G.D. - Canary

• Could you please state your name?

• “Dr. MJ Canary” (12-14) M.D., M,L., PHD

• Dr. Canary, could you briefly describe your professional background for the jury?

• I am a professor of clinical pediatric medicine and the former Chair of the Department of Family Medicine at Kalmia University. I practice in the Laurel County community, and I trained many of the physicians who work in our county.

• How long have you been practicing medicine?

•  Over forty years.

• Are you familiar with the standards of care applicable to family physicians practicing in community settings?

•  Yes. That has been a central part of my career as both a clinician and an educator.

• Could you please describe your education to the jury?

I earned my medical doctorate and law masters at the University of Pennsylvania, as well as completing a residency in family medicine and earning my Ph.D. in public health at Kalmia University.”

Do you have any other professional certifications?

• “I am board certified by the American Academy of Family Physicians

• Have you published any scholarly articles or works?

I am contributor and editor of the Nasir’s Family Medicine textbook.  I have also authored or co-authored over four dozen publications in peer reviewed medical journals

• Have you ever testified as an expert in court?

• Yes.  A handful of times. 

• How have you prepared to testify in this case?

• “I have reviewed the affidavits of all other witnesses and reviewed all exhibits in this case” (23-24)

Is this the type of information that experts in your field typically rely upon?

Yes

• Have you formed an opinion as to whether the Defendant, Dr. Colter’s Medical Practice, met the acceptable standard of care with regard to its treatment of Bo Bridger?

Yes

• What is that opinion?

• It is my opinion, to a reasonable degree of medical certainty, that Dr. Colter’s Medical Practice at all times met and exceeded the applicable standard of care in its treatment of Bo Bridger

What is the basis of your conclusion that Dr. Colter’s Family Medical Practice acted within the standard of care?

• Three main reasons: first, Bo Bridger had very common symptoms that aligned with common illnesses. Second, while we know now that Bo Bridger had trichinosis, the patient’s illness had an unusual Presentation compared to how trichinosis typically presents. Finally, Dr Colter had no reason to believe that Bo Bridger met any of the risk factors for trichinosis, because critical information about Bo Bridger consuming raw game meat was withheld from him until it was too late for him to act on it.

• Before we discuss your analysis in greater detail, Have you ever treated someone with trichinosis?

• Yes. I encountered a patient with a high fever and intense focal pain with no known cause. I diagnosed trichinosis almost immediately, but that diagnosis was comparatively easy in this case: the patient could barely live independently, and they had limited resources to pay for quality meat. I concluded, correctly, that the patient had undercooked cheap pork.

Now I’d like to discuss the basis for your opinions one by one – first you mentioned that Bo Bridger had very common symptoms with very common explanations, please explain what you meant?

• The medical records indicate that Bo Bridger presented to Dr. Colter’s office with a moderate fever and fatigue. These are among the most common complaints seen in family medicine, especially for high school students in flu season. So most doctors would suggest Viral illnesses such as influenza, mononucleosis, or other common infections as the explanation.

Why start there?

• Because medicine works like a funnel. You begin with the most likely and common explanations before considering rare conditions.  And there is a good reason for this.  The most common explanations are typically the correct ones, and need to be ruled out before you consider more exotic and rare solutions.  When you hear hoofbeats, you think horses, not zebras.

Back to the basis of your conclusion, you mentioned that this was an unusual presentation of trichinosis.  Can you explain what you meant?

• Trichinosis differentiates itself by two main symptoms.  An intense, often focused muscle pain from the parasite and a very high fever between 103 and 105 degrees.  In this case, Bo Bridger never developed the kind of intense, localized muscle pain that is characteristic of trichinosis.  She was able to go on runs during the course of her illness, which is extremely unusual and made the diagnosis of trichinosis even harder.

IFinally, you mentioned Bo Bridger’s failure to inform Dr. Colter about eating raw game meat as a basis for your conclusion.  Can you describe what you meant?

• I have no doubt that if Bo Bridger had told Dr. Colter’s office that she had eaten raw game, it would have changed the differential entirely.  If Dr. Colter’s office knew that, trichinosis would have moved up dramatically in the potential answers, but Bo Bridger withheld that information until after she was discharged from the hospital.

Dr. Canary, did you review an email sent by Jamie Bridger to Dr. Colter’s office on December 22?

Yes

• What significance, if any, did the email have?

•  The records reveal that Jamie Bridger was constantly contacting Dr. Colter’s office with new and outlandish theories that s/he learned on WebMD like leukemia, cancer, meningitis, hantavirus.  

• Communication between doctors and patients breaks down when patient family members conduct their own research and barrage doctors with information.  Think needle in the haystack, but each call makes more haystacks.  

• It is extremely difficult to know what to take seriously when doctors have to question the source of information.  Take the December 22^nd email.  Yes.  Jamie suggests that Bo Bridger ate raw wild game.  But the email was hysterical. 

• From your review of the materials in this case, were you able to determine whether Dr. Colter’s office had a reason to question Jamie Bridger as a source?

Yes.  Dr. Colter testified in his deposition that Jamie Bridger was not a clear historian, and from my review of the records, that appears to be 100% correct.

Dr. Canary, based upon your review of this case, what is your opinion as to whether Dr. Colter’s practice acted according to the standard of care for family medicine?

• In my professional opinion based on years of practice, this case of Trichinosis presented more like a virus or bacterial infection for most of its course. The diagnostic and treatment services provided were reasonable and well within the standard of care for a family physician practicing in a community setting.” (133, 208-209)

• Are all of your opinions formed within a reasonable degree of medical certainty?

Yes