THE SCIENCE OF CASE RECORDS REVIEW: FAR BEYOND APPLYING A FINE-TOOTHED COMB
By Saul B. Wilen, M.D. and Jack M. Marden, J.D.

The learning objective and outcome are to understand the spectrum of facts, data, and information that constitute a case record, and be able to identify the framework process for characterizing, integrating, analyzing, and interpreting these constituents.

The assertion “the record speaks for itself” is an indisputable, basic truth.  However, what constitutes the case record is the imperative question.  The complexities of interactions, issues, and disputes have resulted in the widening of definitions and the proliferation of sources that impact interpretations.  There is more information at all levels of reliability, stored in more places, and accessible in more ways than ever before.  All of these sources can and do play a significant role in expanding the traditional definition of a case record.  Ready access to this information further complicates the process. 

Case records requiring forensic consideration and analysis in the 21^st century encompass the widest variety of disciplines from anthropology, medicine, and economics through metallurgy, social policy, and water quality.  The principles of informatics (the study of information) raise the following questions: What is out there?   How can it be retrieved?   What do you do with it once you have it?  How do you assess its validity?  The answers to these questions can be found by applying the principles in a system that provides comprehensive and reliable tools to evaluate the case record existing in any discipline.

The initial process element of this science is the determination and enumeration of the case record constituents.  This element establishes the expanse of the playing field. The second process element requires the clear statement and understanding of the issue or issues involved in the case.  During the review process it is important to be receptive to new and unforeseen points and issues.  The next element requires the identification and application of the appropriate analysis tools.  Methodologies exist that incorporate varying sensitivities and specificities.  Each methodology has one or more specific ranges of applicability including fields and time frames.  Significant among these are horizontal analysis, best-fit analysis, strategic analysis, internal record verifications and inconsistencies, external documentation corroborations and contradictions, applied algorithm, validity analysis, outcomes assessment, statistical analysis modalities, and appropriateness evaluation.  These constitute reliable tools that contribute unique insights that can be applied individually or in combination with other methodologies in the framework process review.  Fourth, historical perspectives in many instances add a dimension that contributes to the interpretation of significance and validity.  Once the appropriate tools are identified, their systematic application to the case record comprises the fifth process element.  This allows for an assessment of the record content with the identification of the pertinent facts, data, and information while maximizing their value.  The final process element incorporates a synthesis of the information resulting in analysis of its meaning relative to the issue(s) of the case.  The reviewer must be able to translate the findings, opinions, and conclusions into language that can be readily understood by those who will utilize this information in decision-making.

The forensic specialist/expert has responsibilities in this review process including ethical considerations, judgment, and a role of leadership.  Gandhi stated this role clearly in his thoughts on leadership.  “In a free society, support for a decision is dependent on confidence in the integrity of the process and the individuals who participate in the process.”  Forensic specialists are the ethical and sophisticated suppliers of information and expert testimony through presentation of the relevant information, answering the questions posed, and supporting validity.  These specialists/experts are judged by the validity of their information and the company they keep.