Anesthesiology and pain medicine review, grounded in active clinical practice.
I am a board-certified anesthesiologist and pain medicine physician in full-time academic practice. I review medical records, prepare written reports, and provide deposition and trial testimony in matters involving anesthesia care, perioperative management, and the treatment of acute and chronic pain.
Adlai Pappy, MD, MBA · Department of Anesthesiology, Perioperative & Pain Medicine · Harvard-affiliated academic medical center, Boston · Currently accepting new matters · Inquiries answered within one business day
Case types within my clinical practice
I accept engagements only in areas where I hold current clinical experience and board certification. If your matter falls outside these areas, I will say so on the first call and, where I can, point you toward the right specialty.
Anesthesia & Perioperative Care
Intraoperative management, airway events, monitoring, medication administration, and perioperative complications across surgical settings.
Chronic Pain Management
Opioid prescribing and monitoring, multimodal analgesia, interventional pain procedures, and longitudinal management of chronic pain conditions.
Interventional Procedures & Targeted Drug Delivery
Spinal injections, neuromodulation, and intrathecal drug delivery systems, including patient selection, technique, and post-procedure care.
Complex Regional Pain Syndrome (CRPS)
Diagnosis, causation questions, and treatment of CRPS following injury or surgery, an area of frequent dispute in personal injury litigation.
Billing, Coding & Documentation
Review of anesthesia and pain medicine billing practices, CPT coding, and clinical documentation, informed by peer-reviewed survey research in this area.
Treatment Reasonableness & Necessity
Assessment of whether pain-related care following an injury was reasonable, necessary, and causally related, for personal injury and workers' compensation matters.
Qualifications
Full CV, including education, appointments, publications, and prior testimony history, is available on request.
Clinical & Academic
- Board-certified in Anesthesiology and Pain Medicine
- Full-time faculty, Department of Anesthesiology, Perioperative & Pain Medicine at a Harvard-affiliated academic medical center
- Active clinical practice in the operating room and pain clinic
- Peer-reviewed research on pain medicine practice patterns and physician billing knowledge
Forensic Practice
- Available to plaintiff and defense counsel
- Record review, written reports prepared to a reasonable degree of medical certainty, deposition, and trial testimony
- MD and MBA training, with experience translating clinical detail for non-medical audiences
- Conflict check completed before any substantive case discussion
How I evaluate a case
"My opinion is the same regardless of which side retains me. The record determines the conclusion."
Independent review. I form opinions from the medical record, imaging, testimony, and the relevant literature, and I document the basis for each conclusion. Where the record does not support an opinion to a reasonable degree of medical certainty, I say so, before a retention deepens rather than after.
Accepted methodology. My analysis follows the same standards I apply in clinical practice and peer-reviewed research: identification of the applicable standard of care, systematic review of the records against it, and consideration of alternative explanations before reaching a conclusion.
Clear communication. Reports are written in plain language for judges and juries, with technical terms defined and every factual statement traceable to its source in the record.
Candor with counsel. If a case has weaknesses, counsel hears about them early. An honest early assessment serves clients better than a favorable opinion that cannot withstand cross-examination.
What to expect, from first call to testimony
Initial call & conflict check
A brief conversation about the general nature of the matter, the key questions, and timelines, followed by a conflict-of-interest check before any substantive materials are shared.
Retention
A written retention agreement setting out scope, hourly rates, and retainer. My CV and fee schedule are provided at this stage.
Record review
Systematic review of all provided records with a documented log of materials received and reviewed. If materials appear incomplete, I identify what is missing and request it.
Preliminary opinion
An oral report of initial findings, including any limitations of the available record, so counsel can make an informed decision before a written report is prepared.
Written report
Where requested, a written report stating opinions to a reasonable degree of medical certainty, with the factual basis, methodology, and materials relied upon set out explicitly.
Deposition & trial
Availability for deposition and trial testimony, prepared in coordination with counsel's schedule.
Fee structure
Discuss a case
The fastest way to reach me is by email. A useful first message includes the case type, jurisdiction, party names for the conflict check, and any operative deadlines — please hold confidential case details until the conflict check is complete.