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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.
Sasha M. Demos, MD, PhD, is a Board Certified Anesthesiologist and Chairman of the Department of Anesthesia at Edward Hospital in the Chicago area. With a PhD in Biomedical Engineering from the University of Illinois at Chicago, she focused on the areas of Drug Delivery Systems and Ultrasonic Imaging.
Prior to her appointment as Chair, Dr. Demos served as Director of Obstetrical Anesthesia and was a member of the pediatric anesthesia team for many years. She has authored multiple manuscripts in the areas of liposomes, ultrasound contrast agents, and targeted therapies, and has a patent for her research and development of Acoustically Reflective Liposomes for Tissue Specific Ultrasonic Enhancement. She currently holds an appointment as Adjunct Professor of Bioengineering at the University of Illinois at Chicago.
Litigation Support - Dr. Demos provides expert witness services to attorneys representing both Plaintiff and Defendant. Her services include medical record review, reports, depositions, and trial testimony when necessary.
Elite Medical Experts is a physician-led team that hand selects nationally recognized Professors of Medicine and Surgery as expert witnesses. Each expert is a board-certified specialist with a busy clinical practice and impeccable credentials. From Stanford to Yale, and from every healthcare specialty and field, Elite aligns leading specialists from top-tier medical universities.
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Robert A. Ertner, MD, is a Board Certified, fellowship-trained Cardiac Anesthesiologist in full-time clinical practice at a Northern California county hospital that serves as a level 2 trauma center. Dr. Ertner has been a certified Echocardiographer for 15 years. He specializes in Cardiac and Thoracic surgical procedures for which he is fellowship-trained.
Background: Dr. Ertner has previously served as an academic physician teaching residents in both MD and CRNA programs, engaged in locum tenens work supervising CRNAs, and presently provides care to over 700 patients each year. His group is involved in providing Spinal, Epidural, Regional, and General Anesthesia for patients undergoing cardiovascular and thoracic procedures as well as general, orthopedic, bariatric, urologic, vascular, otorhinolaryngological (ENT), ophthalmologic, and neurologic surgery. He provides care for patients in the settings of obstetrical and gynecological procedures.
Dr. Ertner maintains licenses in California where his practice is located, as well as in Texas and Georgia, where he trained, and in Missouri. He was awarded Diplomat status by the National Board of Echocardiography and presently a testamur.
Litigation Support: Dr. Ertner has been involved in medical-legal work since 2014. He has reviewed cases for attorneys representing both plaintiff and defense. Dr. Ertner has consulted on over 35 cases, written numerous case opinions, been deposed, and testified multiple times. He works with clients to offer both an understanding of the relevant medicine (anatomy, pathophysiology, pharmacology, etc.) and how to think about what information they need to seek going forward as they pursue their cases.
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, has been quadruple-board certified in Family Medicine, Anesthesiology, Palliative Care, and Pain Management over the arc of his career.
Background: Much of Dr. Kent’s expertise is an artifact of both the clinical and educational leadership roles he has held over the course of his career. He has served as Division Head of Pain Medicine at medical schools between 1997 - 2017; originally at the University of Maryland and subsequently at the University of Rochester. In addition to this clinical leadership role, he also lead the pain medicine educational missions at these institutions from 1997 to 2015. Dr. Kent served as Director of the Pain Medicine Fellowship Training Programs at the University of Maryland form 1997 to 2007 and at the University of Rochester from 2007 - 2015. Both these programs are accredited through the Accreditation Counsel for Graduate Medical Education.
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 opioid. He has served as an expert case reviewer for both the state of Maryland and the state of New York. The vast majority of these case reviews involved resolving concerns regarding the appropriateness of controlled substance prescriptions. In 2014, he provided a series lectures on behalf of the New York State Department of Health which were presented across New York State to educate physicians about the safe use of opioid analgesics in both cancer and non-cancer related pain conditions.
Since July 2017, Dr. Kent has been serving as a content expert on the Opioid Abuse Prevention and Pain Management Advisory Group to the Healthcare Association of New York State (HANYS). All these accomplishments attest to Dr. Kent’s high level of expertise in the complex and evolving realm of opioid therapy for the management of chronic pain problems.
Litigation Support: Dr. Kent has served as a medical expert witness for nearly 20 years. He has served as an expert witness and case reviewer for the states of both Maryland and New York's Departments of Health. He has provided expert case review and litigation support to health insurance carriers seeking restitution for fraudulent expenses related to opioid therapy. Dr. Kent provides litigation support and expert testimony in plaintiff and defense cases.
Expertise: Dr. Kent has expertise in all areas 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, RSD/CRPS and low back pain.
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 has over forty board certified physician specialists and many with subspecialty certifications. 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. Oncall MD's in office daily to discuss your needs if you are unsure of what expert you need.
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 has served on the orthopedic trauma staff at Mercy San Juan Medical Center and serves on the Medical Executive Committee at Mercy San Juan. 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 is a senior member of the medical staff at Mercy San Juan Medical Center and was involved with the development of the orthopedic section of the Level II Trauma Center.
Dr. Klein is a clinical instructor at University of California, Davis, Medical Center, 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.
James Patrick Murphy, MD, MMM, FASAM, is a fellowship trained (Mayo Clinic) board certified Anesthesiologist with subspecialty board certifications in Pain Medicine and Addiction Medicine. Dr. Murphy has a Master of Medical Management degree (MMM) from the University of Southern California, Marshall School of Business.
Background Experience: Dr. Murphy is the president and founder of a private practice in the specialties of Pain Medicine (since 1998) and Addiction Medicine (since 2004), and serves on the faculty in the Anesthesiology Department of the University of Louisville School of Medicine. He has served as a United States Naval Flight Surgeon, Anesthesiologist, Medical School faculty (Mayo Clinic and University of Louisville), Pain Medicine specialist (interventional pain procedures and medication management), and Addiction Medicine Specialist.
Dr. Murphy is a past president of the Greater Louisville Medical Society and is president elect of the Kentucky Society of Addiction Medicine. He currently serves as the American Society of Addiction Medicine's representative on the American Medical Association's Pain Care Task Force. Dr. Murphy is also on the board of the Kentucky Harm Reduction Coalition (i.e. Narcan distribution and training) and serves as a task force work group member of the Kentucky Department for Public Health's Displaced Opioid Patient Workgroup.
Litigation Support: Dr. Murphy provides expert witness services to attorneys representing both plaintiff and defendant. He is particularly adept at defining "legitimate medical purpose in the usual course of professional practice." His services include medical records review, thorough reporting, depositions, and trial testimony as needed.
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, is a Stanford and UCLA trained, board certified Anesthesiologist and Pain Management Physician who has over 25 years of expertise. He holds a PhD in Biomedical Engineering from Stanford and has published in the lumbar decompression and electromedicine literature.
For the past several years, Dr. Odell has been a leader in developing a protocol for the treatment of diabetic and other peripheral Neuropathies. His protocol is being utilized around the country to improve the quality of life of those many patients, especially seniors, who suffer from this debilitating condition. A significant percentage of his pain practice has involved medical-legal cases. Dr. Odell's specialty focus includes chronic pain from Personal Injury Accidents, Over Billing in Pain Management, Over Utilization in Pain Management.
Dr. Odell has been retained as an Expert in Pain Medicine and Anesthesiology over 40 times in the last few years. His goal as a treating expert is to provide an accurate assessment of a patient's condition, to treat if possible, and to enable attorneys to make reasonable, informed decisions about the case. As a non-treating (outside) expert, his goal is to provide an accurate and honest assessment of a case regardless of for which "side" he has been hired. Dr. Odell's Expert Witness Services are available to attorneys for both Plaintiff and Defense.
Manonmani Antony, MD, DABA, DABIPP, is triple board-certified in Anesthesiology (ABA), Pain Medicine (ABA), and Interventional Pain Medicine (ABIPP).
Dr. Antony completed medical school at University of Peradeniya and later finished her residency at Texas Tech University, where she was awarded the Outstanding Resident Award. Dr. Antony was trained to perform advanced pain procedures utilizing cutting-edge technology during her Pain Management Fellowship at the University of Maryland. She currently lectures on Opioid Risk Management for the Medical Society of Delaware and the Delaware State Medical Board.
Dr. Antony's personal philosophy as a physician motivates her to explore every treatment option possible in order to avoid invasive surgeries and Opioid drug abuse in chronic pain patients. With great success, she uses Interventional Spinal / Joint Procedures along with Physical Therapy as alternative pain-management therapies to supplement patients' pharmacological regimens.
Litigation Support - Dr. Antony provides expert witness services for cases involving Interventional Pain Management and Opioid Risk Management. She has performed numerous Independent Medical Reviews (IMEs) and has testified in court approximately 25 times. Dr. Antony's services are available to counsel representing plaintiff and defendant and include Workers Compensation Review, Auto injury Review, Depositions, Narrative Reports, and Peer Reviews.