Ms. Roughan is a Rehabilitation Nurse Specialist who functions in the capacity of case manager, life care planner and expert witness. Her company, Roughan & Associates at LINC, is a nationally recognized Case Management and Medical/Legal Consulting service. It has been in existence since 1987, providing coordination of patient care; construction of Life Care Plans; and, consultative services to both the defense and plaintiff bar on simple and complex cases alike. Ms. Roughan has experience with diagnoses involving both children and adults and are knowledgeable in current treatment philosophies, identification of appropriate resources.
Diagnoses include, but are not limited to:
Neurological Injuries (Brain and Spinal Cord Injury)
Dr. Pia Quimson-Guevarra is Board-Certified in Psychiatry and Forensic Psychiatry by the American Board of Psychiatry and Neurology. She opines about psychiatric issues in civil litigation, employment matters, and criminal cases. She has extensive experience with diagnosis and treatment of depression, anxiety, bipolar disorder, PTSD and other factors of emotional distress, both as a treating physician and in medical-legal cases. She serves as a forensic consultant, and/or disclosed Expert Witness. She assesses competency and undue influence, standard of care, and mental status re judgment and clarity of thinking. Applies to civil, probate and CTST criminal matters including criminal responsibility. She is also experienced in treatment of psychotic disorders, hallucinations, and delusions.
She opines about medication or drug impact on behavior.
Dr. Quimson-Guevarra conducts IMEs and review of medical and legal records. Her assessments are thorough and inform thoughtful and objective expert opinions issued by verbal and written report and testimony. She conducts Independent Medical Evaluations face-to-face in person and by video.
She is a Certified Forensic Evaluator in Oregon.
Dr. Quimson-Guevarra's clinical practice in Portland is Quimson Behavioral Health, providing psychiatric patient care, medication management, and psychotherapy, for patients who suffer from mental disorders, e.g., Anxiety, Depression, Bipolar Disord & PTSD and medication management. She continues to use her expertise in psychopharmacology to treat mental health conditions in the context of medicolegal medically complex cases.
Prior to expanding her private practice, she was a psychiatrist at Cascadia Behavioral Healthcare, in an Assertive Community Treatment (ACT) team, a method to deliver an intensive level of services to patients in the local community. Her patients consisted of individuals who suffer from severe and persistent mental illness. At Cascadia, she also treated patients with a history that includes forensic medical-legal issues.
Previously, Dr. Quimson-Guevarra treated patients who suffered from anxiety, mood, and psychotic disorders at Cedar Hills Hospital, Multnomah County Detention Center, Washington County Jail, Snake River Correctional Institute, and the Portland Veteran's Administration.
Dr. Quimson-Guevarra has served as a forensic consultant for the Washington County Mental Health Court in Oregon. She also has worked in the forensic evaluation service department at the Oregon State Hospital where she performed forensic evaluations.
With training from Harvard, Yale, Columbia, and other top-tier institutions, Dr. Daniel Cousin is a dual-boarded fellowship-trained expert in Diagnostic Radiology in active clinical practice who offers same-day (<24 hr) turnarounds on radiology consultations.
Dr. Cousin has served as a Medical Director in private practice, and also as a Program Director for a residency program where he was responsible for teaching newly minted doctors to be radiologists. He has nearly two decades of experience in the field including both academic and private practices and both clinical and administrative positions. Dr. Cousin is currently the Clinical Director for BayView Radiology in Florida. He is board-certified by both the American Board of Radiology and also by the National Board of Physicians and Surgeons.
Litigation Support - Dr. Cousin is a pioneer in 4D demonstrative evidence, has an impressive lecturing and public speaking experience, presents well before juries, and has testified as an expert over 60 times in the last 4 years. As of 2021, his plaintiff defense split is approximately 50/50. Dr. Cousin offers Independent Medical Reviews (IMEs), Utilization Reviews, Medical Malpractice Reviews, Personal Injury Protection, Bodily Injury Reviews, Second Opinion Imaging Reviews, Re-Reads, and Worker's Compensation Reviews.
Sajid R. Khan, MD, is a board-certified Emergency Medicine physician with over 15 years of experience working in a variety of settings from inner-city level 1 trauma centers serving 100,000 patients per year to 3-bed rural Eds. Dr. Khan has served as a Medical Director, Oral Boards Examiner, and member of the Honor Council. He is ACLS (Advanced Cardiovascular Life Support), ATLS (Advanced Trauma Life Support), and PALS (Pediatric Advanced Life Support) certified. Dr. Khan is a member of AOA (the only national medical honor society in the world) and served as an Assistant Professor of Emergency Medicine at the University of Missouri-Kansas City.
A published author, Dr. Khan has written a number of books including, The Ultimate Emergency Medicine Guide, a comprehensive review book that is the highest-rated and most up-to-date text for Emergency Medicine physicians preparing to certify.
Litigation Support - Dr. Khan offers expert witness services to attorneys representing plaintiff and defendant. Licensed in Kansas, Missouri, Georgia, and Texas, he complies with the ACEP Expert Witness Guidelines and will provide an honest and unbiased opinion on Emergency Medicine Medical Malpractice and Negligence cases. Dr. Khan is available for consultation, chart review, and expert testimony.
Acute compartment syndrome (CS) is a true orthopedic emergency. It is a painful condition that occurs when pressure within the muscles builds to dangerous levels. It is often - but not always - the result of a traumatic injury. Management involves a fasciotomy in which the surrounding skin and fascia
We are in the midst of a global pandemic the likes of which we have never before seen in our lifetime. Every day a new record high number of cases and number of deaths is reached. While the number affected physically, emotionally, and economically spirals out of control, here is something that will serve as a gut check: these will be remembered as the good old days.
Plantar puncture wounds are common and the anatomy of the foot makes it an excellent environment for infection to rapidly spread. Puncture wounds in particular can inoculate bacteria deep into the soft tissues.
A 70 year-old woman presents to the ER with mid-sternal chest pain, shortness of breath, and diaphoresis. She's clutching her chest with her fist. There is isolated ST elevation in aVR and inferolateral ST depression. That's a STEMI! Or is it?
Fluoroquinolone antibiotics (Ciprofloxacin, Levofloxacin, Moxifloxacin, among others) are an important class of antibiotics that are used in a variety of settings. Ciprofloxacin remains one of the primary treatment options for cystitis. It is used routinely for inpatient treatment of pneumonia and many still consider it part of the first-line treatment for diverticulitis. But in the last few years, questions about its safety profile have led to growing concerns.
Managing the Emergency Department is a team sport. That means sharing information with one another, trusting your teammates to perform to the best of their ability, and working together towards a common goal. To that end, one responsibility of [most] ED physicians is supervising mid-level providers.
Cervical arterial dissections most commonly occur in the carotid arteries, followed by the vertebral arteries. Vertebral artery dissection (VAD) often presents after a trivial injury such as hyperextension of the neck while at the salon...
Myasthenic crisis is a rapidly progressive and potentially fatal condition. Early consideration and bedside confirmatory tests are essential. Have a low threshold to establish a definitive airway using higher than typical doses of paralytic medications. Involve the consultant early and be extra vigilant when caring for anyone with a history of myasthenia gravis
When evaluating a patient, we rely on a good history to help us form a differential diagnosis. We use our physical exam skills to refine that list. A bedside ultrasound or ECG can further guide our decision-making and save precious time. Beyond these, we rely on seemingly failsafe data: radiographs, blood tests, and urine samples. But sometimes these reliable tests aren't so reliable.
As disease patterns evolve, so too must we. Being aware of emerging illnesses and remaining diligent in identifying their presence ensures a safe environment for the patient and the community. Measles is a highly contagious and potentially lethal viral infectious disease.
This book is a guide to the first ten years following completion of Emergency Medicine residency training. It’s a review of both the clinical and non-clinical: must-know ECG patterns, uncommon presentations of common illnesses, debunking dogma, bouncebacks, managing administrative duties, how to avoid malpractice lawsuits, tips for paying off debt, and more! With contributions from The White Coat Investor and others, there is no shortage of valuable experience to be gained.
Written by clinicians in day-to-day practice of emergency medicine, this book provides a review of all topics relevant to practicing physicians. Contributions from current and recent emergency medicine residents ensures that it is the most up to date resource available for preparation for the ABEM qualifying examination, the annual in-service examination, and the maintenance of certification examination. Join the thousands of emergency medicine physicians who have successfully used the Ultimate EM Guide!
Ethical Situations are almost never black or white. There are a number of legal principles (autonomy, beneficence, substituted judgment, end-of-life issues, abortion, etc) which play a significant role in the practice of medicine that can help form a basis for decision-making. This book is targeted towards medical students who are seeking to form that foundation to make sound ethical decisions in the care of patients.
Lois Hawkins, RN, CLCP of Hawkins Forensic Consulting, Inc, specializes in Medical and Vocational Damage Assessment in personal injury and catastrophic injury cases throughout the United States. For over 10 years, Ms. Hawkins has been evaluating cases involving children and adults with complex, catastrophic injuries, as well as less serious injuries.
Life Care Planning - Comprehensive Record Review and supportive documentation / Case Analysis, Case Summary Chronology, Clinical Interview and History with Patient, Medical-Legal Research, Assessment of Future Medical / Rehabilitation Needs
Legal Nurse Consulting
Professional Memberships and Associations International Academy of Life Care Planners (IALCP) - Present International Association of Rehabilitation Professionals (IARP) - Present American Association of Legal Nurse Consultants (AALNC) - Past American Operating Room Nurse (AORN ) - Past
EXPERTISE IN: 1. The pathobiology, clinico-pathologic correlation, and histopathologic diagnosis of: diseases of the esophagus, stomach, small intestine, colon, rectum, anus, liver, and pancreas. 2. Human neoplasms (cancer) and preneoplastic conditions. 3. Establishing standard of care, causation and cause of death.
BACKGROUND: 1. Anatomic Pathology Residency: Washington Univ-Barnes Hospital 1991-94. 2. Oncologic Pathology Fellowship: M.D. Anderson Cancer Center 1994-95. 3. Gastrointestinal and Liver Pathology Fellowship: Harvard-Brigham & Womens Hospital 1995-96. 4. Instructor at Harvard Medical School: 1996-1998. 5. Assistant Professor and Director of Gastrointestinal Pathology Division at UT-Health Science Center-Hermann Hospital, Houston Medical Center: 08/1998 - 12/2000. 6. Staff GI Pathologist and Quality Assurance Director at Caris/Miraca Life Sciences, Dallas TX: 01/2001 - 04/2012. 7. Staff Pathologist, Anatomic Pathology Division of the North Shore-LIJ Health System, Long Island NY: 05/2013 - 05/2015. 8. Staff Pathologist, Anatomic Pathology Division of Alliance Health Sciences, Dallas TX: 01/2016 - present. 9. Sole Proprietor of Expert Pathology Consultation Services Laboratory since 01/2001, which provides diagnostic pathology services to hundreds of clinicians of different subspecialties.
Dr. Torres was instrumental in creating a unique model of Gastrointestinal Pathology subspecialty-focused laboratory, during his tenure at Caris/Miraca Life Sciences.
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.