Month: October 2019

Medical malpractice claims are a significant cost to doctors and health organizations, which is why several organizations analyze data for insights to help address these risks. Aon and The American Society for Health Care Risk Management (ASHRM) recently released its 20th Aon/ ASHRM Hospital and Physician Professional Liability Benchmark Analysis. The study provides health care risk managers with a better understanding of their cost of risk compared to an industry benchmark so they can develop proactive strategies to reduce costs and improve outcomes. The report gathers data from more than 127 healthcare systems and 105,000 claims to predict 2020 liability. While intended for health care providers, medical malpractice attorneys can also gain insights into how providers differ in their risk management practices, which can affect patient care and lead to more claims.

Some key highlights from the report include the following:

Total claims and losses. While the number of claims filed against hospitals and physicians is expected to remain the same, claim severity, including defense costs, is projected to increase 2 percent annually. Furthermore, the rate of losses greater than $5 million will continue to increase. This data is important because it indicates that while doctors and hospitals are managing to keep the number of claims relatively stable, the actions themselves are generating higher verdicts. Plaintiff attorneys should be concerned that this may lead to more states instituting damage caps in medical malpractice cases, while defense teams must remain cognizant that epic awards will continue to pose real and increasing levels of risk. Complaints about increasing verdicts have driven many states to limit damages, despite conflicting research about whether malpractice payouts are driving higher insurance rates.

Highest claims. Not surprisingly, claims related to labor and delivery continue to be significantly more severe than claims related to other allegations. Obstetric litigation is common, arising whenever there is a poor or unexpected fetal outcome. Typical allegations include failure to properly monitor the patient and fetus, failure to recognize signs of fetal distress, failure to perform delivery in a timely fashion, and failure to convert to a Cesarean section to avoid undue fetal distress. Since these actions involve newborns, claims often result in a sympathetic and generous jury.

Rising claims. Health care organizations and attorneys should be mindful of liability arising from the use of Physician Assistants (PA) and Nurse Practitioners (NP). According to the study, while PAs and NPs have a small impact on overall medical malpractice claims, they are involved in higher-severity cases, involving diagnosis-related or communication failures. The significant growth in the use of PAs and NPs in recent years means claims are likely to continue to increase.

Physician Assistants are medical professionals responsible for evaluating, diagnosing, and treating patients in almost every specialty. Most malpractice litigation relating to Physician Assistants involves poor outcomes arising from inadequate supervision by a physician, or deviation from the standard of care within the scope of practice of a PA. The U.S. Department of Labor reports that employment of physician assistants is projected to grow 31 percent from 2018 to 2028. The number of Nurse Practitioners is also growing. According to the 2018 National Nurse Practitioner Sample Survey, the number of NPs grew 9% from the previous year (from an estimated 248,000 to 270,000) and has more than doubled since 2007 (120,000 to 248,000). NPs are licensed professionals providing primary, acute and specialty health care to patients in hospitals, clinics, urgent care, private practice, and health centers.

The study has several takeaways for those involved with medical malpractice claims. Health care organizations and doctors need to analyze their risk areas and implement strong policies and oversight to reduce risks and improve patient care. Even if good policies and procedures are in place, when claims arise, medical malpractice attorneys must identify where lapses may have occurred to prove their case. Medical malpractice claims are unique and often complicated by multiple factors. As a result, they often turn on the testimony of expert witnesses who can discuss the relevant standards of care, issues of causation and damages.

Whether you need to prove or defend against a medical malpractice claim, Elite Medical Experts can help you secure nationally recognized university healthcare experts for all types of medical litigation and complex consulting matters. Contact us today for a consultation.

Claims of back and neck injury are common in litigation involving motor vehicle, slip and fall and other accidents. However, back and neck pain are pervasive problems in the general population making causation a critical issue in personal injury actions. How can the parties demonstrate the alleged accident caused the injury when a significant portion of people experience pain unrelated to a third-party’s negligence? The need to identify legitimate damages and prove causation is a challenge for both plaintiff and defense as trial attorneys battle adjusters in high-stakes litigation that often lacks compelling medical documentation.

“Among adults, 60% to 80% will experience back pain and 20% to 70% will experience neck pain that interferes with their daily activities during their lifetimes.” In addition, although adults of every age experience back and neck pain, as we age certain types of problems become more likely such as degenerative changes in discs and joints, spinal stenosis, and spondylolisthesis. Unrelated to an accident or age, a person may have back and neck pain for reasons that include muscle or ligament strain, bulging or ruptured disks, arthritis, skeletal irregularities, and osteoporosis.

With so many possible causes of pain, it is often difficult to link pain syndromes to a specific negligent action by a defendant. Objective documentation, particularly medical imaging such as radiographs, CTs, and MRIs, is critical to the case. In addition, medical records documenting the plaintiff’s condition prior to the accident are also mission critical. When a plaintiff has never or rarely experienced back and neck pain, it may be easier to prove causation because part of the proof will involve comparing the plaintiff’s medical history with his/her present condition. However, since the prevalence of pain is so high in the population, it is likely that a plaintiff will have some history of back or neck treatment, which means the present injury and pain level must be distinguished from the past.

Expert testimony is particularly crucial, and it requires utilizing medical experts in relevant subspecialties. For example, Orthopedic (“Orthopaedic”) Spine Surgery is a focused specialty devoted to the surgical treatment of spine injury and disease. Orthopedic Spine Surgeons treat problems of the cervical, thoracic, lumbar, and sacral spine such as neck and low back pain, disc herniation, spinal trauma (fractures), vertebral infections (vertebral osteomyelitis), and scoliosis. A Spine Surgery expert witness is an invaluable asset for educating the trier of fact on the existence, etiology, relevance, permanency, treatment, and prognosis of various spinal issues.

In addition, experts in Pain Medicine may also be necessary. Pain Medicine physicians are trained in the evaluation, diagnosis, and treatment of various types of pain. These physicians, sometimes referred to as Pain Management specialists, are typically Board Certified in Internal Medicine, Anesthesiology, Neurology, PM&R, Emergency Medicine, or Family Medicine before subspecializing in Pain Medicine.

If you are considering or involved in litigating claims alleging back and neck injury, top-tier Orthopedic Surgery and Pain Management may be critical to proving your case. Contact Elite Medical Experts to secure a leading expert from a nationally recognized US academic medical center.

The rules of evidence recognize that treating physicians may testify as fact witnesses and/or expert witnesses provided the parties make appropriate disclosures. As the doctor who examined a plaintiff before there was any litigation pending, treating physicians often have relevant information. While it may be necessary or useful to have the doctor testify as a fact witness, it does not necessarily follow that he/she would be the ideal expert witness. There are pros and cons to using the treating doctor as an expert witness.

Pros

The benefits of testimony by the doctor who examined and treated the plaintiff revolve around their unique position. The treating doctor examined the plaintiff because he/she was their patient for the purpose of diagnosis and treatment, not in anticipation of testifying in litigation. This means that treating physicians are typically viewed as providing their “expert” opinion based on what they personally examined and observed in real time. As a result, their testimony may be perceived as being more trustworthy and unbiased. Unlike treaters, expert witnesses can be viewed by jurors as having an interest in the case or as hired guns for lawyers. Expert witnesses do not necessarily examine the party claiming injury. They instead rely on medical records and other documentation to support their testimony, which may not seem as reliable as opinions based on a personal examination.

Cons

While a treating doctor may be a useful fact witness, expert witnesses serve a different purpose – to provide an opinion based on their special expertise. There are limits to the testimony of fact witnesses. They can testify as to their own personal observations and medical records they reviewed, but cannot give a medical opinion based on other external facts or examine records which they did not have at the time of diagnosis and treatment. Expert witnesses, however, can offer their opinion and evaluate other records and evidence, which is why they must have appropriate credentials that demonstrate their expertise. The problem is that a treating doctor may not have those credentials.

Beyond issues solely related to physical examination, litigation may involve complex questions of causation or damages to which the examining doctor may not be qualified to testify. In nearly every matter, it is more important to have an expert witness who is highly credentialed in the specific medical specialty related to the facts of the case. The treating physician may have little knowledge or experience in the relevant field of medicine making his/her testimony inaccurate or subject to discrediting.

Another concern that arises with treating physicians is their reluctance to serve as a witness. A treating doctor may be uncomfortable with testifying as an expert witness for many reasons including time constraints, distaste for litigation, concerns about his/her own level of expertise, being perceived as a “professional expert witness,” and possible ethical issues. A witness who would prefer not to testify is highly unlikely to be an effective witness.

The optimal approach for attorneys may be to use a treating doctor as a fact witness and supplement with an expert witness with the necessary qualifications. In addition, where a personal medical examination may help inform the opinion of the expert witness, such examination can easily be arranged if stipulated in advance with the testifying expert.

If you are considering or involved in any type of personal injury litigation, contact Elite Medical Experts to hand select nationally recognized experts for your case. We will secure a top-tier voice who is an expert in the exact injury and issues involved in your matter.

In 2018, the Centers for Disease Control and Prevention (CDC) released a report indicating that the total number of reported vector-borne disease cases involving ticks, mosquitoes, and fleas tripled between 2004 and 2016. Tick-borne diseases more than doubled with Lyme disease accounting for 82% of all tick-borne cases, but spotted fever rickettsioses, babesiosis, and anaplasmosis/ehrlichiosis cases also increased. Mosquito-borne diseases were marked by virus outbreaks involving dengue, chikungunya, Zika, West Nile and other types of encephalitis viruses. A total of 642,602 cases of 16 diseases were reported to CDC during 2004–2016.

Notably, these findings are considered to be substantially underreported. That is because the data relies on a person seeking care, a doctor diagnosing the correct problem and requesting appropriate tests, and providers or laboratories reporting to public health authorities. While many patients with minor symptoms do not seek treatment, even when they do go to a doctor, a proper diagnosis can be challenging for several reasons.

First, symptoms may be vague or common to many types of ailments. Depending on the specific disease, signs of illness may include mild flu-like symptoms, fever, headache, fatigue, restlessness, drowsiness, vomiting, diarrhea, confusion, joint or muscle pain, convulsions, and coma. Very severe cases can result in intellectual impairment, personality disorders, seizures, paralysis, cranial nerve dysfunction, and death.

Another concern is that even when testing is done, it may be unreliable with false negatives and positives. Lyme disease is a good example of this problem. In some cases, patients are mistakenly treated for a tick or mosquito related illness when they have another health problem, or they undergo protracted treatment for Lyme disease when they do not actually have the condition.

Doctors also may not ask for, or patients may fail to disclose, information that would be useful in diagnosis, such as travel to areas with an outbreak. In addition, there have been new tick and mosquito related diseases discovered on a regular basis with 9 new insect-related illnesses in the last 13 years according to the CDC study. Due to climate change broadening the geographic range of previously constrained insect vectors, the CDC expects this to be a continuing threat posing another challenge for doctors.

While in some cases treatment may be as simple as providing a course of antibiotics, delayed or missed diagnosis will nearly always have deleterious and significant long-term health effects. As a result, delayed recognition of tick- and mosquito-borne illnesses is increasingly seen as a claim in medical malpractice actions.

Infectious Disease specialists are frontline expert witnesses in litigation involving delayed or improper treatment of tick- and mosquito-borne illnesses. These experts can evaluate claims and testify regarding standards of care and causation for misdiagnosis, delayed diagnosis, as well as complications from the delayed treatment itself. Securing the most experienced expert with vector-borne diseases is crucial. Contact ELITE Medical Experts to find a nationally recognized expert specifically chosen for your case.