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Dr. Raffle is a Board-Certified Forensic Psychiatrist who has practiced clinical and forensic psychiatry for more than 30 years. He has presented his expert medical opinion in over 5,000 cases in Federal and State jurisdictions and to employers and insurers nationwide. Dr. Raffle has been Assistant Clinical Professor of Psychiatry at U.C. San Francisco Medical School for more than 25 years and for 11 years has taught attorneys at San Francisco’s Hastings Law School Post-Graduate Program on Trial and Appellate Advocacy on the direct examination and cross-examination of expert witnesses. For more information on Dr. Raffle’s background, see his Curriculum Vitae.
Dr. Raffle’s practice is client-centric. By limiting the number of cases he undertakes, he can devote the same individualized level of attention to his forensic psychiatry cases as he does to his clinical practice. At the same time, his knowledge and long experience with a broad range of psychiatric disorders enables him to rapidly master the information on a case with a high level of efficiency, ensuring an accurate diagnosis in a timely fashion. In most cases, he will prepare a report five to seven days after an examination.
Dr. Raffle has extensive experience assessing:
Dr. Raffle has testified in approximately 150 trials and more than 500 depositions. His calm demeanor and experience as a teacher and expert witness enable him to present relevant case information in a way that is understandable and credible to jurors. As a psychiatric expert operating in a legal context, Dr. Raffle can provide his legal clients with litigation support, helping them prepare examination and cross-examination of expert witnesses, and also provide attorneys with an understanding of the case from a medical point of view. Dr. Raffle has worked with attorneys for the plaintiff and defendant in equal measure.
Following his psychiatric examinations, Dr. Raffle applies his diagnostic skills to write clear and concise reports, fully supported by data and explanatory material. He works in a highly collaborative fashion with his clients—attorneys, insurers, employers—to help them understand complex processes related to psychiatry and the law. His knowledge of the legal issues the psychiatrist must address and answer specifically as set out in such laws as Title VII of the Civil Rights Acts, FMLA, and the Americans with Disabilities Act enables him to provide his clients with useful information and advice that is accurate and relevant.
Dr. Raffle’s Articles reflect his experience on a range of subjects. As a forensic psychiatrist and expert witness of many years, Dr. Raffle’s comments on The Role of the Expert in the Courtroom, are insightful. Client feedback tells us Dr. Raffle’s How to Read a Psychiatric Report has found a wide audience. Dr. Raffle’s skill and experience give him much to write about—keep checking for new articles.
To learn how Dr. Raffle can help you with your case or employee concerns, please call his office at 415.461.4845, email him from this site, or your email account at rafflemd@pacbell.net.
By Stephen M. Raffle, M.D.
Mental and emotional injuries in employment litigation are damages usually sought by plaintiffs. These damages are generally subsumed under the category of “emotional distress” by which is included mental suffering, mental anguish, or mental or nervous shock as well as “all highly unpleasant mental reactions such as fright, horror, grief, shame, humiliation, embarrassment, anger, chagrin, disappointment, worry, and nausea.” Also included under emotional distress would be modification of dignity and physical pain. Generally speaking, emotional distress damages occur because the affected individual has suffered a loss of enjoyment of life Continue reading… »
By Stephen M. Raffle, M.D.
Assessment of the impact of undue influence and its effect on limiting a person’s free will in making choices falls within the purview of the forensic psychiatrist. I have evaluated both civil and criminal matters on the issue of undue influence, including cults, but usually within the rubric of testamentary capacity. Continue reading… »
By Stephen M. Raffle, M.D.
(Sometimes Spelled Posttraumatic Stress Disorder)
Post-Traumatic Stress Disorder (PTSD) is a psychiatric condition originally diagnosed in soldiers. The earliest description was in the Crimean War. Since then it has had a variety of names attached to it such as shell shock (World War I) or war neurosis (World War II). It is an anxiety disorder arising as a result of an emotionally overwhelming experience. The symptom complex commonly includes nightmares that recapitulate the traumatic event, recurrent intrusive thoughts about the event, phobias (overwhelming fears) when the person is exposed to a situation reminiscent or resembling the traumatic event, and unbidden intrusive thoughts about the event. Continue reading… »
By Stephen M. Raffle, M.D.
There are a disproportionate number of plaintiffs who have Borderline Personality Disorders than exist in the overall population, due to the nature of their behavioral traits. Continue reading… »
By Stephen M. Raffle, M.D.
The question of testamentary capacity traditionally arises within the context of the execution of a Will. I have performed many types of evaluations around this question:
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I have assessed Individuals who were preparing to execute a Will and whose attorney wanted to ensure that the client was of sound mind and competent to undertake the endeavor. A significant part of my evaluation is assessing the issue of undue influence on a person’s decisions. |
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I also have performed many assessments of individuals who have executed Wills where their testamentary capacity and vulnerability to undue influence was an issue. In this case, the testator (the person who made the Will) may have since developed dementia or passed away. In order to perform this type of evaluation, it is usually necessary to read extensive medical records and interview people who knew the person at or around the time the Will was drawn. A psychological reconstruction is then performed based upon the available evidence. With sufficient evidence, I am able to reach a medical opinion as to the individual’s capacity to execute the Will. |
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There have been occasions when codicils have been appended to a Will, which were then challenged. It was my task then to assess not the individual’s testamentary capacity but rather the testator’s capacity to enter into a contract. A codicil is the amending of a contract—a Will in this case–which may be a very long and complicated document. It is important to distinguish if testamentary capacity or capacity to enter into a contract is the actual issue being evaluated. |
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By Stephen M. Raffle, M.D.
Beginning in my residency and continuing thereafter, I have been interested in learning about neurological disorders which cause psychopathology. From 1971-1975 I was the neuropsychiatric consultant to the neurological rehabilitation unit at Herrick Hospital in Berkeley, California, and thereafter I treated mental disorders of patients who had neurological diseases. Years later, as part of my practice I was a neuropsychiatrist at Kentfield Rehabilitation Hospital, a facility which mainly treats neurologically impaired patients.
Assessment for forensic purposes of the impact of traumatic brain injury (TBI) on an individual’s functioning usually requires a multidisciplinary approach. The evaluative team should include a psychiatrist who is experienced with the evaluation and treatment of TBI, a neurologist with similar experience, and a neuropsychologist who also is clinically involved in the evaluation and treatment of TBI. Continue reading… »
By Stephen M. Raffle, M.D.
“Dangerousness” has three constituents: the assessment of risk (”risk factors”), the type of violence being predicted (”harm”) and the likelihood harm will occur (”risk”). Continue reading… »
By Stephen M. Raffle, M.D.
False memory syndrome may occur in a variety of settings, many of which end up in litigation. The litigation may be either civil or criminal. The false memory itself usually occurs during psychotherapy when the therapist suggests to patient that a particular event might have occurred or must have occurred, based upon the patient’s emotional response to a block in memory or a recollection. It is the process of suggestion in a susceptible person that creates the false memory, which then leads the patient to accuse another person of a wrongdoing that he did not commit. Continue reading… »
By Stephen M. Raffle, M.D.
Malingering may occur for many reasons, usually involving self-preservation, but in a forensic context it occurs as an attempt to obtain money by lying. The essential characteristic of malingering is a person’s knowledge that a claim is not true; nevertheless the claim is asserted strongly or with a great deal of attention-getting behavior. Continue reading… »
By Stephen M. Raffle, M.D.
There is no limit on the amount a jury may award for emotional distress. The only guidance for the jury is an amount a reasonable person could possibly estimate as fair compensation. Although a psychiatrist may not testify to the ultimate issue of the value of emotional distress damages, still he is permitted to provide useful information to the jury. Continue reading… »
By Stephen M. Raffle, M.D.
Once liability is established for any tortious act such as those in the caption as well as Wrongful Termination, the issue of damages arises. The damages may be expressed in a number of ways but they generally constitute “emotional distress.” Emotional distress may be measured by the need for psychological treatment or the impact on social functioning.
Many different psychiatric illnesses may arise as a result of these tortious acts. Continue reading… »
By Stephen M. Raffle, M.D.
Discharge is considered wrongful when it occurs as a breach of public policy. The public policy is expressed in the statutes of various (but not all) states, some state constitutions, and policies which forbid retaliation against an employee who has acted in a way the public would encourage, or not acting in a way the public would forbid. Continue reading… »
By Stephen M. Raffle, M.D.
The assessment of risk or threat of violence at the workplace or elsewhere is a difficult undertaking at best. During the course of over 30 years of psychiatric practice, I have examined approximately 150 murderers to determine whether or not some emotional component might mitigate their actions, the mens rea dimension of guilt. These assessments have provided me with a personal clinical experience for assessing the potential for violence and other anti-social behaviors. A considerable literature exists on this topic with which I am familiar. I use both actuarial and clinical approaches, and I have been assisted by certain psychological tests in making a determination of level of risk for violence at the workplace or elsewhere. Public agencies I have consulted for include the U.S. Postal Service, Department of Defense, Nuclear Regulatory Commission, various municipalities, and various State agencies such as water boards and transit services. I also have consulted with the Lawrence Livermore Laboratory, Department of Energy, Department of Treasury, and the U.S. Coast Guard. Numerous private employers also have requested assessments of employees. My best testament is I have performed in excess of 500 such examinations; some of them I assessed a high risk or very high risk rating and those predictions have on occasion proven to be unfortunately accurate. To date, no person I have assessed at a minimal, low, or medium risk ever has acted out in a violent fashion. I am gratified to know that the accuracy of my assessments has in many cases been a useful tool of prevention. Continue reading… »
By Stephen M. Raffle, M.D.
Fitness for Duty examinations are asked for in my practice relatively frequently, and I have performed more than a thousand, for both public and private entities. Sometimes the exam is requested as a pre-employment evaluation because there is a past history of psychiatric illness. On other occasions, an employee has been taken off of work by a treating mental health professional, and the employer wants an independent evaluation of the employee before returning the person to work. Continue reading… »
By Stephen M. Raffle, M.D.
The U.S. Department of Health & Human Services estimates 1 out of 7 females is sexually molested at some time in their lives. In general, the younger the age of molestation, the greater the damage. Sometimes the damage is repressed, that is, the person puts it out of awareness but always remembers it. Continue reading… »
By Stephen M. Raffle, M.D.
Toxic exposure to certain substances is one of the causes of dementia. Please refer to my discussion of Traumatic Brain Injury and Other Dementias which touch on many of the same issues as dementia as a result of Toxic Exposure.
By Stephen M. Raffle, M.D.
Catastrophic Injuries—Traumatic Brain Injuries (TBIs) Post-Traumatic Stress Disorders, and similar events—are a significant aspect of my practice. A catastrophic injury usually involves an element of brain injury. Diverse questions therefore are raised regarding the injured person’s competence to manage funds as well as the need for caregivers, the prognosis, emotional impact/distress (on the individual as well as the family/network), level of chronic pain, the need for treatment, testamentary capacity and undue influence. Continue reading… »
By Stephen M. Raffle, M.D.
As a forensic consultant, I have frequently been asked to review medical records of an individual who is involved in a lawsuit and to provide consultation to attorneys as to what I find in the medical records that is relevant to the plaintiff’s alleged injury. Upon request, I am prepared to do this without preparing a written summary; if so requested, I will prepare a written summary for the referring party.
By Stephen M. Raffle, M.D.
As a forensic psychiatrist, I have been deposed about 500 times and been examined in about 150 trials. Because my field is so specialized, I believe it is one of my duties to assist attorneys in preparing cross-examination questions so the attorney can obtain the necessary information about psychiatric damages in order to understand the case better. Expert witnesses by their very nature are permitted to testify because they know and understand a body of knowledge that laypeople are not expected to know. Attorneys are laypeople as far as psychiatry is concerned Continue reading… »
By Stephen M. Raffle, M.D.
Insanity is a legal concept, not a medical diagnosis. Historically, the Sharia, in Moslem law, may be the earliest example of a lesser punishment of a person who commits a homicide while in an altered mental state. Both children and “lunatics” are considered unable to intend to kill another and so a homicide by either was deemed unintentional, punishable only by a fine. Intentional or unintentional homicide is punishable by death.
With the rise of humanism, the enlightenment, and the acceptance of the scientific method in Western cultures, a greater acceptance arose that a verdict of murder required both the act of killing another human being (actus reus) and the ability to have a guilty mind (mens rea). This is more or less the state of affairs today. Continue reading… »
By Stephen M. Raffle, M.D.
It is not possible to discuss Diminished Capacity without first understanding the legal concept of insanity since both are joined at their ideological hip by mens rea. Diminished Capacity, like insanity, is a legal concept not a medical diagnosis. I have discussed insanity in another section and will not repeat myself here.
The overarching principle of diminished capacity is that an accused’s level of responsibility for committing an illegal act is reduced because a mental disease or defect diminished his ability to form the intent to commit the act. The act itself must be in the “specific intent” category of crimes, such as murder.
Some law-and-order social philosophers and moralists have objected to the concept of Diminished Capacity because it creates a nuanced grey area of relative wrongdoing. Continue reading… »
By Stephen M. Raffle, M.D.
The mind affects the way the body functions just as the body affects the way the mind functions. Psychosomatic Medicine is the study of this interrelationship. Certain aspects of this field are commonly accepted, such as the role of chronic anxiety on blood pressure; other aspects of it are in dispute or are areas of controversy, such as the role of chronic stress in the development of autoimmune disorders. With rare exceptions, the field of psychosomatic medicine is best addressed by a psychiatrist because psychiatrists are medical doctors. Continue reading… »
By Stephen M. Raffle, M.D.
I taught in the Department of Orthopedic Surgery at the University of California, San Francisco, School of Medicine for 15 years as an Assistant Clinical Professor of Orthopedics in my specialty of Psychiatry. My interest and focus of teaching was the emotional impact of chronic pain on patients. At the Back Clinic, I worked with medical students, interns, and residents in evaluating many hundreds of patients to help the treaters understand the effect chronic pain has on an individual. We also looked at the impact of psychopathology on the perception of pain. My instruction was directed at a clinical level, although some of the patients reevaluated were involved in medico-legal controversy. Continue reading… »
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