Document Type
Article
Publication Date
6-2016
Abstract
Life care planners (LCPs) who provide expert witness testimony must provide their professional opinions within a certain degree of life care planning probability or essentially a 51% chance or greater likelihood of the good or service occurring. In cases involving spinal cord injury (SCI), such opinions become complicated when attempting to include the costs of future secondary complications (SCs) that may or may not have a consistent body of empirical support and/or several physician specialists supporting the probability of occurrence. The present study surveyed 243 life care planners (LCPs), life care planning physiatrists (physiatrist LCPs), and non-life care planning physiatrists (physiatrist non-LCPs) in ascertaining their professional opinions regarding 13 SCs among individuals with a SCI, based upon level of injury. Results revealed that LCPs and physiatrist LCPs generally endorsed higher ratings for SCs in comparison to physiatrist non-LCPs. Life care planning in the legal arena is an adversarial specialization where LCP opinions are often contested by opposing attorneys and their retained experts when the opposition's report(s) are perceived as unreasonably leaning in one direction (e.g., too costly to fund without validation). Being qualified and certified/licensed as an expert witness in any discipline is a privilege that carries with it a code of ethics and standards of practice (e.g., International Academy of Life Care Planners, n.d.). Triers of fact typically expect an impartial and objective set of opinions based upon a reliable and valid methodology from the expert which is generally supported by peers in that profession (Field, 2000; Hoyt & Aalberts, 2001; Johnston & Sartwelle, 2013). Expert witnesses who provide testimony must base their opinions on a certain degree of life-care planning probability, which is defined in the legal arena as a 51% or greater chance of occurring. Prior to 1993, this practice was not present as experts from various disciplines provided testimony they opined as probable, but there were no laws or litmus test required to determine reliability (Field, 2000; Hoyt & Aalberts, 2001). It was not until the 1993 Daubert v. Merrill Dow Pharmaceuticals and later the 1999 Kumho Tire Company v. Carmichael rulings that expert witnesses had to comply with stricter guidelines when proffering their opinions (Hoyt & Aalberts, 2001; Rutkin, 1999). After these rulings, experts were required to demonstrate that their opinions were generally accepted in their field, were subjected to peer-review publication, and employed a reliable methodology to arrive at their conclusions. In most expert witness disciplines, there appears to be a gray area where opposing experts do not always agree. Attorneys from both sides will often only retain an opposing expert when they perceive the life care plan developed by the opposing side is lacking in reasonableness, overall conclusions, and cost. Marini (2012) described the possibility versus probability dilemma life care planners face regarding when to include costs for yet-to-be determined future medical complications and when this is inappropriate. As Marini (2012) argued, some life care planners may "cherry pick" one or two studies in support of their opinions while ignoring the larger body of literature that does not. As noted earlier, the gray area exists when opposing experts cite different literature to support their opinions. Deutsch and Sawyer (1997) previously established a protocol for identifying and documenting potential medical complications that are yet-to-be determined. They stated that possible complication costs should not be included in a life care plan if they are not deemed probable to occur. Physician experts are also supposed to provide generally accepted opinions in their field. However, it is unknown as to whether their opinions have been scrutinized with the same rigor as non-physician life care planners (Marini, 2012). The purpose of the present study was to investigate the ratings of SCs among life care planners and physiatrists to provide those operating as a LCP with empirical support for cost inclusion in a plan when a SC reaches the probability threshold. In addition, we sought to examine whether differences occurred among physiatrists and LCPs when they provided their expert opinions of the likelihood of SCs occurring among people with a SCI. According to the 1993 Daubert and 1999 Kumho rulings, costs may be included if the empirical literature supports the prevalence of such occurrences with a 51% or greater frequency. However, as demonstrated through a comprehensive literature review by Ysasi et al. (2016), research on SCs among individuals with a SCI is often outdated; therefore, the research addressing the 13 secondary complications outlined in this research was long overdue.
Recommended Citation
Ysasi, N. A., Marini, I., Sprong, M., & Silva, I. (2016). Differences Among Life Care Planners and Physiatrists Regarding the Likelihood and Frequency of Secondary Complications for Persons with Spinal Cord Injury. Journal of Life Care Planning, 14(2), 3–37.
Comments
Copyright of Journal of Life Care Planning is the property of International Association of Rehabilitation Professionals and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.