Malingering mixed with Munchausen syndrome

This is a case in which I was an expert for the defense.

Rebecca, a 32-year-old part-time athletic coach, was a passenger in a van operated by the Police Athletic League of a major city. During an outing, the van and a car sideswiped each other. No injuries were evident among the riders in either vehicle, and no one requested or required medical intervention. But Rebecca filed a lawsuit six months later. She alleged that the incident had in fact caused a head injury that resulted in progressive paralysis.

By the time I was retained by the defense, Rebecca was ostensibly quadriplegic. This was highly unusual for a for a motor vehicle accident in which on-site medical evaluation and treatment had been refused. After completing a review of Andrea’s medical records, I found it incontrovertible that she was feigning her paralysis.

To begin with, Rebecca’s purported deficits were highly inconsistent. While in the hospital for the delivery of her baby, Rebecca was observed to move her left arm. At a later date, under video surveillance, she was seen to voluntarily move her fingers and arm to hold the baby after stepping out of a car. Rebecca would variously claim to remember nothing about these coordinated movements, and to have been caused great pain by them.

It appeared that Rebecca was not able to sustain the ruse of quadriplegia. After a few months, she came to describe her paralysis as “incomplete” – openly demonstrating full use of her right arm, hand, and shoulder, in addition to limited movement of her left arm and both legs. Bizarrely, she admitted to being able to stand erect for twelve minutes, but insisted she could not recall doing so. When pressed about why she was using a wheelchair, Rebecca proposed that this was because of “spinal trauma,” but after a thorough assessment, an expert in spinal injuries concluded that her presentation did not remotely indicate trauma of this kind.

Rebecca presented a plethora of symptoms to complement her “paralysis.” These symptoms were mostly unconvincing, and demonstrated a poor understanding of neurological problems. For example, Rebecca alleged that a blow to her head during the car accident had left her with amnesia so severe that she could not even remember how many sisters she had. However, she seemed able to give exquisitely detailed accounts of the vehicle collision, as well as complaints she had made of medical malpractice years before.

The review of older medical records was instructive. They showed that Rebecca had had more than sixty admissions at numerous hospitals for other ailments that consistently eluded formal diagnosis. It became evident that the accident had simply provided a dramatic “explanation” for her feigned or exaggerated symptoms. Even a decade before the incident, she had undergone a startling number of surgeries, including appendectomy, duodenectomy, sphincteroplasty, cholecystectomy, and partial pancreatectomy. Rebecca would present with recurrent and unusual signs and symptoms, some of which she attributed to a diagnosis of porphyria. Though porphyria was documented in her medical records, the diagnosis was always based on her own reports. The claim was later dismissed by both expert opinion and earlier diagnostic testing.
Rebecca’s recent hospitalizations generally ended with her signing out against medical advice after the medical staff recommended a psychiatric consultation or balked at her escalating demands for abusable drugs. For instance, she would demand narcotic drugs continually, and their administration led to complications that included urinary retention, infections at needle sites (for which she would refuse antibiotics), and muscle jerking. Nurses at various hospitals commented that the swelling and hardness in her arms was caused by the repeated injections.
Before the accident, Rebecca was living in poverty, earning just $150 a week and living with a physically dependent grandmother. She had a remarkable history of threatening and pursuing litigation, at one time listing her attorney as the person to contact in case of emergency. After the accident, Rebecca was granted full-time home health care, maid services, workers’ compensation payments, and Medicaid insurance. A financial settlement from this lawsuit would support her house payments and provide financial security.

It was clear to me that Rebecca’s constant attempts to deceive healthcare professionals were fueled by her personality disorder. She showed borderline, dependent, histrionic, and antisocial personality traits. She had been shown to lie gratuitously, even about matters completely unrelated to her health, such as her education. She told one doctor that she was a physics major at Yale, and another that she was a pre-med student at Long Island University. She boasted of having won basketball scholarships to Yale, the University of Miami, and the University of Nebraska, and to have been All-American in high school and college. Any request by hospital staff for clarification had been met with hostility.

Because of the breadth and duration of the symptoms, the associated litigation, and the inappropriate procurement of resources that had already taken place, I predicted that resolution of Rebecca’s behavior was all but impossible. Although the Police Athletic League firmly denied culpability, their lawyers advised settling the case; it was indeed settled for $500,000. Their reasons for the settlement included the complexity of the case, the likelihood of a prolonged trial, and the difficulty a jury might have in believing that a seemingly ill, wheelchair-bound woman would fake her own ailments and could, in the process, successfully mislead so many physicians.
By the time the case came to an end, Rebecca had accumulated over $2 million in outstanding medical debts – meaning that she could not enjoy the fruits of her many enacted ailments.

Leave a reply

rfwbs-sliderfwbs-sliderfwbs-slide