106: Blind expert pathology opinions enabled digital pathology help win legal cases w/ Stephanie Franckewitz, JD, MBA

The episode explores the concept of blind review, a process designed to eliminate hindsight bias by allowing medical experts to evaluate cases without knowing the outcome or the hiring party.

Stephanie Franckewitz, JD, MBA, founder of Blind Review, discusses its application in legal cases, particularly for digital pathology and radiology. By providing an unbiased expert opinion, blind review aids the defense and plaintiff parties in court, increasing the chances of a favorable verdict.

Stephanie outlines her journey from a medical malpractice defense lawyer to starting Blind Review and highlights the potential for digital pathology to revolutionize the legal process, reduce bias, and improve case outcomes.

Collaboration with platforms like PathPresenter enables pathology slides to be reviewed efficiently and effectively within a legal context. This approach benefits both defendants and plaintiffs by ensuring objective evaluations and enhancing the credibility of expert testimonies in trials.

00:00 Introduction to Blind Review
01:19 The Role of Digital Pathology in Legal Cases
02:16 Stephanie Franke Reid's Journey
07:19 Challenges in Traditional Expert Reviews
10:09 Implementing Blind Review in Pathology
18:16 Collaboration with PathPresenter
25:43 Streamlining the Legal Process with Digital Pathology
26:51 Collaborative Tools for Legal Experts
27:20 Path Presenter: A Game Changer for Attorneys
28:17 Understanding Pathology for Juries
29:20 Streamlining Case Preparation with Path Presenter
31:54 Setting Up a Blind Review Process
35:38 The Gold Standard of Blind Review
41:53 Impact of Blind Review on Legal Outcomes
49:49 Empowering Legal and Medical Professionals
54:50 Conclusion and Call to Action - contact Stephanie

THIS EPISODE'S RESOURCES

• Stephanie's LinkedIn Profile
• The Blind Review Website

Transcript

Expert Pathology Opinions for WINNING Medical-Legal Cases! | Stephanie Franckewitz, JD, MBA

Aleks: [00:00:00] What is blind review? 

Stephanie: Blind review's mission is to place the expert into the shoes of the treating physician as closely as we possibly can.

Aleks: And you are not a lawyer in the case anymore, right? You're just like an intermediary. Your main goal and like mission is to find those experts for the cases.

Stephanie: The goal is an objective opinion.

Completely objective without hindsight bias, and the only way to accomplish that is to hide all of that information, and you take the way my application works, I can take the experts step by step by step, through the care and they have to answer the question each step of the way. The gold standard blind review for pathology is to have an agreement with a pathology group [00:01:00] where I can insert the slides into their daily workflow.

And they just read the slides within their daily workflow. Then, they don't even know it's a legal case.

Welcome and Guest Introduction

Aleks: Welcome, my digital pathology trailblazers. Today is a different episode because we're going to be talking about a totally different application of digital pathology. It's going to be about how digital pathology can provide the juries with reliable, unbiased, and very timely expert opinion. And I'm joined today by Attorney Stephanie Frankowicz, the founder of Blind Review.

How are you today, Steph?

Stephanie: I'm great, Alex. Thank you so much for inviting me to be on your podcast. It's, this is terrific.

Aleks: You are the first lawyer on the podcast. Congratulations. Congratulations. 

Stephanie: That's so great. I don't know what, how your audience is going to feel about it. [00:02:00] They might be just like taking a collective groan oh, a lawyer.

Aleks:  Well, I think after they hear what we're going to talk about they're going to be pretty intrigued like I was when we talked the first time, but let's start with you.

Stephanie's Background and Legal Career

Tell me about your background and your journey to starting blind review and what blind review is.

Stephanie: Big question. Okay. So first of all, I am an attorney.

I have devoted my entire legal career to defending physicians. So 23 years, I have defended all specialties of doctors and health care providers, taken many cases to trial argued in front of juries and everything that in, that goes with that. I've been honored in my career being ranked by my peers as a super lawyer, best lawyer in 2023.

I received the [00:03:00] honor of Best Med Mal Defense Lawyer in Cincinnati, and also Top 25 Women Lawyers in Cincinnati. So that was a great milestone in my career. 

Aleks: Congratulations on this. 

Stephanie: Thank you, I appreciate it. I have a passion for defending physician…

Aleks: How did you, how did you start depending on physicians? Is it like a subspecialty you can do in law school or how does that, how did you enter that path? 

Stephanie: Unlike physicians when they do their, residency or fellowship training. Really, in law school, you're getting a generalized law degree, and you sort of pick your path after, and maybe, it may be just as simple as, oh, I got hired by this firm, and this firm needs attorneys in this area of practice, and so that how, that might be how you end up.

Now, [00:03:00]  I had a friend who was a MedMal defense lawyer. Who, needed help when I was in law school, he needed a clerk, somebody to help him do research and whatnot. And so I started clerking for him while I was in law school. And then when I graduated and passed the bar, he offered me a position.

And so, yeah I, it’s MedMal Defense, a boutique law firm. I later became a partner in that firm and just a great group of people practicing throughout the state of Ohio and throughout the state of Kentucky. So yeah. 

Aleks: You became so you became a partner in that practice, but you're no longer with this practice, right? You're doing a full-time blind review.

Stephanie: That's exactly right.

The Concept and Challenges of Blind Review

In, I think it was 2023, actually 2022 is when there [00:05:00] came the groundwork of an impending decision that I needed to make about whether I was going to invest more in the firm or make a change. And I had this idea of blind review for years based on a seminar I had attended years back in Vegas.

Where this attorney who defended radiologists described how he would set up a blind review and he had to go through all these intricate processes to set this up, sent out, but the process was very laborious and the problem with it is once he used an expert, he could never use that expert again because they would know when they would see a letter come in, they would know, Oh, this is the attorney who hired me before.

So it had some drawbacks to, to the system, [00:06:00] but I was fascinated with it. And I came back to my firm. I was so excited and spoke to my mentor about it. And he was like, yeah, this is a great idea. It's a great idea. And we just couldn't figure out a way to really implement it, on a wide scale basis with efficiency and regularity.

And also, you know the problem of you can never use experts again once you use them. And, you learn which experts are good on the stand and if they're responsive to your emails. All those things matter. If they can get their reports in on time. These are all things we consider when we're thinking about experts we want to work with.

And so if you're constantly getting new experts that you have no experience in, it's not really ideal.

Aleks; Yes, I think it's very important in the U.S. Law system, justice system, because [00:07:00] you have the jury. I come from Poland. We don't really have that. And here it's basically convincing the jury, so the confidence and the way the expert presents everything matters as much as, their real medical expertise.

So just one step back for those unfamiliar what is blind review and why is it important specifically in pathology or pathology as well? It's probably important in all medical specialties. And can you say like okay, what was, how was it done before and how is it done with a blind review?

Stephanie: Right, so anyways, tying together my decision point with the firm and I had always tried this blind review and I could never figure out a way to do it while staying in the firm. [00:08:00] So I came to this decision point where if I don't do this now, it's not ever going to happen and am I going to regret it?

I made that very difficult decision to leave my law firm and I started blind review.

Blind Review in Practice

And so the way the process works normally without blind review, if I, I'm defending a case, I will reach out to an expert, say Dr. Smith, and Dr. Smith, I'd like you to review this case for me. Oh what's it about?

It's about a pathology diagnosis. And, we'd like you to review the case. They know already that it's from a defense attorney. They know, I, I'm hoping that they're going to be able to defend the care. And then when I send them the records, they know the outcome. Now we tried to hide it somewhat.

We have, we would do packet [00:09:00] one and packet two. Don't open packet two until you finish packet one. But I'll always, I would get on the phone with these experts and they would have already opened up packet two. It's Oh, the cat's out of the bag, right? They know what happened in the case.

And it impacts, whether you think it or not, it impacts an expert's opinion. It impacts bias because if you know the ending of a case,

Aleks: Yeah, you're basically taking pieces, putting pieces together the outcome.

Stephanie: Exactly. If you know the patient died after a colonoscopy, then you're going to look back.

And say, okay, where, what happened here? Where did that, where did it go wrong? Instead of not knowing the patient died and you're just evaluating the colonoscopy on its own. [00:10:00] That's a whole different thing. And it's also a whole different thing. If you don't know if it's the plaintiff or the defendant who's hired you.

So blind, a blind review hides all of that information. When I contact an expert on behalf of a client, they get contacted from me, not from the law firm. And I'm asking them, can you review this case? I don't tell them anything about the case other than let's say I reached out to an anesthesiologist.

There's this anesthesiologist case in Ohio. Can you review it? And they answer yes or no. And then if they answer yes, I do some vetting with them as far as their qualifications and whatnot. But then they get access through my web application to the case.

Aleks: And you are not the lawyer in the case anymore, right?

You're just like an intermediary. [00:11:00] You're main goal and like mission is to find those experts for the cases.

Stephanie: Well, I don't even, I will find experts for the case. If a lawyer wants to hire me in that way, I can do, but most of the time they know the experts that they want to work with. They have their own process.

Aleks: Their own process.

Stephanie: Exactly. So they would give me maybe, Hey, I want you to contact Dr. Smith. Okay. I contact Dr. Smith, but Dr. Smith doesn't know.

Aleks: That it's a law firm that asked you to contact him for his expertise.

Stephanie: Exactly. He has no idea whether he's worked with this firm before, whether they're plaintiff or defense, because the goal is an objective opinion, completely objective without hindsight bias.

And the only way to accomplish that is to hide all of that information. [00:12:00] And you take the way my application works, I can take the experts step by step, by step through the care, and they have to answer the question each step of the way. So let's say step one is day one in an admission. I ask the question, did this doctor meet the standard of care, yes or no?

And they have to answer electronically, and once they answer, they get a chance to correct it if they've made a mistake. But once it. They answer that and confirm the answer, it's locked in, only then are day two's records released. So they can't access day two's care until they answer the question on day one if the doctor met the standard of care or not.

Aleks: So they are not looking for holes anymore in the whole process. They are kind in the shoes of whoever was the physician for that case and asking themselves, Okay, would I as an [00:13:00] expert make the same decision, yes or no? And would I do something differently?

Stephanie: Absolutely, a hundred percent. It is, Blind Review's mission is to place the expert into the shoes of the treating physician as closely as we possibly can.

And, when you have radiology or pathology, all specialties You can do that by the way put in the record, and you don't allow them to see what's coming next, what's coming around the corner, and so they have to give an objective opinion not swayed by, oh, if this is a defendant that's hired me, then I need to give them a positive opinion.

Not that you would do that. I don't think experts would do that consciously say you know, they try to, they approach these cases with integrity, I believe, but you have this [00:14:00] bias that's going on… 

Aleks: It's theological. It's when you know something, there is confirmation bias. There is like pathways in your brain activated that want to confirm the information that you have.

And it's like across the board neurobiology of humans. So, you know that you can consciously counter that, but, you knoe, there is I wouldn't say a gray zone, but no clear answer where you can, where your bias is going to unconsciously weigh in.

Stephanie: That's it. It's unconscious. And here's an example of a case a couple of years ago, it involved gastro, a gastroenterologist, and this patient had, had 11 EGDs prior to leading up to the subject EGD that was, that was the focus of the [00:15:00] litigation. On the 12th EGD, this patient in post op aspirated and then he got pneumonia and unfortunately passed away.

So it was tragic, a tragic case. And I attended the trial because I had a witness. who was going to testify in that trial? So I was there to sort of usher that process through. And plaintiff's expert was on the stand and the defense attorney was cross-examining him and said, how did you review the case?

They sent me the records. Okay. So you knew this patient died when you reviewed the case. Yes. I knew the patient died and I knew they aspirated. When I was reviewing the case, but I reviewed it in an objective manner. Okay? [00:16:00] He's saying he reviewed it in an objective manner, but he knows the case is from the plaintiff.  He knows the patient aspirated on the 12th EGD, and he knows the patient died from the aspiration.

Aleks: There's no way of objectivity.

Stephanie: The point is, had that been a blind review case. Here's how that would have gone. Step one. The first EGD was this EGD indicated, was it done with a standard within the standard of care, yes or no?

Okay. You answer that question.

Step two, number two, number three, number four. The fourth. EVG, EGD. The fifth. EGD. All the way you're taking him through the care… 

Aleks: Twelve is a lot. But at some point, he would have said that's enough EGDs. How about we do some other diagnostic?

Stephanie: I rated through [00:17:00] periods of years.

It was through a period of, 10 to 15 years, you know, and this guy, obviously, he had, he had issues and it needed to be done because the expert ultimately was not critical of any of the EGDs leading up to the 12th one. But suddenly on the 12th one He knew… 

Aleks: He started picking up… 

Stephanie: It wasn't indicated and you should have known this, and you should have known that and no.

So blind review would've been excellent in that case because it would have hidden the fact that the patient aspirated in the post-op care because it just would've been judging. What did the gastroenterologist do during the procedure? Judge that care alone. It's revealed about the post op aspiration [00:18:00] and the care involving that.

So it would have, I believe, would have been an excellent case for blind review. Yeah. Because you've completely removed that hindsight bias.

Yeah. 

Aleks: Interesting. Yeah.

Digital Pathology and Collaboration with PathPresenter

This you can do, for all specialties pathology, radiology, they involve images, and I know you started collaborating with PathPresenter to present the pathology cases.

And you even come up with the idea to partner with PathPresenter. How did you know about them? How did you know about digital pathology? Did you know this existed before because you worked with radiologists? Tell me this story, how you came across digital pathology as a tool to enable you blind reviews and, pathology is probably part of a [00:19:00] lot of medical cases.

Stephanie: Absolutely, a lot of medical cases involve pathology, even if pathologists aren't the ones sued.

There's more often than not a pathology component of the case, either in a surgical biopsy or whatever, autopsy, whatever. Pathologists are involved a lot in the case, cases. I had no idea about digital pathology.

Zero, one, I'd never heard of it before.

Aleks: It's not surprising to me. That's my mission to tell everybody about this. And let me tell you, even in the medical community, this is not that like widespread idea. Everybody knows radiology is digital, but not everybody knows pathology. So I don't blame you.

It's okay. Yeah.

Stephanie: Yeah. So somehow, one day I was just, I was, I don't even know how I got the idea in my head to think about, you have radiology, In doing a radiology blind review, [00:20:00] you know I have a system, a PAC system, set up for the radiology aspect of blind reviews. And I just thought how, let me look into pathology because pathology is notoriously cumbersome in the legal world because we have to deal with these glass slides.

And they're a total pain, completely inefficient. If you're a defendant, so first of all, the slides have to be mailed to the plaintiff's lawyer. Plaintiff's lawyer has the slides. He or she has to mail them back and forth to their experts to review. So the slides are going back and forth. Then we request the slides.

They have to send them to us, and then we have to send them back and forth to the various experts that we're having review. Then if there's a co defendant, which is typically the case, then they get the slides, they send it back and forth, mailing these glass slides all over. 

Aleks: How many people are going to be [00:21:00] looking at those slides?

Stephanie: It could be, Imean, I mean 10 to 15 pathologists, it could be, depending on the case.

Aleks: So it's let's say one week per pathologist to get the slides and review if you're, we're super, super optimistic. Okay. It's 15 weeks. No, we're not that optimistic.

Stephanie: No, one week. No, forget it. It doesn't happen because the experts are busy.

They're working and so they can't just drop everything to review your case. No, that's not, and then you have to set up the phone call with them to review. Hey, what's, what do you see? What's, please explain this to me. And, you're dealing with the schedules back and forth of trying to get the call done and, And then when they ship the slides back, gee, did they take the pictures that they should have taken of the right slide that are going to be an issue in the trial?

And it's just a logistic nightmare is what it is. And so, yeah, [00:22:00] it's not fun. So I was researching and I came across, unbelievably came across digital pathology at Ohio State University.

Aleks: They are a super strong group.

Stephanie: Oh, super strong. And so I was all over, I thought, digital pathology. This is brilliant. And so I was all over their website. I was watching all their videos. They have some really funny videos on there about it.

Aleks: Yeah, I had some, I had two of the members there as guests on my podcast, Dr. Anil Karwani and Dr. Giovanni Lohan.

And I know what video you're talking about. I need to find it and put it in the show notes here because it's hilarious.

Stephanie: Comparing the two, the old way, and then the digital pathology way, and I just cracked up, so, [00:23:00] now I'm going to reach out to David Kilo, who is I forget exactly his position there, but he was on the website, and I emailed him a really detailed email saying, just basically my idea about using digital pathology, incorporating digital pathology, into blind review so that the legal community could also receive the benefits that the digital pathology community was already receiving from these, the efficiencies and the benefits of it.

Well, I was so excited when he responded to me and he, he had forwarded the email to Ryan Bingham, who's just a rock star at the digital pathology lab there at Ohio State. He and I started talking and, which led me to PathPresenter, [00:24:00] because Ohio State uses PathPresenter, and so then I looked at PathPresenter, read everything I could about them, as well as other formats that you could view digital slides but I reached out to, on their, just on their website.

Their contact page and I sent them an inquiry and I got a response from Patrick Miles, their CEO the same day. And I was just super excited about it. And we set up a call set up a zoom call. And I was so excited when I got onto the call and Dr. Singh, who is a co-founder and also Corey, who's a co-founder, were also on the call.

And it was [00:25:00] just great. And so we just talked everything through, they were excited about the process or the prospecting with blind review and being able to deliver digital pathology to the legal community through, through their platform. And so we talked through a lot of technical issues and whatnot, and just kept moving forward and it's just been a great collaboration.

Aleks: So yeah, I did have Raj Singh, the founder of Path Presenter on my podcast when they were very beginning. It was just for presentations. And recently when like I don't know, they have an application for everything and now they work with you to do the blind reviews.

Which is amazing. So how is the workflow? Like, how do you incorporate it with Path Presenter?

Stephanie: So with Path Presenter, you have Path Presenter who has the platform to you, for you to view the slides, but you have to have somebody digitize the slides. So I have an agreement with [00:26:00] Ohio State.

It means the digital, their digital pathology lab where they digitize all of the glass slides, all of the blind review glass slides. So we have a process where. Basically, the attorney will send the slides to Ohio State. They digitize it and they immediately insert it into the Blind Review Path Presenter platform.

So all that 

Aleks: So it's a one time sending. That's it.

Eliminating Pathologist Barriers

Like we eliminated all the between pathologists. I don't know how many like it's a year of sending slides when you calculate that.

Stephanie: It's been eliminated. And now.

Collaborative Tools for Attorneys

Yeah, and even attorneys can collaborate within the case. If they want to do some cost-sharing, they can.

And every, each attorney would get their own account for their own experts to view the slides. Which it's all protected where you're not [00:27:00] seeing what other people are doing and whatnot. So it's, you can collaborate that way. And everybody has access to the slides 24 hours a day. Unlimited, you can have unlimited experts access it if you're moving through expert witnesses and yeah, it's just fantastic.

Path Presenter Features and Benefits

And so with Path Presenter…

Aleks: You can take pictures, you can do screen sharing and make sure everything is there for the case.

Stephanie: Oh, it's amazing. It's amazing. The ease in which you can, and I think of it in terms of an attorney, how am I going to prepare for trial?

Simplifying Legal Preparations

I need great pictures to put into my presentations, to my opening statement, to my closing argument, to my direct examinations and cross examination, and I need to be able to have that at any time.

And so PathPresenter just saves [00:28:00] attorneys so much time and headache. And the experts as well, because they can just literally select something, click.

Annotation and Expert Collaboration

Aleks: Yeah, there's like a button, you can click the picture button and it takes a screenshot or whatever you can make annotations, you can make arrows, whatever, because I assume this is a challenge because well, I know it's a challenge because if you as a non pathologist needs pathology, need pathology pictures that you are showing you're already familiar with the case and what's in those pictures, you're showing it to juries who have zero idea what's on the pathology picture.

They might have an idea like a normal average patient may understand radiology a little bit. But I don't think anybody understands pathology who's not. In the field.

Stephanie: No, then that, that is absolutely true. And I don't care how many pathology cases I've done in my career. I still need instruct, I need instruction for every single case [00:29:00] because as every case is unique.

And my job as an attorney is to bring it down to a level that jurors can understand and they can understand it quickly.

They've got to make a decision.. 

Aleks: Based on this information… 

Stephanie: Really soon about, and it's got a lot of information to absorb and PathPresenter is just a seamless way to do that. And I love the fact that you brought up the annotation aspect of it because I need taught by the expert.

So when we collect, one of the frustrations of the old way of doing things is you can't see the slides. Or, they didn't take the pictures of the slides that you wanted them to take, or whatever, and it's just hard. To collaborate in that way, where Path Presenter [00:30:00] makes it super easy. They can, you can just annotate and right there.

And what about this? What does this mean? And yes, it's just fantastic. And I love the fact that the gross specimens are also just loaded right there with the case. 

Aleks: You can upload that too, of course. 

Stephanie: Yeah. 

Aleks: And I imagine it's for you like you have your objectives to prepare for the case. The doctor, the pathologist is reviewing from a like very expert point of view.

If you're not with them, hearing them talk about this, you don't know which information is necessary to extract for your case. Whereas when he walks you through it on the image, you know which information you're going to take and show it to the juries. So then you basically like with this platform, you build a bridge between those two professions and before it was like totally siloed pathologists doing their job, as best as they can, but they do not understand your objectives. [00:31:00]

You may not really tell them the objectives, but you can extract them when you have a conversation.

Stephanie: Absolutely. Absolutely. And it's just such a great way to do it. And, when you talk about objectives, like if as a defense attorney, my objective is to defend my client's care.

So experts, as you know can differ in their opinions.

It just is a fact. So PathPresenter allows me greater access to multiple pathology expert opinions like that. It's just fantastic. And they're great. They're great. They're just a great group of people yeah, I really love working with them.

Blind Review Process

Aleks: So technically, we started the law firm sends the images to Ohio State, they're getting [00:32:00] scanned, what's the rest of the setup?

How do you set it up, a blind, how do you set up a blind review for a pathology case? Like from start to finish.

Stephanie: When I receive, so when a client reaches out to me and says I need a pathology review and they give me the name of the expert or they say I want you to find an expert, first of all, I reach out to that expert and vet them for the case without telling them anything about what the case is about or who is hiring them.

Once they agree to do the case, so we send the slides, I have the defense lawyer or plaintiff's lawyer, whoever is my client, send the slides to Ohio State. Ohio State does their thing and puts it into PathPresenter. Once it's into PathPresenter, there are two ways that the expert can access those slides, [00:33:00] depending on the strategy of the case.

They can access it through my web application, Blind Review. And it's just a simple, they get a secure login, they log into the system, they have their case listed there, they simply click on a button, and it takes them directly, seamlessly, right into Path Presenter to the exact case that we're talking about.

The slides pop up immediately for them to start reviewing. So it's, it couldn't be a better experience for the expert because it's so easy to do. Now, in some cases, I may not want to send them through my blind review application. If I don't want to send them through the blind review application, I can simply give them a login for the blind review PathPresenter platform, and they would log in directly to the PathPresenter platform and evaluate the case from there.

So there's two, two ways that we can accomplish that for [00:34:00] them. And then, depending on the client's desire, if they want them to dictate a report, I have them dictate a report. The report is then sent to the client who has hired me, and then after that once the report is done and sent to the client, I make an introduction between the client, the attorney, and the expert, and then I'm out of the case at that point.

I have nothing else to do with it. They take over and go from there. So yeah, that's how it works from start to finish.

Aleks: So you're totally like the person enabling this process. Absolutely. This is amazing. And I didn't even think about that you can like have the slides and have a separate pathologist dictate the report and then compare the reports.

Like totally. As if it was happening in parallel, amazing. [00:35:00] I’m so happy that digital pathology is bringing value to like, not only like to patients, but to the doctors as well.

Absolutely. And you raise a great point about in parallel, being able to draft a report. They look at the slide, they draft a report.

Here's the thing that I'm focused on now, and I'm hoping your audience. can help me get there.

Future Vision for Blind Review

So here's a future, here's a dream for Blind Review. Okay. I call it the gold standard. The gold standard blind review for pathology is to have an agreement with a pathology group where I can insert the slides into their daily workflow.

So and they just read the slides [00:36:00] within their daily workflow, then. They don't even know it's a legal case. I've taken even more bias away, because if I contact an expert, they know there's a legal case, right? And I, I can't eliminate that, except for a couple of specialties.

One is radiology, and two is digital pathology. But you have to have that partnership with private groups or academia. To be able to insert those slides into the workflow, the work list of one of the pathologists on staff who has agreed ahead of time they want to do expert witness work. Does that make sense?

You wouldn't just insert it into anybody's work list. They would have to say, hey, I do want to do expert work. But when it's inserted, they don't know on a day-to-day [00:37:00] basis when they're drafting reports on what they see. I have no idea it's a legal case. I call that the gold standard blind review. And again, you can't do that.

You cannot accomplish a gold standard with hospitalists, anesthesiologists, neurosurgery, any of those other specialties. You can't do it because there's no digital… 

Aleks: That is true.

Stephanie: …environment where they just practice within that digital environment. Like radiology, like pathology. So I'm looking for companies who have the vision to say, I'd be a part of this process of bringing this to the legal community for the benefit of physicians and for plaintiffs.

Because it benefits both. 

Aleks: This is amazing. And you might have get some messages after this podcast because [00:38:00] I cannot speak for my guests, but I have had several guests from practices that are like totally digital or digitally enabled, where I think they would be open. I'm not going to mention them.

Stephanie: Okay. Okay.

Aleks: I'm going to send you the podcast episodes.

Stephanie: That'd be great. That'd be great. I would love that. So yeah, so that's my vision, in taking this to the next level. Once I can, get those collaborations in place. And yeah I would love for your community to think about their own companies and their own situations and leaders in academia to say, we've brought digital pathology to academia against all odds, right?

They have a lot of hurdles that they have to jump through any practice, but academia, a lot more hurdles to go through. I'm advocating for, [00:39:00] let's take it another step further, when a lot of your people are already acting as expert witnesses, let's help them be better experts.

Aleks: This is a non, this is a point C. I recently published a video advantages and disadvantages of digital pathology. And I did not include this as an advantage. I need to redo the video, but definitely some like an additional benefit. And I'm like discovering as I read papers, there's, as I like talk to people and I'm, and immersed in this pathology AI space.

Stephanie: Yeah.

Aleks: You forget that there is also an outside world that can benefit from this. And to us outside world are the patients, but this, the doctors [00:40:00] from the outside world. I don't know how to put it together, but basically it is like tentacles of digital pathology going into the world.  And I love it. I'm so excited. 

Stephanie: Yeah. Yeah. It's super exciting. Yeah. 

Aleks: Yes. So if there was somebody who wanted to work with you on this, where do they find you Steph? 

Stephanie: So my website is, Blindreview.com follow me on LinkedIn, follow my page, Blind Review Corporate Company page on LinkedIn, or my email is very easy, steph, S T E P H at blindreview.com. And I would love to hear from pathologists who  are interested in being experts or who are already experts, but want to work with Blind Review, I would love for them to send me their CV, their fee schedule, and I will help any doctor who wants [00:41:00] to explore being an expert, I would love to talk with them about it, and if there's any interest out there in some kind of training in how to be a great expert, I would love to hear that feedback to see if that is something that doctor would be interested in having access to because I'm thinking about that type of training.

That it would be really beneficial.

Aleks: I'm going to be sharing this with all my digital pathology trailblazers that are subscribed to my newsletter. So I'm going to distribute this as much as I can. I'm also going to include all the links to your pages and your email address in the show notes. Question, how does the use of blind review affect legal cases outcomes for both plaintiffs and defendants?

Impact of Blind Review on Legal Outcomes

Stephanie: That is a great question. There has been researched on this very issue combined comparing the impact of a blinded [00:42:00] expert versus a non-blinded expert in jury trials in, in, it was a mock juries and what was so staggering about the evidence from this clinical study was that the use of a blinded expert against a non blinded resulted in a doubling of the odds of a favorable verdict on either side, whether you were plaintiff or defense.

If you're the one that had the blinded expert against the other side who had the traditional non-blinded expert, you doubled your chances of winning the verdict that you wanted to have. And It also greatly impacted the amount of damages that were awarded in the verdicts by $163, 000 increased for the plaintiff, [00:43:00] or if you were a defendant and you still lost the trial, you say your verdict against you was $163, 000 less than comparing the baseline between two non-blinded experts, which is the traditional method, right?

And so it's just incredible, and it makes sense, it makes intuitive sense that a jury is going to trust a blinded expert against a non-blinded. When you have that expert on the stand and say, Doctor, did you know, when you reviewed this case, did you know who hired you? No. So you don't know whether I was a plaintiff or defendant.

No. Did you know that the patient died of cancer, from this misdiagnosis? No, I didn't know any of that. Okay, so you just reviewed the case, and you reviewed it step by step. Now let's look at step one, [00:44:00] and you take them through that against a non-blinded expert who was, knew the outcome of the case, knew who they were being hired for, and all of the things, and could allow, after acquired information, influence their opinion on whether the doctor met the standard of care or not.

It's a no brainer that juries trust blinded experts, and I actually, my last trial, I was able to pull off a blind review. I had it up two years earlier, and when I got in front of the jury, I put up Lady Justice right behind me here, and she has her blindfold on. And I asked the potential jurors, why is Lady Justice blindfolded?

And they, of course, gave me the answers you would expect because she wants to be fair. He doesn't want to look at it. No, she doesn't want to be [00:45:00] biased. All of those things, juror after juror. And when I presented my case, and I had the only blinded expert in the case, I had a unanimous defense verdict.

And it was a tough case. It was a very sympathetic case. A gentleman died, left behind five kids and a wife. It was very sympathetic case, but I won with a unanimous verdict and I'm convinced it's because I had implemented a blind review. So that was my test for my company. Is this actually going to work?

And it worked great. And so the other benefit, which research also supports, when you have a blinded expert against a non-blinded, The baseline credibility of the blinded expert increases, but it also causes the baseline credibility of the [00:46:00] non-blinded to decrease, which is super powerful. And another interesting aspect was both sides of the aisle.

Spend thousands of dollars for expert witnesses in these cases because experts deserve to be paid. They're taking time out of their practice and whatnot. I've, nobody has any issues with that. But when you have two non blinded experts, what do juries do in the actual jury room during deliberations?

There was a study done about it. It found that if you had two non blinded experts, the jury discounted both of them as hired guns. And didn't even discuss their..

Aleks: Basically wasted your money. 

Stehanie: A 100%. But when one side had a blinded expert against a non blinded, every jury discuss the differences between the [00:47:00] non, the blinded and the non blinded and, this guy was the non blind is a hired gun.

Yeah. But this other expert was blinded. He or she didn't know, and they talk about it. So that when you get, you basically get a ticket into the jury deliberation room and they actually discuss. your expert and what they bring to the table. Otherwise, no hired guns, no.

Aleks: Nobody cares about the expertise, which is unfair to the case, unfair to the expert unfair to whoever is paying for this. So when I hear things like that, and you also said, oh, it's a no brainer.

To me, it's like, why is it not mandatory? Like, why do you even allow non blinded? Especially with if you read any of the legal novels that are taking part in the happening in the U. S. This is the [00:48:00] main thing. You want to try to manipulate the case the way so that they believe you, and you hire this expert and that expert and all this stuff.

And I'm like, you can just eliminate it by mandating blindly. 

Stephanie: Absolutely. And, I don't, do I think that will ever happen? No, I don't. And because the law. Has their way of, their way of doing things and I don't think that would change.

Aleks: So has medicine. 

Stephanie: But, to the clients who hire blind review, they gain a massive competitive advantage in their case.

And they bring to the jury an integrity that cannot be matched by the other side. And jurors reward that. Because if you talk to any person on the street and you talk about blind review, they always ask me, isn't this already done? Isn't this how you guys do it already? No, it's not [00:49:00] how they do it.

So it's no wonder they discount experts on both sides as hired guns, because come on, it's they know what's fair and blinded experts hit juries with total fairness and integrity. So I'm excited to bring an impact. To the legal community to help plaintiffs defense whoever, whoever wants to take this path.

I'm happy to help. So I'm excited.

Empowering Physicians and Legal Fairness

Aleks: You know what I also love, and this is decades with like different new technologies that Okay, like you said, law has their own way and every aspect of life, every like regulated space has their own way. You as the [00:50:00] user or as the like participant of this space, you cannot really influence those ways.

But with this consumer or defendant or somebody who sued, whatever, whoever is taking part in this legal process, you can actually opt-out for something that is going to give you the power back. And you say that law has its own ways, medicine has its own ways. Every aspect of life, especially when if it’s somehow regulated has so-called their own ways and a normal person cannot really influence those ways at that level. We cannot influence those decisions, but indirectly by using those new methods like blind review, leveraging digital pathology for this, leveraging [00:51:00] the benefits that blind experts give. We basically introduce it from the, I will call it consumer.

I don't really know what words you use in the legal process, but you basically can introduce this thing that I just said, Oh, it should be mandated. It will never be mandated, but I can put it in there for my benefit. And, lawyers can put it in there for the benefits of their clients.

Stephanie: Absolutely. And I'd love the, for the word to get out to physicians, that this is available. 

Aleks: Oh, yes. 

Stephanie: This is available for you. And if you, when you are sued, because most, every physician gets sued at some point in their career, understand that this is out here for you. It's out here for plaintiffs as well.

I will not reject a plaintiff case. If plaintiffs want blind review, absolutely. I'm not taking either side. Physicians need to know this is [00:52:00] available because it's the fairest way to have their care measured, right? The standard of care, which is the legal definition, okay, which is how you're judged in a case, is, did this doctor do what was reasonable?

Under the circumstances. Okay, did they meet the standard care? Did they approach this patient in a reasonable way under the circumstances? And so the only way to really test that the fairest way to test it is to put the expert into the shoes of that treating physician through a blinded process. Because otherwise, you're not in their shoes completely.

You already know all this other information that they didn't know at the time. They had no idea what was going to happen around the corner. So [00:53:00] it's the fairest way, and I just want doctors to know about it, so that they can advocate for themselves and say, Hey, I want my case reviewed by blind review. And it can also be done in a peer review context.

And maybe there's some political situation going on in your hospital and you feel targeted or whatnot. Blind review can also step in to help in those scenarios. So yeah.

Aleks: This is amazing. I think Steph it has the potential to change this like aspect of care where physicians are being guided by the fear of not being accused of something.

I don't know what these things are, but it's like American society is a very religious society. This is what guides a lot of decisions. This is a little bit different than in Europe. So yeah, I [00:54:00] think introducing such a tool gives back power to people to, to do their best. 

Stephanie: Exactly, yeah, exactly. 

Aleks: Thank you so much. Thank you so much for introducing me to this. I'm definitely super enthusiastic and you know,  it's digital pathology is my favorite thing and I'm like, okay, this is the new thing that digital pathology can do. Let me talk about it. so much for joining me today. 

Stephanie: Well, I appreciate it so much, Alex. Thank you so much for inviting me on your podcast and yeah, its been a joy, so thank you so much!

Aleks: You have a wonderful day, Steph. 

Stephanie: Thank you. You too.

Aleks: Thank you so much for staying till the end. It means you are a true digital pathology trailblazer. I found this episode so interesting because often we are so focused on our expertise and we contribute within our expertise, but then, you realize that in this case, in case of digital pathology, the digital [00:55:00] pathology expertise can help so many more people than just the pathologists and their patients because pathology is the gateway to treatment.

This is the point of diagnosis. And in this case, you can make the legal system more fair by implementing digital pathology. also, if you want to learn more about how to be an expert witness, feel free to reach out to Stephanie. She's going to be more than happy to help you.