We call a treating physician who testifies to more than just their treatment a hybrid expert. But doctors who both treat and testify can sometimes be less “Doctor Do No Harm” and more “Doctor Show Me the Money.” And when their treatment comes under a letter of protection (“LOP”), things get even murkier. Like, swampy Florida-murky. Which is oddly fitting since today we are talking about Dyer v. Coloplast Corp., 2025 U.S. Dist. LEXIS 200241 (M.D. Fla. Oct. 9, 2025).

Before we get into the case specifics, this is not an attack on treating physicians. Most are competent, ethical professionals who want to help people. But when a doctor is treating under an LOP and then testifying in court with the flair of a paid actor in a late-night infomercial, defendants have to ask–is this about the patient, or the payout?

Plaintiff in Dyer sued the manufacturer of the pelvic sling that was surgically implanted to treat her stress urinary incontinence and pelvic organ prolapse. The sling later was removed due to side effects. Defendant served discovery requests on both plaintiff and her explanting surgeon seeking production of documents related to plaintiff’s counsel’s relationship to the explanting surgeon, including any LOPs, billing agreements, or other documents reflecting referrals and financial relationships.  Plaintiff and her doctor moved to quash and defendant moved to compel.  The opinion starts by dealing with technical and procedural issues. Like that both plaintiff and the physician filed motions to quash in the wrong court–not the court where compliance would occur—and that they filed too late. Id. at *7-9. Or that personal service of Rule 45 subpoenas was not required; giving the subpoena to an employee at the address listed for the physician in plaintiff’s disclosures was reasonably calculated (and did) ensure receipt. Id. at *11-12.

The court also rejected the surgeon’s arguments that the requests sought protected health information (“PHI”) that patient-physician privilege prohibited him from disclosing. Not only did the requests for financial relationship documents not call for PHI, the defendant agreed that if responsive documents did contain such information, it could be redacted. Id. at *13.

So that left only whether discovery of LOPs or financial relationships should be permitted at all. For those blissfully unaware, an LOP is an agreement between a plaintiff’s attorney and a medical provider.  The medical provider agrees to treat the plaintiff now, and in return, the attorney promises to pay the treater later, out of any settlement or award the plaintiff may receive. It’s like a medical IOU. While there may be instances where an LOP is used because a plaintiff cannot otherwise get medical treatment (uninsured), it can also be a litigation strategy. Plaintiff’s counsel refer their clients to physicians who are experienced courtroom testifiers. Now you have a doctor testifying in court who has a quiet financial interest in the outcome, or maybe a not-so-quiet one.

Hybrid expert witnesses are unique creatures. They testify as treating doctors (so they’re supposedly neutral), but they also function like retained experts. That’s not inherently bad. But there is no dispute that discovery of how much retained experts are getting paid to testify is warranted. Everyone agrees it can go to bias. So, the same rule should apply to treating doctors. Defendants should be able to know and cross-examine treaters on their financial interest in the litigation and their financial relationship to plaintiff’s counsel.

Afterall, if a doctor has treated dozens of patients referred by the same law firm, all under LOPs, and all leading to litigation… well, we’re not in Hippocratic territory anymore. We’re in transactional medicine, dressed up as medical opinion. Without discovery, the defense is left poking around in the dark, while the jury sees a white coat and assumes objectivity.

Which brings us back to Dyer and Fla. Stat. §768.0427(3), enacted in March 2023. The statute requires disclosure of any LOP (broadly defined), as well providing generally that the nature of the financial relationship between a law firm and a medical provider is relevant to the issue of bias—making it discoverable. Plaintiff in Dyer, however, tried to rely on pre-2023 cases to quash the discovery. Such as Worley v. Central Florida YMCA, Inc., 228 So. 3d 18 (Fla. 2017), in which the court held that “a lawyer’s referral of a client to a treating physician was a confidential communication protected by the attorney-client privilege.” Dyer, at *15. Fortunately, §768.0427 overturns Worley; therefore, plaintiff and her surgeon were ordered to respond to the discovery. 

Hybrid experts are not the enemy—but unchecked financial bias is. Pulling back the curtain and allowing some of that Florida sun to shine on LOPs is doing the right thing.