Dr. Barry Gustin - Medical-Legal Expert Services

About Dr. Gustin

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Dr_Barry_GustinDr. Gustin is residency-trained and board-certified in Emergency Medicine and Forensic Medicine and has been actively practicing in the fields of Emergency Medicine, Toxicology, and Forensic Medicine for more than 25 years.  He has additional training and expertise in Medical, Occupational, and Environmental Toxicology and has Masters Degrees in Biochemistry, Metabolism and Nutrition, as well as Toxicology and Public Health. He is the primary founder of the American College of Forensic Medicine which currently has more than 2,000 members.

Dr. Gustin has reviewed thousands of medical malpractice, personal injury, criminal, and toxicology cases during his career.  Dr. Gustin also has substantial testimony experience as an expert witness.

You can access Dr. Gustin's medical-legal experience by requesting a FREE phone or email consultation now. To review all the Services he offers, please click here.

Dr. Gustin's education, training, and experience qualifies him to evaluate and testify regarding a broad range of cases, in the following medical and toxicology specialty areas:

  • Emergency Medicine, medical, surgical, pediatric
  • Emergency Medical Ambulance Services (EMS)
  • EMTALA
  • Trauma and Critical Care
  • Forensic Toxicology
  • Medical Toxicology and Poisoning (eg: accidental overdose, carbon monoxide poisoning, and all other product and drug exposures)
  • Occupational and Environmental Toxicology
  • Mechanisms and Forces of Injury in Criminal Cases
  • Substance Abuse and Drug Addiction (Drug and Alcohol, including DUI)
  • Electrical Injury
  • Pharmaceutical Medicine (Drug-Drug interactions, Drug-Disease Interactions, Overdose, Unsafe poorly tested Drugs, Adverse Drug Reactions)
  • Flight, Travel, and Wilderness Medicine
  • Hospital Malpractice
  • Public Health (eg: Legionnaire's Disease, Outbreak Diseases, Food Poisoning, and Waterborne Diseases)
  • Legal Medicine (standard of care, evidence-based causation, medical ethics)

His primary areas of specialization are Emergency Medicine and Toxicology.

A partial list of cases Dr. Gustin has consulted on include:  drugs of abuse including Methamphetamine, Cocaine, Opiates, and Alcohol, occupational chemical poisonings including toluene, benzene, isocyanates, other solvents, heavy metals including lead, carbon monoxide, and cyanide, occupational and travel-related infectious illness including Legionnaire's disease, MRSA, skin infections, bacterial enteritis, misdiagnosis and delayed treatments in the ER, civil rights cases, environmental exposure cases including contaminated water and sewage exposure.

Dr. Gustin's expert opinions will comply with ACEP (American College of Emergency Physicians) guidelines for Expert Witness Testimony: See: http://www.acep.org/practres.aspx?id=29446 ; the ACT (American College of Toxicology); and ACFE (American College of Forensic Examiners) Creed of Ethics.  See: http://www.acfei.com/about_acfei/creed/ 

Office: 2928 Derby Street, Berkeley, CA 94705
Tele: 510-549-1041
Fax: 510-549-3268
Email: Click here to email Dr. Gustin

 

Another Statin Side Effect

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Sunday, 28 December 2014 23:32

Statins are one of the most popular drugs.  They reduce serum lipids implicated in producing cardiac and vascular disease.  Statins have side effects and are well-known, such as liver disease and muscle pain.  Now a new side effect has been discovered.

Statin therapy significantly elevates the risk of developing cataracts severe enough to warrant surgery, suggests analyses of two distinct cohorts, one from Canada and another from the US.

For now, the possibility of such a risk from statins and its potential mechanisms should be explored in prospective trials, "especially in light of increased statin use for primary prevention of cardiovascular disease and the importance of acceptable vision in old age, when cardiovascular disease is common," according to the report, published in the December 2014 issue of the Canadian Journal of Cardiology with lead author Dr Stephanie J Wise (University of British Columbia, Vancouver).

"However, because the relative risk is low and because cataract surgery is effective and well tolerated, this association should be disclosed but not be considered a deterrent to use of statins when warranted for cardiovascular risk reduction," they write.

"For those of us who have prescribed high doses of statins for almost 3 decades, there is certainly no epidemic of cataracts among our longtime lipid-clinic patients," write Drs Steven E Gryn and Robert A Hegele (Western University, London, ON) in an accompanying editorial in the same journal.

"Nevertheless, if the findings of Wise et al are confirmed, physicians might need to factor in this potential risk when discussing statin use with patients," they continue. 

And, in patients at high CV risk, "the prevention of CVD, stroke, and their associated morbidity and mortality vastly outweighs the risk of cataracts. Even among lower-risk patients, for whom the benefit/risk ratio is less dramatic, most patients would still probably prefer having to undergo earlier non–life-threatening cataract surgery over suffering a major vascular event."

 

 

Breaking News: Dozens of Drugs to be Removed from the Market!

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Friday, 23 January 2015 19:49

A committee of the European Medicines Agency (EMA) has just a few days ago recommended suspending the sale of roughly four dozen generic drugs that are used for conditions including diabetes, depression, and hypertension because they noted that their approvals were based on flawed clinical studies conducted only in India. The US Food and Drug Administration (FDA) has not yet taken action on the issue.  But they are in the process of reviewing this issue now.

Familiar names of commonly prescribe drugs on the list include candesartan, donepezil, escitalopram, esomeprazole, and metformin. The list extends more than 120 pages because the drugs are marketed individually in multiple European Union (EU) nations in various dosages, and therefore appear over and over.

Abbott Laboratories, Actavis, Dr Reddy's Laboratories, Mylan Pharmaceuticals, Sandoz, and Takeda Pharmaceuticals are some of the many well-known manufacturers involved in this scandel.

The EMA recommendation to suspend the drugs would apply across the entire EU. Drug regulators in France, Germany, Belgium, and Luxembourg have already acted to stop the sales of 25 of these drugs.

The clinical studies in question were conducted by GVK Biosciences, a contract research organization in Hyderabad, India.

The recommendation of the EMA's Committee for Medicinal Products for Human Use to suspend the drugs was based on an independent French inspection of GVK Biosciences that revealed "data manipulations of electrocardiograms during the conduct of some studies of generic medicines," apparently over the course of at least 5 years. The systematic and prolonged nature of these manipulations and the number of staff involved "cast doubt" on the integrity of the trial methodology and the reliability of the data generated according to the EMA.

FDA Has Taken No Action After Its Own GVK Inspection

When queried the FDA said that some 40 drug applications received from 2007 to March 2012 contained GVK clinical data, and that some of these applications were approved.

The FDA declined to identify the drugs in question or indicate those that had been approved.

According to the FDA statement, the agency inspected GVK Biosciences in September 2014 on the heels of the French inspection in May 2014 and failed to find any evidence "that affects the safety or efficacy of drug products subject to pending applications or products approved in the US."

The agency promised to take "swift and appropriate action" to protect American consumers if it "identifies issues concerning GVK Biosciences that relate to products approved by the FDA."

Exceptions Can Be Made

The EMA investigation of drugs studied at GVK Biosciences encompassed more than 1000 individual generics in various forms and strengths as individually approved in 29 EU nations. Of this group, 300 generics had enough supporting clinical data from other sources to warrant staying on the market, according to the EMA.

That left roughly 700 generics — reiterations of the core four dozen or so drugs — that should be suspended, the EMA said. However, individual countries can make an exception for drugs that are critically important because there are no alternatives to meet patients' needs.

The EMA recommendation goes to the European Commission, the EU's executive agency, for a legally binding decision that will apply to all EU nations, including those that already have suspended the generics in question.

In the meantime, American physicians are waiting for the results of the independent FDA evaluation of this situation.  If the FDA concurs, then this will be the biggest debacle ever in U.S. pharmaceutical history.

Stay tuned!

 

Ecstasy Use Increases Dramatically

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Friday, 10 January 2014 23:00

As Emergency Departments swell while suffering the repercussions of the Affordable Healthcare Act, our nation's youth increase their use of mind-altering drugs, in particular, Ecstasy (Mollys).

The number of emergency department (ED) visits related to the use of Ecstasy (MDMA) (3,4-methylenedioxymethamphetamine) has increased by a staggering 128% in just 6 years, new research shows.

Also known as Ecstasy or Molly, a new report from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that MDMA-related visits among individuals younger than 21 years jumped from 4460 in 2005 to 10,176 in 2011.

In addition, 33% of ED visits involving MDMA use in this patient population also involved alcohol use.

"These findings raise concerns about the increase in popularity of this potentially harmful drug, especially in young people. Ecstasy is a street drug that can include other substances that can render it even more potentially harmful. We need to increase awareness about this drug's dangers and take other measures to prevent its use," Peter Delany, MD, SAMSHA's director of the Center for Behavioral Health and Statistics and Quality, said in a release.

MDMA has both stimulant and hallucinogenic properties. Although it is usually taken by mouth, it can also be snorted or smoked. The drug produces feelings of increased energy and euphoria and distorts users' sense and perception of time.

The report authors also note that the drug can produce a variety of negative health effects, including anxiety and confusion, that can last a week or longer. In addition, it has been associated with hypertension, as well as renal and cardiac failure.

The increase in this population is "a cause for concern due to the serious health risks involved with Ecstasy use and the higher potential for abuse when Ecstasy is mixed with alcohol," the report authors write.

The full report is available on the SAMSHA Web site.

 

Elevated Glucose in the ER

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Wednesday, 18 December 2013 11:13

Over the past few years advancements have been made in the approach to, and management of, elevated blood glucose.  In the emergency room, elevated blood glucose (hyperglycemia) is commonly encountered.  Often times, patients who present with unrelated problems are coincidentally found to have elevated blood glucose.  Many emergency physicians dismiss this finding as a chronic finding and therefore, do not investigate further.  But this is a mistake that often results in an adverse patient outcome, and later a medical-legal inquiry and possibly a medical malpractice lawsuit.

Elevated blood glucose can be a tip-off that there are serious metabolic abnormalites present.  A detailed investigation is warranted in the ER because many of these patients are asymptomatic and will not seek follow-up medical care until they become symptomatic, by which time their condition may be far advanced.  The following review article on the approach to hyperglycemia in the ER is current and represents the standard of care approach to these patients.

Read more... [Elevated Glucose in the ER]
 

FDA Revises AMBIEN guidelines

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Wednesday, 15 May 2013 16:49

Ambien is the most common sleeping medication at the present time.  Unfortunately, although Ambien is usually quite effective at facilitating sleep, it also has been found to have several disturbing side effects, including tolerance, addiction, and somambulism.  Recently the FDA has revised its dosing guidelines on how the medication should be used.  The news brief follows:

Read more... [FDA Revises AMBIEN guidelines]
 

Problems With Ambien

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Monday, 06 May 2013 15:59

Ambien (zolpidem) is currently the most commonly used sleeping medication on the market. Most physicians believe, unknowingly, that it can be prescribed with impunity.  This is not the case.  Ambien has many side effects that have resulted in a big increase in visits to emergency departments.

Read more... [Problems With Ambien]
 

Amitiza for Opioid-induced Constipation

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Tuesday, 30 April 2013 23:25

The FDA finally approved a new drug which ameliorates the severe constipation that accompanies the use of Opiates.  Constipation is one of the main side effects that causes individuals to stop Opiate medication prematurely without any other option for their pain.  This addition to treatment with opiates is a notable advancement.

Read more... [Amitiza for Opioid-induced Constipation]
 

Zithromax and Sudden Death

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Tuesday, 19 March 2013 17:50

At one time or another, most of us have taken the antibiotic, Zithromax.  It is one of the most commonly prescribed medications for conditions including bronchitis, pharyngitis, sinusitis, and others.  The discussion that follows has to do with Zithromax's side-effects, some of which are potentially life-threatening.  Recently, I have seen a case in my emergency room of sudden cardiac arrest secondary to the cardiac effects of Zithromax.  The FDA has recently warned of this phenomenon.

Read more... [Zithromax and Sudden Death]
 

2013 Review of Food Poisoning

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Wednesday, 30 January 2013 14:51

The following article on food poisoning and foodborne outbreak disease was obtained from a recent issue of emedicine #175569.  It is an overview that covers major topics and issues.  It does not address travel medicine.  But it would have direct relevance to community acquired disease, assessments for such diseases, and surveillance.

Read more... [2013 Review of Food Poisoning]
 

2013 Review of Food Poisoning

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Wednesday, 30 January 2013 14:51

The following article on food poisoning and foodborne outbreak disease was obtained from a recent issue of emedicine #175569.  It is an overview that covers major topics and issues.  It does not address travel medicine.  But it would have direct relevance to community acquired disease, assessments for such diseases, and surveillance.

Read more... [2013 Review of Food Poisoning]
 
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