White Plains, New York – In a thirty page decision, Judge Scuccimarra made clear that testimony of The Forensic Panel’s Joseph Merlino, M.D., and the methodology employed in his psychiatric evaluation was the difference maker.
Dennis Watson was an inmate at Fishkill Correctional Facility who asserted that he fell and was seriously injured while performing a plumbing work detail in 2002. Among his reported injuries were an inability to walk and even urinary and fecal incontinence. Watson asserted an inability to move his legs, yet would get erections and even ejaculated during catheterization. Many physician specialists encountered Watson over a period of years, issuing a number of interpretations of his many symptoms – few of which yielded findings on test results.
An earlier trial found the state to be partially liable for negligence. The court scheduled a subsequent damages trial. Mr. Watson claimed a number of ongoing neurological issues. The neurologist retained by Watson’s attorney performed an amytal interview to try to better inform questions of the legitimacy of Watson’s reported paralysis. Under the influence of the amytal, known to many as “truth serum,” Watson moved his legs. The neurologist diagnosed both a neurological condition and a (hysteria) conversion disorder.
Conversion disorder is the rare psychiatric phenomenon in which a person’s loss of neurological function is not real, but rather entirely psychological. The person with a conversion disorder is working through a psychological conflict, and is unaware that no neurological deficit actually exists. So the neurologist retained by Watson asserted that the plaintiff was unaware that his paralysis was not real. But what was the evidence for what Watson knew, or did not?
New York State attorneys retained The Forensic Panel to sort out just this question, presenting a sea of medical records of variable quality of documentation. After considering expertise that straddled both neurology and psychiatry, Dr. Merlino, a psychiatrist with a psychoanalytic background, was selected as the primary examiner. Dr. Merlino is the Executive Director of King’s County Hospital Department of Psychiatry, a pragmatic thinker amidst chaos and an excellent communicator.
The peer review lineup was Steven Snyder, M.D., Associate Professor of Psychiatry at Mount Sinai School of Medicine and Michael Welner, M.D., Chairman of The Forensic Panel. The mission: to tease apart the subtle differences between conversion disorder, factitious disorder (conscious production of symptoms for unconscious gain), and malingering (conscious production of symptoms for conscious secondary gain). All three possible diagnoses are closely related. Dr. Merlino’s evaluation forced an assessment of whether symptoms originated in the unconscious or conscious intent.
Dr. Merlino undertook a careful review of records and integrated a prepared interview plan with the input of his peer reviewers. His analysis closely meshed the progression of Watson’s condition with events in the claimant’s legal proceeding and how informed each caregiver had been about previous history, eventually arriving at an opinion that Watson was malingering, and supportive of the State’s position.
Dr. Merlino took the stand to educate the jury about the contents of his peer-reviewed report. It was only the second time in 2011 that an examiner from The Forensic Panel was even required to present testimony; the practice consistently contributes to cases resolving without trial.
The court ruled that Watson was not injured beyond temporary pain and suffering from the fall, and limited his compensation to $7,500, far less than the many figured judgment he had been seeking. In his opinion, Judge Scuccimarra particularly referenced Dr. Merlino’s testimony for having been evidence-based, noting the testimony was more credible “because it derived from a substantial foundation.” Furthermore, the Court praised Dr. Merlino’s “exhaustive review of the records, his extensive interview of the claimant.” In addition, Judge Scuccimarra cited Dr. Merlino for having his findings vetted through the peer review attested in his report.
In Judge Scuccimarra’s opinion, he lent some credence to the plaintiff neurologist’s testimony. However, the Court endorsed the approach of integrating the medical information with psychiatric understanding, the path directed by The Forensic Panel in Dr. Merlino’s examination. The court appreciated Dr. Merlino’s testimony that malingering can be adaptive, and the court was impressed with how Dr. Merlino carefully presented evidence in full consideration of the other diagnostic possibilities, including somatization disorder.
Responding to The Court’s decision, Dr. Welner commented, “thoroughness, objectivity, and respect for the science are hallmarks of this practice. The Judge recognized these qualities as well as the oversight afforded through peer review. Dr. Merlino’s testimony was the last word because his high competence engaged the case as the evidence would lead. He conveyed clarity from the witness stand and the result is an example for how to sort out the false presentation driven by the unconscious from one consciously inspired by the prospect of monetary gain. Beautifully done.”
