Dr. Hoganstein, SERS Neuropsychologist – 2008

Re-Evaluation 2008

Dr. Hoganstein, SERS Neuropsychologist

(Note: Events are real, names have been changed, and photos are not real professionals described in the story.)

Angela’s re-evaluation in 2007 was done by SERS psychiatrist, Dr. Knutman, who determined that the medical basis of her disability was depression. At that point in time, when she brought new information from her neurologist, oto-neurologist and neuropsychologist, he refused to accept any of the information. In his 2007 report, he stated that she should recover once her personal injury lawsuit was finished.

In 2008, because of a jury award which left Angela with no money, she was distraught because of enormous medical bills she owed as well as insufficient funds from disability to cover her monthly expenses. A friend who was aware of her challenges and situation, offered her a part-time job of 10 hrs/week which she could do working out of her home at her own pace. SERS would not grant her permission to accept the job, stating that it was too similar to her job with the school district because both jobs required using a computer and that her disability which they listed only as depression conflicted with this work.

Her advocate and case manager, Estelle Corbin, contacted an attorney with the Office of Legal Rights and an organization which consisted of retired school employees (RSE). At this time, the attorney sent a letter from her psychiatrist, who provided information saying that this part-time work did not conflict with her disability and would be good for her. A woman from RSE who was upset over the way SERS was treating Angela, was told by them that she did not need SERS’ permission to work and was free to do what she wanted. After SERS received the phone call from RSE and the letter from Angela’s psychiatrist, she received notification that she was being re-evaluated by a neurologist, neuropsychologist and psychiatrist.

The first letter she received told her to show up for neuropsych testing from 9 a.m. – 5 p.m. in a city that was a 90 min. drive from her home. This would be the 5^th time she was tested in 3 ½ years (3^rd in the past 1 ½ year) which is inappropriate, but that is not something they seem to be concerned with. Aside from this, traveling 90 min. each way was difficult for several reasons. First, this would cause Angela to have vertigo and nausea. She would need to take medication for this which makes her drowsy. Second, the effects from traveling and medication would drain her of a lot of energy; an entire day of testing would be difficult for her to concentrate, let alone sit for that long. She typically lies down and rest every couple of hours and needs a lot of head and neck support to cut down on her tremors and migraines. And, third, since it’s not safe for her to drive on the highway and for long periods of time, she would have to find someone to drive her there and back and spend the whole day there while Angela was being tested.

One of her doctors wrote a note stating that the travel and all-day testing would be a physical hardship. Estelle forwarded the note to SERS, as well as phoning them to ask what accommodations could be made. SERS replied that “it wasn’t their problem,” and that Angela would have to find a way to make it work or risk losing her disability. Estelle asked if there was another neuropsychologist who was closer who could do the testing. She was told that they only use two neuropsychologists to do testing for them – Hoganstein and Twittworth. Since Angela had already been tested by Twittworth, that only left Hoganstein which meant traveling 1 ½ hrs.

When Angela heard this, she was very distressed. For one reason, Twittworth was the neuropsychologist who had tested her in 2005. Her lawyer had discovered that Twittworth had his license revoked twice for a period of 3 years each time. The second time was right after he had tested her. That meant he must have gotten his license back just recently. Was SERS aware of the quality of professional they hired?

The other reason for her distress was that Hoganstein had been the neuropsychologist hired for the defense against a person she had met in the local brain injury support group. Having experienced the world of “medical whores,” doctors who are hired to render a point of view which benefits those who hire them, she was suspicious and doubtful that this person would render an “independent” evaluation. What were the odds that this person was totally neutral and above board when SERS hired only 2 neuropsychologists to do testing for them and one of them was someone of Twittworth’s caliber?

The drive to Dr. Hoganstein’s office was very taxing. Melinda, Angela’s caregiver, had drove her there. It took 2 hours to reach the university campus where Hoganstein’s office was located. After finally finding where to park, they discovered that the building was 2 blocks away. Angela had only brought her walker which she use to walk short distances. Fortunately, Melinda had a cell phone and called Hoganstein’s office explaining that they had arrived, but were going to have problems figuring out how to get Angela to the office which was too far for her to walk. Fortunately, they were able to send a van to pick them up. Melinda borrowed one of the wheelchairs that was located inside the door as they came in so she could transport Angela to Hoganstein’s office on an upper level.

Angela was not in very good shape when they got there. She only had 2 ½ hours of sleep, was feeling sick and dizzy from the car ride, and the whole ordeal of finding the parking lot and figuring out how to get to the building had been very taxing. To the point that her tremors were quite pronounced and she could feel a migraine coming on.

The next problem Angela and Melinda encountered was quite a surprise. When they finally found the testing office, the wheelchair could not enter Hoganstein’s office! They had to wait as the receptionist moved chairs and tables around in the waiting room area so that the wheelchair and Angela could enter the office! Something one would not have expected from a university department which tests people with disabilities.

The psychometrist, the person who administered the tests, began the testing with a lot of fine motor tests and math problems that had to be done without paper or pencil. Angela’s tremors made the fine motor tests very frustrating. The math wouldn’t have been so bad if she could have used paper and pencil. Trying to hold all that information in her head was very challenging. Then the psychometrist pulled out some blue blocks, telling Angela to touch them in the same pattern she modeled. Everything went pretty well until they progressed to touching 5 blocks. Although they were only into about 1 ½ hours of testing, that was enough to push Angela over the edge.

The lack of sleep, the tremors and migraine…Angela felt like her brain was a sieve and the harder she tried to remember things, the faster it seemed to run out of her head. She had a melt down. Though she knew it was best to be calm and cooperative, her head was swimming with information overload, a migraine, fear and paranoia. Her eyesight was so blurry, it felt as if someone had rubbed Vaseline all over her eyes. And she was in desperate need of sleep.

Emotions got the best of her as she started crying and screaming. “I can’t do, I just can’t do it. There’s too much stuff in my head. This is all just a bunch of bull-shit, and if you don’t move those f*&&!@$ blue blocks off this table I’m going to pick them up and start throwing them!!!” She was embarrassed at being so out of control and couldn’t stop crying. “I need a nap. I just need a nap!” she told the psychometrist.

The tester had Melinda come back to the room to help Angela calm down. After taking a little break, the psychometrist asked if Angela wanted to take an early lunch break or do a few more tests. Angela knew there was a lot more to go, so she asked if they could do a few easy tests, that didn’t involve blocks, and then take a break. After getting through those, they stopped for lunch. Angela was much more interested in sleeping and asked if there was somewhere she could lie down. She was told that they really didn’t have anywhere. Angela asked if they had a room that was not being used. They did, and so Melinda helped her get comfortable on the floor where she slept the entire 1 ½ hours that was designated for a lunch break.

After waking up, Angela was given some more tests and then Dr. Hoganstein came in to interview her. She felt like she said all the wrong things. Like when he asked why SERS sent her to see him, she replied “Because they’re out to get me.” She did admit to him that probably sounded a bit paranoid.

She didn’t feel like she had very good judgment any more. With the difficulties she had organizing her thoughts, she knew the physical and emotional exhaustion made it even more difficult to stop and think about what she said. Any semblance of thinking and control disappeared and she blurted out whatever was in her head. It wasn’t not until after she rested and thought about what she had said or had the opportunity to talk with someone else that she was able to figure out other ways of responding. She knew that people who don’t have brain injuries can have difficulty with this, but this was not something that she had problems with before. Before her brain injury, she could get up in front of a large audience to do a presentation at a conference without notes, while handling questions from the audience and easily transition back to her presentation.

After a couple hours of more testing, Angela could barely see which made reading difficult. And she was having a hard time comprehending. Angela asked, “How many more tests? I don’t think I can get through any more.” The familiar sharp pain going from her neck up the lower part of the inside of her head was a strong reminder that she need to lie down flat and sleep for a while. The psychometrist read her the 500+ questions from the MMPI while Angela laid her head on the table to try to find relief from the pain.

“I need to stop. I just don’t think I can do any more. The pain is getting worse and I need to lie down and sleep. I need to go home,” Angela pleaded.

“Well, if you really don’t think you can do any more,” the tester said tentatively.

“No, I can’t.” With that the psychometrist left to get Melinda who brought the wheelchair to the doorway for Angela. It wouldn’t fit into the testing room. Angela scooted the rolling chair she was sitting in to the doorway, stood up and tried to take a couple of steps to transfer to the wheelchair. As she tried to walk, her legs felt like concrete blocks. She focused her attention intently on her legs, willing them move, but her whole body went into tremors and she collapsed.

People in the office ran to help her, but she didn’t want their help. She wanted someone she knew and trusted. Angela knew what to expect when it progressed to this level. As she tried to get up, she couldn’t figure out what to do first. She was also having difficulty getting more than a couple of words out at one time. “Melinda…purse…cards,” she said. Hanging on Angela’s purse were laminated cards for a person to read to her explaining how to get up off the floor. One of Angela’s physical therapists helped come up with these directions to use when she had problems with motor planning.

With one person holding the wheelchair in place and Melinda reading the steps for how to get up, Angela managed to get herself into the wheelchair. Melinda wheeled her downstairs, placed her in a quiet corner and left to get the car. It took Angela four days to recover.

© Angela Cramer, 2008-2009