Houston transplant surgeon case may be difficult for prosecutors as judge limits medical care evidence

Federal prosecutors face significant hurdles in the criminal case against Dr. John Stevenson Bynon, with strict limits on how much evidence they can present at trial about the Houston transplant surgeon’s patients and their medical conditions.

In pretrial hearings last week in front of U.S. District Judge Lee Rosenthal, prosecutors and Bynon’s defense team wrestled over the scope of the charges against him and whether prosecutors’ arguments veered too closely to a civil medical malpractice case. Bynon is formally charged with knowingly making false statements in connection with health care services covered by Medicare.

“I’ve tried any number of medicare fraud cases,” Rosenthal said at the hearing Thursday. “None of them are like this.”

PRIOR HEARINGS: Houston federal judge questions viability of case against former Memorial Hermann transplant surgeon

Bynon, who for more than a decade ran the abdominal transplant program at UTHealth Houston and Memorial Hermann-Texas Medical Center, is accused of preventing five patients from receiving organ transplants by improperly changing the criteria for acceptable donor organs. Prosecutors contend that those changes amount to false statements.

Two patients later died before they could receive transplants, while a third died after Bynon determined the patient’s anatomy was too complex to perform the surgery, according to the indictment.

Judge

Rosenthal, however, has questioned whether patient outcomes are relevant to the specific allegations, which focus on government insurance benefits, and barred much of that evidence from being admitted at trial without her permission. In recent court orders, Rosenthal prevented the government’s expert witnesses from talking about whether patients were medically suitable for transplants and barred them from

making moral characterizations about Bynon.

It’s unclear if the case will go to trial as scheduled on Oct. 28, which

would be a highly unusual development in federal court. In the Southern District of Texas, only 36 of 7,807 total defendants went to trial in the 12-month period that ended in September 2025, according to government data. All but four of those defendants were convicted.

On Thursday, prosecutors expressed reservations about their ability to prove key elements of their case, in light of the limitations. “We’re just trying to make decisions as to whether we can proceed in a jury trial or not,” Suzanne Elmilady, deputy chief of the major fraud section of the U.S. Attorney’s Office in Houston, told the judge on

Thursday.

Prosecutors and the defense team will meet for one more hearing, on Oct. 27, before jury selection begins.

Malpractice vs. criminal act

Bynon sat quietly through last week’s hearings, at several points resting his head in one hand on the defense table

and rubbing his eyes. The veteran transplant surgeon has been in the spotlight since 2024, when Memorial Hermann temporarily shut down its abdominal transplant programs to investigate what they called “inappropriate changes” to donor acceptance criteria.

Bynon previously admitted to federal regulators that he unilaterally changed the criteria as an informal way to prevent organ offers for “sick” patients. For instance, in one case outlined in federal inspection records, Bynon changed the criteria for one of his adult patients to only accept organs from a child under 8 years old. Patients were never informed of the changes.

In the indictment, prosecutors allege that Bynon did not have any clinical justification for the changes, departed from established procedure and kept his actions a secret.

Bynon has maintained his innocence. In court filings, he has argued that his patients were too sick to receive a transplant at the time, and that placing them on an informal “hold” gave them a better chance to receive an organ in the future. Organ transplant candidates can receive a higher priority for a new organ when they accrue more time on the waiting list, according to court documents. Patients who are officially deactivated don’t accrue time and lose that priority, court documents say. Bynon also has said he was following COVID-era transplant guidance.

For months, Bynon’s defense team has successfully fought to keep evidence of alleged patient harm from being shared at trial. Rosenthal ruled that the information would be “prejudicial,” or put the defense at an unfair disadvantage, and could only be shared with her permission, according to court records.

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The judge further limited the evidence last week.

Rosenthal issued an order preventing the government’s experts from testifying about the mortality statistics and health outcomes of Bynon’s patients – unless she granted permission. During the pretrial hearings, she also appeared to agree

with the defense team’s request to focus the trial on the specific dates of Bynon’s criteria modifications. Focusing on a longer period of time, after Bynon made the changes, would not be relevant and could prolong the trial for months, argued Samy Khalil, Bynon’s attorney.

“That’s how we’re going to get into a medical malpractice case,” Khalil said at the hearing Wednesday. “Because now we are having to justify not the initial (criteria change), but subsequent decisions a week, two weeks, three weeks later.”

Khalil and U.S. Justice Department attorneys declined to comment about the hearings.

A challenging case

The surviving relatives of multiple patients have filed wrongful death lawsuits against Bynon, Memorial Hermann and UTHealth Houston. Two of the cases have been dismissed, but another case involving three families is ongoing, according to court records.

In a statement, the plaintiffs’ attorney, Tommy Hastings, called Bynon’s argument that he was trying to help patients “offensive, cruel, and a lie.”

“He is a disgrace to the medical profession and it is a travesty that the criminal jury will not be permitted to hear the evidence,” said Hastings.

Limits like those set by Rosenthal aren’t unusual heading into a criminal trial, said Jacob Elberg, a former federal prosecutor and the faculty director of the Center for Health & Pharmaceutical Law at Seton Hall Law School.

In the language of the indictment, the transplant candidates were not identified as victims, and one of the rules set out by Rosenthal prohibits the prosecutors from referring to the patients that way. That rule is meant to prevent the jury from becoming prejudiced and to keep them focused on the case in front of them, Elberg said.

“The government charged the case in a certain way, and the judge is going to hold them to that,” he said

The government will not be prevented from saying a patient was removed from a donor list or that being removed had an effect on their lives, Elberg said.

Still, there will be challenges at trial in a broader sense. Cases involving doctors and their patients are often fraught with debates over whether something is malpractice or a criminal act, Elberg said.

“The two things aren’t mutually exclusive, and they often will overlap,” he said. “That being said, every time there’s medical malpractice, that does not mean that there’s also criminal liability, and judges and generally prosecutors are really reluctant to turn instances of a doctor doing a bad job into criminal charges.”

If the case reaches a jury, the Justice Department lawyers may struggle to prove their case. Elberg

noted that charging documents don’t say there was a financial motive for the alleged false statements. While prosecutors don’t need to show a motive to prove a crime occurred, it can be helpful for proving that a person intentionally broke the law.

“Things can be outrageous and not be a federal crime,” he said.

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This article originally published at Houston transplant surgeon case may be difficult for prosecutors as judge limits medical care evidence.