[Video] How Attorneys Can Benefit from Pediatric Case Reviews with Dr. James Li

Wondering if your medical malpractice case has merit? Ensure you take on the most valuable cases and get a competitive edge in the courtroom with Case Clinics from Expert Institute. Our team of 55+ physicians covering 30 different specialties can screen your cases for merit, review tedious medical files, identify strengths and weaknesses in the facts, and help you develop winning trial strategies—all without formally retaining an expert for your case. We discuss with Dr. James Li, M.S., M.D., about his work on pediatric cases, the cases he usually works on, the importance of Case Clinics, and more.

Video Chapters

00:00 Introduction

01:07 What made you decide to pursue pediatrics?

02:48 What do you do at Expert Institute?

03:57 What is a Case Clinic?

06:16 What do attorneys find most valuable in the Case Clinic process?

08:01 What kinds of cases do you work on?

11:23 What is a memorable case you’ve worked on?

15:01 What should an attorney look for when evaluating NEC or Baby Formula cases?

17:30 Why is it valuable for attorneys to have a pediatrician review their case?

Find the full transcript of his interview below:

Introduction

My name is Dr. James Li. I am a doctor in pediatrics. I grew up in California. I lived in the San Francisco Bay Area for the majority of my life [and] I went to the University of California, Berkeley for my undergraduate degree. Then, about halfway through, I decided, instead of pursuing a career in scientific research in bench research, I decided that it might be a little bit better if I was around people more often. So I decided to go off to medical school instead. In preparation for going to medical school, I obtained a Masters of Science in Physiology and Biochemistry at the University of Cincinnati. Then I went off to Miami to Florida International University for medical school. I did my residency up in Massachusetts for pediatrics.

What made you decide to pursue pediatrics?

It’s a number of things. Prior to going off to medical school, I worked as a teacher for a couple of years. I was a fourth and fifth-grade math and science teacher actually. It was there that I really discovered that I enjoyed working with children. There’s just something about children and the way their faces light up when you’re teaching a new concept—that really appealed to me.

When I was off in medical school and studying, that kind of got placed on the shelf a little bit, but one of the things they have you do in medical school as a third year and fourth year medical student is you rotate through your various core rotations, so internal medicine, surgery, and whatnot. And I was actually getting a little bit worried and anxious over the fact that I wasn’t finding anything that really just gelled with me. I could see myself doing some of the sub specialties, but it just really wasn’t fully fitting well until on the back half of my rotations, I rotated through pediatrics. And within about two days, I realized these people are my people, the people I’m working with, the people that I’m treating, these are my people. And that’s where that love of working with children was rediscovered, essentially. And so that’s how I was inspired to go into pediatrics.

What do you do at Expert Institute?

These days, I do a little bit of everything. My roles include helping out with the intakes for our Expert Search process and our Expert Search team. My primary role is to function as a case reviewer for pediatric cases at Expert Institute. And so what a lot of attorneys will do is they’ll send me their pediatric cases for review. My day-to-day primarily revolves around reviewing these cases, taking my notes, coming to an idea as to what are both the medical and legal issues surrounding a particular case, then discussing them. Usually my discussions run about 30 minutes to an hour or so with various attorneys on these cases. And then somewhere in the middle, if I have time, I’m also helping out with the Expert Search process as well.

What is a Case Clinic?

A Case Clinic is what we call our case review product, where I’m taking in the medical records associated with the case. I also sometimes will speak with an attorney to get a better sense as to what are some of the issues that they’re looking at when they receive the case. And then I’m going through the records and I’m trying to see what happened. Now, being in pediatrics in medical malpractice, a lot of times these are cases where children have had poor outcomes. And a lot of times what I find in pediatrics, which is particularly unique, is getting the medical legal aspect of it is fine but what a lot of people run into is the parental need just for answers, to figure out what happened, what went wrong, or did anything go wrong? If nothing could have been done, that’s also an answer that a lot of people are looking for. And so a lot of times I’m going through the cases, I’m looking at medical records, and I’m making notes of what the disease was, and making notes of what are some things that various physicians are thinking at various points in this child’s care. And then at the end, I kind of sum it up, and I’m reviewing it through the lens of standard of care, causation, and damage issues. And then I prepare my notes. Eventually, we discuss, and we talk about what happened, we talk about whether or not this is the case. But my interest, more than anything else working in pediatrics, and you know, being around parents a lot. My interest is, regardless of whether it is or isn’t a case, I want to make sure that all attorneys are as familiar with the case as I am. And they feel as empowered as possible to fully discuss the case with the families, so that everybody is on the same page and we can come to a decent idea as to what to do next with the case.

What do attorneys find most valuable in the Case Clinic process?

In my experience, what attorneys find the most valuable is that, you know, you can get a yes or no from anybody, and that you can get fairly quickly. What sets us apart from other reviewers, and what attorneys have repeatedly told me is most valuable is the fact that we bring them along for the ride, so to speak. I’m essentially acting as a tour guide throughout the entire process. And I’m explaining, this is how the child came in, this is what people are thinking at this point in time, this is why they attain these labs. And I do this on a point by point basis, hitting all of the critical points within a child’s care. So, at the end of the Case Clinic process, the “what” is something everybody will get, the “whys” and the “hows” on the other hand, that’s what really matters. And that’s what really sets us apart from other people in my mind. Because at the end of the Case Clinic, not only will you really understand what I think of the case, whether I think this will be a strong or relatively weak case, but you understand how and why. And you’ll feel very empowered to go back to the family and explain exactly what happened, and you’ll be best positioned to counsel your client as a result.

What kinds of cases do you work on?

The cases I tend to see fall within general categories or archetypes. One of the most common cases I get are pediatric emergency room cases/pediatric infection cases. These are cases where typically children were brought to the ER, and they were first evaluated. They were diagnosed probably with some viral illness because that’s the most common type of infection that occurs in children. They were then sent home and 24/48/72 hours later something bad happens. And the question is whether or not somebody missed it. So that’s probably one of the more common types. The other two that I get fairly often are birth injury cases. This I do in conjunction with our OB/GYN physician, Dr. Jonathan Kubik. This is a case where pregnant mothers are presenting to the hospital for labor and delivery and, for whatever reason, the labor and delivery process didn’t go as well as planned. Now, our OB/GYN Dr. Kubik will review the labor management. But where I come in a lot is the baby is then presented, resuscitated, and then subsequently usually brought to the neonatal ICU for ongoing management. Does the baby’s course play out within what we expect for a perinatal birth injury? So that’s oftentimes where I get consulted as well. We’ve been doing this for close to four years now, I believe. We’ve done hundreds of these cases together and where our joint Case Clinics kind of sell themselves a part of it is that Dr. Kubik and I are regularly in communication with each other throughout the analysis process. So we do find that this close collaboration throughout the entire process allows for much better insights rather than if an attorney was going to get an OB, and then a neonatologist to review [the case] separately. So that’s the second type.

And the last type that I’m getting a lot these days due to recent events are formula cases, baby formula cases. There’s two that are out there. There’s the baby formula cases with respect to NEC, and then, more recently, there are the baby formula cases with respect to the bacterial contamination out of Abbott in Sturgis, Michigan. So these are pretty much the most common cases I get these days.

What is a memorable case you’ve worked on?

This one was a little bit off the beaten path for me personally. The case was in itself relatively simple. It was a two year old girl who presented to the ER with complaints of vomiting, runny nose, cough, congestion, was diagnosed with a viral illness and then sent home, and then presented something like 24 to 48 hours later, and had very, very critical phosphate deficiency. Now, the way the child presented was because the child started having seizures at home. They controlled the seizures, worked up the seizures in the ER, found that the child’s phosphate level was critically low, and they were starting to replenish the phosphate when the child unfortunately coded and died.

Now, the legal question here was whether or not that could and/or should have been diagnosed at the first ER visit. I went through the records. It was unfortunate, but there really wasn’t much of an indication to work the child up for hypophosphatemia. So the legal aspect for this case was relatively straightforward. But then as I was continuing to discuss the case with the attorney, the attorney said, you know, ‘Mom is just really kind of grasping for answers as to how her child died, and she still doesn’t really know. And she has a twin sister.’ And I said, I’m sorry, ‘Did you say mom doesn’t know’, and in the same sentence, tell me that there’s a twin? And the attorney looked at me and asked ‘Well, yeah, what’s the significance of that?’. And I said, well, generally speaking, you get to this sort of an issue through genetic means. There’s a strong likelihood here. Certainly one that if, you know, this family were my patient, I’d say, we should probably get the twin tested, or at least have a discussion with a geneticist and with an endocrinologist as to whether or not the twin should be tested for hyperphosphatemia.

And so, at my strong recommendation, the attorney reached back out to the family. And the family said, you know, thank you so much for telling me this, because my other daughter hasn’t really been doing well, and they’re not entirely sure what or why. The family had moved to a whole other state after the passing of their first child, and none of the medical doctors were really sure what’s going on. We were actually able to provide one of the key pieces of the family history to start the workup for the surviving twin, and my hope is that they’re well on their way to helping the surviving twin grow and thrive. So that was a really, really unique circumstance for a Case Clinic that I don’t often get to do.

What should an attorney look for when evaluating NEC or Baby Formula cases?

The way that cases are formulated, it’s an investigation as to whether or not in the specific demographic of premature, or predominantly, premature infants, there is the possibility of this disease called necrotizing enterocolitis or NEC. NEC has some associations with formula feedings. But it is particularly nuanced how this all plays out. And so a lot of what I would recommend attorneys do when they’re looking at this is the science is not as clear cut as one might think. And a lot of times, neither are the actual cases that you look into. There are a lot of risk factors for necrotizing enterocolitis. One thing that I strongly recommend is to reach out to a neonatologist to review each individual case for an analysis on how many risk factors are already present for NEC. The reason being that, although a good majority of these infants do receive some formula product at one point or a time in the neonatal ICU, a lot of times there are a lot of other risk factors predominating over the risk of formula feeds. So it’s one of those things, when I’ve been reviewing these cases, what I’ve been finding is the unfortunate surprise of, well, either this child’s extremely premature, or this child was dealing with all of these other medical complications. In this setting, formula feeds may not be contributing nearly as much as one might think towards the development of NEC. [These cases] gets nuanced and gets tricky pretty quickly has been my experience.

Why is it valuable for attorneys to have a pediatrician review their case?

Pediatrics is very, very different from adult medicine. That’s probably the first thing that a pediatrics resident kind of learns on day one, is that kids are not just tiny adults. The diseases that hit kids are very different. The way it’s managed, is very, very different. The way we track these diseases and monitor for these diseases is very different. And so a lot of times, if you’re having an adult provider review these cases, it looks very, very different from how they would do it themselves. So that’s why, for starters, I would strongly recommend getting a pediatrician to review pediatric cases.

Now, as for what we do and why I think we set ourselves apart from just about every other reviewer out there, is because we’ll take the time, we’ll review this, and we will make sure that you understand everything about the case from front to back. And we’ll make sure that, with the level of thoroughness and depth that we review, that it is all conveyed and you understand it all at the end. When you do, I find that attorneys generally are able to do two things better. One, they’re better able to make informed decisions about whether or not they want to proceed and continue to pursue the case. Or, if they decide to drop the case, they can feel much more assured that it was the correct decision for them. If they do decide to pursue the case, they are much more informed about where are some potential pitfalls because we also do an analysis as to what are some likely defense positions that the defendants might decide to take. And we can, to a reasonable degree, even start predicting what are some decent legal battle lines that are going to be drawn with regards to these cases. So that’s kind of part one.

Part two, with regards to pediatric cases, I have found that a lot of times, families are much more interested in figuring out what happened versus how do I win a case. And when it comes to a parent who has lost their child, the desire for answers is almost universal in every single one of the cases that I review. And so what I want to do, and what I want to make sure is that, you know, I was a teacher before I was a doctor, so the human element sometimes gets lost in all of this. I want to make sure when I review these cases that we bring that human element back into everything. It’s why I decided to leave clinical medicine because the human element was starting to become a little bit lacking in my opinion. And I want to make sure that whatever way possible, we at least do provide answers. We try our best to figure out what happened and to empower whoever is working with the families to provide a sense of closure and a sense of proceeding forward and bringing all of this to a close, whether it’s through litigation or just answering the question, why did my child die?

Our website is available and we’ll try our best to work with anybody and everybody, particularly for pediatric cases. I’m someone that regularly just says, Hey, look, I just want to make sure that we get to the bottom of things. I’m not somebody that places an overly high emphasis on things like, you know, how do we make sure that the cases are compact enough. So that it’s tightly reviewed, give me whatever you have, and we’ll find a way to make it work. If you ever want to speak and bring me in on a consultation, I’m more than happy to work with you guys. At the end of the day, my only goal is to make sure that we get these cases reviewed accurately and correctly and to make things right whenever we can.

My email address is james@expertinstitute.com. Feel free to reach out if you have any pediatric cases or any pediatric questions.