Journey to the Edge of Texas Chapter 11

Doctor's Heat

     PETROU BEGAN THE NEXT MORNING with Leatherwood's doctor back on the stand.
"Dr. Blackburn, you wrote Mr. Leatherwood a letter in which you stated that you remained cautiously optimistic that he can be gainfully employed; is that correct?"
"That's correct."
"And can you tell us why you feel that way?"
"That letter was written at a point after he had made some substantial gains during the previous year in terms of schooling, work with the Texas Rehabilitation Commission, and was beginning to focus."
"Dr. Blackburn, if Carl Leatherwood is accommodated for his illness, is there any reason he cannot resume his lifelong occupation of being a journalist?"
"There would be no reason. Perhaps anyway, I'm not sure that any accommodation is required for him to be able to proceed with his life and be gainfully employed again."
"I have no further questions," Petrou said.
The court: "Cross-examination."
Bounds came forward.

GOOD    MORNING,     DR.     BLACKBURN.   I've put in front of you four of defendant's exhibits, which are records from your files regarding Mr. Leatherwood. Now, you testified that you first examined him in December of 1988; is that correct?"
"That's correct."
"I would like for you to turn to page 79 in Exhibit 3, a record of Gayle Goodman, a social worker. Would you please read for me the second paragraph under 'Presenting Problem'?"
"There is a significant discrepancy between the patient's account of the events preceding the commitment and that of the father and Mr. Gary Fortenberry."
"And the next four sentences, please?"
"'The patient denied any emotional difficulties warranting the extreme measure of commitment. He only went so far as to describe himself as eccentric. He expressed bewilderment at the concern and attempt of family and friends to put him in the hospital. He described their efforts as insensitive and repeatedly stated that he wished only to live a peaceful life.'"
"Mr. Leatherwood often referred to people who tried to get him into the hospital as insensitive, didn't he?"
"I don't know."
"You never heard him use that term before?"
"I don't know that he often—that he often referred to people as insensitive. I've heard that at least once or twice, but I can't say often."
"Okay. There's been testimony about Mr. Leatherwood's episode in the fall of 1988. This hospitalization began on December the 8th; is that correct?"
"That's correct. That's when I first saw him."
"At what point does a person become disorganized or delusional or lose their judgment in the midst of an episode?"
"That's an impossible question. Anything can happen, I suppose, at any point. It's not an all or none—psychosis is not like a light switch turning off and on. One's judgment and rationality waxes and wanes."
"Mr. Leatherwood experienced a severe psychosis in 1988, did he not?"
"He did have a severe episode of psychosis, yes, or severe psychotic episode."
"Now, there's been testimony that Mr. Leatherwood went into his employer, The Houston Post, and resigned his employment in somewhere around December 1st of 1988, or were you aware of that?"
"I knew that he had tendered a resignation."
"Would you please read for me the last paragraph on that page 79?"
"Okay. 'The patient indicated that he had travelled to the East Coast in October and suddenly went to the Southwest after Thanksgiving. He states that he wished to relocate to Santa Fe, New Mexico. Upon his return to Houston, he tendered his resignation.'"
"Isn't it true, Dr. Blackburn, that you knew that when Mr. Leatherwood returned to work in January of 1989, that that was only on a conditional basis for a couple of months so that Mr. Leatherwood could earn a little bit of money and have an opportunity to look for another job?"
"That is not a strange idea to me. I heard that statement. He was —my understanding is that he was attempting to get himself reinstated, that he was—felt like that his tendering the resignation, which apparently did occur at a point when he was rather irrational, was not either his wish or in his best interest."
"Even though he had decided to relocate and had some complaints about his employer?"
"Well, he also decided a lot of other things that—such as to take a hotel room and continue traveling and accumulated bills in a hotel room when he was not in the city and was doing many things that were irrational in at least part of his illness process."
"Isn't it true that you in fact had a telephone conversation with Ernie Williamson in which he told you that he was going to allow Carl to come back just for a couple of months so that he could earn some money and look for a new job and you told Mr. Blackburn—I mean, you told Mr. Williamson that you felt that was extremely humane and generous of The Houston Post?"
"I had a conversation with Mr. Williamson. The detail of your words, I do not recall. The gist of the conversation in my memory was that Mr. Williamson was supportive of Carlton coming back, was hopeful to get him back, but felt that the powers that be were not going to support that but that he was able at least temporarily to arrange some employment. So part of what you're saying is my recollection too."
"But if Mr. Williamson were to testify that that's what you told him, you couldn't dispute that, could you?"
"No, I couldn't dispute it. I would say I don't remember all of those details."
"But the bottom line is, you don't remember?"
Petrou: "Objection, Your Honor. The witness has answered that he does remember certain details." ' The court: "Overrule the objection."
"Please, turn to page 85. Is this your admission report?"
"That's correct. This would have been my first dictation at the time the patient came into the hospital."
"At the time that you read—I mean, the time that you dictated this report, you had read the five or six pages that had been prepared by the social worker; is that correct?"
"That's not correct. This would have been dictated the day or the day following his admission, and the social worker's detailed history would not have been available to me for probably a week."
"Would you read for me and the Court the two sentences at the beginning of the paragraph about 'Diagnostic Impression'?"
"The effect was mildly volatile. Irritability and in particular anger about being hospitalized against his will was manifest."
Over on page 87. The first line of your proposed treatment plan. Read it, please."
"Hospitalized for observation and protection."
"Who were you protecting with this hospitalization?"
"I was protecting the patient in my estimation."
"Now, at some point you did read the report of Ms. Goodman, the social worker?"
"That's correct."
"Did it present any kind of surprises to you?"
"There was new information in terms of history that I had not acquired. No major surprises."
"Did you find that your conversations with Mr. Leatherwood, his stories regarding events, were different from the report that you read with Ms. Goodman?"
"There were differences."
"Would you turn to page 80. At what point did you make your determination that Mr. Leatherwood had been disabled by this episode for approximately a month before his termination—I mean, before his admittance to the hospital?"
"I don't have any recollection."
"Okay. Would you please read the first sentence in the third paragraph."
"The parents and Mr. Fortenberry's account of these events present a picture of the patient's emotional deterioration since early October."
"So sometime within the first few days of Mr. Leatherwood's hospitalization, you had indication that his episode had actually begun some two months before his admittance; wouldn't that be correct?"
"That's correct."
"Would you, please, read the first two sentences of the next paragraph for the Court?"
"The parents report a confusing situation around Thanksgiving in which the patient invited them to Houston for the holiday and then denied knowledge of the plan when they arrived. He refused to transport them upon their arrival, although he met them for dinner. They reported that he acted inappropriately, was unkempt, and spoke loudly at the restaurant.
"When he suddenly left for the West Coast after Thanksgiving, he called the parents often but refused to tell them of his whereabouts?"
"That's fine. Is it normal for a person who experiences episodes such as Mr. Leatherwood to act inappropriately, to be unkempt, and to speak loudly?"
"It's certainly something that is often reported. These are the type of things that lead one to a diagnosis of manic depressive illness. A manic episode."
"And Mr. Leatherwood himself does exhibit these types of symptoms when he gets into a manic episode, does he not?"
"That's correct."
"Would you please read the second sentence of the fifth paragraph on page 81?"
"According to the parents, they had been in contact with the patient's supervisors at The Houston Post in an effort to track the patient's whereabouts."
"So you had an indication on reading those notes The Post as well as the—the people from The Post as well as the patient's parents as well as Mr. Fortenberry and his girl friend had all been involved in trying to get Mr. Leatherwood to go to the hospital; is that correct?"
"There's certainly some involvement in their efforts to gather information."
"You testified yesterday that outside stresses often affect a person with bipolar disorder and can cause the reoccurrence of episodes: Is that correct?"
"That's correct."
"Is the condition of personal relationships also an outside stress that can cause recurrence of episodes?"
"Certainly."
"Would you turn to page 83 and read the first two sentence of the third paragraph?"
"The patient's relationship with his parents is not good. He states that he has been unsuccessful in breaking the ties with them."
"Isn't it true that you have seen a pattern in Mr. Leatherwood's experiences in his episodes, and contact with his parents or arguments with his parents have contributed to recurrence of his episodes?"
"That's one of the circumstances that have been associated with the recurrence of his episodes. There are many elements of stress. No one particular stress that I would attribute, I would not say that employment stresses are the only stress this gentleman has had, nor would I say that relationship stresses are the only stresses that have been important in terms of his illness."
"So all of these relationships have equal bearing on his psychological well-being?"
"I would not say equal, necessarily. They all have varying degrees of bearing, yes."
"Were you seeing Mr. Leatherwood on a regular basis from his hospitalization in October through his hospitalization in June of 1989?"
"Approximately monthly, perhaps biweekly initially."
"I said hospitalization in October but I meant December of '88."
"That's what I understood you to mean."
"Would you turn to page 72? The third paragraph under 'History of Present Illness.' Begin with the second sentence."
"Okay. 'The patient remains on a regiment of lithium carbonate, 600 milligrams twice daily. To return to work. He had biweekly office appointments through May 9th. Between that time and an office visit on 6/1/89, a change occurred. Telephone contacts from the patient's girl friend and employer indicated that emotional behavioral change.
"The girl friend learned of changes after the patient went on a driving trip with his aged parents. The parents had also been aware of substantial emotional change in the patient."
"Well, how much credence do you put in telephone calls that you receive from family and friends and coworkers of your patients when they call you to discuss the possibilities of emotional changes?"
"All depends on the circumstance and the informants. I try to listen."
"In this particular case, you had telephone calls from his girl friend and from Mr. Williamson possibly at The Post or at least someone at his employer indicating that his mood had changed and his behavior had changed; is that true?"
"Uh-huh, yes."
"Did you not act on any of those phone calls?"
"J would have taken action. I don't remember the specific nature. I think it would have been that the patient was to see me and, in fact, he did see me at some point, at which time I made some adjustment in medication."
"Would that have been the visit on 6/1/89 that you made the—"
"I suspect so. I don't remember the precise details of the timing."
"Do you ever when you get conversation—get calls like this, do you ever take the time to call your patients and check with them if they don't come in?"
"I do on some occasions. That's not a customary practice, but I certainly support the individuals coming in for appointments when something is changing so that we can evaluate our phone conversation or adjust medication. As a last resort, hospitalization would be something that would be considered."
"Would you please read the next little paragraph and then the first three sentences in the paragraph after that."
"'The patient had uncharacteristically left the girl friend at a Hill Country festival. He was appearing preoccupied and easily distracted.'"
"Continue."
"'At work, hyperactivity and impaired concentration with workers was reported. The patient was reported to be unable to sit down. He was spending more time talking with other people.'"
"Thank you. These things had been reported to you by his girl friend and by his—people at his employment, correct?"
"That's correct."
"What else are these people supposed to do? If they have contacted you, told you that they've got a problem, how much further are they supposed to go? Are they supposed to bodily restrain Mr. Leatherwood and bring him to your office?"
"I don't have a particular opinion about that. This information is about a hospitalization that occurred as a result of this information and these changes. On this occasion the patient was hospitalized, voluntarily, treatment was modified and that was good. I would have no complaints about anybody at this time in the picture."
"So the types of accommodation that you're talking about are what these people have been doing; is that correct? They have been noticing behavioral change, trying to get him to go see a doctor, and reporting that?"
"Some people, certainly some people have been doing this very effectively."
"You don't think it's the responsibility of every person who comes into contact with Mr. Leatherwood to do these kinds of things."
"Certainly not."
"Are there certain cases of bipolar disorder such as Mr. Leatherwood's, where he will experience an episode even if he is taking his medication religiously?"
"Yes."
"Now, following Mr. Leatherwood's discharge in June of 1989, you wrote another letter, this time to Mr. Janiga, his employer at The Post, is that correct?"
"That's correct. What page?"
"Page 67. In that letter, you simply state in your opinion he can resume his usual work activity immediately; is that correct?"
"That's correct."
"In a February letter, you discussed the continuation of treatment of outpatient therapy. You don't discuss that in this June '89 letter. Why is that?"
"I don't know. I mean there were certainly plans for continuing outpatient treatment, but I didn't include that in the letter because of the—the letter was basically to say that in my opinion, the patient could return to work."
"It was your opinion on June 29,1989, that Mr. Leatherwood was perfectly capable of returning to work?"
"That's correct."
"This was to return to work in his usual occupation as a copy writer for The Houston Post, is that correct?"
"That's correct."
"Had you ever spoken to anyone at The Post about what Mr. Leatherwood's job duties and functions on a daily basis were?"
"Not in great detail. That would have been some of, I think, the communication with Mr. Williamson some months before; but I did not pursue that nor do I have any sufficient understanding of the business to have understood what I was told if someone had told me all of that."
"You didn't think it was important for you to know what his usual work activity consisted of before you released him to return to that activity?"
"That's more or less correct, because I did not see compromise of his mental function being such that he could not perform the jobs that he was accustomed to performing. I felt like he had not performed his work well when he was psychotic. When he was nonpsychotic, he could do his work satisfactorily, that was my sense. So the nature of the job at that point was not something I was concerned about."
"Did you have an occasion to write a letter on August 11 of 1989 regarding Mr. Blackburn's health and his ability to perform his job?"
"Mr. Leatherwood's health and—"
"Ability."
"Yes."
"Ability to perform his job?"
"In August."
"I believe it's on page 66."
"August 11, yes."
"This letter is stated 'To whom it may concern;' correct?"
"That's correct."
"I think that Mr. Leatherwood needed the letter in terms at this point in beginning to look at future employment. This was after he had been terminated. There no doubt may have also been some need from this with respect to his attorney. This was a multipurpose letter to document, basically, the status at that point."
"There's been testimony that Mr. Leatherwood was terminated effective July the 12th in a letter dated July the 25th. This letter was written on August llth. And in fact, at about that time, Mr. Leatherwood was attempting to get long-term disability benefits as well as Social Security disability benefits; is that correct?"
"That is likely, correct. I don't recollect the precise dates on the nature of the issues with regard to long-term. I know that those were all relevant, but I was not keeping track of the precise nature of those."
"But, in fact, you wrote letters and filled out reports and sent medical documentation to both the long-term disability carrier and the Social Security administration; is that correct?"
"I'm sure that's true."
"That was in an attempt to facilitate Mr. Leatherwood's obtaining benefits from both of those sources?"
"That's correct."
"Now, you wrote the letter on June 29 saying that, in your opinion, he could resume his usual work activity. On August 11, you wrote this letter."
"Uh-huh."
"In paragraph two, the second sentence says, 'Because of these periods of fluctuation in his emotional stability, Mr. Leatherwood may not be able to work with any continuity in his chosen profession or perhaps any other profession.'"
"Uh-huh."
"What had occurred between June 29 and August 11 to change your position and your opinions so dramatically? He had not had another episode, had he?"
Petrou: "Objection. One question at a time if you would, please."
The court: "Overrule the objection. Overrule the objection."
"The change—several changes. It was during that time that the patient was terminated from his employment, and his mood had substantially changed. He was in this period more depressed, he was not in a manic episode, he was not out of control, he did not require hospitalization but his emotional state was substantially different. His ability in my judgment to pursue some kind of work at that point was substantially less than it had been at the time, both times, after hospital treatment in December '88 and in June '89.
"He chronically responded as people often do when they're in manic episodes. The response—the treatment when they're more depressed—is often slower. But that was just the fact that his clinical condition had changed in my judgment from June until August."
"In that six-month period, how many times had you actually seen Mr. Leatherwood for visits?"
"From June to August, it wasn't six months."
"I mean, six-week period. I apologize."
"I had probably seen him only a couple of times. I don't remember the dates of outpatient appointments, but I would have seen him within several weeks of his hospitalization and then approximately monthly, maybe some extra ones. But I would have had very little contact, but it doesn't take a lot of contact if a person's mood is substantially different and if circumstances are substantially different.
"At this point when I was writing this letter, the patient was fearing destitution. He was unemployed, he did not have plans for employment, he had his bills to pay, et cetera. He was quite concerned and he was depressed and that's reflected, I think, in this."
"Had you altered Mr. Leatherwood's medication at any time in that six week period?”
"I don't remember a change at that point."
"In fact, you did not alter his medication during that period. You did not alter his medication?"
"I said I don't recall altering it during that time."
"He had not been hospitalized during this six-week period either, had he?"
"No."
"And it's your testimony that you probably saw him maybe twice in that six-week period?"
"That would be reasonable. I have no idea."
"Did you have any conversation or telephone conversations or contacts from his parents or his girl friend or had you had any conversation with anyone from The Post in that six-week period?"
"I don't recall any other communication at that time."
"At the bottom of that middle paragraph, you go on to say, 'The manic phases have occurred sporadically in spite of his use of maintenance medication.'"
"Uh-huh."
"'Because of these unpredictable episodes and the necessity of hospitalization, I cannot say that Mr. Leatherwood would be able to perform the material duties of his occupation with a reasonable continuity.'"
"We're talking again about his usual work activity or the material duties of his occupation which you've testified you legally never found out exactly what that was, did you?"
"That's correct. I knew only that they were editorial in nature. And the most important thing from that perspective was that he had performed these duties as for as I understood reasonably well for nineteen or twenty years, and I thought he could do that again."
"Would you read the last paragraph of that letter, please?"
"'From having evaluated and treated Mr. Leatherwood, I know that his education, training, and experience have all been in the newspaper-field as an editor of some type. As this is his current occupation, and as I have already stated, he's disabled with respect to its performance. It follows that he would likely be disabled with respect to similar occupations to which he would be suited by virtue of training and experience."
"So what I've done, I'm prognosticating as far as when the patient is substantially down, he's not manic, he still has the same illness. And we're never very good at prognosticating. As a matter of fact, he has probably done better in terms of his return to ability to function cognitively than I thought he might at this particular time."
"In fact, you weren't able to actually prognosticate about his condition from—approximately month to month; is that correct?"
"I don't remember a change at that point."
"In fact, you did not alter his medication during that period. You did not alter his medication?"
"I said I don't recall altering it during that time."
"He had not been hospitalized during this six-week period either, had he?"
"No."
"And it's your testimony that you probably saw him maybe twice in that six-week period?""
"That would be reasonable. I have no idea."
"Did you have any conversation or telephone conversations or contacts from his parents or his girl friend or had you had any conversation with anyone from The Post in that six-week period?"
"I don't recall any other communication at that time."
"At the bottom of that middle paragraph, you go on to say, 'The manic phases have occurred sporadically in spite of his use of maintenance medication.'"
"Uh-huh."
"'Because of these unpredictable episodes and the necessity of hospitalization, I cannot say that Mr. Leatherwood would be able to perform the material duties of his occupation with a reasonable continuity.'"
"We're talking again about his usual work activity or the material duties of his occupation which you've testified you legally never found out exactly what that was, did you?"
"That's correct. I knew only that they were editorial in nature. And the most important thing from that perspective was that he had performed these duties as far as I understood reasonably well for nineteen or twenty years, and I thought he could do that again."
"Would you read the last paragraph of that letter, please?"
"'From having evaluated and treated Mr. Leatherwood, I know that his education, training, and experience have all been in the newspaper-field as an editor of some type. As this is his current occupation, and as I have already stated, he's disabled with respect to its performance. It follows that he would likely be disabled with respect to similar occupations to which he would be suited by virtue of training and experience."
"So what I've done, I'm prognosticating as far as when the patient is substantially down, he's not manic, he still has the same illness. And we're never very good at prognosticating. As a matter of fact, he has probably done better in terms of his return to ability to function cognitively than I thought he might at this particular time."
"In fact, you weren't able to actually prognosticate about his condition from—approximately month to month; is that correct?"
"It has nothing to do with month to month. The fact is, we can never prognosticate that well. In fact, the whole effort of therapy, I guess, is to—when we're pessimistic, to disprove our pessimism with efforts to facilitate the patient functioning better than we think they're able to do."
"Being aware—"
The judge: "I think that this is as good a point as we can find to take a break for a brief mid-morning recess. The jury may retire."

AFTER THE  RECESS, Bounds returns to her tough pursuit "With regard to your statement, Dr. Blackburn, that the loss of Mr. Leatherwood's job had a significant impact on him—I think you said that yesterday as well as today—isn't it true that most people's job and the loss of that job has a significant impact on them?"
"Yes, that's true."
"You stated that your opinion regarding Mr. Leatherwood's prognosis of never being able to return to work has since changed; is that correct?"
"That's correct."
"When did that change?"
"It changed over a period of approximately a year to a year and a half during which time he managed to work with educational opportunities, TRC, completed courses in school making some adjustments, some change from one subject to another and made satisfactory grades and continued to maintain his emotional stability during much of that time in spite of having some subsequent setbacks toward the latter time that I was seeing him. But he certainly demonstrated that he was more able to function than he had been in the summer following his termination or during the summer that he was terminated from employment."
"Please look at Exhibit 4, page 7, which is the first volume of the Standard Insurance Records. Do you have that?"
"Okay. This is an insurance form. I completed it on 8/22/89."
"Which was some 11 days after you had written this letter; is that correct?"
"I suppose so."
"And you put on the bottom of that under prognosis, could you read the remarks to the Court, please?"
"'Based on the recurring clinical psychotic episodes, I believe it unlikely that the patient can return to and sustain his usual or similar work.'"
"Now, you told me that it was your opinion in October—I mean, in August that he could not continue his usual work, correct?"
"That's correct."
"But that it was your opinion on June 29 of 1989 that he could continue in his usual work, correct?"
"That's correct."
"Now, at the top of that page under what's marked No. 3, 'Assessment'?"
"Uh-huh."
"It says, 'Date you recommend patient should stop working.' Did you fill in that date?"
"I have June 24th, I believe."
"You filled that in?"
"Which I think was the day of hospitalization if I'm not mistaken."
"Actually, Mr. Leatherwood was hospitalized from June 19 until June 24 of 1989, correct?"
"Oh, okay."
"So in August, it became your opinion that as of 6/24, which was the date of his discharge, he should quit working; is that correct?"
"I'm not sure. I perhaps didn't read this very well. I don't know, because it's not—my memory is not that I recommended he stop working on that day but that, in fact, he had—was not allowed to go back to work at that date."
"But, in fact, Mr. Leatherwood hadn't been at work since June 1, had he?"
"That sounds correct, yeah, when he went in the hospital. But I think, if my memory serves me correctly, I recommended that he return to work at the end of the hospitalization. And I think I must have been reading this as a typical insurance form that I'm supposed to give the date when the patent last was employed or the last working day. I can't quibble on that. I said effort to return to work January through April '89 failed in spite of ongoing treatment."
"So is it your testimony that in August of 1989 it was your opinion that he could not—that he should stop working on June 24th?"
"It was my—it was in my knowledge that he had not been working during that period of time. I don't want to, I guess, belabor that, but I don't think that I recommended on 6/24 as I gave that date—I filled it out myself, but I don't think I recommended that he stop working at that time. I think I was filling this out as though he had not been working from June until the date in August when I was completing this form."
"So either you didn't—you did recommend that he quit working on June 24th or you didn't read the form; is that what you're saying?"
"I read—if I read the form, I read it incorrectly. That would be my speculation. At least I don't think it's consistent with the letter that I wrote in June if I'm not mistaken."
"It certainly is not—"
"From the discharge summary when he left the hospital, I felt he should return to work."
"Well, I think we're in agreement that it is not consistent with the letter that you sent to The Post on June 29th, aren't we?"
"That's correct, so I must be inconsistent."
"Following these letters that you wrote in August 1989, did you continue to see Mr. Leatherwood on a monthly basis?"
"That's correct."
"And he, in fact, had another manic episode in the fall of 1989, did he not?"
"That's correct."
"Would you turn to page 63 in Exhibit No. 3? Is this a summary that you wrote or dictated?"
"That's correct. It is a summary that I wrote. It appears not to have the day of admission. I must have been confused at that time, too."
"On the next page, page 64 in the lower left-hand corner, there are some numbers?"
"Dictation numbers which would be close to the time of admission."
"Is that the 'D' that says 11/16/89?"
"That's correct. That would be the time it was dictated, and 'T' is the time it was transcribed."
"So this was dictated by you approximately November the 16th of 1989; is that correct?"
"That's correct. Actually it was—the admission was 11/16, the discharge 12/4."
"Okay, good. Looking at page 63, would you read for the court the first sentence under 'History of Present Illness'?"
"'For the past month, the undersigned had been receiving calls from friends and family of patient suggesting another shift in the patient's mood. He was beginning to be talkative and rambling, restless and preoccupied.'"
"Below that a couple of sentences you say, 'On several office visits, the last on October 30th, the patient maintained reasonable emotional control and confirmed his compliance with usual 1200 milligram lithium carbonate daily.'"
"Uh-huh."
"Did you make any efforts at that time, October 30 or those visits, to change his medication?"
"I would have to review the office visit material to say precisely whether I did or didn't at that time. I don't remember."
"But you did not hospitalize him based on your visits with him at that time?"
"That's correct."
"And at the time that you were having these visits and he was maintaining reasonable emotional control, you were also receiving phone calls from family and friends, were you not?"
"I think the phone calls were subsequent. They were after the hospitalization but I don't think they were before—I don't know the precise time that was."
"It states here that for the past month, the undersigned had been receiving calls from family and friends. Your last office visit was on October 30, and hospitalization you just said began November 19. So would that have been—"
"I'm not sure whether the calls came before; they came sometime reasonably close to the time. He subsequently was hospitalized two weeks afterwards. So my assumption from this is the end of two weeks. I had additional contacts, reports that didn't coincide exactly with my observations at the time I saw him."
"But you put in here that for the past month, which we've determined would be a month prior to November 16, you were receiving these calls?"
"Okay."
"Are you saying now that that was incorrect and that was only for the previous two weeks?"
"I don't remember. I don't remember that."
"So this document is really the best evidence of what was occurring at that time; is it not?"
"Probably the document, which I think you have my notations of office visits, would be more likely to show whether I recommended hospitalization or whether I had had phone calls from family or friends before that visit. That doesn't trouble me too much. It may have been—either way, I would not necessarily change the treatment on the basis of the input that I had received. I would be confronting the patient with what I was hearing, looking at what—how he was looking, seeing what he was doing. I might recommend medication change, I might recommend some altered strategy. So I don't quibble about whether I know the significance of whether they called before or after."
"Well, the significance that I see is that you're saying here that for the past month which would be sometime beginning in the middle of October, you've been receiving calls from friends and family of the patient, which by my understanding from your testimony and a prior expert's would be his support group."
"Okay."
"What you're telling me is that saw him and made an assessment and— “
"At that particular—at the time I saw him that he was in reasonable emotional control."
"So you discounted their information or their observations regarding his situation; is that not correct?"
"I don't know that that means I discounted it."
"Well, you obviously decided that you, as the trained professional, knew more than they did, and based upon your personal observation, it was not as serious as they seemed to think it was?"
"I did not call the police—"
"No, I'm not asking you that."
"—lock him up."
The judge: "Pardon me, but don't overlap each other.
"Proceed."

     I'M NOT ASKING You if you called the police. I'm asking you if you changed his medication, and you've obviously stated that you didn't feel at that time on October 30 that it was necessary for him to be hospitalized. Is that what you're saying?"
"All I'm—what I've said is that I don't remember if I changed the medication at this time. I did not hospitalize him at that time. I don't remember whether—I wondered whether this might end up in another hospitalization, what was happening, but I didn't hospitalize him at that time. The patient appeared reasonably stable, and I did not remember anything important to put in the summary at that point."
"What does reasonable stability or reasonable emotional control mean to you?"
"That means that the patient is not having obvious delusions, hallucinations, is not hyperactive, is not loud, is not manicky. That's basically what I mean. So everybody in here right now is reasonably, emotionally stable."
"You testified yesterday that it was certainly preferable to get someone such as Mr. Leatherwood with a bipolar disability into the hospital or to notice a manic episode as quickly as possible; isn't that correct?"
"That's correct."
"You also testified that the beginning symptoms of these types of episodes are a mood swing, increased repetition in speech, things like that; is that correct?"
"That's correct."
"And those types of things, the mood swings, are what you were receiving phone calls about; is that correct?"
"That's correct. As I say, I don't know the precise times of all the phone calls and what each phone call was about.
"If for example the phone—the hyperactivity was obvious and the dysfunction in other people's eyes was obvious and if I saw the patient and didn't at least discuss—consider with him possible adjustment of medication, that would have been an error on my part. I may have made an error. I may have made a misjudgment, but I don't remember that.
"I'd have to look back at the notation as to what my thoughts were about the medication. But that is—it is true that if the individual is having increased hyperactivity, if there's sleeplessness beginning to occur, this is a telltale sign for me and the patient in the long run to learn—for the—have the patient learn to recognize some of these things so that we can adjust medication on the telephone for example with just a call, for example, we need to increase the medication."
"If you are considered to be the learned professional in this particular situation, and two weeks prior to the admission of this patient you did not notice any problem or in your judgment there was not a problem, how can ordinary coworkers or friends and family be expected to spot that sort of thing?"
"I'm not saying that people should spot that. I also was not saying that I didn't spot any problem. He was coming to me on a relatively regular basis because he had ongoing problems. I don't automatically change the medication. I may offer some support, try to understand, try to get the individual to moderate what their activities are which may be self-monitoring, may be reducing some of the stresses."
"Approximately just over halfway down that paragraph towards the right it begins, 'On the day before'?"
"On the day before the night of admission, he was brought home by a neighbor—neighborhood security patrolman who found him lying on the lawn. Subsequently, he asked his cousin to take him to the hospital which he did. However, while admission was being arranged, he ran away from the hospital."
"Continue."
"Apparently, the family contacted Houston Police Department, and officers located him and brought him to the hospital in handcuffs. Patient was agitated, talking about religious themes including Mother Teresa and about the universe being saved. He had attempted on several occasions to run away. He was combative with the staff and had to be restrained."
"This is much the same as the situation in which Mr. Leatherwood was brought to the hospital in the fall of 1988, is it not?"
"That's correct."
Petrou: "Your Honor, I want to state an objection for the record here that I believe that after his termination, this intensive questioning about what happened to him and his hospitalizations is irrelevant."
The court: "Overrule the objection.
"Would you turn to the next page which is page 64? Again, this was written at the time of Mr. Leatherwood's admission in November of 1986, correct? I mean, 1989. It followed the letters that you wrote in August and the forms you filled out in August, correct?"
"Yes."
"About midway down that paragraph there's a sentence that says, '”The patient had been rather stable until the onset of the present illness episode.'  That seems to me to be a bit contradictory to what you just testified to that in the six-week period between his last hospitalization in June and this in the writing of those letters in August, there had been such a significant change in his emotional state that warranted you completely changing your testimony. Does that not appear to be a bit contradictory to you?"
"Rather stable? I mean rather stable basically means that he wasn't manicky for most of that time. It doesn't mean that he was out of the woods or was not having problems. In fact, what I have indicated that my recollection is that there was more depression, discouragement, deep concern about his situation that—but he was stable. He was coming for appointments, he was taking his medication. And only some several weeks before the hospitalization as you've indicated, I received some calls, began to be aware that he was indeed deteriorating again.
"Now, what you're saying is that in that six-week period between June 29th and August the 11th, you keep saying that he appeared to be very depressed. In your opinion, was Mr. Leatherwood clinically depressed during that period?"
"I'm not saying that he manifested a major depressive episode; I'm not making a diagnosis. I'm simply stating the fact that his mood was that of discouragement and considerable apprehension with respect to his circumstances."
"My problem, Dr. Blackburn, is I have a—it may be semantics. It seems to me that rather stable and reasonable emotional stability is quite different from saying that because of these periods, he can no longer continue with his chosen profession. Do you not see a discrepancy in those two or three statements?"
"Not necessarily. He had been—he was rather stable, but not in a state of high function. There's a—particularly in cyclic disturbances such as bipolar disorder, manic depressive disorder, there is a lot of fluctuation. And when I say stable, I mean there's less fluctuation, but it doesn't necessarily mean that things are operating on a perfectly good level."
"It is your testimony that you did not diagnose Mr. Leatherwood as being clinically depressed in August of 1989?”
"I didn't—"
"But isn't it true that he has really never experienced the low—"
"Has never had—"
"—the clinical depression side of the bipolar disorder?"
"That is correct."
"He was low in '89 because he'd lost his job, correct? Is that what you're saying?"
"I was just saying that he was low. I think losing the job is one element of that."
"Most people who lose their jobs do get—have a certain amount of unhappiness, wouldn't that be correct?"
"That's correct. And people who have significant biological mental disorders such as bipolar disorder are more apt in periods of discouragement or loss to have changes in their clinical state. Perhaps to become manic."
"So do we have a responsibility not to allow negative things to happen to people who have bipolar disorders?"
"I would not generalize to that extent."
"In November of 1992, about the time of Mr. Leatherwood's—I mean, November 1989 about the time of Mr. Leatherwood's hospitalization, you wrote another letter, did you not, to a Charles Crane, who was a disability examiner for the Social Security Administration? If you'll look on page 61, you'll find that letter."
"Yes. On November 22nd."
"Would you read for the court the fourth paragraph of that letter?"
"'The degree of psychosis at the beginning of the present admission was more severe than the two previous compensations which I observed. In view of the chronicity, greater than ten years, and the deterioration over the past year, it is my opinion that if the patient is able to return to work at all, it will require at least three to six months more active rehabilitated effort,
"'Although he appeared to be making an adaptation to work from January through April of '89, he has mostly been seriously disabled since about September 1988.'"
"So again, your opinion has changed. Hasn't it?"
"My opinion has not changed. I have different frames of time that I am reviewing the situation."
"In January of 1990, you had an occasion to fill out another one of these forms to Standard Insurance Company. If you'll look in Exhibit No. 4 on page 2."
"Dated January '90."
"And is that your signature at the bottom?"
"It is."
"And this is some two months after that letter you wrote to the disability examiner?"
"But isn't it true that he has really never experienced the low—"
"Uh-huh."
"Would you please read the paragraph in part B where it says 'Medical Prognosis'?"
"For one-and-a-half years there has been major deterioration with multiple relapses and required hospital care. The patient is not expected to ever be able to return to his prior job situation."
"Do you generally tailor your remarks according to the audience to which you're writing?"
"Certainly do. Try to. Sometimes I fail."
"Then on March, 20,1990, you wrote another rather lengthy letter. I believe you'll find that at page 50 in Exhibit 3. Who was it written to?"
"This was to the Social Security or TRC examiners."
"What isTRC?"
"Texas Rehabilitation Commission. This was for purposes of ascertaining his status for Social Security."
"Please read the first paragraph tided 'Chief Complaint.'"
"'The patient is discouraged, frustrated, and fearful about reestablishing himself vocationally and socially due to recurring manic episodes which have resulted in hospitalizations, dismissal from work after more than twenty years and financial disarray.'"
"So the recurring manic episodes has resulted in hospitalizations as well as the dismissal and the financial disarray, correct? That's what that says, right?"
"That sounds good."
"Would you turn over to page 54, which is several pages into this formalized letter. Under D, 'Deterioration or Decompensation in Work or Work-like Setting in the Past Year.' Would you read that paragraph, please?"
"'Since about September 1988, the patient manifests declining ability to sustain his usual work. Management changes at work may have contributed. Personal stress related to relationship to parents and girlfriend may have contributed. Three grossly psychotic manic episodes have resulted in three hospitalizations during the past fifteen months. In spite of effort to return to work or perhaps because of the effort to return to work, deterioration and relapse occurred.'"
"It was your opinion at that time that the prognosis for Mr. Leather-wood was to be considered guarded to poor; is that correct?"
"That would be no doubt correct."
"One final document. On May 6, 1991, you had an occasion to write a letter to Michael Jobst, the benefits representative for Standard Insurance Company. Would you please read the first two sentences in the last paragraph on page 46?"
"'In the fall of 1988, progressive hyperactivity and inappropriate interpersonal interactions led to work dysfunction. A trial back at work in the spring of 1989 was experienced as highly stressful.'"
"And, on page 47."
"'In my opinion the prognosis is good. Present expectations are for his retraining to include part-time work efforts during the spring 1992. Subsequent to that, a trial of gainful employment may be a realistic goal, though not in the pressured newspaper environment.'"
"Dr. Blackburn, do you feel like you placed The Post in any kind of precarious type of position by providing them with releases to return to work for Mr. Leatherwood and then within weeks changing your opinion as to his ability to perform the job?"
"No, I don't. I changed my opinion after the second hospitalization. That was the—after—actually, I changed my opinion after he was terminated from his employment, and I don't—I did not feel that the clinical situation was that different than it had been six times over ten years when he had gone back to The Post and successfully returned to work."
"But all of a sudden you did in August in an effort to achieve disability benefits for Mr. Leatherwood; is that correct?"
"In August after he had become unemployed, his condition was different."
"He needed benefits, didn't he?"
"He did need benefits, that's correct."
"Did you ever give Mr. Leatherwood a release to return to work while you were treating him after June of 1989?"
"I don't recall any situation of doing that."
"In fact you never did, did you?"
"Although there—there would have been no cause for it and no requirement for it in the work that might occur with the vocational rehabilitation thing. The letters that I wrote to TRC are fully in sync with Social Security law, that I don't understand, but there are two arms, I mean, an individual can be disabled and at the same time the TRC works with them to rehabilitate.
"And that's what was occurring, and part of the rehabilitation may be working. We have people working in the veteran's hospital while they're hospitalized. We used to call it industrial therapy. Now it's called incentive therapy, because you have to pay people something; it's not enough to work. But work is therapeutic, and so that's not exactly out of sync with what we're trying to do."
"So it was—at some point became your opinion that Mr. Leather-wood could return to work and possibly even in the newspaper industry; is that correct?"
"I would say that now. I only say that on the basis of the fact that somewhere in the midst of time—I don't have this in my mind—he began to do some writing. And some of the writing—I'm not a critic of writing, but he was writing what seemed reasonable. And I figured if he can write reasonably now, then that might be somewhat related to the newspaper work."
"Did you ever notify the long-term disability carrier or the Social Security Administration that Mr. Leatherwood was now able to work, therefore, no longer required the disability benefits?"
"I don't recall doing that. He was continuing to work with TRC during all the time that I saw him until I last saw him in June of '92. So there was no situation where he was at a point of sustaining gainful employment. He was still in a rehabilitation posture with respect to the TRC. So that didn't come up to my knowledge."
"Dr. Blackburn, did you come here pursuant to a subpoena today?"
"That's correct."
"Are you being paid for your time?"
"No, I'm not."
"Are you on a salary with the VA Hospital?"
"I'm on vacation today and yesterday."
"Thank you. I pass the witness, Your Honor."
The court: "Mr. Petrou, redirect."
Petrou was brief.
"Did the stress factors of dealing with his parents and his girl friend play a major role in his deterioration in December of '88 and in the spring of'89?"
"I think that the issues of the relationships were important but had also been stresses for him over years, and there was no—the most important single change I'm aware of during this period of time during this year or so was the change of his employment. There were always these other problems in the multiple times that he had returned to work before."
"And the defense counsel talked to you about Carl Leatherwood and whether he was violent or not. From examining all of his medical records and from talking to Carl, did you conclude that he was a violent person?"
"No. The only references to violence occurred on the occasions when he was restrained against his will. And on those occasions, he was indeed struggling with the attendants and that is certainly violence, but it's not the kind of violence that we usually are more concerned with."
"Is it therapeutic if Carlton likes to write and desires to write for him to get a job writing?"
"Certainly."
Judge Gibson: "Thank you, Dr. Blackburn. At long last, the witness is excused."