Dr. Allison Muller:
What are the weaknesses of my case? Because you better believe the other side and their expert is going to figure that out and the attorney has to be ready with their strategies.
Chris Dreyer:
Welcome to Personal Injury Mastermind. I'm your host, Chris Dreyer, founder and CEO of Rankings.io, the legal marketing company the best firms hire when they want the rankings traffic in cases other law firm marketing agencies can't deliver. In September, we wrapped up the first ever PIM conference, and I want to say a huge thank you to all the incredible speakers and everyone who came. Seeing this podcast come to life was amazing. Over the next few weeks we'll have some highlights from the conference that I'm excited to share with you. Until then, let's meet today's guest.
Today, we explore three critical areas that every PI attorney needs to understand: how leveraging toxicology expertise can uncover hidden angles in your cases. Why ongoing education in this field is crucial for staying ahead of the competition, and the art of translating complex scientific concepts in a language that resonates with juries.
To break it all down for us, we got the real heavy hitter in the house, Dr. Allison Muller. With over three decades in the game, including running a poison control center and now heading her own consulting firm, dr. Muller is the go-to expert for lawyers looking level up their drug and alcohol cases. Dr. Muller will walk us through each of those areas providing real world examples and actual insights you can start using immediately. So, whether you're handling a routine DUI or a complex medical malpractice case, get ready to gain a whole new perspective on the role of toxicology in personal injury law.
Dr. Allison Muller:
I was originally trained as a pharmacist and toxicology is one of many sub-specialties in pharmacy. And the Poison Control Center just happened to be almost next door to where I went to pharmacy school, and it was my essentially first job out of undergrad. I love the sub-specialty, and so as you summed up, fast-forward 30-plus years later, I'm not filling prescriptions, I wouldn't even consider myself a pharmacist even though I do have a pharmacy license. My specialty is toxicology, meaning all the bad things that drugs, both illicit and legitimate, can do to someone.
Chris Dreyer:
So, tell me about the transition to becoming an expert witness and getting associated on that side of the coin.
Dr. Allison Muller:
I mean, my whole focus as a toxicologist from the very beginning at the Poison Control Center and even at a drug information department at a major pharmaceutical company was teaching and educating people about the science of drugs and medications. And so, when I was at the Poison Control Center, I would time to time get calls from attorneys looking for a toxicologist to help them with their drug-related case, alcohol-related case, or case related to chemicals or environmental toxins. And what they were looking for essentially was someone to teach them the science of their case so they understand do I even have a viable case? And ultimately teach the triers of facts, so the judge and the jury, about the science of the case, so it makes sense for all involved to make the appropriate call on the case.
And so at that point, I was not in a position to take cases from attorneys. It wasn't smiled upon in my institution to take legal cases just to keep everything conflict free. And I also didn't have the time. I was running a busy Poison Control Center, but when I started my own consulting company, I just had my 10-year anniversary this past January.
Chris Dreyer:
Congrats.
Dr. Allison Muller:
I thought, "That is something that I would like to focus on." And so, I focus on doing expert witness work, but that's not where my teaching ends. I still teach pharmacology, toxicology at University of Pennsylvania and I still do medical education and pharmacy education.
Chris Dreyer:
Yeah. So, you're the principal owner of Acri Muller Consulting. Let's break that down. How do you assist attorneys in assessing cases from a toxicological perspective, especially for personal injury litigation? When would one of those individuals who would be the right fit contact you? And tell me a little bit about that.
Dr. Allison Muller:
Well, hopefully the attorney, and in many many cases it's a personal injury attorney, although it could be a criminal attorney or a prosecuting attorney as well as civil defense attorney, but a lot of them are personal injury attorneys, and so they're putting out their own coin for the case in many situations. In other words, they're taking the risk financially to decide is this a viable case or not? How much time, effort, and money am I going to put towards this case? And they are the legal experts, right?
So, we can't be a master of all trades, so to speak. Personal injury attorneys know the law, they know the ins and outs of trying these cases, but what they often lack, although I could probably count on one hand when I've actually worked with an attorney who has a science or medical background, but most of the time they don't and they want to know all that they can about the science of their case, in my case, the toxicology, so they can decide is this a viable case? And if they decide this is a viable case, "What are some of the strategies I can put together knowing not only the strengths of my case from a scientific point of view? Equally as important, what are the weaknesses of my case?" Because you better believe the other side and their expert is going to figure that out and the attorney has to be ready with their strategies to address those.
Chris Dreyer:
With toxicology, would that apply to things like the mass torts, like Ozempic and Mounjaro's talked a lot about, Suboxone, Paraquat, like are those in your lane or would you speak on behalf of those?
Dr. Allison Muller:
Oh, that's a really good springboard for what I'm about to describe. Say I'm a toxicologist, and specifically I'm a clinical toxicologist, so the focus of my toxicology practice and knowledge is in the assessment and care of poisoned patients, so the key word being patients. So in cases like mass tort, it may be somebody who's a pre-clinical toxicologist, meaning they understand all the toxicology data that went into getting a drug approved. Or let's say if it's a mass tort case and it's an environmental poison, there's an environmental toxicologist that would be on board.
So, when the question becomes: what does this drug do to people, how does it make them act? How does it make them feel? How does it make them think? And then being able to tie it to, "Well, what happened in this specific case?" To really bring it home for the triers of fact, that would be a clinical toxicologist or a medical toxicologist.
And the difference there is a medical toxicologist, is a doctor of medicine an MD or a DO, and I am a PharmD, a doctor of pharmacy, so you bring up suboxone. That is something that I come across in many of my cases because there's still this very troublesome opioid epidemic. Actually most of my post-mortem cases, meaning cases that led to death for one reason or another, whether it be an overdose or there was homicide and there were drugs found, the opioids are almost always coming up in these post-mortem cases. And Suboxone is used to try and treat opioid use disorder.
Chris Dreyer:
We've got some niche specialists like nursing home abuse attorneys, nursing neglect. Could you give me a couple specific situations that you've helped on?
Dr. Allison Muller:
Sure. So, I actually do a one-hour continuing legal education program on scenarios that would happen at a nursing home or some other setting where was there harm that was done to a patient because of a medication? And sometimes it's not so cut and dried. It might be the medication, but it might be other things. So, in the case of a nursing home, you have older adults, and unfortunately with age comes possibly multiple medical problems. And with multiple medical problems, you're on multiple medications.
So, an attorney might think, "Okay, well I want to see if this unexpected, unfortunate event that happened to this nursing home resident had to do with the long list of medications they were on." And perhaps the attorney is just going to say, "Well, let's look at dosages." So we have an old adage in toxicology: the dose makes the poison. And that's certainly true. Like anything depending on the quantity has the potential to be a poison, and drugs obviously being no exception, but that's only the starting point.
So, I'll give you some scenarios where there could be a medication misadventure, and it's not necessarily just because of the dose. It may be drug interactions. So, there's some drugs, even if the dose is on the lower side, they don't play well with each other. There's different levels of interactions from, "Okay, we're going to have this patient on these medications in combination, maybe something minor will happen." Or the other end of the spectrum is you never have these two drugs together, it could lead to serious toxicity if not death.
And other than the dose and the drug interactions there's also monitoring. I mean, one of the things that I learned very early on in my undergraduate program in pharmacy is being able to educate the patient because we are, they're monitoring the patient all the time. They have to know what to look for, what were they counseled about? And then what was the responsibility of the prescriber for follow-up, for monitoring? Maybe that means going in for laboratory testing, either drug levels, or some other testing to make sure that this person isn't being pushed over from the therapeutic range to an area that they can become toxic.
And then of course, there's just out-and-out errors. I've had cases where somebody gets the wrong drug completely. It was meant for bed A and this person was in bed B, or somebody next door, or just a misfill at the pharmacy where the names are similar. This is a battle that's always being fought in terms of patient safety to be able to make sure that the right patient gets the right drug, at the right time, at the right dose and the right combination, so there's a lot that goes into it.
Chris Dreyer:
It makes a ton of sense. A big percentage of our audience is auto accidents, motor vehicle-related. Individuals are getting injured in auto accidents. Have you had any situations like that? Could you give a hypothetical example of where a PI attorney may when a PI attorney may contact you in a scenario like a wrongful death from an auto accident?
Dr. Allison Muller:
A lot of my cases are also auto accidents and take out of the equation, the run-of-the-mill DUI related to alcohol or take that the equation. It may be a situation where somebody is given a prescription medication that may, what we call them, switch off some switches in their brains, meaning it's causing central nervous system depression. They get the prescription, they don't necessarily read the side of the bottle that says, "Do not operate heavy machinery or drive while take ..." Well, that doesn't mean that the person can't drive ever again, but it absolutely means that they shouldn't take the medication at 8:00 AM for the very first time and then get in the car right after. They need to know, it has to be some level of understanding how the drug is going to affect the person and the safety of doing so.
Now you might think, "Okay, well they take the medication, they get into an auto accident, they go to the emergency department, they get toxicology testing done. What do the drug levels mean?" That's a question that I get on many, many cases. It's a very common theme. What do the drug levels mean? Here's my take on that. If all you have is a drug level, all you have is a drug level because there's not many drugs where you could say, "Oh, if you have a level above this, then you were an impaired driver." Everybody wants all these drug levels to be as easy as interpreting alcohol levels, blood alcohol levels, and it's not. So, it may be an impaired driver from even a prescription medication.
What about marijuana? So, depending on the state that you're in, you may have marijuana, not legal at all, or it may be medicinal and or recreational. At least here in Pennsylvania, essentially a level of marijuana that you're allowed to have in your system while driving is nothing.
I mean, it's the one nanogram per mil. Somebody could have smoked last night and then they're driving today and they have a level over that amount. Does that mean they were impaired driver? Scientifically, no, but legally, yes. So, there's questions like that, what's the relevance of this level in terms of were they impaired or not?
Other type of auto accidents may not involve two cars. It may involve a car and a pedestrian. A pedestrian is hit by a car. The driver and/or the pedestrian has drugs in the system. Was it completely the driver's fault? Was the driver impaired? Was the pedestrian impaired? I mean, it takes two to cross the street, right? It's the driver, but it's also the pedestrian. Did the pedestrian have the wherewithal to know like, "Wait, I'm crossing in the middle of the street. I'm not in a crosswalk," may not be aware.
So, there's all these different scenarios. And then last but not least, when it comes to auto accidents, and depending on the state that you're in, you may have dram shop laws. So I've been retained on many dram shop cases, both on defense and on plaintiff side. And personal injury attorneys may be doing dram shop cases in terms of somebody went to an establishment that sells alcoholic beverages, whether it be a bar, a club, a restaurant, etc. And then they get in an auto accident and either they're injured their passengers or somebody else else. And then they had look at, well, was the establishment serving alcohol to somebody who was visibly impaired? And then that becomes a liquor liability question.
So, there's a lot of different scenarios surrounding driving, and it's not just the run of the mill. Did they have an alcohol level above the legal limit, because they can have an alcohol level below the legal limit, but if they have other drugs on board that alcohol level is now bolstered in terms of causing impairment and it's not even above the legal limit.
Chris Dreyer:
Knowing a case inside and out is important for an attorney to maximize the value. Where does hiring you as an expert witness? Obviously it helps for winning, right? You got to win, but how can it be a scenario where it can maximize the value of the case?
Dr. Allison Muller:
I say this in so many areas of my life, but knowledge is power. The more the attorney knows the science of their case, should there be drugs or alcohol in their case, the better that they understand it, the better that they can develop their strategy. Or maybe they're going to say, "This case really has no merit," it depends.
I have a lot of experience explaining very complicated scientific aspects of toxicology to the layperson. Lawyers are some of the most educated, intelligent people that I have ever interacted with, but they may not be scientists, so I need to dial it down. And when it comes to explaining the science to a jury, if I'm explaining it at the same level that I explain it to another healthcare provider, I'm going to lose them in the first five minutes. That's why I love to teach because when I feel that somebody really understands what I've explaining to them, and I get that practice because of years at the Poison Control Center explaining to parents or caregivers, laypeople that are really upset and they need to understand, "What's going on with my child, what's going on with my loved one after this drug exposure, poison exposure?" Whatever. So I have a lot of practice explaining in lay terms, lay to audiences that need that at that level.
Chris Dreyer:
So tell me about the continuing legal education programs and basically how you stay updated on toxicology and continuing your education in this space.
Dr. Allison Muller:
Yes, that's a great twofold education question. So in terms of keeping my skills current and my knowledge current, so I'm a Diplomat of the American Board of Applied Toxicology, that's my credentialing board for my toxicology certification. My pharmacist license is a whole other continued education piece of it that I maintain. There's a certain amount of continued education that I need to do specifically for toxicology, and I have to re-credential every five years for the American Board of Applied Toxicology, the ABAT.
And so, that doesn't involve just writing a check and filling out a form, there's a credentialing committee that goes through to see how much does Dr. Mueller teach? How much does she publish? How does she keep current? Because if you're not someone who's keeping current and active in the field, and that's a pretty broad definition in terms of how a clinical toxicologist is still active in the field of clinical toxicology. Only then am I going to be re-credentialed. I was, well not just, wow, it was 2020, so I'll be re-credentialing next year, actually. They don't make me take the 11-hour exam again, thank goodness. I do need to demonstrate that I am staying current and I have a panel of people that are looking to make sure that it happens.
In terms of continuing legal education and educating lawyers, I say I do continuing legal education programs all over the country thanks to virtual platforms. I'm able to do that. And so I do not charge for them for me to speak to a bar association, bar associations or looking for speakers that can really provide value to their members, and I get all types of attorneys that'll attend these programs. A lot of personal injury attorneys because my topics are very relevant to them. So, topics like my bread and butter talk is toxicology pearls for attorneys, and a lot of that has to do with the basics of drug testing and really understanding some key terminology without it being too dry. And some cases that I've managed that could really get attorneys thinking about, "Okay, how can this help me in a current or future drug or alcohol-related case?"
Some other topics I've mentioned, the medication, misadventures, postmortem, toxicology for attorneys. There's a lot of complex concepts when it comes to postmortem toxicology that I distill down for attorneys. I do a talk on drug facilitated sexual assault. That of course is mostly for criminal attorneys, but some of those cases then have a civil component to them later. And I do talks on specific drug classes and especially for personal injury attorneys, it would be of interest to them because there's one talk on marijuana and synthetic cannabinoids, the fake pot, another one on opioids. So those are just a few of the examples.
I have about seven talks that really the inspiration for those talks were: what are the questions that I get time and time again for attorneys, and then I turned it into a continuing legal education program. That's how I reach attorneys and they think, "Dr. Muller seems to know what she's talking about, and I can even understand her." So, I provide value for them in terms of the education and then they get their CLE credit. And then if they have a case coming up that I may be able to assist them with, assist them with as an educator, not as an advocate, that's not what an expert witness does, then we may connect on an actual case.
Chris Dreyer:
That's excellent. And I love the applied the feedback loop to then giving value and educating, using what you see and applying that to your education.
This has been amazing. I've learned a ton personally, so thank you for that. For the personal injury attorneys listening that want to get in touch and learn more about who you are and what you do, how can they get in touch with you?
Dr. Allison Muller:
If you just Google Allison Muller toxicologist, I'm going to light up like a Christmas tree, so you'll find me.
Chris Dreyer:
Thanks so much to Dr. Muller for her insights. Let's hit the takeaways. Bring in the right experts. Understanding the science behind drug and alcohol related cases can make or break your case. It's not just about blood alcohol content levels anymore, we're talking about prescription meds, drug interactions, marijuana, you name it. Bringing in a toxicology expert like Allison can help uncover angles you might have missed and build stronger, more compelling cases.
Dr. Allison Muller:
Personal injury attorneys know the law, they know the ins and outs of trying these cases, and they want to know all that they can about the science of their case. In my case, the toxicology, so they can decide is this a viable case? And if they decide this is a viable case, "What are some of the strategies I can put together? Knowing not only the strengths of my case from a scientific point of view, but equally as important, what are the weaknesses of my case?"
Chris Dreyer:
Knowledge is power. Look, I get it. You're busy by taking advantage of free CLE programs, especially ones focused on toxicology and drug related issues, it's a no-brainer. It's not just about the credits, it's about staying ahead of the curve. The more you understand these complex cases, the better equipped you'll be able to handle tough cases and get better results.
Dr. Allison Muller:
The more the attorney knows the science of their case, should there be drugs or alcohol in their case, the better that they understand it, the better that they can develop their strategy. Or maybe they're going to say, "This case really has no merit.:
Chris Dreyer:
KIS, keep it simple. Breaking down scientific concepts for judges and juries can make all the difference in the courtroom. Practicing explaining complex ideas in simple, relatable terms, it'll make you more effective and relatable as an advocate. Remember, you don't understand it well enough if you can't explain it simply.
Dr. Allison Muller:
And when it comes to explaining the science to a jury, if I'm explaining it at the same level that I'd explain it to another healthcare provider, I'm going to lose them in the first five minutes.
Chris Dreyer:
Huge thank you to Allison for coming on the show. For more information, check out the show notes. Before you go, do me a solid and smash that follow button to subscribe. I'd sincerely appreciate it, and you don't want to miss out on the next episode of Personal Injury Mastermind with me, Chris Dreyer, founder and CEO of Rankings.io. All right everybody, thanks for hanging out. See you next time. I'm out.
