Expert Witness Blog

In Chest Pain & Medical Malpractice, medical malpractice expert witness Barry Gustin, M.D. writes:

As you can see, the evaluation of chest pain is often highly subjective and imperfect. The differential diagnosis of chest pain alone (approximately 20 common and 15 not so common entities) is enough to dazzle and amaze any attorney as he/she strives to understand the facts of the case. It is no surprising that 20% of malpractice dollar losses by emergency physicians in the US involve the diagnosis and management of patients with acute chest pain.

The only way to make sense of any medical case, especially the complex one, is to have a knowledgeable physician review it an give you the medical insight and understanding you seek.

Construction Accident Reconstruction, 2d edition, by Calvin Zemsky, P.E., and Jon R. Abele Esq, contains data and statistics about fatal and non-fatal construction accidents, OSHA Rules and Regulations, Life/Safety Codes and discussions of many construction accident investigations.

Litigation relating to construction site accidents appear on the court dockets of every judicial district throughout the country. The number of lawsuits filed because of accidents has grown year after year. Until now there has been no single place for a person to obtain the information of what a forensic engineer / accident reconstruction expert witness does when reconstructing an accident. This book, now in its second edition, fills that void. It has been updated and expanded throughout by Jon Abele, Esq. It also allows attorneys to learn the basics of forensic engineering while providing guidance to accident reconstructionists on how to conduct an investigation into a construction worksite accident.

In Dram Shop Laws – Improving Public Safety, dram shop expert witness Maj. Mark Willingham of Alcohol Solutions, LLC, writes:

The phase dram shop is based on a unit of measure popular in Victorian times; approximately 1/8th of an ounce in our vernacular, and has become synonymous with a prohibition on the over-service of beverage alcohol to a patron or guest. The principal purpose of dram shop laws is to protect the public; and even the drinker himself, from the over-service or over-consumption of beverage alcohol and from the service of alcohol to persons under 21 years of age. This law calls upon beverage licensees and their employees to play a significant role in the enforcement of this important public policy. No other business type comes to mind where the holder of a government license; by acceptance of that license, is required to act as an agent of the state in taking affirmative action to monitor and intercede in the behavior of a citizen/business invitee.

Responsible retailing involves the development and implementation of effective alcohol service policies, practices, employee training and management systems. These elements are the keys to responsible retailing and the prevention of acts and situations leading to a dram shop lawsuit. Conversely, irresponsible beverage retailers do not employ these elements or they have developed ineffective policies, practices, training and management systems that fall below a reasonable standard of care.

Risk management expert witnesses may provide testimony regarding value at risk, risk management plans, and the risk management process. The Professional Risk Managers’ International Association, an independent association of professional risk managers from diverse industries in more than 150 countries uses the following definition in their Principles of Good Governance:

Governance – The framework of authority for an organization within which its institutional objectives are pursued and within which risk management operates.

Risk – Unknown future circumstances that alter the value or well‐being of an organization or system.

Livestock production expert witnesses may opine on growth hormones,livestock diseases, and related topics. Here, the EPA writes on Animal Feeding Operations (AFO):

AFOs are agricultural operations where animals are kept and raised in confined situations. AFOs generally congregate animals, feed, manure, dead animals, and production operations on a small land area. Feed is brought to the animals rather than the animals grazing or otherwise seeking feed in pastures. Animal waste and wastewater can enter water bodies from spills or breaks of waste storage structures (due to accidents or excessive rain), and non-agricultural application of manure to crop land.

Read more: epa.gov.

Aerosols expert witnesses may write reports and opine on aerosol sprays, airborne solid particles, and household chemicals. The National Aerosol Association writes: Let’s Set the Record Straight on Aerosols!

Q. What are aerosols, anyway?

A. Aerosols are very fine particles of liquid or solid substances suspended in air. Fog, for example, is a normal aerosol. In aerosol packaging, the substance to be sprayed is propelled through a valve as a fine mist or foam. This provides a safe, efficient means of dispensing thousands of consumer products such as shaving cream, hair spray, paint and antiperspirants.

In Documents, Documents and More Documents, construction site expert witness writes:

Some cases have as few documents as 50 to 100 pages for an expert to review, while others have thousands. When choosing an expert witness for a case, an astute attorney needs to consider whether the case will have a large volume of pages of documents and/or evidence.

The reality is that, while an expert may have the qualifications and expertise for the case, not all experts are equipped to document, catalog or evaluate large volumes of documents and evidence efficiently or properly — this requires a qualified and trained staff. “The devil is in the details,” and thousands of pages to review means thousands of details, all potentially significant.

Bicycle expert witnesses may write reports and opine on bicycle safety, bicycle accidents, and bicycle helmets. In Precious Protection, Bicycling.com writes on helmets:

Helmet designers have learned a lot in 60 years. You might notice that, for instance, the sides of your lid have more material, because, according to Thom Parks, vice president of corporate a! airs at Bell Sports, scientists know that, “Getting hit from the side is more likely to concuss than from the front or rear.” He also says that helmets are designed to protect against impacts to the temporal bone “above and to the rear of the eye, which is the thinnest part of the skull and more easily broken.”

These are just a few of the examples of how modern helmets are far safer than those from even a decade ago. Further proof that helmets are safe: Don’t wear one and you die. According to the Insurance Institute for Highway Safety (IIHS), since 1998 thousands of people have died in bicycle accidents, more than 90 percent of whom weren’t wearing helmets. In 2008, IIHS stats show that 714 cyclists were killed. Only 58 of those cyclists were wearing helmets. The rest, 656, were lidless.

In Chest Pain & Medical Malpractice, medical malpractice expert witness Barry Gustin, M.D. writes:

The quality and quantity of pain itself is highly variable and in some situations may be totally absent and yet an AMI be in progress. Blunted pain responses commonly seen with underlying chronic disease in elderly patients frequently mask AMI and can stear a complacent physician away from the true diagnosis. These patients may present with other symptoms and signs indicative of serious disease such as sweating at rest, increasing fatigue with less activity and shortness of breath. Physicians must maintain a high index of suspicion and entertain a full range of differential diagnosis when evaluating patients.

Other factors can complicate the decision making process such as the stoic patient with chest pain who wishes to leave the ER before receiving a complete evaluation. In this setting, it is important that the family be included in the evaluation so that all clinically relevant information is obtained. Enlisting the family’s participation may also ensure that the patient does not leave the ER prematurely. But even if such a patient refuses admission and the physician is concerned about the possibility of serious disease, a compromise can be struck and the patient can be convinced to stay temporarily in the ER while repeated exams are performed and serial ECGs and cardiac enzymes are obtained thereby increasing the likelihood of detecting acute myocardial disease.