Scientific research and the duty of medical experts
By Jennifer Pritchett, Associate Editor
With scientific research relating to minor motor vehicle accidents more definitive than ever before, medical experts have a duty to be informed of the latest literature in order to make unbiased assessments in matters that are before the courts, says Toronto orthopaedic spine and trauma surgeon Dr. Michael Ford.
“Form 53 [of the Rules of Civil Procedure] says medical experts are supposed to be objective and nonpartisan, and that we can’t act as advocates,” he tells AdvocateDaily.com.
An expert’s credibility is rounded out by both an understanding of the latest medical research for such cases and their own experience as a physician who sees patients, says Ford, a medical expert who has provided advice and testimony to the legal community for almost 30 years.
Since starting to provide such expertise, Ford says he has seen a great change in how personal injury cases involving minor, often hit-from-behind, motor vehicle accidents are handled.
First of all, he says it seems as if the sheer volume of minor motor vehicle accidents has increased so it’s a fair assumption that the legal work around them is also on the rise.
“There’s more in-depth involvement by medical experts than there was previously, and the cases themselves have become far more complex,” he says. “The files seem to be bigger.”
Ford says he believes the approach to these minor accidents has become more adversarial on both the plaintiff and insurance sides, and that means more involvement by medical experts as well.
“Insurance companies seem to be taking a harder line toward some of these smaller accidents and they appear to be going to court more often to fight them,” he says.
In the ensuing years, Ford says, there has been more literature published that has improved the medical community’s understanding of these injuries, particularly those as a result of minor, hit-from-behind motor vehicle accidents.
“Previously, a great deal of it was supposition based on the part of the experts because there wasn’t much medical evidence, but now there’s been a ton of research devoted towards these particular injuries,” he says. “I think our understanding of them is better.”
Ford says when it comes to an injury such as whiplash associated disorder, “there is still more that needs to be studied, but the evidence is clearly shifting towards a psycho-socio-economic model as opposed to purely a biologic one.”
“Straining to explain someone’s symptoms on a purely biologic basis is a mistake,” he says.
“What we’re starting to realize, for instance, is that there’s no relationship between how much damage there was to the car and the subsequent complaints of the individual who was in the vehicle. There isn’t even a good correlation between age and extent of injuries. You would think that older individuals with previous distinctive degenerative change would be more susceptible to chronic complaints afterward, and that’s not the case either.
“You would also think that the incredible sensitivity of today’s imaging studies would be able to identify a specific lesion associated with that phenomenon and we haven’t been able to. MRI hasn’t demonstrated any specific lesion after a hit-from-behind car accident, despite the fact that if you sprain your ankle and you do an MRI, it looks like a bomb went off.”
So for an expert to say that an individual has incurred injury is often not supportive of the literature, Ford adds.
“We have to recognize that typically there isn’t anything objective to find in these cases and that they aren’t purely organic problems — they are psycho-socio-economic,” he says.
“Quite frankly in these minor motor vehicle accident cases, our role as medical experts is simple: it is to determine whether the mechanism would be consistent with a significant injury, and invariably the answer is no because the objective determinants — physician examination, pattern of pain and the imaging studies — all fail to demonstrate a specific explanation.”