Why Forensic medical/psychological examiners are not competent

I went face to face with the forensic psychiatrist Pascua-Lim on the Texas Medical Board several years ago. She volunteered that she knew almost nothing about obstructive sleep apnea. I realized that, for the 7% of Americans with severe sleep apnea
she would not be competent to claim expertise on their mental status at the time they committed a crime. Since these individuals are at high risk of causing injury to others, she should not be allowed to claim expertise at all for anyone committing a crime (since she can’t even evaluate those at very high risk). I’ve since ascertained that the Harvard forensic psychiatry program has the same failure to have expertise (by discussing the issue with the co-director of their program). I have also ascertained that the former forensic psychologist examiner for a major California state prison has no working knowledge of the mental status issues for sleep disorder/sleep deprived individuals also. If this information is being withheld from their education (like it is for all except Boarded sleep medicine physicians) then all the individuals subjected to forensic exams (especially for death penalty) have been deprived of their right to an expert competent/experienced in their areas of disability. let us use this info to turn our criminal justice system into a true rehabilitative system. Otherwise, the damaged individuals who commit crimes will just go on to inflict more injurious behaviors on innocent victims when the afflicted individual is released from prison.

I understand it can be hard to have compassion for someone who has committed a crime. I, too, have been a crime victim. My medical office was robbed at gunpoint by a man intending sexual assault.

In my continuing efforts to understand human behavior, I explored a textbook on Neuropsychiatry. I read that death row inmates in New York State all had evidence of prior brain damage. Surely, this cannot be just a coincidence. I looked forward to the next edition of this textbook, around 2003, only to discover that the topic was not covered in the later edition. I found that individuals well trained in evaluating social behaviors secondary to brain injury, either physical or toxic, were far and few between. I don’t think that forensic psychiatrists are well qualified to evaluate human behavior that lies out of the norm, even though their training asserts that they are. keep in mind that “Board Certification” is actually a commercial qualification. It is not a government status. When I was Board certified in Family Medicine, that meant I had met the qualifications determined by a nongovernmental group and successfully completed examinations. However, the State governments have been accepting these Board Certification statuses as evidence of competency. The Americans with Disabilities Act allows an individual the right to an expert competent and experienced in their areas of disability. Obviously, a forensic psychiatrist who does not even know to discover if the individual they are examining may have oxygen or sleep deficits could not be competent in a court of law.

The issue of obstructive sleep apnea is just the tip of the iceberg. There is a whole area of partial hepatic encephalopathy to explore. Our prisons are full of people with liver disease. It seems that physicians routinely, even if they know a person has a liver disease, does not realize they have mental status impairment until they arrive obtunded with  hepatic encephalopathy. There are much more accurate ways of assessing mental status when the liver is damaged. This involves having a opthalmologist evaluate their pupillary reflexes. This is more sensitive than serum ammonia. Considering that there are cheap safe ways of renewing liver function in humans, this is a boondoggle that benefits only a few financial elite individuals.


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