Expert Witness No.420
Medical/Biomechanical/Neuroscience/and Anesthesiological/Surgical Qualifications Pertinent to Litigation and Opinions, and Service as a Medicolegal Expert
- Private primary and secondary education, New York City. B.A. summa cum laude (Chemistry, Physics)
- Yeshiva University, 1952. S.M. (Biology), Massachusetts Institute of Technology, 1953. M.D. cum laude
- Yale University School of Medicine, 1957. Ph.D. (Neurophysiology), Massachusetts Institute of Technology, 1963.
- I currently serve as an unbiased expert in suitable litigation, whether called by plaintiff or defense, whether in the criminal or civil bar. My role in to review and analyze data, and to prepare detailed reports.
- I interact only with legal counsel, and do not interact with litigants. I do not carry out what are known as “Independent Medical Examinations”.
- Currently, when I do testify, it is via one or another electronic form, and at a suitable area of my home, where I maintain my office.
- Active at age 85, I will have been a physician now for 60 years as of June 2017.
- I maintain a lifelong scientific interest in the interface between body and mind, and in neurophysiological/mathematical theory and practice.
- I am a neurologist (MD, Yale University School of Medicine, cum laude, 1957; Diplomate, American Board Of Neurology and Psychiatry (Neurology), 1975) licensed to practice medicine and surgery in Connecticut (active), New York (currently inactive), and Massachusetts (currently inactive), retired from the clinical practice of medicine effective 7/1/06.
- I am a biologist (BA, Yeshiva University, summa cum laude, 1952), biophysicist (SM, Massachusetts Institute of Technology, 1953), and neuroscientist (PhD, Neurophysiology, Massachusetts Institute of Technology, 1963).
- At Yale University School of Medicine, while a student of medicine, I knew personally and studied the work of J.F. Fulton, MD, a pioneer in the science of the relationship of brain and behavior.
- As a graduate student/National Scince Foundation Fellow and member of the Department of Biology at MIT I conducted research in membrane biophysics. As a post-doctoral NIH Fellow and neuroscientist at MIT, I knew personally and studied the work of W.S. McCulloch, MD, a founder of the modern disciplines of intracerebral connectivity, cognitive science and artificial intelligence.
- As a member of the Department of Experimental Psychology at MIT, I knew personally and studied the work of H.L. Teuber, PhD, a founder of the modern
discipline of neuropsychology. I also knew personally and studied the work of Dr. Teuber’s neurologist colleague and former chief of service, M.B. Bender, MD, of Mt. Sinai Hospital, New York City. I also knew personally, and studied the work of W.J. Nauta, MD, a noted, pioneering neuroanatomist.
- I obtained my PhD in neurophysiology at MIT on the basis of research in the laboratory of P.D. Wall, MD, a founder of the modern science of pain research.
- I have continued my interest in these fields for more than one-half century.
- As a neurologist and neuroscientist, in the Departments of Neurosurgery (primarily, under W.F. Collins, Jr., MD) and Neurology (under G.H. Glaser, MD, DSc), and Anesthesiology (under L.M> Kitahata, MD PhD at Yale, who had earlier worked in my laboratory)I ultimately attained the position of Professor at Yale University School of Medicine, practicing neurology as attending neurologist in the Emergency and Hospital Services (including the diagnosis and treatment of traumata/noxae to the nervous system of all types), and with my personal clinic and private patients as well.
- I established and directed the neuroscience research laboratory in the Department of Neurosurgery, and for close to a decade formally taught neurosurgery residents and advanced faculty members the basis of the neurological sciences. This included, inter alia, the principles of modern neurophysiology, the mechanisms and effects of mechanical, toxic, and metabolic noxae upon the central and peripheral nervous systems; the function of the nervous system in health and disease; the basis of the developing science of electrodiagnosis, and the introduction and use of modern computational techniques in the laboratory and clinic.
- In the Department of Neurosurgery, in addition to my basic research into the neurophysiology of pain as it manifested itself in spinal cord and higher level function, I established an experimental laboratory for the study of spinal cord injury, carrying out investigations, and teaching generations of neurosurgery residents.
- During this period, and later in private practice, I spent substantial periods of time in the operating room, introducing innovative electronic interventional and measurement instrumentation, in collaboration with the departments of Neurosurgery and Orthopedics.
- While at Yale University School of Medicine, as the founder and director of one of the first ever pain clinics, and of, inter alia, a founder both of the International Association for the Study of Pain, and the American Pain Society, to pursue this interest I transferred my formal departmental affiliations from the Departments of Neurosurgery and Neurology to the Department of Anesthesiology, teaching anesthesiology residents and advanced faculty members the physiological basis of the anesthesiological and neurological sciences, and the developing specialty of Pain Medicine..
- While at Yale University School of Medicine, I collaborated in the establishment of its Neuropsychiatric Evaluation Unit (with T. Detre, MD), and engaged in the early study of the use of psychotropic agents in the treatment of mental illness. I was the first to introduce these agents in the United States for the treatment of chronic, intractable pain.
- Upon leaving the full-time faculty at Yale University School of Medicine in 1976 to pursue private practice, I retained the position of Clinical Professor at that institution for more than 25 years (as neurologist in the Department of Anesthesiology).
- My private practice was that of a tertiary, professorial-level neurologist, specializing in complex neurological diagnostic and therapeutic issues, with a central focus upon problems of chronic intractable pain of non-neoplastic origin.
- I introduced the use of long term opioids in this situation for a limited number of meticulously evaluated, selected, individuals, with close follow up. Evaluations included interview and examination and the use of the developing CT, MRI, and isotopic scanning techniques and of local analgesic block, nerve conduction velocity studies, electromyography, and evoked potential studies of brain and spinal cord, and neuropsychological evaluation. I introduced, as noted, the use of psychotropic agents for the control of pain, principally neuropathic pain. I devised and carried out various “interventional” thermocoagulation techniques, on peripheral nerves and neuromata, facets, and dorsal root ganglia.
- While yet a full-time faculty member at Yale, I traveled to China, under the auspices of the United States Government, to evaluate the purported use of “acupuncture” in surgical anesthesia, and to Israel, under the auspices of the Israeli Department of Defense, to evaluate, inter alia, the treatment of wounded in multiple Middle Eastern wars.
- I served, in the UK, as Traveling Fellow of the Royal Society of Medicine, based in London. For the furtherance of my scientific endeavors, I have traveled, in addition to the United Kingdom, to France, Italy, Switzerland, and Australia. I am a foreign member of the Swiss Headache Society, from which I received its Tissot Medal,
- I currently hold the position of Honorary Attending Neurologist at Yale New Haven Hospital, and held that of Emeritus Attending in Neurology at the Hospital of St. Raphael, both in New Haven, CT. The latter hospital has merged with the former.
- My private clinical practice of more than 30 years and with thousands of patients included both inpatient and outpatient neurological diagnosis and treatment. It involved evidence-based diagnosis of neurological disorders of the central and peripheral nervous system, including their physiological, psychological, and occupational concomitants, and the ergonomic analysis of their occupational impacts. It focused upon the diagnosis and treatment of chronic, intractable, pain, and involved, inter alia, personal, inpatient and outpatient, RF radiosurgical operative intervention of my own design.
- I was trained, during my residency, in interventional neuroradiology (arteriography, pneumoencephalography), and, later, was one of the first to put to use, in clinical practice, modern computational imaging techniques, including CT, MRI, SPECT, and ultrasound. I did so for circa forty years since these modalities were first introduced.
- In the course of my training and career I have, personally, entered, for therapeutic purposes, with a needle and trocar technique, numerous times, into the pleural, peritoneal, and cerebrospinal fluid spaces, have deliberately punctured major arteries (including the carotid artery, the major artery leading to the brain) for arteriography, and have insufflated the ventricles of the brain with air.
- In the performance, inter alia, of lumbar sympathetic block, I have entered, numerous times with a needle and trocar technique, into the space immediately anterior to the lumbar vertebrae at all levels, and immediately posterior to the aorta and inferior vena cava.
- In the course of my practice, in the treatment of abdominal pain in, e.g., (retroperitoneal) pancreatic carcinoma, I have, using needle and trocar, and under fluoroscopic control, injected the celiac ganglion.
- In the course of my practice, I have injected local anesthetics and steroid medications, diagnostically and therapeutically into the regions of a wide variety of peripheral nerves and other structured.
- I am familiar, via both CT and anatomical studies, of the locations of all the major abdominal blood vessels, and their spinal tributaries.
- My personal practice included electroencephalography and electrodiagnosis, including nerve conduction velocity studies, electromyography, and somatic, visual and auditory evoked potentials, both with instruments of my own design, and with later, commercially designed apparatus. In electromyography, I researched computed data acquisition and analysis of the signals acquired.
- My specific practice included, in addition to long-term (up to 30 years) neurological follow-up, personal, medically oriented, psychotherapy, related to pain. My patients included those with, in addition to neurological disorders, major psychosis, and inter alia, various anxiety disorders, including civilian posttraumatic stress disorders (e.g., major automobile accidents associated with fatalities, railroad and maritime disasters, gunshot wounds), and endogenous and exogenous depression, which conditions I managed personally and/or jointly with psychiatrists.
- In the course of my practice I personally administered, scored initially by hand and more recently electronically, and interpreted, several types of psychometric (i.e. neuropsychological testing) instruments for the assessment of the effects of brain and spinal surgery and/or trauma, the effects of medication, and controls for malingering, and have followed the sequential development and changes in these instruments for decades.
- I have written textbook and peer-reviewed journal articles on neurological, neurosurgical, and psychological matters, as well as historical neurophysiological matters, and have been invited to lecture and have lectured locally, nationally, and internationally on, among other subjects, pain science, neuropsychological testing, developments in cognitive psychology, and the effects of psychotropic drugs.
- I have maintained a continuous interest in the field of neuroscience, and of brain, behavior, and cognition relationships throughout my career (My first published clinical paper dealt with toxic cranial neuropathy and encephalopathy.) and continuing after my retirement from clinical practice.
- I am currently carrying out, if time permits, the digital imaging, cataloguing, and analysis of some of my clinical experience, perhaps someday to be published, as well as various conceptual mathematical investigations relating to the basis of nervous system function, and to the origin of conscious experience.
- My medicolegal experience extends over a period of more than circa 35 years, and over literally hundreds of cases, during which time I have served as a medicolegal consultant, and, when necessary (rarely) as a sworn witness, for both the civil defense and plaintiff’s bars, as well as for the prosecution and defense for the general criminal bar, and for the CT State and Federal Public Defender offices in capital and lesser crimes.
- In addition, I have assisted the Connecticut State and Federal Attorney’s offices, in, inter alia, the determination or not of injury to the brain as it involved the imposition or not of the death penalty for those convicted of capital crimes.
- Pertinent also is a period in which I served as biomechanical and neurological medicolegal expert, called by the Defense, in the analysis of hundreds of low- velocity motor vehicle accidents involving licensed taxicabs and livery vehicles in New York City. I analyzed the physical aspects of the accidents in detail, and determined the effects of the applied forces upon the passengers, correlating this with extensive data obtained by automotive engineers upon animals, volunteers, and testing, instrumented, anthropoid dummies.
- Major central nervous system noxae I have analyzed medicolegally have included, inter alia, uncontrolled hemorrhage and hypoxia, hypoglycemia, drug intoxication (e.g., alcohol, drugs of all types), industrial and civilian fumes, industrial trauma, automobile, aviation, railroad and marine accidents, falls, blunt trauma, gunshot wounds, and medically and surgically induced injury.
- I have participated, in collaboration with facilities for Functional Capacity Assessment (work simulation and effort testing, with controls for malingering) in determining Permanent Partial Impairment of Function (“Disability”) in civil, Worker’s Compensation, and Social Security Disability litigation, using the standards set forth in the Dictionary of Occupational Titles, and in the AMA Guides to the Evaluation of Impairment (in each successive edition), with appropriate mechanical and electronic goniometric instrumentation.
- In addition to the review of materials submitted in the evaluated cases, I have consulted my personal research library of several thousand volumes and the electronic medical library of the Yale University School of Medicine, where appropriate; and also, including, but not limited to, current editions of relevant neuropsychological test manuals (Vide supra.), for tests conducted in the neuropsychological examinations performed as well as other materials, where appropriate.
- It should be understood, however, that the true basis of my medicolegal opinions is that of my initial and lifelong continuing education, training, and experience, both medical and scientific, as synopsized above, and that no text, given the nature of the science and practice of medicine as I have observed it over more than one-half century, can be said to be either “authoritative” or apodictically “reliable.”
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