Orthopedic Surgeon Expert Witness Report

To whom it may concern:

I, **************, MD, have been asked to review medical records of the above-named person.  These records pertain to the treatment of her knee arthritis and subsequent severe complications of wound dehiscence with multi-organism deep infection, wound necrosis, and multiple operations with plastic surgery.

I am a board-certified orthopedic surgeon has been in continuous active practice for 34 years. I have performed hundreds of total knee arthroplasties and revisions during this entire practice period.  I am currently an attending orthopedic surgeon at the ***** **** *****. I am involved in teaching orthopedic residents. At this medical center, we have concrete criteria for candidates for total knee arthroplasties.

In the process of review of records which are listed below, I have formed opinions which are outlined below and which are based on my education, my practice experience, and my continuing education. These opinions are based on scientific principles and evidence-based orthopedic literature.  I reserve the right to modify or supplement these opinions should additional opinions become available.  Should this case come to litigation, I have no financial interest in the outcome.

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Oncology Expert Witness Report

To whom it may concern: I am responding to your request to review the records that you electronically provided of Ms. M’s medical course and treatment in regard to the squamous cell carcinoma of the left inner ear that was diagnosed at ***** Hospital in NY in July 2011. These records were sent to me as electronic files:

1. Radiology Reports from Imaging Center ****
2. Metropolitan, Hospital Metropolitan, and Services *****
3. Medical Records from ***** **** Medical Center
4. Medical Records from ****** Medical Center
5. Department **** Medical Records
6. Laboratory Reports
7. 4/19/2011 MRI
8. 1/26/11 CT, 3/17/2011 CT
9. Complaint

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Oncology Expert Witness Report

Re: Jane Smith – Sample report – NY / NJ Expert

To whom it may concern:

I am a licensed and board-certified physician in internal medicine and oncology and eligible in Hematology. In the course of my career, I have been involved in clinical research and treatment of patients and had been chief or directory of divisions of Hematology in four institutions, including in a medical school. I developed clinical research programs in two institutions. I am licensed in NY and NJ. I am certified by the American Board of Utilization Review and Quality Assurance and have been in practice since 1990.

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Misdiagnosis of a Heart Attack

A heart attack (myocardial infarction) is the most common cause of death in both men and women. Failure to timely treat will result in further irreversible heart damage with the consequence of heart failure, or worse: death. Classical crushing chest pain is most common in men, but not in women (who more commonly experience jaw, back or arm pain, or just fatigue).

Whenever any adult has symptoms of a heart attack, the following test must be performed: an electrocardiogram (EKG), plus blood enzyme test to rule out heart muscle injury (troponin and CPK). Even if these are initially normal, the patient should be monitored in a hospital for 24 hours, and retested, especially if they have high-risk factors: a previous heart attack, high blood pressure, diabetes, high cholesterol (especially if their LDL {“lousy” cholesterol} is greater than 100), and if they have a family history of a heart attack. The failure to do this is a departure from the accepted standards of care.

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MRSA (Staph) infection

Methicillin-resistant Staphylococcus aureus (MRSA) is a very serious infection. MRSA is the cause of approximately 18,000 American deaths each year. This bacterial germ is present in many hospitals and can be spread through inadequate sterility techniques, including the failure of hospital and medical personnel to wash their hands thoroughly between patients, as well as breach of sterile operating technique.

Obtain the hospital’s documents on infection prevention to document the failures of following their own standards.

Prescription Medication Side Effects

Every year 2 million Americans have side effects complications from prescription medications. And 100,000 die.

Every prescription medication must have a Food and Drug Administration (FDA) approved “drug insert”. This must list the indications, contraindications, side effects, as well as incompatibilities with other medications. This is reprinted every year in the book: Physicians Desk Reference (PDR).

Every patient must be informed of the major side effects and questioned as to any other medications – prescription or over-the-counter (OTC) they may be taking, to reduce all their risks.

One consideration in your drug side effect cases is whether the prescribed medication was actually indicated, whether the dose was correct, and whether the least toxic drug was prescribed.

Missed Diagnosis of Appendicitis

The diagnosis of appendicitis is fairly straightforward. The patient usually presents with mid-abdominal cramping pain that localizes, within 12 to 24 hours to the right lower quadrant of the abdomen. A rectal examination usually documents pain in the right lower side. A pelvic examination helps to rule out an infection of the Fallopian tubes (usually from gonorrhea). The temperature is usually about 100 degrees, and the white blood count is slightly elevated.

When in doubt, surgery is warranted. As the hours’ pass, there is a risk of the infected appendix rupturing (perforating), resulting in an intra-abdominal abscess and risk of death. In children, the passage from the onset of appendicitis to perforation is usually less than 24 hours, and their risk of widespread intra-abdominal infection is much greater than in an adult.

Tubal Ligation Sterilization Causing Intestine Perforation

Laparoscopic tubal ligation surgery is performed through a narrow pipe inserted into the abdomen. Either a clip is placed in each fallopian tube, or it is cauterized (burned by the passage of electricity through a segment of each tube, causing it to char and seal).

Decades ago the electrocautery was of the “unipolar” design. This allowed the electricity to enter through the active electrode, while the current returned to the device through the body, and then via a ground electrode under the thigh. Unfortunately, the electric current had the risk of arcing into the nearby small intestine, burning a hole into this hollow organ. That would result in its leakage causing peritonitis (intra-abdominal infection) requiring emergency surgery.

The modern devices are called “bipolar” because the electric current flows only between each side of the pliers-like grasping instrument. Intestinal burns should never occur. If that happens, it is either from the surgeon negligently touching the metal end to the intestine, or the electrocautery was defective and not properly maintained by the hospital.

Missed diagnosis of Pre-Eclampsia

If the patient starts out her pregnancy with 130/70 and the 70 changes to 80, it must be looked at, not necessarily treated, but looked at. If the 80 goes up to 85, then you have to be concerned about the possibility of early pre-eclampsia, a high blood pressure condition in pregnancy which can cause damage to the mother and the baby. When there is high blood pressure in the mother, blood flow to the placenta, which nourishes the baby, is impaired and there is a higher risk of the placenta separating from the lining of the uterus (abruptio placenta).

Patients suspected of having possible pre-eclampsia are also given urine tests. Protein will appear in the urine abnormally; we call it “spill out”. Actually, the protein leaks through the filtering system of the mother’s kidneys into the urine. The mother’s kidneys filter her blood to remove her impurities and those she absorbs into her blood from the baby through the placenta. With high blood pressure, the filtering mechanism is damaged.

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Infectious Disease Case Strategy

The way to handle infection cases is very interesting. If you can show the operation was not indicated, then any complication from that unnecessary operation is a negligent act. Secondly, was the patient at higher risk for the operation? Were prophylactic antibiotics not given prior to, during and after surgery? Was the patient not timely seen with proper consultation and treatment for infection? In most large cities and/or teaching centers, there are specialists who do practically nothing else but consult and treat infections. Were there infections on or in the patient’s body at the time of an elective operation? If so, the surgery should have been postponed. Was the patient placed into a room before or after surgery where infected patients were located? This doesn’t always mean there’s a higher risk, but it’s good jury appeal.

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