Plaintiff Experts Research Articles

Vascular Surgeons as Expert Witnesses in Malpractice Litigation

This study investigates the role of vascular surgeons as expert witnesses in United States' malpractice claims. We reviewed the Westlaw database from 1999 through 2014 using the search terms "vascular" and "surgeon". Case defendant, plaintiff, allegation, and verdict were compiled. Surgeon expert witness demographic data including age, practice duration, scholarly impact (H-index) and practice setting were reviewed using faculty websites, state licensing boards, and Scopus database. A total of 785 cases were identified, Three-hundred seventy-seven with a vascular surgeon as the plaintiff or defense expert witness. Vascular surgeons were defense experts in One-hundred thirty one (34.75%) cases, plaintiff experts in One-hundred eighteen (31.3%), both plaintiff and defense experts in Ninty six (25.46%), or unspecified in Thiry two cases (8.29%). Two-hunder eighty three individual expert witnesses were identified. Vascular surgeon experts who testified 4 or more times were likely to be plaintiff experts (32.5% versus 18.7%, P <0.05). Mean years of practice (23.5 versus 24.2, P=0.10) between plaintiff and defense experts was comparable. Plaintiff experts were more likely in non-academic practice (64.4% versus 52.5%, P <0.05) with lower scholarly impact (H-index 12.8 versus 16.7, P <0.05). A small percentage of vascular surgeons were experts in multiple cases, especially as plaintiff witnesses. Vascular surgeons as plaintiff's witnesses have similar years of age, work less in an academics, and have lower scholarly impact than defense witnesses. While national organizations provide guidelines defining expert witness qualifications, the required credentials vary by State. Development of minimum qualifications nationally may improve consistency in expert credentialing and lead to more ethical trial representation.

Legal Briefs: Tachysystole, Uterine Rupture, and a Bad Outcome.

EDITOR’S NOTE The Legal Briefs feature is based on actual malpractice cases with opinions of the plaintiff and defense physician experts interspersed throughout the case. The format of this feature does not provide evidence that supports or refutes each of these opinions. A 30-year-old gravida 3, para 1 woman presented at 41 weeks’ gestation for induction of labor. The pregnancy had been unremarkable. Two years before this pregnancy, the woman had undergone a cesarean after protracted labor that resulted in the delivery of a term healthy infant. For this pregnancy, a decision to induce labor and have a trial of labor after cesarean was agreed upon by the woman and her obstetrician. Increasing amounts of oxytocin were administered. Nine hours after induction was started, her contractions dramatically increased in frequency. The intervals between the peak of contractions varied between 60 and 90 seconds and the time between the end of one contraction and the beginning of the next was less than 1 minute in most cases. Long periods of tachysystole emerged. The obstetrician retained by the plaintiff stated that the treating obstetrician was required to decrease or discontinue the oxytocin when the contractions became too frequent. He explained that the time between the peak of one contraction and the next contraction needed to be at least 2 minutes and the interval between the end of one contraction and the beginning of the next needs to be at least 1 minute. He pointed out that these intervals were not maintained. He further explained that fetal gas exchange occurs during the rest phase between contractions and therefore, without proper rest intervals, gas exchange will eventually be compromised. He further pointed out that even the definition of tachysystole was met multiple times. He explained the definition of tachysystole was more than 5 contractions …

Legal and evidenced-based definitions of standard of care: Implications for code of ethics of professional medical societies.

Background:The concept “standard of care” (SOC) is invoked in legal cases, as well as evidence-based, and professional/ethical discussions in medicine and surgery.Methods:We reviewed key legal cases and relevant evidence-based medical articles, and then explored the implications for professional societies seeking to set guidelines for their members testifying as expert witnesses.Results:First, the legal concept of SOC plays a role in malpractice cases in assessing whether a physician's behavior was “within the SOC.” The concept of SOC has evolved from a “standard of a responsible body of medical opinion” (Bolam case), which implicitly did not allow for multiple SOC, to a more evidence-based approach. Second, according to the evidence-based medical literature, there is more than one SOC in medicine and surgery, including neurosurgery. Third, professional, medical, and surgical societies have evoked the concept of SOC to set ethical guidelines for how their members should behave when testifying as expert witnesses. Specifically, the literature argues societies should avoid abusing singular, self-serving definitions of the SOC to sanction members, typically plaintiff's experts, who offer alternative SOC in depositions or in court.Conclusions:Recent legal decisions suggest that testimony should be based upon scientific evidence. The scientific evidence indicates that there is often more than one SOC. Thus, any subspecialty society, including the American Association of Neurological Surgeons, that ignores evidence-based medicine and the existence of multiple SOC, risks the appearance of fostering self-interest at the expense of patient care.

Legal Briefs: Parainfluenza and Immunocompromised Twin

A 21-year-old gravida 4, para 3 African-American mother developed preterm labor. After a course of antenatal steroids and 2 days of tocolysis, dichorionic twins were delivered at 31 weeks'gestation. Twin A, with a birthweight of 1,600 g, was delivered via normal spontaneous vertex delivery, with Apgar scores of 7 and 8 at 1 and 5 minutes, respectively. Twin B required a cesarean delivery secondary to placental abruption, had a birthweight of 1,340 g, and Apgar scores of 7 and 8 at 1 and 5 minutes, respectively. Twin A was briefly given nasal continuous positive airway pressure and had an uneventful course. Twin B required a brief period of intubation, but also had an uneventful course. Four days before discharge of twin A, when he was 5 weeks old, 3 infants in the NICU developed nasal congestion and were tested with the direct fluorescence antibody (DFA) method for parainfluenza virus (PIV). Type 3 PIV was found in all 3 cases. The treating nurses, respiratory therapists, and physicians were questioned on depositions why only those 3 infants were tested as there were 5 infants in the room and dozens in adjacent rooms in the NICU. The treaters explained that they only tested infants who had symptoms of nasal congestion. The plaintiff experts were critical of this approach because the asymptomatic infants in the room were likely exposed, colonized, and had a high risk of being infected; all NICU infants were immunocompromised, and the preterm infants were especially vulnerable. Furthermore, the plaintiff experts explained that symptoms would not necessarily manifest as, or be limited to, nasal congestion in a newborn infant. The symptoms could manifest as apneic episodes, tachycardia, respiratory distress, or in other ways. Moreover, the plaintiff pointed out that type 3 is the most virulent form of PIV. The treaters were …

The collapse of the Sella Zerbino gravity dam

When a severe flood wave completely filled the Ortiglieto reservoir on August 13, 1935, the 14m high “Sella Zerbino” secondary dam failed catastrophically causing >100 casualties. Both of the dams, Sella Zerbino-Zerbino Saddle and Bric Zerbino-Zerbino Peak (Fig. 1) were overtopped but only the Sella Zerbino failed whereas the main barrage did not suffer any damage. The lawsuit that followed this tragic event ended with a full acquittal of the dam's designers since the plaintiff experts succeeded in demonstrating that the collapse was due to an extreme rainfall storm of unpredictable intensity. The case was then officially closed and still today the failure of the Sella Zerbino dam is attributed to the unpredictable hydrological event. Recently, Natale and Petaccia (2013) re-examined the case assessing the capacity of the flood spillways which equipped the Bric Zerbino dam. This paper thoroughly reviews the mechanics of the collapse of the Sella Zerbino dam focusing on the stability of the structure. The water pressure underneath the dam and the poor quality of the foundation rock is believed to have played a major role in the sequence of events that ended in the collapse of the barrage.

The Role of the ‧SNFologist' in Today's Transitional Care

The Role of the ‧SNFologist' in Today's Transitional Care

Legal Briefs: Anemia From Rh Hemolytic Disease of the Fetus and Newborn

A 3,480-g male infant was born at 36 weeks' gestation to a 32-year-old gravida 1 para 1 woman whose pregnancy was complicated by a group B Streptococcus –positive cervical culture result and hemolytic disease of the fetus and newborn (HDFN) due to Rh incompatibility. The prior pregnancy resulted in an infant who was healthy but whose records were unavailable during litigation. On an early prenatal visit for the current pregnancy, the mother's antibody screen result was positive with a titer of 1:8, at which point the obstetrician gave her an injection of anti-Rh antibodies (Rho[D] immune globulin, sold under the brand name RhoGAM). The pregnancy was not monitored for HDFN; the antibody titers were not drawn again until the day of delivery. The plaintiff obstetrician was critical of the treating obstetrician for administering RhoGAM because the patient was already sensitized, for not following the antibody titers, and for not performing aggressive fetal surveillance required in an Rh sensitized pregnancy. He pointed out that the antibody titers of 1:32 or less require serial antibody titers every 2 to 4 weeks. When and if the titers become 64 or greater, then titers and serial amniocentesis become necessary. Because the mother experienced decreased fetal movement for 1 day, her obstetrician admitted her for an evaluation. The plaintiff experts pointed out that decreased fetal movement underscored the anemia, indicating the fetus' attempt to conserve energy. The biophysical profile was found to be 2/10, the only normal score being normal amniotic fluid volume. Of note was an increase in liver size and mild ascites on the fetal ultrasonogram. Pericardial and pleural effusions were not present. The plaintiff experts pointed out that abdominal fluid collections precede pleural and pericardial effusions in hydrops from HDFN. The antibody titer was 1:2,048. The plaintiff obstetrician pointed out that this …

Legal Briefs: Iatrogenesis: Prolapsed Umbilical Cord After Artificial Rupture of the Membranes and Unskilled Stabilization

* Abbreviations: AROM, : artificial rupture of the membrane ETT, : endotracheal tube FP, : family practitioner HR, : heart rate PPHN, : pulmonary hypertension of the newborn PPV, : positive pressure ventilation A 3,530-g term infant was delivered to a 22-year-old G1P0 mother who had an unremarkable prenatal course. She smoked during pregnancy and had a placenta previa that resolved by mid-gestation. A family practitioner (FP) was the treating physician during pregnancy. He decided at 39 1/2 weeks’ gestation to induce because of “uterine irritability.” When asked during the deposition why he induced labor, he said that the mother complained of abdominal discomfort, and she was at high risk because of her smoking. The plaintiff obstetrician was critical of the decision to induce because a valid reason was lacking, in his opinion. The defense obstetrician countered by saying 39 weeks is an acceptable gestation to induce. The plaintiff obstetrician said it was very unlikely that a successful induction would occur because the mother was a prima gravida, the fetus was large, and the cervix was unfavorable. Induction was by dinoprostone, followed by oxytocin (Pitocin®, JHP Pharmaceuticals, LLC, Rochester, MI) augmentation. When the cervix was 70% effaced and 2 cm dilated, and the fetus was at a −2 station, the FP decided to rupture the membranes. A few minutes after artificial rupture of the membranes (AROMs), multiple severe variable decelerations occurred, and 8 minutes after AROMs a prolapsed cord was discovered; the fetal heart rate (HR) became 50 beats per minute. The plaintiff obstetrician was critical of the decision to rupture the membranes because the fetal head was not engaged. The FP defendant said that the head was “well applied” to the cervix. The defense obstetrician said that because the FP said the head was well applied to the cervix, it was within standard of care to perform AROM even if the head was not technically engaged. All agreed that engagement of the head meant that in cephalic presentations …

Legal Briefs: Devastating Consequences From Prolonged Use of an Umbilical Arterial Catheter

A 960-g, 26-3/7 weeks’ gestation male twin B was delivered by normal vaginal spontaneous delivery in the breech position to 31-year-old, healthy, gravida 3 para 1 mother whose pregnancy was complicated by preterm labor and diamniotic dichorionic twins. The mother received antibiotics, a partial course of betamethasone, and magnesium sulfate for tocolysis. At delivery, the infant had a heart rate (HR) less than 100 beats per minute, no respiratory effort, and was blue. The infant was intubated and required resuscitation, including chest compressions for 15 seconds, and 2 doses of epinephrine via an endotracheal tube (ETT). Apgar scores were 2 at 1 minute, 4 at 5 minutes, and 7 at 10 minutes. The infant was then admitted to the NICU, where an umbilical venous catheter (UVC) and an umbilical arterial catheter (UAC) were placed. The UVC was placed in the right atrium, where it remained until its removal several days later, and his UAC was placed appropriately at the seventh thoracic vertebrae and removed on day 13. The infant’s vital signs and blood pressure were normal. He had respiratory distress syndrome, for which he was given 3 doses of surfactant. Initially, the infant required 100% oxygen, but after several hours, the inspired oxygen was weaned to 30%, and the ventilator settings were low. His initial complete blood cell count revealed a white blood cell count (WBC) of 3.1 × 103/uL, a platelet count of 185 × 103/uL, and a hematocrit reading of 51% (0.51). The infant was given ampicillin and gentamicin after blood culture results were obtained, and he was started on low-dose indomethacin for intraventricular hemorrhage prophylaxis. On day 1, the fraction of inspired oxygen (Fio2) and ventilatory settings were low. The blood gas values were normal, with some permissive hypercarbia in the …

Legal Briefs

Twins (31 3/7 weeks) were born to a 31-year-old healthy mother with a pregnancy remarkable for an accidental administration of epinephrine at 10 3/7 weeks. The mother was experiencing severe hyperemesis gravidarum for which her physician ordered intravenous (IV) dolasetron mesylate (Anzemet®, sanofi-aventis, Bridgewater, NJ), but the outpatient nurse unintentionally administered epinephrine instead. The nurse gave the mother 1 mL of the 1:1,000 concentration of IV epinephrine. In adults, the dose of epinephrine for anaphylaxis is 1 mL of 1:1,000 solution intramuscularly or subcutaneously, and for cardiac arrest, it is 1 mL of 1:10,000 intravenously. The plaintiff experts pointed out that this mother received a concentration of epinephrine 10-fold higher than that used for cardiac arrest; for the 10-week fetuses, they were likewise exposed to a mega-dose. The mother immediately became pale and dizzy and developed chest pain, shortness of breath, tachycardia, and hypertension. An electrocardiograph showed a subendocardial myocardial infarction. A perinatologist closely observed the twins before and subsequent to this event. The twins were diamniotic monochorionic (DiMo) males as a result of in vitro fertilization (IVF). A week after the epinephrine administration, the mother experienced vaginal bleeding and an ultrasound showed a “possible subchorionic hematoma.” At 14 5/7 weeks’ gestation, 30 days after the epinephrine mishap, discordance was noted in the twin size (121 g and 96 g). The larger twin had polyhydramnios, for which 220 mL of red-brown amniotic fluid was removed. Both bladders were visible. No further amnioreduction was needed for the remainder of the pregnancy. The twin-to-twin transfusion syndrome (TTTS) met the least severe grade of the Quintero grading system (I of V). At 30 4/7 weeks’ gestation, the mother experienced a mild brownish discharge. On external monitoring, regular uterine contractions were occurring. The mother was admitted for IV tocolysis and antenatal steroids, …

Legal Briefs

A 37-weeks'-gestation infant whose birthweight was 3,572 g was born in 1991 to a 23-year-old G2P1 woman. A previous pregnancy with a 3-kg infant was complicated by the need for a cesarean delivery secondary to cephalopelvic disproportion (CPD). The mother was 5 ft 3 inches tall and weighed 160 pounds before the current pregnancy. After contractions began, she was admitted to the hospital. Her membranes ruptured spontaneously and resulted in clear fluid. After several hours of labor, an internal monitor was placed and an epidural was provided. The second stage of labor was 1 hour and 15 minutes. Forceps were applied. The medical records indicated mid and low forceps. The treating obstetrician denied using midforceps. Shortly after the forceps were applied, the fetal heart rate declined to ∼90 with the development of several deep variable decelerations. Shoulder dystocia developed. According to the plaintiff obstetrician, the treating obstetrician should have known about the CPD with the previous pregnancy and recognized that the pelvis was untested. The treating obstetrician stated that previous knowledge of CPD would not have influenced his decision because operative deliveries carry risks, and, because the pelvis was not tested, he considered it was good judgment to allow a vaginal delivery. The plaintiff obstetrician pointed to the record that the infant was too high when forceps were applied, and it was a risky maneuver that is known to be associated with shoulder dystocia. The fetal heart monitor was removed 5 minutes before the vaginal delivery. The infant was delivered lifeless. Resuscitation consisted of intubation, positive pressure ventilation, chest compressions, two doses of Narcan, three doses of epinephrine via the endotracheal tube, an umbilical arterial line placed at 6 minutes, as well as 6 mEq of bicarbonate at 13 minutes. The chest compressions were discontinued at 15 minutes. Apgar Scores …

Legal Briefs

A 3,760-g 38 weeks' gestation African American male was vaginally delivered to an 18-year-old woman whose pregnancy was normal. Apgar scores were 8 and 9, at 1 and 5 minutes, respectively. The mother's blood type was O Rh-positive. The Direct Coombs was negative. He was gavaged once and put to breast twice, but data on latching or audible swallow were not documented. The mother and infant were discharged at 31 hours after delivery. The nurses noted that there was “no jaundice” when the infant left the hospital. No bilirubin assessments were made. At the time of discharge the mother was told to call the pediatrician's office after a week to obtain an appointment. A phone number was provided. She was told to call sooner if there were problems. Before the delivery, the mother had been living in a group foster home for many years. Because she had just turned 18 years old, she was not allowed to return to the group home, but was told to go an apartment that had been set up for her through social services. The plaintiff experts were critical of the hospital for early discharge because 1) feeding issues existed, 2) the mother was a teenager and had no support structure, and 3) an immediate follow-up appointment either by a visiting nurse or a pediatrician was not scheduled. The mother stated in her deposition that she did not feel that her infant ever fed well, in the hospital or at home. She said she felt scared staying in her new apartment and tried staying with her sister. However, because of overcrowding at her sister's, she returned to her apartment. She called her mother for feeding advice and was told to keep trying, that every infant is different, and there was probably no problem. The defense …

Legal Briefs

A 1,563-g, 30 weeks' gestation female infant was delivered to a mother whose pregnancy was complicated by a history of herpes, without recent outbreaks, and a history of a treated urinary tract infection and pyelonephritis in the first trimester. She developed preterm labor and was started on magnesium sulfate and antenatal steroids. Labor was halted for a few days, but when it reoccurred the infant was delivered by C-section. Membranes were ruptured at delivery and the fluid was clear. Apgar scores were 6 and 8, at 1 and 5 minutes, respectively. The infant had poor respiratory effort and was intubated in the delivery room. The infant was admitted to the newborn intensive care unit (NICU) where she received one dose of surfactant replacement therapy and was placed on assisted ventilation. An evaluation for infection was done, and Ampicillin and Gentamicin were started. On day 2 the infant was extubated and placed on nasal continuous positive airway pressure. Antibiotics were discontinued on day 2 because the blood culture was negative and the infant was asymptomatic at that point except for some apneic episodes. A contingency order was written at the time of extubation for the nurses to start caffeine if the baby began having apnea. Plaintiff experts were critical of the contingency order and stated that the doctors needed to be informed about the development of any new symptoms the infant experienced, including apnea. Only then could the physicians make an appropriate decision about the need for an evaluation and potential intervention at that point in time. Although the intervention for caffeine could be appropriate, apnea of prematurity (AOP) is a diagnosis of exclusion and the physicians needed to be informed of its development. Several hours after extubation, the nurses started caffeine for the apnea. On day 4 the nasal continuous …

Legal Briefs

A 2,385-g 35–6/7-weeks' gestation male was delivered to a 26-year-old woman whose pregnancy was unremarkable until 2 days before delivery. She was walking up the staircase in her mother's home during a family celebration where she briefly lost her footing, stumbled, and twisted her body, although she braced herself without falling. Two days later, she experienced vomiting, cough, shortness of breath, and severe left flank as well as chest and abdominal pain. The paramedics were summoned to her home, where they found her blood pressure (BP) to be only palpable and her capillary refill delayed. She had a heart rate (HR) of 74 beats/min, a respiratory rate (RR) of 16 breaths/min, and a pulse oximetry reading of 100%. She was conscious but weak. They inserted an intravenous line and began infusion of 1,000 mL of normal saline, leaving the stopcock wide open on the way to the emergency department (ED). The woman arrived at the ED 20 minutes later, at 0000. Her BP was 96/70 mm Hg, HR was 70 beats/min, RR was 70 breaths/min, and temperature was 35.6°C. She was conscious but drowsy and having difficulty breathing. On physical examination, she was pale and had tenderness on her left side. She was transmitting her history through her husband because she was so weak and only he could understand what she was saying. The ED physician's differential diagnoses were pulmonary embolism and pneumonia. Blood was drawn for a complete blood count (CBC), blood chemistries, activated partial thromboplastin time (APTT), prothrombin time (PT), and d-dimers. The treating physicians and defense experts pointed out that the woman was totally stable when she arrived at the ED and showed no signs of hypotension or bleeding on arrival. The plaintiff experts pointed out that her BP was not obtainable by the paramedics before the …

Legal Briefs

A 2,222-g 34-weeks' gestation male twin was delivered in the winter to a mother whose pregnancy was unremarkable except for diamniotic, dichorionic twins. This twin was delivered via normal spontaneous vaginal delivery. Apgar scores were 8 at 1 and 5 minutes. Both twins were admitted to the newborn intensive care unit because of their gestational age. The male twin exhibited tachypnea at birth and received a 7-day course of antibiotics. Findings on chest radiography were consistent with transient tachypnea, and a blood culture was negative after 1 week. Other than mild apnea of prematurity and a slightly elevated serum bilirubin concentration, his course was unremarkable. The mother missed several days of visitation near the time of discharge because she had an upper respiratory tract infection. The infant was discharged 16 days after birth at 36–1/7 weeks' gestation. He had three siblings at home: his twin sister, who was discharged close to the time he went home; a 3-year-old brother who had an upper respiratory tract infection; and a 7-year-old healthy sister. After being home for 6 days, when he was 22 days old (37 weeks' gestation), his mother called the pediatrician because the infant had developed nasal congestion, refused to nurse, and seemed excessively sleepy. The pediatrician reassured the mother over the telephone. A few hours later, she brought the infant to the hospital because he had vomited three times and she had ongoing concerns about his poor feeding and excessive sleepiness. On physical examination, the infant's respiratory rate was 40 breaths/min, temperature was 37.4°C, heart rate was 140 beats/min, and oxygen saturation was 97% in room air. The emergency department (ED) physician noted clear breath sounds, unlabored breathing, and moist mucous membranes. The ED nurse noted and documented a congested cough for the infant, and the heart rate was …

Legal Briefs

A 3,545-g, 35–3/7 weeks', large for gestational age (LGA) male is delivered to an insulin-dependent diabetic mother who became pregnant with the help of a fertility specialist. After conception, a general obstetrician managed her pregnancy. The antenatal course was uneventful except for a history of herpes simplex virus (HSV) infection. A cesarean section was planned at 38 weeks' gestation because of a relatively large fetus and a small pelvic outlet. The mother developed premature rupture of membranes (PROM) at 35 weeks' gestation, and 48 hours later, labor began. The obstetrician was out of town, and the mother was triaged to a midwife for the delivery. The mother's last HSV outbreak was 2 weeks before delivery, with lesions healing 4 days before delivery. The mother claimed in her deposition that she told the midwife about her history of herpes. The medical records from the fertility specialist and the obstetrician documented the history of HSV. The medical records reflecting the herpes were computerized and available to the midwife and the nurses who managed labor and delivery. The infant was delivered by a spontaneous vaginal vertex delivery. The Apgar scores were 8 at 1 minute and 9 at 5 minutes. The infant was asymptomatic and observed for 6 hours before rooming-in with his mother. Multiple bedside glucose evaluations were read as normal. A complete blood count (CBC) yielded unremarkable results. A blood culture was reported as negative on the final reading. Vital signs were stable. The infant was sleepy at the breast, but the mother fed him formula. The discharge examination was performed at 41 hours, and the only notable finding besides the LGA and late preterm gestation was that an ophthalmic examination could not be performed because the eyes were closed. The grandmother stated in her deposition that the baby's eyes were …

Legal Briefs

A 2,320-g 33–2/7-weeks' gestation male infant was delivered to a 30-year-old woman whose pregnancy was complicated by 4 days of premature prolonged rupture of membranes (PPROM). The mother was afebrile, and she received antenatal steroids and amoxicillin. When labor began, a repeat cesarean section was performed. Resuscitation consisted of blow-by oxygen. The Apgar scores were 8 and 8 at 1 and 5 minutes, respectively. The infant was asymptomatic, was not started on antibiotics, and received intravenous fluids via the peripheral route. A complete blood count (CBC) yielded unremarkable results. Blood cultures were drawn. On postnatal day 2, small feedings were begun. On day 3, results of a CBC and C-reactive protein (CRP) measurement were unremarkable. The pathology report available on day 2 showed chorioamnionitis with green discoloration of the membranes and nonspecific villitis. The blood culture drawn on the day of birth was negative on day 3. The infant continued to be asymptomatic until postnatal day 5, when he had a residual of 6 mL from a 17-mL feeding. Five hours later, he experienced an apneic episode. Shortly thereafter, he began having tachycardia, worsening apneic episodes, and elevated temperatures (37.8°C) despite a serial reduction in the ambient temperatures. The physician was not notified of any of the findings until many hours later, when the apneic episodes worsened. The plaintiff's experts were critical of the nurses for not notifying the physician of the gastric residual, the tachycardia, the elevated temperatures, and the apneic episodes. The nurses said in their depositions that they did not need to call the physician; they were entitled to make judgments about notifying a physician. The treating neonatologists agreed with the nurses. They further claimed that the apnea was probably due to reflux or apnea of prematurity (AOP) and that a residual of that magnitude was not …

Legal Briefs

A 2,980-g 35-weeks' gestation female infant is delivered to a 30-year-old woman whose pregnancy was complicated by chronic hypertension. Four days before delivery she had a clinic visit, and fetal ultrasonography performed at that time was read as normal. Two days later (2 days before delivery), the woman called the clinic because she began experiencing chills, a “crampy feeling,” and loose stools. She reported good fetal movement. Several hours later, she visited the emergency department because of additional symptoms of nausea, myalgia, back pain, and vomiting. During this visit, her temperature was 38.9°C. The long-term variability on a nonstress test (NST) was reported as fair, but one spontaneous deceleration was noted. The woman reported that fetal movements decreased from earlier in the day. (The monitoring strip was missing and unavailable for review at the time of litigation.) Complete blood count findings were unremarkable, and urinalysis showed 0 to 3 red blood cells and a large amount of hemoglobin. The plaintiff experts said the physician caring for the woman should have considered a transfusion reaction from the fetus because of the hemoglobinuria, the woman's symptoms, and the report of decreased fetal movement. A more detailed evaluation should have been performed, including a biophysical profile (BPP) and a Kleihauer-Betke test (KB). The box on the paperwork for “fetal movement” was left blank. The woman said in her deposition that she shared with the nurses that fetal movement was reduced. The plaintiff experts said this was the fetus' attempt to conserve energy because of the anemia. The defense experts said that the reduction in fetal movement meant that the damage already had occurred. The mother was discharged. Later that day, the woman visited her obstetrician and had a repeat NST. The obstetrician read the NST as reactive, although he stated on his deposition …

“I Never Wanted to Be a Quack!”

When medical practitioners act as expert witnesses for the plaintiff in contested illness lawsuits, they can be stigmatized by their professional community. Drawing on ethnographic research surrounding the condition multiple chemical sensitivities (MCS) in Australia, this article focuses on: how plaintiff experts specialize; their rationale for deviance from the professional norm; and structural constraints to medical advocacy. By diagnosing and treating the condition as organic, these experts oppose the accepted disease paradigm of the medical community and therefore face professional isolation and peer pressure. They rationalize their continued advocacy within a moral discourse, which includes a professional aspiration toward altruism, an ethical commitment to "truth," and the explicit emphasis that financial gain is not a motivation. For their deviance the experts have been confronted with professional disillusionment and emotional drain. Ultimately, the medical profession is disenfranchising experts who may be vital characters in the quest for understanding about environmental illnesses.

Forensic Engineering Critique Of The Methodology Eliminating Fire Cause Possibilities

In A Case Involving A Residential Fire With Fatalities, Plaintiff Experts Alleged That The Fire Originated In A Bedroom As A Result Of An Electrical Failure In An Oscillating Pedestal Fan. At The Time Of The Fire, The Fan Was Plugged Into A Six Foot Extension Cord That Was Lying On The Floor Under The Bed And Plugged Into A Standard 115 Volt Duplex Receptacle. The Plaintiffs, Specific In Their Allegations, Opined That The Failure Occurred In The Rotary Switch That Controlled The Speed Of The Fan Even Though No Physical Evidence Of A Failure Of That Nature Was Identified Or Collected During The Analyses Of The Fire Scene. Since No Physical Evidence Of A Failure Was Identified, Nfpa 921, Guide For Fire &amp; Explosion Investigations, Requires That All Other Potential Ignition Sources In The Area Of Origin Be Eliminated As A Possible Cause. Plaintiffs Eliminated The Power Cord For The Fan, The Extension Cord And The Cord Plug And Cord Receptacle Connection Under The Theory That The Material Was Pvc With A Vw-1 Fire Rating. Plaintiffs Testified That The Self Extinguishing Characteristics Of Vw-1 Material Were Such That, Even With An Electrical Failure In One Of Those Components That Resulted In The Ignition Of The Material, There Would Be Insufficient Heat Released To Ignite The Box Spring For The Bed. Plaintiffs Also Eliminated Improperly Discarded Smoking Material As A Potential Cause.Efendants Were In Sharp Disagreement With Plaintiff Case In Chief Regarding The Elimination Of The Vw-1 Materials As A Potential Fire Cause, Since The Material Will Combust In Situations With A Sustained Electrical Fault. Defendants Conducted Tests Which Not Only Demonstrated An Electrical Failure With Ignition At The Extension Cord Plug Receptacle Interface, But Also That The Burning Vw-1 Pvc Released Sufficient Heat Energy To Ignite A Box Spring Similar To The Box Spring Involved In The Fire. The Results Of Those Tests Assisted In The Resolution Of The Case Prior To Trial.