintiff's case. "[Plaintiff's legal team] tell[s] us, 'Your theory doesn't make sense. There's no way that Mr. Kazandjian's cancer could have gone from a de novo lesion to a stage-4 cancer in the short amount of time you're talking about. It takes years. Years, and years, and years," Puya said.

But, "[The 2008 colonoscopy] did not show any cancer, did not show any abnormalities. And yet [plaintiff's attorneys are] telling us that by the time of Dr. Vastola's procedure in October of 2011, Mr. Kazandjian had at least a 1 centimeter, at least a half-in in diameter lesion."

Puya added that Kazandjian's case was built on theories and inferences without solid evidence. "There's no concrete evidence that Dr. Vastola is negligent, other than trying to extrapolate back," Puya said, "knowing how the movie ended and trying to fill in a couple of scenes two years earlier."

Jurors deliberated about 90 minutes before clearing Vastola of the negligence claim.