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Communicable Diseases Medical Expert Witness


 

 

Expert Witness No.2538

 

I am a physician who has dedicated his entire career to population/public health. I was introduced to public health while doing a research project in Israel, while still a medical student. After graduation, I began as a medical epidemiologist (EIS Officer) for the U.S. Public Health Service. I then transitioned to public health administration, as program director, then local health director, then as a state health director. Along the way I picked up academic credentials in public health and public administration, and Board Certification in Preventive Medicine. For the past nineteen years I have been self employed as a policy consultant.

I have served on the Boards of Directors and Executive Committees of several large hospital and health insurance enterprises, and on multiple national advisory committees and commissions. I was President of the National Association of County and City Health Officials (NACCHO), 1988-89 and President of the American Association of Public Health Physicians (AAPHP), 1996-1998. 

I have been actively involved in professional education and mentoring for my entire career. While in Miami in the early 1970’s I directed a Preventive Medicine Residency program. From the early 1970’s through 1992, I supervised multiple Epidemic Intelligence Service (EIS) physician assignees. Everywhere I have been located I have been active in the teaching and research agendas of local medical schools and schools of public health.  Since working as a consultant, I have developed and implemented two educational curricula; one having to do with the early symptoms of heart disease and stroke, and the other relating to teaching policy, management and advocacy skills to doctors, nurses and other health professionals. Almost every year I have made one or more educational, policy analysis and/or research presentations at national meetings. 

On a voluntary basis, I have played lead roles on behalf of AAPHP in workforce development, tobacco control and the continuing education of public health professionals.  For detail see the www.aaphp.org resource pages on the Preventive Services Tool Kit and on Tobacco.  

Since February 15, 2007, the day the FDA tobacco law was introduced into Congress, I have spent substantial time and energy on exploration and promotion of the potential public health benefits of tobacco harm reduction and e-cigarettes. After five years of pursuing these issues on a totally voluntary basis on behalf of the American Association of Public Health Physicians (AAPHP), I developed a relationship with the R Street Institute, a Washington, D.C. think tank to enable me to continue work in this arena. 

On a personal basis, I am married, have two grown children, and enjoy jazz, scuba diving, travel, and genealogy.  Since 1997 I have played a major leadership role within a Mardi Gras Krewe, serving as Captain from 2004 through 2007.

Experience

New Orleans, LA

1992-1994, and 1997 to Present

Health Policy Consultant

  • Tobacco Control: As a medical epidemiologist and public health administrator I have been involved in tobacco control since the 1970’s. My involvement in tobacco control fundamentally changed in February 2007, when the FDA tobacco law was introduced into Congress. Since that time, primarily due to what I and AAPHP colleagues perceived to be major anti-public-health provisions of the FDA tobacco law, I became a major proponent of tobacco harm reduction (advising smokers who are unable or unwilling to quit that smokeless products on the American market and e-cigarettes present far less risk than cigarettes). Unfortunately, federal tobacco control leadership has been totally committed to the letter of the law and remains unalterably opposed to any consideration of tobacco harm reduction. After five long and frustrating years of voluntary effort to address these issue, I signed onto the R Street Institute, in 2012 as Senior Fellow for Tobacco Policy to enable me to continue work in this arena.  
  • Faculty appointment at the level of Associate Clinical Professor, Virginia Commonwealth University, School of Medicine, Department of Epidemiology and Community Health (Richmond, VA). This appointment is to enable me to function as part-time clinical faculty for purposes of providing both on-site and distance-based instruction in policy and management skills and help develop a translation research agenda. September 2007 through June  2010.
  • Principal Investigator on behalf of AAPHP on a federally funded project to teach policy and management skills to technically trained healthcare and public health leaders to enhance their ability to secure funding and to enhance both clinical and community-based preventive services. This project, referred to as the “Preventive Services Tool Kit,” was supported by the Centers for Disease Control (CDC) from September, 2005 through December 2009.
  • Principal Investigator on a locally funded project to develop Needs Assessment and Strategic Plan for the New Orleans Health Department, 2003.
  • Principal Investigator on a Substance Abuse and Mental Health Administration (SAMHSA) project to review the literature on preventive mental health services that should be implemented in healthcare settings. The final report includes over 500 bibliographic references and the evidence base, description of interventions and guidelines for planning and evaluation of 15 clinical preventive behavioral health services, covering all age groups.  2002 to 2004. This report was published as a 180 page “clinical update” monograph. It is accessible on the Internet and is now in its second printing.
  • Consultant to Ochsner Health Plan, New Orleans for disease management and quality assurance in preparation for NCQA site visit. All materials generated by JLN secured “full” acceptance by the NCQA review team. 2001.
  • Principal Investigator on four federally funded projects, on behalf of Engineering Management & Economics, Inc.: Interactive Guide to Community Preventive Services, Centers for Disease Control, September 2000; Geographic Information System Enhancement of Community Planning for Cardiovascular Diseases, Centers for Disease Control, June 1999; Listen to Your Heart Project (computer and web-based educational materials and administrative decision-support simulator to get patients experiencing symptoms suggestive of a heart attack into definitive medical care more rapidly) National Library of Medicine/NIH, November 1998; Automated Simulation Analysis Platform for Health Care Project (computer simulation program to project costs and benefits of implementation of preventive programming for adult onset diabetics) Centers for Disease Control, September 1997.
  • Policy consultant to Merck & Co. relative to development of innovative risk assessment based wellness programming for selected municipal and corporate clients, 2000
  • Policy advisor for development of integrated set of management information systems for the El Paso County Department of Health, Colorado Springs, CO, 2000 
  • Medical Director, LifeStyle Directions, Inc., Monaca, PA, 1996 to 2000 – provision of medical, epidemiological and policy guidance to LDI relative to their family of health risk assessment questionnaires, report forms and program components.
  • Medicare quality assurance - helped develop Health Care Quality Improvement Initiative for Louisiana Health Care Review (Louisiana’s Peer Review Organization)
  • Hansen’s Disease Center, Carville, LA  - program evaluation, strategic planning and successful advocacy for addition of $1.4 million for 1993 budget and $3 million for 1994 budget
  • Correctional Health Liaison- development of new medical and mental health policies and procedures within the Louisiana State prison system, and improved communications with the Charity Hospital system

Expert Witness: 

I have served as a substantive or expert witness for most of my career, with many depositions and a handful of court appearances. Much, but not all of this, was in the context of my public health work, or voluntary activities in the field of tobacco control. From 1992 through March 24, 2016 I served as expert witness in 121 cases.  Of these, 19 were food poisoning cases, 23 nosocomial (hospital related) infections, and 36 prison/jail health. Eighteen related to other community-acquired infections, 11 to other aspects of health care quality, 7 to deaths in critically ill patients who were not evacuated for Hurricane Katrina, and 5 were tobacco-related and 2 were other.  I served the plaintiff in 80 of these cases, defense in the other 41. During this period, in addition to record review and related research, I provided 22 depositions and 14 court appearances.  As an expert witness, I see my goal as the elimination of ambiguity, seeking out-of-court settlements wherever possible. While I have not tracked the numbers, I estimate that I decline service in about one third of the cases brought to my attention on the basis of an initial impression that the opposing party should prevail.

Louisiana State University School of Medicine

New Orleans, LA

1994-1997

Associate Professor  

  • Principal Investigator, Louisiana TELEMEDicine Research Project. This involved initial development of LSU telemedicine program, development of a management information system, and working with stakeholders to expand the system. 1993-1996
  • Medical Director, University Home Care. 1994-1997
  • Consultant to Medical Center of Louisiana at New Orleans (Charity and University hospitals) on disease and demand management, continuity of care, and compliance with JCAHCO and HCFA guidelines 1995-1997
  • Medical Director and Management Consultant to, Daughters of Charity Neighborhood Health Partnership (DCNHP) 1995-1996

Louisiana Office of Public Health

New Orleans, LA

1989-1992

State Health Director: 

Medical Director, Health Officer (official responsible for enforcement of State Sanitary Code), and Chief Executive Officer of  the state public health agency with headquarters, nine regional offices, 62 local health departments and three laboratories.  I was hired to “fix” a “broken” and demoralized public health agency that had drifted for 18 months without top-level leadership. During that 18 months there had been major cuts and no enhancements. With “fix” as a mandate, I provided the administrative and political leadership that resulted in agency growth from 1,800 to 2,100 staff positions and from $136 million to $172 million annual budget during my 27 month tenure. Of the $36 million in new annual revenues, $25 million was in recurring federal funding, most of which has continued to this day.  One major political victory resulted in six million dollars in new funding (also annual and recurring) was from a single act of the state legislature to dramatically upgrade the safe drinking water program. Another legislative victory was adoption of Louisiana’s first clean indoor air (anti-smoking) legislation. This was a politically appointed position by then-Governor Buddy Roemer to “fix” what they referred to as damage to the agency from twelve years of Edwards administration “corruption and mismanagement.”  I was relieved of this position when Edwards was re-elected.

Monroe County Health Department

Rochester, NY

1976-1989

County Health Director: 

  • Medical Director, Health Officer and Chief Executive Officer of local government agency with 450 staff and a $12 million budget.  Major accomplishments included the following:
  • Developed and implemented new data systems. 
  • Quadrupled home health agency revenues in first three years. 
  • Played major role in Emergency and Disaster Planning relative to Ginna Nuclear Plant, bomb threats and possible bioterrorist attacks. 
  • Played major leadership roles on the Boards of Directors of health insurance, hospital, long term care and mental health entities
  • Served as President of one local, one state, and one national organization. 
  • Worked closely with the Monroe County Jail and the Jail Health Project of the American Medical Association in the initial development of the health standards that later became the National Commission on Correctional Health Care (NCCHC) standards for accreditation of prison and jail health programs.
  • Supervised a continuous string of EIS Officers assigned to the MCHD under my supervision. Prior to my arrival, there had never been an EIS assigned to this local health department. After my departure, no others were assigned.
  • This was a politically appointed position by then County-Manager Morin. I stepped down from this position due to disagreement on selected critical issues with his successor.

Dade County Health Department

Miami, FL

1970-1976

Chief, Office of Consumer Protection: 

  • Directed communicable and chronic disease control programs, immunization, tuberculosis and sexually transmitted disease clinics, vital records and nursing home inspection.  
  • Supervised a public health residency program and a continuous string of federally-assigned physician Epidemic Intelligence Service officers. 
  • Played lead role in designing and managing health-related anti-terrorism programming for 1972 Democratic and Republican National Conventions in Miami Beach. 
  • My most dramatic accomplishments were investigation and control of a large outbreak of typhoid fever in a migrant labor camp and development of an innovative childhood immunization program that eliminated local transmission of diseases preventable by routine childhood immunization for the final four and a half years of my six year tenure in Miami. 

US Public Health Service

Frankfort, KY

1967-1969

Epidemic Intelligence Service Officer 

(Assigned from the Centers for Disease Control to Kentucky Department of Health, Frankfort, KY):

  • Trained by CDC in epidemiology, biostatistics, surveillance, communicable disease control, bioterrorism and in family planning program design
  • Communicable disease investigation and control – this included investigation and control of multiple outbreaks, including a large epidemic of infectious hepatitis, rebuilding state surveillance systems, and rewriting much of the state sanitary code
  • Sixty day assignment to Northern Nigeria to assist and help assess the regional smallpox eradication program 

Post Sophomore Fellowship

Jerusalem and Kiryat Shmoneh, Israel

1963-1964

Post Sophomore Fellow:

This experience, between my sophomore and junior years of medical school, diverted my career from clinical medicine to public health. I started as a hematology research fellow studying an “epidemic” of megaloblastic anemia of pregnancy in a small town in northern Israel. With assistance and mentoring from Professor Sidney Kark (Social Medicine), I determined the behavioral determinants of this illness and recommended that a huge lunch served at the Hebrew language school for these Moroccan immigrants. This simple, but previously not considered, intervention eliminated the anemia.

Formal Education

  • Public Health Leadership Institute, Berkeley, CA, Participating Scholar, 1991-1992
  • Nova University, Fort Lauderdale, FL, Doctor of Public Administration, 1977-1978
  • Nova University, Fort Lauderdale, FL, Master of Public Administration, 1975-1977
  • Dade County Health Dept. (Miami, FL) Residency in Public Health/General Preventive Medicine 1970-1974
  • University of California, Berkeley, CA, Master of Public Health, 1969-1970
  • Centers for Disease Control; Epidemic Intelligence Services: Basic and specialized training in prevention and control of infectious and other diseases, bioterrorism and family planning; 1967-1969
  • Parkland Memorial Hospital, Dallas, TX, Internship, 1966-1967
  • Wayne State University, Detroit, MI, School of Medicine, Medical Doctor, 1961-1966
  • Wayne State University, Detroit, MI, School of Liberal Arts, 1958-1961

Current Certification and Licensure

  • American Board of Preventive Medicine, since 1974
  • Medical Licensure: Louisiana since 1989
  • (I have been licensed to practice medicine since 1967 and have held licenses in Michigan, California, Kentucky, Florida and Louisiana at various stages in my career. I am maintaining only Louisiana in an active mode at this time.)

Current Professional Affiliations

  • American Association of Public Health Physicians

  • American College of Preventive Medicine

  • American Public Health Association
  • American Medical Association

Publications and Presentations

  • Over 80 publications. One to five presentations at national meetings almost every year since the mid-1980’s.

  • More complete Curriculum Vitae with current and past academic and other appointments, awards, publications and presentations available on request. 
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