logo Gastrointestinal Medical Experts
Stuart I. Finkel M.D.

920 Park Avenue
New York NY 10028 USA
Phone:   800-666-2946
Fax:   212-737-5317

giexpert@aol.com

Areas of Testimony:

More than 20 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, patent law, 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 more than 25 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.

Services:

 

References and Fee Schedule:

On request.

Case Report:

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.