How to Choose a Speech-Language Pathology Expert Witness (Forensic SLP)

What attorneys should look for when vetting a speech-language pathology expert witness, including credentials, clinical setting experience, & case fit

How to Choose a Speech-Language Pathology Expert Witness (Forensic SLP)

Cases involving dysphagia, choking, or communication deficits after a medical event often reach a point where a general medical expert can't fully address the speech-language pathology (SLP) side of the case. That's where a medical SLP expert comes in: not to replace a physician's opinion, but to speak specifically to swallowing, airway safety, and communication function, and to the standard of care an SLP was expected to meet.

Why Would an Attorney Need a Medical SLP Expert?

Speech-language pathologists (SLPs) are trained specifically in swallowing and communication function, an area that falls outside most physicians' and nurses' scope of practice. When a case turns on whether a patient was appropriately evaluated for aspiration risk, whether a swallowing recommendation was followed, or whether a communication deficit was properly managed, the medical record needs someone who understands it in the specialized way an SLP does.

This applies across a wide range of case types and diagnoses, including stroke, traumatic brain injury, prolonged ventilator dependence, and recovery from cardiac or other major surgery. Post-cardiac surgery dysphagia, for example, comes up more often than people outside medical SLP practice might expect, since swallowing complications following intubation and surgery are a recognized, though frequently overlooked, likelihood.

What Does a Medical SLP Case Review Involve?

A medical record review starts with reading the clinical documentation the way a treating SLP would: evaluation notes, swallow study results, treatment recommendations, and how (or whether) those recommendations were carried out.

But a detailed record review involves much more than just the SLP notes. It must include a deep dive of the medical chart and include review of things such as:

Medical and surgical histories
H&P
Diagnostic, laboratory, and imaging reports
Operative and procedure notes
Nursing notes and flow sheets
Progress notes from multiple disciplines and specialists
Diet orders and swallowing history
Communication history

The goal at this stage is straightforward: does the record support a claim that the standard of care was or wasn't met, and is there enough in the documentation to say so with confidence?

This crucial step often happens before a case is fully committed to litigation. An early review can tell an attorney whether a claim has merit from an SLP standpoint, which can ultimately shape whether the case moves forward, settles, or does not have sufficient merit.

What Should an Attorney Send for a Medical Record Review?

After briefly discussing the case and accepting it, the SLP will begin the medical record review.

A comprehensive review depends on having the right records available from the start. Typically useful documentation includes the complete medical record for the relevant admission (if the case involves a hospital stay); speech-language pathology evaluation and treatment notes; instrumental swallow study results and, if available, the actual video or images rather than only the report; nursing flow sheets documenting diet and intake; physician and dietary orders related to swallowing or diet texture; imaging, laboratory, and operative reports; and any documentation of aspiration events, choking incidents, or related complications. Incomplete records may or may not support a preliminary opinion, but gaps in the record are often themselves part of what a review identifies.

What Might a Review Identify?

Every case is different, and a review reflects what's actually in that specific record, but there are categories of issues that commonly surface in dysphagia and swallowing-related cases. These include whether an aspiration risk assessment was performed and documented appropriately, whether SLP recommendations (such as diet texture or supervision level) were communicated to and followed by the care team, whether diet advancement decisions were consistent with evaluation findings, and whether changes in a patient's swallowing status were reassessed and addressed in a timely way. A review may find that documentation supports the standard of care was met on some or all of these points, or it may find gaps.

How Is This Different From a General Medical Expert?

A physician or nursing expert can speak to the overall medical management of a case, and to their clinical specialty, but swallowing and communication disorders are uniquely involved in a clinical discipline with its own standard of care, assessment tools, and treatment protocols. When a case hinges specifically on how swallowing risk was assessed or managed, an SLP expert is uniquely positioned to evaluate that piece of the record the way another SLP would have made the same clinical decisions; a general medical expert typically isn't trained to do this and does not have the same expertise as an SLP with years of direct clinical experience.

Can a Case Review Find That a Claim Lacks Merit?

Yes. Findings follow the clinical record, applicable standard of care, and current best evidence rather than the outcome either side is hoping for. A review may support a claim, may not support it, or may find that some elements are supported while others aren't. This is what makes a review useful to both plaintiff and defense counsel: the same standard is applied regardless of who requested it.

How Do Case Findings Support Legal Strategy?

Once a review is complete, the findings typically feed into broader case strategy. That might mean helping an attorney understand how a specific SLP documentation gap relates to a larger negligence claim, or clarifying which parts of the record are strong versus which are open to a different interpretation.

When Does an SLP Expert Need to Testify?

Not every case that starts with a records review ends up needing testimony. When it does, the same findings from the review form the basis of a written report, and from there, deposition or trial testimony as the case requires. The record review is the foundation; testimony, when it happens, is an extension of the same analysis presented directly to the court.

What Types of Cases Involve a Medical SLP Expert?

Medical SLP case review comes up across a range of populations, including stroke, traumatic brain injury, post-surgery recovery, prolonged intubation and ventilator dependence, tracheostomy-related care, head and neck cancer treatment, and Parkinson Disease, among many others. A list of areas covered is on the medical SLP expert witness services page.

How Can Attorneys Determine an SLP's Expertise?

SLPs work across a wide range of settings, from preschools to intensive care units, and licensure alone doesn't indicate setting-specific expertise. When vetting an SLP expert witness, it is crucial to identify whether that expert has proven experience and years of consistent practice in the specific medical setting relevant to the case. An SLP who has worked exclusively with adults in a medical setting, for example, is unlikely to be the right fit for a school-based pediatric case, and the reverse is also true.

My work, for example, has been exclusively caring for adults in medical settings-- including ICU and outpatient-- since 2009.

What Credentials Should You Look For?

A few credentials and experience markers are worth confirming when vetting any SLP expert witness. The CCC-SLP (Certificate of Clinical Competence in Speech-Language Pathology) is the core, optional professional certification issued by ASHA (American Speech-Language and Hearing Association). Active state licensure is separate from CCC-SLP and required to practice, but licensure alone doesn't indicate setting-specific expertise, as discussed above. Years of consistent practice in the relevant clinical setting and with the relevant population matters more than years of licensure alone, since an SLP can hold an active license while working in a setting unrelated to the case. Additional continuing-education involvement or teaching in the relevant clinical area can also be a useful signal of depth of expertise beyond day-to-day clinical practice.

Questions to Ask Before Hiring an SLP Expert Witness

What percentage of your clinical work has been in [the relevant setting, e.g., adult acute care or ICU]?
How many years have you worked specifically in that setting?
Have you reviewed cases for both plaintiff and defense, or do you work with only one side?
What is your process for records review, and what documentation do you need to get started?
Can findings from a review conclude that a claim does not have merit?
Are you available for deposition and trial testimony if the case requires it?

It can also be helpful to identify the expediency with which you need the case reviewed; if the SLP can start in 4 weeks but you want the case reviewed within 7 days, you need to determine if the expert is worth waiting for.

Choosing the Right Expert for Your Case

Vetting an SLP expert witness carefully at the outset tends to pay off later, both in ensuring that a case that holds up and in standing up to scrutiny from opposing counsel. Setting-specific clinical experience, consistent findings regardless of which side has retained the review, and a clear process from initial inquiry through testimony are the things worth confirming before you commit to an expert.

For more on how this works in practice, see the medical SLP expert witness page, or email me to discuss your case.

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About the author: Brooke Richardson, MS, CCC-SLP, is a medical speech-language pathologist with clinical experience in adult acute care and ICU settings since 2009. She holds ASHA certification (CCC-SLP) and earned her MS in Medical Speech-Language Pathology from the University of Washington.

For case inquiries, please send me an email.