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Infectious diseases are among the most common conditions for which patients seek medical care, and potentially the most serious. Fortunately, since the discovery of penicillin over 70 years ago, antibiotics have made the treatment of serious infections highly successful. Nevertheless, physicians and advanced practioners such as nurse practitioners and physician's assistants must use caution in administering antimicrobial medications, both to ensure effectiveness and to prevent side effects. Careful prescribing will help minimize the legal risks resulting from antibiotic treatment.
Over the past two decades, there has been a growing trend for the care of the hospitalized patient to be assumed by physicians who care only for patients in the inpatient setting, and who do not have an outpatient medical practice. These physicians have come to be known as "hospitalists", and their area of practice as "hospital medicine". Hospitalists are a departure from the old style of practice, in which the primary care physician (PCP) cared for their seriously ill patients in the hospital while still maintaining a busy outpatient practice. Because of the increasing complexity of modern medicine, and due to a variety of economic pressures, the trend now is for physicians in primary care specialties to focus their practice on either outpatient or inpatient care, but not both.
Congestive heart failure can be simply described as the inability of the heart to meet the metabolic demands of the body. The heart functions as a pump to deliver oxygen and nutrients to the tissues. Failure of the pump to deliver nutrition to the tissues stimulates a number of compensatory responses in an effort to improve tissue perfusion. These responses result in the clinical symptoms and signs associated with the heart failure syndromes-shortness of breath, rapid heartbeat, and fluid retention.
Acute respiratory distress syndrome (ARDS) was first described in 1967 by Ashbaugh, who described a syndrome of severe respiratory failure associated with pulmonary infiltrates, similar to infant hyaline membrane disease.
Anterior Cruciate Ligament Injury (ACLI) is most often a result of low-velocity, noncontact, deceleration injuries and contact injuries with a rotational component. Contact sports also may produce injury to the anterior cruciate ligament (ACL) secondary to twisting, valgus stress, or hyperextension all directly related to contact or collision.
Some of the most abstract medical occurrences that may also prove to be legally challenging are transient disorders of awareness. The very nature of their transient occurrence often results in an absence of objective laboratory or examination abnormalities. Since these conditions result in an alteration of the patient's awareness, there may also be inadequate historical information to assist in diagnosis. Yet, these disorders can have very significant consequences that range from a loss of one's driving privileges or job to the participation in a criminal event. The two most common causes of altered awareness are seizures and reduced blood flow to the brain.
There are many wrist and hand symptoms related to the multiple tunnels that tendons, nerves, and blood vessels pass through. Wherever there is a "crease" in one's wrist, palm, or fingers on the flexor/volar side, there is a tunnel that these structures must pass through. These tunnels are usually soft transverse tissue bands that keep the tendons from bowstringing as they pass from forearm to fingers, as we use our hands in grasp and function.
Almost every American from eighteen to eighty years of age has heard enough about LASIK to understand on a basic level what it is and how it works. On average approximately 1,000,000 LASIK procedures are performed annually in the United States. The vast majority of these procedures are successful, but unwanted side effects and/or suboptimal results can occur in a small percentage of patients. Below is a discussion of the essential elements in the pre-operative evaluation of a patient being considered for LASIK.
There is an epidemic of diabetes in the United States. In the last ten years, the number of American diagnosed with diabetes has increased 40 percent. The number has risen from 4.9% to 6.9%. It is estimated that the number will increase buy another 16.5% by 2050. A woman born in 2000 has a 39% risk of developing diabeteso. The epidemic of obesity is responsible for the current epidemic of diabetes in pregnancy. The incidence of diabetes complicating pregnancy has increased 40% between 1989 and 2004.
Crude Oil has been pouring into the Gulf of Mexico and is causing numerous and significant health issues for children, pregnant mothers, and adults. Exposure occurs via inhalation, ingestion (of liquid droplets in the air), and direct skin contact. Some of the health effects will be long-term sequelae and may last a lifetime or affect future generations. Crude oil is a known teratogen and can cause birth defects and changes in fetal development. The target organs for crude oil are the hematopoietic (blood forming) system, lymphatic system, nervous system, and reproductive system. The Benzene component is a known carcinogen.
Persistent neuropsychiatric impairment following head injury is a significant public health problem. From 400,000 to 500,000 are hospitalized in the United States every year from head injury; many more people are injured and do not require admission. Head injury is the third most likely cause of dementia, after infection and alcoholism, in people younger than 50 years.
In 1911, Hammond and Sutton of Philadelphia performed the first human-to-human kidney transplant with transient success. Since then the techniques and indications have evolved. The first wholly successful human transplant took place on December 23, 1954, in Boston, Massachusetts. Surgeon Joseph Murray performed a kidney transplant between identical twin brothers. Although this and subsequent twin transplants did little to solve the problem of rejection, these procedures contributed to proving the value of the procedure and to the solution of many technical problems.
Neonatal emergencies are not uncommon problems. They appear either at the time of birth, during the in-hospital post-birth period, or at home within several weeks of discharge. In all instances they present significant diagnostic and treatment challenges to the clinician, and must be taken seriously.
Cardiovascular disease (CVD) is the leading cause of death in the United States, accounting for approximately 500,000 deaths each year. More women in the United States die of heart disease than of any other cause, and one form of heart disease, myocardial infarction, is responsible for the majority of these deaths. In every year since 1984 it has claimed the lives of more women than men.
A large number of reports have been produced on HP and its pathogenetic potential. In fact, although peptic ulcer disease is the most studied disease related to HP infection, this bacterium is seemingly involved in the pathogenesis of several extragastric diseases, such as mucosa-associated lymphoid tissue lymphomas (MALTomas), coronaritis, gastroesophageal reflux disease, iron deficiency anemia, skin disease, and rheumatological conditions.
Abdominal aortic aneurysm (AAA) is a relatively common, potentially life-threatening condition. It has a wide spectrum of presentations and should be considered in the differential diagnosis for a number of symptoms.
Acetaminophen is the most widely used pharmaceutical analgesic and antipyretic agent in the United States and the world; it is contained in more than 100 products. As such, acetaminophen is one of the most common pharmaceuticals associated with both intentional and accidental poisoning. Acetaminophen-induced hepatotoxicity is well recognized.
Salicylates are ubiquitous agents found in hundreds of over-the-counter (OTC) medications and in numerous prescription drugs including topical preparations used for the treatment of pain, warts, and acne.
Peptic ulcer disease (PUD) is one of the most common diseases affecting the GI tract. It causes inflammatory injuries in either the gastric or duodenal mucosa, with extension beyond the submucosa into the muscularis mucosa.
Among suicidal patients who had taken antidepressants, fluoxetine (Prosac) was associated with the lowest risk for causing suicidal tendencies and venlafaxine (Effexor) with the highest risk, according to the results of a cohort study published in the December 2006 issue of the Archives of General Psychiatry.
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Terence K. Gray, DO, is a Harvard trained Anesthesiologist / Interventional and Multidisciplinary Pain Management Specialist. Currently the Medical Director at Mercy Pain Management Center, he is responsible for assisting in the leadership, physician oversight, and management of a large multidisciplinary pain management program.
Dr. Gray served as a physician leader and partner in a large multistate anesthesia practice in southern New England and has been on the faculty of Harvard Medical School and Tufts University School of Medicine. He is a diplomate of the American College of Osteopathic Anesthesiologists.
Along with treatment modalities for spine and radicular back pain, Dr. Gray has a special interest in treating pain associated with sacroiliac dysfunction, Piriformis pain, joint bursitis, and arthritis (in particular genicular nerve blocks for knee pain), as well as post hernia repair and abdominal surgery neuropathic pain.
Dr. Gray was awarded 1 United States Patent for a Ventilating Tube and Stylet System patent number, and has 3 patents pending. He also holds 1 United States Copyright. Dr. Gray is currently an Adjunct Professor of Clinical Research at the University of New England College of Osteopathic Medicine.
Litigation Support - Dr. Gray has been a medical expert consultant for several years. He provides medical forensic reviews and expert testimony in the areas of Anesthesiology, Pain Management, and Medical Malpractice. His services include medical record review, written reports, depositions, and trial testimony.
Occipital neuralgia is characterized by severe pain, accompanied by tenderness and trigger points, in the distribution of the greater, lesser, and/or third occipital nerves. Occipital neuralgia is typi- cally idiopathic, but also is characterized as a common form of posttraumatic headache. Typical treatments include nerve blocks with local anesthetic, nerve stimulation, pulsed radiofrequency, and cryoablation. OnabotulinumtoxinA (ONA) has recently been utilized in nerve blocks to treat occipital neuralgia, with the potential for a longer duration of pain relief than local anesthetic.
Occipital neuralgia, while typically idiopathic in presentation, is a common form of posttraumatic headache. It is associated with severe pain in the greater, lesser, and/or third occipital nerves, and often accompanied by tenderness or trigger points in the surrounding musculature. OnabotulinumtoxinA (ONA) has been recently utilized in nerve blocks to treat occipital neuralgia, but current literature supporting such use is scarce. We describe a case of occipital neuralgia in a patient following C1 fracture and vertebral artery dissection due to gunshot injury. Successful treatment with bilateral ONA nerve blocks led to an 80% - 90% improvement in pain, with decreased Visual Analog Scale (VAS) pain scores immediately following treatment and upon follow-up 1 month later.
Joel L. Kent, MD, is an expert in all realms of Pain Medicine and has focused expertise in the prescribing and oversight of opioid analgesics. His specialties include acute and chronic pain management, opioid analgesics, interventional pain management therapies, spinal cord stimulation, intrathecal drug delivery, RSD/CRPS and low back pain.
Dr. Kent has provided expert case reviews and testimony for over twenty years. The majority of his expert work has focused on the standard of care in the practice of Pain Medicine and the use of opioid analgesics. Dr. Kent has provided expert case opinions in Federal and State civil courts. He has provided defense support to the US Department of Justice in two cases. He has served as an expert witness and case reviewer for both Maryland and New York State. Dr. Kent assisted the District Attorney of New Jersey in prosecuting a case of unlawful prescribing of controlled substances. He has provided expert case review and litigation support to health insurance carriers seeking restitution for fraudulent expenses related to opioid therapy.
Over the course of his career, Dr. Kent has developed particular expertise surrounding the use of opioid analgesics. He has provided over 50 lectures to other physicians regarding the safe and proper use of these medications. He has been recognized as an expert in both State and Federal Court in cases related to opioid therapy. He has served on advisory boards helping craft regulatory policies related to opioid medication. All these accomplishments attest to Dr. Kent’s high level of expertise in the complex and evolving realm of opioid therapy.
Primary area of expertise: Pain Medicine
Expert consulting experience:
Authored over 50 expert case reports
Participated in over 25 depositions
Testimony experience in civil trials and professional hearings
Provides litigation support and expert testimony in plaintiff and defense cases
Over 25 years of experience in Pain Medicine
Triple Board Certified
Practice Director of University Multi-Disciplinary Pain Management Practices from 1998 to 2017
Program Director of a Multi-Disciplinary Pain Management Fellowship Training Programs from 1998 to 2015
Professor of Anesthesiology, Palliative Care, and Physical Medicine and Rehabilitation at University of Rochester School of Medicine
MRK Medical Consultants provides Medical-Legal Evaluations to help legal and insurance professionals reach appropriate conclusions about their client's situations. MRK provides a wide array of medical experts that offer objective review and analysis of personal injuries. Each stage of the process—research to review, analysis to opinion—is addressed in a comprehensive manner in order to help legal and insurance professionals reach appropriate conclusions about their client’s situations. MRK's prestigious list of more than forty consultants are active clinicians and surgeons, who are all board-certified or eligible in one or more specialties. MRK provides physician experts to the entire State of California, the Reno/Lake Tahoe area, and Las Vegas, and we travel to many areas of the United States. Physical therapy, registered nurses, physician assistant, and billing review consultants are available services MRK provides. Our office physicians are available for telephone review of the merits of your case before you decide to proceed.
Edward W. Younger, III, M.D., Medical Director of MRK Medical Consultants, specializes in Orthopedic Surgery. He has extensive experience in total joint replacement, as well as reconstructive surgery of the knee, hip, and shoulder. He was instrumental in bringing computer navigation technology to his hospital. He served on the orthopedic trauma staff at Mercy San Juan Medical Center in Carmichael, California, for more than fifteen years and was instrumental in bringing computer navigation technology to that institution. He is a member of Alpha Omega Alpha National Honor Society and is a Diplomate of the American Board of Orthopedic Surgery, a member of the American Medical Association, the American Academy of Orthopedic Surgeons, and the California Orthopedic Association.
Dr. Michael R. Klein, Jr., M.D., specializes in Orthopedic Surgery and is a founding member and the first Medical Director of Northern California Orthopedic Centers. He was involved with the development of the orthopedic section of the Level II Trauma Center at Mercy San Juan Medical Center. He served as a clinical professor at the University of California, Davis, Medical Center for more than thirty years. He has been a member of the North American Spine Society since 2009 and was awarded the David O. Selby Award in 2020 for his contributions. He is a fellow of the American College of Surgeons and American Academy of Orthopedic Surgeons, and a member of the American Medical Association and the California Medical Association. He retired from the USAF in 1998 after being on active duty during the Vietnam War, and he was activated for Operation Desert Storm in 1991.
James Patrick Murphy, MD, MMM. has been a devoted champion of our nation’s health care for over 30 years. His combination of clinical expertise, leadership skills, communication skills, creativity and business acumen are clearly unique. Dr. Murphy is among the most highly trained Pain Specialists in the world.
As a board-certified Anesthesiologist, Dr. Murphy possesses a thorough understanding of pharmaceuticals. He is also one of the first physicians in the world to attain subspecialty board certification in Addiction Medicine from the American Board of Preventive Medicine. Aside from a thriving clinical practice, Dr. Murphy regularly authors medically related published articles, participates in research, lectures to various groups in a variety of media, and advocates for the health and well-being of his community.
Consulting Services: Dr. Murphy provides consulting services to healthcare systems, governmental agencies, regulatory bodies, law enforcement, pharmaceutical companies, and agricultural enterprises in the areas of:
Product Development - Anesthesiology, Pain Management (interventional, i.e. invasive procedures such as epidurals) and pain medication related products
Pain Management Software Development
Electronic Medical Records Development
Background Experience: In recognition of his devotion to his profession, Dr. Murphy was honored with the prestigious Mayday Fellowship in Washington, D.C. He also added to his education and credentials by completing a rigorous business curriculum culminating in his graduation from the University of Southern California’s Marshall School of Business with a Master of Medical Management degree.
Dr. Murphy's positions have ranged from president of one of our nation’s largest physician groups, the Greater Louisville Medical Society, to medical school class vice president, to Commander in the United States Navy. In 1994, he founded a state-of-the-art Anesthesia group of physicians and nurse practitioners that became the dominant provider of anesthesia services in central Kentucky.
After his Pain Medicine fellowship at Minnesota’s prestigious Mayo Clinic, where he also served on the faculty of the Mayo Medical School, Dr. Murphy returned to his hometown of Louisville in 1998. It was there that he founded Murphy Pain Center, which would become, by some metrics, the largest pain care provider in the state of Kentucky. In recognition of this accomplishment Dr. Murphy was selected as a Louisville Business First 40 Under 40 honoree.
Based on my research, terms like “legitimate medical purpose” and “usual course of professional practice” are not found in medical textbooks, nor are they taught in medical schools. It does not seem to be necessary. It is intuitive to physicians what we do and why we do it.
Dr. Robert H. Odell, Jr., MD, PhD, owner and Medical Director of Neuropathy and Pain Centers of America in Las Vegas, NV, is a Stanford and UCLA trained Anesthesiologist and Pain Management Physician. As a fellow of the Medical Scientist Training Program, he received his Ph.D. in Biomedical Engineering from Stanford University in 1974 and his MD degree from Stanford in 1976. He completed his residency in anesthesiology at UCLA, and served as chief resident at Harbor/UCLA Medical Center in 1982. He is a diplomat of the American Board of Anesthesiology (1983), American Academy of Pain Management (2001) and the American Board of Pain Medicine (2007) and a Fellow of Interventional Pain Practice of the World Institute of Pain (2008).
Dr. Odell has extensive experience with a wide variety of non-interventional and interventional Acute and Chronic Pain Management techniques, including Vertebral Axial Decompression and Electroanalgesia. Treatment utilizes the Combined Electrochemical Block (CEB), which combines the clinical benefits of these Electronic Signal Treatment (EST) devices with interventional pain management techniques to produce dramatic patient outcomes in a wide variety of Refractory Neuropathic Pain States, including Low Back Pain, Diabetic Neuropathy, Idiopathic Neuropathy, Failed Spine Fusion Syndrome and Carpal Tunnel Syndrome.
Over the last several years, Dr. Odell has been working with some advanced electromedical devices which produce salutary effects for some of the most refractory pain management challenges. He is the first author on three significant papers in the Electromedicine and Pain Management literature. The first, "Electroanalgesic Nerve Block: Theory and Case Reports" appeared in Practical Pain Management in 2006. The cornerstone of treatment at New Vision is the use of local anesthesia along with the Electroanalgesia block. This technique is outlined in Dr. Odell ‘s third paper, "New Device Combines Electrical Currents and Local Anesthetic for Pain Management," Practical Pain Management (2011). Dr. Odell has also been invited to deliver presentations in his field of expertise throughout the United States.