Do You Need an Expert Witness Board-Certified in Both Brain Injury Medicine and Forensic Psychiatry?
A properly qualified expert witness is essential, but it becomes especially crucial in the event of brain injuries where training and credentials are not all equal. For example, the event that causes Traumatic Brain Injury (TBI) or Concussions might also lead to PTSD or emotional distress. A Forensic Psychiatrist is adequately qualified to address the PTSD or emotional distress, but may not have the depth of training necessary to evaluate TBI and its impact. These inter-relationships, or lack, are best understood and assessed by a qualified Expert Witness in both Psychiatry and Brain Injury Medicine. In addition, a Forensic Psychiatrist has additional experience with the medico-legal aspects of a case. Helping juries understand complex cross-over conditions may require an Expert with a unique background and credentials.
Board-Certification in Brain Injury Medicine is relatively new and rarely paired with Forensic Psychiatry despite the obvious relationship. Let’s better understand how a Forensic Psychiatrist obtains Board-Certification in Brain Injury Medicine and what it describes.
Board-Certification in BIM is granted by the American Board of Psychiatry and Neurology. Certification follows a rigorous course of study and examination. Qualified Board-Certified Psychiatrists, Neurologists, Physiatrists (Physical Medicine and Rehab) and Sports Medicine physicians are permitted to take the exam. Doctors in other areas of medicine may not be allowed to take the exam.
Brain Injury Medicine encompasses disorders of brain function due to injury. These disorders involve a range of medical, physical, neurological, cognitive and psychiatric disorders that result in psychosocial, educational, and vocational consequences. A specialist in BIM would have expertise in other central nervous system disruptions (e.g., encephalopathies, anoxia) with similar neurocognitive and psychiatric symptoms.
BIM qualifications enable the forensic psychiatrist to treat and render medico-legal opinions on the neuropsychiatric manifestations of Traumatic Brain Injury (TBI) with a high level of expertise. The psychiatrist with this training is not a substitute for a Neurologist. The relationship between Brain Injury and Psychiatry speaks to behavior, personality and emotional response-the primary purview of the Psychiatrist. There is overlap with Neurology and it may make sense in a lawsuit involving a brain injury, or suspected brain injury, to assemble a team of experts including a Forensic Psychiatrist with BIM Board Certification, a Neurologist and a Neuropsychologist who is trained to conduct testing and interpret data. In some cases, a Physical Medicine and Rehabilitation or Sports Medicine doctor would add necessary input.
Personal Injury Cases
If a physical injury to the body includes the brain, such as a motor vehicle accident, psychiatric conditions should not be automatically attributed as an emotional response to the accident. If an MVA results in chronic pain associated with, for example, a back injury, we might see severe depression. It is logical for an attorney, or even a psychiatrist without BIM or Forensic training to conclude the depression is associated with pain or a prognosis that changes the ability to work or family dynamics. If the Depression is related to a brain injury, diagnosis, prognosis and, ultimately, damages awarded in litigation, can look very different. If one expert believes brain injury to drive other psychiatric conditions, but that expert does not have the qualifications to opine in this way, it behooves an attorney to consider an expert witness who is better qualified in this area. Testimony is only one piece. An attorney preparing to depose an expert witness who has rendered an opinion might want to consult with a BIM Board-Certified doctor to prepare questions that invite a better understanding of an expert’s opinions–including if they are founded on sound experience and qualifications.
Competency, Testamentary Capacity, Undue Influence.
Brain Injury can lead to neurocognitive symptoms that impact decisional capacity. Competency implies the exercise of free will with clear-thinking and lucid decision-making–and a functioning brain. TBI can impact Testamentary Capacity in of itself. TBI and Chronic traumatic encephalopathy (CTE) can increase the risk of Dementia which is associated with many Testamentary Capacity cases. Both TBI and Dementia can render an individual susceptible to undue influence.
Criminal Allegations and TBI
About half of all criminal offenders have a history of TBI. In criminal cases, TBI may play a role in Mitigation, Competency to Stand Trial and Insanity (NGRI) questions. A brain injury can interfere with decision-making, clarity and even behavior, including criminal behavior. Many jurisdictions require certification in Forensic Psychiatry or other specific training to be qualified to opine on these questions. A non-forensic psychiatrist, neurologist and PM&R physicians may not be qualified to perform Competency to Stand Trial and Insanity evaluations.
Dr. Adhia is a triple Board-Certified Forensic Psychiatrist, among fewer than a dozen Board-Certified Forensic Psychiatrists in the U.S. who are also Board-Certified in Brain Injury Medicine. He treats patients with brain and spinal cord injuries at TIRR Memorial Hermann Research and Rehabilitation in Houston as a Psychiatrist and Brain Injury Medicine specialists. Dr. Adhia is an Assistant Professor of Psychiatry at the University of Texas Health and Science Center.
Dr. Adhia is sought as a consultant and expert witness by attorneys about competency, psychiatric damages in civil litigation, impact of drugs and alcohol on behavior, mitigation and damages (civil) including DFSA (date-rape drugs), criminal responsibility and Fitness for Duty though he is qualified to testify about a range of psychiatric topics and has conducted many IMES, review of records and opinions by report including settled cases.
Copyright Sanjay Adhia, M.D.
More information about this article at Sanjay Adhia, M.D.
Disclaimer: While every effort has been made to ensure the accuracy of this publication, it is not intended to provide legal advice as individual situations will differ and should be discussed with an expert and/or lawyer.For specific technical or legal advice on the information provided and related topics, please contact the author.