January 30, 2013 ~ On this half day of trial in the Linda Gross v. Ethicon case being heard in an Atlantic City courtroom, psychiatrist Dr. Ronni Seltzer was on the stand. She conducted two evaluations of Linda Gross and determined the focus of her life, along with her husband Jeff, is pain that permeates every aspect of her life.
Thanks go out to Courtroom View Network for the live feed.
Before her surgery to have the Prolift transvaginal mesh implanted Dr. Seltzer determined Ms. Gross was a “dynamic woman” who loved her job. Her family is very important to her, said the doctor. She has three adult sons and young grandchildren.
Outdoor life was important, especially since she had three boys, surmised the medial doctor/psychiatrist.
“She opted to have surgery so she could improve her quality of life,” she said.
Linda Gross had an Ethicon Prolift transvaginal mesh implanted in July 2006. She claims the defective product has caused her permanent harm both physically and psychologically.
Pre-Prolift she did not have a depression history, according to Dr. Seltzer. She did have some physical problems though.
Ms. Gross had a hysterectomy in 2001 which was followed with excessive bleeding and stress incontinence. She had spinal anesthesia which caused a tear in the dura, a complication of spine surgery where the covering over the spinal cord is nicked by the surgeon’s instrument.
It resulted in nine months of spinal headaches. She needed three blood patches to address the headaches. When the spinal pain abated it turned into migraine headaches for about nine months. She was treated and that pain ended in March 2002 and has not returned.
David Mazie asked if Ms. Gross’ pain were to suddenly go away today, would her depression, feelings of hopelessness and anxiety?
Dr. Seltzer said, “When you’ve had pain since 2006 and gone through this experience it alters your sense of security in your environment. The symptoms might lessen but the syndrome is permanent. The pain takes over one’s life and its very easy to develop depressive symptoms.”
Dr. Seltzer recounted a very sad story of Linda Gross’ life today.
Initially after surgery in July 2006 she was fine but problems with pain would wax and wane. As they became more intense and permanent she developed depression symptoms related to the pain and anxiety- not knowing what was happening or when it would occur next.
There was an evolution in her mood. Sleep became attainable only with medication, and even then she got no more than four hours a night.
As she had to reduce her work hours due to the pain, she gained weight from overeating to compensate and withdrew socially from both friends and co-workers. She felt guilt toward her family that she was not able to enjoy things as she previously did. Ms. Gross was not able to maintain her household, play with the grandchildren or be intimate with her husband.
Dr. Seltzer described anxiety that followed each of the 55 medical procedures she experienced. After one procedure there was a problem with breathing that forced her to use a C-Pap.
“She rallies, then there is a payback,” Dr. Seltzer said, describing her youngest son’s marriage in 2012. Linda showed up for the first dance with her son and had to miss the rest of the festivities. She had to rest for the next several days to recuperate.
“She feels sad this daughter-in-law will never know her as she had been,” Dr. Seltzer testified. She also described feelings of worthlessness, and ruminations – repetitive thoughts about what happened to her and all of the things she lost.
Mazie asks, “Did you reach a diagnosis what she suffers from?
“Yes. There are three psychiatric diagnosis I reached – she suffers from pain syndrome due to the ramifications of the mesh but due to the pudendal neuralgia, due to complex regional pain syndrome in the nerve fibers in that region, it has caused dyspareunia, an inability to be sexually active.”
Pain is the primary focus of her life which in itself can cause psychiatric symptoms such as pervasive anxiety about things she has no control over, Dr. Seltzer said.
“Depressed mood , insomnia, overeating, fatigue, feeling hopeless, worthless, and unrealistic guilt on the impact it has on other people. When she is at her lowest she has not had thoughts of suicide, she has had thoughts – Is is this worthwhile? Would I be better off dead?”
With such a picture painted, the cross examination by Kelly Crawford had to be sensitive but sometimes became combative with Dr. Seltzer.
Once again she established for the jury that Dr. Seltzer was testifying and had done her evaluation for compensation, about $35,000 so far. Crawford tried to establish that the psychiatrist spent half of her professional life testifying in trials but Dr. Seltzer shot back that was a typo in the deposition, she did NOT spend half of her time involved in litigation (the “not” had been left out of the deposition).
Dr. Seltzer said she has a very active practice as a psychiatrist in Englewood, New Jersey and begins her day at 7:30 am seeing patients all day until she stops often not until 8:00 pm.
Crawford established the doctor is not a urogynecologist and has no experience in mesh used in pelvic floor repair.
Because Linda Gross chose biofeedback and physical therapy to address her headache pain, Crawford tried to indicate she did not choose psychological counseling, as if to imply she did not seek help for her mental state.
Crawford asked if Dr. Seltzer understood Linda Gross had three difficult births, problems defecating and problems with her pelvic floor pre-Prolift? The two got into some semantic wrangling over whether or not the doctor had fully explained that she did not examine Ms. Gross in person.
Crawford also established that a person-to-person evaluation is preferable if possible for diagnostic purposes but it was clear that during her deposition of Dr. Seltzer, Crawford was not aware until the 14th question that the evaluation had been over the phone.
Following a lot of back and forth it became clear that a “personal” evaluation is a professional term differentiated from a review of the records and can include a phone evaluation.
As far as her ongoing pain, Crawford did not sound sympathetic when she indicated the Mayo Clinic’s pain program, which Linda Gross is scheduled to visit in March, has an 80% success rate.
Q: “At the Mayo Clinic 80% have greater control over their pain and lesser depressive symptoms. You factored all of that into your evaluation that she is permanently depressed?”
A: “It can improve the quality of life but it doesn’t take away the reality of their pain. Fear, anxiety and depression is permanent.”
Crawford had Dr. Seltzer read the guidelines from American Association of Psychiatry and the Law about the importance of having a personal evaluation. She read, “Being retained by one side exposes psychiatrist for unintended bias and unintended distortion of their opinion.”
Despite an objection, attorney David Mazie came back to establish an earlier point. “When did she have any record of urinary retention from the records?”
A:”It was after the Prolift mesh surgery. Thank you.”