Medical and Legal Symposiums

Reflex Sympathetic Dystrophy (RSD):

Medical Fact or Fiction

Unraveling the Mystery by Applying Daubert

 

Program & Schedule

7:30 to 8:30 am

Registration & Continental Breakfast

8:30 – 8:50 am (20 minutes)

Framing of the Conference Objectives

Mitchell Nudelman, MD, JD, FCLM

 

Your host for this most unusual academic exercise, Mitchell Nudelman, MD, JD, FCLM, is board certified in Family Medicine, a member of the Georgia Bar, and fellow of the prestigious American College of Legal Medicine. He is the managing member of Nudelman & Associates, LTD, a niche law firm that specializes in areas where law and medicine collide. Since 1997, Dr. Nudelman has also been Chief Medical Officer to Medical Director Solutions, LLC, a peer review company dealing in complex claims. He served as the sole peer review physician to the Georgia State Board of Workers Compensation for more than twelve years and has vast experience in reviewing most every type of medical claim. His special interest in “self-reported” claims that are predicated upon only the subjective complaints of the patient, such as Chronic Fatigue Syndrome, Fibromyalgia, and of course - perhaps the most vexing of them all - RSD and CRPS, led him to organize this symposium. Dr. Nudelman will set forth the conference objectives and pose the Socratic question this conference sets out to answer: Can the diagnoses of RSD and/or CRPS meet the Evidence Based Medicine model and the legal burden under Daubert?

8:55 – 10:10 am (75 min. inc. 10 of Q&A)

Session I: LEGAL Framework of Daubert as It Applies to Medical Cases in WC, Tort Liability & Disability in Georgia

Faculty: Tony Cochran, Esq., Prof. Tom Eaton, and Mary Donne Peters, Esq.

 

This panel will set out to provide an overview of the main principles of Daubert, with special attention to how they apply to medical evidence and testimony. How do Georgia's rules compare with the Federal rules and those of other states regarding the standards for admitting such testimony? What actually serves to make the testimony reliable and credible, and what factors are applied to determine if the burden has been met? Are all experts the same? What makes an expert, well... an expert? Do all Daubert motions fail? What is the purpose of a judge documenting the “gate keeping” thought process? Is it an unnecessary burden in administrative cases where there is no jury? What is Daubert-Lite? What happens when an administrative case is adjudicated with the “not strictly applied” standard and is then appealed and goes to State court?

10:10 - 10:30 am - BREAK (20 Minutes)

10:30 - 11:45 am (75 min. inc. 10 of Q&A)

Session II: MEDICAL Framework – Using Principles of Evidence Based Medicine and the Medical Literature as It Applies to Diagnostic Testing & Treatment of RSD/CRPS

Faculty: Carlton D. Dampier, MD, Michael Schaufele, MD, and Victor Chin, MD

 

Listen to someone who is a respected and renowned expert in the area of Evidence Based Medicine - the bedrock of credibility in the medical sciences. He will explain the basic tenets of what is reliable or unreliable medical research. Carlton D. Dampier, MD, is the Medical Director & Assistant Dean of the Emory University School of Medicine Office for Clinical Research, and a pediatric hematologist oncologist specializing in Sickle Cell Anemia and the management of pain. Dr. Dampier will be followed by Michael Schaufele, MD, who is board certified in Physical Medicine & Rehabilitation, with subspecialty certification in Pain Management. Now in private practice, he was the Director of the PM&R Residency program at Emory for a number of years. Dr. Schaufele will educate us on what the current medical literature says about the medical criteria that are typically applied in making the diagnosis. Is it true that following them carefully is said to lead to the wrong diagnosis more than half the time? What about some of the more common diagnostic tests and treatments for RSD & CRPS? Does the scientific peer reviewed literature support their use and how it should impact pain management practices and coverage? Our third pain management expert, Victor Chin, MD, a highly experienced and well-respected community based pain management physician, will round out the panel. Dr. Chin's medical pedigree includes being a graduate of the Johns Hopkins School of Medicine and completing his post graduate training and fellowship at Massachusetts General Hospital, Harvard University. He has a particular interest in Evidence Based Medicine and literature, and will strive to keep us honest.

11:50 am to 12:30 pm (40 min.)

Session III: Biopsychosocioeconomic Model of RSD & CRPS

Robert J. Barth, Ph.D.

 

If anyone can address the often-posed question regarding RSD & CRPS - Is it psychological or organic in etiology? - and speak to how other biological and social factors affect the symptomatology of RSD & CRPS, it has to be Robert J. Barth, Ph.D. A Fellow of the National Academy of Neuropsychology and noted expert in the field of Psychology & Pain, he is in private practice at Barth NeuroScience in Chattanooga. Dr. Barth, included by the American Medical Association on its list of “nationally recognized expert authors,” has been invited to lecture and write on the subject of CRPS by such prestigious organizations as the National Association of Workers' Compensation Judiciary, the American Academy of Orthopaedic Surgeons, and many other medical and governmental bodies internationally.  Dr. Barth has contributed to the AMA's Guide to Permanent Impairment, 6th edition, section on CRPS. Learn the results of some of the most riveting and relevant scientific literature on the psychological aspects of RSD & CRPS from Dr. Barth.

12:40 - 1:30 pm  - Gourmet Boxed Lunch from "Affairs to Remember"

Topic: Use of Narcotics & Risk Assessment in RSD/CRPS (30 minutes)

John Gaston, MD

 

John Gaston, MD, will lead this lunchtime discussion with the audience regarding the Use of Narcotics and Risk Assessment in RSD/CRPS, drawing similarities between RSD/CRPS and other chronic non-malignant pain syndromes, such as fibromyalgia. Dr. John Gaston is a board certified psychiatrist and Associate Professor of Psychiatry at the Morehouse School of Medicine, where he was the director of the residency program for fifteen years. In a career spanning three decades practicing psychiatry, he has treated many chronic pain patients, as well as those with factitious disorder, somatoform disorders, addiction, and other psychiatric conditions that lead to symptom magnification.

1:30 - 2:10 pm (40 minutes inc. 10 of Q&A)

Session IV: Analyzing and Evaluating the RSD & CRPS Claim Using Case Studies

Faculty: Mitchell S. Nudelman, MD, JD, FCLM, and "Our Esteemed Audience"

In this session, Dr. Nudelman will discuss some of the most perplexing RSD & CRPS cases in which he has been involved, either as medical director or consultant. Because this symposium has attracted so many knowledgeable and accomplished professionals, Dr. Nudelman will not draw upon an expert panel for this session, but rather upon the collective professional knowledge and experience of the audience. Dr. Nudelman and the audience will exchange views, information, and lessons learned from their own cases, including some that, well, maybe we just “heard about.” This session is sure to stimulate some very interesting, informative, and spirited discussions!

We will consider what can be done to sort out the legitimate claims from those that are dubious, taking into account all that we have learned in the earlier medical and legal sessions. What happens to the patient when the medical and legal worlds collide?  Could RSD & CRPS simply be an “advocagenic” condition, or the result of “circumstances of life”? What does this diagnosis have in common with Fibromyalgia, Chronic Fatigue Syndrome, Multiple Chemical Sensitivities Syndrome, Chronic Lyme Disease, and other often co-morbid conditions? Can a patient have more than one of these and, if so, what might it tell us? Is there such a thing as generalized RSD & CRPS? Can it progress to the other side? What is muscle disuse syndrome? What about surveillance – what may it tell us or not tell us?  Are these patients malingering? What are these patients doing ten years after they settle the litigation?   Hear about the types of studies that Dr. Nudelman would like to see done, and share your thoughts regarding the types of studies you would like to see conducted, and why. 

2:15 – 2:55 pm (40 minutes)
Session V: Ethical Challenges in IME, Medical Peer Review and Testimony, and Choosing an Expert

Faculty: Judge Richard S. Thompson, Chris Whitlock, Esq., and Mitchell S. Nudelman, MD, JD, FLCM  

 

The panel will help us to understand what makes a qualified medical expert reliable and credible, so as to meet the Daubert standard. Learn how to counter the use of a “pseudo-expert.”
    •    How Do Evidence Based Medicine & the Standard of Care Apply?
    •    What is a “Pseudo-Expert”?
    •    To What Codes of Ethics are Physicians Bound?
    •    Conflicts of Interest
    •    Sneaking in UR
    •    Stretching the “Truth” of the (medical) Matter Asserted
    •    Harm Due to Breach in Standard of Care – Duty to Disclose to Claimant
    •    The Review Reveals Psychiatric Issues - What to Do?
    •    Filing a Board of Medicine Complaint Against an ATP – Is this Ethical and Feasible?  

2:55 to 3:15 pm - MILK & COOKIE BREAK (20 Minutes)

3:20 to 4:20 pm (60 minutes)

Session VI: Panel Discussion: RSD - Medical Fact of Fiction? Getting "Krogered" -  YOU be the Judge!

Faculty: Michael L. Neff, Esq., and Professor Jessica D. Gabel

The pièce de résistance of our symposium, a distinguished panel moderated by Dr. Nudelman, will try to come to a consensus – or maybe not - as to whether the diagnoses of RSD & CRPS meet the Evidence Based Medicine Model for clinical significance, as well as the legal burden that medical testimony be reliable and credible under Daubert. If so, what diagnostic criteria are reliable, and what treatments are shown to be efficacious? If not, then is any claim for RSD or CRPS valid? Listen to Attorney Neff, who this year had a 2.9 million dollar award against Kroger affirmed by the Supreme Court of Georgia - the largest slip and fall award ever in the state. Diagnosis - RSD. Joining him will be GSU law professor Jessica Gabel, whose primary research focuses on fraud and ethics at the intersection of law and science, where Daubert is essential to her work involving medical evidence and expert testimony. When Professor Gabel applies Daubert to the medical evidence, it is often life and death that are at stake. Her area of expertise adds a sense of gravity to our discussion and highlights the critical importance of the rules of evidence regarding expert medical testimony and evidence. Some of her publications include Realizing Reliability in Forensic Science From the Ground Up, 104 J. Crim. L. & Criminology 283 (2014); Reigning in the Wild West: The Necessary Outcomes and Inevitable Pitfalls of Reforming Forensic Science, 24 Alb. L.J. Sci. & Tech. 81 (2014); "Good" Science Gone Bad: How the Criminal Justice System Can Redress the Impact of Flawed Forensics, 59 Hastings L.J. 1001 (2008); Forensiphilia: Is Public Fascination with Forensic Science a Love Affair or a Fatal Attraction, 36 New Eng. J. on Crim. & Civ. Confinement 233 (2010). 

4:20 to 4:30 pm (10 minutes)

Closing Comments & Adjournment

Mitchell S. Nudelman, MD, JD, FCLM

 

5 TO 7 PM - AWESOME COCKTAIL PARTY AT THE SKYLOUNGE ATOP THE GLENN HOTEL
Voted one of “Top 23 Best Rooftop Lounges in the World”