Legal 1

Forensic Psychiatric Case Evaluations

by Mark I. Levy, MD, DFAPA

WHAT IS FORENSIC PSYCHIATRY?

Forensic psychiatry, or psychiatry and the law, is a subspecialty of medicine and psychiatry concerned with the interface of psychiatry and legal proceedings. Forensic psychiatrists serve s experts for civil and criminal attorneys, the judiciary, government and non-government agencies and corporations.

The keystone of forensic psychiatric practice is the Independent Medical (Psychiatric) Examination or "IME." It consists of the application of the principals of psychiatric diagnosis and clinical assessment to plaintiffs in civil lawsuits and to defendants in proceedings.

The goal of a forensic IME is to determine:

In Civil matters, whether the plaintiff has evidence of psychiatric injury or illness and, if so, to determine with "reasonable medical certainty" whether of not the psychiatric condition was caused or exacerbated by the event(s) alleged in a lawsuit.

In Criminal matters, whether the defendant is competent to enter a plea, stand trial, be sentenced and/or to undergo punishment. Rarely, the task of a forensic psychiatrist is to independently determine whether or not the defendant is "insane" according to the legal definition of sanity and, if so, to determine whether or not the defendant is "not guilty by reason of insanity," according to state or federal legal definitions, statutes and principles.

The practice of forensic psychiatry in the United States is governed by a strict code of ethics, derived from the Principles of Medical Ethics as codified by the American Medical Association and as applied to psychiatric practice by the American Psychiatric Association. The recognized governing organization of Forensic Psychiatry is the American Academy of Psychiatry and the Law, a subsidiary of the American Psychiatric Association.

Forensic Psychiatric training is now available at a limited number of medical schools in the United States as a twelve month fellowship program for MD's after their completion of a full three year psychiatric residency training. Sub-specialty certification in Forensic Psychiatry by the American Board of Psychiatry and Neurology is now available following completion of a Forensic Psychiatric Fellowship as well as passing a comprehensive written examination.

Selected Abstracts: Returned: 1 citations and abstracts. Click on down arrow or scroll to see abstracts.
LH Strasburger, TG Gutheil, and A Brodsky: On wearing two hats: role conflict in serving as both psychotherapist and expert witness
Am J Psychiatry 154: 448-456.

Abstract 1 of 1

Am J Psychiatry 1997; 154:448-456
Copyright © 1997 by American Psychiatric Association

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On wearing two hats: role conflict in serving as both psychotherapist and expert witness

LH Strasburger, TG Gutheil and A Brodsky
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.

OBJECTIVE: This article explores the clinical, legal, and ethical problemsthat typically occur when a psychotherapist serves as both a treatingclinician and forensic evaluator (or expert witness) in the same case.METHOD: The professional literature, ethics codes, opinion surveys, and thechanging economic and institutional contexts of psychotherapy are reviewedin order to identify obstacles to widespread recognition of thisstraightforward ethical issue. The processes of psychotherapy and forensicevaluation are then analyzed so as to reveal fundamental incompatibilitiesbetween the psychotherapist's clinical and legal functions. RESULTS:Attempting to treat and evaluate the same person typically creates anirreconcilable role conflict. This role conflict manifests itself indifferent conceptions of truth and causation, different forms of alliance,different types of assessment, and different ethical guidelines.CONCLUSIONS: Although circumstances sometimes compel a practitioner toassume the dual role of treater and evaluator, the problems that surroundthis practice argue for its avoidance whenever possible.

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On Wearing Two Hats

LH Strasburger, TG Gutheil and A Brodsky
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.

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Reviews and Overviews

Liability for the Psychiatrist Expert Witness

Renée L. Binder, M.D.

OBJECTIVE: An increasing number of general psychiatrists areacting as expert witnesses in the legal system. The purposeof this article is to help psychiatrists who are interestedin doing forensic work by informing them of the risks entailed.METHOD: The author reviews the medical and legal literatureabout expert witness immunity. RESULTS: The author explainsthe traditional concept of expert witness immunity and showshow a variety of factors have led to the erosion of this immunity.These factors include the proliferation of experts, the inadequacyof traditional safeguards of potential prosecution for perjuryand cross-examination, the growth of attorney malpractice, thelack of protection of the injured party from unscrupulous witnesses,and the ineffectiveness of Daubert v. Merrell Dow Pharmaceuticals.Examples are given of how expert witnesses are being held accountableby professional associations and state medical boards and throughtort liability. CONCLUSIONS: The author provides risk-managementstrategies and guidelines for psychiatrists who are consideringengaging in forensic work.

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Important Court Rulings on Standards for Experts

borrowed from Medicine & Psychiatry Expert site
by Harold J. Bursztajn, MD

e-mail: harold_bursztajn@hms.harvard.edu

National Certification for Forensic Psychiatrists: A Preview of the Post-Daubert Expert An examination of the admissibility of scientific testimony in court, an important issue in the education of judges and juries as claims of emotional, medical, and psychological damages may sound dubious to the non-expert.
U.S. Supreme Court Rules About Standards In Expert Witness Post-Daubert

Summaries of some recent court decisions as to the admissability of expert evidence post the U.S. Supreme Court Daubert decision:
Article: "Massachusetts Federal District Court Applies Kumho Tire to Exlude Plaintiffs' Expert Testimony on 'Hedonic' Damages" See also:
- Case: Mayotte M. Jones v. Metro West, Inc.
- Case: Kumho Tire Co., Ltd. v. Carmichael
- Case: General Electric Co. v. Joiner
- Article: "Daubert Without Prejudice: Achieving Relevance and Reliability Without Randomness"
- Case: Doe v. Doe Expert Testimony & Workman's Compensation
Federal Rule of Evidence 702 - The Proposed Revision
"Judicial Conference Approves Changes to Federal Rules of Evidence"
Excerpt on the case: Massachusetts v. Crawford, 706 N.E.2d 289