5. Regular review of expert medical witness testimony by medical specialty organizations?

None of the expert medical witness review and evaluation committees of medical specialty organizations mention any process to regularly review the activities of their experts unless in response to a specific complaint. Given the economics of defending against litigation, the medical specialty organizations have generally become less inclined to question to known expert witness misbehavior, simply for economic reasons and to avoid potential litigation.  As a result, such inappropriate testimony is largely uncontrolled and recovery for plaintiff injuries involving true standards breaches, and inappropriately filed lawsuits in other cases where no breach occurred because of general lack of testimony review. Although some medical specialty organizations are beginning to address these issues, the review process is different as to each specialty and the liability exposure of the medical specialty organization continues to exist.^{1, 2} Therefore, there is currently no effective method of review of medical expert opinions given in litigation by the medical specialty organizations.

In summary, a review of the state and federal initiatives that provide for peer review reveals that this legislation is incomplete for effective peer review on a national basis. Immunity from litigation is a primary requirement to gain the assistance of review physicians.^{1, 2} The Health Care Quality Improvement Act, passed in 1986, provides immunity only in limited circumstances and does not protect peer review documents or discussions from disclosure.¹ The state peer review protections are so different in character that they provide little protection when involving entities and expert medical witnesses involving multiple states.  ¹ The organizational and governmental restraints inherent in present rules and regulations make it difficult to develop a meaningful nationwide, multi-specialty expert medical witness peer review mechanism that would be effective and that could operate without the litigation liabilities now inherent in medical specialty expert medical witness evaluations. The lack of an educational track for expert medical witnesses in any specialty had led to a broad spectrum of expertise in the legal details of being an expert witness and clear standards within specialty need development.