I recently had occasion to refer a neuro-ophthalmologist to Jason Rubin, a plaintiffs’ attorney in New York who is one of my regular clients. The plaintiff/patient had increased intracranial pressure (the reason is not important here) that was affecting her optic nerves, with resulting visual impairment. She eventually had a ventriculoperitoneal shunt inserted to relieve the pressure, but by that time she had very significant vision loss that got even worse postoperatively, and she ended up with severe, permanent vision loss. The issue requiring the expert’s opinion was whether earlier placement of the shunt would have resulted in a better outcome.
As always, I had sent the expert a detailed case summary, on the basis of which he agreed to review the case. When I emailed the expert’s CV and fee schedule to Jason, he replied: “Thanks, Marty. I will try to reach out to him for a brief convo this week. Any indication from him re: the potential for a case based upon your synopsis? I really just want to make sure the case isn’t a non-starter for him.” I responded as follows:
Jason: If he thought it was meritless on its face, he would have told me. I suppose there are experts who will cynically review a case they know is a loser just to make a few bucks, but the ones we work with (medical school faculty, mostly) aren’t like that – they’re devoting a minuscule portion of their time to legal consulting, and they’re too busy with academic and clinical work to waste time reviewing hopeless cases. If anything, I’d say the experts I work with are only too happy to give me a thumbs down based one of my (very good) summaries.
My own feeling is that earlier placement of the shunt could certainly have led to a better result – the question is, *how much earlier* did it have to be done in order to make a *meaningful* difference? FYI, here’s the last paragraph of my case summary:
The question requiring your expertise has two parts: Would earlier placement of the shunt have resulted in either (a) permanent visual impairment that was less severe, or (b) complete resolution of the visual impairment with full recovery of normal vision? If so, how much earlier did the surgery need to be performed in order to make a meaningful difference? [The treating neuro-ophthalmologist] noted on September 11 that the patient “needs to see a neurosurgeon urgently to have a shunt placed, as she has an advanced stage of visual acuity and visual field loss in both eyes.” So, for example, if the surgery had been performed on September 25 instead of September 30, would that have yielded a better result, or would the outcome have been no different? If the answer is “no different,” would placement of the shunt on September 20 have made a difference, or would it have had to be done still earlier? You see where I’m going with this. It even occurred to me (and I’m just hypothesizing here – obviously this is not my field of expertise) that the following scenario might have been the only way to avoid significant, permanent vision loss: Obtain neuro-ophthalmology and neurosurgery consults while the patient was still hospitalized, i.e., before September 9; keep her on Lovenox rather than transitioning to Coumadin, so she could have surgery a day after stopping Lovenox (which is what actually happened on September 30); and either place the shunt before discharge, or discharge her on September 9 and readmit her two days later for placement of the shunt. Was the situation in fact that dire?
So, I think it’s perfectly okay for you to ask him if he has any preliminary thoughts (pending a full review of the records, of course) about “how much earlier.” – Regards, Marty
And in response to that, I received the following very gratifying reply from my client: “Marty: I totally agree re: your analysis. I appreciate the work you put into obtaining these reviews. Other expert search firms don’t put nearly this much thought (or any, for that matter) into the cases. You are a cut above!”
I am being so immodest as to share this with our readers because it’s one thing to say (as every referral service does, including us) “we’re the best,” and it’s another thing to demonstrate what makes us the best. We go the extra mile to make sure we understand the case, so that we in turn can present it correctly and straightforwardly to potential experts. This is the key to achieving our goal, which is to provide our clients with the right expert for every case.
