(Cross-posted on the Squidoo Lens)
Written by: Medical Device Accident Expert Witness No. 3571
In preparing drugs for a surgical procedure, an anesthetist assembled a syringe. The syringe used a glass plunger/vial containing the anesthetic drug and was used for injection once the drug was mixed with sterile water in the vial. Holding a water bottle in one hand and the syringe in the other, the anesthetist pressed the base of his thumb against the glass vial to force air into the bottle. As he did this, the glass vial broke, and shards of glass severed several nerves in his hand. He lost the use of most of his hand. Read More on this Article
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Friday, November 4, 2011
Wednesday, October 26, 2011
Bladder Necrosis
Written by: Medical Device Accident Expert Witness No. 3571
A patient underwent a trans-urethral resection of the prostate. The bladder was distended with sterile water hung about 1 meter above the patient and run through a fluid warming device. The surgery went as planned, but the patient later presented with pain and trouble urinating. Cystoscopy revealed what appeared to the surgeon to be a thermally burned lining of the bladder that was sloughing off. The bladder later necrosed and was surgically removed.
Pathology of the bladder found the bladder lining to have necrosed and sloughed, but the prostate, which was also removed, was pink and healing. No mention of any burn to the urethra was made.
If the bladder had been thermally burned during the surgery, the distending water would have to have been above 60°C, the temperature at which tissue proteins denature. If this was the case, then the prostate would also have been burned because it was opened to the water in the bladder. As this water flowed out through the metal resectoscope, the urethra would likely to have been burned as well. However, the surgeon and surgical technician had noted that the effluent water was warm but not hot. Additionally, the fluid warmer could not warm the water above 43°C. So something other than heat caused the bladder to necrose.
The 1950’s and 1960’s cystitis was sometimes treated by distending the bladder for up to 30 minutes. There are reports of bladder necrosis due to this treatment. Cystoscope and resectoscope instruction manuals warn against leaving the outflow stopped for long periods as this could cause necrosis of the bladder.
The bladder has a blood supply separate from the prostate, and is a thin walled structure like a balloon. When the bladder is distended, the blood vessels are forced shut by the tension in the bladder wall. If the blood flow is stopped for sufficient time, the tissue begins to die. Because the prostate has a separate blood supply, a more massive shape, and was being removed, it was not necrosed by the pressure.
We concluded that the bladder pressure had to have been maintained for sufficient time to cause bladder necrosis and that the fluid warmer did not overheat.
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A patient underwent a trans-urethral resection of the prostate. The bladder was distended with sterile water hung about 1 meter above the patient and run through a fluid warming device. The surgery went as planned, but the patient later presented with pain and trouble urinating. Cystoscopy revealed what appeared to the surgeon to be a thermally burned lining of the bladder that was sloughing off. The bladder later necrosed and was surgically removed.
Pathology of the bladder found the bladder lining to have necrosed and sloughed, but the prostate, which was also removed, was pink and healing. No mention of any burn to the urethra was made.
If the bladder had been thermally burned during the surgery, the distending water would have to have been above 60°C, the temperature at which tissue proteins denature. If this was the case, then the prostate would also have been burned because it was opened to the water in the bladder. As this water flowed out through the metal resectoscope, the urethra would likely to have been burned as well. However, the surgeon and surgical technician had noted that the effluent water was warm but not hot. Additionally, the fluid warmer could not warm the water above 43°C. So something other than heat caused the bladder to necrose.
The 1950’s and 1960’s cystitis was sometimes treated by distending the bladder for up to 30 minutes. There are reports of bladder necrosis due to this treatment. Cystoscope and resectoscope instruction manuals warn against leaving the outflow stopped for long periods as this could cause necrosis of the bladder.
The bladder has a blood supply separate from the prostate, and is a thin walled structure like a balloon. When the bladder is distended, the blood vessels are forced shut by the tension in the bladder wall. If the blood flow is stopped for sufficient time, the tissue begins to die. Because the prostate has a separate blood supply, a more massive shape, and was being removed, it was not necrosed by the pressure.
We concluded that the bladder pressure had to have been maintained for sufficient time to cause bladder necrosis and that the fluid warmer did not overheat.
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Friday, October 14, 2011
Propofol to induce sleep?
Written by: Neurology and Neurophysiology Expert Witness No. 3614
One day a fellow physician came to my practice to be evaluated for a neurological condition. The staff wanted to know what "special measures" we should take for a VIP. Of course the answer to that is simple. If one is already providing the best care possible, the answer is "the same measures we take for everyone". If the answer were anything else, it would imply that every other patient received something less than optimal care.
It seems that at times certain patients receive care that is outside the established standards based on the patient's position, wealth, or notoriety. If excellent medical care is the standard, this deviation from standard practices will by definition provide something other than optimal care.
One of the most recent examples of practicing outside the standard of care is the case involving Michael Jackson and Dr. Conrad Murray. While the details of the case are still being discussed in court, it is clear that Michael Jackson was given the powerful anesthetic Propofol to induce "sleep".
Propofol (Diprivan) is a short-acting, intravenously administered hypnotic agent. Its uses include the induction and maintenance of general anesthesia, sedation for mechanically ventilated adults, and sedation for procedures typically performed in an operative setting with constant monitoring. Propofol acts on the GABAA receptor to slow the closing time of the channel. Activation of this receptor in the brain produces sedating effects. While there is some variability in how patients respond to Propofol, it is always highly sedating and commonly associated with decreased respirations.
The American Academy of Sleep Medicine has a number of suggestions for managing various forms of insomnia. While the use of some sedatives is considered useful, there has never been a recommendation for the use of general anesthetics. Such an idea is so far outside the standard of care that most physicians consider it comical at best.
For any physician dealing with a patient the most important aspect of the interaction is to practice within the standard of care. There is no level of notoriety or financial incentive on behalf of the patient that should warrant clear violations of that standard. Incidents of this nature are shameful and an embarrassment to the profession.
However, we can only speculate as to how many other physicians refused Michael Jackson's request for such medications and instead provided sound advice such as entering a coordinated drug rehabilitation program. Of course, any such physicians are not sitting in the courtroom today.
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One day a fellow physician came to my practice to be evaluated for a neurological condition. The staff wanted to know what "special measures" we should take for a VIP. Of course the answer to that is simple. If one is already providing the best care possible, the answer is "the same measures we take for everyone". If the answer were anything else, it would imply that every other patient received something less than optimal care.
It seems that at times certain patients receive care that is outside the established standards based on the patient's position, wealth, or notoriety. If excellent medical care is the standard, this deviation from standard practices will by definition provide something other than optimal care.
One of the most recent examples of practicing outside the standard of care is the case involving Michael Jackson and Dr. Conrad Murray. While the details of the case are still being discussed in court, it is clear that Michael Jackson was given the powerful anesthetic Propofol to induce "sleep".
Propofol (Diprivan) is a short-acting, intravenously administered hypnotic agent. Its uses include the induction and maintenance of general anesthesia, sedation for mechanically ventilated adults, and sedation for procedures typically performed in an operative setting with constant monitoring. Propofol acts on the GABAA receptor to slow the closing time of the channel. Activation of this receptor in the brain produces sedating effects. While there is some variability in how patients respond to Propofol, it is always highly sedating and commonly associated with decreased respirations.
The American Academy of Sleep Medicine has a number of suggestions for managing various forms of insomnia. While the use of some sedatives is considered useful, there has never been a recommendation for the use of general anesthetics. Such an idea is so far outside the standard of care that most physicians consider it comical at best.
For any physician dealing with a patient the most important aspect of the interaction is to practice within the standard of care. There is no level of notoriety or financial incentive on behalf of the patient that should warrant clear violations of that standard. Incidents of this nature are shameful and an embarrassment to the profession.
However, we can only speculate as to how many other physicians refused Michael Jackson's request for such medications and instead provided sound advice such as entering a coordinated drug rehabilitation program. Of course, any such physicians are not sitting in the courtroom today.
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Tuesday, October 11, 2011
Is Justice Being Served?
"Hot Coffee" : Cup of Cheer for Plaintiffs
"Hot Coffee" is named for the high-profile 1994 case of an elderly New Mexico woman, Stella Liebeck, who spilled McDonald's coffee on herself and sued. Comedians, journalists and politicians mocked her case, adding momentum to the effort to cap damage awards.
The film is an aggressive attempt to channel the public's sympathy back to plaintiffs — using Liebeck's case and others. In graphic detail, it shows Liebeck's third-degree burns that required hospitalization and skin grafts, and it notes Liebeck settled out of court for an undisclosed amount likely far less than her initial $2.9 million jury award.
Business groups are beginning to denounce the film. A spokesman for the U.S. Chamber Institute for Legal Reform said it's as fanciful as the Flat Earth Society, while Victor Schwartz, who appears in the film as general counsel of the American Tort Reform Association, said he regrets participating in what he calls "the most effective piece of propaganda" that trial lawyers have ever put out. Read the whole story here...
The film is an aggressive attempt to channel the public's sympathy back to plaintiffs — using Liebeck's case and others. In graphic detail, it shows Liebeck's third-degree burns that required hospitalization and skin grafts, and it notes Liebeck settled out of court for an undisclosed amount likely far less than her initial $2.9 million jury award.
Business groups are beginning to denounce the film. A spokesman for the U.S. Chamber Institute for Legal Reform said it's as fanciful as the Flat Earth Society, while Victor Schwartz, who appears in the film as general counsel of the American Tort Reform Association, said he regrets participating in what he calls "the most effective piece of propaganda" that trial lawyers have ever put out. Read the whole story here...
Monday, September 19, 2011
Harris County Challenges its own Expert Witness’ Credibility
by Matt Sharp
The Harris County District Attorney’s Office has decided to pursue charges against an expert it has used in multiple murder cases. A pathologist is a doctor who examines a dead body to determine cause and time of death among other things. If the State wishes to prove up that someone was murdered they rely on the truthful testimony of a pathologist to get that proof. If their pathologist has a history of falsifying government documents, lying to authorities, or just lying in general, then a jury is likely to disbelieve the pathologist and will be more likely to uphold the presumption of innocence. Read More on this Article
The Harris County District Attorney’s Office has decided to pursue charges against an expert it has used in multiple murder cases. A pathologist is a doctor who examines a dead body to determine cause and time of death among other things. If the State wishes to prove up that someone was murdered they rely on the truthful testimony of a pathologist to get that proof. If their pathologist has a history of falsifying government documents, lying to authorities, or just lying in general, then a jury is likely to disbelieve the pathologist and will be more likely to uphold the presumption of innocence. Read More on this Article
Thursday, September 15, 2011
Consolidated Consultants' is Celebrating 16 years of Great Expert Witness Referrals
We are happy to announce that today is Consolidated Consultants' 16th Birthday! 16 years in helping attorney's find the right expert for their cases!
If you are in need of a Technical Expert Witness or Medical Expert Witness, contact us today!
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Google has also Congratulated us! Thank you Google!
If you are in need of a Technical Expert Witness or Medical Expert Witness, contact us today!
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Google has also Congratulated us! Thank you Google!
Hot Coffee Documentary Goes After Tort Reform
By Thomson Reuters NEWS & INSIGHT
NEW YORK, June 24 (Reuters) (CORRECTED)- It was the case that launched a thousand jokes. The McDonald's hot coffee lawsuit came to represent for most people everything that's wrong with the American civil justice system-a plaintiff with a serious shortage of common sense, a huge windfall in damages and a waste of everyone's time...Read More on this Article
NEW YORK, June 24 (Reuters) (CORRECTED)- It was the case that launched a thousand jokes. The McDonald's hot coffee lawsuit came to represent for most people everything that's wrong with the American civil justice system-a plaintiff with a serious shortage of common sense, a huge windfall in damages and a waste of everyone's time...Read More on this Article
Monday, September 12, 2011
ProPublica Provides Database of Payments to Physicians by Pharmaceutical Companies
ProPublica, the "independent, non-profit newsroom that produces investigative journalism in the public interest," has created a searchable database of payments made by pharmaceutical companies to doctors - usually as compensation for presentations the doctors make that discuss the companies' drugs.
Read More on this Article
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Monday, August 8, 2011
Medication Errors: Do No Harm
Written by: Registered Pharmacist and Diabetes Educator Expert Witness No. 3591
Medication errors are a primary source of patient injury that plague our healthcare system. According to the Physicians. Insurers Association of America, in 2008, 334 claims closed with a medication error. Medication errors related to the treatment of diabetes are more common than one would like to think. This is in part due to the many facets involved in diabetes treatment from insulin administration to blood sugar monitoring both at home and in the hospital setting. Read more on this article...
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Sexual Harassment and Preventative Medicine
Written by: Workplace Psychology Expert Witness No. 149
When companies consider the impact of sexual harassment they probably think of being legally defensible. Not bad thinking. But a better thought is -- why not prevent the problems of sexual harassment in the first place?
A true story
Two partners in a large consulting firm, Frank and Jessica, considered themselves friends and were notorious for teasing each other in the office. In one incident Jessica put up a picture of a bodybuilder flexing his muscles and pasted a photo of Frank’s head on it. Frank responded by putting up a picture of a girl in a bikini posing by a car and pasted her head on the picture. Read more on this article...
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Promissory Notes - Traps & Tips
Written by: Real Estate Broker, Promissory Note, Mortgage Financing Expert Witness No. 83
The Trap
Although appearing relatively simple in concept, a promissory note and the accompanying loan documents can be very complex in construction. Additionally, the attorney must insure that its terms and conditions of the note and other loan documents comply with all federal and state laws. Read more on this article...
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Litigation and the Bicycle
Summer 2011 Newsletter Written by: Bicycle Accident Reconstruction Expert Witness No. 76
Many of us in the bicycle industry refer to cycling as the “The new golf.” The popularity of bicycles has expanded faster than any other participant sport in America. 2010 sales figures indicate a 33.2% increase in volume from just a year ago. To put that in perspective, there are far more cyclists in America than golfers, tennis players and skiers combined. The participation profile indicates many more adults; from their mid-twenties-through their mid 60’s are now riding bikes. While a lot of us are enjoying our bicycles, we cannot forget the ever present risks. Many of the new crops of mature riders are more secure financially, so those risks are worth calculating. Read more on this article...
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Tuesday, July 12, 2011
Small Businesses Fined by the IRS Initiating Lawsuits Against Benefit Plan Advisors
Written by: Financial, Estate Planning and Retirement Expert Witness No. 3306
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Advisors and insurance brokers, for many years, beginning in the 1990s, have sold the 412(i) plan, a type of defined-benefit pension plan, and the 419 plan, a health and welfare benefit plan, to small businesses as a way of providing certain benefits to their employees, while also, and much more importantly receiving large tax deductions. Some of these plans were structured in a way that has subsequently been deemed as an abusive tax shelter.
Via legislation enacted in October 2004, Congress changed the law to address these certain tax shelters which were considered abusive and required that these companies file with the Internal Revenue Service if they had these plans in place. Contributions to these plans were described by advisors as fully tax deductible and, it was claimed, large contributions could be sheltered, especially in the early years of the plan’s life, so a significant amount of income was sheltered, possibly forever, if rolled into annuities and similar financial products. It was actually sometimes claimed that money could be contributed, as well as withdrawn, tax free. Another outrageous claim was that the amount of tax deductions was unlimited.
Until recently, the IRS had instituted a moratorium on collecting these fines. However, the moratorium ended on June 1, 2010. Many companies and financial advisors were not aware that this was a cause for concern. However, according to experts, the author of this article included, employers are now receiving heavy scrutiny from the Federal Government, as the IRS has been aggressive in auditing these plans. The fines for failing to notify the agency about them are $200,000 annually for businesses and $100,000 annually for individuals, for every year of participation in whatever plan is in question.
The IRS increasingly is issuing penalty notifications to businesses, as well as to advisors who sold these plans to small businesses or who recommended plan participation, in addition to accountants who prepared and/or signed tax returns claiming deductions for participation in such a plan. Not surprisingly, the businesses affected by these fines often resort to litigation against the advisors who persuaded them to adopt these plans, or who sold them. The situation for the businesses is bad enough, and they sue to recover, among other things, the expenses of these penalties. But it could be even worse for the advisors involved, who face not only litigation but IRS penalties as well, and perhaps even having action taken against professional licenses.
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Tags: insurance, brokers, IRS, tax, planning
Click here to View this Expert's CV
Advisors and insurance brokers, for many years, beginning in the 1990s, have sold the 412(i) plan, a type of defined-benefit pension plan, and the 419 plan, a health and welfare benefit plan, to small businesses as a way of providing certain benefits to their employees, while also, and much more importantly receiving large tax deductions. Some of these plans were structured in a way that has subsequently been deemed as an abusive tax shelter.
Via legislation enacted in October 2004, Congress changed the law to address these certain tax shelters which were considered abusive and required that these companies file with the Internal Revenue Service if they had these plans in place. Contributions to these plans were described by advisors as fully tax deductible and, it was claimed, large contributions could be sheltered, especially in the early years of the plan’s life, so a significant amount of income was sheltered, possibly forever, if rolled into annuities and similar financial products. It was actually sometimes claimed that money could be contributed, as well as withdrawn, tax free. Another outrageous claim was that the amount of tax deductions was unlimited.
Until recently, the IRS had instituted a moratorium on collecting these fines. However, the moratorium ended on June 1, 2010. Many companies and financial advisors were not aware that this was a cause for concern. However, according to experts, the author of this article included, employers are now receiving heavy scrutiny from the Federal Government, as the IRS has been aggressive in auditing these plans. The fines for failing to notify the agency about them are $200,000 annually for businesses and $100,000 annually for individuals, for every year of participation in whatever plan is in question.
The IRS increasingly is issuing penalty notifications to businesses, as well as to advisors who sold these plans to small businesses or who recommended plan participation, in addition to accountants who prepared and/or signed tax returns claiming deductions for participation in such a plan. Not surprisingly, the businesses affected by these fines often resort to litigation against the advisors who persuaded them to adopt these plans, or who sold them. The situation for the businesses is bad enough, and they sue to recover, among other things, the expenses of these penalties. But it could be even worse for the advisors involved, who face not only litigation but IRS penalties as well, and perhaps even having action taken against professional licenses.
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Tags: insurance, brokers, IRS, tax, planning
Monday, May 2, 2011
Noise: An Environmental Pollutant Demanding Greater Attention
Written by Noise Pollution Expert Witness
Spreading dirt on the cobblestone street in front of the State House in Philadelphia in 1787 protected the men inside from the noises of passing carriages and carts which would have intruded upon their deliberations as they worked on the http://www.barefootsworld.net/consti15.html document that would set down the principles by which our country would be governed. In 1972, 185 years after the writers of our Constitution recognized the intrusiveness of noise, the United States passed the Noise Control Act, designed to protect citizens from the dangers of noise. The Environmental Protection Agency (EPA) was charged with carrying out the mandate of the Act and in 1978 stated in its “Noise: A Health Problem” booklet: “It is finally clear that noise is a significant hazard to public health.” Unfortunately, EPA’s noise division was essentially dismantled IN 1981 and today EPA is minimally involved in lessening the din of overhead planes, the loud blasts of railroad horns, and the myriad of noises engulfing millions of citizens daily.
Our federal government is essentially “out of the noise abatement” business, leaving the control of noise to cities and states. While New York City has recently updated its 1970s Noise Code and other cities across the country have passed anti-noise legislation, our country has regressed with respect to noise control and abatement. This, at a time when a review of the growing number of noise studies, many of which we cite in our soon to be published book Why Noise Matters (Earthscan, 2011), makes it abundantly clear that noise is indeed hazardous to our mental and physical well-being. Children are especially vulnerable as demonstrated by the many published articles on the adverse impacts of noise to their cognitive, language and learning skills.
Health and education costs are rising in this country and one way to reduce these costs is to abate noise which we know adversely impacts our health. What to do? Learn about the hazards of noise and urge your public officials in Washington to enforce the Noise Control Act.
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Monday, April 4, 2011
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Monday, March 28, 2011
Profile of a Serial Bomber
Written by Clinical Psychology Expert Witness
Expert Witness No. 2006
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Late in 1996 when I was still a psychological assistant, I was asked to assist in helping a well-known forensic psychologist to evaluate a man known for instigating terrorist acts in small suburbs of Los Angeles. He enjoyed making pipe-bombs and letting them off. The explosives never escalated beyond that point, but that was enough in this tense atmosphere. Nineteen ninety three saw the first Trade Center bombing, and anger and dissention seemed to be mounting enough to keep the federal agencies on their toes.
I was delighted to be asked to help with the evaluation since I had planned on becoming a forensic psychologist with a bent toward neuropsychology. Basically the referral question was whether or not this man was mentally competent to stand trial.
Competency can be a difficult evaluation. According to Frye, the standard by which this evaluation is measured, to be competent a person must have known at the time of the crime that he or she was doing a crime and that it was wrong. They must also be able to assist their attorney in their defense.
The man in question, a compilation of two different people for this article, had been known by various police departments for many years, but he had never “shown his hand” so to speak until he blew up a building in a small suburb that had been marked for demolition in California. The names of the perpetrators and certain identifying facts have been changed to protect his privacy and that of his family. I will call him Mr. C.
Why the bomber would want to pick this city, so out of the way and non-main stream, was never really known, other than he reported during his evaluation that he had enjoyed a nice hike in one of the beautiful open trails and decided this was the place to investigate “down home Americans.” No one had been hurt or killed, yet the police department had been building a case against Mr. C for quite a while and found it interesting, and somewhat hopeful, that this simple act of defiance, that hadn’t hurt anyone, was the moment Mr. C had decided to become careless.
My colleague and I were asked to meet him at the jail and sat opposite him separated by a Plexiglas window. We spoke to him through the glass by taking turns on the phone. He was a very large man, at least six foot five, with a large girth. He looked scruffy in the jail jumpsuit and older than his 56 years. He had tried to shave in the jail, but the accoutrements provided gave him a day-old beard. His excuse was that someone had been watching him while he performed this function, and that had made him exceedingly nervous. We took the usual information down, taking turns to ask the questions, which seemed to give him an ego rush. For some reason, I suspect that interacting with the two of us women rather than telling all this to a man was more intriguing for him and enabled him to play with our sympathies, or so he apparently thought. He cried easily, looked abashed and ashamed and more than once apologized with all his heart. I believed him; my colleague was a little more circumspect.
An evaluation usually consists of taking down current living situation, a good mental status examination including his appearance, whether or not he is oriented, his thought processes, his degree of alertness, his reality testing, his judgment and his insight. A formal history is then taken including a personal history such as when the person had been born, where and how he was brought up, his schooling record, any military record, his legal problems, arrest records, any juvenile disciplinary problems or arrests, alcohol and drug history, medical history including childhood illnesses, diseases or surgeries, suicide or homicide attempts and current functioning.
Mr. C had been born in 1940 and grew up in Las Vegas, Nevada, near “the Strip”. His father had been a janitor and his mother had worked in one of the drug outlets. But she could have been a lead dancer at the Lido, he exclaimed. He had no brothers or sisters and had been considered a “loner” in school. His IQ had been in the superior range, but his strength was English, although his mathematics acumen was not to be denigrated. Sometime in middle school Mr. C. had become increasingly withdrawn from society.
In collateral information, his mother stated she noted that he was changing and becoming more introspective, unable to connect with anyone. He was also becoming more depressed and paranoid. Currently, he refused conventional psychotherapy or the use of any medications from a prison psychiatrist.
We noted he had been picked up outside the latest bombing site by a uniform police who noticed he was picking up pieces of the wreckage and handing them over personally to crime techs to assist in the investigation, even though he was asked to leave the scene. Finally, officers became intrigued by this interfering person and took him to the back of a police car where he immediately confessed to having done the crime. Shocked and somewhat skeptic, they took him in where forensic examiners discovered soot and explosive particles on his hands and clothing.
Mr. C was a voracious reader and seemed intent upon explaining to me how Batman ruled his life. He identified completely with Bruce Wayne, Batman’s doppelganger, and had decided early on that he, Mr. C., would take in all fears, just as Bruce Wayne had done, to overcome them and use them for the benefit of mankind. Part of these fears included loud bangs and the destruction of evil.
Even in the sterile atmosphere of the jail; the steel stools, the grayish walls and picture-less atmosphere where he was incarcerated, he appeared not to be affected by the drab. He focused instead upon an inner world that bordered on paranoid schizophrenia or simply a wild and crazy fantasy life. It was hard to determine. He denied hearing voices or seeing things other people told him were not there. His medical records indicated an MRI and a CAT scan that showed no gross brain disorder, but a Luria Nebraska Neuropsychological Battery was in order to make sure the finer problems undetectable by medical examination or equipment, could be revealed. Slight memory loss, inability to remember words, perhaps sight, sound, or hearing problems could be uncovered where the medical examination had failed and these almost undetectable changes could be reported to medical personnel for further evaluation.
His mental status examination indicated that Mr. C. was scruffy but clean, oriented to person, place and reason for examination. He appeared to be present and alert. His speech and language were clear with no tics or stuttering. His thought processes, however, appeared to be somewhat bazaar, indicative of Paranoid Schizophrenia, but Mr. C. was aware of how he sounded and that others might not buy into these delusions, making it hard to make a diagnosis of schizophrenia. He reported correctly that before he his arrest currently resided in a small hut an outlet just on the edge of a weed encrusted bike lane. He further reported quite straightforwardly that no one ever bothered him there and he was basically homeless except for this covering over his head. He had no real ideas of reference, circumstantial speech or word salad.
The rest of his history was gleaned from collateral sources. There was little other history other than he had never married and to his knowledge had no children. He didn’t remember attending high school, although he was told he had. He was also told he had done very well in high school and had been accepted to UCLA, another fact of which he was clueless. His grades were disparate some A’s, some B's and even some C's in mathematics, but generally good. He didn’t like to study and took many exams without even cracking a book. These records were backed up and documented.
It is very difficult to do testing in a jail setting. Unable to touch some of the testing material, whole subtests of the Wechsler measures cannot be used. The Block Design for instance, where blocks are placed in particular configurations according to pictures in a book, cannot be used. It basically becomes a verbal measure from which an idea of the intelligence can be gleaned. The Bender-Gestalt cannot be executed, either. It requires a pencil and white paper where the client recreates geometric figures positioned in front of him or her. There is no normative sample of these tests for this population. So, my colleague and I simply gave him the examination for competency to stand trial.
We asked him to describe his offense and I asked him how he learned to make the pipe bombs he’d used outside Lancaster and he told me simply, “Over the internet it’s simple.” He then outlined a complete and intricate formulation including ingredients and assembly that would have been difficult for me to follow. He did this with extreme pride and accomplishment in his face, showing off acumen and understanding of each facet of this procedure.
I asked him if he could tell me, therefore, the charges against him. He told me that he’d been drinking all weekend and on Monday began “feeling” he should explode something to put him back in “full form”, by which he meant ‘reality’.
The next question is: How do you plan to plead? answered, ‘not guilty’, but not “by reason of insanity.” He felt that people should beaware of the dangers of the world and how easy it is to take control physically.
When asked what he expected in sentencing, he fully expected to get off once the jury understood his reasoning.
He wasn’t able to define the roles of courtroom personnel other than his own attorney and what that person was to do for him, but he did understand that his attorney wanted him to admit he was insane. He disagreed and began a long rancor of what insanity means: not seeing the unfairness in the world, the lack of respect. I asked him if he had a good relationship with his attorney and he suddenly changed gears and announced he certainly did. Once things are explained, everything falls into place.
He felt he could cooperate fully and if this attorney did not understand what was to be done, he, Mr. C. would defend himself. There was amble indication that this defendant could disrupt courtroom proceedings, but my colleague and I found him competent to stand trial.
Mr. C. was entitled and angry. He knew what he was doing was wrong, but he did it anyway. His substance abuse had escalated to the point where he was delusional and vengeful.
That afternoon, it occurred to me that substance abuse in its totality, including illicit drugs, alcohol and other mood changing concoctions carried with them a real danger even stronger than the drug itself: the chance to become Bipolar, an illness that runs across the life-span, but usually shows up in the twenties to thirties with sleep onset disturbance. However if there is a co morbid or pre morbid substance abuse problem, Bipolar can show up in the forties or fifties. It is not curable. In this disorder, depressive moods are followed by wild mood swings that encompass thoughts of grandeur, hallucinations and delusions and other psychotic features, before they are usually followed again by a severe low.
It further occurs to me even now that severe substance abuse is a gold-printed invitation to Bipolar illness, probably even stronger than the genetic component it usually carries. I worked for two years on a Schizophrenic/Bipolar ward of a large hospital in Los Angeles and even further believe this to be true.
Mr. C. was competent to stand trial. He knew at the time of his crime that doing it was wrong and he knew how to assist his attorney in his defense (the generally accepted ‘competency to stand trial’ of the legal establishment). I still felt bad for him. Most schizophrenia occurs during the ages of 18 to 25. He was probably too old to acquire it at fifty-six years old. A Bipolar system seemed to be occurring. Wild delusions began to plague him and although his current medication seems to calm him, he still suffers from wondering which is the fantasy life and which is reality.
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Expert Witness No. 2006
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Late in 1996 when I was still a psychological assistant, I was asked to assist in helping a well-known forensic psychologist to evaluate a man known for instigating terrorist acts in small suburbs of Los Angeles. He enjoyed making pipe-bombs and letting them off. The explosives never escalated beyond that point, but that was enough in this tense atmosphere. Nineteen ninety three saw the first Trade Center bombing, and anger and dissention seemed to be mounting enough to keep the federal agencies on their toes.
I was delighted to be asked to help with the evaluation since I had planned on becoming a forensic psychologist with a bent toward neuropsychology. Basically the referral question was whether or not this man was mentally competent to stand trial.
Competency can be a difficult evaluation. According to Frye, the standard by which this evaluation is measured, to be competent a person must have known at the time of the crime that he or she was doing a crime and that it was wrong. They must also be able to assist their attorney in their defense.
The man in question, a compilation of two different people for this article, had been known by various police departments for many years, but he had never “shown his hand” so to speak until he blew up a building in a small suburb that had been marked for demolition in California. The names of the perpetrators and certain identifying facts have been changed to protect his privacy and that of his family. I will call him Mr. C.
Why the bomber would want to pick this city, so out of the way and non-main stream, was never really known, other than he reported during his evaluation that he had enjoyed a nice hike in one of the beautiful open trails and decided this was the place to investigate “down home Americans.” No one had been hurt or killed, yet the police department had been building a case against Mr. C for quite a while and found it interesting, and somewhat hopeful, that this simple act of defiance, that hadn’t hurt anyone, was the moment Mr. C had decided to become careless.
My colleague and I were asked to meet him at the jail and sat opposite him separated by a Plexiglas window. We spoke to him through the glass by taking turns on the phone. He was a very large man, at least six foot five, with a large girth. He looked scruffy in the jail jumpsuit and older than his 56 years. He had tried to shave in the jail, but the accoutrements provided gave him a day-old beard. His excuse was that someone had been watching him while he performed this function, and that had made him exceedingly nervous. We took the usual information down, taking turns to ask the questions, which seemed to give him an ego rush. For some reason, I suspect that interacting with the two of us women rather than telling all this to a man was more intriguing for him and enabled him to play with our sympathies, or so he apparently thought. He cried easily, looked abashed and ashamed and more than once apologized with all his heart. I believed him; my colleague was a little more circumspect.
An evaluation usually consists of taking down current living situation, a good mental status examination including his appearance, whether or not he is oriented, his thought processes, his degree of alertness, his reality testing, his judgment and his insight. A formal history is then taken including a personal history such as when the person had been born, where and how he was brought up, his schooling record, any military record, his legal problems, arrest records, any juvenile disciplinary problems or arrests, alcohol and drug history, medical history including childhood illnesses, diseases or surgeries, suicide or homicide attempts and current functioning.
Mr. C had been born in 1940 and grew up in Las Vegas, Nevada, near “the Strip”. His father had been a janitor and his mother had worked in one of the drug outlets. But she could have been a lead dancer at the Lido, he exclaimed. He had no brothers or sisters and had been considered a “loner” in school. His IQ had been in the superior range, but his strength was English, although his mathematics acumen was not to be denigrated. Sometime in middle school Mr. C. had become increasingly withdrawn from society.
In collateral information, his mother stated she noted that he was changing and becoming more introspective, unable to connect with anyone. He was also becoming more depressed and paranoid. Currently, he refused conventional psychotherapy or the use of any medications from a prison psychiatrist.
We noted he had been picked up outside the latest bombing site by a uniform police who noticed he was picking up pieces of the wreckage and handing them over personally to crime techs to assist in the investigation, even though he was asked to leave the scene. Finally, officers became intrigued by this interfering person and took him to the back of a police car where he immediately confessed to having done the crime. Shocked and somewhat skeptic, they took him in where forensic examiners discovered soot and explosive particles on his hands and clothing.
Mr. C was a voracious reader and seemed intent upon explaining to me how Batman ruled his life. He identified completely with Bruce Wayne, Batman’s doppelganger, and had decided early on that he, Mr. C., would take in all fears, just as Bruce Wayne had done, to overcome them and use them for the benefit of mankind. Part of these fears included loud bangs and the destruction of evil.
Even in the sterile atmosphere of the jail; the steel stools, the grayish walls and picture-less atmosphere where he was incarcerated, he appeared not to be affected by the drab. He focused instead upon an inner world that bordered on paranoid schizophrenia or simply a wild and crazy fantasy life. It was hard to determine. He denied hearing voices or seeing things other people told him were not there. His medical records indicated an MRI and a CAT scan that showed no gross brain disorder, but a Luria Nebraska Neuropsychological Battery was in order to make sure the finer problems undetectable by medical examination or equipment, could be revealed. Slight memory loss, inability to remember words, perhaps sight, sound, or hearing problems could be uncovered where the medical examination had failed and these almost undetectable changes could be reported to medical personnel for further evaluation.
His mental status examination indicated that Mr. C. was scruffy but clean, oriented to person, place and reason for examination. He appeared to be present and alert. His speech and language were clear with no tics or stuttering. His thought processes, however, appeared to be somewhat bazaar, indicative of Paranoid Schizophrenia, but Mr. C. was aware of how he sounded and that others might not buy into these delusions, making it hard to make a diagnosis of schizophrenia. He reported correctly that before he his arrest currently resided in a small hut an outlet just on the edge of a weed encrusted bike lane. He further reported quite straightforwardly that no one ever bothered him there and he was basically homeless except for this covering over his head. He had no real ideas of reference, circumstantial speech or word salad.
The rest of his history was gleaned from collateral sources. There was little other history other than he had never married and to his knowledge had no children. He didn’t remember attending high school, although he was told he had. He was also told he had done very well in high school and had been accepted to UCLA, another fact of which he was clueless. His grades were disparate some A’s, some B's and even some C's in mathematics, but generally good. He didn’t like to study and took many exams without even cracking a book. These records were backed up and documented.
It is very difficult to do testing in a jail setting. Unable to touch some of the testing material, whole subtests of the Wechsler measures cannot be used. The Block Design for instance, where blocks are placed in particular configurations according to pictures in a book, cannot be used. It basically becomes a verbal measure from which an idea of the intelligence can be gleaned. The Bender-Gestalt cannot be executed, either. It requires a pencil and white paper where the client recreates geometric figures positioned in front of him or her. There is no normative sample of these tests for this population. So, my colleague and I simply gave him the examination for competency to stand trial.
We asked him to describe his offense and I asked him how he learned to make the pipe bombs he’d used outside Lancaster and he told me simply, “Over the internet it’s simple.” He then outlined a complete and intricate formulation including ingredients and assembly that would have been difficult for me to follow. He did this with extreme pride and accomplishment in his face, showing off acumen and understanding of each facet of this procedure.
I asked him if he could tell me, therefore, the charges against him. He told me that he’d been drinking all weekend and on Monday began “feeling” he should explode something to put him back in “full form”, by which he meant ‘reality’.
The next question is: How do you plan to plead? answered, ‘not guilty’, but not “by reason of insanity.” He felt that people should beaware of the dangers of the world and how easy it is to take control physically.
When asked what he expected in sentencing, he fully expected to get off once the jury understood his reasoning.
He wasn’t able to define the roles of courtroom personnel other than his own attorney and what that person was to do for him, but he did understand that his attorney wanted him to admit he was insane. He disagreed and began a long rancor of what insanity means: not seeing the unfairness in the world, the lack of respect. I asked him if he had a good relationship with his attorney and he suddenly changed gears and announced he certainly did. Once things are explained, everything falls into place.
He felt he could cooperate fully and if this attorney did not understand what was to be done, he, Mr. C. would defend himself. There was amble indication that this defendant could disrupt courtroom proceedings, but my colleague and I found him competent to stand trial.
Mr. C. was entitled and angry. He knew what he was doing was wrong, but he did it anyway. His substance abuse had escalated to the point where he was delusional and vengeful.
That afternoon, it occurred to me that substance abuse in its totality, including illicit drugs, alcohol and other mood changing concoctions carried with them a real danger even stronger than the drug itself: the chance to become Bipolar, an illness that runs across the life-span, but usually shows up in the twenties to thirties with sleep onset disturbance. However if there is a co morbid or pre morbid substance abuse problem, Bipolar can show up in the forties or fifties. It is not curable. In this disorder, depressive moods are followed by wild mood swings that encompass thoughts of grandeur, hallucinations and delusions and other psychotic features, before they are usually followed again by a severe low.
It further occurs to me even now that severe substance abuse is a gold-printed invitation to Bipolar illness, probably even stronger than the genetic component it usually carries. I worked for two years on a Schizophrenic/Bipolar ward of a large hospital in Los Angeles and even further believe this to be true.
Mr. C. was competent to stand trial. He knew at the time of his crime that doing it was wrong and he knew how to assist his attorney in his defense (the generally accepted ‘competency to stand trial’ of the legal establishment). I still felt bad for him. Most schizophrenia occurs during the ages of 18 to 25. He was probably too old to acquire it at fifty-six years old. A Bipolar system seemed to be occurring. Wild delusions began to plague him and although his current medication seems to calm him, he still suffers from wondering which is the fantasy life and which is reality.
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