Clark Race, MD is board certified in Orthopedic Surgery by the American Board of Orthopaedic Surgery and has been in private practice in the Austin area since 1983.
Dr. Race recently created Expert Witness Doctors to provide medicolegal services, which include depositions, trial testimony, medical record reviews, IMEs, peer reviews, disability evaluations, designated doctor exams, rehabilitation planning, and maximum medical improvement/impairment ratings.
TOA recently sat down with Dr. Race to discuss the latest developments in the medical expert witness industry.
TOA: How did you decide to create a medical expert witness company?
Clark Race: I have been practicing orthopedics in Texas for approximately 40 years. During that time, I have treated many patients in the Texas Workers’ Compensation system. In the process of doing that type of work, I would receive inquiries from third parties to review medical records and render an opinion regarding the appropriateness of orthopedic care, causation, and future medical expenses. As time went on, I began to receive requests directly from law firms to review cases and render opinions. In many of these cases, the law firms requested that I become a designated medical expert witness.
Over time, I found it increasingly difficult to work through third party companies who hired me on behalf of a law firm or an insurance carrier. Many of these third-party companies had opaque fee schedules and poor communications, which would result in many cases in confusion and/or missing of deadlines. As a result, I decided to form a PLLC which was solely engaged in medical/legal work. That business has grown over time, and I have received requests for services from other types of specialists. For that reason, the company that began solely to represent me and my work has begun to include other specialists for review of medical/legal cases.
Another reason for forming this company was to circumvent the middleman in this process. The customers for this type of work are law firms and insurance carriers. I found over time that having a third-party middleman became more confusing than it was helpful, and I have found that it is much easier to conduct this business in a situation where communications and deadlines are controlled and managed more efficiently.
Under its current structure, this company is engaged in providing services for Independent Medical Examinations, record reviews, Peer Reviews, disability examinations, and medical/legal expert witness work. The company is structured so that any potential clients can directly speak with my administrative assistant, who responds promptly and accurately to the requests and communicates any necessary information to the doctors who are involved. This has greatly improved the efficiency and decreased the stress level associated with trying to do this type of work through one’s medical office. The type of work is often confusing to medical practice office staff, and I found that calls and requests were frequently mishandled or delayed. Under the current structure, there is one individual who is responsible for coordinating the collection of records, communicating with clients and with the participating physicians, and making sure that no deadlines are missed. Medical records are stored in a HIPAA secure website where participating physicians may review these records at their convenience to perform their work. This has also eliminated the need for handling large volumes of paper files, which become extremely burdensome after a period of time.
TOA: TOA hears from a lot of medical expert witness companies. What is it that you have done differently?
Clark Race: The difference between this company and other medical expert witness companies is that this company is physician owned and managed. We have a transparent fee schedule so that all participating physicians have access to our fee schedule and their expected reimbursement rates. This company is structured as a “group practice.” We help with report writing, deposition preparation, and offer other educational and useful information on our website regarding performing medical expert witness work. Again, the primary difference in this company and other companies is that we can communicate efficiently and directly with our participating physicians with minimal disruption of their daily workflow. This alleviates stress and utilizes less of the physicians’ time trying to keep up with deadlines, report requirements, contact information, etcetera.
TOA: What types of orthopaedic services are needed the most?
Clark Race: As I am an orthopedic surgeon, most of the requests that I receive are for the evaluation of orthopedic cases. We also receive frequent requests for neurological and neurosurgical consultants. To a lesser extent are requests for emergency room physician services, OB/GYN physicians, and general surgery consultants.
Most of the orthopedic cases involve injuries sustained in motor vehicle accidents in which the plaintiff is alleging multiple injuries that may or may not be compatible with the accident in question. The plaintiff’s bar normally works with medical providers who will often overtreat the patients and recommend surgeries that are not indicated. There is frequent over-treatment of these clients, which generates large medical charges that form the basis of the damages, which are the basis of the litigation. Common issues that need to be opined upon include mechanism of injury, causation of alleged injuries, the relationship of alleged injuries to the accident in question, future medical treatment, and ability to return to work.
Practicing physicians who have experience dealing with traumatic injuries are uniquely qualified to opine on these issues.
In my opinion, the most common injuries which are involved in litigation involve alleged spine injuries. These are often the result of motor vehicle accidents or other traumatic injuries. Other common injuries include shoulder injuries, hip and knee injuries, and alleged neurological injuries as a result of trauma.
TOA: What types of reactions have you seen orthopaedic surgeons had towards orthopaedic surgeons who acted as expert medical witnesses against them?
Clark Race: In my experience, there have been no negative reactions from other orthopedic surgeons or treating physicians regarding testimonies and expert witness. The crucial factor in rendering these opinions is to base them on evidence-based medicine and to provide fair and accurate reports without bias toward the plaintiff or the defendant. If these principles are followed, it is my experience that there is minimal risk to the medical expert providing opinions.
As long as the testifying medical experts are qualified to opine on the alleged injuries in dispute and they use scientifically based information to form their opinions, there is minimal risk of being disqualified as an expert or being involved in any litigation over one’s opinions.
The American Academy of Orthopedic Surgeons has been supportive of physicians participating in the medical/legal system. These legal matters require expert medical opinions to resolve the issues in question. The Academy has rules of conduct that require participants to give fair and accurate opinions and to base their opinions on scientific evidence.
Being a medical expert witness has a sidebar to my orthopedic practice for several years. I find the work interesting and, in large part, the involved attorneys are intelligent and courteous. They are glad to have expert medical witnesses who are able to present the facts of the case and render cogent opinions regarding the questions at hand. The work has the additional benefit of being able to be done when an individual has extra time. The deadlines for production are usually far into the future, allowing ample time to review records, create reports, etcetera. The reimbursement is quite satisfactory and is an additional method to counteract declining reimbursements for the actual practice of medicine. If a physician is interested in engaging in this type of work, it is helpful to begin by performing Peer Reviews or medical record reviews. Working in the Workers’ Compensation system is also quite useful as that system has many similarities to the civil litigation system. If one becomes adept at this type of work, it has been my experience that interested parties will begin to request an individual’s service to review legal cases and possibly testify as a medical expert witness.
There are multiple educational resources to gain further knowledge and experience in this area. The American Academy of Orthopedic Surgeons’ annual occupational medical meeting is an excellent starting place. There are multiple other companies that are national in scope, which provide ongoing in-person training for performing IMEs, doing record reviews, and participating in expert witness work. These would be highly recommended to anyone considering engaging in this type of work who has not had previous experience.
Learn more about the company at: www.expertwitnessdoctors.com.