PHYSICIANS REVIEWING PHYSICIANS
Monday, September 18th, 2017
8:15 - REGISTRATION & CONTINENTAL BREAKFAST
PART 1 - General Morning Sessions (9:00 am - 12:30)
9:00 - 9:05 am
Welcome and Framing of the Conference Objectives
Mitchell S. Nudelman, MD, JD, FCLM (Medical Director Solutions)
9:05 - 10:05 am - SESSION I
What’s All the Fuss About? The Role of Evidence Based Medicine in Litigated Medical Injuries
Daniel Dressler, MD, MSc, SFHM, FACP, Professor of Medicine & Director of Internal Medicine Teaching Services at Emory University Hospital, where he directs the Evidence-Based Medicine curriculum for the internal medicine residency program.
Whatever the legal setting, whenever medical expert opinions are involved and may be used for testimony to meet some sort of Daubert requirement, they are required to be reliable. Some factors in that determination by the court include not only the qualifications of the expert, but also the methodology by which the expert reaches his conclusions: whether the expert's theory has been tested and subjected to peer review and publication, and if the technique is generally accepted in the scientific community. Hear Dr. Dressler cover the basics of EBM, and explain why the expert’s opinion absent peer reviewed scientific literature is considered the is the least reliable of all on the Levels of Evidence Pyramid. Learn why not all medical studies are the same, get a better understanding of the term medical probability and how it is evaluated in medicine. Learn how the EBM process works from a professor who is an Associate Editor for the Journal of Hospital Medicine and NEJM Journal Watch Hospital Medicine.
10:10 - 11:10 am - SESSION II
Selection and Credentialing of the Medical Expert
Thomas Bojko, MD, MS, JD, FCLM is Managing Partner of Hospital EXPERTS™; Kelly Baldwin Krail, Esq., is Executive Vice President and General Counsel for Hospital EXPERTS™. Cases involving alleged hospital corporate negligence due to hospital system failures in the context of medical negligence are some of the most complex. The knowledge and testimony of a credible medical and administrative expert is vital in this high stakes setting and can make or a break a case. Tom Bojko , MD, JD and Kelly Baldwin Krail, Esq., who are involved in such cases on a daily basis, will explain the requirements necessary to establish solid medical expertise. They'll describe circumstances that may preclude a physician from serving as a medical expert witness and go step-by-step through selection process and vetting of an expert. By the conclusion of the session attendees will have a better understanding of how to find the right expert for their particular case and the nuances of credential vetting.
11:10 - 11:30 am - Coffee Break & Networking
11:30 - 12:30 PM - SESSION III
Communicating Between the Attorney or Claims Professional and the Medical Expert - What Could Go Wrong?
Gregory C. Lisby, PhD., JD, Chairman, Department of Communications, Georgia State University
It is not without reason that people speak of “legalese” and medicalese”. Each academic discipline has its own distinct language, and Medicine and the Law are no exceptions. One may even consider sub-specialties in law and medicine to have their own dialects. Think of a pediatric neurologist talking over a head injury case with and attorney specializing in personal injury. The problem appears to be “functional”, maybe even “idiopathic”. Can these words have entirely different meanings in the two dialects? Do doctors and lawyers mean different things when they want what is “best” for their patient or client? How important is the distinction between medical “possibility” and “probability” in regard to the outcome of a case? Let someone who really knows about Communication and language help you understand what can go wrong, why it does so, and what can be done to prevent it from happening in your cases.
12:30 - 1:00 pm - GOURMET BOXED LUNCH & NETWORKING
PART 2 - Afternoon Sessions (1:00 - 4:45 pm)
Law, Medicine and the Opioid Epidemic
Framing of Workshop: C. William Hinnant, Jr., MD, JD, DABU, FCLM, President, ACLM
1:00 - 1:45 pm - SESSION I
An Addiction Medicine Primer: The Science of Opioids, Tolerance, Dependence and Addiction
Faculty: Lance L Gooberman, MD, JD, FCLM, DABAM
What can be learned from 20 plus years of using and abusing drugs followed by 30 plus years of trying to understand why and how to keep from going back. Applying a medical and legal education to the search for understanding addiction, Lance L Gooberman, MD, JD, FCLM, DABAM is a true pioneer in the field of Addiction Medicine, having integrated it into his internal medicine practice in the late 1980’s, until 1995 when he decided to devote his practice entirely to Addiction Medicine when it was still in its infancy. In recovery himself for some thirty years, he brings a personal perspective to this devastating disorder. Moreover, Dr. Gooberman has helped countless others suffering with the same biological condition - one that had become stigmatized - making it that much harder to diagnose and successfully treat. Dr. Gooberman, the inventor who holds a patent for a naltrexone implant, will cover the scientific basis for tolerance, dependence and addiction to opioids. He will also address the newest scientific literature that seems to suggest that addiction may be triggered in as few as three days, and other recent advances or those on the horizon. Is there going to be a vaccine anytime soon? Don’t be surprised if he deviates a bit to mention the public health risk of the new most potent opioids including their potential as a weapon of mass destruction.
1:50 - 2:50 pm - SESSION II
Update on CDC Guideline for Prescribing Opioids for Chronic Pain
Faculty: Christina Mikosz, MD, MPH, Medical Officer, Division of Unintentional Injury Prevention, CDC Prescription Drug Overdose Health Systems team
Not the same old same old, at all. Presented by Dr. Mikosz - physician, epidemiologist and academic scientist based at the CDC in Atlanta - this session, will begin with an overview of the epidemiology of the US opioid epidemic, covering the most recent morbidity/mortality data and recent literature, that helps to describe how the epidemic has evolved. It will also cover the CDC’s state-based work to address this epidemic, and finish with a summary of the CDC Overdose Prevention in States (OPIS) initiative, and implementation update for the evidence-based CDC Guideline for Prescribing Opioids for Chronic Pain. Plenty of time for your questions has been reserved.
2:50 - 3:10 - BREAK FOR MILK AND DONUTS
3:10 - 3:55 pm - SESSION III
Patient Safety: The Role of the Prescription Drug Monitoring Program (PDMP) in the Opioid Epidemic
Faculty: Bill Kanich, MD, JD, Chief Medical Officer, MAG Mutual Insurance Company’s Patient Safety Institute; Rep. Kevin Tanner, 9th District
The new Georgia Prescription Drug Monitoring Program (GA PDMP) requires that “…Each Georgia prescriber with a DEA shall register to use the PDMP no later than January 1, 2018…On or after July 1, 2018, any person initially prescribing a schedule II opioid or any benzodiazepine shall seek and review a patient’s PDMP information, then at least once every 90 days thereafter, unless…” Hear Rep. Kevin Tanner, author of this new Georgia Law discuss how it will work, and how it will impact physicians. Rep. Tanner will be joined by Bill Kanich, MD, JD. Dr. Kanich is currently VP & Chief Medical Officer for the MAG Mutual Insurance Company’s Patient Safety Institute, and responsible for leading all clinical risk management initiatives.
4:00 - 4:45 pm - SESSION IV
The Impact of the Opioid Epidemic on Policy, Law and Medicine
Faculty: C. William Hinnant, Jr., MD, JD, DABU, FCLM, President, ACLM
The Opioid Epidemic has ramifications as public policy both intrinsic and extrinsic impact on the practice of Law and Medicine. The latter impact the prior. As opioid prescribing and patient usage has skyrocketed, physicians have become more comfortable with liberal prescribing of these agents while Medical Boards are becoming more scrupulous as to monitoring and disciplining those practitioners. Criminal authorities are likewise more attentive to opioid-related impairment in the operation of motor vehicle vehicles, despite no standardization by any authority as to the measurement of such impairment, particularly at the incident site. Attorneys and physicians can be patients and their intrinsic work product can be impacted. Recognition as to such professional impairment will be discussed as will diversion practices applicable to doctors and lawyers, both administrative and criminal. The same information applicable to attorneys in advising their clients. They should also be familiar with State Prescription Drug Databases in that their clients could easily require a criminal or administrative defense related to activities listed therein. In the civil arena, the CDC Guidelines on Opioid Prescribing will largely be seen as authoritative and will be considered Standard of Care by many. How can a legal practitioner defend a client arguably acting outside the Guideline's parameters and if he, or she, cannot, what mitigation strategies might or might not be effective.
NETWORKING COCKTAIL RECEPTION
4:45 pm - 6:15 pm
Join us right at the State Bar of Georgia
Tuesday, September 19th, 2017 - Half-day only
8:15 - REGISTRATION & CONTINENTAL BREAKFAST
PART 3 - Interactive Workshops (9:00 am - 12:20 pm)
9:00 to 10:30 am - WORKSHOP A
The "Bad, Incompetent, or Unethical" Medical Expert in a Litigated Medical Claim - What to Do & When to Do It
Faculty: Fred L. Cohen, MD, JD, FCLM, practicing Neurosurgeon & member of Gary Roberts & Associates; Paul Blaylock, MD, JD, FCLM,Trauma/Injury Clinic, Portland Oregon.
Preparing for a Battle of Medical Experts in a litigated medical claim is critical to the outcome of many cases where medicine and the law collide. Therefore close evaluation of all testifying physicians with a focus on credibility and reliability is always an essential aspect, especially at deposition. Sometimes, the opinions and testimony offered by a physician involved in the litigated claim are not predicated upon evidence based medicine or best practices, to the point that they are not credible, and therefore should not be relied upon by the trier of fact (judge or jury).
This work shop is designed to address the situation that arises when medical testimony is tantamount to intentionally misleading the court, e.g., by offering “alternative medical facts” or misstating the medical literature. The injured party in a litigated medical claim and their attorney often has a different calculus based upon divergent interests and may view things differently than opposing defense counsel, and their client’s standpoint. How you handle such an “expert” demonstrating this or some other unprofessional conduct, may have great bearing on the outcome of your case.
Tactics include legal maneuvers such discrediting the witness or filing a Daubert motion. Yet in certain cases, submitting a complaint to the American Board of Medical Specialty certifying board, an accreditation body such as the Joint Commission (JC), NCQA or URAC, and especially the state medical board, might be a more aggressive but justified alternative with more impact. The medical board in Georgia includes such things for which a licensee may be disciplined as inappropriate prescribing especially with inadequate record keeping, insurance fraud and improper billing practices and of course practicing below minimum standards or outside the scope of their license or specialty. And yes, even dishonesty.
How to proceed may take into consideration factors such as how much money is at stake (including medical experts and defense litigation costs), the type of claim (WC, general or professional liability, etc.), the stage of the proceedings, venue and/or jurisdiction). Join these two physician/attorneys as they lead this interactive workshop, and try to sort out this complex medical legal matter and consider the viability and practicality of various remedies, both legal and medical. Come prepared with your own hypothetical for our workshop facilitators to help you consider.
10:30 - 10:50 - COFFEE BREAK
10:50 to 12:20 - WORKSHOP B
The Written Medical Report for the Legal Setting: Where Medicine & the Law Collide
Faculty: Mitchell S. Nudelman, MD, JD, FCLM, Chief Medical Officer, Medical Director Solutions, LLC, and Attorney at Law, Nudelman & Associates, LTD; Paul Blaylock, MD, JD, FCLM,Trauma/Injury Clinic, Portland Oregon.
Since the overwhelming proportion of litigated medical claims settle, often before even depositions of the experts are even taken and never go before the trier of fact, the credibility and reliability of the expert(s) and the strength of their medical opinion(s) stated in the report(s), are frequently the deciding factor. The brightest of physicians often are not as good at articulating their medical opinions as they are in reaching them. Articulating them in such a manner that non-physicians may comprehend is an entirely different skill set, and the focus of this workshop.
First, the topic “What Makes for an Effective Medical Report?” will be discussed in Socratic manner, because as anyone attending this Symposium probably realizes this is an elusive query, and there are those who might argue that there really is no single or simple solution on any given day.
However, on the less lofty but perhaps more practical goal, this interactive workshop will cover important facets preceding the report to enhance the likelihood of a good report, such as:
Medical match: perhaps in your case the best specialty for the medical expert is not a match at all? •
The nature of the referral, including to what end the opinion and/or report are to be used, e.g., undeclared expert for internal road map; the likelihood the same expert may be asked for live testimony.
Conflicting concepts: ‘One Medical Opinion’ versus ‘It Does Matter Which Side Retained Me’
Contents, preparation and organization of the file for the medical expert. Should other medical expert opinions be included?
Request to the expert, and framing of questions.
The workshop will also cover these concepts about the expert report:
Understanding how most physicians write reports in terms directed to other medical professionals, not attorneys or claims payers, and especially not judges or juries.
Medical Possibility & Medical Probability – two totally different inquiries of differing medical and legal significance.
How many pages are too many? A simple way to see the forest for the trees…
To list the medical and other records reviewed, or not?
The medical rationale and the evidence based medicine upon which it is predicated, if any is applicable.
Mechanism of Injury
Interpreting the Report: Does ii answer the questions posed?
Asking for Clarification/Correction - An Essential but Perilous Undertaking
For more information, call or 770-790-4772 or email us at 2017SEMedicalLegalSymposium@nudelmanandassociates.com
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