Depositions

[NeuroGuyIP]

I do an occasional deposition for some extra money and was recently asked to do a video taped one that will be played in the courtroom. Is this a common request? Any thoughts? Also, is the best way to prepare for these to just be familiar with the patient’s case? Should I be asking for any additional info from the patients attorney to prepare? Thanks!

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[drusso]

I do an occasional deposition for some extra money and was recently asked to do a video taped one that will be played in the courtroom. Is this a common request? Any thoughts? Also, is the best way to prepare for these to just be familiar with the patient’s case? Should I be asking for any additional info from the patients attorney to prepare? Thanks!

Small-Firm Lawyer Tells Biglaw Team To 'Eat Bowl Of Dicks' During Settlement Negotiations - Above the Law

Don't try this 'confidential negotiating tactic' in practice, folks.

abovethelaw.com

 

[willabeast]

I do an occasional deposition for some extra money and was recently asked to do a video taped one that will be played in the courtroom. Is this a common request? Any thoughts? Also, is the best way to prepare for these to just be familiar with the patient’s case? Should I be asking for any additional info from the patients attorney to prepare? Thanks!

Be honest, succinct, do not go off on a tangent, and if you do not know the answer say you do not know the answer. For an example of terrible examples see the recent House impeachment hearings.

 

[painfree23]

I do an occasional deposition for some extra money and was recently asked to do a video taped one that will be played in the courtroom. Is this a common request? Any thoughts? Also, is the best way to prepare for these to just be familiar with the patient’s case? Should I be asking for any additional info from the patients attorney to prepare? Thanks!

Yes normal. It’s easier this way than appearing in court urself. It’s better for the jury to be able to see who’s behind the scenes for credibility purposes.

 

[deleted993114]

I do an occasional deposition for some extra money and was recently asked to do a video taped one that will be played in the courtroom. Is this a common request? Any thoughts? Also, is the best way to prepare for these to just be familiar with the patient’s case? Should I be asking for any additional info from the patients attorney to prepare? Thanks!

I have done TONS of depos. Video depositions are preferred, as it limits the amount of wasted time for the physician.

You bill for depos for prep time and for depo time. The usual cost is $500 per hour. I charge $1,000 per hour for the depo itself, as it discourages them from deposing you (I used to have to do two depos a week, and it was a pain- I don't want their money). I always tell them I can fill out their "yes-no" forms (which do the same thing) for free and take about 1 minute to fill out. Keep in mind that anything they pay you comes out of the patient's loot.

One side will try to say that the injury and resulting surgery would have occurred anyway, just due to wear and tear and aging:
1. Isn't spondylosis a normal degernative process?
2. They will show evaluations for a similar presentation in the past
3. they will try to demonstrate minimal imaging changes
4. they will show a delay in onset of pain, or a delay in seeking treatment
5. they will show an opinion by another doc (expert) who says all the pain is muscular and did not need any further treatment
6. they will show Waddel's signs noted by other docs
7. they will show a submaximal effort on an FCE
8. They will note that symptoms get better in work comp/accident when the case is solved

The plaintiff says:
1. spondylosis is a "normal" degernative process, but is usually painless until some force/trauma is applied
2. you would expect past episodes in a patient with spine disease- that is the norm
3. imaging changes do not equate to pain and facet injury can occur with no radiographic changes
4. pain is usually delayed in onset from trauma/injury. Not all patients immediately report an injury, as theythink it will get better
5. you will respectfully refute the other doctor's contention (here is where you want to note a few references from memory)
6. You state that Waddel's signs are an indication for poor surgical outcomes, not a psychological screen
7. FCEs may not be valid when applied to patients of other cultures/ethnic groups. Submaximal efforts can occur when the patient is not instructed properly prior to the exam and they are seeking to avoid further pain.
8. Symptoms do get better after cases- that can occur due to the stress of litigation and the patient not returning to work which has exacerbated injury.


There you go..................... that is what the defense and plaintiff attys will do. They will review EVERY visit you had with the patient and have you explain what you mean by your wording and what specifically the imaging states. They will be interested in whether you are boarded (or not) and how long you have been practicing.

Keep your answers SHORT and NEVER EDITORIALIZE. If you can answer a question with just "yes" or "no"- do so. You can always ask to go off the record and explain something, or ask an attorney to be more respectful, otherwise you will just get up and leave.

 

[Ligament]

I have done TONS of depos. Video depositions are preferred, as it limits the amount of wasted time for the physician.

You bill for depos for prep time and for depo time. The usual cost is $500 per hour. I charge $1,000 per hour for the depo itself, as it discourages them from deposing you (I used to have to do two depos a week, and it was a pain- I don't want their money). I always tell them I can fill out their "yes-no" forms (which do the same thing) for free and take about 1 minute to fill out. Keep in mind that anything they pay you comes out of the patient's loot.

One side will try to say that the injury and resulting surgery would have occurred anyway, just due to wear and tear and aging:
1. Isn't spondylosis a normal degernative process?
2. They will show evaluations for a similar presentation in the past
3. they will try to demonstrate minimal imaging changes
4. they will show a delay in onset of pain, or a delay in seeking treatment
5. they will show an opinion by another doc (expert) who says all the pain is muscular and did not need any further treatment
6. they will show Waddel's signs noted by other docs
7. they will show a submaximal effort on an FCE
8. They will note that symptoms get better in work comp/accident when the case is solved

The plaintiff says:
1. spondylosis is a "normal" degernative process, but is usually painless until some force/trauma is applied
2. you would expect past episodes in a patient with spine disease- that is the norm
3. imaging changes do not equate to pain and facet injury can occur with no radiographic changes
4. pain is usually delayed in onset from trauma/injury. Not all patients immediately report an injury, as theythink it will get better
5. you will respectfully refute the other doctor's contention (here is where you want to note a few references from memory)
6. You state that Waddel's signs are an indication for poor surgical outcomes, not a psychological screen
7. FCEs may not be valid when applied to patients of other cultures/ethnic groups. Submaximal efforts can occur when the patient is not instructed properly prior to the exam and they are seeking to avoid further pain.
8. Symptoms do get better after cases- that can occur due to the stress of litigation and the patient not returning to work which has exacerbated injury.


There you go..................... that is what the defense and plaintiff attys will do. They will review EVERY visit you had with the patient and have you explain what you mean by your wording and what specifically the imaging states. They will be interested in whether you are boarded (or not) and how long you have been practicing.

Keep your answers SHORT and NEVER EDITORIALIZE. If you can answer a question with just "yes" or "no"- do so. You can always ask to go off the record and explain something, or ask an attorney to be more respectful, otherwise you will just get up and leave.

This here is gold for you newbies.

It is pretty much exactly how it will go for your spine cases.

Here is what he means by never editorializing.

"Doctor, do you know what date and time it is?"
"Umm, its 12/4/19 at 9:55 AM"

The above is the WRONG answer.

Here is what you should answer:

"Doctor, do you know what date and time it is?"
"Yes."

Thats IT! Answer the question in the most binary fashion possible.

 

[deleted993114]

This here is gold for you newbies.

It is pretty much exactly how it will go for your spine cases.

Here is what he means by never editorializing.

"Doctor, do you know what date and time it is?"
"Umm, its 12/4/19 at 9:55 AM"

The above is the WRONG answer.

Here is what you should answer:

"Doctor, do you know what date and time it is?"
"Yes."

Thats IT! Answer the question in the most binary fashion possible.

That is a good example. "Yes" or "no" whenever you can. Don't give anything away by editorializing- you will work yourself into a corner. Also, if you do so, the depo will go longer.

Charge very high prices for depos and then tell them it is free if they get it done in 45 minutes or under. While they pay well, you really don't want to be wasting a lot of your time doing depos, which usually are scheduled at the end of the work day. High prices will scare them away to doing something faster and cheaper for their client.

PS- If one of the lawyers is young, you are going to be there forever. The inexperienced guys are usually sent by experienced senior partners to do "leg work". They take WAY too much time, as they are afraid to miss something. You literally have to help them out and lead them along, otherwise you will be there forever.

 

[Ligament]

High prices will scare them away to doing something faster and cheaper for their client them.

I totally agree with you but made a little change. The attorneys will complain about the fees of this doctor or that doctor or you, and that is taking money out of "their clients pocket." They will never complain about how high their fees are with much less education and training and none of the medlegal risk that we take, nor opportunity cost we take closing clinic for half a day to go to court or do a video deposition. They do not see their piece of the pie as a loss for the client. My advice is to remember that you as a physician are worth the time you charge as you should be helping people in the clinic instead of being tied up in the legal system. I always do the best quality work I can in a medlegal setting but have to recognize if I'm doing medlegal work, my clinic and patients are suffering as a result.

 

[deleted993114]

I totally agree with you but made a little change. The attorneys will complain about the fees of this doctor or that doctor or you, and that is taking money out of "their clients pocket." They will never complain about how high their fees are with much less education and training and none of the medlegal risk that we take, nor opportunity cost we take closing clinic for half a day to go to court or do a video deposition. They do not see their piece of the pie as a loss for the client. My advice is to remember that you as a physician are worth the time you charge as you should be helping people in the clinic instead of being tied up in the legal system. I always do the best quality work I can in a medlegal setting but have to recognize if I'm doing medlegal work, my clinic and patients are suffering as a result.

I understand and agree that physicians should be well reimbursed for their time.

I really don’t want their money (as time is more valuable for me now) and like to avoid depos.

When I increased my fees, the number of depos I did went from two a week to one a month- mission accomplished.

If the attorneys run me down- that’s okay with me. The problem with the attorneys is that they LIKE longer deposed, as it is more billable hours.

 

[strike5858]

Kind of off topic a bit but it’s relevant. As a newer private pain physician I have started looking into some personal injury cases. I have seen a couple patients. My questions for you guys is, how do you guys mitigate risk in these patients? I’m a bit apprehensive to take on too many of these cases in fear being held responsible for missing a injury. These patients are already more likely to sue. If they come in with Pain all over after a car accident, how do you guys approach this? Or do you not take the case to begin with? Or maybe ask to be consulted specifically for certain issues? (This May lose me referrals easily). I find myself many times being the first doctor they are seeing, after failing chiro. Multiple injured areas. No insurance. Alota times months out from the accident. I find myself feeling like in a intern during my trauma surgeon rotation all over again.

 

[Ligament]

I understand and agree that physicians should be well reimbursed for their time.

I really don’t want their money (as time is more valuable for me now) and like to avoid depos.

When I increased my fees, the number of depos I did went from two a week to one a month- mission accomplished.

If the attorneys run me down- that’s okay with me. The problem with the attorneys is that they LIKE longer deposed, as it is more billable hours.

I'm on your side

 

[Ligament]

Kind of off topic a bit but it’s relevant. As a newer private pain physician I have started looking into some personal injury cases. I have seen a couple patients. My questions for you guys is, how do you guys mitigate risk in these patients? I’m a bit apprehensive to take on too many of these cases in fear being held responsible for missing a injury. These patients are already more likely to sue. If they come in with Pain all over after a car accident, how do you guys approach this? Or do you not take the case to begin with? Or maybe ask to be consulted specifically for certain issues? (This May lose me referrals easily). I find myself many times being the first doctor they are seeing, after failing chiro. Multiple injured areas. No insurance. Alota times months out from the accident. I find myself feeling like in a intern during my trauma surgeon rotation all over again.

Most of these patients are focused on getting money from the other side and their insurance company, not you. Most of them have legitimate pain issues and want help, but many (not all) of their own attorneys are going to make them push off definitive treatment and prolong suffering for as long as possible. You really need to be aware of this; if a TON RADIOFREQUENCY ABLATION will definitively fix their whiplash injuries, they may be coached by their own attorney to wait until AFTER their settlement to get the RF. Yes, they will advise them to suffer as long as possible to maximize settlements. Getting 40 sessions of chiro and 60 sessions of PT over 3 years looks worse to the judge and jury than seeing you for two MBBs and an RF and being done with it in a few weeks.

Most of the patients are not really a higher medlegal risk to you, the treating physician, believe it or not.

You will not be held responsible for missing an injury any more than the standard patient, IMO. These patients will have already seen or will see many physicians about their injury in the course of their lawsuits and claims, making the chances of missing "badness" very low.

If they come with pain all over, try to systematcially rule things in and out. You don't to do it all on the first visits. Work on their cervicogenic headaches first, then their lumbar pain and gluteal tendonopathy, etc etc.

Also pay attention to what are or may be "accepted injuries" meaning; what specific complaints will the insurance company pay for? Anything outside that; treat with their private insurance.

Be careful not to get screwed on lien work. The attorneys and chiropractors will present this as the best opportunity ever but IMHO unless you focus mostly or largely on medlegal work, dont get caught up in that game.

Just remember they have already been to the ER in most cases. The vast majority of occult serious injuries have been discovered by the time they get to you.

If you do ethical work on them, you will discover lots of pain generators to address and help them in many ways. Just be aware of the forces working against you and the patient themselves, oftentimes their own attorney.

 

[Ducttape]

Be honest, succinct, do not go off on a tangent, and if you do not know the answer say you do not know the answer. For an example of terrible examples see the recent House impeachment hearings.

off topic, as part of your comment was, but impeachment hearings are not criminal hearings per se. you can go off topic.

back on topic - if it is your patient, know the case and review the chart beforehand, but remind yourself to "pretend" not to remember intimate details.

it is easy to forget this, and start rambling on about something that maybe was not well documented in the records. its a good practice always look up specific points/references in the chart.

and yes, in my experience it is common for them to be played back in court, instead of calling you in to testify.

 

[10KHertz]

Move this to a private forum...trolling attorneys beware

 

[10KHertz]

I have done TONS of depos. Video depositions are preferred, as it limits the amount of wasted time for the physician.

You bill for depos for prep time and for depo time. The usual cost is $500 per hour. I charge $1,000 per hour for the depo itself, as it discourages them from deposing you (I used to have to do two depos a week, and it was a pain- I don't want their money). I always tell them I can fill out their "yes-no" forms (which do the same thing) for free and take about 1 minute to fill out. Keep in mind that anything they pay you comes out of the patient's loot.

One side will try to say that the injury and resulting surgery would have occurred anyway, just due to wear and tear and aging:
1. Isn't spondylosis a normal degernative process?
2. They will show evaluations for a similar presentation in the past
3. they will try to demonstrate minimal imaging changes
4. they will show a delay in onset of pain, or a delay in seeking treatment
5. they will show an opinion by another doc (expert) who says all the pain is muscular and did not need any further treatment
6. they will show Waddel's signs noted by other docs
7. they will show a submaximal effort on an FCE
8. They will note that symptoms get better in work comp/accident when the case is solved

The plaintiff says:
1. spondylosis is a "normal" degernative process, but is usually painless until some force/trauma is applied
2. you would expect past episodes in a patient with spine disease- that is the norm
3. imaging changes do not equate to pain and facet injury can occur with no radiographic changes
4. pain is usually delayed in onset from trauma/injury. Not all patients immediately report an injury, as theythink it will get better
5. you will respectfully refute the other doctor's contention (here is where you want to note a few references from memory)
6. You state that Waddel's signs are an indication for poor surgical outcomes, not a psychological screen
7. FCEs may not be valid when applied to patients of other cultures/ethnic groups. Submaximal efforts can occur when the patient is not instructed properly prior to the exam and they are seeking to avoid further pain.
8. Symptoms do get better after cases- that can occur due to the stress of litigation and the patient not returning to work which has exacerbated injury.


There you go..................... that is what the defense and plaintiff attys will do. They will review EVERY visit you had with the patient and have you explain what you mean by your wording and what specifically the imaging states. They will be interested in whether you are boarded (or not) and how long you have been practicing.

Keep your answers SHORT and NEVER EDITORIALIZE. If you can answer a question with just "yes" or "no"- do so. You can always ask to go off the record and explain something, or ask an attorney to be more respectful, otherwise you will just get up and leave.

Attorney to Dr. Hawkeye:
How many depositions do you participate per year? What percentage of your practice is personal injury?
How much do you make for a typical deposition? How much are you making today ?
When was you last deposition?
Would you say you’re and expert in deposition taking?

take home message: be ready for these questions AND don’t do a TON of depositions , for several reasons ....

 

[Ligament]

Pro tip; for folks in MVAs, a lot of their lumbar pain is due to gluteus tendonitis, in addition to the suspected lumbar facet irritation and ligamentous injury in the lumbar spine. Don't overlook the glutes. They really strain them in the impact on the floorboard.

 

[soccrwz]

Pro tip; for folks in MVAs, a lot of their lumbar pain is due to gluteus tendonitis, in addition to the suspected lumbar facet irritation and ligamentous injury in the lumbar spine. Don't overlook the glutes. They really strain them in the impact on the floorboard.

how are you diagnosing this, and what are you using to treat it, TPIs?

 

[deleted993114]

Attorney to Dr. Hawkeye:
How many depositions do you participate per year? What percentage of your practice is personal injury?
How much do you make for a typical deposition? How much are you making today ?
When was you last deposition?
Would you say you’re and expert in deposition taking?

take home message: be ready for these questions AND don’t do a TON of depositions , for several reasons ....

I've never been asked any of those questions in the hundreds of depos I have done. They NEVER ask those questions. I outlined above the questions that are normally asked. One does not seek out depos- one is asked to do them. They are a pain in the butt and I try to avoid them whenever possible.

When they do "opening questions", they ask:
1. name
2. where you practice
3. how many years in practice
4. what is your specialty
5. What does pain management entail
6. Are you board certified in pain management
7. Are you licensed to practice in your state
8. Did you have the occasion to treat pt X
9. Who referred them to you
10. Did you examine medical records/images prior to seeing the pt and from which practitioners

.................................. then they get into the back and forth I described above for spine cases. After that, they ask whether your charges for care are "reasonable and customary".

My practice was not personal injury in scope- it was associated with a group of neurosurgeons. Most of my depos were due to work comp cases and secondarily auto/casualty. Given the large number of depos I was asked to do, I raised my prices to discourage attorneys from so freely scheduling depos.

 

[Ligament]

I've never been asked any of those questions in the hundreds of depos I have done. They NEVER ask those questions. I outlined above the questions that are normally asked. One does not seek out depos- one is asked to do them. They are a pain in the butt and I try to avoid them whenever possible.

When they do "opening questions", they ask:
1. name
2. where you practice
3. how many years in practice
4. what is your specialty
5. What does pain management entail
6. Are you board certified in pain management
7. Are you licensed to practice in your state
8. Did you have the occasion to treat pt X
9. Who referred them to you
10. Did you examine medical records/images prior to seeing the pt and from which practitioners

.................................. then they get into the back and forth I described above for spine cases. After that, they ask whether your charges for care are "reasonable and customary".

My practice was not personal injury in scope- it was associated with a group of neurosurgeons. Most of my depos were due to work comp cases and secondarily auto/casualty. Given the large number of depos I was asked to do, I raised my prices to discourage attorneys from so freely scheduling depos.

Attorney to Dr. Hawkeye:
How many depositions do you participate per year? What percentage of your practice is personal injury?
How much do you make for a typical deposition? How much are you making today ?
When was you last deposition?
Would you say you’re and expert in deposition taking?

take home message: be ready for these questions AND don’t do a TON of depositions , for several reasons ....

In contrast to hawkeye2009, I have been asked about my number of depositions, % of my practice that is personal injury, how much I am making today, when my last deposition was...I've been asked these things a number of times.

And I do NOT do a ton of depositions. Even at my max, I was probably doing 2-3 per month...recently hardly any.

 

[10KHertz]

Unless you’re an old fart, most do not do a TON of depositions... just mandatory depositions, based on practice volume.

sincere apologies to old farts.

 

[lonelobo]

I rarely do any Depositions .. probably because I was unwilling to feed a BS diagnosis on behalf of the patient to the PI attorneys

 

[Taus]

Attorney to Dr. Hawkeye:
How many depositions do you participate per year? What percentage of your practice is personal injury?
How much do you make for a typical deposition? How much are you making today ?
When was you last deposition?
Would you say you’re and expert in deposition taking?

take home message: be ready for these questions AND don’t do a TON of depositions , for several reasons ....

I don’t do a lot. 3-4/year.
I have been asked these questions at nearly all depos.

Prob less depos now as I’ve gotten more comfortable calling a spade a spade on the record in my office notes about stating there is nothing objectively wrong re the ongoing diffuse c/t/l spine pain with non-dermatomal paresthesia and normal mri, emg, open legal case, etc, 6 months conservative care. No mas for your strain/strain. No perpetual tpi. No opioids, No reason for long term disability. Cbt/biofeedback referral although they won’t do and only settling the case will help.

They can go find someone else to play games with. Even for the ones I thought were legit I’ve regretted every mbb/rf (and scs) I’ve done in an ongoing medicolegal case.

 

[deleted993114]

Unless you’re an old fart, most do not do a TON of depositions... just mandatory depositions, based on practice volume.

sincere apologies to old farts.

?????

I did a lot of depositions when I was younger and had a very busy practice that encompassed patients from our spine clinic, as well as work comp and auto/casualty patients. As a result, one is obliged to do quite a few depos. I do very few now, as I have a very different practice (and I am older). I had additionally raised my rates to discourage frequent depos.

I have NEVER been asked about the number of depositions I have done, nor my fees during a depo- NEVER. I HAVE been asked those questions when doing expert witness work (only for the defense).

I sense some tone of hostility about depos. Depos are requested by attorneys for patients you happen to treat. You don't "seek" out depos like an ambulance chaser.You only do depos on patients you personally have treated, otherwise there is no reason whatsoever to depose you. If you have seen the patient and treated them, you are somewhat obligated to provide such information for the patient in the legal arena in which they have entered. Depos (in my opinion) are a hassle and the information gained by both parties can be achieved by a much faster, economical means.

 

[deleted993114]

I don’t do a lot. 3-4/year.
I have been asked these questions at nearly all depos.

Prob less depos now as I’ve gotten more comfortable calling a spade a spade on the record in my office notes about stating there is nothing objectively wrong re the ongoing diffuse c/t/l spine pain with non-dermatomal paresthesia and normal mri, emg, open legal case, etc, 6 months conservative care. No mas for your strain/strain. No perpetual tpi. No opioids, No reason for long term disability. Cbt/biofeedback referral although they won’t do and only settling the case will help.

They can go find someone else to play games with. Even for the ones I thought were legit I’ve regretted every mbb/rf (and scs) I’ve done in an ongoing medicolegal case.

The efficacy of a stim in a work comp setting is only 5%. Just say "no" to work comp stims, as you will regret it. Although I am not aware of a published study showing similar poor results, I can personally say the same about Medicaid patients- they always want them pulled in short order.

I don't know what states you guys are practicing in, but I have practiced in six states and have never been asked about my fees nor how many depos I have done- not once.

They ALWAYS ask whether the cost of your medical services provided were reasonable, customary, and related to the injury in question. They don't give a rip how much you charge for a depo, as they are trying to calculate the total medical costs associated with the injury- that is what they want and do not focus their time on something that is completely irrelevant to determining the total cost of the claim. The medical bills are the focus of their financial claim (and work related losses), not a deposition fee, which is peanuts. Think about it for a minute.

 

[Taus]

The efficacy of a stim in a work comp setting is only 5%. Just say "no" to work comp stims, as you will regret it. Although I am not aware of a published study showing similar poor results, I can personally say the same about Medicaid patients- they always want them pulled in short order.

I don't know what states you guys are practicing in, but I have practiced in six states and have never been asked about my fees nor how many depos I have done- not once.

They ALWAYS ask whether the cost of your medical services provided were reasonable, customary, and related to the injury in question. They don't give a rip how much you charge for a depo, as they are trying to calculate the total medical costs associated with the injury- that is what they want and do not focus their time on something that is completely irrelevant to determining the total cost of the claim. The medical bills are the focus of their financial claim (and work related losses), not a deposition fee, which is peanuts. Think about it for a minute.

I figured they asked what I was paid to try to discredit me, ie I was paid to answer in favor of my patient.

 

[10KHertz]

Any good attorney is going to discredit a plaintiff’s expert witness in a deposition. If they are not doing this , they need to go back to law school....

A busy practice like yourself is doing mandatory depositions. Totally reasonable. No hostility.

There are older colleagues making a second careers out of expert witness/depositions. It’s not a bad gig when you’re winding down, as long as you are ethical .

Also, do your deposition result in trials? Because as they get closer to actual trial a repeat deposition and subsequent trial gets heated. Settlements can be massive and discrediting competing expert witnesses is the sport.
An example was a pain doctor that took 100k as a plaintiff expert witness case in an epidural catastrophe. He was banned by several ortho and pain societies and blacklisted , subsequently fired from an academic center. Cant name names on the forum but you catch my drift ...

 

[lobelsteve]

Some of us do depositions for other reasons. Not our patients. Not medmal.

 

[painfree23]

Any good attorney is going to discredit a plaintiff’s expert witness in a deposition. If they are not doing this , they need to go back to law school....

A busy practice like yourself is doing mandatory depositions. Totally reasonable. No hostility.

There are older colleagues making a second careers out of expert witness/depositions. It’s not a bad gig when you’re winding down, as long as you are ethical .

Also, do your deposition result in trials? Because as they get closer to actual trial a repeat deposition and subsequent trial gets heated. Settlements can be massive and discrediting competing expert witnesses is the sport.
An example was a pain doctor that took 100k as a plaintiff expert witness case in an epidural catastrophe. He was banned by several ortho and pain societies and blacklisted , subsequently fired from an academic center. Cant name names on the forum but you catch my drift ...

Fired from an academic center do you think because the amount he took or because he was a plaintiff expert witnress?

 

[Ligament]

Any good attorney is going to discredit a plaintiff’s expert witness in a deposition. If they are not doing this , they need to go back to law school....

A busy practice like yourself is doing mandatory depositions. Totally reasonable. No hostility.

There are older colleagues making a second careers out of expert witness/depositions. It’s not a bad gig when you’re winding down, as long as you are ethical .

Also, do your deposition result in trials? Because as they get closer to actual trial a repeat deposition and subsequent trial gets heated. Settlements can be massive and discrediting competing expert witnesses is the sport.
An example was a pain doctor that took 100k as a plaintiff expert witness case in an epidural catastrophe. He was banned by several ortho and pain societies and blacklisted , subsequently fired from an academic center. Cant name names on the forum but you catch my drift ...

why was this doc punished?

 

[10KHertz]

This pain guy was shady with his fellowship program, research antics, and clearly Med-malpractice and PI doesn’t sit well with academic departments.

 

[deleted993114]

Some of us do depositions for other reasons. Not our patients. Not medmal.

What would that be for? I do IMEs, but have never been deposed after an IME.

I really don't like depos and try to avoid them at all costs. They are at the end of the day, I'm hurting like hell by then, and I want to get out of there.

 

[deleted993114]

Any good attorney is going to discredit a plaintiff’s expert witness in a deposition. If they are not doing this , they need to go back to law school....

A busy practice like yourself is doing mandatory depositions. Totally reasonable. No hostility.

There are older colleagues making a second careers out of expert witness/depositions. It’s not a bad gig when you’re winding down, as long as you are ethical .

Also, do your deposition result in trials? Because as they get closer to actual trial a repeat deposition and subsequent trial gets heated. Settlements can be massive and discrediting competing expert witnesses is the sport.
An example was a pain doctor that took 100k as a plaintiff expert witness case in an epidural catastrophe. He was banned by several ortho and pain societies and blacklisted , subsequently fired from an academic center. Cant name names on the forum but you catch my drift ...

I don't know- I would feel dirty being an expert witness or doing legal work alone. Also, from the attorneys I have worked with, they say an expert witness who is not currently practicing is not worth that much. In two states in which I have practiced, the expert witness MUST be a doc in your field who is currently practicing. I think that is a good measure, as it prevents the schills who will say anything for cash. After all, there is a reason we went into medicine, rather than law in the first place.

IMEs are a good "winding down" gig, as long as you are stone cold objective and still practice in spine care. They get a little boring and I certainly would not want to do a lot of them. When you do them properly, they take a TON of time and prep work. I never fully charge for the time I put in, otherwise the charge would be too high (I cap all of them at $2500, regardless of how many hours I put in). I do them for some of the local attys if they think their patient is legit and got the shaft from a bad IME. Surprisingly, a lot of patients really get screwed on impairment ratings. Then again, there are unscrupulous docs who give someone a 60% impairment rating when the guidelines work out to be 6% or so. Most of those guys lose credibility with the judges and are not worth much.

I have reviewed malpractice cases, because I find it very instructive, only for defense. It is about two times a month and is kind of like detective work, so I find it entertaining. I'm pretty cheap for those also, as I like doing them. Most of the time, you can help to bail a guy out and get a case dismissed that has little or no merit. Of course, really bad docs need to get whacked, but in the vast majority of cases I have seen, the doc did nothing wrong.

I also review cases (pain management only) for our state medical board. I do those for free (only to find out after 20 years of doing them that other docs charge them $500 per hour!). I think if your board asks you, you should provide services to them for free, as it maintains the quality of care and shows some appreciation to them for providing your license. It also shows that you are one of the "good guys" out there, which may come in handy if some malcontent ever turns you into the board for something.

 

[lobelsteve]

What would that be for? I do IMEs, but have never been deposed after an IME.

I really don't like depos and try to avoid them at all costs. They are at the end of the day, I'm hurting like hell by then, and I want to get out of there.

The government. Like jury duty, just a different seat in the courtroom. But more than $20 per day.

 

[strike5858]

So I have been listed as a “non-retained” expert and need to schedule a deposition. So basically all of the above discussed apply? I’m assuming in a they are bringing me in as a neutral party? Still a huge hassle on my day to have to do this and review case ect? Fair game to charge whatever I want for my time? I have never done a deposition.

 

[gaseous_clay]

I have done TONS of depos. Video depositions are preferred, as it limits the amount of wasted time for the physician.

You bill for depos for prep time and for depo time. The usual cost is $500 per hour. I charge $1,000 per hour for the depo itself, as it discourages them from deposing you (I used to have to do two depos a week, and it was a pain- I don't want their money). I always tell them I can fill out their "yes-no" forms (which do the same thing) for free and take about 1 minute to fill out. Keep in mind that anything they pay you comes out of the patient's loot.

One side will try to say that the injury and resulting surgery would have occurred anyway, just due to wear and tear and aging:
1. Isn't spondylosis a normal degernative process?
2. They will show evaluations for a similar presentation in the past
3. they will try to demonstrate minimal imaging changes
4. they will show a delay in onset of pain, or a delay in seeking treatment
5. they will show an opinion by another doc (expert) who says all the pain is muscular and did not need any further treatment
6. they will show Waddel's signs noted by other docs
7. they will show a submaximal effort on an FCE
8. They will note that symptoms get better in work comp/accident when the case is solved

The plaintiff says:
1. spondylosis is a "normal" degernative process, but is usually painless until some force/trauma is applied
2. you would expect past episodes in a patient with spine disease- that is the norm
3. imaging changes do not equate to pain and facet injury can occur with no radiographic changes
4. pain is usually delayed in onset from trauma/injury. Not all patients immediately report an injury, as theythink it will get better
5. you will respectfully refute the other doctor's contention (here is where you want to note a few references from memory)
6. You state that Waddel's signs are an indication for poor surgical outcomes, not a psychological screen
7. FCEs may not be valid when applied to patients of other cultures/ethnic groups. Submaximal efforts can occur when the patient is not instructed properly prior to the exam and they are seeking to avoid further pain.
8. Symptoms do get better after cases- that can occur due to the stress of litigation and the patient not returning to work which has exacerbated injury.


There you go..................... that is what the defense and plaintiff attys will do. They will review EVERY visit you had with the patient and have you explain what you mean by your wording and what specifically the imaging states. They will be interested in whether you are boarded (or not) and how long you have been practicing.

Keep your answers SHORT and NEVER EDITORIALIZE. If you can answer a question with just "yes" or "no"- do so. You can always ask to go off the record and explain something, or ask an attorney to be more respectful, otherwise you will just get up and leave.

Don’t forget the time-honored tactic of discrediting your credentials and opinion when the lawyers have run out of factual arguments against your testimony.

Nevermind - 10KHertz mentioned it earlier...doh!

 

[SommeRiver]

I recently did a depo with the pt across the table from me. Was a great time talking about teenage rape in front of her! Yesssssss!

 

[painfree23]

I recently did a depo with the pt across the table from me. Was a great time talking about teenage rape in front of her! Yesssssss!

How was that even part of the depo?!

 

[SommeRiver]

How was that even part of the depo?!

Well...This is one of those comp cases where there are 4 doctors involved and multiple IMEs. Chronic pain since teenage years. I went back to notes from the 1980s.

My pt I'd been seeing for two years prior to the depo. Decades of emotional turmoil and huge psychological issues. Rapes that result in pregnancy, spousal abuse, all that stuff...

It matters in this case bc my opinion is she won't ever get better and she needs pain psych exclusively - WC had denied that request several times.

They wouldn't even pay for a TCA and I'm treating what was initially positive Budapest that resolved with a few stellates.

 

[10KHertz]

Don’t forget the time-honored tactic of discrediting your credentials and opinion when the lawyers have run out of factual arguments against your testimony.

Nevermind - 10KHertz mentioned it earlier...doh!

I used to retaliate and lambaste the opposing attorneys when they went of script. Now I just kill them with kindness, works much better .

 

[painfree23]

I used to retaliate and lambaste the opposing attorneys when they went of script. Now I just kill them with kindness, works much better .

Can u give an example?

 

[TIVAndy]

The efficacy of a stim in a work comp setting is only 5%. Just say "no" to work comp stims, as you will regret it. Although I am not aware of a published study showing similar poor results, I can personally say the same about Medicaid patients- they always want them pulled in short order.

I don't know what states you guys are practicing in, but I have practiced in six states and have never been asked about my fees nor how many depos I have done- not once.

They ALWAYS ask whether the cost of your medical services provided were reasonable, customary, and related to the injury in question. They don't give a rip how much you charge for a depo, as they are trying to calculate the total medical costs associated with the injury- that is what they want and do not focus their time on something that is completely irrelevant to determining the total cost of the claim. The medical bills are the focus of their financial claim (and work related losses), not a deposition fee, which is peanuts. Think about it for a minute.

hey do you have a citation to a paper regarding the number you quoted regarding stim success rate in WC? or is it your guesstimate? (btw i believe that number, i just need a reference in case i need it)

 

[deleted993114]

I'll try to dig it up. It was published about ten years ago- pretty eye opening. As such, I consider WC to be a contra-indication to stim, as I do Medicaid patients. Both result in high failure rates.

Here it is:

Pain. 2010 Jan;148(1):14-25. doi: 10.1016/j.pain.2009.08.014. Epub 2009 Oct 28.

There was another article in SPINE about the same time that showed the same thing. Stims and work comp don't mix.

hey do you have a citation to a paper regarding the number you quoted regarding stim success rate in WC? or is it your guesstimate? (btw i believe that number, i just need a reference in case i need it)

 

[SommeRiver]

Work comp failed back to be specific, but I'd doubt other indications would be much better.

 

[deleted993114]

Work comp failed back to be specific, but I'd doubt other indications would be much better.

Indeed. Just say "no" to work comp stims. You will be made to look like a fool in the end (I learned the hard way). Also, I would say that I have only seen a handful of Medicaid stims who have not been explanted within five years of implant. I consider work comp and Medicaid to be stim contra-indications.

I also use dehiscence risk factors in choosing who to implant and will only trial those patients who have > 75% leg pain. My little experimental "SVN stim" bit is coming along well, yet I need to accumulate more cases. This really seems to work, but I don't want the usual industry crooks to destroy it (as they usually do).

 

[SommeRiver]

I'm doing a WC SCS trial in a few weeks on a really nasty case of CRPS after a crush injury. I normally wouldn't do this for a WC pt, but he's got real Budapest and he's miserable. He doesn't speak English either.

 

[callmeanesthesia]

I'm doing a WC SCS trial in a few weeks on a really nasty case of CRPS after a crush injury. I normally wouldn't do this for a WC pt, but he's got real Budapest and he's miserable. He doesn't speak English either.

I had a guy like that - bad crush injury of the hand, met criteria for CRPS, but he refused to take his arm out of a sling even though cleared by Ortho. Injury long since healed. Wouldn’t do any PT or use the arm at all because it hurt too much. He wanted me to put in a stimulator and “fix” it. Said he couldn’t do anything until I made the pain better. I told him no way.

 

[SommeRiver]

In my experience (nowhere close to some of yall), the upper extremity CRPS gets better unless the pt avoids therapy and develops adhesive capsulitis. I've seen that on several occasions.

 

[callmeanesthesia]

I’m in an orthopedic practice so my experience may be skewed to seeing a lot more acute CRPS, but I see the vast majority of them (probably 95% or more who are compliant) get better with appropriate PT and home exercises, smoking cessation, and treatment of the underlying injury. The smokers never get better unless they quit. As such though, if they can’t quit smoking I would also consider them poor SCS candidates.

 

[painfree23]

I’m in an orthopedic practice so my experience may be skewed to seeing a lot more acute CRPS, but I see the vast majority of them (probably 95% or more who are compliant) get better with appropriate PT and home exercises, smoking cessation, and treatment of the underlying injury. The smokers never get better unless they quit. As such though, if they can’t quit smoking I would also consider them poor SCS candidates.

why poor SCS candidates if can't quit smoking?

 

[BobBarker]

I do quite a bit of SCS on medicaid patients (10-15/year). They have done really well. FBSS almost exclusively.