Joshua Dumoch, PA-C Medicolegal Consulting
Emergency & Urgent Care Record Review

Know whether the case has merit before you pay for an expert.

I'm a practicing emergency medicine physician associate. For $750 flat, I review one ED or urgent care encounter and send you a written memo within 72 hours on how the care holds up and what's missing from the record.

The merit screen

$750flat, prepaid · 72-hour memo

One patient, one ED or urgent care encounter, up to 200 pages. Half the fee credits toward a full review if engaged within 60 days of the memo being delivered.

Read by someone who works the shift

Seventeen years in emergency departments and urgent care, currently lead PA at a Connecticut community emergency department. I read charts the way they were written, under the same time pressure.

PA and NP cases specifically

In many states the standard of care for a physician associate has to come from someone who actually knows PA practice. Scope, supervision, and escalation questions do not map cleanly onto a physician expert.

Why this exists

Most cases do not need a $4,000 expert review to answer a $750 question.

The question at intake is simple. Is there a standard-of-care problem here worth pursuing, or is this a bad outcome with defensible care? Answering it should not require retaining a full expert, waiting three weeks, and spending four figures before you know whether the file is worth anything.

The merit screen answers that question in a page or two, in 72 hours, for a fixed fee you know before you start.

A screen that always says yes is worthless to you and to me. If the case does not hold up, the memo will say so plainly, and it will tell you why.

That's what the flat fee is for. I get paid the same whether the chart supports a case or not, so nothing about the answer changes what I earn. The sample memo on this site shows what that looks like. It works through five documentation and standard-of-care problems, then spends a full section on why the case is weaker than those findings make it look, and it ends by recommending more records rather than a full review.

What I look for

The things that are usually missing from an ED chart

  • Reassessment after treatment. Whether anyone actually put hands on the patient again after the analgesia, and whether that recheck was charted.
  • Nursing notes against the physician note. These diverge more often than people expect, and the divergence is frequently the case.
  • Abnormal results that never reach the MDM. A flagged lab or vital that appears in the results and nowhere in the reasoning.
  • Exam findings that appear in one note and not the other. Focal tenderness documented by triage and absent from the physician exam.
  • Return precautions that are pure template. Generic discharge instructions where the specific risk was foreseeable.
  • The differential that was written but not worked. Listing a diagnosis is not the same as ruling it out.

Start with the conflict check

Send the party names and the facility. I run the conflict check the same day at no charge, before any case facts change hands.