BLOGS

Expert Witness Testimony

A Physical Therapist's Perspective

Case study:

A 68-year-old female in the state of New Jersey attended her 1st physical therapy session on 2/4/22. She has a history of Falls, Peripheral Neuropathy, Diabetes Mellitus Type 2, Lumbar spine surgery at L3-L5 Laminectomy (2017), and Diabetic Foot Ulcers. This patient went to physical therapy because her balance was worsening during gait and she had some falls.

The physical therapist did an initial evaluation of her lower extremity muscle strength, hip and back range of motion, and a balance assessment. **There was no noted sensory evaluation of the patient’s lower extremities.
On the 2nd session of physical therapy, toward the end of the session the patient received a hot pack to her lower back. The physical therapy aide/technician had the patient lay on her back on top of the hot pack. After approximately 7 minutes, the patient yelled out in pain as her back/buttocks felt immense pain. The physical therapy aide/technician came back in put another towel under the patient and then left again for another 10 minutes.
The patient wound up having 2nd-degree partial thickness burns to her sacrum and buttocks.

This case did not settle and wound up going to court.

1. The therapist needs to clearly understand the matter and whether or not there was a deviation in the standard of care. Whether the therapist is testifying for the plaintiff or the defense, the therapist needs to understand the national standard of care and the practice act of the state in this matter is taking place. In this particular case study, the female patient had a history of diabetes, peripheral neuropathy, diabetic foot ulcers, and lumbar spine surgery. All of these preexisting medical conditions put the patient at risk for loss of sensation in her lower extremities. The problems identified in this matter were:

There was no sensory evaluation done in the initial evaluation to determine the patient’s sensation in her lower extremities.
A hot pack was used over an area that was not tested for sensory loss.
The patient was supine on the hot pack which facilitated her burn.
A physical therapy technician applied the hot pack to the patient and also determined that the hot pack would stay on the patient even after the patient complained of immense pain.

2. The therapist needs to be able to have a jury understand the matter that occurred and the laws in that state, that made the therapeutic act permissible or not. The therapist needs to be able to understand the details of the matter so that it can be explained more easily to the jury. In this particular case, the therapist would need to be able to explain to the jury the contraindications that exist with Diabetes Mellitus, Peripheral Neuropathy and Spinal Surgery. The therapist would also need to explain the New Jersey Physical Therapy Practice Act to the Jury in which physical therapy aides/technicians are not permitted to administer, apply, or remove any modalities and make patient care decisions.

3. The therapist needs to rely on evidence-based research and solid data points when taking the stand. Being able to point out solid evidence-based research and medical data points during the trial testimony is very important to make a case. In this particular case, bringing and speaking about peer-reviewed journal articles would be very helpful to show the contraindications that exist with heat and Diabetes Mellitus. This is an example of a research article that could be discussed during trial testimony and explained to the jury: The Factors Associated with Contact Burns from Therapeutic Modalities, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3503945/. This peer-reviewed article from the National Institute of Health, also explains how peripheral neuropathy can occur from Diabetes Mellitus or Spinal Surgery and the effects that it has on the nerves (https://www.ninds.nih.gov/health-information/disorders/peripheral-neuropathy.)