Defending Claims for Psychological Damages as Part of a Medical Malpractice Lawsuit

Size: px
Start display at page:

Download "Defending Claims for Psychological Damages as Part of a Medical Malpractice Lawsuit"

Transcription

1 Defending Claims for Psychological Damages as Part of a Medical Malpractice Lawsuit Leslie C. O Toole Brian C. Vick Ellis & Winters, LLP Post Office Box Raleigh, North Carolina Page 1

2 Leslie C. O Toole is a partner in the Raleigh office of Ellis & Winters LLP. She received her A.B. degree, magna cum laude, from Brown University and her J.D. degree, with high honors, from The University of North Carolina School of Law. Ms. O Toole practices in the areas of civil litigation, products liability (including drugs and medical devices), and medical malpractice defense. Ms. O Toole has also been part of a regional and trial counsel team in the breast implant litigation, as well as other drug and medical device litigation. Ms. O Toole currently serves as Executive Vice President of the North Carolina Association of Defense Attorneys, and is Vice Chair of the Drug, Device and Biotechnology Section of the FDCC for She is also the Board Chair for Special Olympics North Carolina. In addition, Ms. O Toole has given numerous presentations on Daubert, trial skills, company documents, and other topics for organizations such as the North Carolina Association of Defense Attorneys, DRI, the FDCC, The North Carolina Bar Association, and the National Institute for Trial Advocacy. Brian C. Vick is an associate in the Raleigh office of Ellis & Winters LLP. He received his B.A. degree from Vassar College, and his J.D. Degree summa cum laude from the University of Georgia School of Law. Following graduation, Mr. Vick served as a law clerk to the Honorable Joel F. Dubina on the United States Court of Appeals for the Eleventh Circuit. Brian Vick practices in the area of civil litigation, including products liability (including drugs and medical devices), catastrophic injury, medical malpractice defense and satellite piracy. At the University of Georgia School of Law, Mr. Vick was a member of the editorial board and a notes editor for the Georgia Law Review. He was also elected to the Order of the Coif. Mr. Vick is currently a member of the North Carolina Bar Association and the North Carolina Association of Defense Attorneys. Page 2

3 Defending Claims for Psychological Damages as Part of a Medical Malpractice Lawsuit I. Introduction Leslie C. O Toole Brian C. Vick Ellis & Winters, LLP Post Office Box Raleigh, North Carolina Medical negligence cases often involve claims of psychological damages or injuries. Defending against such claims can be difficult due to the inherently subjective nature of psychological injuries and mental disorders. However, sufficient preparation and planning by defense counsel can reduce the impact of such claims by either exposing their weaknesses or raising significant questions about their merit. A psychological injury can be associated with a physical injury, or may be the only claimed injury in the case. Typically, the psychological injury will be part of a set of claimed injuries, both physical and psychological. However, the psychological component of damages may become more significant as the case develops if the physical injuries start to improve or are shown not to be disabling. The mere fact that psychological damages are not alleged early in a case should not be taken as a sign that no such damages will be claimed. If the possibility of a psychological damages claim exists, defense counsel should take steps throughout the case to prevent such a claim from arising or negate such a claim when alleged. The types of psychological damages or injuries involved in medical negligence cases can range from depression to anxiety disorders to post traumatic stress disorder. This paper focuses on post traumatic stress disorder ( PTSD ) as an exemplary injury because it is prevalent in medical, as well as non-medical, negligence cases and it provides a good example of how to defend against most claims of psychological damage. II. The Example of Robert M. This paper uses the case of Robert M. as an illustrative example at various points in the discussion. These examples are drawn from an actual case, but certain facts have been changed to protect the identity of the parties involved. Robert M. was a middle-aged man who developed pneumonia, and subsequently acute respiratory distress syndrome (ARDS). His illness required him to be hospitalized for several months with a significant portion of that time in the intensive care unit connected to a ventilator. Page 3

4 Robert M. brought suit against several of his physicians alleging that their failure to properly diagnose his pneumonia caused it to be significantly worse that it otherwise would have been. He claimed that he suffered both a physical injury of impaired respiratory functioning as a result of the failure to diagnose, and a psychological injury of post traumatic stress disorder from his stay in the hospital and a rehabilitation center. His case illustrates many of the topics discussed in this paper. III. How Psychological Disorders Are Diagnosed The psychological injuries most commonly alleged in medical malpractice cases will almost invariably have been diagnosed using the Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition ( DSM-IV ). AMERICAN PSYCHIATRIC ASSOCIATION, DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (4th ed., text rev. 2000) [hereinafter DSM-IV]. The DSM-IV is the Bible of psychological disorders and is almost universally used by clinicians in diagnosis. It provides both a general framework for assessing an individual s overall well-being and criteria for diagnosing specific psychological disorders. The DSM-IV is so widely used and accepted that it will rarely, if ever, be called into question either by a plaintiff s treating physician or expert. Before delving into a case involving psychological damages, defense counsel should be familiar with both the general assessment framework and the specific diagnostic criteria for the mental disorder involved in his or her case. A. General Assessment Framework The DSM-IV utilizes a multi-axial assessment model to aid clinicians in diagnosing a patient s condition, determining the patient s prognosis and developing a treatment plan. Each of these five axes focuses on a separate area of an individual s mental health state, physical health state, and level of functioning. One goal of this model is to help clinicians develop a global picture of a patient s state of well-being by looking beyond his or her current symptoms or condition. This approach benefits defense counsel by developing information that be used to undermine both the severity of the plaintiff s alleged injury and to frame alternate causation arguments. The following is a list of the five axes used in the DSM-IV assessment model: 1. Axis I Clinical Disorders / Other Conditions That May Be a Focus of Clinical Attention Axis I is used to gather information about the mental disorders or conditions that an individual is currently suffering. This assessment will Page 4

5 often include the psychological injury underlying the lawsuit. In some cases, the Axis I assessment will also list mental disorders unrelated to the events underlying the plaintiff s injuries. Such disorders should be evaluated to determine whether they contribute to or are a cause of the plaintiff s alleged psychological injuries. The Axis I assessment will also often specify either the principal diagnosis for the plaintiff or the principal reason for the plaintiff s visit to the psychiatrist. It is helpful to the defense when a plaintiff s alleged psychological injury does not fit into either of these categories. Such circumstances can be used to cast doubt on the severity of the alleged psychological injury or to bolster an alternate causation argument. 2. Axis II Personality Disorders / Mental Retardation Axis II is used to gather information about any personality disorders or mental retardation that an individual may suffer. These conditions can, and often do, pre-date the Axis I disorders or the trauma underlying a plaintiff s claim and can be used to support alternate causation arguments. In addition, the Axis II diagnoses may be listed as the primary diagnosis or reason for the visit and can be used to question the severity of the alleged psychological injury. 3. Axis III General Medical Conditions Axis III is used to gather information about an individual s general state of health and any non-psychological/psychiatric medical conditions. These medical conditions merit close scrutiny by defense counsel to determine whether and how they are related to the alleged psychological injury. In some instances, defense counsel may find that a medical condition underlying a plaintiff s psychological injury is unrelated to the actions of the defendant or that the psychological injury is caused by a medical condition entirely different from that alleged by the plaintiff. In less ideal cases, defense counsel may find that a plaintiff s Axis I diagnosis is assessed by a psychiatrist as being directly related to a general medical condition caused by the defendant s actions. 4. Axis IV Psychosocial and Environmental Problems Axis IV is used to gather information about psychosocial and environmental problems that may affect the diagnosis, prognosis or treatment of an individual s current mental disorder. This information is beneficial to defense counsel because it highlights factors that can be argued to cause, contribute to or exacerbate the alleged psychological injury. Problems commonly assessed under this axis include: negative life events, lack of social support, problems with family or interpersonal relationships, educational problems, personal problems, work problems, Page 5

6 housing problems, problems with access to health care, economic problems, and legal problems. Supra DSM-IV, at Axis V Global Assessment of Functioning Axis V provides the clinician an opportunity to assess an individual s global level of functioning, or GAF. The GAF focuses solely on psychological, social and occupational functioning without regard to physical or environmental limitations. The GAF has been described by one commentator as a psychological impairment rating. James T. Brown, Compensation Neurosis Rides Again: A Practitioner s Guide to Defending PTSD Claims, 63 DEF. COUNS. J. 467, 471 (1996). The GAF is based on a 100 point scale that is broken into ten discrete ranges of functioning: 1-10: Persistent danger of severely hurting self or others... OR persistent inability to maintain minimum personal hygiene OR serious suicidal act with clear expectation of death : Some danger of hurting self or others... OR occasionally fails to maintain minimal personal hygiene... or gross impairment in communication : Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgments... OR inability to function in almost all areas : Some impairment in reality testing or communication... OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood : Serious symptoms OR any serious impairment in social, occupational, or school functioning : Moderate symptoms... OR moderate difficulty in social, occupational, or school functioning : Some mild symptoms OR some difficulty in social, occupational, or school functioning..., but generally functioning pretty well, has some meaningful interpersonal relationships : If symptoms are present, they are transient and expectable reactions to psychosocial stressors... no more than slight impairment in social, occupational, or school functioning : Absent or minimal symptoms..., good functioning in all areas : Superior functioning in a wide range of activities. Supra DSM-IV, at 34. A GAF of between is beneficial to the defense because it indicates that the plaintiff s own treating physician or expert has Page 6

7 determined that the plaintiff s condition is mild and that he or she is functioning at a reasonable level. A GAF score in that range can cast serious doubt on a plaintiff s claim that he or she is unable to work or is suffering from a severe and long-term psychological injury. The GAF score is a not a static assessment and will often be assessed differently at different points in time (i.e. immediately posttrauma, pre-trauma, at discharge, etc.). Defense counsel should pay close attention to all assessments of the plaintiff s GAF and track any changes in the score in relation to the events underlying the lawsuit. In some instances, the plaintiff s GAF will not drastically change after a traumatic event. That fact can be effectively used by the defense to demonstrate that the impact of the defendant s actions on the plaintiff did not have a significant impact on the plaintiff s ability to function. B. DSM-IV Diagnostic Criteria In addition to the multi-axial assessment model, the DSM-IV sets out specific criteria that are used in diagnosing individual mental disorders. These criteria reflect the various psychological or behavioral components of a given disorder. The application of these criteria vary from disorder to disorder. It is important for defense counsel to pay close attention to these criteria and the specified method of their application to develop a clear understanding of which factors must be present to diagnose a mental disorder. The DSM-IV contains a prefatory caution that the criteria should not be treated as a checklist and that clinical judgment should be exercised in assessing and diagnosing a patient. Supra DSM-IV, at xxxii. However, this caution does not free a plaintiff s treating physician or expert from the DSM-IV framework because the DSM-IV also warns that excessively flexible and idiosyncratic application of DSM-IV criteria or conventions substantially reduces its utility. Id. Therefore, care should be paid to how much a physician or expert deviates from the DSM-IV criteria. While some deviation is allowable, there are bounds on how far a physician can stretch the DSM-IV criteria. In the case of PTSD, the DSM-IV sets out six criteria used to diagnose the disorder: A. The person has been exposed to a traumatic event in which both of the following were present: (1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) the person s response involved intense fear, helplessness, or horror. Page 7

8 B. The traumatic event is persistently reexperienced in one (or more) of the following ways: (1) recurrent and intrusive distressing recollections of the event, including images, thoughts or perceptions. (2) Recurrent distressing dreams of the event. (3) Acting or feeling as if the traumatic event were recurring (4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. (5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following: (1) Efforts to avoid thoughts, feelings, or conversations associated with the trauma (2) Efforts to avoid activities, places, or people that arouse recollections of the trauma (3) Inability to recall an important aspect of the trauma (4) Markedly diminished interest or participation in significant activities (5) Feeling of detachment or estrangement from others (6) Restricted range of affect (7) Sense of foreshortened future D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: (1) Difficulty falling or staying asleep (2) Irritability or outbursts of anger (3) Difficulty concentrating (4) Hypervigilance (5) Exaggerated startle response E. Duration of the disturbance is (symptoms in Criteria B, C, and D) is more than 1 month F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Supra DSM-IV, at These criteria provide fertile ground for the defense of a claim of PTSD and demonstrate how the diagnostic framework of the DSM-IV can be used to defend against other claims of psychological damage. For Page 8

9 example, if discovery were to reveal that a plaintiff did not experience intense fear, helplessness or horror, he or she would not meet the A criterion for PTSD. Similarly, if it can be shown that the plaintiff does not re-experience the traumatic event or does so only on occasion, she would not meet the B criterion. While a savvy physician or expert may attempt to explain away or justify the failure of a plaintiff to strictly meet a specific criterion, such a failure provides ready means to attack the merit of a PTSD claim. In the case of Robert M., the plaintiff claimed to have PTSD, but failed to meet certain aspects of the C criterion. He claimed that his PTSD arose following an extended illness and stay in both a hospital and rehabilitation center. However, following his recovery from the illness, he returned to both the hospital and rehabilitation center on multiple occasions, going so far as to teach a class at the rehab center. These visits not only failed to meet, but were wholly inconsistent with, the avoidance criterion and provided a strong basis to call his PTSD claim into question. C. The Self-Imposed Limitations on the Legal Relevance of a DSM-IV Diagnosis The DSM-IV provides its own warning about the limitations of its relevance in the legal context: In most situations, the clinical diagnosis of a DSM-IV mental disorder is not sufficient to establish the existence for legal purposes of a mental disorder, mental disability, mental disease, or mental defect. In determining whether an individual meets a specified legal standard... additional information is usually required beyond that contained in the DSM-IV diagnosis. Supra DSM-IV, at xxxiii. Thus, a physician or expert relying on the DSM- IV is limited to testimony regarding the clinical diagnosis of mental disorders. This fact can be used to great effect where a plaintiff s treating physician or expert attempts to go beyond the diagnosis of a specific condition and use the DSM-IV to justify a legal conclusion. In addition, the DSM-IV offers a specific cautionary statement on issues of causation and liability: It is to be understood that inclusion [in the DSM-IV], for clinical and research purposes, of a diagnostic category... does not imply that the condition meets legal or other non-medical criteria for what constitutes mental diseases, mental disorder, or mental disability. The clinical and scientific considerations involved in categorization of these conditions as mental disorders may not be wholly relevant to legal judgments, for example, that take into account such issues as individual responsibility, disability determination, and competency. Page 9

10 Supra DSM-IV, at xxxvii. Defense counsel should use both of these selfimposed limitations of the DSM-IV when confronting a physician or expert who is attempting to use the DSM-IV to justify opinions or conclusions that fall outside of its bounds. D. Challenging Methodology Used to Diagnose Psychological Injury Although most psychological injuries that a plaintiff may claim will be mental disorders that are well recognized by the medical community, the methodology used in their diagnosis may not meet the legal standard for the admission of scientific or expert testimony. The evidentiary standard set out in Daubert v. Merrell Dow Pharmaceuticals, Inc., 113 S. Ct (1993) is well-known. Under this standard, which has been adopted by numerous states, scientific or expert testimony must meet a minimum standard of reliability to be admissible into evidence. Id., at Although many mental disorders will easily meet the Daubert standard, defense counsel may confront a situation where a plaintiff may attempt to draw a novel and unfounded connection between a defendant s actions and an alleged psychological injury. In Isley v. Capuchin Province, 877 F. Supp (E.D. Mich. 1995), the defendant challenged expert testimony that the plaintiff suffered from PTSD as a result of sexual abuse. Although PTSD is a recognized mental disorder, the defendant argued that it did not meet the reliability standard in Daubert. In Isley, the court required the plaintiff to establish each of the elements set out in Daubert as a foundation for their expert testimony. Although the court in Isley admitted the expert testimony proffered by the plaintiff, the court s requirement that the plaintiff s expert satisfy Daubert demonstrates that defense counsel should not merely assume that testimony on a wellrecognized mental disorder is admissible without question. Each claim of psychological injury should be analyzed on its own and in the context of the case in which it arises to determine whether its diagnosis would be reliable and admissible. For example, if Robert M. had alleged that he developed a personality disorder, instead of PTSD, as a result of the defendants actions and had been able to produce an expert to offer an opinion on that fact, the defense would have included a challenge to the admission of any such testimony. Although personality disorders are well recognized in the field of psychiatry and psychology, they are generally described as chronic behavioral disorders that are pervasive, arise during adolescence or early adulthood and are stable over time. Supra DSM-IV, at 685. Thus, although such disorders are well-recognized, their clinical criteria and presentation are not consistent with a single incident of medical negligence. Had Robert M. offered expert testimony that he developed a personality disorder as a result of a single incident of medical negligence, Page 10

11 it is unlikely that the methodology used by such an expert would meet the criteria set out by Daubert. While this is an extreme example, it highlights the possibility of mounting a challenge to the admissibility of expert testimony. IV. Practical Methods for Defending against Post Traumatic Stress Disorder Claims There are three general methods of defending against PTSD claims: (1) questioning the existence of the condition (is the plaintiff lying, malingering, or exaggerating), (2) raising questions about the severity of the condition (is it as bad as the plaintiff says), or (3) raising questions about the cause of the condition (is my client the cause of the PTSD). The unique facts of a given case will generally drive which of these strategies presents a viable defense, but each should be explored as the case develops. Perhaps the most critical elements of a successful defense is early and vigorous preparation. Defense counsel should move aggressively to begin preparing the defense against a claim of PTSD where it is included in or suggested by the initial pleadings and discovery. The following are practical areas and approaches that can be effectively used to defend against PTSD claims. A. Using Discovery to Explore the Plaintiff s Presentation of PTSD The plaintiff s deposition and written discovery submitted to the plaintiff should focus on an examination of the various elements of PTSD. Because the DSM-IV provides the diagnostic framework for the disorder, defense counsel should pay close attention to the diagnostic criteria and explore the facts underlying each element of the disorder. For example, plaintiff should be questioned extensively about the traumatic event, particularly if it extended over a prolonged period of time. If the plaintiff s testimony reveals that he or she did not feel intense fear, helplessness, or horror in response to the traumatic event, any diagnosis of PTSD can be called into question. In addition to exploring each of the PTSD criteria, defense counsel should explore all other traumas that the plaintiff may have experienced in his or her life. Discovery may reveal that the plaintiff either has a prior history of PTSD or has exhibited symptoms of PTSD that pre-date the event underlying the lawsuit and have gone unnoticed. For example, in the case of Robert M., discovery revealed indications of familial abuse and elements of PTSD that pre-dated the traumatic event underlying that lawsuit. These facts were explored and provided a strong basis to argue alternate theories of causation. Any deposition testimony of the plaintiff should be videotaped to record his or her description of the facts outside the presence of a jury or Page 11

12 physician. Often, plaintiffs will view their deposition very differently than an examination by a physician or testimony before a jury. While a plaintiff may become overwhelmed when recounting the traumatic event before a jury or to a physician, he or she may describe the same event dispassionately to an attorney. Such a difference in affect can be used effectively before a jury or with a defense expert to demonstrate that the plaintiff is exaggerating his or her condition. Defense counsel should establish a clear timeline of the onset and treatment of the plaintiff s PTSD. Because PTSD can be used to prop up cases where physical injuries either resolve or are not as severe as initially thought, the onset and treatment of the PTSD can arise under dubious circumstances. In some instances, an attorney may have referred the plaintiff to a mental health provider. Accordingly, it is important for defense counsel to pin down when, by whom and under what circumstances the plaintiff was first diagnosed with PTSD. The fact that a plaintiff did not receive treatment for PTSD until referred to a psychiatrist by his or her attorney can be used to great effect, particularly before a jury. Where PTSD is not alleged in the initial pleadings, but may arise later in the case, defense counsel should use discovery as a prophylaxis against such a claim. It is important to assess the facts of the individual case to determine whether they could support a PTSD claim. This is particularly true where the plaintiff s physical injury is one that is likely to improve over time or not be debilitating. One effective way to prepare such a defense is to explore the DSM-IV criteria with the plaintiff during discovery. For example, if defense counsel suspected that a plaintiff might later attempt to add a PTSD claim to his or her case, it would be wise to question the plaintiff on his or her reaction to the traumatic event to establish the absence of the response required by the DSM-IV A criterion. If the plaintiff should then attempt to complain of PTSD, his or her previous testimony can be used to undermine any such allegation. B. Using the Plaintiff s Medical Records to Undermine Allegations of PTSD Defense counsel should make sure to collect all of the plaintiff s prior medical records, including all billing and insurance claim records. Such records may reflect facts regarding the plaintiff s condition or opinions of the plaintiff s physicians that are inconsistent with either the fact or severity of the plaintiff s PTSD. Such facts can be effectively used to cast doubt both on the severity of the plaintiff s condition and the plaintiff s credibility. In reviewing the medical records, careful attention should be paid to notes or other information about the plaintiff s state of well-being prior to the events underlying the lawsuit. Such a comparison may reveal that s the plaintiff s overall condition did not change dramatically following the Page 12

13 traumatic event. For example, in the case of Robert M., the plaintiff s psychologist listed a global assessment of functioning of 55 in an insurance billing record submitted prior to the traumatic event in that case. However, in notes following the incident, the same psychologist listed the plaintiff s global assessment of functioning as 50. Such a slight decrease in this assessment was inconsistent with the near total incapacity that the plaintiff claimed he experienced as a result of the traumatic event. As records are collected, particular attention should be paid to treating physicians, particularly mental health providers, who are not voluntarily identified by the plaintiff. By working back through the medical records, defense counsel can uncover either traumatic events or symptoms of PTSD that pre-date the events underlying the lawsuit. In addition, such records can uncover other diagnosed mental disorders or facts indicative of undiagnosed mental disorders that can provide alternate theories of causation. For example, in the case of Robert M., an independent medical expert determined that the plaintiff likely suffered from anti-social personality disorder, a condition with which he had not been diagnosed, after reviewing the extensive records on the plaintiff s mental health treatment. In addition, defense counsel should pay close attention to any indication of how the plaintiff s psychiatrist came to believe the plaintiff suffered from PTSD. In some instances, the medical records may reflect that the plaintiff, rather than the doctor, was the person who raised the issue of PTSD. Records such as these raise the possibility that someone other than a medical professional suggested that the plaintiff may suffer from PTSD. Influence of this type can be used by the defense to call the plaintiff s condition into question before the jury. C. Placing the Plaintiff under Surveillance Depending on the specific facts of a plaintiff s PTSD claim, defense counsel should consider the possibility of placing the plaintiff under some type of surveillance. Such a defense strategy is beneficial where it is possible to observe the plaintiff engaging in activities that are inconsistent with his or her PTSD or that directly contradict the plaintiff s sworn testimony. PTSD involves some level of impairment of basic functioning, as do most psychological injuries. To the extent that surveillance observes the plaintiff engaging in activities he or she claims are traumatic, without impairment, it can cast a long shadow on the plaintiff s allegations. Surveillance without a clear goal of this sort, however, often is not worthwhile. D. Confronting the Plaintiff s Expert Witnesses Any expert witnesses retained by the plaintiff should be approached with the realization that psychiatrists and psychologists are difficult Page 13

14 subjects for effective cross-examination. Such mental health professionals are highly trained and knowledgeable in their subject matter. Given the highly subjective nature of their substantive testimony, their opinions are often easy to defend and hard to deflate. In order to prepare for an effective cross-examination, defense counsel should have a basic understanding of the field and a good understanding of the diagnostic criteria for PTSD. Although a plaintiff s experts may be difficult to cross-examine, there are several areas where defense counsel should be able to extract concessions that can limit the damage of their testimony. First, defense counsel should get the plaintiff s expert to concede that the information used to diagnose PTSD, or other psychological injuries, is subjective and largely gathered from self-reports of the plaintiff. Further, the expert should be asked to concede that malingering, false reporting of symptoms or exaggeration of symptoms is difficult for mental health professionals to detect and that such professionals can be fooled by patients. These concessions allow the defense to argue that whatever opinions the expert offers are based solely on what the plaintiff told the expert or another physician. The key point to stress to the jury is that there is no objective way to determine the plaintiff s condition there is no blood test, x-ray, MRI or other objective diagnostic test that can reveal PTSD or many of the other common psychological injuries alleged in medical malpractice cases. Second, defense counsel should get the plaintiff s expert to concede that the plaintiff s condition will improve and the plaintiff will get better if he or she commits to therapy. By and large, the psychological injuries that arise in medical malpractice cases, including PTSD, will improve with time and therapy. To the extent that the expert concedes that the plaintiff s condition will improve, the damages are limited. Should the expert maintain that the plaintiff s condition will not improve, defense counsel may be presented with an opportunity to undermine the credibility of the expert or argue that the plaintiff is not committed to improving his or her condition, depending on the circumstances. Third, defense counsel should get the plaintiff s expert to concede that, where applicable, the cost of treating the plaintiff s condition is low. Defense counsel should develop a clear picture of the treatment the plaintiff s condition will require and how much that treatment will cost. The cost of treating psychological injuries, including PTSD, can be relatively low when compared with other types of injuries. A concession to that effect by an expert can reduce any damages awarded to the plaintiff for such injuries. Finally, defense counsel should pay close attention to all expert reports and confront the designated experts with any stressors in the plaintiff s life that have been overlooked or ignored. In addition, defense counsel should ask the expert about all of the areas of psychosocial stressors in the plaintiff s life that were not considered or investigated when the expert formed his or her conclusion. Often, an expert or treating Page 14

15 physician will not have all of the information that an attorney can assemble through discovery. To the extent that the expert lacked information that is significant to the plaintiff s condition, he or she should be confronted with such information. Defense counsel should be on guard for any attempts by the plaintiff to turn her treating physicians into experts. Often, plaintiff s counsel will try to elicit opinion testimony from the plaintiff s treating physicians that are called to testify. Although rules regarding experts vary from jurisdiction to jurisdiction, they invariably require the designation of witnesses who intend to offer expert opinions and various disclosures to accompany such designations. See Fed. R. Civ. P. 26. Where such designation and disclosures has not been made, it is improper for plaintiff s counsel to attempt to elicit expert opinion. If plaintiff s counsel should attempt this, defense counsel should object and, through crossexamination, establish that the treating physician has not been retained to offer expert opinions. Beyond the legal limitations on offering expert opinions into evidence, the psychiatric community has recognized that it is improper for a physician to act as a treater and an expert witness. When a psychiatrist is treating a patient, his or her role is to assess and treat the patient based on the patient s perception of his or her condition and symptoms. A treating psychiatrist, thus, acts on the patient s subjective self-reports without independent corroboration, rather than on the basis of an objective assessment of their condition. This approach is encouraged by the DSM- IV and the American Academy of Psychiatry and the Law. E. Defense Expert Witnesses Aside from concessions extracted from the plaintiff s witnesses, expert testimony is the primary method of defending against claims of PTSD. Where a case either does or may involve a PTSD claim, defense counsel should move quickly to secure a qualified expert, preferably one who is versed in forensic psychiatry or psychology. Not only will such an expert aid the defense by offering opinions at trial, but he or she can also help guide discovery and provide recommendations on how to approach the plaintiff s claims. This expert can synthesize all of the information regarding the plaintiff s condition and either point to alternate causes or offer opinions that the plaintiff is not as incapacitated as he or she may claim. One strategic question the defense will have to confront is whether to present expert testimony that labels the plaintiff a malingerer. This is a case-specific determination that should be carefully weighed. The primary concern is that an allegation of malingering can cast the defendant in a negative light to the jury where the plaintiff s condition appears credible on the stand. Page 15

16 Often the best approach is not to have a defense expert challenge the plaintiff s symptoms, but, rather, to have him or her testify that the plaintiff s PTSD was caused by something other than the defendant s actions. In addition, a defense expert should offer testimony on the prognosis of the plaintiff s condition and how soon it will improve. Many cases of PTSD are not chronic or untreatable and will improve over time. This fact should be stressed to the jury as it undermines a larger damage award that the plaintiff may be seeking. Finally, care should be used when deciding whether to take advantage of discovery rules that allow a defense expert to examine the plaintiff. See Fed. R. Civ. P. 35. Such procedures allow a physician retained by the defense to examine the plaintiff and explore his or her medical condition. An examination holds the possibility of revealing additional weaknesses in the plaintiff s claims of incapacity or injury. In addition, where the plaintiff exaggerates his or her symptoms, such an examination provides an opportunity to draw a strong contrast with how the plaintiff described their injury and the underlying trauma during their deposition. If the examiner reaches conclusions that are positive to the defense, invocation of this procedure can be beneficial. However, defense counsel runs the risk of helping the plaintiff prove his or her case if the examiner reaches conclusions similar to those reached by the plaintiff s treating physician or expert. The risk is giving plaintiff s counsel the opportunity to stand before the jury and proclaim: The defendant s own expert says that my client suffers from PTSD! F. Assemble All Psychological Testing Data on Plaintiff In most cases where a plaintiff claims PTSD, he or she will have undergone some type of psychometric analysis, such as the Millan Clinical Multi-axial Inventory III (MCMI-III) or Minnesota Multi-phastic Personality Inventory 2 (MMPI-2) test. Where such tests have been conducted, defense counsel should endeavor to obtain all of the results and raw data from the tests. Such data can be useful in a number of ways. For example, some tests will reveal Axis II personality disorders that are not included in a patient s assessment. Such disorders generally pre-date the events underlying the lawsuit and can contribute to or cause the plaintiff s psychological problems. This information provides additional grounds to offer alternate theories of causation. In addition, the MMPI-2 test is widely recognized in the psychiatric field as the most useful tool to detect malingering. One problem that defense counsel may face in attempting to obtain raw data is resistance on the part of mental health professionals to release such information on ethical grounds. However, under Ethical Principle 9.04 of the American Psychological Association, psychologists are allowed to distribute such information, except in certain limited circumstances. Page 16

17 Available at There is no corresponding ethical rule binding psychiatrists. Where such an objection is raised, defense counsel should inform the practitioner of his or her ethical responsibilities and, if that approach proves unsuccessful, move the court for an order compelling disclosure of the data. G. Raising Questions about the Plaintiff s Credibility The inherent subjectivity of PTSD and the diagnostic reliance on the plaintiff s self-reporting also presents a possible defense against PTSD claims. Diagnosis of PTSD is inherently subjective. A mental health provider must rely on the subjective self-reports of their patient. There is often no objective means to test or verify a plaintiff s complaints underlying a diagnosis of PTSD. Given this subjective nature, the plaintiff s credibility, or lack thereof, may present defense counsel an opportunity to attack either the presence or severity of PTSD. Such frontal attacks can be difficult to mount, primarily because of the lack of objective evidence and the fact that a plaintiff s complaints are generally supported by his or her treating physician and expert. However, defense counsel should be careful not to overlook the possibility of calling the entire condition into question when the means present themselves. V. Assessing the Legal Requirements of the Plaintiff s Claim Although the foregoing discussion provides a general framework for defending PTSD claims, the specific legal theory relied on by a plaintiff can provide additional grounds for defense. Plaintiffs can seek psychological damages under a variety of different legal theories, including intentional infliction of emotional distress, negligent infliction of emotional distress and common negligence. Certain of these legal theories have specific requirements that must be met to state a valid claim for relief. For example, different jurisdictions apply a variety of different rules to claims for negligent infliction of emotional distress. Some jurisdictions require that the plaintiff suffer some level of physical contact or impact in order to state a valid claim for negligent infliction of emotional distress. See Plaisance v. Texaco, Inc., 937 F.2d 1004, (5th Cir. 1991) (summarizing the various approaches to negligent infliction of emotional distress claims). Other jurisdictions apply the zone of danger rule where the plaintiff can recover damages that result from the witnessing of peril or harm to another if the plaintiff is also threatened with physical harm as a consequence of the defendant s negligence. Id. While an exhaustive description of the myriad different requirements to state valid claims for emotional distress in the various jurisdictions around the country is beyond the scope of this paper, defense counsel should pay close attention to the legal requirements underlying the legal theory that a plaintiff uses to recover psychological damages. Page 17

18 VI. Conclusion Although allegations of psychological damage can be daunting to defend against, careful preparation and attention to detail while preparing a case for trial can often reveal various weaknesses in the plaintiff s claim that can be effectively used by the defense. Bibliography AMERICAN PSYCHIATRIC ASSOCIATION, DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (4th ed., text rev. 2000). James T. Brown, Compensation Neurosis Rides Again: A Practitioner s Guide to Defending PTSD Claims, 63 DEF. COUNS. J. 467 (1996). Debra S. Katz and Lynne Bernabei, Damages Issues in Employment Discrimination Cases: Expert Testimony in Sexual Harassment and Other Employment Discrimination Cases After Daubert v. Merrell Dow Pharmaceuticals, Inc., SD06 ALI-ABA 603 (1998). Karl Kirkland, Post-Traumatic Stress Disorder vs. Pseudo Post-Traumatic Stress Disorder, 56 ALA. LAW. 90 (1995). Paul R. Lees-Haley, Pseudo Post-Traumatic Stress Disorder, TRIAL DIPLOMACY J., Winter 1986/87, at 19. Amihay Levy, Compensation Neurosis Rides Again, 6 BRAIN INJURY 401 (1992). Mark I Levy, Stressing the Point: Post Traumatic Stress Disorder Claims, FOR THE DEFENSE, Nov. 1995, at 27. Nicholas J. Motherway, Post-Traumatic Stress, 49 AM. JUR. Proof of Facts 2d 73 (2004). L. A. Neal, The Pitfalls of Making a Categorical Diagnosis of Post Traumatic Stress Disorder in Personal Injury Litigation, 116 MED. SCI. L. 117 (1994). Pinchas Noy, New Views of Psychotherapy of Compensation Neurosis: A Clinical Study, in NEW DIMENSIONS IN PSYCHIATRY: A WORLD VIEW (John Wiley & Sons 1975). Page 18

19 Phillip J. Resnick, Guidelines for the Evaluation of Malingering in Post Traumatic Stress Disorder, in POST TRAUMATIC STRESS DISORDER IN LITIGATION (Robert I. Simon ed., 1995). Gerald M. Rosen, Post Traumatic Stress Disorder, Pulp Fiction, and the Press, 24 BULL. AM. ACAD. PSYCHIATRY & L. 267 (1996). Ralph Slovenko, Legal Aspects of Post-Traumatic Stress Disorder, 17 PSYCHIATRIC CLINICS OF N. AM. 439 (1994). Page 19

Psychiatric Issues and Defense Base Act Claims. Dr. Michael Hilton

Psychiatric Issues and Defense Base Act Claims. Dr. Michael Hilton Psychiatric Issues and Defense Base Act Claims Dr. Michael Hilton Criteria for DSM-IVRPosttraumatic Stress Disorder with changes now in effect with DSM5 a. The person has been exposed to a traumatic event

More information

VIRTUAL UNIVERSITY OF PAKISTAN FORMAT OF THE INTERNSHIP REPORT FOR BS Psychology (Clinical Setting)

VIRTUAL UNIVERSITY OF PAKISTAN FORMAT OF THE INTERNSHIP REPORT FOR BS Psychology (Clinical Setting) VIRTUAL UNIVERSITY OF PAKISTAN FORMAT OF THE INTERNSHIP REPORT FOR BS Psychology (Clinical Setting) 1. Title page The title page of the report will include: Clinical Case Studies The name of the internee,

More information

FACT SHEET. What is Trauma? TRAUMA-INFORMED CARE FOR WORKING WITH HOMELESS VETERANS

FACT SHEET. What is Trauma? TRAUMA-INFORMED CARE FOR WORKING WITH HOMELESS VETERANS FACT SHEET TRAUMA-INFORMED CARE FOR WORKING WITH HOMELESS VETERANS According to SAMHSA 1, trauma-informed care includes having a basic understanding of how trauma affects the life of individuals seeking

More information

C HAPTER 9 T RAUMA AND P OST-TRAUMATIC S TRESS D ISORDER IN P ATIENTS W ITH HIV/AIDS

C HAPTER 9 T RAUMA AND P OST-TRAUMATIC S TRESS D ISORDER IN P ATIENTS W ITH HIV/AIDS C HAPTER 9 T RAUMA AND P OST-TRAUMATIC S TRESS D ISORDER IN P ATIENTS W ITH HIV/AIDS Exposure to a traumatic event is normally accompanied by distress. For most individuals such distress resolves spontaneously

More information

HOW TO ASSESS AND COMPENSATE PSYCHIATRIC INJURIES IN THE WORKPLACE Grace Lawson 1

HOW TO ASSESS AND COMPENSATE PSYCHIATRIC INJURIES IN THE WORKPLACE Grace Lawson 1 1 HOW TO ASSESS AND COMPENSATE PSYCHIATRIC INJURIES IN THE WORKPLACE Grace Lawson 1 Introduction Mental illness has become a major health problem in Australia. Work-related mental injuries have also become

More information

Initial Evaluation for Post-Traumatic Stress Disorder Examination

Initial Evaluation for Post-Traumatic Stress Disorder Examination Initial Evaluation for Post-Traumatic Stress Disorder Examination Name: Date of Exam: SSN: C-number: Place of Exam: The following health care providers can perform initial examinations for PTSD. a board-certified

More information

Acute Stress Disorder and Posttraumatic Stress Disorder

Acute Stress Disorder and Posttraumatic Stress Disorder Acute Stress Disorder and Posttraumatic Stress Disorder Key Messages Traumatic Events Events that involve actual or threatened death or serious injury (real or perceived) to self or others (e.g., accidents,

More information

Overcoming the Trauma of Your Motor Vehicle Accident

Overcoming the Trauma of Your Motor Vehicle Accident Overcoming the Trauma of Your Motor Vehicle Accident Chapter 1 Introduction Case Study: Janelle Janelle s accident happened so suddenly. She was simply making a left turn as she was leaving the shopping

More information

Proving Causation and Damages in Spinal Fusion Cases

Proving Causation and Damages in Spinal Fusion Cases Page 1 of 7 Ben Brodhead on proving causation and damages in spinal fusion cases. Friend on Facebook Follow on Twitter Forward to a Friend Proving Causation and Damages in Spinal Fusion Cases By: Ben C.

More information

Traumatic Stress. and Substance Use Problems

Traumatic Stress. and Substance Use Problems Traumatic Stress and Substance Use Problems The relation between substance use and trauma Research demonstrates a strong link between exposure to traumatic events and substance use problems. Many people

More information

Understanding PTSD and the PDS Assessment

Understanding PTSD and the PDS Assessment ProFiles PUTTING ASSESSMENTS TO WORK PDS TEST Understanding PTSD and the PDS Assessment Recurring nightmares. Angry outbursts. Easily startled. These are among the many symptoms associated with Post Traumatic

More information

DEFENDING PSCYHOLOGICAL AND EMOTIONAL DAMAGES CLAIMS

DEFENDING PSCYHOLOGICAL AND EMOTIONAL DAMAGES CLAIMS DEFENDING PSCYHOLOGICAL AND EMOTIONAL DAMAGES CLAIMS Mitchell A. Orpett TRIBLER ORPETT & MEYER P.C. 225 West Washington - Suite 1300 Chicago, IL 60606-3408 312-201-6413 maorpett@tribler.com Presented at

More information

Overcoming the Trauma of Your Motor Vehicle Accident

Overcoming the Trauma of Your Motor Vehicle Accident Overcoming the Trauma of Your Motor Vehicle Accident Chapter 1 Introductory Information for Therapists Case Study: Mary The day had begun like any other. Mary was on her way to work early in the morning.

More information

WHAT IS PTSD? A HANDOUT FROM THE NATIONAL CENTER FOR PTSD BY JESSICA HAMBLEN, PHD

WHAT IS PTSD? A HANDOUT FROM THE NATIONAL CENTER FOR PTSD BY JESSICA HAMBLEN, PHD WHAT IS PTSD? A HANDOUT FROM THE NATIONAL CENTER FOR PTSD BY JESSICA HAMBLEN, PHD Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can occur following the experience or witnessing of a

More information

A Guide for Childhood Sexual Abuse Survivors

A Guide for Childhood Sexual Abuse Survivors You are not alone. It was not your fault. You have courage. You have choices. You have power. We re here to help. A Guide for Childhood Sexual Abuse Survivors Breaking the silence. Raising Awareness. Fighting

More information

Case 4:04-cv-03221 Document 50 Filed in TXSD on 08/03/05 Page 1 of 10

Case 4:04-cv-03221 Document 50 Filed in TXSD on 08/03/05 Page 1 of 10 Case 4:04-cv-03221 Document 50 Filed in TXSD on 08/03/05 Page 1 of 10 IN THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF TEXAS HOUSTON DIVISION EDGAR COELLO, et al., Plaintiffs, v. CIVIL

More information

REPORTER. Decision of the Appeal Division

REPORTER. Decision of the Appeal Division WORKERS COMPENSATION REPORTER Decision of the Appeal Division Number: 00-1682 Date: October 26, 2000 Panel: Marguerite Mousseau Subject: Whether Worker Suffered Psychological Impairment Constituting a

More information

Appendix 5. Victim Impact

Appendix 5. Victim Impact Appendix 5 Victim Impact ACQUAINTANCE RAPE: THE VICTIM Gail Abarbanel Director Rape Treatment Center Santa Monica-UCLA Medical Center Issues in Acquaintance Rapes Not common perception of rape Not real

More information

Trauma, PTSD, Complex Trauma, and the ARC Framework

Trauma, PTSD, Complex Trauma, and the ARC Framework Trauma, PTSD, Complex Trauma, and the ARC Framework Learning Objectives What do we mean when we use the term trauma? What do different types of traumatic events have in common? Why do people respond differently

More information

EMOTIONAL AND BEHAVIOURAL CONSEQUENCES OF HEAD INJURY

EMOTIONAL AND BEHAVIOURAL CONSEQUENCES OF HEAD INJURY Traumatic brain injury EMOTIONAL AND BEHAVIOURAL CONSEQUENCES OF HEAD INJURY Traumatic brain injury (TBI) is a common neurological condition that can have significant emotional and cognitive consequences.

More information

Cognitive Behavioral Therapy for PTSD. Dr. Edna B. Foa

Cognitive Behavioral Therapy for PTSD. Dr. Edna B. Foa Cognitive Behavioral Therapy for PTSD Presented by Dr. Edna B. Foa Center for the Treatment and Study of Anxiety University of Pennsylvania Ref # 3 Diagnosis of PTSD Definition of a Trauma The person has

More information

MENTAL IMPAIRMENT RATING

MENTAL IMPAIRMENT RATING MENTAL IMPAIRMENT RATING Lev.II Curriculum Rev. 6/09 155 OBJECTIVES MENTAL AND BEHAVIORAL DISORDERS 1. Identify the axes used in the diagnostic and statistical manual of mental disorders - DSM. 2. Understand

More information

Minimize Your Risk: Mental Stress And The WSIB

Minimize Your Risk: Mental Stress And The WSIB Minimize Your Risk: Mental Stress And The WSIB By Joseph Cohen-Lyons and Samantha C. Seabrook Mental health in the workplace has been the focus of both employer and legislative interest in recent years.

More information

Mental Disorders (Except initial PTSD and Eating Disorders) Examination

Mental Disorders (Except initial PTSD and Eating Disorders) Examination Mental Disorders (Except initial PTSD and Eating Disorders) Examination Name: Date of Exam: SSN: C-number: Place of Exam: The following health care providers can perform initial examinations for Mental

More information

Post-Traumatic Stress Disorder (PTSD) and TBI. Kyle Haggerty, Ph.D.

Post-Traumatic Stress Disorder (PTSD) and TBI. Kyle Haggerty, Ph.D. Post-Traumatic Stress Disorder (PTSD) and TBI Kyle Haggerty, Ph.D. Learning Objects What is Brain Injury What is PTSD Statistics What to Rule Out PTSD and TBI Treatment Case Study What is Brain Injury

More information

INVESTIGATIONS GONE WILD: Potential Claims By Employees

INVESTIGATIONS GONE WILD: Potential Claims By Employees INTRODUCTION INVESTIGATIONS GONE WILD: Potential Claims By Employees By: Maureen S. Binetti, Esq. Christopher R. Binetti, Paralegal Wilentz, Goldman & Spitzer, P.A. When can the investigation which may

More information

BETHANY TOD. Plaintiff CINCINNATI STATE TECHNICAL AND COMMUNITY COLLEGE. Defendant Case No. 2006-07732. Judge Clark B. Weaver Sr.

BETHANY TOD. Plaintiff CINCINNATI STATE TECHNICAL AND COMMUNITY COLLEGE. Defendant Case No. 2006-07732. Judge Clark B. Weaver Sr. [Cite as Tod v. Cincinnati Technical & Community College, 2010-Ohio-3222.] Court of Claims of Ohio The Ohio Judicial Center 65 South Front Street, Third Floor Columbus, OH 43215 614.387.9800 or 1.800.824.8263

More information

FRCP and Physician Testimony: Treating Physicians, Experts, and Hybrid Witnesses

FRCP and Physician Testimony: Treating Physicians, Experts, and Hybrid Witnesses May, 2011 FRCP and Physician Testimony: Treating Physicians, Experts, and Hybrid Witnesses The US Court of Appeals, Ninth Circuit, rules on these matters in the case of Goodman v. Staples the Office Superstore,

More information

The Forgotten Worker: Veteran

The Forgotten Worker: Veteran The Forgotten Worker: Veteran Larry Ashley & Meghan Pierce University of Nevada, Las Vegas Veteran Workforce Statistics The unemployment rate of veterans from all eras is 8.7% (Bureau of Labor Statistics,

More information

POST-TRAUMATIC STRESS DISORDER PTSD Diagnostic Criteria PTSD Detection and Diagnosis PC-PTSD Screen PCL-C Screen PTSD Treatment Treatment Algorithm

POST-TRAUMATIC STRESS DISORDER PTSD Diagnostic Criteria PTSD Detection and Diagnosis PC-PTSD Screen PCL-C Screen PTSD Treatment Treatment Algorithm E-Resource March, 2014 POST-TRAUMATIC STRESS DISORDER PTSD Diagnostic Criteria PTSD Detection and Diagnosis PC-PTSD Screen PCL-C Screen PTSD Treatment Treatment Algorithm Post-traumatic Stress Disorder

More information

A Review of Conduct Disorder. William U Borst. Troy State University at Phenix City

A Review of Conduct Disorder. William U Borst. Troy State University at Phenix City A Review of 1 Running head: A REVIEW OF CONDUCT DISORDER A Review of Conduct Disorder William U Borst Troy State University at Phenix City A Review of 2 Abstract Conduct disorders are a complicated set

More information

Client s Rights and Counselor Responsibilities

Client s Rights and Counselor Responsibilities Client s Right to Give Informed Consent Client s Rights and Counselor Responsibilities Chapter 5 Psychology 475 Professional Ethics in Addictions Counseling Listen to the audio lecture while viewing these

More information

Michael S. McLane, Psy.D. Licensed Psychologist. Informed Consent to Treatment / Evaluation of a Minor Child. who was born on and who resides at

Michael S. McLane, Psy.D. Licensed Psychologist. Informed Consent to Treatment / Evaluation of a Minor Child. who was born on and who resides at Michael S. McLane, Psy.D. Licensed Psychologist 12830 Hillcrest Road Suite D233 Dallas, TX 75230 Ph: (972) 620-1225 Fax: (972) 620-4393 Informed Consent to Treatment / Evaluation of a Minor Child I am

More information

Understanding the Civil Involuntary Commitment Process

Understanding the Civil Involuntary Commitment Process Understanding the Civil Involuntary Commitment Process About the Author By D. Renée Hildebrant http://www.okbar.org/obj/articles_05/021205.htm Oklahoma Bar Journal D. Renée Hildebrant is the trial court

More information

Post traumatic Stress Associated with Cancer

Post traumatic Stress Associated with Cancer Post traumatic Stress Associated with Cancer BCCA Survivorship Forum June 8, 2016 Alan Bates, MD, PhD, FRCPC Provincial Practice Leader for Psychiatry BC Cancer Agency None Disclosures Acknowledgments

More information

Mental Health 101 for Criminal Justice Professionals David A. D Amora, M.S.

Mental Health 101 for Criminal Justice Professionals David A. D Amora, M.S. Mental Health 101 for Criminal Justice Professionals David A. D Amora, M.S. Director, National Initiatives, Council of State Governments Justice Center Today s Presentation The Behavioral Health System

More information

USVH Disease of the Week #1: Posttraumatic Stress Disorder (PTSD)

USVH Disease of the Week #1: Posttraumatic Stress Disorder (PTSD) USVH Disease of the Week #1: Posttraumatic Stress Disorder (PTSD) Effects of Traumatic Experiences A National Center for PTSD Fact Sheet By: Eve B. Carlson, Ph.D. and Josef Ruzek, Ph.D. When people find

More information

S T A T E O F M I C H I G A N WORKERS' COMPENSATION APPELLATE COMMISSION V DOCKET #95-0724 OPINION

S T A T E O F M I C H I G A N WORKERS' COMPENSATION APPELLATE COMMISSION V DOCKET #95-0724 OPINION CAROLYN A. ASH, PLAINTIFF, 1998 OPINION #238 S T A T E O F M I C H I G A N WORKERS' COMPENSATION APPELLATE COMMISSION V DOCKET #95-0724 TECHNICOLOR, INCORPORATED, AND ARGONAUT INSURANCE COMPANY, DEFENDANTS.

More information

Suzanne R. Merlis, Psy. D. Georgia-LLC Licensed Psychologist

Suzanne R. Merlis, Psy. D. Georgia-LLC Licensed Psychologist Suzanne R. Merlis, Psy. D. Georgia-LLC Licensed Psychologist If going to asylum officer at affirmative stage: ASYLUM OFFICER, ARLINGTON ASYLUM OFFICE In the Matter of Mr. X Respondent If referred to judge:

More information

CRITERIA CHECKLIST. Serious Mental Illness (SMI)

CRITERIA CHECKLIST. Serious Mental Illness (SMI) Serious Mental Illness (SMI) SMI determination is based on the age of the individual, functional impairment, duration of the disorder and the diagnoses. Adults must meet all of the following five criteria:

More information

NEW TRENDS AND ISSUES IN NEUROPSYCHOLOGY: Mild Traumatic Brain Injury and Postconcussive Syndrome Cases

NEW TRENDS AND ISSUES IN NEUROPSYCHOLOGY: Mild Traumatic Brain Injury and Postconcussive Syndrome Cases NEW TRENDS AND ISSUES IN NEUROPSYCHOLOGY: Mild Traumatic Brain Injury and Postconcussive Syndrome Cases Carl F. Mariano Barry H. Uhrman Introduction to Neuropsychology As many of you are aware, clinical

More information

Presently, there are no means of preventing bipolar disorder. However, there are ways of preventing future episodes: 1

Presently, there are no means of preventing bipolar disorder. However, there are ways of preventing future episodes: 1 What is bipolar disorder? There are two main types of bipolar illness: bipolar I and bipolar II. In bipolar I, the symptoms include at least one lifetime episode of mania a period of unusually elevated

More information

Great Bay Mental Health Associates, Inc. Notice to Clients and Consent to Mental Health Treatment Agreement Courtney A. Atherton, MA, LCMHC, MLADC

Great Bay Mental Health Associates, Inc. Notice to Clients and Consent to Mental Health Treatment Agreement Courtney A. Atherton, MA, LCMHC, MLADC Great Bay Mental Health Associates, Inc. Notice to Clients and Consent to Mental Health Treatment Agreement Courtney A. Atherton, MA, LCMHC, MLADC Patient Name (please print): Welcome to the therapy services

More information

CHAPTER 6 Diagnosing and Identifying the Need for Trauma Treatment

CHAPTER 6 Diagnosing and Identifying the Need for Trauma Treatment CHAPTER 6 Diagnosing and Identifying the Need for Trauma Treatment This chapter offers mental health professionals: information on diagnosing and identifying the need for trauma treatment guidance in determining

More information

Post Traumatic Stress Disorder (PTSD) Karen Elmore MD Robert K. Schneider MD Revised 5-11-2001 by Robert K. Schneider MD

Post Traumatic Stress Disorder (PTSD) Karen Elmore MD Robert K. Schneider MD Revised 5-11-2001 by Robert K. Schneider MD Post Traumatic Stress Disorder (PTSD) Karen Elmore MD Robert K. Schneider MD Revised 5-11-2001 by Robert K. Schneider MD Definition and Criteria PTSD is unlike any other anxiety disorder. It requires that

More information

V OCATIONAL E CONOMICS, I NC.

V OCATIONAL E CONOMICS, I NC. V OCATIONAL E CONOMICS, I NC. This document was downloaded from Vocational Economics Inc. (www.vocecon.com). For more information on this document, visit: www.vocecon.com/articles/arttbi.htm Volume 2,

More information

Program Policy Background Paper: Compensability of Workplace Stress

Program Policy Background Paper: Compensability of Workplace Stress Program Policy Background Paper: Compensability of Workplace Stress April 24, 2013 TABLE OF CONTENTS 1. INTRODUCTION... 3 2. PURPOSE OF THIS PAPER... 3 3. PROGRAM POLICY RATIONALE AND INTENT... 5 4. BACKGROUND...

More information

OPINION Richard B. Klein DATE: June 14, 2001. Plaintiff, Patricia Daniels, filed this lawsuit on behalf of

OPINION Richard B. Klein DATE: June 14, 2001. Plaintiff, Patricia Daniels, filed this lawsuit on behalf of PATRICIA DANIELS, p/n/g of : PHILADELPHIA COUNTY RODERICK STERLING, a minor : COURT OF COMMON PLEAS : TRIAL DIVISION v. : June Term, 1996 : HOSPITAL OF PHILADELPHIA : NO. 2450 COLLEGE OF OSTEOPATHIC :

More information

PTSD IN PRIMARY CARE. Kari A. Stephens, PhD & Wayne Bentham, MD Psychiatry & Behavioral Sciences University of Washington

PTSD IN PRIMARY CARE. Kari A. Stephens, PhD & Wayne Bentham, MD Psychiatry & Behavioral Sciences University of Washington PTSD IN PRIMARY CARE Kari A. Stephens, PhD & Wayne Bentham, MD Psychiatry & Behavioral Sciences University of Washington What to expect today? Defining and assessing PTSD Approach for doing differential

More information

Litigating the Products Liability Case: Discovery

Litigating the Products Liability Case: Discovery www.goldbergsegalla.com NEW YORK PENNSYLVANIA CONNECTICUT NEW JERSEY UNITED KINGDOM Litigating the Products Liability Case: Discovery New York State Bar Association Buffalo, NY October 22, 2013 Presenter

More information

Special Topics. Goals and Objectives

Special Topics. Goals and Objectives Special Topics Goals and Objectives 1. Forensic Psychiatric Evaluation To be capable of performing a competent comprehensive forensic psychiatric evaluation whether it is a civil dispute or criminal matter.

More information

IN THE DISTRICT COURT OF WYANDOTTE COUNTY, KANSAS PLAINTIFF S PROPOSED JURY INSTRUCTIONS

IN THE DISTRICT COURT OF WYANDOTTE COUNTY, KANSAS PLAINTIFF S PROPOSED JURY INSTRUCTIONS IN THE DISTRICT COURT OF WYANDOTTE COUNTY, KANSAS KC Plaintiff ) ) Plaintiff, ) ) v. ) Case No.: 06 CV 1383 ) Defendant Doctor ) ) Defendant. ) PLAINTIFF S PROPOSED JURY INSTRUCTIONS Plaintiff submits

More information

Expert Witness Services for Personal Injury Lawyers

Expert Witness Services for Personal Injury Lawyers Advanced Assessments Ltd Expert witnesses and Psychologists A Member of the Strategic Enterprise Group 180 Piccadilly, London, W1J 9HP T: 0845 130 5717 Expert Witness Services for Personal Injury Lawyers

More information

FEATURE ARTICLE Evidence of Prior Injury. Admissibility of Evidence of Prior Injury Under the Same Part of the Body Rule

FEATURE ARTICLE Evidence of Prior Injury. Admissibility of Evidence of Prior Injury Under the Same Part of the Body Rule FEATURE ARTICLE Evidence of Prior Injury Admissibility of Evidence of Prior Injury Under the Same Part of the Body Rule By: Timothy J. Harris Broderick, Steiger, Maisel & Zupancic, Chicago I. Introduction

More information

The Effect of Product Safety Regulatory Compliance

The Effect of Product Safety Regulatory Compliance PRODUCT LIABILITY Product Liability Litigation The Effect of Product Safety Regulatory Compliance By Kenneth Ross Product liability litigation and product safety regulatory activities in the U.S. and elsewhere

More information

Postpartum Depression and Post-Traumatic Stress Disorder

Postpartum Depression and Post-Traumatic Stress Disorder Postpartum Depression and Post-Traumatic Stress Disorder Emotional Recovery: Postpartum Depression and Post-Traumatic Stress Disorder By: Lisa Houchins Published: July 23, 2013 Emotions vary widely after

More information

Michael S. McLane, Psy.D. Licensed Psychologist. Informed Consent to Treatment / Evaluation I,, who was born on and who resides at

Michael S. McLane, Psy.D. Licensed Psychologist. Informed Consent to Treatment / Evaluation I,, who was born on and who resides at Michael S. McLane, Psy.D. Licensed Psychologist 12830 Hillcrest Road Suite D233 Dallas, TX 75230 Ph: (972) 620-1225 Fax: (972) 620-4393 Informed Consent to Treatment / Evaluation I,, who was born on and

More information

PROFESSIONAL NEGLIGENCE ACTIONS EFFECTIVE EXPERT OPINION EVIDENCE

PROFESSIONAL NEGLIGENCE ACTIONS EFFECTIVE EXPERT OPINION EVIDENCE PROFESSIONAL NEGLIGENCE ACTIONS EFFECTIVE EXPERT OPINION EVIDENCE ) - \ These materials were prepared by Jeffrey Scott of.jeffreyd. Scott Legal Professional Corporation,. Regina, Saskatch13wan for the

More information

Borderline personality disorder

Borderline personality disorder Understanding NICE guidance Information for people who use NHS services Borderline personality disorder NICE clinical guidelines advise the NHS on caring for people with specific conditions or diseases

More information

Medical Malpractice Litigation. What to Expect as a Defendant

Medical Malpractice Litigation. What to Expect as a Defendant Medical Malpractice Litigation What to Expect as a Defendant Being named as a defendant in a malpractice suit may be your first exposure to civil litigation. You will probably wish it would just go away.

More information

DEALING WITH POLICE MISCONDUCT OR EXCESSIVE FORCE IN WISCONSIN

DEALING WITH POLICE MISCONDUCT OR EXCESSIVE FORCE IN WISCONSIN DEALING WITH POLICE MISCONDUCT OR EXCESSIVE FORCE IN WISCONSIN Written by: Jonathan S. Safran This guide attempts to answer some of the most common questions and provides a basic understanding of the steps

More information

Depression & Multiple Sclerosis

Depression & Multiple Sclerosis Depression & Multiple Sclerosis Managing specific issues Aaron, diagnosed in 1995. The words depressed and depression are used so casually in everyday conversation that their meaning has become murky.

More information

Depression Assessment & Treatment

Depression Assessment & Treatment Depressive Symptoms? Administer depression screening tool: PSC Depression Assessment & Treatment Yes Positive screen Safety Screen (see Appendix): Administer every visit Neglect/Abuse? Thoughts of hurting

More information

WORKERS COMPENSATION PROTOCOLS WHEN PRIMARY INJURY IS PSYCHIATRIC/PSYCHOLOGICAL

WORKERS COMPENSATION PROTOCOLS WHEN PRIMARY INJURY IS PSYCHIATRIC/PSYCHOLOGICAL WORKERS COMPENSATION PROTOCOLS WHEN PRIMARY INJURY IS PSYCHIATRIC/PSYCHOLOGICAL General Guidelines for Treatment of Compensable Injuries Patient must have a diagnosed mental illness as defined by DSM-5

More information

Abnormal Psychology PSY-350-TE

Abnormal Psychology PSY-350-TE Abnormal Psychology PSY-350-TE This TECEP tests the material usually taught in a one-semester course in abnormal psychology. It focuses on the causes of abnormality, the different forms of abnormal behavior,

More information

`çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå. aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí=

`çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå. aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí= `çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí= Overview: Common Mental What are they? Disorders Why are they important? How do they affect

More information

IN THE COURT OF COMMON PLEAS OF PHILADELPHIA COUNTY CIVIL TRIAL DIVISION

IN THE COURT OF COMMON PLEAS OF PHILADELPHIA COUNTY CIVIL TRIAL DIVISION IN THE COURT OF COMMON PLEAS OF PHILADELPHIA COUNTY CIVIL TRIAL DIVISION PHYLLIS BROWN v. AUGUST TERM, 1997 NO. 0787 ALBERT EINSTEIN MEDICAL CENTER, and GUY HEWLETT, M.D. ------------------------------------------------------------------------------------------------------------------

More information

Introduction to the DSM-IV and Psychological Testing

Introduction to the DSM-IV and Psychological Testing Introduction to the DSM-IV and Psychological Testing Significance of Mental Illness In any given year, how many Americans will suffer with a diagnosable mental illness? How many will suffer with a serious

More information

Vocational Rehabilitation Experts in the Litigation Context. Presented by Scott Haworth March 22, 2011

Vocational Rehabilitation Experts in the Litigation Context. Presented by Scott Haworth March 22, 2011 Vocational Rehabilitation Experts in the Litigation Context Presented by Scott Haworth March 22, 2011 PART ONE WHAT DO THEY DO? Vocational Rehabilitation Defined Medical, psychological, social and occupational

More information

ASSEMBLY BILL No. 597

ASSEMBLY BILL No. 597 AMENDED IN ASSEMBLY APRIL 14, 2015 california legislature 2015 16 regular session ASSEMBLY BILL No. 597 Introduced by Assembly Member Cooley February 24, 2015 An act to amend Sections 36 and 877 of, and

More information

Psychological Injuries - background

Psychological Injuries - background Psychological Injuries Policy Bully-Free Workplaces International Conference June 11-13, 2014 Psychological Injuries - background Injuries caused by exposure to workplace stress has received significant

More information

ENTITLEMENT ELIGIBILITY GUIDELINE ALCOHOL USE DISORDER

ENTITLEMENT ELIGIBILITY GUIDELINE ALCOHOL USE DISORDER MPC 30390 ICD-9 305.0, 303 ICD-10 F10.1, F10.2 DEFINITION ENTITLEMENT ELIGIBILITY GUIDELINE ALCOHOL USE DISORDER ALCOHOL-RELATED DISORDERS Alcohol-Related Disorders are divided into two categories: Alcohol

More information

2) Recurrent emotional abuse. 3) Contact sexual abuse. 4) An alcohol and/or drug abuser in the household. 5) An incarcerated household member

2) Recurrent emotional abuse. 3) Contact sexual abuse. 4) An alcohol and/or drug abuser in the household. 5) An incarcerated household member Co Occurring Disorders and the on Children: Effectively Working with Families Affected by Substance Abuse and Mental Illness Definition (Co-Occurring also called Dual Dx) A professional diagnosis of addictive/substance

More information

The Indiana Trial Lawyer Association s Lifetime Achievement Seminar. Honoring Peter L. Obremsky. May 23-24, 2005

The Indiana Trial Lawyer Association s Lifetime Achievement Seminar. Honoring Peter L. Obremsky. May 23-24, 2005 The Indiana Trial Lawyer Association s Lifetime Achievement Seminar Honoring Peter L. Obremsky May 23-24, 2005 The Use of Medical Literature in the Brain Injury Case Thomas C. Doehrman Doehrman-Chamberlain

More information

Psychological and psychopathological problems of victims and rescuers in accidents and catastrophes

Psychological and psychopathological problems of victims and rescuers in accidents and catastrophes Psychological and psychopathological problems of victims and rescuers in accidents and catastrophes (photo taken in Katowice on 28.01.2006) Paweł Rasmus When there is an accident or a catastrophe it can

More information

Working with the Physician s Counsel in Defending Off-Label Use Litigation

Working with the Physician s Counsel in Defending Off-Label Use Litigation Working with the Physician s Counsel in Defending Off-Label Use Litigation By Gerald P. Schneeweis Morris Polich & Purdy LLP Working with the Physician s Counsel in Defending Off-Label Use Litigation By

More information

Welcome New Employees. Clinical Aspects of Mental Health, Developmental Disabilities, Addictive Diseases & Co-Occurring Disorders

Welcome New Employees. Clinical Aspects of Mental Health, Developmental Disabilities, Addictive Diseases & Co-Occurring Disorders Welcome New Employees Clinical Aspects of Mental Health, Developmental Disabilities, Addictive Diseases & Co-Occurring Disorders After this presentation, you will be able to: Understand the term Serious

More information

Differentiating PTSD and ADHD. Elizabeth Risch, Ph.D. & Melissa Hakman, Ph.D.

Differentiating PTSD and ADHD. Elizabeth Risch, Ph.D. & Melissa Hakman, Ph.D. Differentiating PTSD and ADHD Elizabeth Risch, Ph.D. & Melissa Hakman, Ph.D. ADHD vs. PTSD One is a disruptive behavior disorder and the other is a reaction to trauma.so what s to differentiate??? The

More information

Question 5. After the trial, Attorney sent a $500 gift certificate to Doctor, with a note thanking her for recommending that Peter call him.

Question 5. After the trial, Attorney sent a $500 gift certificate to Doctor, with a note thanking her for recommending that Peter call him. Question 5 Attorney mailed a professional announcement to several local physicians, listing his name and address and his area of law practice as personal injury. Doctor received Attorney s announcement

More information

REVIEW DECISION. Re: Review Reference #: 13243 Board Decision under Review: November 24, 2003

REVIEW DECISION. Re: Review Reference #: 13243 Board Decision under Review: November 24, 2003 REVIEW DECISION Re: Review Reference #: 13243 Board Decision under Review: November 24, 2003 Date: Review Officer: Zen Kozak The worker requests a review of the decision of the Workers Compensation Board

More information

Commonwealth Of Kentucky Court of Appeals

Commonwealth Of Kentucky Court of Appeals RENDERED: OCTOBER 27, 2006; 10:00 A.M. NOT TO BE PUBLISHED Commonwealth Of Kentucky Court of Appeals NO. 2005-CA-002095-MR DEBRA IRELAND APPELLANT APPEAL FROM JEFFERSON CIRCUIT COURT v. HONORABLE MARTIN

More information

D. Clinical indicators for psychiatric evaluation are established by one or more of the following criteria. The consumer is:

D. Clinical indicators for psychiatric evaluation are established by one or more of the following criteria. The consumer is: MCCMH MCO Policy 2-015 Date: 4/21/11 V. Standards A. A psychiatric evaluation shall be done as an integral part of the assessment process. It serves as the guide to the identification of medical and psychiatric

More information

Lisa C. Tang, Ph.D. Licensed Clinical Psychologist 91 W Neal St. Pleasanton, CA 94566 (925) 963-8835

Lisa C. Tang, Ph.D. Licensed Clinical Psychologist 91 W Neal St. Pleasanton, CA 94566 (925) 963-8835 Lisa C. Tang, Ph.D. Licensed Clinical Psychologist 91 W Neal St. Pleasanton, CA 94566 (925) 963-8835 Professional Policies and Consent to Treatment Welcome to my practice. I appreciate your giving me the

More information

TORT AND INSURANCE LAW REPORTER. Informal Discovery Interviews Between Defense Attorneys and Plaintiff's Treating Physicians

TORT AND INSURANCE LAW REPORTER. Informal Discovery Interviews Between Defense Attorneys and Plaintiff's Treating Physicians This article originally appeared in The Colorado Lawyer, Vol. 25, No. 26, June 1996. by Jeffrey R. Pilkington TORT AND INSURANCE LAW REPORTER Informal Discovery Interviews Between Defense Attorneys and

More information

DSM-5: A Comprehensive Overview

DSM-5: A Comprehensive Overview 1) The original DSM was published in a) 1942 b) 1952 c) 1962 d) 1972 DSM-5: A Comprehensive Overview 2) The DSM provides all the following EXCEPT a) Guidelines for the treatment of identified disorders

More information

Guide. to Recovery Under The Illinois Workers Compensation Act. The Injured Employee s

Guide. to Recovery Under The Illinois Workers Compensation Act. The Injured Employee s The Injured Employee s Guide to Recovery Under The Illinois Workers Compensation Act Prepared By: Romanucci & Blandin, LLC 33 North LaSalle Street, 20th Floor Chicago, Illinois 60602 Toll Free: 888.458.1145

More information

ENTITLEMENT ELIGIBILITY GUIDELINE

ENTITLEMENT ELIGIBILITY GUIDELINE ENTITLEMENT ELIGIBILITY GUIDELINE BIPOLAR DISORDERS MPC 00608 ICD-9 296.0, 296.1, 296.4, 296.5, 296.6, 296.7, 296.8, 301.13 ICD-10 F30, F31, F34.0 DEFINITION BIPOLAR DISORDERS Bipolar Disorders include:

More information

How to Professionally and Personally Survive a Malpractice Suit John Baillie, MB, ChB, FRCP, FACG

How to Professionally and Personally Survive a Malpractice Suit John Baillie, MB, ChB, FRCP, FACG How to Professionally and Personally Survive a Malpractice Suit John Baillie, MB, ChB, FRCP, FACG ACG Annual Meeting 2013 How to Professionally and Personally Survive a Malpractice Suit John Baillie, MB,

More information

On April 6, 2004, a Board Hearing Officer confirmed the Case Manager s findings.

On April 6, 2004, a Board Hearing Officer confirmed the Case Manager s findings. 1 CLAIM HISTORY AND APPEAL PROCEEDINGS: The Worker was employed in a coal mine operation from 1978 until 2001, primarily as a long wall electrician. He was also a member of the mine rescue team (a Drägerman

More information

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF TENNESSEE AT KNOXVILLE

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF TENNESSEE AT KNOXVILLE IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF TENNESSEE AT KNOXVILLE UNITED STATES OF AMERICA ) ) v. ) No. 3:02-CR-30 ) CHARLES MICHAEL BEATTY ) MEMORANDUM AND ORDER This criminal case

More information

CLAIMS AGAINST TELEPHONE ANSWERING SERVICES: THE TRILOGY OF PREVENTION, HANDLING AND RESOLUTION PART TWO: WHAT TO DO WHEN A CLAIM HAPPENS

CLAIMS AGAINST TELEPHONE ANSWERING SERVICES: THE TRILOGY OF PREVENTION, HANDLING AND RESOLUTION PART TWO: WHAT TO DO WHEN A CLAIM HAPPENS CLAIMS AGAINST TELEPHONE ANSWERING SERVICES: THE TRILOGY OF PREVENTION, HANDLING AND RESOLUTION PART TWO: WHAT TO DO WHEN A CLAIM HAPPENS Martin M. Ween, Esq. Partner Wilson, Elser, Moskowitz, Edelman

More information

Dusty L Humes, Ph.D., Licensed Psychologist

Dusty L Humes, Ph.D., Licensed Psychologist ! Dusty L Humes, Ph.D., Licensed Psychologist 2201 San Pedro NE, Building 4-102, Albuquerque, NM 87110 512.917.3126 dustyhumesphd@gmail.com www.dustyhumes.com Profile I am a clinical psychologist who recently

More information

CASE SELECTION: EVALUATING THE RECORDS TO DETERMINE WHICH CASES TO REJECT OR TAKE

CASE SELECTION: EVALUATING THE RECORDS TO DETERMINE WHICH CASES TO REJECT OR TAKE CASE SELECTION: EVALUATING THE RECORDS TO DETERMINE WHICH CASES TO REJECT OR TAKE Philip C. Henry, Esquire Henry, Spiegel, Fried & Milling, LLP Suite 2450 950 East Paces Ferry Road Atlanta, Georgia 30326

More information

Case 1:09-cv-00554-JAW Document 165 Filed 01/23/12 Page 1 of 8 PageID #: 2495 UNITED STATES DISTRICT COURT DISTRICT OF MAINE

Case 1:09-cv-00554-JAW Document 165 Filed 01/23/12 Page 1 of 8 PageID #: 2495 UNITED STATES DISTRICT COURT DISTRICT OF MAINE Case 1:09-cv-00554-JAW Document 165 Filed 01/23/12 Page 1 of 8 PageID #: 2495 UNITED STATES DISTRICT COURT DISTRICT OF MAINE MICHAEL HINTON, ) ) Plaintiff, ) ) v. ) 1:09-cv-00554-JAW ) OUTBOARD MARINE

More information

Helping Heroes Come Home

Helping Heroes Come Home Helping Heroes Come Home Harris County Veterans Court May 30, 2012 Honorable Discharge, on active duty or in reserves Have pending eligible felony offense Be a legal resident of/or citizen of the United

More information

96TH GENERAL ASSEMBLY State of Illinois 2009 and 2010 SB3527. New Act 225 ILCS 60/29 from Ch. 111, par. 4400-29

96TH GENERAL ASSEMBLY State of Illinois 2009 and 2010 SB3527. New Act 225 ILCS 60/29 from Ch. 111, par. 4400-29 *LRB0ASKb* TH GENERAL ASSEMBLY State of Illinois 00 and 00 SB Introduced /0/00, by Sen. Bill Brady SYNOPSIS AS INTRODUCED: New Act ILCS 0/ from Ch., par. 00- Creates the Affordable Health Care Act and

More information

Alternative Burdens May Come With Alternative Causes

Alternative Burdens May Come With Alternative Causes Portfolio Media. Inc. 860 Broadway, 6th Floor New York, NY 10003 www.law360.com Phone: +1 646 783 7100 Fax: +1 646 783 7161 customerservice@law360.com Alternative Burdens May Come With Alternative Causes

More information

New York Law Journal. Tuesday, August 22, 2000. Trial Advocacy, Cross-Examination Of A Medical Expert: Collateral Attack

New York Law Journal. Tuesday, August 22, 2000. Trial Advocacy, Cross-Examination Of A Medical Expert: Collateral Attack New York Law Journal Tuesday, August 22, 2000 HEADLINE: BYLINE: Trial Advocacy, Cross-Examination Of A Medical Expert: Collateral Attack Ben B. Rubinowitz and Evan Torgan BODY: Expert testimony adds a

More information

INPATIENT SERVICES. Inpatient Mental Health Services (Adult/Child/Adolescent)

INPATIENT SERVICES. Inpatient Mental Health Services (Adult/Child/Adolescent) INPATIENT SERVICES Inpatient Mental Health Services (Adult/Child/Adolescent) Acute Inpatient Mental Health Services represent the most intensive level of psychiatric care and is delivered in a licensed

More information

FINAL ORDER REVERSING TRIAL COURT. Appellant, Joseph Pabon (herein Appellant ), appeals the Orange County Court s

FINAL ORDER REVERSING TRIAL COURT. Appellant, Joseph Pabon (herein Appellant ), appeals the Orange County Court s IN THE CIRCUIT COURT OF THE NINTH JUDICIAL CIRCUIT, IN AND FOR ORANGE COUNTY, FLORIDA APPELLATE CASE NO: 2011-AP-32 LOWER COURT CASE NO: 48-2010-MM-12557 JOSEPH PABON, vs. Appellant, STATE OF FLORIDA,

More information