Sample Deposition of Psychologist and Nursing Home Administrator

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BY MR. KNIGHT:

Q. Would you please state your name for us?
A. My name is Denise Gehrling.
Q. And what is your occupation or profession?
A. I'm a clinical psychologist.
Q. And you have a PhD; is that correct?
A. Yes.
Q. So I'll refer to you as Dr. Gehrling. Is that satisfactory?
A. Yes.
Q. Dr. Gehrling, you have just been sworn as a witness in this case to give true testimony regarding certain facts and circumstances, and you understand that; correct?
A. Yes.
Q. Good morning to you.
A. Good morning.
Q. Are you -- as a neuropsychologist, are you licensed within the State of Illinois?
A. I am licensed as a clinical psychologist through the Illinois Department of Professional Regulation and have been since February of 1991.
Q. Is neuropsychology a specialty within the field of -- the general field of psychology?
A. Yes. Neuropsychology is a subspecialty. It concerns brain behavior relationships.
I generally evaluate and treat people with suspected brain dysfunction.
Q. Can you tell us -- we'll get into more detail a little bit later with respect to this particular case, but can you tell us what brain dysfunction is as a phenomenon that you address your expertise and profession to?
A. Certainly. The brain is the most important organ in the body in that it controls thinking, feeling, emotions, motion, basically all of the functions of the human body.
When the brain is injured or for some other reason not functioning well, then patients tend to have a wide range of symptoms in a variety of areas.
It is my task to specify what problems they may be having and help them to cope with those more effectively.
Q. Are you engaged in what, for lack of a better term, I'll refer to as a private practice?
A. Yes. I am not an employee. I work as a private contractor to a number of agencies.
One of those is the Paulson Center where we are currently located.
I also work in several different pediatric nursing homes, as well as doing evaluations for the State of Illinois.
Q. For how long have you been in private practice evaluating patients within the specialty area of neuropsychology?
A. Since approximately May of 1991.
Q. So that would be about 12-and-a-half years or so?
A. Approximately.
Q. So in the course of that evaluation, I -- tell me if I'm wrong, but I assume you see patients with suspected brain dysfunction problems?
A. Yes. They are generally referred to me by a medical doctor of some sort, and because of concern that they may be having difficulty with this, and I then do an evaluation to see if they are having problems, and if so, what I can do to be helpful for them.
Q. Let me direct your attention to October 1 of 1998, and I would like to ask you if on that date you received a patient by the name of Jerry Wattron for whom you were requested to provide some care or attention?
A. Yes. Mr. Wattron was referred by his physiatrist Dr. Eilers for evaluation to me, and our first date of evaluation was October 1 of 1998.
Q. And that Jerry Wattron would be the plaintiff in this case, is that correct, to your knowledge?
A. Yes.
Q. Where did you first see the plaintiff?
A. He was seen here at the Paulson Center for three sessions of evaluation and then a feedback on the results of the evaluation.
Q. And did you say that you received him as a patient on a referral from Dr. Eilers?
A. Yes.
Q. Can you tell me what the scope of that referral was, as you recall it, what you were asked to do for Dr. Eilers with respect to the plaintiff?
A. Dr. Eilers was concerned that Jerry may be exhibiting symptoms consistent with a traumatic brain injury, and he asked me to do a more in-depth evaluation regarding that.
Q. Is traumatic brain injury one of the entities or categories of brain dysfunction?
A. Traumatic brain injury is one mechanism that can cause brain dysfunction.
Q. So when you were to conduct a more in-depth evaluation, were you going to try to determine whether there was a brain dysfunction and then whether it was traumatic brain injury as Dr. Eilers suspected or some other entity which was causing it?
A. Yes. And then to make recommendations in terms of reducing the impact of those symptoms.
Q. Okay. Was it also part of your problem to evaluate the nature and extent of that brain dysfunction that Dr. Eilers suspected the patient was having?
A. Yes. That's part of the purpose of the evaluation.
Q. Now, based on what you've told me, you are not a medical doctor; correct?
A. No. I'm a clinical psychologist.
Q. How is it that doctors like -- well, let me -- let me withdraw that, and, first, is Dr. Eilers the only doctor that refers patients to you for this type of neuropsychological evaluation?
A. No. I get referrals from many doctors in the community, either physiatrists or several neurologists.
Q. How is it that -- or what is it about your expertise or profession that doctors would refer their patients to you for more in-depth evaluation of their suspected brain dysfunction?
A. The usefulness of a neuropsychological evaluation is that it specifically addresses thinking and emotional problems that are associated with brain dysfunction.
That's a good compliment to the services of a neurologist who usually looks at the sensory and motor components of brain dysfunction.
Q. I presume doctors study psychology when they're in medical school; is that your understanding?
A. I'm not sure.
Q. Okay.
A. I know that they have at least some training in psychiatry as part of their broad overall medical education, which is similar but more medically based than psychology.
Q. So how does your training in the field of psychology, and, in particularly, neuropsychology differ as far as its intensity or its focus than that which a physiatrist or a primary care doctor might have?
A. As noted, I'm not a physician, and so, therefore, it's not medical training.
As a clinical psychologist, I learn things such as testing and evaluation, different technical information regarding certain conditions of the brain, how those are expressed, and, in particular, with a focus on remediation therapy, ways to assist the patient in a practical sense to live more effectively with their symptoms.
Q. Is it fair to say that the nature of your -- and scope of your education is such that you have a much more extensive focus on brain function in your education and training than a primary care doctor would have, generally speaking?
A. Most likely, although I think the area that I'm probably more intensely trained in than medical doctors are the emotional and behavioral implications and symptoms of both psychological disorders and brain trauma.
Q. Okay. Let's talk a little bit about your formal education and background, if we may.
You're a college graduate, I presume?
A. Yes, UCLA.
Q. And do you remember when you graduated from UCLA?
A. I believe it was '76.
Q. Okay.
A. '80 --
Q. In 80?
A. I'm sorry. I started in '80.
Q. All right.
A. I graduated in -- I started in '76. I graduated in '80.
Q. And did you graduate with any honors?
A. Yes. I graduated with highest honors.
Q. Is that what people sometimes call a summa cum laude?
A. Yes.
Q. And after your undergraduate degree, did you proceed to graduate school?
A. Yes. I went to Arizona State University and received both my master's and later my PhD in clinical psychology.
Q. Do you remember when you received your PhD in clinical psychology?
A. It was August of 1989.
Q. Okay. In that course of study through college, graduate school, and for your PhD, did you spend a substantial amount of your study time focusing on brain dysfunction, its evaluation, testing for it, such things as that?
A. Yes. I did the neuropsychology courses which were available within the broad clinical psychology program.
I also chose internships, which are part-time supervised jobs that are part of the program, which were focused on neuropsychology. I worked in the neuropsychology unit of the VA Medical Center.
I also worked in an outpatient head injury treatment program, and as part of my graduate education, there is a one-year, full-time internship which I did at the Rusk Institute of Rehabilitation Medicine, which is the rehabilitation portion of NYU Medical Center in New York City.
Q. And during those -- I take it, it sounds like those training experiences took place while you were still engaged in your graduate level education, is that correct, to this point?
A. Yes.
Q. And can you tell me a little bit to what extent you were involved with evaluating brain dysfunction cases during those work experiences?
A. During the internship, it was exclusively focused on neuropsychology, half adult and half child, and at that point that was a fairly intensive experience in that way.
Since I have been in private practice, I have been both evaluating adults outpatient and I also work with children, as I mentioned, in pediatric nursing homes who have brain dysfunction, as well.
Q. Okay. I did want to move a little bit into after you finished your education in 1989, and I think you've told me earlier you have been in private practice since about 1991?
A. Yes.
Q. Can you tell -- elaborate a little bit further on the extent of your ongoing development of your expertise and any additional training you may have had in evaluating of brain dysfunction cases during that work.
A. As I mentioned, my internship was very intensely focused on neuropsychology.
Following that I was the director of services for Saint Colettis of Illinois, which was a facility for mentally handicapped children and adults.
Following that I went into private practice, and since that time I have been evaluating adults on an outpatient basis, both at the Paulson Center and for the Illinois Department of Rehabilitation, as well as evaluating children in the pediatric nursing homes.
In terms of continuing education, I always attend both the national and the state conference on a yearly basis in order to keep current in terms of developments in neuropsychology.
Q. Okay. Incidentally, during the course of your education, either during the college and graduate years or continuing education, have you learned anatomy of the brain and the skull as part of your work?
A. Yes.
Q. Is that a standard part of the education for neuropsychology?
A. Yes.
Q. Are there any professional organizations or societies that help you keep abreast of the developments in the field of neuropsychology and the things that you're colleagues are doing?
A. I'm a member of both the Illinois Psychological Association and the American Psychological Association, as well as Division 40, which is the neuropsychology division of the American Psychological Association.
Through those I go to conferences, receive journals, things of that nature.
Q. During the course of your work, have you received any awards or honors because of performance that you've engaged in?
A. Yes. Both undergraduate and graduate I received a number of scholarships, as well as Phi Beta Kappa, and a child clinical training grant for my internship.
Q. What I think I would like to do now is to move along, but do you have a written summary of your education and work experience that would contain some of the details that we haven't been able to address here of your background?
A. Yes. It's called a vitae. It's marked as Plaintiff's Exhibit 16. The one update is that the licensure is expiring in 2004, not 2002. Everything else is current.
(Plaintiff's Exhibit No. 16 marked.)
BY MR. KNIGHT:
Q. Okay. So, whereas, on that written document it says, “Expires September 30, 2002,” the expiration date is actually 2004 now?
Is that the change --
A. Yes, because --
Q. -- that you made?
A. -- I have renewed it since that time.
Q. It's been renewed. Okay.
Other than that, did you say that this is a true and accurate summary of the things that we've talked about and your background and education in general?
A. Yes.
MR. KNIGHT: Then I would at this time like to offer that exhibit into evidence, if there is no objection at this point.
MR. DOMBROWSKI: That's fine.
BY MR. KNIGHT:
Q. Okay. Let's get back to the patient, Jerry Wattron, the plaintiff in this case whom you first saw, as I understand it from your prior testimony, on about October 1 of 1998; is that correct?
A. Yes.
Q. At that time were there certain steps that you took as a matter of custom and practice in order to evaluate a patient who was referred to you by a doctor such as Dr. Eilers requesting that you conduct an in-depth neuropsychological evaluation to determine whether there was a brain dysfunction, and to what extent there was, and what caused it?
A. Yes. At that point I began the process of neuropsychological evaluation. That consists of clinical interviews with the patient, including their medical, social, and vocational history, as well as their perceptions of any current problems, and their description of any incidents.
In addition to that, I interview significant others, get the patient's permission to seek medical records. Then I begin the process of testing.
At the conclusion of that, I gather all of that information, look at it as a whole and make a diagnostic conclusion.
Q. And, in general, did you follow that system with respect to your care and treatment of the plaintiff, Jerry Wattron?
A. Yes.
Q. I take it you didn't do all that on October 1 of 1998; is that correct?
A. No. That was a three-day process, October 1, October 7, and November 5 of 1998, followed by a feedback session to go with the results and recommendation.
Q. Why do you -- why did you do a clinical interview in this case, and in general, of the patient? What are you attempting to learn that helps you do your evaluation?
A. In the clinical interview, as I mentioned, I look at things such as medical history, vocational history, academic history.
Part of the reason for that is because I need a context to interpret the information that I'll be receiving, and I want to rule out that a person has had something like a severe learning disability or a prior head trauma that might be accounting for some of the symptoms that I could see in the evaluation.
Q. Okay.
A. I'm also interested in their perception of their symptoms, what problems they've been having.
Q. At the same time as you're taking this history from the patient, do you also observe them as a neuropsychologist to see whether there are any signs or symptoms of a brain dysfunction?
A. Yes. I think behavioral observation is a very important part of the evaluation. That's one of the reasons that I do all of my own testing as opposed to delegating it to a psych technician, for example, because I want prolonged one-to-one interaction with the patient.
And at that point I'll observe things such as their mood, their memory, their ability to concentrate in the process by which they do the testing.
Q. Is it your custom and practice to make a written record of the examinations that you've performed, the history you've taken, the tests and so forth so that you can recall them later and provide them for use for other doctors or for your own use as you continue to treat the patient?
A. Yes. I always do a written evaluation after the evaluation process, both for the reason you mentioned, and also because I want to be able to give the patient a written document to refer back to later, especially in terms of implementing the recommendations.
Q. And did you do that in this case?
A. Yes.
Q. Is that what would be referred to as a chart for the patient or do you have a chart for the plaintiff, Jerry Wattron, that you created?
A. Certainly, and a large part of that chart is the written and typed neuropsychological evaluation, treatment notes, and neuropsychological reevaluation.
Q. Well, I'm going to ask you some detailed questions, so if you have a copy of your evaluation from that time period that we've talked about in October of 1998 with respect to the plaintiff, Jerry Wattron, can you -- do you have that in front of you now so you can resort to it, if necessary, to refresh your recollection or --
A. Yes.
Q. -- provide us with information that you've recorded?
A. Yes, I do.
Q. In part of your clinical interview -- and you mentioned that you were attempting to take a history -- can you tell me what you learned from Jerry Wattron concerning his statement as to the history of what lead to his problems?
A. In terms of a social history, he noted that he was the third of six siblings raised at home by his married, biological parents, with his parents and sibling being alive and well and him maintaining contact with them, that he graduated high school, described himself as an average student, said that he had never needed special education services or been diagnosed with any learning problems.
He also completed a year of training in mechanics in auto body, worked in car dealerships, and later opened his own auto body repair shop in July of 1980, and at the time that I saw him, he was continuing to own and operate that and reported that he was doing well.
He was single, didn't have children, was -- reported a positive romantic relationship at that time with a girlfriend and lived alone.
His medical history was unremarkable. He was not reporting surgeries, illnesses, injuries, hospitalizations, psychiatric history, prior brain trauma.
Q. Now, let me stop you for a moment and just ask, why is that something that you would be concerned about in doing your evaluation as to whether he had a brain dysfunction and what may have caused it?
A. Because it's important to see the current information in the context of previous functioning, and so because of that, as I said, if he had a severe learning disability, if he had a major prior head trauma, if he had a long psychiatric history, those would be things that could conceivably result in testing -- in an impact on the testing, and it's important to know those, and, if possible, to rule them out in order to rule out competing explanations for any changes or problems I was seeing.
Q. Okay. Well, I interrupted you and you were telling me the history.
So you got to the point where you told me about the fact that there was no significant prior medical history.
Would you continue to tell me what you learned in particular with respect to his recollection of what he thought may have caused the problems he came to you for.
A. He described a motor vehicle accident on May 11 of 1998. He mentioned that he was alone driving and that he was hit on the front driver's side by another driver who he reported failed to yield the right-of-way while he was making a left turn.
At that point he said his recollection is a little sketchy. He mentioned that he thinks he remembers the impact, that he wasn't sure if he was unconscious, maybe for a small while, that he doesn't know if he hit his head, and that he doesn't really think he remembers all of what happened immediately.
Q. Now, you made some detailed notations of that description that he gave concerning what he remembered at the time of the accident in your evaluation; is that correct?
A. Yes.
Q. Well, why is it that you emphasized that in detail as you were recording your evaluation?
A. The reason for that is that generally, in order for a head trauma to have occurred, there needs to be some change in consciousness, and a -- and not necessarily a loss of consciousness, but a change in consciousness.
His description was typical of what I generally hear from people who have had a mild head trauma, that they -- it's a little sketchy, they're not sure they remember all of it; they remember parts of it, and that they're not really clear whether or not they were unconscious, because it's hard to know that if you are, you know, maybe just for a little bit, but that he got out of the car.
And so his description to me told me that he wasn't comatose and he wasn't having a prolonged period of unconsciousness, but that he was describing changes in consciousness which could be consistent with a mild head trauma.
Q. Okay. If a patient that you were seeing had had no altered consciousness, typically what type of a description do you get of a patient as to the event that they're describing?
A. If they have no altered consciousness, generally they have a clear and continuous recall of the event, meaning they remember the impact, they remember exactly what happened afterwards.
They do know whether or not they hit their head. They do know whether or not they were unconscious. You know, they -- they are more clear and continuous in their recall.
Q. Okay. Once again, I interrupted you, which I'm going to do from time to time -- forgive me -- but as I think of things, I'll stop and ask them, but you were telling me about the history.
Was there any other significant history that would help the Ladies and Gentlemen of the Jury understand the basis for any conclusions you reached concerning this patient?
A. He noted that he declined an ambulance at the scene, went on to work, but became increasingly concerned about pain and other symptoms, and went to an emergency around two weeks later, an emergency room, because, as he described it, his head didn't feel right, that he thought he -- it would go away but it didn't, that there was a tingly feeling centered on the top of his head.
He described it almost as like your foot being asleep, and he was also noting that he was having some trouble staying focused, that he would forget names, that he would look at something and have trouble pulling up the word for what it was, and that that was of concern to him, that he had never experienced that before.
Q. Okay.
A. At that point he was followed up in the emergency room and had some tests, an MRI and a CT, which were negative at that point, and he was discharged from there.
Q. Did you later have occasion to examine the records of that emergency room visit yourself to help you fill in your information for evaluation --
A. Yes.
Q. -- at a later time?
I would like to direct your attention to an exhibit which we've had marked and placed on a screen.
A. Do I need to move?
Q. And you'll want to stand up because the screen -- the projector is going to face directly toward where you are now.
So if you can stand where you can see the screen that's behind you, and I think the camera from the evidence deposition here will focus on the exhibit itself, so you may not be actually in the field of view at this point in time, and you can see that a document is coming up on the screen, which we've had marked as Plaintiff's Exhibit No. 14.
I would like you to look at that and tell me whether that was one of the documents from the emergency room that you later obtained to help you complete your understanding of the facts and circumstances in this case.
A. Yes. That was from Alexian Brothers Medical Center dated the 26th of 1998, May, and, in fact, I summarized that in my review of the medical records in the reevaluation.
Q. All right. And it's -- it has a date of May 26 of '98.
Is it your understanding that is the date that you were just referring to in your testimony as to him going to the emergency room a week or so following the accident?
A. Yes.
Q. Okay. I want to -- I take it you've read these type of records a great deal in the course of your work as a neuropsychologist, that is, medical records, handwritten medical records; correct?
A. Yes.
Q. So for those of us who may not understand those types of details, up at the top where it says “Complaint,” can you tell us what that “MVA” stands for?
A. “MVA” stands for motor vehicle accident. “HA” stands for headache, and the last word is “dizzy.”
Q. Okay. So those were the complaints that they were summarizing brief -- briefly in the emergency room triage evaluation; correct?
A. Yes.
Q. All right. And then down below there's a section that's called “Triage assessment.”
Do you see that?
A. Yes.
Q. It's also handwritten; correct?
A. Yes. More legible than most.
Q. All right. But it does contain some abbreviations that you may be more familiar with than some of us --
A. Sure. Let me read --
Q. -- and you're also closer than our Jury may be at this point to look at it.
Can you tell us what that triage assessment said?
A. Yes. It first says “22:10,” which I believe is military time for what time he did that, most likely.
It says, “Driver with seat belt. Hit head on two weeks ago. Since that time, headache on top of head, occasional dizziness, and feels like, quote, numbness top of head, end quote, and, quote, hard to stay focused. No headache now. Alert and oriented times 3,” meaning that he was oriented to person, place, and time.
Q. And then there is a signature, which presumably would be the person who was taking that triage -- making that triage assessment; correct?
A. I imagine that's the doctor's signature.
Q. Okay. And I'm going to ask you to stay standing because I think we're going to show you another document in just a moment, but when that triage assessment states that the patient was having a hard time staying focused, how does that relate to the issue that you were addressing as to whether he had experienced a brain dysfunction, and, in particular, whether he had experienced it as a result of that motor vehicle accident?
A. That was consistent with what he was telling me, were the symptoms that were of increasing concern for him in the two weeks following the accident, that he was having trouble staying focused on his work, as well as having difficulty finding words.
Q. Okay. I think we'll talk about that phenomenon a little bit more later, but since you're standing there, what I would like to do at this time is to put the other document up which we've had marked as Plaintiff's Exhibit 15.
This is a typewritten document. Can you look at that a moment and orient yourself.
(Plaintiff's Exhibit No. 15 marked.)
BY THE WITNESS:
A. Yes. This is the other document that I received and reviewed.
BY MR. KNIGHT:
Q. Okay. And it also indicates at the -- under the “History” -- would this be a document made by the emergency room doctor?
A. Yes, I would assume, “Emergency Room Physician Assessment.”
Q. Okay. And, again, since I'm not sure how well our Jury will be able to see what you're looking at rather closely here, can you tell us what that history contained that was significant to you in attempting to evaluate the patient, the plaintiff, Jerry Wattron?
A. He stated that he was having intermittent dizziness since a motor vehicle accident two weeks ago, that he wasn't having any symptoms at the moment, but that he was concerned regarding the persistence of that, and that the rest of the history was noted in the triage evaluation, which is the document you just saw.
Q. Okay. And then, of course, there are other things which that emergency room doctor did, some of the same kind of things you were telling us that you do, taking a medical history, social history, family history and so forth; right?
A. Yes.
Q. But then at the bottom there's what's called a “Discharge diagnoses.”
Can you tell us what the discharge diagnoses was, especially as it relates to what you were attempting to do?
A. The first discharge diagnosis was “Motor vehicle accident,” the second was “Head contusion,” and the third was “Persistent dizziness.”
Q. Okay. Thank you. If you can have your seat again -- let me just ask one more question with regard to both of these documents. As you've looked at them, except for the Plaintiff's Exhibit number, do these two documents appear to be in substantially the same condition as the ones which you reviewed in the course of your effort to evaluate the patient, Jerry Wattron?
A. Yes.
Q. Okay. Thanks. If you'll have a seat and we'll turn -- actually, why don't you wait for a minute. We'll turn the projector off first so it won't shine in your face.
A. Thank you.
Q. And then if you'll have a seat, we'll continue.
When we asked you to stand up, you told us that you had obtained and considered some records from the emergency room, and those are the ones -- among those, at least, were the ones that we've just shown you; correct?
A. Yes.
Q. Were there other -- was there other medical history relating to the immediate history, that is, since the motor vehicle accident, which you were informed about at that time?
A. I also received his permission to get a copy of Dr. Eilers' evaluation of him, and I reviewed and summarized that.
Q. Okay. And in Dr. -- in Dr. Eilers' evaluation of him, did you see anything which dealt with those symptoms of dizziness that you've just read to us from the triage assessment and the emergency room doctor's report in the hospital? Did Dr. Eilers deal with that at all with respect to a possible cause of that dizziness?
A. I believe so. His diagnostic impression was “Probable traumatic brain injury with multiple cognitive deficits.”
Q. Okay. And did you learn about any testing that was done of the plaintiff, Jerry Wattron?
A. Yes. There were several CT scans, as well as an MRI, all of which were found to be unremarkable.
Q. Now, in general, are MRI's and CT scans devices which are used to attempt to evaluate or diagnose the existence of some kinds -- some kinds of brain dysfunction?
A. Yes. The reason that those are often given after someone comes in from a motor vehicle accident and is complaining of thinking-related symptoms, is that those particular tests are used to rule out acute changes in the brain that may need treatment, things such as bleeding in the brain, for example, and so they are very helpful in regard to that because that would be considered a medical emergency that would need intervention.
Q. Okay. So those types of things can help you rule out certain serious trauma to the brain; correct?
A. Yes.
Q. Including things like tumors, maybe, and things like that?
A. Tumors, strokes, bleeding in the brain.
Q. Okay. But when they are -- as in this case, it was reported to you that they were unremarkable, which I presume means that they didn't show any signs of a particular injury. Of what significance is that to you when you're engaged in the ongoing process of evaluating whether there is a brain dysfunction?
A. That does rule out a severe brain injury, in that a severe brain injury would have findings on a CT or an MRI.
A mild brain injury is less likely to have findings on a CT or MRI, the reason for that being that the CAT scan and the MRI look at structure and not function.
And so microscopic damage to the neurons, for example, because of the force of the brain being battered within the skull because of the forces of the motor vehicle accident, are unlikely to show up on those type of tests.
And so they are better at ruling in severe brain injury than they are ruling out mild brain injury.
Q. So this information concerning the negative results of MRI and CT scan were helpful to you in narrowing your focus for evaluation?
A. Yes, and in ruling out the more severe brain injury.
Q. All right. In addition to the things you've told us about already, did you also take a history from the plaintiff as to what types of things he was experiencing or to try to ascertain his input as to what the problems were from his perspective that he was having?
A. Yes. He was complaining of physical symptoms, a numb area on the top of his head, some problems with headaches and dizziness.
In terms of his thinking, he mentioned that it was slower and harder, that he would have to read things four or five times, even if he was reading slowly, in order to get what they were meaning.
He also mentioned his problems with concentration, that it's harder to remain focused, that he really had to work at staying on something, and problems with his memory, that he would have trouble with names of people and objects, that he was trying to write things down more and consistently work off a list because he was having difficulty with follow-through because of his memory problems.
Also, trouble with word finding, that he would be able to think it but have trouble saying it, that he would pause more, and that sometimes he would still pull up the wrong word or not be able to pull up the word he was looking for.
Emotionally he mentioned that he was more irritable and shorter tempered and that he got angrier more quickly.
Q. Okay. Based on the history that you took, to your knowledge, had the plaintiff ever had a neuropsychological evaluation before he came to see you on October 1 of 1998?
A. No, he hadn't. I specifically inquire about that because clearly if one exists, it would be helpful to be able to compare the two.
Most of my patients have not had one previously because this type of extensive evaluation would only be requested if there was a strong suspicion of brain dysfunction, and that had not been true for him up to the point of this trauma.
Q. Now, you mentioned earlier that while you do this clinical interview with the patient, you also observe the patient yourself as a professional to see whether there are signs or symptoms of any brain dysfunction; correct?
A. Yes.
Q. Can you tell us what you observed about the plaintiff when you interviewed him and tested him, as you've alluded to?
A. I noted that he was neatly groomed and dressed, generally unremarkable in appearance, that he could walk without assistance, that he could use his hands appropriately, that his hearing and vision appeared functional, that he was very pleasant and cooperative and seemed to be putting forth his best effort, although he had a somewhat limited tolerance for stress and frustration, that his emotional state was generally positive and appropriate.
He did have some anxiety in response to challenge and failure, that his social venues and social skills were good, that his thinking was generally logical and coherent.
I did see some problems with slowed thinking, that he would often have -- need a prolonged pause before being able to answer a question.
His memory, he would need me to repeat instructions. He would forget the question while he was trying to figure out the answer. It was hard for him to pull something out of his memory.
Some word finding problems, that he would pause trying to find a word or would have to talk around a word because he couldn't find it, and as well as some confusion. For example, he would miss -- he missed part of an appointment because he thought the appointment was the next day even though he had it written correctly in his calendar.
He initially gave me the wrong phone number for his girlfriend, and I noted that I thought that was somewhat unusual.
Q. Would it be fair to say that you've conducted these type of clinical interviews on hundreds, if not thousands of patients who have come to you for one reason or another?
A. Yes. Basically a clinical interview is done in a standard way in any evaluation.
Q. Okay. Would it be fair to say that you're aware that -- that patients can, I mean, sometimes try to fake their behavior and try to snow you in some way?
A. Certainly, and one of the issues that I always address is called “Differential diagnosis,” meaning are there other possible reasons for these symptoms other than something like a head trauma.
One of the differential diagnoses I always address is called malingering, which is the exaggerating or faking of symptoms, and I think that's an important thing to rule out in terms of having faith in the results of the evaluation.
I do that in a number of ways. One way I do that is by looking at the consistency of the patient's behavior with me, with his report of symptoms, with the results of the testing, and, also, with the information provided to me by significant others.
I also have specific instruments that I include in the testing process to measure motivation and to ensure that someone is putting forth their best effort.
I never had any doubt regarding Jerry. In fact, he seemed to be more minimizing his symptoms as opposed to exaggerating them.
Q. Okay. So you use your experience and skill to judge the person as you're talking to them as a doctor, not as, you know, a juror or a judge or anything, but to assess them as to whether they're being forthright, accurate, and honest when they're giving you their history?
A. Yes, and I think that's important because you need to rely on that to some extent, and, therefore, I think that the credibility of the patient is an issue that needs to be addressed.
Q. Well, you mentioned that you also talked to significant others, and you did that in this case; is that correct?
A. Yes.
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