When you have what you regard as a suspicious record or handwritten entries, the following clues should alert you to the need for a document examiner and/or handwriting expert.

You were treated by many doctors over a period of time and cannot be sure which one was responsible or whether they all were.

A mugger sticks a knife in you and kills you or leaves you maimed for life. A surgeon sticks a knife in you, and kills you or leaves you maimed for life. What is the difference between the two? The mugger will go to jail and the surgeon will not. Why? Because you consented: you signed a consent form and gave the surgeon permission to stick the knife in you.

Before you decide whether you have a legitimate complaint for lack of informed consent, let us look at some of the ways you can consent to a doctor’s treatment and some of the ways a doctor can treat a patient without that person’s formal consent.

To work on a patient without anybody’s consent, a doctor must comply with four requirements: 1. The patient is in dire danger. 2. The patient is unable to consent. 3. If the patient is a child, a parent or guardian is not readily available. 4. It can be reasonably assumed that the patient would consent if able.

Does he have to tell you everything he is going to do? Go through the surgical operation step-by-step? Warn you about every possible complication? Discuss all possible alternative treatments, even if they are hardly ever used? What if the chance of a certain complication is one in a million? What if it is one in ten? How about a 50-50 chance?

Lawyers call this the Lay Standard, because it is based on what a layman (the patient) understands and not what a professional thinks she needs to understand.

A physician or dentist does not undertake to cure you. He only has to do his best for you according to the standard of care for his community or medical or dental specialty. If he did not, you have a legitimate complaint. If he did, you probably do not have a case, no matter how disastrous the results.

You have already read about the New Jersey case, which held that a podiatrist cannot be expected to treat a cardiac arrest, because he is only trained to work below the ankle. However, an Arizona podiatrist treated an elderly man for pain in the leg and lameness.

You are sitting outside the treatment room of a hospital when you hear one nurse say to another, “Dr. Jones is butchering that poor patient!” The patient is your mother.

Exposure to water damage can cause illnesses and distressing symptoms in susceptible individuals. Some of the problems are of an allergic or immunologic nature, some from the irritant effects of microbial volatile organic compounds ,but the causes for many other symptoms remain unknown.

Often, requests are made for psychological testing as part of the child custody evaluation (CCE) process, and too often, the results are disappointing. The root cause of this is two fold: lack of practicable and executable referral questions and findings that are presented in jargon-based, non-behavioral terms.

Choussat’s “Ten Commandments”, to describe the components of an ideal Fontan candidate, were first published in 1977. Despite the wisdom of these commandments, it is clear from a historical perspective that total compliance with all criteria does not necessarily portend excellent long-term survival. We believe it is time to modify the original commandments with the end-point being an improvement in survival. We suggest the following single commandment, “Thou Shalt Be Perfect”.

Brief overview of PA scope of practice and supervising physician role and relationship. Recommendations for the use of PA experts to provide opinions on the standard of care.

Aortopulmonary collateral vessels are extremely common in single ventricle patients. We present the rationale that these vessels are not innocent bystanders and can lead to significant hemodynamic, neurohormonal and mechanical perturbations ultimately leading to ventricular dysfunction.

Tests such as the Thematic Apperception Test, the House-Tree-Person (HTP), Human Figure Drawing (HFD) and the Draw-A-Person (DAP) “tests” are inappropriate for use in a forensic context.

When an analyst is presented with an insufficient amount of DNA to obtain a full profile, should an individual be included in a mixture? Should we assume the remainder of the profile by resonable assumption or should we find further evidence/arguments. Secondary transfer of DNA is being studied due to potentially incarcerating the innocent.

Change causes crisis and crisis causes change; nevertheless, too many people are capitalizing on the current state of --well everything, and providing mental health treatment without a license. This article is of particular interest to anyone who has been injured by seeing a “life coach” or someone providing coaching or counseling services without a license.

Orthopaedic surgeons assist in medical/legal evaluations in several ways. Orthopaedic expert witnesses may evaluate claimants with musculoskeletal injuries in cases that require an objective unbiased physical examination and/or expert orthopaedic opinion for settlement, negotiations, or trial.

Since no studies are done to confirm natural hair that is sold to merchants or individuals are free and clear of controlled substance contamination, the consequences of placing donor’s hair within your own should be considered as a potential threat to your job or status within your family or community.

Standards of practice (standards of care) are guidelines used to determine what a nurse should or should not do. Standards may be defined as “ a benchmark of achievement which is based on a desired level of excellence”. Standards of care (SOC’s) measure the degree of excellence in nursing care and describe a competent level of nursing care.

Poppy Seeds as a False Positive Result

Computational fluid dynamics (CFD) studies of airflow in a digital reference model of the 17-generation airway (bronchial tree) were accomplished using the FLUENT® computational code, based on the anatomical model by Schmidt et al. (2004). The lung model consists of 6.744•106 unstructured tetrahedral computational cells. A steady-state airflow rate of 28.3 L/min was used to simulate the transient turbulent flow regime using a Large Eddy Simulation (LES) turbulence model.

Patients who leave without being seen and how to reduce risks with follow-up programs.

The forensic expert must be qualified and very familiar with the literature in the field about which he is going to express that opinion in addition to having extensive clinical experience in the field. Over the past 36 years, I not only have been a forensic psychiatrist but also a clinical psychiatrist spending about half of my time in clinical practice.

The therapist as expert witness: reasons the treating psychotherapist should not be the expert witness.

Attorneys rely heavily on experts for many cases, and a Registered Nurse can be critical in managing a Medical Malpractice case. One of the most daunting tasks for attorneys, paralegals and LNCs is finding an appropriate expert witness. Many qualified nurses are busy doing their jobs in hospitals, clinics and nursing homes and are “hidden” from view. This, in conjunction with the frequency of the urgency factor in securing an expert, provides a great opportunity for both nurses and attorneys.

When it comes to medical legal liability, we all know the system is broken. Risk in the emergency department, of concern both to practicing physicians and administration, is no exception. Add emergency care for children into the mix, and the level of concern increases even more.

Nationwide Physician Assistant Malpractice Demonstrates Lower Malpractice Incidence and Average Payment Amounts over a 17 Year Period Compared to MDs and Advance Practice Nurses

Medical negligence litigators seek to establish which clinical standards are pertinent to their case, define what these clinical standards are, and then set out to demonstrate how the clinical standards were not followed.

To accept or reject a medical negligence case: this is the single most important decision you will make when processing a medical negligence case. If you choose unwisely, either a case with good potential will be lost, or an unmeritorious case will tie you up for long periods of time at great expense.

How much should I charge for my expert witness services? It’s an important question that will determine the success of your consulting practice.

By their very nature, managed care contracts carry a great deal of business risk, including the insurance risk that contracted rates may not cover costs; the financial risk of being paid late, or even underpaid; and the legal risk of being contractually barred from pursuing the patient, the employer, or even the payer, under certain circumstances.

Pain and addiction can often co-exist. Approximately 33% of the population has tried illicit drugs, and about 6.5% actively abuse illicit drugs. Pain management and prescription drug addiction is a serious health crisis facing the world today. The author examines the disadvantages of this situation.

The article by Dr. David E. Arredondo was published in the Standford Law and Policy review and explains principles of child development and discusses the various ways children of different developmental stages experience the same sanction. It goes on to describe different sanctions and their effects on children, and then to urge decision-makers to tailor sanctions to each offender’s individual developmental, emotional, and social circumstances.

Reciprocal Connectedness and the Limitations of Attachment Theory in the Family and Dependency Courts.

Over the past several years, the number of bariatric surgery operations (surgery for weight loss) has grown from a handful to over 150,000 procedures per year in the USA alone, increasing faster than any other procedure. Since these procedures are complex and the patients are of high surgical risk, the number of complications and mortalities are significant. Inevitably, concerns about malpractice have followed.

Review for Merit & Causation: The review of a patient’s medical record can be a complicated and daunting task. The documents are different from institution to institution.

The "bible" of diagnoses, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision, known as the DSM-IV-TR and published by the American Psychiatric Association is extensively used by psychiatrists, psychologists, social workers and most other mental health professionals in the U.S., Canada and abroad to provide a common nomenclature for diagnostic purposes and for communicating about mental disorders.

Psychological assessment is an invaluable and inestimable tool in the understanding of individual uniqueness. A comprehensive assessment helps explain the connection between psychological functioning and behavior. To be comprehensive, an assessment needs to examine a range of psychological factors.

Guardians ad litem originate from a practice in the English Court of Chancery when the King, under his parens patriae powers, would appoint a guardian ad litem to protect the interests of the infant. Today, the court appoints child custody evaluators, (GALs) whenever it believes it necessary to protect the interests of a child in a judicial proceeding.

When deciding upon an expert one might want to consider the following questions: • Has the expert ever testified before? How many times? • How does the expert present in court? Is he well organized and is his thinking logical and easy to follow? • Is he a member of major professional organizations? • Does he employ well-known and generally accepted psychological tests?

Cross-examining mental health experts is often a difficult challenge for attorneys as they are un-familiar with the material. I will discuss the most commonly used psychological measures and key points to keep in mind when questioning experts, either in deposition or on the stand.

Parent Alienation Syndrome (PAS) in custody cases

The contents of the medical record, such as deviations from standards of care, inaccurate or incomplete documentation can make the difference in your pressure ulcer case.

Post Traumatic Stress Disorder, or PTSD, is a psychiatric diagnosis that is overused in civil litigation. Plaintiffs inappropriately claim to suffer from PTSD despite the fact they they did not experience a life-threatening, horrific circumstance. The role of subjectivity in psychiatric diagnosis is explored and the objective criteria for PTSD are explained.

As an attorney, any time you or your firm handles a case where health, illness, or injury is an issue you are going to need to review medical records. Whether you are a plaintiff or defense attorney, everyone needs to analyze and understand the contents of the medical record, and face it; they can be extensive and seem like a complex mystery.

Many people think psychiatric illness routinely renders patients incompetent to make important decisions about their lives. This month’s column, by Dr. Brian Crowley of Washington, DC, attacks that myth and discusses some situations in which clinicians must address their patients’ mental capacity. William H. Reid, MD, MPH

Trauma medicine can be somewhat like doing a jigsaw puzzle backwards. Outwardly, you know there are interlocking sides and flat sides. You don’t know which pieces are the top or bottom, which are the picture, or what the picture is about. To do a puzzle backwards takes a specific sequence of priority and planning.

Disaster preparedness is no longer just an accreditation issue. “All Hazards” disaster planning is no longer just a requirement of qualifying for federal grants. Education is no longer a last priority. Disaster planning, preparation and education are the newest legal shield for the healthcare corporate officer.

Adult Attention Deficit Disorder affects 4% of the population, and an even higher percentage of criminal defendants. It is a valid diagnostic concept, and treatment with correct medications is usually effective in some behavioral change.

The Science of Eyewitness Testimony Published in the Los Angeles Lawyer Magazine, October, 2007

In nearly every meritorious missed cancer case there comes a time when the defendant’s attorney, losing on the facts, considers use of The Doubling Time Defense. By that time, the Plaintiff has already shown beyond doubt that the defendant physician had a Duty to take care of the patient and that there probably was a Breach of the Standard.

Is the defendant guilty? Is the defendent suffering from a mental health malady that prohibit's him from understanding the nature of the crime? Is the defendent able to consult with a lawyer and fully understand the charges against them?

The growing shortage of nurses in the United States as well as in California has been well publicized over the last few years. In response, numerous studies have been conducted to identify the causes, analyze the issues and determine solutions.

Do you need a mental health expert in your corner? Mental health and the justice system have been working side by side for decades. Forensic Mental Health Professionals have been called upon to evaluate and/or assist in many cases over the years.

Wills are generally contested either on the grounds that the testator lacked Testamentary Capacity (was incompetent to make a will at the time of signing it) or the testator, because of his/her mental state, was subject to Undue Influence (i.e. if there is evidence of coercion, manipulation, deception, compulsion, intimidation, etc.) or an Undue Influence secondary to a thought disturbance (such as delusions affecting the testator's free will in making decisions).