The Expert: Dr. Jacqueline Valdes, a Florida-based expert in psychology and neuropsychology, who testifies to tests she administered to the plaintiff and concludes that the results are inconsistent with a person who has suffered a TBI.
Testifying as a defense expert in a 2016 medical malpractice trial out of Florida involving the cognitive dysfunction of a cardiologist following electric shock therapy, Dr. Jacqueline Valdes, a Florida neuropsychologist who frequently treats brain damage, concussion, and dementia, explains how her testing at different time intervals sorts out expected declining brain function from damage related to the convulsive therapy.
The expert begins by cautioning that during two yearly testings in 2011 and 2012, which were designed to ferret out malingering, the patient’s effort appeared to be inconsistent in a significant way. In 2014, the doctor readministered the Spatial subtest of the Webster Memory Scale that had been given three years earlier. The plaintiff scored in the top 25% in 2011, but in the bottom 1% in 2014. This would be indicative of someone with a progressive dementia disorder. A “one time” traumatic brain injury is not considered a progressive disorder.
Similarly, in 2012, a reading test administered to the cardiologist was interpreted as “the upper end of average”, but in 2014 it was “low average”. This is significant in that it demonstrates a decline in cognitive ability over time that is likely not related to any one time trauma. As well this same trend was noted in testing for drawing ability and his memory of the thing he was to draw. This reinforced the idea that the patient’s cognitive abilities were declining as a result of something other than the trauma that occurred years before. His problem solving abilities had declined from average to impaired to below average over the years. This variation in performance was also inconsistent with a traumatic brain injury.
There was a claim that the patient had suffered a frontal lobe brain injury from the plaintiff’s attorney. The frontal lobe affects social or emotional behavior, as well as “executive functioning”. The latter includes strategizing, planning, multitasking, sustaining attention, impulse control, and complex problem solving. The fact that the patient was able to perform some of these functions well, but was inconsistent in doing this, is an indication that he was capable of doing this on a more consistent basis. His ability to plan ahead and efficiently solve complex problems at a superior level disputes traumatic frontal lobe damage.
Finally, his verbal reasoning skills had been low average and had improved significantly over time as had his math skills. The neuropsychologist concluded that the inconsistencies in his performance supported a progressive dementia as opposed to a brain injury related to convulsive shock treatments. The jury agreed, finding for the defense.
Gary Gansar, MD, is residency-trained in general surgery. He served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Touro Infirmary and Mercy Hospital in New Orleans, LA. Dr. Gansar was Board Certified in general surgery while in active practice. He joined AMFS in 2015 as a Physician Medical Director.
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