An American lawyer has tapped medical experts in India to help with legal cases in the United States. Mike O'Sullivan reports, it is part of a growing trend in the outsourcing of professional services.

Dorothy Clay Sims handles cases against medical insurers that refuse to pay for treatments that her clients say they deserve. She also represents plaintiffs who claim they are suffering from pain or a disability because of an accident.

Opposing lawyers often call on medical experts, and Sims, as a medical layperson, needs help from a doctor just to understand the testimony. The expert advice could cost her client one-thousand dollars an hour, or even more.

Sims has reduced that cost by hiring medical experts in India for a fraction of the price, and she makes the service available to other American lawyers through an Internet-based business called MD in a Box. The U.S. lawyers pay $90 an hour for the medical consulting.

The process works through a real-time link to an Indian doctor by computer. Sims describes a typical case in which a U.S. orthopedic surgeon disputes her client's claims in an American courtroom.

"I have my computer with me, and my doctor in India is listening to the orthopedic surgeon the whole time, through a microphone plugged into my laptop," said Dorothy Clay Sims. "He is then sending me instant messages saying, "that is not true. It is actually such and such or so and so." And I look down at my screen and I will just say exactly what the doctor said from India."

Sims got the idea for the business while visiting India, where she and her husband were doing volunteer work at a hospital.

"And then, my husband got ill and ended up needing a digital x-ray, and he met with a radiologist, got the digital x-ray, and then had a consultation with another doctor, and the whole bill was $35," she said. "And that is when I realized, 'Oh my gosh, they could help lawyers here in the U.S.'"

Sims assembled a group of doctors in India that has helped on more than 100 U.S. cases.

There are pitfalls in any business, especially one that operates on opposite sides of the globe. Sims has encountered problems ranging from cultural misunderstandings to money that disappeared while being processed by an Indian accountant. But she says her web-based consultancy is showing a profit and growing.

Outsourcing expert Kevin Desouza teaches in the Information School at the University of Washington. He says outsourcing to India began with manufacturing and telephone call centers, then moved to high-end services, like the one that Sims offers.

"In the late 1980s to early '90s, companies realized that especially India had a large talent pool of skilled engineers. Almost all of them were computer engineers. They had training in electrical engineering and all of the computational sciences."

As U.S. high-tech companies began to outsource software design, other companies drew on India's educated, urban labor pool. Some outsourced administrative services, such as paralegal and medical research.

Desouza says many U.S. firms are doing payroll and tax preparation in India and China. He adds that India, with its many engineers and scientists fluent in English, is well positioned to move into technical fields such as biotechnology.

An Indian trade association for the outsourcing industry says revenue from exports of software, services and business outsourcing grew more than 30 percent last year, and should reach $40 billion in the current fiscal year.