Expert Witness Truism: Consider the Social Context but Ground Your Final Opinions on Medical Records Alone

𝗣𝗹𝗮𝗶𝗻𝘁𝗶𝗳𝗳'𝘀 𝗔𝘁𝘁𝗼𝗿𝗻𝗲𝘆: 𝘚𝘰, 𝘺𝘰𝘶'𝘳𝘦 𝘴𝘢𝘺𝘪𝘯𝘨 𝘵𝘩𝘦𝘳𝘦'𝘴 𝘯𝘰 𝘣𝘳𝘦𝘢𝘤𝘩?

𝗔𝗻𝗲𝘀𝘁𝗵𝗲𝘀𝗶𝗮 𝗘𝘅𝗽𝗲𝗿𝘁 𝗪𝗶𝘁𝗻𝗲𝘀𝘀 (𝗠𝗲): 𝘠𝘦𝘴, 𝘵𝘩𝘦𝘳𝘦'𝘴 𝘯𝘰 𝘣𝘳𝘦𝘢𝘤𝘩.

𝗛𝗲𝗿𝗲'𝘀 𝗮 𝗰𝗮𝘀𝗲 𝘀𝘂𝗺𝗺𝗮𝗿𝘆 𝗳𝗿𝗼𝗺 𝟮𝟬𝟭𝟵:
↳49 Yr old male - Elective plastic surgery - Self-pay
↳Ambulatory surgery center - Unremarkable procedure

𝗧𝗵𝗲𝗻, 𝘁𝗵𝗲 𝗮𝗰𝘁𝗶𝗼𝗻 𝗯𝗲𝗴𝗶𝗻𝘀

In the Post-Anesthesia Care Unit (PACU):

• Pain is controlled
• Voided and ambulated
• No nausea or vomiting
• Full recovery from anesthesia
• 𝗣𝗲𝗿𝘀𝗶𝘀𝘁𝗲𝗻𝘁 𝗣𝗩𝗖𝘀 𝗲𝘃𝗲𝗿𝘆 𝟰 𝗯𝗲𝗮𝘁𝘀 (𝙣𝙚𝙬 𝙛𝙞𝙣𝙙𝙞𝙣𝙜)

𝗧𝗵𝗲𝗻, 𝘁𝗵𝗲 𝗳𝗶𝗴𝗵𝘁 𝗵𝗮𝗽𝗽𝗲𝗻𝘀

✴️Surgeon defers discharge order to anesthesiologist
✳️Anesthesiologist defers discharge order to surgeon

Neither feel a 𝙎𝘼𝙁𝙀 discharge is warranted
↳EMS is called to transfer the patient to the ER
↳The payment for EMS transport is argued
↳Patient has a 12-hour stay in the ER
↳Total bill ~$𝟭𝟮,𝟴𝟮𝟬

𝗤𝘂𝗲𝘀𝘁𝗶𝗼𝗻: 𝘞𝘢𝘴 𝘵𝘩𝘦𝘳𝘦 𝘢 𝘣𝘳𝘦𝘢𝘤𝘩 𝘪𝘯 𝘵𝘩𝘦 𝘴𝘵𝘢𝘯𝘥𝘢𝘳𝘥 𝘰𝘧 𝘤𝘢𝘳𝘦?

𝗔𝗻𝘀𝘄𝗲𝗿: 𝘕𝘰.
↳The average anesthesiologist in the same position would 𝙉𝙊𝙏 feel comfortable discharging the patient home and would have done the same

𝗩𝗲𝗿𝗱𝗶𝗰𝘁: 𝘕𝘰 𝘣𝘳𝘦𝘢𝘤𝘩𝘦𝘴 𝘪𝘯 𝘵𝘩𝘦 𝘢𝘯𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 𝘴𝘵𝘢𝘯𝘥𝘢𝘳𝘥 𝘰𝘧 𝘤𝘢𝘳𝘦

𝗣.𝗦. - 𝗧𝗵𝗲 𝗲𝗴𝗿𝗲𝗴𝗶𝗼𝘂𝘀 $𝟭𝟮,𝟴𝟮𝟬 𝗯𝗶𝗹𝗹 𝘀𝗵𝗼𝘂𝗹𝗱 𝗺𝗮𝗸𝗲 𝘂𝘀 𝗮𝗹𝗹 𝗮𝗻𝗴𝗿𝘆 ... 𝗯𝘂𝘁 𝘁𝗵𝗮𝘁 𝗶𝘀 𝗮 𝗱𝗶𝗳𝗳𝗲𝗿𝗲𝗻𝘁 𝗳𝗶𝗴𝗵𝘁.