[Dysphagia] "The Forensic Aspects of Dysphagia"

[bsonies at comcast.net (Barbara C. Sonies)]

For those of you with the skills and interest we now have a new category of
Board Recognized Specialist in Swallowing and Swallowing Disorders. See
www.swallowingdisorders.comor go to the ASHA web site for division 13 and
find the link


> From: <Drirenect@aol.com>
> Date: Sun, 12 Feb 2006 17:45:06 EST
> To: <sorriso@adelphia.net>, <dysphagia@b9.com>
> Cc: <eripley@yahoo.com>
> Subject: Re: [Dysphagia] "The Forensic Aspects of Dysphagia"
> 
> I have read the article and plan to respond to it. I have never had the
> slightest problem in explaining to the court (and having it accepted) that
> VFSS  
> is not the be all and end all and why (it often isn't available  anyway), that
> aspiration pneumonia from inhaled oropharyngeal contents  is impossible to
> diagnose accurately, that the patient is in more danger of  developing it from
> his/her own saliva about which nothing can be done  except try to get good
> mouth 
> care and be able to testify that you did indeed  check the patient's
> dentition and  oral hygiene to estimate the risk of  infection from the
> aspirated 
> saliva. This is far more important in the process  of attempting to protect
> the 
> patient.  The other is trying to maintain or  improve nutrition and hydration
> status so that the patient has a chance of  fighting off infection.. VFSS is
> particularly unreliable when food is used since  it it impossible to quantify
> the 
> results with respect to the published data on  swallowing dynamics - all of
> which have been done with barium alone.
>  There are certain things recommended by clinicians that are  indefensible
> e.g. thickened fluids since there is no evidence of usefulness and  increasing
> evidence of deleterious effects, PEG feedings when not required with
> resultant 
> aspiration pneumonitis, and so on but the issues around aspiration and  its
> putative causes is a monster created by the practitioners who now fear it.
> Courts and juries are more impressed by expert research and valid, published
> medical opinion than anything else.What should be feared is the possible
> inability to assure the court that, as a clinician, you have all of the
> knowledge 
> and skills as outlined in the ASHA position paper as being required in  this
> field. In my experience, few possess them and some are unaware that they  are
> required to possess them. An expert witness must be board certified and that
> represents a problem for SLPs since they are not so certified re dysphagia. It
> also presents a problem for the lawyers since they have some difficulty
> finding 
>  appropriately qualified experts.
> We should all fear making mistakes - and everyone makes them. Making a
> mistake is not a crime - but ignorance will create more problems any  day.
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