A CD of the entire 4-day symposium program is available. You can play it in your computer or any MP3 compatible CD player. Call Debbie at 760-929-9777

American College of Forensic Psychiatry

26th Annual Symposium

April 3-6, 2008

San Francisco, Stanford Court Hotel

The American College of Forensic Psychiatry is accredited by the Accreditation Council for Continuing Medical Education to provide Continuing Medical Education for physicians. The American College of Forensic Psychiatry designates this educational activity for a maximum of 23 AMA PRA Category 1 creditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity

The American College of Forensic Psychiatry certifies that this activity has been approved for 22 hours of MCLE credit by the State Bar of California.

Goal: The goal of this symposium is to keep forensic psychiatrists abreast of important issues which lie within the interface of psychiatry and law, recent developments in psychiatry that require new knowledge for expert witnesses, and new case law affecting forensic practice. Target Audience: The program is intended to benefit practicing forensic psychiatrists, psychiatrists in other subspecialties, and attorneys who litigate civil and criminal cases involving psychiatric evaluations and expert testimony.

Objectives: Participants should improve their knowledge and skills in the following areas: (a) evaluation or treatment of forensic litigants and individuals with other forensic psychiatric issues; (b) new and ongoing research and developments in the field of forensic psychiatry; (c) relevant concepts useful in testifying and educating the court on mental health issues, and in working within the legal system; (d) changes in the law that affect clinical and forensic practice; (e) legal and psychiatric aspects involving the mentally disordered inmate in correctional facilities.

Disclosure of Relevant Financial Relationships: All faculty members received and signed a Disclosure of Relevant Financial Relationships statement in which they were asked to disclose all relevant financial relationships with any commercial interest. All of the faculty have indicated they have nothing to disclose. The meetings each day will be in the Stanford East Ballroom. Registration and continental breakfast each day will be outside the meeting room. Thursday night's welcome reception will be in the Vista Terrace.

This Symposium is dedicated to the memory of our dear friend and colleague, Donald T. Lunde, M.D.

final Program

Wednesday, April 2

4:30-6:00 Early Registration--Russian Hill Room

Thursday, April 3

7:00-7:45 Registration and Continental Breakfast

7:45-8:00 Opening Remarks and Announcements

8:00-8:40

Malingering v. Munchausen: How Much is too Much? A Case of Greed Goes Terribly Wrong

Douglas Anderson, M.D.

According to DSM-IV criteria, the diagnoses of Malingering and Factitious Disorder are mutually exclusive, based on the type of secondary gain involved. But what happens when the feigned efforts to support personal injury litigation and disability far exceed those seen in any prior forensic experience? A fascinating case of personal injury litigation in which the plaintiff underwent ten seemingly unnecessary surgeries following a motor vehicle accident in which she sustained only minor injuries will be presented. Attendees will learn how to distinguish between Malingering and Factitious Disorder and how these apparently mutually exclusive diagnoses can, in fact, overlap when the medical evidence leads the expert to no other reasonable conclusion.--Douglas Anderson, M.D. has been a practicing clinical and forensic psychiatrist for more than thirty years. He has been retained in seventeen states and overseas.

8:40-9:20

Posttraumatic Stress Disorder in Combat Veterans

Eric W. Fine, M.D. and Lawrence D. Levin, J.D.

The incidence and criteria for the diagnosis of PTSD in combat veterans will be discussed. Treatment options are described that include the use of psychoactive medications and appropriate psychotherapy. The difficulty in treating these disorders is exemplified by a veteran from WWII and another from the Vietnam war who were evaluated by the author and found to have significant residual signs and symptoms of PTSD despite treatment. The current state of VA law pertinent to PTSD will be discussed with regard to Global Assessment of Functioning that is emphasized by the VA as being a critical factor in determining levels of disability. Attendees will become familiar with PTSD in veterans and the legal implications, and prepared for a new influx of veterans of the Iraq war with PTSD.--Eric W. Fine, M.D. is in the private practice of clinical and forensic psychiatry in Philadelphia, PA. He is an Associate Professor of Psychiatry and Human Behavior at Jefferson Medical College. Lawrence D. Levin, J.D. is an attorney at law in Jenkintown, PA.

9:20-10:00

Restrictions on Expert Testimony

Ralph Slovenko, Ph.D., J.D.

In this presentation the following topics are discussed: 1) the trial judge as gatekeeper, 2) right of confrontation, 3) testimony on ultimate issue, 4) form of testimony, 5) special rules on qualification of experts, 6) ethics guidelines, 7) treating therapist as expert, 8) forensic consultation in states in which the expert is not licensed, and 9) suspension or termination of professional license.--Ralph Slovenko Ph.D., J.D. is Professor of Law and Psychiatry at Wayne State University Law School in Detroit Michigan, and author of the 2-volume Psychiatry in Law/Law in Psychiatry (Brunner-Routledge, 2002).

10:00-10:15 Coffee Break

Note: The meeting will split into 2 rooms following the coffee break.

Room 1: Stanford East Ballroom

10:15-11:00

An Acute Interest in Bad Behavior: Criminal Profiling

Timothy J. Michals, M.D. and Steven E. Samuel, Ph.D.

A forensic psychiatric profiler is a consultant and investigator who fuses professional experience on the scratchpad of personal intuition and data from crime scenes, victims, and witnesses, to draw a portrait of the type of individual who perpetrated a crime. Various forms of profiling are used to answer four basic questions: who, why, what and when. Crimes benefiting from profiling are those which are seemingly inexplicable, sadistic, bizarre, and apparently motiveless. With few exceptions, the forensic psychiatric profiler's treatise is not admissible in evidence. Despite this, and the lack of scientific evidence with which to assess its validity, criminal profiling is widely used, its status remains largely undisputed, and it has been utilized to apprehend some of the world's most notorious offenders.--Timothy J. Michals, M.D. is Clinical Assistant Professor of Psychiatry and Director of the Division of Forensic Psychiatry at Jefferson Medical College in Philadelphia. Steven E. Samuel, Ph.D. is a clinical and forensic psychologist in Philadelphia.

11:00-12:10

Panetti's Rational Understanding of Mental Illness: Denial and the Death Penalty

Alan Abrams, M.D., J.D., Alan Newman, M.D., Kylee Stevens, M.D., Tyler Jones, M.D., Gavin Rose, M.D.

Facts and jurisprudence related to the Supreme Court's Panetti decision announcing a further refinement of the Ford prohibition against executing "the insane" will be covered. Presenters will explore both the history, rationales and jurisprudence related to the concept of competency to be executed, and the underlying conception (misconception) of mental illnesses held by the courts in considering individual cases. The role of denial and more primitive psychological defenses against terror, and how these relate to concepts of mental illness will be addressed, as will continuing contradictions in Supreme Court Jurisprudence on mental illness, mental retardation and the death penalty.--Alan Abrams, M.D., J.D. is Director of the Forensic Psychiatry Fellowship at Georgetown University Hospital, with co-director, Alan Newman, M.D. Drs. Abrams and Newman have examined many defendants in capital cases. Co-Presenters: Kylee Stevens, M.D.; Tyler Jones, M.D.; Gavin Rose, M.D.

Room 2--Stanford West Ballroom

10:15-10:55

Protecting the National Air Space: Applications for the Forensic Psychiatrist

Elin Berg, M.D., Ph.D., Michael Berry, M.D., Charles Chesanow, D.O.

To be optimally effective, governmental medical consultants should have a working understanding of both the regulations and the process of the agency for whom they contract. While this presentation will be focused specifically on our aviation system, it will be applicable to others involved in governmental consultations, particularly in security sensitive areas. FAA standards will be described. Participants will discuss their experience with consultations and NTSB (National Transportation Safety Board) hearings. Actual cases will be presented including strategies and outcomes of the hearing process.--Elin Berg, M.D., Ph.D. is in private practice in Columbia, SC. Michael Berry, M.D. is Manager, Division of Medical Specialties, FAA. Dr. Berry has been involved (and certified) in aerospace medicine for decades. He has been the Flight Surgeon for NASA on the Enterprise and Columbia space missions. Charles Chesanow, D.O. is chief psychiatrist for the FAA.

10:55-11:35

What treating doctors do not know in civil forensic situations,

And do not know that they do not know

F. Wayne Furlong, M.D., FRCP (C)

Most forensic psychiatrists at some point in cross examination have been asked, or will be asked, whether they would not agree that a treating psychiatrist, psychoanalyst or family doctor who has known the patient for decades must know the patient/examinee better than the forensic expert. The answer should be a clear and confident no--I do not agree that such an assumption is reasonable, and moreover that is rarely the case. Support for this view of the forensic deficiencies in the evidence of treating doctors lies in the literature on compliance and medication problems, psychotherapy research on non disclosure, the role of illegal drugs and alcohol in non disclosure and injury and research on the social attitudes of physicians about "faking" psychiatric diagnoses. Attendees should be able, having absorbed this material, to handle this question with confidence.--Dr. Furlong is a fellow of the Royal College, Canada, and certified in forensic psychiatry (ABPN). He has served as a psychiatric expert in civil litigation and other civil matters, in Ontario, Canada.

11:35-12:15

Is There a Paraphilic Rape Disorder?

Mohan Nair, M.D. and Robert Friedman, J.D.

For mental health professionals who evaluate sex offenders and testify in court, the issue of paraphilic rape goes beyond the theoretical. Critics argue that 1) there is no reliable way to separate paraphilic rape from non paraphilic rape and that attempts by mental health professions to do so in the courts are both unethical and unscientific, 2) finding Paraphilia NOS represents collusion by MHPs to advancing police powers. Of these three diagnoses, Paraphilia NOS has been the most problematic since unlike Pedophilia and Sexual Sadism, rape paraphila is not spelled out as a separate diagnosis in the DSM. Attendees, following this presentation, should: understand the concept of paraphilic rape; differentiate paraphilic rape from nonparaphilic rape and paraphilic rape from sexual sadism; and understand controversies involving Paraphilia NOS (paraphilic rape) as it applies to Sexually Violent Predator civil commitment laws.--Mohan Nair, M.D. is a forensic psychiatrist in the Los Angeles area and is on the faculty of the UCLA Forensic Psychiatry Fellowship Program. Robert Friedman J.D. has been an assistant public defender in Tallahassee, Florida since 1998.

12:15-1:30 Lunch Break (on your own)

1:30-4:30 Two Rooms

Room 1-- Stanford East Ballroom

1:30-2:15

Aftermath of Atkins: A Perspective on Managing the Death Penalty

and Mental Retardation Cases

Clarence Watson, J.D., M.D. and Kenneth Weiss, M.D.

The United States Supreme Court decision in Atkins v. Virginia held that the Eight Amendment of the U.S. Constitution prohibits capital punishment of mentally retarded defendants. The Supreme Court, however, left for the individual states the task of adopting procedures to legally determine the presence of mental retardation. The presenters will explore the evolution of judicial treatment of mental retardation and the death penalty and will discuss a recent state court decision in State of New Jersey v. Jimenez (2007) and its approach to managing the requirements of Atkins. Important considerations for the forensic psychiatrist to bear in mind in criminal cases where a diagnosis of mental retardation must be appropriately established in order to avoid the death penalty will be outlined.--Clarence Watson, J.D., M.D. is Assistant Professor of Psychiatry and Associate Director of Residency Training, Dept. of Psychiatry, Jefferson Medical College, Thomas Jefferson University Hospital. Kenneth J. Weiss, M.D. is Clinical Professor of Psychiatry, UM.D.NJ-Robert Wood Johnson Medical School, and is also in the private practice of forensic psychiatry in Bala Cynwyd, PA.

2:15-2:55

How Healers Become Killers: The Psychology of Physicians as Suicide Bombers

Jamshid A. Marvasti, M.D.

The 2007 terrorist attacks in the United Kingdom startled many since the alleged attackers were physicians or medical students. In this presentation an attempt is made to explore the motivation of these alleged bombers by focusing on the inside elements (psychological) and the outside circumstances (cultural and political) which contribute to violence. Attendees will increase their knowledge in regard to: psychological causes of terrorism; application of ego defense mechanisms; cultural and environmental elements that contribute to the development of hate and violence; similarities and differences between cases of clinical suicide and suicide bombers.--Jamshid A. Marvasti is a child and adult psychiatrist practicing at Manchester Memorial Hospital in Manchester, CT. He is the author/editor of four books--most recently, Psycho-Political Aspects of Terrorism, Suicide Warriors and Martyrdom, Charles Thomas Publisher, 2008

2:55-3:50

The Stalking of Forensic Mental Health Evaluators

Neena Sachinvala, M.D. and Mohan Nair, M.D.

A growing body of literature has looked at the phenomena of stalking of mental health professionals by patients. Less studied is the stalking of forensic evaluators by those they evaluate. Many of the factors that predispose clinicians to being stalked are amplified in the forensic evaluation setting. Forensic evaluations are often adversarial (or perceived as such); they often involve individuals with serious personality disorders, including those who have shown a propensity for violence; the outcome of the evaluation may have a troubling impact on the evaluee. Starting with an overview of the current data in this area, we will present cases from our forensic practice that involve being stalked. Threat assessment and management of these complex cases are reviewed. The audience is encouraged to provide their own experiences, observations and wisdom in this area.--Neena Sachinvala, M.D. is Clinical Professor of Psychiatry at UCLA and Director of the UCLA Forensic Psychiatry Fellowship Program. Mohan Nair, M.D. is Assistant Clinical Professor at the UCLA Forensic Psychiatry Fellowship Program and has researched and published in the area of stalking.

3:50-4:30

Unweaving the Enigma of Endangered Psychiatric Ethics In Corrections

Richard L. Grant, M.D.

Widely acknowledged as our contemporary de facto mental hospitals, the correctional institutions of the United States contain many inmates with recognized and yet to be recognized mental disorders affecting their behavior or mental suffering. As "total institutions" (Goffman) with many sometimes conflicting goals and purposes, our jails and prisons nevertheless are required by statute to provide mental health treatment for those inmates. The compromises to the full ethical provision of that care by psychiatrists are profound. This presentation attempts to lay bare and disentangle the diverse influences leading to these compromises. By such clarification, perhaps a way forward for achieving maximally ethical and improved psychiatric care in our correctional institutions may be derived.--Richard L. Grant, M.D. is a Clinical Professor of Psychiatry at the University of Illinois College of Medicine at Peoria, and practices forensic psychiatry.

Room 2-- Stanford West Ballroom

1:30-2:35

Evaluating and Documenting Function, The Missing Piece in the Forensic Response

Marcia Scott, M.D. and George S. Glass, M.D.

You've been asked to see a claimant whose disability application has been denied. You've read the denial letter and accompanying medical records. What is the information that will actually be effective in assuring a realistic and fair decision? How can you best communicate that to all parties including the patient? This presentation will involve discussion of specific cases by the panelists and audience, directed at answering the questions: 1) What should the decision be? 2) What critical data and observations provide the basis for that opinion? 3) How can that information best be communicated? 4) How can the decision be used to maintain/improve function? Following this presentation, attendees will be able to enhance both treatment and forensic outcomes for patients by learning to evaluate and document function. They will develop skills for effectively communicating that data to non-clinical entities.--Marcia Scott, M.D. is a child psychiatrist and clinical faculty at Harvard. She was VP of medical services, Prudential's Disability Division, and consults to the Boston Police. George S. Glass, M.D. is on the clinical faculty at Baylor and Cornell-Weill in Houston.

2:35-3:15

Forensic Evaluation of Juvenile Fire Setters

Eugene Schiller, Psy.D., MSW

Fire setting behaviors continue to be a societal problem, resulting in both human and property damage. The causes of such behaviors remain poorly understood, and represent a final common pathway of biological, psychological, social risk factors. Often, the behaviors start in childhood, and if properly analyzed, could result in preventive measures. In this presentation, a forensic psychologist experienced in such analyses will review the phenomenology, risk factors, differential diagnoses, and management of juvenile fire setters. The relationship of firesetting to psychopathy and biological under-arousal will be explored, as will a mens rea analysis of the fire setter, evaluating the quality of risk taking.--Eugene Schiller is a clinical psychologist working for Juvenile Forensic Services, County of San Diego. In this capacity, he routinely conducts evaluations of juveniles for the potential to set fires.

3:15-3:55

What Do Lawyers Want? What Do Lawyers Need?

Sander J. Breiner, M.D.

Lawyers want reliable testimony from an expert who can present in a believable, understandable and expert manner and who understands the legal system as it applies to psychiatric testimony. In addition, they want testimony that will aid their client. They want to know what the expert witness will say and how the expert will respond to a variety of questions posed by the opposing attorney. They want to avoid any information they might receive which would be discoverable, and not to their client's advantage. Following this presentation, attendees will have an increased knowledge of techniques in assisting lawyers who seek their help, in ways the lawyers may not have understood or appreciated.--Sander J. Breiner M.D. is Professor of Psychiatry, Michigan State University, Associate Professor of Psychiatry Wayne State University, and Lecturer Law School, Wayne State University.

3:55-4:30

Forensic Issues Related to Psychotropic Medications

Richard D. May, M.D.

Choice of medications given to the mentally ill patient must be based on efficacy and tolerability, but always mindful of other important variables as medical comorbidity, dosing complexity, treatment refractoriness, urgency, compliance, and standard of care. Informed consent, medical work-up, baseline lab tests pre-treatment, follow-up monitoring to gauge effectiveness and prompt detection and management of side-effects are basic essentials in order to avoid risk of serious harm and legal liability. Some of the pitfalls and attendant lawsuits from inadequate and/or negligent medication management will be presented in addition to careful off-label use of psychotropic medications, and other related forensic issues.--Richard D. May, M.D. is formerly Assistant Clinical Professor of Psychiatry at University of California, Davis. He currently is working in a sex offender commitment program in California.

5:30-7:00 Welcome Reception--Vista Terrace

Friday, April 4

7:15-8:00 Registration and Continental Breakfast

8:00-8:40

Legal Cases Impacting Psychiatric Practice

Carla Rodgers, M.D.

This presentation will review pertinent legal cases that have had significant impact on the way psychiatry is practiced in the United States. Included will be cases regarding informed consent and confidentiality/privacy, which are now standard of care in psychiatric practice. Following the presentation, attendees should be able to describe the components of informed consent, define the term "professional standard," explain the effect of landmark decisions on the practice of psychiatry, demonstrate knowledge of the origins of right to privacy.--Carla Rodgers, M.D. is Clinical Assistant Professor at University of Pennsylvania Medical School and in private practice of forensic psychiatry in the Philadelphia area.

8:40-11:00

Forensic Skills Workshop: The Role of the Psychiatrist in Civil Litigation

Albert M. Drukteinis, M.D., J.D., Douglas Anderson, M.D., Eric W. Fine, M.D., Alan Abrams, M.D. J.D.

This practical workshop will focus on advanced issues that confront psychiatrists in civil law cases, an interactive session involving moderator, panelists, and the audience. Vignettes submitted to the panel by practicing forensic psychiatrists will be read aloud and discussed. The vignettes describe problems and experiences that forensic psychiatrists often confront in their practices and in court. These will include procedural problems, such as ethical or practical issues in performing evaluations; dealing with courts, attorneys, or opposing experts; as well as substantive problems, such as dilemmas that come up in difficult cases, reliability of psychiatric opinion, and testimony.--Albert M. Drukteinis, M.D., J.D. (Moderator) is Adjunct Associate Professor of Psychiatry at Dartmouth Medical School, and Director of New England Psychodiagnostics, specializing in personal injury and employment stress claims. Douglas Anderson, M.D. is in private practice in New York City; Eric W. Fine, M.D. is in private practice in Philadelphia; Alan Abrams, M.D. J.D. is Director of the Forensic Psychiatry Fellowship at Georgetown University Hospital.

11:00-12:00

Case Study: Psychiatric Sequelae Following Stroke in a Litigated medical malpractice Case

David N. Glaser, M.D. and Steve Gambardella, Esq.

A specific case will be discussed in detail by the expert retained by plaintiff (Dr. Glaser) as well as the attorney pursuing the litigation (Mr. Gambardella). The complexities of the factors considered will be described from the perspective of the expert as well as that of the attorney actively involved in litigating the case. Strengths and weaknesses of the case will be discussed from the standpoint of the attorney involved as well as the forensic psychiatrist engaged. Following this presentation, attendees should: appreciate how strokes, especially arising out of care below the standard-of-care, can be devastating to both the plaintiff as well as the important other; achieve an understanding of how attorneys conceptualize such malpractice matters with a focus upon damages; learn how to provide detailed, relevant opinions on such litigated matters from both a plaintiff as well as defense perspective.--David N. Glaser, M.D. is the medical director of a forensic group in Los Angeles providing comprehensive forensic services for attorneys in litigated matters, including neuropsychology and neurology. He is on the faculty of the Forensic Psychiatry Fellowship Program at UCLA. Steve Gambardella, Esq. is an attorney in the Los Angeles area specializing in litigating medical malpractice cases.

12:00-1:30 Lunch Break (on your own)

1:30-2:30

Validity evaluation in Forensic Psychiatry: It Is No Longer Whether or When but How

to Establish Validity of Plaintiff's Complaints, Symptoms, and Functional Abilities

Alexander Obolsky, M.D.

The role of a forensic psychiatrist is to determine the nature, extent, and cause of alleged mental injury. Forensic psychiatrists investigate claims of emotional injury by utilizing record review, neuropsychological and psychological testing, and interviews, among other techniques. Neuropsychological and psychological testing and plaintiff interviews depend on plaintiff's compliance through motivated performance on testing and in provision of truthful information in interview. Plaintiffs are often under pressure by powerful forces that affect their cooperation with forensic psychiatric evaluation. Attendees will be able to enumerate various areas where biased information may enter forensic psychiatric evaluation; enumerate various techniques available to evaluate plaintiff's complaints; describe the rationale for evaluation of plaintiff's compliance with evaluation; and describe state of the art techniques for compliance evaluation.--Alexander Obolsky, M.D. specializes in the evaluation, treatment, and fitness to work issues of employees with various anxiety, depressive, and trauma-induced mental disorders.

2:30-3:10

Deceptions in Psychopharmacology

Ansar M Haroun, M.D. and Shahram Ahari, MPH

Clinical psychiatrists routinely use psychopharmacological interventions, and forensic psychiatrists often work on cases involving psychotropic medications, in a variety of contexts, including forensic analyses of patients' competency to refuse medication, the permissibility of a court ordering involuntary medications, based on the Sell decision, malpractice cases involving medications, and abuses of informed consent. Valid informed consent requires that three elements be satisfied, including: information be transmitted, patient's decision be voluntary, patient have decision making capacity. All three elements may be fudged, resulting in assent rather than consent, which may be uninformed, rather than informed. We will review some of the abuses of all three of these elements, which result in a failure of valid informed consent, and we will argue that real informed consent is a myth, rather than a reality.--Ansar Haroun, M.D. is the Supervising Psychiatrist at the San Diego Superior Court. He teaches at UCSD School of Medicine, where he is a Clinical Professor of Psychiatry and Pediatrics, and at USD School of Law, where he is an Adjunct Professor of Law. Shahram Ahari is a UCSF health researcher with expertise in misinformation (how industry can misinform doctors).

3:10-3:50

Child Molestation--Determining Genuine Versus Bogus Allegations of Child Sexual Abuse

Howard B. Terrell, M.D.

Child molestation is a very serious crime. It has lifelong effects on the child victim. Allegations of child molest can also have lifelong effects on the person accused of it regardless of whether they are guilty or innocent of the crime. In this information age, children, parents, school officials, health care professionals and law enforcement officials are more aware of the crime and now more inclined to promptly address it when such allegations are made. By the same token, many people are aware that even the accusation of child molestation (truthful or untruthful) can immediately halt a child custody dispute and turn it to the favor of the accusing parent. It can also destroy the life, reputation and career of the accused regardless of whether they have done anything wrong or not. This presentation will help to delineate the signs, symptoms and findings to look for in genuine versus bogus allegations of child molestation.--Howard B. Terrell, M.D. is Assistant Clinical Professor at UC San Francisco School of Medicine, Fresno Medical Education Program.

3:50-4:30

The Internet, Sex Offenders and the Law

Clarence Watson, J.D., M.D. and Nicole Foubister, M.D.

The Internet has had a dramatic impact on the way that our society exchanges ideas, disseminates information and conducts business. Despite the many positives of the Internet, it also provides a new venue to extend criminal activities beyond traditional means. Such a critical extension has occurred in the setting of the sexual predator's behavior. The presenters will discuss how sexual predators attempt to use the Internet to locate, groom, and eventually make contact with victims. Statistics that address the impact of this online behavior on child victims will be reviewed. A practical guide for the assessment of sexual predators who are caught in Internet sting operations will be provided, and legal defenses often utilized by the defendants in these cases will be examined.--Clarence Watson, J.D., M.D. is Assistant Professor of Psychiatry and Associate Director of Residency Training, Dept. of Psychiatry, Jefferson Medical College, Thomas Jefferson University Hospital. Nicole Foubister, M.D. is Assistant Professor of Psychiatry, NYU School of Medicine and Director, Tisch Young Adult Unit, New York University Child Study Center.

Saturday, April 5

7:15-8:00 Registration and Continental Breakfast

8:00-8:45

Insanity Is Smashing up Against My Soul:

Panetti v. Quarterman and Questions That Won't Go Away

Michael Perlin, J.D.

In Panetti v. Quarterman, the U.S. Supreme Court expanded upon and clarified its earlier decision in Ford v. Wainwright, barring the execution of a person with mental disabilities who does not have a "rational understanding" of the reasons he is to be executed. The Panetti decision, however, has a second holding that may be equally important: that the failure to provide a defendant an adequate opportunity to submit expert evidence in response to the report filed by the court-appointed experts thus deprived him of his "constitutionally adequate opportunity to be heard." Both holdings leave open questions that will likely be explored in subsequent cases. The Court chose not to address the question that many observers had thought was at the core of the case: whether a defendant can be medicated so as to make him competent to be executed. In this presentation, the author will discuss Panetti, and offer some possible answers to the unanswered questions.--Michael Perlin is Professor of Law at New York Law School, where he is the Director of the Online Mental Disability Law Program. He is the former director of the Division of Mental Health Advocacy in the NJ Department of the Public Advocate.

8:45-11:00

Forensic Skills Workshop: The Role of the Psychiatrist in Criminal Litigation

Steven Pinkert, M.D., J.D., MBA, Carla Rodgers, M.D., Kenneth Weiss, M.D.

This practical workshop will focus on advanced issues that confront psychiatrists in criminal law cases, an interactive session involving moderator, panelists and the audience. Vignettes submitted to the panel by practicing forensic psychiatrists will be read aloud, discussed by the panel and by the audience.--Steven Pinkert, M.D., J.D., MBA of the Pinkert Law Firm in Miami, practices in the areas of professional discipline, complex medical/technical litigation, admiralty, and patent law. Prior to law he practiced clinical psychiatry. Carla Rodgers, M.D. is Clinical Assistant Professor at University of Pennsylvania Medical School and in private practice in the Philadelphia area. Kenneth J. Weiss, M.D. is Clinical Professor of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, and in private practice in Bala Cynwyd, PA.

11:00-12:00

"My Disability Made Me Do It!"

James J. McDonald, Jr., J.D.

Previously, most courts held that an employee's job-related misconduct was not protected under the Americans with Disabilities Act even if the misconduct was caused by a medical or psychiatric disorder. Recently, this trend has begun shifting. Courts are now holding that even threatening conduct by an employee may be protected under the ADA if it can be tied to a psychiatric condition. This presentation will examine this shift in the law and its implication for psychiatrists who serve as fitness-for-duty examiners.--Attorney James J. McDonald, Jr. is managing partner of the Irvine office of Fisher & Phillips, a national labor and employment law firm, and editor of the treatise Mental and Emotional Injuries in Employment Litigation.

12:00-1:00

Updating Your Approach to Competence to Stand Trial Assessments

John T. Philipsborn, M.Ed., J.D.

This presentation will approach the assessment of competence to stand trial from the perspective of the latest case law on the issue, emphasizing that lawyers are being trained to approach competence issues with specific standards of practice in mind. Attendees can expect a review of case law from around the country in this presentation. Attendees should be able to describe both the static legal definitions of competence to stand trial and some of the more recent additions to those definitions, together with the standards of practice that will be applied both to their work on competence evaluations, and to their testimony in court.--John Philipsborn is a criminal defense lawyer in San Francisco. His extensive trial and appellate work has resulted in numerous published decisions dealing with forensic mental health issues.

Sunday, April 6

7:15-8:00 Registration and Continental Breakfast

8:00-8:40

Forensic Evaluation of the Sexually Violent Predator:

Psychiatric Facts and Philosophical Fictions

Omar Haroun

Many forensic psychiatrists are familiar with the controversies surrounding SVP legislation. Up to now, most of the challenges to such legislation have been legal. This lecture will review some new challenges, arising from philosophy, specifically criticizing the law's false understanding of the nature of free will, and whether a mental disorder can "make" a person sexually dangerous. If the law is indeed misguided, and if it is not the case that a mental disorder "makes" a person sexually dangerous, then almost no person would qualify to be a SVP. Hence, such a finding would either require release of all people currently called SVPs or demand a change in the law as it stands.--Omar Haroun studied Law and Economics at UC Berkeley and is now studying Philosophy at Oxford University, with a focus on Jurisprudence. He recently completed an internship in the Forensic Psychiatry Clinic in the San Diego Superior Court.

8:40-9:20

A Forensic Psychiatric Analysis of the Case of Seung Hui Cho

Linda D. Francis, M.D. and J. Arturo Silva, M.D.

An analysis of the case of Seung Hui Cho, a 23-year-old college student who, on April 16, 2007, executed 26 fellow students and 5 faculty members in a mass shooting at Virginia Technical Institute, before shooting himself in the head, will be presented. Aspects of the growing body of data regarding Cho's biopsychosocial development and behavior will be examined, with consideration of potential contributing factors, including developmental considerations, mood and anxiety disorders, psychopathy, stress and other ecological mediators. Although we make principal use of the APA's DSM-IV-TR, will also discuss the available data in light of other important diagnostic systems.--Dr. Linda D. Francis is a psychiatrist at Southwestern Virginia Mental Health Institute, and a Clinical Assistant Professor of Psychiatry at the Virginia College of Osteopathic Medicine. J. Arturo Silva, M.D. has a practice of forensic psychiatry in San Jose, California.

9:20-10:00

Overview of Mental Health Firearm Prohibitions

Joseph R. Simpson, M.D., Ph.D.

This presentation reviews the evolution of federal law and case law relating to mental health firearm prohibitions, and the implementation of the federal law, as well as examining some of the differences found among state laws. Individuals who are prohibited from possessing firearms on mental health grounds can appeal the prohibition in many jurisdictions. Data on such appeals from Los Angeles County, California will be presented. Some of the implications of these laws for mental health clinicians and forensic practitioners will be discussed.--Joseph R. Simpson, M.D. Ph.D. completed his psychiatric residency at the UCLA Neuropsychiatric Institute/West Los Angeles VA Medical Center and a forensic psychiatry fellowship at the University of Southern California. He has performed court-appointed firearm restoration evaluations and has published three peer-reviewed papers in this area.

10:00-10:15 Coffee Break

10:15-10:55

Are Psychopaths Treatable?

Alisa Duclos-Robinson, Ph.D.

This talk will address the controversial question of whether psychopathic individuals are "treatable." Discussion will include the current definition of psychopathy and how it is similar and different from Antisocial Personality Disorder and sociopathy. In order to treat psychopathy there must first be a consistent and accurate definition of what constitutes a psychopathic individual. Current measures such as the MMPI-2 and the PCL may aid in identifying individuals with these traits, but without a clear definition outcome studies are unreliable. Answering the question of whether an individual is treatable also lies in understanding the goal of the clinician. The ambiguity as to whether psychopaths are treatable will be illustrated by reviewing current understanding of psychopathic behaviors, definitions of psychopathy, common measurement tools and outcome research.--Dr. Duclos-Robinson is a licensed psychologist at Kaiser Permanente, Adjunct Professor at Argosy University, and volunteer faculty for the San Diego Courthouse Department of Forensic Psychiatry.

10:55-11:30

Epidemiological observation of the evolution of PTSD in the American General Population

Maurice M. Ohayon, M.D., D.Sc., Ph.D.

The causes of PTSD have been documented over the years. Most of the studies have placed emphasis on the most dramatic events such as violent crimes, natural catastrophes and war. However, from our epidemiological data, it appears that a significant number of cases of PTSD are developed without direct contact with the traumatic event. In this presentation the main differences between these two types of PTSD will be presented in terms of depression, anxiety and cognitive impairment. Legal issues will be discussed.--Dr. Maurice Ohayon is Professor of Psychiatry and Behavioral Sciences at Stanford University and is Director of the Stanford Sleep Epidemiology Research Center.

11:30-12:10

Contribution of Neuropsychological Evaluation in Capital Cases

Deborah S. Miora Ph.D.

Historical and more recent legal developments in capital cases have permitted the presentation of defenses about neuropsychological deficits even in the absence of blatant mental retardation. Certain types of deficits are routinely found which bear investigation and consideration, often in the context of histories of complex trauma. Examples focused on executive dysfunction and its ramifications for neuropsychological function will be offered to illustrate the value of neuropsychological investigation in such cases. Problems with ethnic demographic corrections in such contexts will be discussed as pertains to the potential obfuscation of neurodevelopmental disorders and the more appropriate comparison of such data to the general population.--Deborah S. Miora, a licensed psychologist in practice for over 20 years, teaches at Alliant International University and is frequently called upon by the courts and attorneys to consult on psychosocial and neuropsychological assessment in both noncapital and capital cases at various phases of legal proceedings. She maintains an active clinical and neuropsychological practice in Beverly Hills, California.

AMERICAN COLLEGE OF FORENSIC PSYCHIATRY

PO BOX 130458 , CARLSBAD, CALIFORNIA 92013

Telephone: 760-929-9777 , Fax: 760-929-9803

Email: psychlaw@sover.net , Web site: www.forensicpsychonline.com