In this episode . . .

We sat down with Dr. Hervey Segall, a radiology expert. Topics in this episode include maintaining expertise, ethics, and research. Dr. Segall recommends a simple solution when conducting research and maintaining expertise. He states, “There’s nothing more helpful than Google. Anything you want to know . . . just go to the web.” He adds, “You have to maintain a curiosity [and] continue to educate yourself and grow. There are a lot of people who do the minimum . . . but I like to go beyond that to be a real expert in everything that I do.”

Episode Transcript:

Note: Transcript has been lightly edited for clarity.

Host:  Noah Bolmer, Round Table Group

Guest: Dr. Hervey Segall, Neuroradiologist, Professor Emeritus of Radiology

Noah Bolmer: Welcome to Discussions at the Round Table. I am your host, Noah Bolmer, and I am excited to welcome Dr. Hervey Segall. He is a Professor Emeritus of Radiology at USC and has over 60 years of experience in medicine. He maintains a full-time teleradiology practice and is possibly the foremost expert in pediatric neuroradiology. Dr. Segall holds a Medical Degree from the University of British Columbia. Dr. Segall, thank you for joining me here today.

Dr. Hervey Segall: It is a pleasure, Noah. Thank you.

Noah Bolmer: Absolutely. Let’s jump into it. You have had a successful medical career spanning over 6 decades, was medicine and radiology specifically always your path?

Dr. Hervey Segall: At an early age, I acquired an interest in becoming a physician. I had an aseptic necrosis of my hip when I was around 7 years old and was put into a cast by an orthopedist, and my mother pointed out how wonderful the orthopedist was. I was interested in medicine but defaulted to radiology because I did not know what I wanted to do. I thought that would be a nice broad specialty to engage.

Noah Bolmer: With such a long and storied career. I imagine that both the medical technology and the legal framework have changed quite a bit. How do you remain an expert in your field throughout all of these changes?

Dr. Hervey Segall: The specialty of neuroradiology as I practice it today is different than when I started my fellowship. In those days, we visualized the brain largely by cerebral angiography, in which we punctured the carotid arteries and injected contrast or did retrograde brachial injections. We did angiography and then we also did pneumoencephalography where we put air into the ventricular system via lumbar puncture or in some cases by doing ventriculography through a catheter placed into the ventricles. Then, Myelography either used air or a lipid-based contrast. Over the years now, that has changed, and most of the imaging that we do is CT, MR, and in infants, ultrasound. There has been a complete turnover in the specially over the years and then Magnetic Resonance Imaging has developed in different types of studies. That is an amazing evolution.

Noah Bolmer: I have heard similar accounts in varying fields where technology has changed, and some people have said that you must pick and choose the technologies that you want to become an expert in, and some of them you may find to be a fad. In terms of being what you would call quote-unquote, an expert in your field. What techniques do you use to stay abreast? Do you read papers? Do you attend trade events? Do you take continuing education classes? What techniques do you and experts in your field use to maintain your expertise?

Dr. Hervey Segall: I think attending meetings is certainly a big help. For the upcoming meeting of the American Society of Head Neck Radiology, I had two accepted presentations and have been invited to speak at this year’s October meeting of the Western Neuro Ideological Society. Not only am I attending the meeting, but I am on the faculty of these, so that is helpful. There is nothing more helpful than Google. Anything you want to know you go to Google and that also pertains to medicine. If I see a condition where I need to refresh my knowledge or if I come up with something that I need to get myself familiar with, I go to the web. There are so many resources out there, and many of these courses are online, so you must maintain a curiosity and continue to educate yourself and grow as a physician.

Noah Bolmer: How did you take that expertise and parlay that into a career or a sub-career of expert witnessing? When were you first contacted to be an expert witness? Is it something you had even heard about before being contacted?

Dr. Hervey Segall: I think this happened when I was at the Los Angeles County USC. The local attorneys would get in touch with me on various cases that fell within my area of expertise.

Noah Bolmer: if you think back to maybe not the specific cases, but when you were first getting started, did you feel prepared, ready, and well-versed? Did the attorneys do an adequate job preparing you for either a report, a deposition, or cross-examination, compared to now? What have you learned throughout your career? What are the make-ups that attorneys use to prepare an expert that you find helpful?

Dr. Hervey Segall: The attorney would send me the records and tell me the problems and contentions. I looked at the available data, Then, we would engage in further discussions, address the salient points, and go from there. The process has not changed. It has been the same from the get-go. The only thing I have developed over the years is a better understanding of the legal process. How to navigate through the pitfalls you might encounter along the way. What to say, what not to say, and how to behave during a deposition. I think what I have learned is nothing about the medical aspects. I think it is…

Noah Bolmer: Because that is what you are an expert on.

Dr. Hervey Segall: It is an understanding of the legal process.

Noah Bolmer: When we talk about pitfalls, what are some of those pitfalls that you or other experts can find yourselves in when they are in the middle of a deposition or cross-examination?

Dr. Hervey Segall: Just answer the questions. Do not elaborate if it is not needed. Do not be overly argumentative.

Noah Bolmer: Have you been in a position where the opposing team has tried to impeach your expertise? To say Dr. Segall is not an expert in this area. Look at these things. Have you been the subject of oppositional research?

Dr. Hervey Segall: Once or twice, I found it appropriate to debate something that has happened, but rarely.

Noah Bolmer: Have you often known the experts on the other side?

Dr. Hervey Segall: Yes. For example, I was on the opposite side of pediatric cases from a physician who is now deceased. It always seemed that in some of these pediatric cases, I was on the defendant’s side, and he was on the plaintiff’s side. I always respected him for that. I could never argue with his analysis, his findings, and how he reported it. I admired his honesty. I have also encountered others whom I think are less well.

Noah Bolmer: On the same topic of ethical considerations, before the show, we were talking about fly-by-night operations for lack of a better term, where people are expert witnesses or alleged expert witnesses claim they can be an expert that is going to be in your favor regardless of what your position is. That was fascinating to me. Can you tell us a little about that?

Dr. Hervey Segall: I have noted that there are several centers where they perform imaging studies that have certain embellishments and are purported to discover abnormalities that cannot be seen by the human eye. They take this hocus pocus information that is generated by certain software and methods where they claim they are abnormalities. Then they refer to articles written by psychiatrists who contend these are valid observations and they are an important component. The imaging evaluation where there is not a neuroradiologist involved, but rather a psychiatrist and they publish this information, which demonstrates how useful the information is. Better than what an experienced neuroradiologist can provide which of course is contradicted by more honest and solid information by real experts who are not radiologists, but they invoke these references from the literature. That is pure garbage authored by psychiatrists. So, there are various shops, and they will advertise on their websites that we will evaluate where we have expertise in brain injury.

Noah Bolmer: Besides the more obvious breaches of ethics, have you had attorneys try and get you to fudge your opinion one way or the other?

Dr. Hervey Segall: Oh yeah, sure.

Noah Bolmer: How do you handle that? If it is at the beginning of an engagement, you cannot take the case. But if it is during an engagement, do you just walk away? Do you tell them, “This is not the kind of work that I do?” How do you handle a situation like that?

Dr. Hervey Segall: It has been a long time since I have had that type of situation. I would just be upfront about it. I would say, “That is a position I cannot support.” Tell them, “I don’t think I’m your best expert because I don’t think there’s a case here.”

Noah Bolmer: You do not take as many cases these days, but thinking back on your career, have you turned down a significant number of engagements?

Dr. Hervey Segall: Yes, I got a wonderful offer to be a Professor of Radiology at the Medical College of Wisconsin and to start up a new Pediatric Neuroradiology Service, I was turning away cases for 7-8 years.

Noah Bolmer: You are saying that more often than the reason to turn down cases has not had anything to do with expertise, but more of a timing consideration.

Dr. Hervey Segall: That would be the main thing. In most cases, when they come to me, I look at them. They come from either side and if I see no reason not to, I will take them on.

Noah Bolmer: Did you use to advertise?

Dr. Hervey Segall: I always thought it was unethical.

Noah Bolmer: That is interesting. In what way?

Dr. Hervey Segall: Back in the days when I came out of medical school, this business of driving down the freeway and seeing attorneys advertise did not exist. Now, well everybody is advertising.

Noah Bolmer: Is your reputation that brings in business at this point?

Dr. Hervey Segall: I do not need it once I get into a case and work with an attorney. I do it when it comes. If it does not, that is fine too.

Noah Bolmer: Before we wrap up, I want to pivot to a few things that I like to ask all my guests and one of them is the importance of winning a case. First, do you stay abreast of a case? If you give a deposition if you are in for cross-examination, or even if you just do a report, do you follow the case through to completion? Do you stay in touch with the attorney to see how the case winds up? Is that important to you as an expert?

Dr. Hervey Segall: I guess to some extent. I remember one case where there was a great satisfaction to me. There was an ace brought against a prominent pediatric neurosurgeon in Philadelphia. I moved to Philadelphia after I had been retained to do the case where I worked for a year, and I went to court. He was there during my testimony. He was so grateful for the way I handled myself at the time of deposition and we won, and he said the way I did it deflated the plaintiff’s attorney. So yes, there are instances where it is joyful to learn and be aware of the outcome.

Noah Bolmer: Finally, let’s talk about billing at the end of the case. Do you typically do project-based billing hourly? Do you take a retainer? What is the best way to get paid?

Dr. Hervey Segall: I request a retainer and then I submit a bill. That is about it.

Noah Bolmer: Any final advice for newer experts or attorneys out there? Many newer experts listen to the show looking for advice from more experienced experts. So, is there any wisdom that you have picked up that you wish you had when you started, or think a newer witness or an attorney who is hiring a newer witness might benefit from?

Dr. Hervey Segall: My advice is to go ahead and do it. I think there are some pluses to being an expert witness. It is an educational experience that gives insight into the legal profession which is worthwhile understanding. Then be aware of the medical legal environment, it is healthy in terms of your performance and well-being, and it is helpful to understand. So, I say, do It but the first thing to remember is that you are sworn to tell the truth and the whole truth. You are a physician first, so practice your specialty profession. Do not make it your major means of living, I am sure it is very tempting. Do what you are supposed to do. Take care of patients. My advice to an attorney is to get an expert with the best credentials. There are many people out there who are upfront. I will take on your case, and you do not want to get into a situation where you have a bogus expert. When push gets to shove, they rip holes into your credentials, your honesty, and your evidence. You do not want to be in that position.

Dr. Hervey Segall, Professor Emeritus of Radiology

Our guest, Dr. Hervey Segall, is a Professor Emeritus of Radiology for the University of Southern California. He maintains a full-time teleradiology practice and is an expert in multiple fields, including pediatric neuroradiology. Dr. Segall holds an M.D. from the University of British Columbia.