(Automatic transcript - may present inaccuracies)

>> Good evening, ladies and gentlemen. In cooperation with the New York Academy of Medicine we bring you another of the season's Lectures to the Laity. The lectures presented by the Academy are open to the public free of charge and are held at the auditorium of the Academy in New York City from which we are now broadcasting. The lectures are intended to bring to the layman knowledge and understanding of the new developments in medicine an insight into the processes involved in that development. The lecturers are the scientists whose labors in the many fields come up to this progress in medicine. Their talks, though given in the layman's language, don't sacrifice the precision and the reality of the experiences which add up to the knowledge attained. This season's theme is the reciprocal relations between medicine and the other disciplines. Our speaker tonight is the Honorable David W. Peck, Presiding Justice of the Appellate Division of the New York Supreme Court in the First Department. And now to open the evening's program, here is the Chairman of these Laity Lectures, Dr. Harold Brown Keyes.

>> Dr. Harold Brown Keyes: Good evening, ladies and gentlemen. Again we welcome you here for what I'm sure will be an interesting and inspiring evening. It's my privilege and duty to introduce to you the Chairman of the evening who is the Director of the New York Academy of Medicine, Dr. Howard R. Craig who, before he came to occupy the enviable position as Director of the New York Academy of Medicine, was in his own name a distinguished physician. If you don't know about the New York Academy of Medicine I'd suggest that you try and get information about it. This Academy contains the second largest medical library in the United States. The only library larger is that of the Surgeon General in Washington, and it is probably as beautiful a library as you will ever see. I suggest you visit it. It is a public library. I now take pleasure in introducing to you Dr. Howard R. Craig, the Director of the New York Academy of Medicine.

>> Dr. Howard R. Craig: Thank you, Dr. Keyes and ladies and gentlemen. Before I go on to introduce the guest of the evening, I would like to first of all express my own appreciation, express my own gratitude, to Dr. Keyes who is the Chairman and Dr. Gallstone who is the Secretary, and to each member of the Committee who, out of their busy and their really consecrated lives have planned and engineered this whole series of lectures as a public service. On this point I'd like to reiterate what I have iterated time and time again that the Academy of Medicine is a public service institution dedicated to the welfare and the health of this whole community. Our work is chiefly in the educational field but we do go into all of the aspects of public health and well being which affect this, our city and our community. Without attempting to assume the role of prophet, I would like to venture to suggest that in the centuries to come the age in which we presently live will be remembered, partly at least, as the period in which the sharp definitions between previously isolated sciences and disciplines, that is the demarcations, became blurred or even evanescent. Time was when Vesalius labored in the field of anatomy; Liebig's limits were those of what we like to call today pure chemistry; Newton and Boyle observed the physical laws of nature. All of these men and many, many others, all working within their own compartmentalized fields. The picture we see today has a very different focus and presents a very different panorama. Chemistry and physics have been wedded, and they have as a legitimate offspring all of the biological sciences. Chemistry is not chemistry anymore without physics and electronics. Biology, which is the study of life, no longer exists in a vacuum but is part of the whole interwoven fabric of all of the natural sciences. Now medicine as a science has its origin in this fabric of natural science. We know that medicine has been described as a science and described as an art. Medicine as an art has grown to be almost as much of a social science as it is a biological science. The art of medicine deals with people and in so doing it is inevitable that the barriers between medicine and the other social disciplines must fade. Medicine with a broad horizon, and I say broad horizon because the horizon of medicine has broadened in the last 25 years, but medicine with this broader horizon must depend on sociology, anthropology, psychology, and the other social sciences. But even moreso in day-to-day practice, in the day-to-day relationships, medicine and law, the ministry, and education approach each other and even impinge on each other. If these professions which I have mentioned are wise, and in general they are wise, and if they are foresighted, I'm afraid they're not always foresighted, cooperation and collaboration between them will go far toward producing that better community for which we all strive. An example of this collaboration is what brings our speaker here with us tonight. He should need no introduction but off the bench many of these judges are very retiring. Our guest tonight comes from the "Banks of the Wabash Far Away." He graduated from Wabash College in Indiana. He graduated with the highest honors from the Harvard Law School where he ran a tutoring class of such proportion that there was occasionally doubt whether the student was enrolled in John Harvard's Law School or in Peck's classes. He then entered practice here in New York, becoming a partner in one of the largest law firms in this city. Only a few years ago he was appointed, and then elected on a bipartisan nomination, to the Supreme Court of this district. After a relatively short period, he was elevated to the Appellate Division and then was presently made Presiding Justice. Noted for the vigor and the clarity of his opinions he has made an outstanding record as a judicial administrator for it should be noted at this point that in his position of Presiding Justice he is responsible for the administration of all of the courts in his First Department. He has striven continuously and aggressively for a reorganization of our courts and also for an equalization of the caseloads within the courts. It is my privilege and my pleasure to introduce my good and my old friend, the Honorable David W. Peck, Justice of the Appellate Division of the New York Supreme Court First Department, who will speak on the subject "Where Law and Medicine Meet." Judge Peck.

[ Applause ]

>> David W. Peck: Dr. Craig, I thank you for a very generous introduction. I would like to have an inscription of it as an epitaph for my tombstone [laughter]. Ladies and gentlemen, law and medicine are not akin, but they have increasingly much in common. Medicine is concerned with the functioning of man as a physical being. Law is concerned with his relationships with other men and society. The connection between the physical being and the social being is obviously a close one. Behavior, which is of equal concern to the doctor and lawyer, certainly cuts across the fields of law and medicine, carving a wide area in which the action of the individual can be weighed, his accountability measured, and society's treatment of him fashioned only by combining, focusing, and harmonizing medical and legal views. We shall roam with it tonight over the fields in which law and medicine meet. We shall see many close contacts and intimate relationships, and we should look ahead to where they might meet, for there are domains of the law which medicine hardly enters, where the employment of medical services could be most useful, and which offer the most challenging opportunities for cooperation between the two professions for the social good. An interesting place to begin our observations is at the beginning of human life. Embryonic life is of major medical cognizance and concern. Until lately, however, the law hardly took notice of the existence of life before birth and its entry into the external world. It was not an existence in legal estimation. Hence, if an infant still in his mother's womb suffered an injury through the negligence of another, resulting in his being born into the world maimed or crippled, there was no right of action against the wrongdoer responsible for the condition and a blighted life. That was the law of New York State by judicial decision until two years ago. Then the law caught up with reality and justice. What is interesting about the case for present purposes is how medical and legal arguments were arrayed together in the assault upon and defense of the old rule. On the one side it was argued medically that it was difficult to prove or disprove how certain injuries befell an unborn child, and legally, that a fetus in utero has no existence of its own apart from its mother, that it was not a being in essence. On the other side it was argued, and the Court was finally persuaded, that the medical facts were no more difficult to ascertain than the facts in many kinds of lawsuits, and that not to recognize legal rights consistent with the actual existence of a viable fetus was to sacrifice fact [inaudible] fiction and perpetuate injustice. Recognition and regard for the medical facts and their importance to the decision of this case were not denied or minimized by the dissenting justices. On the contrary, the connection between law and medicine in the case was emphasized as the dissenting justices expressed the view that if unborn children were to be endowed with rights it should not be by judicial decision on the facts in a single case but rather should be the product of legislative action taken after hearings in which the legislature could be advised with the aid of medical science and research, not only as to the stage of gestation at which a fetus is considered viable but also as to the difficulty of tracing causation from pre-natal injury to post-natal deformity. The most common meeting ground of lawyers and doctors is in the field of personal injury litigation and its offshoot, Workman's Compensation. Indeed the major part of the lawsuits throughout the country are cases of personal injuries arising out of accidents. Here the medical facts and incidents are intimately involved with the law. The legal remedy is largely dependent upon and supposedly responsive to the medical facts and indicated medical remedies. The nature and extent of injuries, the resulting incapacity, the prognosis for recovery, and the medical attention and expense required for healing are questions which are uppermost in many cases and determinative of the award to be made. Medical testimony thus looms large in the trials of personal injury cases and consideration of claims for Workman's Compensation. A man is run down by an automobile. He sues the owner and operator of the car. The first question which a court of law must resolve is who was at fault in causing the accident. Was it fully the negligence of the defendant which caused the accident, in which case the plaintiff is entitled to recover, or was the plaintiff himself partly at fault, in which case he may not recover damages. There may be numerous subsidiary questions of fact which a judge, a jury, must determine in reaching a conclusion as to fault. For example, was the traffic light red or green? How fast was the automobile going? Was it on the right side of the road? Was the injured party looking where he was going? Such questions, and the determination of the responsibility for the accident and consequent liability, are the first consideration of the judge and jury in a personal injury case. If the decision is reached that the injured person is entitled to recover, then the question arises, how much? The how much may be as hotly contested and require as much trial time as the question of fault or liability. And at this point the courtroom is apt to become as much a battleground of doctors as of lawyers. More often than not, the lawsuit which is tried to completion rather than settled along the way, is complicated with a serious dispute about the injuries. The medical facts are not readily ascertainable or, at least, they are not beyond controversy. One doctor is prepared to make one diagnosis and prognosis while another doctor is prepared to make quite a different diagnosis and prognosis. Frequently you would not think that they were talking about the same case, the difference between them exceeding one of degree and becoming even one of the existence of any injury at all such as brain injury or even a skull fracture. Head injuries have become a fruitful field of litigation with the widest disparity in medical testimony because the presence or absence or extent of injury cannot generally be observed or demonstrated, and opinions can stretch with the imagination or interest of the one expressing them. Neurological tests may reveal something, but whether the plaintiff has constant headaches, insomnia, or personality change, is so subjective and impossible of verification as to leave wide room, not only for honest differences of opinion, but for negation, exaggeration, and falsification. The risk in choosing between the real and fanciful and in awarding excessive or inadequate damages may be considerable. In such cases, not only is the credibility and integrity of the plaintiff involved, but also the competency and honesty of the medical experts as well as the scruples of the lawyers. There has been a regrettable tendency on the part of some doctors to specialize in giving expert testimony in personal injury litigation and to become expert testifiers. The emphasis then may not be on objective or independent medical analysis but rather upon personality and pattern to persuade the jury to a view which the doctor has been retained to expound. There has been an equally regrettable tendency on the part of leading medical authorities and practitioners to avoid the courtroom. The retention of medical experts on each side is necessary and desirable, and any doctor should be available. But it is unfortunate if the doctor becomes so aligned with the side which retains him as to share with the lawyer the role of mouthpiece. Judges have long been concerned with the spectacle of doctors expounding diametrically opposing views with respect to injuries and minimizing or exaggerating them as suits the interest of the side which has engaged them. Judges have observed trials stretch out inordinately in a battle between the medical experts, leaving a jury confused rather than enlightened by the testimony. The feeling grew and took hold among the judges of this city that if a panel of true and independent medical experts, men whose authority and integrity could not be questioned, were available at the call of the Court in perplexing cases, much time could be saved and truer verdicts reached. This opinion was expressed to representatives of the bar associations and medical associations, and resulted in the formulation and adoption of a program for making available to the Court outstanding medical men who would serve on a panel of independent experts. The panel, comprising leaders in various branches of medicine, was selected jointly by the New York Academy of Medicine and the New York County Medical Society. It was of the essence of such a program that the doctors called as experts by the Court be beholden to neither side, and it was necessary therefore to arrange for their compensation without requiring either side to make a payment. No funds were available for this purpose. But the Alfred P. Sloan Foundation and Ford Motor Company [inaudible] generously agreed as a public service to underwrite the program as a pilot project for a trial period. The panel has worked out very satisfactorily. Each side is still privileged to retain and call its own experts, but the Court may refer a case to an appropriate member of the medical panel at some time in advance of trial and receive from him a report which is also delivered to counsel for both parties. The results generally have been that the cases have been disposed of in shorter time and on a sounder basis then would be possible if left to the battle of partisan experts as well as partisan lawyers. Indeed, the cases are usually settled on the basis of the independent medical report without the necessity of calling the expert to testify or holding a trial at all. The independent medical panel is thus contributing measurably to speeding up the judicial process, and the judges have no doubt that a healthy byproduct of the plan and of the availability of such a panel is that doctors and lawyers alike, on both sides of a case, are more careful and controlled in their judgments and claims. It is only in a small percentage of the cases that there is occasion to call upon the medical panel. The panel is so useful and valuable, however, not only in the cases where actually employed but also in general influence, that it should be integrated into our judicial system and Court budget. The relatively small cost of doing this would be more than made up by actual savings in Court time and expense, and the returns in better justice would be great. The development of the panel has been a fine example of cooperation between the professions and aid of the courts. And in behalf of the judges I would like to take this occasion to thank Dr. Craig and the officers of the Academy and the officers of the County Medical Society, and the doctors who serve on the panel for their important contribution to the administration of justice. In Workman's Compensation cases the medical aspects are dominant and generally constitute the entire issue, for the underlying philosophy of Workman's Compensation is that cases of injury to working men in the course of their employment should be taken out of disputation and litigation as to fault, and that prompt, certain, and fixed compensation should be provided in accordance with the injury sustained. This still leaves ample room for dispute both as to the nature and extent of an injury and as to the causal connection between the injury and the work. While causal connection between an injury and the work of the person injured is a legal question, it is almost wholly determined by the evidence as to whether there is a medical connection between the work and the injury. A good example of this and of the difficult problems which may arise is the heart cases. When a milkman, for instance, who has been carrying 50 pound crates of milk for many years without any ill effect, one day lifts a crate and suffers a coronary occlusion, the question is whether this is an accident as the doctor views it, and whether it is an accident as the lawyer views it. The testimony and countless records on this subject indicates that there is a sharp difference of opinion among physicians as to whether such a condition could have any accidental connection with the work. The opinion expressed by one group of physicians is that ordinary activity, the work that a man usually does, has nothing to do with the incidence of an acute coronary attack, that experience shows that such attacks are quite as likely or even more likely to happen at rest. Another group of physicians regularly testify that when the underlying physical conditions are right for it, even the ordinary work a man does involving physical effort helps to induce the attack and that it is, therefore, an accident. It is interesting to note the number of cases arising both in the Courts and in Workman's Compensation, tendering the issue of whether cancer has been caused by an accident. We had two cases in my Court within the past year where the plaintiff asserted, and was supported by medical testimony, that breast cancer was caused or aggravated by an accident. One was the case of a woman who was thrown and bruised in an automobile collision. A pimple which was shortly thereafter discovered in the breast and grew into a serious cancer requiring radical surgery was attributed to the accident. In the other case, a man suffered a fall and his claim and medical testimony were that an existing but dormant breast cancer was thereby activated and aggravated into a mortal condition. In both of these cases the Court had to entertain the varying views expressed by the medical witnesses and delve into the medical authorities and texts cited pro and con as to whether trauma could cause cancer at all and closely follow and apply the more or less accepted postulates for determining whether or not a cancer could be of traumatic origin or effect. Recently the Supreme Court of this state and the Appellate Division of the Third Department had to consider the claim that a carcinoma of the lung was an accident connected with the work. And this claim was at least supported by a medical opinion that there was a causal connection between the development of the carcinoma and the exposure of the worker to a draft coupled with a strain in opening a locker door a few months before. Thus, in the area of Workman's Compensation as well as in the area of private litigation, there is difficulty in determining the medical facts as between different medical views. Here again the experts for each side are apt to become partisans. Here again it has been found desirable to create an independent medical panel of the Workman's Compensation Board. Undoubtedly the administration of Workman's Compensation could be improved by a closer check on the medical science. A more carefully selected, experienced, and better paid medical staff of the Board itself could bring more objectivity and control into decisions and awards. But there is one thing which is totally lacking in the concept and administration of Workman's Compensation and is sorely needed. That is attention to the possibilities of rehabilitation. We have learned in recent years of the enormous opportunities in rehabilitating the sick, injured, and incapacitated to useful, productive, and rewarding life by training and fitting them for suitable work. This science or design for living has never been applied in a field to which it could well be adapted. We should not be content, either as a human or economic matter, to write off the casualties of everyday employment in the terms of so many dollars paid for a lost limb or other injury which incapacitates one for the work to which he is accustomed. A broader, more individual, and more social view should be taken with the end and effort in mind of salvaging the human value and realizing the potential which may remain for a useful life, that it should be introduced into the Workman's Compensation Law and its administration is urgently recommended. Enough has been recounted to indicate the close connection between law and medicine where injuries are involved. Fairly satisfactory working bases have been established for assimilating the medical and legal incidence of such cases and putting both the law and medicine through a judicial process which is supposed to result in justice in each case. Our procedures can be improved but the process is basically sound. We move now into another field of the law where medical connections are not so well recognized and where there's almost wholly lacking any process for taking account of medical facts and factors which are fundamental. Our busiest courts are concerned with family ruptures, juvenile delinquency, and crime by youth. Here we endeavor by judicial inquiry and legal directives to handle cases with so many facets that they cannot be reviewed by any mere judicial screening or settled by any court order. It is utterly unrealistic to consider these cases in any conventional courtroom frame. Take the criminal courts, for example, as they function with respect to youthful offenders. It is the ordinary concept and function of a criminal court to determine guilt or innocence, and if the finding is one of guilt, to impose an appropriate sentence. But as the Chief Justice of the Court of Special Sessions in this city, Irving Ben Cooper has said, "The determination of guilt or innocence in most cases of youthful offenders is incidental to any really proper consideration of the case." Viewed either as an individual or social matter, the serious and pointed questions are the causes and conditions which involve the youthful offender in crime and the treatment which will be remedial and rehabilitative. In the courts which deal with youthful offenders there is not presently available any medical aid, although every judge of these courts knows that youthful crime has its roots in physical and mental conditions and that medical service is necessary, both to the diagnosis and treatment of the offenders, as much might be said of the adult criminal. But at least in dealing with the young, the opportunities and chances of redemption through adequate attention and constructive treatment are more promising. It is vital if the court is to do anything but an inadequate routine job or to look behind the offense and ascertain the relevant circumstances inducing the behavior and with like insight and understanding fashion the remedial measures. In both aspects, general medical, psychoanalytical, and psychiatric services are required. I give you as an example the case of a schoolboy who was brought before the Court for assaulting his classmates and stealing from his teachers. His vicious propensities could not be curbed by any corrective measures at school, and he was placed in the hands of the law for the well-known corrective measures of a penal institution. His guilt of the crimes with which he was charged was beyond question and could not have even given the Court pause. But a wise and a humane judge was interested in why this boy was given to such malicious conduct. His interest prompted an inquiry and it was ascertained that the boy stuttered badly. And that his stuttering occasioned cutting comment from his schoolmates and was a source of exasperation to the teacher. The psychological reaction upon the boy led him to respond in his own misguided way. The judge in this case was convinced that the stuttering was at the root of the misconduct, and upon his personal plea a psychologist took the boy in charge, with the result that he is now leading his class at night school while working during the day with a business concern from whom he has already received his fourth promotion. Every youthful offender and every juvenile delinquent should have a thorough physical and psychological examination by qualified experts. The causes behind the crime or delinquencies should be ascertained as they can only be ascertained by such examinations and investigations by a social caseworker. In the same way, the remedial or corrective measures which are taken in the cases of youthful offenders and juvenile delinquents must be dictated largely by medical considerations and in many cases will involve medical supervision and psychotherapy. We have not begun to give rudimentary recognition to the medical and psychological aspects of crime and delinquency or to implore the aid of doctors, psychologists, and psychiatrists in fashioning a program of reformation which is corrective, useful, and sound. I have no doubt that past concepts and practices in the treatment of youthful offenders and juvenile delinquents will have to be completely altered and that we must get away from even thinking in court terms or of attempting to handle these cases in the courtroom. The legal process should be revised in keeping with the determinative medical and social facts and we should devise and set up an integrated program for handling these problems and cases through a proper coordination of the offices of doctor, lawyer, and social caseworker. Likewise in dealing with family disputes. We must conform court processes and practices with the known realities of life. The cases which come before the Family and Children's Courts are usually cases of sick people. As Magistrate Cross, now Commissioner of Corrections, who is a pioneer in modernizing the insight, outlook, and work of the Magistrate's Court in family matters, has put it, "We are learning to evaluate crime in medical terms." She finds that most of the cases of family disputes and wayward minors stem from physical or psychological facts. In this court there is token psychiatric aid but it is so inadequate as to be almost insignificant. The Court does, however, have an alcoholic clinic which is maintained by the joint support of city, state, and private funds and which, on a limited scale, is a model incorporating general medical, psychiatric, psychological, and social services. Law progresses more slowly than medicine. Indeed the law is notable for slowness to change and delay is commonly associated with the law. Nevertheless, law does move forward in accordance with political, economic, and social change, although the advances are not as spectacular as they are in medicine. We do not have in the law the laboratories and research facilities which the medical profession and allied sciences have created. There are inherent differences in the way law is practiced and develops and the way medicine is practiced and develops. We do not have similar opportunities for discovery or experimentation in the law and revolutionary changes do not happen. Yet we can learn much from our brother profession and take some leaves from its book. The concept and practice of preventative medicine, for example, are established. Our ideas as to preventative law are novel. But it is perfectly apparent that on such ideas and the opportunities for their development lie in new frontiers in the law as exciting and promising as anything in medicine. It is doubtless not coincidental that those opportunities are related to medicine and that the indicated action in advance on the legal frontiers require close cooperation between the two professions. Furthermore, and what is appropriate to emphasize before this audience, is that the advance in realization of the potential are dependent upon the spark and support of the laity. The adage of an ounce of prevention being worth a pound of cure is quite as true in the law as in medicine. Only we have never either preached nor practiced it. We just don't happen to think in those terms in the law and our thinking requires reorientation to reality. In fact, we don't even think in the terms of cure. We don't speak of crime and cure; we speak of crime and punishment. The economics of this approach is not the principle consideration. But as we are always confronted and frequently stymied with obstacles of costs and advancing recommendations for reform, it is appropriate to meet the economic questions head-on. What is the cost of our present system of punishment which is single-minded in its approach to the problem of crime and criminals and takes little account of the possibilities of cure? The exact figure is not available. But I calculate on the basis of known information that it must cost $300 million a year to maintain the penal institutions of this country. $1500 a year an inmate is the individual cost. There is no return on this investment. It is a dead weight on society. What is the cost of crime in the United States? That figure is incalculable. More incalculable still is the cost in wrecked or wretched lives of broken homes, wayward minors, juvenile delinquents, youthful offenders, and finally, chronic criminals. Compared with these costs, the cost of prevention and cure is insignificant. But it is the constructive cost which stands in the way of doing a constructive job. For lack of aid of doctors, investigators, and counselors, the courts are prevented from getting at either the roots or remedies of family break-ups, delinquency, and mushrooming crime, and are relegated to the frustrating routine of issuing support orders or divorce decrees, prison or reformatory sentences, or turning offenders loose in the hope that they will mend their ways. There are practically no available services of a social caseworker, marriage counselor, psychiatrist, or psychologist to help either the parties or the Court. There is, indeed, something opposite in the picture of justice as a blind goddess. Just the little pioneering that has been done points the way to a better court and social service. The Children's Division of the Domestic Relations Court now has clinic facilities to provide psychotherapy for 300 children. This is a small part of the 6500 delinquent children who come before this Court each year, most of whom John Warren Hill, the Presiding Justice, describes as emotionally disturbed and needing treatment. The clinic treatment, while the children can live at home and attend school, is felt to be more effective and is known to be much more economical than institutionalization. Judge Hill is anxious not only to expand the facilities in the Children's Division but also to extend them to the Family Court. Chief Judge Cooper of the Court of Special Sessions and Chief Judge Murtagh of the Magistrate's Court are pressing for the establishment of adequate investigatory and probationary services in those courts, emphasizing that the cost of such service, including medical, psychological, and psychiatric aids, is only $150 a case a year as against $1500 a year for incarceration. With only one psychiatrist available as against 5000 cases a year in the home term of the Magistrate's Court, Judge Cross resorted to group therapy and found it valuable. From these slight but hopeful beginnings we can build. We can largely save the human and the economic toll of delinquency and crime, mend many a broken home, and retrieve for good citizenship a large percentage of the unfortunates who are lost. This is not only possible but assured by applying to the law and institutions of the law the sound principles and practices of prevention and cure. Here is the great and challenging opportunity of doctors and lawyers, to meet in designing, planning, and the administration of a basic program of social health. Many careers must be devoted and dedicated to this program. The doctors, the social caseworkers, and the judges must be educated, trained on supply, and paid. Good citizens, forward-looking citizens, must provide leadership at the governmental level lest we be stopped by the whale from the shortsighted conservators of a false economy. What we cannot afford is the price of our unconcern. Law, medicine, and the laity meet at the threshold of the social order.

[ Applause ]

Thank you.

>> I think you'll agree with me that this has been one of the most [inaudible] expositions that most of us, as citizens of this town, have heard. I think one gets a feeling from Judge Peck's address of the [inaudible] to these vision and the vigor with which he is attacking this problem. I'm very glad that he mentioned people like Judge Hill, Judge Cross, Judge Cooper. All of them have been in the forefront of this movement to acquire the methods, let's say, of medicine and the techniques of medicine in the administration of justice. He spoke of preventive medicine. I always think of Mr. Waring who's sitting at the far end of the platform. He was the first man that I ever heard user the term "preventive law." And in essence this is really what it is. And while I'm saying these few words I want to just acknowledge the fact that Judge Motine [assumed spelling] who's sitting here on the platform has been another bulwark in the setting up in the administration of these panels in which medicine and the courts have cooperated in trying to mete out a better justice and trying to present the best medical evidence that can be had for the benefit of the sitting judges and the juries. I am sure that there are going to be many questions from you which Judge Peck -- I am not sure that he knows whether he's in for this or not, but we always have a question and answer period. And within the limits of time and within the limits of reason, Judge Peck is going to undertake to answer what questions you may have. And if you will write them on papers, which I think you have received, the ushers will come down and pick them up and bring them to the platform and we'll put it up to Judge Peck to answer specific questions with regard to his address. I think his address has been stimulating enough to originate and stimulate questions from all of you, not only in the field of law and medicine but in the field of socializing and the care of people who are involved in the toils of the law. I'm going to ask the ushers, if they will, to come down and if you'll just pass them to the ushers and they'll bring them to the platform. Could I have any questions from the floor which I think in the meantime Judge Peck will be glad to answer. Do I gamble on this?

>> Oh, yeah, happy to [inaudible].

>> One question from the floor here.

>> Why would it not be practical to have medically present deputy? I often get [inaudible]. I don't mean necessarily medically a doctor.

>> David W. Peck: Well, I think that would be a very good idea to have judges of some courts, at least have some concentrated and intensive post-graduate course which might be designed for his particular work. I don't think it would be practical to have a long educational medical career behind him, but within limits, a pointed up medical education would be very helpful. No reason why he shouldn't have it.

[ Inaudible Speaker ]

That wouldn't mean very much in most personal injury suits because they're tried before a jury, and the judge doesn't have much to do except rule on evidence and charge the jury. In Workman's Compensation cases, the referees certainly should be educated along that line and, of course, if they're worth their salt over a period of time they get quite a liberal education.

>> I'm going to interrupt because we have a great many questions here, and the answers will have to be, I think, brief if we're going to cover them. Otherwise we'll have to leave a lot of them unanswered. Here's a question. Is there any legislative programming in works that effectuate the family thought in juvenile court correlation with medicine? In other words, I assume this question is [inaudible] legislation.

>> David W. Peck: Most courts are all supplicants before the Board of Estimate really, the legislative body of this city, asking for appropriations adequate to establish and carry on the kind of facilities that I've talked of this evening. The answer is, it is in the works but whether they'll get it or not depends upon how much of a public support there is for it. Hence, the emphasis upon some of the things I've said this evening.

>> Is the use of the voluntary medical panel obligatory and if not when is it called upon?

>> David W. Peck: It's entirely at the discretion of the judge. Any case that the judge finds by preliminary inquiry of the lawyers, that the difference between them as to the medical aspects of the case is serious and wide, the judge will call in a member of the independent panel. If he finds that the parties aren't so far apart, that the matter of the injury isn't very serious anyway, he doesn't do it.

>> For the Utopia of Future, instead of these pleas for cooperation between doctor and lawyer, why not have our colleges educate capable individuals as medical jurists or judicial doctors?

>> If you've ever had any experience with deans [laughter] and with curricula and with the crowding and the lack of time in the medical course, and I speak, I think, perhaps, for the law. But I have one son who's been through a [inaudible]. I'm afraid it would be rather impractical.

>> David W. Peck: I'm going to deduct that answer and I think it can be taken care of in what you might call post-graduate education of a type that I referred to in answering the previous question.

>> Would you think it advisable for justices in Children's Court to have training in social casework?

>> David W. Peck: I wouldn't think so in the sense of having been social caseworkers. But they certainly should have some feeling for it and sufficient experience by working with social caseworkers in that kind of work to be thoroughly familiar with it, to understand it, to appreciate it, and to have an aptitude for dealing with it.

>> Assuming failure to settle, in spite of revealed opinion of the medical panel examiner, would the court make such opinion available to a jury?

>> David W. Peck: Yes.

>> The answer is yes.

>> David W. Peck: Yes.

>> If so, would such examiner personally testify or could he be cross-examined by either of the trial attorneys?

>> David W. Peck: Both. He could testify and be examined and cross-examined by both of them.

>> In youth crime, is it not a fact that the rapid increase of various drugs -- I can't read it. I'm sorry. I shouldn't really go over them [inaudible].

>> David W. Peck: There's a very prime cause and I'd also make a much stronger approach in the background on this. Well, I think it is a prime cause in many cases and the strongest possible approach and attack should be made on it, without question.

>> Please comment on the room for progress via medicine in law and insane, a legal label.

>> David W. Peck: Well, that's quite an order. I suppose that nothing causes much more difficulty in the law than those cases where a defense of insanity is being interposed and you have to reconcile varying medical views as to what is insanity and whether it exists in a given case, and legal views as to what insanity is. We have a pretty strict sort of a simple elementary idea of what insanity is in the law. You see, the law hasn't kept up in its ideas of insanity with medical progress. And I don't know just how you would do it because what is insanity if it's going to depart, case by case, from what has been the established law by judicial decision. A trial judge who took it in his mind to charge differently would get reversed by an Appellate Court. So that, really, the only way to approach it would be by legislation and insanity by its nature just doesn't quite lend itself to that niceness of definition and distinction. As to the other aspect of it, as to treating people, that is more simple. If you find somebody who comes into court who has something wrong with him mentally, why, of course, he ought to be turned over for proper medical treatment which, again, is something that I at least touched on this evening.

>> The next question, and I don't think we'll attempt to answer. Well, one is the Kinsey Report's influence, legislation, and lawmakers.

>> David W. Peck: Other than that.

>> Dr. Kinsey's going to be here next week. Let him answer for himself.

>> David W. Peck. Yeah.

>> We have had Workman's Compensation for decades. Why do we not have adequate medical testimony there? They do have the right to have physicians and specialists.

>> David W. Peck: Well, they do have medical testimony, plenty of it. And I didn't mean to suggest that it wasn't adequate. But there is the same problem that I've talked about, is what you do when you have these conflicting views, and how do you resolve them? What I was trying to suggest is that there ought to be right at hand, within the Board itself, a somewhat larger and I would say on the whole, a more experienced and more highly paid staff than they have available at the present time. Workman's Compensation, at the administration level, suffers from the same trouble that so many governmental agencies suffer from: inadequate pay and insufficient insistence upon getting highly qualified people.

>> The next one I don't think can be answered because it's really a medical question. I don't think it's fair to put it to you.

>> David W. Peck: I certainly couldn't answer it. Maybe you can.

>> This one [laughter]?

>> This person asked, after my car accident I had no recollection how it happened for about six months when it gradually came back into memory and I was able to witness what the cause of the accident. Is this a medical fact?

>> I don't think it's quite a question for Judge Peck.

>> David W. Peck: Marital dispute I would say [laughter].

>> May an attorney ask the Court to invoke the medical panel? If he may, is the panel available only in the Supreme Court or in the lower courts as well?

>> David W. Peck: Yes, an attorney could ask for it. Again, it would be at the discretion of the judge. The panel is presently only available in the Supreme Court.

>> What is the criterion by which the amount of compensation is granted by the courts in accident cases?

>> David W. Peck: No criterion beyond the judgment of a jury to make a finding under a charge that it must be due compensation for what they find to be the injury sustained. Wide latitude [laughter].

>> In accepting the expert opinion of a member of a medical panel, thereby injecting the opinion of a paid expert, is this not in effect placing a penalty upon the testimony of an expert who's paid for his attendance in court?

>> David W. Peck: I don't quite follow.

>> Well, I assume that -- is this not in effect placing a penalty upon the testimony of an expert who is brought in by one of the contending parties?

>> David W. Peck: Well, I don't think it -- I don't think it's placing a penalty upon him. It's just a matter of the jury deciding between expert witnesses just the same as between other witnesses who they're going to believe and I suppose naturally, and I would say, properly, a certain weight is going to be attached to the fact that a number of the panel comes there without any interest in the case whatever, whereas the medical experts engaged on each side of the case are admittedly paid and possibly influenced in their testimony by that fact. That's for the jury to decide, whether or not so.

>> Can a judge call upon the medical panel during the trial of a personal injury case to aid in deciding a sharp medical question?

>> David W. Peck: Not aid in deciding. All he could do is call him as a witness to give testimony and then the jury is to give such weight to that testimony as they think it deserves.

>> This question I think is not germane to the discussion. Will mercy killing ever be legalized where prolonging life would only mean terrible suffering to be followed by certain death as in some cases of cancer?

>> David W. Peck: Well, that's --

>> That's a question you'll have to --

>> David W. Peck: Yeah.

>> -- discuss with [inaudible].

>> David W. Peck: That gets into the legislative realm.

>> Where injuries are sustained by an infant --

>> -- how far back do we [inaudible] and [inaudible] should recovery be allowed?

>> David W. Peck: Well that's -- I think I touched on perhaps about as well as I could. That's what the dissenting judges said in this one case. They had the same sympathy as the majority did about recognizing a right in such a case, but they thought that there ought to be -- that the medical facts ought to be carefully ascertained upon the basis of a lot of data and hearings and findings and then they felt they'd be prepared to act. But short of that they didn't think it ought to be done just in an individual case.

>> The next question I think, again, is a social question, and rather than even a medical or legal question. Have we made any headway in helping Puerto Ricans adjust [laughter]?

>> David W. Peck: Now that's out of my ken, I'm sorry to say.

>> Now this question I think has been answered during the address, the presentation tonight. Since medical problems and legal evidence sometimes disagree, what method of solution is available so that justice could prevail in a negligence suit? Admit he was --

>> David W. Peck: Yeah, I hope I've reached a -- embraced it.

>> Would it be practical to train lawyers in practical psychiatry for the purpose of dealing with criminal cases more adequately?

>> David W. Peck: I would think so, dependence [inaudible]. That touches on the other questions that you've asked.

>> How will Governor Dewey's program of 350 million for mental hospital and clinics tie in with the courts?

>> David W. Peck: It really doesn't have much to do with the courts except for taking care of those people who the courts find need care.

>> This question I think is one of these questionable questions where we used to have these talks dealing with specific diseases. We always got a certain number of questions that related to mother/father, sister/brother, wife or nephew or aunt who had the disease which was being discussed that night in which medical opinions were asked. And this is really in that category. Please give legal ruling on hernia cases and low back strain found frequently on -- It isn't funny if you have it [laughter]. Amongst men either in the construction field or doing heavy lifting. I don't think that is answerable, is it [inaudible] tonight?

>> David W. Peck: No. I would say if you've had such an injury and it happened in an accident, yeah, you won't have any difficulty in finding a good lawyer who will [laughter] advance it as something which is worthy of very substantial compensation [laughter].

>> Is there a possibility of a comparable Workman's Compensation Board for present personal injury cases?

>> David W. Peck: Is there a possibility of a new --

>> Is there a possibility of a comparable Workman's Compensation --

>> David W. Peck: Yes, there's a possibility of it and it's been advocated by a good many people of the -- what steam there is behind it is generated from the fact that it takes so long to get these cases tried in court because the judicial process is so slow in relation to the flood of negligence cases in the court, that some people say, well, the thing to do is to compensate and not litigate. Instead of fussing around four years after the event and trying to ascertain whose fault it was that caused the accident and how much is it worth, just as in compensation give certain prompt and fixed compensation and be done with it.

>> This question I think the answer is why, oh why? The question is why do we spend so much money to punish and so little to help the better life? That was the point you --

>> David W. Peck: Well, I tried to get at that.

>> Well, we've gone through these questions rather quickly. Thank you, Judge Peck.

[ Applause ]

Very nice. [Inaudible].