Areas of Expertise

Dr. Wickline provides expert analysis and testimony across the full spectrum of emergency medicine cases. With experience in Level I trauma centers, community hospitals, and rural emergency departments, he understands how the standard of care applies in varied clinical environments. His areas of particular depth include the following.

Stroke

Stroke cases in the emergency department are among the most time-sensitive and high-stakes presentations a physician faces. The standard of care requires rapid recognition of stroke symptoms, timely neurological assessment, and adherence to established treatment protocols. Missed or delayed stroke diagnoses are a leading source of medical malpractice claims in emergency medicine, particularly when failure to activate stroke protocols or administer thrombolytics within established time windows results in preventable neurological damage.

  • Missed or delayed diagnosis of ischemic and hemorrhagic stroke
  • tPA administration decision-making and time windows
  • NIH Stroke Scale assessment and documentation
  • Stroke alert activation and protocol compliance
  • Transfer decisions and inter-facility transport timing
  • Posterior circulation stroke and atypical presentations

Sepsis

Sepsis remains one of the leading causes of death in the emergency department, and early recognition is the most important determinant of patient survival. The standard of care has evolved significantly with the adoption of Sepsis-3 criteria and CMS quality measures, requiring emergency physicians to identify sepsis quickly, initiate antibiotics within the first hour, and follow structured resuscitation protocols. Litigation frequently centers on delays in recognition, failure to trend lactate levels, or inadequate fluid resuscitation during the critical early hours of presentation.

  • Early recognition and Sepsis-3 diagnostic criteria
  • Time-to-antibiotics and the golden hour
  • Lactate monitoring and trending
  • Fluid resuscitation protocols
  • Sepsis bundle compliance (SEP-1 / CMS measures)
  • Septic shock management and vasopressor initiation

Cardiac Emergencies

Cardiac emergencies require immediate recognition and time-critical intervention. For ST-elevation myocardial infarction, national guidelines establish clear door-to-balloon time targets, and deviations from these standards are a frequent basis for litigation. Emergency physicians must rapidly identify acute coronary syndromes, initiate appropriate management, and coordinate with interventional cardiology services. Missed arrhythmias, failure to recognize aortic dissection, and inadequate cardiac arrest management are additional areas where standard of care disputes commonly arise.

  • STEMI identification and catheterization lab activation timing
  • Acute coronary syndrome (ACS) evaluation and management
  • Cardiac arrest management and ACLS protocol compliance
  • Arrhythmia recognition and treatment
  • Aortic dissection and emergent vascular conditions
  • Chest pain evaluation and risk stratification

Trauma

Trauma care in the emergency department follows structured protocols designed to identify and treat life-threatening injuries in order of priority. The Advanced Trauma Life Support (ATLS) framework establishes the standard against which emergency physician performance is measured. Litigation in trauma cases often focuses on triage decision-making, adequacy of the primary and secondary surveys, delays in transfer to appropriate facilities, and compliance with EMTALA requirements for stabilization and transfer.

  • Primary and secondary survey methodology
  • Triage decision-making and acuity assessment
  • Stabilization priorities and damage control resuscitation
  • Transfer criteria and EMTALA compliance
  • ATLS protocol adherence
  • Pediatric trauma evaluation

Failure to Diagnose / Delayed Diagnosis

Failure to diagnose is the most common allegation in emergency medicine malpractice claims. These cases require careful analysis of the differential diagnosis process, the adequacy of diagnostic testing, and whether clinical decision-making met the standard of care given the presenting symptoms. Cognitive biases such as anchoring and premature closure frequently contribute to diagnostic errors. High-risk chief complaints—chest pain, headache, abdominal pain—demand a systematic approach, and deviations from accepted diagnostic methodology are central to many malpractice disputes.

  • Differential diagnosis methodology and cognitive bias
  • Diagnostic test ordering, interpretation, and follow-up
  • Atypical and uncommon presentations
  • High-risk chief complaints (chest pain, headache, abdominal pain)
  • Documentation standards and medical decision-making

Emergency Department Operations

System-level factors in the emergency department directly affect patient care and outcomes. Cases involving ED operations require analysis of staffing levels, patient throughput, boarding practices, and communication protocols. Dr. Wickline's experience in clinical governance and peer review provides particular insight into how departmental processes, handoff failures, and resource constraints contribute to adverse events. These system issues are increasingly relevant in medical-legal cases where individual provider decisions must be evaluated in the context of the operational environment.

  • Patient throughput and boarding
  • Staffing adequacy and provider-to-patient ratios
  • Handoff communication (physician-to-physician, nursing)
  • Discharge instructions and follow-up planning
  • Peer review methodology and clinical governance
  • Patient experience and communication standards

Last updated: March 2026

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