Expert Witness Blog

Trademark expert witness William D. Neal is Senior Executive Officer at SDR Consulting and in Modeling Brand Equity, he writes on branding:

The measurement and management of brand equity has become a major issue for marketers and marketing researchers over the last several years. The concept of brand equity goes well beyond the legal concept of a trademark or the accounting concept of goodwill. Brand equity encompasses a gestalt of intrinsic values, or equities, that adds to the tangible, measurable benefits delivered by a particular product or service. These intrinsic equities may include such things as the image imparted to the purchaser, advertising quality, advertising quantity, trust, long term reputation for reliability, customer support, social responsibility, and so forth.

As an example, two unbranded home breadmakers may deliver the exact same set of features in terms of capacity, warranty, ease of use, display, color alternatives, and price. As long as these two breadmakers remain unbranded, they will be undifferentiated and therefore equivalent to the purchaser. But, if we label one of those breadmakers, say, an Acme and the other Braun, most purchasers will attribute additional, intrinsic, value to the Braun product. The two branded breadmakers are no longer undifferentiated and, to most consumers, the Braun breadmaker has more value. Most purchasers associate the Braun brand name with the intrinsic values of quality, durability, reliability, trust, and an image with which they want to be associated.

the Ninth Circuit Court of Appeals in San Francisco is deciding whether millions of women who work at Wal-Mart or are former employees can join a class action sex-discrimination lawsuit against the chain. Plaintiff’s attorney Brad Seligman says that discrimination was “a system-wide process” at Wal-Mart’s 3,400 stores and that their sexual discrimination expert witness found that “in every one of 41 regions, women got paid less than men” by an average of a couple of thousand dollars a year. As a class action it would be the largest civil rights suit in US history. Seligman wants to see all the women compensated and the company change its practices.

Excerpted from SFGate.com.

The Coalition for Affordable Health Care was in Pittsfield, MA, Friday to talk to the public and business owners about their coverage. Health New England President & CEO Peter Straley told them that a lot needs to change and the best way to get coverage costs under control is to take better care of ourselves. Our health should also include more conservative care. Too often, Straley says, doctors order more tests than are needed. “MRIs, CTs…these are exceptionally expensive, exceptionally important diagnostic tools, but we use them too much,” said Straley.

One local insurance expert says another way to rein in health care costs is to shop around. “As frustrated as employers are, they are having more options and they are taking advantage of the marketplace forces,” said True North Financial Services insurance broker Holly Taylor.

Pulmonary medicine expert witness Kathleen S. Adams, RCP, RRT-NPS, is an instructor and owner of Packmule Education & Consulting Services in Southern California. Also the president-elect of the California Society for Respiratory Care, here she writes on difficult airways.

Difficulty or inability to perform adequate bag-mask ventilation can be predictable in some patients, such as those with obvious facial trauma or beards that may interfere with obtaining an adequate seal. There are more subtle challenges-such as obstruction by the tongue, either by falling back or by swelling; airway edema or spasm; or blockage due to foreign body.

Difficult tracheal intubation can be related to the inability to visualize the glottic opening or those procedures requiring multiple and/or unsuccessful attempts to place the endotracheal tube. Reasons for these are many, including, but not limited to, upper airway edema, trauma, airway anomalies, obesity, limited neck mobility, or limited opening of the mouth. This could also be related to a lack of skill or use of improper technique by the practitioner. Without proper training in the endotracheal intubation procedure and/or proper use of a selected device, the practitioner can actually turn what could be a normal intubation procedure into a difficult one and increase the risk of complications to the patient as a result. To avoid this situation, practitioners expected to perform such tasks should first receive good basic training in the endotracheal procedure. They should then receive special training necessary for intubation pertinent to their patient population, followed by training for a specific device or technique in addition to standard laryngoscopy. No technique or device can replace good airway management training.

In Clinical Standards in Medicine medical expert witness Barry E. Gustin, MD, MPH, FAAEM, writes:

Although this clinical policy standardizes the approach to evaluating chest pain, the researchers responsible for its development emphasized its limitations stating that the reality of medical practice is that the physician is often gathering data, performing interventions and making decisions simultaneously, sometimes within a short period of time. Once again, the clinical policy is a reasonable standardized approach to the evaluation of chest pain but can never supersede the physician’s clinical judgement which, because of the immense number of clinical variables and continually changing circumstances, must be taken as the final word in making patient care decisions.

Clinical standard development is here to stay. Although they are a cause of consternation among many physicians because of their potential for use against physicians in medical malpractice lawsuits, they will, in the long run, help physicians continue to practice higher quality medicine, avoid malpractice, and more easily defend against frivolous or spurious lawsuits.

Pulmonary medicine expert witness Kathleen S. Adams, RCP, RRT-NPS, is an instructor and owner of Packmule Education & Consulting Services in Southern California. Also the president-elect of the California Society for Respiratory Care, here she writes on difficult airways.

What constitutes a difficult airway? It is important to have an understanding of this and particularly what is causing the airway difficulties that you are experiencing in order to better understand which Plan B may be your best option. There is however, no single generally accepted definition of a difficult airway. For the purposes of its practice guidelines for the difficult airway, the American Society of Anesthesiology set a definition of a clinical situation in which a conventionally trained anesthesiologist experiences difficulty with face mask ventilation of the upper airway, difficulty with tracheal intubation, or both. The guidelines continue that an airway proven to be difficult is a combination of patient factors, the current clinical setting and the skill level of the practitioner performing the airway maneuvers.

This article appears in RT for Decision Makers Magazine March 2009.

In Clinical Standards in Medicine medical expert witness Barry E. Gustin, MD, MPH, FAAEM, writes:

For each of these rules, there are corresponding guidelines which may or may not be appropriate to act on. For example, under character of pain, it may or may not be useful to ask about the onset of the pain, the severity, the location, whether radiation occurs, its frequency, duration, similar previous episodes, precipitating or mitigating factors, its relationship to exertion, rest, movement or deep breathing and so on. It is clear to physicians that although this information is relevant for many patients presenting with chest pain, there are times when this information does not apply and has no real utility, such as the young otherwise healthy patient with fever who complains of chest pain only when coughing.

Similarly, there are no absolutes about what constitutes appropriate adherence to the guidelines for physical examination. A physician may decide, based on the overall clinical picture of the patient, to listen to the lungs, percuss the lungs, X-ray the lungs, assess the oxygenation of the lungs by doing pulse oximetry or arterial blood gases and so on. It would be left up to the physician to decide whether these things were or were not appropriate to do.

Leading brain injury expert Dr. Neil Martin of UCLA Medical Center says that even falling from a standing position is “a six-foot fall as far as your head is concerned” and that relatively minor accidents can prove fatal.

The first three hours following the onset of a critical health episode like a stroke are critical. If care is delayed beyond this critical time window, the chance of recovery or even survival declines substantially. Much of the first hour following the onset of these critical episodes is spent simply getting the patient to the emergency room. Then the patient must then be diagnosed, CT and MRI images and scans taken and developed. Finally, a specially trained physician must review the images and make a decision on the appropriate treatment protocol.

Dr. Martin is Founder/CEO of Global Care Quest and Chief of Neurosurgery at UCLA Medical Center. His company has developed a new wireless mobile technology that allows physicians to view CT and MRI images and scans from remote locations. This solution, ICIS Mobile, transmits images over high speed wireless networks to a physician’s cell phone or PDA.