Opinion ID: 1592333
Heading Depth: 1
Heading Rank: 2

Heading: Evidence Regarding the Nature of the Psychological and Psychiatric Treatment Meinhardt Refused

Text: Saad's Healthcare argues that the evidence presented to the trial court demonstrates that the psychological and psychiatric treatment Meinhardt refused was intended to treat her physical disability and that its goal was the restoration of physical and vocational function. In support of this argument, Saad's Healthcare cites an April 30, 2002, note by Dr. Jake Epker, one of Meinhardt's treating psychologists, in which Dr. Epker wrote: I spent time educating the patient and her husband regarding the fact that she is experiencing a normal reaction to traumatic events and that many of the physical symptoms she describes are likely due to anxiety, but that her symptoms will improve through a combination of medication and therapy. Saad's Healthcare also references the following testimony from the July 29, 2004, deposition of Dr. William Wilkerson, a psychiatrist who treated Meinhardt: Q: . . . Is there a psychological component to how they [a hypothetical person with no depression and a hypothetical person with moderate depression] view pain, I guess is what I am getting at? A: Well, that's a different question, and the answer is yes, there is a psychological component to pain. Q: Elaborate on that, if you don't mind, because I failed to ask you the right question that gets to that issue. A: Well, I think I understand what  the subject matter, at any rate. I am not sure I understand the specific question even now, but the relationship between physical symptoms and depression is complex, and varies from patient to patient, and varies with the type of ailment a person has. It is true that some people, when they are depressed, will suffer more with particularly pain, than someone who is not depressed. However, it's well known people get depressed and then they will become physically ill. Likewise, they become physically ill and then they get depressed. The brain is part of the body. The brain is, in fact, the sensing mechanism for pain. If the brain is sick, then it stands to reason that there is going to be a difference in the perception of any physical symptom. But it may go the other way. It may be that the person is less aware of their physical symptoms. They may neglect themselves and become sicker because they are just not perceiving, for example, that they are becoming dehydrated. So, I mean, as I say, the relationship is complex. It's not something you can just cut it out and say that is it. The following passage from the November 8, 2006, deposition of Dr. Wilkerson addresses the nature of psychological and psychiatric treatment: Q: Is posttraumatic stress disorder and major depression something that could also affect your physical condition; how you feel; how you function physically? A: Particularly major depression. People need to have their depression treated in order to heal at the best rate because the body's immune response is altered when somebody is depressed. Their motivation to do things can be impaired by depression. Q: Well, then in this case with the major depression and the posttraumatic stress disorder, would the psychiatric/psychological treatment that had been prescribed be intended to help both her mental condition and her physical well-being? A: The treatment is not directed at her physical problems. It would be more directed at her emotional response to what happened to her; her response to the injuries and to her pain; and trying to help her be the best she can be; to try to decrease the troublesome painful symptoms as much as possible. Q: And I think last time you had testified that her condition, as of your last deposition, you felt that she was unable to work? A: That's correct. Q: Would psychiatric and psychological treatment which is to  as you just indicated  improve her overall functioning, that that's something that would also, if successful, be intended to return her to work if possible or get her to a position where she could actually engage in some kind of gainful employment down the road? . . . . A: You really don't have any limit on what you're trying to achieve with any kind of treatment. You're trying to make the person the best they can be whether it's orthopaedic surgery or psychiatry or anything else. We need to as psychiatrists be somewhat disciplined as Freud said and direct ourselves to the diseased part of the person. Q: Let me ask it differently. The diseased part here being the mind affects both her physical condition and her ability to work; is that accurate? A: Yes. Q: And that if you're able to improve the mind you would therefore improve her physical condition and hopefully potentially possibly her ability to work? A: It would depend on the case. In terms of improving her physical condition obviously, if her lungs are so damaged that they're not going to get better beyond a certain point, psychiatric treatment is not going to make her lungs any better. If she develops, for example, arthritis because of injuries she's had at the various joints, she may  psychiatric treatment may make her better able to tolerate her pain and suffering and become adjusted to the result of disability, but it's not going to make her joints get well, if that's clear enough. Q: I think I understand what you're saying. That you're not treating with a focus towards improving physical condition or vocational ability; you're looking to treat the mind because that's where  that's your focus; is that more accurate than what I said before? A: Yes. Q: But wouldn't a by-product of treating the mind also be potentially improving her physical condition or her ability to work . . . as a by-product? A: It would depend on the case. Some people clearly are not going to be able to work. Others are. That's not actually a goal of what we do typically. . . . Well, this harkens back to the previous deposition where we talked a little bit about military medicine and psychiatry where they put hospitals up near the front and when guys come back with shellshock  which is, you know, a form of posttraumatic stress disorder  they patch them up fast and try to get them back to the unit. There have been some people that said they didn't know whether that was a good idea or not. Anyway, that's usually  that's not really a goal of psychiatry per se, but it may well be a by-product depending on the case. Q: And I think that's the disconnect I was having the way I was asking it as far as the goal. But let me ask you this. In your opinion is it her mind or her mental condition that is preventing her from work? A: That's a big part of it. But as I point out, she had pretty bad physical symptoms too. Q: Are you treating the physical symptoms or the physical complaints  A: No. Q  or you're treating strictly the mental complaints? A: Yes. Q: And your opinion that she's unable to work is based upon her mental condition? A: Yes, that's my area. Q: And so if her treatment for her mental condition improved her mental status, would not a by-product also possibly be, not your goal, but a potential by-product be that it would improve her ability to work? . . . . A: It may well be. It would remain to be seen depending on the case. Q: And how the patient responded to treatment? A: Yes. This Court notes that this evidence was not accurately conveyed in Saad's Healthcare's briefing on the issues. [2] Meinhardt, however, argues that the above testimony demonstrates that her refusal of psychological and psychiatric care in this case was not a refusal to undergo physical or vocational rehabilitation because, she argues, the psychological and psychiatric care was not intended to restore her physical and vocational functions. Meinhardt also relies on the following testimony by Dr. Wilkerson: Q: Do you consider your treatment of Ms. Meinhardt to be physical rehabilitation? A: No, sir. Q: Do you consider your treatment with Ms. Meinhardt to be vocational rehabilitation? A: No, sir.