James C. Johnston MD, JD, FCLM, FACLM, FAAN

Addressing the Neurological Disorders in Ethiopia

10/23/2019

Licensed to practice in both the medical and the legal professions, Dr. James C. Johnston has over 30 years of experience as a neurologist. James C. Johnston, MD, JD, is the founder and director of the nonprofit organization Global NeuroCare, which focuses on enhancing neurological services in developing regions.

The World Health Organization (WHO) acknowledges that neurological disorders, including stroke, neurological infections, and dementia, are among the world’s greatest public health threats. Ethiopia is one country with a daunting neurological disorder challenge. The country has approximately 50 neurologists, yet WHO recommends up to 4,500 more neurologists to provide appropriate care for the country’s 105 million citizens.

Global NeuroCare has been helping address the issue through a long term collaborative partnership with the neurology residency program at Addis Ababa University. The program, which began in January 2006, has been administered by national and international neurologists. The only neurology training program in Ethiopia, it has made sustained and substantial achievements under extraordinarily difficult circumstances.

Since its establishment, the program has become self-sufficient, training local neurologists who can teach Ethiopia’s next generation of physicians to manage common neurological diseases. The program needs ongoing support. To see how you can help, visit globalneurocare.org.

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Advancing Neurological Care in Ethiopia

8/29/2019

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A board-certified neurologist with additional certification in rehabilitation, Dr. James C. Johnston has been in private practice for more than 30 years. James C. Johnston, MD, JD, focuses on advancing global health in an effort to improve neurological care for the most vulnerable populations in the most impoverished regions, especially in sub-Saharan Africa and particularly Ethiopia, one of the least developed nations on the planet.

Dr. James C. Johnston is an Honorary Professor of Neurology at Addis Ababa University, and established the 501(c)(3) non-profit organization Global NeuroCare to advance physician training, improve patient care and further medical research in Ethiopia and other developing regions. Global NeuroCare is accredited by the World Health Organization, and holds Special Consultative Status with the United Nations ECOSOC.

On behalf of Global NeuroCare, James C. Johnston, MD, JD strongly recommends forming ethically congruent collaborative partnerships focused on establishing self-sufficient local training programs in order to advance the recruitment, development, training and retention of healthcare workers in developing regions and thus improve healthcare access while protecting vulnerable populations. And Dr. Johnston condemns the harmful practices engendered by academic institutions engaging in self-serving medical missions which fail to provide any substantive benefit to the host nations and, in fact, impedes development of local medical care in the very regions it is most needed. (E/2019/NGO/19 Statement at 2019 High Level Political Forum).

This is the most effective means of improving neurological services - training local physicians, to treat local conditions, with the limited available resources in their community, followed by a focus on expanding resources. This is the approach adopted in Ethiopia through the neurology residency training program which has graduated over 50 neurologists in the past decade. These neurologists are treating many thousands of patients but more importantly, they are training the next generation of doctors how to manage common neurological conditions such as stroke, epilepsy, neuropathy, headache and similar disorders.

Dr. James C. Johnston and his Ethiopian colleague Professor Mehila Zebenigus have presented their recommendations and findings at the American Academy of Neurology meetings in Los Angeles and Philadelphia, and the World Congress for Medical Law conferences in Baku, Tel Aviv and Tokyo. In 2018, the World Association for Medical Law in conjunction with the Israeli Ministry of Health and Tel Aviv University honored Drs. Johnston and Zebenigus with the Inaugural Davies Award in Public Health for their work through Global NeuroCare.

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WHO Names Neurological Disorders as Global Threat to Public Health

6/4/2019

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Neurologist and Attorney Dr. James C. Johnston is the Founder and Director of Global NeuroCare and Global Neurology. Through these organizations, Dr. James C. Johnston works to improve neurological services in developing nations, where large numbers of people suffer from neurological disorders.

The World Health Organization (WHO) designated neurological disorders as one of the greatest threats to global public health. These disorders - stroke, epilepsy, dementia, headache, neuropathy, spine disorders - are more prevalent in the developing nations, leading to severe disability which results in lost income, fewer opportunities, and increased vulnerability. These noncommunicable diseases are rapidly increasing, along with persistent communicable diseases and increasing injuries, all complicated by a severe global shortage of trained neurological professionals.

Ethiopia, for example, has only one neurologist for every 4 to 5 million people. Since over three-quarters of the world population lives in low- to middle-income countries that are experiencing rapid population growth, similar statistics are present in many areas.

The WHO has launched global health initiatives that aim to increase professional and public awareness of neurological disorders across the globe. Additionally, organizations such as Global NeuroCare and Global Neurology are addressing the problem in several developing nations. By forming critical partnerships with universities, hospitals, and clinics, these organizations are working toward improved care and self-sustaining programs expected to enjoy long-term success.

Global NeuroCare is in Special Consultative Status with the United Nations ECOSOC, and Dr. James C. Johnston serves as a Delegate to the UN providing expert analysis and recommendations on improving healthcare access, especially in the least developed nations. Dr. Johnston focuses on a collaborative approach, which guides Global NeuroCare and Global Neurology in advancing standards of care, training physicians, and conducting medical research on a global scale.

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GLOBAL NEUROLOGY REPORT: NON-COMMUNICABLE DISEASES IN THE DEVELOPING WORLD

9/21/2018

The non-communicable diseases (NCDs) – heart and lung diseases, stroke, cancer, diabetes – are responsible for 7 out of 10 deaths in the world, 41 million people every year. The United Nations 2030 Sustainable Development Goal of reducing premature mortality from NCDs by one-third appears out of reach. Additionally, the overall situation is worse in the least developed nations that are facing a triple burden on ongoing infectious diseases, rapidly increasing NCDs and the diverse effects of globalization including increasing accidents and injuries.

Neurologist and Attorney James C. Johnston, MD, JD and Neurologist Dr. Mehila Zebenigus discussed these concerns at the 2018 United Nations (UN) High Level Political Forum where their recommendations to improve healthcare in sub-Saharan Africa were accepted for further action. Drs. James C. Johnston and Mehila Zebenigus outlined these recommendations and future plans at the 24th World Association for Medical Law (WAML) Congress in Tel Aviv, Israel on 2-6 September 2018. Leading international experts from over 40 countries met and discussed topics related to Global Health, Medical Law and Bioethics, with a focus on Public Health, Humanitarian Medicine and the Right to Health.

The WAML in conjunction with the Israeli Ministry of Health and Tel Aviv University awarded Dr. Johnston the Inaugural Davies Award in Public Health. Dr. Johnston dedicated the award to Dr. Mehila Zebenigus and the entire Department of Neurology in Addis Ababa, Ethiopia, and donated the funds to Global NeuroCare®.

Global NeuroCare® is a 501(c)(3) non-profit organization founded by Dr. James Johnston to advance healthcare in the most impoverished regions of the world. Global NeuroCare® is accredited by WHO and holds Special Consultative Status with the UN ECOSOC, allowing Dr. Johnston to provide expert analysis on issues related to global health, help monitor and implement UN goals and objectives, make written and oral recommendation statements, and serve as a UN delegate at the UN sessions in New York, Geneva and Vienna. In accordance with Article 71 of the UN Charter, the ECOSOC of the United Nations has fully accepted Global NeuroCare® in its circle of accredited non-governmental organizations.

There are some relatively simple approaches to NCDs that will save lives – treating hypertension, cancer screening, increasing physical activity, decreasing pollution - but it will take the combined effort of elected government officials, local ministries of health and other select government and non-government organizations to implement these measures in a coordinated and effective fashion. Dr. Johnston provided recommendations for improving healthcare access at the UN High Level Political Forum and Commission for Social Development. These matters will be further discussed at the 27 September UN General Assembly High Level Meeting on NCDs.

The Challenges of Cerebral Palsy in Africa

2/28/2018

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Dr. James C. Johnston, the founder and director of Global Neurocare, and partner in Global Neurology Consultants, has published extensively on neurology and global health topics. One area of neurology Dr. James C. Johnston has written on is cerebral palsy (CP), a group of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination. There may be associated intellectual disability, epilepsy, vision and hearing impairment, contractures and a number of orthopedic deformities.

The limited available data from Africa suggests the prevalence of CP is 3-fold higher than in the developed world. CP may be due to genetic mutations that impact brain development, or other damage to the brain as well as acquired causes including post-natal diseases such as meningitis or cerebral malaria.

There is no cure for CP, but children should be treated with appropriate physical, occupational and speech therapy, as well as medications for management of seizures or spasticity, and appropriate specialist care. Assistive devices are also necessary to ensure children are able to lead productive lives if possible.

More importantly, neurological specialist care is essential to treat the children as well as train therapists, coordinate research and teach the general practitioners how to address CP. This is an overwhelming hurdle in sub-Saharan Africa where there is a severe shortage of neurologists, and many patients are treated by traditional healers. Global NeuroCare works in partnership with the Addis Ababa University Department of Neurology which has trained almost 40 neurologists over the past decade, increasing the ratio in Ethiopia to one neurologist for every 2-3 million people. The program now trains physicians from other Africa nations but it will be many years, if ever, before this region meets the World Health Organization recommendation of one neurologist for every 100,000 people. Even then, if it ever reaches that ratio, the neurologists need adequate resources to treat these children with CP and related conditions, including trained therapists, adequate medications and a contingent of other specialists to manage the orthopedic issues, impaired vision, and hearing loss.

And this is just one condition having a profound impact on this region of the world - it is imperative for the medical community to focus on advancing neurological care in Africa, which already has the greatest burden of disease and the least resources.

James C. Johnston, MD, JD recently discussed the important of addressing this burden in Africa, and previously summarized the model training program in Ethiopia in letters to Neurology Today.
https://journals.lww.com/neurotodayonline/pages/articleviewer.aspx?year=2018&issue=01250&article=00005&type=FullText https://journals.lww.com/neurotodayonline/Fulltext/2016/12220/Letters_to_the_Editor.4.aspx

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Keeping Clear of Errors and Malpractice in the Neurology Field

11/19/2016

An alumnus of the University of Texas Health Science Center in San Antonio, TX, Dr. James C. Johnston is a board certified neurologist and a licensed attorney and counselor at law. With close to three decades of professional experience, he serves as medical director of Legal Medicine Consultants. Dr. James C. Johnston shared his expertise in a letter he co-wrote to the editor of Neurology Today which was published on March 17, 2016.

Reacting to a published article on diagnostic errors in neurology, he noted that the report understated the problem and did not provide practical advice to neurologists on how to better deal with the issue. His letter states two fundamental principles to apply in order to manage the risks.

The first is for the practitioner to come to a clear understanding about how evidenced-based medicine can be used to treat patients, and conversely, how this knowledge can be used against the practitioner in a clinic and in court. Once it is understood, stringent patient treatment documentation will become habitual, saving the physician from additional lawsuits as compared to other means of risk mitigation.

The second principle is for the physician to become aware of the scenarios that will usually lead to litigation. When faced with one of these scenarios, the practitioner should escalate attention, increase followups, and promptly address patient complaints. Adhering to these principles will lead to better patient outcomes and lower the probability of a malpractice suit.

Dr. James C. Johnston provides specific examples in a recent chapter published in Neurologic Clinics 2016 entitled "Neurological Fallacies Leading to Malpractice: A Case Series Approach." This article may be accessed on researchgate: https://www.researchgate.net/profile/James_Johnston6/contributions

The Risks of Continuous Electronic Fetal Heart Monitoring

5/27/2016

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Dr. James C. Johnston is a board certified neurologist with 26 years of medical experience, and is also an attorney who serves as the director for Legal Medicine Consultants. As a medical and legal professional, Dr James C. Johnston, who received his MD from the University of Texas Health Science Center in San Antonio, Texas, has published on a number of subjects regarding medical malpractice and litigation.

He has co-authored several articles on cerebral palsy and electronic fetal monitoring (EFM), which have been published in the Journal of Child Neurology, Journal of Maternal-Fetal and Neonatal Medicine, Journal of Childhood and Developmental Disorders, and The Surgery Journal.

Electronic fetal monitoring is based on a virtually non-existent scientific foundation, has a false positive rate exceeding 99%, and has not affected the incidence of cerebral palsy or any other neonatal malady. It has, however, increased the cesarean section rate, with the expected increase in morbidity and mortality to mothers and babies.

EFM is the cardinal driver of the worldwide malpractice litigation crisis centered around cerebral palsy. In addition, the daily use of this ineffective procedure creates a ethical dilemma of extraordinary proportions, as expectant mothers are not routinely provided with informed consent regarding EFM, which is performed to protect doctors and hospitals from lawsuits.

Dr. Johnston and his co-author propose linking EFM to the Daubert exclusionary evidence doctrine to end cerebral palsy litigation, and following contemporary ethical guidelines to provide women with a choice by telling them the whole EFM story, including the emerging evidence that cesarean sections may expose babies to the risk of future chronic diseases and neuropsychiatric disorders.

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American Academy of Neurology

3/19/2016

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A graduate of the University of Texas Health Science Center in San Antonio, TX, Dr. James C. Johnston has nearly three decades of experience as a neurologist. Throughout his professional career, Dr. James C. Johnston has remained an active member of various professional organizations like the American Academy of Neurology.

The American Academy of Neurology (AAN) is the world's largest professional association of neurologists, and the leading resource center for neurologists around the world. The organization was founded in 1948, and now represents more than 30,000 members. It is dedicated to promoting the highest quality patient-centered care.

The 68th AAN Annual Meeting will take place April 15-21, 2016, in Vancouver, British Columbia, Canada, where leading neurologists will discuss the latest breakthroughs in the field. There will be more than 12,000 attendees including neurologists and neuroscience specialists. Lectures, meetings and discussions will focus on common neurological problems and controversies. Additionally, there will be presentations of contemporary issues such as global health concerns. These are particularly relevant for Dr. Johnston, a Partner in Global Neurology Consultants and Director of GlobalNeuroCare.org, a 501(c)(3) charity dedicated to improving neurological care in resource limited regions.

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Task Force Overlooks Electronic Fetal Monitoring Failures

7/2/2015

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Dedicated to evidence-based neurological care and expanding neurological services in developing countries, Dr. James C. Johnston serves as the director of Legal Medicine Consultants, and is the founder of the nonprofit Global NeuroCare. As a lawyer and board-certified neurologist, Dr. Johnston also authors various articles related to his fields of expertise, including a recent article in the Journal of Maternal-Fetal and Neonatal Medicine titled Neonatal Encephalopathy 2015: Opportunity Lost and Words Unspoken.

Dr. James C. Johnston co-authored the article with Thomas Sartwelle in response to what they deemed to be an oversight by the international Task Force Study on Neonatal Encephalopathy Second Edition 2014. According to the article, the Task Force failed to denounce the use of electronic fetal monitoring (EFM), a 40-year practice unsupported by science that trial lawyers exploit to blame physicians for infant cerebral palsy. The authors state that the task force acknowledged EFM’s inadequacies but still recommended that physicians use EFM for every woman in labor.

In the article, the authors explore the Task Force’s omission of critical EFM information, trial lawyers’ interest in continuing the use of EFM, and EFM’s misguided support from professional organizations. The authors also assert that the Daubert doctrine could help exclude “EFM junk science” from courtrooms around the world.

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Malnutrition and Neurological Problems

6/23/2015

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Dr. James C. Johnston is a neurologist serving as director of Global NeuroCare, an organization that strives to improve people’s health at home and around the world. Dr. James C. Johnston’s areas of focus include the neurological consequences of malnutrition.

In many areas of the globe, malnutrition is a common problem, and a well-known factor of infant and child mortality rates in regions with little food availability and limited medical resources. Not getting enough nutrients (causing malnutrition, retarded growth and related problems), or lacking the proper balance of nutrients (causing micronutrient deficiencies), has many negative effects on an individual’s body and long-term health outlook. It affects all aspects of the anatomy, with a profound impact on the nervous system. These neurological effects are long-term, and greatly impact a person’s ability to function. Early detection is crucial since proper nutrition may prevent many of the developmental abnormalities.

For example, malnutrition can lead to problems in the cognitive development of children. Malnourished children may have difficulty remembering things, have poor reasoning skills, and experience trouble paying attention, all issues which can negatively affect school performance and long-term well-being. Additionally, the lack of energy associated with not getting enough food can make children less playful and interested in their surroundings, circumstances which can further stunt their mental and emotional growth. With these extraordinarily serious effects, the problem of malnutrition should be addressed as soon as possible.

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Addressing the Neurological Disorders in Ethiopia

Advancing Neurological Care in Ethiopia

WHO Names Neurological Disorders as Global Threat to Public Health

GLOBAL NEUROLOGY REPORT: NON-COMMUNICABLE DISEASES IN THE DEVELOPING WORLD

The Challenges of Cerebral Palsy in Africa

Keeping Clear of Errors and Malpractice in the Neurology Field

The Risks of Continuous Electronic Fetal Heart Monitoring

American Academy of Neurology

Task Force Overlooks Electronic Fetal Monitoring Failures

Malnutrition and Neurological Problems

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