James M. Wheeler, MD, MPH, JD

Obstetrician / Gynecologist / Reproductive Endocrinologist
Clinical Epidemiologist / Biostatistician

Case Topics

Birth Injury — Causation
  • Evaluating neurologic injury: birth injury vs. antepartum vs. postpartum causation
  • Looking for birth injury “look alikes”: endocrine and metabolic diseases, birth defects
Cesarean Section Complications
  • Bowel injury: occurrence, failure to diagnose
  • Cellulitis
  • Cesarean Hysterectomy: indications, performance, sequelae
  • Wound infections
Cesarean Section: Indications and Timing
  • Group B Beta Streptococcus (GBS) associated
  • Causal vs. associative relationship with preterm labor (PTL) and premature rupture of membranes (PROM)
  • Diagnosis and management
Congenital Uterine Anomalies
  • Uterine septa; uterine duplications including uterus didelphys
  • Association with incompetent cervix
Contraceptive Complications
  • Thrombotic Complications of Oral Contraceptives
  • Systemic Complications of Intra-uterine Contraceptives
Diabetic Complications
  • Gestational diabetes: diagnosis, treatment, follow-up
  • Diabetic ketoacidosis in pregnancy
  • Environmental and infectious causes of loss of limb in diabetes
  • Tourniquet use in diabetic’s knee replacement
  • Effects of severity/duration of diabetes on surgical complications
Direct-from-Patient Consultations
  • Endometriosis diagnosis and treatment
  • Ovarian retention at time of hysterectomy for severe endometriosis
  • Neurogenic bladder resulting from hysterectomy for severe endometriosis
  • Infertility evaluation and treatments
  • Embryo quality within in vitro fertilization/prognosis factors for pregnancy
  • Transgender issues in family law context
Drugs and Birth Defects
  • SSRI’s (Paxil, Effecxor, Celexa) and cardiothoracic fetal defects
  • Methotrexate inadvertently administered to intrauterine pregnancies
  • Diagnosis, timely vs. delayed; clinical “look alikes” e.g., pelvic adhesions
  • Medical and surgical treatments
  • Recurrence risks
  • “Definitive treatment” – hysterectomy; type of hysterectomy, associated complications
  • Indication for ovary removal at hysterectomy
Electronic Fetal Monitor (EFM)
Essure: Transcervical Tubal Sterilization
  • Patient selection
  • Performance of procedure
  • Post-procedure assessment and patient follow-up
  • Epidemiologic analysis of literature in evolution
Family Law Consultations
  • Epidemiology of genital Herpes infections
  • Epidemiology of Human Papilloma (HPV) colonization vs. infection
  • Alleged sexual assault – adult and pediatric
  • Transgender issues and child custody
Foreign Bodies
  • Vaginal foreign bodies associated with D&C, hysteroscopy, laparoscopic procedures
  • Intra-abdominal foreign bodies associated with hysterectomy, laparoscopy, laparotomy
Hysterectomy Complications
  • Thromboprophylaxis, chemical vs. sequential compression devices (SCD’s)
  • Inadvertent suture placed in bladder wall: recognition, treatment, possible sequelae
  • Distal ureteric obstruction: suspicion, diagnosis, sequelae
  • Bowel injury: suspicion, diagnosis, sequelae
  • Positioning injury with stirrups: boot type vs. stirrup type
  • Vesicovaginal fistula following hysterectomy
  • Uterine sarcoma: discovered at hysterectomy vs. delayed diagnosis
Iatrogenic Injury from Cosmetic Procedures
  • Vulvar 1st/2nd degree burns from genital laser hair removal
Infertility Including In Vitro Fertilization (IVF)
  • Indications for medications, laparoscopy/hysteroscopy, IVF
  • Thrombosis risk with fertility drugs and IVF
  • Use of donor eggs, use of donor sperm
Insurance Reviews
  • Fetal surgery: experimental vs. standard of care
  • Various medical conditions: timeliness of diagnosis, treatment or referral
  • Causation analysis within complex cases
Medication Complications
  • Topical anesthetics with vs. without epinephrine
  • Oral contraceptives, Depo-medroxyprogesterone
  • Fetal effects with inadvertent use, e.g., methotrexate
  • Sedation effects with drug combinations
  • Thrombotic effects of progestins, GnRHa’s, oral contraceptives
  • Peri- vs. post-menopausal bleeding: evaluation techniques, treatment options
  • Medical treatments vs. surgical treatments
  • Menopausal medications and breast cancer
  • Conjugated equine estrogens as an unusual cause of pancreatitis
Methotrexate, Inadvertent Use
  • Over-reliance of a single HCG level
  • Misdiagnosis of early intrauterine pregnancy as ectopic pregnancy
Military Medicine, OB/GYN Matters in the Context of
  • Ectopic pregnancy, diagnosis and treatment
  • Obstetric care
  • Gynecologic surgery
  • Indication/timing of cervical dilation/uterine curettage (D&C)
  • Repeated pregnancy loss: evaluation, diagnosis, treatment and prognosis
  • Association vs. causation: first vs. second and third trimester motor vehicle accidents
Motor Vehicle Accidents and Pregnancy
  • Nonreassuring fetal heart monitoring
  • Preterm labor and delivery
  • Neonatal positional problems, e.g., torticollis
  • Temporal association with loss of chemical pregnancy
  • Causation of vs. temporal association with, miscarriage in the first trimester
  • Association vs. causation of placental abruption in later pregnancy
  • Association vs. causation of stillbirth in third trimester
Multiple Pregnancies
  • Diagnosis by early ultrasound; sonographic follow-up
  • Determining monoamniotic or monochorionic twins
  • Special aspects of preterm labor and preterm delivery
  • Special aspects of cervical incompetence, bed rest, tocolysis
Office Procedures
  • Sonohysterography: uses and pitfalls
  • Office hysteroscopy
  • Endometrial ablation: proper patient selection, proper performance
  • ESSURE sterilization: patient selection, proper performance, post-procedure follow-up
  • Endometrial biopsy
  • Use of lidocaine with or without epinephrine: dose calculation, complications
Pap Smears
  • Excessively aggressive treatment: cervical incompetence, dyspareunia, infertility
  • Biopsies: colposcopy and loop electrical excision procedure (LEEP)
  • Fertility aspects/reproductive potential
Female Pelvic Fracture
  • Reproductive potential
  • Genital injury associated with bony fracture
Chronic Pelvic Pain
  • Interstitial cystitis and its “look-alikes”
  • Endometriosis: diagnosis, treatment, reducing recurrence
  • Pelvic infections
  • Pelvic adhesions (“Pelvic Adhesive Disease”)
  • Treatments, including chiropractic and Botox injections
  • Prognosis
  • Retained placenta, complications thereof, at vaginal and Cesarean delivery
  • Placenta previa
  • Placenta abruption (Placenta abruptio; premature separation of the placenta)
  • Placenta accreta
  • Placental anomalies (Circumvallate, succenturiate, bilobed, et al.)
  • Twin-to-Twin Transfusion Syndrome (TTTS)
  • Meconium staining
  • Placental infarctions
  • Clinical interpretation/application of placental pathologic findings
Polycystic Ovaries Syndrome (PCOS)
  • Metabolic Complications
  • Insulin Resistance
  • Fertility Complications
Pregnancy Induced Hypertension (Toxemia, Pre-Eclampsia)
  • Diagnosis, and delay/lack thereof
  • HELLP (Hemolysis, Elevated Liver function tests, Low Platelets) Syndrome
  • Thrombocytopenia (low platelet count)
  • Distinguished from gestational hypertension or chronic hypertension
Pregnancy Complications
  • Decreased fetal movement: diagnosis and evaluation
  • Hyperemesis gravidarum: diagnosis, differential diagnosis within, treatment, follow-up
  • Indications for induction of labor; choice of induction agents
  • Stillbirth, intrauterine fetal demise (IUFD): diagnosis, evaluation, prognosis
  • Adrenal disease in pregnancy: adrenal tumors, Addison’s disease
  • Cholestasis of pregnancy: diagnosis and treatment
Preterm Labor (PTL) and Delivery Risks
  • Cervical incompetence: pro’s/con’s of historical vs. objective diagnosis
  • Transvaginal assessments of preterm labor risk (fetal fibronectin)
  • Ultrasonographic measurement of cervical length
  • Recognizing symptoms/signs of PTL by physicians, nurses, and other staff
  • Factors potentially impacting PTL risk: cervical lacerations, vaginal/cervical infections, stress
Premature Rupture of Membranes (PROM)
  • Assessment and diagnosis; false positives and negatives of diagnostic tools
  • Ultrasonographic assessment of amniotic fluid
Referrals: Primary Care to Specialist; Specialist to Sub-Specialist
  • Urgency of referral to neurologist by PCP of classic Guillain-Barre syndrome
  • Referral from infertility treatment to ob/gyn vs. maternal fetal medicine
  • Indications for intraoperative consultation with urologist, colon surgeon, oncologist
Sexual Assault
  • Presence, or absence, of genital injuries following alleged sexual assault
  • Evaluating evidence for consensual contact vs. sexual assault
  • Presence, or absence, of anal injuries following alleged assault
Transport of the Pregnant Woman
  • Choice of hospital by ambulance staff
  • Second motor vehicle collision involving pregnant woman during ambulance transport
Vaginal Mesh in Gynecologic Surgery
  • Indications, alternatives in terms of techniques and materials
  • Epidemiologic analysis of evolving medical literature
Voluntary Termination of Pregnancy (VTP), Abortion
  • Retained tissue at attempted VTP
  • Ongoing pregnancy despite attempted VTP
  • Complications of VTP procedures and medications
Vulvar and Vaginal Disease
  • Complications of laser hair removal
  • Bartholin’s gland cyst and abscess treatment and complications
  • Surgical complications: removal of excess labial tissue
Weight Loss Clinics
  • Employee delegation and supervision issues
  • Misrepresentation of care provided, with subsequent patient reliance thereof
  • Substandard care and follow-up resulting in Medical Board involvement
Wound Complications
  • Cellulites, fascial infection, abscess: diagnose, treatment and sequelae
  • Wound separation and dehiscence

‘Thank you for explaining the medicine of my case to me and my husband. I knew it was complicated, but once things turned bad, my doctors stopped explaining things to me. Thanks for the name of Mr. _____, but we don’t think we’ll proceed with litigation after talking with you. Thank you.’

— Houston patient who had a difficult hysterectomy for endometriosis