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AMERICAN COLLEGE OF FORENSIC PSYCHIATRY
20TH ANNUAL SYMPOSIUM
April 11-14, 2002
San Francisco, California, Stanford Court Hotel
WEDNESDAY, APRIL 10
4:30 - 6:00 Early Registration
THURSDAY, APRIL 11
7:00 - 7:45 Registration and Continental Breakfast
7:45 - 8:00 Opening Remarks and Announcements
8:00 - 8:35
Psychiatry and the death penalty
This presentation will cover the role of psychiatry and psychiatric testimony in the imposition and carrying out of the death penalty. Attendees will learn about the legal issues involving psychiatric testimony in capital cases.
Ralph Slovenko, J.D., Ph.D., Professor of Law and Psychiatry, Wayne State University Law School, Detroit
8:35 - 9:30
Two faces (or more) of workersí compensation interaction: a play in several acts
The superficial and hidden agenda among patients, lawyers, evaluating and treating doctors, adjusters and pharmacists will be demonstrated through role-playing to exhibit ethical, legal and professional conflicts. Attendees will understand the conscious and unconscious goals and conflicts within the workersí compensation system.
Marshall S. Cherkas, M.D., Ph.D., Private Practice, Los Angeles, CA, Clinical Associate Professor of Psychiatry at U.S.C. (ret.).; David Glaser, M.D., Clinical and Forensic Psychiatry, Los Angeles, CA
9:30 - 10:00
Primary doctors, alleged emotional distress and the workersí compensation system in California
Most patients who sustain, complain of, or report mental or emotional job injuries are "taken off work" and/or "put on disability" by primary physicians. These physicians do not ordinarily understand the workersí compensation system and the full implications of taking such action. Often more harm than good results. There is little evidence that any remedial action to resolve problems which cause emotional distress within the workplace are considered or even viable in our current health delivery climate. Involving these primary physicians more meaningfully in the industrial medicine system and orienting them to such issues might benefit patients and employers and save money. Meeting attendees will have the opportunity to consider possible solutions to this problem, see a perspective which is often overlooked and hopefully work to foster positive changes.
Ronald Shlensky, M.D., J.D., Montecito, CA, Founding editor, American Journal of Forensic Psychiatry
10:00 - 10:15 Coffee Break
10:15 - 11:00
Selective Serotonin Reuptake Inhibitors (SSRIs) and cases of allegedly related violence
Considerable controversy still exists regarding the occurrence of aggression and violence as a result of treatment with SSRIs. This group of drugs represents a revolutionary development in the treatment of depression and other psychiatric disorders and, since the introduction of fluoxetin in the early 1980s, this and other similar drugs have been used in the treatment of vast numbers of patients worldwide. Their clinical efficacy has been clearly established, but over the years, isolated cases of extreme violence have been associated with their use, instances where patients being treated with SSRIs have committed murders, and the so-called "Prozac defense" had been used, unsuccessfully, to defend these individuals. In the last year however, there have been a number of successful outcomes with large sums awarded to the plaintiffs, and this issue has now become one that should concern clinicians who prescribe these drugs, and particularly forensic psychiatrists who are asked to provide expert testimony.
Eric W. Fine, M.D., Private Practice, Philadelphia, PA; Director of the Division of Psychiatry, Saint Agnes Medical Center; Associate Professor of Psychiatry and Human Behavior, Thomas Jefferson University Medical School
11:00 - 11:35
Involuntary treatment to restore competency
Following Riggins v. Nevada, the D.C. Circuit has issued significant decisions regarding the use of involuntary medications to restore competency to stand trial. A discussion of 6th Amendment fair trial issues with regard to self representation by mentally ill, but competent, defendants will also be included. Attendees will learn under what conditions an incompetent defendant can be forcibly medicated.
Alan A. Abrams, M.D., J.D., Private Practice; Chief Psychiatrist, Centinela State Prison, Imperial, CA
11:35 - 12:15
Competence to stand trial in the context of mental retardation
The defendant with limited intelligence presents special problems in evaluating competence to stand trial. Determination of mental retardation does not automatically render a defendant incompetent. However the presence of "a reasonable degree of rational understanding" can be difficult to determine. The author presents a case of contested competence to stand trial involving a 51-year-old man with a full-scale IQ of 64, charged with first and second-degree criminal sexual conduct. This case is discussed, relevant literature is reviewed, and an approach to assessment is offered. Attendees will be able to explain the impact of limited intelligence on assessment of competence to stand trial, and will be able to describe ways to assess competence, taking into account the defendantís limitations.
Susan Pearlson, M.D., Private Practice, Rochester, MN; Part-time employee, Minnesota State Security Hospital
12:15 - 1:30 Lunch break (on your own)
1:30 - 2:15
Psychiatric treatment of sexually abused children and adolescents
Children who have been abused may develop psychiatric symptoms such as PTSD, depression, anxiety, and sexually reactive behaviors. The impact of incest and sexual abuse as a psychic trauma will be explored and psychiatric treatment of aftermath is discussed. Play therapy, cognitive psychotherapy and using medications for the alleviation of disorders is the focus of this lecture. Attendees will become familiar with the impact of sexual trauma on the victims and therapeutic modalities that may be effective in remedy of symptoms.
Jamshid A. Marvasti, M.D., Private Practice, Manchester, CT; Editor of the book, Child Suffering in the World
2:15 - 2:55
Civil commitment for sexual predators: maintaining patientsí rights and clinical challenges
Secure units for sexual predators under indefinite civil commitment present new legal and ethical challenges for psychiatrists. Besides the controversy around predicting likelihood of sexual reoffending, issues of involuntary medication, right to treatment, right to refuse treatment, and chemical castration arise in treatment planning and in court. Treatment planning is affected by legal action, requiring clarification of priorities by providers. The presentation includes case-based discussion of these issues in Washingtonís Special Commitment Center, including some unique legal challenges and treatment dilemmas.
Mark R. McClung, M.D., Private Practice, Seattle, WA; Clinical Instructor, University of Washington
2:55 - 3:35
When patients deceive doctors: a review of factitious disorders
Factitious physical disorders refer to those conditions that individuals willfully create by producing signs and/or symptoms of physical or mental illness. There are at least five variations of Factitious Disorder (FD). The inability to recognize this condition often leads to inappropriate diagnostic tests, invasive interventions and multiple iatrogenic complications, which makes the condition even more difficult to recognize. Two clinical cases will be discussed that highlight the diagnostic and therapeutic difficulties associated with suspected cases of factitious disorders. Attendees will learn more about the etiology of these mental disorders, recognize their manifestations, understand the basis for treatment and be better able to explain factitious disorder in court to legal triers of fact.
Jose Maldonado, M.D., Ph.D., Assistant Professor of Psychiatry and Behavioral Sciences, Stanford University School of Medicine; Chief, Medical Psychiatry Section, Director, Medical Psychotherapy Clinic, Medical Director, Consultation/Liaison Service, Stanford University
3:35 - 4:05
Psychiatric fraud: why do psychiatrists pretend they can properly diagnose religious delusions?
Two years ago Brandon Wilson cut the throat of a 10-year-old boy, saying God told him to do so. Every psychiatrist who examined him concluded that because his beliefs were false, fixed, and of a religious nature, he must consequently be suffering from a religious delusion. Dr. Haroun, who examined him, supported these findings but could not find scientific evidence that the patientís beliefs were false. Private discussions revealed that the methodology used by many forensic experts is based not on science (as the doctors pretend) but rather on pseudoscience.
Ansar Haroun, M.D. Supervising Forensic Psychiatrist, Psychiatric Examining Facility, Superior Court, County of San Diego
4:05 - 4:35
Forensic psychiatric issues related to psychotropic medications
Psychotropic medications have been implicated in multiple forensic-psychiatric issues, including prescription without informed consent, misdiagnosis, right to treatment, and right not to be treated, treatment of violent patients and inmate patients in forensic settings, malpractice due to nonrecognition of serious side effects. These and other medicolegal issues will be illustrated by citing relevant landmark cases. Attendees will be able to use the above described knowledge in the proper care of patients in forensic settings.
Richard May, M.D., Assistant Clinical Professor of Psychiatry, UC Davis, Sacramento, CA; Chief Psychiatrist, Central California Womenís Facility, Chowchilla
5:30 - 7:00 Welcome Reception
FRIDAY, APRIL 12
7:15 - 8:00 Registration and Continental Breakfast
8:00 - 9:30
Forensic issues in Complex Regional Pain Syndrome
Complex Regional Pain Syndrome is a particularly enigmatic form of chronic pain often seen in personal injury litigation and workersí compensation claims. Formerly known as Reflex Sympathetic Dystrophy or Causalgia, it was thought to be due to sympathetically mediated processes. More recently, non-specific pathology is incorporated in the concept. Because of the lack of objective findings and the dramatic disability that patients frequently present, both somatoform disorders and malingering may be implicated. Attendees will be able to understand the classification of Complex Regional Pain Syndrome, its typical symptoms, and the potential association with psychological factors.
Richard L. Levy, M.D., Adjunct Assistant Professor of Medicine and Neurology, Dartmouth Medical School; Albert M. Drukteinis, M.D., J.D., Adjunct Associate Professor of Psychiatry and Director of Forensic Psychiatry Training at Dartmouth Medical School; Director of New England Psychodiagnostics, specializing in personal injury and employment stress claims
9:30 - 9:45 Coffee Break
9:45 - 10:45
The Daubert decision and how it affects the testifying psychiatrist
What every testifying psychiatrist needs to know about this significant landmark in the rules of evidence regarding expert testimony from Daubert to the present outlines the objective of this presentation. The United States Supreme Court's decision in Daubert v. Dow Merrill held that an expert must have a scientific basis for any opinion rendered in court. How does that impact the psychiatric expert? Is it a roadblock the psychiatrist needs to prepare for? That ruling - and the decisions that have followed it - subject the expert to heavy scrutiny about the basis for opinion. What exactly must you be able to do or say to comply with the Daubert standards? These and other issues will be addressed.
Clifford E. Haines, Esq. is a member of the firm of Litvin, Blumberg, Matusow and Young in Philadelphia and engages excusively in civil litigation practice. He holds a Juris Doctor, cum laude from the Ohio State University College of Law. Prior to joining the firm, Mr. Haines served for 9 years as an Assistant District Attorney and was Chief of the Homicide Division and Chief of Hiring and Training. In 1997, Mr. Haines was Chancellor of the 13,000 member Philadelphia Bar Association, the oldest metropolitan Bar Association in America. Mr. Haines is the director of Temple University's Academy of Advocacy and lecturer at the University College of Law.
10:45 - 11:45
Forensic practice in employment lawsuits: a practical demonstration
This role-play demonstration involving a forensic psychiatrist and an employment lawyer will highlight techniques for conducting a forensic mental examination of a plaintiff with significant Axis II pathology, as well as role-play demonstrations of deposition testimony and direct and cross examination involving issues such as adequate review of records, privacy issues, alternative causation, failure to follow DSM diagnostic criteria, therapeutic bias, financial bias and the role of Axis II pathology in the genesis of harassment and discrimination claims. Techniques for clear and effective presentation to judges and juries will also be emphasized.
Ronald Shlensky, M.D., J.D., Montecito, CA; James J. McDonald, Jr., J.D., Attorney at Law, specializing in employment law, Fisher & Phillips LLP, Irvine, CA
11:45 - 1:00 Lunch Break (on your own)
1:00 - 2:00
Speaking in tongues: making yourself understood in the nonclinical world (workshop)
The presenters reviewed several hundred independent psychiatric file reviews and examinations on patients claiming benefits in a variety of systems. Information and data about the difficulties in documentation, verification, and communication of relevant information and conclusions between the business and professional systems were analyzed. Five areas of discontinuity were isolated and strategies for remediation developed. Both data and interactive descriptions of strategies will be presented. Attendees will develop skills, standards and templates for translating clinical information into material that meets professional, legal and business needs and standards.
Jennifer Christian, M.D., Occupational Medicine Physician, President, Webility Corp; Marcia Scott, M.D., Psychiatrist and Consultant, Cambridge, MA, Former VP, Medical Services for Prudential Group Insurance
2:00 - 3:00
Conducting an effective fitness-for-duty mental examination under the ADA
Increasingly, psychiatrists are called upon to conduct mental examinations to determine whether employees are fit for duty within the meaning of the Americans with Disabilities Act. This presentation will include a brief overview of ADA law applicable to mental disabilities and illustrate the kinds of preparations that are essential to an effective fitness for duty examination, what should be considered during such an examination, and how and to whom the results of the examination should be communicated.
James J. McDonald, Jr., J.D. Attorney at law specializing in employment law, Fisher & Phillips LLP, Irvine, CA
3:00 - 4:00
Using Power Point for presentations and as an audiovisual instrument in court
The objective of this workshop is to demonstrate the advantages and potentials of Power Point. The workshop will enable participants to create a simple Power Point presentation by the end of the session. Attendees will learn how to use the program in meeting presentations and in the courtroom as an audiovisual tool with which to graphically clarify issues for triers of fact. Those who have laptop computers may bring them along; if not, attendees can still learn by observing Dr. Rodgersí graphic presentation and taking notes. The workshop is primarily for psychiatrists who are familiar with Windows 95, 98, or 2000. However, Power Point is now available for Macintosh and Mac users are also welcome to attend.
Carla Rodgers, M.D., Private Practice, Philadelphia, PA; Senior attending psychiatrist; Friends Hospital
SATURDAY, APRIL 13
7:15 - 8:00 Registration and Continental Breakfast
8:00 - 8:35
In response to the increasing criticism of expert testimony, various solutions have been offered to curb expert abuses. They include capping expert witness fees, pre-screening experts, using only court-appointed experts, adherence to a strict code of ethics, peer review, and a science court. What about expert witness malpractice litigation? This presentation discusses recent developments.
Ralph Slovenko, J.D., Ph.D., Professor of Law, Wayne State University Law School; Author of a forthcoming two-volume work: Psychiatry in Law (Vol 1) and Law in Psychiatry (Vol 2), published by Routledge
8:35 - 11:45
Mock trial: a contested will following a suicide
This yearís mock trial is based on a will and testamentary capacity issues. The case at law revolves around the disappearance of a 59-year-old woman, Barbara, whose car was found parked at a beach late at night. Because of her psychiatric history it was ultimately presumed that she had committed suicide by walking into the ocean, but her body was never found. After the requisite five years had elapsed, she was declared legally dead by court order. Shortly thereafter, the plaintiffs, her brother, Tom, and his wife, petitioned to have the will probated. Barbaraís last will and testament was executed eight months before her disappearance and left her entire estate to Tom and his wife. This will revoked her prior will, which had left her estate to her four siblings in equal shares. Her other siblings contested the will on grounds of testamentary capacity and undue influence, alleging that Barbara was not competent to execute the will and that Tom and his wife forced her to change her will through intimidation and threats. The trial will focus on the testimony, direct and cross-examination of the psychiatrists as expert witnesses in court. Attendees will learn more about the role of the forensic psychiatrist in testamentary capacity cases, particularly when wills are challenged in court.
Douglas Anderson, M.D., Private Practice, New York City; Albert Drukteinis, M.D., J.D., Adjunct Associate Professor and Director of Forensic Psychiatry Training, Darmouth Medical School; Roger Sharp, Attorney at Law, Salt Lake City. Other participants will be listed in the final program.
11:45 - 12:35
Use of countertransference in the process of forensic evaluations
All experienced psychotherapists are familiar with the concept of countertransference, a term narrowly associated with the psychotherapy process; however, countertransference can be a valuable instrument when performing forensic evaluations. In both criminal and civil cases countertransference can provide valuable data. Where there is live testimony before a jury, use of countertransference data can help humanize the expert in the eyes of the jurors; it may also prove to be a helpful tool in explaining a litigantís behavior. Attendees will be able to use countertransference in daily forensic practice and to more effectively communicate in forensic settings.
David Glaser, M.D., Private Practice, Los Angeles, CA; Richard Romanoff, Ph.D., Forensic Psychologist, Los Angeles, CA
Learning from errors: a database of completely innocent people wrongfully convicted of crimes
Despite the high standard for determining guilt in the United States, innocent people are sent to prison for crimes they have not committed. The author has researched publications describing examples of wrongful convictions that were reversed with new evidence establishing innocence. Approximately 300 cases have been found and analyzed. The details of the cases have been categorized and stored in a database available on the World Wide Web. The most common errors are eyewitness misidentification, false confessions, false informants and official misconduct. Psychiatrists can be instrumental in educating juries about the imprecise nature of some evidence presented in criminal court. Attendees will understand the common errors in wrongful convictions and the importance of learning from these errors, and will appreciate the problem of rigid thinking.
Edmund S. Higgins, M.D., Private Practice, Charleston, South Carolina; Treating Psychiatrist, Charleston County Jail; Clinical Assistant Professor of Family Medicine and Psychiatry, Medical University of South Carolina
SUNDAY, APRIL 14
7:15 - 8:00 Registration and Continental Breakfast
8:00 - 9:00
The role of forensic psychiatrists in capital murder cases
There are an estimated 3,700 inmates on death row within 40 jurisdictions having capital punishment statutes. Of these individuals, approximately 700 have been put to death since 1977. Capital murder cases raise constitutional questions and also pose intense personal, professional and ethical issues for the forensic psychiatrist who is often asked to assume multiple roles in the pre and post conviction phases of the trial. These roles are shaped by many forces; there are few existing guidelines for the forensic practitioner; and the cases themselves are embedded in a continually evolving sociocultural/legal context. This presentation will focus on several capital murder evaluations completed by the speakers. The case vignettes will highlight a variety of forensic issues. An evaluative format will be presented along with guidelines for training of future forensic practitioners. The objectives of this presentation are to provide the participants with updated literature on capital murder cases; to describe an evaluative format for forensic psychiatrists who participate in such cases; and to educate participants about the multiple psychiatric, moral, legal, and personal issues faced by the forensic psychiatrist who participates in capital murder cases.
Steven Samuel, Ph.D., Clinical Associate Professor, Jefferson Medical College, Philadelphia, PA; Timothy Michals, M.D., Private Practice, Philadelphia, PA, Clinical Assistant Professor of Psychiatry, Jefferson Medical College
9:00 - 9:45
What mental health experts need to know about police training, policies, and practices in relation to interrogation and related subjects
While many psychiatrists and psychologists are aware of the current interest in false confessions, mistaken identifications, and related issues, few are aware of police training, policies, and practices that are viewed as potential problems to the integrity of adjudications and investigations. For mental health experts, this absence of knowledge may mean that the focus of an evaluation or the basis of an opinion about a patient involved in the criminal court process may be improperly focused, or even incorrect. Two lawyers who have been involved in the forefront of significant litigation of the impact of police training and investigation policies on interrogation and investigation will discuss their work, and will show the audience examples of the training materials that mental health experts should be aware of.
Charles Weisselberg, Professor of Law and Director of Clinical Education at the University of California at Berkeley. He has briefed interrogation and related police practice issues before the United States Supreme Court, the California Supreme Court, and before Federal and State Courts of Appeal, and has published several significant law review articles on the subject; John T. Philipsborn is a criminal defense lawyer who regularly litigates in courts around the country, particularly in death penalty cases.
9:45 - 10:00 Coffee Break
Forensic aspects of hypnosis and "memory work"
Over the last few years there has been a number of court cases disputing the veracity of memories recovered during the course of psychotherapy. This presentation addresses the issue of memory and the role of hypnosis in the recovery of previously repressed memories, particularly those of presumed traumatic origin. Therapists using hypnosis must be aware that its use during the course of therapy may compromise witnessí ability to testify in court. Attendees will understand the ways memory works, the limitations and flaws of hypnosis in memory work and learn the "rules of engagement" when hypnosis is used as an instrument in the forensic setting.
Jose Maldonado, M.D., Ph.D., Assistant Professor of Psychiatry and Behavioral Sciences, Stanford University School of Medicine; Chief of the Medical Psychiatry Section, Director of the Medical Psychotherapy Clinic, and Medical Director of the Consultation/Liaison Service
Why psychiatrists should be interested in security related matters
In metropolitan Los Angeles, many celebrities hire professional security experts to deal with real and suspected threats to their lives. The security industry, police departments, the FBI and other protective agencies often consult psychiatrists on a wide spectrum of cases involving threats made to executives and high-profile personalities. The speaker will educate the audience on the inner workings of security assessment, a growing field in the United States and elsewhere. Attendees will become aware of opportunities to work with security personnel as well as law enforcement personnel in security related work, and will appreciate the complex web of individuals and agencies involved in threat assessment.
Kevin Berman, Retired police officer who heads a Los Angeles based company that provides security work for the general public and celebrities
11:20 - 12:00
Second opinions:legal consultations in criminal competency evaluations
Throughout the United States, an essential element for a defendant to be found competent to stand trial requires that the defendant understand the nature and purpose of the proceedings, and participate in an appropriate defense. Forensic psychiatrists and psychologists routinely evaluate defendants for this purpose, despite the fact that the relationship between counsel and defendant is very different than the relationship with an alienist. This presentation reviews the legal and forensic literature and the law supporting the practice of second opinions, as well as providing two case examples. Attendees will become familiar with competency laws and restoration procedures, as well as case law supporting second opinions.
John W. Podboy, Ph.D., Forensic Psychologist practicing in state and federal courts; Daniel Greenfield, M.D., Private Practice, Millburn, NJ
The American College of Forensic Psychiatry is accredited by the Accreditation Council for Continuing Medical Education to provide Continuing Medical Education for physicians. The American College of Forensic Psychiatry designates this Continuing Medical Education activity for 23 credit hours in Category I of the Physician's Recognition Award of the American Medical Association.
23 Hours CME, Category I
AMERICAN COLLEGE OF FORENSIC PSYCHIATRY
P.O. BOX 5870
BALBOA ISLAND, CALIFORNIA 92662
Telephone: 949-673-7773 ï Fax: 949-673-7710