Rodrigo Miziara Yunes — medico-legal consultant
Non-testifying technical review — for internal use, worked entirely remotely

Before you retain an expert, find out what the record actually shows.

How instructions work

Your record, read first by a medico-legal consultant.

A technical analysis of the record, prepared for the instructing party’s internal use. Not evidence, not an expert report — the reading that comes before either.

Neurosurgeon and spine surgeon, 25 years in practice. Also a qualified lawyer, and six years as a court-appointed medical expert. The work is documentary and is carried out entirely remotely.

See how a review starts Fees and turnaround

What a review contains

One document, written for the lawyer who instructed it. It answers a single question: does the record show a departure from accepted practice, and where.

Clinical chronology
The admission reconstructed in order, from the chart, nursing notes, imaging reports and operative record — including what is missing from the record and when.
Points of departure
The specific moments where the care given appears to diverge from established practice, each tied to the entry in the record that shows it.
Literature
A targeted review of the published evidence and institutional protocols bearing on those specific moments — not a general survey. The reading is directed at the legal question, not at the medicine in the abstract.
Causation, kept separate
A preliminary view on whether the departure plausibly caused the injury, stated apart from the question of whether the care fell short. These fail independently, and conflating them is how weak files survive too long.
What to do next
Which specialty of expert the file calls for, and the questions worth putting to them. Where the record shows no departure, or none that plausibly caused the injury, the review says so and explains why.
Two formats
Delivered either as a named medical analysis over my signature, or as an unattributed working document for internal use. Your choice, decided before I begin.

What the document is, and what it is not

This point comes before everything else, because it governs how the review is written and how it should be used.

It carries no evidentiary status

A review is a technical medical analysis. It is not an expert report, it is not sworn or certified for filing, and it proves nothing. No court is asked to receive it and I do not testify to its contents. It exists to inform your own assessment of the file — what the record shows, and on what medical grounds — not to be put before a tribunal.

Where a matter proceeds, a properly qualified expert in the relevant jurisdiction is retained to produce the report that will be filed. My work sits upstream of that and is designed to make it faster and narrower.

It is prepared for internal use

The review is written for the instructing party alone. In common-law systems, work of this kind, commissioned by counsel for the dominant purpose of a contemplated or existing action, is ordinarily covered by litigation privilege — it is created because of the litigation, and is therefore generally shielded from disclosure to the other side.

Two consequences follow, and both matter.

The privilege is yours
It belongs to the client and to counsel, not to me. Whether it attaches depends on how the retainer is structured, which is the reason I accept instructions only from a licensed lawyer. A review commissioned by a party acting alone, before any lawyer is retained, may attract no protection at all and could later be disclosable — which is precisely the outcome this practice is arranged to avoid.
Because it is internal, it can be blunt
A document written for filing must be cautious. One written for your desk need not be. If the record shows nothing that departs from accepted practice, the review says so in the first paragraph and explains why, which is often the most valuable thing it can do.
It confines itself to the medicine
The review contains no litigation strategy, no view on settlement value and no tactical assessment. That is deliberate. Should the document ever leave your file, it should contain nothing but medical analysis — which stands on its own in any setting — and nothing that reads as a party working out its case.

Why an opinion from abroad holds up

Medical practice is not local knowledge. The management of a cauda equina syndrome, the indications for fusion, the window for decompression, the reading of a post-operative deficit — these rest on institutional protocols and a body of published evidence that circulate the same way everywhere. Surgeons are trained from the same journals and the same trials wherever they practise.

What changes from one jurisdiction to another is the legal test applied to the medical answer — the burden of proof, the treatment of consent, the standard against which conduct is measured. That part belongs to counsel, and I do not trespass on it.

The review itself is never generic. It is built from your record, on your dates, around the specific decisions your clinicians made or failed to make.

How a review starts

Every file reaches me the same way — through a licensed lawyer. What differs is only how you get to that point.

Every instruction comes from a lawyer

I take instructions from counsel, and from parties who are already represented. I do not accept a file directly from a patient, and I do not assess anyone’s case for them before a lawyer is involved.

There are two reasons, and both work in your favour. The first is privilege: a review commissioned by counsel in preparation for an action is ordinarily shielded from disclosure, which is what allows it to be candid. The second is scope: my work is the medicine in the record. Whether that medicine gives rise to a claim, whether a limitation period has run, whether an action is worth bringing — those are legal questions for the lawyer on the file, and I do not answer them.

If you are the patient or a family member

Ask your lawyer to instruct me. I do not take instructions from patients directly.

This is not a formality. A review commissioned by your lawyer, in preparation for your case, is ordinarily privileged — it cannot be demanded by the other side, and it is therefore free to tell your lawyer that the record is weak without that ever reaching them. A review you commission alone may carry no such protection, and if it turns out badly it could reach the very people you are complaining about.

  1. Retain a lawyer, or speak to the one you already have. If you do not know where to start, any firm that handles medical negligence for claimants will do.
  2. Ask them to look at this page. If they think a technical read of the record would help them decide, they instruct me and everything after that runs between us.
  3. The review is delivered to your lawyer, who goes through it with you.
I do not assess cases for patients, advise on whether to sue, or comment on limitation periods or prospects. Those are questions for your lawyer. What I do is read the medicine in the record, for your lawyer, on your lawyer’s instructions.

If you are counsel, an insurer or another interested party

Screening a file before committing to a retained expert.

  1. A short call to establish what you need decided and by when. No charge for this.
  2. Scope, price and delivery date confirmed by both sides in writing, with a signed engagement letter. Payment by PayPal on acceptance.
  3. You send the record with the patient's written authorisation, de-identified as far as your file permits. Names, addresses and health numbers are not needed — the clinical sequence is.
  4. You receive the review in the format you choose, and the questions to put to the expert you go on to retain.
Patient authorisation is required in every case. I will ask to see it before any record is opened.

Fees and turnaround

Both depend on the same two things: how long the record is, and how difficult the medicine is. A single admission with clear imaging is not a fifteen-year history across four institutions. You are quoted a fixed price before anything starts — never an open hourly account.

USD 500 Preliminary review of a record up to 500 pages, delivered within three days. Longer records, multiple institutions and complex files are quoted individually after the online consultation.

Payment is by PayPal, in US dollars, once scope and price are confirmed and the engagement letter is signed. There is no charge for the initial call in which we establish what you need decided.

Who is reading your record

Rodrigo Miziara Yunes, neurosurgeon and spine surgeon

A spine surgeon who also trained in law, and who has spent six years reading records for the courts.

  • Neurosurgery and spine surgery — CRM-SP 100.602 · RQE 39.830
    Medical registration in Brazil only
  • Legal training — OAB/SP 553.091 (Brazil)
    Health law and medical liability, in Brazil only
  • Court-appointed medical expert, São Paulo State Court
  • ORCID 0000-0003-4722-264X

I am a neurosurgeon and spine surgeon in São Paulo with 25 years in practice. I trained in medicine and then in neurosurgery at UNIFESP / Escola Paulista de Medicina, where I later served on staff, and I coordinate the spine surgery group for the neurosurgery residency at Hospital CHS. My clinical work is instrumentation and fusion, decompression, percutaneous procedures, and the neurological complications that follow them.

I then read law, and I hold a practising licence at the São Paulo bar in health law and medical defence. For the past six years I have worked before the São Paulo State Court as a court-appointed medical expert and as a technical assistant to parties, in medical liability and health coverage litigation. That work is the whole of this service: reading a record against the medicine and against the questions a court will actually ask. I am the author of six books on surgical technique and medico-legal subjects.

I practise clinically in Brazil. The review work has always been done from the record itself, and is carried out entirely remotely, wherever the instructing party is based.

Office, São Paulo

Rua Borges Lagoa, 1065 — cj. 78
Vila Clementino, São Paulo — SP
Brazil

Direct contact

Office +55 11 3459-4916
WhatsApp +55 11 97454-1233
contact@theindependentmedicalreview.com

What this service is not

  • My medical registration is in Brazil. I do not opine on the standard of care of any other jurisdiction, and I do not act as a testifying expert or sign expert reports for filing.
  • My legal qualification is Brazilian and I do not practise law outside Brazil. Nothing here is legal advice, and no solicitor-client relationship arises from a review.
  • I do not examine patients, order investigations, prescribe, or provide any form of clinical care. This is document analysis only.
  • No record is opened without the patient's written authorisation, and material is destroyed on request once the review is delivered.
  • All analysis is prepared in Brazil, where I hold my medical and legal registrations, and is provided remotely as documentary work. It is not, and is not offered as, medical or legal practice in the jurisdiction where you are located.
  • A review is not evidence and is not intended for filing. Whether it is protected from disclosure depends on how you instruct me, and that protection is yours to hold, not mine to give.
  • I accept instructions only from a lawyer licensed in the jurisdiction where the matter sits, or from a party already represented by one. I do not open a file on a patient’s own instruction.
  • A review is preliminary. It is based only on the material supplied to me, it does not replace the opinion of a qualified expert in your jurisdiction, and it should not be the sole basis on which a file is accepted, declined or abandoned. My liability in respect of any review is limited to the fee paid for it.
  • Records are held encrypted, are used for no purpose other than the review, are not shared with anyone, and are deleted on delivery unless you ask me to retain them. I am glad to work under your own confidentiality, security and retention terms, and to sign them before any material is sent.

Send a case

Instructions must come from a lawyer licensed in the jurisdiction where the matter sits. If you are a patient or a family member, ask your lawyer to write to me — I cannot open a file without a licensed lawyer standing behind the request.

Counsel: describe the matter, roughly how many pages the record runs to, and what you need decided. A reply within two business days, with a price and a date.

contact@theindependentmedicalreview.com

WhatsApp +55 11 97454-1233  ·  Office +55 11 3459-4916
Rua Borges Lagoa, 1065 — cj. 78, Vila Clementino, São Paulo, Brazil