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Scientific
and Medical-Legal Review of New Mexico (SMLR) has been providing
technical
consulting on medical and chiropractic malpractice, accident analysis
and reconstruction, and evaluation of personal injury claims since
1985. By way of background, I have a degree in physics (AB
Princeton, 1975)
and am also a physician (Univ. of Pittsburgh School of Medicine, 1979),
board-certified
in
Internal Medicine by the American Board of Internal Medicine
(1992). I have also completed a fellowship in Clinical
Rheumatology (Univ. of New Mexico, 1992-3). Since 1985 I have
done approximately 200 consultations for
both plaintiff and defense attorneys in the areas of medcial
malpractice, personal injury analysis and biomechanical analysis of
accidnets. My approach to these tasks is guided by one simple
principle:
good science almost always dictates the appropriate outcome of legal
disputes over alleged malpractice and negligence.
The phrase
"good science" is, of course, key. Over the past 20
years or so, the medical literature has trended strongly toward
carefully controlled clinical trials, meta-analyses (combination of
multiple trials addressing more or less the same question) and rigorous
statistical analysis in addressing common -- and not-so-common --
medical conditions. This body of knowledge is sometimes called
"evidence-based medicine" (raising the somewhat disturbing question of
what kind of
medicine was practiced before the arrival of the evidence-based
medicine era), and can
often serve as the basis for establishing appropriateness of diagnosis
and medical care. Note that evidence-based medicine is not synonymous with practice
guidelines. Practice guidelines are just that -- guidelines --
and in and of themselves have ambiguous legal standing. They do
not necessarily constitute
"best practice" or "accepted community standards of practice".
Practice guidelines are often issued by professional organizations
(e.g. the American College of Cardiology, or the British Academy of
Dermatology) and are consensus review documents that are by the nature
of the review process often out-of-date. This is not to say that
they are valueless, but rather that they typically describe what is
known to be harmful or beneficial (for a particular condition) at a
particular time.
The application
of the scientific medical literature in the analysis of
allegations of malpractice (including defense against malpractice)
involved the following steps:
- Careful review of the medical records by a
knowledgeable
physician with delineation of critical decisions during the care of the
patient, with attention to:
- nursing notes
- diagnostic tests, and
- doctor's orders and notations
- Comprehensive search of the literature of
relevance to the case;
- Assessment of applicability of the literature
to the specific
case;
- Establishing the duty of the caretaker
(physician,
physician-assistant, nurse practitioner, nursing home staff);
- Establishing the existence of negligence, if
any; and
- Measuring the degree of harm, based on outcomes
studies already
available in the literature.
- This latter step is very important for
determining ultimate
damages, if any if negligence is demonstrated.
A similar
approach is used in accident analysis, recognizing that
negligence is perhaps of less relevance in those cases. Often,
medical or chiropractic care will be out of proportion to the degree of
injury sustained.
Analyses are
always supported with relevant citations from the
literature. Since, in most cases, attorneys and their clients
wish to know the extent of harm (as may be applied to the awarding of
damages), careful calculations are generally included comparing
expected outcome (with appropriate care) and the actual outcome (if
quality of care is in question). For example, in
situations where elderly nursing home residents die (perhaps due to
inadequate or inappropriate care), before undertaking expensive
litigation and mediation (or jury trial) it is important to know the
expected longevity -- and quality of life -- in a given nursing home
resident, based on the underlying medical problems specific to that
patient.
An example of a
typical (though somewhat complicated) pediatric case
analysis I have done can be seen here
(with names changed). In this case, an
infant was brought to a regional emergency room with fever but may have
received inadequate testing and treatment. The implications of
the probable negligence can be quantified, utilizing statistical and
decision-analysis tools after thorough literature searching is
completed.
Allegations of
nursing home malpractice are increasing. In these
cases (and assuming negligence has been demonstrated), the question
that always arises is "what is the degree of damage" (or harm)?
Often it is possible to predict longevity (absent negligence) with
careful statistical calcutions based on firm data in the literature --
this is one of the benefits of the movement towards "Evidence-Based
Medicine" that has (correctly, in my view) dominated medicine for the
past decade
or so.
Finally, there
is a burgeoning slate of of personal injury based on
accidents either at work or on the road. Accidents involving
minimal forces or accelerations (less than those otherwise experienced
in activities of daily living) seem to cause pain and disability far in
excess of what might be expected. The complex interaction of
litigation-in-process, pre-accident health status and therapies (some
from the orthodox medical community, some from alternative-medicine
practitioners) makes for contentious mediation or trial
testimony. A thorough application of data from the published
literature can usually sort out cause-and-effect, taking into account
many of the influences on the individual's perception of pain and
disability.
Finally, I have
testified for New Mexico's Attorney General on
the use
and abuse of
polygraphs.
As a former
senior scientst at a Department of Energy national
laboratory, I have become interested in energy prodcution and
conservation. In 2000 I began to do consulting in these areas and
established a subsidiary of SMLR called Enviromentally
Friendly Energy Systems.
focusing on conservation and residential solar
power generation.
Legal
consulting fees are available upon request as are references from
both plaintiff and defense attorneys.
My special thanks to
Jim Stadnyck of Point of View
Photography for design of
this webpage and much inspiration.
[Webpage last updated
2/8/07]
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ICQ# 21627838 |
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Screen name: apzelic
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