Specialties

When it comes to Pain Medicine expert witness testimony, a forensic expert trained, experienced and Board Certified in Pain Medicine can provide comprehensive services and litigation support. This involves organizing and presenting medical evidence and relevant data in a manner that is convincing to the fact finders.

“Pain” can be described in a variety of ways, one of which can be as follows: “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.” Expanding on this description, you can guarantee that pain in of itself is always subjective. Furthermore, acute pain is a physiologic response to tissue damage and is protective.

Pain doesn’t necessarily need to present itself as a single occurrence. Knowing this, pain can present itself over a prolonged period of time. The term “chronic pain” is used to describe the persistent/recurring feeling both emotionally and physically debilitating. In reality it serves no useful purpose, even in chronicity which represents low levels of underlying pathology that does not explain that presence and extent of pain, or both. This idea of a ‘biological value’ needed to determine at which point chronicity can be determined is usually accepted if the pain equates to period of three months or more in length. With chronicity comes repetitive nervous system responses to pain impulses which then causes pain to become a disease by itself.

This feeling of pain affects individuals, families and society. It causes physical and psychological impact. It can subsequently affect work and ADLS. In addition, pain can affect sleep and emotional state (e.g. depression, anxiety, anger, etc.), and self-esteem. Lastly, pain can affect social, familial, parental, marital, and/or sexual relations.

The medical profession is considered to be one of the noblest professions that exist. Same goes for those with the title of juris doctorate. As a forensic psychiatrist, Dr. Nair operates at the interface of the justice and health systems daily. He plays an intricate role in the presentation of facts essential to the characterization of the symbiosis between the two fields. Physicians, unlike in the past, are no longer regarded as infallible and beyond questioning, and an opposing counsel would love nothing more than to get their own expert to join in on a case. It is in these specific circumstances that someone American Board Certified in Forensic Psychiatry will be most useful.

To understand the benefits of having such a certification one must be able to distinguish between two types of testimony. Clinical testimony is when a clinician has assessed/treated a patient in the normal/usual course of practice (clinical).

Signs and symptoms of impairment often present first at home and in other nonprofessional settings. When impairment manifests itself, in the workplace for example, the substance use has usually been occurring for years. The impact of substance use can extend beyond the personal toll on the individual and extend to professional colleagues, clients, and family members. Early intervention and/or prevention for substance misuse are vitally important, but inevitably it may be too late and the repercussions can vary—ultimately having a negative effect.

So, what does this mean? Physicians in various specialty areas of practice are from time to time called upon to testify in civil proceedings. The testimony in and of itself needs to be impartial and fair. In addition, the testimony needs to be accurate within the specialty area based upon the expert’s opinion, but also on the opinions of common practice established by the American Board of Addiction Medicine. Dr. Nair will utilize current research, evidence-based practice, peer-reviewed scientific and health publications, clinical practice guidelines, and/or expert professional consensus in his case analysis.

Dr. Nair will review all of the materials presented to him to determine if substance-related disorders have been accurately assessed and diagnosed. Patient assessment can be influenced by a number of patient characteristics, including the patient’s age, gender, ethnicity, and legal, marital, and employment status; degree of insight into the nature of the problem; medical or psychiatric comorbidity; stage in the course of illness (e.g., recovery, recent relapse, first treatment); current phase of use (e.g., intoxication, withdrawal, interepisode); and stage of readiness for change and motivation.

A complete substance use assessment requires eliciting the history of use for all the major categories of substance, with a focus on age at first use, frequency and amount of use, consequences of use, substance abuse treatment history, and complete psychiatric, medical and social, and developmental histories. Couple this with the meticulous review of collateral informant interviews, standardized questionnaires, and biological testing will provide helpful information in developing an opinion.

There is no such one-size-fits-all model for a forensic investigation. Each case will be individualized based on patient placement criteria which incorporate multidimensional assessments of severity of illness and level of function; problem and priority identification; treatment matching needs to services; and level-of-care placement within a broad continuum of care.

Addiction Medicine Expert Witness Services

When it comes to Addiction Medicine expert witness testimony, it is imperative that the expert furnish the judge or jury with the necessary scientific criteria for testing the accuracy of their conclusions. This will enable individuals to develop their own independent judgement by the application of these criteria to the facts provided in evidence. A forensic expert must be trained, experienced and Board Certified in Addiction Medicine so as to provide comprehensive services and litigation support.

Signs and symptoms of impairment often present first at home and in other nonprofessional settings. When impairment manifests itself, in the workplace for example, the substance use has usually been occurring for years. The impact of substance use can extend beyond the personal toll on the individual and extend to professional colleagues, clients, and family members. Early intervention and/or prevention for substance misuse are vitally important, but inevitably it may be too late and the repercussions can vary—ultimately having a negative effect.

So, what does this mean? Physicians in various specialty areas of practice are from time to time called upon to testify in civil proceedings. The testimony in and of itself needs to be impartial and fair. In addition, the testimony needs to be accurate within the specialty area based upon the expert’s opinion, but also on the opinions of common practice established by the American Board of Addiction Medicine. Dr. Nair will utilize current research, evidence-based practice, peer-reviewed scientific and health publications, clinical practice guidelines, and/or expert professional consensus in his case analysis.

Dr. Nair will review all of the materials presented to him to determine if substance-related disorders have been accurately assessed and diagnosed. Patient assessment can be influenced by a number of patient characteristics, including the patient’s age, gender, ethnicity, and legal, marital, and employment status; degree of insight into the nature of the problem; medical or psychiatric comorbidity; stage in the course of illness (e.g., recovery, recent relapse, first treatment); current phase of use (e.g., intoxication, withdrawal, interepisode); and stage of readiness for change and motivation.

A complete substance use assessment requires eliciting the history of use for all the major categories of substance, with a focus on age at first use, frequency and amount of use, consequences of use, substance abuse treatment history, and complete psychiatric, medical and social, and developmental histories. Couple this with the meticulous review of collateral informant interviews, standardized questionnaires, and biological testing will provide helpful information in developing an opinion.

There is no such one-size-fits-all model for a forensic investigation. Each case will be individualized based on patient placement criteria which incorporate multidimensional assessments of severity of illness and level of function; problem and priority identification; treatment matching needs to services; and level-of-care placement within a broad continuum of care.

Serving as an expert witness can be a rewarding experience if done correctly. For instance, if a psychiatrist can contribute his expertise to the legal system’s pursuit of justice and administer fair and factual testimony while abiding by principals and guidelines of his craft; then one can walk out of a courtroom knowing he was impartial and accomplished what needed to be done. Dr. Nair, being board certified in psychiatry and neurology, has special training and experience evaluating a multitude of neurological disorders and is able to convey his opinions to judges and juries alike in a manner that is comprehendible. More often than not experts will talk at a level that most people will not be able to understand. Dr. Nair’s testimony allows people to understand complex and technical aspects of neuroscientific evidence relevant to each individual case. Furthermore, this specialty suffers needlessly from arbitrary barriers that are maintained by the power of tradition. While there may be differences between psychiatry and neurology, the commonalities promise further understanding of brain-behavior relationships which Dr. Nair utilizes when testifying. Dr. Nair’s psychiatric evaluations are evidence based and he is able to provide his medical opinion on relevant disorders, in good faith, as to his reasonable degree of medical certainty.

The legal system is an important part of society’s response to child and adolescent psychiatric complaints that are filed. Representatives of the courts must continue to hear the opinions of medical experts in order to best achieve mutual education between themselves and the parties that stand before them. This collaborative process allows for experts to opine on medical and mental health topics with an understanding that the ultimate goal is for the rehabilitation of families rather than punishment. The medical expert must be well acquainted with issues of child development, medicine, decisions on separating parent and child, and what to expect of social agencies.

When the Dr. Nair is presenting his findings to the court he must first make sure that all material facts are put into evidence before testifying. Once the facts are processed then the Dr. Nair can begin to develop a direction in which to take, such as family proceedings (i.e care proceedings) relating to children or straight to criminal proceedings. When it comes to sensitive topics regarding children an expert must be familiar with the milieu of the courtroom and the adversarial nature that can be intimidating for non-forensic doctors. Although the physician doesn’t represent the plaintiff or the defendant, the expert must still provide accurate and impartial testimony in a relevant manner while keeping the child’s well-being in mind—which Dr. Nair will do.

A psychopharmacology expert witness may opine on psychoactive drugs, drug action/effect, and pharmacology. They cover everything between psychotherapy and pharmacotherapy. When done well, a determination of whether or not the proper management of both fields of study in this “split” environment can be advantageous for legal counsel. For instance, perhaps a patient is receiving split treatment and one doctor doesn’t quite communicate his reasoning for changing medication to the other. The potential could be catastrophic in nature due in part because between all the back and forth the patient falls between the cracks, visits become fragmented and too short, medications aren’t jiving with insurance coverages, patients are relying on therapists to prescribe medications, or maybe patients just are asking the right questions and placing an overabundance of trust in their doctor. Furthermore, it is well documents that nonpsychiatric physicians prescribe the majority of psychotropic drugs.

This country is littered with antidepressants and antianxiety medications. An expert understands the nervous system’s function (physiology) and structure (physiology); they can determine what can go wrong based on the medication taken to determine things such as: neurotransmission stoppage, problems with brain circuitry, results stemming from developmental delay, imbalances in the brain, genetic factors, brain deterioration, or pharmacokinetic interactions. The role of the expert is to utilize all these factors to determine the pathophysiological (i.e. cause) outcome of a psychiatric illness while incorporating characteristics of the individual patient to devise a rational approach to determining the validity of claim(s) brought about in a lawsuit.