EXAMINATION 2- Direct and Cross Exam of Expert Neurologist Witness in car accident case - Part 2
by Mr. Lyman
Q. Dr. Shenker, the two MRIs one taken in July of 1996 and then subsequently in the summer of 2000 basically had the same result that they were normal,?? rrect?
A. That's right.
MR. LYMAN: I have nothing further, Judge. Thank you, Doctor.
THE WITNESS: You're welcome.
THE COURT: Any questions?
MR. GARROW: No, sir, I do not.
THE COURT: Thank you. Dr. Shenker, thank you for being here today. We can excuse you.
THE WITNESS: Thank you, your Honor.
THE COURT: And make sure you take with you that which you brought but no more.
THE WITNESS: In that spirit I'm going to leave this.
THE COURT: Sometimes we're careless and exhibits are supposed to stay here and they inadvertently get picked up.
THE WITNESS: I think I'm okay.
THE COURT: Mr. Lyman and Mr. Garrow, please approach.
(Whereupon, further proceedings were held outside the hearing of the jury and the court reporter.)
THE COURT: I guess I was mistaken. I think I told you that one witness for the morning and one witness for the afternoon.
Counsel just reminded me the second witness would be prepared to testify this morning, but we need just a short break and get that set up so I'll ask you to please relax in the jury room for a little while and we'll get that witness here. And looks like it'll be another short day for the jury.
MR. LYMAN: I'm expecting.
(Whereupon, a recess was held in the proceedings.)
(Whereupon, further proceedings were held in open court.)
THE COURT: Let's show that all the jurors and alternate have returned to the courtroom.
Mr. Lyman? Please be seated, ladies and gentlemen.
Mr. Lyman, would you please indicate to the jury who your next witness will be.
MR. LYMAN: My next witness, ladies and gentlemen, is Dr. John Wilson.
THE COURT: Dr. Wilson, before you take the witness chair, please receive and acknowledge the witness oath from the deputy clerk.
THE COURT: Doctor, please be seated. Mr. Lyman?
MR. LYMAN: Thank you very much, Judge.
called as a witness herein, having been first duly sworn, was called to the stand and testified as follows:
by Mr. Lyman
Q. Dr. Wilson, will you state your full name, please?
A. My name is John Preston Wilson.
Q. Doctor, where do you reside?
A. In Cleveland, Ohio.
Q. With whom do you reside there?
A. With whom do I resi??
Q. I'm sorry, with whom do you reside? Who do you live with?
A. My family.
Q. Doctor, let me show you what we have marked as Defendant's Exhibit No. 9 and ask that you take a look at that.
Q. Would you tell the ladies and gentlemen of the jury what that document is?
A. This is my curriculum vitae or resume.
Q. And how many pages is your curriculum vitae, sir?
Q. And can you generally tell us the topics of the type of things that are included in your curriculum vitae?
A. It includes my educational background, my residence address, my specialization of degrees and certification.
It includes professional agencies and organizations of which I'm a member. It includes my publications of books, scientific articles, presentation of scientific papers and conferences, and it includes cons??tations both nationally and internationally.
It includes awards, declarations and other things of that type.
Q. Generally, Doctor, is your resume or curriculum vitae up to date?
A. No. The one you're holding is not.
Q. And briefly, what additions or deletions should be made to it?
A. There are no deletions. I've just finished publishing two books, which actually are indicated in there, but they're now out in press.
I've had some additional publications and journals and made some additional presentations at conferences.
And in addition to that, I've been consulting internationally overseas in Yugoslavia recently.
Q. Doctor, what is your profession?
A. I'm a psychologist.
Q. And what is a psychologist?
A. A psychologist is a person who studies human behavior. Psychology is the study of the mind. Psychology is the study of those processes that involve also mental disorder or psychological disorders as well.
It also involves the treatment of mental disorders.
Q. Do you have an area of specialty, Doctor?
A. Yes, I do.
Q. And what is that area?
A. Post-traumatic stress disorder.
Q. Are you licensed, Doctor, in any states?
A. In Ohio and Texas.
Q. When were you licensed in the State of Ohio?
Q. And when were you licensed in the state of Texas?
A. That's a good question. 1992, I believe.
Q. Doctor, would you tell the ladies and gentlemen of the jury a little bit about your educational background?
A. Sure. My bachelor's degree with a major in psychology and a minor in philosophy and biology,?aldwin Wallace College, I graduated it with honors and distinction, from where I received my master's and doctorate in psychology. And following receipt of my Ph.D. in 1973 I went to Harvard University 1974 for my postdoctoral experience.
Q. Are you a member, Doctor, of any professional associations or organizations?
Q. Can you tell us the type of associations that you're a member of?
A. There are many of them. Let me highlight a few of them. American Psychological Association.
I'm a member of the International Society For Traumatic Stress Studies, the founder and past president of that organization.
I'm a fellow of the American Academy of Experts in Traumatic Stress. I'm a fellow and member of the American College of Forensic Examiners.
I'm a diplomat and fellow of the American College of Forensic Examiners in the area of trauma, post-traumatic stress disorder.
I'm a member (many other organizations. Those are some of the highlights.
Q. And I assume that all those in some way, shape or form involve your area of specialty of post-traumatic stress disorder?
A. That's correct.
Q. Doctor, you referenced earlier that you do work internationally?
Q. And would you tell the ladies and gentlemen of the jury about your overseas and international work, please?
A. Sure. My most recent work was in Croatia for a month in December into early January. I was asked by the Croatian government to help set up programs for war victims, refugees and people during the war in Bosnia. I spent one month doing that consulting.
Prior to that from 1993 to 1995 I was in the war in Bosnia working with United Nations and the World Health Organization to set up programs for the victims of the war in Bosnia.
And specifically we set up programs in various hospitals throughout Bosnia to deal with the tens of thousands t??refugees and homeless people who were victims of the war.
Those programs were to treat primarily post-traumatic stress disorders. In addition to that I've done similar work recently in the last year in Europe.
In Holland I spent a week training psychiatrists in the treatment of post-traumatic stress disorder for torture victims at a center where they treat them near Amsterdam, Holland.
Following that I went to Stockholm, Sweden where there is a hospital which is the primary government hospital in Stockholm, Sweden where they have a center that treats refugees that go through torture. And likewise, I trained the staff there for a week.
I went to another location in Sweden in the south of Sweden where they treat the refugees and torture victims who come to Scandinavia from places such as Iraq or Iran where torture is routinely used.
That's the kind of consulting I document. I also do consulting with the International Red Cross. They're? also concerned with treating torture victims.
They have five centers in Sweden where their staff of psychiatrists, the mental health professionals, work with victims who have been tortured as part of victimization in a political process.
In addition to that I do education and training with different agencies both in Europe as well as in Australia.
I've been professor at the Royal Brisbane in Australia in 1989-1991 and serve as an ongoing consultant to that.
I'm also the international consultant to the National Center for post-traumatic stress disorder in Zagreb, Croatia. Those are some of the places.
Q. And all of those assignments or projects involve individuals who are involved in some type of war or torture trauma; is that correct?
A. Yes, that's correct.
Q. And let's go back to your assignment in Croatia which is the most recent; is that correct?
Q. Tell the ladies and, gentlemen of the jury what you would actually do on a day-to-day basis at the hospital in Croatia?
A. Well, what I did at the hospital at Croatia -
MR. ARROWS: Objection, your Honor, based on relevance.
THE COURT: Overruled.
BY THE WITNESS:
A. What I did at the hospital in Croatia, they are currently setting up a center for post-traumatic stress disorder which has two components.
On the one hand is the setup of a program to treat people suffering from PTSD who were involved in the war in Croatia and Bosnia between 1991 and 1995 when the war ended in Bosnia.
There are tens of thousands of refugees there of women who have been tortured and raped in camps run by Serbian army forces. These women are suffering from post-traumatic stress disorder.
There are tens of thousands of refugees who are homeless, exposed to the horrors of the war, cross of family, killing! destruction and so forth.
That national center is creating treatment programs for people to come into the hospitals and receive treatment.
The second component involves research in which there is scientific research on the patients coming there to learn more about the particular nature of their condition as a result of their war trauma.
BY MR. LYMAN:
Q. Okay. And on those occasions in Croatia would you be required to diagnose post-traumatic stress disorder?
Q. Have you ever spoken before Congress, Doctor?
Q. On how many occasions?
Q. In all of those occasions was post-traumatic stress disorder involved in those speeches?
Q. Doctor, do you hold any teaching positions?
Q. Do you currently teach?
Q. Where do you teach, Doctor?
A. I teach - my home university is Cleveland State University. I'm professor of psychology.
And currently I'm teaching a graduate course on post-traumatic stress disorder. I also teach undergraduate in experimental psychology which is a research course.
I'm on the faculty of New York University their international trauma studies programs, which is based, of course, in New York City.
And in that program we train professionals in the treatment of post-traumatic stress disorder.
Q. Are you involved or have any privileges at any hospitals?
A. Not at the current time I don't.
Q. Do you do any work in any hospitals with vic??ms of trauma?
A. Yes, I do.
Q. And what hospitals?
A. In Cleveland I work at the Cleveland State University Hospital doing grand rounds in the Department of Psychiatry and likewise the major medical school teaching hospital is University Hospitals of Cleveland, and I go there approximately every year to do training of psychiatry and social workers in the area of post-traumatic stress disorder.
In addition to that, the major hospital in Cleveland responsible for the treatment of burn victims is Cleveland Metro General Hospital.
And they have a level one trauma center for burn victims, and I'm often asked to do consultations with victims who have been severely burned because most of them have post-traumatic stress disorder as a result of the massive burns they experienced usually in some kind of an industrial accident or fire situation.
Q. Doctor, are you involved or aware of any clinics, free clinics in the Cleveland area that provide medical care for persons with mental disorders.
Q. Have you worked or rendered services to those persons?
A. Yes, I have. I've worked at those centers as well.
Q. Have you given any lectures, Doctor?
Q. And generally, if you could, briefly describe for the ladies and gentlemen of the jury the type of lectures you've given?
A. Well, there's probably three categories of lectures. One is invited lectures where I'm invited by a signature agency or organization to do lecturing or training or both.
For example, I'll soon be going out to Washington State where there's a hospital that has a trauma specialty unit, and they've asked me to come for three days to do lecturing and consulting. That's one type.
A second type is where I'm invited to scientific - in two weeks I'll be going to a conference where I'm the keynote speaker and giving three different talks on post-traumatic stress disorder and its treatment, That's an international conference.
There are other type of lectures where I'm invited to university settings where I give academic lectures to those interested in the topic of stress.
Q. Doctor, you told us early on that you've published recently two books?
Q. How many books have you published in your career?
A. I'm on my twelfth book now.
Q. What are the topics of those books?
A. All of them but one, concern post-traumatic stress disorder. The one that does not was my first book which concerned the relationship of human personality factors to different types of social behavior.
Q. Have you published articles in papers on the subject of PTSD?
Q. Are you able to estimate for us how many?
A. The papers I've presented at conference is over??O, and the published scientific peer review articles somewhere in the vicinity of around 30.
Q. Doctor, are you currently employed?
Q. By whom are you employed?
A. Cleveland State University.
Q. Do you have another private practice?
A. Yes, I do.
Q. What's the name of that practice?
A. The name of the practice is the Forensic Center For Post-Traumatic Stress Disorder.
Q. And how are you involved with that?
A. I'm the president of the organization. I'm the director.
Q. I'm sorry, what is the nature of that business?
A. The nature of the business is basically three-fold. One is we do review of cases that are in litigation where we're asked by an attorney or an agency or an insurance company or a doctor or somebody else to review a case to determine whether or not that case involves post-traumatic stress disorder. That's one kind of the services we provide.
A second service we provide is assessment and evaluation of patients who may have post-traumatic stress disorder.
Many of them come from attorneys or physicians or other psychologists or mental health professionals wanting our assistance in determining the particular nature of post-traumatic stress disorders or illness of a patient they may be treating and having problems understanding. That's a second service.
A third service we provide is education and training. And we put on seminars for attorneys, for physicians, for colleagues in the field, other people who are interested in learning about - learning about PTSD.
We have a number of these kind of services which include consultation to agencies that would request our help as well.
Q. How many employees do you have?
Q. One other than yourself?
Q. What's the name of your other employee?
A. Dr. Thomas Moran.
Q. And do you know what his area of specialty is?
Q. Are you familiar with his educational background?
Q. And what is that?
A. Dr. Moran has a bachelor's degree in English, a master's degree in English, and I supervised his doctoral at Catholic University in post-traumatic stress disorder.
He's a board certified forensic traumatologist, and he's a fellow and member of the American Academy of Experts in Traumatic Stress, and he's a fellow and member of the American College of Forensic Examiners.
Q. Does Dr. Moran assist you in your consultations for projects -
Q. - that you've taken on?
Q. And in what way would he typically assist you?
A. A number of ways.?? is that he might be the first one to review the file and see what's there and then give me his opinions about that, and then I would review it and the two of us would discuss it.
Secondly, when we're doing evaluations of clients, Dr. Moran will often take a very comprehensive history of the client and summarize that for me.
Thirdly, under my supervision he will administer psychological questionnaires where we think it's appropriate.
And fourthly, he will provide me with summary information regarding a given case and consult with me on the case.
Q. Did Dr. Moran assist you in this case?
Q. Did he provide you with such information that you just described for the jury?
Q. And did you rely upon that information in formulating your opinions in this case?
Q. Do you typically rely upon that information in reaching your con??asions?
Q. Doctor, what is post-traumatic stress disorder?
A. Post-traumatic stress disorder is an anxiety disorder. It's really a response of human beings to abnormally stressful situations.
The term post-traumatic means post-injury in that after a traumatic event or a traumatic injury from an experience, for example, combat in warfare or rape or a major disaster or an industrial explosion, an airplane crash in which people survive and so forth, people develop symptoms following the trauma and that's where the term post-traumatic stress disorder comes from.
There are a number of characterizations which are characterizations of PTSD.
And for simplicity sake, the American Psychiatric Association groups them into three categories.
The first category talks about the way the people re-experience their traumatic event, how do they relive it, how do they go back to, you know, remember in a disti??ssing way traumatic memories of that experience.
So one set of symptoms deals with the way people relive their experiences. People have flashbacks, they have nightmares, they have unwanted thoughts that pop into their mind. They relive it. They see it again. They smell it again. They have painful emotions connected with what happened to them in the experience.
They may have sleep disturbances associated with nightmares and dreams of the experience.
They may develop other symptoms that are associated with it. Feeling like it's going to happen again or fearing that it might happen again because they can make associations to things that remind them of it.
You know, if it's a tornado, for example, and someone's been subjected to a life-threatening tornado when the sky gets dark and the wind blows, they start to feel like it's going to happen again.
People also have changes biologically associated with post-traumatic stress so when ley re reminded of the experience or they have a flashback or they have a painful traumatic memory, that suddenly appears in their consciousness.
They sometimes have rapid heartbeat or they'll start to sweat or they will have a sense of impending doom and anxiety that something terrible is going to happen again like the first time. That's the first cluster.
The second cluster of the symptoms talks about the way people try to push away the reminders and memories of the traumatic event.
We call this avoidance and numbing cluster, meaning people find ways to avoid talking about the experience or they avoid situations that remind them of it or they avoid exposing themselves to some kind of a cue or situation.
For example, a television program. Let's say a person's been raped and there is a show on television that deals with rape. They often don't want to watch that. That can bring it back again.
Sometimes people have lost memory associatea with the event. They ave amnesia for certain aspects of the traumatic experience.
Other people experience changes that go with the second cluster. It's not uncommon, for example, for people to have a loss of sexuality to pull away from other people, to have detachment, to have difficulty experiencing their own feelings.
Oftentimes they want to be alone and isolated because they don't want others to know what's going on in their minds as they're reliving the experience.
So there's a whole group of symptoms that deal with the way people face and confront the reality of what they're going through.
That includes denial or disbelief that it even happened in the first place. That's a common mechanism in the second cluster where people don't want to believe it was real.
Finally, the third cluster talks about what we refer to in the scientific community as psychological changes. That means there are changes in the brain chemistry that occur in post-traumatic stress disorder.
The simplest way I can explain it is when the body reacts to traumatic it engages in a fight/flight response.
This refers to changes in how the brain is energizing the body to deal with the traumatic experience.
When that happens though sometimes after the trauma has stopped, the person can't switch off that fight/flight response. It's as if their body is still revved up dealing with the trauma even though it's over.
And that leads to certain symptoms that we see. One is sleep disturbance where the person has a problem going to sleep or staying asleep or wakes up somewhere in the sleep cycle.
Secondly, often a person loses their capacity to control certain emotions. And one of the common symptoms here is the person becomes irritable or has a short fuse. They snap quickly in a way they did not do before.
Other ways we see these changes is people sometimes become hypervigilant. By that we mean they're always looking around the environment. They're scanning looking for cues, looking for something that might?? threatful or harmful to them. That's hypervigilance, hyperscanning of the environment.
Other things include exaggerated startle response where a sound that reminds them of their trauma produces this automatic biological startle response much like they probably had at the time of the original event.
Those three clusters, the avoidance, numbing, denying and the psychobiological changes that were not present before the event make up the cluster of symptoms that define post-traumatic stress disorder as a syndrome.
Let me say this. The simplest way to think about this, PTSD is the normal response of human beings to abnormally stressful events.
And this normal response means that the normal stress response tendency of persons then continues on after the trauma with these characteristic features I've just outlined.
Q. Are you qualified, Doctor, to diagnose post-traumatic stress disorder?
Q. You're obviously qualified to treat post-traumatic stress disorder?
Q. Are you qualified, Doctor, to determine the cause of post-traumatic stress disorder?
Q. Doctor, are you familiar with the term conversion disorder?
Q. And what is conversion disorder?
A. Conversion disorder is a term that is used to describe how people sometimes convert emotional problems into bodily problems or physical problems.
Very simply stated, people in aconversion disorder, a person is taking anxiety or distress or conflict, emotional conflict they may have and they transform that. They convert that into a different form and it comes out in some kind of a bodily symptom.
So examples might be paralysis of a hand. This is sometimes called a glove paralysis. It may be blindness. It might be deafness. It may be an inability to feel certain sensations on the skin.
There are many different ways that psychological problems can get converted into biological or somatic problems for an individual, but that's the feature.
The other important thing to understand I think about conversion disorder is that there's no medical basis for it.
There's no illness in the person, there's no medical reason for this particular symptom to exist. Therefore, it has a psychological basis for the symptom.
Q. You said biological problem. What do you mean by that?
A. By biological I mean if you did a routine medical examination, if the person for example, has glove paralysis, if their hand was paralyzed and had a neurological examination, it would determine if there was damage to the nerves that would cause that hand to be paralyzed.
That would be the somatic or physical manifestation of the problem. Glove paralysis is one fairly common type of conversion disorder.
But when that examination is done and reveles no physical cause for the paralysis, then the cause has to be something else which is psychological in nature.
Q. Are you qualified, Doctor, to diagnose conversion disorder?
Q. Do you deal with conversion disorder in your treatment of patients with post-traumatic stress disorder?
Q. Are you qualified to treat conversion disorder?
Q. Doctor, can a patient have both post-traumatic stress disorder and a conversion disorder?
Q. Is it common?
Q. Doctor, in your long career how many patients have - how many post-traumatic stress disorder patients have you treated or consulted with?
A. Thousands and thousands. I couldn't even est?? You know, probab?? two, three, four - I can't even guess - thousands.
Q. In any of those cases, Doctor, where you diagnosed post-traumatic stress disorder, did you ever find a diagnosis of conversion disorder?
Q. Have you ever read any literature or case study where that has been the case?
Q. Doctor, can you tell the ladies and gentlemen of the jury some of the types of cases that your center is involved in currently that involves automobile trauma?
A. Yes. I reviewed our caseload in preparation for testimony today and we currently have eight or nine different cases that involve motor vehicle accident related trauma.
Q. Would that be a small portion or a large portion of your center's involvement?
A. It's a small portion.
Q. Could you tell the ladies and gentlemen of the jury briefly about some of the facts in those cases?
A. Sure. Let me give you a couple different cases here.•
MR. GARROW: Your Honor, I'm going to object on the basis of relevance.
THE COURT: The problem is how do we tie up what I would believe to be a very fact specific set of circumstances to what we're dealing with here? I have a problem with that.
That's the concern that I have is that what might be true for those individuals in that set of circumstances I'm not sure is there going to be a carry-over or would you be able to make a connection?
THE WITNESS: Yes, surely.
THE COURT: All right. Then go ahead.
BY MR. LYMAN:
Q. Go ahead.
THE COURT: The objection is overruled.
BY THE WITNESS:
A. Let me give you a couple of examples. Actually, several of these cases are here in Chicago.
The first case I'm going to tell you about is a woman who was driving to work one morning and going through an int?? section. She was hit by a car that was speeding and went through a red light.
She was rendered unconscious and was taken to a hospital and suffered brain injury as a result of this, which she still has to this day. She has permanent brain damage.
In addition to that, she developed post-traumatic stress disorder which persists. This accident happened about five years ago.
Another case I have here in Chicago involves two young girls who were riding in the back seat of their car with their mother in the right passenger seat and her boyfriend driving the car when they were hit by trucks, and the mother went through the windshield and was killed and the two young girls who were 11 and 9 at the time I believe both witnessed the injury to the mother and subsequently her death as well as the injury to the driver who had glass embedded in his face.
The mother's neck was broken and she, of course, was severely injured in that situation. We have another case currently in which a mother was taking her child to school when they were both hit by a car and the child was killed.
And we have several other cases in which people were severely injured in car accidents , all of them resulting in need for medical treatment, hospitalization, and these people all developed post-traumatic stress disorder in those cases.
BY MR. LYMAN:
Q. In all those cases, Doctor, you've been asked to provide some consultation, correct, or provide a diagnosis?
Q. Doctor, you were retained by my firm Henderson & Lyman; is that correct?
Q. And how much do you charge per hour?
A. $300 an hour.
Q. You are being paid for your time here today?
A. I hope so. I hope so.
Q. Doctor, you were sent numerous documents once you were retained
Q. Would you tell the ladies and gentlemen of the jury what documents you were initially sent?
A. Well, I have a folder right here so you can see there's a lot of stuff. These are actually just the summaries of the documents. The documents themselves are boxes full of them.
The documents that were sent include the complaint that was filed in this case. I have documents, summaries of a number of things which include such things as the deposition of Mark Gustafson, the deposition of Sharon Mckinnis, his wife, the summary depositions and notes of Dr. Timothy Hull, and likewise the notes and deposition of Dr. Kenneth Kessler, the deposition of Timothy Hull and many other documents of that type -
A. - that were provided to me.
Q. Did you review those documents, Doctor?
A. Yes, I did.
Q. Did Dr. Moran assist you in the review of those?
A. Yes, he did.
Q. Did those documents assist you in reaching your opinions in this case?
Q. Did you rely on any other information, Doctor, in forming your opinions in this case?
Q. And what information is that?
A. Well, there were a number of things I've done. Of course, my own interview with Mr. Gustafson, which was on January the 9th of this year.
I also had my associate, Dr. Moran, conduct an independent evaluation and examination of Mr. Gustafson. That was in December of 2000.
Q. Isn't it true, Doctor, you requested that my firm make arrangements for both you and Dr. Moran to interview Mark Gustafson?
A. That's correct.
Q. And who interviewed Mr. Gustafson first?
A. Dr. Moran did.
Q. And did that interview take place in December of the year 2000?
A. December the 28th of 2000.
Q. And then subsequent to that you conducted another interview of Mr. Gustafson?
A. On January the 9th of this year.
Q. Do you know how long the interview lasted between Dr. Moran and Mark Gustafson?
A. Yes. It was about six hours.
Q. Where did that interview take place?
A. In Aurora, Illinois.
Q. That required Dr. Moran to travel here from Ohio?
Q. Can you describe for the ladies and gentlemen of the jury what would be involved in that initial interview between Dr. Moran and Mr. Gustafson?
A. Basically there would be two components. The first one would be to administer some psychological questionnaires that help us to get a clinical picture of Mr. Gustafson.
And Dr. Moran did do that with several of the questionnaires that I recommended he take to this first interview.
The second component really involved taking a detailed history of Mr. Gustafson including a history of the accident on March the 16th, 1996.
Q. Could you explain how - strike that.
Could you explain the significance of the questionnaire?
A. The questionnaire is important because these are standardized scientific questionnaires that are widely used to look at symptoms and symptom presentation in patients.
They provide us with an objective measure. We can compare the results of those findings to what's known scientifically about other persons who have had certain types of psychological problems or mental illness, if you will, and as well as getting kind of a snapshot of personality functioning or symptoms in a given patient at any point in time.
Q. Are they objective written tests?
Q. What are the names of those tests?
A. They're - altogether there were a number of tests that both Dr. Moran and I gave.
Q. Do you know which o??s Dr. Moran administered?
A. Yes, yes. He administered -
MR. GARROW: Your Honor, I object based on foundation. It's going to call for him to rely on hearsay for this information.
THE COURT: Overruled.
BY THE WITNESS:
A. The tests that Dr. Moran administered were the following: The Milan Clinical Multi-Axial Inventory III or MCMI-III for short.
It's a measure of personality and psychopathology or psychiatric symptoms to say it simply.
The second test he gave was a Symptom Checklist 90R or revised SCLR 90R. And that is a symptom checklist that has 90 items, and it asks the patient how often they're experiencing a certain kind of symptom such as a headache or dizziness or fear of people, persons and places.
There's many different types of questions that it asks. And that provides a summary across nine different psychiatric subscales of how much the person is endorsing a particular kind of symptom on the checklist and we'll able to profile that and then interpret that.
And finally, the last one that Dr. Moran administered was a Life Events Checklist, and this is a measure of 17 different categories of stressful life events that a person may have experienced.
And that is a way of developing a screen to look to see if the person's had different types of stressful or traumatic life experiences both now and in the past.
And that helps us then to see what kinds of other events may have taken place in a person's life that would be relevant to the development of post-traumatic stress disorder or other kinds of problems.
Q. Did you have the opportunity to review Dr. Moran's notes that he took of his interview with Mr. Gustafson and the profile and results of those tests?
A. I had the opportunity to review Dr. Moran's notes. We didn't have the profile scored at that point in time as it was the Christmas holiday, but I did have the summary notes for my review prior to my interview.
Q. And then you had your interview at the beginning of January 2001, correct?
Q. Was it important to you to - strike that.
And you met with Mr. Gustafson in Aurora, correct?
Q. And you traveled from Ohio here for that purpose?
Q. And did you take or did you make written notes of your interview with Mr. Gustafson?
A. Yes, I did.
Q. Did you administer any written objective tests?
Q. And what tests did you administer?
A. The first one's called the Minnesota Multi-Phasic Personality Inventory 2 for the second edition. We call that - for short we call it the M.M.P.I. 2.
It's a measure of personality and psychopa??logy. It gives us a??isure of many different dimensions of a person's functioning.
It talks about personality dimensions such as if a person's depressed. It gives us indications of such things as a level of anxiety or it gives us an indication on certain other kinds of more severe mental illness like if a person's having paranoid symptoms or having psychotic symptoms of a certain type.
It also contains a number of scales that look to see if the person is being truthful and reliable in their reporting of symptoms.
It contains what is technically known as a number of validity scales. And in simplest terms what that means is that these are built in devices to detect how the person is taking the test, if they're exaggerating their symptoms or being overly defensive.
If you ask the same question four times in one instrument, they ought to be consistent on it.
If they're inconsistent, it suggests a number of possibilities including they're faking o??not paying attention or?? hey may be deliberately trying to skew findings one direction or another. That's one instrument I measured.
The other one I measured was called a Trauma Symptom Inventory, T.S.I., Trauma Symptom Inventory, and it's a measure of post - traumatic stress disorder and some other features that often are associated with post - traumatic stress disorder such as depression or tension reducing behaviors or decreases in sexuality or changes in sexuality.
And that also contains measures that look at how the person is taking the test and includes importantly a scale called the Assessment Scale so if we ask a person about a traumatic experience, they say yes, I'm having nightmares and you ask that question in a different way, they should say yes. And if they don't, they're being inconsistent.
It has internal checks to make ure they're responding in a reliable and consistent way.
The other one that I administer is called the Impact Events Scale Revised IESR, Impact ox Events Scale, and that a measure of post-traumatic stress disorder symptoms.
Q. And did you, Doctor, rely upon your notes, Dr. Moran's notes and the results from those tests in formulating your opinion?
Q. Are those test results, Doctor, conclusive or do they serve as a guidance?
A. They're guidance.
Q. Had you formed an opinion as to whether or not Mark Gustafson had post-traumatic stress disorder before you arranged the meetings in Aurora, Illinois to interview Mark Gustafson?
A. Did I have an opinion?
Q. I'm sorry, did you have an opinion as to whether or not Mark Gustafson had post-traumatic stress disorder prior to conducting those interviews?
Q. You were holding off, correct?
Q. And for what purpose?
A. I wanted to evaluate him myself. I wanted to do my own clinical and forensic evaluation.
I certainly had some ideas about Mr. Gustafson, but I hadn't formulated an opinion at that point in time.
Q. Prior to - strike that.
Subsequent to conducting the two interviews and administering the tests, do you know how much time you would have spent in consulting and evaluating Mr. Gustafson's condition?
A. Well, just between Dr. Moran and myself we had had about 12 to 14 hours, which includes scoring the tests and interpreting the tests and the direct contact with Mr. Gustafson.
On top of that is the review of all the documents that you sent to me, which gave me additional foundational bases to evaluate.
Q. And how much time approximately did you spend on that, if you recall?
A. Oh, boy. I'll be guessing, but I'm going to say at that point in time it was probably around 20 hours I would think.
Q. Doctor, what was the purpose in conducting two separate interviews for Mark Gustafson?
A. The purpose for con??ing two separate interviews is to have two evaluators independently examine the patient.
Wherever possible this is a standard procedure in my center. I want two people to independently examine the patient to take a history and to do testing.
Now, the reason for this is one of the important issues in making a diagnosis is whether or not the person is consistent in what they tell people.
Consistency in reporting of ymptoms, consistency in talking about their history, consistency or inconsistency in terms of their description of the traumatic event and their response to it.
By having two independent people o that, you have the opportunity to compare to see if this consistency or inconsistency factor exists.
And in that sense you have more han one observer who is doing the evaluation. And it frankly just gives you much more information to work with.
And if there's any errors in the process, they tend to cancel each other out because you have two examiners working independently on the same issue.
Q. Why is the determination - strike that.
How is an inconsistency or a consistency applied in your diagnosis of a patient with post-traumatic stress disorder?
THE COURT: Compound question. Why don't we break it apart.
MR. LYMAN: I'm sorry, Judge.
THE COURT: It would be easier for us too.
BY MR. LYMAN:
Q. Why is consistency so important?
A. There are a number of reasons consistency is important when we're looking at post-traumatic stress disorder.
First of all, in some patients with post-traumatic stress disorder consistency may not always be present because of memory problems.
If they've had a severe trauma - and I underscore severe trauma - that has impacted either their brain or impacted them emotionally, that they don't always remember?? in the right way, so that at time one they might tell you one thing, at time two another, as memories come back.
That doesn't mean they're necessarily inconsistent. That means they may not have that accessibility to report to you. That's one possibility.
And I see that all the time in severe trauma cases, the horror of a trauma sometimes overwhelms patients so much that, you know, they can only tell you so much on a certain time.
But when they tell you, it hangs together, it threads together in terms of its relationship of what happened in the event.
Now, the other way it's important, sometimes people are not consistent in reporting and their inconsistencies may not match up to what happened in the experience.
And, therefore, you suspect something else is at work. They may be making up a story, they may not be telling the truth, they may be exaggerating or they may flat out be lying.
I can give you an example of that. I was asked to evaluate a??tient who claimed to have post-traumatic stress disorder.
MR. GARROW: Objection to the relevance of this example.
THE COURT: Only as an example of how an inconsistency may lead you to certain conclusions?
THE WITNESS: Yes.
THE COURT: This is your methodology?
THE WITNESS: Yes.
THE COURT: Overruled.