Physician experts often review hundreds or thousands of pages of medical records before issuing an independent medical evaluation, disability opinion, utilization review, causation analysis, or expert report. Those records may include emergency department notes, treating physician opinions, Physical Therapy records, imaging reports, operative reports, impairment ratings, and prior expert reports.
It is therefore natural for a physician expert to write or testify:
“The treating physician diagnosed cervical radiculopathy.”
Or:
“The MRI report stated there was no disc herniation.”
Or:
“The orthopedic surgeon concluded the shoulder tear was traumatic.”
In many settings, this seems like ordinary medical record review. But in California trial testimony, this can trigger a Sanchez objection. The objection is based on People v. Sanchez, a 2016 California Supreme Court case that changed how experts may discuss hearsay evidence in court. Although Sanchez was a criminal case, its reasoning has become important in California civil litigation, including personal injury and medical expert testimony.
For physician experts, the issue is practical: you may be allowed to rely on medical records, but you may not always be allowed to repeat case-specific statements from those records to the jury as if they are proven facts.
What Is Hearsay?
Hearsay is generally an out-of-court statement offered to prove the truth of what it says.
In ordinary language, if a witness says, “Another doctor wrote that the patient had a traumatic disc herniation,” and the purpose is to prove that the patient actually had a traumatic disc herniation, that may be hearsay unless an exception applies or the underlying evidence has been admitted.
The reason for the hearsay rule is cross-examination. The person who made the original statement is not in court being questioned about accuracy, assumptions, methodology, bias, or context.
Medical records often contain many layers of hearsay:
- The patient told the doctor something.
- The doctor recorded it.
- The doctor interpreted it.
- Another doctor summarized it.
- A later expert relied on it.
Some statements in medical records may fall within hearsay exceptions. Others may not. The physician expert does not need to become a lawyer, but should understand why an attorney may object when the expert recites another doctor’s diagnosis, conclusion, or opinion.
What Is People v. Sanchez ?
People v. Sanchez is a California Supreme Court decision from 2016. The case addressed whether an expert could relate case-specific hearsay to the jury as the basis for the expert’s opinion. The court held that when an expert relates case-specific out-of-court statements and treats them as true to support the expert’s opinion, those statements are hearsay. If they are testimonial in a criminal case, they may also implicate confrontation rights.
The court drew a key distinction between:
- General background information, which experts may discuss; and
- Case-specific facts, which cannot be smuggled into evidence through expert testimony if they are otherwise inadmissible hearsay.
California Evidence Code section 801 allows an expert opinion to be based on matter that is personally known to the expert or made known to the expert before or at the hearing, even if that matter is not admissible, so long as it is the type reasonably relied upon by experts in the field. But Sanchez limits the ability of the expert to repeat the content of inadmissible case-specific hearsay to the jury. The expert may rely on it; the expert may not necessarily recite it as factual proof.
The Practical Rule for Physician Experts
A simplified working rule is:
In California, a medical expert may generally rely on medical records as part of the basis for an opinion, but should be cautious about repeating another provider’s case-specific opinions, diagnoses, or factual assertions unless those records or statements have been admitted into evidence or a hearsay exception applies.
This means the physician expert should shift from being a narrator of the chart to being an independent medical analyst.
The expert should not merely say:
“Dr. X diagnosed the claimant with CRPS, so the claimant has CRPS.”
A stronger and safer formulation is:
“Based on my review of the reported symptoms, documented examination findings, diagnostic testing, treatment course, and my own examination, the claimant does not meet the Budapest criteria for CRPS.”
Or, if the opinion is supportive:
“The documented clinical findings, including regional allodynia, temperature asymmetry, edema, decreased range of motion, and absence of a better alternative diagnosis, support the diagnosis of CRPS.”
The difference is important. The expert is not simply repeating another doctor’s conclusion. The expert is applying medical reasoning to the data.
Case-Specific Facts Versus General Medical Knowledge
The core Sanchez distinction is between case-specific facts and general background information.
General Background Information
Experts can usually testify about general medical knowledge, such as:
- “Lumbar disc degeneration is common with aging.”
- “Rotator cuff tears increase in prevalence with age.”
- “CRPS is diagnosed clinically using the Budapest criteria.”
- “A whiplash mechanism commonly produces neck pain and trapezial pain.”
- “A positive MRI finding does not necessarily prove symptom causation.”
- “Patients with depression or anxiety may have delayed recovery from pain.”
This is general medical expertise. It is not a statement about what happened to the specific claimant.
Case-Specific Facts
Case-specific facts relate to the particular parties, events, injuries, treatment, or medical findings in the case. Examples include:
- “The claimant told the emergency physician she had immediate back pain.”
- “The treating surgeon diagnosed a traumatic labral tear.”
- “The radiologist reported an acute L4-5 disc herniation.”
- “The physical therapist documented positive Waddell signs.”
- “The pain physician stated the medial branch block gave 90% relief.”
- “The neurologist concluded the claimant was permanently disabled.”
These statements may be very important. But under Sanchez, the expert should be careful about repeating them as true unless counsel has established that the records are admissible, the statement fits a hearsay exception, or the expert is being asked a permissible hypothetical.
Why Treating Doctor Opinions Are More Vulnerable Than Exam Findings
Physician experts often distinguish between:
- A treating physician’s objective observations, and
- A treating physician’s diagnoses or opinions.
For example, a medical record might say:
“Motor strength was 5/5, sensation was intact, reflexes were symmetric, straight leg raise was negative, and the physician diagnosed lumbar radiculopathy.”
The exam findings are more useful to the reviewing expert than the diagnosis. The reviewing physician can independently analyze whether normal strength, intact sensation, symmetric reflexes, and negative straight leg raise support or contradict radiculopathy.
By contrast, simply repeating “the treating physician diagnosed lumbar radiculopathy” may be more vulnerable because it transmits another doctor’s conclusion without cross-examination.
A better expert report emphasizes the underlying data:
- Symptoms reported
- Physical examination findings
- Imaging findings
- Electrodiagnostic findings
- Treatment response
- Functional status
- Chronology
- Consistency or inconsistency across records
Then the expert states their own opinion.
How to Improve Medical Record Reviews After Sanchez
The best way to reduce Sanchez problems is to change how the record review is written.
Instead of writing a record review as a long series of quoted provider opinions, the physician expert should focus on medically relevant data and then provide independent analysis.
Less Helpful Record Review Style
“Dr. A diagnosed cervical strain. Dr. B diagnosed cervical radiculopathy. Dr. C diagnosed post-traumatic headache. Dr. D stated the claimant remained disabled. Dr. E concluded the symptoms were caused by the accident.”
This reads like a chain of hearsay opinions.
Stronger Record Review Style
“The early records document neck pain without objective neurologic deficit. Upper extremity strength was repeatedly recorded as normal. Reflexes were symmetric. Cervical MRI showed degenerative spondylosis without acute fracture, cord compression, or focal nerve root compression. Electrodiagnostic testing did not confirm cervical radiculopathy. Based on this chronology and objective data, the records support a cervical strain but do not support traumatic cervical radiculopathy.”
This is far more useful. It relies on the medical record, but the expert is doing the work.
Avoid Overquoting Medical Records
Physician experts should be cautious about extensive quotations from treating notes. Quoting may feel precise, but it can create evidentiary problems and may make the expert appear to be using the report as a conduit for another witness.
Use direct quotations only when:
- The exact wording is important.
- The statement is likely admissible or has been admitted.
- Counsel has asked for it.
- The quotation concerns the claimant’s own reported symptoms and counsel agrees it is appropriate.
- The quote is necessary to explain a discrepancy.
Even then, it is often better to paraphrase and analyze rather than quote.
Use “Records Document” Carefully
Many experts write:
“The records document that the claimant had no prior back pain.”
That may be acceptable in some contexts, but it can become problematic if the expert is simply repeating hearsay.
A more precise version is:
“I found no pre-accident medical records provided for review documenting complaints or treatment for low back pain.”
This is not the same statement. The first asserts the claimant had no prior back pain. The second states what the expert found in the provided records.
Similarly:
Instead of:
“The MRI was normal.”
Consider:
“I reviewed the MRI report, which described no disc herniation or nerve root compression. I did not personally review the images.”
Or, better when possible:
“I personally reviewed the MRI images. They do not show a disc herniation or nerve root compression.”
This distinction is particularly important because some jurisdictions may object to testimony about imaging based solely on a radiology report. A physician who personally reviewed the images is in a stronger position to offer an independent opinion.
Medical Records as Evidence Versus Medical Records as Basis
A key legal distinction is whether the medical record itself has been admitted into evidence.
If the medical records have been admitted, the expert may have more freedom to discuss them. If the treating doctor has testified, the expert may be able to respond to that testimony. If the statement falls within a hearsay exception, counsel may be able to use it. But if the record has not been admitted, and the expert is the first person telling the jury what the treating doctor said, Sanchez may be invoked.
This is why pre-testimony preparation with counsel matters. Before deposition or trial, the physician expert should ask:
- Which medical records have been admitted into evidence?
- Which records can I discuss directly?
- Which treating physician opinions should I avoid reciting?
- Are there hearsay exceptions counsel intends to rely on?
- Should I phrase the opinion as a hypothetical?
- Are there expected Sanchez objections?
- Should I avoid naming another doctor’s diagnosis unless asked?
- Have imaging studies been admitted, or have I personally reviewed them?
This is not legal strategizing by the expert; it is testimony preparation.
Deposition Versus Trial
The practical consequences may differ between deposition and trial.
In deposition, attorneys may object to preserve the issue, but the testimony often continues. The objection may be addressed later. In trial, the objection may prevent the jury from hearing the answer, or the judge may strike the answer. That can disrupt testimony and weaken the expert’s presentation.
Because of that, physician experts should use trial-safe habits even during deposition:
- Avoid unnecessary quotations.
- Avoid reciting another doctor’s opinions as facts.
- Give your own medical opinion.
- Explain the underlying medical reasoning.
- Distinguish records reviewed from facts independently verified.
- Ask for clarification if counsel’s question invites a hearsay problem.
How to Respond When a Sanchez Objection Is Made
A physician expert should not argue the law. That is counsel’s job.
If an attorney objects “Sanchez” or “hearsay,” the expert should stop and wait for instruction. If allowed to answer, the expert can reframe:
“I relied on the medical records as part of my review. My opinion is based on the pattern of documented symptoms, examination findings, imaging, treatment course, and my own medical analysis.”
Or:
“Rather than repeat another physician’s conclusion, I can explain my own opinion based on the findings documented in the records.”
Or:
“I understand. My opinion is that the objective findings do not support radiculopathy because strength, sensation, reflexes, and electrodiagnostic testing were not consistent with nerve root injury.”
This keeps the expert in the proper role.
How to Discuss Another Doctor’s Report Without Becoming a Hearsay Conduit
Physician experts often need to address other doctors’ reports, especially in rebuttal opinions. The key is to critique the reasoning rather than merely repeat the conclusion.
For example:
Problematic
“Dr. Smith said the claimant’s shoulder tear was caused by the accident.”
Better
“The causation opinion attributing the shoulder tear to the accident is not supported by the mechanism, the delayed onset of shoulder-specific complaints, the absence of instability, and the MRI findings showing degenerative labral abnormality without acute edema.”
This avoids relying on the other doctor’s statement as proof. It evaluates the medical basis for the opinion.
Problematic
“The treating doctor stated the claimant could not work.”
Better
“The work restrictions in the records were not accompanied by objective neurologic deficit, structural instability, or functional testing demonstrating inability to perform sedentary work.”
Again, the physician expert is analyzing the medical basis.
Use Independent Medical Opinions
The strongest testimony follows this structure:
- What records were reviewed?
- What objective data were medically important?
- What did the expert personally observe or examine?
- What general medical principles apply?
- What conclusion follows?
For example:
“I reviewed the emergency department records, orthopedic records, therapy records, MRI report, and electrodiagnostic report. The medically important findings are that the claimant reported neck pain immediately after the collision, but there was no documented motor deficit, reflex asymmetry, dermatomal sensory loss, fracture, instability, or electrodiagnostic evidence of radiculopathy. Based on those findings and the expected course of cervical strain, my opinion is that the accident caused a cervical strain but did not cause cervical radiculopathy.”
This testimony does not depend on repeating another doctor’s diagnosis. It explains the expert’s own reasoning.
What About Patient Statements in Medical Records?
Patient statements made for medical diagnosis or treatment may fall under a hearsay exception in many jurisdictions. Federal Rule of Evidence 803(4), for example, provides an exception for statements made for medical diagnosis or treatment. California has its own evidence rules and case law, and counsel should determine how they apply in a particular case.
For the physician expert, the practical point is to be careful:
- “The patient reported neck pain in the emergency department” may be treated differently from
- “The treating doctor concluded the collision caused a permanent injury.”
The first may be a symptom history used for diagnosis. The second is a causation opinion by another physician.
Imaging Reports and Sanchez-Type Issues
Imaging reports can create another problem. If the expert says:
“The MRI showed no herniation,”
but the expert only read the radiologist’s report and did not personally review the images, the testimony may be vulnerable depending on the jurisdiction and evidentiary posture.
A safer approach is:
“The radiology report described no disc herniation. I did not independently review the MRI images.”
Or, if qualified and images were reviewed:
“I reviewed the MRI images, and in my opinion they do not show a traumatic disc herniation.”
Physician experts should be honest about whether they reviewed the actual images or only the report. In many cases, reviewing the images directly strengthens the opinion and reduces reliance on another physician’s hearsay interpretation.
Practical Report-Writing Strategies
To improve IME reports and record reviews, consider the following approach.
- Separate Facts From Opinions
Use headings such as:
- Records Reviewed
- Claimant History
- Examination Findings
- Diagnostic Studies
- Medical Analysis
- Opinions
Avoid mixing long record summaries with conclusions.
- Minimize Treating Physician Opinion Recitations
Do not make the report a list of what other doctors concluded. Summarize the medically relevant data.
- Use Objective Findings
Emphasize:
- Range of motion
- Strength
- Reflexes
- Sensory findings
- Atrophy
- Swelling
- Imaging features
- Electrodiagnostic findings
- Operative observations
- Functional testing
- Medication use
- Work status
- Identify Source Limitations
If you relied on a report rather than images, say so. If records were missing, say so. If you did not perform an examination, say so.
- Give Your Own Diagnosis
Do not adopt another physician’s diagnosis without analysis. State your diagnosis and explain why.
- Use Literature as General Background
Medical literature is usually not case-specific hearsay. It can support general medical principles, such as prevalence, natural history, diagnostic criteria, or treatment efficacy.
- Prepare With Counsel
Before testimony, ask counsel how to handle medical record references, admitted exhibits, hypotheticals, and expected objections.
Example: Poor Versus Better Testimony
Poor Testimony
“The treating neurologist said the claimant had CRPS, the pain doctor agreed, and the therapist documented severe pain, so I accepted CRPS.”
This repeats other opinions and does not show independent reasoning.
Better Testimony
“I applied the Budapest criteria. The records document reported pain and decreased use of the limb, but the examinations did not consistently show objective vasomotor, sudomotor, edema, sensory, or trophic signs in the required categories. The claimant also had prolonged nonuse with adhesive capsulitis and contracture, which better explains the functional limitation. Therefore, I do not find that the diagnostic criteria for CRPS are met.”
Poor Testimony
“The radiologist said the MRI showed a traumatic disc herniation.”
Better Testimony
“The imaging report described a disc protrusion. However, the clinical record does not show acute radiculopathy, and the described imaging finding is common in degenerative spine disease. I did not see objective evidence that the protrusion was traumatic.”
Poor Testimony
“The orthopedic surgeon said the claimant could never return to work.”
Better Testimony
“The restrictions are not supported by objective findings in the record. The examinations show preserved strength, no neurologic deficit, and no structural instability. Based on those findings, permanent total work restriction is not medically supported.”
How This Applies in Medicolegal Reporting
For physician experts, Sanchez reinforces a broader professional point: your value is not that you can recite the chart. Your value is that you can interpret the chart.
A high-quality medical-legal report should:
- Identify the records reviewed.
- Summarize the clinically important findings.
- Avoid unnecessary repetition of treating opinions.
- Distinguish patient-reported symptoms from examiner-observed signs.
- Distinguish radiology reports from personal image review.
- Apply medical literature and diagnostic criteria.
- Provide independent opinions.
- Explain the reasoning clearly enough that the opinion does not depend on hearsay.
The best expert report is not a transcript of the medical record. It is a reasoned medical analysis of the record.
Practical Implications for Attorneys, Adjusters, and Physician Experts
For attorneys, Sanchez affects how expert testimony should be prepared. If case-specific facts are important, counsel should consider how those facts will be admitted independently, whether records qualify under an exception, whether treating physicians must testify, or whether hypotheticals should be used.
For claims professionals, the issue explains why a strong IME report should not merely summarize every provider’s diagnosis. The report should identify the medical facts that matter and explain the expert’s independent conclusions.
For physician experts, the practical lessons are:
- You may rely on medical records.
- Do not assume you can freely repeat every statement in those records at trial.
- Emphasize objective data, not other doctors’ conclusions.
- Give your own opinions.
- Avoid becoming a conduit for inadmissible hearsay.
- Clarify whether imaging opinions are based on reports or personal review.
- Prepare with counsel before testimony.
- When objected to, stop and let counsel handle the legal issue.
Conclusion
In California, People v. Sanchez changed how expert witnesses may discuss hearsay. A physician expert may rely on medical records as part of the basis for an opinion, but may not always be allowed to recite case-specific hearsay from those records as proof of the facts asserted.
For medical experts, this means record reviews and testimony should be written and delivered differently. The strongest approach is to focus on symptoms, objective findings, imaging, testing, chronology, and functional evidence, then explain your independent medical opinion. Avoid simply repeating treating physician diagnoses or conclusions unless counsel has established that the evidence is admissible.
The central principle is clear: an expert should not merely tell the jury what other doctors said. An expert should explain what the medical evidence means.
References
- People v. Sanchez, 63 Cal.4th 665, 374 P.3d 320, 204 Cal.Rptr.3d 102 (2016).
- California Evidence Code § 801. Expert witness opinion testimony.
- Advocate Magazine. People v. Sanchez. April 2024.
- Poole Shaffery & Koegle, LLP. California Supreme Court clarifies hearsay restrictions under People v. Sanchez. 2021.
- Hanson Bridgett. Expert testimony, case-specific facts, and hearsay. 2017.
- Plaintiff Magazine. The California Supreme Court’s new limitation on an expert’s ability to rely on hearsay evidence.