Nuts & Bolts of HWE Cases (1) (Part 3 of 4)
Interpretive Report: Clinical Settings
M Mpi-2-Rf®
M innesota Multiphasic Personality Inventory-2-Restructured Form® Yossef S. Ben-Porath, PhD, & Auke Tellegen, PhD N ame: IM E2 A ge: 57 G ender: Female M arital Status: Not reported Y ears of Education: Not reported Date Assessed: 02/27/2022 Copyright © 2008, 2011, 2012 by the Regents of the University of Minnesota. All rights reserved.
Distributed exclusively under license from the University of Minnesota by NCS Pearson, Inc. Portions reproduced from the MMPI-2-RF test booklet. Copyright © 2008 by the Regents of the University of Minnesota. All rights reserved. Portions excerpted from the MMPI-2-RF Manual for Administration, Scoring, and Interpretation. Copyright © 2008, 2011 by the Regents of the University of Minnesota. All rights reserved.
Used by permission of the University of Minnesota Press. Minnesota Multiphasic Personality Inventory-2-Restructured Form and MMPI-2-RF are registered trademarks of the University of Minnesota. Pearson is a trademark in the U.S. and/or other countries of Pearson Education, Inc., or its affiliate(s). This report contains copyrighted material and trade secrets. The qualified licensee may excerpt portions of this output report, limited to the minimum text necessary to accurately describe their significant core conclusions, for incorporation into a written evaluation of the examinee, in accordance with their profession's citation standards, if any. No adaptations, translations, modifications, or special versions may be made of this report without prior written permission from the University of Minnesota Press.
[ 4.3 / 57 / Qg ]
MMPI-2-RF® Interpretive Report: Clinical Settings 02/27/2022, Page 2 IM E2 MMPI-2-RF Validity Scales 120 --- --- --- --- --- --- --- T --- --- --- 30 --- VRIN-r TRIN-r F-r Fp-r Fs FBS-r RBS L-r K-r Cannot Say (Raw): 0 Percent True (of items answered): 35% The highest and lowest T scores possible on each scale are indicated by a "---"; MMPI-2-RF T scores are non-gendered.
VRIN-r Variable Response Inconsistency Fs Infrequent Somatic Responses L-r Uncommon Virtues TRIN-r True Response Inconsistency FBS-r Symptom Validity K-r Adjustment Validity F-r Infrequent Responses RBS Response Bias Scale Fp-r Infrequent Psychopathology Responses
---.
--- ---.
MMPI-2-RF® Interpretive Report: Clinical Settings 02/27/2022, Page 3 IM E2 MMPI-2-RF Higher-Order (H-O) and Restructured Clinical (RC) Scales Higher-Order Restructured Clinical 100 --- --- --- --- --- --- --- --- --- 90 --- 40 --- --- --- --- --- --- --- --- 30 --- EID THD BXD RCd RC1 RC2 RC3 RC4 RC6 RC7 RC8 RC9 The highest and lowest T scores possible on each scale are indicated by a "---"; MMPI-2-RF T scores are non-gendered.
EID Emotional/Internalizing Dysfunction RCd Demoralization RC6 Ideas of Persecution THD Thought Dysfunction RC1 Somatic Complaints RC7 Dysfunctional Negative Emotions BXD Behavioral/Externalizing Dysfunction RC2 Low Positive Emotions RC8 Aberrant Experiences RC3 Cynicism RC9 Hypomanic Activation RC4 Antisocial Behavior
--- --- --- --- ---.
MMPI-2-RF® Interpretive Report: Clinical Settings 02/27/2022, Page 4 IM E2 MMPI-2-RF Somatic/Cognitive and Internalizing Scales Somatic/Cognitive Internalizing 100 --- --- --- --- --- --- --- --- 80 --- --- --- 40 --- --- --- --- --- --- --- --- --- --- --- --- --- ---
Mls Gic Hpc Nuc Cog Sui Hlp Sfd Nfc Stw Axy Anp Brf Msf
The highest and lowest T scores possible on each scale are indicated by a "---"; MMPI-2-RF T scores are non-gendered. MLS Malaise SUI Suicidal/Death Ideation AXY Anxiety GIC Gastrointestinal Complaints HLP Helplessness/Hopelessness ANP Anger Proneness HPC Head Pain Complaints SFD Self-Doubt BRF Behavior-Restricting Fears NUC Neurological Complaints NFC Inefficacy MSF Multiple Specific Fears COG Cognitive Complaints STW Stress/Worry
--- ---. ---.
--- ---. --- --- --- ---.
MMPI-2-RF® Interpretive Report: Clinical Settings 02/27/2022, Page 5 IM E2 MMPI-2-RF Externalizing, Interpersonal, and Interest Scales Externalizing Interpersonal Interest 100 --- 90 --- 80 --- --- 40 --- --- --- --- --- --- --- --- --- ---
Jcp Sub Agg Act Fml Ipp Sav Shy Dsf Aes Mec
The highest and lowest T scores possible on each scale are indicated by a "---"; MMPI-2-RF T scores are non-gendered. JCP Juvenile Conduct Problems FML Family Problems AES Aesthetic-Literary Interests SUB Substance Abuse IPP Interpersonal Passivity MEC Mechanical-Physical Interests AGG Aggression SAV Social Avoidance ACT Activation SHY Shyness DSF Disaffiliativeness
MMPI-2-RF® Interpretive Report: Clinical Settings 02/27/2022, Page 6 IM E2 MMPI-2-RF PSY-5 Scales 100 --- --- --- 30 --- --- --- AGGR-r PSYC-r DISC-r NEGE-r INTR-r The highest and lowest T scores possible on each scale are indicated by a "---"; MMPI-2-RF T scores are non-gendered. AGGR-r Aggressiveness-Revised PSYC-r Psychoticism-Revised DISC-r Disconstraint-Revised NEGE-r Negative Emotionality/Neuroticism-Revised INTR-r Introversion/Low Positive Emotionality-Revised
MMPI-2-RF® Interpretive Report: Clinical Settings 02/27/2022, Page 7 IM E2
Mmpi-2-Rf T Scores (By Domain)
Protocol Validity
Content Non-Responsiveness 0 43 65 T CNS VRIN-r TRIN-r F-r Fp-r Fs FBS-r RBS L-r K-r
Substantive Scales
Rc1 Mls Gic Hpc Nuc Cog
EID RCd SUI HLP SFD NFC 50 67 RC2 INTR-r RC7 STW AXY ANP BRF MSF NEGE-r
Thd Rc6
RC8 PSYC-r
Bxd Rc4 Jcp Sub
RC9 AGG ACT AGGR-r DISC-r
Fml Rc3 Ipp Sav Shy Dsf
Aes Mec
S cale scores shown in bold font are interpreted in the report. Note. This information is provided to facilitate interpretation following the recommended structure for MMPI-2-RF interpretation in Chapter 5 of the MMPI-2-RF Manual for Administration, Scoring, and Interpretation, which provides details in the text and an outline in Table 5-1.
MMPI-2-RF® Interpretive Report: Clinical Settings 02/27/2022, Page 8 IM E2 This interpretive report is intended for use by a professional qualified to interpret the MMPI-2-RF. The information it contains should be considered in the context of the test taker's background, the circumstances of the assessment, and other available information.
Synopsis
Scores on the MMPI-2-RF validity scales raise concerns about the possible impact of under-reporting on the validity of this protocol. With that caution noted, scores on the substantive scales indicate emotional, thought, and interpersonal dysfunction. Emotional-internalizing findings relate to anxiety.
Dysfunctional thinking relates to ideas of persecution. Interpersonal difficulties include social avoidance and cynicism.
Protocol Validity
C ontent Non-Responsiveness There are no problems with unscorable items in this protocol. The test taker responded relevantly to the items on the basis of their content. O ver-Reporting There are no indications of over-reporting in this protocol. U nder-Reporting The test taker presented herself in an extremely positive light by denying many minor faults and shortcomings that most people acknowledge. This level of virtuous self-presentation is very uncommon even in individuals with a background stressing traditional values. Any absence of elevation on the substantive scales is uninterpretable1. Elevated scores on the substantive scales may underestimate the problems assessed by those scales2.
Substantive Scale Interpretation
Clinical symptoms, personality characteristics, and behavioral tendencies of the test taker are described in this section and organized according to an empirically guided framework. Statements containing the word "reports" are based on the item content of MMPI-2-RF scales, whereas statements that include the word "likely" are based on empirical correlates of scale scores. Specific sources for each statement can be accessed with the annotation features of this report.
MMPI-2-RF® Interpretive Report: Clinical Settings 02/27/2022, Page 9 IM E2 The following interpretation needs to be considered in light of cautions noted about the possible impact of under-reporting on the validity of this protocol. S omatic/Cognitive Dysfunction There are no indications of somatic or cognitive dysfunction in this protocol. However, because of indications of under-reporting described earlier, such problems cannot be ruled out.
E motional Dysfunction The test taker reports feeling anxious3 and is likely to experience significant anxiety and anxiety-related problems4, intrusive ideation, and nightmares5. T hought Dysfunction The test taker reports significant persecutory ideation such as believing that others seek to harm her6.
She is likely to be suspicious of others7, to experience interpersonal difficulties as a result of suspiciousness8, and to lack insight8. B ehavioral Dysfunction There are no indications of maladaptive externalizing behavior in this protocol. However, because of indications of under-reporting described earlier, such problems cannot be ruled out.
I nterpersonal Functioning Scales The test taker reports having cynical beliefs, distrust of others, and believing others look out only for their own interests9. She is likely to be hostile toward others10 and feel alienated from them11, and to have negative interpersonal experiences as a result of her cynical beliefs12. She also reports not enjoying social events and avoiding social situations13. She is likely to be introverted14, to have difficulty forming close relationships15, and to be emotionally restricted16.
I nterest Scales The test taker reports an average number of interests in activities or occupations of an aesthetic or literary nature (e.g., writing, music, the theater)17. She also reports an average number of interests in activities or occupations of a mechanical or physical nature (e.g., fixing and building things, the outdoors, sports)18.
Diagnostic Considerations
This section provides recommendations for psychodiagnostic assessment based on the test taker's MMPI-2-RF results. It is recommended that she be evaluated for the following: E motional-Internalizing Disorders - Anxiety-related disorders including PTSD19
MMPI-2-RF® Interpretive Report: Clinical Settings 02/27/2022, Page 10 IM E2 T hought Disorders - Disorders involving persecutory ideation20 In terpersonal Disorders - P ersonality disorders involving mistrust of and hostility toward others21 - Disorders associated with social avoidance such as avoidant personality disorder22
Treatment Considerations
This section provides inferential treatment-related recommendations based on the test taker's MMPI-2-RF scores. P s ychotherapy Process Issues - P ersecutory ideation may interfere with forming a therapeutic relationship and treatment compliance23. - Cynicism may interfere with forming or seeking a therapeutic relationship24.
P o ssible Targets for Treatment - A nxiety25 - P ersecutory ideation23 - L ack of interpersonal trust21 - Difficulties associated with social avoidance26
Item-Level Information
U nscorable Responses The test taker produced scorable responses to all the MMPI-2-RF items. C ritical Responses Seven MMPI-2-RF scales--Suicidal/Death Ideation (SUI), Helplessness/Hopelessness (HLP), Anxiety (AXY), Ideas of Persecution (RC6), Aberrant Experiences (RC8), Substance Abuse (SUB), and Aggression (AGG)--have been designated by the test authors as having critical item content that may require immediate attention and follow-up. Items answered by the individual in the keyed direction (True or False) on a critical scale are listed below if her T score on that scale is 65 or higher. The percentage of the MMPI-2-RF normative sample that answered each item in the keyed direction is provided in parentheses following the item content.
Anxiety (AXY, T Score = 70) 228. I feel anxiety about something or someone almost all the time. (True, 17.3%) 289. I have often been frightened in the middle of the night. (True, 12.7%)
MMPI-2-RF® Interpretive Report: Clinical Settings 02/27/2022, Page 11 IM E2 Ideas of Persecution (RC6, T Score = 70) 71. I believe I am being plotted against. (True, 2.0%) 110. I feel that I have often been punished without cause. (True, 9.9%) 194. I am sure I am being talked about. (True, 17.1%) 264. Someone has it in for me. (True, 5.3%)
MMPI-2-RF® Interpretive Report: Clinical Settings 02/27/2022, Page 12 IM E2
Endnotes
This section lists for each statement in the report the MMPI-2-RF score(s) that triggered it. In addition, each statement is identified as a Test Response, if based on item content, a Correlate, if based on empirical correlates, or an Inference, if based on the report authors' judgment. (This information can also be accessed on-screen by placing the cursor on a given statement.) For correlate-based statements, research references (Ref. No.) are provided, keyed to the consecutively numbered reference list following the endnotes.
3 Test Response: AXY=70 6 Test Response: RC6=70 9 Test Response: RC3=70 13 Test Response: SAV=75 17 Test Response: AES=39 18 Test Response: MEC=52 21 Inference: RC3=70 23 Inference: RC6=70 25 Inference: AXY=70 26 Inference: SAV=75
MMPI-2-RF® Interpretive Report: Clinical Settings 02/27/2022, Page 13 IM E2
Research Reference List
The following studies are sources for empirical correlates identified in the Endnotes section of this report. 1. Anderson, J. L., Sellbom, M., Ayearst, L., Quilty, L. C., Chmielewski, M., & Bagby, R. M. (2015). Associations between DSM-5 Section III personality traits and the Minnesota Multiphasic Personality Inventory 2-Restructured Form (MMPI-2-RF) scales in a psychiatric patient sample.
P sychological Assessment, 27, 801-815. doi: 10.1037/pas0000096 2. Anderson, J. L., Sellbom, M., Pymont, C., Smid, W., De Saeger, H. & Kamphuis, J. H. (2015). Measurement of DSM-5 Section II personality disorder constructs using the MMPI-2-RF in clinical a nd forensic samples. Psychological Assessment, 27, 786-800. doi: 10.1037/pas0000103 3. Arbisi, P. A., Polusny, M. A., Erbes, C. R., Thuras, P., & Reddy, M. K. (2011). The Minnesota Multiphasic Personality Inventory-2 Restructured Form in National Guard soldiers screening positive for posttraumatic stress disorder and mild traumatic brain injury. Psychological A ssessment, 23, 203-214. doi: 10.1037/a0021339 4. Arbisi, P. A., Rusch, L., Polusny, M. A., Thuras, P. & Erbes, C. R. (2013). Does cynicism play a role in failure to obtain needed care? Mental health service utilization among returning U.S.
N ational Guard soldiers. Psychological Assessment, 25, 991-996. doi: 10.1037/a0032225 5. Arbisi, P. A., Sellbom, M., & Ben-Porath, Y. S. (2008). Empirical correlates of the MMPI-2 Restructured Clinical (RC) Scales in psychiatric inpatients. Journal of Personality Assessment, 90, 1 22-128. doi: 10.1080/00223890701845146 6. Ayearst, L. E., Sellbom, M., Trobst, K. K., & Bagby, R. M. (2013). Evaluating the interpersonal content of the MMPI-2-RF Interpersonal Scales. Journal of Personality Assessment, 95, 187-196.
d oi: 10.1080/00223891.2012.730085 7. Block, A. R., Ben-Porath, Y. S., & Marek, R. J. (2013). Psychological risk factors for poor outcome of spine surgery and spinal cord stimulator implant: A review of the literature and their assessment with the MMPI-2-RF. The Clinical Neuropsychologist, 27, 81-107. doi:
1 0.1080/13854046.2012.721007 8. Burchett, D. L., & Ben-Porath, Y. S. (2010). The impact of over-reporting on MMPI-2-RF s ubstantive scale score validity. Assessment, 17, 497-516. doi: 10.1177/1073191110378972 9. Cox, A., Courrege, S. C., Felder, A. H., & Weed, N. C. (2017). Effects of augmenting response options of the MMPI-2-RF: An extension of previous findings. Cogent Psychology, 4, 1323988.
d oi: 10.1080/23311908.2017.1323988 10. Cox, A, Pant, H., Gilson, A. N., Rodriguez, J. L., Young, K. R., Kwon, S., & Weed, N. C., (2012). Effects of augmenting response options on MMPI-2 RC Scale psychometrics. Journal of P ersonality Assessment, 94, 613-619. doi: 10.1080/00223891.2012.700464
MMPI-2-RF® Interpretive Report: Clinical Settings 02/27/2022, Page 14 IM E2 11. Crighton, A. H., Marek, R. J., Dragon, W. R., & Ben-Porath, Y. S. (2017). Utility of the MMPI-2-RF Validity Scales in the detection of simulated underreporting: Implications of i ncorporating a manipulation check. Assessment, 24, 853-864. doi: 10.1177/1073191115627011 12. Finn, J. A., Ben-Porath, Y. S., & Tellegen, A. (2015). Dichotomous versus polytomous response options in psychopathology assessment: Method or meaningful variance? Psychological A ssessment, 27, 184-193. doi: 10.1037/pas0000044 13. Forbey, J. D., Arbisi, P. A., & Ben-Porath, Y. S. (2012). The MMPI-2 computer adaptive version (MMPI-2-CA) in a VA medical outpatient facility. Psychological Assessment, 24, 628-639.
d oi: 10.1037/a0026509 14. Forbey, J. D., & Ben-Porath, Y. S. (2008). Empirical correlates of the MMPI-2 Restructured Clinical (RC) Scales in a non-clinical setting. Journal of Personality Assessment, 90, 136-141. doi: 1 0.1080/00223890701845161 15. Forbey, J. D., Lee, T. T. C., Ben-Porath, Y. S., Arbisi, P. A., & Gartland, D. (2013).
Associations between MMPI-2-RF validity scale scores and extra-test measures of personality and p sychopathology. Assessment, 20, 448-461. doi: 10.1177/1073191113478154 16. Forbey, J. D., Lee, T. T. C., & Handel, R. W. (2010). Correlates of the MMPI-2-RF in a college s etting. Psychological Assessment, 22, 737-744. doi: 10.1037/a0020645 17. Franz, A. O., Harrop, T. M., & McCord, D. M. (2017). Examining the construct validity of the MMPI-2-RF Interpersonal Functioning Scales using the Computerized Adaptive Test of Personality Disorder as a comparative framework. Journal of Personality Assessment, 99, 416-423. doi:
1 0.1080/00223891.2016.1222394 18. Gottfried, E. D., Anestis, J. C., Dillon, K. H., & Carbonell, J. J. (2016). The associations between Minnesota Multiphasic Personality Inventory-2-Restructured From and self-reported physical and sexual abuse and posttraumatic symptoms in a sample of incarcerated women.
I nternational Journal of Forensic Mental Health. doi: 10.1080/14999013.2016.1228088 19. Handel, R. W., & Archer, R. P. (2008). An investigation of the psychometric properties of the MMPI-2 Restructured Clinical (RC) Scales with mental health inpatients. Journal of Personality A ssessment, 90, 239-249. doi: 10.1080/00223890701884954 20. Ingram, P. B., Kelso, K. M., & McCord, D. M. (2011). Empirical correlates and expanded interpretation of the MMPI-2-RF Restructured Clinical Scale 3 (Cynicism). Assessment, 18, 95-101.
d oi: 10.1177/1073191110388147 21. Marion, B. E., Sellbom, M., Salekin, R. T., Toomey, J. A., Kucharski, T., & Duncan, S. (2013). An examination of the association between psychopathy and dissimulation using the MMPI-2-RF V alidity Scales. Law and Human Behavior, 37, 219-230. doi: 10.1037/lhb0000008 22. Menton, W. H., Crighton, A. H., Tarescavage, A. M., Marek, R. J., Hicks, A. D., & Ben-Porath, Y. S. (2017). Equivalence of laptop and tablet administrations of the Minnesota Multiphasic P ersonality Inventory-2 Restructured Form. Assessment. doi: 0.1177/1073191117714558
MMPI-2-RF® Interpretive Report: Clinical Settings 02/27/2022, Page 15 IM E2 23. Rogers, M. L., Anestis, J. C., Harrop, T. M., Schneider, M., Bender, T. W., Ringer, F. B., & Joiner, T. E. (2017). Examination of MMPI-2-RF substantive scales as indicators of acute suicidal affective disturbance components. Journal of Personality Assessment, 99, 424-434. doi:
1 0.1080/00223891.2016.1222393 24. Sellbom, M., Anderson, J. L., & Bagby, R. M. (2013). Assessing DSM-5 Section III Personality Traits and Disorders with the MMPI-2-RF. Assessment, 20, 709-722. doi: 1 0.1177/1073191113508808 25. Sellbom, M., & Bagby, R. M. (2008). The validity of the MMPI-2-RF (Restructured Form) L-r and K-r scales in detecting under-reporting in clinical and non-clinical samples. Psychological A ssessment, 20, 370-376. doi: 10.1037/a0012952 26. Sellbom, M., Bagby, R. M., Kushner, S., Quilty, L. C., & Ayearst, L. E. (2011). Diagnostic construct validity of the MMPI-2 Restructured Form (MMPI-2-RF) scale scores. Assessment, 19, 1 76-186. doi: 10.1177/1073191111428763 27. Sellbom, M., & Ben-Porath, Y. S. (2005). Mapping the MMPI-2 Restructured Clinical (RC) Scales onto normal personality traits: Evidence of construct validity. Journal of Personality A ssessment, 85, 179-187. doi: 10.1207/s15327752jpa8502_10 28. Sellbom, M., Ben-Porath, Y. S., & Bagby, R. M. (2008). Personality and psychopathology:
Mapping the MMPI-2 Restructured Clinical (RC) Scales onto the five factor model of personality. J ournal of Personality Disorders, 22, 291-312. doi: 10.1521/pedi.2008.22.3.291 29. Sellbom, M., Graham, J. R., & Schenk, P. (2006). Incremental validity of the MMPI-2 Restructured Clinical (RC) Scales in a private practice sample. Journal of Personality Assessment, 8 6, 196-205. doi: 10.1207/s15327752jpa8602_09 30. Sellbom, M., Lee, T. T. C., Ben-Porath, Y. S., Arbisi, P. A., & Gervais, R. O. (2012).
Differentiating PTSD Symptomatology with the MMPI-2-RF (Restructured Form) in a Forensic D isability Sample. Psychiatry Research, 197, 172-179. doi: 10.1016/j.psychres.2012.02.003 31. Shkalim, E. (2015). Psychometric evaluation of the MMPI-2/MMPI-2-RF Restructured Clinical S cales in an Israeli sample. Assessment, 22, 607-618. doi: 10.1177/1073191114555884 32. Tellegen, A., & Ben-Porath, Y. S. (2008/2011). The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF): Technical manual. Minneapolis: University of M innesota Press.
33. Van der Heijden, P. T., Egger, J. I. M., Rossi, G., Grundel, G., & Derksen, J. J. L. (2013). The MMPI-2 Restructured Form and the standard MMPI-2 Clinical Scales in relation to DSM-IV. European Journal of Psychological Assessment, 29, 182-188. doi: 10.1027/1015-5759/a000140 End of Report
MMPI-2-RF® Interpretive Report: Clinical Settings 02/27/2022, Page 16 IM E2
Item Responses
Client is capped under Title VII yet Employer Settled for Well Above Cap Diagnosis – Causation – Prognosis Function is always key Forensic Psychiatrist Conclusions: In view of my findings, I have reached the following conclusions in this case to a reasonable degree of psychiatric certainty: 1. Ms. Client is suffering from a serious psychiatric condition. Her diagnoses are Posttraumatic Stress Disorder; Major Depressive Disorder, Recurrent, Severe, without Psychotic Features; Generalized Anxiety Disorder with Panic Attacks (and Agoraphobia). Her prognosis is very poor.
2. As a result of her psychiatric condition, she continues to experience clinically significant emotional distress and her functioning has deteriorated in a number of important areas. 3. In my differential diagnosis, I have considered and ruled out malingering as the cause of her psychiatric condition.
4. My differential diagnosis includes other possible alternative causes of her psychiatric condition. This would include the family discord surrounding the disposition of her father’s property and her altercation with her brother. These issues were a chronic source of stress over many years and, in my professional opinion, were not causally related to her present psychiatric condition. A medical condition, namely, menopause (and hormone replacement therapy) may have possibly contributed to some extent to her psychiatric condition.
5. Ms. Client’s perceptions of alleged constant sexual harassment, a hostile work environment, and a punitive demotion at work, as described above, were a substantial cause of her psychiatric condition, causing overwhelming traumatic emotional stress which resulted in severe and persistent psychiatric symptoms and deteriorated functioning.
6. Ms. Client’s condition has remained refractory and she has not shown a favorable response to evidence-based treatment measures. In view of her lack of improvement despite intensive treatment for about one and a half years with psychotherapy and a regimen of psychotropic medications and her mental health
providers’ repeated statements that she requires continuing medical leaves and remains unable to return to work, as well as the determination by Social Security Disability that she is disabled and entitled to disability benefits, in my professional opinion, she will never be able to return to work at Employer in the same capacity (i.e. Executive Assistant to the CEO) or be able to function in a comparable position at the same level of responsibility and duties at another major medical facility in Montana. Moreover, in my professional opinion, the totality of circumstances has establishedthat, in view of her refractory disabling psychiatric condition, emotional fragility, entrenched functional deterioration, and the humiliation ofstarting from the bottom again, she would be unable to start over again and return to work at any other type of non-medical administrative job.
7. There is not a scintilla of evidence that Ms. Client has demonstrated slow but steady progress, or any progress whatsoever, in treatment; nor is there any realistic psychiatric basis to prognosticate that she is likely to respond to continuing treatment measures in the future to the extent that she will be able to return to a functional level of daily living including the ability to return to employment of any kind.
8. Ms. Client would benefit from continuing mental health treatment to attempt to alleviate her emotional distress to whatever extent possible and to prevent further deterioration of her condition and a need for hospitalization in the future. 9. I have had extensive clinical experience in the evaluation and treatment of PTSD. I treated and supervised the treatment of well over a thousand patients suffering from PTSD during my tenure as Director of Psychiatric Outpatient Services at the New York VA Medical Center. Over the years, I have treated many patients suffering from PTSD in my private practice; I have been retained as a psychiatric expert in a number of criminal and civil cases on the issue of PTSD; and I have authored articles in the professional literature on stress-related psychiatric conditions and given lectures and presentations on the diagnosis and management of PTSD.
Example of the caselaw including in the 9th Cir where we were and excerpt of letter to opposing counel: In Pollard v. E. I. du Pont de Nemours & Co., 532 U.S. 843 (2001), the Court held that where “reinstatement [was] not viable because of . . . psychological injuries suffered by the plaintiff as a result of” sexual harassment, “front pay [i]s a substitute for reinstatement, . . . not an element of compensatory damages within the meaning of § 1981a, and, . . the statutory cap of § 1981a(b)(3) is inapplicable to front pay.” 532 U.S. at 846- 848.
In Wooten v. BNSF Ry. Co., No. 19-35431, 2020 U.S. App. LEXIS 19446, at *5-7 (9th Cir. June 22, 2020), this Circuit affirmed an award of over 33 years of front pay. The court noted that: Wooten had a limited education and was from a small railroad town. He came from a railroad family—his grandfather retired from the railroad— and worked at one of the best paying jobs in the area. Notably, Wooten acquired at BNSF a specific set of skills that were related only to the transportation industry. After being dismissed in violation of the FRSA,1 Wooten was faced with an essentially non-existent job market [*6] for comparable paying jobs.
Wooten v. BNSF Ry. Co., No. 19-35431, 2020 U.S. App. LEXIS 19446, at *5-6 (9th Cir. June 22, 2020). Crediting the jury’s verdict, the Ninth Circuit noted Defendant had the burden of proof that Plaintiff failed to mitigate, and that: BNSF did not show that Wooten would be able to find a comparable job at any point over his expected working career.
Moreover, given the salary Wooten earned at BNSF and the benefits associated with the seniority that he enjoyed, Wooten would not have had any economically rational reason to ever leave BNSF, making it far from speculative to find that he would have stayed at the company until his retirement. Wooten v. BNSF Ry. Co., No. 19-35431, 2020 U.S. App. LEXIS 19446, at *6 (9th Cir. June 22, 2020)(unpublished)
There are significant parallels between the Ninth Circuit’s holding and the instant case. The Ninth Circuit found it important that: BNSF's own expert . . . testified that Wooten had a highly specialized set of skills derived from his work at BNSF; . . [and] that it was unclear whether another railroad would even be willing to hire him.
Wooten, 2020 U.S. App. LEXIS 19446, at *6 (9th Cir. June 22, 2020) Here, the expert selected by Defendant opined that Ms. Client would be “incapable of functioning efficiently or in being able to concentrate. I would encourage continuation of the FMLA until her physicians feel that she is prepared to return to her regular duties.” Report of Psychologist, Ph.D. April 10, 2019. At trial Employer will face a much steeper uphill battle than the Defendant in Wooten. It will also be forced to impeach its own highly respected mental health practitioners. Emily psychiatrist, a respected former attending psychiatrist at Employer, wrote in April 2019 that “I am currently unable to estimate a return-to- work date. This will depend greatly on her progress with aggressive medication management and psychotherapy.” Ms. Client’s current treating practitioner Anne Nurse-Practitioner, APRN, also a respected mental health practitioner and current employee of Defendant, wrote in a January 17, 2020 letter Ms. Client “continues to experience severe anxiety including panic attacks with agoraphobia and symptoms of depression. . . I am currently unable to estimate a return-to-work date.” Ms. Nurse-Practitioner has not changed her opinion. Ms. Client will call both of these providers.
age. 31-Dec. elapsed. W2 AMOUNT (2019. % change. avg % change. present value discount @ 1% based on 10. tax by year. lump sum tax. tax gross up. present value of lost wages 14 and 19 years out.
FRONT PAY.
2002. 31,532.
2003. 31,446. 0%.
2004. 34,562. 10%.
2005. 35,724. 3%.
2006. 37,725. 6%.
2007. 39,872. 6%.
2008. 45,727. 15%.
2009. 49,217. 8%.
2010. 49,566. 1%.
2011. 53,161. 7%.
2012. 55,275. 4%.
2013. 56,637. 2%.
2014. 56,547. 0%.
2015. 59,207. 5%.
2016. 60,875. 3%.
2017. 67,929. 12%.
2018. 71,416. 5%.
52. 2019. 1 year. 74,987. 5%. 5%. $ 74,245. $ 19,194.
53. 2020. 2 years. 78,737. $ 77,957. $ 20,564.
54. 2021. 3 years. 82,673. $ 81,855. $ 22,003.
55. 2022. 4 years. 86,807. $ 85,948. $ 23,514.
56. 2023. 5 years. 91,147. $ 90,245. $ 25,100.
57. 2024. 6 years. 95,705. $ 94,757. $ 26,766.
58. 2025. 7 years. 100,490. $ 99,495. $ 28,597.
59. 2026. 8 years. 105,515. $ 104,470. $ 30,534.
60. 2027. 9 years. 110,790. $ 109,694. $ 32,568.
61. 2028. 10 years. 116,330. $ 115,178. $ 34,703.
62. 2029. 11 years. 122,146. $ 120,937. $ 36,945.
63. 2030. 12 years. 128,254. $ 126,984. $ 39,300.
64. 2031. 13 years. 134,666. $ 133,333. $ 41,662.
65. 2032. 14 years. 141,400. $ 140,000. $ 43,840.
1,469,648. $ 1,455,098. $ 425,290. $ 645,237. $ 219,947. $ 1,675,045.
66. 2033. 15 years. 148,470. $ 147,000. $ 46,128.
67. 2034. 16 years. 155,893. $ 154,350. $ 48,529.
68. 2035. 17 years. 163,688. $ 162,067. $ 51,051.
69. 2036. 18 years. 171,872. $ 170,171. $ 53,699.
70. 2037. 19 years. 180,466. $ 178,679. $ 57,082.
2,290,036. $ 2,267,365. $ 681,779. $ 1,024,667. $ 342,888. $ 2,632,924.
MITTIGATION PAY.
56. 2023. 5 years. 35,000. $ 34,654.
57. 2024. 6 years. 36,750. $ 36,386.
58. 2025. 7 years. 38,588. $ 38,205.
59. 2026. 8 years. 40,517. $ 40,116.
60. 2027. 9 years. 42,543. $ 42,122.
61. 2028. 10 years. 44,670. $ 44,228.
62. 2029. 11 years. 46,903. $ 46,439.
63. 2030. 12 years. 49,249. $ 48,761.
64. 2031. 13 years. 51,711. $ 51,199.
65. 2032. 14 years. 54,296. $ 53,759.
440,226. $ 435,868. $ 435,868.
66. 2033. 15 years. 57,011. $ 56,447.
67. 2034. 16 years. 59,862. $ 59,269.
68. 2035. 17 years. 62,855. $ 62,233.
69. 2036. 18 years. 65,998. $ 65,344.
70. 2037. 19 years. 69,298. $ 68,612.
755,250. $ 747,773. $ 755,250.
FRONT PAY REDUCED BY MITIGATION.
age 65. $ 1,239,177.
age 70. $ 1,877,675.
1 age 31-Decelapsed (2019 % change avg % change based on 10 tax by year lump sum tax tax gross up and 19 years out
2 Front Pay
3 2002 31,532 4 2003 31,446 0% 5 2004 34,562 10% 6 2005 35,724 3% 7 2006 37,725 6% 8 2007 39,872 6% 9 2008 45,727 15% 10 2009 49,217 8% 11 2010 49,566 1% 12 2011 53,161 7% 13 2012 55,275 4% 14 2013 56,637 2% 15 2014 56,547 0% 16 2015 59,207 5% 17 2016 60,875 3% 18 2017 67,929 12% 19 2018 71,416 5% 20 52 2019 1 year 74,987 5% 5% $ 74,245 $ 19,194 21 53 2020 2 years 78,737 $ 77,957 $ 20,564 22 54 2021 3 years 82,673 $ 81,855 $ 22,003 23 55 2022 4 years 86,807 $ 85,948 $ 23,514 24 56 2023 5 years 91,147 $ 90,245 $ 25,100 25 57 2024 6 years 95,705 $ 94,757 $ 26,766 26 58 2025 7 years 100,490 $ 99,495 $ 28,597 27 59 2026 8 years 105,515 $ 104,470 $ 30,534 28 60 2027 9 years 110,790 $ 109,694 $ 32,568 29 61 2028 10 years 116,330 $ 115,178 $ 34,703 30 62 2029 11 years 122,146 $ 120,937 $ 36,945 31 63 2030 12 years 128,254 $ 126,984 $ 39,300 32 64 2031 13 years 134,666 $ 133,333 $ 41,662 33 65 2032 14 years 141,400 $ 140,000 $ 43,840 34 1,469,648 $ 1,455,098 $ 425,290 $ 645,237 $ 219,947 $ 1,675,045 35 66 203315 years 148,470 $ 147,000 $ 46,128 36 67 203416 years 155,893 $ 154,350 $ 48,529 37 68 203517 years 163,688 $ 162,067 $ 51,051 38 69 203618 years 171,872 $ 170,171 $ 53,699 39 70 203719 years 180,466 $ 178,679 $ 57,082 40 2,290,036 $ 2,267,365 $ 681,779 $ 1,024,667 $ 342,888 $ 2,632,924
42Mittigation Pay
43 56 2023 5 years 35,000 $ 34,654 44 57 2024 6 years 36,750 $ 36,386 45 58 2025 7 years 38,588 $ 38,205 46 59 2026 8 years 40,517 $ 40,116 47 60 2027 9 years 42,543 $ 42,122 48 61 2028 10 years 44,670 $ 44,228 49 62 2029 11 years 46,903 $ 46,439 50 63 2030 12 years 49,249 $ 48,761 51 64 2031 13 years 51,711 $ 51,199 52 65 2032 14 years 54,296 $ 53,759 53 440,226 $ 435,868 $ 435,868 54 66 203315 years 57,011 $ 56,447 55 67 203416 years 59,862 $ 59,269 56 68 203517 years 62,855 $ 62,233 57 69 203618 years 65,998 $ 65,344 58 70 203719 years 69,298 $ 68,612 59 755,250 $ 747,773 $ 755,250
61Front Pay Reduced By Mitigation
63 age 65 $ 1,239,177 64 age 70 $ 1,877,675
1 David R. Spiegel, Md
2 Exhibit 3, but you're also able to view it on
3 the screen, correct, Doctor?
4 A. Yes. 5 Q. Alrighty. And I'd like you just to 6 take a moment to review it and tell me if you 7 recognize it as the DSM-V criteria for paranoid 8 personality disorder. 9 A. Yes. 10 Q. Thank you. So the document seems to 11 be broken down into two sections, A and B, and 12 tell me if this is correct:
13 "A" sets forth a couple of conditions 14 that are absolute, that have to be present, and 15 then it lists seven conditions, four of which 16 have to be present. 17 A. Yes. 18 Q. And in A, among those that have to be 19 present is onset of the paranoid personality 20 disorder beginning by early adulthood. Is that
21 correct?
22 A. Yes. 23 Q. And it doesn't rule out the 24 possibility that it could have manifested
25 earlier than early adulthood, correct?
TransPerfect Legal Solutions 212-400-8845 - Depo@TransPerfect.com
1 David R. Spiegel, Md
2 A. Potentially, correct. 3 Q. So in order for you to reach your 4 diagnosis, you relied on facts or evidence that 5 demonstrated that Ms. paranoid 6 personality disorder was manifested latest by
7 early adulthood, correct?
8 A. Correct. 9 Q. I'd like you to tell me what those 10 facts were. And if those facts were provided to 11 you by a source, I'd like you to tell me what 12 the source was. 13 A. Well, again, we'll start with the 14 MMPI because that source said she also had 15 paranoid personality disorder. But beyond that, 16 the -- I'm attributing the variety of context of 17 the legal action to be some rough evidence.
18 I didn't know in her 19 20s, so I couldn't tell you exactly when, but it 20 is certainly not uncommon for patients with 21 paranoid personality disorder not present to 22 treatment, so it would be hard to say exactly 23 when in early adulthood it began. 24 All I can tell you is that it clearly 25 predated this working episode, and my TransPerfect Legal Solutions 212-400-8845 - Depo@TransPerfect.com
1 David R. Spiegel, Md
2 understanding would be that it probably occurred 3 in her adulthood. But, again, I did not know 4 her, so -- at that point. 5 Q. Are you aware of any other evidence 6 that the onset was in early adulthood besides
7 what we've just discussed?
8 A. Well, paranoid -- by definition of 9 paranoid personality disorder, which the MMPI 10 came up with as just as well as me, it has to 11 occur in early adulthood. So even if we weren't 12 there, the fact that the test and the screening 13 criteria and the symptoms meet the criteria, 14 that would imply that it began by early 15 adulthood. But if you ask me did she develop it 16 in her early 20s, mid 20s, I couldn't tell you 17 the exact time she developed it.
18 Q. You cannot tell me the exact time she
19 developed it, correct?
20 A. I don't know if could 21 tell me the exact time she developed it because 22 I don't think she has any insight that she has 23 this condition. So even if I asked her, I don't 24 think she would know. 25 Q. But did you ask her questions that TransPerfect Legal Solutions 212-400-8845 - Depo@TransPerfect.com
1 David R. Spiegel, Md
2 were intended to determine when it developed in 3 order to determine that it meet -- it met
4 Criterion A?
5 A. Honestly, I didn't document it in the 6 note, so therefore -- or the report, so I can't 7 say I did or did not ask her. Obviously it 8 would be on the tape. 9 When the time I evaluated her, I 10 initially -- like I said, I came in there 11 objective and independent, so I wasn't out to 12 necessarily diagnose her with anything other 13 than what she told me.
14 And after I did the MMPI, that I got 15 collateral history from her former occupations 16 in terms of the similar litigation, and then 17 based on that, the most logical parsimonious 18 explanation is paranoid personality disorder. 19 Q. The litigations you referred to were 20 approximately ten years before the current
21 lawsuit?
22 A. The three other suits?
23 Q. Well, we'll get to the number, but I 24 just want to make sure we're talking about the 25 same thing. TransPerfect Legal Solutions 212-400-8845 - Depo@TransPerfect.com
1 David R. Spiegel, Md
2 A. If you're stipulat- -- Mr. Friedman, 3 if you're stipulating that they were within the 4 last ten years -- I don't remember exactly when 5 they were, but if you are stipulating to me that 6 you've seen they were within the last ten years, 7 then I will agree with you. 8 Q. I'm not. I'm saying they're 9 approximately, give or take, within the last ten 10 years.
11 A. If you're stipulating that to me, 12 then I agree with you. 13 Q. Yeah. And is currently 14 59, so if that approximate number of years is 15 correct, those lawsuits would have been in her 16 mid to late 40s. Am I correct that that would
17 not be early adulthood?
18 A. Again, the lawsuits are just showing 19 a pattern. The most -- okay, to answer your 20 question, your 40s is not early adulthood. The 21 lawsuits are the manifestation of clearly what's 22 been happening with this woman for a fairly long 23 time, but she didn't engage litigation until the 24 last ten years.
25 Q. I'm just trying to make sure we're on TransPerfect Legal Solutions 212-400-8845 - Depo@TransPerfect.com
W Shawn Buffkin - Recross-Exam 01:23:59 1 testify now. 01:23:59 2 THE COURT: And slightly out of order. 01:24:01 3 MS. HOULDING: Yes. 01:24:02 4 THE COURT: To accommodate the schedule of 01:24:04 5 this next witness, he will be coming not in the order of 01:24:09 6 proof that in a perfect world plaintiff would 01:24:11 7 appreciate, but recognizing the need to accommodate his 01:24:16 8 schedule, plaintiff has called him to the stand now.
01:24:21 9 Is there anything further you wanted me to
01:24:22 10 say?
01:24:23 11 MS. HOULDING: No. Thank you, Your Honor. 01:24:26 12 THE COURT: So that explains a little bit 01:24:29 13 about the order. 01:24:37 14 THE CLERK: Please watch your step whenever 01:24:39 15 coming up on the carpet. There's a little bit of an 01:24:42 16 incline. 01:24:42 17 Please come forward and stand in front of 01:24:44 18 the clerk's bench. Place your left hand on the Bible 01:24:49 19 and raise your right hand.
01:24:50 20 State your name for the Court. 01:24:54 21 THE WITNESS: Robert L. Goldstein, M.D. 01:24:56 22 THE COURT: Please spell your name for the 01:24:58 23 Court. 01:24:59 24 THE WITNESS: G-o-l-d-s-t-e-i-n. 01:25:02 25 (Whereupon the witness was sworn by the
Goldstein - Direct Exam 01:25:06 1 clerk.) 01:25:06 2 THE CLERK: Thank you. Please take the 01:25:21 3 witness stand and be seated.
01:25:31 4 Robert L. Goldstein, M.D., Direct Examination
01:25:31 5 By Ms. Houlding:
01:25:31 6 Q. Good morning, Dr. Goldstein. 01:25:33 7 A. Good morning. 01:25:34 8 Q. If you could, could you just state your full name 01:25:37 9 for the record and the jury again, please. 01:25:39 10 A. Robert L. Goldstein, M.D. 01:25:41 11 Q. And would you describe for the jury your 01:25:45 12 educational background briefly, please.
01:25:47 13 A. Okay. I'm a medical doctor. I obtained my M.D. 01:25:52 14 degree from Chicago Medical School. I then did a 01:25:57 15 one-year internship in internal medicine at New York 01:26:03 16 Presbyterian Lower Manhattan Hospital. I did a two-year 01:26:09 17 residency in psychiatry at Downstate Medical Center in 01:26:13 18 Brooklyn, New York; my last and third year of 01:26:18 19 psychiatric residency at Bellevue Hospital in New York 01:26:22 20 City. I took a fellowship in child and adolescent 01:26:27 21 psychiatry, also at Bellevue; and a fellowship in 01:26:33 22 psychoanalytic psychotherapy at Hillside Hospital in 01:26:38 23 Glen Oaks, Queens.
01:26:43 24 Q. What degrees do you hold, Dr. Goldstein?
01:26:46 25 A. I have an M.D. from Chicago Medical School. I
Goldstein - Direct Exam 01:26:50 1 also have a JD degree from Columbia University; that's a 01:26:54 2 law degree, but I don't practice law.
01:26:56 3 Q. And how long have you been a licensed physician?
01:26:58 4 A. Since 1967 in New York.
01:27:05 5 Q. All right. And when did you obtain your JD?
01:27:09 6 A. 1984.
01:27:12 7 Q. Did you ever practice law?
01:27:14 8 A. Technically for about eight months I worked for a 01:27:17 9 law firm part-time finishing up some projects for them 01:27:22 10 that I had started in law school. 01:27:25 11 Q. Are you board certified in any medical
01:27:29 12 specialties?
01:27:29 13 A. I am board certified in adult psychiatry. 01:27:34 14 Q. And would you explain for the jury what it means
01:27:37 15 to be board certified?
01:27:39 16 A. Basically all it means is that you've taken a 01:27:43 17 three-day grueling exam where you have an oral part and 01:27:51 18 a part where you examine two psychiatry patients and one 01:27:56 19 neurology patient. And if you pass it, which about 01:27:59 20 maybe 50 percent of psychiatrists in the country have 01:28:03 21 passed it, you're certified as a specialist in 01:28:07 22 psychiatry.
01:28:08 23 Q. And if you told us already, I apologize. For how
01:28:13 24 long have you been board certified?
01:28:15 25 A. Since 1976.
Goldstein - Direct Exam 01:28:18 1 Q. All right. And where do you -- do you currently
01:28:21 2 work?
01:28:21 3 A. Yes.
01:28:21 4 Q. And where do you work?
01:28:23 5 A. I'm a clinical professor of psychiatry at 01:28:27 6 Columbia University in New York City where I have run 01:28:31 7 programs for residents and teach residents and 01:28:36 8 postgraduate fellows in various psychiatric lectures, 01:28:42 9 seminars, colloquia. I do research and write articles 01:28:48 10 as part of my academic work there. And I'm in full-time 01:28:53 11 private practice in an office in New York City.
01:28:57 12 Q. Thank you. Do you have experience giving
01:28:59 13 lectures in the field of psychiatry?
01:29:02 14 A. Yes, quite often. 01:29:04 15 Q. Are you on the faculty of any school? Where do
01:29:08 16 you give lectures?
01:29:09 17 A. I'm a clinical professor of psychiatry at the 01:29:13 18 College of Physicians and Surgeons at Columbia 01:29:16 19 University. 01:29:16 20 Q. Are you a member of any other professional
01:29:19 21 associations?
01:29:20 22 A. I'm a member of the American Psychiatric 01:29:24 23 Association and an officer of the American Academy of 01:29:30 24 Psychiatry and the Law. 01:29:32 25 Q. And I'm going to show you for identification
Goldstein - Direct Exam 01:29:35 1 purposes what we've marked as Plaintiff's Exhibit 42. 01:29:40 2 And as soon as we can -- can you -- I don't know if you 01:29:46 3 can see the whole thing, but can you tell us what
01:29:51 4 Plaintiff's Exhibit 42 is?
01:29:53 5 A. This is -- I think it's page 1 of my resumé or 01:29:59 6 curriculum vitae. 01:30:01 7 MS. HOULDING: We would move for admission 01:30:03 8 of Exhibit 42. 01:30:04 9 THE COURT: All right. 04:38:21 10 (Whereupon Plaintiff's Exhibit 42 is 04:38:23 11 admitted into evidence.) 01:30:08 12 MS. HOULDING: And we would also like to 01:30:10 13 move to have Dr. Goldstein accepted as an expert in the 01:30:13 14 field of psychiatry.
01:30:17 15 MS. KERN: No objection. 01:30:18 16 THE COURT: All right. Ladies and 01:30:21 17 gentlemen, usually in trials a witness isn't allowed to 01:30:24 18 give his or her opinion, but there is an exception to 01:30:26 19 that rule, and that's with experts. I'm qualifying this 01:30:31 20 individual as an expert, and he will be asked in some 01:30:34 21 respects to give his opinions, and you would consider 01:30:37 22 his testimony just like you would any other witness.
01:30:39 23 I'll come back at the close of the trial and I'll give 01:30:42 24 you more directions at that point. But I thought that 01:30:45 25 might be helpful to you now.
Goldstein - Direct Exam 01:30:47 1 You may continue. 01:30:48 2 MS. HOULDING: Thank you.
01:30:50 3 By Ms. Houlding:
01:30:51 4 Q. Can you tell us just briefly what percentage, if 01:30:54 5 you can quantify, of your practice is dedicated to 01:30:58 6 giving expert opinions or expert testimony as opposed to 01:31:03 7 your private practice and some of the other things that
01:31:09 8 you do as part of your job?
01:31:11 9 A. Roughly ten percent or less. 01:31:14 10 Q. And can you quantify of the ten percent of your 01:31:21 11 practice that goes to testifying as an expert, what 01:31:26 12 percentage is for the plaintiff, what percentage is for
01:31:30 13 the defendant? Can you tell us that?
01:31:32 14 A. Over the years, roughly 50/50. Although I think 01:31:36 15 in recent years probably more frequently for defendants 01:31:41 16 in civil lawsuits. 01:31:43 17 Q. And before we get into your expert opinion in 01:31:47 18 this case, Dr. Goldstein, have you testified in court or 01:31:54 19 in a deposition for any of my firm's clients before Mr.
01:32:03 20 Ward?
01:32:03 21 A. Yes. 01:32:03 22 Q. Okay. And approximately how many times, if you 01:32:07 23 know, let's say in the last five years, have you been 01:32:12 24 designated as an expert in a case in which you've
01:32:15 25 testified for one of my firm's clients?
Goldstein - Direct Exam
01:32:18 1 A. In the last five years, you said?
01:32:21 2 Q. Yeah, approximately. 01:32:22 3 A. Roughly maybe half a dozen times. I've testified 01:32:27 4 at depositions, not at trials. 01:32:29 5 Q. And have you ever testified in cases in which 01:32:32 6 you've been the opposing expert; in other words, the 01:32:37 7 expert for the defendant in a case in which my firm was
01:32:40 8 involved?
01:32:41 9 A. Yes. I testified in a case on the other side 01:32:45 10 against your firm in one major case a few years ago. 01:32:50 11 Q. And has our firm consulted with you to see 01:32:56 12 whether there was a psychiatric condition present for 01:32:59 13 any of our clients in which we haven't designated you as
01:33:04 14 an expert to testify?
01:33:06 15 A. Over the years, yes. 01:33:09 16 Q. All right. So just, in other words, there have 01:33:13 17 been times where our firm has sought your opinion but 01:33:19 18 you haven't provided an opinion that there was a 01:33:22 19 psychiatric condition connected to what a client was
01:33:28 20 alleging; is that correct?
01:33:30 21 A. That's correct. 01:33:31 22 Q. Now, you've talked about a number of the cases 01:33:35 23 where our firm has retained you. Do you know the 01:33:39 24 outcome one way or the other of all of those cases in
01:33:43 25 which you've been retained?
Goldstein - Direct Exam 01:33:46 1 A. Actually, I rarely find out how a case turns out. 01:33:53 2 Q. And you're being paid here for your work,
01:33:56 3 correct?
01:33:56 4 A. I hope so, yes.
01:34:00 5 Q. Did you prepare an expert report in this case?
01:34:06 6 A. I actually prepared two separate expert reports. 01:34:10 7 Q. Okay. So we're going to show you Plaintiff's 01:34:23 8 Exhibit 39. And I'm going to ask you if you can 01:34:30 9 identify this for us. 01:34:31 10 A. This is the first expert report I prepared dated 01:34:37 11 April 25, 2016.
01:34:42 12 Q. And is that -- is April 25, 2016 around the time 01:34:47 13 that you -- withdrawn. 01:34:52 14 Did you subsequently prepare a supplemental
01:34:55 15 report?
01:34:56 16 A. Yes, I did.
01:34:58 17 Q. And when did you do that?
01:35:00 18 A. That was a supplemental report that was dated 01:35:05 19 April 9, 2018. 01:35:09 20 MS. HOULDING: Your Honor, we would move for 01:35:11 21 the admission of Plaintiff's Exhibit 39. 01:35:13 22 MS. KERN: Your Honor, Defendant objects on 01:35:15 23 hearsay grounds. 01:35:16 24 THE COURT: I'll take that under advisement.
01:35:18 25 MS. HOULDING: Sure.
Goldstein - Direct Exam
01:35:20 1 By Ms. Houlding:
01:35:20 2 Q. And I'm going to show you what we've marked as 01:35:24 3 Plaintiff's Exhibit 39A and just ask if you can identify 01:35:31 4 that for us. 01:35:33 5 A. Yes. This is the second, the supplemental report 01:35:39 6 that I prepared dated April 9, 2018. 01:35:45 7 Q. And just for the record, is that April 9 or April
01:35:48 8 17?
01:35:49 9 A. I'm sorry?
01:35:50 10 Q. Was the date on that April 9 or April 17?
01:35:55 11 A. I'm sorry. April 17, 2018. 01:35:58 12 MS. HOULDING: And, Your Honor, we would 01:35:59 13 also move for the admission of 39A. 01:36:04 14 MS. KERN: Same objection, Your Honor. 01:36:05 15 THE COURT: I'll take this under advisement.
01:36:07 16 By Ms. Houlding:
01:36:08 17 Q. So could you just briefly tell the jury generally 01:36:14 18 the materials that you considered in forming the 01:36:17 19 opinions that you are going to be testifying about here
01:36:24 20 today?
01:36:24 21 A. Yes. I reviewed and analyzed Mr. Ward's medical 01:36:31 22 records, voluminous medical records over the years. I 01:36:38 23 reviewed and analyzed the complaint in this case. I 01:36:43 24 reviewed and analyzed Mr. 's filing of a charge of 01:36:48 25 discrimination with the EEOC. And I reviewed and
Goldstein - Direct Exam 01:36:53 1 analyzed the sworn statement or declaration of a Mr. 01:36:59 2 Wayne Tarkington. 01:37:02 3 Q. All right. I'm not going to ask you right this 01:37:06 4 moment about every medical record that you reviewed. 01:37:10 5 We'll talk a little bit later on about some specifics.
01:37:13 6 But did you conduct an examination of Mr. at any
01:37:16 7 time?
01:37:18 8 A. Yes. I examined him on three occasions on May 01:37:23 9 28, 2014; again in April, 2016; and most recently in 01:37:31 10 April, 2018. 01:37:36 11 Q. Now, if you can recall, how long was each of
01:37:39 12 those exams approximately?
01:37:41 13 A. Approximately -- the first exam in 2014 was 01:37:46 14 roughly an hour and a half. The subsequent exams -- I'm 01:37:53 15 sorry, the first exam was May, 2014. The second exam in 01:37:57 16 April, 2016 was roughly a half hour. And the most 01:38:03 17 recent exam in April, 2018 was also roughly about a half 01:38:08 18 hour.
01:38:09 19 Q. And did you examine him face-to-face? How did
01:38:14 20 you conduct the exam since you're in New York?
01:38:16 21 A. Well, since I'm in New York and he's in North 01:38:19 22 Carolina, I conducted a -- what's called a video 01:38:21 23 conference or video call examination using Skype where I 01:38:27 24 had a very large desktop console screen where I could 01:38:35 25 see his image, upper half of his body and his face,
Goldstein - Direct Exam 01:38:42 1 fairly enlarged image, and conducted the examination 01:38:45 2 remotely that way. 01:38:49 3 Q. Why didn't you do it face-to-face? Was it
01:38:51 4 simply geographic limitations?
01:38:55 5 A. It was because it was more convenient and 01:38:59 6 feasible to do a long-distance exam rather than have him 01:39:02 7 come all the way up to New York or my travelling down to 01:39:06 8 North Carolina. 01:39:07 9 Q. And in providing an expert opinion or conducting 01:39:15 10 an examination of this nature, are there limitations 01:39:21 11 resulting from using video or Skype rather than doing an
01:39:25 12 in-person examination?
01:39:26 13 A. There are no limitations or drawbacks. This has 01:39:33 14 been going on for many years. And there's a fairly 01:39:36 15 large body of research that has established that these 01:39:42 16 kind of telepsychiatry evaluations or long-distance 01:39:48 17 evaluations are just as reliable and have excellent 01:39:55 18 accuracy and reliability compared to when a patient is 01:40:00 19 actually in your office face-to-face.
01:40:03 20 Q. What was the purpose of examining Mr. ?
01:40:07 21 A. Well, the initial purpose was to examine him like 01:40:13 22 I would any other new patient and find out if he's 01:40:17 23 suffering from any psychiatric disorder. If so, what 01:40:21 24 the nature and diagnosis is of that psychiatric 01:40:27 25 condition, what the prognosis or future prediction of
Goldstein - Direct Exam 01:40:32 1 the outcome of that condition is, if possible what the 01:40:37 2 causal factors are that led to that condition in the 01:40:42 3 patient, and what helpful treatment measures would be 01:40:48 4 indicated for that diagnosis in that patient. 01:40:51 5 Q. Can you explain to the jury, what does the 01:40:55 6 comprehensive psychiatric exam consist of, and otherwise
01:40:59 7 what do you do and what's the methodology?
01:41:02 8 A. Well, a comprehensive psychiatric exam for any 01:41:06 9 patient is a standard format psychiatric exam consisting 01:41:14 10 of two basic sections; the psychiatric history and the 01:41:20 11 mental status evaluation. 01:41:25 12 The psychiatric history, it's roughly analogous 01:41:29 13 to what your internist does when you go for a medical 01:41:33 14 checkup; gets a complete history from you, what brought 01:41:36 15 you there, gets some background that's relevant to you 01:41:41 16 and to your health problems and so forth.
01:41:47 17 What a psychiatrist does is get the presenting 01:41:50 18 problem, why the patient is there for the examination; 01:41:52 19 gets extensive past history; the patient's family 01:41:57 20 history; childhood; family history of psychiatric 01:42:03 21 illness, if any; the patient's educational history; 01:42:08 22 patient's work history; patient's social and marital and 01:42:13 23 sexual history; patient's past psychiatric history, if 01:42:18 24 any; alcohol and drug abuse history; and past medical 01:42:23 25 problems that the patient had. So this is the -- all of
Goldstein - Direct Exam 01:42:29 1 this data is gathered by the psychiatrist as part of the 01:42:33 2 psychiatric history. 01:42:36 3 The second part of the exam is called the mental 01:42:40 4 status. That's, again, analogous to what your 01:42:44 5 internist does when he examines your chest with a 01:42:47 6 stethoscope or presses on your abdomen or does other 01:42:51 7 physical examinations. For a psychiatrist the mental 01:42:55 8 status involves observing the demeanor of the patient; 01:43:00 9 the presentation -- physical presentation of the 01:43:05 10 patient; his emotional responses, emotional symptoms he 01:43:09 11 may or may not be having; psychiatric information such 01:43:16 12 as the presence of anxiety or depression, 01:43:21 13 hallucinations, delusions, suicidal ideations; other 01:43:29 14 psychiatric symptoms that are relevant to making a 01:43:33 15 diagnosis; what's called the sensorium, his orientation, 01:43:41 16 his memory, his general intelligence, his insight and 01:43:45 17 judgment. All of these go into the mental status.
01:43:50 18 The purpose of the exam is to put together the 01:43:52 19 history and the mental status and reach a diagnosis, if 01:43:57 20 any is present, of a psychiatric illness; the nature of 01:44:01 21 that illness; and what the prognosis, causation, and 01:44:06 22 optimal treatment would be for that patient's condition.
01:44:13 23 Q. Thank you. To be clear, this is the same form of
01:44:15 24 exam you conducted with Mr. Ward; is that correct?
01:44:17 25 A. Correct.
Goldstein - Direct Exam 01:44:21 1 Q. Did you come to a conclusion after conducting 01:44:24 2 that exam with Mr. as to whether he was suffering 01:44:27 3 from a diagnosable psychiatric illness within a
01:44:30 4 reasonable degree of psychiatric certainty?
01:44:32 5 A. Yes, I did.
01:44:33 6 Q. And what did you conclude?
01:44:35 7 A. I concluded that his psychiatric condition had -- 01:44:42 8 the diagnosis, what's called unspecified anxiety 01:44:46 9 disorder with panic attacks. 01:44:49 10 Q. And what findings are necessary -- what did you 01:44:54 11 need to find in order to diagnose unspecified anxiety
01:44:58 12 disorder with panic attacks?
01:45:00 13 A. Okay. Well, that's an official diagnosis in 01:45:05 14 what's called the DSM, the Diagnostic and Statistical 01:45:10 15 Manual, which is a book put out by the American 01:45:13 16 Psychiatric Association, which has every psychiatric 01:45:19 17 diagnosis and the diagnostic criteria that are required 01:45:25 18 to make that diagnosis.
01:45:26 19 And in this case -- well, in general and in this 01:45:29 20 case unspecified anxiety disorder is a condition in 01:45:37 21 which the patient has the usual symptoms of an anxiety 01:45:44 22 disorder, that is chronic anxiety, panic attacks, 01:45:50 23 insomnia, and so forth that predominate which cause 01:45:55 24 clinically significant emotional distress or some 01:46:00 25 impairment in the patient's functioning, in important
Goldstein - Direct Exam 01:46:05 1 areas of functioning, but the symptoms that are present 01:46:11 2 don't meet the full criteria to diagnose other anxiety 01:46:17 3 disorders. There are about eight or nine other anxiety 01:46:22 4 disorders. So this patient has symptoms of an anxiety 01:46:27 5 disorder, but they don't fit neatly into any of the 01:46:30 6 other diagnostic categories for the other anxiety 01:46:34 7 disorders. So this is a separate diagnostic category, 01:46:40 8 unspecified anxiety disorder.
01:46:43 9 "With panic attacks" means the patient has 01:46:48 10 intermittently or had recurrent attacks of panic, which 01:46:53 11 are extremely marked anxiety -- limited but extremely 01:46:58 12 marked anxiety. Plus a number of other physical and 01:47:04 13 psychiatric symptoms that go along with it such as -- 01:47:09 14 well, the physical ones are commonly something like 01:47:12 15 chest pain, palpitation, shortness of breath. The 01:47:17 16 psychological components are a fear of dying, fear of 01:47:21 17 losing control, sometimes a fear of going crazy. So the 01:47:26 18 patient has these attacks that accompany or 01:47:30 19 intermittently accompany the chronic anxiety.
01:47:35 20 Q. And is an unspecified anxiety disorder, is that
01:47:42 21 common or unusual in the population?
01:47:45 22 A. No, it's not uncommon; it's a fairly -- anxiety 01:47:51 23 disorders in general are a fairly common diagnosis that 01:47:55 24 patients suffer from. 01:47:57 25 Q. All right. And did you come to any conclusions
Goldstein - Direct Exam 01:48:01 1 in this case regarding the cause of the psychiatric
01:48:05 2 illness?
01:48:05 3 A. Yes. 01:48:06 4 Q. And what methods or information did you use to 01:48:10 5 come to your conclusion relating to causation in this
01:48:15 6 case?
01:48:15 7 A. Well, in general the methodology for assessing 01:48:21 8 causation is really two parts. One, did the patient 01:48:26 9 ever have this psychiatric condition in the past, or is 01:48:29 10 it something that has a new onset at some point? And 01:48:34 11 secondly, what triggered it? What caused the onset of 01:48:38 12 that? And in this case the onset in my opinion was 01:48:43 13 clearly the constant trauma of being exposed to what he 01:48:50 14 perceived as a course -- relentless course of sexual 01:49:00 15 harassment at the workplace.
01:49:01 16 Q. And specifically in connection with Mr. , did 01:49:04 17 you make any -- what information did you use to come to 01:49:08 18 your findings? You said there hadn't been a prior 01:49:11 19 history. Were there any other facts related to -- that
01:49:19 20 supported your conclusion about causation here?
01:49:24 21 A. There was no psychiatric history of this 01:49:29 22 psychiatric condition or, in fact, any other psychiatric 01:49:32 23 condition in Mr. 's past history. And the 01:49:37 24 development of the symptoms of unspecified anxiety 01:49:42 25 disorder began during the course of what he perceived as
Goldstein - Direct Exam 01:49:50 1 very threatening and very traumatic sexual harassment at 01:49:53 2 the workplace. And this set of symptoms had its onset 01:50:01 3 at that point in time, continued up through the last 01:50:06 4 time I saw him in April of 2018 or examined him in April 01:50:12 5 of 2018. And during that entire period he was under 01:50:17 6 treatment with medication that seemed to some extent to 01:50:23 7 alleviate or help the symptoms he was suffering from.
01:50:26 8 Q. And what medication are you referring to?
01:50:29 9 A. He was taking what's called a benzodiazapine 01:50:36 10 medication, which is an antianxiety medication, by the 01:50:41 11 name of -- the brand name is Valium; the chemical name 01:50:47 12 is diazepam. 01:50:50 13 Q. Now, Dr. Goldstein, have you ever heard of the
01:50:53 14 phrase "malingering" or the word "malingering"?
01:50:56 15 A. Yes, quite often. 01:50:57 16 Q. Would you explain to the jury what that means in
01:51:00 17 psychiatric terms?
01:51:01 18 A. Malingering is when an individual either 01:51:05 19 completely fakes or grossly exaggerates symptoms of a 01:51:12 20 psychiatric or a physical illness with the ulterior 01:51:20 21 motive of gaining some advantage like getting out of 01:51:23 22 being criminally responsible for something or getting 01:51:25 23 out of the military or getting some kind of compensation 01:51:28 24 in a lawsuit or an insurance matter, workman's comp 01:51:33 25 matter, and so forth. So basically malingering is
Goldstein - Direct Exam 01:51:37 1 something that a psychiatrist should consider in every 01:51:42 2 case, particularly where there's litigation involved and 01:51:47 3 it may come up. So that's why generally malingering is 01:51:53 4 an important part of evaluating these kind of cases. 01:51:57 5 Q. Did you do any assessment or evaluation in
01:51:59 6 connection with whether Mr. was malingering?
01:52:01 7 A. Yes, I did in my clinical evaluation of him. 01:52:05 8 Q. And could you describe what you did to make an 01:52:09 9 evaluation and what conclusion you came to. 01:52:10 10 A. Okay. Well, the first part of assessing 01:52:14 11 malingering is: Is the patient -- patients who malinger 01:52:19 12 often have no clear idea what genuine psychiatric 01:52:24 13 illness looks like, so they kind of put together a 01:52:27 14 Chinese menu of different symptoms that really don't go 01:52:31 15 together that don't seem like a real psychiatric 01:52:34 16 condition. So first you have to look for: Is the 01:52:37 17 clinical presentation consistent with an authentic 01:52:41 18 genuine psychiatric condition.
01:52:45 19 Secondly, is it the kind of psychiatric condition 01:52:49 20 you often see with the kind of stress that the patient's 01:52:53 21 been subjected to? Does the symptomatology kind of 01:52:58 22 match what you see in many patients who have been under 01:53:01 23 those -- in that condition under those circumstances, 01:53:04 24 and is it internally consistent with everything else 01:53:09 25 that's going on? In other words, does it affect the
Goldstein - Direct Exam 01:53:13 1 patient's functioning in some adverse way? Has the 01:53:17 2 patient sought treatment for it that is appropriate for 01:53:21 3 that particular condition? And is the patient
01:53:24 4 responding to that treatment in any way?
01:53:27 5 So all of these factors go into internal 01:53:31 6 consistency; what you examine, what you see in the 01:53:35 7 patient, and what medical records -- something like 01:53:38 8 that, medical records corroborate that the patient has 01:53:42 9 suffered from these symptoms and been given the 01:53:46 10 treatment for these particular symptoms.
01:53:50 11 Q. In terms of Mr. , did you draw any
01:53:52 12 conclusions specifically as it relates to malingering?
01:53:55 13 A. Yes. My impression was that there was no 01:53:58 14 malingering in this case.
01:54:00 15 Q. And specifically what was that based on?
01:54:03 16 A. Based on all the factors I said, that he had -- 01:54:09 17 my impression was it was a genuine psychiatric 01:54:14 18 condition. It met all the criteria; the symptoms he 01:54:18 19 had; the factors that led up to those symptoms, which 01:54:20 20 are pretty typical; the medical records that confirm 01:54:25 21 these symptoms; and the treatment that he's been under 01:54:29 22 for that particular condition.
01:54:34 23 Q. Are there medical records you've seen which are
01:54:37 24 inconsistent with malingering?
01:54:39 25 A. Inconsistent?
Goldstein - Direct Exam 01:54:41 1 Q. Yes. 01:54:42 2 A. Yeah, I would say definitely inconsistent.
01:54:46 3 Q. And why do you say that?
01:54:49 4 A. A malingerer is trying to build a case for why he 01:54:52 5 has this illness that doesn't really exist, but he's 01:54:55 6 trying to fake it or pretend he has this illness. So a 01:55:01 7 malingerer would, in this particular case, would -- 01:55:07 8 every doctor's appointment, every doctor the patient 01:55:10 9 saw, the patient would say: Doctor, I'm having this 01:55:14 10 horrible anxiety, panic attacks, insomnia because I was 01:55:19 11 sexually harassed at work and traumatized. In other 01:55:22 12 words, he'd try to build up a case for his ulterior 01:55:28 13 motive and malingering in the first place.
01:55:31 14 In contrast, Mr. 's medical records, he 01:55:36 15 didn't confide in most of the times he saw doctors about 01:55:42 16 the fact he was having these symptoms or why -- what had 01:55:46 17 caused these symptoms because of his feelings of shame 01:55:51 18 and feelings of reluctance to discuss what had happened 01:55:57 19 to him. It was kind of the opposite of malingering.
01:56:01 20 Q. And you mentioned a moment ago that one of the 01:56:05 21 ways that you assess malingering is to look at whether 01:56:11 22 the person presenting to you is responding in a sort of 01:56:16 23 typical way to the matter that they're alleging has 01:56:20 24 caused the stress, so in this case sexual harassment.
01:56:23 25 In your experience as an expert, or in your practice, do
Goldstein - Direct Exam 01:56:28 1 you generally have some experience with people who are 01:56:31 2 complaining about stress that they're attributing to
01:56:36 3 sexual harassment in the workplace?
01:56:39 4 A. Yes. I've treated/evaluated a number of patients 01:56:45 5 with sexual harassment. I've been involved in teaching 01:56:49 6 about the psychiatrist's experience of sexual harassment 01:56:55 7 cases. And my experience has been that anxiety 01:57:01 8 disorders, panic disorders, sometimes depression, 01:57:07 9 sometimes even post traumatic stress disorder are the 01:57:10 10 most common symptoms you see in patients who have been 01:57:15 11 sexually harassed.
01:57:17 12 Q. Switching gears for a minute, are you familiar
01:57:23 13 with psychological testing for malingering?
01:57:26 14 A. Yes. 01:57:27 15 Q. And before I get to that, can you just tell us 01:57:30 16 very briefly what's the difference between a
01:57:32 17 psychiatrist like yourself and a psychologist?
01:57:36 18 A. Briefly speaking, a psychiatrist is a medical 01:57:43 19 doctor; a psychiatrist has much more experience in 01:57:49 20 diagnosing medical -- psychiatric illnesses by examining 01:57:54 21 the patient, doing a psychiatric history, mental status 01:58:01 22 evaluation, and has a high level of confidence in the 01:58:05 23 accuracy and reliability of making diagnoses by doing 01:58:09 24 that. And also a medical doctor can treat patients with 01:58:15 25 medication when it's necessary.
Goldstein - Direct Exam 01:58:19 1 A psychologist is a Ph.D. or master's degree 01:58:24 2 professional who cannot prescribe medication, as you 01:58:29 3 probably know, and who have less experience doing 01:58:36 4 clinical examinations of the patient but rely more 01:58:41 5 frequently and heavily on paper and pencil tests, 01:58:45 6 psychological tests that they administer to the patient.
01:58:50 7 A patient gets the form, paper and pencil, completes 01:58:54 8 them, and the psychologist interprets the results. 01:58:58 9 So basically those are the differences. 01:59:01 10 Psychological testing has its place, but I personally 01:59:08 11 believe that psychiatric evaluation is the more 01:59:15 12 meaningful and accurate.
01:59:16 13 Q. Did you order any paper and pencil testing for
01:59:21 14 Mr. ?
01:59:22 15 A. I only order psychological paper and pencil tests 01:59:26 16 when I have a strong suspicion that there is malingering 01:59:31 17 going on in the case. In this case I didn't have such 01:59:36 18 a suspicion. Also I might order them, psychological 01:59:40 19 paper and pencil tests, occasionally when there's a -- 01:59:46 20 some meaningful uncertainty about what the diagnosis 01:59:50 21 should be. And I also order them in cases where there's 01:59:54 22 some brain damage or traumatic brain injury or some 01:59:57 23 impairment of intellect, cognitive problems where they 02:00:03 24 are most useful, I think, in measuring the degree of 02:00:07 25 impairment.
Goldstein - Direct Exam 02:00:09 1 Q. All right. And I think it's fair to say you have 02:00:12 2 ordered psychological testing for other clients or
02:00:16 3 patients, correct?
02:00:17 4 A. Yes, where it's appropriate. And in this case I 02:00:20 5 had no strong suspicion or even weak suspicion that 02:00:25 6 malingering was in the picture here. 02:00:29 7 Q. Aside from the malingering evaluation that you 02:00:32 8 perform to determine whether or not -- to assess whether 02:00:36 9 Mr. is faking symptom, did you attempt to determine 02:00:41 10 whether Mr. or do you generally attempt to
02:00:43 11 determine whether the patient is faking anything else?
02:00:47 12 A. Faking anything else?
02:00:49 13 Q. Yeah. Do you -- 02:00:51 14 A. Oh, I understand. 02:00:53 15 Q. Okay. 02:00:54 16 A. Whether a patient is faking his illness is 02:00:59 17 relevant to what I'm doing. I'm only here to testify 02:01:05 18 about my psychiatric determinations about whether he was 02:01:10 19 & malingering a psychiatric condition. Whether he was 02:01:14 20 faking anything else in terms of the workplace situation 02:01:18 21 or the sexual harassment would not be for me to 02:01:23 22 determine. That would be up to the jury to decide.
02:01:27 23 Q. So your expert opinion doesn't include a 02:01:32 24 determination as to whether, in fact, Mr.
02:01:37 25 experienced sexual harassment; is that correct?
Goldstein - Direct Exam 02:01:40 1 A. No, I have no basis -- it's beyond the scope of 02:01:44 2 what I can do. I'm here to assess the psychiatric 02:01:50 3 issues. Whether he was actually sexually harassed or 02:01:54 4 not, again, I have no personal knowledge of that. And 02:01:56 5 again, that's in the province of the jury to decide.
02:02:00 6 Q. So did you interview anyone in this case who 02:02:06 7 might have witnessed or been a witness to sexual
02:02:10 8 harassment of the plaintiff that he described to you?
02:02:15 9 A. No. Again, that would not be my role, or that 02:02:18 10 would be beyond my expertise to get involved in whether 02:02:24 11 or not sexual harassment actually occurred. I just gave 02:02:29 12 an opinion about the fact that Mr. had the 02:02:34 13 perception that this was going on, and that's what 02:02:37 14 triggered his psychiatric problems. Whether that's 02:02:41 15 factually correct is not up to me.
02:02:44 16 Q. You talked a little bit earlier about reviewing 02:02:47 17 medical records in connection with coming to a 02:02:52 18 conclusion in this case or forming an opinion in this 02:02:55 19 case. What role generally did these records play in
02:03:00 20 your evaluation?
02:03:01 21 A. Well, the medical records are reviewed as 02:03:09 22 collateral information that would supply a more 02:03:13 23 objective corroboration or lack of corroboration of 02:03:21 24 whether what the patient told you is factually accurate. 02:03:24 25 And the medical records I was reviewing, the purpose of
Goldstein - Direct Exam 02:03:30 1 my review was to see whether doctors who are 02:03:35 2 evaluating -- other doctors evaluating/treating him 02:03:38 3 found these same conditions and symptoms, whether they 02:03:42 4 provided treatment for these symptoms and conditions 02:03:46 5 which were appropriate for the diagnosis, and whether 02:03:50 6 they confirmed or didn't confirm what Mr. Ward had 02:03:55 7 related to me.
02:03:57 8 MS. HOULDING: Your Honor, may I approach
02:03:58 9 briefly?
02:03:58 10 THE COURT: Yes.
02:04:32 11 By Ms. Houlding:
02:04:33 12 Q. Dr. Goldstein, we've placed in front of you a 02:04:35 13 large binder of materials. I'm not going to go through 02:04:38 14 all of these. And before I ask you about any specific 02:04:43 15 exhibits, I'd like to move for the admission of 02:04:46 16 Plaintiff's Exhibit 25 through 30 to which I believe 02:04:51 17 there's no objection.
02:04:52 18 THE COURT: Let them be received. 04:38:21 19 (Whereupon Plaintiff's Exhibits 25-30 are 04:38:23 20 admitted into evidence.)
02:04:58 21 By Ms. Houlding:
02:05:08 22 Q. I wanted to ask you specifically whether there 02:05:11 23 were any records in particular which confirmed the 02:05:19 24 findings that you are offering in this case. If you 02:05:21 25 know offhand, you can let me know, or I can tell you
Goldstein - Direct Exam 02:05:25 1 where in the binder the records are. 02:05:30 2 A. This is one of them. This is a record -- this is 02:05:33 3 from the medical records. It's a letter from the 02:05:37 4 cardiologist who performed what's called a cardiac 02:05:41 5 catheterization. And this is a letter writing his 02:05:45 6 report to the -- to Mr. 's primary care provider, 02:05:51 7 his medical doctor, about the results of that cardiac 02:05:55 8 test.
02:05:57 9 Q. And is that Plaintiff's Exhibit 26? Is that what
02:06:02 10 you're looking at?
02:06:03 11 A. Correct. 02:06:06 12 MS. HOULDING: Publish that for the jury.
02:06:10 13 By Ms. Houlding:
02:06:11 14 Q. Just briefly, this is Plaintiff's Exhibit 11. 02:06:14 15 Can you tell us why this confirmed your diagnosis or
02:06:18 16 helped confirm your diagnosis and opinion?
02:06:24 17 A. Well, Dr. John S. Kelley, who was the 02:06:27 18 cardiologist, is reporting back to the general 02:06:33 19 practitioner, primary care physician of Mr. that a 02:06:39 20 cardiac catheterization test was carried out to find out 02:06:45 21 if the symptoms of chest pain were related to any 02:06:49 22 cardiac -- actual cardiac illness or pathology. And Dr.
02:06:55 23 Kelley reports he's happy to report that the test is 02:07:00 24 essentially normal, that the patient was reassured about 02:07:08 25 the fact there was no -- that the pain is not cardiac
Goldstein - Direct Exam 02:07:12 1 pain; in other words, it's not due to actual pathology 02:07:16 2 in the heart. And Dr. Kelley further says that some of 02:07:21 3 the chest pain is related to stress and responded quite 02:07:27 4 well to Valium. 02:07:31 5 Q. I'm going to have you flip one page forward and 02:07:34 6 see if you can -- I'm going to look at the next two 02:07:40 7 pages, but first of all, if you can just tell us briefly 02:07:43 8 what the next page is.
02:07:46 9 A. This is actually a summary of the procedure that 02:07:52 10 was done, the cardiac catheterization, something called 02:07:56 11 a left ventriculography and coronary arteriography, 02:08:06 12 which was carried out for the indication of chest pain 02:08:08 13 and hypertension. The findings, the most important one 02:08:18 14 was normal left ventricular function. And the 02:08:21 15 recommendation was the patient was reassured. He'll 02:08:27 16 follow up with his primary care physician, Dr. Henry 02:08:33 17 Traylor, in Whiteville, North Carolina for further 02:08:37 18 evaluation of noncardiac chest pain.
02:08:44 19 And the following page under a heading "Comment: 02:08:47 20 Patient's pain is not cardiac. This is a 02:08:51 21 musculoskeletal component. There may be some 02:08:55 22 superimposed anxiety and stress related. He'll follow 02:08:59 23 up with his primary care physician for ongoing care."
02:09:05 24 Q. And going forward in your exhibit binder but a 02:09:09 25 little -- let me just actually ask you: What was the
Goldstein - Direct Exam
02:09:13 1 date on this report that you just read?
02:09:15 2 A. The cardiac catheterization was performed on 02:09:21 3 10/25 -- October 25, 2013. 02:09:26 4 Q. Moving forward in your binder to Plaintiff's 02:09:32 5 Exhibit 27, if you go to the second page of that 02:09:40 6 exhibit. 02:09:43 7 A. Yes. 02:09:44 8 Q. If you can tell us whether there's anything in 02:09:46 9 there that related to or supports your findings in this 02:09:54 10 case.
02:09:55 11 A. Yes. This is a note from the Whiteville Medical 02:09:59 12 Associates dated 10/15 -- October 15, 2013, the notice 02:10:10 13 and records of his primary care provider. And the 02:10:14 14 important part is that it's a recheck of his chest pain, 02:10:17 15 symptoms include chest pain -- it says he was seen for 02:10:22 16 chest pain and pressure by the ER on September 25, 2013.
02:10:29 17 That would be the month before this note was made. 02:10:33 18 States he was told he's only having PVCs. States this 02:10:38 19 has been going on for several months with feelings like 02:10:42 20 his heart is doing flip-flops. Then it goes on to 02:10:48 21 say -- no, that's the end of the most relevant findings 02:10:58 22 in this note.
02:11:02 23 Q. And how did this support or relate to your
02:11:05 24 specific findings in this case?
02:11:10 25 A. Well, this indicates that the patient was
Goldstein - Direct Exam 02:11:13 1 evaluated at the emergency room, followed up with his 02:11:17 2 PCP, primary care physician. It documents a history of 02:11:23 3 several months on and off of these chest pains and PVCs, 02:11:28 4 which are premature ventricular contractions, which in 02:11:32 5 simple language means the heart skips a beat, irregular 02:11:38 6 heartbeat usually related to stress. And the bottom 02:11:41 7 line is the patient was told that this pain and 02:11:49 8 premature ventricular contractions are not due to actual 02:11:52 9 heart pathology but are due to anxiety and stress. That 02:11:57 10 was documented in the cardiac catheterization. And he 02:12:03 11 responded well to Valium, which is an antianxiety 02:12:08 12 medication.
02:12:09 13 Q. And if you can flip, I guess, backwards again to 02:12:13 14 Plaintiff's Exhibit 25. And I'm going to just ask you, 02:12:20 15 on the bottom of each page there's a number stamped; 02:12:24 16 it's a little bit hard to read, but if you can try to 02:12:27 17 skip forward to page 346 and 347, I'll ask you a couple 02:12:38 18 brief questions.
02:12:39 19 A. You said Exhibit 25?
02:12:43 20 Q. 25. I'll put them up on the screen. I think it 02:12:46 21 will be easier. So you don't have to worry about it. 02:12:50 22 A. Okay. 02:12:50 23 Q. So this is part of Plaintiff's Exhibit 25. And I 02:12:56 24 want to see if you're familiar with this. If you see on 02:13:04 25 here the date of treatment here. Do you see September
Goldstein - Direct Exam
02:13:12 1 15, 2013?
02:13:14 2 A. The date of treatment, yes. 02:13:15 3 Q. Okay. And is that the date of the ER visit to
02:13:19 4 your knowledge?
02:13:20 5 A. The date of what?
02:13:21 6 Q. The emergency room visit?
02:13:24 7 A. It's 9/15, 2013. 02:13:26 8 Q. Okay. 02:13:27 9 A. And this is from the emergency room, yes. 02:13:29 10 Q. All right. And in this middle section here do 02:13:34 11 you see anything that relates to or supports your
02:13:37 12 findings in this case?
02:13:41 13 A. Yes, it says the complaint was chest discomfort. 02:13:48 14 The onset was hours ago, that it's gone now. And the 02:13:57 15 onset was during rest; in other words, he wasn't 02:14:00 16 exerting himself when this happened. And the severity 02:14:04 17 was a 4 on a scale of -- 4 out of 10 in severity.
02:14:10 18 Q. All right. Then I'm going to put up the next 02:14:13 19 page of the exhibit, which is part of this same record. 02:14:17 20 And if you see here, are there any other -- is there any 02:14:24 21 other information in here that relates to or supports
02:14:27 22 your findings in this case?
02:14:31 23 A. It says that the quality of the pain is stabbing, 02:14:37 24 and that there are palpitations present.
02:14:42 25 Q. And how does that relate to your findings?
Goldstein - Direct Exam 02:14:45 1 A. Well, these are the symptoms that he had been 02:14:48 2 experiencing on and off for several months; that is, 02:14:53 3 chest pain, which could have been related to a heart 02:14:58 4 attack or an impending heart attack; and palpitations, 02:15:02 5 which are rapid beats where the patient feels his heart 02:15:07 6 is pounding in his chest and so forth. And that was 02:15:10 7 probably -- most probably related to the premature 02:15:14 8 ventricular contractions, which are also generally 02:15:18 9 stress related.
02:15:22 10 Q. I'm going to show you one or two other exhibits 02:15:29 11 from Plaintiff's Exhibit 26. And I'll just put it up on 02:15:35 12 the screen. We're just going to move on from that for a 02:15:46 13 moment. 02:15:47 14 Did you know in the medical records whether there
02:15:50 15 had been prescriptions for Valium subsequent to this?
02:16:00 16 A. Yes. He's been receiving Valium starting back in 02:16:06 17 2013 up until the present time. 02:16:11 18 Q. Are you aware of whether there are any other 02:16:15 19 indicators in his records reflecting symptoms that are 02:16:21 20 associated with the unspecified anxiety disorder with
02:16:26 21 panic attacks that you've discussed?
02:16:29 22 A. Well, there are some notations about the same 02:16:32 23 kind of somatic or physical manifestations of that, the 02:16:39 24 palpitations, heart pain, shortness of breath. And 02:16:44 25 there are some notations about anxiety associated with
Goldstein - Direct Exam 02:16:48 1 the Valium prescriptions. 02:16:54 2 Q. If we could, in part of Plaintiff's Exhibit 27 -- 02:16:57 3 I'll just show you -- if you can tell the jury what this 02:17:09 4 is. 02:17:11 5 A. This is a note from his medical records from 02:17:16 6 Whiteville Medical Associates, that's his primary care 02:17:20 7 physician, on an appointment December 14, 2015. And 02:17:32 8 among the conditions listed that are relevant here:
02:17:38 9 atypical chest pain, anxiety, and fatigue. 02:17:48 10 Q. All right. And then I'm going to show you the 02:17:50 11 next page of that exhibit, which appears to be from the 02:17:56 12 same record, if you see at the top, the same date,
02:17:59 13 12/14/15?
02:18:01 14 A. Correct. 02:18:01 15 Q. Is there anything in this record that relates to
02:18:04 16 or supports your findings in this case?
02:18:11 17 A. Again, he's given yet another prescription for 02:18:16 18 Valium, five milligrams, to take by mouth once daily. 02:18:23 19 Q. All right. And just looking back again at page 02:18:31 20 923, if you look at the date at the top here, what do
02:18:39 21 you see? Do you see the date there of May 12, 2016?
02:18:43 22 A. Yes. 02:18:43 23 Q. And is there anything in here that's consistent,
02:18:47 24 again, with your findings in this case?
02:18:51 25 A. Again, he's prescribed Valium, five milligram
Goldstein - Direct Exam 02:18:57 1 tablets, taken once daily. And it says it's an active 02:19:02 2 prescription; that would mean it's kind of an ongoing 02:19:07 3 regular prescription that he's getting. 02:19:29 4 Q. I wanted to show for identification purposes 02:19:32 5 only, if we can turn off the screen, I'm going to show 02:19:39 6 you what I've marked as Plaintiff's Exhibit 27A. And if 02:19:52 7 you could just tell me briefly what's noted on the first 02:19:58 8 page. We'll move the binder clip.
02:20:06 9 When is this record from, if you can tell?
02:20:08 10 A. This is a medical record dated December 8, 2014. 02:20:16 11 MS. HOULDING: And, Your Honor, if I may, 02:20:18 12 this is just an excerpt of a couple additional medical 02:20:22 13 records that were withdrawn from our original list, but 02:20:26 14 we'd like to add back in this response to some of the 02:20:29 15 questions that were asked of plaintiff. I'd like to 02:20:31 16 move for its admission.
02:20:32 17 I've just handed defendant a copy. 02:20:34 18 They were produced by the defendant in this 02:20:37 19 case, if there's any objection. 02:20:40 20 MS. KERN: That's fine, Your Honor.
02:20:41 21 THE COURT: What would you call these?
02:20:43 22 MS. HOULDING: These would be 27A.
02:20:46 23 THE COURT: What is 27A?
02:20:48 24 MS. HOULDING: 27 were medical records that 02:20:49 25 included records from Dr. Traylor. These are some
Goldstein - Direct Exam 02:20:53 1 additional records.
02:20:54 2 THE COURT: Additional Traylor records?
02:20:58 3 MS. HOULDING: Additional Traylor records. 04:38:21 4 (Whereupon Plaintiff's Exhibit 27A is 04:38:23 5 admitted into evidence.)
02:21:10 6 By Ms. Houlding:
02:21:10 7 Q. We're going to skip to 972. I'll show you this, 02:21:23 8 Dr. Goldstein. If you can see on here a date of
02:21:26 9 9/2/2014 at the top. Do you see that?
02:21:29 10 A. Yes. 02:21:30 11 Q. All right. And is there anything in here that
02:21:33 12 relates to or supports your finding in this case?
02:21:47 13 A. Well, here again there's a notation about 02:21:53 14 prescription for Valium, 5 milligrams, once a day by 02:21:59 15 mouth. Active. It says "active," meaning ongoing 02:22:04 16 medication. 02:22:05 17 Q. All right. And then turning -- we're going to 02:22:09 18 give you 959. I'm going to essentially ask you the same 02:22:14 19 question, which it should be from December 8, 2014, if 02:22:19 20 you see that right at the top.
02:22:22 21 A. Yes. 02:22:22 22 Q. And then again, is there anything in here that
02:22:25 23 relates to your findings or supports your findings?
02:22:31 24 A. Again, a prescription for Valium, 5 milligram, 02:22:36 25 once a day by mouth. And it says it's active, active
Goldstein - Direct Exam 02:22:40 1 prescription. 02:22:41 2 Q. Okay. Thank you. 02:22:54 3 One more here, Dr. Goldstein. I'm going to show 02:22:58 4 you what's been marked 958, the front page. And if you 02:23:09 5 can see when this record is from, this is from December 02:23:22 6 8, 2014. Is there anything in here that relates to or
02:23:26 7 supports your findings?
02:23:33 8 A. It states on the list of conditions/treatments: 02:23:39 9 Atypical chest pain, fatigue, and anxiety. 02:23:47 10 Q. And how does that relate or support to your
02:23:50 11 opinion?
02:23:55 12 A. Well, that documents that he's having the same 02:24:00 13 constellation of symptoms, the chronic anxiety that he's 02:24:06 14 had for some time, associated with chest pain and 02:24:10 15 fatigue. 02:24:13 16 Q. Now, in general I note you reviewed a lot of 02:24:18 17 records in this case. Did you notice whether Mr.
02:24:25 18 Ward -- or whether the medical records indicated 02:24:29 19 specifically that Mr. had complained about sexual 02:24:32 20 harassment in the workplace or any of the conduct that
02:24:38 21 is being alleged in this lawsuit?
02:24:40 22 A. Based on my review there were no times that he 02:24:47 23 specifically mentioned the sexual harassment at work and 02:24:52 24 the experiences that he had in relation to the sexual 02:24:56 25 harassment.
Goldstein - Direct Exam 02:24:57 1 Q. And did that indicate to you anything one way or 02:25:01 2 another as it concerns your findings in this case? Did 02:25:05 3 it cause you concern that it wouldn't be in the medical
02:25:08 4 records, that he hadn't complained?
02:25:10 5 A. Well, my understanding is that it's not in the 02:25:17 6 medical records specifically because Mr. was too 02:25:24 7 self-conscious or ashamed or felt it was derogatory, 02:25:29 8 didn't want to talk about it, basically didn't want to 02:25:33 9 share it with anybody, and didn't specifically mention 02:25:37 10 it. And as I said earlier, that would be kind of the 02:25:41 11 opposite of what a malingerer would do who would try to 02:25:45 12 emphasize it on every possible occasion.
02:25:51 13 MS. HOULDING: Your Honor, might this be -- 02:25:53 14 I don't know what time the Court wanted to break for 02:25:56 15 lunch. 02:25:57 16 THE COURT: Yes, this is a good time. 02:25:59 17 Ladies and gentlemen, thank you for your 02:26:03 19 minutes for lunch. There are a couple of things I want 02:26:06 20 to talk to counsel about, so we'll keep working and let 02:26:09 21 you go. We'll start back at 1:15. Thank you very much.
02:26:16 22 (Jury exits the courtroom.) 02:26:47 23 THE COURT: You can take a break as well. 02:26:55 24 THE WITNESS: Thank you.
02:26:59 25 THE COURT: What did you want to talk about?
Goldstein - Direct Exam
02:27:01 1 Anything? Just a break?
02:27:05 2 MS. HOULDING: Just a lunch break, Your 02:27:07 3 Honor. I don't know if the Court wants to take up now
02:27:15 4 any issue relating to the tape or hold off on that?
02:27:20 5 THE COURT: I'm going to take up the expert 02:27:21 6 reports. Now, as an additional matter, I did not see on 02:27:25 7 your pretrial order 39A. So was that just an oversight 02:27:31 8 or -- 02:27:31 9 MS. HOULDING: I can't quite remember the 02:27:34 10 timing now, Your Honor, but we did obtain that after -- 02:27:37 11 we did finalize and produce that after the Court's 02:27:40 12 ruling that he would not be excluded on Daubert grounds.
02:27:45 13 I did give the Defendant a copy to at that time. So 02:27:49 14 it's more just -- 02:27:49 15 THE COURT: On the pretrial order, which is 02:27:51 16 my template, I've got 39, which is a Goldstein report 02:27:55 17 dated April 25 of 2016. 02:27:59 18 MS. HOULDING: That's right, Your Honor.
02:28:00 19 THE COURT: Did I write down correctly that
02:28:03 20 39A was April 17 of 2016?
02:28:07 21 MS. HOULDING: Of 2018. So it's just 02:28:11 22 recent. 02:28:11 23 THE COURT: So we need to be clear because 02:28:13 24 I'm not letting either one in. And I know that you 02:28:16 25 might like to put those in the record just to preserve
Goldstein - Direct Exam 02:28:19 1 your appeal rights. But those reports are hearsay. And 02:28:24 2 I'm not aware of any other avenue for you to get them 02:28:28 3 in. 02:28:29 4 MS. HOULDING: Understood, Your Honor. I 02:28:30 5 know sometimes courts let them in, sometimes they don't. 02:28:34 6 THE COURT: I've only done it once in my 02:28:36 7 recollection when both sides stipulated they both wanted 02:28:40 8 their experts' reports to go in to the jury. I'm 02:28:43 9 hearing an objection. So 39 and 39A don't come in.
02:28:47 10 I'm still pondering on the tape. 02:28:49 11 MS. HOULDING: Sure. 02:28:50 12 THE COURT: The cat's kind of out the bag 02:28:53 13 because they heard Mr. Ward, and I gave them a limiting 02:28:55 14 instruction. But let me just think through what might 02:29:01 15 be the best way for that to go back to the jury, whether 02:29:04 16 it's a redacted version or the whole version.
02:29:06 17 Now to help me make that decision, could you 02:29:08 18 give a copy or send a copy of that audio? Could you 02:29:12 19 send it to the clerk electronically, or do you need 02:29:15 20 to -- 02:29:15 21 MS. HOULDING: I can do either. I have an 02:29:18 22 extra copy on a DVD that I can give, or I can email it.
02:29:22 23 THE COURT: What's easiest for you?
02:29:24 24 MS. HOULDING: Either one is really fine. 02:29:25 25 THE COURT: Go ahead and email it then, and
Goldstein - Direct Exam 02:29:28 1 she'll email it to me. I'd like to listen to the whole 02:29:31 2 thing again. 02:29:31 3 MS. HOULDING: Sure. 02:29:32 4 THE COURT: Now, I have a one strike and 02:29:35 5 you're out rule on cell phones. And I think you already 02:29:38 6 are on your second strike. So was that your phone both
02:29:43 7 times, Ms. Riley?
02:29:45 8 MS. RILEY: Yes, Your Honor. 02:29:45 9 THE COURT: Okay. Your phone doesn't come 02:29:47 10 in the courtroom anymore. 02:29:48 11 MS. RILEY: Yes, Your Honor. 02:29:49 12 THE COURT: Everybody have a good lunch. 02:29:51 13 We'll see you at 1:15. 03:27:29 14 (Lunch recess taken.)
03:42:28 15 THE COURT: Are you ready to continue?
03:42:30 16 MS. HOULDING: We are Your Honor. 03:43:58 17 (Jury enters the courtroom.) 03:44:12 18 THE COURT: Good afternoon. Are we ready to
03:44:17 19 continue?
03:44:21 20 MS. HOULDING: Thank you, Your Honor.
03:44:23 21 By Ms. Houlding:
03:44:24 22 Q. Dr. Goldstein, I just have a couple of additional 03:44:27 23 questions for you. Earlier today you described that you 03:44:33 24 conducted interviews of Mr. Ward on three different 03:44:37 25 occasions. Can you briefly tell the jury what symptoms
Goldstein - Direct Exam 03:44:42 1 Mr. described to you that you found were relevant
03:44:47 2 to the conclusions that you've drawn in this case?
03:44:50 3 A. The relevant symptoms he described were the 03:44:59 4 presence of chronic anxiety or nervousness over a long 03:45:04 5 period of time; intrusive thoughts or recollections that 03:45:10 6 would pop into his head about the actual events of the 03:45:15 7 sexual assault, sexual harassment. And these would 03:45:22 8 trigger off the physical somatic symptoms of the 03:45:26 9 palpitation, the chest discomfort, the pain, shortness 03:45:30 10 of breath. And then he would take a Valium, and it 03:45:33 11 would kind of calm him down.
03:45:38 12 Feelings of shame and helplessness when he would 03:45:42 13 think about what had happened to him; sleep problems: 03:45:48 14 trouble falling asleep, trouble staying asleep, 03:45:51 15 sometimes with nightmares about the woman who had 03:45:56 16 harassed him. These had been improving over a period of 03:46:02 17 time, getting less severe, less frequent nightmares.
03:46:07 18 Some mild concentration problems that he encountered. 03:46:13 19 And kind of a problem with his self-esteem, feeling like 03:46:19 20 he'd been through the ringer, and he felt like he had 03:46:25 21 been damaged in some way. It was like a wound that 03:46:27 22 wouldn't heal; he couldn't get over it. Those were 03:46:31 23 basically the -- occasional depression and irritability, 03:46:36 24 moodiness. Those were basically the symptoms that were 03:46:41 25 significant.
Goldstein - Direct Exam 03:46:42 1 Q. And I'm not going to ask you to recount all of 03:46:46 2 what he told you, but did he describe for you what he 03:46:53 3 experienced at the workplace, the sexual harassment that
03:47:00 4 he experienced?
03:47:01 5 A. Yes, he did. 03:47:03 6 Q. And again, you don't form an opinion about
03:47:06 7 whether the sexual harassment actually occurred or not?
03:47:10 8 That's not your job?
03:47:12 9 A. Correct. 03:47:13 10 Q. And you said you had examined him -- excuse me -- 03:47:24 11 via Skype. How did he appear to you or how did he 03:47:27 12 present to you? And I know there were three different 03:47:30 13 sessions, so if there was a change, you can describe 03:47:32 14 that. 03:47:32 15 A. Basically there was very little change in the way 03:47:35 16 he appeared. He usually appeared kind of tense, sad 03:47:41 17 looking a lot. When he actually talked about the sexual 03:47:45 18 harassment incidents he would get kind of visibly 03:47:49 19 distressed looking and uptight. Basically he was pretty 03:47:56 20 cooperative and forthcoming, answered all my questions.
03:48:00 21 Q. All right. And you told us that you issued an 03:48:05 22 initial report in 2016 and then a supplemental one in 03:48:10 23 2018. Did your opinion change between the first report
03:48:17 24 and the second report?
03:48:19 25 A. Well, the second report was kind of an update.
Goldstein - Direct Exam 03:48:22 1 And what I learned from him was that some of his 03:48:26 2 problems had seemingly improved. He had -- his social 03:48:32 3 life had improved; he was more interested in going out, 03:48:36 4 seeing friends with his family, going to dinner with his 03:48:40 5 wife sometimes; getting interested again in hunting and 03:48:45 6 fishing, which he had kind of completely lost interest 03:48:49 7 in after the sexual harassment incidents. So his social 03:48:53 8 life seemed to be improving.
03:48:55 9 His relationship with his wife seemed to be 03:48:58 10 improving. He wasn't so uptight and irritable and moody 03:49:05 11 at home. 03:49:06 12 So there were some areas of improvement that he 03:49:09 13 recounted. 03:49:10 14 The symptoms of feeling uptight, anxious, panic 03:49:16 15 attack, episodes of chest pain and shortness of breath, 03:49:21 16 those had more or less stayed the same. And as the 03:49:27 17 lawsuit has progressed and he's had to rehash all this 03:49:31 18 stuff and talk about it with his lawyers and so forth, 03:49:35 19 his sleep and his nightmares seem to have come back a 03:49:38 20 little bit and be more frequent.
03:49:42 21 Q. Thank you, Dr. Goldstein. You already testified 03:49:47 22 to your conclusion that he's suffering from an 03:49:50 23 unspecified anxiety disorder with panic attacks. Is 03:49:55 24 there something that you're familiar with called a
03:49:57 25 differential diagnosis?
Goldstein - Direct Exam 03:49:58 1 A. Yes.
03:49:59 2 Q. And what is that?
03:50:00 3 A. That means comparing the diagnosis you make with 03:50:05 4 other possibilities that may be relevant and excluding 03:50:10 5 them so that you're more confident about the diagnosis 03:50:15 6 you made. 03:50:16 7 Q. And is that something that you did in connection
03:50:18 8 with Mr. ?
03:50:20 9 A. Yes. 03:50:21 10 Q. And did you rule out a medical condition or some
03:50:24 11 other cause of his psychiatric condition?
03:50:26 12 A. Well, I ruled out -- as I said earlier, I ruled 03:50:31 13 out malingering. I thought that was not in the picture. 03:50:35 14 I ruled out any medical conditions that could 03:50:39 15 have caused this anxiety picture. There are some 03:50:42 16 medical conditions like hyperthyroidism or some adrenal 03:50:48 17 gland tumors that can cause a lot of anxiety. He didn't 03:50:52 18 have that. And all of the other medical, psychiatric, 03:50:56 19 anxiety disorders which he didn't have either. So 03:51:00 20 that's why the only diagnosis left was unspecified 03:51:06 21 anxiety disorder.
03:51:07 22 Q. And I apologize if you testified to this earlier, 03:51:12 23 but did you come to a conclusion within a reasonable 03:51:15 24 degree of psychiatric certainty as to whether his 03:51:20 25 perceptions of sexual harassment at AutoZone were
Goldstein - Direct Exam
03:51:24 1 related to the onset of his psychiatric condition?
03:51:29 2 A. Yes, I testified that I believe they were. 03:51:33 3 Q. Okay. Do you have any recommendations as to what 03:51:40 4 would assist Mr. in connection with potentially
03:51:45 5 improving -- having is his condition improve?
03:51:51 6 A. Yes.
03:51:52 7 Q. And what were your recommendations?
03:51:54 8 A. Ideally he should be on medication that would 03:51:59 9 alleviate some of his symptoms that are more 03:52:03 10 troublesome. And he is on Valium, which seems to help 03:52:07 11 to some extent. I also recommended psychotherapy for a 03:52:13 12 period of time, but that doesn't seem to be something 03:52:18 13 that he's able or has been able to do.
03:52:21 14 Q. And is that something that you spoke with him
03:52:24 15 about prior to doing your supplemental report?
03:52:29 16 A. I mentioned it to him, yes. 03:52:31 17 Q. And has his prognosis changed at all between --
03:52:37 18 well, let me back up. What is his prognosis?
03:52:40 19 A. The prognosis I put in my reports is guarded.
03:52:44 20 Q. And what does that mean?
03:52:45 21 A. And guarded is a medical term of art. It just 03:52:49 22 means the outlook for the future is uncertain 03:52:53 23 compared -- dependent on a number of factors that are 03:52:58 24 hard to predict at this time. 03:53:01 25 Q. And so from your expert perspective, what's your
Goldstein - Cross-Exam 03:53:05 1 prognosis for Mr. Ward improving in areas of functioning
03:53:11 2 in his life?
03:53:12 3 A. Well, it's -- you know, it's a very debilitating 03:53:16 4 condition, and the longer it goes on, the more difficult 03:53:19 5 it is to treat successfully. It becomes engrained. But 03:53:25 6 we don't like to think anything is hopeless. So I'd say 03:53:28 7 the prognosis is still guarded.
03:53:30 8 Q. Is there anything else specifically that you 03:53:36 9 considered to be relevant to your opinion here today
03:53:41 10 that you haven't already generally described?
03:53:44 11 A. No, I don't think so. 03:53:47 12 MS. HOULDING: I have nothing further at 03:53:49 13 this time, Your Honor. 03:53:51 14 - - -
03:53:51 15 Robert L. Goldstein, M.D., Cross-Examination
03:53:51 16 By Ms. Kern:
03:53:51 17 Q. Thank you, Your Honor. 03:53:53 18 Good afternoon, Dr. Goldstein. How are you
03:53:57 19 today?
03:53:57 20 A. Good afternoon. 03:53:59 21 Q. I believe the last time you and I saw each other 03:54:04 22 is when I travelled up to New York to take your
03:54:06 23 deposition; is that right?
03:54:07 24 A. Yes.
03:54:08 25 Q. And I believe that was back in July of 2016?
Goldstein - Cross-Exam 03:54:10 1 A. Sounds right.
03:54:12 2 Q. So almost two years ago?
03:54:14 3 A. I'm sorry?
03:54:14 4 Q. It was almost two years ago?
03:54:16 5 A. Yes. 03:54:17 6 Q. Now, you and I have not spoken or exchanged any 03:54:20 7 type of emails or communications since your deposition;
03:54:24 8 is that right?
03:54:24 9 A. Correct. 03:54:25 10 Q. But you have been in contact with Mr. 's 03:54:29 11 attorneys about this case for at least the last four
03:54:33 12 years?
03:54:34 13 A. Yes. 03:54:35 14 Q. And you met with Mr. 's attorneys over the
03:54:38 15 weekend?
03:54:40 16 A. Yes. 03:54:42 17 Q. I'm going to talk a little bit more about the 03:54:45 18 relationship that you have with Mr. Ward's counsel. Do 03:54:49 19 you recall that Ms. Houlding called you back in April of
03:54:54 20 2014 to hire you for this case?
03:54:57 21 A. Yeah, April or May of 2014.
03:55:00 22 Q. Okay. Mr. did not hire you; is that right?
03:55:03 23 A. That's correct. 03:55:05 24 Q. And you're here today to give testimony on behalf
03:55:08 25 of Mr. ?
Goldstein - Cross-Exam 03:55:09 1 A. Yes. 03:55:10 2 Q. Now, you testified that this isn't the first time 03:55:15 3 that you've been hired by Ms. Houlding's firm to testify
03:55:22 4 as an expert?
03:55:23 5 A. Yes. 03:55:23 6 Q. You've had a relationship with her law firm for
03:55:25 7 at least the past ten years, haven't you?
03:55:27 8 A. Approximately -- yeah, approximately over a 03:55:30 9 ten-year period. 03:55:37 10 Q. In that ten-year period you've been retained for 03:55:39 11 litigation purposes between 12 and 24 times; is that
03:55:43 12 fair?
03:55:44 13 A. Roughly about -- on the average perhaps maybe 03:55:47 14 once or twice a year. 03:55:48 15 Q. And in all of these cases where you've been 03:55:50 16 retained or hired by Ms. Houlding's law firm, you were 03:55:54 17 testifying on behalf of the plaintiff, the person
03:55:56 18 bringing the lawsuit?
03:55:58 19 A. I didn't testify in all of the cases. Sometimes 03:56:03 20 I was just the consultant. But it was always on behalf 03:56:06 21 of their clients, who were plaintiffs. 03:56:08 22 Q. Who were plaintiffs, okay.
03:56:10 23 Now, you live in New York, Dr. Goldstein?
03:56:13 24 A. Yes. 03:56:14 25 Q. And that is also where Ms. Houlding's law firm is
Goldstein - Cross-Exam
03:56:18 1 located?
03:56:18 2 A. I think they're in Westchester, which is a suburb 03:56:23 3 of New York. 03:56:24 4 Q. Now, you are being paid directly by Mr. 's 03:56:30 5 counsel for the time that you spend on this case; is
03:56:33 6 that right?
03:56:33 7 A. Correct. 03:56:33 8 Q. I'd like to show you what we've previously marked 03:56:37 9 as Defendant's Exhibit -- I'm sorry, Plaintiff's Exhibit 03:56:41 10 41. And I'm going to ask if you recognize this 03:56:45 11 particular document. 03:56:49 12 A. Yes. This is the fee schedule in this particular 03:56:53 13 case.
03:56:54 14 MS. KERN: Your Honor, I'd move to introduce 03:56:56 15 Plaintiff's 41. 03:56:58 16 THE COURT: All right. 04:38:21 17 (Whereupon Plaintiff's Exhibit 41 is 04:38:23 18 admitted into evidence.)
03:57:02 19 By Ms. Kern:
03:57:03 20 Q. So according to this particular document, Dr. 03:57:08 21 Goldstein, you were paid $3,000 to review written 03:57:11 22 materials and conduct your psychiatric examination of
03:57:16 23 Mr. Ward?
03:57:16 24 A. And prepare the report. 03:57:18 25 Q. And prepare the reports. And in total I believe
Goldstein - Cross-Exam 03:57:20 1 you told me that you'd spent approximately six hours
03:57:24 2 doing those things?
03:57:25 3 A. Yes, I did. 03:57:27 4 Q. Now, in addition to the $3,000 that you've 03:57:30 5 already received from Mr. 's counsel, you're also
03:57:34 6 being paid $5,000 just to testify here today, correct?
03:57:38 7 A. Yes. 03:57:39 8 Q. Okay. And you're not here pursuant to any type
03:57:43 9 of subpoena?
03:57:44 10 A. No. 03:57:45 11 Q. You willingly travelled down here from New York
03:57:48 12 to testify today; is that correct?
03:57:51 13 A. Yes, I did.
03:57:52 14 Q. I assume you're staying at a hotel?
03:57:55 15 A. I'm sorry?
03:57:56 16 Q. I assume you're staying at a hotel?
03:57:59 17 A. I think it's a motel. 03:58:00 18 Q. All right. And all of your travel costs, your 03:58:03 19 airline ticket, hotel, food, cabs, those have all been
03:58:07 20 paid by Mr. 's counsel?
03:58:08 21 A. Yes. 03:58:09 22 Q. And I see that you require in this particular 03:58:12 23 document, in fact, that these extra fees be paid to you
03:58:15 24 in advance?
03:58:16 25 A. Usually I do, yes.
Goldstein - Cross-Exam 03:58:18 1 Q. How much have you been paid for these additional
03:58:20 2 expenses?
03:58:22 3 A. Actually, I'm very lazy; I haven't gotten around 03:58:26 4 to submitting a bill for that yet.
03:58:28 5 Q. But you certainly intend to do so; is that right?
03:58:30 6 A. I will, yes. 03:58:31 7 Q. And you also -- what is not on this fee schedule 03:58:36 8 is you also charged AutoZone $3,450 so that I could talk 03:58:41 9 to you back in July and take your deposition in 2016,
03:58:45 10 correct?
03:58:45 11 A. Correct. 03:58:46 12 Q. How many cases -- how many other cases currently
03:58:50 13 are you working on with Mr. 's counsel?
03:58:52 14 A. Currently working on?
03:58:54 15 Q. Yes. 03:58:55 16 A. I really don't know because I -- I'm very rarely 03:59:02 17 informed when older cases have been settled or are still 03:59:06 18 pending, so I have no idea. 03:59:08 19 Q. Okay. Is it fair to say that you have a
03:59:11 20 continuing relationship with Ms. Houlding's firm?
03:59:15 21 A. I don't have any, you know, formal relationship 03:59:18 22 with them. If they want to contact me to review or 03:59:22 23 consult on a case, if I have the time, I would, yes.
03:59:26 24 Q. Which they have done over the past ten years?
03:59:29 25 A. Yes. As I said, once or twice a year.
Goldstein - Cross-Exam 03:59:32 1 Q. And you get your legal work from referrals; do
03:59:37 2 you not?
03:59:37 3 A. Occasionally they're court referred by a court, 03:59:43 4 but mostly by referrals, yes. 03:59:46 5 Q. Referrals by counsel that you've been retained
03:59:49 6 by?
03:59:49 7 A. Either by lawyers or by ex-clients or by other 03:59:55 8 colleagues, psychiatrists. 03:59:56 9 Q. Now, you testified on direct examination that you
04:00:00 10 obtained your medical degree, I believe, back in 1965?
04:00:05 11 A. Yes. 04:00:06 12 Q. And you also testified that currently today you
04:00:11 13 do treat some patients?
04:00:12 14 A. Yes. 04:00:15 15 Q. Mr. , to be clear, he's not a patient of