Experts in the field of forensic sleep medicine explain their role and how clinicians can apply this perspective to their practice.
Sleep medicine clinicians serve an important purpose in treating patients with sleep disorders and improving their quality of life. However, there is another important area where these subspecialists can offer their expertise: criminal investigations.
“Forensic sleep medicine involves using my expertise in sleep medicine in a variety of legal cases,” says David Brodner, MD, owner of The Center for Sinus, Allergy, & Sleep Wellness. Brodner, double board certified in sleep medicine and otolaryngology-head and neck surgery, was recently elected president of the Forensic Expert Witness Association (FEWA) Florida Chapter, where he hopes to promote the importance of expert witnesses services, engage more professionals to take interest in forensics, and help his FEWA chapter expand to include more clinicians.
Most forensic sleep medicine consultants won’t discuss the specifics of cases on which they have personally worked. But to see examples of forensic sleep medicine in action, one only needs to look to the mainstream media. For example, the Atlanta Journal-Constitution reports that the murder trial of Claud McIver may include expert opinion that McIver has been diagnosed with a parasomnia that could have caused him to pull the trigger upon awakening. Other forensic sleep medicine scenarios include defendants saying they were asleep during the commission of an assault or when behind the wheel in a crash.
Brodner describes some of the forensic tasks he’s undertaken. “I perform medical exams where an independent practitioner is needed to evaluate a patient and render an opinion that is used in the proceedings,” he says. “I serve as an expert witness for the field of sleep medicine and am utilized by attorneys to review medical records and provide an opinion in written or verbal form on record; and ultimately, if it progresses, I would play a part during a deposition or a trial.”
A unique aspect of the job, according to Brodner, is the ability to help veterans and current military members who have sleep-related problems like sleep apnea or insomnia and need to determine if the disorder was caused by post-traumatic stress disorder. “I help veterans who suffer from sleep issues caused by military service to get the proper disability payment,” he says.
Even if clinicians don’t picture themselves being involved in any legal cases, there are benefits to seeing patients through the lens of forensic sleep medicine. Brodner says clinicians can “take it as a way of viewing their patients and their symptoms, and how their daily life can be affected by their disorder.
“The role of forensics is to direct their thoughts in other directions. For instance, the bus drivers in my county have to be screened annually for certain health problems like sleep apnea. And if they have it, they need to be treated since they are driving the kids around in the school buses [in part to avoid a legal case arising from a crash]. That’s something a sleep medicine clinician working in the office setting may not think about.”
Parasomnia expert Carlos Schenck, MD, is a consultant for Sleep Forensic Associates, where the website includes brief descriptions of historical case studies in which forensic sleep medicine has played a role. “Documentation is very important,” says Schenck, who is also a member of the Minnesota Regional Sleep Disorders Center. For parasomnia patients, Schenck says it is important to get the participation of the patient’s partner/spouse in observing the patient’s nocturnal behavior and for the clinician to keep thorough documentation of these observations, “especially if there is a future claimed parasomnia episode with medical-legal consequences.”
Brodner believes working in forensics helps him in the clinical setting. He says, “It gets me to research the latest literature to know what the most cutting edge-info is about a specific health problem. So, doing non-clinical work actually helped me become a better clinician.”
Dillon Stickle is associate editor of Sleep Review.