Expert witness can be new career path for CMs

Opportunities are increasing in litigious society

If you’re looking for opportunities to enhance your case management career, consider becoming a case management expert witness.

"As case management comes under closer scrutiny in the legal system, there are more opportunities for case managers to be called on to speak on standards of practice, ethics, and other issues," says B.K. Kizziar, RN, CCM, CLCP, owner of B.K. and Associates, a case management consulting and life care planning firm based in Southlake, TX, and a longtime nurse expert witness.

An expert witness may be called by a plaintiff or a defendant. In some cases, both sides of an issue may call their own case management expert witness.

Case manager expert witnesses carry on with their usual caseload and only occasionally are called to be an expert witness. They are not "hired guns," a term used to describe full-time expert witnesses.

"Being an expert witness gives case managers experience in an area other than managing cases. It is a good way for case manager to broaden their horizons," Kizziar says.

Attorneys are looking for case managers who have the expertise to speak on case management standards and practice issues. The ones who have the work history and can demonstrate it are the most likely to be chosen, Kizziar says.

What do you need to become a case management expert witness? Education, experience, and professional credentials are essential, she says.

Case management expert witnesses should have achieved professional certification, Kizziar says, adding that CCM certification offered by the Commission for Case Management Certification (CCMC) is the gold standard among credentials.

"It’s best to have a rounded case management job history in terms of working extensively in a particular field or working extensively in more than one field," she points out.

For instance, if you put yourself forth as an expert witness in hospital case management, you should have had a lengthy history as a hospital case manager and have supervised case managers in the hospital setting. State and federal rules of court require an expert witness to have "scientific, technical, or other specialized knowledge."

Your expertise must be directly related to the matter under consideration. You should testify only in the area in which you are qualified.

Academic credentials, including advanced degrees and special areas of study, membership and participation in professional associations, and publication of papers in your field of expertise also should be used to establish your credibility.

It’s important to stay in daily practice as you pursue a career as an expert witness because it adds to your credibility, Kizziar notes.

"Case managers should continue to practice in the area in which they are holding themselves up as an expert. If someone hasn’t worked in an area for a few months, it can affect their credibility because things change so quickly," she says.

It’s important not to put yourself in the market as someone who sells out to the highest bidder, Kizziar adds.

In fact, she advises appearing for the plaintiff and defense attorneys during your career as an expert witness to avoid being discredited as a "hired gun" who always works for just one side.

"It should not be apparent for which side the expert is working just by reading the written opinion or hearing testimony. The opinion of the expert should not change based on which side is paying the fee," Kizziar emphasizes.

In most of the cases you’ll encounter as an expert witness, someone has been blamed for injuring someone else, Kizziar says.

For instance, a patient may claim that he or she was discharged prematurely from the hospital and experienced complications as a result or that the home care plan was faulty or went awry.

A case manager expert witness will be called on to describe the standards of care that happen in a typical case and how a prudent case manager should have acted.

"If a case manager is testifying as an expert witness to standards of care, the testimony should be consistent, regardless of which side he or she is on," Kizziar says.

For instance, if the issue is a hospital discharge plan that didn’t work, the case manager would be likely to start her testimony saying, "In my experience, I have found this to be the case. . . ."

One typical kind of case in which a case manager may be called on to testify as an expert witness occurs when a patient is turned down for additional days in the hospital, goes home, and has a bad outcome.

The issue in these cases is: Is the insurance company to blame for the patient going home and having bad outcomes?

One part of the equation that people who are not in health care don’t understand is that if a patient is turned down for additional benefits, the hospital or provider has an option to present more information, documentation, or literature to persuade the insurance physician reviewing the case to approve additional care.

"This is where the breakdown comes. Often the providers, for whatever reason, don’t take advantage of that opportunity," she says.

In a case where the patient left the hospital because he didn’t have additional benefits, the expert witness on the plaintiff’s side would be called on to testify that the case manager in the hospital did everything she should have done but that because the insurance company wouldn’t approve a longer stay, the patient had a bad outcome.

On the other side, the insurance company’s expert witness might argue that the insurance case manager did what the patient’s insurance policy required her to do by alerting the provider and inviting to contact the medical director with any additional information that might help gain approval for an additional stay.

"One expert might testify that the hospital case manager acted prudently, and the other might testify that the insurance case manager was doing what a prudent case manager would do," she says. "In these types of cases, it’s very important to know that there is a fine line between an avoidable day and an early discharge."