One of the things that makes medicolegal work so interesting and so challenging is appearing in court. Everyone, especially those who have just started working in the area worry about making a mess of it.
I estimate I have been a witness in court more than 2000 times. Well, on Tuesday it was a stuff up. I am getting pretty good at avoiding the usual hurdles, saying too much, getting argumentative, lack of preparation and I dress conservatively and appear on time.
Let me digress a little and talk about preparation. Preparation obviously involves reading my report, seeing any potential problems and correcting them where possible, checking on words that I may have put in the report that I do not really understand, and sometimes being a little creative. There was one case that turned on the issue of when pethidine was known to cause malignant hypertension when used with MAOIs. Instead of chucking out MIMS annuals, I keep every fifth one. In this case I could demonstrate that this interaction was well-known at the time the victim, a psychiatric patient, well known to be addicted to pethidine, had been prescribed an MAO inhibitor. I made photocopies of the relevant pages both for when the event occurred and from the MIMs annual five years before that. I made copies for the judge and for both sides.
When I asserted that this interaction was well-known at the time the event occurred, the judge in a kindly patronising way told me, “that’s all very well Dr Epstein but we have had expert evidence to the contrary so it really is a case of your word against the other expert witness isn’t it?” It was with some pleasure that I produced the photocopies. The case settled that afternoon.
I realise I am avoiding talking about my stuff up so let me tell you about another stuff up while I’m still on a roll. I appeared in a “hot tub” in Sydney in 2013 with two other psychiatrists about a man claiming income protection insurance payments due to a mental illness preventing him working. His illness had commenced in 2000. The highly regarded psychiatrist from Sydney was an impressive witness-until he was told “there is nothing in your report doctor about what happened to this man from 2000 onwards? Why is that?” This was an astonishing lapse. To his credit the expert said “I have no explanation, it’s clear I made a mistake.”
Let’s get back to my stuff up. This was a man who had worked in his father’s construction business from school and had married and had two children. He had become a project manager but was still “on the tools” and expected to take over when his dad retired. In the same year his marriage broke down, his father borrowed a large sum of money from him because of a “temporary financial situation” and a week or two later his sister told him that the business was bankrupt. His father promptly had a breakdown and was hospitalised and he was left to deal with the train wreck. An administrator was called in, he had to assist the administrator, try and complete the jobs they were already doing and deal with subcontractors.
About three or four months later, when the dust had settled he finally had an inguinal hernia repair that he had been delaying because of the pressure of work. There were a host of other pressures on him over the next 10 years or so including a drug dependent son who assaulted him and his new partner, alcoholism and various physical health issues.
I saw this fellow four times from 2007 onwards. Each time I wrote a comprehensive report but I failed to pick up that the critical issue was whether or not his mental state was contributed to by his employment. I had detailed information about a host of other things that happened to him but what I wrote above was pretty much all I had gathered about the critical three or four month period when the business failed.
In cross examination I was asked such questions as “how many projects had to be completed?” and “how many subcontractors were involved?” and “what other pressures were on him at the time coming from the business?” and “what is your understanding of the role of the administrator?” and “when did he and his wife separate and what was their relationship like after the separation?”. I hesitate to go on with the other questions because it is too embarrassing. The fact is I did not have any answers to these questions because I had not asked them.
My report contained only one paragraph to do with the collapse of the business and this paragraph included a quote “he was left to pick up the pieces” that I had lifted from a psychologist’s report but that I had never explored.
What I found particularly annoying was that I had seen this man four times and I had never picked up how inadequate was my history.
When I stuff up in court I go through about 24-48 hours of distress until my ego gets over it and I can then work out what I did wrong and how to make sure I don’t put myself in that position again.
The lesson I learned here was to focus on the main game, the history of the accident or injury that led to the claim. The rest is important but unless I have that information, it is irrelevant. It’s like doing all the preparation for a lecture and not turning up.
I walked out of the courtroom feeling like an idiot and for a short moment was tempted to waive my witness fee but fortunately sanity and greed prevailed.
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