Monday, January 28, 2013

Dentists, Playa del Carmen, Mexico, Coral Dental Center

I had seen a dentist in Canada and had a temporary filling put in a lower molar. He said I'd need a root canal and crown. My temporary filling came out while I was at a medical conference. I attended Dr. Marco Laguna, Endodoncia at Coral Dental Center in down town Playa Del Carmen on Riviera Maya. Alvarez and 25. 984 803 1622. The offices are on the 3rd floor above a pharmacy across from the Bancomer Bank. The waiting room was clean with recent magazines and one with Shania Twain on the cover. The receptionist was attractive and friendly. She took the appropriate information and spoke English well.
Dr. Marco Laguna is a handsome intelligent professional man who instilled confidence as  took a careful history, performed an examination, did an X-ray, and discussed my options. His English is excellent. He then performed a 'pain free" root canal. Then he took a follow up X-ray showing me his splendid work. 
I was then booked for an appointment with Dra. Mayra Miranda, Odontologia estetica. She is a tall beautiful intelligent young woman with a sense of humour and excellent English. Whereas Dr. Marco Laguna worked quietly, Dra. Mayra Miranda chatted pleasantly with her helpful staff during the procedures. Both approaches were calming and reassuring.
Dr. Mayra Miranada is also in Coral Dental Center where it seemed there were a couple of more dentists working as well. They had at least three, maybe four modern dental surgical suites with several staff in addition to reception. All were sensitive to my concerns.
Dr. Mayra Miranda saw me initially to build a core, make casts and put in a temporary crown. I returned for another short visit when she removed the temporary crown and installed the permanent ceramic crown. My bite and appearance are just fine.
The cost was at about a half what I would have paid in Canada. Frankly, I enjoyed not losing time from work and especially liked recuperating in the sun on the beach. I would thoroughly recommend Coral Dental Center to anyone who needs dental work while they're in Playa Del Carmen. I am very thankful. Both doctors spoke fluent Spanish as well.DSCN0957

Sunday, January 27, 2013

Cenote Chac Mool, Mexico, January 2013, Cave Diving

Cenote Chac Mool
Lois Gerardo Bonilla Cepeda
+52 9848064931

I love scuba diving and have advanced and rescue PADI. I started my dive master course but sinusitis interrupted that.  Having once dove every couple of weeks I'm now lucky if I dive every year so make a point of going alone with an experienced divemaster.  It had been almost a year since I dived last so was absolutely delighted to dive with Luis Gerardo Bonilla Cepeda. I'm 60.  Geraldo dives with all ages, has been cave diving for 10 years, has lots of older divers, his oldest being 84. I've cave dived before in great deep ocean caverns down tunnels accompanied by sharks. Chac Mool is a whole lot nicer with lots of the grandeur and thankfully no sharks.  It's all stalagmites and fascinating Yucatan Peninsula geology. Relatively shallow dives in fresh water and friendly catfish. Incredible views. We started out in a shallow pool, almost like having a pool dive before the main dive. When I gave the o sign I was okay we descended deeper into first the open cave with just a little canopy effect. Incredible. The second dive was the  the Chac Mool, each cave having it's own Mayan name. This was a great second dive. It's real enclosed cave diving but no great distance. We went down through a passage following the rope and then came up in a large air pocket with light coming down from above along the roots of trees. The great tree roots were simply too remarkable. I'd never had this experience, coming up into a cave above the water. We talked about ecology and the Mayans and all sorts of thing before dropping down again to explore more of the incredible stalagmites. A group of divers were following along behind us so though we doddled we couldn't stay in the air pocket for ever.    What a tremendous experience though. I'd recommend this dive with Gerardo to anyone. I was also delighted with the pictures an underwater cameraman (Ivan Ayala Palacios - NACD#170) took and sold to me later. These a some of the many he took. There were also movies and a gallery with maps of the caves.
Bill and Geraldo Scuba Chac Mool IAP00173 IAP00184" width="460" height="259" /> IAP00194 IAP00190 Bill GeraldoScuba

Saturday, January 26, 2013

Playa Del Carmen, Mexico, January 26, 2013

I'm just uploading some more pictures from my morning wandering around the beach at Playa del Carmen near downtown. The beaches have a lot of beauty here. I had huevo rancheros on the strip before heading up town and catching a taxi back to the Iberostar Paraiso Maya resort. A turtle resides in a pond in the middle of the Iberostar resort. It likes being massaged by the bubbling fountain water. I booked a late afternoon swim with dolphins. Our very helpful Best Day travel agent who works with Westjet Travels,  booked my swim with the dolphins. There are some pretty photogenic iguanas on the walk. Delphinous has their own photographers which was good. My hands were full swimming, stroking and holding on to the dolphin. Tonight there is a beautiful full moon. DSCN1054
IMG 2522

Delphinus, Swimming With Dolphins, Mexico, 2013

I really really enjoyed this. The female bottlenosed dolphin's name was Kaan which means "sky" in the original native Mexican language. I was swimming with the dolphins, pushed through the water by dolphins, had dolphins jumping over me, playing with dolphins and even got kissed by KAAN. Sailing I've been surrounded by dolphins as far as the eye can sea travelling off the Mexican coast. I always seem to be joined by dolphins near the San Juan Islands and often in the Strait. I've even had dolphins swimming about me when I was night scuba diving. That truly was exciting but this was simply wonderful. CD1 CD2

Playa Del Carmen, Mexico

My scuba diving was cancelled today because of wind and rain in the morning. Near noon, the rain stopped and the sun came out.  I went into town for a meeting and met Rick from Connecticut. We had lunch while he regaled me with tales of his experiences which included touring Stepping Stones. After he pointed me in the direction of the beach and said "There's even a Starbuck's." I'd not been in this part of town, the truly tourist Cancun like experience. Of course I had to buy a Harley Davidson T Shirt. A half dozen young men offered to sell me ganja, while one offered coke, then women, when I said no to the drugs. Meanwhile every vendor called out to me on the street much like the Arab bazaars. Everything was there from the finest products to tourist schlock. It's just that I'm fairly blessed in life, and all I thought of was missing Gilbert, my cockapoo, seeing all the little dogs accompanying owners. At Starbucks, the Americano really was good.  Though I didn't connect to wifi it was the one place it seemed everyone felt safe with a laptop out. I suspect if I came again and wasn't going to a resort like this Iberostar I'd stay in one of the many hotels within a block of the beach. I love sitting in an outdoor cafe writing and watching people. DSCN1045 DSCN1041 DSCN1043 IMG 2493 IMG 2494 IMG 2497 IMG 2499 DSCN1048 DSCN1009 DSCN1010

Friday, January 25, 2013

Expert Witness from the perspective of the judge, TLABC Medical Legal Conference, Mexico, 2013

The following is from the rough notes I took at the Trial Lawyers of British Columbia Medical Legal Conference in Playa Del Carmen, Mexico, 2012.  The Hon. Marion Allen, having served 24 years as a judge was obviously an expert herself on expert testimony.  Even by Mohan standards she was well qualified to be the keynote speaker at this conference. What was immediately obvious was her intimate knowledge of the English language and the way she chose her words, conveying maximum meaning with minimum waste. She was also very amusing, sharing anecdotes about her own career with honest humility.  Hon. Marion Allen is a marvellous presenter.  

Experts are expected to be experts in their area of expertise, she said. The expert must understand that he has a duty to assist the court - rule 11 6.
She clarified the "Expert's duty of neutrality", going on to say, experts will be considered more neutral if they work both for defendants and plaintiffs.
Family doctors are more often subjective and objective and the judges will sometimes make allowances for the fact they are the family doctor.  It is understood this is different from a doctor doing an IME.

The expert's has a duty of full disclosure
- there is no room in court for any dishonesty or lack of full disclosure

She went on to describe the  test for science versus junk science
-discussion of 'motion capture' technique tool admissability - judicial level of reliability - and opposing views presented and discussed . This case was chosen because it was so 'close to the line'.

To this end, she recommended strongly that lawyers reread Mohan when considering introduction of leading edge technology.

She then went on to discuss at length what she called were  "really, really" bad reports quoting a fellow judge who'd described  one such engineering 'expert'  report as  'so foggy to confuse gobblygoop"

One medical report, she described  contained no statement of qualification. In another report the medical expert said a woman couldn't return to work because of an injury  she suffered  at work but knew nothing about the MVA that was subject of the trial, 
She said that the lawyer had  screwed up that badly, letting that get to the court.

Another Medical expert  had simply catalogued the complaints but offered no opinion

Her recommendations to the expert were as follows:
- don't be arrogant 
- cross examination is adversarial - remain objective and don't be offended - expect to be vigorously cross examined.  
- doctors insist on professional independence - resist pressure to make statements with which you are uncomfortable - lawyers are advocates for their clients - an expert must stand firm giving a neutral position on the facts
- make sure you know where the trial will be held
- I realize that doctors are busy but it's recommended that a doctor pop into a public trial and hear a portion of a personal injury trial if they have been retained and are going to be an expert witness for the first time
- speak slowly so the judge can write. It is up to counsel also to keep an eye on judge to ensure the expert isn't speaking too quickly.
-speak up, the acoustics of courts in BC are not that could be desired.
-for lawyers - call the plaintiff first unless there is a good reason not to- the plaintiff's version serves as  the skeleton for the judge in hearing the rest of the trial.
- get expert reports before the courts
- ensure judge or jury understands the expert's reports

Expert Opinion or Advocacy, TLABC Medical-Legal Conference, Mexico, 2013

These are my rough notes from the Trial Lawyers Association of British Columbia Medical Legal Conference. Hopefully they give an idea of the presentation which I suspect could be accessed in fuller detail from the presenter or the TLABC itself.  Obviously, if one is interested they should seriously consider attending a future TLABC conference.  I've found them extremely informative and likely to help me serve my patients whose illness involves them legal dispute. Lesra Martin was a naturally talented teacher and made lucid what at first appeared obtuse and obscure. I'm sorry my notes don't do justice to his wonderful presentation.

Invisible Line in the Sand: Expert Opinion or Advocacy
Lesra N Martin, Martin and Martin Lawyers, Kamloops, BC
Graduated University of Toronto, and Law Degree from Dalhousie University
Was Crown Prosecutor in Kamloops, BC now practices primarily personal injury

TLABC Medical-Legal Conference, Mexico , 2013

Last week attended conference by Dr. O Shaughnassey, Psychiatric and Psychological Aspects, then Hon. Peter Wilson, presented 
- I thought they'd leaked my talk to them but instead I will summarize what they said and add to what I said, but this told me the role of the expert was a central issue

When I hired an expert I get reply
"dr x assumed the role of an advocate"
"Dr. X has provided opinions that go beyond the scope of his area of expertise"

"The report is speculative and argumentative"

When I talk to the family physician he responds "i'm an advocate for my client, and he is expected to be an advocate for his client". There is a clear difference between being an advocate for the client and having a report declared inadmissable 

Principles of law
Supreme Court of canada
- relevance
-necessity in assissting the trier of fact
-absence of any exclusionary rules
-a properly qualified expert
-RV Mohan 1994 
paragraph 16-8 issue of relevance is a qustion of law it is role of the trial judge to conduct a cost/benefit analysis.  
paragraph 19-22 - expert opinion must be necessary ---in regard to whether or not the information provided falls outside the knowledge and expertise of the jury.

Courts caution experts about dx of malingering 

Must be properly qualified expert

R.v Abbey 2009 ONCA
-refined Mohan criteria - in stage 1 , expert must be properly qualified
- trial judge is the gatekeeper - insure that the expert is relevant 'prior' to judge deciding jury may hear the expert

Expert opinion for his or her opinion
Description of any research done to perform their opinion
List of documents that formed opinion 

2010 Mazur
expert is required to state facts and assumptions
rule 11-6  expands under old rule  - know the basis of decision

Avoiding common pitfalls
- They must not become advocates , but express their opinion in objective and impartial way and not present argument
It's not the experts role to look for collaborating evidence in the documents.  it is not the role of expert to draw inference and making editorial comments

Medical Experts should be abreast of current academic literature and maintain certification.  
Encouraged lawyers to seek experts who are leaders in the field not just available

Exclusionary rules - Mohan - 
-expert has met all the requirements set out under Mohan
- it may not be that 'credentials' are sufficient, must also have specific expertise

Mock Trial, TLABC Medical Legal Conference 11, Playa Del Carmen, Mexico, 2013

IMG 2481The mock trial was a piece de resistance. What a marvellous teaching tool. In a light hearted comedy about an obviously serious and tragic subject, the participants exposed the main errors that the conference itself had been addressing. Seeing them played out before us was extremely elucidating as well as unsettling. I confess I saw my own errors, as a treating clinician, in those of the family physician Dr. Goodman's 'report. Mr. Justice Preston, playing himself, the Judge, gave an Oscar winning performance alone for witticism and repartee, especially with the brilliant if dubious defence attorney, Terrence Robertson QC, who acted on behalf of Dumb E. Driver. IMG 2483The court recorder, playing herself, and using a romance novel, had the experts sworn in. IMG 2482The exchanges between Mark Frobb, playing Dr. Goodman, and Terrence Robertson were reminiscent of the high art of English parliamentary banter. It was positively 'droll' and I can't recall another time I've heard such amusing debate as to characterize it with this adjective. Danielle Daroux, the plaintiff, "Paula Passenger's attorney, was reminiscent of the lawyer performances of Glen Close as she literally disembowelled the testimony of Dr. Bones, the arthropod expert, played by Stanley Leete, clearly caught wiIMG 2485th his medical knickers in an embarrassingly major twist. Stanley Leete's performance of wide eyed innocence caused the audience to break out with spontaneous applause. Judge Preston increased the disruption sternly castigating us, the audience, for our unruly behaviour. Beth Inglis, playing the OT expert witness was so amusing as she answered any direct questions with cute cupidity,tangents and jargon. IMG 2487Douglas Lee, playing the psychologist, "Ima Testing" sounded really very erudite with only occasional lapses into high comedy being examined by Danielle Dareux, until Terrence Robertson guilefully discredited most everything he had said. What was educational though was observing Dr. Lee attempting to maintain professional and scientific neutrality as hard as that was in the artfulness of this particular court. In later summing up and discussion lead by Justice Marion Allen the key 'take home' issues regarding expert testimony were reviewed.
  IMG 2488

Thursday, January 24, 2013

Horseback Riding with Rancho Baaxal, Maroma Beach, Playa del Carmen

I have just returned from horseback riding on Maroma Beach. Olimpo, who also teaches horse jumping, was my guide. India was my horse. Because of rain the other rider coming down from Cancun backed out, leaving me to go alone with Olimpo, a handsome young Mexican with military bearing.

Grandad had a ranch, my uncle lived his life as a cowboy and my cousin raised Appaloosas. I rode a lot as a young man. One of my fondest memories is a week in Saskatoon with my Dad when I was 16. He took me riding a couple of times with his cowboy and cowgirl friends. They were all wild and I had a great time, mostly being with my Dad and his friends. Later I'd marry a woman who rode English. I never rode but to stay on a horse so could only admire her comfort in the saddle. I introduced her to my Mount Currie friend Wayne Andrews, World Indian Broncho champion. That was nearly 20 years ago. We had some fun times riding with Wayne, doing "man from snowy river'downhill, racing across moonlit fields, riding bare back through ponds. She loved every minute whereas frankly I was really just glad to survive being along. Since then I've ridden only once a year, if that, sometimes a lone, sometimes with a group.

It's 2 years now since I was trail riding in Tucson, Arizona.This was just that at first. Great horses. Great guide. Beautiful trail. Jungle all around. Then we came out on the beach. Spectacular. Olimpo turned to me and said, "this is my office". Some office! A little blue sky with lots of white clouds, green foliage meeting the white sand then aquamrine water. Beauty everywhere.

What I didn't know was India thinks like a race horse. My retired jockey friend, Jim, will be impressed when I describe in detail to him how suddenly the horse was prancing(and probably why all ranches the world over have you sign a waiver). There's a couple football field beach run. The horses like to gallop here. With India prancing sideways, I asked Olimpo, "Does he smell oats or something?" Olimpo responded, "This is where we let the horses gallop if you want."

I'm getting old. But what the heck. I gave India a little rein and off we went not like the proverbial freight train, but more like a jumbo jet. I was bouncing a bit, standing on the stirrups too. None of that jockey over the neck of the horse pose. When India let loose I was lucky I wasn't back out flying over the tail. I actually stayed in the saddle thanks to a combination of prayer and terror.

At the end Olimpo who'd been riding alongside just a little behind me, said, "If you want we can gallop back." I don't know that I really wanted too. I was still thanking Jesus.

India however was gung ho to have another go. Now this time I think he had my measure. India wanted to run and run and run. That's just what he did. Faster and faster and faster! I was shouting 'whoa' and trying to remember what whoa was in Spanish. There was absolutely no time to consult a dictionary. At the end of this run, India slowed and literally grinned back at me, with a "ney" I'm sure said, "I knew you could do it."

That's when Olimpo told me, "India likes to run. He's really fast, isn't he?" No kidding. I was thinking Hadron Collider fast.

I'd circled the level 'moderate experience but not ridden lately'. I must remember to put 'novice' next time. I'm sure was glad I didn't say I had moderate recent experience or claimed to be 'an expert'. This was just enough for me. I can't remember going that fast on a horse since I was 20, back when I had more confidence than brains.

I told Olimpo I'd done more cantering than galloping in recent years. He thought I held on well. Then he said, "Most horses walk, canter and gallop, but India only likes to walk and gallop". Now I know what Harley Davidson was aiming  for when they designed my motorcycle..

We stopped on the beach for soda and snacks. Big beaked pelicans that were sitting in the water every once in a while took off to circle, scouting for fish. A sailboat was anchored down aways just off the beach. The horses had a breather. Dark clouds rolled in. We mounted again.

Now as we rode back to the stables the skies opened up. I had my jacket and hat on but Olimpo and the horses thought nothing of the warm rain. Back at the tack shop the main concern was to get the saddles off the horses so the leather was under cover. The horses were glad to join their half dozen or more horse compatriots.

I had a spectacular time. My friend Anil told me how much he and his daughter enjoyed beach riding and now I get to tell him I understand. Nothing like it.

Horseback Riding with Rancho Baaxal Maroma Beach, Playa del Carmen 77710, Mexico 1-984-145-8962

My assistant, Hannah arranged everything over the internet. Thank you Hannah. Now I can say, "Yo estoy vaquero, Me llama es John Wayne!" DSCN0655 DSCN0657 DSCN0661 DSCN0664 DSCN0665 DSCN0668 DSCN0669 DSCN0671 DSCN0670 DSCN1034 DSCN1038 DSCN1040