~ This was so hard to do - but you have to! ~

~ If you're in N.Y. you need a Lawyer & Psychologist ~

~If you don't they'll steal your life worse than they have already~

Mr Henry has been treated by prior psychiatrists and prior counselors. He saw me on 6/18/07.To this point I have seen Mr. Henry alone for a 90-minute interview, and I have seen him with his wife for a 60-minute interview. I have also talked with him on two occasions on the phone to gather information and evaluate the effects of medication I have prescribed.

I will not attempt to summarize this man's orthopedic treatment, as it is well summarized in the medical record. It is clear from the fact that he has had a number of surgeries and a number of IMEs supporting his disability that he has severe back injury, complications from the surgery, surgical revisions and continues with ongoing problems.At this point Mr. Henry presents markedly depressed with an irritable, paranoid flavor. He is hesitant to disclose or do things fearing continued videotaping of his activities by the compensation insurer. In his mind his actions have been misinterpreted such that his attempts to do well have been construed as him not having a disability. This persecutory view is supported by the report of the investigation firm provided to me.In fact Mr. Henry has lost his ability to do many of his prior activities and has problems walking, most evidenced by severe pain subsequent to attempts to perform activities. Psychiatrically he has multiple symptoms of depression, which qualify him psychiatrically for a diagnosis of major depression, single episode, chronic, severe (DSM-IV-R: Axis I: #296.23).Specifically in relation to his major depressive episode, this man presents with insomnia on a nightly basis, which may in part be due to his pain, but he also has concurrent excessive sleeping during the day. He is psychomotor slowed despite his hyper-vigilance and irritability. He complains of fatigue and lack of energy and loss of interest in most activities daily. He gets little pleasure out of even activities he can accomplish. An excellent example of this is his lack of enjoyment of and loss of taste of food even when it is well prepared, and obviously even when eating is an activity that his back injury does not effect. His weight has varied up and down with his activity level. He subjectively is depressed on an essentially daily basis, feeling hopeless and worthless. Although he denies such, his wife describes him as tearful frequently. He experiences concentration problems, frustration, and trouble making decisions.He concurrently does appear to have marked irritability and experiences heightened reactivity when the traumatic event, namely the injury and the subsequent insurers and investigators actions such as being videotaped by the insurance company, are discussed. He has nightmares about being followed, being accused of lying and being videotaped. He is enraged that there have been comments in the videotape summary, making reference to his wife. He feels that this is clearly an invasion of privacy and feels violated by the process. He has experienced avoidance of stimuli associated with the traumas, namely he has avoided activities that arouse recollection of the videotaping. For a while he was living with his blinds closed and avoided going out. He also unfortunately, for a period of time, was avoiding attempting most activities out of fear that the reports from the investigators would be used against him. He has suffered marked loss of interest. He does not participate in many activities that he can still do with the family. As mentioned above, he has difficulty concentrating, marked irritability at times, intrusive argumentative interactions, and hyper vigilance.Clearly the above symptomatology meets the DSM-IV criteria not only for major depression but a superimposed post-traumatic stress disorder, which in fact is more related to the events of being observed and videotaped than his initial injury.

When I initially saw Mr. Henry, the mental status examination revealed an oriented, alert and cooperative man who spoke in soft, monotone speech with psychomotor slowing, and long response latency. In addition he was hyper-alert and irritable. He made good eye contact after an initial period of time. His appearance was clean. His affect was flat and constricted. His mood was depressed, sad, hopeless, angry and irritable. He was self-blaming and self¬-depreciating for not being able to be the man of the family. He experiences little enjoyment in life. Thinking was generally linear, but he experienced racing, ruminative thought intrusion. He obsessed about his somatic issues and about his ongoing conflicts with the insurer, mostly focused on his privacy being invaded and being videotaped especially through the windows of his home. There were no delusions, but there was a persecutory preoccupation (which certainly after having read the summaries from the investigators of which I was provided copies, was reasonable). I felt these symptoms to be post traumatic and within understandable but pathologic range for what he has been through. His cognitive function was grossly intact. His insight and judgment was grossly normal. There was no suicidal or homicidal ideation.

Diagnosis for this man is DSM-IV:

Axis I: (296.23) Major depression single episode, chronic, severe.

Axis II: (309.81) Post-traumatic stress disorder with the initial stressor being the injury but subsequent stressors being feeling vulnerable and violated by the surveillance.

Axis III: Reveals no identifiable diagnosis.Axis IV:Back injury with chronic pain syndrome.

Axis V:Reveals multiple stressors in multiple areas.

GAF 42.Treatment Issues: The patient has been treated by a counselor and at least two psychiatrists: Manuel Astruc in Saratoga Springs, and Kevin George in Albany, New York. Medications generally have not helped and in fact often have resulted in a worsening mentally.Because of the issues of his PTSD and specifically the private investigators involvement, I reviewed a copy of the report of July 12, 2004 sent to PMA Claims in Lehigh Valley, Pennsylvania from Mark A. Kelly, Private Investigator and Associates in Clifton Park. While I will not discuss this here in detail, I think that it is important to consider the tone of this document in the patient's psychiatric status, since it relates to his paranoia.Overall the report from my point of view is problematic in the sense that there are medical and psychiatric assumptions made from the observations. Assuming the observations are accurate, the investigator has expanded his report to assumptions about the patients ability to function and medical and psychiatric state.I think a good example of this is in the report of August 15th, which makes reference to August 8, 2006. At 7 AM surveillance was initiated at the claims residence. His new Dodge Durango was parked at the residence. Later on they say at 1:14 PM the claimant exited the residence and departed in the Durango. He drove directly to the Stillwater Post Office where he entered inside using a cane. Within moments he exited with mail in his right hand and the cane in his left hand. He climbed back up into the "high-sitting SUV fluently" and departed. I think this is evidence of one of literally dozens, if not hundreds, of problems with this material. First a minor point namely from how far away can you judge "fluidity" and what does this word mean in this context. Emphasizing the height of the SUV gives the implication that somehow it was an indication that this man was more functional than he claimed because he could get up and down.This actually only shows that the investigator was neither an expert but only was trying to work in expert medical interpretation and has never had a back problem. He does not realize that for many patients with back injuries the more sturdy, straight seats of SUVs and the stepping up and stepping down much like a stairway rather than swinging in and dropping down to a seat, is much less painful and leads to much less pain later in the day. There are numerous examples of such leading material through this report.One of the examples of what the patient finds especially enraging, and I think rightfully so, is a comment in the report about Mrs. Henry in her pajamas. What relevance could Mrs. Henry being outside in her PJs have to Mr. Henry condition?? Unless it was evidence he could not function and she had to do things which is not the implication in this report. There is also at least one comment about people moving about within the house and can be observed thru the window. The implication was that it was the client without clear definition of what he was doing or even clear identification.

Be that as it may, I think much of the material in the private investigator's report is focused on interpretations of behaviors which might discredit a client who has clearly had multiple surgeries, surgical revisions and without doubt has substantial pain, which has been documented medically. This in part contributes to my patients post-traumatic stress issues; his feelings that he is being persecuted and watched. Quite frankly this insurance company behavior has deteriorated him psychologically to some extent. Attempts to do well and go out and live a normal life have been undercut by negative implications that he might have gone to a campground or tried to enjoy anything. In short, this man, according to the insurance company, is damned if he does and damned if he doesn't, and this has made a very difficult situation in reference to treatment.What is clear here is this man is severely depressed, highly reactive to stimuli and meets the criteria for both major depression and post-traumatic stress. His orthopedic difficulties appear well documented with surgery that failed, revisions of surgery and ongoing difficulties. Attempts that would psychologically be positive in terms of trying to do what he can are thwarted by his paranoia about being accused of lying or faking, especially because of not just the videotaping but also the out-of-context interpretation of the results.It is my opinion that Mr. Henry is totally disabled on psychiatric grounds separate from but secondary to his orthopedic injury.

Ralph L Berry III, MDDiplomat American Board of Psychiatry and Neurology Workers Compensation Board Certification #CPN-P 122920

*This document, this report, bought tears to my eyes... First time in 3 1/2 years since I felt such emotion.

**I'm very lucky to find a Doctor whom has insight and ability