Choosing the right medical expert
In this article, we are going to explore the different factors to consider when finding the right medical expert for your case. Furthermore, how do you find these experts for your case? We are going to identify a few options you have as an attorney and some of the pros and cons of each of these paths. Below we are going to discuss two scenarios based on real cases.
A 50-year-old woman comes to see you about a personal injury case. She worked as a nurse in the emergency room. She was entering a gift shop and tripped, falling on both knees and couldn’t get up. She said they were doing construction and this is what caused the trip which resulted in the injury. She was taken to the hospital and the x-rays were negative. The Emergency Room doctor discharges her with instructions to see an orthopedist in 1-2 days where she would be sent for an MRI if her pain and range of motion worsened. The client tells you she insisted she couldn’t move legs and was very displeased with the doctor. When the nurse gives instructions on how to use crutches, your client explains that she tried to stand and reached for nurse who backed away from her. She lost her balance and fell to the floor on both knees. They then do an MRI and the doctors find she has bi-lateral torn quadriceps.
She was seen by orthopedics and operated on. She develops a blood clot and has sensitivity to anticoagulants and thus needs a filter inserted. Afterwards, she goes on disability. She was released from the hospital and complains about her right knee having more pain then the left at her one-week follow up. She tells you that the orthopedist changed the dressing and started her on antibiotics. Two weeks later she is admitted with sepsis and she had MRSA, diagnosed from a positive culture taken at what was now a wound at the right knee surgical site. Additionally, she has osteonecrosis. She was followed by vascular doctor and a wound care team. She is discharged and follows up with the wound care team and eventually heals, but has suffered permanent damage to the right knee. She can no longer work in the emergency room or as a floor nurse. She was unemployed and now taking paralegal classes to become a nurse expert.
You’ve done a quick legal analysis and find there could be a duty of both the gift shop and emergency room staff that was breached and caused the client to suffer damages. Looking first at the gift shop construction issue first, you find that the client tripped and there was nothing in her way and no damage to the carpet. Our assumption is she just tripped. So now the focus is on what happened in the emergency room. Does this case have merit? Is this case worth your time? Oh yea, there are also 1200 pages of records and you need an expert.
A 72-year-old man is driving and is rear ended. He breaks his left hip and both wrists. He lived independently, but after the accident had to live in an assisted living facility and then moved in with his son. The driver that hit him was certainly at fault. There was a breach of duty that caused damages in this case, but what are the damages? There are 300 pages of records and you need an expert.
So now it is time to get an expert involved in your case. We are going to discuss the initial thought process involved when trying to figure out what expert and how to find them.
Items to consider on each case:
How to find your expert | Your time spent | Your budget | What Expert | Finding Merit
Find the expert:
Find an expert on your own?
Find a company to meet your expert needs?
Your Time Spent
How much time do you have to find an expert?
Do you have a paralegal that can do the research and find one?
Will you have to do the research yourself?
Do you need to hire a company to find the expert for you?
How much time will it take to organize the medical records?
Do you need a chronology done?
How much money does the firm have to invest on the case?
How much will it cost to discover if the case has merit and/or determining damages?
Do you want to send ALL records to the expert or just the ones they can attest to as an expert?
By fine tuning your medical records, you make sure to keep the bill as low as possible. Remember, you are paying by the hour for these experts.
Does an orthopedist need to read EKG results?
Does a gastroenterologist need to read urology consult notes?
Do you really know what type of expert you need? If you have a case against a dermatologist, you need to ask what type of dermatologist and what procedure was performed? Not all dermatologists do chemical peels or interventional venous procedures. If you have a case is against a general surgeon you need to ask if you need a trauma, robotic or laparoscopic surgeon.
Not all cases have merit
Does your expert provide a free consultation prior to hire to see if they have merit?
Many do but some don’t.
You’ve determined the expert you need either through your research or the company you hired, but what if you see yellow flags that present an issue with the budget?
Perhaps a pre-case review by a nurse or medical professional should be done?
How much experience should your expert have?
Note that Federal Cases require an expert case CV.
How good is my expert at testifying?
Some of the agencies that find experts train them on how to give testimony.
When to find your own expert: When to hire a team to help:
Your 100% sure the case has merit. You’re not sure the case has merit
You 100% sure of the expert you need You’re not sure of the type of expert
You have the time to find an expert Your time can’t be spared
You have staff to organize files You need to have the files organized
You have staff to do a chronology You’re in need of a chronology
The case requires a simple expert The case requires a trained expert
Finding an Expert on Your Own
Your confident you know what kind of expert you need. You need an interventional cardiologist, an expert in the insertion of catheters. Plus, time is not an issue.
There are websites that doctors pay to list their information on such as ALM Experts and SEAK have their members CV’s and contact information for you to obtain. Click a specialty, then a state. Then sift and read through the information. Then you reach out to an expert, and it’s the waiting game. This can be taxing and grueling depending on the sub-specialty. Plus, while its not difficult to do, its time consuming. Also, you must deal directly with the doctor for everything. There is no liaison to assist you scheduling IME’s or depositions. There is no one to phone the expert on your behalf when the report is late, and the expert isn’t calling you back. Furthermore, if the expert doesn’t offer a free quick consultation, you may find out that they feel there is no merit or it’s even possible that they are not the right expert.
Using an agency to provide you an Expert
Contacting a firm to provide you an expert. There are many companies such as ours, Homestead Medical Experts, where you can request an expert and even get a medical review, chronology and your files organized. Some agencies have you fill out a request form to submit and they get back to you with the expert’s information. There are some companies that do just referrals services connecting attorneys to experts. Their services stop there. If you are a solo practicing doctor it may become just as daunting trying to get in touch and communicate with this expert. Make sure if you are looking at a company to help you with your expert, see what other value-added you are getting from their ancillary services.
Things to consider when looking at a company to help with an expert:
How well does the agency know their experts?
Do they do their due diligence, request updated licenses and medical malpractice information?
How is this agencies customer service?
Is all communication via email or can you get someone one the phone when you need them day or night?
Do they provide other services you may need?
What if you’re not sure about the case and need it reviewed for merit before sending it to an expert at $300/hr.?
Do they offer medical reviews?
Do they employ nurses and or paralegals that have a better understanding of what you need and how their expert will support your argument?
Analysis of the Scenario 1
In scenario 1, the woman had a lot of damages; but was the nurse or ER doctor to blame? Should she have been forced to walk? Also, MRSA isn’t always a sign of neglect, but was it in this case? The attorney knew that he needed an Emergency Room Physician Expert. The other issue with the MRSA, he wasn’t sure. That’s when he hired me, a medical paralegal, to review the case. With respect to the ER incident, there was no clear deviation. Torn quadriceps don’t show on an x-ray and follow up with an orthopedist is standard. What about the fall? Was there negligence? Perhaps. Even if the staff was negligent and she feel as a result, there would be no way to determine if the tares in the quads happed at the shop or hospital. Further, the fact that she was there at the hospital and complained she couldn’t walk lead to the fact they were torn at the gift shop. Regardless, even if she had followed up with ortho the next day; she would have had surgery, she would have gotten the blood clot. The infection is a different story. Was there negligence that led to the infection. In my review of the notes, the doctor and nurses put in a referral for a wound care nurse to look at the site. This was ordered two days prior to her discharge. The wound care nurse never came, and no one followed up. Further, for her to have been admitted with sepsis, my spider senses tingled. Why didn’t the orthopedic surgeon have her follow up with the wound care nurse, which he ordered prior to her discharge? That is a question for an orthopedic surgeon to answer. But for that infection, she could have recovered and with physical therapy returned to work.
Analysis of the Scenario 2
Less dramatic. It was clear that the attorney needed an orthopedist. He also needed a Life Planning Expert to determine how much his living expenses would be. The defense hired one as well. We were hired to find an expert that not only performs the Life Planning Report, but one that is so much of an expert, they teach it and know the exact way the analysis is performed. We were able to find them THE expert; she has instructed over half of the Life Planners in practice. She found that the way in which the report was done was incorrect. The defendants saved a lot of money for the insurance company.
So, the end of the day you need your expert to support your argument. You can try to find one yourself, or a trusting and diligent third-party company who will act as a liaison between you and the expert with that same result as the goal. Happy Expert Hunting!