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”
Reflex Sympathetic Dystrophy (RSD): Medical Fact or Fiction?
Unraveling the Mystery by Applying Daubert
ROBERT J. BARTH, Ph.D., a Fellow of the National Academy of Neuropsychology and noted expert in the field of Psychology & Pain, 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.
VICTOR A. CHIN, M.D., a native of Auburn, Alabama, received his undergraduate degree from the University of Alabama at Birmingham, and earned his medical degree from Johns Hopkins University, where he was awarded the Sylvan Shane Award for Anesthesia. Dr. Chin completed his residency in Anesthesiology at Massachusetts General Hospital, Harvard University, in 2008. As an anesthesiology resident, he was awarded the MGH Donald P. Todd Award for Excellence in Pain Management. He then completed his fellowship in Pain Medicine, also at Massachusetts General Hospital. Dr. Chin is board certified in Anesthesiology and has an additional subspecialty board certification in Pain Medicine from the American Board of Anesthesiology. Dr. Chin is a partner with The Physicians.
TONY COCHRAN, Esq., a Partner at the law firm of Chilivis, Cochran, Larkins & Bever LLP, served as an Assistant United States Attorney for the Northern District of Georgia, and as an Adjunct Faculty Member of the Emory University School of Law from 1986-2000. He is listed in Super Lawyers, Corporate Counsel Edition, under Business Litigation. Mr. Cochran has been a Fellow in the American College of Trial Lawyers since 2005. Notably, he was counsel to General Electric in the landmark case General Electric Co. v. Joiner, 864 F. Supp. 1310 (N.D. Ga ), establishing the standard of review on Daubert motions, and has maintained a great interest in that area.
CARLTON DAMPIER, M.D., is Professor of Hematology/Oncology in the Department of Pediatrics, Emory University School of Medicine, and also serves as the Assistant Dean for Clinical Research, Emory University School of Medicine. As a research administrator, he has great interest in process improvement and quality management of clinical trials, as well as research ethics and scientific integrity in the conduct of clinical trials. He is an expert in the principles of Evidence Based Medicine. Dr. Dampier’s own personal research interest is the assessment of patient-reported outcomes and subsequent symptom management in children and adolescents, particularly those with pain from sickle cell disease. He is the Network Chair and Protocol co-director for an NIH-funded multi-center randomized clinical trial of patient-controlled analgesia in children and adults hospitalized for pain management.
PROFESSOR TOM EATON teaches torts, health care regulation, and workers compensation at the University of Georgia School of Law, where he was named J. Alton Hosch Professor in 1993. He has served as chair of the Georgia Governor's Workers' Compensation Review Commission.
PROFESSOR JESSICA D. GABEL, associate professor of law, teaches courses on forensic evidence, forensic medicine, bankruptcy, and contracts. Her 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. Professor Gabel received her J.D., magna cum laude, from the University of Miami School of Law. While in law school, she co-founded and served as the executive director for the Wrongful Convictions Project, which assisted defendants with claims of actual innocence. The project continues and is a fully-funded Innocence Clinic. Prior to joining Georgia State Law, she clerked for Judge Peter T. Fay of the U.S. Court of Appeals for the 11th Circuit, and practiced law with Covington & Burling LLP in San Francisco. She has written on a wide range of topics, including the validity of forensic evidence genetic testing, forensic DNA identification, trial and jury tactics, bankruptcy fraud, lender liability, legal ethics, and bioethics. In 2009, she received the American Bar Association’s Kathryn R. Heidt Memorial Award for her service, scholarship, and practice, and in 2010 received a publication award from the American Bankruptcy Institute.
JOHN O. GASTON, M.D., is a board certified psychiatrist who completed all of his medical training at Yale University School of Medicine and is an Associate Professor of Psychiatry at the Morehouse School of Medicine. He has also served as the Vice Chairman of the Department of Psychiatry at the Morehouse School of Medicine since 1998, and the Director of the Residency Training Program from 1998 to 2013. Since 1985, Dr. Gaston has been the Associate Director & Senior Attending Physician - Division of Consultation & Liaison Psychiatry, at Grady Memorial Hospital. 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.
MARY DONNE PETERS, Esq., a principal in the firm of Gorby, Peters & Associates, LLC, handles complex commercial litigation focusing on the technology and health care sector, and catastrophic injury and death cases in the areas of premises liability, medical malpractice, and other professional malpractice cases. She is the author of The Admissibility of Expert Testimony in Georgia, Thomson Reuters Westlaw, 2013-2014 Edition, and taught the ICLE CME course entitled Georgia Expert Testimony Update 2013.
MICHAEL L. NEFF, Esq., is a Principal at The Law Offices of Michael L. Neff, P.C., and has handled all facets of personal injury and civil litigation, including mediation, arbitration, and trial. In 2011, 2012, and 2013, Mike was counsel in three record-setting verdicts in Georgia, including a $2.79 million verdict in a grocery store fall case where the client developed RSD/CRPS. A graduate of George Washington University (B.S. Finance) and The Dickinson School of Law at The Pennsylvania State University (J.D.), Mike is also a member of the Executive Committee of The American Association for Justice (AAJ)’s Traumatic Brain Injury Section, the 2014 Chair Elect for the AAJ’s Complex Regional Pain Syndrome Section, and Vice President of the Georgia Trial Lawyers Association.
MITCHELL S. NUDELMAN, M.D., J.D., F.C.L.M., will be your host for this event. Board certified in Family Medicine since 1987 and a member of the Georgia Bar since 1991, Dr. Nudelman is an experienced medical director and served as the sole Peer Review Physician to the Georgia State Board of Workers Compensation for more than a decade. His medical director experience includes adjudication of every type of claim involving medical peer review in most every setting. He has been involved in many RSD-CRPS cases, and it has become a special interest of his.
MICHAEL SCHAUFELE, M.D., an expert in Pain Management, is board certified in both Physical Medicine and Rehabilitation & Pain Management (PM&R). Fairly new to private practice, he was the Emory PM&R Residency Program Director and supervising physician for Emory's pain fellowship rotation at the Emory Spine Center for a number of years.
JUDGE RICHARTD S. (Rick) THOMPSON, now a Partner with Levy & Thompson, has practiced in the area of workers’ compensation since 1989 and was appointed by Georgia Governor Sonny Perdue to serve as Chairman of the Georgia State Board of Workers’ Compensation, a position he held from 2009 through 2013. In addition to handling other matters, Judge Thompson is applying his formidable skill set and experience to mediation services throughout Georgia.
CHRISTOPHER A. WHITLOCK, Esq., is a Partner at the law firm of Carlock & Copeland. His practice includes general liability but is focused primarily in the area of Workers’ Compensation Defense -- practice areas where understanding the credibility and reliability of the medical evidence and expert testimony are paramount, since damage awards are so heavily predicated upon medical diagnosis and treatment. Mr. Whitlock has represented numerous insurance companies, self-insured employers, and third-party administrators in defense of workers’ compensation claims, as well as subrogation litigation against third party tortfeasers. His practice experience has included numerous claims in the Georgia State and Superior Courts, as well as the United States District Court, and many jury and bench trials. Over the years, he has developed a great interest in the ethics of medical peer review and independent medical evaluations.