Standard of Care Reviews

What is a standard of care review?

A standard of care review is a board-certified physician's reading of the medical record to answer one question: whether the care a provider gave met the standard that a competent practitioner in the same specialty would have met at the time and in the setting where the care was given. The reviewing physician reads the episode of care from the first contact to the outcome, identifies each point at which a decision was made or not made, states what the accepted standard called for at that point, and reports whether the care met it, with the record pages and the medical literature that support each finding. The review is a medical opinion prepared for counsel and the court; it does not decide negligence, liability or damages.

KWVRS offers the review through a licensed physician, and the specialty of the care under review is confirmed against the reviewing physician's specialty at intake, because the standard is the specialty's own. A matter outside it is identified at intake rather than after retention, and no retainer is taken for a review the physician will not conduct.

What the review answers and what it leaves to others

The review answers whether the standard of care was met and, when the assignment includes it, whether a departure caused the harm alleged. It does not answer whether a departure amounts to negligence in the forum's law, who is liable, or what the harm is worth; those belong to counsel, the court and the damages experts. It is not an examination of the patient: an independent medical evaluation is a separate engagement, and the review is a reading of records. It is not a life care plan, a vocational opinion or an economic calculation, though it is often the opinion those experts build on. And it is not advocacy: the same reading is done for counsel presenting a claim and counsel defending one, and its conclusion may be that the care met the standard at every point.

How the review proceeds

The physician's work has a fixed order. The record is assembled into a chronology of the episode of care, with the imaging and the results placed at the time they were available to the treating team rather than at the time they were reported, because the standard is judged on what the provider knew or should have known when the decision was made. Each decision point is then examined: the presenting complaint and history, the examination documented, the differential considered, the tests ordered and not ordered, the interpretation of results, the treatment given, the consultations sought, the discharge or transfer decision and the follow-up arranged.

For each point the physician states the accepted standard for the specialty at that time, from training, practice and the published literature, and compares the care to it. The findings are written with page references to the record so that counsel and an opposing physician can go to the same page and see the same entry. Where the record is incomplete, the report says what is missing and what could change if it were produced, rather than filling the gap with an assumption.

How the review pairs with life care planning and vocational opinions

In a medical malpractice case the review sits at the head of the damages chain. Until a physician has said whether the care departed from the standard, and whether the departure caused the injury, the damages experts have no line to draw between the harm the patient would have suffered anyway and the harm the case is about. Once that line exists, the life care planner prices the future care attributable to the departure and sets aside the care the patient would have needed regardless, the vocational expert measures the loss of the ability to work against the baseline the patient would otherwise have had, and the forensic economist values both.

KWVRS can staff all four opinions from one roster, with the physician's causation framing handed to the planner and the vocational expert in the terms it will be stated at trial, so the reports do not disagree about what the departure caused. Each expert stays inside a discipline: the physician does not price care and the planner does not opine on the standard. The medical malpractice case page describes how the four opinions fit a case from retention to trial.

How a standard of care engagement proceeds

A standard of care review proceeds through the five steps below, from the intake that confirms the clinical questions and the specialty fit to testimony. The physician's reading of the record is the engagement; everything else is scoping before it and writing after it. The standard of care process page describes each step in full.

Typical timeline

A standard of care report is typically 30 to 60 days from receipt of complete records, and the record is what moves the date: the physician does not start reading until the whole chart is in hand, and a review that adds causation or several providers uses the whole window. Each phase and what moves it is on the standard of care timeline page.

What a standard of care engagement costs

The cost of a standard of care review is the physician's time, and the record sets most of it, because the whole chart is read before an opinion is formed; a causation question or several providers under review add hours in proportion. Fees are hourly against a retainer with an estimate before work begins, and the standard of care cost page sets out the drivers and the billing terms.

Who retains a standard of care review

Standard of care reviews are retained by counsel presenting a malpractice claim, by counsel defending a provider, and by the carriers and risk managers who decide whether a claim should be defended or resolved. The physician's reading does not change with the retaining side: the same chronology, the same standard and the same literature produce the opinion, and a review retained to support a claim may report that the care met the standard, just as one retained to defend it may find a departure. Counsel asks the question; the record answers it. Because the reviewing physician may later testify, the engagement is confirmed only after the conflict check clears the providers and the parties.

Deliverables

The written report is the deliverable: a chronology of the episode of care, the decision points identified, the standard stated for each, the finding at each, and the basis for every opinion with page references and the literature relied on, written to the admissibility and disclosure standards of the forum so that it can serve as the expert's disclosure where one is required. A literature review is included where the questions call for the accepted standard to be documented. A rebuttal opinion on an opposing physician's report is a separate deliverable, scoped when that report is served. Deposition and trial testimony rests on the report and is given by the reviewing physician.