Stephen M. Raffle, M.D. is double Board-Certified in Psychiatry and Forensic Psychiatry. Dr. Raffle has over 49 years as a clinical and forensic psychiatrist offering his expert opinion in Federal and State jurisdictions nationwide. In addition to serving as an expert witness, Dr. Raffle consults to attorneys, judges, insurers, and to employers regarding Fitness for Duty and Risk of Violence (Threat) Assessment:
5000+ psychiatric assessments
Expert testimony in 700 depositions and trials
Successful clinical practice
The job of an expert witness is to educate a jury, judge, attorney, and trier of fact about the forensic psychiatrist's conclusions and how those opinions were derived in a manner well-reasoned, skillful, and easily understood by every person, not only another forensic psychiatrist. In short, an educator. Dr. Raffle’s experience as an educator extends well beyond a forensic venue, yet underpins the key to his ability to explain his opinions.
Prof. of Psychiatry, UCSF Medical School, 20 years
U.C. Hastings College of the Law postgraduate course "Trial and Appellate Advocacy" instructing seasoned attorneys about the direct and cross-examination of expert witnesses, with special focus on mental health experts and licensed medical professionals, Psychiatrists (MDs), Psychologists (LCSWs / MFTs), and physicians in other medical specialties, 11 years
Stephen M. Raffle, M.D. & Associates' expertise is well-established in forensic assessment in the areas of:
In order for a medical opinion to be admissible as evidence in civil, criminal and administrative cases, the basis of the opinion must fulfill either the Daubert Criteria or the Frye test, depending on the jurisdiction. The judge of the court rules on the admissibility of the expert opinion. The effect of Daubert has been to limit expert testimony to opinions which are based on a scientific foundation. Daubert specifies that adequate scientific support and method and a known error rate must exist. The testimony of a mental health expert rendering an opinion using criteria which does not meet Daubert standards is weakened by the implication that it is not based on "sound science." In some instances, for example, a mental health expert uses an approach where there are no peer-reviewed studies or methods, such as when psychologists compose their own neuropsychological test batteries. In most cases where an attorney is considering a "Daubert challenge," a contemporaneous and up-to-date literature search is indicated. Also, extensive case law presently exists as to specific issues. Being familiar with the Daubert criteria enhances effectiveness in challenging a mental health expert's opinion, whether on voir dire or cross examination. On direct examination, the strengths of an opinion reached under Daubert criteria become a "teaching moment" for the trier of fact, because it will be founded on the science of mental health assessment.
Undue influence occurs when the testator's freewill and freedom of choice in the disposition of the assets of his or her estate is replaced by the substituted judgment/wishes of another. This can apply to creating a will, codicil to amend a will, trust or other legal instrument.
The medical expert cannot express an opinion about the ultimate question to the trier of fact: how much is the plaintiff's emotional distress (emotional injury) worth in dollars? Yet when the question of these monetary damages is put to a jury, their deliberations are better-served if considered in the context of a Forensic Psychiatrist's knowledgeable findings and testimony.
My teacher and mentor, Dr. Bernard Diamond, pondered the question about the role of the psychiatric expert and other experts in the courtroom. My first public presentation was to the American Criminology Society on this topic, and it has continued to occupy my attention to the present
All psychiatric reports evaluate something, but not always the same thing. For example, eligibility for benefits, or fitness to do a job. To make sense of the report, the reader must determine what is being evaluated and how it is being done
In civil cases where emotional distress is alleged, it often occurs that the plaintiff’s attorney designates the treater as his expert. Usually the argument is that the plaintiff’s own therapist has spent many more hours with the plaintiff than the defense expert and therefore "knows" the plaintiff better. The treater often agrees with this reasoning
Joseph B, Marzouk, MD, FACP, has been in clinical practice exclusively in the field of Infectious Disease since 1982 and has consulted and treated thousands of patients. He has more than 35 years of experience in the medico-legal aspects of Infectious Disease and has provided numerous objective reviews and testimonies for defense and plaintiff’s attorneys.
Degrees / Licenses: MD (Licenses: AZ, CA), American Board of Internal Medicine, Infectious Diseases; Certification Board of Infection Control. HIV Specialist. See CV on Website for more details.
Areas of Expertise: Infectious Disease in all medical specialties:
Dr. Matthew Lee, MD, RPh, MS. is a Physician, Pharmacist, Pharmacologist and Toxicologist who also practices as an Expert Witness and Legal Strategy Consultant. Specific Benefits Include:
Increased quality and integrity of written expert reports, based on an expanded knowledge base
Time savings by only having to coordinate and discuss a case with one expert as opposed to two or more
Since there is so much overlap between fields in the medical profession it is often hard to determine where one scope ends and another begins. This ambiguity is dramatically decreased , and scope increased by combining physician, pharmacist, and pharmacologist into one
Communication skills of a pharmacist and experience dealing directly with the lay-public, in addition to the knowledge and background of a physician is extremely beneficial describing technical details to a jury
Practicing in different realms within the healthcare field has allowed Dr. Lee to integrate the multiple facets giving him a unique and distinct perspective that no other expert has.
Case Experience Includes:
Criminal and Civil Cases
Pharmacist Dispensing Errors
Pharmacy Standard of Care
Medication Adverse Effects
Falls Related to Medications (in and out of hospital)
Dilaudid is a commonly used opioid narcotic analgesic in hospitals due to its potency and effectiveness in the management of acute pain. On occasion, patients may be administered too much Dilaudid resulting in an overdose.
Clive M. Segil, MD, FACS, FRCS is an internationally renowned Orthopedic Surgeon with 45 years of experience in the management of Musculoskeletal Disorders. He practices orthopedic surgery, treating all orthopedic conditions.
Dr. Segil is on the staff of Cedars-Sinai Medical Centre, St Johns Hospital Medical Centre, Valley Presbyterian Hospital.
He is in active practice in the Los Angeles, with offices in Century City, Encino, Lawndale, Glendale, Lancaster, Pomona. He is a past assistant clinical professor of orthopedics at the University of Southern California School of Medicine and a past Clinical Chief of Orthopedics at Cedars-Sinai Medical Center.
Dr. Segil completely understands the forensic system, is comfortable and confident in presentation and trial appearance, and is not intimidated by court proceedings. He has experience in all aspects of Orthopaedic Surgery. He is familiar with the new changes in the Workers' Compensation arena, including using the AMA guidelines, the ACOEM guidelines, and the American Academy of Orthopedic Surgery guidelines for spine problems.
Dr. Segil testifies for defense and plaintiff cases with an unbiased, erudite, understandable, and logical argument to support the facts and evidence. He has provided unbiased, detailed, ratable, and credible reports concerning injured workers and has given an honest opinion as to their condition, causation, prognosis, disability, and apportionment in a precise organized manner.
AMFS is the nation's leading provider of medical expert witnesses. We maintain a network of thousands of actively practicing, board-certified physician medical experts as well as expert witnesses in all other health care related fields. Since 1990 we have provided medical expert witnesses to thousands of attorneys in thousands of cases, including medical malpractice, personal injury, wrongful death, criminal and other matters. Contact AMFS now for a free case analysis with our team of U.S. based Medical Directors.
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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.
Richard Stripp, PhD, is a nationally recognized expert in Toxicology providing services in all aspects of a Clinical and Forensic Toxicology. He has served as an expert consultant in 100’s of cases in the field of toxicology and pharmacology for attorneys, investigators, and physicians involved in forensic and clinical toxicological evaluations associated with ethanol, drugs of abuse, prescription medications and chemical exposure. Dr. Stripp provides unbiased expert case reviews involving drug effect on human performance, toxicity of iatrogenic/ therapeutic agents, lead and other toxic metals, carbon monoxide and environmental/occupational hazards. These services include, impartial evaluations involving drug impairment, overdose, toxic chemical exposure, medical issues associated with drug therapy, poisoning, and the role of drugs, alcohol, or chemical exposure in civil and criminal litigation. This covers a full breath of forensic medical-legal cases including:
Analytical Toxicology and Laboratory Operations
Review and Interpretation of Toxicology Reports
Assessment of Impairment and the Role of Drugs/Alcohol in fatalities, accidental injury, overdose, MVA / DWI / DUI, criminal and civil litigation
To Serve as an Expert Witness: Experienced in Depositions and Court testimony
Forensic Toxicology Case Reviews
Drug and Alcohol Effects
Environmental/Occupational Chemicals & Toxic Chemical Exposure
Interpretation of Analytical Results and Drug Testing Cases