Doing medical-legal consulting is a great way to use your medical training in a non-clinical field that really helps people. One of the many things we can do is help attorneys refute the question of a pre-existing medical condition. Often opposing counsel will try to lay off accident injuries as not related to the accident or injury in question.
As you may know, medical-legal consulting is a new non-clinical field in which doctors work pre-trial/pre-litigation consulting in legal cases that don’t go to trial. We act as physician consultants in approximately 9 out of 10 negotiated and settled cases. In fact, we work on the strategic development of medical issues and can be the missing piece in maximizing case value and getting the appropriate treatment for injured persons. We don’t act as medical experts, and we don’t participate in medical malpractice cases.
I recently had a case of a 57-year-old man who suffered a mild traumatic brain injury in a work-related accident. The client was walking up a flight of stairs at his place of work to get to his office. A workman installing an electrical conduit on the roof for a backup generator was above the client on the stairway landing and dropped his tool belt, which fell approximately 20 feet and hit the client on the top and frontal areas of his head. The tool belt was estimated to weigh 15 pounds. The client received a laceration to the scalp as well as being knocked to the floor. He had a period of approximately one minute when he lost consciousness. On regaining consciousness, the client felt dazed, confused, disoriented, and had a brief period of retrograde amnesia.
The client began to suffer cognitive deficits immediately after the accident. In the medical records, the client has been repeatedly diagnosed as suffering a mild traumatic brain injury(mTBI), and he had an abnormal MRI of the brain, which showed “a small right frontal abnormality on gradient echo imaging which most likely represents a hemosiderin stain or deposit from a blood vessel associated with a traumatic injury within the anterior corpus callosum.”
The client was eventually diagnosed as having a traumatic brain injury with significant cognitive loss, depression, and anxiety. In addition, the client also developed a visual/perceptual disorder and a sleep disorder as part of his post-concussion syndrome secondary to the mTBI.
The client had a pre-existing history of coronary artery disease and, approximately seven months after the work-related accident, underwent coronary bypass surgery without complications due to myocardial infarction. Opposing counsel suggested the pre-existing coronary artery disease and subsequent bypass surgery accounted for the client’s cognitive and other symptoms.
To a reasonable degree of medical probability, it was my medical opinion that the client’s coronary artery disease did not play a part in the client’s post-accident symptoms. First, the client began to experience mTBI symptoms immediately after the blow to his head. He was describing the same constellation of mTBI symptoms prior to his myocardial infarction as he did after the myocardial infarction. This point cannot be emphasized strongly enough, there were no new brain disorder symptoms after his myocardial infarction and subsequent bypass surgery, and there was essentially no change in the nature and intensity of the mTBI symptoms he described after the cardiac events. In addition, I pointed out the client had objective brain MRI changes consistent with traumatic brain injury.
I also noted evidence from the medical records. The client’s treating brain injury specialist opined in a progress note he did not think the client’s symptoms were related to the heart disease or heart surgery. The doctor stated, “The question has been raised as to whether these problems are all due to his concussion and the residual effects of mild traumatic brain injury or if the cardiac condition may have contributed in some way. Our records indicate that the complaints of cognitive and visual problems stem from the workplace concussion incident which preceded his cardiac problems and surgery.”
I also noted in my report that the treating Ph.D. neuropsychologist in her report stated, “His cognitive deficits, at this time, appear consistent with a concussive injury or mild traumatic brain injury.” She went on to state, “The results (of her neuropsychological testing) do not indicate that the client is experiencing the verbal memory deficits and executive functioning deficits often seen in coronary artery disease patients or patients with congestive heart failure.”
Armin Feldman is a medical consultant to attorneys.
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