By James J. Mangraviti, Jr., Esq.
If you are considering starting a neurosurgery expert witness practice, you may wonder what types of cases you may be asked to opine on. Below are 10 case examples:
- Evaluate whether earlier treatment (i.e., TPA, etc.) to a patient would have saved his life. Plaintiff had walked into the ER with stroke-like symptoms, but these were not recognized as a stroke.
- Trip and fall case with a plaintiff who claims a TBI two years post-accident. Did the plaintiff suffer a TBI as a result of the fall? Are current symptoms a result of the fall? Has the treatment the plaintiff has received been medically necessary?
- Anterior approach to disc surgery, patient has a stroke. Was there a breach of the standard or care or is this a case of a known and unavoidable complication of the procedure?
- Cervical fusion results in major complications. Was it within standard of care to perform the surgery before trying less risky options?
- Subdural hematoma after a fall. Patient sues treating neurologist for failure to refer to neurosurgeon. What would have been the likely result had the neurosurgeon been called in earlier?
- A man falls and suffers a brain bleed. He calls 911 before passing out but EMS negligently shows up hours late. What would have been his course but not for the mistake by EMS?
- Did epilepsy cause a defendant driver involved in a fatal class to pass out at the wheel?
- Patient becomes a paraplegic after a slip and fall. Was the paraplegia caused by the slip and fall?
- Delay in diagnosis of brain tumor, what would the likely result have been with earlier diagnosis/treatment?
- Motor vehicle accident. How much of the plaintiff’s current problems are a result of the accident versus multiple preexisting problems?
Neurosurgeons commonly bill over $1,000/hr for their time. This makes the earning potential of a neurosurgery expert witness in the millions of dollars over the course of his/her career. Experts who take this endeavor seriously, do outstanding work (and gather glowing word of mouth), think long-term and maintain their moral compass are best positioned to succeed.
To find out more about becoming a neurosurgery expert witness, please visit www.testifyingingtraining.com.
FAQs
Q. Will I have time to do this work? I can’t be in court all the time.
A. Trial testimony is very rare, typically 1-2% of one’s cases as most cases settle. Deposition testimony is more common, but this is typically given via Zoom at a time convenient to you such as late afternoon or during your admin time.
Q. When would a busy neurosurgeon do this work?
A. Nights, weekends and during admin time.
Q. Where would a busy neurosurgeon do this work?
A. At home or wherever convenient, as most of the work is document review, research, writing, talking on Zoom, etc.
Q. Do I need to be a medical school professor or to have graduated from an Ivy League Medical School in order to be a successful neurosurgery medical expert witness?
A. Absolutely not. The vast majority of successful neurosurgery expert witnesses are neither academicians nor Ivy League graduates.
Q. What are attorneys looking for in a medical expert witness?
A. A knowledgeable professional who is responsive, easy to deal with and can communicate well to lay people both in writing and orally.
Q. Will I have to say something I don’t believe in?
A. The way it works is that you will be sent a chart to review and will be paid (typically up front) to review it. If you cannot support the position the attorney is looking for (a very common occurrence) you tell the attorney that and that will generally be the end of the assignment. When reviewing charts for plaintiffs on standard of care it is typical for you to find that a large majority of cases did not involve a breach or standard or that if they did, no harm resulted.
Q. What if your opinion does not support the client’s case.
A. That happens all the time. Your job is tell the truth and let the chips fall where they may. Your job is NOT to say what retaining counsel would have liked your opinion to be. In the case where your opinion is non-supportive retaining counsel may seek a second opinion from another expert or drop or settle the matter.
Q. I only want to testify for defendants, can I do that?
A. You can, but this would make you vulnerable to attack on cross-examination as being potentially biased. The most credible and successful medical expert witnesses call cases like they see them and are available to both plaintiffs and defendants.
Q. Can I turn down cases or clients I am not comfortable with?
A. Yes, not only CAN you do this, but you SHOULD do this – it will prevent all kinds of aggravation.
Q. Do I have to meet deadlines?
A. Yes, but often times these can be negotiated/extended.
Q. Travelling to a trial to testify can be disruptive to my practice and life. Can I do this work without testifying at trial?
A. No, when you take a case you are committing to testify in person at trial if and when necessary. Bear in mind that although trials are disruptive, you will rarely have to appear as the vast majority of cases settle, you are well-compensated for appearing and the experience of testifying in front of a jury can be very interesting as well as personally and professionally rewarding.
Q. Do I need to keep performing surgery full-time?
A. That depends. If you would like to testify on standard of care in medical malpractice cases it is best that you maintain at least a part time surgical practice. This may be a legal requirement in many jurisdictions. An active surgical practice is less critical for causation opinions, IMEs, and personal injury cases. Many later-career neurosurgeons do increasing amounts of IMEs and PI cases after they transition to a part time, semi-retired non-surgical practice.
Q. What are the overhead costs?
A. Minimal compared to the revenue potential and compared to a medical practice. For medical-legal work typical overhead is: A cell phone, computer, insurance if you choose to insure (see below), probably a budget to get the word out, and a very busy expert may hire a part-time or full-time admin.
Q. Do I need liability insurance?
A. The vast majority of expert witnesses do not carry liability insurance as the potential liability in this field is relatively small. For experts who do carry insurance the premiums are typically reasonable i.e. commensurate with the (relatively low) risk involved.[1]
Q. Do I need an active medical license?
A. Generally speaking, yes.
Q. I don’t want to do medical malpractice work, are there other opportunities available to me?
A. Yes, there are many opportunities as neurosurgeons deal with trauma cases, so there is plenty of work out there in personal injury and workers’ compensation cases involving back injuries, neck injuries and TBI. There may also be cases involving patent, medical billing, and other issues. Also keep in mind that even in malpractice cases neurosurgeons are commonly asked to address causation and not standard of care where the case is against a different specialty such as an ER doctor, radiologist, etc for delay of diagnosis.
Q. How do attorneys find medical expert witnesses?
A. Attorneys will often look for experts in directories, such as SEAK’s National Expert Witness Directory, referral services, and through word of mouth.
Q. How long does it take to build a large medical-legal practice?
A. Typically 3-5 years as one needs that time to develop a positive reputation amongst lawyers – which is what can really cause an expert witness practice to take off. The harder you work at expert witnessing (getting the word out and improving your work product), the faster your results and the better your results.
Q. What is the earning potential over time?
A. That depends on how old you are, how much time you have to devote to this work, how seriously you take your expert witness practice and how much you are in demand. A 55-year-old neurosurgeon who has a $300,000/year practice would have a career earning potential over the next 25 years[2] of $7.5 million. The younger you are and the more seriously you take this work, the more you can earn over time.
Q. Do I need to be board certified?
A. The vast majority of successful neurosurgery expert witnesses are board certified. Medical-legal work may be an uphill struggle without boards, but it depends on the circumstances. Please feel free to contact SEAK at 508-457-1111 to discuss.
Q. I have been sued before, can I still succeed at this work?
A. Being sued before is usually not an impediment to being a successful expert witness, but it depends on the circumstances. Please feel free to contact SEAK at 508-457-1111 to discuss.
Q. I have a blemish on my license, can I still succeed at this work?
A. That depends on the circumstances including how far back in time the problem occurred and what exactly the problem is/was. Please feel free to contact SEAK at 508-457-1111 to discuss.
About the Author
James J. Mangraviti, Jr., Esq., is a Principal of SEAK, Inc– The Expert Witness Training Company. SEAK helps experts get started, teaches experts how to excel at their work and helps experts obtain case assignments. Jim has trained many thousands of expert witnesses including numerous nephrology expert witnesses. He has been retained to train experts for the FBI, SEC, IRS, DoD as well as leading firms, corporations, and professional associations. He is the co-founder of SEAK’s National Directory of Expert Witnesses, the #1 rated expert witness directory. Jim can be reached at 978-276-1234 or jim@seak.com. For more information on SEAK, Inc. – The Expert Witness Training Company, visit www.testifyingtraining.com
[1] See SEAK’s 2024 Survey of Expert Witness Liability and Insurance for more information.
[2] Expert witnesses commonly stay busy to around age 80 if their health coopertes.