Medicolegal Practice

In these litigious days, physicians who evaluate cases with medicolegal overtones are often thought of as either "hired guns" for one side or the other of a legal dispute; or often, include those physicians who concentrate on medicolegal work as opposed to the active and contemporary treatment of patients. Unfortunately, this can result in opinions which are either biased towards one side or the other; or are not in keeping with present-day methods and standards of medical treatment. I have come to this area of professional work out of my active practice of neurological surgery, this based on the treatment of thousands of ill and injured patients over thirty-five-plus years of clinical practice.

Background

I began my involvement in medicolegal consulting work through my involvement in an active urban trauma service at a local hospital which served as the designated facility for the Berkeley/Oakland, California area. I became involved in the frequent treatment of victims of vehicular and other types of trauma, as well as the management of cases of violent crime, this during the turbulent period of the sixties and seventies. Such cases, no matter what their medical outcome, often became matters of the legal system, whether in the civil sphere (damages, product liability, wrongful death, etc.) or in the criminal arena (where I had often been the treating surgeon for the victims); and I found myself being called to testify in such legal proceedings. With my training and experience as a teacher of medical students, nurses, and residents, I found that I was able to communicate with juries and judges in a way that was understandable to medical laypersons; and I was told by various attorneys and prosecutors that I was a "good witness".

After some time, I found that attorneys and some law enforcement agencies were calling me to evaluate cases where I had not been a treating physician, and thus, my work in medicolegal consulting began, this back in the mid-seventies.

It is important that medical experts maintain at least a significant involvement with patient care, so that opinions regarding standard of care are derived from the active "hands-on" practice of medicine and involvement with "real patients" and their medical conditions.

^ back to top

Protocol for Case Evaluation

The usual beginning of our involvement in a medicolegal case is for the attorney (Plaintiff or Defendant) to contact my office and speak to me with the basic details of the case. If it appears that the medical aspects of the case are within my area of expertise and experience, I will ask for the referring attorney to send me all medical records, including the actual x-ray and other films for review. Depending on the volume of records, the evaluations can usually be completed within 3-4 weeks; but special arrangements can be made for more rapid evaluation in those instances were there is some time pressure (such as an impending Statute of Limitations). My office has full electronic communication capabilities, and much of our communication is done through electronic means, including e-mail, facsimile, and the Internet. This includes the ability to transmit and receive graphical data by electronic means.

We request a retainer at the time of our engagement and will ask that the attorney sign an Agreement regarding our policies. We will request a retainer amount dependent on the volume of records that we will be asked to initially review, with a minimum retainer amount of three hours of review time ($1500.00). If the case is to be "expedited" (requiring work outside of regular business hours), the retainer as well as the subsequent fees will be surcharged (see "Special Conditions" below). The initial retainer will be non-refundable. Subsequent deposits to the retainer may be requested as the case proceeds.

Billing will be rendered at thirty-day intervals and payment will be expected on receipt of the billing. The financial arrangements are between myself and the attorney, and the patient will not be billed for these medicolegal services. In those (rare) cases where it becomes necessary for the patient to be actually examined by us, we will bill (for the purely medical services) any health insurance program which may cover these services; but the patient, and/or his/her attorney will be responsible for full payment of such medical charges if the insurance company does not make full payment as billed.

Following the initial contact with the attorney (and payment of the initial retainer), the attorney will be asked to sign the Agreement letter listing the terms of the engagement. Once the review of the medical records is completed, I will seek a telephone conference with the referring attorney. If, after the conference, the attorney wishes a narrative report, such will be supplied according to our regular rates for such (usually based on our hourly rate). If, after the evaluation is completed, the attorney feels that he/she does not wish to proceed further, the records will be either returned or destroyed as requested.

Following the initial review, and if it is decided that the case will proceed, future services may be requested by the referring attorney. This includes review of additional material, search of medical databases (this office maintains full capabilities for such), submission of Affidavits, testimony at Deposition; and eventually, if necessary, testimony at trial or arbitration hearings. It is our experience that most cases in which we become involved settle out of court; but, if we are requested to do so (and appropriate arrangements are made sufficiently in advance), we will testify in Court as to our opinions.

^ back to top

Fee Schedules

Basic hourly rate..............$500.00/hour or fraction thereof.

Full narrative report......$500.00 and up, depending on time required.

Depositions........................$700.00 per hour or fraction thereof. Minimum 2 hours. Payable in advance.

Affidavits: 0.5 hour charge for execution of prepared Affidavit.

Testimony in Arbitration or Court......$6000.00 per day (minimum one day). See below for travel charges and policies regarding travel.

Please note: In the event of cancellation of depositions or other appearances within less than five (5) business days, a charge of one hour of deposition time (or one day of out-of-town testimony) will be assessed. All fees for depositions, arbitrations, or court testimony are payable in advance.

^ back to top

Travel Policies

In all cases where travel out of the immediate San Francisco Bay Area (Alameda, Contra Costa, Marin, or San Francisco Counties) is required, travel expenses and fees for services rendered will be payable in advance and before departure for travel. Cancellation fees, as described above, are non-refundable. This requirement is due to the fact that I must usually hire (and reimburse) other colleagues to cover my clinical practice while I am away.

Travel expenses include air transportation (First or Business Class), transportation to and from airports, all meals and lodging; and any transportation costs necessary between place of lodging and courts or other offices. It is my usual preference that I travel to the location of the trial and/or deposition (unless local to me) the afternoon or evening before the scheduled appearance; and I also prefer to make the return trip the morning after the testimony is completed. I will not charge for a second day of service if the testimony is completed within one day and I return the following morning; but I will expect reimbursement for the meals and lodging expenses for the second night. The purpose of this policy is so that I can arrive for testimony in a rested, fresh state; and return to my clinical practice the following day in a similar state.

^ back to top

Special Conditions

In cases where there is an extraordinary time pressure (such as in the situation where a Statute of Limitations is about to expire), we will accept, as caseload permits, "rush cases" where review has to be completed unusually rapidly. Hourly rates in these cases will be surcharged by a factor of 20% and advance payment (to be submitted along with the records) will be requested. This situation will include work which must be carried out over weekends, holidays, or other times which are outside of normal business hours.

^ back to top

Summary

We have a "track record" of careful, fair, and efficient evaluation of medicolegal cases. We utilize all of the modern capabilities of the "Information Superhighway" in this work, and our experience has been recognized by both the medical and legal professions. We hope that you will consider us for assistance in your medicolegal needs.

^ back to top