Expert Witness Profiler

Tag: Withdrawal

  • Correctional Healthcare Expert’s Testimony About the Risk of Overdose Admitted

    Correctional Healthcare Expert’s Testimony About the Risk of Overdose Admitted

    S.F., a former detainee in the Denton County Jail, asserted claims for alleged violations of her constitutional rights on account of the jail’s treatment of her withdrawal from opioids during two separate incarcerations and the alleged denial by the jail of medication for Opioid Use Disorder (“OUD”).

    Plaintiff filed a motion to strike or limit the expert testimony of Dr.
    Nicholas Longnecker, contending that he is not qualified to opine on addiction medicine, the ADA (Americans with Disabilities Act), Denton County policies, and Department of Justice (“DOJ”) policies.

    Correctional Healthcare Expert Witness

    Nicholas Longnecker obtained a Bachelor of Science in Microbiology and Immunology from the University of Miami with minors in Chemistry and Religious Studies and his Doctor of Medicine from the University of Miami Miller School of Medicine. He completed his residency at The Washington Hospital Family Medicine Residency Program in Washington, Pennsylvania, and is licensed to practice medicine in the states of Texas, New Mexico, Colorado, and Wyoming.

    Longnecker is also a certified correctional health professional (CCHP), and he obtained his DEAX licensure, which allowed him to prescribe buprenorphine before this required waiver was eventually removed.

    Get the full story on challenges to Nicholas Longnecker’s expert opinions and testimony with an in-depth Challenge Study. 

    Discussion by the Court

    A. Longnecker’s Qualification to Opine on Addiction Medicine

    To begin with, S.F. argued that Longnecker is not qualified to offer an expert medical opinion on addiction medicine.

    She asserted that Longnecker might be qualified to talk about the administration of some medications in a correctional setting for general ailments but lacks certification or advanced training in addiction medicine and lacks training in psychiatry and addiction psychiatry.

    However, Longnecker gained experience in addiction medicine through his work at several facilities over the course of many years.

    Longnecker worked at Greenbriar Treatment Center and the Washington County Jail for two years. He evaluated and treated patients suffering from addiction there. And at the Washington County Jail, he managed patients with addiction disorders. For the next six-and-a-half years, he worked at the University of Pittsburgh Medical Center, where he regularly treated patients suffering from addiction and managed their addiction medications.

    For a year-and-a-half after that, he worked at WellPath, where he oversaw the MAT program for Albion Prison. And since 2022, he has worked at CorrHealth, where he is responsible for directing inmate medical care. He also developed and manages its MAT program for sites across four States.

    The Court found Longnecker qualified to opine on addiction medicine.

    B. Improper Topics of Expert Testimony

    I. The ADA

    S.F. argued that Longnecker is not qualified to testify as to his legal conclusions about whether illicit substance abuse removes ADA protection.

    The Court held that Longnecker is qualified to draw that conclusion because he cited DOJ guidance and because he is experienced both in determining whether to offer Medication-Assisted Treatment (“MAT”) for OUD in a correctional setting and in drafting policies and procedures addressing that issue.

    II. County Policies

    S.F. argued that Longnecker is not qualified to testify that the Denton County Jail does not have a blanket policy prohibiting MAT. She said that the record did not show that Longnecker has worked at the jail, that his employer has performed services there, or that he has reviewed the jail’s or Public Health’s policies.

    The entirety of Longnecker’s opinion about the jail’s policies reads as follows: “No evidence exists that the Denton County Jail had a blanket policy prohibiting MAT. Conversely, there is evidence of MAT administration at the jail when the appropriate conditions were met (i.e. pregnancy).” 

    Since the jury did not need expert testimony to determine what evidence is in the record, the Court held that Longnecker’s opinion about the jail’s policies constituted improper expert testimony.

    III. DOJ Policies

    S.F. argued that, in the absence of any evidence or training showing otherwise, Longnecker is not qualified to opine as an expert that the jail provided treatment consistent with DOJ policies.

    Longnecker stated that the jail’s treatment of S.F. was “consistent with . . . DOJ expectations.” He did not, however, specify what expectations he had in mind. And his report mentioned only one DOJ report: a document that “provides informal guidance” to the public, the contents of which “do not have the force and effect of law and are not meant to bind the public in any way.”

    The Court held that the jury did not need an expert to opine on a document that was drafted for the public. Longnecker was expressing a prohibited legal conclusion if he meant to convey his opinion that, based on his understanding of the ADA’s requirements described in that document, the jail complied with the ADA.

    C. Relevance

    S.F. argued that Longnecker’s testimony about whether the jail treated her withdrawals is irrelevant. In her view, the issue is whether the jail treated her alleged disability—that is, her OUD—as opposed to her withdrawal symptoms.

    The Court held that Longnecker’s opinion about whether it was medically reasonable for S.F. to be treated for her withdrawals rather than being given MAT is relevant to showing deliberate indifference as to her constitutional right to medical care.

    D. Reliability

    I. County policies

    S.F. argued that Longnecker’s opinion about the county’s policies is unreliable because it is not based on any instances of the jail actually providing MAT. As already noted, the county refutes that assertion based on Longnecker’s review of county records.

    But even if Longnecker reached his conclusions about the county’s policies after reviewing relevant records, the Court held that he did not identify which facts in the record he relied on or what method he used to reach his conclusion.

    II. Standard of Care

    S.F. argued that the scientific and medical community regards methadone, buprenorphine, or naltrexone as the standard of care for treating OUD.

    In her view, Longnecker’s opinion that forced withdrawal, followed by treatment of withdrawal symptoms, constitutes effective treatment for Opioid Use Disorder “is so far outside the established medical community as to be unreliable, unsupportable, and viewed with extreme skepticism.”

    Longnecker did not opine, as S.F. argued, that forced withdrawal would be within the acceptable medical standard of care in all circumstances. And even if he did, S.F.’s argument that Longnecker’s opinion is “far outside the established medical community,” would still fail. The “general acceptance” factor from Daubert questions whether a theory or technique is reliable. It does not matter, at this stage, whether Longnecker is correct in finding forced
    withdraw reasonable. What matters is how he reached that conclusion, and his report makes that sufficiently clear.

    The Court held that Longnecker supported his opinion that MAT was not appropriate during S.F.’s first incarceration with sufficient facts and data. He opined that it was medically appropriate to provide “medically-assisted detox” because S.F. would not have been able to continue MAT after her transfer to Christian Farms, a facility that does not provide MAT.

    Further, Longnecker cited the “grave risk of severe overdose when using both fentanyl and methadone” as another reason the jail should not have administered methadone.

    Held

    The Court granted in part and denied in part the Plaintiff S.F’s motion to strike defense expert Dr. Nicholas Longnecker.

    Key Takeaway:

    Longnecker was allowed opine on whether the jail’s treatment of S.F. during both incarcerations, including its treatment of her withdrawals, was within the acceptable standard of care; and the severity of S.F.’s withdrawal.

    Case Details:

    Case Caption: S.F. V. Denton County, Et Al.
    Docket Number: 4:23cv864
    Court Name: United States District Court, Texas Eastern
    Order Date: May 27, 2025

  • Correctional Healthcare Expert Witness’ Testimony on the Risks of MOUD in Correctional Settings Excluded

    Correctional Healthcare Expert Witness’ Testimony on the Risks of MOUD in Correctional Settings Excluded

    A district judge in West Virginia barred the Correctional Healthcare Expert from opining that there was no evidence of medical malpractice, deliberate indifference, discrimination, or negligence.

    Joseph Taylor has struggled with opioid addiction for nearly half his life. He is diagnosed with Opioid Use Disorder (“OUD”) and is treating this chronic brain disease with Medications for Opioid Use Disorder (“MOUD”).

    Wexford and the West Virginia Division of Corrections and Rehabilitation (“WVDCR”) denied Taylor access to MOUD while he was detained from January through March at Central Regional Jail. Plaintiff alleged that Defendants had a policy of forced withdrawal from MOUD, which was discriminatory and evinced deliberate indifference to his clear and acute need for MOUD while detained at CRJ.

    Wexford provided an expert report from Dr. Grady Bazzel who testified that the Defendants met the standard of care in their treatment of Taylor. Taylor filed a motion to exclude the testimony of Bazzel as an expert in addiction medicine.

    Correctional Healthcare Expert Witness

    Dr. Grady Judson Bazzel is currently the Patient Safety Officer and Medical Director of Care Management for Wellpath, a company that provides correctional healthcare throughout the United States. He has worked in corrections since 2005 and is licensed to practice medicine in multiple states. In his current role, he investigates patient deaths and other care errors and helps improve quality of care across Wellpath-managed sites. He has familiarity with the Bureau of Prisons (BOP) Clinical Guidelines for the Diagnosis, Evaluation, and Treatment of Opioid Use Disorder (OUD), although he did not review them specifically while compiling his report. 

    Fortify your strategy by reviewing a Challenge Study detailing grounds for excluding Grady Bazzel’s expert testimony. 

    Discussion by the Court

    Bazzel explained that there are risks to the use of MOUD in correctional settings that are not present in the outside world, including the risk that other inmates will target a patient to obtain the medication.

    Bazzel stated that “proper patient selection is the key to a successful Medication Assisted Treatment (MAT) program.” He stated that the “psychological triggers for relapse are less present and the access to substances of abuse is greatly diminished,” during incarceration, reducing the need for treatment. Bazzel suggested that gaps in Taylor’s treatment record, both before and after his period of incarceration, showed a “pattern of spotty follow-up for this medication that he claims to need so badly.”

    He offered the opinion that Taylor was not a good candidate for MAT while incarcerated because of his lack of compliance with Clinical Opiate Withdrawal Scale (COWS) assessments, his urine drug screen results, and his gaps in treatment before and after his incarceration.  He further opined that “the medical staff at CRJ were under no obligation to continue [buprenorphine] until such time that it became clear that it was needed. This need never presented itself,” as demonstrated by “the fact that his first drug screen post-incarceration was negative for illicit drugs.”

    Bazzel lacks experience and specialized training related to OUD, MOUD, and opioid withdrawal

    Taylor conteded that Bazzel lacked the necessary qualifications as per Rule 702. He noted that Bazzel has “never conducted an OUD screening or a Rapid Opioid Dependence Screen and is not sure if he has ever reviewed such a test.”

    Plaintiff added that Bazzel’s opinions were contradicted in key areas by the Federal Bureau of Prisons (“BOP”) Guidelines, a resource that he stated he was familiar with and considered authoritative.

    Absent full exclusion, the Plaintiff argued that several specific opinions offered by Bazzel are improper. He argued that Bazzel should not be permitted to offer opinions on the legal issues of medical malpractice, deliberate indifference, discrimination, and negligence. In addition, he contended that Bazzel’s opinion on the reduction in psychological triggers in jails and prisons should be excluded because it lacks any scientific support, and he is not a psychiatrist or psychologist with any qualification to offer such testimony.

    Since Bazzel’s report did not contain citations or references to medical or scientific sources, the Court looked to his deposition to gain an understanding of how he formed his conclusions.

    When asked what relevant medical literature he relied on in formulating his opinions, he replied, “None.” He stated that he did not review any scientific literature or journal articles related to COWS scores. As to his opinion that some patients who would be appropriate candidates for treatment with MOUD in the community are not good candidates in a correctional setting, he stated that he did not know if any literature or reports existed to support that viewpoint. He did not review any medical or scientific literature to formulate his opinion that there are fewer triggers for opioid cravings or relapse in jail, stating, “I’m sure I could find some. But it’s just commonsensical.”

    Bazzel’s testimony related to incidents of alleged diversion and urine screen results should be excluded 

    The Plaintiff next argued that Bazzel’s testimony and conclusions related to incidents of alleged diversion and urine screen results, all occurring after the Plaintiff’s January — March 2023 detention, should be excluded because medical staff could not have considered future events when determining Taylor’s medical treatment at the time. He further argued that Bazzel’s opinions regarding security concerns in a correctional setting related to MOUD are “pure conjecture.” Bazzel admitted in his deposition that he ‘has no experience in correctional security,’” and cited no scientific or medical sources. Finally, he argued that Bazzel’s testimony opining about Taylor’s credibility should be excluded.

    The Court held that Bazzel’s opinion that the Defendants met the standard of care in their treatment of Taylor was formed based on the analysis of Taylor’s treatment as discussed above, none of which was based on facts, data, or reliable principles or methods. 

    Held

    The Court granted the Plaintiff’s motion to exclude certain opinions of Grady Bazzel.

    Key Takeaway:

    Bazzel’s report lacked citations or references to medical or scientific sources. When asked what relevant medical literature he relied on in formulating his opinions, he replied, “None.”

    The Court held that Bazzel’s opinion that the Defendants met the standard of care in their treatment of Taylor was formed based on the analysis of Taylor’s treatment, none of which was based on facts, data, or reliable principles or methods. 

    Case Details:

    Case Caption: Taylor V. Wexford Health Sources, Incorporated, Et Al
    Docket Number: 2:23cv475
    Court: United States District Court, West Virginia Southern
    Order Date: June 17, 2024
  • Court Partly Admits Nursing Expert Witness’ Assertion that the Nursing Care was Substandard

    Court Partly Admits Nursing Expert Witness’ Assertion that the Nursing Care was Substandard

    A district judge in Washington ruled that the testimony advanced by an expert on nursing practice was relevant to the Plaintiff’s argument that Chelan County Regional Justice Center’s medical care of inmates is substandard.

    Facts of the Case:

    Defendant Chelan County Regional Justice Center (“CCRJC”) accepted Blair Nelson into its jail on November 21, 2020. At jail, Blair was suffering from severe alcohol withdrawal. Defendant Licensed Practical Nurse Kami Aldrich attended to her and had to hold her hand so she could get pills into her mouth because she was shaking so much. She was “found” dead in her cell several hours later. 

    Plaintiff brought this lawsuit on behalf of Nelson’s estate, contending that Blair’s death was preventable and would not have occurred had she received the constitutional minimum of medical care. She left behind four siblings.

    Defendants brought a Motion for Summary Judgment and requested the Court to strike the testimony given by three of the Plaintiffs’ expert witnesses: Dr. Richard Cummins, Dr. Lori Roscoe (PhD), and Catherine Fontenot, prior to considering the Motion for Summary Judgment. 

    Court Partly Admits Nursing Expert Witness' Assertion that the Nursing Care was Substandard

    Emergency Medicine Expert Witness

    Richard Cummins is a Washington State licensed medical doctor who is board certified in both internal medicine and emergency medicine. Cummins has been a member of the University of Washington Department of Internal Medicine and Emergency Medicine since 1981, when he became an attending physician. He was promoted to full professorship in 1985 where he remained for 28 years until retiring from clinical work in July 2020 to Professor Emeritus. During his tenure at the University of Washington Medical Center, he practiced and taught other physicians in the field of emergency medicine, as well as supervised nurses, medical students, and residents in training. Over the course of his career, Cummins has authored more than 150 articles and book chapters on emergency care, including cardiac care.

    Discover more cases with Richard Cummins as an expert witness by ordering his comprehensive Expert Witness Profile report.

    Nursing Expert Witness

    Lori Roscoe is a Certified Correctional Health Professional and a Certified Correctional Health Professional — Registered Nurse. Roscoe holds a bachelor’s degree in education, a bachelor’s degree in nursing, a master’s degree in public administration with a healthcare concentration, a master’s degree in nursing, a Doctorate Degree in Healthcare Administration, and a Doctor of Nursing Practice degree. She began work in correctional healthcare in 1995 and today is the principal of Correctional HealthCare Consultants LLC and The Correctional Nurse LLC. Roscoe holds an active registered nurse license in the states of Florida, California, Washington, and Georgia, and is licensed as a nurse practitioner in Florida, California, Virginia, Georgia, and Kentucky. Over the course of her nearly 30-year career, Roscoe has worked in a variety of correctional center settings relating to healthcare. 

    Get in-depth insights into Lori Roscoe’s expert witness experience by requesting her Expert Witness Profile today.

    Criminology Expert Witness

    Catherine Fontenot is the Director of the Reception and Diagnostic Unit for VitalCore Health Strategies and was retained for her expertise in correctional practice. Fontenot has had a lengthy career in the field of corrections. She obtained her Bachelor of Science in criminal justice in 1992 and has worked in a variety of correctional settings since that time. Fontenot obtained her master’s degree in criminology from Grambling State University in 2006, and became an adjunct professor at various institutions, teaching courses covering Criminal Law, Criminalistics, Emergency Management, Criminology, Juvenile Justice, Corrections Process, Drugs and Substance Abuse, and the Death Penalty. In her current role, Fontenot was hired to streamline the inmate intake process and to implement an evidence-based health and safety classification.

    Gain a comprehensive understanding of Catherine Fontenot’s qualifications and casework history with her Expert Witness Profile report.

    Discussion by the Court

    Defendants took umbrage with all three witnesses’ reference to the September 7, 2021, death of Joseph A. Verville. Verville was booked into CCRJC on September 5, 2021, with noted signs of opioid withdrawal. LPN Aldrich first assessed him for withdrawal and gave detox medications at dinner the following evening, September 6. Surveillance footage showed Verville vomiting at least six times after taking the withdrawal medication, but he was not assessed again by medical staff until he was found dead at 8:50 a.m. on September 7.

    After his death, LPN Aldrich was notified of potential discipline on September 27, 2021, and was given a verbal warning on November 23, 2021, after the death of Nelson. Defendants objected to the expert testimony inclusion of Verville’s death as impermissible character evidence.  Plaintiff asserted that each of the expert witnesses can discuss the death of Verville because it established a notice of a pattern of conduct by CCRJC, Director Christopher Sharp, and LPN Aldrich.

    Dr. Richard Cummins

    Cummins is qualified to give an expert opinion on medical care

    Cummins reviewed the entire case file, including medical reports, video footage, discovery related documents, and deposition transcripts. In doing so, he determined that CCRJC has a substandard training program and procedures in place which led to; failure to medically assess Nelson when she was booked into jail, failure to follow the internal alcohol withdrawal policy, and failure to provide a proper level of assessment, monitoring, and care. Cummins determined that had CCRJC rectified any of the failures in care, Nelson would not have died.

    Defendants asserted that Cummins was not qualified to give expert testimony on the operations of medical procedures inside a corrections facility because his experience was with emergency departments in hospitals. Defendants also objected to Cummins statements on the basis that he is offering impermissible character evidence in his discussion of LPN Aldrich’s conformity with past negligence, which is inadmissible character evidence. Finally, Defendants argued that Cummins should not be able to opine on causation relating to the practice of jail staff and the death of Nelson.

    Despite the fact that Nelson’s death took place in a corrections facility rather than a hospital, the Court found that Cummins had extensive knowledge of treating patients in various stages of medical stability, including alcohol withdrawal, given his career in the emergency department. 

    While Cummins is not necessarily familiar with medical practices in a correctional facility, he is familiar with the standard practice regarding medical care for individuals receiving treatment for alcohol withdrawal. As an expert witness, Cummins is permitted to testify on causation. Based on his own medical background and review of the record, the Court held that Cummins’s opinion on the ultimate issue, that Nelson’s death was caused by failure in treatment for alcohol withdrawal syndrome, is permissible.

    Cummins’ testimony does not amount to impermissible character evidence

    Defendants asserted that Cummins’ testimony amounts to impermissible character evidence, based on his comparison of the facts at hand with the death of Verville.

    Defendants asserted that Cummins’ report drew a comparison between Nurse Aldrich’s treatment of Nelson and the treatment of Verville, improperly concluding that Nurse Aldrich had a propensity to behave in a medically negligent manner. 

    Plaintiff asserted that a comparison is not offered in violation of Federal Rule of Evidence 404(b), but instead is offered to show a pattern of administering lower than the established standard of care to inmates, or lack of knowledge or mistake that a particular mode of operation would result in the death of an inmate under the care of CCRJC.

    While this evidence could be construed as character evidence suggesting that jail medical staff may have engaged in substandard care, the Court agrees that evidence of Verville’s death, and the circumstances surrounding it, are indicative of lack of mistake or absence of notice. Regardless, under Federal Rule of Evidence 703, a Court is vested with the discretion to allow otherwise inadmissible facts or data if the “probative value in helping the jury evaluate the opinion substantially outweighs their prejudicial effect.”

    Though not completely analogous, the inclusion of the similar circumstances surrounding Verville’s death may be indicative of absence of mistake or lack of accident via noncompliance with the internal protocol, which would result in the death of an unmonitored detoxing inmate.

    Because Cummins is an expert being offered to opine on the standard of medical care provided by CCRJC and the potential cause of Nelson’s death, the Court declined to strike his expert testimony as it did not amount to impermissible character evidence.

    Dr. Lori Roscoe, PhD

    Roscoe determined that Nelson received substandard nursing care. As part of her finding, she determined that LPN Aldrich’s administration of 100 milligrams of Librium without consulting a provider was illegal but opines no further on this statement except to state that it deviates from the scope of practice of a licensed practical nurse. She also included Verville’s death in determining that CCRJC has a substandard practice of care based on its failure to take corrective action after Verville’s death.

    Defendants asserted that Roscoe’s testimony that LPN Aldrich “illegally” administered Librium without contacting a medical provider should be disregarded pursuant to Rule 401 and 403. Further, Defendants alleged that her discussion of Verville amounted to character evidence and was therefore inadmissible.

    As an expert on nursing practice, Roscoe was permitted to opine on whether the standard of care was administered from a nursing perspective. Much like Cummins, the Court found that her discussion on the treatment received by Verville was relevant to Plaintiff’s argument that CCRJC’s medical care of inmates is substandard.

    As to her statement that LPN Aldrich’s administration of Librium was illegal, Plaintiff offered additional support that any nurse would understand that they are not permitted to administer the narcotic without first contacting a provider. 

    While potentially dangerous, against the stated internal policy, and seemingly in a general lexicon of knowledge that it should not be done, Plaintiff offered no additional information that administering Librium without first contacting a doctor was “illegal.” As such, the Court disregarded the notion that LPN Aldrich’s conduct was “illegal” based on Roscoe’s testimony, because Plaintiff has provided no additional information to support this statement. However, the rest of her report was deemed admissible.

    Catherine Fontenot

    Fontenot ultimately determined that CCRJC was not proactive in rectifying standards of care that led to the death of Verville, and these gaps in care led to the death of Nelson. 

    Defendants’ objected to the inclusion of Fontenot’s testimony because it alleged her testimony was based on medical information, impermissible under Federal Rule of Evidence 702 based on her background. They also alleged that the language used, and the conclusions drawn ran afoul of the character evidence requirement under Federal Rule of Evidence 401 and 402.

    Plaintiff contended that Fontenot’s testimony is not being offered for a medical purpose, but instead is offered to demonstrate best corrections practices against the opinion of Defendants’ expert witness.

    The Court determined that no part of Fontenot’s opinion ran afoul of Rule 702. She did not make a medical diagnosis of withdrawal beyond the scope of what would have been asked of officials without a medical background working in the jail and recognized the difference between medical and non-medical staff.

    Further, while the language used by Fontenot is passionate at times, it is not excludable under Federal Rule of Evidence 403. 

    Held

    With the exception of Roscoe’s reference to the administration of Librium being “illegal,” the Court denied the Defendants’ motion to strike Dr. Richard Cummins, Dr. Lori Roscoe (PhD), and Catherine Fontenot. The Court also denied the Defendants’ motion for summary judgment.

    Key Takeaways:

    • Despite the fact that Nelson’s death took place in a corrections facility rather than a hospital, Richard Cummins had extensive knowledge of treating patients in various stages of medical stability, including alcohol withdrawal, given his career in the emergency department. He is qualified to discuss how and when medication should be administered, and allowed to give his opinion about the initial medical intake and ongoing monitoring of inmates who are under the care of jail medical staff. 
    • Plaintiff offered no additional information that administering Librium without first contacting a doctor is “illegal,” despite it being potentially dangerous and against the stated internal policy. As a result, the Court disregarded the notion that LPN Aldrich’s conduct was “illegal” based on Lori Roscoe’s testimony.
    • As demonstrated both by Defendants’ own expert witness and additional filings, many times jail officials without a formal medical background must nevertheless be able to render rudimentary care, including identifying withdrawal symptoms, and continued monitoring of inmates. The facts of this case demonstrate that in a jail system, staff must work together to keep everyone safe, inmates and each other alike, and as such non-medical staff is asked to do initial medical intake of inmates after hours and provide ongoing monitoring to recognize withdrawal and alert medical staff. In this spirit, no part of Catherine Fontenot’s opinion ran afoul of Rule 702.

    Case Details:

    Case Caption: Nelson V. Chelan County Et Al
    Docket Number: 2:22cv308
    Court Name: United States District Court, Washington Eastern
    Order Date:  April 19, 2024