A preliminary hearing began Thursday in the case against Dr. Carlos Chacon, who is charged with second-degree murder in the death of Megan Espinoza, a 36-year-old mother of two.

Espinoza died at a hospital more than a month after undergoing a breast augmentation operation at Chacon’s Divino Plastic Surgery center in Bonita on Dec. 19, 2018.

Prosecutors allege that among other things, Chacon, 48, delayed contacting emergency services for about three hours after Espinoza went into cardiac arrest. Along with Chacon, prosecutors charged Heather Lang Vass, one of the nurses present during the procedure. She pleaded guilty to an involuntary manslaughter charge earlier this year.

On Thursday, John Shamoun, a Newport Beach-based plastic surgeon, testified that he was asked by the Medical Board of California to review the case.

Shamoun testified that through his review, it appeared that in the latter stages of the surgery Espinoza’s blood pressure dropped rapidly and her oxygen saturation — or the oxygen within her blood tissues — was very low.

When her pulse could not be detected, Chacon began CPR, which Shamoun said was appropriate.

However, he testified that after her vital signs improved, she should have been taken to a hospital or urgent care center, which did not happen in a timely fashion.

One of Chacon’s defense attorneys, David Rosenberg, questioned Shamoun about several measures Chacon took such as performing CPR, checking for Espinoza’s pulse, and providing her with fluids and medications in an attempt to revive her. Rosenberg asked whether Chacon would have done those things if he had no concern for Espinoza’s life.

Prosecutors alleged earlier this year that Chacon ordered his staff not to call 911 when Espinoza’s condition declined and that he instructed staff to lie to Espinoza’s husband regarding her condition

They also allege Chacon lied to several anesthesiologists he telephoned for assistance on Dec. 19, 2018, when he told them Espinoza never lost her pulse or was unconscious.

Shamoun described the surgical team’s response to Espinoza’s condition as ”essentially a circus.”

He testified, ”I just don’t think they knew what was going on and they weren’t competent to take care of anything that was going on at that time.”

Chacon was initially charged in 2021 with involuntary manslaughter in connection with Espinoza’s death, but prosecutors amended that to a murder charge earlier this year.

In court earlier this year, another of Chacon’s attorneys, Marc Carlos, said prosecutors ”ramped this up to a murder charge” despite no changes in the case since it was originally filed.

”I’ve never seen anything like this and I really think that doctors out there should be concerned because if something bad happens, this is what’s happening to them next,” he told reporters.

Shamoun was the lone witness to testify Thursday. At the conclusion of the preliminary hearing, a judge will rule whether Chacon will go to trial on murder and other charges.

Due to scheduling issues, the remainder of the preliminary hearing will be held next month.

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