Dr. Barry Gustin - Medical-Legal Expert Services

Dr. 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

Bacteria has a proclivity for finding any medium that can support its growth.  That includes the gel that is used by ultrasonographers to perform routine ultrasounds.  Normally the skin acts as a decent barrier against microbials but not always.  Staphylococcal organisms have a tendency to find their way through the skin barrier and can cause superficial or deep skin infections.  Sterile technique and good habits are necessary to prevent contamination of these biologic media.  The following report details the recently discovered contamination of ultrasound gel:

Opiates are prescribed regularly by physicians in all medical specialities for pain.  Patients frequently request opiates from their physicians when they are in pain.  Recent studies show a trend of increasing prescriptions.  Opiates, when taken in excess, or when they are taken on a regular basis, create addiction, by causing tolerance, that phenomenon where increasing doses of the medication are necessary to ameliorate the pain.  Opiate addiction increases the risk of overdose and death.  Opiate-related overdose and death has increased dramatically over the past few years, and now surpasses deaths from heroin and cocaine combined.  Physicans may be in violation of acceptable standards of practice by excessive prescribing and poor pain management practices.  The following study compares the use and abuse of opiate pain relievers by State.

The following is a noteworthy article appearing in the Journal of Emergency Medicine, volume 41, issue 6, 2011.  Emergency physicians who have not had an opportunity to read it will find it helpful to their practice.  Because emergency medicine is a high risk speciality with regards to malpractice litigation, most emergency physicians adjust their practice so as to avoid situations that could lead to a medical malpractice lawsuit.  Moreover, most ER physicians live with a certain sense of unease because of the uncertainty and unpredictability of the emergency room environment, and the perception that it is just a matter of time before some adverse outcome leads to a lawsuit.  Read the article in its entirety.

With increasing frequency over the past 2 years, emergency departments have witnessed a sharp spike in visits related to energy drinks especially amongst teenagers.  These drinks are high in caffeine, sugar, and other herbal stimulants.  When combined with alcohol or illicit drugs, overdoses occur.  Read the article explaining the sharp increase of cases as well as the problems associated with this particular type of overdose.

There are ways to deal with such encounters in which you work with the angry patient and guide them through their emotions, and the accompanying volatility, to the point where it is possible to have a constructive, or at least manageable discussion with them.

Recently the DEA took emergency action to ban for one year bath salts that are composed of PABS, methylenedioxypyrovalerone, which is structurally and toxicologically related to pyrovalerone and a-pyrrolidinophenone compounds that inhibit norepinephrine-dopamine reuptake and act as central nervous system stimulants.  These salts are deadly, and are sold under the brand names:  Ivory Wave and Vanilla Sky.

Users take it orally, intranasally, intravenously, or rectally and achieve a high that is similar to methamphetamine.  It enhances alertness, increases energy, and is an aphrodisiac.  On the street, it is being called "legal cocaine".  

Doses as low as 3-5 mg will produce an effect.  The average dose ranges from 5 to 20 mg, and the risk for overdose is high because packages contain up to 500 mg.  In fact, it was the increase in overdose, emergency room visits, and death that prompted the DEA to take action.  Orally, absorption is rapid, and the rush (euphoria) that is produced peaks at 1-2 hours after ingestion, and the total effect lasts about 3-4 hours.

The physical effects of PABS include tachycardia, hypertension, arrhythmias, hyperthermia, seizures, stroke, myocardial infarction, and even death. Behavioral and mental effects include panic attacks, anxiety, paranoia, hallucinations, psychosis, aggressive or violent behavior (such as self-mutilation, suicide attempts, and homicidal activity), insomnia, anorexia, and depression.

Emergency treatment consists of benzodiazepams for sedation and IV fluids to prevent hypercatabolic rhabdomyolysis.  Metabolic acidosis, if present, is treated in the usual manner.

Click Here:  to obtain the New England Journal of Medicine article in PDF format

Can you imagine a vaccine that would eliminate smoking, cocaine, methamphetamine, heroin or opiate use?  Researchers are tantalizingly close to developing a vaccine that would permanently block those receptors that when stimulated by these and other substances of abuse provide the addictive euphoric and mind-altering effects.

Addicts would no longer be able to use and enjoy the effects of the substances they abuse.  The research is being headed by Dr. Janda at Scripps Research Institute.

To read the full NY Times article:  Click Here

According to the American Medical Association, more than 42% of physicians have been sued for medical malpractice over their careers, and more than 20% were sued at least twice.  What causes medical malpractice lawsuits, and how can they be prevented?

Most physicians are taken by surprise when they received a summons alleging that their negligence had injured or killed a patient. Most assume that although the patient was injured they would not be sued.  Other might have lost the patient in follow-up and had no idea that anything was wrong until they were sued.  In other cases, physician who are sued might not have even seen the patient.  Rather, they may have been consulted in a brief phone call.

In other instances, physicians who were surprised by a lawsuit should have seen it coming. They missed that in the context of an unexpected adverse health outcome, their patient was unhappy.  Many are oblivious to how patients were lost in follow-up or how their own behavior may have provoked the lawsuit.