Scope of Practice for Life Care Planners
Certified life care planners adhere to a well-defined, peer-reviewed, and generally accepted set of professional standards and guidelines (“Standards).[1] The standards require that items in a life care plan be causally related to the indexed incident and have sufficient medical foundation. To this end, life care planners are required to consult with treating and/or consulting physicians to obtain medical recommendations that are translated into life care plan items. Consistent with this logic, life care planners should rely on medical professionals who are making recommendations within their specific scope of practice. For example, it would be inappropriate to ask a cardiologist for recommendations for future kidney dialysis. This would of course strain the credibility of the recommendation and likely violate certain rules of evidence.
Occasionally, treating physicians are unavailable for consultation for a variety of reasons, which may necessitate involvement of a consulting physician. This provider would presumably conduct a physical examination if possible and review relevant treatment records. The life care planner could then collaborate with the consultant for recommendations regarding future care. Again, it would be inappropriate to ask this consultant for recommendations outside of their scope of practice like the example above.
But what happens when the consulting physician is also acting as the life care planner who is costing out their own medical recommendations? While it may be convenient or beneficial at times to combine these different roles, there are inherent concerns which may jeopardize the admissibility of their opinions. For example, we routinely review life care plans generated by physicians who do not consult with the treating doctors and base their entire life care plans on their own recommendations. This practice is acceptable when the physician life care planner is making recommendations specific to their medical specialty. The Standards state that the life care planner “Seeks recommendations from other qualified professionals and/or relevant sources for inclusion of items and services outside the life care planner’s scope of practice (p.17).” Routinely we see physician life care planners offering recommendations outside of their professional scope. Most frequently, we see recommendations by physiatrists (physical medicine and rehabilitation specialists) for orthopedic surgery, detailed ongoing psychological or mental health treatment, routine neurology follow ups, or other ongoing routine care that would otherwise require the input of the specialist providing the care.
A recent federal court decision for the Western District of Missouri involved a motion to exclude the plaintiff’s expert physician life care planner based on a Daubert challenge, which was granted[2]. In this case, plaintiff’s counsel hired a physiatrist to produce a life care plan. According to the ruling, the physiatrist’s testimony did not meet the standards for evidence to be admissible under Rule 702, which states that an expert “must show by a preponderance of the evidence both that the expert is qualified to render the opinion and that the methodology underlying his conclusions is scientifically valid.”
The decision added that the defense challenged the qualifications of the expert, his methodologies, and the reliability of his opinions. Defendants stated that the physiatrist opined that ongoing treatment was necessary in a specialty for which he or she had little to no knowledge or experience. The defendant also contended that the physiatrist did not speak with the patient’s treating physicians. Accordingly, the physiatrist affirmed that his opinions were not based on medical records, a review of literature, or conversations with the patient’s treating physicians. The court concluded there must be support in the medical records, from a treating specialist, or other expert in that specialty for the physiatrist’s opinions to be reliable. As the court stated, “merely possessing a medical degree is not sufficient to permit a physician to testify concerning any medical-related issue.” Furthermore, the physiatrist admitted that he lacks the expertise to determine costs of future medical care and leaves the process of doing so to the “actuary department.”
In order to ensure that we provide credible, valid, and defensible reports, we endeavor to confirm that the medical foundation underlying our plans falls within the generally accepted professional standards that guide our work. We are also mindful of the important legal standards that govern the ultimate admissibility of our opinions.
[1] IARP/Life Care Planning IALCP Section (2022). Standards of Practice for Life Care Planners (4th Ed.). IARP.
[2] Hartley v. Kawasaki Motors. USDC for W. Div, St. Joseph Division, Case No. 20-06098-CV-SJ-GAF (2022)