Implementing Istanbul Protocol standards for forensic evidence of torture in Kyrgyzstan

The Kyrgyz government declared a policy of “zero tolerance” for torture and began reforms to stop such practice, a regular occurrence in the country's daily life. This study presents the results of 10 forensic evaluations of individuals alleging torture; they represent 35% of all criminal investigations into torture for the January 2011–July 2012 period. All individuals evaluated were male with an average age of 34 years. Police officers were implicated as perpetrators in all cases. All individuals reported being subjected to threats and blunt force trauma from punches, kicks, and blows with objects such as police batons. The most common conditions documented during the evaluations were traumatic brain injury and chronic seizures. Psychological sequelae included post-traumatic stress disorder and major depressive disorder, which was diagnosed in seven individuals. In all cases, the physical and psychological evidence was highly consistent with individual allegations of abuse. These forensic evaluations, which represent the first ever to be conducted in Kyrgyzstan in accordance with Istanbul Protocol standards, provide critical insight into torture practices in the country. The evaluations indicate a pattern of brutal torture practices and inadequate governmental and nongovernmental forensic evaluations.     

Injuries due to violent crimes.

This is a study of police reported assaults during 1979, 1982 and 1985 in the County of Kopparberg. Criminological and odontological variables of 1,870 cases of assaults reported to the police during these three separate one-year periods were collected and analysed. Most of the cases were from densely populated areas. There was an increase in cases from 1979 to 1985, particularly of violence in residences. No differences in the type or kind of assault could be found. The proportion of women victims increased markedly and, to a lesser extent, so did the proportion of women offenders. One third of the victims were not injured by the assault, one third suffered haematomas or swellings and one third suffered wounds. 6.5 per cent of the total had fractures. The left side of the face was the most common site of soft-tissue injuries and zygomatico-orbital fractures. No aggravation of the violence or the resultant injuries could be found during these periods.     

Assessment in police custody of individuals under the influence of alcohol with co-morbid psychiatric disorders

Individuals with a diagnosis of excessive alcohol intake are commonly encountered in police custody. These individuals have a high incidence of co-morbid psychiatric disorders. The Epidemiological Catchment Area (ECA) Study reported that 37% of alcoholics have a co-morbid mental disorder.(1)It is, therefore, important that individuals in custody who have a history of excessive alcohol intake are adequately assessed, in order to identify such co-morbid disorders so that appropriate management is implemented. Assessment of all individuals in police custody should include: To date, little has been written on how such assessments should be carried out in police custody. This paper discusses the presentation of psychiatric disorders in individuals with a history of excessive alcohol intake and suggests how they should be assessed in custody. A subsequent issue of the journal will include an article discussing the management of such individuals.     

Medical examination of fitness for police custody in two large German towns

Worldwide, there is a high risk of medical complications or death in police custody. This risk is often increased by unclear legislation, a lack of clearly defined responsibility and medical examination standards. Any solution to these problems requires as a very basis the systematic analysis of the medical examinations that determine whether a person is fit to be detained in custody. We analysed a total of 3,674 medical records on fitness for custody, taken from two large German towns (Halle/S and Bremen). The examined individuals were predominantly males or of a younger age. The indication in the majority of cases was acute alcoholic intoxication or drug withdrawal syndromes. Traumata and internal or mental diseases were also quite frequent. For approximately 50% of all cases, fitness for custody was declared on certain conditions. Only 39.8% were found to be unconditionally fit for detention in custody. In just under 10% of the cases, the person was found unfit for custody. These cases concerned mainly persons with psychological symptoms and advanced alcohol or drug withdrawal syndromes. We were able to show that the recent introduction of new police custody regulations in Halle/S had a significant influence on the medical decision on fitness for custody. Our detailed assessment has provided us with the basis to develop solutions for the improvement of medical care in police custody. The focus lies here on the organisation and legal regulation of the medical aspects of custody but also on policing and medical work.     

Health needs of detainees in police custody in England and Wales. Literature review

The aim of this systematic is to review and analyse the literature concerned with the health needs of detainees in police custody in England and Wales.The healthcare of detainees in police custody is regulated by the England and Wales Police and Criminal Evidence Act 1984. The Faculty of Forensic and Legal Medicine of the Royal College of Physicians also sets quality standards for the provision of custodial healthcare. The provision of healthcare in custody presents a number of challenges including the patient group, the setting and the overlap between the legal and medical concerns that are addressed by the medical team. Currently, care to the detainees in custody is delivered by a mixture of private organisations, police-led forensic medical services and the NHS.A search of the PUBMED, EMBASE and PsycINFO databases undertaken using the search terms: (police custody) OR (detainees) OR (police detainees) yielded 830 publications. All of the titles were screened to identify potentially relevant publications concerned with the health needs of detainees in police custodies in England and Wales. There were no design specific criteria set for inclusion of the studies in this literature review. 77 articles were initially identified as relevant and obtained in full. After further analysis 28 publications were included in this literature review.A total sample of over 12,000 detainees was examined in this literature review. Approximately 20% of detainees seen by health care teams suffer from psychiatric conditions. On average, 50% of patients claim that they have problems with drugs and alcohol. Physical health conditions are also highly prevalent with up to 74% of detainees requiring regular medication. Forensic medical issues included the management of detainees who were restrained using handcuffs, irritant sprays and TASER. Detainees who are suspected of internal drug concealment also require intensive medical input. Injury documentation in custody is often requested for both the police officer and detainees.Current literature indicates that mental health problems including substance misuse and physical conditions are highly prevalent among the custody population and require both emergency and routine care. The current quality of the health-care services has been discussed and the need for improvement has been indicated by a number of agencies. Recent attempts have been made to incorporate the custodial services into the general structure of the NHS, aiming for more robust governance and standardization of services. Implementation of a routine health promotion service in custody has also been discussed which can be integrated into the general health care provision during detention.     

Detainees in police custody in the Paris,France area: medical data and high-risk situations (a prospective study over 1 year)

Background and objective

The annual number of detainees held in police custody in France is approximately 700,000. Medical data regarding arrestees are scarce across countries. We present the medical characteristics of detainees kept in police custody, including addictive behaviours and high-risk medical situations.

Methods

We conducted a prospective study over 1 year in a suburban area near Paris.

Results

A total of 19,098 medical examinations were performed on 13,317 individuals. The examinations mainly concerned male subjects (18,116 of 19,098, 95 %). Median age was 24 years (range 13–83). Medical examination was requested by the detainee in 6,638 of 16,801 cases (40 %). Assaults were reported in 4,052 of 17,312 cases (23 %) and occurred at the time of arrest in most cases (2,243, 13 %). A total of 2,394 of 13,317 detainees (18 %) had at least one chronic somatic disorder including asthma (603, 5 %), diabetes (263, 2 %) and arterial hypertension (205, 2 %). A history of psychiatric disorder was reported by 6 % of individuals (674 of 11,787). Regular alcohol drinking was reported by 58 % of detainees. Illicit drug use mainly involved cannabis (4,021 cases, 30 %). In 14,661 of 19,098 cases (77 %), detainees were considered to be unconditionally fit for detention in custody, and 274 detainees (1 %) were declared unfit to be detained.

Conclusion

The present study showed a high frequency of alcohol or substance use and reported assaults or traumatic lesions in arrestees. Attending physicians should pay particular attention to addictive behaviours and traumatic injuries in arrestees, both for immediate care and for prevention.     

Vergleichende klinisch-rechtsmedizinische Analyse von Verletzungsmustern

Domestic violence, specifically intimate partner violence, is a phenomenon that has significant relevance to society as a whole (estimated life-time prevalence of 37% in German women) and to the field of legal medicine. During a 12 month time-period (February 2003 to January 2004), 1,071 individuals were examined at the Gewaltopferambulanz (Forensic Examination Center for victims of violent crime) of the Hamburg Institute of Legal Medicine. Of these 1,071 persons 312 individuals were victims of intimate partner violence. Injuries to the neck (22.9%), as well as blunt force trauma to the craniofacial bones (53.5%) and to the upper extremities (46.2%) were more prevalent among victims of intimate partner violence than among victims of family violence, sexual assault or assault by strangers. In 21.4% of cases, attending physicians diagnosed the presence of the least one potentially life-threatening injury as a direct consequence of injuries sustained by the victim during the conflict. Morphologically unambiguous patterns of injury, i.e., evidence of old and recent injuries, are often indicative of domestic violence. These patterns of injury were found in only 14.3% of cases involving intimate partner violence without a sexual component compared with 17.2% of cases of family violence. Our results suggest that specific patterns of injury may feature clinical findings indicative of stemming from a specific conflict category, such as intimate partner violence. Furthermore, our results on the large proportion of serious injuries sustained as a direct consequence of the conflict, emphasize the appropriateness of including the field of legal medicine in the acute, clinical forensic care of victims of domestic violence. A reduction in funding in this area would undermine the topic’s relevance to society and lead to a socially and legally underserved patient population.     

Victims of violence: an Asian scenario

The term 'violence' is difficult to define. Aggressive behaviour with actual use of physical force may result in some form of physical and emotional trauma to an individual and this could be considered as violence against the person. The trauma may range from minimal physical injury to death. It is also relevant to note that in some jurisdictions if members of the law enforcement agencies with appropriate authority resort to certain acts of 'violence' for lawful purposes, then such acts of violence may be excluded from this category. However, if the law enforcement personnel exceed their limits of authority, or resort to various unacceptable and unauthorized methods of violence, then certainly such acts will become violence against the person. In today's context the word violence has expanded to encompass many issues, besides the usual physical violence such as assault. Rape, child sexual abuse, other forms of sexual abuse, non-accidental injury to children, battered wife, assault in custody, torture, victims of war, civil unrest and ethnic violence are all considered under 'violence'. While general violence is almost endemic in many countries, assault in custody, torture, political and ethnic violence are serious problems in some of the developing world. In these countries, particularly, the law enforcement agencies and other unlawful groups who are backed by politicians may inflict politically motivated violence against its citizens. In such cases attempts are often made to cover up such crimes. Forensic physicians and forensic pathologists who examine these cases may be placed in difficult positions at times owing to various 'pressures' being brought upon them to issue 'favourable' reports. On the other hand there is also a general dearth of suitably trained forensic physicians and forensic pathologists in many of these countries. Medical officers without any training in forensic medicine often undertake the examination of victims of violence, both living and fatal cases. Lack of training makes them more vulnerable to political and other forms of 'pressure'. The objective of this article is to highlight some of the common problems that are encountered, particularly in developing countries.     

The epidemiology of violence in Denmark

A 1-year prospective study was carried out to describe the epidemiological changes in interpersonal violence in Aarhus (Denmark) over a 12-year period. Data was collected from the Accident & Emergency department, the Department of Forensic Medicine, the local police and compared to previous studies carried out in 1981-1982 and 1987-1988. The incidence of violence was found to have declined significantly over the study period, but severity of violence remained unchanged. The composition of pubs, discotheques and cafes might be an important factor in reducing inner city violence. Police statistics alone may give a false picture of the assault rate. All of these factors are discussed.     

Review of 212 individuals attending a city centre genitourinary medicine clinic following acute sexual assault

A retrospective case note review of 212 individuals (190 women) attending a city-centre Genitourinary Medicine clinic between 1/4/2002 and 31/3/2004 following an acute sexual assault. Direct referral by the Forensic Medical Examiner to the dedicated weekly clinic for victims of sexual assault facilitated the attendance of 55/113 attending the dedicated clinic. The 99 individuals who did not disclose a recent assault as the reason for attendance were seen at routine clinics. One third of individuals attending the dedicated clinic were less than 16 years old, reflecting the facilitated referral pathway. Those attending the dedicated clinic were more likely to be offered the extended service outlined in the departmental protocol. Twenty four sexually transmitted infections were detected in 23 (11%) individuals but 23/24 could have been acquired during other recent consensual sexual activity. Overall, the assailant was known to the victim in 53% cases, there was an allegation of violence associated with the assault in 20%, suspicion of a drug facilitated ('spiked drink') assault in 24% and admission of alcohol intoxication in 11% cases. The 22/212 (10%) who were male were more likely to present to a routine clinic.     

A retrospective audit of the extent and nature of domestic violence cases identified over a three year period in the two district command units of the police service of Northern Ireland

The work load of forensic medical officers (FMOs) who provide medical cover for the Coleraine and Limavady district command units (DCU) of the police service of Northern Ireland (PSNI) in dealing with domestic violence was investigated over a three year period from 1st April 2003 to 31st March 2006. A total of 128 cases involving domestic violence were identified during this three year period. There was a significant increase from 4% (32/791) in the first year to 6.6% (56/851, p<0.01) in the number of cases of identified domestic violence in the second year which dropped to 4.2% (40/956) in the third year. Victims were identified in 38% of these domestic violence cases with 62% being identified as assailants. It was noted that there was a significant difference in the proportion of male assailants (96.2%) from female assailants (3.8%). Fifty-four percent of victims were noted to have injuries in accordance with the more serious injury categories of assault of actual bodily harm (AOABH) and grievous bodily harm (GBH). Domestic incidents occurred at the home in 91% of cases, with the FMO being the primary contact in 97% of cases. Alcohol was implicated in 56% of all domestic violence cases recorded.     

Tötungsdelikte an älteren Menschen im Versorgungsgebiet des Bonner Instituts für Rechtsmedizin 1989–1998

The present study examined the autopsy and police records of 24 homicides and ¶6 attempted homicides involving 13 males and 17 females aged 60 years or older, which were committed in the Bonn area from 1989 to 1998. The incidence of these homicides decreased sharply with respect to increasing age of the victims. The causes of death were predominantly by direct physical assault with seven cases of blunt force injury and nine cases of compression of the neck alone or in combination. Defence wounds were found in only 12 cases. The deceased all suffered from diseases of the cardiovascular or respiratory systems. Of the homicides 67% were committed in the victim’s own residence, 85% of the perpetrators were males, mainly between 20 and 50 years old and in only 15% of the cases they were older than 65 years. Only 18% of the assailants were ¶unknown to the victims. Robbery in 38% and family/partner conflicts in 17% were the most common motives. These data underline that violence in the close social context endangers the elderly more than violent street crimes. Individuals at greatest risk were found to be elderly females living on their own and the homicides were most often committed by sociopathic neighbours during a robbery. However, elderly homicide ¶victims were underrepresented compared ¶to the proportion of elderly persons in the general population. No increased tendency in the homicide rate of the elderly population was found over the 10-year period ¶covered by the present study.     

Severity of injuries among sexual assault victims

It is generally accepted that victims of sexual assault sustain bodily injury. This study's objective was to determine specific characteristics and severity of injuries among victims of sexual violence in Belgrade. Retrospectively, we analyzed a subgroup of victims of sexual violence that was legally processed over a five-year period. We evaluated 113 cases of sexual crimes selected from the District Court of Belgrade in order to analyze the medical records. All victims were female, at average 24.1 years old (range 5-80 years). In more than half of the cases (52%) evaluated, a medical examination was completed on the day of assault, while 84% took place within 72 hours post-assault. Due to delayed referral, body examination was not conducted on 12 victims (10.6%). We noted one or more extra-genital injuries in 64 victims (63.4%), no injuries in 36 victims (35.6%), whereas for one victim the medical records were inconclusive. Injuries, predominantly bruises, were located on limbs (32%), face (23%), and torso (7%). Abrasions and contusions were less frequently present, while two victims sustained lacerations. The Clinical Injury Extent Score was used to rate the physical severity of the assault. The majority of victims (44%) sustained light injuries, 18% were moderate, while one victim had severe injuries.     

Health screening in police custody

BackgroundThere have been few previous studies on the health needs of police detainees. London’s Metropolitan Police Service (MPS) uses health screening procedures which have not yet been evaluated. The objective of this study is to determine the extent of health problems and ‘mental vulnerability’ in detainees in police custody, and the efficacy of current health screening procedures.MethodsCustody records from five London Boroughs were reviewed. Prevalence data for health problems and mental vulnerability was obtained from the anonymised records of 307 detainees who were referred to the Forensic Medical Examiner (FME). Data were analysed for the identification of physical and psychiatric morbidity.ResultsInjuries, epilepsy and asthma were the most common physical health problems noted. Drug and alcohol issues were also frequently encountered along with depression and self-harming behaviour and suicidal ideation. Morbidity was lower than that reported in other, interview based studies. Less than 2% of detainees were thought to require an Appropriate Adult to be present during police interview.ConclusionsA significant amount of health morbidity is present among detainees in police custody. Our findings suggest that current police screening procedures detect only a proportion of this. Further research is warranted to evaluate the effectiveness of health screening in police custody.     

Analysis of 756 cases of sexual assault in Tours (France): medico-legal findings and judicial outcomes

We describe the medico-legal findings in a population of sexual assault cases assessed in an urban French referral centre, analyse the subsequent legal dispositions in each case and determine whether the characteristics of the assault and the medico-legal findings were associated with conviction of the assailant. We performed a retrospective study of medicolegal reports in all the sexual assault cases reported in Tours (France) during a seven-year period. We defined two groups of victims: children under 15 years old and victims aged 15 years or more. Legal outcomes were obtained from courtroom proceedings. The relationship between the outcomes and the circumstances of the case was analyzed by logistic regression. We enrolled a total of 756 cases during the study period. The mean age of the study population was 16.5 years and 68.3% of the cases involved children under 15 years old. In 57% of these cases, the assailant was a family member. 31.7% of all the victims were aged 15 years or more. The assailant was an acquaintance of the victim in 62.2% of the cases. Drug-facilitated assault was suspected in 2.9% of the cases. In 46.2% of the cases, formal criminal charges were not filed due to insufficient evidence; 36.3% of the assailants were convicted. Examination at the request of the police authorities and previous acquaintance of the assailant by the victim were significantly associated with conviction. Allegations of penetration, the presence of general body trauma and the presence of genital trauma were not necessarily associated with conviction. Medical examiners need to be circumspect when they record non-medical variables. Physical evidence of trauma was neither predictive nor essential for conviction. Successful prosecution depends on the quality of the testimony provided by the victim.     

City centre violence

Emergency medicine departments have often proved to be an important source of information concerning violence. These resulting studies of violence have not previously focused on city centre violence, but instead described violence from an entire casualty department or police district. Results from the Aarhus violence study of 1999-2000 revealed differences in characteristics of victims, place of assault and alcohol consumption when violence in the city was compared to violence elsewhere. The present study constitutes a one-year period (1999-2000), during which a total of 1106 assault victims were registered, and among these 230 were assaulted downtown. Forty-six percent of victims from the city centre were assaulted in public houses or streets nearby compared to 5% in the district outside city centre. Both in- and outside the city centre the number of victims decreased significantly in relation to the previous period. However, women who experienced violence in the city were then more likely to be assaulted in the streets, when compared to previous studies. Victims who were assaulted in the city were more frequently under the influence of alcohol than victims from the outside. It is believed that the present results are comparable with other major cities.