Accredited Psychiatry and Medicine
Medical and Psychiatric Experts
How is an Objective Medical/Psychiatric Opinion Formed?
A medical expert is a physician who has the requisite clinical experience
and academic achievement to form an objective medical opinion to a reasonable
degree of medical certainty. A forensic
psychiatrist is a physician who integrates clinical experience, knowledge
of medicine, mental health, and the neurosciences to form an independent,
objective opinion. Relevant data are gathered and analyzed as part of
a process of alternative hypothesis testing to formulate an expert medical/psychiatric
opinion. This expert opinion can be effectively communicated by written
report, deposition, or courtroom testimony. The applications of forensic
psychiatry are widespread in settings ranging from health
care and the workplace to criminal
justice and public safety questions. Common areas of expertise are
briefly described below. For more details, see the left column listing
of specific areas of interest, or confidentially call or e-mail our
Expert Multispecialty Team Analysis
Dr. Bursztajn continues to have an active clinical
practice and consults as a forensic psychiatric expert and teaches nationally
both as an individual and as a distinguished multispecialty team expert.
He has had a long standing special interest in medical and psychiatric
diagnosis. His publications analyzing clinical and forensic neuropsychiatric
diagnosis and misdiagnosis range from the highly acclaimed book Medical
Choices, Medical Chances through Analysis:
DSM Biases Evident in Clinical Training and Courtroom Testimony published
in the September 2007 issue of Psychiatric Annals.
Review and analysis, consultation, and expert opinion formulation in
medical and mental health malpractice, informed consent, product liability,
risk management and testamentary capacity cases are a longstanding area
of special interest. Other areas of special interest include psychiatric
diagnosis, suicide prevention, sexual boundary violation claim evaluations,
boundary training, detection of malingering, pain impairment evaluations,
custody, testimentary capacity, medication management standards, managed
health care, psychiatric and forensic neuropsychiatric autopsies, diminished
capacity, death penalty mitigation, and employment related issues such
as ADA, disability, workers' compensation, and sexual harassment. Responses
to initial telephone or e-mail inquiries regarding case merit and expert
assistance are at no cost, as well as referrals to colleagues where a
multispecialty expert team seems best.
Who Can Benefit?
A forensic psychiatrist/medical expert can assist individuals and institutions,
plaintiffs and defendants, attorneys, federal agencies, and the courts
to evaluate claims ranging from medical and mental health malpractice
to medical product liability, disability, sexual harassment and diminished
capacity. Organizations can also benefit from an expert consultation
evaluating the validity and response strategy to employment, supervisory
responsibility, or maintenance of health care standards claims. Public
safety and criminal justice professionals can also find forensic psychiatric
expert consultation effective in areas ranging from analyzing and preventing
threats to security to capacity to form specific criminal intent.
Some Case Examples:
- Case: [Plaintiff]
v. New York City Transit Authority, et al. Dr.
Bursztajn’s testimony regarding a plaintiff’s malingering
and misattribution debunks neuroimaging gimmickry in a post-concussive
- Case: [Plaintiff]
v. United States of America. Dr. Burstajn's evaluation
of a plaintiff claiming traumatic brain injury indicates
a factitious disorder, also known as Munchausen syndrome.
- Case: Carvajal
v. Mihalek, et al. Dr. Bursztajn's reference to
an antisocial history in the course of his examination, opinion,
and testimony was affirmed on appeal by a panel which included
one of the better senior judge writers in the federal judiciary, Guido
Calabrese, whose book, Tragic
Choices deals with many of the issues of Dr. Bursztajn's
book Medical Choices, Medical
Chances in a legal context.
- Case: Silverstein v. U.S. Dr. Bursztajn's
review of the plaintiff's, Thomas Silverstein, mental state through
review of medical and case records and a forensic psychiatric interview
of the plaintiff lead to his opinion: "...I do not find evidence
of damage to Mr. Silverstein's mental health resulting from the conditions
of confinement." This opinion led to the court's granting the
Bureau of Prison's Motion for Summary Judgment dismissing the case
as reported by the Denver
- Case: State of New York v. Nixzaliz Santiago.
(2008) Dr. Bursztajn was retained by the prosecution for examination
of defendant. Articles on
the verdict in
the New York Times.
- Case: US
v. Jane Doe. Mental Illness Creates Eligibility
for a Lower Sentence. Dr. Bursztajn testifies in Federal
Court that defendant suffered from diminished capacity and
complex PTSD (vs. simple PTSD) which often presents itself
in compulsive self-destructive behavior. (January 2004).
- Case: Vick
v. Northrop Grumman. Neuropsychiatric autopsy
of a suicide in the context of a workers compensation case.
- Case: deVries,
et al. vs Secaucus Fire Department, et al.. A
landmark civil rights verdict in a case alleging a town's
politicians' failure to protect a gay couple who were harassed
and eventually driven out of their home next to a fire station
in Secaucus. Dr. Bursztajn served as the plaintiffs' attorneys'
retained testifying expert regarding causation, the nature
and extent of the emotional injuries and standards for reliability
and validity for an forensic psychiatric Independent Medical
Some Examples of Expertise:
A physician who is an expert in psychiatry, primary medical care, medical
causation, and clinical ethics can analyze the informed consent process
and primary medical care decision making and formulate an expert opinion
applicable to specific questions, such as whether the standard of primary
medical and mental health care for medical decision making and informed
consent has been met by the treating physician, the staff, and the health
Dr. Bursztajn has been retained by clinicians and institutions as an
expert for peer review and to consult to the courts and plaintiff's and
defense attorneys on questions such as:
- Were appropriate professional relationships boundaries observed?
- Was an appropriate informed consent process implemented?
- Were appropriate steps taken to prevent a tragic outcome such as
suicide or a medication-related death or injury?
- Was an appropriate referral made?
- Were appropriate steps taken subsequently to mitigate the consequences
of a treatment-related death or injury?
- What is the extent of impairment, pain, suffering, changed prognosis,
need for treatment, and loss of consortium that can be validly attributed
or is being misattributed causally?
In the workplace, the forensic psychiatrist may be asked to consider
whether a claimed disability (e.g., a chronic general illness, such as
Chronic Fatigue Syndrome, a chronic pain syndrome, such as Fibromyalgia,
or a mental disorder, such as Depression, Obsessive-Compulsive Disorder
or Post Traumatic Stress Disorder) is valid and work stress-related.
Some other frequently asked employment-related examination questions
- Is a claimed impairment subject to the ADA mandate for accommodation?
- What is the appropriate organizational response to a sexual harassment
- What is the validity and extent of sexual or racial harassment-related
damage claims, such as emotional injury or Post-Traumatic Stress
Frequently asked questions range from evaluation of defendants for determining
mitigating and treatable neuropsychiatric disorders to advising public
safety and law enforcement officers. Dr. Bursztajn is frequently chosen
as a peer reviewer by journals in medicine and psychiatry, ranging from
the Journal of the American Medical Association to the American Journal
of Psychiatry. Among his forensic psychiatric contributions you can read
his review of the book "Are
You There Alone?" The Unspeakable Crime of Andrea Yates,
by Suzanne O’Malley. New York, Simon & Schuster, 2004.
Areas of special interest include:
- Competency to confess and false confessions
- Competency to stand trial and post-Sell medication
- Neuropsychiatric and medication-related impairments diminishing
capacity and influencing mens
- Mitigating factors and forensic neuropsychiatric evaluation as an
aid to sentencing, ranging from "white collar" to death
penalty fact patterns
- Identification of malingering and its mimics
Product liability cases often raise issues of informed consent processes,
assumption of risk, professional and organizational ethics, complex neuropsychiatric
causation of claimed injuries, and the validity and reliability of expert
methodology and opinion formulation. There can also be a question of
distinguishing medical product liability from the physician's or patient's
knowing assumption of risk. Here the level of informed consent available
may be crucial.
Dr Bursztajn consults and teaches physicians, including psychiatrists,
regarding the fundamentals of informed consent processes. "Informed
Consent in Neuropsychosocialpharmacology," Psychiatric
Times, 2005; 22(13):59-63. His longstanding interest in the ethical
foundations of pharmaceutical and medical device research led to his
serving on the National Committee for Quality Assurance (NCQA) under
contract to the U.S. Department of Veterans Affairs (VA) in developing standards
for the accreditation of programs for the protection of human subjects.
These standards served as a basis for field testing and adoption nationally
by the Institute of Medicine.
Areas of special interest include:
- Protection of human research subjects and patient and public safety
- Informed consent processes and assumption of risk
- Effects of marketing on physician and patient decision-making including
the debate over
the current revision of the Diagnostic
and Statistical Manual (DSM)
- Evaluation of claims of neuropsychiatric impairment
- Effects of publicity, placebo, and nocebo effects on the doctor-patient
relationship and symptom presentation
In the wake of a series of U.S. Supreme Court decisions on standards
for reliability of expert methodology, distinguished forensic psychiatric
experts may be asked to evaluate and opine as to the reliability of forensic
psychiatric methodology of previously retained experts. Dr. Bursztajn
has been retained as an "expert on experts" based on his teaching
and publications (see for example his recent article On
Skepticism and Tolerance in Psychiatry and Forensic Psychiatry in
the Psychiatric Times' Forensic Bonus Issue) in the area of evaluation
of reliability of forensic methodology and his service on a variety of
relevant national professional standards committees. These range from
the American Academy of Psychiatry and Law Ethics Committee to the American
Bar Association's Advisory and Expert Panel for the State Justice Institute
(SJI) Benchbook Project on Psychiatric and Psychological Evidence.
Questions of interest include whether the opinion of an expert meets
generally accepted standards for reliability for forensic medical, psychiatric,
and mental health evaluations. These include analyses of an expert's
methodology for reliability of:
- Data gathering
- Data analyses
- Opinion formulation
Dr. Bursztajn's classic article Avoiding
Ipse Dixit Mislabeling: Post-Daubert Approaches to Expert Clinical
Opinions (J Am Acad Psychiatry Law 31:205-10, 2003)
informs us how experts can reduce the likelihood that their conclusions
will be mislabeled. He continues to advise clinical experts across
the spectrum of medical specialties, the bar, and the judiciary as
to the fundamentals of clinical expertise post-Daubert/Joiner/Kumho evidentiary
standards for the reliability of testimony of clinical experts. Also,
see Dr. Bursztajn and colleagues explore the evolving role of the
clinical expert post-Kumho in
his article, Kumho for
Clinicians in the Courtroom.
J. Bursztajn, MD -[Curriculum Vitae]-
has over twenty-five years of service as a distinguished patient
care-focused clinician and as senior clinical faculty at Harvard
Medical School. Among his many distinctions at Harvard Medical School
is being recognized as a practicing "doctor's doctor" by
being named Principal
Mentor at Harvard Medical School and being awarded the A.
Clifford Barger Excellence in Mentoring Award as well as being
the first physician/forensic psychiatrist in Harvard Medical School's
history to be appointed as the representative of the Harvard Medical
School Alumni Board of Directors to the Harvard University Alumni
Board. He continues to be active in patient care, forensic consultation,
and judicial education. Among the many clinical honors bestowed by
Dr. Bursztajn's patients and colleagues nationwide is his being recently
named to the "Best Doctors in America" list.
He is co-Founder of the Program in Psychiatry and the Law at the Beth
Israel Deaconess Medical Center Department of Psychiatry of Harvard Medical
School and Associate Clinical Professor of Psychiatry at Harvard Medical
School. Author of the highly acclaimed book, Medical
Choices, Medical Chances this classic has been reviewed favorably
in leading medical journals ranging from the New England Journal
of Medicine and the Journal of the American Medical Association to
the American Journal of Psychiatry. Among his other leading
contributions to medical and mental health education are three books Divided
Staffs, Divided Selves, a Case Approach to Mental Health Ethics, Decision
Making in Psychiatry and the Law and Psychiatric
Ethics and the Rights of Persons with Mental Disabilities in Institutions
and the Community, as well as numerous articles in medicine, psychiatry,
forensic neuropsychiatry and clinical ethics.
Dr. Bursztajn consults clinically and forensically, provides second opinions
in patient care, teaches medical students and conducts continuing medical
education courses for professionals; and advises institutions, the courts,
and public health-oriented media on forensic psychiatry and clinical
ethics-related issues. He serves as a peer reviewer expert for leading
medical and psychiatric journals, non-profit medical and ethics review
organizations, health care and human services corporations and the judiciary.
His numerous awards and honors in the course of twenty-five years of
service as a Harvard Medical School clinical faculty member range from
the Solomon Faculty Research Prize to his being named as one of only
Clinical Mentors for Harvard Medical School entering class.
In addition to his twenty-five-year commitment to patient care, Dr. Bursztajn
consults nationally and internationally to individuals and institutions,
plaintiff and defense attorneys, and the courts as a distinguished forensic
psychiatric expert. Among his areas of expertise are treating vulnerable
patients, improving medical and mental health decision making, informed
consent and malpractice and product liability risk reduction, and standards
for the forensic evaluation of employment-related claims, diminished
capacity, psychiatric autopsies, and violence prevention.
Dr. Bursztajn is active in public education and promoting intergenerational
learning and inquiry. Contributions to public education include his work
as a guest analyst on news programs including NPR's
Talk of the Nation; CNN
Headline News; ABC News on such diverse topics as end
of life criminal confessions, mental
vulnerability of terrorist recruits, and Randy
Quaid's financial problems; Boston's
WCVB News Show Chronicle and public education programs such as those
presented by ABC's Discovery Channel including "Who
Killed Julius Caesar?, " "Who
Killed Tutankhamun?," "Who
Killed Alexander the Great?,"
"The Mysterious Death of Cleopatra," and "Columbus:
Secrets From The Grave."
His work in public education with teams of experts from a variety of
scientific and humanities backgrounds has been recognized both academically
in Harvard Magazine and
publicly in The
Sunday London Times.
Dr. Bursztajn teaches and consults nationally to psychiatrists and other
mental health professionals, as well as to physicians across the primary
and specialty medical care spectrum. He serves as faculty for the Harvard
Medical School Psychiatric Intensive Diagnostic Interviewing Preparatory
Course for the Board of Psychiatry & Neurology certification examinations.
He continues to publish and present workshops nationally and internationally
on a variety of special interest topics in medicine and in general and
There are a variety of areas of human suffering which, insofar as they
evoke painful or frightening feelings, can become all too sadly unspeakable.
Among Dr. Bursztajn's special interests are the long term consequences
of massive psychic trauma. Over the years he has explored this topic
in workshops for health
care providers both nationally and internationally. He also continues
to consult and teach to a variety of health-care professionals, ranging
from members of hospice ethics committees to surgical
grand rounds (written up here in
the Boston Globe) attendees regarding the foundations of current clinical
and organizational ethics standards for patient care. Dr. Bursztajn's
motivation for becoming a doctor and for continuing to practice clinically
and to teach nationally can be found in the following article: "The
Shoah and its Aftermath," which presents the testimony of Dr.
Bursztajn father, a Holocaust survivor.
- Interview: Potential
psychological explanations behind bombings. Dr. Bursztajn
is interviewed in the Boston Globe on the recent Boston Marathon
bombings. This is further explored on WBUR's CommonHealth: The
'Folie à Deux' Theory of the Boston Bombings.
- Article: Children
on psych meds raise these ethical concerns. Dr. Bursztajn
is quotes in the Medical
Ethics Advisor, January 2013.
- Dr. Bursztajn is interviewed and quoted in several news articles
surrounding the mass shooting at Sandy Hook Elementary School in
Newtown, CT on December 14, 2012.
- Regarding the relationship and the needed caution with autism
related impairments and the likelihood of violence:
- Regarding the caution necessary in looking for genetic markers
for the tendency towards violence:
- Interview: Understanding
the Mindset of a Shooter's Parents. Dr. Bursztajn is interviewed
for Time.com on the frequently ignored and otherwise silent dimension
of the grief not only of the families of the victims of a tragedy
but also the grief of the families of the perpetrators.
- Interview: The
Sergeant in Question: A Portrait of the Accused Shooter of Kandahar.
Dr. Bursztajn is interviewed on the apparent disconnect between
the prior conduct of the United States soldier accused of shooting
16 Afghani civilians and the details of the incident.
- Article: Love
in the Shadow of the Third Reich. An introduction by Susan
Kweskin that appeared in the print edition of the Psychiatric
Times to the online-only article Revisiting
Lodz, Poland in 2011 and Reconstructing How My Parents Survived
the Shoah (1939-1945).
- Article: Sex
Offenders Often Minimize Behaviors, Say Experts. Dr. Bursztajn
is interviewed for ABC News correspondent Kim Carollo's blog
exploring the implications surrounding the Penn State scandal.
- Presentation: You
can kill us but you can't humiliate us. On March 7, 2011,
Dr. Bursztajn will present lessons he learned from his parents'
experience, followed by a discussion by Anna Ornstein, MD at
the Boston Psychoanalytic Society and Institute.
- Interview: Tucson
Shooting Renews Gun Control Debate. Dr. Bursztajn is interviewed
on NPR's Talk of the Nation on February 16, 2011 on the public
safety issues arising out of the shooting of Congresswoman Gabrielle
Giffords. The January shooting of Rep. Gabrielle Giffords (D-AZ)
and 18 others in Tucson has reignited two issues in the debate
over guns in America: the legality of extended magazine clips
like the one used by the suspected shooter, and access to firearms
by the mentally ill.
- Presentation: Lodz
Ghetto. Dr. Bursztajn and Geoffrey Brahmer give presentations
at Arlington High School in Arlington, MA. The students later
wrote comments on the presentation, linked to above.
- Article: Undue
Pharmaceutical Influence on Psychiatric Practice: Steps That
Can Reduce the Ethical Risk. Dr. Bursztajn and Lisa Cosgrove's
latest article in the Psychiatric Times regarding increasing
concerns arising about the ways in which corporate sponsorship
of clinical trials and continuing medical education activities
may bias the information that is published and disseminated about
the benefits and risks of medications.
- Book: Teaching
Ethics in Organ Transplantation and Tissue Donation: Cases and
Movies. Dr. Bursztajn contributed a case
study in this new book on the the ethics organ transplantation.
Being a global and transnational endeavor, organ transplantation
raises universal ethical concerns and, yet, has to be adapted
to culturally mediated beliefs. In this book, 30 case studies
collected from all over the world illustrate the range of global
and local, ethical, social, and cultural problems associated
with this new form of treatment. Together with a list of relevant
movies, the collection provides a unique resource for ethics
education in medicine, health care, philosophy, and religious
- Article: Conflicts
of interest bedevil psychiatric drug research. Dr. Bursztajn
is mentioned along with his colleague and frequent co-author
in USA Today.
- Video: Psychology
Behind Unthinkable Crimes. Dr. Bursztajn comments in a Fox
News story on unthinkable crimes between loved ones and family
- Article: Developing
Unbiased Diagnostic and Treatment Guidelines in Psychiatry.
A letter to the editors of the New England Journal of Medicine
on the continuing crisis in psychiatric conflicts of interest
in relation to the upcoming revision of the DSM.
- Article: Conflicts
of Interest and Disclosure in the American Psychiatric Association's
Clinical Practice Guidelines.
- Article: Firms
tied to some MDs who set policy. Dr. Bursztajn along with
his colleagues Lisa
Cosgrove and Sheldon
Krimsky is mentioned in a Boston Globe article examining
his latest paper on the writers of psychiatric clinical guidelines
and their financial ties with pharmaceutical companies, published
in the journal of Psychotherapy