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At the Round Table with Neurology Expert, Dr. Jill Cramer

November 3, 2023

In this episode…

Dr. Cramer points out the “nice guy” strategy during cross-examination stating, “Some of them will try to lull the expert into a sense of ‘I am just a nice person. I am on your side.'” She continues “. . . you cannot bait me . . . [I] just answer the question, give my opinion…. so that the discussion is not derailed by a super sweet or a snarky cross-examiner.”

Additional topics include cross-examiners and the importance of winning and getting experience on both sides. She offers up this advice, “Make sure that you work for the defense and plaintiff. This makes you a better-rounded witness, and it helps you to understand both sides of [cases] you are in.”

Episode Transcript:

Note:    Transcript has been lightly edited for clarity.

Host: Noah Bolmer, Round Table Group

Guest: Dr.Jill Cramer, Founder and Director at Roanoke Area MS Center

Noah Bolmer: Welcome to Discussions at the Round Table. I am your host, Noah Bolmer, and I am excited to welcome Dr. Jill Cramer to the show. Now, Dr. Cramer is the founder and director of the Roanoke area, MS Center, and is a board-certified neurologist, maintaining a practice at Blacksburg Neurology, both of which are in Virginia. She is the principal investigator for numerous studies and is a sought-after expert witness. Dr. Cramer holds a Medical Degree from Georgetown and a Bachelor of Science in Neurobiology and Behavior from Cornell. You have an impressive medical career spanning over 30 years. Was medicine always your path?

Dr. Jill Cramer: It is about 20 years and I do not want to age myself too much. When I finished high school, I knew I wanted to go into medicine and do something in neurobiology. I am a practicing neurologist now.

Noah Bolmer: The medical field is always evolving, and you are an accomplished researcher. Is research the primary means to remain an expert in your field?

Dr. Jill Cramer: It is not my clinical practice. The patients I see every day are the typical mechanism for getting patients in and working with the lawyers.

Noah Bolmer: That is interesting. Backing up a little bit, in your specific field, what does expertise mean to you? What does it mean to be an expert?

Dr. Jill Cramer: That is a great question. If you have ever been in a deposition, you know what the legal definition is, but as a physician, what makes an expert in their area is somebody who has sufficient training, certification, and appropriate time in the field. Is that 2 years? Is it five years? Is it ten years? We could certainly bargain with one another about how much time and how involved a person needs to be to see some experience to go with all of the credentials we come out of medical school and residency.

Noah Bolmer: Let’s talk about your career as an expert witness. When you were first engaged, what was that initial call like? Was it out of the blue or were you looking to get into expert witnessing?

Dr. Jill Cramer: No, I had no idea what expert witnessing was. It fell upon me. I was treating a gentleman ejected from his truck in a terrible car accident. He had a traumatic brain injury, and his lawyer called and said they wanted to videotape me interviewing the patient. Would I be comfortable with that? I said sure. Because he had a brain injury, the patient had trouble coming up with the date. He started stuttering and crying, and the lawyer said that demonstrated his brain injury and his deficits. Would you like to do more of this work in the future? I said, “That is another way to help people.” I could not cure this man’s traumatic brain injury, but I could help the lawyers create a secure future for him, and his wife would not be homeless. I see him occasionally. He is still working in his garage and fixing cars. He is not who he was before the accident, but he lives in his house and has relationships. It is rewarding to see another way of helping people.

Noah Bolmer: That is great to hear. So, being an expert witness is not only a path to additional income, but you can help people with it.

Dr. Jill Cramer: You can, and it is rewarding.

Noah Bolmer: Tell me about the vetting process that occurred when the attorney called you. I know this is some time back, so you might not remember all the specifics, but do you remember what that first call was like and some of the types of questions they asked?

Dr. Jill Cramer: Honestly, I do not remember, it was an informal call. It was like, “Hey, we are representing this patient. Can we come by, talk to you, and maybe set up an interview where we videotape you interviewing the patient.” I said, “Sure, I am happy to help.” I do not remember any of the formalities. We were not talking about hourly rates and things like that. At that point, we were starting the dance, so to speak.

Noah Bolmer: Let’s pivot to preparation. Did you meet the attorney in person?

Dr. Jill Cramer: Yes, he came to my office.

Noah Bolmer: Did you do any mock depositions? What was the preparation like?

Dr. Jill Cramer: Not in that case. We discussed the case, my opinions, and the client’s deficits. We did the video, and throughout the video, I was able to show what the gentleman’s deficits were. I have done several more video depositions. In some, we were working in mediation with this attorney. He likes to utilize my background in demonstrating people’s deficits. How their brains are not functioning properly, or they do not walk properly. What the MRI of their brain means. We have an interesting interview style in many of the videos that I have done with this attorney.

Noah Bolmer: You have worked with different lawyers and have been prepared differently. What works for you as a witness? What are the types of things that an attorney could or should be doing to help an expert prepare to do their best, especially if they are a newer expert witness?

Dr. Jill Cramer: Lawyers do things differently, helping me understand my part as an expert witness. I am not the person playing the game of chess. I am the pawn, the rook, or the queen in the situation. I need to know. What is my latitude? Where can I go? How do you want to utilize me? I think it is helpful to know how we build up to me. What do we do after me or am I the final piece of the whole puzzle that is going to take this case home? Understanding where in the strategy or process helps me to focus my energies so I am not getting lost in the woods or preparing for something that I am not going to be asked about or need to talk about.

Noah Bolmer: How proactive of approach do you take? Do you find yourself offending or often offending? Do you find yourself often needing to either second guess something that the attorney is telling you or need to correct things often? Do you roll with it?

Dr. Jill Cramer: I tend to do some of both. I am not the one with the overarching strategy. I do like talking with the lawyer. “This is a stronger argument than this one.” “Here are some areas that might trip you up” or “Here is what you need to establish to make any sense.” They know the legal process far better than I do. I know medicine and am working with lawyers to develop a strategy where my piece is important. That is how I make sure I understand and give feedback to the lawyer about where my piece of the puzzle might be the strongest.

Noah Bolmer: Have you found yourself subject to getting grilled and cross-examined often during depositions? If so, how do you handle that kind of pressure?

Dr. Jill Cramer: It is an interesting kind of pressure. I tend to work well with a pot of coffee and pressure. I am well-versed in late-night depositions and early-morning trial testimony. I find it very invigorating. If somebody is asking me questions. I know I must do my best during cross-examination. Where are they going with this? What game are they playing? Where are we two steps ahead of here? If I say yes to this, but do not answer in full, do I lead the jury or the judge in a path that we are not intending? You are constantly walking, looking for snares or places that I could be led astray, or testimony could be used in sound bites to mean something that you did not say. I find that an interesting, and fun game. Different lawyers on cross-examination play it differently. Some will try to lull the expert into a sense of “I am just a nice person. I am on your side and just follow along, “Doctor. wouldn’t you agree with me?” “Never. No, I will never agree with you.”  Some of them get angry and I have found when they do that is go into my quiet space and smile, especially if I am not on camera. Let them know you cannot bait me and try to do my absolute best to continue with my line of thinking and the medical information that makes sense. I try hard to answer the question and give my opinion. My opinion should not change based on how the questions are being asked. I try to be as solid in what my thoughts are. So, the discussion does not get derailed by a super sweet or snarky cross-examiner, I find it to be a way to think about cases and medicine in general. I am weird, but I think it is fun.

Noah Bolmer: Is this something that you have learned over time, your attorney prepped you on or is this you as a person?

Dr. Jill Cramer: Part of it is personality. I will argue with a rock. Part of it was the first time I was cross-examined. I had sweaty palms and was shaking. I did not know how the process was going to go. Afterward, I got a debriefing from an excellent lawyer. “Here is what you did that was good and natural. Here is what you could do better next time.” I had a couple of lawyers do this with me to refine my skills as an expert witness, which I found to be tremendously helpful going forward.

Noah Bolmer: That is something attorneys should be doing because you never know when an attorney might use you again. The better their experts are, the better they will be able to perform the next time around,

Dr. Jill Cramer: That is true, and I find that much of my work comes through word of mouth. If one attorney has utilized me in the past and then tells another attorney, would it not be in everybody’s best interest for me to know what I am doing?

Noah Bolmer: I would like to pivot for a moment to ethics. I have interviewed experts who have said sometimes they feel nudged not to lie, but to present their expert opinion in a particular way they might not entirely agree with. Is that something that you have experienced? How do you deal with that?

Dr. Jill Cramer: I have. I do not stretch my opinion if my opinion is “No, that did not happen, this happened” or, “This is how the medicine works.” I will tell the lawyers straight up, “I cannot help you in that direction, but here is how I could help you.” Or “This is how you could utilize my testimony,” I tell lawyers all the time because I think it is important to have a reputation for being honest and telling the truth instead of being swayed in whatever direction that someone wants to move. I was doing adapted recently where I had worked with the cross-examining lawyer in a previous case. They were unrelated cases, so this was kind of fun. I am being crossed by somebody who has utilized me as their witness in the past. When we got to the end, he commented something that I was willing to say in this case. The lawyer I was working with said, “You should have heard all the stuff she said no to.” Both lawyers knew me and knew that I was going to do my best, to be honest about what I believed and not be nudged. I think that makes you a stronger witness. If everybody at the table knows. that is what you are going to say, and you are not going to be wishy-washy on the stand. You are not going to be going all over the place and be confusing to a jury.

Noah Bolmer: You are accomplished at this. You have been doing this for a long time. You have a body of work that is even longer than your career as an expert witness. Have you ever been in a situation where somebody has tried to impeach you on something that you said a long time ago that maybe you have changed your opinion on? Maybe new information has come out. Anything like that?

Dr. Jill Cramer: I feel like I am tempting fate by saying this, but, no, not that specific situation. I have had attorneys try to prove that I am either defense-heavy or plaintiff-heavy. Whenever they have got a hold of my list of cases, they see that I do more plaintiff work because of the lawyers who have utilized me in my area. I do a good amount of defense work as well. If there is a defense attorney who wants to prove that I do not do defense, they are going to be disappointed in my resume.

Noah Bolmer: Before we wrap up, I have a question that I ask my interviewees. How important is winning to you? Is winnability a factor in deciding whether you will accept an engagement?

Dr. Jill Cramer: Being the pawn, the queen, or the Rook, I do not feel like I have an overall sense of the entire process so helping is important to me. Winning is the lawyer’s job and I do not always know all of the factors. I do not know what the counsel’s information is much of the time. If I am honest in my piece, whether we win the game is less important than if we played well. We did the best that we could.

Noah Bolmer: Do you have any last advice for experts or attorneys working with experts before we wrap up?

Dr. Jill Cramer: The most important piece of advice I can give to an expert is to make sure you work for the defense and the plaintiff. It will make you a well-rounded witness and help you understand both sides of the case. It strengthens the impact of your statement if we understand where we fit in the whole process, strengthens our opinion, and helps the lawyer make a stronger case. Coaching is also helpful. We are not lawyers and we do not know how law works. Attorneys can give us an idea of what we are working with. I have always found attorney coaching useful.

Noah Bolmer: Sage advice. Thank you, Dr. Cramer, for joining me.

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After a quarter century helping litigators find the right expert witnesses, Round Table Group’s network contains some of the world’s greatest experts. On the Discussions at the Round Table podcast, we talk to some of them about what’s new in their field of study and their experience as expert witnesses.

At the Round Table with Neurology Expert, Dr. Jill Cramer

Dr. Jill Cramer, Owner, Blacksburg Neurology, PC

Our guest today, Dr. Jill Cramer, is a board-certified neurologist, and the founder of the Roanoke Area MS Center. She is a sought-after expert witness with decades of experience. Dr. Cramer holds an MD from Georgetown and a BS in Neurobiology from Cornell.