Exposure and Psychic Injury-A Review of 48 Claims

Irwin N. Perr, MD, JD

Asbestos exposure has been a common occupational risk resulting in much litigation. Where pulmonary dysfunction has been minimal or even absent, psychic injury has been made an element in claimed damages. Analysis of psychiatric and psychologic claims in 48 cases reveals that diagnoses often do not conform to professional standards, are based on insufficient data sampling, lack adequate overall history as well as medical history, and do not comport with the standard of probability usually required for litigation. The group studied was elderly (mean age- 62.6), mostly retired (71%), with some significant medical illnesses (18% on medical retirement). None were retired for pulmonary reasons. As expected, conflict in opinion between the opposing professional medical participants was frequent. Commonly the patients did not substantiate the complaints reported in the medico- legal reports; some ridiculed statements made on their behalf. Many psychological reports reflected simplistic or erroneous concepts of medicine or ignored relevant medical data. This study indicates that in this group claims of psychic injury due to asbestos exposure have little justification and supports the view that the current system of utilization of expert opinions is not reliable or in conformity with reasonable professional standards. Correspondingly, these claims did not result in augmented awards.

Asbestos exposure has resulted in a mas- Psychic injury can. of course, be ex- sive explosion of litigation. In many aggerated.'.' Many psychiatric disorders cases. parenchyn~allung disease and pul- are easier to mimic than other diseases: monary disability are clearly related to lack of selevant test procedures and re- . as are and in- liance 011 history create problems as do creased rate of lung cancer. Employees. the short superficial exan~inationschar- present and retired, have been encour- acteristic of many forensic review^.^ aged to seek litigation through an appar- Some treating professionals attempt to ently well organized referral system. When clear-cut impairing pulmonary please their patients. clients. or cus- pathology is not present, other bases for tomers and thus also have dubious ob- claims of damages have been sought. jectivity. Further. referral systems are so One increasingly popular claim where structured that people are sent for physical damage is absent or minimal. professional care and evaluations to is that of psychic injury. those who are likely to reflect a given or predictable point of view. Address reprlnt request5 to Dr. Perr. Robert Wood This article explores these issues in Johnson Med~calSchool, UMDNJ, 675 Hoes Lane, P~scataway,NJ 08854-5635. relation lo asbestos exposure. Here 48

Bull Am Acad Law, Vol. 20, No. 4, 1992 383 Perr

Table 1 cases of claimants are reviewed, all of Age Distribution of Group Studied whom were examined by me for attor- n O/o neys representing defendant con~panies. Age (N = 48) Certainly, the possibility of my bias must 65 or over 25 52 be considered by the reader. However. 1 60-64 12 25 55-59 2 4 have attempted to focus on the medical 50-54 7 15 data so that the reader can judge the 49 and under 2 4 merits of the various contentions. Generally. the examinees had at least atively high incomes as skilled blue col- some exposure to asbestos in the course lar workers: apparently many had in- of their work, some for many decades. comes in the $30.000 to $45.000 range An overall issue was a claim of failure while working, and only a few had finan- to warn and its role in the resultant cial difficulties. mostly related to the injury. Whether or not illjury resulted care of disabled adult children. Some from this exposure in a legal re- seen soon after the 500 point drop in the quires a professional conclusion of a re- stock market in 1987 displayed little lationship based on reasonable medical concern. or scientific certainty. Theoretically, the Of the 34, six retired on the basis of burden to demonstrate this falls on a medical disability. These were based on claimant. Therefore. examiners should the following causes: cardiac-four. not speculate but should be required to back illjury-one. and psychiatric- meet this standard of at least probability one. Curiously. but not unexpectedly. in their opinions. none had been retired for pulmonary The Group Studied dysfunction. The man retired for psy- chiatric reasons had an injury (described Forty-eight individuals were refel-red below) with possible and or- for psychiatric evaluation (47 male. 1 ganic brain syndrome with severe female). The female was the wife of a depression, many hospitalizations. and man who died of lung cancer that may treatment with electro-convulsive ther- have been asbestos related. and she in apy (ECT- I0 treatments) with no turn had a claim both of asbestosis and period of function following the illjury. mental injury. The group was somewhat elderly with a mean age of 62.6-with a Other Medical Conditions low age of 39 and a high age of 79. The Four examinees had retired on cardiac distribution by age is shown in Table 1. disability. A number of others had had Thus. 77 percent were 60 and over. myocardial infarcts, . ar- Thirty-four were retired. A number rhythmias, angina pectoris. enlarged retired at age 62 or in response to finan- hearts, or congestive failure-a total of cial incentive by their employers for 14. For practical purposes. there was early retirement. Most worked for refi- almost no functional cardiac disability neries and chemical plants and had rel- in this group. even in the small group

384 Bull Am Acad Psychiatry Law, Vol. 20, No. 4, 1992 Asbestos Exposure and Psychic Injury who had retired for this reason. One formation about pathology or functional person had had a bypass operation. restrictions was common. Some gener- None expressed concern about their car- alizations can be made. As a group. the diac states. even though several had had individuals showed an almost total ab- significant past problems. sence of functional impairment. Most. One had a history of stroke but this despite their age, were quite active and was not verified. and no confirmatory did not complain of any symptoms: only record was available. One had a history a few complained of shortness of breath of right frontal intracerebral lieniorrhage under certain circumstances; most re- with a 16-day hospitalization and good ported a lifestyle witli much physical recovery. This occurred six weeks before activity. In one unusual case the pa- the individual was seen hy a psychologist tient's doctor reported pleural thicken- who made no mention of this. various ing and increased interstitial markings. cardiac problems. and past orthopedic At a medical school work-up two years injuries, including a concussion, in his later, the patient reported that he could report. This claimant also had had a walk 10 flights of stairs without stopping malignant colon polyp removed 3.5 years earlier. and could walk 20 city blocks without Several had experienced head and resting. At the time of this work-up, his back injuries: one had previously been chest x-ray was normal as were pulmo- diagnosed as having Parkinson's disease: nary function tests. there was also one questionable seizure Practically all of the claimants did disorder, one severe Menicre's disease, show at least pleural thickening, though and one possible post-traumatic enceph- in a few cases even here these was disa- alopathy. Four had had prostate surgery. greement. Fifteen showed pleural One individual witli sqiianious cell car- plaques with a few cases described as cinoma of the neck had extensive neck calcified. A number showed interstitial surgery and radiation therapy. There changes, vascular markings. peribron- were known indications of an alcohol chial scarring. or some parenchymal problem in five. One had had a lumbar changes. For practical purposes, clearcut sympathectomy for peripheral vascular parenchyma changes were not de- disease. scribed. Spirometry in several cases re- In no case was a diagnosis of organic portedly showed small airway disease. brain disease due to aging made by the Pulmonary function tests were almost claimant's examiner. However, in niy all normal; some showed minimal find- examinations, five showed organic brain ings. The terms. chronic obstructive pul- changes. compatible with a primary de- monary disease or obstructive restrictive generative dementia or Alzheimer's dis- impairment. were used in six cases. In ease (average age 65.4). some. the defense doctors attributed the Pulmonary Evaluations findings to infectious processes in con- Summarizing the pulmonary condi- trast to the claimant's doctors who felt tions is difficult: clearly conflicting in- the cause was asbestos exposure.

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Several had had various other pill- atric liospitalizations for (1) depressive monary diagnoses over the years- psychosis, (2) organic brain syndrome chronic bronchitis. broncliiectasis. and depressive psychosis, and (3) or- chronic interstitial pneumonitis. and ganic brain syndrome and depression atalectasis with "suspected infection." with possible convulsive disorder. He One person had had an aspergilloma had a 50-pound weight loss and no sex- with bronchiectasis and pneumotliorax ual activity since tlie explosion. In gen- with a right upper lobectomy. Two years eral, he was impaired since his accident later this person had a bilateral pneu- and unable to function despite ECT, monia. In another case. the person was medication, and . The hospitalized with a fibrotic pleuritis "sec- pertinent psychiatric report was one in ondary to infection" with a resultant which the examiner stated the trauma right thoracotomy. The issue of smoking could not have produced such a pro- was one for the pulmonologists to argue found. persistent. and unresponsive about. and at times they did. depression. that the patient was hospi- talized after lie found that lie had asbes- Prior Psychiatric or tosis and tlie "psychic pressures brought Psychologic Treatment on by that knowledge not the pleural Few of the group evaluated for litiga- thickening, probably triggered the tion purposes actually required psyclii- depression which caused tlie patient's atric evaluation or treatment. These six profound disability." individuals will be briefly considered. My examination showed regression 1. The most severely disabled was a and depression (tearful, childlike. de- man who was in an explosion four years pendent. tremulous. hesitant). Diagnosis earlier where he may have been uncon- was major depression and personality scious and suffered inhalation or chem- change compatible with post-traumatic ical bronchitis. He had a number of encephalopatliy. The plaintiffs attorney diagnoses during his seven hospitaliza- liked this defense report so much that tions and numerous consultations- he used it in obtaining an ample settle- anxiety neurosis, post-traumatic depres- ment for his client in the separate case sion with paranoid episodes. syncope. claiming injury from the explosion. dizziness, fainting. blackouts and nu- Here there was no question as to psy- merous other symptoms, and possible chiatric disability-only its possible re- hysterical neurological symptoms. He lation to asbestos exposure. did have pleural plaques. One forensic 2. A 60-year-old man had been in psychiatrist made a diagnosis of cerebral weekly psychotherapy for 1.25 years concussion. post-concussion syndrome. with a psychologist and had been on and severe traumatic anxiety psyclio- imipramine. The treating psychologist neurosis-apparently in evaluation for a noted a wide variety of symptoms. in- workmen's compensation claim. Subse- cluding agoraphobia. anxiety. and quently the patient had three psyclii- deoression. He noted that the patient

386 Bull Am Acad Psychiatry Law, Vol. 20, No. 4, 1992 Asbestos Exposure and Psychic Injury

had a concern about a lung condition was no mention of this in the report of that may be related to asbestosis and the psychologist. The only pulmonary that was a contributing factor "to the reference was pleural thickening. stress he was experiencing.'. A neuropsy- 4. Especially interesting was the case chiatrist supported this opinion but ac- of another 69-year-old man who had knowledged "underlying" problems. seen a psychiatrist for at least eight years. Other records indicated obesity. a his- Thougl~there was limited information, tory of hypertension. Meniere's disease, the patient had been injured in an acci- . and suprapubic prostatectomy. dent ( 17 years earlier, he had a chronic He also had an enlarged heart and hy- back problem. with an ultimate lami- peruricemia. He was seen at a prominent nectoniy). Psychiatric diagnosis was clinic where his Meniere's disease was post-traumatic stress disorder (reports reviewed as well as his psychologic were prepared for another earlier litiga- symptoms: there was no reference to a tion). The psychologist in the current pulmonary condition (the only pulmo- asbestos litigation made no reference to nary finding at issue was claimed pleural this diagnosis. prior litigation and pro- thickening according to the plaintiffs longed prior treatment. He stated that internist who saw him for the the Minnesota Multiphasic Personality report for the litigation). He had had Inventory indicated concern over bodily Meniere's for 10 years and had dizziness. health, though it was "normal." The psy- tinnitus, and unsteadiness. His retire- chologist indicated that the asbestosis ment at age 59.5 was not a medical one. was potentially lethal and "his assess- Current mental status was good: no pho- ment is indicative of some alteration and bic symptoms or symptoms referable to displacement away from comfort and pulmonary dysfunction were noted. Pos- contentment. Because of the rather per- sible early organicity was suggested. He nicious. chronic, and progressive nature was primarily concerned about his Men- of his disease. it is felt that the person- iere's and cardiac status ("abnormal ality changes caused by his disorder will heartbeat"). My diagnosis was adjust- be, in turn. chronic and permanent." ment disorder with mixed emotional (This psychologist has invoked a post- features. primarily depression in a per- traumatic stress disorder in eight of the son with preexisting personality prob- nine cases reported in this series; his lack lems. of reference to this previously diagnosed 3. A third man, 69. had been treated condition is quite striking here). a number of years earlier by a psychia- The patient has a history of back in- trist with an (phenothi- jury and was on Social Security disabil- azine and tricyclic antidepressant com- ity for several years for that reason: he bined). He related this to his marital had an enlarged heart. arteriosclerotic conflict. the long separations (3 years heart disease. and atrial fibrillation. In- and 1.5-2 years), his wife's seeing other terstitial lung findings by one examiner men. and their ultimate divorce. There were related to chronic congestive fail-

Bull Am Acad Psychiatry Law, Vol. 20, No. 4, 1992 387 Perr ure. A recent stress was his wife's Alz- most prominent was utilized as a pri- heimer's disease. His treating doctors at- mary classification. In 15 (more than tributed his dyspnea to his cardiac con- 30%). no diagnosis could be ascertained. dition. When seen by me. he did show Where a number of diagnoses were of- evidence of a chronic mild depression fered by different examiners in the same but with good functioning and a positive case. the one from the forensic specialist philosophical outlook. was used. The internist who evaluated him to The diagnoses by the plaintiffs ex- support his litigation claim reported cal- aminers are shown in Table 2. The ex- cium-containing pleural thickening and aminers for the plaintiff were catego- an enlarged heart. Acknowledgment of rized by profession. Where multiple re- congestive heart failure as a cause of ports were submitted, the profession interstitial markings was made-"but in utilized is that of the forensic specialist my experience this is highly unlikely in who prepared a report or primary report a person with this clinical history and is for legal purposes. The examiners were probably due to pulmonary asbestosis." psychologist (Ph.D. or Ed.D.)-38, psy- Spirometry suggested small airway dis- chiatrist (M.D.)-six. psychiatrist (D.0.)- ease. and pulmonary function tests done two. and no examiner-two (the latter elsewhere were normal. where no supportive report was submit- 5. One 67-year-old man previously ted). Three examiners performed 39 of had psychotherapy for six months after the 46 evaluations (two did not have any the death of his father-in-law. evaluations). One psychologist did 3 1 6. A 39-year-old man had a long- examinations (67%). and a psychologist standing drinking problem from his 20s and a psychiatrist each did four (8.7% until three years earlier when he partic- each). Each seemed to have a diagnostic ipated in an alcohol rehabilitation pro- style. Thus. the examiner who per- gram. formed 31 contributed most of those Thus. of 48 cases only six had had any with no diagnosis: he also made eight of psychiatric or psychologic treatment or the nine post-traumatic diagnoses review for therapeutic purposes-none (whether called post-traumatic response. of which could be related to a lung con- Table 2 dition. Diagnoses by the Plaintiffs' Examiners Diagnosis Psychiatric or Psychologic None Examinations Submitted Post-traumatic disorder by the Claimant for the Cancer phobia Depression (unspecified) Asbestos Litigation Anxiety The evaluations on behalf of the plain- Personality change Dysthymic disorder tiff offered diagnoses in a number of Adjustment disorder different categories. Where a number of Mixed diagnoses were listed or inferred, the No report submitted

388 Bull Am Acad Psychiatry Law, Vol. 20, No. 4, 1992 Asbestos Exposure and Psychic Injury post-traumatic disorder. or post-trau- decays in the marital relationship as well matic stress disorder). The psychiatrist as Mr. X's personal adjustment. He and diagnosed all four cases as canceroplio- the marriage are clearly in need of psy- bia. and the other psychologist three of c1iological intervention." four as cancer phobia. In my examination. X was son~ewhat vague about his sexual relationship with Examples of Profferred Opinions his wife. He related. "She claims 5 years Analyzing each case and presenting in ago: that's what she told the psycliolo- detail the history and the reports of all gist." I-Ie indicated that lie had no sexual examiners are not possible. Some sam- desire. He also indicated tliat he and his pling is necessary in order to communi- wife rarely talk to each other ("when we cate the essence of the conclusions and have to"). They communicate by notes. pertinent information related to the rea- He described her as picayune and critical sonableness of such conclusions. Claims ("I don't need tliat anymore"). He of cancer phobia and post-traumatic dis- added. "She says 'you go your way and order will be discussed in other papers. I'll go mine!' " Asked how long the mar- X, a 60-year-old man was interviewed ital problem existed, lie stated, "l've by the psychologist together witli his wife been bickered and badgered for 39 (the report seems to indicate tliat they yeass." They have been married for 39 were seen togethes). He purportedly re- years. lated that since lie received a diagnosis In this particular case. X did have of asbestosis three years earlier, he had pulmonary and pleural findings with no sexual desire and he had become mild obstructive disease functionally as impotent. that he became more solitary. well as an enlarged heart and liyperten- that he and his wife led "dual" activities, sion. The defense internist stated that and that lie did little with his wife. His there was moderate restrictive disease wife reported tliat the diagnosis came with nosma1 airway functioning. Tlie ad- the week tliat her mother was in a coma versarial intesnists disagreed as to the that led to her death. She said tliat since cause. In addition, there was evidence of tliat time. it was "like living with a an alcohol problenl (enlarged liver. ele- stranger," that they did not sleep to- vated liver tests, history of drinking). He gether or go out together. and that she liked to travel, garden, and do wood- leaves the house to be away fsom him. working. He showed no symptoms psy- She expressed great anger. chologically. Tlie attribution of the The psychologist concluded. "Mr. (X) prime. and apparently only significant. is an individual who, through occupa- problem-marital conflict. to the pulmo- tional exposure to asbestos. has con- nary condition seems at the very least to tracted asbestosis. He has sesponded to be simplistic and unmerited and was not this disease witli a psychiatric disorder, atypical of many of the com~nentsin characterized by depression and agita- these records. tion. This stressor has psoduced 11ia.jor Claims of niasital difficulty or declin-

Bull Am Acad Psychiatry Law, Vol. 20, No. 4, 1992 389 Perr

ing sexual interest related to asbestos showing that tlie patient attempted to exposure wire made in several cases "minimize problems." The psychologist without very con~pellingsupport. One comniented that occupational exposure examiner apparently usually had a short to asbestos "has led him to develop as- interview and had the patient fill out a bestosis. which leads to diminished vital symptom check list and a Minnesota capacity and difficulty with breathing. Multiphasic Personality Inventory He clearly shows concern over his health (MMPI). The use of the MMPI in med- and of his physical well-being. However. icolegal situations has long been recog- his concern is not such that it comprises nized as fraught with diffi~ulty.~When a psychiatric disorder. He must clearly a true-false fill-in by the examinee dc- live with the anxiety of having an incur- scribing himself is utilized. reposting of able disease and one that increases his pathology may be questioned. although likelihood of fatal mesothelioma." Of a normal pattern in a litigation sit~~ation interest was a note from a university usually indicates that the person is re- hospital where he had eye surgery several acting reliably. Frequently, access to or months earlier (subsequent to the inter- use of medical and other personal his- nist's examination noted above) where tory was limited. or ignored. and ob- the patient was described as "a remask- viously in psychiatric conditions (as well ably healthy 78-year-old gentleman as other medical conditions). history is without cardiopulmonary or end organ a major factor in an adequate evalua- disease." tion. Often the language was dramatic. In a In a number of tlie reports, the ex- case of a 61-year-old, retired for aminee denied difficulties on the screen- nonmedical reasons with no pulmonary ing devices. The examiner attempted to function impairment. the psychologist explain this by pointing out that this was stated. "While Mr. B's illness is irsevers- an example of denial. Similarly, when ible, there is little doubt that his current the history was negative. this also could psycl~ologicaladjustment to it can be be called denial. Thus. "even though Mr. improved . . . . No one can remove the (A) denies it, this recosd is indicative of sword hanging over his head of de- a clinical depression." creased vital capacity. probability of A 79-year-old man's main complaint early death and cancer." was of his knees (apparently a knee re- A 61-year-old man was told by a fel- placement had been recommended). He low worker that he should "put in" for was also concerned about his eyes (hav- asbestosis. His x-ray did show "irregular ing had recent cataract surgery with bi- pulmonary densities," and he was diag- lateral lens inlplantation). He had no nosed by a pulmonologist as having pul- other con~plaints.Psychiatric examina- monary asbestosis with normal function tion was quite normal. His forensic in- tests. The psychologist reported that he ternist made a diagnosis of pleural as- was defensive and "his attempt to foster bestosis. The MMPI was reposted as an image of health adjustment is . . .

390 Bull Am Acad Psychiatry Law, Vol. 20, No. 4, 1992 Asbestos Exposure and Psychic Injury transparent . . . ." He was described as ment that (he) is currently utilizing is having depression. moderate distress. tenuous and may deteriorate . . . . The presenting a profile often seen after se- probability is that his current defense vere physical injury. "He has taken the system will not prove satisfactory. Con- news of his disease clearly in a traumatic tinued care will be required for him to way, and it has produced a negative maintain his fi~nctionalcapacity..' effect on his adjustment even with his This man was seeing no physician for attempt to minimize its impact on him. treatment and has never been on any Because of the chronicity of his disorder medicine except disulfiram. He was a and the life-threatening nature that it foreman overseeing fiberglass installa- does present to him. it is clearly felt that tion, worked regularly. and liked to go his negative adjustment pattern will be fishing and hunting. chronic and pern~anent."The psychol- In one case. the psychologist indicated ogist also stated that he had "collateral that the then 68-year-old patient was hypertension," implying a relationship irritable. snappy. and more argumentive to his pulmonary condition that his in- and that relations with his son had be- ternist did not note. At my psychiatric come strained. The history from other examination Mr. D. said that he did not sources indicated long-standing difficul- have any problems. that he understood ties with his son who had suffered brain that he had asbestosis and worried about damage following cardiovascular sur- it lately. He did not climb as far "without gery: his son was destructive and abusive breathing heavy." He currently was at home for many years. In fact, six years working as a maintenance man in a earlier, the claimant was beaten by his school system. was in good health. and son and hospitalized for chest injuries had not seen a physician in 2.5 years. A (he did not report his information to jovial man. he was asked if he were me). His son was disabled. unemploya- happy-go-lucky: he responded, "I really ble, and a chronic financial drain. am. A 66-year-old man with pleural thiek- A 39-year-old man was diagnosed as ening and no other findings was de- having pleural asbestosis with pleural scribed by the psychologist as chroni- thickening and a probable increase in cally tense and anxious. self-deprecating. interstitial markings. Work-up at a uni- and socially withdrawn. The psycholo- versity hospital reported an asympto- gist used the expression. "alteration in matic state. normal x-rays. and no pul- personality." As there was no family or monary impairment. The psychologist other medical I~istoryin his report. the explained a negative MMPI by stating. psycliologist did not note a chronic mar- "He clearly had a bias (sic!) away from ital problem since the beginning of their complaint and away from negative re- marriage culminating in divorce the port." He commented further, "Given same year that he saw the psychologist his history of alcoholism. his father's (after 40 years of marriage). The psy- asbestosis. as well as his own. the adjust- chologist did not report the death of the

Bull Am Acad Psychiatry Law, Vol. 20, No. 4, 1992 39 1 Perr

patient's only son eight years before. The monary dysfunction; almost all had patient started seeing a psychiatrist 15 some radiological findings supportive of years earlier and had been on a pheno- a possible asbestos reaction. Generally. thiazine-tricyclic combination drug for they were referred through channels many years. Of his son's death. he said. publicized by coworkers or union for "his death still bothers me, haunts me." possible litigation purposes. The dispar- None of this was in the psycl~ologist's ity of professional opinions by internists report. and pul~nonologistssuggests that pecu- Most common was the comment liar disparity of opinions is not restricted based on one interview of a progressive to psychiatrists and psychologists. Also deterioration that was inevitable. A 68- clear was the fact that many of the ex- .year-old man had an MMPI in the "nor- aminers did not have access to hospital mal range, indicating a basically well and other medical records at the time of adjusted individual . . . . (He) is adept at their evaluations. making a good first impression." Re- The group was consisted generally of garding the patient's concern about his elderly white men; the average was 62.6. health. the psychologist said. "Due to Thirty-four were retired. six of whom the chronic and ever-growing nature of had retired for medical reasons, none his disorder. it is felt that his concerns related to puln~onarydysfunction. The will be permanent and realistic." men were unusual in that they were A general tenor was the opinion that quite cooperative and made few claims lung disease is directly related to the in the interview situation, many stating degree of physical disorder, and there- just that they were sent to be examined. fore if the physical disease progresses, a Practically all had good. long work rec- mental disorder must also do so. This is. ords and high incomes as blue collar of course. not a reasonable professional skilled workers. Most were of Central opinion. People with deteriorating phys- European background. ical conditions do not necessarily have They were a diverse but usually so- any mental disorder. and indeed those cially active and well adjusted group. in this group who did have significant The problems described by some were physical disorders did not demonstrate not typical of the group. They were psychologic dysfunction-one notable stl-rtightfonvard, blunt, and friendly. exception being the man involved in the Many who did have problems discussed explosion. then1 frankly; those dealt generally with realistic problems of everyday life. Review of these cases raises a serious Discussion question as to the quality of work used Forty-eight cases involving claims in legal claims referable to asbestosis both of asbestosis and related psychic in- where pulmonary findings are minimal jury have been analyzed. As a group, the and psychic injury is claimed. Diagnoses claimants demonstrated minimal pul- seemed to be more characteristic of the

392 Bull Am Acad Psychiatry Law, Vol. 20, No. 4, 1992 Asbestos Exposure and Psychic Injury examiner than of the examinee. Psy- Most of the cascs were settled for chologists offered I-emarks refelable to amounts in the $15.000 to $30.000 medical issues which were either repeti- range-perhaps in the nuisance settle- tions of the claimant's forensic pulmon- ment range. Those that went to trial ologist or which reflected limited medi- resulted in verdicts of no damages to cal sophistication. Often the 11isto~;cal $77,000. Verdicts in New Jersey are re- information utilized was grossly inade- portedly somewhat less than elsewhere. quate. Significant issues, medical and The attorneys for the defense felt that psychiatric. were omitted from many of the claims of psychic injury had little the discussions. merit. played no role in settlement, and Diagnoses were often unclear 01- not did not result in augmented damage in synchrony with professional stand- awards. Reportedly. plaintiffs' firms ards. One third of the cases had diag- have submitted fewer such claims re- noses of post-traumatic reactions (9) or cently as the expenses involved in cla~m- cancer phobia (7). Analyses of these ing psychic injury apparently ha\e cases are to be published separately. brought little in rctur-n. Interestingly. psychiatric or psycho- This review would support the conclu- logic testimony was presented in only sion that "expert" opinions in support one case. that of the woman who of damage claims for psychic injury after claimed to have gotten asbestosis li-om asbestos exposure have little merit from proximity to her husband. Her case as the clinical standpoint and that gcner-ally were the others was based on "faili11-eto such claims in at least one jurisdiction warn." One of her allegations was based have met little acceptance. on sur~ivorshiprules and loss ofconsor- References tiurn. The second was based on direct Trimble MR: Post-Tra~~maticNeurosis: from injury to her. The jury I-ejected the claim Railway Spine To The Whiplash. New York. based on her husband's illness. conclud- Wiley. 198 1 Ziskin J: Coping with Psychiatric and Psy- ing that there was no proximate cause as chological Testimony (ed. 3). Marina del warning would have made no difference Rey. CA. Law and Psychology Press. 198 1 Butcher JN. Harlow TC. Personality assess- in the ultimate result. The jury also de- ment in personal i11,jul-ycascs, in Handbook cided that she had had no physical ~~JLII-~ of Forensic Psychology. Edited by Weiner related to asbestosis and that there were IB, Hess AK. New York, Wiley. 1987 Galluci NT. Prediction of dissimulation on thus no damages based on emotional the MMPl in a clinical field setting. J Consult reaction to a physical injury. Clin Psychol 529 17-8, I984

Bull Am Acad Psychiatry Law, Vol. 20, No. 4, 1992