The Expert: Dr. Lester Zackler, a psychiatrist in California that evaluated the impact the injury has had on the motorcyclist.
Offering testimony as an expert for the plaintiff in a 2021 California bench trial, Rojas v. Hajoca Corp., in which an accident cost a motorcyclist his leg, Dr. Lester Zackler, a California psychiatrist, shares his evaluation of the impact of the injury on the life of the victim.
The doctor begins his explanation with a discussion of Mr. Rojas’s clinical diagnoses. He has had a traumatic amputation, and this has caused limb pain related to the interaction of the stump with his prosthesis, and phantom pain in which the brain still detects that the extremity is present and painful. The psychological issues begin with an adjustment disorder, an emotional reaction to a specific life event, with accompanying anxiety and depression. This can become chronic when the stressors persist, and in this case, the stressor is the loss of his limb. The patient’s anxiety and depression have waxed and waned, sometimes becoming so strong the he became suicidal, or doubted that his marriage would survive. This reflects the change in the role he played in his marriage as well as his life. Post traumatic stress disorder also followed this trauma.
This sudden and unexpected trauma caused a “cluster of symptoms” such as re-experiencing with nightmares and intrusive thoughts, avoidance, and arousal, part of the fight or flight response. These symptoms are particularly noted when driving.
Relationship distress is imposed on spouse and family due to the victim’s changing role with both. This is deeply effected by one’s original personality traits which have genetic as well as developmental roots. People become distressed when they breach the distress threshold. Stress become distress once it breaks that threshold. In this case, Mr. Rojas was existing below the threshold prior to the trauma and has been above the threshold ever since. As a sensitive and conscientious person who has grown up fatherless, but in a culture that particularly values masculinity or “machismo” in its males, Mr. Rojas expects himself not to be emotionally vulnerable. Instead, he is expected to be the solid support for his family. This accident took his ability to be mobile, defend himself, or do his job without help. This is a loss of control of his life and a threat to his family.
The psychiatrist then goes through an explanation of the stages of grief from loss. First is denial followed by anger and depression. In the initial stage of denial, one will reassure oneself that the problem is not that bad and can be overcome. When it becomes obvious that this might not be true, anger is the reaction. This is unrelenting and will result in depression. Bargaining is the next stage. “What can I do to be restored to what I was?” Finally, when this is addressed, there can be acceptance. In this case, he has stayed with his marriage and attempted to recover physically as part of the bargaining. Yet there cannot be acceptance without closure. This trial represents that closure. It will establish his future from a financial aspect as well as establishing him as the head of the family once again. Without this closure, he will remain angry and depressed.
The expert’s presentation put things in perspective and laid out clearly that these problems cannot be addressed with medicine alone. The judge agreed, pronouncing a judgement of $23.8 million.
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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