Chapter 36 - Forensic issues in neuropsychology Flashcards
When is forensic neuropsychology relevant?
Neuropsychologists may be called on to assist in civil cases (e.g. in
personal injury claims after traumatic brain injury (TBI)) and other brain
injury including medical negligence (e.g. anaesthetic accident). Cases in
which there is severe brain injury are amongst the largest personal injury
claims coming before the Courts.
Neuropsychologists sometimes also assist in criminal cases where
issues regarding fitness to plead and fitness to present evidence arise in
individuals who may be neuropsychologically impaired (p. 742)
What information do the lawyers and the court need from the psychologist?
In order to decide what, if any, compensation is due, the court must decide on two broad areas:
◆ liability: did the defending party cause “loss, injury and damage” to
the plaintiff (England) or pursuer (Scotland) or claimant/petitioner
(some other jurisdictions)?
◆ quantum (amount) of damages, which depends on the extent and
implications of the loss, injury and damage suffered.
What is the difference between ‘general damages’ (England) or ‘solatium’ (Scotland). And ‘special damages’,?
The extent of pain and suffering is relevant here, as is the extent of the injured person’s awareness: the more the injured person is aware of his/her predicament, the greater this element of the
damages, other things being equal (Always less then 2.5 mio dkk in UK)
Key factors in
calculating quantum of special damages include extent of loss of earnings and extra costs arising from disability (Often huge sum)
What are some of the key information that a lawyer could seek from the neuropsychologists’ reports?
◆ the nature and extent of any impairment, disorder, or other effect of injury.
◆ causality: did the injury cause or substantially contribute to the
difficulties suffered?
◆ the prognosis (with and without treatment), including timescale.
◆ the functional implications, especially for work and care needs.
The neuropsychologist should therefore consider:
◆ What is the nature/extent of neuropsychological impairment and
emotional/behavioural change? What abilities remain intact?
◆ Are the impairments/disorders/etc more likely to be due to the injury
than to any other cause?
◆ Is further treatment/rehabilitation indicated (and, if so, what kind,
with what aims)? What is the prognosis?
◆ What implications–in broad terms–do the impairments and other changes have for functional outcome, including ability to work and
lead a social life, and need for care/supervision? (p. 742)
How should the assessment be conducted? (forensic assessment)
Stage 1–Accepting instructions (Know what your job is in this particular case)
Stage 2–Reviewing records; understand your patient and the case
Stage 3–The examination; screening of everything relevant
Stage 4–Reporting and giving evidence
These stages are ellaborated in length on pages 743-751
Including what you should do in the specific cases. - The most important step here is stage 3, which is elaborated in the next card.
Elaborate what you think is relevant to examine in stage 3 : the examination.
Both general screening and neuropsychological tests.
(Careful long ass card incoming)
◆ The physical/sensory changes (including epilepsy)
◆ There may be symptoms such as headaches, dizziness, poor balance, intolerance of noise, tiredness, changes in sleep/wake pattern, loss of libido.
◆ The cognitive changes should be reviewed, and an attempt made to
identify how they affect daily life.
◆ The emotional/behavioural changes should likewise be reviewed
◆ Progress in returning to education or employment should of course be
considered
____
Neuropsychological tests:
◆ A language screen should include consideration of spontaneous
speech and brief tests of repetition, naming, obeying commands,
reading and writing
◆ Intellectual level–premorbid and current
◆ Both verbal and visuospatial memory should be assessed.
◆ Another key area to consider is attention/concentration
◆ Executive functions
◆ ‘Focal’ problems (e.g. dyspraxia/agnosia/etc)
◆ Some clinicians include questionnaire measures of emotional adjustment. (p. 747f)
About stage 4: Reporting and giving evidence.
What should be included in a medico-legal neuropsychological
report?
The report (like other medico-legal reports) should set out the instructions given, state where and when the patient and relative were assessed/interviewed, and describe the documentation studied.
Also describe :
- nature and severity of injury (based on patient/relative interview and evidence from the records)
- the social and health background
- The information from
patient/relative interviews and from the neuropsychological examination should be presented.
: The report should set out conclusions on the key areas of relevance to
the court, as set out more fully above (p. 751f).
What areas should be addressed with caution regarding the report of the results (stage 4. as well)
There are areas which it is not appropriate to cover as they are primarily a matter for
related reports;
It may be quite appropriate for a neuropsychologist to say that someone has such severe
deficits that they are likely to be incapable of open market employment, or would be capable only of restricted/simple work. However, to speculate as to what jobs may be available in more detail may be unwise. (p. 752)
___
It is also unhelpful for clinicians to be too specific on care needs: the details are a matter for a care specialist who knows the practicalities of care provision, and costs hereof.
What should you do if you see a prospect of rehabilitation in the case?
- You should not hold out to patient/family the definite prospect of rehabilitation or other treatment until and unless funding is in place.
◆ If there is a case for such rehabilitation, you should do no more than discuss it with patient/family as a possibility (to gauge their receptiveness), then raise the matter with your instructing lawyers. (the lawyers acting may be able to obtain funding for this purpose)
What is comprising retrograde amnesia–RA; and
post-traumatic amnesia–PTA)?
The signature of a significant
concussional head injury. The individual recalls nothing from sometime before injury until sometime after it.
where RA/PTA is an issue, study of the
contemporaneous records is a key step in trying to clarify how extensive
RA and PTA are likely to have been, as the injured person may have a
motive for claiming to remember or forget what happened.
