[Dysphagia] "The Forensic Aspects of Dysphagia"

[sorriso at adelphia.net (sorriso@adelphia.net)]

The ASHA Leader of February 7, 2006 contained the above-referenced article.  I would like to discuss the quote, "Neglecting to conduct an instrumental evaluation of the swallow in cases of suspected dysphagia is analogous to refusing to X-ray a leg for suspect fractures" (Tanner, 2003, p. 86--that's it for the note, I can't find the full reference in the text).  The author states that "juries rely on visual evidence of swallowing disorders as opposed to bedside evaluation clinical 'assumptions'."  (Quotes around "assumptions" are mine.)

Quoting the biography at the end of the article, the author is Dennis C. Tanner, "professor of health sciences in the Speech-Language Sciences and Technology Program at Northern Arizona University in Flagstaff.  He has served as an expert witness in several cases involving dysphagia malpractice."

Irene, as our resident expert witness on the list, and others who may have also been similarly involved, do you find the above quote to be true?  

The article does discuss the need for good clinical documentation but seems to place emphasis on the MBS/VFSS (i.e. "Do the records show that you recommended, in a timely and clear manner, a video swallow study" and that if the study showed aspiration or the potential for aspiration "did your treatment contribute to the patient suffering negative dysphagia management outcomes," "did you recommend follow-up video swallow studies to confirm the results of the treatment?") in order to validate any dysphagia treatment.

Thank you,
Linda A. Zanchi MA CCC-SLP