Medico-legal Report Writing

• Author: Hy Bloom
• Pages: 39-58

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CHAPTER 4

Medico-legal Report Writing

Hy Bloom

I. INTRODUCTION

Medico-legal reports are the essential vehicle for conveying the medical and psychiatric ndings of a

particular assessment. e report must address the psycholegal questions that the parties — lawyers,

courts, professional regulatory bodies, and agencies — have identied as the key issues when retaining

the clinician. Medico-legal reports are the most fundamental and important means of communicating

health-care data and opinions that may be pivotal in a legal case. As such, their importance extends

beyond the interests of the parties and has implications for the administration of justice. A report, the

product of an assessment, is oen the only document that is formally introduced into a particular legal

proceeding. In most instances it brings the totality of the psychiatric evidence before the court and,

consequently, must be draed as a comprehensive recitation of all that is relevant from a mental-health

perspective. In many fewer cases, the report serves a foundation upon which more expansive oral testi-

mony may be built.

It is always important to bear in mind that once the lawyer tenders the report in court, it becomes

an exhibit and hence a public document (Weinstock et al., 1994). In that way it is accessible to anyone

interested, including the press (subject to any publication limitations or bans imposed by the court).

If obtained in this way, and presented to the world-at-large, reports can either engender respect for psych-

iatry or bring it into disrepute, depending on how the report is written.

Psychiatrists may avoid preparing medico-legal reports for numerous reasons. Aside from a cautious

approach physicians take to working with lawyers, most clinicians have received little or no training in

how to write reports for medico-legal purposes. is lack of training oen results in a diagnostic and

therapeutic report that may be consistent with psychiatric training and practice, but that fails to address

the legal issues and considerations at play in the legal contexts for which these reports are requested.

A report that is poorly written, that is inaccurate, that fails to address the specic psycholegal issues,

or that contains extraneous information, especially information of an inammatory and/or editorial

nature, can leave the clinician vulnerable both to negative inferences about the quality of her profes-

sionalism and work and to particularly intensive cross-examination. Poorly written reports containing

erroneous and/or extraneous information can also have a negative impact on the quality of representa-

tion and advocacy for the party tendering it, and of course, can adversely aect the interests of the liti-

gant. A thorough, well-reasoned, and balanced report that represents a synthesis of all the information

in the case relevant to mental-health issues, written in terms that are understandable to lawyers, judges,

and laypersons will predictably be well received by the participants to the proceeding, and may oen

obviate the need for the psychiatrist to attend court.

Medico-legal reports can, and oen do, exert a powerful inuence in cases of mentally disordered

accused. According to Walker (1969), a diagnosis in a report “usually inuences the court against puni-

tive measures even if the psychiatrist cannot oer treatment.” Mental disorder almost invariably serves

to mitigate an accused’s disposition.

Hy Bloom

Medico-legal reports necessarily have dierent foci depending on the subject of the case. Reports

may be required in a broad number of forensic situations, many of which are specically canvassed in

other chapters in this book. Table 4.1 below, however, provides a quick overview of the types of medico-

legal reports that can be prepared and their purposes.

Table . Types of Medico-legal Reports and their Purposes

Criminal Law

• Fitness to stand trial

• Suitability (from a psychiatric perspective) for bail

• Voluntariness of a confession

• Diversion

• Criminal responsibility and automatism

• Diminished responsibility (e.g., intoxication and

intent)

• Provocation, self-defence, and duress

• Capacity of a witness to testify

• Sentencing:

· dangerousness

· treatability and prognosis

· explaining psychological motivation for

conduct

Civil Law

Mental Health and Capacity

• Civil commitment

• Capacity to consent to treatment

• Testamentary capacity

• Capacity to contract

• Financial competency

Family Law

• Suitability of mother or father for custody or

access

• Alleged sexual impropriety/impact of incest

• Child welfare — abuse and neglect

• Adoption

• Matrimonial — claims of mental damages by a

divorcing spouse

Civil Liability

• Motor vehicle — damages for psychiatric injury

• Sexual victimization — post-traumatic stress

disorder

• Sexual harassment — psychological impact

Professional Regulatory Body

• Professional misconduct

• Sexual abuse of patient or client

• Financial irregularities

• Disruptive and unprofessional behaviour

• Fitness to practice

Worker’s Compensation

• Psychiatric disability

• Workplace stress claim

Employment L aw

• Incapacitated employee

• Sexual harassment in the workplace

• Workplace threats, aggression, and violence

• Fitness for duty and disability

• Stress claims

Medical (Psychiatric) Malpractice

• Liability for suicide

• Liability for harm to third parties

• Liability for medication side ef‌fects

Immigration Law

• Mental disorder preventing entry into Canada

• Impact of torture/mistreatment and claim to

refugee status

• Too dangerous to remain in Canada

• Psychological impact of deportation