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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.
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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Mary Wickens, JD, CFE, CHC has over 35 years experience in the Healthcare Insurance, Managed Care, and Compliance Industry. Her experience includes advising and counseling health care providers, insurers, government contractors, and others in compliance, ethics, fraud and abuse, Medicare, Medicaid and Federal Employees Plan, managed care, and other matters. Background Experience - Ms. Wickens is a former compliance officer for a major health insurer and former legal and compliance specialist for a CMS Medicare Program Safeguard Contractor. Also a former operations director for government programs (Medicare Part C, Medi-gap, and FEHBP) for a major HMO, she is experienced with government audits and investigations, commercial audits, as well as self-reporting and internal investigations. Ms. Wickens has decades of experience as in house counsel to HMOs and health insurers. She has drafted, developed, negotiated, and implemented numerous healthcare provider-payor contracts, and developed and implemented codes of conduct, ethics programs, compliance programs and numerous corrective action plans. Litigation Support - Mary Wickens provides litigation support, including skilled expert services, reports and testimony in federal False Claims Act cases, arbitrations, and provider-payer disputes. She is an experienced testifying expert, responsive to the needs of counsel, with excellent report writing skills. Ms. Wickens' services are available to counsel representing both plaintiff and defendant. Areas of Expertise:
This brief describes: Which government agencies and health care providers have power to act and what are those powers? Who controls testing and reporting results and who has the power to isolate individuals, impose quarantines and take other steps to mitigate the outbreak.
The US Department of Justice (DOJ) recently joined a federal qui tam lawsuit1 brought against a private equity firm that specializes in health care pharmacies. Notably, the case also charges individual partners of the private equity firm, Riordan, Lewis & Haden, Inc. (RLH) based in Los Angeles2. They are charged with violations of the federal Anti-Kickback Statute (AKS) and the federal False Claims Act (FCA) in connection with their management of Diabetic Care Rx/Patient Care America (PCA), a compounding pharmacy. The case involves reimbursements from TRICARE, the health care program for the military and their families.
Health care fraud and abuse cases are often won or lost on the effective use of expert witnesses. As health care fraud cases have become more complex and technical, the scope and use of expert testimony has proliferated, and the successful use of experts is one of the lawyer's most important jobs. False Claims Act, Anti-Kickback Statute, and Stark Law cases all demand various types of experts to assist the trier of fact in understanding the nature of the case, the morass of rules at play, the evidence, and a variety of billing, valuation, contractual, technical, and compliance concepts. Increasingly, expert reports and testimony play a pivotal role in motions for summary judgment, as well as at trial. Experts also are used in "conference room litigation," such as mediations or negotiations between defense counsel and enforcement agencies. This article is the result of interviews with health care fraud litigators and expert witnesses in the field who identified their best practices to produce optimum outcomes for their clients.
Mari S. Truman, PE, has more than 37 years of experience in Orthopedic Product Design and Development. As Principal Engineer with her company, Orthobiomech, LLC, she acts as an R&D design and development consultant to the orthopaedic industry and an injury biomechanics and medical device forensic expert.
Ms. Truman's design experience includes implants and instrumentation systems used to repair fractured bones, torn ligaments and/or to reconstruct spine, knee, wrist, hip, ankle, elbow, thumb based cmc, and other finger and toe joints for many of the USA based orthopaedic conglomerates and a few Asian, Australian and European firms.
Having designed and developed implants and instruments used for both human joint reconstruction and skeletal trauma repair, Ms. Truman is named on 12 Orthopaedic Patents and frequently gives talks on implant design and injury biomechanics on topics such as: knee and thumb-based joint surfaces and kinematics, joint design, rapid prototyping, medical device design control, and injury biomechanics.
Litigation Support - Ms. Truman has been providing Forensic Impact and Injury Biomechanics and Orthopedic Biomechanics to the legal industry for over 15 years. She draws on her strong knowledge of FDA and ISO EN13485 compliant design control processes, failure modes and effects analysis, clinically relevant tissue loading, and design safety assurance, including device performance requirements and warnings, during her medical device litigation reviews. Ms. Truman has a strong knowledge of the production and quality assurance processes used in the manufacture, cleaning, and sterilization of medical devices and the effects of such processes on product performance.
Analysis of Traumatic Injuries Related To:
Falls and Fall Recovery
Assaults and Fights
Occupation or Workplace
Failed Medical Implants
Sports and Recreation, Occupational Overuse / Injury
Rod O'Connor, C.P.O. has over 30 years experience with Prosthetic and Orthotic Devices. His company has been Orange Countie's premiere Orthotic and Prosthetic supplier. After almost three decades of excellence, Mr. O'Connor sees client’s from around the globe including Spain, Iran, Japan, and more. He uses a combination of tried and true techniques combined with cutting-edge technology to tailor each device to the client’s needs.
O’Connor Orthopedic is the first orthotics and prosthetics clinic in Southern California to incorporate 3d printing and scanning into our everyday practice. Patients will see a reduction in the time it takes them to get their device and also a vast increase in the comfort due to the precision fit they can offer.
Litigation Support - Mr. O'Connor is available for consulting, expert witness services, forensic work, case viability and second opinions. He is certified by the American Board for Certification in Orthotics & Prosthetics. He has expertise in all types of artificial limbs and orthopedic appliances (braces).
Mr. John F. Schulte, is an accomplished Orthotic and Prosthetic practitioner with 40 plus years of experience consulting and treating Body and External powered upper and lower extremity prosthetics for all age groups.
Mr. Schulte has vast knowledge and experience in clinical practice prosthetic and orthotic component development, design, and manufacturing. A Clinician, Patient Care Consultant, and Senior Manager of 27 offices throughout 5 states, he is considered an expert in his field. Mr. Schulte continues to be asked to consult on Clinical ‘Best Practices’ by physicians, third party payors, peers, and patient users on the most appropriate component utilization and outcome measurements.
A published author, consultant, and Clinical Board Examiner, Mr. Schulte has treated and been involved with the treatment of persons of all ages with congenital birth defects, limb weakness and loss, and spinal cord injury.
Litigation Support - John Schulte's intimate knowledge in prosthetic and orthotic clinical practice and management, component prescription recommendation, and selection and utilization for all patient ages and levels of function make him an excellent expert witness resource. His services are available to attorneys representing plaintiff and defendant and include medical record review, second opinions, written reports, depositions, and trial testimony.
The 3D printing manufacturing process has been garnering the Medical headlines lately. While exciting to literally print a device right from the computer, some very important aspects relative to placing a printed device on a medical referral person particularly regarding prosthetics and orthotics will be discussed...
There may be more to the complaint than meets the eye. There may be obvious issues, such as a failed component resulting in a fall, a skin breakdown that on the surface appears that it was as a result of overuse or a rough area within the prosthetic socket.