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Okay, so expert witnesses, best practices.

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The purpose and our objectives today are

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to provide the a CR practice, not rules, not guidelines,

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but parameters on expert witness work.

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Discuss the ethics of being an expert witness,

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provide some tips from my personal experience,

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and Kelly will provide some from her experience.

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And then share insights into what is has

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provided for me, uh, being an expert witness.

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First, we're gonna look at the a CR practice parameter.

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Remember they changed the name to practice parameter

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because I don't want to use the term standards or guidelines

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because that could be used to establish the standard of, um,

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standard procedures or, uh, practice standard.

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So the a CR says that, um, it,

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it encourages people to be an expert witness.

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And let me pull some of the

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text from this practice parameter.

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The A CR has in the text

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that radiologists are frequently called upon to serve

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as medical expert witnesses in a variety

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of legal proceeding proceedings and have an obligation.

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It actually says an obligation to do

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so in appropriate circumstances,

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which includes the willingness to give sworn testimony

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by deposition or in court.

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I think that this paragraph is important

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to have people understand that

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when you give an expert opinion to lawyers,

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you should commit yourself that if necessary,

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you are willing to also provide testimony at

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deposition or in court.

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It's not as if you can just give it a, an opinion

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and to the lawyers and then say, no,

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but I don't wanna testify.

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They actually do encourage radiologists to make

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that commitment and to show the willingness

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to give a sworn testimony by deposition or in court.

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So this is what they actually con constitutes an obligation

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according to the American College of Radiology.

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Not only that, but it says that the public interest

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requires readily available objective

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and unbiased medical expert testimony.

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We're doing this as part of an, an, uh, a public interest,

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and the physician should be objective,

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have no personal interest in the outcome of the case,

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which means that you are not paid based on the

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outcome of the case.

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You're usually paid based on your time,

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but whether it ends up being a plaintiff

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or defense verdict, you should not have any

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monetary interest in the outcome of the case,

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and you have expertise in the matter.

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Finally, it says that you should provide opinions

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on things such as a defendant, doctor's training

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and expertise, the standard of care, which is basically

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what most expert witnesses provide relevance

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of imaging findings to causation or damages,

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and the adequacy of the equipment used based on the

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information available at the time of the incident.

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So sometimes you have to wind the clock back

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and even though technology may have advanced into 2025,

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if the cases from 2019, the readily availability of,

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for example, artificial intelligence readings

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in 2019 might be different than it is now.

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So you do have to do it at available at the time

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of the incidents based on generally accepted standard

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of care for the site of the incident under consideration.

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So that's all. These are important,

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and remember that this is standard of care for the site

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of the incident under consideration.

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And in my opinion, as an expert, that site,

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whether it's a university hospital

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or a community practice where it's dominated

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by general radiologists, there's a difference in the type of

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quality or standard

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that is occurs in those two different settings.

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Now, I might defer a little bit to Kelly on this, uh, point,

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and that is, um, the Daubert ruling

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and the Daubert ruling says that conclusions

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and opinions of expert witnesses must be based on sound

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reasoning and reliable scientific methodology.

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There are occasions where you may be challenged as

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to whether your expert opinions are based in sound

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reasoning and reliable scientific methodology,

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and a lot of times when you're called as an expert witness,

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they will ask, have you ever been excluded from an expert

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witness based on dalbert criteria,

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that you did not give it an opinion based on sound reasoning

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and reliable scientific methodology,

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and that mu science obviously must be generally accepted.

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Um, Kelly, any comments about the dalbert, uh, rule

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or have you ever employed that to exclude a expert?

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I have not had to do so.

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Um, we kind of know it's out there,

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but it's not something that in this arena, uh,

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in Colorado we use with e frequency.

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I mean the, the principles are there,

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but you know, we're looking at, uh, standard of care.

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It's a national standard.

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Um, and what is the, uh, you know, the,

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the physician who's acting

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as an expert witness is testifying as to

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what a reasonable physician would do under same

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or similar circumstances based on their education, training

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and experience.

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When you get into newer stuff or,

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or different sort of standards or technologies.

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Um, they actually have special Daubert hearings, uh,

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to review all of this.

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Thank you. Okay.

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So, um, the a CR practice parameter,

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which I think was written the most recent one,

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was written in 2021,

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says you should consider the original medium on which

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studies were interpreted, uh, used to be film.

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Now most of it is electronic,

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but that electronic medium may, um,

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vary depending upon the technology that's being employed

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and with the history provided at the time of the study.

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So this tries to get at the issue of

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retrospective bias,

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and that is that it's always easy in hindsight to

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once you know the diagnosis, to see something as opposed to

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what the history was provided at the time of the study.

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And therefore, based on that, provide the standard of care.

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The compensation of the expert according

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to the a CR practice.

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Parameters should be based on time and effort.