Resources

Dr. Wickline shares insights on emergency medicine standard of care and medical-legal topics relevant to attorneys working with expert witnesses.

What Attorneys Should Know When Retaining an Emergency Medicine Expert Witness

March 2026  |  By Dr. Donald Wickline, MD, FACEP

Selecting the right emergency medicine expert witness can be the difference between a compelling case and a vulnerable one. Not all physician experts are created equal, and the specific characteristics of your expert matter in ways that may not be immediately obvious to attorneys who work primarily outside of medical malpractice.

Board Certification and Active Practice

The single most important credential to verify is board certification by the American Board of Emergency Medicine (ABEM). This confirms that the physician completed an accredited emergency medicine residency and passed a rigorous examination process. Beyond initial certification, look for evidence of active clinical practice. An expert who currently treats patients in the emergency department carries significantly more credibility than one who retired from clinical work years ago. Juries and opposing counsel will scrutinize whether your expert's knowledge is current.

Range of Practice Settings

Emergency medicine is practiced in vastly different environments. A Level I urban trauma center operates differently from a rural critical access hospital with limited resources. The standard of care is informed by the resources and capabilities available at a given facility. When retaining an expert, seek someone whose clinical experience spans multiple settings, so they can credibly speak to what was reasonable given the specific practice environment at issue in your case.

How Emergency Medicine Cases Differ

Emergency medicine malpractice cases are distinct from other medical specialties. The ED environment involves high patient volumes, time-critical decision-making, incomplete information, and patients who arrive undifferentiated. An expert must understand that the standard of care in the ED accounts for these realities. Look for experts who can articulate these nuances clearly, as this understanding directly affects how persuasive their testimony will be.

Questions to Ask During the Initial Consultation

When you first speak with a prospective expert, consider asking: How many years have you been in active clinical practice? What types of facilities do you currently work in? How many cases have you reviewed as an expert witness, and for which side? Have you published or spoken on topics related to the case at hand? Do you have experience with the specific clinical issue involved in this case? A thorough initial conversation helps ensure the right match.

If you have questions about retaining an emergency medicine expert witness, contact Dr. Wickline for a consultation.

Understanding the Standard of Care in Emergency Medicine

March 2026  |  By Dr. Donald Wickline, MD, FACEP

The concept of the standard of care is central to every medical malpractice case, yet it is frequently misunderstood. In emergency medicine, determining the standard of care involves more nuance than in many other specialties, because the circumstances under which emergency care is delivered vary dramatically.

What the Standard of Care Means in the ED

The standard of care is generally defined as the degree of care, skill, and treatment that a reasonably competent emergency physician would provide under similar circumstances. The key phrase is "under similar circumstances." In emergency medicine, circumstances include not only the patient's presentation but also the facility's resources, staffing levels, available consultants, and time constraints. What constitutes appropriate care at a Level I trauma center with 24-hour subspecialty coverage may differ from what is expected at a rural community hospital with limited imaging and no on-site specialists.

Clinical Guidelines vs. Clinical Judgment

Attorneys sometimes equate clinical practice guidelines with the standard of care, but the relationship is more complex. Guidelines from organizations like the American Heart Association or the American College of Emergency Physicians represent evidence-based recommendations, and they are highly relevant in defining expected practices. However, guidelines are not rigid protocols. Emergency physicians must exercise clinical judgment when applying guidelines to individual patients, and deviation from a guideline does not automatically constitute a breach of the standard of care. The question is whether the physician's reasoning and decision-making were appropriate given the clinical picture.

Where Standard of Care Disputes Commonly Arise

In emergency medicine litigation, standard of care disputes most frequently involve timeliness of diagnosis and treatment, adequacy of the diagnostic workup, appropriateness of disposition decisions (admit vs. discharge), quality of communication during handoffs, and completeness of discharge instructions. Each of these areas requires expert analysis that accounts for the specific clinical scenario, the available resources, and the information the treating physician had at the time decisions were made.

The Importance of Context

Effective expert witness analysis never evaluates clinical decisions in a vacuum. An expert must reconstruct the clinical scenario as it unfolded in real time, without the benefit of hindsight, and assess whether the physician's actions fell within the range of acceptable practice. This context-dependent analysis is what distinguishes reliable expert testimony from superficial opinion.

If you have questions about the standard of care in an emergency medicine case, contact Dr. Wickline for a consultation.

The Critical First Hour: Time-Sensitive Diagnoses in the Emergency Department

March 2026  |  By Dr. Donald Wickline, MD, FACEP

In emergency medicine, minutes matter. Several of the most common and most litigated conditions seen in the ED have outcomes that are directly tied to the speed of recognition and treatment. Understanding these time-sensitive diagnoses is essential for attorneys evaluating potential malpractice claims.

Stroke: The tPA Window

For acute ischemic stroke, the administration of tissue plasminogen activator (tPA) within a defined time window is one of the most significant interventions available. Current guidelines support tPA administration within 4.5 hours of symptom onset, with earlier treatment producing better outcomes. Every minute of delay results in additional neuronal loss. Cases involving alleged delays in stroke diagnosis frequently turn on whether the emergency physician recognized stroke symptoms promptly, activated the stroke protocol, and obtained imaging in a timely fashion. Documentation of the timeline—from patient arrival to assessment, imaging, and treatment—becomes central evidence.

STEMI: Door-to-Balloon Time

ST-elevation myocardial infarction requires percutaneous coronary intervention (PCI) as rapidly as possible. National quality standards target a door-to-balloon time of 90 minutes or less. The emergency physician's role is to obtain and interpret the ECG quickly, identify the STEMI, and activate the catheterization lab. Delays at any point in this chain can result in greater myocardial damage. In litigation, the medical record's timestamps for ECG acquisition, physician interpretation, and cath lab activation are scrutinized against established benchmarks.

Sepsis: The Hour-1 Bundle

The Surviving Sepsis Campaign and CMS quality measures emphasize early intervention in sepsis. The Hour-1 bundle calls for blood cultures, lactate measurement, broad-spectrum antibiotics, and intravenous fluid resuscitation to be initiated within one hour of sepsis recognition. Research consistently demonstrates that each hour of delay in antibiotic administration increases mortality. Sepsis cases in litigation often focus on whether the emergency physician recognized sepsis in a timely manner and whether the initial resuscitation met accepted standards.

Why Timing Documentation Is Critical in Litigation

Across all of these time-sensitive conditions, the medical record serves as the primary evidence of what happened and when. Emergency physicians are expected to document key decision points, interventions, and their timing. In litigation, gaps in documentation or inconsistencies between timestamps and clinical events become focal points for cross-examination. Attorneys should work with experts who understand both the clinical significance of timing and the documentation standards expected in emergency medicine.

If you have questions about a case involving time-sensitive emergency diagnoses, contact Dr. Wickline for a consultation.

Last updated: March 2026