What is the Test of Admissibility?

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Blogs The Benefit(s) of Having a Psychiatrist on a Multidisciplinary Treatment Team

What is the Test of Admissibility?

In this blog, we will discuss the recent court decision: Morris et al. v. Prince et al., 2022 ONSC 1291. In this voir dire, the judge ruled the defense expert life care planner’s evidence inadmissible due to his “failure to be impartial and unbiased.”

In the subject case, the Plaintiff was a pedestrian who was struck by a motor vehicle driven by the Defendant. As a result of the MVA, the Plaintiff suffered a traumatic brain injury.

An expert in life care planning and vocational rehabilitation was retained by the Defendant to provide the court with evidence regarding the Plaintiff’s future care needs and vocational capabilities.

In this case, the Plaintiff seeks a ruling to declare the evidence of the defense expert life care planner inadmissible because it does not meet the Mohan test for admissibility.

The judge determined the admissibility of the defense expert’s proposed evidence using the Mohan criteria which state that:

“Admissibility of expert evidence has to be (a) relevant (b) necessary in assisting the trier of fact, (c) does not fall within any exclusionary rule and (d) is given by a properly qualified expert.”

Justice Mitchell determined that the defense expert was not a properly qualified expert due to his lack of impartiality and independence as an expert witness.

According to Justice Mitchell, a proposed expert’s impartiality is one of the basic standards for the admissibility of expert evidence.

He further states that expert witnesses have a “special duty to the court to provide fair, objective and non-partisan assistance [and] if they are unable or unwilling to comply with this duty, they are unqualified to give their opinion and should not be permitted to do so.”

The defense expert life care planner erred in overstepping and aligning himself with the Defendant who is also his client.

Justice Mitchell determined that the Defendant’s life care planner assumed the role of an advocate for the Defendant’s position from the outset of his retainer and therefore is unable to provide fair objective evidence in this case.

In the defense expert’s report, he highlighted the positive information about the Platintiff and downplayed injuries and capabilities. The positive information highlighted was not relevant to the assessment of the Plaintiff’s future care needs.

To highlight the positives and downplay the negatives regardless of evidence is, in the judge’s view, an indication of bias in favor of the Defendant and demonstrates that the defense expert does not understand his role and duty to the Court to remain impartial and free of bias.

In addition, rather than meeting with the Plaintiff to conduct an independent assessment of his vocational abilities and his ability to perform activities of daily living (which the defense expert admitted was industry best practice), he relied entirely on reports, interviews and assessments conducted by others.

One-half of the defense expert’s 60-page report was a summary of the information he reviewed. The defense expert did not request, let alone conduct, an in-person, virtual or telephone interview with the Plaintiff.

Justice Mitchell opines that this strongly suggests a lack of independence in his approach to the assessment of the issue.

Justice Mitchell further states the defense expert has the responsibility to provide the Court with his opinion as to the realistic future needs of the Plaintiff. His optimism for the Plaintiff’s future should have played no part in his assessment of future care needs.

To conclude, life care planners should bear in mind the importance of providing unbiased, impartial and independent evidence in court, as these are basic standards for the admissibility of expert opinion and evidence.

To be precise, the expert’s opinion must be impartial in the sense that it reflects an objective assessment of the question at hand. It should also be independent in the sense that it must be a product of the expert’s independent judgment, uninfluenced by who retained him/her, or the outcome of the litigation.

Sources

Bartlett, Danielle. “Morris Et Al. v. Prince Et Al., 2022 ONSC 1291.” Ontario Trial Lawyers Association Blog, 26 May 2022, https://otlablog.com/morris-et-al-v-prince-et-al-2022-onsc-1291/.

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The Importance of OT Input in the Diagnosis of Chronic Pain

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Blogs The Benefit(s) of Having a Psychiatrist on a Multidisciplinary Treatment Team

The Importance of OT Input in the Diagnosis of Chronic Pain

In Mustafa v. Aviva General Insurance Company, 2022 CANLII 81523 (ONLAT), Mr. Mustafa was involved in an MVA on April 25, 2018 and developed psychological and physical impairments including pain.

Mr. Mustafa reported symptoms of headaches, neck, shoulder, and back pain, disturbance of sleep, and disturbance of physical activities. He also experienced psychological symptoms of worry, anxiety, anger, low energy, fatigue, sleep problems, difficulties with concentration, and memory problems.

Following assessments with his family physician, Mr. Mustafa attended an examination at Mediwise Healthcare Centre. This resulted in the OCF-18 for functional impairment assessment and physiotherapy.

Mr. Mustafa attended a functional impairment assessment with Dr. Nathanson, chiropractor, in June 2020 who diagnosed him with chronic pain.

The OCF-18s were denied and an IE was sent. The September 2020 IE assessor indicated that there was no evidence of musculoskeletal or neurologic impairment in this case.

Aviva submits that the OCF-18 issued by Mediwise Healthcare Centre is not reasonable and necessary due to the “lack of contemporaneous medical evidence.”

The insurer further submits that the applicant does not meet the test for a diagnosis of chronic pain as described in the American Medical Association (“AMA”) Guides.

Vice-Chair Brett Todd states that answering the chronic pain question is necessary to justify the OCF-18s. He agrees with the respondent that the examiner did not properly assess the applicant against the criteria required to provide a diagnosis of chronic pain.

To meet a diagnosis of chronic pain, an individual must meet at least three of the six criteria set out in the AMA Guides:

  • Use of prescription drugs beyond the recommended duration and/or abuse of or dependence on prescription drugs or other substances;
  • Excessive dependence on health care providers, spouse, or family;

Secondary physical deconditioning due to disuse and or fear-avoidance of physical activity due to pain;

  • Withdrawal from social milieu, including work, recreation, or other social contacts;
  • Failure to restore pre-injury function after a period of disability, such that the physical capacity is insufficient to pursue work, family, or recreational needs; and
  • Development of psychosocial sequelae after the initial incident, including anxiety, fear-avoidance, depression, or non-organic illness behaviours.

In the subject case, there was no OT on file.

OT assessment and intervention could have helped the chiropractor or any physician to illustrate the impact of Mr. Mustafa’s pain on his function.

In the chronic pain assessment set by the AMA Guides, as listed above, criteria (II)- (VI) are asking about the client’s level of dependency on health care providers, spouse, or family with daily functions; development of physical deconditioning due to disuse and or fear-avoidance of physical activity due to pain; withdrawal from social milieu, including work, recreation, or other social contacts; failure to restore pre-injury function after a period of disability, such that the physical capacity is insufficient to pursue work, family, or recreational needs; and development of psychosocial sequelae after the initial incident, including anxiety, fear-avoidance, depression, or non-organic illness behaviours.

OTs are uniquely trained to evaluate the impact of pain on the client’s ability to engage in meaningful activities as per the domains listed above.

OT assessment and intervention reports are describing the extent of the pain symptoms on a client’s physical, cognitive, and psychosocial function and are identifying challenges in clients’ engagement of daily activities.

This would assist the chiropractor in Mr. Mustafa’s case to substantiate the diagnosis of chronic pain.

Here at GLA Rehab, our OTs are experienced in evaluating functional status and assessing changes in all these domains. Our OTs have the tools to address dependency on others, deconditioning, fear of movement, withdrawal from activities of daily living and the effect of the client’s mood on his/her function.

We are also skilled in conducting situational assessments, which help illuminate the relative impacts of various impairments on a client’s ability to engage in self-care, housekeeping, caregiving, driving, work and recreational activities.

If necessary, our OTs can also recommend referrals to other specialists, who can explore diagnosis and prognosis related to pain and emotional symptoms.

All this information is useful to assist physicians in reaching the diagnosis of chronic pain.

If you have a client who demonstrates changes in ability to manage daily function and is reporting changes in behaviour, it is imperative that an OT be part of the assessment and rehab team.

Please contact us. We would love to help.

Best wishes for a safe and productive Autumn season!

From all of us at GLA Rehab!

Sources:

 Mustafa v Aviva General Insurance Company, 2022 CanLII 81523 (ON LAT), <https://canlii.ca/t/jrtcv>, retrieved on 2022-10-22

Rondinelli, R. D., Genovese, E., Katz, R. T., Mayer, T. G., Mueller, K. L.,

Ranavaya, M. I., & Brigham, C. R. (2022). Pain-Related Impairment. In AMA

Guides to the Evaluation of Permanent Impairment, Sixth Edition, 2022 (Vol. Sixth,

2022, pp. 0): American Medical Association.

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Cognitive Functional Capacity Evaluation (Cog-FCE)

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Blogs The Benefit(s) of Having a Psychiatrist on a Multidisciplinary Treatment Team

Cognitive Functional Capacity Evaluation (Cog-FCE)

GLA Rehab now offers an assessment called the Cognitive Functional Capacity Evaluation (Cog-FCE.)

This is in addition to Cognitive Functional Capacity Evaluation (FCE) and Vocational Assessment which we have been doing so far.

The FCE mostly addresses the physical capacity and physical limitations, as they affect work capacity and employability. The FCE is not designed to accommodate for the cognitive and/or behavioural challenges, faced by individuals with traumatic brain injury or mental health conditions.

The Cognitive Functional Capacity Evaluation (Cog-FCE) accounts for the functional cognitive barriers, and psycho-emotional and behavioural barriers to return to work, faced by this diagnostic group. It compliments the FCE that addresses the physical barriers.

This assessment will be completed by our occupational therapists in collaboration with our trained FCE+Cog-FCE assessors.

So, what is the Cognitive Functional Capacity Evaluation?

The Cognitive Functional Capacity Evaluation (Cog-FCE) is designed to evaluate the ability to work for individuals with cognitive disabilities.

This assessment helps to explain how clients’ cognitive challenges may affect their ability to work. This evaluation will be used to assist with a client’s return-to-work plan and goals, as it combines a cognitive analysis with a focus on how the client is able to perform functionally and vocationally.

The first step involves an analysis of the cognitive job demands of the client’s pre accident job.

The second step is when the OT will be using a variety of different assessment methods, including a combination of subjective and objective measures. The OT will use high-level cognitive screens and questionnaires that will provide a baseline of the client’s cognitive status.

Some of the work-related cognitive tasks that the OT will look for are the client’s ability to follow instructions, remember procedures, sustain attention on a task, problem solve, plan and organize, reason, self-regulate, self-correct decisions, meet deadlines, work under pressure, be flexible and shift thoughts and plan when needed, multi-task, use adequate judgement and more.

We will address the client’s ability to communicate with others, be clear, understand instructions and self-advocate in a work environment.

The third step, work simulation, is when the OT will be asking the client to complete tasks that mirror the demands they would be responsible for if they were to return to work. This is through simulated situational assessments and analysis of the client’s ability to meet job demands. The OT will create situational tasks that model real-life work demands to see how these cognitive disabilities may manifest during work tasks.

Why is this evaluation helpful?

The Cognitive Functional Capacity Evaluation can be a very helpful tool to assess a client’s occupational performance and cognitive disabilities, in relation to their ability to perform their pre-accident job or any job that is “reasonably suited by education, training or experience.”

By taking a comprehensive and holistic approach to assessment, the client is observed through several different avenues of obtaining information.  The assessor can develop further insight into how the client’s cognitive disability is apparent in a variety of tasks and situations.

The assessment findings and the identified gaps in ability to perform the cognitive job demands will be of assistance for Income Replacement Benefits claims and disputes

The team at GLA Rehab is excited to start using the Cognitive Functional Capacity Evaluation as this will allow us to collect data related the client’s ability to work, while he/she/they are coping with cognitive-behavioural impairments, following a motor vehicle accident.

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