DOC.049.006.0030_R
.I Dr Gary P Larder MB.B.S. [QLD}, F.R.A.C.G.P., F.R.A.N.ZC.P. C.I.M.E.[AMERICAN BOARD of INDEPENDENT MEDICAL EXAMINERS]
Clinical Senior Lecturer Departmen1'of Psychiatry University ofQld
2nd Floor, Suite 7 201 Wickham Terrace Brisbane Q 4000 Phone: 3839 6450 Fax: 3832 7016 Email:
[email protected]
ABN: 90 068 933 675
15 July 2002 Corrs Chambers Westgarth GPO Box 9925 BRISBANE Q 4001
ATT:
Julie Cameron
PRIVATE & CONFIDENTIAL RE:IBQS
llimJ!73]
REDACTED
Dear Sir/Madam In reply to your written request of 30 May 2002 and with jBQS I's infonned written consent the following report is submitted. I am a registered medical practitioner and consultant psychiatrist in the state of Queensland. 5
It is noted that REDACTED is pursuing a claim for personal injuries against the Brisbane Grammar School. He alleges he experienced sexual abuse by the then School Counsellor when he was a student in at the school.
I understand that you require a medico legal report. 10
This report is compiled using the general principles of forensic report writing as published in the Australian and New Zealand Journal of Psychiatry by S H Allnutt and S H Chaplow as a guide [1]. The interview began with an explanation of the purpose of the interview, a review of the relevant issues to be addressed in the assessment, and the process of the interview. Ethical Guidelines for Medicolegal Reports #9 produced by The Royal Australian and New Zealand College of Psychiatrists, October 1992 [2] was reviewed prior to the interview. 20
SOURCES OF INFORMATION
25
The following history obtained from BQS is an overview [though not necessarily all] of the relevant information prov1 ed in the assessment process which took place at consultation on 5 June 2002 for a duration of 60 minutes. IBQS Iattended my rooms prior to the interview to read material explaining the nature of the assessment and assessment questionnaires.
30
The full typed transcript copy of the taped interview is enclosed as Appendix One.
1111111111111111111 Ill CCW.053.0226
DOC.049.006.0031_R
I have subsequently considered the following material m formulating my opm10n:•
The Plaintiffs Personal Record Sheet.
•
The Plaintiff's Statement of Loss and Damage .
•
Medical records released from Dr . d a t e d 5 June 2002 .
•
Medical records released from Dr REDACTED
5
1O
SPECIFIC QUESTIONS
15
In reply to your specific questions from a medical psychiatry perspective and as an independent medical examiner I advise:The opinion is the result of my consideration, analysis and interpretation of the history obtained from f the mental state examination and collateral information available.
IBQS
20
GENERAL
1. The alleged period of abuse, and its nature and extent. 25
IBQS
I
confirmed that the statement he gave to his lawyers covered in points (a) to (f) were the issues that occurred with Mr Lynch. The !allowing are the incidents that ~1___ _ _~1 confirmed that he expenenced:-
808
30
[a] Lynch subjected the plaintiff to relaxation techniques and hypnosis techniques; [b] Lynch undid the plaintiffs shirt, belt and pants; [c] Lynch placed the plaintiff's hand on his (the plaintiff's) penis; [d] Lynch fondled the plaintiff's genitals; 40
[e] Lynch forced the plaintiff to such his thumb;
[fl Lynch spoke to the plaintiff in an indecent and inappropriate manner.; He remembers a particular issue:45
50
"When he put his hands down my pants. I was Grade 8 and didn't know what was going on. He had this way about him that you could trust him and everything was the way it was meant to be to the point where I couldn't question at all. I just didn't understand. He'd push his hands down, holding onto my hand, pushing it down my pants. The tie was loosened. This happened a few times."
1111111111111111111111 CCW.053.0227
DOC.049.006.0032_R
2. The reason for the plaintifrs attendances with the Counsellor. It was for non-specific difficulties with his behaviour that he was ordered to see a school counsellor by members of the teaching staff. 5
lcould not be more specific about the reasons for referral. For example he stated it was for:-
IBQS
10
"Trouble I had. I was sent by Mr Byron and Mr Cochrane, teachers in the lower house." "I kept getting sent back to him because I was having problems. I didn't want to see him and I told Mr Byron that. He said I had to. I remember I was crying in Mr Byron's office."
15
3. Reporting - when did the plaintiff first mention the alleged abuse to someone, to whom was it reported and what, if anything, occurred as a result of the report? 20
.IBQS someone.
I
could not recall when he first mentioned the alleged abuse to
~-----
It may have been Drll' ' a TA therapist in transactional analysist, or his 1 mother after 1998. 25
It appears no particular changes resulted for this reporting. 4. Corroboration - is there any independent evidence of abuse beyond the plaintifrs description? 30
There is no independent evidence of abuse beyond the plaintiffs description. 5. The nature and extent of any diagnosable psychiatric condition suffered by the claimant.
The fundamental issues concerning the medical/psychiatry assessment of this claimant are summarised diagrammatically in Appendix Three.
40
This diagram refers to issues of primary concern to the doctor/psychiatrist on the left hand side of the time line. This diagram refers to issues of primary concern to the legal professional on the right hand side of the time line.
45
50
The doctor/psychiatrist assessment concerns predisposing life issues [that is events of mental health significance prior to the pathological studentcounsellor interpersonal relationship whilst the student was attending the Brisbane Grammar School] and possible events of significance in the years after the Brisbane Grammar School education experience prior to the medical/psychiatry assessment in 2002.
1111111IIll11111111 Ill CCW.053.0228
DOC.049.006.0033_R
~BOS
.,,_173~]_ _ _ _ _ _ _ _4
I understand that the legal professional issues concern the possible link
between adverse experiences at the Brisbane Grammar School and subsequent life events. 5
IO
Adverse life events prior to the reported pathological student-counsellor interpersonal relationship are assessed as insignificant in this case. Other issues assessed as significant in the overall Brisbane Grammar School experience [that is non-pathological student-counsellor interpersonal relationship issues] are significant. Adverse life events subsequent to the pathological student-counsellor interpersonal relationship issues are assessed as significant.
15
20
25
The claimant's reaction to the events of 1998 when the first media and public discussion of the events that allegedly occurred at the Brisbane Grammar School appeared is assessed as significant. The following evidence supports this claimant's assertions that the pathological student-counsellor interpersonal relationship subsequently resulted in significant life difficulties:IBQS I's memory of his Brisbane Grammar School experience is marked by a negative attitude, truancy and an unenjoyable period of adjustment difficulty, as he stated:-
"I have an overall sense of shame and confusion; it's such a really vulnerable time. The whole experience of the school just wiped feelings of the problems I had. It just compounded my ability to talk about anything." 30
"flt waf)j pretty scary. I felt quite inadequate. I didn't enjoy my time there. I didn't have the stability. I was in the boarding house at one stage and ran away from that." His school counsellor experience was not helpful. The pathological student-counsellor interpersonal relationship in the claimant's history is marked by issues concerning:40
•
45
•
50
• • • •
•
a disturbance of teenage development concerning o trust o sexual development o power/control issues the experience of anxiety particularly in situations that are reminiscent as cues symbols and reminders of the pathological student-counsellor interpersonal relationship issues. shame guilt an unfulfilled need for assistance/help a lack of assistance 111111 II Ill /11111111/I CCW.053.0229 physical trauma
DOC.049.006.0034_R
• • •
emotional trauma psychological trauma and a disturbance of emotional, psychological, social and sexual development.
5
The nature and extent of any diagnosable psychiatric condition suffered by the claimant, using the DSMIV system of diagnosis [3] is therefore:AXIS I
CHRONIC DEPRESSION ALCOHOL ABUSE Stimulant abuse Opioid dependence ANXIETY DISORDER [post alleged abuse]
AXIS II
severe personality vulnerability
10
15
AXIS III hepatitis C AXIS IV SEVERE STRESSORS 20
AXIS V
GAF current [60] GAF 6 months [60]
The medical records released from Dr WJ'f¢Mated 5 June 2002 and the medical records released from Dr REDACTED are consistent with this assessment. 25
This assessment must be placed in context.
30
There have been numerous studies examining the association between a history of child sexual abuse and mental health problems in adult life that have employed clinical samples, san1ples (usually of students), and random community saniples [see for example references 5-11 ]. There is now an established body of knowledge clearly linking a history of child sexual abuse with higher rates in adult life of depressive symptoms, anxiety symptoms, substance abuse disorders, eating disorders and post-traumatic stress disorders.
40
45
50
The relationship between child sexual abuse and adult psychopathology can be conceptualised in terms of a chronic form of posttraumatic stress disorder. In it's more sophisticated formulation, this model attempts to integrate the damage inflicted at the time to the victims' psychological integrity, by the child sexual abuse and the need to repress the trauma, with resultant psychological fragmentation. The latter manifests itself in adult life in mental health problems, and in problems of interpersonal and sexual adjustment. The post-traumatic stress model found its strongest support in the observations of clinicians dealing with individuals with histories of severe and repeated abuse. It was also often linked to notions of a highly specific post-abuse syndrome in which dissociative disorders were prominent [features absent in this case]. A less medicalised model for the mediation of the long-term effects of child sexual abuse has been proposed as a 'traumatogenic model'. This suggested that
l\\ \Ill I\l \I\ ll\ l\ ll\l ccw.053.0230
DOC.049.006.0035_R
~BOS
5
.,_73~]_ _ _ _ _ _ _6
child sexual abuse produced a range of psychological effects at the time and, secondarily, behavioral changes. This model predicts a disparate range of psychological impairments and behavioral disturbances in adult life, which contrasts with the post traumatic syndrome model with its specific range of symptoms. This model, though less medical and symptom-bound, pays only scant attention to the developmental perspective. It gives primacy to the psychological ramifications of the abuse with less
1O
15
20
25
30
acknowledgment of the social dimensions. Only in recent years have attempts been made to articulate the long-term effects of child sexual abuse within a developmental perspective and to attend to the interactions between child sexual abuse and the child victims' overall psychological, social and interpersonal development. There are social, political, media, religious, medical, education, and legal issues impacting on this interviewee's and interviewer' s perceptions beliefs, ideas and emotions. In my opinion the impact of the media reporting on events in 1998 concerning Mr Lynch and the processes that have evolved over the ensuing four years since that time is very significant, in that it has served as a cue, reminder and stressor in it's own right. This presentation concerns the actions of an authority figure, in a position of power, and trust whose behaviour distorted, interfered with and in my view damaged this man's sexual, personal and social development. The sexual activities were in my opinion, age and developmentally inappropriate, forced in subtle ways, using very powerful controlling and manipulative techniques, a sequence of events which, has subsequently had a disabling effect on this man's development. The alleged abuse is an abuse of power over a younger person and was a violation of this man's right to normal, healthy, trusting adolescent relationship expenences. This man has reported the following general behaviour changes that have been described in persons who have been sexually abused: -
40
•
• • • • 45
•
• •
Fear or dislike of certain people or places sleep disturbances academic problems withdrawal from family, friends, or usual activities depressed mood passive or overly pleasing behaviour low self-esteem self-destructive behaviour [alcohol binges].
Emotional problems identified include:50
•
A long standing anger at the abuser, at other adults around him who did not protect him, and at himself (feeling as ifhe caused trouble).
\\\ \""\\\I\"' \\\I\\ ccw.os3.0231
DOC.049.006.0036_R
• 5
1o
15
•
Isolation because "something is wrong with me", because he felt alone in his experience, because he still has trouble talking about the abuse Sadness about having something taken from him, about losing a part of himself, about growing up too fast, and about being betrayed by someone he trusted.
There is a probable connection between post traumatic anxiety symptoms which he reports post abuse and use of drugs that has assisted him to an extent as it has resulted in his "escape" from intrusive memories, nightmares, and caused a numbing of general responsiveness. Drug use has been so severe and long term however that clearly separating the devastating consequences of the illicit drug use and it's complications [physical, mental, social, legal] and in particular the impact on his sense of self and identity from the impact on the pathological student-counsellor interpersonal relationship issues is not possible, in my view.
20
I find no evidence to support the view that this man is anything but a reliable, accurate, historian and there is no evidence therefore to support the view that he is consciously or purposefully lying, inventing, exaggerating his difficulties, therefore I cannot support any argument that he is malingering.
25
Similarly I do not believe that there is any evidence to suggest that he suffers from a factitious disorder where unconscious psychological processes are at work to result in the difficulties that he describes.
30
This presentation can, on the balance of probabilities, be partially attributed to the alleged abuse. The extent of attribution must consider the possible alternative outcomes, if IBQS I had received beneficial school counselling, if the alleged abuse did not occur. In my opinion the experiences with Mr Lynch has most likely had a moderate lin that they formed a very abnormal component of his impact o~BQS adolescent development particularly disturbing his social and identity development.
40
The current assessment of the severity of this claimant's reaction to the pathological student-counsellor interpersonal relationship issues referred to in each of these domains is assessed on the following rating scale. Rating
.,
Severity Mild Moderate Severe Severe Severe
Degree
1 2 3
Percentage 0-30% 30-60% 60-75% 75-90% 90-100%
45
11111111 \11111111111\I ccw.053.0232
DOC.049.006.0037_R
be
5
A component of this condition can, on the balance of probabilities, be attributed to the alleged abuse. There is considerable evidence that this condition could have resulted from many other life experiences.
10
15
7. Prognosis -What is the plaintiffs long term prognosis in relation to any condition caused by the alleged abuse?
The plaintiffs long term prognosis in relation to any condition caused by the alleged abuse is assessed as guarded and is dependent on his accessing and benefiting from appropriate psychiatric treatment. The prognosis is poor without treatment. This means that this man is likely to continue to experience difficulties indefinitely.
20
That is to say that after 20 years it is likely that the symptoms reported will continue indefinitely.
PRE-EXISTING CONDITIONS OR PREVIOUS EXPERIENCES/LIFE EVENTS 25
8. Did the plaintiff have any pre-existing condition or previous experiences/life events or stressors which have affected his psychological/psychiatric status, 30
Yes. (a) What were those conditions/experiences?
IBQS
Ipresents a complex constellation of psychiatric difficulties.
~youngest of four siblings [one older brother and two older sisters], IBQS I ~s
life story is one of tragedy, dysfunction, disorganisation and struggle.
At age 28 40
45
years]~B_a_s_ _~]is working two jobs:-
•
A support worker for an organisation called~ [which looks after people with acquired brain disease [for three~
•
And as a night watchman for the REDACTED accommodation centre in a men's hostel [for 18 months].
m a crisis
His occupational history is marked by unskilled work, unemployment and labouring type work, as a service station attendant, on trawlers as a deckhand, and in spray painting. 50
Factors assessed as contributing to this stark reality include:-
\\\ \ccw. IU I\\053 \U \I.0233 \I\\ I\\
DOC.049.006.0038_R
•
A biological predisposition to mental disorder [an older sister has mental health problems, his father is an alcoholic].
•
A teenage back condition REDACTED was aged 14].
•
A knee condition [surgery was performed for osteochondritis desiccans.]
•
Difficult relationships with his father and his father's wife step mother].
•
Estrangement from his family.
5
IO
15
1s as ~.----~
• IBQS I' s report of his family history indicates a history of severe interpersonal conflict [particularly between his parents], aggression, paternal alcohol abuse and finally parental separation when he moved to live with his father. It was distressing, poignant, and very moving to heaJBQS
20
25
I' s account, unsuccessful attempts as a child to assist his mother in physical altercations with his father ["I can remember several occasions where I physically tried to stop him from physically hurting my mother." ] (b) What was the plaintiff's likely progress to date and long term prognosis in the absence of the alleged abuse?
I believe it reasonable to conclude that there is a direct and complex relationship between some of these subsequent life issues and the alleged abuse. 30
(c) How, if at all, has the plaintiff's progress and future prognosis been different because of the alleged abuse? I believe that such conditions/experiences would have had, on the balance of
3:i
probabilities, a different effect on the plaintiff, in the absence of the alleged abuse. SUBSEQUENT CONDITIONS OR EXPERIENCES/LIFE EVENTS
40
9. Has the plaintiff suffered any condition or life experience/s or stressors since the alleged abuse which affect his psychological/psychiatric status and, if so:Yes.
45
(a) What were those conditions/experiences? There is clinical evidence of any pre-existing diagnosed condition.
50
There is much historical evidence of previous experiences/life events or stressors that have affected his psychological/psychiatric status.
DOC.049.006.0039_R
•
IBQS I did not complete secondary education [leaving after year 11]. I here 1s a marked disparity between his life successes and those of his
siblings [who are very successful in comparison]. 5
•
The history indicates a very significant predisposing history of family issues, prior to and separate from any adverse events in a studentcounsellor relationship at the Brisbane Grammar School.
•
Social isolation.
•
Alcohol abuse began at age 15 years and lead at age 18 years to a severe opioid dependency.
•
A severe substance abuse state that has had a devastating effect on this man's life development.
10
15
It is currently active [this illicit drug is costing seven to eight hundred dollars per week] and causing a severe functional life impairment, for example:20
25
"I thought I was going to miss my appointment because I was using it." •
A positive history of legal issues as a result of his severe and long term drug problem.
•
Efforts to pay for the drug cause severe financial stressors.
•
There is no history of significant fulfilling personal relationships.
•
There is a history of compulsive behaviour and a gambling problem.
30
The nature of his life struggle is a time when he resorted to work as a male prostitute in Brisbane just over five years ago when he was in his early 20's [he needed money for Heroin.] 35
40
•
He is Hepatitis C positive.
•
He is reportedly HIV negative.
There is a clear temporal relationship between the onset of binge alcohol use and the history of alleged sexual abuse by Mr Lynch. .IBQS Lynch.
I
~-----
45
reported a history of sexual interference prior to the events with Mr
There are complex family developmental issues with respect to relationship between the children in this family, their parents and step parents. There is a history of significant family dysfunction.
50
The plaintiffs likely progress and long tenn prognosis in the absence of the alleged abuse was likely to have been improved, as a result of improved social,
1111111111111111111111 ccw.053.0235
DOC.049.006.0040_R
BQS RE:
I
•
&'-73~]~_ _ _ _ _ _ _ _ _ _1_1
I
~~~~~~~~~~
sexual and relationship functioning and the likelihood that he would have been more likely to access appropriate therapy 5
He has required psychiatric treatment, institutional treatment and long term drug related rehabilitation. It is not possible to state that these conditions/experiences were caused directly
10
by the alleged abuse. Relationship problems and drug abuse have very strong links to the alleged abuse. These conditions/experiences would have affected the plaintiff adversely in the absence of the alleged abuse.
15
The plaintiffs progress and future prognosis would have possible been improved but for the alleged abuse. (b) Were those conditions/experiences caused by the alleged abuse?
20
I believe it reasonable to conclude that there is a direct and complex relationship between some of these subsequent life issues and the alleged abuse. (c) If not, how would such conditions/experiences have affected the plaintiff in the absence of the alleged abuse?
25
I believe that such conditions/experiences would have had, on the balance of probabilities, a different effect on the plaintiff in the absence of the alleged abuse.
30
(c) If not, how would such conditions/experiences have affected the plaintiff in the absence of the alleged abuse? I think that such conditions/experiences would have affected the plaintiff in the absence of the alleged abuse. d] How, if at all, has the plaintiff's progress and future prognosis been different because of the alleged abuse? The plaintiffs progress and future prognosis have become, on the balance of probabilities, significantly worse because of the alleged abuse.
40
EMPLOYMENT
45
10 If it be within the province of your expertise, and to the extent that it is, please review the aptitude test results contained in the plaintiff's Student Record and his school results and advise:I believe that it is within the province of my expertise to review the aptitude test results contained in the plaintiffs Student Record and his school results.
50
I confirm the meaning of the aptitude test codes that is included as Appendix Two.
1111111111111111111111 ccw.053.0236
DOC.049.006.0041_R
(a) Are the results consistent with what would be expected based on the aptitude test results? 5
10
15
The results of the Standardized Test Scores OT: TO: SS: MA: RV: RC:
fo~~B_a_s_ _ _ _~lare:-
104 111 7 11 8 4 5
The results indicate an average aptitude. Therefore are not consistent with what would be expected based on the aptitude test results.
(b) If not, what results should have been expected? What is your assessment of the cause of that difference? If a combination of factors, what would the likely position have been had the alleged abuse not occurred? 20
In my opinion this man's academic abilities are not reflected in his overall academic performance at this secondary school. That is to say that his results could have been better. 25
I cannot give an accurate or precise or specific figure on the extent to which they could have been better.
30
:, .
I believe however that using terms like a little better, a moderate improvement and a very significant improvement that it is very likely that this man was capable of a very significant improvement in his overall academic results. My assessment of the cause of this difference is that a combination of factors concerning school and non-school [personal, family issues, biological issues] factors are significant. The likely position if the alleged abuse had not occurred is that this man's academic outcome would have been improved.
40
45
(c) Is there any evidence of a deterioration in the plaintiffs school results after the commencement of the alleged abuse? Having reviewed the aptitude test results contained in the plaintiffs Student Record, hi.s school results and considering his family history [parents and siblings capabilities,] and intelligence [as assessed clinically] I advise:IBQS I's results as a day student from Year 8 to Year 11 did not reflect his true academic capabilities.
50
This man's school results are not consistent with what would be expected based on the aptitude test results. I believe he could have achieved better results.
Ill CCW.053.0237 111111.1111111111111
DOC.049.006.0042_R
BQS
RE:
13
There is evidence of a deterioration in the plaintiffs school results after the commencement of the alleged abuse. 5
lo
In my opinion this assessment supports the view that multiple factors impacted negatively on his school results [family conflict, his father's problems, alcohol abuse and the alleged sexual abuse]. In this combination of factors, the likely outcome if the alleged abuse had not occurred is very difficult to determine. I believe his results would have been better but for the abuse.
15
(d) Has the plaintiff's employment history since leaving school been consistent with what might have been expected based on the aptitude test results? The plaintiffs employment history since leaving school has not been consistent with what might have been expected based on the aptitude test results.
20
He has not achieved a good work history on the basis of his results. There are multiple factors predating and post dating the alleged abuse that impact very significantly on this man's work history. 25
It is possible, but not probable, that in the absence of the alleged abuse his work
record could have been improved.
30
.)
If the school counselling had lead to family assessment, and referral to a psychiatrist [the most likely form of therapy to have been appropriate and helpful at that time] as opposed to be unhelpful and in fact a source of alleged abuse, the outcome would probably have been a lot better.
(e) If not, in what respect is it not consistent and what is your assessment of the cause of that difference? If a combination of factors, what would the likely position have been had the alleged abuse not occurred? My assessment is that the cause of the difference is a combination of factors, and could have resulted if the alleged abuse not occurred.
40
In my opinion this assessment supports the view that multiple factors impacted negatively on his employment history [family conflict, his father's problems, alcohol abuse and the alleged sexual abuse]. 45
In this combination of factors, the likely outcome if the alleged abuse had not occurred is very difficult to determine. I believe his history would have been better but for the abuse.
50
(t) Has the plaintiff's ability to work in the past been affected by the abuse and, if so, when and in what respects has it been affected?
This assessment confirms that his current function is moderately impaired.
1111111111111111111111 ccw.os3.023s
DOC.049.006.0043_R
BQS
RE:
14
The plaintiff's ability to work in the past has probably been affected by the alleged. 5
10
In my opinion this assessment supports the view that multiple factors impacted negatively on his employment history [family conflict, his father's problems, alcohol abuse and the alleged sexual abuse]. The respects that it has it been affected are assessed using the Guide to the Evaluation of Permanent Impairment [4] published by the American Medical Association in 5th Edition [2001], wherein specific issues are addressed in the assessment of mental and behavioural disorders impact on function. Table 14-1 Classes of Impairment Due to Mental and Behavioural Disorder
15 Area or Aspect of Functioning Activities of daily Living Social functioning Concentration Adaptation
[l]
Class 1 No impairment No impairment noted
Class 2 Mild Impairment Impairment levels are compatible witb most useful functioning
Class3 Moderate Impairment Impairment levels are compatible with some, but not all, useful functioning
Class 4 Marked Impairment Impairment levels significantly impede useful functioning
Class 5 Extreme Impairment Impairment levels Preclude useful functioning
Limitation in activities in daily living.
l•s ability to function in the activities of daily living such as self care, personal hygiene, communication and sexual function are impaired. There is moderate impairment for ambulation, travel, sleep, social and recreational activities. [CLASS 3].
IBQS
20
[2]
Social functioning.
25
30
35
40
Social functioning refers to an individual's capacity to interact appropriately and communicate effectively with other individuals. It includes the ability to get along with others, such as family members, friends, neighbours, grocery clients, landlords or bus drivers. Impairment of social functioning may be demonstrated by a history of altercations, evictions, firings, fear of strangers, avoidance of interpersonal relationships, social isolation or similar events or characteristics. The impact of this condition has produced moderate impairment of functioning in this area [CLASS 3]. [3]
Concentration, persistence and pace refer to the ability to sustain focused attention long enough to permit the timely completion of tasks commonly found in work settings. Deficiencies in these areas are best noted from previous work attempts or from observations in work-like settings. There is mild impairment of function in this area [CLASS 2]. [4]
45
Concentration, persistence and pace.
Deterioration or decompensation in work or work-like settings.
1111111111111111111111 CCW.053.0239
Deterioration or decompensation in work or work-like settings refers to repeated failure to adapt to stressful circumstances. Stressors common to the work
DOC.049.006.0044_R
~BOS
5
~73]
15
environment include attendance, making decisions, scheduling, completing tasks and interacting with supervisors and peers. Independence, appropriateness and effectiveness of activities should be considered. Fitness for work capability may be assessed by the completion of tasks as filing index cards, locating telephone numbers, disassembling and reassembling objects. There is evidence of moderate impairment of functioning in this area [CLASS 3]. I believe the degree of this impairment would have been reduced but for the
10
abuse. (g) Has the Plaintiff's ability to work now in in the future been affected by the abuse and, if so, in what respects?
15
20
The plaintiff's ability to work now or in the future has possible been affected by the abuse. Depression and drug abuse have probably become significantly more problematic since 1998 and there is a serious risk of long-term impact on all aspects of life function [including work] as a result of these psychiatric issues. The plaintiffs ability to work now or in the future has been affected by the abuse to s significant extent.
25
TREATMENT 11. Has the plaintiff received any psychological or psychiatric treatment (including medication and/or therapy) to date
30
Yes. This condition resulted in referral for psychiatric assessment.
~IB_o_s_~-~lwas admitted to the
REDACTED
in about 1994 for about 101/z
months. There is a four year history of psychiatric treatment [with Dr~ from 1993 iJ3!mll until 1997] from age 20 until age 24 years. 40
liJe•f@I
IBQS Ireported he also saw another psychiatrist, Dr He stated he had not seen any other psychiatrists in the past five years since consulting Dr
111·rt11 45
He has been admitted for opioid overdose [to a psychiatry unit at the Royal Brisbane Hospital ['I overdosed three days in a row and they regulated me for a couple of days. I wasn 't'1(ying to kill myself.'] IBQS
50
(a)
lis not taking any medication at the present. What treatment has been received?
Counselling, medication.
II 11111111111111 111 111 CCW.053.0240
DOC.049.006.0045_R
(b)
When and by who was the treatment given?
Dr -psychiatrist. 5
12. Does the plaintiff require treatment and/or medication now or in the future?
Yes. 1O
This condition requires specialist psychiatry treatment. The full range of biological, psychological and social management principles should be espoused.
15
20
25
The treatment of the consequences of pathological student-counsellor interpersonal relationship as reported in the matter at a time about 20 years later requires the application of a carefully designed biopsychosocial management plan incorporating a consideration of legal, psychological, social and biological issues. The tr~ati:nent o~BQS Is mental health difficulties should be coordinated by a ~---psychrntnst. Treatment consists of an acute phase, during which rem1ss10n is induced; a continuation phase, during which remission is preserved; and a maintenance phase, during which the susceptible patient is protected against the recurrence of subsequent episodes. It would be reasonable to expect tha~BQS
I
~----
would be constantly involved in a
medical treatment plan for a period of years. 30
In my opinion remission has not yet been achieved in this matter. (a) Please advise the nature of the treatment, required duration and frequency, and approximate cost.
The required duration of this treatment is measured in a period of months to years.
40
The required frequency of this treatment is measured in a period of weekly, fortnightly or monthly treatment.
Control of drug use is a treatment priority. IfI was treatin~~B_o_s_ _~I I would see him on a weekly basis.
1111111111111111111111 CCW.053.0241
45
I would start medication to ensure that he is initially sleeping well about 8 eight hours from 1Opm to 6am and I would increase the dose of his antidepressant drugs to maximum tolerable levels providing adjuvant second line additional treatment if required. 50
The cost of this treatment could range from a minimum $12,500 per year for five years [outpatient specialist care at $200 per consultation, fifty per year, with medication at $50.00 per week] to a cost in the range of up to $80,000 per year [if
DOC.049.006.0046_R
80 8
RE:
1~__ _ _ _ _~~--73_._l_ _ _ _ _ _ _ _ _ 17
hospitalisation is needed in addition to outpatient therapy [hospitalisation costs $10,000 per week].
(b)
What is the plaintiff's prognosis at the completion of treatment?
5
The plaintiff's prognosis at the completion of treatment is assessed as guarded. That is to say that it is not clear that the symptoms of concern will be controlled. 10
The absence of psychiatric treatment for the last five years and a negative attitude to treatment is a major concern. The prognosis will become clearer after a six month period of appropriate treatment, with compliance in a good therapeutic relationship.
15
DECLARATION [4) As far as I am aware, there is no conflict of interest that I can declare in the preparation of this report. 20
I do not believe there is inconsistency among the history, physical examination, laboratory findings, and/or other studies.
25
I advise that this report is based on the assumption that this interviewee has given a truthful account. I believe that there is sufficient information available to form the conclusions made in this matter.
30
The conclusions made in this report could be altered by further collateral information or the provision of other facts relating to this matter. I have made all the enquiries that I believe are desirable and appropriate. I consider no matters of significance that I regard as relevant have, to my knowledge, been withheld from this report. The completion of this report is not contingent on the provision of payment. REFERENCES
40 [l] Allnutt SH Chaplow D General principles of forensic report writing. Aust NZ J Psychiatry. 2000 Dec; 34(6):980-7.
45
[2]Ethical Guidelines for Medicolegal Reports #9 produced by The Royal Australian and New Zealand College of Psychiatrists, October 1994. [3 ] DSMIV The Diagnostic and Statistical Manual of Mental Disorders 4th Edition [American Medical Association 1994].
50
[4] The Guides to the Evaluation of Permanent Impairment 4111 Edition [1994] American Medical Association. [5] Hunter, J. A. (1991). A comparison of the psychosocial adjustment of adult males and females sexually molested as children. Journal oflnterpersonal Violence, 6, 205-21 7.
55
11\ 1IU11111111\l II Ill ccw.053.0242
DOC.049.006.0047_R
~BQS RE: [6] Hunter, M. (Ed.) (1990). The sexually abused male: Prevalence, impact, and treatment. Vol.1. Lexington, MA : Lexington Books.
5
[7] Hunter, M. (Ed.) (1996). The sexually abused male: Application of treatment strategies. Vol. 2. Lexington, MA: Lexington Books. (8] Lisak, D. (1994). The psychological impact of sexual abuse: Content analysis of interviews with male survivors. Journal of Traumatic Stress, 7, 525-548.
10
[9] Bruckner, D. F. & Johnson, P. E. (1987). Treatment for adult male victims of childhood abuse. Social Casework, 68, 81-87. [10] Lew, M. (1988). Victims no longer: Men recovering from incest and other child sexual abuse. New York: Nevraumont.
15 [1 1] Myers, M. F. (1989). Men sexually assaulted as adults and sexually abused as boys. 13th Annual Canadian Sex Research Forum Conference (1986, Vancouver, Canada). Archives of Sexual Behavior, 18, 203-215 . 20
RELEASE OF REPORT
25
In consideration of the amendments to the Privacy Act 1988 effective from 21 December 2001 and specifically the 'Guidelines on Privacy in the Private Health Sector; Office of the Federal Privacy Commissioner; 9 November 2001' which states:Access would pose a serious threat to the life or health of any individual.
NPP 6.l[b) 30
35
40
45
There may be cases where a health service provider believes that providing information could present a serious threat to the life or health of the individual or another person. In such cases access may be denied. A 'serious threat to the life or health of any individual' may include harm to physical or mental health. The threat must be significant; for example where there is a serious risk an individual may cause deliberate self-harm or where they may harm others. This may include situations where the health service provider believes the information may cause the individual significant distress that may in turn present a serious risk to the individual's health. Where the health service provider judges that there is a serious threat, and it is possible to provide the information in another form which would remove this threat (for example, by discussing the information in person), then this option could be offered. The Practice Policy in relation to the patient accessmg a copy of this report states:-
50
55
Dr Larder will provide the original of this report to the requesting third party who shall be advised that a copy of this report should be released to your treating medical practitioner who has the knowledge and expertise to help you with the interpretation of its contents. 1111111111111111111111 CCW.053.0243
DOC.049.006.0048_R
It will be necessary there/ore for you to provide a signed release to your treating medical practitioner who will then need to contact the third party and seek release of a copy of this report. 5
Dr Larder does not authorise the release of this report to any other party without his prior knowledge. Should you require any further or specific information, or seek clarification of any of these issues or other matters please do not hesitate to contact me.
cc: Roger Singh, Shine Roche McGowan, PO Box 12011, George Street, Brisbane 4003
1111111111111111111111 CCW.053.0244