Gastrointestinal Medical Experts
Stuart I. Finkel M.D.
920 Park Avenue
New York NY 10028 USA
Areas of Testimony:More than 30 years' experience as an expert medical witness for plaintiffs and defense in Gastroenterology, Gastrointestinal Endoscopy, Digestive Disorders, Liver and Pancreatic Diseases, Internal Medicine, Primary Care Medicine, and Managed Medical Care, including medical malpractice, disability, and civil rights cases.
Cases have included alleged failures to diagnose gastrointestinal cancers, complications of gastrointestinal endoscopy, complications of gastrointestinal and laparoscopic surgery, wrongful death, medical patent violations, and alleged violations of patients' constitutional and civil rights.
Dr. Finkel testified in the landmark Massachusetts case, Matsuyama v. Birnbaum et al, permitting recovery for a "loss of chance" in a medical malpractice wrongful death action, where a jury found that the defendant physician's negligence deprived the plaintiff's decedent of a less than even chance of surviving cancer. Details of the decision may be found on line.
Dr. Finkel also served as the Gastroenterology consultant on behalf of the Ground Zero First Responders in the World Trade Center litigation, settled in November 2010. He evaluated and stratified the severity of their gastroesophageal reflux disease (GERD) suffered as a consequence of environmental exposure at Ground Zero, and provided objective individual assessments used in the determination of disability awards.
Clinical and Academic Appointments:Board certified in Gastroenterology and Internal Medicine, with 40 years' experience in private medical practice. Assistant Clinical Professor at a major New York City medical school and teaching hospital with an international reputation for excellence in Gastroenterology and Gastrointestinal Endoscopy. Published in peer-reviewed journals.
- Objective expert medical testimony offered for plaintiffs' or defense counsel, depending on merits of case. Medical case reviews and evaluations for merit or defensibility, computer literature searches, and independent medical evaluations;
- Verbal and written reports delineating pertinent standards of care, alleged and potential deviations, proximate causation, and damages - or rebuttal of allegations, depending on the respective merits of individual cases;
- Meritless or indefensible cases will be presented as such, if that is the opinion of the expert, in order to minimize further expenditures of attorney's time and money;
- Articulate and credible deposition and court testimony presented by experienced clinician, teacher, and expert witness;
- Objective critical analysis of documents, testimony and expert reports, for both sides, and assistance in preparation of effective cross-examination strategies;
- Expedited reviews, reports, and testimony available.
References and Fee Schedule:
I received a case from a plaintiff's attorney about a woman with Crohn's Disease who was admitted to a hospital, and her doctor wanted to start her on total parenteral nutrition (TPN). When a nurse came to start the infusion, her husband, who was present at the time, said that she had adverse reactions to TPN in the past, including shortness of breath, and refused to allow the TPN to start. Unfortunately, the nurse did not convey this information to the doctor, the order was not cancelled, and the nurse on the overnight shift started the TPN when the husband was not present, and the patient was asleep. The patient shortly went into respiratory distress, and expired.
The case was sent to me with the autopsy report, describing pulmonary fibrosis and pulmonary microemboli of crystalline cellulose. The attorney had done his own literature search, and found reports of pulmonary microcrystalline calcium phosphate emboli associated with TPN, and concluded there was a causal relationship between the TPN, the pulmonary emboli, and the patient's death.
Unfortunately for the case, my review of the literature found that microcrystalline cellulose pulmonary emboli are associated with IV drug abuse, i.e., grinding up pills, usually narcotics, followed by IV injection of a liquid suspension of the ground-up pills. Cellulose is used as an inert binder in forming the solid structure of pills, into which the active ingredient is incorporated.
It turned out the decedent was receiving chronic pain management prescriptions of Demerol pills, and also had long-term indwelling IV access for other medications at home, so she clearly had the opportunity for self-injection. The microcrystalline cellulose emboli had to come from ground-up pills – not the TPN; the absence of calcium phosphate microcrystalline emboli on autopsy refuted the attorney's theory that the emboli were from the TPN; and the pulmonary fibrosis indicated a long-term history of self-injection of ground-up material.
While it is possible, or even likely that the TPN infusion exacerbated a pre-exist-ing, but self-induced and undiagnosed pulmonary condition, and even likely precipitated the final episode of respiratory failure, the role of surreptitious narcotic abuse, and con-cealment of this from her physicians - and husband - caused the attorney to drop the case.
Lessons: 1) Surreptitious drug abuse can wreck the best of cases; 2) Let your expert search the literature for you; 3) Read autopsy reports carefully, or let your expert inter-pret them; 4) A good plaintiff's expert also serves the defense in disclosing non-meritorious cases.
Splenic injury from colonoscopy:
I am contacted several times a year re splenic injury at the time of colonoscopy, including lacerations, hematomas, hemorrhage, and frank rupture. I do not believe that, at the present state of the art and science of colonoscopy, splenic injury is either predictable or preventable, and can occur "in the best of hands and best of circumstances." Fortunately, it is a rare complication, but is probably occurring more frequently, as the population ages and more screening colonoscopies are being done. Failure to diagnose this complication in timely fashion, however, may well be a deviation from accepted standards, but I do not believe, in general, that the occurrence of this complication bespeaks any deviation(s) on the part of the colonoscopist.