Articles Written by Medical Expert Witnesses
Do you know what opioid-naïve means? What about opioid-tolerant? If you don’t know the definitions of these terms, you need to learn them—because a patient’s history of opioid use (or lack thereof) has important implications for nursing care.
Human injury is complicated. If we lived our lives inside a protective bubble then, one day experienced an incident, it may be relatively simple to ascribe any injuries to the traumatic event. But that is typically not the case.
Medical malpractice is defined by Merriam-Webster as careless, wrong, or illegal actions by a doctor who is performing a professional duty. Most medical-legal cases are settled for a variety of reasons, however, those cases that make it to a court of law rely on experts to teach, train, and educate the jury. The importance of choosing the right medical-legal expert can turn a sure victory for the plaintiff into a common sense verdict for the provider.
I was recently involved in a medical malpractice case that went against the physician. In this particular case, however, lack of communication and common sense led to a favorable plaintiff’s verdict.
Part of our Forensics practice at Evidence Solutions,Inc. includes Electronic Medical Record (EMR) / Electronic Health Record (EHR) forensics. We take special interest in finding out about hacking events that affect Electronic Medical Record (EMR) Systems.
Federal officials say the copy-and-paste features common to computers which are used to enter Electronic Medical Records (EMR) and Electronic Health Records (EHR) invite fraud. Merely copying and pasting another patient’s clinical notes can be considered fraud. The Federal Government believes there is a need to reduce the healthcare provider’s ability to duplicate notes.
The opinions of a forensic psychiatrist must be firmly grounded in thorough clinical training combined with substantial experience. Nevertheless, the roles of psychiatric clinicians and forensic psychiatric experts are widely disparate.
Mission, Methodology & Ethical Duty of Independent Forensic Psychiatric Experts Contrast with Treating Doctors
The mission of the forensic psychiatric expert is not the alleviation of suffering but rather the determination, as accurately as possible, of what is objectively true, assuming a professionally skeptical point of view and seeking firm evidence to support any conclusions while always considering alternative hypotheses.
Catastrophic events will not cause the same emotional response or injury to occur among all persons who experience the same or similar events. Forensic psychiatric examinations including psychological testing early in the process can help validate or disprove plaintiffs’ claims.
Electronic Medical Records (EMR) and Electronic Health Records (EHR) are great tools that allow for data exchange between providers and faster access to a person’s medical history. Along with this ease of access comes the potential for abuse.
Prescription drug misuse and abuse has skyrocketed to unprecedented proportions, forming an epidemic in the United States.
An ID Experts study says that the increased use of smart phones and tablets is significantly increasing the risk of cyber attacks in the health care industry. It links the risk to these devices to not having proper malware and virus protection. The study also indicates that there has been a 100 percent increase in attacks in these types of organizations since 2010.
Who are you in your relationships? Do you have a hard time sustaining them? A common dynamic observed in difficult relationships.
Every year there are about 52 million surgeries performed in the United States. Tens of thousands of these surgeries are performed unnecessarily due to several reasons. The average American that lives to be 85 years old will have 9.2 surgeries in their life time. The ability to accurately calculate an overall surgical medical malpractice rate is currently next to impossible due to a conglomerate of false and unreported claims.
Advances in spinal surgery have resulted in surgical procedures that are less invasive, less time consuming, and are performed on an outpatient basis. Conventional private third party payers have balked at reimbursing for most of these surgeries labeling them experimental. However, patients with solid PPO plans can get a significant amount of the charges reimbursed in most instances. The remaining patients end up paying out of pocket for these services.
With the rise of diagnoses such as heart failure, chronic obstructive pulmonary disease and various neurological degenerative disorders, the number of cancer related admissions to hospice organizations have fallen. However the symptom burden these patients experience remain high.
Lead (Pb) has been recognized as toxic for centuries, yet we continue to learn more about lead toxicity and environmental issues. This expanding understanding of lead influences approaches to identifying at-risk populations and intervening to reduce exposure and risk.
Research studies have shown consistent associations between the presence of dampness and mold in buildings and respiratory symptoms in building occupants.
When dealing with a legal matter that involves embalming failure or service complications, you must look at several essentials that will result in the best results. In that regard, you need a consultant or expert that knows mortuary law and the daily functions of funeral service.
Imagine a 200-lb man twisting about on the back of a galloping pony and swinging a mallet at a polo ball. The strike is solid and the ball soars down field. He kicks his horse up a gear to keep a claim on it, an impulse bested by the pony who has already hit high drive. The movement may be repeated hundreds of times over a season.It’s a thrill to watch such an athletic partnership but sometimes the thrill is followed by an impulse to call a physical therapist for both horse and rider.
The heat of summer can pose a severe health hazard to your horse. Heat can cause your horse to dehydrate, stop sweating, colic, poor exercise tolerance and even heatstroke.
Pharmaceutical neurotoxicants are defined as a drug or drug-like entities due to its own properties or in combination with other drug or drug-like entities illicit an untoward response to its host’s nervous system. Unfortunatley, they can induce syndromes of hyperthermia. Understanding can help minimize morbidity and mortality.
370 B.C. Hippocrates was the first to recognize lead poisoning colic. (Hunter, 1974 p238, 240)
RADS is referred to as New Onset Asthma. It is only seen in persons who never before had asthma. RADS is caused by inhalation of a very heavy dose of an irritating substance. RADS is not caused by allergy. RADS symptoms appear suddenly; within 24 hours of the irritant inhalation. RADS is basically a subtype of irritant induced asthma (IIA).
From a medical expert witness' perspective, I believe certain preliminary steps a law firm should consider undertaking before taking on a client who claims to have suffered illnesses from water damage/mold exposure. This is not intended to offer any legal advice but suggestions which may help you to decide whether the case may be valid or not. Obviously the ultimate decision can only be made by your medical expert. Remember that not everyone who is exposed to water damage or molds gets ill.
Anaphylaxis comes on very suddenly and death may be the consequence if it is not recognized or treated promptly. The most effective medication to treat it is epinephrine and not , as often erroneously believed, antihistamine. People with this problem should wear a MediAlert ID to signal this condition to emergency medical personnel since just minutes of delay may mean the difference of life or death.
Is there a way to reliably determine impairment due to marijuana consumption?
A brief history of the physician assistant profession, it's development and it's role in the medico-legal community.
When you have what you regard as a suspicious record or handwritten entries, the following clues should alert you to the need for a document examiner and/or handwriting expert.
You are sitting outside the treatment room of a hospital when you hear one nurse say to another, “Dr. Jones is butchering that poor patient!” The patient is your mother.
You have already read about the New Jersey case, which held that a podiatrist cannot be expected to treat a cardiac arrest, because he is only trained to work below the ankle. However, an Arizona podiatrist treated an elderly man for pain in the leg and lameness.
A physician or dentist does not undertake to cure you. He only has to do his best for you according to the standard of care for his community or medical or dental specialty. If he did not, you have a legitimate complaint. If he did, you probably do not have a case, no matter how disastrous the results.
Lawyers call this the Lay Standard, because it is based on what a layman (the patient) understands and not what a professional thinks she needs to understand.
Does he have to tell you everything he is going to do? Go through the surgical operation step-by-step? Warn you about every possible complication? Discuss all possible alternative treatments, even if they are hardly ever used? What if the chance of a certain complication is one in a million? What if it is one in ten? How about a 50-50 chance?
To work on a patient without anybody’s consent, a doctor must comply with four requirements: 1. The patient is in dire danger. 2. The patient is unable to consent. 3. If the patient is a child, a parent or guardian is not readily available. 4. It can be reasonably assumed that the patient would consent if able.
Before you decide whether you have a legitimate complaint for lack of informed consent, let us look at some of the ways you can consent to a doctor’s treatment and some of the ways a doctor can treat a patient without that person’s formal consent.
A mugger sticks a knife in you and kills you or leaves you maimed for life. A surgeon sticks a knife in you, and kills you or leaves you maimed for life. What is the difference between the two? The mugger will go to jail and the surgeon will not. Why? Because you consented: you signed a consent form and gave the surgeon permission to stick the knife in you.
You were treated by many doctors over a period of time and cannot be sure which one was responsible or whether they all were.
Exposure to water damage can cause illnesses and distressing symptoms in susceptible individuals. Some of the problems are of an allergic or immunologic nature, some from the irritant effects of microbial volatile organic compounds ,but the causes for many other symptoms remain unknown.
Often, requests are made for psychological testing as part of the child custody evaluation (CCE) process, and too often, the results are disappointing. The root cause of this is two fold: lack of practicable and executable referral questions and findings that are presented in jargon-based, non-behavioral terms.
Choussat’s “Ten Commandments”, to describe the components of an ideal Fontan candidate, were first published in 1977. Despite the wisdom of these commandments, it is clear from a historical perspective that total compliance with all criteria does not necessarily portend excellent long-term survival. We believe it is time to modify the original commandments with the end-point being an improvement in survival. We suggest the following single commandment, “Thou Shalt Be Perfect”.
The Physician Assistant Expert Witness and Medico-legal Consultant: A Guide for Attorneys and Experts
Brief overview of PA scope of practice and supervising physician role and relationship. Recommendations for the use of PA experts to provide opinions on the standard of care.
Aortopulmonary collateral vessels are extremely common in single ventricle patients. We present the rationale that these vessels are not innocent bystanders and can lead to significant hemodynamic, neurohormonal and mechanical perturbations ultimately leading to ventricular dysfunction.
Tests such as the Thematic Apperception Test, the House-Tree-Person (HTP), Human Figure Drawing (HFD) and the Draw-A-Person (DAP) “tests” are inappropriate for use in a forensic context.
The traditions of our cultures are changing. People are considering cremation and direct burials more than before. The open casket viewing has been apart of the death process for centuries and is slowly fading away. Professional embalming, restorative art and preservation can be accomplished with skill, as well as appreciated by families for that final farewell.
Orthopaedic surgeons assist in medical/legal evaluations in several ways. Orthopaedic expert witnesses may evaluate claimants with musculoskeletal injuries in cases that require an objective unbiased physical examination and/or expert orthopaedic opinion for settlement, negotiations, or trial.
Computational fluid dynamics (CFD) studies of airflow in a digital reference model of the 17-generation airway (bronchial tree) were accomplished using the FLUENT® computational code, based on the anatomical model by Schmidt et al. (2004). The lung model consists of 6.744•106 unstructured tetrahedral computational cells. A steady-state airflow rate of 28.3 L/min was used to simulate the transient turbulent flow regime using a Large Eddy Simulation (LES) turbulence model.
The therapist as expert witness: reasons the treating psychotherapist should not be the expert witness.
When it comes to medical legal liability, we all know the system is broken. Risk in the emergency department, of concern both to practicing physicians and administration, is no exception. Add emergency care for children into the mix, and the level of concern increases even more.
Nationwide Physician Assistant Malpractice Demonstrates Lower Malpractice Incidence and Average Payment Amounts over a 17 Year Period Compared to MDs and Advance Practice Nurses
By their very nature, managed care contracts carry a great deal of business risk, including the insurance risk that contracted rates may not cover costs; the financial risk of being paid late, or even underpaid; and the legal risk of being contractually barred from pursuing the patient, the employer, or even the payer, under certain circumstances.
Pain and addiction can often co-exist. Approximately 33% of the population has tried illicit drugs, and about 6.5% actively abuse illicit drugs. Pain management and prescription drug addiction is a serious health crisis facing the world today. The author examines the disadvantages of this situation.
Reciprocal Connectedness and the Limitations of Attachment Theory in the Family and Dependency Courts.
Child Development, Children's Mental Health and the Juvenile Justice System – Standford Law and Policy Review
The article by Dr. David E. Arredondo was published in the Standford Law and Policy review and explains principles of child development and discusses the various ways children of different developmental stages experience the same sanction. It goes on to describe different sanctions and their effects on children, and then to urge decision-makers to tailor sanctions to each offender’s individual developmental, emotional, and social circumstances.
Over the past several years, the number of bariatric surgery operations (surgery for weight loss) has grown from a handful to over 150,000 procedures per year in the USA alone, increasing faster than any other procedure. Since these procedures are complex and the patients are of high surgical risk, the number of complications and mortalities are significant. Inevitably, concerns about malpractice have followed.
Review for Merit & Causation: The review of a patient’s medical record can be a complicated and daunting task. The documents are different from institution to institution.
Psychological assessment is an invaluable and inestimable tool in the understanding of individual uniqueness. A comprehensive assessment helps explain the connection between psychological functioning and behavior. To be comprehensive, an assessment needs to examine a range of psychological factors.
The "bible" of diagnoses, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision, known as the DSM-IV-TR and published by the American Psychiatric Association is extensively used by psychiatrists, psychologists, social workers and most other mental health professionals in the U.S., Canada and abroad to provide a common nomenclature for diagnostic purposes and for communicating about mental disorders.
Guardians ad litem originate from a practice in the English Court of Chancery when the King, under his parens patriae powers, would appoint a guardian ad litem to protect the interests of the infant. Today, the court appoints child custody evaluators, (GALs) whenever it believes it necessary to protect the interests of a child in a judicial proceeding.
Cross-examining mental health experts is often a difficult challenge for attorneys as they are un-familiar with the material. I will discuss the most commonly used psychological measures and key points to keep in mind when questioning experts, either in deposition or on the stand.
When deciding upon an expert one might want to consider the following questions: • Has the expert ever testified before? How many times? • How does the expert present in court? Is he well organized and is his thinking logical and easy to follow? • Is he a member of major professional organizations? • Does he employ well-known and generally accepted psychological tests?
Parent Alienation Syndrome (PAS) in custody cases
The Attorney's Quick Guide: "The 6 Essential Elements of Pressure Ulcers You Must Find in the Medical Record."
The contents of the medical record, such as deviations from standards of care, inaccurate or incomplete documentation can make the difference in your pressure ulcer case.
Post Traumatic Stress Disorder, or PTSD, is a psychiatric diagnosis that is overused in civil litigation. Plaintiffs inappropriately claim to suffer from PTSD despite the fact they they did not experience a life-threatening, horrific circumstance. The role of subjectivity in psychiatric diagnosis is explored and the objective criteria for PTSD are explained.
As an attorney, any time you or your firm handles a case where health, illness, or injury is an issue you are going to need to review medical records. Whether you are a plaintiff or defense attorney, everyone needs to analyze and understand the contents of the medical record, and face it; they can be extensive and seem like a complex mystery.
Many people think psychiatric illness routinely renders patients incompetent to make important decisions about their lives. This month’s column, by Dr. Brian Crowley of Washington, DC, attacks that myth and discusses some situations in which clinicians must address their patients’ mental capacity. William H. Reid, MD, MPH
Trauma medicine can be somewhat like doing a jigsaw puzzle backwards. Outwardly, you know there are interlocking sides and flat sides. You don’t know which pieces are the top or bottom, which are the picture, or what the picture is about. To do a puzzle backwards takes a specific sequence of priority and planning.
Disaster preparedness is no longer just an accreditation issue. “All Hazards” disaster planning is no longer just a requirement of qualifying for federal grants. Education is no longer a last priority. Disaster planning, preparation and education are the newest legal shield for the healthcare corporate officer.
Adult Attention Deficit Disorder affects 4% of the population, and an even higher percentage of criminal defendants. It is a valid diagnostic concept, and treatment with correct medications is usually effective in some behavioral change.
The Science of Eyewitness Testimony Published in the Los Angeles Lawyer Magazine, October, 2007
Is the defendant guilty? Is the defendant suffering from a mental health malady that prohibits him from understanding the nature of the crime? Is the defendant able to consult with a lawyer and fully understand the charges against them?
The growing shortage of nurses in the United States as well as in California has been well publicized over the last few years. In response, numerous studies have been conducted to identify the causes, analyze the issues and determine solutions.
Do you need a mental health expert in your corner? Mental health and the justice system have been working side by side for decades. Forensic Mental Health Professionals have been called upon to evaluate and/or assist in many cases over the years.
Wills are generally contested either on the grounds that the testator lacked Testamentary Capacity (was incompetent to make a will at the time of signing it) or the testator, because of his/her mental state, was subject to Undue Influence (i.e. if there is evidence of coercion, manipulation, deception, compulsion, intimidation, etc.) or an Undue Influence secondary to a thought disturbance (such as delusions affecting the testator's free will in making decisions).