Educational Programs
Substance Abuse & Forensic Toxicology
Overview
Over the past few years, Dr. Benjamin has participated in many educational conferences for physicians, forensic experts, and attorneys. Presentations have included Medical Negligence, Vicarious Liability for Physicians and Hospitals, Medical Risk Management, Understanding the Rules of Evidence and Legal Procedure for Experts, Preparing to Testify as an Expert, and Preparing For Cross-Examination.
Dr. Benjamin would like you to have the opportunity to learn about these important subjects in the privacy of your own office, and now offers a series of self-study written materials and Office Seminar Programs designed to address your specific educational needs. After you have reviewed the programs listed below, please feel free to contact Dr. Benjamin to discuss your particular objectives and help design a program dedicated to fulfilling your personal and professional educational requirements.
Medical Risk Management for Physicians, Hospitals, Pharmacists & Nurses
This program has been specifically developed to assist physicians, pharmacists and nurses minimize medication prescribing, dispensing, administration and communication errors. Portions of the program have been presented at Boston’s Brigham and Women’s Hospital, Harvard School of Public Health, at conferences of the American College of Legal Medicine and other educational programs and institutions around the country. The 65-page self-study syllabus written for the program (containing over 50 references) comprises the core of information used by Dr. Benjamin for teaching the Forensic Pharmacology: Management of Risk section of the Clinical Pharmacology course offered at Tufts University School of Medicine.
The program is designed to teach the risk management principles of clinical pharmacology to healthcare professionals and, more specifically, to improve physician prescribing skills and minimize exposure to liability. An outline of possible program topics is provided below.
Medical Risk Management
Clinical Pharmacology
- Why do Patients sue Their Doctors & What can you do to Minimize Your Liability ?
- What are the Major Causes of Medication Errors – Review of the Literature
- Risk Management Strategies for Prescribing Drugs
- Characterizing Adverse Drug Reactions – Frequency and Severity
- Determining Risk and Communicating Risk to Patients
- Legal Requirements for Informed Consent and Your Role as a “Learned Intermediary”
- Medical-Legal Issues in “Failure-to-Warn” Cases Involving Drugs
- How to Learn the Most From a Detailperson and by Reading the Package Insert
- A Review of Drugs Frequently Involved With Physician Law Suits
Legal Medicine for Physicians
Legal Medicine deals with the interface of medicine and the law. In today’s highly litigious society, it has become extremely important for physicians and healthcare professionals to develop a sense of “Litigation Consciousness” and to impart an awareness of the consequences of litigation to their professional associates and office staff. The Legal Medicine program is designed to answer your questions about those areas of the law related to Medical Negligence (malpractice) lawsuits and drug product liability suits in which physicians are frequently sued “vicariously”, when they prescribed a drug which caused an adverse reaction, even though the physician was not negligent in doing so.
See some photos from the 1997 conference on Daubert v. Merrell Dow.
Legal Medicine
- A Brief Overview of Legal Medicine
- Definition of Terms (e.g., Standard of Care, Negligence, Proximate Cause, etc.)
- Theories of Drug Product Liability and Physician Negligence
- Stages of a Law Suit
- What can I Expect at my Deposition and What Types of Questions Will be Asked?
- What do Lawyers try to Accomplish With Their Questions?
- How to Identify and Respond to “Trick” Questions
- Typical Areas of Inquiry on Cross-Examination
- Recognizing Improper, Unfair and Unethical Questions
Substance Abuse & Forensic Toxicology
Do you have questions about Substance Abuse or the interpretation of blood or urine test results? You can now obtain a copy of Dr. Benjamin’s presentation, The Legal and Social Ramifications of Urine Drug Screening in the Workplace which was presented in part at a conference of the National Forensic Center, and which includes excerpts from Dr. Benjamin’s learned treatise “Forensic Pharmacology” dealing with the following issues:
- Fourth, Fifth & Eleventh Amendment Issues Regarding Drug Testing
- Chain of Custody of Evidence (Remember OJ?)
- “False Positive” and “False Negative” Test Results
- How Long do People Test Positive After Exposure to Drugs?
Cross Examining the DRE
Officer, do you administer the HGN test?
What is the name of the eye muscle you are testing? Ans. Lateral Rectus
And which nerve innervates that muscle? Ans. The Abducens nerve.
In a subject who had not taken any alcohol or drugs, what medical conditions cause HGN? Ans. Meniere’s Disease, inner ear infection, labyrinthitis, vertigo, and water in the ear.
Officer, are you an expert in the pharmacology and toxicology of narcotics in general?
Can you tell me the name of the 3 six membered rings in a narcotic’s chemical structure? Ans. Phenanthrene
Does methadone have a phenanthrene structure? No.
Can you tell me the name of the six membered ring that contains a nitrogen atom in a narcotic’s chemical structure? N-methyl-piperidine, or just piperidine.
Well, can you tell me the difference between an opiate and an opioid? Ans: Opiates are naturally-occurring in the opium poppy. Opioids are narcotics that aren’t naturally occurring.
What are the naturally occurring opiates? Ans. 3 opiates, morphine, codeine, and thebaine.
And how is methadone classified? Ans. synthetic opioid
How about oxycodone? Ans. semi- synthetic opioid
What is the difference between a semi-synthetic opioid and a synthetic opioid? Ans. A semi-synthetic opioid begins with a natural opiate like morphine or codeine and a synthetic opioid is made in the laboratory using other chemicals but not naturally-occurring opiates.
Now, narcotics can all cause the pupil of the eye to constrict, right? Yes
And when caused by a narcotic, this is called “pinpoint pupils”, right? Yes.
And a person who takes his or her medicine at the dose directed by his physician would not be considered to be abusing the drug, right? Yes
And he would develop “pinpoint pupils” as well, right? Yes
Now when a patient takes a narcotic at a fixed dose, a specific number of times a day as directed by his physician, after 2-3 weeks, the patient may develop tolerance to the pain relieving properties of the medication, right? Yes.
And tolerance means that at that the dose the patient began taking initially the effects become less, right? Yes.
And tolerance develops to other effects of opioids in addition to pain relieving, right? Yes.
So patients who might have been sleepy when they first began taking the medication, may no longer be sleepy after a few weeks, right? Yes.
And patients can develop tolerance to other impairing side effects of opioids in addition to pain relieving, like sleepiness, or incoordination, right? Yes.
How about “pinpoint pupils”, would a patient also develop tolerance to “pinpoint pupils”? Ans. NO.
So it is very possible that an individual taking opioids could have “pinpoint pupils” indicating that he had consumed a narcotic, but also could be tolerant to any of the impairing effects? Ans. Yes
Failure of the Drug Influence Examination method
Notice that DREs are incorrect in their assessments 13% of the time when suspects admit using a drug, but when suspects do not admit drug use, they are incorrect 34% of the time, 2.6 times as often. If a method is truly valid, it should have the same degree of reliability under any circumstances of use. The DIE method is pathetic!
