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“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.”
Armin Feldman is a medical consultant to attorneys.
He shares his story and discusses his KevinMD article, “How a medical-legal consultant helped refute a possible pre-existing medical condition argument.”
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Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at kevinmd.com/rate. Subscribe at kevinmd.com/podcast. Today on the show, we welcome back Armin Feldman. He’s a physician and a medical consultant to attorneys. We’re going to talk about his most recent KevinMD article titled “How a medical-legal consultant helped refute a possible pre-existing medical condition argument.” Armin, welcome back to the show.
Armin Feldman: It’s a pleasure to be here, Kevin. Nice to see you again.
Kevin Pho: So, we’ve had Armin on multiple times. If you’re interested in hearing more about his story, just go to kevinmd.com/podcast, upper right-hand corner, search for his prior episodes, and you can hear about his story. But I want to go right into this most recent case. So, Armin, tell me the background of this case.
Armin Feldman: Sure. Kevin, as I work as a medical consultant in legal cases, I don’t work as a medical expert. So, I’m working primarily on those approximately nine out of 10 cases that the attorney is going to negotiate and settle. Now, the cases are primarily in personal injury and workers’ compensation, although I’ll tell you that a physician in any specialty can learn how to do this work.
So, this case happened to be a workers’ compensation case. This was a 57-year-old man. He was an engineer who worked at an aerospace company. He had the habit, for exercise, of walking up the stairs to get to his office. There was a worker putting some stuff on the roof, and the worker was a couple of flights up. Unfortunately, this poor guy was at the landing where he would turn to go up the next stair, and the worker dropped his tool belt. The tool belt weighed about 15 pounds, and it hit this man right on the top of his head and then his forehead. He was sent to the ground. He lost consciousness for about a minute.
As a result of this accident, he wound up with a mild traumatic brain injury and subsequent post-concussion syndrome. He had a lot of problems after this, by the way. He was unable to work, and his life was just turned upside down, but his biggest problems were the cognitive problems that he had. The onset of these cognitive problems was immediate. What the problems were is well documented in his medical records from his treating doctors. I won’t go into all of it, but he had short-term memory loss, he had word-finding problems, and he had difficulty with executive functioning, for example, planning and the execution of plans. He had trouble tracking conversations. He couldn’t even watch television and follow it properly. So, obviously, he was quite injured from this accident.
What happened was that this happened in January of 2021. He was still in treatment, by the way, but then in November of 2021, he had an MI and subsequently had coronary bypass, four-vessel bypass surgery, from which he had a very good recovery. What often happens in all of these cases is that opposing counsel and opposing doctors are often looking for some way to lay off the problems that the person has from an accident onto something else, obviously, so they’re not liable. In this case, the opposing doctors, from an IME, and opposing counsel subsequently were saying, “We don’t think that these problems are from the accident. We think this is all related to his heart attack, and then he had to have bypass surgery. He was on a heart-lung machine, and this is clearly from that.”
OK. This is something that we often do. In fact, one of the things that I do with regularity is I actually physically sit in and observe independent medical exams done by other physicians, and that puts me in a position to write an IME rebuttal. Now, let me say there are very good doctors that do very good IMEs. We also know that everywhere in the country, there are doctors that get hired by insurance companies for obvious reasons.
So, the attorney that hired me, who was representing the injured worker, asked me, “What is your opinion with regard to the myocardial infarction itself, the sequelae of that, and particularly the sequelae or problems or issues related to his bypass surgery? Is that at all at play here in this man’s cognitive difficulties?” It was clear that it was not.
First of all, the cognitive difficulty started immediately after the accident. It was well documented. Sometimes it isn’t, by the way. The issues of cognitive loss sometimes show up days, weeks, sometimes even months after an accident, because the symptoms are foreign to the person injured. Oftentimes they have other injuries that are preoccupying their thinking. There’s even literature, by the way, medical literature, that these symptoms are often foreign to or misinterpreted by physicians as well. But this was clear, and his symptoms were no different from the time that these problems started. They were exactly the same after his MI and his bypass surgery.
Also, in many of these cases of mild traumatic brain injury, MRIs and CT scans will be negative, and that’s really the case most of the time. But in this particular case, there was objective evidence that this poor man had a bleed. It showed up on the MRI. So, we had no change in symptoms, and we had MRI evidence prior to his myocardial infarction. It was good for the case, bad for the injured person, but good for the case. That supported my medical opinion, to a reasonable degree of medical probability, that the heart attack and the subsequent surgery played no role. Then we also had supporting data from the neuropsychologist who had done the neuropsych testing and then subsequently provided cognitive rehabilitation.
So, I quoted the doctors. That was my opinion, and I supported it by quoting the treating doctors and by quoting the PhD psychologist in the case, so we could support the position that the injury was the immediate and proximate cause of his mild traumatic brain injury, the subsequent symptoms, and the resulting complete disability.
Kevin Pho: Now, did you talk to the injured patient yourself, or was your opinion just purely based on a review of all of his medical records?
Armin Feldman: Yeah, you always ask such good questions. So, in every case, here’s what we do. Obviously, we’re going to talk to the attorney involved. Then we’re going to read the medical records. Then we will interview the client in every case, no matter what the situation is. In the olden days, we used to typically do that by phone. Now, typically, we’ll do it by Zoom meeting. Occasionally, when it’s indicated, we might interview them in person in the conference room at the attorney’s office. That puts us in a position to do whatever medical research we need to do to back up our opinion. For the viewers, if they want to read the report, there’s a link to it, and they’ll see how I backed up my opinions with evidence from the medical literature.
Kevin Pho: I’m also going to assume that the opposing party also potentially can hire medical consultants as well. So, what happens when your opinion conflicts with the other side’s medical expert’s opinion?
Armin Feldman: We’re just on the medical side, right? So, we provide our medical opinions to the best of our abilities, to a reasonable degree of medical probability. Then, obviously, it’s up to the client-patient’s attorney to advocate on their behalf. What we’re typically doing is trying to help that attorney better negotiate and bring the case to a satisfactory settlement. I can tell you, having done this for 15 years, I’ve done over 3,000 cases, and the feedback from the attorneys that I work with is that, in fact, by using our medical consultancy services, as opposed to having to hire medical experts, they are settling these cases for more money with less attorney time, and we’re helping them bring that case to settlement.
Now, in those maybe one or two out of 10 cases that can’t be negotiated and settled, and the attorney is going to have to take the case to trial, then of course at that point, the attorney is going to need medical experts in every area of injury. But for the purpose of negotiating and settling the case, typically what the attorney needs is well-reasoned, thought-out, cogent reports backed up by evidence from the medical literature, which really any physician can provide after getting some training in how to do this kind of work.
Kevin Pho: So, without being privy to the decision-making process, what was the outcome of this case, and can you speculate on the influence your medical report had on the outcome of this case?
Armin Feldman: Yeah, this case did not go to trial. This was a workers’ comp case, so it would have gone to an administrative hearing, which has an administrative judge that has the force of law. It’s really a trial, right? But prior to needing to go to the administrative hearing, the attorneys were able to negotiate that case. This argument was refuted, right? It was on the basis of my report, really, but as supported by the treating doctors. This case was able to be settled satisfactorily, meaning that the client would get the appropriate medical care that they needed to bring them to maximum medical improvement, which, you know, is a term specific to workers’ compensation cases. So, I was able to help that attorney satisfactorily settle this case.
Kevin Pho: Now, of the thousands of cases that you’ve done, this particular case that we’re talking about today, where does that fall in the spectrum of how straightforward that opinion was for you?
Armin Feldman: This was actually a pretty straightforward case. This claim by opposing counsel and doctors, frankly, was out in left field, and there just wasn’t evidence. Obviously, in a legal case, you have a medical theory, but you need to support that medical theory with evidence. That’s how it’s done. I think opposing counsel realized there just wasn’t evidence to support that particular argument that they were making.
Kevin Pho: What happens when you encounter a case where an attorney asks for your opinion that’s out of your area of medical expertise?
Armin Feldman: Again, if it was going to trial, then I couldn’t do that, but really any good physician is able to do this kind of work. So, you size up the case and you do those things that I mentioned earlier. But first of all, the way our legal system works, a physician is able to give a medical opinion about medical questions. But we have to back up our opinions with evidence from the medical literature.
So, in specific answer to your question, it doesn’t come up very often that I feel I can’t help that attorney. If I can’t help the attorney, I can certainly help the attorney get an expert in the field, but most of the time, almost all the time, I can support my medical opinions with evidence from the medical literature. By the way, it would be the same medical literature that an expert would rely on.
Kevin Pho: Now, just to give us a sense of this particular case in terms of how long it took you, from reviewing the medical chart to writing a report, how long did it take you to do that for this particular case?
Armin Feldman: This case was 10 hours of my time.
Kevin Pho: All right. We’re talking to Armin Feldman. He’s a medical consultant to attorneys. We’re talking about his most recent KevinMD article titled “How a medical-legal consultant helped refute a possible pre-existing medical condition argument.” Armin, tell us some take-home messages that you want to leave with the KevinMD audience.
Armin Feldman: So, one of my biggest take-home messages is if physicians. By the way, I’m very pleased to say I’ve been doing this for 15 years. I’ve been training other physicians to do this for the past 13 years. I’ve trained over 1,600 physicians, and I’m very pleased to say this is really becoming a new subspecialty of forensic medicine. There are physicians all over the country who are doing this once they get some training. It’s actually very well accepted in our legal system to use a medical consultant for these kinds of issues, and to use your medical experts if you’re going to trial.
So, as a physician, if you enjoy medicine in general, if it was exciting to you to be in medical school, if you want to learn about all kinds of various aspects of medicine and really help people in a way that they weren’t afforded this help in the past, and be able to see the tangible results of what you’re doing, then this is something that you might want to consider.
Kevin Pho: And how can people reach you?
Armin Feldman: Sure. Probably the best way to reach me is to send me an email at [email protected]. That’s Armin, A-R-M-I-N, at MD Biz Con, short for MD Business Consultants, mdbizcon.com.
Kevin Pho: Armin, always wonderful to have you back on the show, sharing your story, time, and insight.
Armin Feldman: It’s a pleasure to be here.
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