Medical Causation Analysis


What is a Medical Causation Analysis?

A Medical Causation Analysis is an Evidence-Based Medicine (EBM) causation analysis—whether in a hospital or in a courtroom—is the systematic method capable of distinguishing expert pronouncements about medical or scientific questions of causation as either (1) authority-based opinions (derived from expert intuition or reasoning, principles of pathophysiology, or inference based on experimental or observational data of insufficient quality) or (2) evidence-based conclusions (objective knowledge arising from the availability of sufficient, high-quality evidence).[1]

TD&P Consulting and its Medical Causation Experts hold that the evidence-based medicine methodology ought to govern all medical causation analyses to (1) accurately distinguish medical knowledge from mere opinion and (2) thereby assist the court in its effort to accurately adjudicate disputed medical matters.

Sometimes, medical causation experts first formulate an opinion and then selectively cite scientific data in support. Evidence-Based medicine operates in reverse. TD&P’s experts work first to conduct a complete and transparent standard-based analysis of all available published evidence and then formulate an evidence-based conclusion, one that is reproducible by others familiar with the method.

When you identify a testifying expert to represent your client, it is essential to ask them whether they offer an evidence-based conclusion. Suppose the expert admits to not applying an evidence-based method. In that case, the answer by itself indicates that the expert is merely offering an authority-based opinion. Suppose the expert is offering an evidence-based conclusion. In that case, their testimony is backed by their investigation into whether there is existing evidence about the matter that has been derived from the best available, methodologically sound, and statistically significant studies.

Most causation evidence does not qualify as evidence-based. Instead, authority-based opinions rely on speculation, anecdote, individual, or collective personal clinical experience, or evidence of insufficient quality and/or amount. And while many healthcare practitioners report that they have treated hundreds of patients and formed their opinion based on years of experience, supplemented by training, reading, and (anecdotal or incomplete) scientific study. Such expert opinions are merely opinions. They may be right, but they may be wrong. Causation requires facts and valid scientific proof as practiced by TD&P Consulting.

The right medical expert must examine the material facts of a case, such as medical records, and provide a strong foundation for their opinions. A critical part of this process is preparing the written report. The expert may base her opinion on personal experience, academic studies, and publications depending on the jurisdiction. But the most effective medical experts can break down the scientific, technical language and terminology so that a person without any medical training can understand the critical issues of the case. The medical expert witness must be able to offer her opinions to a “reasonable degree of medical certainty.” More importantly, she must help the jury reach an accurate, reliable, and valid conclusion about the facts of the case. TD&P’s medical experts have an in-depth understanding of the healthcare market, the clinical environment, and hospital system policy. Our experts work closely with TD&P’s team to produce well-written reports and visual aids to explain their opinions and provide convincing evidence to the court.

When clients are involved in litigation or compliance matters, having the right expert witness or consultant makes all the difference. The testimony of an experienced expert delivers a strategic advantage in litigation and ultimately can win the case. The right consultant can help her clients navigate serious damage to their reputation and bottom-line. TD&P’s medical, actuarial, and economics experts and consultants offer the right choice.

Our economic experts’ experience in healthcare, coupled with our proprietary business process for the collection and analysis of large databases, claims data, medical records, and third-party data allows us to provide strategic assistance to our clients in navigating healthcare disputes. TD&P economic experts service as medical pricing experts offering a wide range of technical assistance to legal counsel through litigation support services, focused on the healthcare industry, in such areas as healthcare valuation; damages; lost or enhanced earnings capacity, managed care issues; healthcare industry research; and, fraud and abuse issues.

Part of ensuring that a person or organization receives a fair trial is making sure the decision-makers in the case understand the issues involved. Health insurance-focused actuarial issues involving the Affordable Care Act costs, health care systems, and risk assessments by their nature tend to be complicated and specialized.  A credentialed actuary is best able to understand, articulate, and quantify those issues in actuarial terms.

TD&P’s actuarial experts are vital to the litigation process when it comes to interpreting health insurance-focused data. Whether it involves assessing market pressures placed on premium pricing by regulatory changes or analyzing the impact of inflation statistics on cost trend data, TD&P’s experts provide the answer. As actuarial scientists, our experts recognize the relationship between Medicare, Medicaid, and commercial insurance products and the consequences political and regulatory changes may have on pricing. And they work closely with TD&P team members to accurately interpret patient, hospital, and insurance data that may influence their analysis.

While the overall legal dispute may involve broader issues, TD&P experts and consultants remain focused on assisting clients with the formation of case strategy, quantifying damages, or just helping the legal team better understand the sensitivity of the issues involved.

To learn more about our Expert Witness Services and to get help developing new best practices in litigation and damages analysis, contact TD&P Consulting, Inc. today.

[1] Davidson, T., & Guzelian, C. (2012). EVIDENCE-BASED MEDICINE (EBM): THE (ONLY) MEANS FOR DISTINGUISHING KNOWLEDGE OF MEDICAL CAUSATION FROM EXPERT OPINION IN THE COURTROOM. Tort Trial & Insurance Practice Law Journal, 47(2), 741-779. Retrieved February 19, 2020, from

Dr. Vera Dvorak, MD
Dr. Vera Dvorak, MD

Our expert Dr. Vera Dvorak, MD, leads our  Medical Causation Analysis department. She is an authority on standards of care in the healthcare industry, transitions of care, long-term planning in the inpatient and outpatient setting, and medical necessity in the group practice setting.

Dr. Dvorak is a board-certified internist and geriatrician with more than 40 years of professional experience. Over this period, she has led her profession as a (1) practitioner, (2) health insurance executive, (3) hospital system professional, and (4) medical consultant. Dr. Dvorak is well-read and maintains continuous medical education at 100 hours per year. She has devoted her professional career to individual patient care and ensuring that all patients are treated with dignity and respect, receiving medically necessary at the right level and the right time. A critical focus of Vera Dr. Dvorak’s career has been to help patients and caregivers clearly understand their medical diagnosis and its impact on the quality of life. Read More on Dr. Dvoark