Medical Expert Witness Testimony - Principles and Practice
This seminar is designed to teach occupational medicine practitioners, residents, and select doctorally-trained OEHS professionals regarding admissibility of scientific evidence, pertinent aspects of the Federal Rules of Evidence, qualifications to provide testimony, legal aspects of the determination of work-relatedness, principles of evidence, differences between jurisdictions, Daubert, Frye and similar US Supreme Court cases and standards and the integration of principles of epidemiology into the determination of work-relatedness. The material is covered as follows:Legal Principles: Admissibility of Evidence (Frye, Daubert, and Workers' Compensation). The session will cover the varying legal standards for the admissibility of scientific evidence in medicolegal proceedings. These are essential for physicians to understand to provide admissible, evidence-based testimony.
Methods to Determine Work-Relatedness
1. A Guide to the Work-Relatedness of Disease. 1979. Rev'd Ed., Kusnetz, S. and Hutchison, M., Eds., NIOSH Pub. No. 79-116.
2. Guides to the Evaluation of Disease and Injury Causation, AMA (2008) (2d Ed. 2014).
3. Greaves, WW, Das, R, Green-McKenzie, J, Sinclair, DC. 2018. Work-Relatedness. JOEM 60(12): e640-646; MDGuidelines®.Web, Hegmann, KT, Ed., www.mdguidelines.com. Reed Group, Ltd., acc'd Aug. 21, 2024.
Evidence of Disease. This part of the course will address determination of evidence of disease according to specific diagnostic criteria and objective testing, including laboratory data, imaging, electrodiagnostic and other special testing methods. Sometimes, establishing evidence of disease is straightforward. At other times, the diagnosis is not supportable by the evaluating physician and/or corporate medical director. So what is the physician to do? Options include both addressing the purported diagnosis, obtaining second opinions, and addressing both the proposed diagnosis and the diagnosis best supported by the evidence. Principles of the "differential diagnosis" methodology in compensation environments will be addressed.
Epidemiology. This section of the course will provide information on how to obtain evidence-based summaries of the literature, especially when systematic reviews and metanalyses are not available. The critical importance of epidemiological evidence to quantitate individual exposure will be addressed. The prerequisite of epidemiological evidence to prove causation and the evaluation and interpretation of the epidemiology in medicolegal proceedings will be reviewed in depth.
Evidence of Individual Exposure. Quantified exposure is optimal for determining work-relatedness, providing precision. This section of the course will provide a summary of how to obtain evidence of exposure, with whom to collaborate to quantify exposure, and how to quantify risk utilizing valid and reproducible (reliable) methods to measure exposure and acceptable surrogates for individual dosimetry.
Consideration of Other Relevant Factors. At times, there are confounding factors that overwhelm the occupational factors. In some workers compensation systems, these factors may result in exclusion of coverage for a work-related condition, while in other systems, coverage is still provided; however, a permanent impairment rating becomes apportioned between the occupational and non-occupational causes. Principles of sole and multifactorial causation will be discussed.
Validity of the Testimony. The physician must opine when there is evidence that the opinion of another expert witness is not founded on facts, has not adhered to a valid and reliable method, and/or otherwise demonstrates unreliability, including testimony of lay and expert witnesses on exposure to occupational and environmental physical, chemical, and biological factors.
Conclusions. The forgoing steps are synthesized in a paragraph in the physician's report and an opinion on causation is succinctly stated.
Panel Discussion. The panel will address questions, answers, and discussion with the audience in addition to the brief Q&A sessions at the close of each sub-part of this seminar.
Please contact our office regarding availability of this course:
RMCOEH
801-626-6600
ce-enrollment@weber.edu