Subpoenas?

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AthensBeth

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I got subpoenaed for a child custody case for a parent that I saw during my inpatient psychiatry rotation 10 days into my residency training. I wrote the H&P, which my attending co-signed. Is it weird that I'm being sent as the witness in this case rather than my attending? Anyone have any experience with this in other programs?

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Your attending likely has a subpoena as well. Anyone who signs the chart can be subpoenaed.

Don't go to court unprepared. Talk to the hospital attorney and definitely read Gutheil's The Mental Health Professional in Court: A Survival Guide and The Psychiatrist As Expert Witness.



Better call Saul.
 
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I'm very excited about that new spinoff. Unfortunately. I don't think I have a Saul available. Can't find anything about an attorney on our GME website, and my program just had one of our attendings briefly counsel me on what to expect. I did some reading on the AMA website and talked to lawyerly friends and family because I was really confused about the role of physician-patient privilege. What I gather is that in cases where child abuse/neglect is a question, confidentiality goes out the window.

The attending didn't know about the subpoena until I told him. Another attending explained the court chooses residents because we are cheaper? So the court has a conversation with my program and chooses based on rates? I'm really unsure of how it all went down and resulted in my driving two + hours away to sit on a witness stand and explain my H&P and diagnosis to a DCF attorney, the patient's attorney, and a judge. It is going to be really interesting when they ask about how much experience I have.
 
Subpoenas could be handed pretty much to anyone. Courts usually don't understand who the best person is to testify so they often just ask everyone in question and sort it out in court. Every hospital has a legal adviser. Just call the operator and ask for hospital legal. Another source other than the attending could be the program director.

They don't have to pay you anything if you're subpoenaed, so this is likely not anything to do with rates.
 
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Thanks, Whopper. I don't know why one of our attendings told me it came down to pay rate. She seems to think the court or DCF (who called me to the stand) pays the university for my time.
I'll try getting in touch with hospital's legal counsel. The GME site only suggests a free legal clinic offered by the law school, so finding help make take more initiative than merely browsing the interwebs. I hate when that happens.
 
Privilege and confidentiality are two distinct doctrines.

If you treat a patient, a state may recognize a physician-patient privilege or, more specifically, a psychotherapist-patient privilege. That is the patient's privilege not to have the physician/psychotherapist disclose information obtained during treatment in court. Generally, there are exceptions to the privilege. The patient can assert that privilege. If the patient does not assert the privilege, it falls to the physician/psychotherapist to assert the privilege. At that point, the judge will order you to answer the questions, or the attorneys will stipulate to a waiver, in which case you have discharged your legal duty to protect confidentiality. If you don't answer, you could be held in contempt.

I have been subpoenaed as an expert/fact witness in criminal matters over 50 times. I have never been paid b/c I am the treating psychiatrist. Sometimes I get the rental car, hotel, and meals comped, but that's about it. In civil matters, when I am hired as an expert, I charge my usual and customary, all expense, portal to portal rate.

Sometimes, attorneys have no idea what to ask/do. Last month, I spent two hours on the stand explaining the DSM-IV axial system and then why V does not use it. In a deposition, I was once asked about my pets. Often, I give an answer and expect a follow-up which never comes.
 
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Someone in the court only has to pay you a "rate" if you're coming in with a distinct relationship where it's either the defendant's attorney, plaintiff's attorney (or prosecutor) or the court itself paying you. Those things, such as the pay, are to be worked out before you go to court.

If there is nothing established, there's no pay to be expected other than the local court's standard pay for any witness, expert or not, which is usually meager such as $5 no matter how long you are there.

If someone is thinking "rates" in your department, and I do not mean this as a criticism because medical doctors are as clueless about the law as lawyers are about medicine, it's possible they don't know what's going on and are speculating. Most psych departments have no forensic psychiatrist they can ask for info on such matters. While hospitals have lawyers, they might not be good at explaining these things because they don't have medical experience. While I was a resident, several attendings misled me on forensic issues. While I understand they had limitations, I was even in hindsight, disturbed with their lack of admission to their limitations and instead of humbly stating they were only acting on what little knowledge they had, instead pretended as if they knew what they were doing.

One of the few attendings that didn't mislead me wasn't a forensic psychiatrist but did have an interest in it but clearly stated he did not have knowledge on several issues, while a forensic psychiatrist that I did do a rotation with turned out to be a hired gun willing to say anything, and it turned out the other attendings never went to court to see his unethical actions, so they kept him in their good graces none-the-wiser.
 
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So as I understand it-- confidentiality falls into the realm of ethics and privilege is a legal doctrine?

So, here's my plan, since I'm unsure of which exception/waiver requires me to provide information about my patient in court: I will assert privilege (unless patient does first) when I'm on the stand. The judge or attorneys will cite the exception/waiver, and then I'll answer questions. I know that's pretty much what you just said. Just double-checking.
 
You really ought to be asking your attendings on what to do. Worst case scenario you could be held in contempt-of-court. Would this ever happen? It's unlikely in several cases because courts want to maintain good relationships, but it can happen. I don't want you to worry about this excessively. I compare it to driving. One could get into an accident but one doesn't want to shove the possibility of an accident in the face of a new driver too much cause it can just make the situation worse.

In going to court, everything you did is really the bottom-line responsibility of your attending. As such, don't formulate anything without working with them on it.

As for privilege, in some courts, the cases are sealed (e.g. civil commitment) and due to that the court's expect the doctors to talk about the patients because they assert the confidentiality is maintained.
 
Someone in the court only has to pay you a "rate" if you're coming in with a distinct relationship where it's either the defendant's attorney, plaintiff's attorney (or prosecutor) or the court itself paying you. Those things, such as the pay, are to be worked out before you go to court.

If there is nothing established, there's no pay to be expected other than the local court's standard pay for any witness, expert or not, which is usually meager such as $5 no matter how long you are there.

If someone is thinking "rates" in your department, and I do not mean this as a criticism because medical doctors are as clueless about the law as lawyers are about medicine, it's possible they don't know what's going on and are speculating. Most psych departments have no forensic psychiatrist they can ask for info on such matters. While hospitals have lawyers, they might not be good at explaining these things because they don't have medical experience. While I was a resident, several attendings misled me on forensic issues. While I understand they had limitations, I was even in hindsight, disturbed with their lack of admission to their limitations and instead of humbly stating they were only acting on what little knowledge they had, instead pretended as if they knew what they were doing.

One of the few attendings that didn't mislead me wasn't a forensic psychiatrist but did have an interest in it but clearly stated he did not have knowledge on several issues, while a forensic psychiatrist that I did do a rotation with turned out to be a hired gun willing to say anything, and it turned out the other attendings never went to court to see his unethical actions, so they kept him in their good graces none-the-wiser.
This is a great thread. Maybe the department didn't want to lose the attending for a day, and that is what they are more concerned with.
As an attending physician in solo practice, I would ask my malpractice carrier.
 
I got subpoenaed for a child custody case for a parent that I saw during my inpatient psychiatry rotation 10 days into my residency training. I wrote the H&P, which my attending co-signed. Is it weird that I'm being sent as the witness in this case rather than my attending? Anyone have any experience with this in other programs?

How long ago did you see the patient?
 
I'm very excited about that new spinoff. Unfortunately. I don't think I have a Saul available. Can't find anything about an attorney on our GME website, and my program just had one of our attendings briefly counsel me on what to expect. I did some reading on the AMA website and talked to lawyerly friends and family because I was really confused about the role of physician-patient privilege. What I gather is that in cases where child abuse/neglect is a question, confidentiality goes out the window.

The attending didn't know about the subpoena until I told him. Another attending explained the court chooses residents because we are cheaper? So the court has a conversation with my program and chooses based on rates? I'm really unsure of how it all went down and resulted in my driving two + hours away to sit on a witness stand and explain my H&P and diagnosis to a DCF attorney, the patient's attorney, and a judge. It is going to be really interesting when they ask about how much experience I have.

What is DCF?
 
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As a trainee, it would be best to do what your program director and co-signing attending tell you to do. Chances are they have been in court and are familiar with your state's laws regarding your duties and obligations. I would ask them about privilege, confidentiality, and what you should say and do in court. They may not give you the correct or best advice, but they write your evaluations.

You should still read Gutheil.
 
What about having hospital legal to have your name removed from the suit as you are only a trainee at the time of the incident?

Also I've heard that you may need to get your own lawyer as the hospital/residency lawyer won't have your interests at heart and you want to prevent yourself from being thrown under the bus.
 
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DCF is the Dept of Child and Family (they have had custody since I saw the patient in July).

My PD didn't talk to me about this matter, but she did ask an attending from our forensic dept to get in touch with you. I had a similar experience to whopper when I asked about legal matters. I asked about privilege and was told, "HIPPA doesn't apply in a court subpoena." I'm not a legal scholar, but I know privilege has been a thing long before HIPPA.
I will read gutheil has a postmortem on this experience because the court date is tomorrow! I like the idea that the diagnosis and treatment plan is the responsibility of my attending. I plan to bring that up if I don't know the answer to something. I discussed the patient with my attending though and feel ready to answer questions though. I'm also prepared to state that I can't comment on matters beyond this clinical encounter.

I'm also prepared to answer questions about my pets.
 
What about having hospital legal to have your name removed from the suit as you are only a trainee at the time of the incident?

That is an option but I'd only do so through your attending/program. Hospital legal could be involved.

Get a lawyer? Depends. Getting a lawyer could cost you thousands of dollars. Several lawyers will insist you work with them, charge hundreds to thousands and it turned out they were really not needed. Such cases could be a lawyer's dream. "I just charged this doctor $3000 and all I had to do was sit there for about 2 hours."

If I knew the specifics I could give more info, but then again the more specifics, the more it'd be like me filling in what the program should be doing for the resident.

Often times I see doctors freak out about cases where there is nothing really to freak out about. I also see doctors get on that witness stand as if they're a struggling actor finally getting the limelight and over-do it. They give speeches when all they had to do was answer yes or no to a few questions. Then again the case could be serious. I can't say what it is without knowing what it is.

Again, work with your department. I can say that unless I knew a lot about the case, and it were a child case, I wouldn't let the resident go without an attending, or as the attending insist I should be going on the witness stand and have the resident go to court with me as a learning experience.

If the department lets you go without an attending and you fully informed them as to what's going on, they are fully responsible for you. If they let you go and something bad happens, a lot of the blame needs to be placed on them.

Maybe the department didn't want to lose the attending for a day, and that is what they are more concerned with.

Even if it's not serious, departments need to deal with any court hearings/cases with the utmost of respect and hence should not try to have an attending dodge going to court. If they are doing it for a defensive reason (E.g. they want to shield the attending) they're only making the situation worse by having a resident go instead given that the attending is responsible anyway and should bad things happen the question will be begged for asking, "why didn't you go if you're responsible?".

I can think of some situations where it could be appropriate for a resident to go alone but I'd only allow this if the I knew the situation, knew it wasn't a big deal (e.g. I knew the case, the lawyers involved, the judge, and what type of questions would be asked), and if the resident was experienced with this type of stuff.

If the program doesn't own up to this situation, I hate saying this, this is a mark of a program that doesn't know how to handle such situations.
 
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With only 100 days of internship experience you may spend more time driving than testifying. Even as a PGY-26, I find that is often the case.

I think federal law (HIPPA), state law, and medical ethics (do no harm, patient advocacy etc.) all apply in this situation.

Rather unfortunate that your program is not providing guidance, but I suspect, not uncommon.
 
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I talked to the Dept of Child and Family Services attorney today and asked her why I ended up with a subpoena rather than my attending. She said something to the effect of "You wrote the H&P and interviewed her, so you'll do just fine." I feel like there must be more to it because the attending that advised me a little on this matter mentioned that money is the real reason. Asking around, some say that the courts don't pay at all but others in my program say that there is indeed an hourly rate that our university is paid by the court (or the plaintiff) and that the resident hourly rate is significantly less than the attending rate. So who really knows. Maybe each state is different.

I agree with Whopper that this should be a learning opportunity and that ideally, an attending should come. The one attending that has been somewhat helpful said she had wanted to come with me, but then she found out she had some sort of clinic commitment. That always seems to be the case at my program, from what I can tell so far, with both attendings and residents spread very thin. Perhaps that situation is not in the administration's control right now, but, even so, it could be handled in a more supportive way. For instance, I found out about the whole thing via an email form the PC with the subject line, "Subpoena." I was having a busy day on my inpatient medicine rotation and nearly had a heartache. All the email said was, "This came for you at the clinic" with .pdf of the court subpoena attached. The pdf didn't even have information about my patient and only had the name of the child, so I didn't even know what it was about. The PD was cc'ed in that email, but she has not once communicated with me directly about it. I saw her in person for the first time today since that email, and, although the court date is tomorrow, she just reminded me to get my flu shot. Sorry for the rant. I am bring my lawyer husband with me tomorrow for moral support, so thank goodness for him.
 
Expert witnesses should charge a fair price. You are not an expert witness here.

A fact witness as a treating physician only regurgitates facts and is part of your job as a physician if subpoenaed. Requesting a fee is unethical here in my opinion.
 
Rather unfortunate that your program is not providing guidance, but I suspect, not uncommon.
Despite what I said, I believe it. Some of my own program's attendings while I was as a resident (this was in NJ about 10 years ago) would've also likely left me in possible dire straits. I can tell you at U of Cincinnati where I used to work I never would've let such a thing happen nor would most of the attendings. I'm currently at St. Louis U. and I can tell you that we have enough forensic training in our department to not allow such a thing to happen as far as I know (I'm still new so I don't know all the ins and outs).

I talked to the Dept of Child and Family Services attorney today and asked her why I ended up with a subpoena rather than my attending. She said something to the effect of "You wrote the H&P and interviewed her, so you'll do just fine."

Again, it could not be a big deal, it might be. I can't really judge but I also wouldn't trust someone with an agenda, and each lawyer has the agenda for their side.

So who really knows. Maybe each state is different.
Likely not. Even if they were paying some nice fee, the department couldn't make money off of your work without an attending stamping their approval, and even then it's supposed to be through the program. It's highly inappropriate for an attending to have a resident testify with the attending somehow approving it despite not being there.

Again court officers have to have a previous set-up for payment of fees.

What I suspect is going on is your program is trying to have the attending make them more money because if he's gone during his usual hours he can't do that at the expense of appropriately taking responsibility over the situation. They could do the right thing and contact the court to explain to them what's going on so the attending can testify in your stead but are choosing not to do that, nor does the court likely understand either hence it's why medicine and the law do not interface well.

Another suspicion is they have no idea what to do in such a legal situation and have no legal/forensic knowledge or training and are possibly hoping to avoid the situation by playing ostrich hiding their head in the sand.
head-in-the-sand.gif


IMHO this is something worthy of complaining to your hospital's GME.

Again this could be no big deal at all, but on the other hand it could be and the program should, at least out of self-preservation, try to figure that out before they let this proceed. So many screw ups could happen such as the witness getting in trouble for releasing HIPAA protected information to the resident being held in contempt of court. Again, if something bad did happen, the program would have some serious responsibility over this and apparently from your posts aren't seeming to rise to the occasion.

For your own self-preservation, formally tell (e.g. by e-mail and save it) the attending and program director what is going on and that you do not feel you can do anything without their approval. You also do not know if you are allowed to divulge any information because you do not know if answering in this situation is a HIPAA violation and you require this to be answered.

You are not an expert witness here.
Technically the resident is. The definition of an "expert witness" is simply that the witness have more knowledge and expertise than a layman. Even a medical student could qualify as an expert witness, but then what happens is the other side will get an expert witness with better credentials to blow that expert witness out out of the water. That's why lawyers will not go with a medstudent though if one is foolish enough to do so they can.

Medical student (T-800), meet Attending with board certification in forensic psychiatry (AKA T-1000).

http://img2.wikia.nocookie.net/__cb20080816062314/terminator/images/d/db/Terminatorpanel1.jpg

3154840-t-1000+ability+liquid+metal+body+used+for+grappling.png


Let the sparring between medical student (or resident) charging nothing vs attending charging $500/hr commence.

All things being equal, I think one of two things will happen.

1-you testify, no big deal, it's over, move on and because no attending is there you might not be able to make out what really happened.
2-Something bad can happen, in which case so far it seems your program isn't doing much to prep you or even find out what's up with this situation.

The likelihood is it's #1, but if it's #2, a whole bunch of headaches can happen.
 
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When ths happens, th first thing to determine is whether you are gong to be a fact witness or expert witness. Expert witness you get paid a good bit, so this is what you want. Now if you are a fact witness, you can make to clear ahead of time that you will be USELESS to either side. A psychiatrist being called as a fact witness has to be carful to maintain that frame, because what they want to do is try to get you to provide pseudoexpert witness testimony while calling you as a fact witness. Don't let that fly.
 
A fact witness has firsthand knowledge of the events. Fact witnesses may give opinion testimony if they are based on the rational perception of the witness.

An expert witness must be qualified by knowledge, skill, experience, training or education in an area of scientific, technical or other specialized knowledge. The judge determines if you are qualified to be an expert witness. Once qualified, the expert’s opinion may be based upon matters that he personally knows or has perceived, or upon facts related to him by someone else.

A hybrid witness is a fact/expert witness who has firsthand knowledge of the events and is qualified by knowledge, skill, experience, training or education in an area of scientific, technical or other specialized knowledge. A treating physician in many jurisdictions is now recognized as a "hybrid" witness.

When I am a hybrid witness I can give the facts and limit my opinion to diagnosis, treatment, and prognosis, but do not go beyond the scope of a general psychiatrist. When I am an expert witness, I can extend my opinion to include the forensic aspects.

In federal courts under the Federal Rules of Evidence, reports distinguish what type of witness you are. From the ABA:

Traditionally, treating physicians have been treated as fact witnesses and are not required to provide any expert report. "They are a species of percipient witness . . . not specially hired to provide expert testimony; rather, they are hired to treat the patient and may testify to and opine on what they saw and did without the necessity of the proponent of the testimony furnishing a written expert report.” Goodman v. Staples The Office Superstore, LLC, 644 F.3d 817, 819 (9th Cir. 2011). [Was this a New Mexico case?]​


Once a treating physician renders and completes treatment, however, he or she may be provided with additional information by plaintiff’s counsel and asked to opine as to matters beyond his or her treatment of the plaintiff. In these instances, treating physicians become “hybrid” witnesses, that is, part fact witness, part expert. If their opinions go beyond the scope of a traditional treating physician, a court may require the physician to provide a report consistent with Rule 26(a)(2). See Goodman, 644 F.3d at 819 (applying the rule prospectively).​


The distinguishing feature of an expert required to provide a report is that his or her opinion is based on information provided by others and not his or her function as a percipient witness to the events at issue. See In re Application of Rep. of Ecuador, 280 F.R.D. 506, 511(N.D. Cal. 2012).

This is a child custody case and these can get quite contentious. The other side may have a child/forensic T-1000.
 
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The hospital/my program/some other entity already handed over the records, but I still think I can be held responsible for divulging information. I am going to call the attorney from plaintiff side and warn her that I plan to assert privilege on the stand. Then she or the judge will explain the waiver for privelege, and I'll proceed. Merely asserting privelage won't lead to my being held in contempt if court.

From those definitions, it sounds like I am expected to be a hydrid witness. I think I will quickly demote myself to fact witness once they ask about my training. I'm prepared to discuss only the history the patient gave me, our diagnosis, and treatment. If they ask for an opinion or anything requiring a solid foundation in psychiatry, I'll tell them it is beyond my knowledge scope. I have to bring my CV and explain my training so far, so my lack of knowledge will be clear.

Wish me luck...
 
I believe it's unethical to be anything other than a fact witness for your patients. More than that and you are either biased or damage the physician relationship. Both I perceive as unethical.

If they asked for anything beyond facts, I would simply state that I did not do a forensic eval and thus have no opinion on the matter. Most questions would have me just reading from my documentation. Keep it simple.
 
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Great thread. It is a shame that the OP's program, PD, etc. have been so passive in this matter. I'm surprised the attending supervision who signed off on the H&P isn't more involved, as the OP's work is ultimately their responsibility. OP…you are handling this more calmly than most I'd expect.

I'm curious if as a trainee you can be considered as an expert (up to the judge). In my limited experience, acting as a fact witness is a far easier go of things because you can stick to your documentation. "As I documented on XX/XX/XX, the patient presented as XYZ…" If you do not have it documented, then you can fall back on, "I do not recall." "That was not a part of my evaluation." "I can only speak to the patient's status during the dates of evaluation."

*Not legal advice. I'd strongly advise consulting with a lawyer who practices in this area. *
 
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Well folks, on the way to the courthouse, I got a call from the attorney telling me they canceled my testimony. It has something to do with the patient verifying what is written in my note, so they don't need me. Phew.

Thank you all for the fine discourse and support!
 
A trainee may be an expert if he meets the criteria and the judge qualifies him. But, as Whopper said, if one side has a trainee and the other side has a triple boarded person with years of experience, this goes to credibility and is weighed by the jury in evaluating their testimony. Usually each side tries to call the best, most qualified expert they can. Some of the most interesting cases are when there are preeminent experts on both sides as in the Texas case where Phil Resnick was the defense expert and Park Dietz was the prosecution expert.

There may be some semantic confusion as to the terms "expert," "fact," and "opinion." For example, if a treating psychiatrist on the stand is asked "How does Risperdal work?" and the psychiatrist starts talking about receptors, blockade, and pathways etc., this is technically "expert" testimony since it is derived from knowledge, skill, experience, training or education in an area of scientific, technical or other specialized knowledge. True, the answer is based on facts, but it is expert testimony nonetheless. In other words, it is not common knowledge. This witnesses may also give opinion testimony if it is based on his rational perception. So, a fact witness can give expert testimony and opinions. That's why treating physicians are now referred to as fact/expert "hybrid" witnesses.

In contrast, the non-treating expert witness can answer the same question and can also give opinions not based on perceptions (e.g., after the fact) as to dangerousness, insanity, etc. The questions posed to this witness can be hypothetical, be based upon matters that he personally knows or has perceived, or upon facts related to him by someone else.

Whereas the treating psychiatrist has a doctor-patient relationship and ethical duties, the non-treating expert has no such relationship and a different set of ethical duties apply.

Hope this helps.
 
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ome of the most interesting cases are when there are preeminent experts on both sides as in the Texas case where Phil Resnick was the defense expert and Park Dietz was the prosecution expert. - See more at: http://forums.studentdoctor.net/threads/subpoenas.1102363/#sthash.zUuQcLzQ.dpuf

U of Cincinnati and Case Western have mock trials over live netstreaming. They usually try to have at least one mock trial/year where Doug Mossman goes up against Resnick or Noffsinger. Resnick is quite popular and needs no introduction, but for those that don't know, Mossman and Noffsinger are also titans in the field, both ranked among the top 100 physicians in the country and have advanced the field of psychiatry.

I always tell the fellows something like this is quite an opportunity to watch. Mcenroe vs. Lendl, Ali vs. Foreman, Hulk vs. Thing....I'd rather watch Mossman vs. Resnick.

I was at a midwest AAPL conference once and Mossman got into a debate with Resnick. Wonderful to watch. (A friendly debate, the two men are friends).
 
When ths happens, th first thing to determine is whether you are gong to be a fact witness or expert witness. Expert witness you get paid a good bit, so this is what you want. Now if you are a fact witness, you can make to clear ahead of time that you will be USELESS to either side. A psychiatrist being called as a fact witness has to be carful to maintain that frame, because what they want to do is try to get you to provide pseudoexpert witness testimony while calling you as a fact witness. Don't let that fly.

There is nothing to "determine." The OP got a subpoena. It can only be as a fact witness. Can an expert witness even BE subpoenaed? Because if so, well then good grief, I'm sorry for our society and its jurisprudence, because what the heck quality of expert psychiatric witness has to be FORCED to testify in freaking court? Seriously In the future when I'm on trial for murder or theft or forgery or whatever, believe me I will demand of my low-paid public defender that we get someone who's above a subpoena and $5 a day plus lodging at the Quality Inn. Maybe it's just me, but that would seem to bode better for my case than subpoenaing Ye Olde Psychiatry Resident.

For real, I think the only fear this resident even potentially could have had was the extremely remote threat of perjury, or contempt of court. But how could you ever prove perjury if someone merely minimized the extent of their expert knowledge? Maybe this person legitimately failed the PRITE 10 times in a row. And otherwise, what the heck does it matter?

Or do our courts really work this way, where they subpoena experts? If so that's scary.
 
The OP got a subpoena. It can only be as a fact witness. Can an expert witness even BE subpoenaed?

I can happen. It shouldn't, but it can. The problem here is just like doctors, judges or magistrates are human beings. Just like the idiot psychiatrist all of us see that prescribes a med to everyone because "it's my favorite," or gives benzos to everyone, there are good and bad. The fact of the matter is many judges, especially in the lower courts, got their job because they couldn't survive doing a law practice and they were able to shmooze into the position somehow. Usually by being the college roommate of the mayor, his brother-in-law, fraternity brother, what have you.

It's been clearly stated in prior cases that a doctor can maintain a patient's privacy even in court. Yet some judges demand the doctor break the privacy without knowing the prior cases that set this precedent. If a judge holds a doc in contempt of court, he can point to photocopies of the prior cases all he wants, he will spend time in jail.

I've seen courts handle things wrong all the time. The problem is that as a physician, I can't tell the judge what to do. To do so is considered highly inappropriate. I've seen judges rudely ask me why I didn't force-medicate a patient, and tell them that I need to so a SELL hearing before that can happen and they're like "huh? what's SELL?"
http://en.wikipedia.org/wiki/Sell_v._United_States

(Aren't you the guy who's supposed to be the one that interprets law, not me?)

Now I have some some truly great judges. One judge never did a SELL hearing and when he did his homework (many never do) because I requested he do so, he read up on the case, allowed it to happen, and made a ruling, while stating it was his first one so he double-checked everything and was declaring in the record he would be willing to take responsibility for it. The bad ones don't even read up on it and pretend it doesn't exist or make up crap while the court hearing goes on. I wish I was joking just like I wish there weren't idiot doctors out there.
 
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To be fair to judges…they are responsible for ruling on a ton of cases that cite a variety of related but not specific enough cases to have a clear-cut decision. I have befriended a few judges in the past handful of years, and it has been fascinating to ask them about different cases. One judge in particular has presided over hundreds of malpractice cases, and the nuance with which he considered different aspects of the case really gave me a better appreciation (and respect) for his job. Contrast that with some of the seemingly knee-jerk decisions that I've read that literally make no sense. It is crazy how judge specific a case can get (in regard to the outcome). Maybe certain cases get overturned/corrected on appeal…but the roll of the dice is scary from all seats in the courtroom.
 
Regarding subpoenas and experts, Mark R. Miller writes in The Reluctant Expert:

Experienced trial lawyers know that there is no paucity of experts willing and available to testify (at prodigious hourly fees) as expert witnesses in a wide variety of cases. But what about a situation where a person who possesses unique expertise, which a party needs to either prosecute or defend against a claim, simply does not wish to spend time in court testifying in a matter in which he or she has no interest? Can counsel for a party subpoena an unwilling expert to testify at trial? Recent case law suggests that, absent a showing of compelling circumstances, an expert cannot be compelled to testify.​

Many federal and state courts hold to the traditional rule that an expert cannot be subpoenaed to serve as a witness against his or her will. The rationale behind such a rule is that it is unfair to impose the burden of having to neglect one's business or profession to appear in court in a case in which the witness has no interest. Likewise, compelling an expert to divulge his/her opinion in effect forces him/her to give up the intellectual fruits of many years of study and investigation.​


NYCourts.gov states: " An expert witness may NOT be compelled to testify by subpoena, but you have the option of paying the expert witness the expert witness' fee for coming to Court to testify."

Nolo.com states it more simply: "Expert witnesses cannot be subpoenaed."









To strive, to seek, to find, and not to yield.
 
To be fair to judges…they are responsible for ruling on a ton of cases that cite a variety of related but not specific enough cases to have a clear-cut decision.

Agree which is why I find it the mark of a good judge to simply state he/she not know the case law, call for a continuation, and then read up on the cases needed to make an appropriate case or hearing. I've seen that.

What I've also seen are judges, even when finding out they're not doing it the appropriate way, balk, and proceed anyway, completely doing it wrong.

No doctor knows everything. Some of the notable doctors I've trained under or worked with such as Nasarallah or Mossman will be the first to admit they don't know something if I brought up an issue and are open to learning about it (just that it's very unlikely given how smart and experienced they are). Resnick says if you are wrong on something you stated, just fess up to it and move on. Don't fight it or pretend to know it.
 
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Regarding subpoenas and experts, Mark R. Miller writes in The Reluctant Expert:

Experienced trial lawyers know that there is no paucity of experts willing and available to testify (at prodigious hourly fees) as expert witnesses in a wide variety of cases. But what about a situation where a person who possesses unique expertise, which a party needs to either prosecute or defend against a claim, simply does not wish to spend time in court testifying in a matter in which he or she has no interest? Can counsel for a party subpoena an unwilling expert to testify at trial? Recent case law suggests that, absent a showing of compelling circumstances, an expert cannot be compelled to testify.​

Many federal and state courts hold to the traditional rule that an expert cannot be subpoenaed to serve as a witness against his or her will. The rationale behind such a rule is that it is unfair to impose the burden of having to neglect one's business or profession to appear in court in a case in which the witness has no interest. Likewise, compelling an expert to divulge his/her opinion in effect forces him/her to give up the intellectual fruits of many years of study and investigation.​


NYCourts.gov states: " An expert witness may NOT be compelled to testify by subpoena, but you have the option of paying the expert witness the expert witness' fee for coming to Court to testify."

Nolo.com states it more simply: "Expert witnesses cannot be subpoenaed."

Technically there must be some way to force experts to testify, because we've got the CDC director testifying in front of Congress this week, and I'm sure he did not volunteer to do so. Although actually he may be a fact witness...

But in general, I think the main reason experts cannot be subpoenaed has got to do with the low quality of forced testimony. To me it doesn't make sense to say it's the "unfair burden of having to neglect one's business," because the courts place that burden on fact witnesses and on jurors. I think the reasoning must be that if you force someone to do a job, there's no guarantee they'll do a good job. The whole point of expert witnesses is that they provide good information. You could subpoena Albert Einstein to testify about the Theory of Relativity, but if he's not in the mood, all he has to say is, "I just don't get that physics stuff," and what are you going to do then? You could resurrect Mussolini and grill him about fascism, and he could just go mute, or say, "I do not know what that is." And unless the cross-examining lawyer knows more about the subject than the expert, then how will they know the "expert" even knows the subject??? (I'm thinking about how if I were subpoenad to testify on the topic of Human Anatomy. I guess I am an "expert" at that, although I have been known to confuse the radius with the femur. But what lawyer would appreciate that?) It seems to me that the ideal expert witness is someone who wants to show off their knowledge to the world, who has a track record of doing so reliably, and anything less is useless.

Beyond that, couldn't a person who is forced to be an expert witness plead the 5th amendment? Say Dr. Phil got subpoenaed to talk about his field of expertise. Quacks might be forced to reveal their quackery, if it came to that.
 
Some of the notable doctors I've trained under or worked with such as Nasarallah or Mossman will be the first to admit they don't know something if I brought up an issue and are open to learning about it (just that it's very unlikely given how smart and experienced they are). Resnick says if you are wrong on something you stated, just fess up to it and move on. Don't fight it or pretend to know it.

That's easy for people like them to say. What if you were the bottom of your med school class, had to take Step 1 three times, remediated the class on Public Health, have been on probation in residency, and passed the Boards by one point on your 15th try? Would you feel ok just "fessing up" when it comes to light that you've never heard of Zyprexa? Or didn't know that Haldol causes EPS?
 
It's been clearly stated in prior cases that a doctor can maintain a patient's privacy even in court. Yet some judges demand the doctor break the privacy without knowing the prior cases that set this precedent. If a judge holds a doc in contempt of court, he can point to photocopies of the prior cases all he wants, he will spend time in jail.

Wouldn't this be a situation where it's appropriate to stand your ground and go to jail? Once confidential information is out, it's out. Going to jail unfairly is nothing compared to having one's health information revealed unfairly in court.

I personally would love to hear about situations where psychiatrists have stood up to judges. I recently was forced by a judge to admit a non-mentally-ill patient to the psych ward, involuntarily, for the treatment of thyroid problems and seizures, and I was all set to discharge the patient and be held in contempt of court, and sent to jail. The reason I didn't is that it would have embarrassed my hospital horrifically. It would also create problems in terms of my medical license. But if I was in private practice I would have seriously considered it.
 
Technically there must be some way to force experts to testify, because we've got the CDC director testifying in front of Congress this week, and I'm sure he did not volunteer to do so.

I think he was called to appear in front of a house investigative committee - usually a non-adversarial proceeding. The committee was trying to assess what happened and what is needed from a public health perspective. His "testimony" was different from courtroom testimony. Also, the CDC is a federal agency under the Dept. of Health and Human Services. Agency directors are usually willing to appear when congress has questions. Directors failing to appear may affect the funding of their institutions, not to mention their reputations and continued employment/appointment.

* * *​

Trial lawyers generally want their client to prevail, especially if they are retained on a contingent fee basis. They want the best expert witnesses with impeccable credentials, mountains of publications, and faculty appointments. I would not hire a resident as an expert on human anatomy. Instead, I would consult my handy, dandy Trial Lawyers of America directory of Experts and find someone whose educational pedigree traces back to Vesalius.

* * *​

Beyond that, couldn't a person who is forced to be an expert witness plead the 5th amendment?


The Fifth Amendment protects criminal defendants from having to testify if they may incriminate themselves through the testimony. By extension, a witness may "plead the Fifth" and not answer if the witness believes answering the question may be self-incriminatory. Not every disclosure can be the subject of a Fifth Amendment assertion—only those that the witness “reasonably believes could be used in a criminal prosecution or could lead to other evidence that might be so used.” (Kastigar v. United States, 406 U.S. 441, 444-445 (1972).) I don't know if quackery is self-incriminatory.

* * *

I personally would love to hear about situations where psychiatrists have stood up to judges.


see in re Lifschutz, a 1970 California Supreme Court case:

Dr. Joseph E. Lifschutz, a psychiatrist practicing in California, seeks a writ of habeas corpus to secure his release from the custody of the Sheriff of the County of San Mateo. Dr. Lifschutz was imprisoned after he was adjudged in contempt of court for refusing to obey an order of the San Mateo County Superior Court instructing him to answer questions and produce records relating to communications with a former patient. Dr. Lifschutz contends that this underlying court order was invalid as unconstitutionally infringing his personal constitutional right of privacy, his right effectively to practice his profession, and the constitutional privacy rights of his patients. He also attacks the order, or more specifically, the statutory provisions which authorize the compulsion of his testimony in these circumstances, as unconstitutionally denying him the equal protection of the laws since, under California law, clergymen could not be compelled to reveal certain confidential communications under these circumstances.

. . .

Arabian then subpenaed for deposition Dr. Lifschutz and all of his medical records relating to the treatment of Housek. (Code Civ. Proc., §§ 2016, 2019, subd. (a).) Although Dr. Lifschutz appeared for the deposition, he refused to produce any of his medical records and refused to answer any questions relating to his treatment of patients; the psychiatrist declined even to disclose whether or not Housek had consulted him or had been his patient. Although notified, neither plaintiff Housek nor his attorney was present at this deposition and neither has appeared in any of the subsequent hearings related to this proceeding. Housek has neither expressly claimed a psychotherapist-patient privilege, statutory or constitutional, nor expressly waived such a privilege.


In response to the psychiatrist's refusal to cooperate, defendant Arabian moved for an order of the superior court compelling the production of the subpenaed records and the answers to questions on deposition (Code Civ. Proc., § 2034, subd. (a)). Relying on the patient-litigant exception [2 Cal. 3d 421] of section 1016 of the Evidence Code, the superior court determined that because the plaintiff, in instituting the pending litigation, had tendered as an issue his mental and emotional condition, the statutory psychotherapist-patient (Evid. Code, § 1014) privilege did not apply. On December 20, 1968, the court therefore ordered Dr. Lifschutz to comply with the subpena and to answer questions posed during deposition. fn. 1 On January 15, 1969, defendant attempted to continue with the deposition of Dr. Lifschutz as ordered by the superior court, but petitioner remained resolute in his refusal to respond or produce records. Thereafter, petitioner sought a writ of prohibition to restrain the superior court from enforcing its order; the writ was denied by the Court of Appeal, a petition for hearing was denied by this court, and finally a petition for certiorari to the United States Supreme Court was similarly denied.

The superior court held another hearing on December 5, 1969; when Dr. Lifschutz again refused to comply with the order, the court adjudged him in contempt (Code Civ. Proc., § 1209, subd. 5) fn. 2 and ordered him to be confined in the custody of the Sheriff of San Mateo County (Code Civ. Proc., § 1219). After the Court of Appeal on December 8, 1969, denied without opinion a petition for habeas corpus, this court agreed to hear the case and ordered the petitioner released on his own recognizance pending our determination of the cause.

. . .

In sum, we conclude that no constitutional right enables the psychotherapist to assert an absolute privilege concerning all psychotherapeutic communications. We do not believe the patient-psychotherapist privilege should be frozen into the rigidity of absolutism.

. . .

Inasmuch as plaintiff had already disclosed that he had consulted Dr. Lifschutz for psychotherapeutic treatment, petitioner could not properly have refused to answer at least that question concerning the communications; since neither plaintiff nor the psychotherapist has as yet made any claim that the subpenaed records are not directly relevant to the specific "mental and emotional" injuries for which plaintiff is claiming relief, Dr. Lifschutz had no right to refuse to produce the records.​




Ignorantia juris non excusat
 
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BUMP!

So, rather than start a new thread on this, I'll just drop my own case into this one.

Got sent a subpoena from the lawyer of a local hospital requesting ("commanding" in their words) to give a deposition in a civil case in which the hospital and a physician employed by them are being sued by one of my former therapy patients from residency. My best guess is that the patient is accusing another patient of assault during a time she was hospitalized there, but I honestly don't remember any more details beyond that... it was more than two years ago when I last saw this patient. None of the suit is public record at the moment and this patient is simply listed as "victim" on the subpoena and case record.

I only know who the plaintiff is by calling the lawyer's office, who told me to schedule the deposition at my convenience. I asked for any further information about the suit since none of it is public record, and was told they could send my records to review after I schedule the deposition..

...so in this case, what's the best course of action? Anyone I still need to talk to? Am I actually compelled to give the statement given that it's for the defendant's lawyer and not the court itself? Pay?
 
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BUMP!

Anyone I still need to talk to?

The legal dept at wherever you did residency? Presumably they will guide you seeing as you saw pt while employeed there, if not I'm sure they can refer you elsewhere.

I always wonder why folks sit around and ponder legal stuff. I encountered a weird legal situation once, so just paged legal and within 10 minutes was talking to a lawyer and had a definitive answer.
 
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Can't hurt. Though a current colleague of mine who also had a similar situation (same residency) said that Legal said they wouldn't represent her since she wasn't the one being sued... oh well.

Another resident was doing the med management for the patient, and there would be two other attending names on the chart from that time too (therapy and E+M), so going to let them know too.
 
You don't necessarily need to have your own lawyer in these situations; most of the time you as a doctor are not directly involved in the case and there is no question of liability, they are just wanting to use you as a convenient fact witness. You should still talk to your hospital's legal department, it could be called legal or risk management, every teaching hospital should have one independent of the training program.
I sometimes have found it helpful to speak to the attorneys sending the subpoena to make sure they know who I am and what my role in the patient's care was. If you can say something like, "I am a second year resident and only saw the patient once at 2 AM for crosscover and don't know anything else about them", they may drop it.
 
You don't necessarily need to have your own lawyer in these situations; most of the time you as a doctor are not directly involved in the case and there is no question of liability, they are just wanting to use you as a convenient fact witness. You should still talk to your hospital's legal department, it could be called legal or risk management, every teaching hospital should have one independent of the training program.
I sometimes have found it helpful to speak to the attorneys sending the subpoena to make sure they know who I am and what my role in the patient's care was. If you can say something like, "I am a second year resident and only saw the patient once at 2 AM for crosscover and don't know anything else about them", they may drop it.

...yeah, I saw this patient for two years in almost weekly therapy, so I know her well. The exact details of what she's suing about though are super dicey. Plus, my documentation is just psychotherapy EMR notes, so should be pretty useless even to me at this point.
 
BUMP!

So, rather than start a new thread on this, I'll just drop my own case into this one.

Got sent a subpoena from the lawyer of a local hospital requesting ("commanding" in their words) to give a deposition in a civil case in which the hospital and a physician employed by them are being sued by one of my former therapy patients from residency. My best guess is that the patient is accusing another patient of assault during a time she was hospitalized there, but I honestly don't remember any more details beyond that... it was more than two years ago when I last saw this patient. None of the suit is public record at the moment and this patient is simply listed as "victim" on the subpoena and case record.

I only know who the plaintiff is by calling the lawyer's office, who told me to schedule the deposition at my convenience. I asked for any further information about the suit since none of it is public record, and was told they could send my records to review after I schedule the deposition..

...so in this case, what's the best course of action? Anyone I still need to talk to? Am I actually compelled to give the statement given that it's for the defendant's lawyer and not the court itself? Pay?


You are being deposed. I'd first start with whether or not your hospital's legal or risk management department knows about it and what support, if any, they can give to you. If the hospital is the defendant, their lawyer would likely want to at least be present at the deposition.

The lawyer can issue a subpoena on the court's behalf. If you refuse to adhere to it, they can then ask a judge to issue a subpoena on the court's behalf and if you refuse that, you can be held in contempt of court. Unless there is some compelling reason why you should not testify, assume that you need to participate in the deposition.

There is no pay involved. You are not being called on to give expert testimony at a fee.

Source: Watching Law & Order. :)
 
Was this the hospital's in house attorney or an attorney representing the hospital?

As for pay, you will usually be entitled to compensation for your time, not your testimony. You are allowed to request a reasonable amount. Depends on your jurisdiction.

Source: Been there, done that.
 
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Call the legal dept where you were working. This could get dicey depending on who is asking for what. I would be less concerned if the former patient's attorney was asking you for a deposition. Instead, the hospital lawyer is requesting you to provide testimony about your former patient who is now suing them. Unless the patient has okayed release of information for you to talk with them you'd be violating confidentiality.
 
Unless the patient has okayed release of information for you to talk with them you'd be violating confidentiality.

Depends on your jurisdiction. If the former patient [plaintiff] is alleging claims involving her emotional state or claiming emotional distress damages, a patient-litigant exception may apply.

When I give a deposition, or testify in court, before I answer a question about a patient [after giving my qualifications], I ask if I am correct in assuming the patient has waived confidentiality. The record [videotape/transcript] then shows that I raised the issue. If the attorneys stipulated that confidentiality was waived, I would proceed. If I were unsatisfied with the response, I would end the deposition.

Since this is residency related, I would call your PD. I doubt this is the first time this has happened and there may already be a policy/procedure in place.
 
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Depends on your jurisdiction. If the former patient [plaintiff] is alleging claims involving her emotional state or claiming emotional distress damages, a patient-litigant exception may apply.

When I give a deposition, or testify in court, before I answer a question about a patient [after giving my qualifications], I ask if I am correct in assuming the patient has waived confidentiality. The record [videotape/transcript] then shows that I raised the issue. If the attorneys stipulated that confidentiality was waived, I would proceed. If I were unsatisfied with the response, I would end the deposition.

Since this is residency related, I would call your PD. I doubt this is the first time this has happened and there may already be a policy/procedure in place.

The rep I talked to for the defense lawyers (who subpoenaed me) made it sound like they already had access to my records, but that's still a good piece of advice. Risk did say they could potentially offer up an attorney present.

Was this the hospital's in house attorney or an attorney representing the hospital?

As for pay, you will usually be entitled to compensation for your time, not your testimony. You are allowed to request a reasonable amount. Depends on your jurisdiction.

Source: Been there, done that.

Outside counsel. Risk department at my residency's hospital said they also use the same firm that they use themselves in defense cases.
 
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