drmargaret

I am a forensic clinical neuropsycholgist. What that means in English, is that after I completed a doctoral degree in clinical psychology, I went on to complete two training programs. My first was in forensic psychology. Forensic is misinterpreted (thanks to television) to mean either working with dead people or with the police as a crime scene investigator, but what it actually means is with the law. I write reports for people to have in court. I’ll get back to the types of evaluations I do in a minute and the types of reports I write. I generally do not go to crime scenes. I never conduct investigations of crimes with police. I went through an additional training program following my forensic training program. I learned how the brain functions and how it impacts behavior in a variety of ways. I learned how the brain works when it is damaged from accident and disease. My ability to study the brain through psychological tests in this manner makes me a neuropsychologist. When I apply this to legal matters, I’m a forensic neuropsychologist.

All in all it’s about 24 years of training. It’s a lot of school. Areas of law are quite vast. They involve knowing cases specific to the local, state or federal judicial system. It involves keeping up with rules of evidence and what will be admissible in court or not. The rules change over time with judicial rulings. My training started off with evaluating individuals who were admitted or convicted sex offenders as part of their ongoing treatment and presenting reports to the parole and probation departments.

I left clinical psychological training with the misinformation that I should like the people I was working with. My work with sex offenders changed that. My role was to evaluate their treatment and to ensure compliance with treatment. I was an extention of their court order. I needed to treat them with respect and dignity. It was fine if I did like them, but it wasn’t a requirement. The most violent of the offenders were brought into the office in chains with armed guards. I knew their offenses. They primarily offended against children. I could respect them; it would be hard to like some of them. It was surprising to me when I did like them. It was heartbreaking when they were not following their treatment, or were reoffending and were having to be sent back to jail or prison. Evaluation involved psychological testing with mental status questionniers, tests specific for sex offender populations, and showing slides or movies or listening to audiotapes of sex offenses and wating for arousal patterns on a penile plethismograph–think of it as a lie detector for a man’s penis. So if they were saying they were no longer aroused by children, I could actually show them pictures of children and tell. The men sat behind me in a small room with a door closed. I just watched the numbers on the dial and listened to dialogue on headsets or saw the slides or the movie as he did. There was a microphone attaching the man to my headset. Sometimes he would make comments to me. Almost always the comments were inappropriate. The comments would go into my report.

After that I worked on injury and accident cases for people claiming they were hurt emotionally or suffered head injuries. They called the emotional injuries damages to their “psyche.” It’s a very different population. The reports are for alleged, not determined, injuries. A judge, arbitrator or a jury would have to determine if the person was in fact injured and the monetary value of the injuries based on the reports.

There are different rules for people injured at work than for people injured elsewhere. I worked with this population as well. There are tables to determine the monetary value of parts of people and whole people in various levels of education and ages. In years past, the industry of Worker’s Compensation, especially in California, was rife with fraud. There were lots of clinics set up to process people with very questionable injuries. People were plucked out of unemployment lines to file for psychological injuries from their last employer for simply having been laid off. In some cases the people had legitimate injuries and simply didn’t know about the system. In other cases there were no injuries present and the person was just told it was a way to get money. In more recent years the laws have tightened. Fraud laws have been put in place and clarified. Most people have legitimate injuries but some still exaggerate the nature and extent of their difficulties trying to get more money.

Finally, I got called in to testify at court. The court cases have been of a wide variety. I testify in court based on how the attorney knows me. If the attorney knows me from my treating sex offenders I may get called in to testify on behalf of a sex offender. I do not like these cases and am no longer taking them. I don’t believe psychology has tools available to adequately treat offenders and I don’t believe we can differentiate who will offend from who will not offend. The most recent studies are showing that the treatment programs the prisoners are volunteering for are not doing anything for the offenders. For career sex offenders, I don’t think there is anything much we can do for them. There may be a few sex offenders who benefit from treatment. I have met them. They go on and live normal lives. These are people who are offending in their family and aren’t offending against stranges. Violence or coersion isn’t involved. People abusing substances during offenses may also benefit from treatment. Once the substance abuse is stopped, the offense may stop. The vast majority of sex offenders are adult men molesting young girls.

I do take cases where there are personal injuries with psychological damage or possible head injuries. I do evaluate people who have had injuries where the people may have had something wrong with them when they were injured to start with and the degree of injury is unclear. I have worked with criminals and police officers. I have given testimony in court on behalf of both in different cases. If a police officer does something wrong I will say so. If a criminal is injured wrongly I will say so. If a police officer is following the rules set down by the department I will say that too. If the criminal was injured prior to coming into contact with the police in a prior incident I will say that as well.

Some attorneys know me from my ability to testify about rules and regulations in health care. I did quality assurance. I know what health care agencies are supposed to do. This applies to doctors, their notes, their office procedures, the hospitals where they work, authorizations, managed care organizations, appeals and grievance procedures, pharmacies, labeling of pharmaceuticals, prescription writing, and handling of sample medications. So I can tell an attorney to hire a pharmacist specialist because the prescriptions and the process of prescription management is wrong in a case. Or I can tell an attorney that the chart notes are wrong and not standard and to hire a medical doctor to comment on that for that speciality. Or I can explain to the attorney that the hospital is governed by the JCAHO and to contact someone on the standards because the organization doesn’t seem to be in compliance and to pull the most recent report.

One of the things I worked on as a forensic psychologist was compliance with regulatory agencies for large organizations. This involved making sure that all aspects of an agency were in correct compliance with all local, state, national and federal regulations. It involves a lot of paper. There are tons of lists. I actually got called in to fix problems because the organization was not in compliance with some aspects. Usually there are timetables involved in fixing the problems. I did a couple of these “projects” and got noticed by some attorneys and testified in some cases at depositions and in court.

Another area of forensics is competency. The ability to understand things. I have done two areas of competency. The ability to understand the legal documents someone is signing and the ability to provide legal testimony in court and to understand the charges against the person and to aide in their defense. Competency to sign legal documents means having the ability to read and comprehend what is written adequately enough to make an informed decision about signing or not signing the document. In the case I worked on the person did not have the reading level for the document, was corersed into signing the document, and even had she read the single words individually she would not have understood them. In the case on competency to stand trial I was asked to evaluate the individual independently because the court had already found him competent and the individual wanted a second opinion. I was the second opinion. He was charged with a felony case and was facing possibly 10 years in prison. He had no recollection of the crime due to his use of drugs at the time of the offense. He completely understood the charge against him. He spoke English although it was not his first language. He was fully able to participate in his defense. He understood all the major participants in the court-the judge, the prosecutor, the jury, his attorney and what heir respective roles were. He was above average intellectually. I too would find him competent to stand trial. I told him so. And he said “but I don’t feel competent at all. I think I’m going to lose this case.” So I then explained that “competent” means to understand the legal process and “confident” means to think you might win the case. He might benefit from a dictionary during the trial. I don’t know how the case came out.