[Dysphagia] "The Forensic Aspects of Dysphagia"

[Drirenect at aol.com (Drirenect@aol.com)]

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.