Medical Evaluation of Daniel Yeh

March 2, 2006

REPORT ADDENDUM TO:

 SEQ CHAPTER \h \r 1

NAME:                        Daniel Yeh, Ph.D.

MRN:                          16760262

DOB (Age):               04/27/1953 (52)

DOE:                           02/09 & 13/2006

REFERRED BY:       Mr. Robert Bennett, attorney
                             Bennett Law Firm
                             Houston, Texas

DIAGNOSIS:            Dementia in conditions classified elsewhere,
                             secondary to brain tumor (294.10; 239.6)

To Whom It May Concern:

Given the recent joint telephone conversation I participated in, along with Mr. Robert Bennett & Ms. Sherri Katz, from Bennett Law Firm, the Assistant United States Attorney (AUSA), Mr. Gregg Costa, and Special Assistant United States Attorney (SAUSA), Mr. Jason Varnado, on Wednesday, March 1, 2006, I am preparing this addendum to my clinical report regarding Daniel Yeh, completed on February 13, 2006.  During the telephone conversation, it is my impression that the prosecutor misinterpreted my conclusions and recommendations due to taking several of the comments in my report out of context.  I am writing this Report Addendum in an attempt to clarify those perceived mis-understandings.  To begin with, I would like for it to be understood that my report was written for clinical purposes and not for legal proceedings.  As such, the goal of the report is to provide a picture of both weaknesses, or deficits, and strengths, so that the patient and his/her family have some hope for the future.

Specifically, in regards to the section of my report under "Neuropsychological test results" within the paragraph:

"(page 7) Language.  Sight reading revealed average estimated premorbid verbal intellectual skills, although less than expected given his educational attainment; his poorer than expected performance was related to difficulty accurately pronouncing certain phonemes.  Completion of the Western Aphasia Battery revealed intact repetition (with the exception of lengthy phrases), intact sentence completion, and intact basic spelling.  However, mild deficits were evidenced on tests of basic yes/no comprehension (for example:  Will paper burn in fire? client responded "no") and comprehension of sequential commands as the length and complexity of the command increased.  Reading and reading comprehension were intact.  His ability to comprehend mildly complex ideational material was impaired for his age.  His performance on a timed test of his ability to read, comprehend, and select the one word that spoiled the meaning of the sentence was significantly impaired in time to completion and in accuracy.  Generative lexical (letter) fluency could not be adequately assessed given that English was not his primary language.  Semantic fluency (generating animal names) was moderately impaired for his age.  Visual confrontation naming was moderately impaired for his age and educational attainment, even compared to norms from Asian men with English as their second language.  His performance improved only mildly when he was allowed to respond in either English or Chinese, his primary language."

1.      The "results section" of my reports includes the specific findings from each individual test comprising the neuropsychological test battery and do not  include any interpretation on my part.  My interpretation of the test results is located within the "summary of test results" section on page one of my report.  The underlined sentence within the above paragraph denotes performance on one test of reading comprehension within the Western Aphasia Battery that assesses very basic reading and reading comprehension in a simple, forced, multiple-choice format and is comprised of only eight questions.  As can clearly be seen from the remainder of this paragraph taken from my report, I clearly state that his performance on all other tests of comprehension in a variety of contexts, was impaired, including his comprehension of even simple "yes or no" questions and more difficult tests of comprehension.  

2.  In regards to my recommendation listed below:

"Recommendation #3.  Given his difficulty with problem-solving, poor judgment, expressive language and comprehension problems, it is recommended that he not be solely responsible for the management of any business operations.  Given the intact nature of his memory, he may function better returning to his prior profession of teaching computer science courses, although he may require a teaching assistant to help manage the tests and grading portions of the class." 

This recommendation was a clinical recommendation and made in reference to the patient's potential capacity to teach following the scheduled surgical resection of his tumor.  As his prior medical records indicated improvement in his neurologic and cognitive symptoms following surgical excision of his two prior tumors, it was reasonable for me to surmise that following this third brain surgery, he may show clinical improvements in his functioning.  However, it must be noted that at the time of cognitive testing and at the time of his alleged criminal behavior (fall of 2005), the tumor in his left frontal lobe was present and had clearly been growing over the previous two years (documented from neuroimaging studies) causing a disruption in his thinking abilities.  In conclusion, my recommendation was understood to be referring to his post-surgical outcome.  Moreover, as can be seen in my report, I stated that he "may function better" in his old teaching position.  I do not state that he could absolutely return to teaching. 

3.  Finally, it is my clinical conclusion, that at the time of the cognitive testing and during the time the tumor was present and growing within the patient's frontal lobe (i.e., the fall of 2005), he was cognitively incapable of making decisions (medical, financial, and business) in his own best interest because he was incapable of understanding the rules regulating his business in regards to FEMA's regulations (which were not a typical and regular part of his business prior to the hurricanes), incapable of comprehending the consequences of his decisions and actions, and incapable of changing his mind once he had made a decision, regardless of the legitimacy of that decision. 

If you have any questions regarding this addendum, please feel free to contact me. 

Sincerely,
Diane M. Mosnik, Ph.D.
Licensed, Clinical Neuropsychologist
Assistant Professor
Department of Neurology