Thursday, July 11, 2013

Minimal evidentiary weight

AAOS said take a year off.

Applicant’s attorney argues that Dr. Winell’s peer review report should be afforded minimal evidentiary weight because the documentation from the American Academy of Orthopaedic Surgeons Committee on Professionalism demonstrates that he was found guilty ofviolating mandatory standards of condemning the performance of a provider that falls withingenerally accepted practice standards and/or endorsing or condoning performance falling outsidethose standards and/or lacking the knowledge and experience about the standard of care andavailable scientific evidence for the condition that led to the proceeding. She notes that the Committee on Professionalism and the Judiciary Committee conducting the appeal hearing voted to suspend his fellowship for one full year on November 2007. She further argues that Dr. Winell has demonstrated a pattern of ignoring standards or care and/or failing to accurately represent the facts of the case he performed a peer review on. To support her argument, she submitted a number of arbitration awards in which the arbitrators raised such issues. See New York Spine Specialists LLP and State Farm Mutual Automobile Ins. Co., AAA Case No. 412011067028, AAA Assessment No. 17 991 39362 11 ( Arbitrator Martin Schulman, Esq. 05/25/12), Elvina Surgical Supplies, Inc. and Allstate Ins. Co, AAA Case No. 412011022139, AAA Assessment No. 17 991 21936 11 (Arbitrator Andrew Horn, Esq., 04/13/12) and Day-Op Center of Long Island Inc. and Fiduciary Insurance Company of America, AAA Case No. 412010021134, AAA Assessment No. 17 991 15427 10 ( Arbitrator Lucille S. DiGirolomo, Esq., 08/10/10). She notes that in this case, the right shoulder arthroscopy showed a full tear of the right shoulder rotator cuff. Thus, she argues that Dr. Winell completely ignored the above findings of the arthroscopic surgery and therefore did not set forth a sufficient factual basis or medical rationale. Consequently, she contends that for the above reasons, it should be determined that Dr. Winell’s peer review was legally insufficient. Thus, she argues that Applicant should be fully reimbursed its claim.  
In light of Dr. Winell’s history of ignoring pertinent facts in a case and offering inappropriate expert testimony [ as discussed in the documentation from the American Academy of Orthopaedic Surgeons], I am very reluctant to rely upon facts discussed by Dr. Winell without the supporting documentation. Moreover, Dr. Winell failed to cite any medical authority to support his conclusion that the Injured Party would have had severe pain immediately after the trauma or that the full tear would have happened immediately and not progressively. Therefore, I find unpersuasive Dr. Winell’s conclusion that the condition requiring the surgery was unrelated to the accident. Also, I find that the peer reviewer also failed to demonstrate that the disputed water circulating unit was prescribed inconsistent with the standard of care since he failed to cite the standard of care for post operative treatment of a full rotator cuff tear.

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