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Shaw Chiropractic Physicians as Biomechanics Experts The increasing trend by carriers to use "experts" to discuss injury potential from a biomechanical perspective has alarmed many attorneys. These attorneys are concerned that in the absence of their own biomechanical expert they are unable to balance the scales of evidence. This newsletter will discuss the training of physicians and their qualifications to discuss biomechanics of injury and particularly injury threshold. To determine if a witness is sufficiently qualified as an expert is a matter to be decided by the court. The expert must be shown by the party calling him to have scientific, technical or other specialized knowledge. A witness may be qualified as an expert by reason of knowledge, skill, education, training or experience. Under the Federal Rules of Evidence, Rule 702, a witness may be qualified as an expert by virtue of any one such factor, or upon a combination of any of the five factors. Specific degrees, certifications, training or membership in a professional organization are not required. Let’s look at the physician’s training. Prior to attending their specialty training they are required to complete both high school and college level physics. Of course, mathematical training both at the high school and undergraduate level provide the physician with the skills to solve relatively complex algebra, geometry and trigonometry equations. These core studies are fundamental to the understanding of collision analysis and biomechanics. The basic understanding of forces, vectors, momentum are foundational but by themselves would be insufficient to qualify them as an expert. Now, lets look at the specialized training of physicians in their related fields. Orthopedists, physiatrists and chiropractors in particular have specialized training in biomechanics because it is integral to their specialty practice. As a chiropractor, I recall spending late evenings cramming for examinations on joint biomechanics. We had specific courses to study topics such as mechanical advantages of muscle attachments and joint motions. These course were not just touching the surface material but required specific knowledge of each joint and the forces and vectors which act upon them. The same is true for orthopedists and physiatrists who’s background in joint biomechanics is the basis for which much of their practice will depend. Biomechanical considerations of joint replacements or prosthetics are a daily consideration for these specialists. Clearly, physicians with musculoskeletal orientations have the adequate basis to be established as biomechanical experts. What about physician experience in treating patients who have sustained injuries? As physicians, we see patients involved in traumatic insults on a daily basis. During our initial consultation we ask questions regarding injury mechanisms. We determine which bodily structures may be damaged after which we do focused examinations on those body parts. The physicians experience in connecting the injury mechanism to the injured structures is unique. No other expert (biomechanist, physicist, engineer, accident reconstructionist) can make this connection since they do not have the training to relate diagnostic findings to mechanical insults. Even the biomechanist, with their training in anatomy and physiology, does not have the experience with treating patients and diagnosing illness. For example, biomechanists cannot take into consideration the complicating effects of Diabetes or Lupus on a patient’s injuries. Clearly, physicians have the fundamental requirements to be qualified as an expert but it is still up to the court to make the determination. Perhaps with some paranoia I can relate that my trial experience as a chiropractic expert has at times made me feel like a second class citizen. I have experienced judges who have ruled that as a chiropractor I could not interpret neurologic reports and imaging studies which I had ordered. Others have prejudices which put chiropractors next to witch doctors. Therefore, in an effort to overcome these potential adverse rulings you should qualify your expert chiropractor for the court by pointing out the additional training taken related to the expert opinions you wish to extract. The physicians of Shaw Chiropractic are uniquely qualified to provide expert testimony on a variety of topics. As an example, attached is a partial listing of post-graduate training I have had which you may find helpful. You should make sure that your client’s physicians have similar background so they too can provide you with the medical legal support you and your clients require. ---------- Sample
of Trauma and Biomechanics Post Graduate
Training Masters study leading towards MS in Trauma Biomechanics: This Masters level graduate program is designed to provide it’s candidates with advanced knowledge in the field of biomechanics as it relates to trauma. The present cohort is scheduled to be completed in the Fall of 2000 Diplomate, American Board of Chiropractic Orthopedists (DABCO): This 360 hour program is considered the pinnacle for the chiropractic profession. Along with several other board specialties it is a 3 ½ year course of post graduate study followed by a two part board certifying exam. The program is designed to further develop the chiropractors clinical skills to the level one would expect of a board certified specialist. The ABCO has begun re-certification of it’s diplomates as of 1999. Certified , Chiropractic Spinal Trauma (CCST): 1 year/100 hour certificate program with training in injury biomechanics, injury management, literature review, medical legal considerations. The program is offered through accredited chiropractic colleges. Fellow, Physician’s Academy of Advanced Diagnostic and Clinical Procedures: This program consists of three- 100 hour levels of training. Each 100 hours is followed by an examination. Upon completion of the 300 hours of study and satisfactory passing of the examination the physician is considered a Fellow of the Academy. The program, as the name would suggest, concerns itself with state of the art training in diagnostic and clinical procedures. The emphasis of the interdisciplinary program was trauma related issues. The program included training on topics including hospital protocols, manipulation under anaesthesia, expert witness testimony, injury biomechanics, accident reconstruction, risk management etc. Collision Analysis for the Medical Physician: This program is offered through Texas A&M and is the same program taken by accident reconstructionists as part of their training. The program was initially a 40 hour program and has now been expanded to include 100 hours of training. The course includes all aspects of low speed collision analysis, biomechanics, literature review, crash testing, expert witness testimony. The program was designed for the physician who specializes in the management of traumatically injured patients and wishes to master their skills as a forensic expert. In addition to the specific courses of study above, your potential expert witness should be qualified by demonstrating their continued educational efforts. Symposiums and conferences which they have attended are particularly useful (ex. American Back Society, International Whiplash Conference). Also, if the expert writes for trade journals or publishes in scientific journals this should be pointed out. For example, earlier this year I wrote an article for the American Chiropractor titled "Accident Reconstruction for Physicians". In September 1999, the Journal of the American College of Chiropractic Orthopedists will be publishing "The Chiropractic Orthopedist Expert Witness: Motor Vehicle Injury Dynamics". If you want your physician to testify
about topics not generally accepted to
be within their area of specialty make
sure that specific disclosure is made.
A strategy for introducing this information
should be prepared by the attorney well
before trial and discussed with the expert
if there are any questions or potential
complications. You can be assurred that
the defense will make every attempt to
eliminate the physicians expert scope
of testimony. With adequate preparation
the physician expert should easily be
qualified to offer expert testimony regarding
the facts of the case and his resulting
professional opinions. |
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