COLONOSCOPY ISSUES
GASTROENTEROLOGIST FROM PENNSYLVANIA
Physicians can be criticized and sued for problems that fall under the headings of errors of omission and commission. One of the more common problems that can be considered a problem of omission is a failure to diagnose colon cancer. Colonoscopy is credited with being, at least to a large extent, responsible for a greater than 40% reduction of colon cancer mortality. Although it is an excellent diagnostic tool, the best currently available, it is not perfect by any means. The major reduction of colon cancer and death attributable to early diagnosis, and polypectomy, primarily of distal lesions, those below the splenic flexure. Lesions in the ascending...
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Missed Diagnosis Expert Witness
Missed Diagnosis
Hematology/Oncology Expert From New York
Among the most successful matters of this kind are cases of missed diagnosis. In out rushed, fragmented health care system, where doctors don’t often talk to patients and not even to one another, it is not uncommon for lab result, a finding on imaging, or even a pathology report to go missing or to be missed. In such cases, the defense cannot argue the facts and will often invoke scientifically questionable theoretical concepts such as doubling time and micrometastases to claim that the patient was already doomed, even as early as the time of the missed diagnosis. It is then my responsibility to explain why...
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Critical Care Technology Expert Witness
Critical Care Technology
By Critical Care Expert in Maryland
During the past 20 years, there has been a slowly developing but drastic change in the practice of Critical Care Medicine:
The technology of Critical Care has undergone a revolution. We can support almost any key organ in the body artificially, including lungs (ventilator, extracorporeal membrane oxygenation), kidney (dialysis as well as sophisticated dialysis that does not decrease blood pressure, CVVH), heart (left ventricular assist device, defibrillating pacers, coronary stenting, etc.), liver (MARS), and vascular system (pressor medications, intra-aortic balloon pump). We have sophisticated and accurate ultrasound devices to determine the cause of problems such as lung collapse and low blood pressure. We can...
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Nurse Expert Witness – Changed Records
Changed Records
Nurse from Pennsylvania
COMMON FEATURES OF MISSED APPENDICITIS IN THE EMERGENCY DEPT
Would it have been possible to prevent blindness in an extremely immature infant? Despite showing all the associated risk factors for development of retrolental fibroplasia (RLF), the infant's eyes were not examined until the 121st day of life. The exam revealed bilateral retrolental fibroplasia at Grade V, with poor prognosis for vision. Medical Advisors was asked to determine whether or not an eye examination should have been done at an earlier date. If so, would that have prevented eye damage? Following birth, the infant was placed in the intensive care nursery for therapy of respiratory distress syndrome--Hyaline membrane disease....
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Emergency Room Expert Witness
Appendicitis: Failure to Diagnose in the Emergency Department (ER) Emergency Room
Physicians from Chicago
COMMON FEATURES OF MISSED APPENDICITIS IN THE EMERGENCY DEPT
Appendicitis is one of the most common surgical diagnosis made in the ER and the failure to diagnose acute appendicitis is among the five leading causes of successful ER suits, accounting for 15% of the total dollars paid out for ER malpractice litigation. It is important to emphasize that as many as 30% of patients with acute appendicitis have been seen previously and incorrectly diagnosed by a prior physician.
The classic case of acute appendicitis is most often only found in books, as a large number of cases do not have...
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General Surgeon Expert Witness
Hospital Billings
General Surgeon from Georgia
Hospital billings are notoriously inaccurate. Overcharges commonly are in the 20% or 25% range. Patients only see the insurance adjustment and blindly pay their 20% thinking they are saving money To save 25% on a $ 4000 bill puts $ 1000 back in their pocket.. Perhaps more distressing are billings paid by Estate settlements and malpractice cases. Often a hospital bill in these cases follows a long period of costly hospitalization. Bills in the $ 300 to $ 400 thousand range are not unusual. A proper review of these bills could result in a savings to an estate lawyer or liable malpractice insurance carrier in the...
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Radiology Expert Witnesses
Medical Aspects of Three Dimensional Reconstruction
By Radiologist in Delaware
Over the past decade, medical imaging with three dimensional reconstruction (rendering) has become a valuable tool for not only the radiologist in diagnosing various pathologic conditions throughout the body, but more recently as an adjunct for the attorney in demonstrating the specific etiology for the pain caused by a particular injury. The concept of three dimensional imaging has been utilized to detect and confirm subtle findings suggested on more common 2-D images. This concept starts with a two dimensional CT or MRI image and then we stack contiguous two dimensional images in various planes which are modified by software algorithms via a...
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Endocrinologist Expert Witness
DIABETES
Endocrinologist from Pennsylvania
Diabetes is epidemic in the United States. Especially in Latinos and African Americans. Diabetes affects 21 million Americans- 7% of the population - and will grow to 22 million by 2025. A new diagnosis of diabetes is made 2200-3500 times each day, yet 25% of people with diabetes are undiagnosed! The estimated costs of managing people with diabetes approaches a staggering 132 billion dollars a year. Thus Type II diabetes represents a major health care crisis and continues to grow.
Diabetes vents its damaging effects on multiple organs. Each year 82,000 amputations, 18,000 cases of blindness, 41,000 new dialysis starts and 213,000 people die from diabetes and its complications....
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Hospital Administrator Expert Witness
Hospital Administrator from Florida
Medical malpractice cases require stringent and comprehensive clinical review and attorneys always employ medical experts to review their cases. Often overlooked is the use of a hospital administration expert who can add significantly to the case by evaluating the corporate responsibilities of the hospital involved in the matter.
It is important to utilize a person who has actually worked as a hospital administrator and, indeed, some states require a person actively engaged in the field. While many physicians feel that they have hospital administrative experience, it may not be adequate to evaluate hospital compliance with accreditation standards, licensure regulations, and administrative policy and
procedures. As a person with nearly...
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General Surgery Expert Witness
BARIATRIC SURGERY – MALPRACTICE ISSUES
General Surgeon from New York City
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. In evaluating a potential claim for malpractice in a bariatric surgical case, several issues require analysis.
Indications -- The indications for bariatric surgery are well established, starting with an NIH consensus conference in 1992. The patient who is a...
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