Arie Blitz is an independent cardiac surgeon who, after training at UCLA Medical Centre, has been practicing in the field for 20 years. He spent most of his career in the academic environment, having achieved full professorship, serving on numerous national committees, performing a broad range of cardiac surgical procedures, presenting at national and international meetings, and publishing articles in peer reviewed journals. With such extensive experience and knowledge in the medical field, he shares with us the reasons to why he is often called to act as an expert in legal cases, and how to overcome the difficulties of drawing to an opinion during tricky cases.
Throughout your years of experience as an expert, what common mistakes do other medical professionals make, which thus has the potential to lead to lawsuits?
In the medical field, the most common and egregious errors that lead to liability include a lack of transparency and misrepresentation. All human beings make errors, and physicians are no exception. Most errors do not constitute negligence. However, ‘negligence’ can be a grey area, and if a physician does not communicate honestly with the patient or the patient’s family about a mistake that occurred - i.e., either not coming clean about the mistake or mischaracterising the mistake - that action itself can push the perception of the mistake beyond the grey area, to a clear breach of the standard of care in the eyes of the trier of fact. Be honest, own your error, and answer questions frankly. That is the best advice I can give to a physician regarding protecting himself from liability.
How have you seen surgery guidelines change over the years- do you think this has affected the occurrence of legal cases?
One thing I need to clarify is that guidelines do not define the standard of care. One challenge in medicine, like in law, is that every case is unique in some dimension. Clinical guidelines constitute a proposed template of how one might proceed in the generic case. The expert’s role here is to explain ways in which the guidelines are relevant to the case at hand. Now, given the above, if guidelines change - as they always do with accumulating evidence - that does impact whether the specific guidelines are relevant to a case. However, I do not feel that the evolution of guidelines has any meaningful impact on the occurrence of legal cases.
What common misconceptions do those outside the industry have about heart surgery; how does this pose difficulty on your role, especially as an expert witness?
The most common misconception I encounter is a lack of appreciation as to how every cardiac surgical procedure is unique. Each case presents its own unexpected challenges, and surprises are plentiful; however, the key distinguisher of the reasonably prudent surgeon is the ability to cope and address the surprises as they arise.
Are there any ways in which the legal industry in the US could adapt in order to make your role as an expert witness easier?
For any medical expert, I think the most helpful change would be for the hiring attorney to offer the following in writing, which is really a truncation of the usual IRAC (Issue, Rule, Application, and Conclusion) format for evaluating cases: Provide your expert with all the ‘I’s and ‘R’s before he reviews the case. In other words, formalise all the issue questions and provide all the applicable rules of law for the state in which the alleged tort occurred. Making the issues and rules concrete will allow you to get the most out of your expert.
In what instances are reaching a conclusion of opinion difficult, and how do you overcome said difficulty?
Obtaining clarity regarding the standard of care and its breach can sometimes pose difficulties. For any alleged breach, I ask myself the following questions: (1) Could this happen to me? (2) How would I react in this situation? (3) Is the conduct and/or reaction a representation of what a reasonably prudent surgeon would do? An expert needs to keep at the forefront of their mind that they need to continually ensure that their own bias about how something should be done does not cloud their judgment of what a reasonable surgeon might do. These issues are clearly distinguishable, and the surgeon who does not take care to clearly observe and apply this distinction will not serve their client, or justice, well.
Arie Blitz, MD, MBA
Cardiac Surgeon, Consultant, Forensics, JD Candidate
http://www.linkedin.com/in/ArieBlitzMD
216-798-2260
The combination of my medical degree, management degree, and ultimately a JD degree provides me with a unique and advantageous vantage point from which to provide expert witness services. In my experience, there are deep chasms that exist among the clinical, administrative, and legal fields in terms of communication and thought processes. My background in the three fields allows me to communicate more effectively and logically, thereby crossing and bridging the chasm.
I frequently lecture on the role of the expert witness in medical malpractice cases. One of my goals during these presentations is to convey to the audience a sense of responsibility. The role of the expert witness is to measure the acts of the defendant according to the standard of care that the expert himself brings to the table. In this process, it is imperative to follow the code of being honest and objective. The expert should neither be a hired gun nor perceived as one. If one adheres to such a code, one brings tremendous value and integrity to the process.
