Medical malpractice case reviews can present a number of challenges to all parties. This is especially true with a expert witness. On occasion, an expert might feel pressured to shade their assessments to suit the needs of their client. In providing a pharmacologic or pharmacokinetic assessment in a medical malpractice case, this tends to be less of a problem. And the reason why, is simple. The data usually speaks for itself and therefore, causation can be readily determined by a pharmacology expert witness.
In providing a pharmacologic or pharmacokinetic review, we first seek to determine what medications are involved in the case. What we know is that medications, just like people, have their own distinct personalities and as a result, each behaves in a very predictable manner. This behavior like that of a person changes as the conditions change. The conditions include the age, gender and overall health of the patient along with other medications they may be taking concomitantly. However, a quick review of the literature along with experience with the medication, allow us to predict this behavior and also understand just how long the behavior or effect will last.
In reviewing a patient’s records, we can assess the patient’s overall health and quickly gain an understanding of their ability to tolerate the medication, assess what dose is appropriate and predict not only what effects would be most likely produced by the medication but also predict the duration of those effects.
Cause and effect or causation, can usually be determined quite readily by comparing what is reported in the literature with what is expected based on the expert’s experience based on their assessment of the patient’s records. Of course, knowing what to look for in the records is a key component in the process.
So once the literature review has been completed and the patient’s records have been reviewed, then causation can be determined by simply asking the very objective question, are the effects that we see with the patient’s records consistent with those reported in the literature and what the pharmacology expert would expect to see based on their own experiences. If the answer is yes, then we have cause and effect or causation. The degree of certainty may come into play when multiple causes are possible. In our next blog, we will discuss how to use the principles of pharmacokinetics to help distinguish between multiple variables of causation.