One of the most entertaining things that I do with Phoenix Medical Legal Services is observing IMEs.
It takes a long time and a lot of work to accumulate enough knowledge and experience to be an expert witness on any subject. When it comes to expert witnesses hired by the defense, I am the one who questions their standing to testify.
The AMA Code of Medical Ethics is clear that when an MD testifies, they must have recent and substantive knowledge in the area in which they testify. Having observed defense medical exams, more times than not the examining doctor will demonstrate competence within their specialty and incompetence in regards to the mechanism of injury or diagnosing all of the injuries caused by the motor vehicle collision.
One doctor upon establishing that the patient was rear-ended always asks, “Did your airbags go off.” One patient actually told him, “I don’t have airbags in my backseat.”
I have often seen a patient complain of a specific area of pain that was completely overlooked in the examination. I have seen doctors who are specialists in one part of the human body doing an examination on a part that is not even remotely related to their specialty.
I advise the plaintiff attorney to get the doctor’s CV. Being board-certified in any specialty has value within that specialty but does not imply broad knowledge beyond the limits of that specialty. I have seen a CV where the examining doctor’s most recent addition was 10 years prior. This falls far short of the AMA’s requirement of recent knowledge. It is even more embarrassing to read it and find out that this addition from 10 years ago was, Little League coach. I doubt that helps him determine the extent of injuries.
I have seen too many IME reports with statement like, “There were no objective findings to justify the testing or the treatment.” Most reports will conclude that, “It was a simple cervical strain that should have resolved in 4 to 8 weeks.”
This is upsetting to me when a patient is complaining of pain two years after the trauma. This is especially upsetting when there are radiographic studies that demonstrate herniated discs and ligamentous injuries. Clearly these are not simple muscle injuries that should have resolved two months after the crash.
I have provided plaintiff ’s attorneys with questions to depose these “experts” and have been told, “I have never seen an MD so embarrassed in my life. He could not answer a single question you posed.”
I have done numerous whole person permanent impairment ratings over the last several years. I not only have the education but now also the experience to do these with greater confidence. I have also reached the point where defense counsel has tried to keep my report out of court.
This began with an email from a plaintiff attorney telling me that defense counsel does not believe that I have standing to do an impairment rating and asked how do you answer that?
I immediately sent a copy of page 23 of the AMA Guides 6th Edition that states, doctors of chiropractic medicine are qualified to do this work. I included five certificates that I had received from the AMA having completed their courses that required a passing grade of 80%. I went on to tell him that if that is not enough, I had taught a 15 hour class on the subject five times.
It is quite simple for me to find where any doctor was deficient in their examination or history. As someone who teaches, I know what to look for in order to correct my students. It is just as easy to see with these “experts”.
There are IME doctors I do respect. Overall, I expect that their work outside this arena is nothing short of excellent. It is evident however, that their training as IMEs is often limited to a weekend seminar on how to write a report for the defense or how to testify in court.
A knee surgeon is not an expert on whiplash injuries. A psychiatrist’s MD license may allow them to do open heart surgery, but they will not do that for me. As long as we accept that expertise in one area implies expertise in all areas these IME doctors will continue to get away with denying your case. When we question their standing beyond their specialty, they will carry less weight.