In most US jurisdictions, the plaintiff's attorney must obtain a medical expert's opinion that there is a probable cause for a medical malpractice action before a complaint can be filed. Too often, however, the attorney's inquiry terminates at this initial review stage once a favorable opinion is obtained and a decision to move forward has been made. This is a mistake and an underutilization of the medical expert.

Pursuant to this, below is a discussion of pertinent concepts that will help attorneys, whether representing plaintiffs or defendants, properly and effectively employ medical experts.

The initial consultation should include a qualified medical expert's review of all pertinent medical records and, if possible, a review of historical patient records. It is important that all the necessary records are eventually obtained and reviewed prior to deposition and trial. No expert should be presented at deposition, or worse, at trial with an important medical record that had not been previously reviewed, although it was available or obtainable.

The expert should review medical records for all areas of liability (violations of the appropriate standard of care) and look at questionable occurrences as areas of potential liability. It is important to ask the medical expert to identify areas of concern that may be outside his or her specialty and suggest other specialists for additional review and opinion.

Historical patient records should be reviewed to find any pre-existing conditions that may have complicated the treatment and were missed by the treating physician(s) or which explain an otherwise apparently unexpected result.

Often, a seemingly simple case requires more than one specialist to provide standard-of-care testimony for different acts of malpractice, especially in hospital and multiple physician matters. To successfully present or defend a case, the attorney may need an expert to analyze and offer testimony as to causation and another to establish the proper measure of damages. Depending on the case, one expert might be needed to provide testimony regarding a national standard of care and another for local standards that may be pertinent. Regardless of the locale in which they practice, board-certified physicians are expected to adhere to a uniform standard of care.

It is important to obtain an early and meaningful analysis of potential damages and litigation costs - medical malpractice cases are costly to prosecute and defend. Unlike your garden -variety personal-injury case, if you cannot establish a high likelihood of a substantial settlement or verdict, there is very little probability of obtaining a nuisance-value settlement.

Medical malpractice insurers have long maintained a negative attitude toward nuisance-value payments on cases they perceive as lacking substantial merit. For the defense, an accurate and realistic analysis of liability exposure and potential damage awards will generally dictate whether to litigate and proceed to trial in order to obtain a defense verdict or seek early mediation and resolution. For the plaintiff's attorney, a failure to properly investigate both the case's medical and economic aspects early can result in his or her overextending before realizing the case is not worth pursuing because it lacks sufficient economic value.

Although medical malpractice cases are involved and expensive to litigate, usage of medical experts is not the place to skimp. Any physician may opine about standard-of-care violations and refer cases to attorneys for prosecution, but there is no substitute for an early file review by a board-certified specialist who practices in the area of concern.

Finding the right expert is critical to case preparation, deposition and trial. You should always ask each expert if he or she is qualified by training and experience to offer expert testimony on every important point in the case. It is a disaster to be very close to trial or in a deposition and find your expert attempting to proffer an opinion in an area that he or she has no expertise. Employ as many experts as the case requires, but avoid redundancy, which can give the impression of uncertainty and cause a negative juror reaction.

Preparation of the expert prior to deposition and trial testimony is another area of concern that requires substantial attention by the litigator. In many jurisdictions, expert witnesses must be "disclosed prior to trial". The attorney must set forth the areas of opinion testimony on which the expert will opine. And care should be given to delineate in the disclosure notice the areas for which the expert will testify. This precludes opposing counsel from objecting at trial to expert testimony that was not properly noticed.

If an expert responds to a question during his or her deposition that he or she has no opinion on the subject area, the expert will be precluded from testifying on that point at trial. Make sure all potential "gaps" are filled by an expert with the appropriate specialization.

The litigating attorney does not usually need to educate the medical expert about the medical aspects of the case, but don't underestimate the need to educate the medical witness about the legal requirements and standards for proving your case. Therefore, you should do the following: