Dr M Badana

Department Forensic Pathology

INTERPERSONAL VIOLENCE:
PHYSICAL ASSAULT
 FOCUS OF PRESENTATION
• INTRO - What is Assault?

• Classification of Interpersonal Violence

• Physical Assault –Forms / categories of

physical assault.

• Legislation.

• Locard’s Principle/triangle

• Clinical Forensic Examinations: Consent , history,

exam, typical injuries, assessment of injuries.

• Special ML Investigations: X-Ray, Bite mark pattern

(dentistry and DNA), Blood for lab tests

• Scene of assault: Search of evidence, trace

and others
 FOCUS OF PRESENTATION cont.
• Identification and Preservation of evidence: History,
photography, X-Rays, Blood results, J88 and clinical
notes.

• Completion of J88 and affidavit. IMPORTANT

• Differential diagnosis.

• Treatment and follow-up.

• Common mistakes made in ML clinical examination

of physical assault survivor.

• ML significance of Physical assault survivor

examination.
 WHAT IS ASSAULT?
• Unlawful / Intentional,
• Application of force (mechanical, chemical or otherwise) (direct or indirect) to another
person, or
• Threatening of another with immediate personal violence.

Examples:
1.Mechanical: Gunshot, stabbing, mob justice blunt force injuries.
2.Chemical: water/acid/fire burns, electrocution, Ingested of poisoned food.
3.Exposure to environmental hazards: extreme heat, cold, drowning etc.
 CLASSES OF INTERPERSONAL VIOLENCE:
ASSAULT.

Physical assault in community: Blunt force, gunshot, stabbing, mob

justice etc.
Family violence.
Domestic violence: Spousal (intimate partner) abuse at home.
Child abuse.
Elderly abuse.
Sexual abuse.
Institutional abuses e.g. Schools - Corporal punishment, homes -
abuse of disabled, aged, foreigners etc.
State torture (abuse) of detainees and prisoners.
 PHYSICAL ASSAULT –FORMS / CATEGORIES
OF PHYSICAL ASSAULT
Blunt trauma: fist fights, mob justice etc.
Stabbing injuries.
Gunshot injuries.
Water burns.
Acid burns.
Fire burns.
Poisoning e.g. food.
Electrocution
Torture e.g. Made to stand for hours, etc.
? Neglect
 LEGISLATION: SECTIONS 11, 12 AND 13 OF THE
BILL OF RIGHTS IN THE CONSTITUTION.

Life
11.Everyone has the right to life.

Freedom and security of the person

12.(1) Everyone has the right to freedom and security of the person, which
includes the right
-not to be deprived of freedom
-not to be detained without trial;
-to be free from all forms of violence from either public or private sources;
not to be tortured in any way; and
-not to be treated or punished in a cruel, inhuman or degrading way.
 LEGISLATION cont.

(2) Everyone has the right to bodily and psychological integrity, which includes the
right
-to make decisions concerning reproduction;
-to security in and control over their body; and
-not to be subjected to medical or scientific experiments without their informed
consent.

Slavery, servitude and forced labour

13. No one may be subjected to slavery, servitude or forced labour
 LOCARD’S PRINCIPLE / TRIANGLE

“EVERY CONTACT LEAVES A TRACE”

• Criminal justice investigations involve three parties:
SAPS, Forensic Sciences professionals (YOU) and
judiciary.

• Evidence is commonly found in: survivor, suspect and

scene.
 CLINICAL EXAMINATION OF SURVIVOR OF
PHYSICAL ASSAULT: CONSENT

Survivors seek medical assistance at following facilities:

-casualty departments of public and private hospitals and
clinics.
-Private Health Professionals.
-Public Social Services.
-Traditional Practitioners.

Consent is mandatory!
Important to seek written consent from victims, especially if
minor.
 CONSENT cont.

Suggest reporting case to police, and request SAP 308 form.

SAP 308 completed by SAPS and victim: Voluntary consent by
survivor.

Objective of SAP 308: Gives the Med. Practitioner permission to

break confidentiality code by completing SAP J88 and submitting
to SAPS and Courts.

NB - ONLY Complete J88 if SAP 308 has been completed and

given to you.
 CONSENT cont.

Suspects are mostly taken to health facilities by SAPS mostly during SAPS
investigations or at the request of prosecutor or court.

If suspect’s consent not required, SAPS must provide evidence of arrest

and give permission for forensic exam through SAP 308(a) form

Use of force by medical personnel to be avoided.

Remember: History provided is commonly unreliable.

Sap 308
CONSENT FOR
FORENSIC EXAMINATION

Include consent for:

Obtaining history
Physical examination
Documentation
Compiling a report
Diagramming
Photography
Evidence collection
Breach of the confidentiality clause
Testifying in a court of justice
Sap 308(a)
CONSENT FOR
FORENSIC EXAMINATION

Explain to the suspect

•The collection of evidence is essential to serve the
ends of justice
•Early collection will increase the possibility of a
positive laboratory diagnosis
• It is for the physical and psychological well-being of
the victim
• Has the right of access to their own private doctor
• Entitled to the best possible service
 CLINICAL EXAMINATION IN PHYSICAL
ASSAULT CASE: HISTORY

• Personal particulars: Name, Surname

• Six thinking hats: What, where, when, who, how and why.
• What injuries did survivor/suspect suffer?
• What instrument was used?
• Did survivor/suspect lose consciousness?
• What treatment was given?
• Past history: Assault, accidents, operations, deformities, illnesses etc.
• Recognize that this could be first presentation of other abuses e.g.
spousal, sexual etc.
 CLINICAL EXAMINATION OF A PHYSICAL
ASSAULT CASE: EXAMINATION
Vital signs: resuscitate if unstable.

Organ systems: Cardiovascular system, respiratory system, Central nervous

system.

Condition of Clothing

Assessment of injuries:
-Skin: Contusions, abrasions, lacerations, Incisions (REMEMBER definitions).
-Organ systems: Fractures, Intrathoracic, pericardial, intracranial, abdominal
haemorrhage.
 EXAMINATION cont.

Special examinations:
• X-Ray,
• CT scan,
• ECG examinations.

History of loss of consciousness: Always

consider admission to observe progress.
 CLINICAL EXAMINATION OF A PHYSICAL ASSAULT
CASE: TYPICAL INJURIES

• Fist fight: Raccoon eyes, Contusions and lacerations of lips, Contusions

on knuckles etc.
• Bite mark injuries.
• Self-inflicted injuries (be aware).
• Defense wounds (fore arms, dorsum of hands).
• Gunshot and Stab wounds.
• Burns: Fire, water or acid.
• Electrocution injuries
 CLINICAL EXAMINATION OF A PHYSICAL
ASSAULT CASE
FIST FIGHT RACCOON EYES BITE MARKS
 CLINICAL EXAMINATION OF A PHYSICAL
ASSAULT CASE
SELF INFLICTED INJURIES DEFENSE WOUNDS
 CLINICAL EXAMINATION OF A PHYSICAL
ASSAULT CASE: ASSESSMENT OF INJURIES

Record objective findings only.

Any determination made must be based on medical evidence and be
objective.

Not role of Health Practitioner to determine manner of causation of a

particular injury: Intentional or accidental, rape, assault.

Re-assessing injuries 24 hours later help e.g. bruises may become

more prominent.
 SPECIAL MEDICO-LEGAL INVESTIGATIONS

X-Ray: Show fractures, ruptures bowel, pneumothorax.

CT-Scan: Hemorrhages, Fractures, diseases etc.

Bite Lesions: Dental formula of suspect, Traces of saliva with DNA of

suspect.

Blood: Suspected poisons.

 SCENE OF ASSAULT

• Physical (Direct) Evidence

• Trace evidence (hair,

fibers, skin cells)
 IDENTIFICATION AND PRESERVATION OF
EVIDENCE:

• History: Record interview session.

• Examination: Detailed description of injuries in clinical notes.
• Photography of Injuries.
• Special investigations: X-Ray, CT Scan, Bite Mark
investigations, Blood investigations.
• J88: Medico-legal Report.
 IDENTIFICATION AND PRESERVATION OF EVIDENCE:
COMPLETION OF J88

• J stand for Justice Dept.

• Is a Medico-Legal Report for ML purposes of investigating a criminal case.
• Completed to best of your knowledge and assessment of survivor/suspect.
• No place for subjective information.
• Areas not completed should be deleted.
• Sign every page and pictures that you have marked injuries.
• Submit J88 with an affidavit.
• Make a copy that will stay with you and hand original J88 form to
Investigating Officer.
 DOCUMENTATION ON J88

Remember:
There will be allegation & counter allegations
Widely diverging accounts will be given

Therefore the records:

• Should be precise
• Impartial and objective
• Negative findings (absence of visible injuries)
• Must include condition of clothing (torn etc.)
 INJURY DESCRIPTION ON J88

Location
Size
Shape
Color
Foreign bodies
Age; Evidence of healing
Indicate on J88
diagram
 Example
J88 COMPLETED
HEIGHT (CM), MASS AND GENERAL BODY BUILD:
• Will determine victims ability to defend him / herself.
• Also when cases go to court some years later the victims
physical appearance will have changed and the court will
then be able to refer to the J88 for clarification

*CLINICAL FINDINGS
• The nature, position and extent of all injuries must be
described and noted (in black) with its probable date and
manner of causation.
• The position of all injuries and wounds must also be
noted on the sketches as well.
Extra sheets can be attached as long as these are
signed and dated.
 J88 COMPLETED

To be discussed in length next week

 J88 COMPLETED
NB - Always draw findings in black and label clearly on diagram
 CONCLUSIONS ON J88

• Summary and opinion

• Interpret findings objectively & impartially
• No room for speculation
• Is injury consistent with history given
• Is injury consistent with time it is said to have
occurred
• Is there a specific pattern of injury
• Legal conclusions like rape/assault/GBH
have no place on the J88
 EXAMPLES OF CONCLUSIONS
• “My findings were consistent with:”
• “History provided by the complainant”
• “Physical assault as described by the patient”
• “The wounds observed were consistent with the type
of alleged assault in terms of position, type of force
and age”.
• “the absence of injuries does not exclude rape/sexual
assault.”
 DIFFERENTIAL DIAGNOSIS

• Assault injuries are difficult to differentiate from –Accidental injuries and

self-inflicted injuries.
• Be careful in interpreting injuries seen in children, elderly and people
with chronic illnesses.
• Seek advise from colleague, seniors or specialists if you are not sure.
• Refer difficult cases.
• Admit cases where there is evidence of chronic abuse, danger of serious
future harm or signs of other abuses. (Children and Elderly)
 TREATMENT AND FOLLOW-UP

• Clinical management.

• Critical that follow-up is made for progress.

 COMMON MISTAKES MADE IN MEDICO-LEGAL CLINICAL
EXAMINATION OF PHYSICAL ASSAULT SURVIVOR

• Failure to identify that these patient also require medico-legal

management.
• Failure to request clinical and medico-legal consent.
• Failure to document findings in clinical notes.
• Failure to preserve evidence.
• Failure to keep chain of evidence.
• Failure to submit J88 in affidavit format.
• Failure to recognize pattern injuries.
• Failure to associate incident with other abuses.
• Failure to protect survivor from further abuses.
 MEDICO-LEGAL SIGNIFICANCE OF PHYSICAL
ASSAULT SURVIVOR EXAMINATION

• Assault is a criminal offense.

• Survivors require medico-legal assessment and
completion of J88.
• Doctors need to avail themselves for court testimony if
required.
• If death happens in these cases, report death to Police.
THANK YOU