Building Successful Partnerships Between State Health Departments and Attorney General Offices: The Minnesota Example.

In recent years, the Minnesota Attorney General's Office and the Minnesota Department of Health have cultivated a productive partnership to strengthen the state's multidisciplinary response to overlapping health equity and social justice issues. This article describes shared efforts in three areas: post-conviction justice, drug overdose, and human trafficking/exploitation.

Case Management Consultant to Attorneys in Litigated Cases.

ABSTRACT: Rehabilitation nurses possess knowledge and skills that are ideally suited to a variety of roles. This article informs rehabilitation nurses about opportunities to work in private case management for medical-legal cases. A brief overview of the process of litigation gives nurses the context in which case management interventions are needed. Case examples illustrate the services that nurses provide to attorneys and their clients that help obtain needed care and aid in progressing litigation to resolution.

[Medical negligence in cardiology: enter the lawyers and the experts and, then, the judge]. / Colpa medica in cardiologia: entrano gli avvocati e gli esperti e, poi, il giudice.

Legal proceedings for medical negligence usually origin from painful events and their management is often complex, also at an emotional level, both for the families involved and for the physicians assumed to carry responsibility. Many of these aspects are unfamiliar and unclear to the doctors themselves who then need to interact, together with their lawyers, with judges who must take serious decisions on technical facts not easy to be fully comprehended by non-medical persons.On the basis of our different and highly specific personal experience, we have tried to clarify some of the fundamental issues concerning medico-legal cases. Accordingly, we have discussed the different types of guilt, made the distinction between civil and penal cases, with special focus on one issue which is particularly critical, namely that of the importance of guidelines. We have presented some examples of clinical cases and highlighted some glaring differences existing in the management of medico-legal cases between Italy and the United States. Despite obvious complexities, these differences might suggest some approaches toward the simplification of these proceedings and the shortening of the time involved to reach a conclusion.

Professional Values and Mental Health Tribunals: How Healthcare Professionals' and Lawyers' Views Are Shaped by Values, and How This Might Impede Reform.

Most countries that provide for compulsory treatment for mental illness have a system by which this treatment is subject to independent legal oversight. Many countries use a special type of legal body for this purpose, called a mental health tribunal. Mental health tribunals have been subject to criticism from the points of view of both legal professionals and mental healthcare practitioners. Similar themes have manifested in these criticisms and have been consistent across several decades; legal professionals tend to focus on the tribunals being biased toward the medical opinion, and acting as a 'rubber stamp', whereas healthcare practitioners tend to focus on the adversarial nature of the trial, and the adverse effect that this can have on clients. However, empirical studies of the tribunals have not separated and directly compared these perspectives. This study aimed to explore this dynamic between lawyers' views and healthcare practitioners' views of mental health tribunals. We used thematic analysis to re-analyse data from two previous research studies, one which looked at lawyers' views of the tribunals, and one which looked at healthcare practitioners' views. Our results are divided into three themes: views of the problems with tribunals, professional roles in relationship to the tribunals and professional values demonstrated through these views and roles. We then consider if the 'clash of values' represented by these findings, and found in the literature, may pose an impediment to tribunal reform. Identifying and exploring this barrier is an important step to moving beyond critique to reform.

Forensic Professionals' Stress Inventory (FPSI): Development and psychometric properties.

Professionals in the justice system are particularly susceptible to occupational stress and burnout due to factors intrinsic to their profession. The Forensic Professional's Stress Inventory (FPSI) was designed to assess stress and psychological distress specifically in justice system professionals. A preliminary 41-item scale was administered to a sample of 690 forensic professionals (i.e., judges, lawyers, and attorneys). Exploratory factor analysis, exploratory structural equation modeling, and confirmatory factor analysis were conducted to find the most interpretable and parsimonious factor solution for FPSI. The 25-item bifactor model (with four first-order factors) demonstrated the most adequate fit to the data. Overall, FPSI revealed adequate psychometric properties and would be a useful instrument for assessing psychological strain and stress in forensic professionals.

Realistic three-dimensional imaging of injuries in forensic medicine - Survey-based method comparison of CRT and VRT.

OBJECTIVE: A comparison between Cinematic Rendering Technique (CRT) and Volume Rendering Technique (VRT) in cases with postmortem CT-angiography (PMCTA) was carried out. METHODS: For different injuries seen in PMCTA, a VRT and a CRT image of exactly the same pathological section was generated. Two questionnaires were created, one with CRT and one with VRT reconstructions, with the same questions per 3D-image. The questionnaires were sent to forensic pathologists, lawyers and police officers. In total eleven different injuries had to be analyzed. RESULTS: In total 109 questionnaires were answered fully. Of these returnees, 36 stated that they were forensic pathologists. Seventy-three people were assigned to the group of medical laypersons, in the study this group consists mainly of police officers, judges and lawyers. Between the two software programs CRT and VRT that were compared, no significant difference could be identified in any of the participating groups with regard to the assessment of the life-threatening nature of the injury images shown. When asked about the comprehensibility of pathology, there was a significant difference in favour of CRT. This advantage was apparent to named medical laypersons and to forensic pathologists. CONCLUSIONS: The study showed a positive trend that CRT may be more understandable than VRT. Not only the medical laypersons, but also the forensic physicians found CRT to be beneficial.

The power of meaningful numbers: Attorney guidance and jury deliberation improve the reliability and gist validity of damage awards.

OBJECTIVE: A mock jury experiment tested the effects of attorney guidance and jury deliberation to mitigate the challenges that civil juries face in assessing damages. HYPOTHESES: We hypothesized that two types of attorney guidance (per diem, per diem + lump sum), theoretically based in the Hans-Reyna model of jury decision making, would improve jury decision making compared with no guidance against five key benchmarks: injury assessment, validity, reliability, verbatim-gist coherence, and metacognitive experience. We expected that deliberation would increase reliability of, confidence in, and polarization of awards compared with predeliberation. METHOD: Community members (N = 317; 61% women; 86.1% White; Mage = 48.68 years) deliberated in 54 mock juries. Participants watched a videotaped trial involving an automobile accident in which two plaintiffs sustained concussions (one mild and one severe). The plaintiffs' attorney's closing arguments varied attorney guidance (no guidance, per diem, per diem + lump sum). Mock jurors provided individual judgments before deliberating as a jury and reaching group verdicts and awards. RESULTS: Juries performed well against benchmarks. Providing gist-based guidance with a meaningful award recommendation increased the validity of jurors' individual damage awards (η²p jurors = .03) and the reliability of jury damage awards (η²p jurors = .04; η²p jurors = .20); gist-based guidance without an award recommendation did not improve performance against benchmarks and increased perceptions of decision-making difficulty (η²p = .13). Deliberation increased reliability of (η²p = .17), confidence in (η²p = .02), and polarization of (d = 2.14) awards compared with predeliberation. CONCLUSION: Juries performed well against objective benchmarks of performance (injury assessment, validity, reliability, and verbatim-gist coherence), and deliberation improved performance compared with predeliberation decisions. Jury decisions were further influenced by attorney closing arguments (the guidance manipulation), especially when the attorney requests a lump sum, which can serve as a powerful influence on jury awards, mainly by setting an upper limit. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Criminal Defense Attorneys and Client Suicide: Survey and Recommendations From Washington State.

The connection between suicide and incarceration is well documented, in particular after recent arrest. Criminal defense attorneys may be one of the few people in meaningful contact with this population, and lawyers have a unique window into their clients' well-being. In this Viewpoint, we explore the experiences of attorneys who work with clients with suicidal thoughts and behaviors. We developed and administered a survey to criminal defense attorneys in the State of Washington, ascertaining their experiences with client suicide. A total of 44 responses were collected, with over 95% of respondents having been concerned about a client's risk for suicide. We conclude that client suicide widely impacts criminal defense attorneys, and lawyers' role with justice-involved clients uniquely positions them to be a potential asset in suicide prevention efforts.

Attorneys' experiences, perceptions, and plea recommendations in child sexual abuse cases.

OBJECTIVE: We examined attorneys' experiences, perceptions, and decisions regarding plea recommendations in child sexual cases. HYPOTHESES: We hypothesized that characteristics of the child (age, relationship to alleged perpetrator) and the report (timing of disclosure, consistency across reports) would affect attorneys' perceptions of evidence strength, likelihood of conviction, and plea recommendations. METHOD: We collected data from a national sample of actively practicing prosecutors (n = 217) and defense attorneys (n = 251) who had experience with child abuse cases. They averaged 18 years of experience practicing law, were slightly more likely to be men (53%) than women, and primarily identified as White, non-Hispanic (86%). In Part 1, attorneys answered general questions about their experiences in child sexual abuse cases. In Part 2, they reviewed materials from a hypothetical case that varied the child's age (5 years, 11 years), the child's relationship to the alleged perpetrator (familial, nonfamilial), the timing of the child's initial disclosure (1 week, 6 months), and the consistency of the child's report (inconsistent, consistent). They rated the evidence strength, estimated the likelihood of conviction, and assessed whether they would recommend that the defendant accept a plea offer or proceed to trial. RESULTS: In Part 1, attorneys reported that they often have access to police reports, information about the alleged perpetrator, and evidence from the child when making plea recommendations. They said that it was important to know about prior allegations against the alleged perpetrator or by the child when assessing their credibility. They reported that the length of the sentence, sex offender registration requirement, and possibility of time served guided their plea recommendations. In Part 2, the consistency of the child's report influenced their decisions the most; they rated the evidence against the defendant as stronger when the child was consistent across reports than when the child was inconsistent. Additionally, their perceptions of evidence strength drove their recommendations. When the evidence against the defendant was stronger, attorneys thought that the defendant was more likely to be convicted at trial; thus, prosecutors were less willing and defense attorneys were more willing to recommend a plea. CONCLUSION: Similar to other cases, evidence strength and the perceived likelihood of conviction drive attorneys' decisions to offer or recommend a plea to a defendant in a child sexual abuse case. The consistency of the child's report plays a major role in predicting perceptions of evidence strength. Future research is needed to determine which other factors in child sexual abuse cases may also predict attorneys' perceptions and plea recommendations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Attorney demands for protected psychological test information: Is access necessary for cross examination or does it lead to misinformation? An interorganizational* position paper.

Objective: Some attorneys claim that to adequately cross examine neuropsychological experts, they require direct access to protected test information, rather than having test data analyzed by retained neuropsychological experts. The objective of this paper is to critically examine whether direct access to protected test materials by attorneys is indeed necessary, appropriate, and useful to the trier-of-fact. Method: Examples are provided of the types of nonscientific misinformation that occur when attorneys, who lack adequate training in testing, attempt to independently interpret neurocognitive/psychological test data. Results: Release of protected test information to attorneys introduces inaccurate information to the trier of fact, and jeopardizes future use of tests because non-psychologists are not ethically bound to protect test content. Conclusion: The public policy underlying the right of attorneys to seek possibly relevant documents should not outweigh the damage to tests and resultant misinformation that arise when protected test information is released directly to attorneys. The solution recommended by neuropsychological/psychological organizations and test publishers is to have protected psychological test information exchanged directly and only between clinical psychologist/neuropsychologist experts.

Large language models as tax attorneys: a case study in legal capabilities emergence.

Better understanding of Large Language Models' (LLMs) legal analysis abilities can contribute to improving the efficiency of legal services, governing artificial intelligence and leveraging LLMs to identify inconsistencies in law. This paper explores LLM capabilities in applying tax law. We choose this area of law because it has a structure that allows us to set up automated validation pipelines across thousands of examples, requires logical reasoning and maths skills, and enables us to test LLM capabilities in a manner relevant to real-world economic lives of citizens and companies. Our experiments demonstrate emerging legal understanding capabilities, with improved performance in each subsequent OpenAI model release. We experiment with retrieving and using the relevant legal authority to assess the impact of providing additional legal context to LLMs. Few-shot prompting, presenting examples of question-answer pairs, is also found to significantly enhance the performance of the most advanced model, GPT-4. The findings indicate that LLMs, particularly when combined with prompting enhancements and the correct legal texts, can perform at high levels of accuracy but not yet at expert tax lawyer levels. As LLMs continue to advance, their ability to reason about law autonomously could have significant implications for the legal profession and AI governance. This article is part of the theme issue 'A complexity science approach to law and governance'.

A survey of what legal populations believe and know about inattentional blindness and visual detection.

Inattentional blindness refers to when people fail to notice obvious and unexpected events when their attention is elsewhere. Existing research suggests that inattentional blindness is a poorly understood concept that violates the beliefs that are commonly held by the public about vision and attention. Given that legal cases may involve individuals who may have experienced inattentional blindness, it is important to understand the beliefs legal populations and members of the community have about inattentional blindness, and their general familiarity and experience with the concept. Australian police officers (n = 94) and lawyers (n = 98), along with psychology students (n = 99) and community members (n = 100) completed a survey where they: a) stated whether an individual would have noticed an event in six legal vignettes, b) rated whether factors would make an individual more, less, or just as likely to notice an unexpected event, c) reported their familiarity with and personal experiences of inattentional blindness, and d) indicated whether they believed individuals could make themselves more likely to notice unexpected events. Respondents in all populations frequently responded "yes" to detecting the unexpected event in most legal vignettes. They also held misconceptions about some factors (expertise and threat) that would influence the noticing of unexpected events. Additionally, personal experiences with inattentional blindness were commonly reported. Finally, respondents provided strategies for what individuals can do to make themselves more likely to notice of unexpected events, despite a lack of evidence to support them. Overall, these findings provide direction for where education and training could be targeted to address misconceptions about inattentional blindness held by legal populations, which may lead to improved decision-making in legal settings.

What medical-legal partnerships can do for trauma patients and trauma care.

ABSTRACT: Trauma patients are particularly vulnerable to the impact of preexisting social and legal determinants of health postinjury. Trauma patients have a wide range of legal needs, including housing, employment, debt, insurance coverage, and access to federal and state benefits. Legal support could provide vital assistance to address the social determinants of health for injured patients. Medical legal partnerships (MLPs) embed legal professionals within health care teams to improve health by addressing legal needs that affect health. Medical legal partnerships have a successful track record in oncology, human immunodeficiency virus/acquired immune deficiency syndrome, and pediatrics, but have been little used in trauma. We conducted a scoping review to describe the role of MLPs and their potential to improve health outcomes for patients with traumatic injuries. We found that MLPs use legal remedies to address a variety of social and structural conditions that could affect patient health across several patient populations, such as children with asthma and patients with cancer. Legal intervention can assist patients in obtaining stable and healthy housing, employment opportunities, debt relief, access to public benefits, and immigration assistance. Medical legal partnership structure varies across institutions. In some, MLP lawyers are employed directly by a health care institution. In others, MLPs function as partnerships between a health system and an external legal organization. Medical legal partnerships have been found to reduce hospital readmissions, increase treatment utilization by patients, decrease patient stress levels, and benefit health systems financially. This scoping review outlines the potential of MLPs to improve outcomes for injured patients. Establishing trauma-focused MLPs could be a feasible intervention for trauma centers around the country seeking to improve health outcomes and reduce disparities for injured patients.

An offer you cannot refuse: Plea offer size affects innocent but not guilty defendants' perceptions of voluntariness.

OBJECTIVE: We examined whether various plea outcomes-including sentence reduction size (smaller, larger), type (traditional guilty plea, Alford plea), and frame (plea discount, trial penalty)-differentially affected innocent and guilty defendants' perceptions of the voluntariness of their guilty pleas. HYPOTHESES: We hypothesized (1) guilty defendants would rate guilty pleas as more voluntary than would innocent defendants; (2) defendants would rate larger sentence reductions either as more voluntary than smaller sentence reductions because they feel more fair or as less voluntary because they feel harder to reject; (3) defendants would rate guilty pleas as more voluntary when the plea offer was framed as a discount compared with a penalty; (4) penalty framing would differentially affect defendants offered large versus small sentence reductions; and (5) Alford pleas would differentially affect guilty versus innocent defendants. METHOD: Adults from Qualtrics Research Panels (N = 1,518; Mage = 59.22 years; 52% male; 83% White, non-Hispanic) played the role of a defendant in a simulated plea decision-making process. They were either innocent or guilty of the accusation. The prosecutor offered them a plea deal that varied in sentence reduction size (smaller, versus larger), type (traditional versus Alford plea), and frame (plea discount versus trial penalty). Participants then decided how to plead and rated the voluntariness of the decision-making process. RESULTS: Plea outcomes affected innocent and guilty defendants in slightly different ways. Innocent and guilty defendants were less likely to plead guilty when the plea offer had a smaller compared with a larger sentence reduction. However, innocent defendants were less likely to plead guilty overall, required more prompting from their defense attorney to plead guilty, and rated the plea decision-making process as less voluntary than did guilty defendants. Innocent defendants also rated the plea decision-making process as less voluntary when offered a smaller compared with larger sentence reduction and when they were offered an Alford plea compared with a traditional guilty plea. Framing the plea offer as a discount or a penalty did not affect defendants' perceptions of voluntariness. CONCLUSION: Variations in plea outcomes affect defendants' perceptions of voluntariness. Moreover, at least some courts' definitions of voluntariness do not align with how laypeople-and thus, possible defendants-view the same construct. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Association between hours of work and subjective well-being. How do physicians compare to lawyers and accountants?

Analyses of physician well-being typically rely on small and unrepresentative samples. In April 2011, the UK Office for National Statistics incorporated subjective well-being metrics (SWB) into the Annual Population Survey (APS), a well-established survey. This survey includes variables from the labor market, making APS an ideal source for measuring the association between work hours and SWB metrics and comparing among different professionals. Using APS data from 2011/12 to 2014/15, this study examined the association between SWB levels and work hours using multiple linear models for physicians (primary care physicians and hospital doctors), lawyers, and accountants. Of the 11,810 observations, physicians were more satisfied, happier, and less anxious; females were more stressed (10.7%); and age was negatively associated with happiness and satisfaction. Incorporating information on preferences to work more hours (underemployment) did not affect physicians' but worsened the well-being of other professionals (lawyers and accountants). Surveyed physicians were less anxious, happier, and more satisfied than lawyers or accountants before Covid. Although the total work hours did not alter the SWB metrics, overtime hours for other professionals did. Increasing the working hours of underemployed physicians (with appropriate compensation) could be a relatively inexpensive solution to tackle the shortage of health workers in the short run.

Exploring how attorneys address grooming in criminal trials of child sexual abuse.

Grooming is a common tactic among perpetrators of child sexual abuse (CSA). It is important that grooming is addressed in court to explain the unintuitive ways a child may act when they have been victims of abuse. The present study draws upon 134 transcripts of CSA criminal trials to establish how attorneys talk about grooming in court. Only 1.8% of attorney's questions addressed grooming behaviors. The majority of these focusing on exposure to pornography (27%) or boundary pushing (19%). Invitations elicited the most productive reports of grooming from children. There was a statistically significant difference in the proportion with which defense and prosecuting attorney's raised grooming issues, with prosecutors raising grooming issues more often than defense attorneys. We suggest that attorneys consider devoting proportionally more time to addressing grooming in court, to help jurors demystify common myths surrounding CSA.

Integrating Lawyers Into Perinatal Care Teams to Address Unmet, Health-Harming Legal Needs.

Across the United States, historically imposed structural, social, and environmental variables are intimately connected to poor obstetric outcomes and high maternal and infant mortality rates among Black pregnancy-capable people. Efforts to diminish the effect of these variables include integrating screening for social determinants of health during the perinatal period and treating them with social services, mental health support, and other referrals, including connections to community-based resources. Although helpful, some of these social determinants cannot be overcome without legal advocacy. Medical-legal partnerships, which integrate lawyers into health care, fill this gap. This commentary by an interprofessional team of authors relies on the experience of an established MLP. We posit that unmet legal needs of perinatal patients merit ongoing monitoring and intervention. We explain the rationale for perinatal practice medical-legal partnerships and share implementation suggestions from a high-intensity safety-net urban hospital.