Depression and Post-Traumatic Stress Disorder (PTSD) are the most common psychological responses to severe burn injuries. Those who develop PTSD as a result of such injuries become highly susceptible to long term depression and anxiety. In addition to burns being sudden, unexpected life-threatening experiences, burn injuries also involve extremely painful and intrusive medical procedures. The procedures alone can be traumatic. Disfigurement can exacerbate symptoms of PTSD because of the likelihood of flashbacks about the injury. Greater disfigurement also has a greater impact on the victim’s day-to day-interaction with others.
The Plaintiff in this case is a young man, age 21, who was on vacation and driving a dune buggy, when the vehicle burst into flames following a roll over. As a result of the injury, the young man sustained 50%+ burns leaving him with substantial and permanent scarring on his arms, back, chest, and abdomen. He was admitted into the intensive care unit and was resuscitated. Initially his wounds were cleaned, followed by debridement, and then numerous grafting surgeries. These surgeries were extremely painful. The young man did not begin walking until more than one year after the accident. He was released from the hospital one and one-half years after the injury. The Plaintiff continued to return to the hospital for treatments and subsequent surgeries to the wounds on his body. He was unable to return to work for two years, post-accident, and eventually returned to work part time. As a result of the incident and subsequent injuries, as well as the painful and lengthy treatment process, the young man developed significant psychological symptoms after the incident. He continued to avoid social interactions due to his embarrassment about his scars. He also developed panic attacks and sought therapy for his psychological injuries. Finally, his injuries left him with limited energy, and he no longer enjoyed the active life style he had previously enjoyed.
I was contacted by the Plaintiff’s attorney and asked to complete an independent psychological evaluation of the Plaintiff. Regardless of which attorney contacts me, I follow the same evaluation process. The process utilized is one that permits the examiner’s opinion to be documented by multiple sources of information and scientific data. The process described minimizes confirmatory bias and increases the credibility of the expert’s ultimate opinions.
Records Obtained Prior to the Examination:
I initially requested all the legal documents, including the Complaint. I also requested a complete copy of the Plaintiff’s medical and counseling records, from five years before the incident, up until the time of the evaluation. Finally, I requested and reviewed the Plaintiff’s school records. These outside records allow for the examiner to rule out other traumatic events in the life of the Plaintiff, as well as underlying behavioral and personality functioning prior to the incident. School records are an excellent way of learning about the Plaintiff’s educational aptitude and achievement, which can impact the functioning of the Plaintiff, beyond that of the alleged injury.
At the time of the evaluation, I began by taking a family history from the Plaintiff, again to assess any pre-existing injuries the Plaintiff experienced prior to the incident. I also asked the Plaintiff to describe the incident and medical treatment following the incident. Finally, I asked the young man about any changes to his life that had occurred because of the incident. Specifically, I asked him about his recreational, vocational, and relational functioning, both prior to and after the incident. I then administered a battery of psychological tests. Psychological testing is particularly helpful in such cases to scientifically evaluate the Plaintiff’s functioning at the time of the evaluation. Psychological tests are like the diagnostic tests administered by physicians. Such testing permits the opportunity for the evaluator to objectively assess the Plaintiff’s injuries with demonstrative evidence that can be shown to a potential jury. Psychological testing is also effective in determining the Plaintiff’s response style–whether the Plaintiff’s responses are suggestive of malingering or under reporting. The battery of tests utilized included a well validated objective personality test, projective testing to assess the Plaintiff’s underlying personality functioning, and a trauma assessment inventory. Utilizing a Trauma Assessment Inventory that is well validated again provides quantifiable results to substantiate the expert’s ultimate opinion about the presence of PTSD.
Unfortunately, many experts interview the Plaintiff and form an opinion based on the interview alone, coupled with only some of the records reviewed. The standard of care in forensic evaluations, according to the American Psychological Association, is that the evaluator review multiple sources of information and utilize multiple assessment measures prior to forming their opinion. A forensically sound independent psychological evaluation obtains information from multiple sources to prevent the examiner’s confirmatory bias. Psychological testing further offers outside scientific documentation of the examiner’s ultimate opinions. In my experience over the past 35 years conducting such evaluations, psychological testing is extremely helpful in reaching settlements, and particularly effective if the case goes to trial.