Respiratory Therapist Expert Witnesses: Importance of Respiratory Expertise in Law

Understanding Respiratory Expertise

Respiratory expertise encompasses a wide range of knowledge related to the respiratory system, including treatment of respiratory issue, the impact of environmental factors on lung health, and the implications of respiratory conditions in various contexts. Professionals in this field include pulmonologists, respiratory therapists, pulmonary function technologists, sleep technologists, adult critical care specialists and educators.

Key Areas of Respiratory Expertise

• Diagnosis and Treatment: Understanding various respiratory conditions such as asthma, chronic obstructive pulmonary disease (COPD), and lung cancer.

• Environmental Impact: Assessing how pollutants and occupational hazards affect lung health.

• Hemodynamic instability and following trends that potential lead to compromise in the healthcare setting.

• Policy & Procedures not followed during care.

The Plaintiff's Use of the Expert Witnesses

The plaintiff bears the burden of proof, so their experts are primarily offensive — they must establish the case.

Key goals:

• Prove that harm occurred

• Establish causation (linking the defendant's actions to the injury)

• Set the standard of care and show it was breached

• Make complex technical issues understandable

• Common expert types for plaintiffs: Medical doctors (injury causation), economists (lost wages/damages), accident reconstructionists, registered nurses, respiratory therapists, etc.

• Medical Malpractice: Cases where patients claim that healthcare providers failed to diagnose or treat respiratory conditions appropriately often rely on expert testimony to establish the standard of care.

  
  

The Defendant's Use of Expert Witnesses

The defendant's experts are primarily defensive — they challenge, undermine, or offer alternative explanations.

Key goals:

• Dispute causation ("something else caused the harm")

• Minimize or contest the extent of damages

• Counter the plaintiff's standard-of-care arguments

• Create reasonable doubt about the plaintiff's narrative

• Common expert types for plaintiffs: Medical doctors (injury causation), economists (lost wages/damages), accident reconstructionists, registered nurses, respiratory therapists, etc.

Respiratory Therapist Expert Witnesses: Plaintiff vs. Defendant

Respiratory therapists (RTs) are increasingly called as expert witnesses in cases involving airway management, mechanical ventilation, pulmonary care, and neonatal/ICU settings. Here's how they function on each side and is it something you may want to consider?

When Representing the Plaintiff

The RT expert's job is to establish that something went wrong and that it caused harm.

What they opine:

• The standard of care for the respiratory therapist was not met (improper ventilator settings, delayed intervention, failure to recognize respiratory distress or hemodynamic instability)

• Improper airway management caused or worsened the patient's condition

• The RT or supervising team failed to escalate appropriately to a physician

• Documentation was inadequate or protocols were ignored

• A reasonably competent RT would have acted differently

Common case types they appear in:

• Ventilator-associated lung injuries (volutrauma, barotrauma)

• Failed/delayed intubation leading to anoxic brain injury

• Neonatal respiratory distress mismanagement (premature infants, surfactant timing)

• Improper weaning from a ventilator

• Home oxygen/equipment negligence

• CPAP/BiPAP errors

• PFT errors that lead to compromise

Their core message :

"Here is what a competent RT should have done — and this is exactly what didn't happen."

When Representing the Defendant

The RT expert's job is to defend the care provided or create reasonable doubt about causation.

What they argue:

• The care rendered met or exceeded the standard of care given the clinical circumstances

• The patient's outcome was the result of their underlying disease, not the RT's actions

• Clinical decisions were reasonable and within accepted practice at the time

• Protocols were followed and documentation was appropriate

• The plaintiff's RT expert is applying hindsight bias — the situation was ambiguous in real time

Defensive angles they take:

• Challenging the plaintiff expert's qualifications (Are they currently practicing? Same clinical setting?)

• Arguing the plaintiff expert is using an unrealistic or outdated standard of care

• Highlighting that the patient's condition was already critical and irreversible

• Pointing out that the RT acted under physician orders and had limited autonomous authority

Their core message:

"Given what the care team knew in that moment, the respiratory therapist did exactly what a competent professional would do."

Key Battlelines Specific to RT Cases

Issue	Plaintiff RT Expert	Defendant RT Expert
Ventilator settings	Settings caused injury (too high pressure/volume)	Settings were appropriate for the patient's condition
Escalation duty	RT should have called physician sooner	RT appropriately deferred to physician judgment
Standard of care source	AARC guidelines, hospital protocol	Same guidelines, interpreted differently
Scope of practice	RT had both duty and ability to act	RT was operating within physician-directed orders
Causation	RT error directly caused the harm	Underlying disease was the true cause

Unique Challenges for RT Expert Witnesses

Scope of practice ambiguity — RT autonomy varies significantly by state, hospital, and ICU culture. Both sides exploit this — plaintiffs argue the RT could have acted independently; defendants argue they had to follow physician orders.

Credentialing scrutiny — Courts and opposing counsel will examine:

• RRT (Registered Respiratory Therapist) credential status

• Whether they practiced in the same clinical setting (ICU vs. home care vs. neonatal)

• How recently they actively practiced

  
  

Physician overlap — In many cases, RT negligence claims overlap with physician negligence. RT experts must carefully navigate how much responsibility sits with the RT versus the ordering physician, without undermining their own side's broader case.

AARC Guidelines as a double-edged sword — The American Association for Respiratory Care publishes clinical practice guidelines that both sides cite. The fight is often over interpretation, not the existence of a standard.

Bottom Line:

An RT expert witness on the plaintiff side reconstructs what should have happened and draws a clear line from the deviation to the harm. On the defendant side, they reframe the clinical reality — showing that under pressure, with incomplete information, the RT made reasonable, defensible decisions. The most effective RT experts on either side are those who can translate highly technical ventilator and airway concepts into language that a layperson can easily grasp and trust.