According to the U.S. National Library of Medicine, “Medical malpractice is defined as any act or omission by a physician during treatment of a patient that deviates from accepted norms of practice in the medical community and causes an injury to the patient.” Medical malpractice is a component of tort law, which addresses professional negligence and offers reparations for civil offense. Some common examples of medical malpractice include misdiagnosis / delayed diagnosis, prescription drug errors, surgical / procedural errors, and failure to treat. However, until the recent COVID-19 outbreak, medical malpractice suits related to a pandemic have rarely been discussed. In this blog post, Experts.com aims to shed light on the topic with insight from Emergency Medicine Members, Sajid R. Khan, MD, and Vipul Kella, MD, MBA FACEP.
The COVID-19 pandemic brought about a plethora of problems for citizens, businesses, and industries all over the globe. According to Dr. Kella, “The pandemic placed enormous strain on our health systems: hospitals were operating at maximum capacity, supply shortages were well-publicized, and healthcare providers were scarce and overworked.” To add, during the pandemic, medical professionals had to simultaneously learn about the nature of the virus, its symptoms, and how it affected people of all ages. Despite the circumstances, essential workers in the medical field have abided by their ethical duty to commit no harm and to save their patients to the best of their ability. With the mystery of an unprecedented illness, and the learning curve associated with it, should the medical community be held to the same medical malpractice standard for COVID-19 as for other illnesses?
To his knowledge, Dr. Khan is unaware of any COVID-related malpractice lawsuits. However, to make a medical malpractice claim in most states, deviation from the standard of care must be demonstrated. Dr. Khan confirmed that the standard of care has frequently changed throughout COVID-19 due to the oddity of the situation. “Therapeutic recommendations change from month to month, making establishment of medical malpractice that more challenging,” he added. During the pandemic’s inception, healthcare professionals had to care for patients and prioritize their own physical well-being. Especially in populated areas like New York City, the medical community faced a scarcity of supplies. Dr. Khan, and many other Emergency Medicine professionals, have participated in a multitude of discussions about how to best select the patients who had the strongest chance of surviving. This of course is not the preferred method of treatment, but desperate times call for desperate measures. He stated, “It would be irresponsible to hold providers responsible for failing to provide optimal care to patients with such an illness.” Through the news and social media, the whole world has seen the medical community in action to help minimize the spread of COVID-19. Has the United States government taken any action to minimize the legal ramifications towards the healthcare industry? What measures can healthcare providers take to reduce the risk of medical malpractice involvement?
According to Dr. Kella, there have been a few acts passed by the federal government to alleviate the stress of the medical community. He mentions the Public Read and Emergency Preparedness (PREP) Act and the Coronavirus Aid Relief and Economic Security (CARES) Act. The PREP Act, amended by the US Department of Health and Human Services, provides legal protections to medical providers, whereas the CARES Act protects healthcare providers offering volunteer services during the pandemic against liability. “These regulations were good news for physicians as they allowed more leeway for trying to deliver care during difficult circumstances that were often out of their direct control,” Dr. Kella mentioned. Although there is protective legislation, this does not mean the medical community should not maximize efforts to minimize medical malpractice lawsuits. COVID-19 is known to advance a patients’ pre-existing or chronic disease. For instance, the standard of care has altered throughout the pandemic and, as such, Dr. Kella has suggested healthcare providers to meticulously check the documentation and routines of their patients to avoid negligence.
As the United States produces and administers vaccinations, the medical community’s knowledge of COVID-19 expands. Medical malpractice may not have played a large role throughout the beginning of the pandemic. As the days pass and perhaps more litigation arises, holding COVID-19 medical professionals to a strict standard of care, unless it is an egregious departure, could have a chilling effect on the medical community. As was apparent in the middle of the outbreak, the last outcome our country needs is fewer doctors and nurses.
Technology giants like Amazon, Facebook, and Google face legal battles yearly. Recently, another behemoth has followed suit (pun intended). On August 13th, 2020, Apple found itself involved in an antitrust lawsuit against Fortnite video game creator, Epic Games. The trial began on May 3rd, 2021 and is ongoing, so this blog post will not have all the answers. As it unfolds, this post will delve into the perspectives of both businesses, describe the nature of the trial, introduce opening statements from the first day of the trial, and explain possible outcomes for both Epic Games and Apple.
Epic Games has filed an antitrust lawsuit against Apple Inc. in response to the removal of its most popular game, Fortnite, from the iPhone App Store. This prohibited 116 million of its 350 million users from updating the game and new consumers from downloading the app (this does not affect the remaining players using other smartphones or gaming consoles). Fortnite’s eradication from iOS App Stores has caused players from around the world to unite in a social media campaign called #FreeFortnite. Epic Games accused the tech giant of monopolizing purchasing options for apps by restricting other methods of conducting transactions. Due to Apple’s renowned international success, Epic Games has filed lawsuits against Apple in Australian, United Kingdom, and European courts. Epic Games not only wants Fortnite back on the iOS App Store, but it also wants to launch a rival App Store on all Apple devices so users can purchase Epic Games products through non-Apple means.
The catalyst for Fortnite’s removal from Apple’s App Store was the release of a new update by Epic Games which included the implementation of an in-game purchasing currency called “V-Bucks.” This currency allows players to buy items through non-App Store channels. Users who purchase Fortnite items such as outfits, pickaxes, and the latest season’s Battle Pass get to enjoy a 20% discount, which incentivizes players to continue using V-Bucks. Since these purchases are not made through the App Store, V-Bucks circumvents Apple’s chances of receiving its 30% share of any transaction, hence its removal from the App Store and the foundation of #FreeFortnite. In response to Epic Games’ claim of Apple becoming a monopoly, Apple explains the fairness in its decision to remove the game from its App Store. According to Apple, Epic Games violated its agreement by installing V-Bucks without Apple’s permission. If Apple wins the trial, this contract violation could keep Fortnite and all other apps made by Epic Games, or apps run by its game engine, Unreal Engine, from the App Store (The Verge).
The trial began on Monday, May 3rd, 2021 in federal court in Oakland, California. This proceeding is a bench trial; thus, the judge will be making the final ruling with no jury. The trial will be held in person and the press and public are prohibited from entering the courtroom. The presiding judge for the United States trial is Judge Yvonne Gonzalez Rogers. Pending trial, she declined Epic Games’ request for Apple to host Fortnite on iOS devices. Trial dates for the international lawsuits against Apple are unknown. However, Epic Games has recently filed lawsuits in November 2020 (Australia), January 2021 (United Kingdom), and February 2021 (Europe).
Opening Statements and Trial Arguments (photo credits from The Verge)
In its opening statement, Epic Games compares Apple’s restrictive policies to a “Walled Garden.” Its argument is based on the unfairness of Apple’s control over purchasing options. Two expert witnesses testified on behalf of Epic Games. University of Chicago economist, Dr. David Evans, told the court, “Apple’s rules unfairly prevent developers from letting consumers know if their prices for in-app purchases take into account the iPhone maker’s 30% commission or that consumers may be able to get better deals elsewhere,” (Wall Street Journal). To add, Susan Athey, an Economics of Technology professor at the Stanford Graduate School of Business, explained Apple’s stronghold over consumers is due to their prohibitive iOS mobile operating system. In the case of this trial, if a consumer wanted to access Fortnite an iPhone, the user would need to switch to a different smartphone brand and repurchase all the apps originally purchased from iOS devices. Since the internet is needed to play Fortnite, Evans highlights how gaming consoles could never replace smartphones, as it lacks cellular data for users who want to play the game from anywhere.
Apple’s opening statement was a defensive response to Epic Games’ claims. According to The Wall Street Journal, Apple hired University of Pennsylvania Wharton School professor, Lorin Hitt, to discuss in-app purchases. Hitt claims, “anticompetitive measures tend to result in reduced quality, yet that hasn’t happened with iPhone and iPads apps, as developers have seen their revenue increase over time.” Essentially, consumers notice the value in the offers proposed by Apple. As noted by the graph below, Mr. Hitt also denounced Epic Games’ claim about Apple’s monopoly-like practices. Users switch devices frequently because people like the products acquired for different reasons. If this were not the case, Play Station and XBOX would not generate over 50% of Fortnite’s revenue for the last two years. This also infers that most Fortnite users are not on iOS devices, which is surprising considering there are 1.5 billion active Apple devices. In addition, Apple insists the iPhone offers multiple avenues for financial transactions. Although difficult to decipher, the second picture provided by Apple indicates that the iPhone, compared to its competitors and subsidiaries, offers three types of digital game transactions options: The App Store, Web Applications, and Purchasing on Other Platforms to play on iOS. Ultimately, Apple is arguing that its practices are not prohibitive nor remotely resemble a “Walled Garden.”
The outcome of the trial between Epic Games and Apple Inc. can end in multiple ways. One hypothetical is the verdict will resume the current situation: users could not access Fortnite on iOS devices, but other games produced by Unreal Engine will remain on Apple’s App Store. If the judge rules in favor of Epic Games, it may be able to create and launch its own App Store on iOS devices.
In addition to the trial, a new state bill that recently passed the House 31-29 may negatively impact Apple’s case. According to The Verge, Arizona’s House Bill 2005, “prevents app store operators from forcing a developer based in the state to use a preferred payment system…,” which would ultimately force Apple to provide various payment methods on iOS. This development could be beneficial for Epic Games.
Computer technology is one of the most pivotal inventions in modern history. Artificial Intelligence, smartphones, social media, and all related apparatus have significantly enhanced living conditions in an unprecedented manner and connected the world with a click of a button. It is used in various occupations: from business related fields to more creative professions. To say modern technology has been advantageous in recent decades is an understatement. However, every creation has its flaws. This multi-part blog series is intended to reveal one of those flaws, and a dangerous one at that, deepfake videos. This first post includes an introduction to deepfake videos, and the steps taken by federal and state governments to identify such duplicitous content. Special insight on the subject is provided by our Experts.com Member and Audio, Video, and Photo Clarification and Tampering Expert, Bryan Neumeister.
Editing footage and photos is normal practice in our selfie-addicted new normal, but creating distorted content is a whole new ballgame. According to CNBC, deepfakes are “falsified videos made by means of deep learning.” These videos, images, audios, or other digital forms of content are manipulated such that counterfeits pass as the real thing. What makes matters worse is the internet allows anyone and everyone to create, edit, and post deceptive content. It is one of many threats to cybersecurity strategists, police departments, politicians, and industries alike because the purpose of making them is to spread misinformation, tarnish reputation’s, exploit evidence, and to ultimately deceive an audience. The unfortunate reality is deepfake videos which display pornographic scenarios and manipulated political moment are the most common. For instance, a notable deepfake video was posted by Buzzfeed in 2018 depicting former United States president, Barack Obama, slandering another former United States president, Donald Trump. However, the voice behind Obama is none other than Jordan Peele. The video was intended as a moral lesson to explain how important it is to verify online sources, and to highlight the dangerous problem of trusting every post uploaded to the internet.
According to Mr. Neumeister, who specializes in this area of expertise, there are two types of artificial intelligence programs used to create deepfake videos: GANs and FUDs. He states, “GANs (Generative Adversarial Networks) are used by professionals, and FUDs (Fear, Uncertainty, and Doubt) are the homemade ones.” Although FUD videos garner more attention among internet users, the real menace to society are the videos made from GANs.
Videos made from Generative Adversarial Networks have an algorithmic framework designed to acquire input data and mimic the desired output data. One can visualize how GANs work through the viral Tom Cruise TikTok deepfake. According to NPR, the creator of the deepfake, Chris Ume, used a machine-learning algorithm to insert an accumulation of Tom Cruise footage. This allowed him to give a digital face transplant to the Tom Cruise lookalike actor he hired for the video. Ume input a plethora of videos to create a desired output of a realistic face swap. Neumeister also adds that the most realistic deepfakes correlate to the amount of footage a person can acquire. Specifically, “the more bits of video clip you have to put together, the more accurate you can make facial movements, ticks, etc.” From this logic, it can be inferred that Ume’s Tom Cruise deepfake looks more realistic than those that lack algorithmic programs.
Because viewers typically see deepfakes in politics and pornography, federal and state governments have recently implemented laws to counteract deepfake content creation and distribution. President Trump signed the first deepfake federal law near the end of 2019. This legislation is included in the National Defense Authorization Act for Fiscal Year 2020 (NDAA), which is a $738 billion defense policy bill passed by both Senate (86-8) and the House (377-48). The two provisions in the NDAA requires: “(1) a comprehensive report on the foreign weaponization of deepfakes; (2) requires the government to notify Congress of foreign deepfake-disinformation activities targeting US elections,” (JD Supra). The NDAA also implemented a “Deepfakes Prize” competition to promote the investigation of deepfake-detection technologies. On a state level, there have been laws passed by multiple states that criminalize specific deepfake videos (JD Supra):
Virginia: first state to establish criminal penalties on the spread of nonconsensual deepfake pornography.
Texas: first state to ban creation and dissemination of deepfake videos aimed to alter elections or harm candidates for public office.
California: victims of nonconsensual deepfake pornography can sue for damages; candidates for public office can sue organizations and individuals that maliciously spread election-related deepfakes without warning labels near Election Day.
Although the Trump administration and various states established policies against deepfakes, it remains ubiquitous on almost all online platforms. How can users at home distinguish authentic content from deepfakes?
Mr. Neumeister provides a few tips and tricks for detecting a deepfake. One giveaway mentioned is mouth movement, otherwise known as phonemes and visemes. Mouths move a certain way when people speak. For instance, words like mama, baba, and papa start with a closed mouth. Words like father, and violin start with the front teeth pushing against the bottom lip. To add, consonants and vowels also sound a certain way when pronounced correctly. “Words with t, f, n, o, and wh, are pretty good for tells,” adds Mr. Neumeister. When analyzing video, the frames in which a person is speaking are broken down into approximately six to ten frames to determine if the way someone talks in other videos is the same as the video being analyzed. Another tip Mr. Neumeister suggests is to watch videos with context in mind. Viewers should pay attention to background noise, crowd ambiance, and the cadence in a speaker’s sentences. Authentic and original content would have, by nature, realistic frames. Users can detect a deepfake by sensing dissonance in, for instance, a speaker’s proximity to the microphone or a size of a room. For users at home or on-the-go, these tips are crucial for distinguishing verified sources from manipulated misinformation.
The emergence of deepfake content, its continuously improving technology, and the spread of disinformation is a multifaceted and complex problem. This blog post has only scratched the surface, so stay tuned for part 2 for a more in-depth read.
Mental health professionals are being targeted by a failure to appear scam. The first scam we’ve seen targeting expert witnesses.
This is the first blog post I’ve written that falls directly into the “public service announcement” category. Yesterday morning, I saw an article by the Washington Post where the author describes a telephone-based scam, where perpetrators pretend to be police officers.
The story grabbed my attention because the suspects have a little deeper knowledge about prospective victims. They know enough to know you are likely to act as an expert witness.
The caller, impersonating a police officer, claims the victim failed to appear at a court hearing in which they were subpoenaed to testify as an expert witness. The criminal claims to be an officer and provides the real name of an an officer employed at the local law enforcement agency, which can be confirmed online. The victim is told they have a civil option to pay a fine and avoid jail time.
As recounted in the Washington Post article, “The problem, the alleged detective stressed, was that because of the coronavirus, people couldn’t come into police headquarters to settle such matters. He said she needed to purchase “MoneyPak” electronic cash transfer cards — at one point transferring the call to his purported supervisor, who also had assumed the name of a real Montgomery officer.”
You need to start asking questions at this time! Have them send you some documentation in the mail. Have them personally serve you the paperwork. Do not get frightened by someone claiming to be an authority figure over the phone. That’s their goal! Get you nervous and acting irrationally.
The option to pay a fine should immediately get your attention. Not to mention this silliness of paying with “electronic cash transfer cards.” There is no reason you shouldn’t be able to pay a fine with a check or credit card.
If you are accused of missing are accused of missing a court hearing. You should know that police officers, detectives, investigators, are not usually those responsible for collecting fines. Generally that’s a different department.
Scam Has Been Taking Place for a While:
Although this fake police officer scam targeting mental health professionals, took place in Maryland. However, in preparing to write this post, I did a little research and found that the Los Angeles Police Department (LAPD) had also warned about this type of a scam back in 2019. Here is their press release on the subject. The LAPD specifically mentioned therapists and psychologists as more likely to be targeted:
“It should be noted that many of the victims are current/former employees in the mental health industry. In each of these incidents, the caller claimed that the victim missed an appearance as an expert witness in a court case. Therapists and psychologists should particularly beware of the scam. You can get help determining the authenticity of a call by contacting your local police station.”
Before Nikola and the Trevor Milton scandal, there was a prominent blood-testing startup called Theranos. Its founder, Elizabeth Holmes, currently faces a criminal fraud trial.
If you’ve been tuning into business news recently, the latest scandal with Nikola, a electric-powered truck manufacturer, and its founder, Trevor Milton, is no surprise to you.
For those who have not been following along, a quick summary is as follows: Nikola (NKLA) recently became a publicly traded company alleging they had hydrogen fuel cell (battery) technology that would revolutionize the trucking business. The stock did well after IPO. Nikola then did a multi-billion dollar deal with General Motors. The stock went higher. A few days after the GM deal, a short-seller released a report that accused them of a being an intricately constructed fraud. The founder, Trevor Milton, contested the accusations on social media and asked for time so he could rebut all of the allegations. Within a couple of days he went silent, was removed as executive chairman, and deactivated his social media accounts. It has been widely reported that both the SEC and DOJ are conducting investigations related to his actions and claims as founder and executive chairman.
I share that story because some news agencies have suggested Trevor Milton’s story is similar to that of Theranos founder and CEO, Elizabeth Holmes. Ms. Holmes is now facing a criminal fraud trial and she is the focus of our our post today. Stay tuned next week for some further discussion on the issues surrounding Nikola.
Elizabeth Holmes founded a privately held biotechnology company called Theranos. The company intended to revolutionize blood tests, with just a drop of blood. No more needles and vials, just a small drop of blood, and the tests results would be available rapidly. Ultimately, they failed to deliver tangible results and led consumers to believe false promises. After receiving more than $700 million in private investment, the company began falling apart.
In Spring 2018, Holmes was charged with fraud by the SEC, as reported by Bloomberg. This being a civil action, Holmes settled it without admitting any of the allegations. The settlement required her to relinquish her shares to the company and abstain from being an officer or director of a public company for a period of 10 years. There was also a fine, according to Barron’s. To the best of my recollection, Ms. Holme’s settled with the SEC on the same day she was charged.
In the Summer of 2018, the US Attorney’s office filed charges against Holmes’ for conspiracy and wire fraud, as reported by CNN. This criminal indictment is the inspiration for this blog post.
For more than 2 years, we’ve followed the developments in the criminal prosecution of Elizabeth Holmes, wondering if it would lead us to an interesting analysis from an expert witness perspective. In September of 2020, I found this article from the New York Daily News. It seems Ms. Holmes is preparing for the use of a “mental disease or defect” defense.
More specifically, the article from the New York Daily News, indicated the judge had assigned a neuropsychologist and psychiatrist to conduct a two-day, 14 hour evaluation of Ms. Holmes. Additionally, this evaluation is to be recorded. Now, I had never heard of psychological evaluation being this long and I worked in the mental health field for years before joining Experts.com.
To the best of my knowledge, I had not heard about the “mental disease or defect” defense since law school. I remembered it as a mitigating factor to a crime. Something we learned about when we learned about defenses and factors related to defenses.
So, I did what I usually do with these blog posts, and reached out to the experts. This time, I thought it would be good to get insights from a federal public defender and a psychiatrist.
First, let’s see get a view of the legal opinion…
Analysis from Federal Defense Attorney, Diego Alcalá-Laboy:
Diego Alcalá-Laboy is a criminal defense attorney with his own practice Defensoria Legal, LLC, in Puerto Rico, where he represents federal criminal defendants and advises startups. He is also an adjunct professor at the Inter-American University, School of Law and teaches the Federal Evidence and Federal Criminal Procedure courses at the University of Puerto Rico Law School’s Federal Bar Review.
Nick Rishwain: Why would one use a defense of “mental disease” and what impact might it have on the case?
Diego Alcala: A prosecutor must prove that a defendant intended to commit an act (mens rea), and that he committed the act (actus rea). And most crimes require that the defendant acted intelligently, knowingly, or willfully, and on some occasions recklessly or negligently. The type of “mens rea” a crime requires is defined by Congress and the interpretations given by the courts. On some occasions, an offense may not even require a mens rea, such as with strict liability offenses.
Crimes may have different elements, and a prosecutor may have to prove that the defendant had the required mens rea to commit each element of the offense. If the prosecutor cannot prove this, the defendant may be found not guilty.
Congress also recognized that a defendant may show that because of a medical defect he was unable to appreciate the nature and quality of his or her acts because of a severe mental disease or defect. After the John Hinkley trial, Congress amended its statutes and eliminated the affirmative defense of diminished capacity but allowed a defendant the possibility to attack an element of an offense because of a mental condition.
This is a lot harder than it sounds. The Courts are the gatekeepers of the any scientific testimony intended to be presented at trial. Therefore, whenever a defense of mental defect is offered by a defendant, the Court must ensure that the evidence offered is grounded in sufficient scientific support. This scientific evidence then must be scientifically sound and must also show that the medical condition negates mens rea of an element of the offense. So, a defense of mental defect, if grounded on scientific basis, and shows that it negates an element of the charged crime, will clear the defendant from a particular case.
NR: Have you ever seen a “mental disease” defense used in a criminal fraud matter?
DA: I have never seen a mental disease defense presented before. But I did find some cases where the defense tried to introduce this type of evidence but was ruled inadmissible because it did not satisfy the Court that the proffered evidence: a) was based on sound scientific principles, or b) even if it was based on sound principles, it failed to negate mens rea for the element(s) of the offense. In fraud cases, a defendant is accused of committing some type of false representation. It follows that the evidence of mental disease must show that if his/her medical condition can be logically connected to a subjective belief that his/her assertions were not false, baseless, or reckless vis-a-vis the truth. I have not found a fraud case in which the defense has been able to overcome this burden.
NR: If it is established that Elizabeth Holmes is suffering from “mental disease,” can she still be held criminally liable for her actions?
DA: If a defendant presents a successful mental disease defense, the federal law states that she will be found not guilty. But a finding of not guilty does not necessarily mean that she is free to leave. A determination of not guilty by reason of mental defect will then place a defendant in a “suitable facility” and may be release only after showing that she is no longer a threat.
NR: Does a “mental disease” defense have much success in federal criminal trials?
DA: As mentioned, I have not found a successful case, and primarily the difficulty lies in the very narrow type of cases that may meet the discussed admissibility standard. Even if she can get this evidence into trial, it is still up to the jury to accept this defense.
Now that we have some idea of the application of the law for fraud in federal criminal cases, we need to review the science as outlined by Mr. Alcalá.
Analysis from Forensic Psychiatrist and Expert Witness Dr. Sanjay Adhia:
Dr. Sanjay Adhia is triple-Board-Certified in Forensic Psychiatry, Brain Injury Medicine, and Psychiatry. Dr. Adhia serves as a Psychiatrist and Brain Injury Medicine specialist at TIRR Hermann Memorial, a Rehabilitation and Research hospital treating those with brain and spinal cord injuries and psychiatric elements of their injury and recovery. In private forensic practice he conducts Independent Medical Examinations (IMEs), and renders his opinions by report and testimony. Dr. Adhia serves on the faculty of McGovern Medical School at UTHealth. You can visit his website at: forensicpsychiatrynow.com.
Nick Rishwain: According to the psychiatric community, what constitutes “mental disease” and “mental defect?”
Sanjay Adhia, MD: These are more legal terms rather than actual formal psychiatric definitions.
According to Merriam-Webster, the legal definition of “mental disease” is “an abnormal mental condition that interferes with mental or emotional processes and internal behavioral control and that is not manifest only in repeated criminal or antisocial conduct”.
Examples would include Schizophrenia, Schizoaffective Disorder and Bipolar Disorder which are considered Severe Mental Illness (SMI). These conditions may lead to psychiatric hospitalization. The conditions maybe associated with and loss of touch with reality and a lack of volitional control.
“Mental defect,” on the other hand, is defined by Merriam-Webster as a “an abnormal mental condition (as mental retardation) that may be of a more fixed nature than a mental disease”. “Fixed” disorders would include Intellectual Developmental Disorder (IDD; formerly known as mental retardation), Autism and Brain Injury. According to this definition, Antisocial Personality Disorder (ASPD) would be excluded. ASPD is marked by a tendency to lie, break laws, and act impulsively. It shares some features with psychopathy or sociopathy. A number of states do not permit the use of ASPD in the insanity defense. Allowing ASPD would have unintended repercussions. For example, it could potentially permit a defendant like Ted Bundy or Jeffrey Dahmer to avoid prison.
NR: In the court order, it limits the evaluation of Ms. Holmes to a 14 hour, 2-day, psychiatric examination. Is this out of the ordinary in a criminal matter?
SA: There is a wide range of exam times in criminal cases. It would depend on a variety of factors including the type of case, the jurisdiction, the funding available and the severity of the charge. Assessment time in a misdemeanor will not be identical to a capital case. Ms. Holmes’ case is not a capital case, but it helps to understand differences in how long the examination might take. The exam time in a Competency to Stand Trial for a misdemeanor trespassing case would likely be under two hours. I have seen some examiners spend 30 minutes for the interview in such cases. The other extreme would be Capital cases which could go over 8 hours or several days; this is especially true if neurocognitive testing is required, which can take an entire day.
Again, in a capital case the threshold and the stakes are very high—especially in death penalty cases that often go to the appeals court.
In misdemeanor cases, you may have a single mental health expert and the findings may be accepted without the need for an opposing expert. In Capital cases, the defense itself may retain several mental health and other medical experts (i.e. Fetal Alcohol Syndrome experts). In the Holmes case, the 14 hours is to be shared between a forensic neuropsychologist and a forensic psychiatrist.
As it is a high-profile case, it is possible that the court may allow additional funds or there maybe a willingness of the expert to work within a budget.
It is my experience that the examination in insanity cases take more time than other types of cases as you have to elicit a detailed account of the crime from the defendant and then determine the mental state at a time in the past and consider malingering (lying for secondary gain—like a lesser sentence). I suspect in the Holmes case, it is likely the charges are not limited to one circumscribed incident so it could take additional time. It is worth noting that time spent reviewing records and preparing a report could exceed twenty hours or more.
NR: What information might you need to establish or rebut an insanity defense?
SA: In addition to interviewing the defendant, it would be helpful to review medical records, legal records along with police records and videos. I often will interview collateral informants as well. In Ms. Holmes’s case there maybe, media accounts, if admissible, as well as financial records and corporate documents. Of course, an expert would review the other expert witness reports. Records in a violent crime could include an autopsy, or blood splatter expert reports, for example. In the Holmes case, there may be a forensic accounting or fraud expert report. Other sources of data could include polygraph testing, school records and employment records.
NR: In the Holmes case, the defense has retained a trauma expert. Is it common to successfully assert an insanity defense in cases of PTSD?
SA: Insanity defenses are more commonly associated with other diagnoses that are considered to be more severe forms of mental illness such as schizophrenia, bipolar disorder and IDD because they have a different impact on decision-making and regulating behavior. Although many individuals with PTSD do suffer with severe symptoms, they are generally able to maintain awareness of the nature of their acts and appreciate the wrongfulness of such acts. In jurisdictions that allow for the volitional prong, individuals with PTSD are generally considered to be able to behave lawfully. Of course, there are cases where PTSD is successfully asserted as an insanity defense. In cases where the defense attorney realizes the PTSD does not lend itself for an insanity defense, they may successfully utilize it for sentence mitigation.
United States v. Bennett,29 F. Supp. 2d 236 (E.D.Pa. 1997), aff’d 161 F.3d 171, 183 (3d Cir.1998), cert. denied, 528 U.S. 819, 120 S. Ct. 61, 145 L. Ed. 2d 53 (1999)
Remote depositions appear to be growing. As an expert witness, what should you do to improve your presentation and performance to maintain credibility and authority?
As more professionals work from home, remote depositions will continue to rise in popularity and usage. But, the extent of the rise is hard to tell since there is a lack of any hard data on the subject. One of our contributors, Isaiah Leslie, has provided some anecdotal information on the subject. We know court hearings and administrative meetings are taking place remotely. In an article from the Fort Worth Star Telegram, we learn about what may be the first remote jury trial in the U.S., which occurred in Texas. With an increase in remote hearings, depositions, and even jury trials, we wanted to give you some information about presentation and performance as an expert witness in remote deposition.
There have been an abundance of articles discussing remote depositions, but none of them appear to cover best practices for the deponent and, relevant to Experts.com members, the expert witness. Instead, the articles discuss the law permitting remote depositions; the local rules to be followed; agreements between lawyers about sharing of discoverable information; procedures for exhibits; whether the deposition is going to be taken by video conference or the deposition is being video recorded; and operation of several of the remote video platforms. The information is important for all parties to a litigation, but none of it helpful to the deponent.
To this end, I had to do some digging and contact a bunch of folks for their insights. We received some great feedback from court reporters, court videographers, and live video marketing professionals. Below is a summary of suggested best practices for expert witnesses before and during a remote deposition, focusing on presentation, apparel, lighting, audio, video, and overall performance.
Increase in Remote Depositions:
One of our contributors, Isaiah Leslie, a co-founder and partner at Regal Court Reporting, provided us with the best data on the increase in remote depositions from his company’s personal experience. In March of 2020, only 2.6% of their depositions were remote. By April, all of their depositions were remote, increasing by 550%. Although remote depositions have not outnumbered their previous in-person deposition numbers, as Isaiah noted, the adoption is still significant.
The increase in remote depositions makes sense, given the shelter-in-place orders throughout the country. Many of those who adopted remote deposition by necessity have discovered its advantages. By no means am I suggesting remote depositions would replace in-person depositions entirely. However, as legal professionals become more comfortable with videoconferencing technology, it’s reasonable to anticipate continued growth in remote depositions even after COVID-19.
Legal system participants are likely to realize, if they have not already, the value of videoconferencing. It is convenient for all involved, as there is no need to travel to the deposition location. Reduced travel should lower litigation costs as parties will no longer have to pay for travel time and costs (for lawyers and expert witnesses). Most importantly at the present time, it provides the added benefit of being socially distanced.
With this expectation remote depositions will become more prevalent, even post-COVID-19, here are the suggestions from our contributors, to help you as a deponent, give your best presentation and performance.
Court Reporter Suggestions:
Isaiah Leslie and I have become friendly on Twitter, which for those who know me, is where I’ve made a significant number of professional relationships. Isaiah brought his partner and wife, Stephanie Leslie, into the conversation so we can get some outstanding suggestions direct from a court reporter who regularly participates in depositions.
As with other past blogs, I provided a variety of questions and Mrs. Leslie provided some outstanding responses (some edited for brevity and clarity).
Nick Rishwain: Have you experienced an increase in remote/virtual depositions during COVID-19?
Stephanie Leslie: We have certainly seen more remote depositions than usual, but unfortunately most law firms are still not jumping on board fully quite yet for a variety of reasons. One being their lack of comfort with the technology aspect of things. Once they try it, they typically schedule more after that. It’s just making the plunge.
NR: Based on your experience doing in-person video depositions and remote depositions, have you identified any best practices for deponent performance?
SL: The most crucial thing with remote depositions is abiding by the admonition to not talk over others. As a working reporter myself, I can attest to the fact that speakers talking over each other is always a nuisance and makes my job exponentially harder, but in remote depositions it is absolutely critical because remote platforms, such as Zoom, act similarly to a speakerphone, and it can only choose one voice to allow through the system, so if there is simultaneous speaking, I can usually hear no one. And then, to add insult to injury, if other speakers are talking, I cannot successfully interrupt and remind everyone to speak one at a time because no one can hear me either. I have found that even though it feels very tedious to go slowly and methodically, it actually makes the deposition go more quickly and smoothly.
NR: My customers are concerned with coming across as credible, knowledgeable, professional and authoritative in their field. What do you recommend for best remote deposition performance?
SL: I have taken several expert depositions recently, all remotely, and I don’t think the virtual aspect of the deposition makes much of a difference. I felt like it was any other expert deposition. It was very clear to me which experts were knowledgeable and confident about the subjects upon which they were opining, and others were obviously not as much. I think a great CV and clear opinions backed by evidence still come through clearly to all observers.
NR: Any suggestions on apparel, lighting, audio/video setup?
SL: I have seen some sharp solid-colored virtual backgrounds created with an expert firm’s logo placed in the top corner just to the side of the witness, and it is very professional looking and memorable while not detracting from the substance of the proceeding. Apparel — I suggest still making sure you’re completely professional on top. What’s on bottom is up to you! I use an inexpensive cube light to help illuminate my face, but if the room is well lit (not too much back light), I don’t think it’s particularly necessary. Audio is the most important thing. Please test your connection and audio quality beforehand!
NR: Any further suggestions I may not have asked?
SL: As usual (but even more important with remote), if you are able to provide any spellings or technical words to the stenographer before the deposition, that is always appreciated. We usually come into the case with little to no context on the facts and your background and role, so anything you can assist with along the way is invaluable!
Legal Videographer Suggestions:
Isaiah, continued to provide me with excellent access to his team and we got some outstanding feedback from Sean Malone, of Malone Video, who works primarily with Regal Court Reporting.
The same questions provided to Stephanie Leslie were also sent to Mr. Malone. His different experiences from a videographer perspective are equally beneficial to the expert witness.
Sean answered the questions in a slightly different format, which have been edited for brevity and clarity.
Nick Rishwain: Have you experienced an increase in remote/virtual depositions during COVID-19?
Sean Malone: Definitely. Though overall some attorneys are still hesitant to go remote, others have been willing to test, and even embrace remote depositions right now, due to the quarantine. As a legal videographer, before the quarantine I had done exactly zero remote depositions. Since the quarantine, I have done at least 2 to 3 per week, on various platforms, and all for clients that were mainly accustomed to in-person depositions before COVID-19.
For the following, questions 2-4, Sean answered the questions in aggregate. So, you don’t have to scroll up to find those questions again, I’ve added them below:
NR: Based on your experience doing in-person video depositions and remote depositions, have you identified any best practices for deponent performance?
NR: My customers are concerned with coming across as credible, knowledgeable and an authority in their field. What do you recommend for best remote deposition performance?
NR: Any suggestions on apparel, lighting, audio/video setup?
SM: As a legal videographer, the things that matter in an in-person deposition are the same things that matter for a remote deposition. For example, is the deponent well lit? Are they centered in frame? Can they be clearly seen and heard? I’d recommend a similar approach for everyone involved in a remote deposition: identify your best in-person deposition practices and translate those to the medium of video conference.
Just like in real life, the witnesses I’ve observed that come off well are the witnesses who:
Are professionally dressed.
Are well mannered/aware that they are the focus of the deposition and the video record.
Listen to and directly answer attorney questions.
One note on that last one: Just like in real life, we all know that deponents should let the taking attorney finish their question before starting to answer, and also pause a little so that the opposing attorney can get in their objections… But this is especially important during a remote deposition, because of that notorious split-second delay present in all video conferencing platforms.
To present yourself well and make the videographer love you, you can:
Make sure you are well lit, and not heavily backlit.
Make sure whatever is in the background behind you is relatively neutral and not distracting (in other words, maybe take that Backstreet Boys poster down before logging on).
Make sure the area around you is tidy and free from clutter.
Make sure the camera built into your computer is as close to your eye-level as possible. If the camera is too low, like on your lap for instance, everyone will view you (and the video record will capture you) from an unflattering, upward angle. Eye-level or at least face-level is the best idea for a flattering shot of you.
Ideal framing is you in the center of the frame, with your torso and head visible in frame, with a little bit of headroom on top (headroom is the small space between the top of your head and the top of the frame). See picture:
Make sure you are joining the video conference from a reliable device that has a decent camera and microphone built in.
Make sure that device is charged!
Some additional tips on your Internet connection. So that your testimony can be captured optimally by both the court reporter, and the videographer, make sure your Internet connection is as strong as possible. Office internet is more robust than home internet, but if you are at home, you can try:
Connecting your device via Ethernet cable rather than WiFi.
If you cannot connect via Ethernet cable, choose the spot in your home with the strongest WiFi signal.
Ask other members of your household to refrain from moderate or heavy Internet use that day (e.g. have them avoid streaming TV, playing online games, etc.)
NR: Any further suggestions I may not have asked?
SM: I always like to say that everyone in a deposition has a job to do. Therefore, I try to help others do their jobs well, by doing my job well. I think that approach can be helpful no matter what your job is!
As we feel this is going to be a growing experience for witnesses and expert witnesses, we wanted to create a blog post that is truly helpful to your presentation and performance. So, we brought in one more voice to help you nail that remote deposition!
Live Video Marketing Professional Suggestions:
As some of my readers know, I’ve been doing live video since about 2015. However, I do it as a hobby. Our next contributor does it professionally and has written a book on the subject. I’m just lucky enough to know her and call her a friend. Jennifer Quinn, is a leading consultant on Internet live-streaming. I reached out to her and asked her for her input regarding presentation and performance.
Here are the suggestions provided direct from Jenny. In this instance, I asked questions more generally and Jenny gave me us some outstanding suggestions, all of which should be considered for remote depositions.
NR: I’m looking for suggested best practices. How would you want an expert witness to be prepared for remote deposition? What best practices do you suggest?
Jennifer Quinn: The fastest way to build trust with someone is to show up the way they expect you to show up. Traditionally, as an expert witness, you would arrive, dressed professionally, sit upright, and be fully prepared for the deposition.
The question most expert witnesses have today is how to transfer that same level of authority, and trust one would have face to face or in-person to a video format.
There are a few quick and easy ways to convey instant authority and credibility when preparing for a video deposition.
Pay attention to your background – be sure it conveys professionalism.
Dress the same way you would dress if you were attending court in person.
Make virtual eye contact with the video viewers by looking directly into the lens of the camera. Yes, this will feel awkward; however, it is possibly the most crucial skill you can master if you want to instantly build trust in this new era of video. Looking directly into the lens of the camera simulates eye contact and conveys authenticity more powerfully than anything else you can do when recording video.
In my book, I reference the need to pay attention to L.A.V.S.: Lighting, Audio, Video, Stability.
Daylight – sit in front of the window with the light shining in on your face.
Ring light – clips on to your phone.
Box lighting – home office studio setup.
Turn off the overhead lighting in the room.
Earbuds with built-in mic.
Cell phone camera.
Keep the lens camera at eye level.
Look into the lens.
Prop phone up – at eye level (think books, boxes, etc.).
Tripod or mount.
Desktop/laptop – don’t bump desk or table.
There you have it. Four different individuals telling you how to up your remote deposition game as remote depositions have drastically increased in the last 90 days.
Throughout shelter-in-place, many lawyers and parties have experienced the benefits of remote depositions. It has proven both convenient and cost effective. We do not expect the trend in growth to wane any time soon. If anything, we could be witnessing a completely new shift in how the legal system communicates.
A hastily-developed app and combined with a lack of user testing caused a ruckus in Iowa Caucus voting this week. What’s in store for New Hampshire, Super Tuesday, and beyond?
It has been an exciting week in US politics. We had a State of the Union address and an impeachment vote. A whirlwind week by any standard! Before we could even get to those two events, we started the week with an outrageous technology failure in the Iowa Democratic Caucus. For purposes of this blog post, I’m not going into the differences between a caucus and a primary. Let’s just assume they accomplish the same result: selecting a candidate for political office.
For the Iowa Democratic Party, Monday night was a disaster and then it continued into Tuesday, Wednesday… you get the idea. As I write this blog post on Friday morning, I’m not even sure if they have an official determination of who won. The news stories seem to be conflicting.
So here is what we know about the app (IowaRecorder) failure based on available reports. The Iowa Democratic Party hired a marketing technology company to build an app which would be used, statewide, to report results of local caucus votes (I’m simplifying for purposes of brevity). The app was going to be used to submit voting results. Nobody was actually voting through the app.
This first really good article I read that outlined the technology implementation failure, came from Slate. Here was a good summary from a couple of days ago:
“It’s still unclear what exactly went wrong with the app, but all of these issues appear to have something in common: The Iowa Democratic Party clearly wasn’t prepared for any possible issues with the app and a more involved method of vote reporting introduced this year—and sure enough, it reportedly turns out that the app was never tested on a statewide scale. Shadow, which is run by alumni of the Barack Obama and Hillary Clinton campaigns as well as Google, was paid $60,000 to develop the app, but it had just two months after party officials decided to abandon plans to report results over the phone.”
There’s some updated information on the failure from Motherboard, which was released yesterday (along with the app code). Below, you’ll see that they released an app that was still in beta format:
“And Instead of going through proper app store review processes conducted by Apple and Google, Shadow used beta testing platforms like Apple’s TestFlight to distribute the software so it could meet the Monday deadline. So when it came time for the app to do its most critical role — letting Democratic precinct leaders report results from Iowa on Monday — it failed in every way imaginable.”
As I do when these major stories break, I turn to Experts.com members to get insights. You may recall Dr. Stephen Castell. Dr. Castell, Chartered Information Systems Practitioner and Member of the Expert Witness Institute, is Chairman of CASTELL Consulting. He is an internationally acknowledged Independent Computer Expert who has been involved in a wide range of computer litigation over many years.
Below, please find my questions and Dr. Castell’s answers (Disclaimer: these questions and answers provided on February 5th, 2020):
Nick: From available reporting, it appears the Iowa Democratic Party failed to do a statewide testing of this vote reporting application. What type of tests would have been necessary to identify errors in the system before statewide roll-out?
Dr. Castell: As other ICT professionals comment in the reports, there should be thorough systems testing and QA procedures, including User Acceptance Testing and Pilot Trials, plus scaled-up ‘soak testing’, before contemplating any real-world launch, such as this statewide roll-out. You expect to get errors in systems testing – its main purpose is to identify faults and fix them. Sadly, software systems and Apps these days do seem often to be launched publicly without adequate systems testing, let alone with adequate prior User Testing and Pilot Trials. If such standard professional QA processes were omitted, or truncated, for something as high-profile and important as an App to collect and relay voter data in the Iowa Caucus, that does appear rather astonishing.
Nick: It doesn’t appear that all of the fault lies with the app developer. It seems the Iowa Democratic Party only gave the app developer 2 months to develop and deploy this application. What sort of time-frame would you anticipate to develop, test, and implement a software of this scale?
Dr. Castell: That is difficult to estimate without more knowledge of the actual detailed Customer Requirements Specification that the developer’s App was contracted to meet. On the face of it, an App simply to in-gather voting data, aggregate and transfer it, sounds in principle like fairly straightforward functionality to code, test (at scale) and implement, and 2 months may not have been an unrealistic timescale for development, testing and deployment.
Nick: Would you expect there to be a certain level of user sophistication for those using the app on this scale? Should there have been company representatives available at caucus sites?
Dr. Castell: Reports suggest that there was little prior familiarity, let alone ‘training’, or ‘user sophistication’, with the App on the part of those expected to employ it for real, in the high-pressure, real-time Iowa Caucus conditions. Whatever the state of compliance of the App with its contractual specification – perhaps reasonably well delivered to time, budget, specification, and of suitable quality, ‘fit for purpose’ – if there was no program for adequate user familiarity and training, plus some sort of support and trouble-shooting team from the developer company at caucus sites, that alone could account for the problems encountered in statewide roll-out operation.
Nick: From what I’ve read, it looks like the company was paid $60,000 to build this application. Is there any way to gauge whether this is too little or too much for this type of application development?
Dr. Castell: Again, that is difficult to gauge without more knowledge of the actual detailed Customer Requirements Specification, and thus the likely complexity of the functionality needed, and its associated software design and coding; also, there may have been a tight budget to which the developer company was obliged to work. It is not unusual for software developers to invest in a ‘plum’ assignment such as this high-profile Iowa Caucus project, for the promotional and marketing impact that gives them in securing hopefully more lucrative and profitable development jobs later. In this case, the $60,000 could have been much less than the true cost to the developer company of the analyst, designer, coder, tester, deployer and trainer man-days expended in building and launching the App with a statewide roll-out, against a tough deadline.
Nick: What sort of testing, trials, and quality assurance requirements would you have employed prior to such an implementation?
Dr. Castell: There should ideally have been thorough systems testing and QA procedures, including User Acceptance Testing and Pilot Trials, plus scaled-up ‘soak testing’, well understood by ICT professionals, before the real-world launch of this statewide roll-out. Relevantly, I teach a Course Avoiding IT Disasters – the Expert Way, the principles of which are also covered in my seminal paper “Forensic Systems Analysis: A Methodology for Assessment and Avoidance of IT Disasters and Disputes”, issued as a Cutter Consortium Executive Report, Enterprise Risk Management & Governance Advisory Service series (Vol. 3, No. 2, March 8, 2006).
We cannot say that New Hampshire is next. All available information tells us that New Hampshire is not using the same company/app used in the Iowa Caucuses. Furthermore, there was talk of Nevada using the app, but they have claimed they will not move forward with the application.
That’s the end of this particular blog post. Though, we’re already in talks about another post related to voting systems.
Last week the news exploded with the story of Alexander Urtula’s suicide. The story garnered attention because of the allegedly outrageous actions of Mr. Urtula’s ex-girlfriend, Inyoung You, who is accused of psychologically manipulating Urtula and pushing him to kill himself.
Reports from the Boston Globe outlined the accusations against Inyoung You, a 21-year old former Boston College student and South Korean national, who badgered her ex-boyfriend into committing suicide.
In an editorial article calling for a coerced-suicide law in Massachusetts, the BostonGlobe stated “According to prosecutors, You psychologically and physically abused her boyfriend, Alexander Urtula, over an 18-month relationship, and repeatedly urged him to kill himself. The two exchanged 75,000 text messages, which Suffolk County District Attorney Rachael Rollins said showed You’s ‘complete and total control over Mr. Urtula both mentally and emotionally.’”
Readers may recall a similar incident, out of Massachusetts, which made headlines back in 2017 when Michelle Carter was tried for involuntary manslaughter for the death of her boyfriend, Conrad Roy. You can read more about that case in this Washington Post piece.
These two cases from the same state, with strikingly similar fact patterns, ending in the suicide death of two young men has made the state consider a law about coerced-suicide. An issue, I might add, my lay mind never would have considered necessary.
The reason Massachusetts is considered a coerced-suicide law is pretty straight-forward. Michelle Carter was prosecuted and convicted of involuntary manslaughter. Inyoung You, is now being charged with the same crime. However, the punishment for involuntary manslaughter in Massachusetts, carries a punishment of up to 20 years. Whereas a proposed law, Conrad’s Law (named after Michelle Carter’s victim), would make punishment for coerced-suicide a 5 year maximum sentence.
To me this makes sense. If you do not actually cause the death (i.e. pull the trigger or pilot the automobile) then you should not face the same criminal liability as someone who did cause loss of life. With that said, you need to be punished for being a truly terrible person and manipulating someone to take their own life.
Now, I do have difficulty with words being used to convict someone of a crime. The ACLU had difficulty with this too when they criticized the Michelle Carter case. They felt it would chill free speech. I understand that concern, so I needed to dig into the psychological manipulation and coercion aspect a bit deeper.
Lucky for me, I have access to an incredible database filled with expert witnesses and consultants. Turns out I didn’t have to look far, because one of my members, Dr. Sanjay Adhia was already sharing about the subject matter on social media. So we coordinated a little question and answer on the topic.
Forensic Psychiatry Expert Witness Dr. Sanjay Adhia:
Dr. Sanjay Adhia is triple-Board-Certified in Psychiatry Forensic Psychiatry and Brain Injury Medicine. In addition to forensic/expert witness practice, Dr. Adhia serves as the Assistant Professor of Psychiatry at University of Texas Health and Science Center and a Psychiatry Consultant at The Institute for Rehabilitation and Research (TIRR) Memorial Hermann in Houston. He treats those with brain and spinal cord injury who have complicating psychiatric disorders along with general psychiatry and addiction psychiatry patients.
His forensic practice focuses on the psychiatric impact of personal injury, abuse, competency, violence, intoxication and complicating mental illness. He is experienced at assisting attorneys in medical malpractice and wrongful death claims. He also performs occupational and other Independent Medical Exams. In addition, Dr. Adhia works with Physicians for Human Rights and DAYA Houston to assess victims of kidnapping and false imprisonment, human trafficking, undue influence, physical and sexual abuse and rape. Learn more about Dr. Adhia’s practice by visiting his webiste: www.forensicpsychiatrynow.com.
Let’s get to the nitty-gritty. I provided questions and Dr. Adhia provided some outstanding answers regarding coercion.
NR: According to the article from the Boston Globe, coerced-suicide has not been defined by law. Does forensic psychiatry have a definition? If not, can you describe how you would define “coerced suicide?”
Dr. Adhia: As far as I know, there is no formalized definition of “coerced suicide” for forensic psychiatrists. With coerced suicide, there could be an element of undue influence which is defined as “influence by which a person is induced to act otherwise than by their own free will or without adequate attention to the consequences”. I believe “coerced suicide” should be distinguished from “assisted suicide”.
NR: Can you describe what one may be going through when considering suicide?
Dr. Adhia: Suicidal ideations are generally accompanied by severe distress. Suicide is seen as a solution to the distress and may be perceived as the best if not only solution. It may start with fleeting thoughts without intent to more frequent thoughts with intent. One may then consider various methods of suicide and develop a plan. There could be several suicide attempts before a completed suicide. Of course, there are instances when a catastrophic stressor or coercion may lead to an impulsive suicide without a preceding history.
From the media account, Mr. Urtula was described as having depression. One of the potential symptoms of Major Depressive Disorder (MDD) are suicidal ideations. Additionally, victims of abuse can have suicidal ideations without necessarily having depression.
With additional information, we may be able to determine if Mr. Urtula had suicidality brewing for months or if he was suddenly coerced to jump without any preceding suicidal intent.
NR: This is now the second high-profile case involving young women encouraging a boyfriend to end his own life. Would this qualify as a form of domestic abuse according to psychiatrists?
Yes. However, I would expect there be other forms of abuse present preceding the coerced suicide. The literature often refers to domestic abuse as Intimate Partner Violence (IPV). According to the Centers for Disease Control and Prevention, there are four types of IPV:
Coerced Suicide would be consistent with psychological aggression which is defined by the CDC as “use of verbal and non-verbal communication with the intent to harm another person mentally or emotionally and/or to exert control over another person”. According to prosecutors, Mr. Urtula endured both physical and psychological abuse. The fact that he was located at the parking garage may represent stalking.
Of note, Intimate Partner Violence in of itself, absent suicide coercion, can lead to unintended suicide.
NR: Would coercion in a suicide case (involuntary manslaughter) be similar to the coercion involved in an “undue influence” matter? Are the power dynamics similar?
Dr. Adhia: Coercion is one of the tactics involved in undue influence. Undue influence constitutes controlling others by utilizing the dominance or authority in a relationship, taking advantage of a vulnerability and by employing certain tactics. These tactics include controlling necessaries in life, using or withholding affection, intimidation and coercion. Coercion is the act of threatening to compel an act.
It is worth referring to the proposed “Conrad’s Law” which indicates coerced suicide involves “substantial control or undue influence over the victim, or to have manipulated their behavior through fraud or deceit”.
NR: Some stories I’ve read, indicate Inyoung You had “complete and total control” over Mr. Urtula. How would a person find themselves under complete and total control of a significant other?
Dr. Adhia: To understand how Ms. You would achieve such control; one can look at the cycle of IPV which consists of:
Tension Building Phase
Acute Battering Episode
The Honeymoon Phase
In the first phase, the victim attempts to appease the perpetrator in hopes of avoiding abuse. It may feel as if the victim is walking on eggshells. Eventually the tension will build and phase two will occur with the abuse. Afterwards, there will be a honeymoon phase where the abuser will convince the victim to stay in the relationship. The abuser could promise an end to the abuse. Many of the victims have been are conditioned to be highly dependent on the abuser. They may be convinced they will be unable to obtain love and happiness without the abuser. This may help explain why Mr. Urtula did not leave Ms. You and how she was able to gain control of him.
According to the CNN article, Ms. You threatened self-harm to manipulate Mr. Urtula in order to control and isolate him. She sent him over 47,000 texts and commanded him to end his life. The abuse escalated just prior to the suicide. She tracked the location of Mr. You and was at the scene of the parking garage where he jumped to his death.
In Mr. Urtula’s case, it is likely he was rendered particularly vulnerable due to depression. Some of the symptoms of depression include fatigue, indecisiveness, decreased concentration along with feelings of worthlessness, helplessness and hopelessness.
With the interplay of Depression accompanied by the tactics and dynamics of IPV, one can get a sense of how Ms. You could achieve “complete and total control” over Mr. Urtula.
NR: Anything additional you feel like you need to add to this story… Please do so.
Dr. Adhia: The hope is someone with suicidal ideations in a relationship would have a supportive partner who will encourage their loved one to seek help. In extreme cases, a partner can call 911 and involuntary treatment in a psychiatric hospital can be sought. There are unfortunate instances when the partner does not recognize the signs of suicide or does not know help is available. In Mr. Urtula’s case, it appears his partner literally pushed him off the parking garage.
The mass suicide in Jonestown by devotees of Jim Jones could be considered a mass coercion. Jim Jones had his followers practice drinking the Kool Aid. Having the children drink the Kool Aid first served to coerce the parents to follow course.
The Urtula and the Conrad case reminds us both males and females can be victims of Intimate Partner Violence. It is worth noting that the dynamics could be more complicated if there are children involved and the victim is financially dependent on the perpetrator.
If a victim is danger of imminent violence or suicide, call 911 to obtain immediate assistance. Other phone numbers can be found https://ncadv.org/resources.
Special thanks to Dr. Sanjay Adhia for taking the time to help educate us about this unfortunate matter of coerced-suicide. Please share this article with those who need to read it. Please take care of those around you. Let’s all try to be a little nicer to each other.
The last two years have been a whirlwind for those of us following the litigation response to the opioid crisis. Thousands of lawsuits have been filed throughout the country. Most notably, the National Prescription Opiate Litigation (a multi-district litigation).
So what is happening on next week? Well, one of the first major opioid trials took place in Oklahoma earlier this summer. When I say “opioid trial,” I mean the legal trial, not “clinical trial.” Forgive me, I had to make the joke. The trial took place and the judge is expected to deliver his ruling on Monday. Berkeley Lovelace, Jr., of CNBC, provides an in-depth analysis of the trial here.
The case was brought by the State of Oklahoma against Johnson & Johnson, et al. The Oklahoma attorney general is seeking damages in excess of $17 billion dollars. The state sued Johnson & Johnson claiming their sales and marketing practices fueled the opioid epidemic and created a public nuisance, resulting in approximately 6,000 overdose deaths. Any damages awarded, assuming there is not a settlement before the ruling, would be used for addiction treatment and preventative measures for the next few decades.
We, at Experts.com, have been following pharmaceutical litigation for a long time. In the last two years, we’ve been laser-focused on opioid litigation. We started to pay strict attention to the matter when we realized it was similar in magnitude as the civil lawsuits involving tobacco, in the 1990s. It meant we were going to see significant litigation for years to come.
With a database of expert witnesses, we set out to write multiple articles on the matter, in the form of question-and-answer-style blog posts. In addition, I’ve written a couple of guest blogs on the topic for other legal companies. This blog post is to recap these resources we’ve published over the last two years.
Unfortunately for our country, we expect to be writing about these lawsuits for years to come. What happens next week, may pave the way for more lawsuits and major settlements? We don’t know how it might end, but we’re pretty sure the pharmaceutical companies will end up paying a lot of money. If not in Oklahoma, in other lawsuits still to come.
Today, Cleveland County District Court Judge Thad Balkman ruled against Purdue Pharma LLP, Johnson & Johnson and others. He ruled the defendant’s in the first civil opioid trial are responsible for causing a public nuisance, and held them liable for abatement of the nuisance, in the amount of $572+ million.
When the news hands you a juicy story about wealthy celebrities, elite universities, college admissions, cheating, corruption, federal crimes, racketeering and conspiracy, it is really difficult to choose a title for the article.
If you are at all like me, when the news broke yesterday about wealthy celebrities bribing college officials to help get their children into elite schools, you were probably immediately angry with your parents for not doing the same! I kid. Sometimes, you just have to make light of these situations.
If you’re not up-to-date on “Operation Varsity Blues,” there is some good coverage here.
More likely, you were angry to read that one of the alleged criminals paid to have someone take an SAT for their daughter, scoring approximately 400 points higher than the child could score on their own merit.
Then you probably scrolled through the indictment to see another wealthy family is accused of bribing a crew coach (spending approximately $500,000 in bribes), to help their child be admitted as an athlete, when the child had no history of rowing competitively.
Those of us who have had to work hard to achieve our educational credentials, as a result of learning disabilities, were further angered by parents helping their children to fake disabilities to get more time on a test. This author struggled with school his whole life because of undiagnosed learning disabilities that were discovered only as an adult. I survived. I worked harder to excel. Needless to say, trying to cheat the system and fake a disability really bothered me because accommodations are meant to level the playing field, not give someone unnecessary an edge.
Most of us are aware students receive special benefits if parents or family members have previously gone to the university. We also know that the donating of a building or program often provides family members with special influence. We know this and we sort of accept it as part of society. Successful people work to help their families achieve success. Most of us have accepted this idea. However, when those efforts break the law, corrupt the education system, and displace truly qualified students, we cannot accept it and we should not accept it.
As a result of yesterday’s news, I reached out to one of our members’ to get some early insights on this matter. It is important to remember this story is still developing and what we learned yesterday, may change tomorrow or the next day.
Education Management Expert Witness Dr. Edward Dragan:
Dr. Edward Dragan, has over 40 years experience in education. He has been a special-education teacher, served as a public school principal and a superintendent, founded an alternative school with a group of disenchanted parents and students, and much more. After consulting with an attorney and testifying in court as an expert witness, Dr. Dragan decided he would best be able to help schools, children, and families by developing a practice where he could use his experience to review cases involving schools, education, and the supervision of children and provide expert opinions. Further, he has obtained a law degree with a specialty in education law and has consultation to plaintiff and defendant attorneys around the country and Canada more than 800 times on cases involving wrongful death, sexual harassment, negligent supervision, Title IX, and Section 1983 matters. Dr. Dragan has testified around the country over 125 times. You can learn more about his practice here: http://education-expert.com.
Nick: It seems some of the allegations in the college racketeering conspiracy involve bribing entrance exam administrators. Are there procedures for qualifying entrance exam administrators?
Dr. Dragan: There are no procedures for qualifying entrance exam administrators that would guard against the bribery charges. Unfortunately, even if there were procedures or license for such administrators this type of scam can still occur. When parents, especially privileged parents, want something for their child they usually find a way – and it can involve paying a gatekeeper to a college. It takes two dishonest individuals to engage in this conspiracy and, unfortunately, the honest parents and kids lose out.
Nick: Many of us have long heard the stories of someone posing as a student for the entrance exams. I always took it as “lore.” What policies and procedures are in place to prevent test-taking fraud?
Dr. Dragan: Test-taking fraud is controlled on site by monitoring identification including pictures on license, school identification, passports, etc. Even this method can be circumvented. But careful screening can help deter fraud. Off-site or computer initiated test taking presents unique problems.
Nick: Admittedly, it is early in the publicly available information, but what policy and procedure changes would you suggest to limit test-taking fraud in the future?
Dr. Dragan: I am not an expert in electronic fraud but I imagine that for those off-site test-taking experiences software design might be helpful.
Nick: Do you expect universities to take action against coaches and other school officials who allegedly accepted bribes?
Dr. Dragan: Yes, I do expect universities to take action against coaches and other school officials who are convicted of taking bribes. They should immediately be placed on leave – no work at the university – pending investigation. If there are criminal charges made and they are convicted they should be fired. Of course, employment contracts and other elements will need to be taken into account.
Nick: Is there anything else you wish to add. Comments, concerns, or otherwise…
Dr. Dragan: The education system, and the honest pursuit of education, is a privilege enjoyed by those who are eligible to “get into” the club. When parents circumvent honest endeavors of their children they are teaching their children, by example, how to be cheaters and how to lie to get what they want. This is shameful – and especially for those who fit high-profile status.
It should be noted that USC has already taken action against at least one coach and one school administrator for their alleged wrongful conduct. They fired two employees yesterday, according to the LA Times, while Dr. Dragan and I were communicating about this article. As the story develops, Dr. Dragan and I may return with a Part 2 on this topic!