Serving: Ardmore, Mainline, and Center City Philadelphia, Bryn Mawr, Haverford, Villanova, Gladwyne, Narberth, Wynnewood, Bala Cynwyd, Paoli, Devon, Delaware Cherry Hill, Haddonfield, Penn Valley, Radnor, Wayne, Lower Merion
Vascular Surgery Expert Witness and Medical Malpractice Litigation in Philadelphia Pennsylvania and the State of Georgia
Lee Kirksey MD is available in the state of Pennsylvania, the State of Georgia and the State of New Jersey to provide medical expert chart review as a board certified vascular surgeon in peripheral vascular surgery. As an expert witness, Dr Kirksey provides medical expert services for cases involving the identification, diagnosis and treatment of vascular disease. Dr Kirksey is available to consult and testify regarding these areas of medical liability in vascular medicine and vascular surgery.
As a vascular surgery expert witness Dr Kirksey is:
Board Certified
Extensive experience-clinically active in patient care with ongoing research experience
Able to provide an objective written opinion and eloquently communicate these findings
Dr Kirksey is available for case review (file review), literature review, opinion letters, surgical product review, surgical outcomes, treatment guidelines and clinical/surgical explanations.
Surgery - Vascular Experts Witnesses
Wound Healing Experts Witnesses
Vascular Medicine Experts Witnesses
Medical Malpractice Experts Witnesses
Hospital Malpractice Experts Witnesses
Vascular Surgery Experts Witnesses
Vascular Surgery Expert Witnesses Directory
Wound Care Expert Witnesses Directory
Vascular Medicine Expert Witnesses Directory
Wound Healing Expert Witnesses Directory
Liability topics in vascular surgery and woundcare
Extremity amputation due to gangrene, ulceration, nonhealing wounds
Prompt identification and timely treatment of limb ischemia, carotid stenosis and abdominal aortic aneurysm
Dialysis access creation (fistula, graft) and steal syndrome
What a MEDICAL - LEGAL EVALUATIONS and Independent Medical Examinations in New Jersey, Philadelphia Pennsylvania and Georgia provides
A Medical Legal Evaluation should provide educated, balanced, and germane medical information as required by the legal system.
Our Expert Medical Consultant services are provided on a timely basis.
Practicing physicians are sometimes best qualified to render expert medical opinions as they have extensive experience in diagnosing and treating patients with the conditions in question..
Objective opinions are most likely to occur when the expert has years of personal experience with the subject.
Additional benefits of Medical Legal evaluations or an Independent Medical Examination
Customized evaluation and report to assess the validity of a claim from the non biased expert physician viewpoint.
Recommend additional testing that may help the patient and support the claim
Suggest additional treatment options or alternatives ie, can hyperbaric oxygen therapy potentially salvage this gangrenous extremity.
A "fresh set of eyes" can sometimes offers a previously unidentified approach to the defense of a medical malpractice or plaintiff case
The Impact of Diversity on Medical Malpractice Litigation
By Brian LaSalle, M.S., A.R.M., C.H.R.M., C.P.C.U., Claims Manager
It is well-established that poor communication and a poor patient outcome often combine and create
the environment where patients seek redress through litigation. True medical negligence is not
necessarily a component of this equation, and this is very frustrating for the defendant physician
or nurse.
Because much of medical care is really information management, this communication between treatment
team members and the patient and the patient’s family is a core component of health care—it is more
than an adjunct or facilitator of health care (J Gen Intern Med 22:360-1).
A patient’s culture affects his understanding of a conversation or situation and has implications as
to his compliance with directions. It is amazing to watch injured patients and their family members
testify in deposition or in court, as their version of the events is often very far removed from what
was perceived and documented by the caregivers.
It is important to remember that patients’ perceptions of events are their reality. They are
usually perceptions formed in a vacuum of misunderstanding, lack of context and unintended intimidation, all heavily influenced by an emotionally charged setting. I feel confident saying that, if you asked our obstetrician and labor and delivery nurses to describe the circumstances surrounding the delivery of my first child, it would be pretty far afield from my layman’s
recollection. Add in the complicating factor of a different culture, and the opportunity for
miscommunication or misunderstanding grows significantly. The impact to the patient and provider,
and subsequent price tag associated with litigation, can be disastrous.
This is not a minor issue. In California and Texas, minority children make up two-thirds of the
pediatric population (Hayes-Bautista, Am J Prev Med 2003, 24). Competencies in cross-cultural
health care are becoming more important, not less.
In addition, the U.S. Census Bureau data states that 52 million U.S. residents speak a language
other than English at home, and between 11 million and 21 million have limited
English proficiency (Guglielmo, Medical Econ, April 2008, pp 1-5).
In recent trials involving LVHN cases, we have seen attorneys bring translators into the courtroom, sometimes to give the jury the impression that the patient had only a limited understanding of English. We have witnessed extensive questioning over the ethnic contributions
to diet in a gestational diabetes case. It is routine that plaintiff’s counsel will claim that a
resident-staffed clinic provides substandard care to a lower socioeconomic
population of patients.
Obviously, the unscrupulous will try to use any differences to their advantage. Clear documentation that the patient understood your interaction will greatly assist your attorney
in defending your care should you become involved in litigation. The impact of culture on medical
professional litigation is clear. You cannot always control the outcomes experienced by your patients. What is within your control are your interactions and communication with patients and their families.
Additionally, providing culturally competent services has the potential to improve health outcomes,
increase the efficiency of clinical and support staff, and result in greater
client satisfaction with services (Med Care Res Rev 2000; 57:181-217).
Guidelines For Testimony By Vascular Surgeons Serving As Expert Witnesses In Litigation from the Society for Vascular Surgery (SVS)
Preamble
The American legal system often calls for expert medical testimony. Proper functioning of this system requires that when such testimony is needed, it be truly expert, impartial, and available to all litigants. To that end, the following guidelines have been adopted by the Society for Vascular Surgeons ("SVS"). These guidelines apply to all SVS members providing expert opinion services to attorneys, litigants, or the judiciary in the context of civil or criminal matters and include written expert opinions as well as sworn testimony.
A. Impartial Testimony
1. The vascular surgeon expert witness shall be an impartial educator for attorneys, jurors and the court on the subject of vascular surgery practice.
2. The vascular surgeon expert witness shall represent and testify as to the practice behavior of a prudent vascular surgeon giving difference viewpoints if such there are.
3. The vascular surgeon expert witness shall identify as such any personal opinions that vary significantly from generally accepted vascular surgical practice.
4. The vascular surgeon expert witness shall recognize and correctly represent the full standard of vascular surgery care and shall with reasonable accuracy state whether a particular action was clearly within, clearly outside of, or close to the margins of the standard of vascular surgery care.
5. The vascular surgeon expert witness shall not be evasive for the purpose of favoring one litigant over another. The vascular surgeon expert shall answer all properly framed questions pertaining to his or her opinions on the subject matter thereof.
B. Subject Matter Knowledge
1. The vascular surgeon expert witness shall have sufficient knowledge of and experience in the specific subject(s) of his or her written expert opinion or sworn oral testimony to warrant designation as an expert. Ideally, the witness should hold current hospital privileges to perform those same procedures.
2. The vascular surgeon expert witness shall review all pertinent available medical information about a particular patient prior to rendering an opinion about the appropriateness of medical or surgical management of the patient.
3. The vascular surgeon expert witness shall be very familiar with prior and current concepts of standard vascular surgical practices before giving testimony or providing a written opinion about such practice standards. Ideally, the witness should be able to demonstrate evidence of continuing medical education relevant to the subject matter of the case.
Prior to the Social Security Amendments of 1972 extending Medicare coverage to persons with end-stage renal disease (ESRD), diabetes was a contraindication to treatment for persons in need of dialysis or transplant. Since that time, the number of treated incident cases of ESRD has risen dramatically. In 1994, there were 62,266 persons who began renal replacement therapy in the Medicare ESRD program. This is four times the 15,327 who began treatment in 1978. In addition, diabetes is the most common cause of renal failure, accounting for 38% of all new cases in 1994, which is up from 17% from 19781. The progression of diabetes to end-stage renal failure is associated with the progression of multiple other complications of diabetes, including neuropathy and peripheral vascular disease2. Not uncommonly, lower extremity amputation (LEA) results in the loss of part of the toe, foot, or leg in the persons being treated for end-stage renal failure. In addition, problems leading to amputations often recur in the ipsilateral or contralateral extremity, further impairing mobility and rehabilitation from the initial amputation.
The pathogenesis of LEA in diabetes is multifactorial. The initial lesions are often initiated by minor trauma leading to ulcerations, which progress because of the combination of ischemia and peripheral neuropathy complicated by faulty wound healing and gangrene. Diabetic ESRD patients are at high risk for these conditions. Similar predisposing conditions (that is, peripheral neuropathy and vascular disease) exist in ESRD patients who do not have diabetes. Many amputations in diabetic patients are initiated by a potentially preventable event such as minor trauma or ill-fitting footwear. In a series from the Veterans Administration, such events were identifiable in 86% of the diabetic persons undergoing amputation10. Thus, the diabetic ESRD patients and those with uremia from other causes are at high risk for potentially preventable LEAs.
The epidemiology of LEA has been described in diabetic populations using hospital discharge records. Age-adjusted rates of 8 out of 1000 per year were reported from the National Health Discharge Data in 1990. Most studies have shown higher rates among males than among females and significant racial and ethnic variation with African Americans and Native Americans experiencing higher rates than non-Hispanic whites. Mortality is high in follow-up, with a two-year survival rate reported at 50% from the United Kingdom. In a preliminary study, Hill et al identified a higher rate of foot problems in diabetic ESRD patients (25%) compared with 10% of diabetic patients who were not receiving renal replacement therapy.
Several intervention studies have been published showing reductions in amputation rates. In general, successful programs have used a multidisciplinary approach targeting patient education and regular foot care services to diabetic individuals known to be at high risk for lower extremity problems. In one case, a special foot clinic organized for diabetic renal transplant patients reduced gangrene and major amputations in a group of patients with both diabetes and renal disease26. Because of the growing recognition that the identification and intervention among high-risk persons may reduce rates of LEA, this study was undertaken to examine the rates of LEA among the Medicare ESRD population. This article describes variation among population subgroups, recent trends in amputation, and postamputation mortality.
