Hospital Medicine Expert | Standard of Care

Specialties & Experience of this Expert Witness

Additional Information

Dr. Pahresah L. Roomiany is a board-certified Internal Medicine physician and practicing academic hospitalist who provides independent, evidence-based expert witness services in adult inpatient internal medicine and hospital medicine matters nationwide. She maintains active inpatient clinical practice and regularly manages complex hospitalized adult patients. Her areas of expertise include hospital medicine standard of care, inpatient internal medicine standard of care, failure to diagnose, delay in diagnosis or treatment, clinical deterioration, escalation of care, sepsis management, chest pain and cardiovascular risk assessment, anticoagulation management, thromboembolic disease, electrolyte and metabolic emergencies, medication-related adverse events, and hospital-based systems issues affecting patient outcomes. Dr. Roomiany serves as Vice Chair of Peer Review at Duke Regional Hospital, where she participates in structured evaluation of physician performance and formal assessment of whether care met accepted standards. In this role, she reviews complex inpatient cases involving diagnostic error, adverse outcomes, communication failures, documentation concerns, and systems-based contributors. Her peer review responsibilities require careful differentiation between complications of illness and true deviations from the standard of care. She has completed peer review training through Horty Springer, focusing on medical staff governance, defensible peer review processes, and structured evaluation of clinical performance. In her academic leadership roles, Dr. Roomiany is extensively involved in physician performance assessment and remediation planning for residents and practicing physicians. She develops individualized remediation plans when clinical reasoning, documentation, communication, or systems-based practices fall below expected standards. This work requires identification of cognitive biases, knowledge gaps, system-level contributors, and deviations from accepted practice patterns. Her experience in structured remediation allows her to clearly articulate what occurred, why it occurred, and whether it represents a departure from the applicable standard of care. Dr. Roomiany has particular expertise in systems-based practice analysis, including evaluation of institutional processes, supervision structures, consultation timing, escalation protocols, and interdisciplinary communication. She understands how hospital systems function and how breakdowns may contribute to patient outcomes. She also has significant experience evaluating medical documentation standards, including adequacy of history and physical examination documentation, clinical decision-making support within the medical record, informed consent discussions, discharge documentation, and communication between providers. She assesses whether documentation accurately reflects clinical reasoning and whether it meets accepted professional standards. Her approach to expert review emphasizes objective medical record analysis, application of contemporaneous clinical guidelines and peer-reviewed literature, and clear explanation of how the standard of care applies to the facts of a case. She carefully distinguishes adverse outcomes from negligence and provides methodical, defensible opinions. Dr. Roomiany provides services for both plaintiff and defense counsel and routinely evaluates cases for merit prior to engagement. She understands the importance of clarity, timeliness, and preparation in medico-legal matters. Expert services include: Independent medical record review Case screening and merit evaluation Standard-of-care analysis Written expert reports and affidavits Deposition and trial testimony when appropriate Board Certified: Internal Medicine Licensed in: North Carolina Available for nationwide consultation