MODULE 9
Prevention through Documentation Project
Report Writing and Testifying in Court
CONTRIBUTORS:
Vincent Iacopino, MD, PhD, Physicians for Human Rights
Alejandro Moreno, MD, JD, Boston Center for Refugee Health and Human Rights
Uwe Jacobs PhD, Survivors International
Kathleen Allden, MD, Indochinese Psychiatric Clinic
PtD Project (IRCT, HRFT,
REDRESS, PHR)
Module 9 Outline
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Written reports
– General Considerations
– Content
– Conclusions
– Guidelines for Medical Evaluations of Torture and
Ill Treatment (Istanbul Protocol, Annex IV)
– Inconsistencies
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Providing testimony in court
– Court testimony guidelines and maxims
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Mock Judicial Proceeding
PtD Project (IRCT, HRFT, REDRESS, PHR)
Written Reports
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Purpose:
– Document evidence of torture and ill treatment
and effectively communicate this evidence to
adjudicators
– Provide expert opinions on degree to which
his/her findings correlate with individual’s
allegation of abuse
– Each written report and oral testimony
represents opportunity for clinicians to educate
adjudicators on physical, psychological evidence
of torture
PtD Project (IRCT, HRFT, REDRESS, PHR)
Written Reports
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Contexts for medial reports/testimony:
– Prosecution in national or international courts
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of alleged perpetrators
Claims for reparation
Challenging credibility of statements extracted
by torture
Identifying need for further care and
treatment
Identifying national and regional practices of
torture in human rights investigations
Support of allegations of torture in asylum
applications
PtD Project (IRCT, HRFT, REDRESS, PHR)
Written Reports
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Considerations for written reports:
– Conducted with objectivity and impartiality
– Do not over-interpret the findings and thus diminish quality of
evidence
– Define medical terminology, no jargon
– Clinicians should
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have specific training in forensic documentation of torture and
other forms of physical and psychological abuse
have knowledge of local prison conditions and torture methods
review all relevant materials
not include in written reports or oral testimony any opinion(s)
that cannot be defended under oath or during crossexamination
– Any discrepancies should be pursued to point of clarity
PtD Project (IRCT, HRFT, REDRESS, PHR)
Written Reports
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Considerations for written reports:
– Physical and psychological evaluations of alleged torture victims
may provide important confirmatory evidence of torture.
However, absence of such physical evidence does not suggest
that torture did not occur as such acts of violence against
persons frequently leave no marks or permanent scars
– Historical information such as descriptions of torture devices,
body positions and methods of restraint, descriptions of acute
and chronic wounds and disabilities, and identifying information
about perpetrators and the place(s) of detention very useful in
corroborating applicant’s allegations of torture.
PtD Project (IRCT, HRFT, REDRESS, PHR)
Written Reports
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Considerations for written reports:
– In clinician’s interpretation of findings, he/she should relate
various categories of evidence, i.e., physical and psychological
evidence of torture, and historical information as well.
– Effective written reports and oral testimony require accurate
and effective communication skills
– Quality of any testimony, whether written or oral, can only be
as good as the interview and examination that was conducted
PtD Project (IRCT, HRFT, REDRESS, PHR)
Content of Written Reports
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The examiner should
– Document physical and psychological evidence of injury and
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abuse
Correlate degree of consistency between examination findings
and specific allegations of abuse by patient
Correlate degree of consistency between individual examination
findings with knowledge of torture methods used in a particular
region and common after-effects
Render expert interpretation of findings of medical-legal
evaluations and provide expert opinion regarding possible causes
of abuse in court hearings, criminal trials and civil proceedings
Use information obtained in appropriate manner to enhance fact
finding and further documentation of torture
PtD Project (IRCT, HRFT, REDRESS, PHR)
Content of Written Reports
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Medical expert qualifications:
– List educational and professional qualifications
– Highlight prior experience examining survivors of torture and
trauma and any experience working with individuals who suffer
from common psychological symptoms such as PTSD and Major
Depression
– Participation in training and seminars related to torture
survivors
– Attach a copy of curriculum vitae
– May be helpful to refer to clinician’s application of Istanbul
Protocol standards in his or her medical evaluation
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Source of case referral and reason for the evaluation
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Note whether the evaluation was conducted on a pro bono basis
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List of any background documents read beforehand if required
PtD Project (IRCT, HRFT, REDRESS, PHR)
Content of Written Reports
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Generally a written report contains:
– Account of event(s) as described in Module 3
– Description by individual of his or her physical and psychological
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symptoms and signs at the time of alleged ill-treatment, and
account of how symptoms evolved with or without medical
treatment
Description of individual’s physical and mental health at time of
interview(s) and how they have changed with treatment.
Note of any medical treatment in detention, or any treatment
that was requested but denied
Account of the physical and psychological findings from
interview(s)
Professional opinion on likely causes of findings, discussing other
relevant possible causes attributed to torture
Summary and conclusions of overall evaluation
Any relevant recommendations for additional tests,
consultations, and/or need for treatment services.
PtD Project (IRCT, HRFT, REDRESS, PHR)
Content of Written Reports
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Some trial attorneys and judges have objected
to affidavits in which medical professionals
recite information provided by the alleged
torture victim to the professional
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Clinician should be careful to state only that
individual “states” or “reports” that a specific
incident occurred
PtD Project (IRCT, HRFT, REDRESS, PHR)
Content of Written Reports
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Written reports should comment on:
– Emotional state of person during interview
– Symptoms, history of detention and torture, and personal and
family history prior to torture
– Factors such as the onset of specific symptoms in relation to
the trauma, the specificity of any particular psychological
findings, as well as patterns of psychological functioning
– Additional factors such as forced migration, resettlement,
difficulties of acculturation, language problems, loss of home,
family, social status, as well as unemployment
– If formal psychiatric diagnosis is given, reasons should be
explained
PtD Project (IRCT, HRFT, REDRESS, PHR)
Content of Written Reports
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Conclusion: opinion on extent to which all sources of medical evidence
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Additional sources of information may include:
corroborate individual’s specific allegation of torture and ill treatment
– Copies of previous court decisions about individual
– Correspondence from other health professionals to whom patient has
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been referred
Country-specific information on torture and ill treatment practices
Account of event(s) as described by the individual
Notes on individual’s description of his or her physical and mental
health
Records of psychological and physical findings from the interview(s)
Results of any clinical investigations
Recommendations for further treatment
PtD Project (IRCT, HRFT, REDRESS, PHR)
Guidelines for Medical Reports
1. Relevant case information
 2. Clinician’s qualifications
 3. Statement regarding veracity of testimony
 4. Background information
 5. Allegations of torture and ill treatment
 6. Physical symptoms and disabilities
 7. Physical examination
 8. Psychological history/examination
 9. Photographs
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PtD Project (IRCT, HRFT, REDRESS, PHR)
Guidelines for Medical Reports
10. Diagnostic test results
 11. Consultations
 12. Interpretation of physical and psychological
findings
 13. Conclusions and recommendations
 14. Statement of truthfulness (for judicial
testimonies)
 15. Statement of restrictions on the medical
evaluation/investigation (for subjects in custody)
 16. Clinician’s signature, date, place
 17. Relevant appendices
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PtD Project (IRCT, HRFT, REDRESS, PHR)
Inconsistencies
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Torture survivors may have difficulties recalling and recounting
specific details of their torture experience(s) because of:
– Factors directly related to torture experience
– Factors related to psychological impact of torture
– Cultural factors
– Factors related to interview conditions or barriers of
communication
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Inconsistencies that are attributable to an individual’s torture
experience may, in fact, support an individuals allegations of abuse,
rather than undermine it
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It is extremely important for clinicians to clarify all inconsistencies
prior to report writing or testifying in court
PtD Project (IRCT, HRFT, REDRESS, PHR)
Testifying in Court
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Purpose: Present oral material that has been submitted in
written report and respond to questions from lawyers and
adjudicators
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Clinicians should:
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Anticipate challenges to his/her testimony
Bring all relevant sources of evidence to court
To extent possible, educate court about physical and/or psychological
evidence of torture
Proceedings usually include:
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Certifying the clinician as an expert witness
Direct examination by the alleged victim’s attorney
Cross-examination by the opposing attorney
“Redirect” questions by the alleged victim’s attorney
PtD Project (IRCT, HRFT, REDRESS, PHR)
Testifying in Court
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Possible responses to challenges regarding clinician’s
cross-cultural knowledge:
– Expertise that he/she has with respect to culture in question
– Cross-cultural research on psychological trauma and
symptomatology indicating valid application of, for example,
PTSD criteria across cultures
– Skills in clinical listening and assessment which allow
exploration of cross-cultural experience without being a
specialist in particular culture
– Common sense and face value components of the assessment
process. (i.e. marked emotional distress on recounting the
alleged torture and ill treatment)
PtD Project (IRCT, HRFT, REDRESS, PHR)
Testifying in Court
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Providing opinions on an individual’s credibility:
– Finding of credibility is a legal matter; responsibility of
the judge
– Expert witness is one resource that judge draws upon to
make determination
– Clinician need not feel compulsion to make that
determination for the judge, and, indeed, judges may
resent an expert who tries to do so
– Clinician should respond to attorney’s and the judge’s
questions on credibility as thoroughly and professionally as
possible and let judge arrive at his/her own conclusion
PtD Project (IRCT, HRFT, REDRESS, PHR)
Testifying in Court
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Some general guidelines for oral testimony
– Do not “react” to provocative statements
– Clarify questions that you do not understand before
providing an answer
– Answer questions directly and succinctly. However, take the
opportunity, when available, to editorialize and educate
– Do not offer opinions on subjects about which you are not
qualified to comment
– Speak clearly, slowly, and make eye contact with whomever
you are speaking.
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See Stanley Brodsky’s Testifying in Court: Guidelines and
Maxims for the Expert Witness; and The Expert Witness: More
Maxims and Guidelines for Testifying in Court.
PtD Project (IRCT, HRFT, REDRESS, PHR)
Mock Judicial Proceeding
Group Activity: “testifying in court” using
evaluation findings from Modules 7 and 8.
 Students should use their written findings as the
basis for their expert testimony.
 Ideally, each student should have an opportunity
to practice testifying on their medical evaluation
findings for at least one case.
 One or more students should assume the role of
the medical expert and one or more students
should assume the role on a cross-examining
lawyer (or prosecutor/judge).
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PtD Project (IRCT, HRFT, REDRESS, PHR)
Mock Judicial Proceeding
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Consider the following questions for the “crossexamining lawyer”:
– Describe your qualifications as a clinician, in general, and
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as an expert on the psysical and psychological evidence of
torture.
Were you paid to conduct this evaluation?
Did the attorney you are working with prepare you for
this court hearing?
Describe your primary findings (physical and
psychological).
What are the possible causes of the findings you
described? Are there other possibilities?
PtD Project (IRCT, HRFT, REDRESS, PHR)
Mock Judicial Proceeding
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Consider the following questions for the “crossexamining lawyer:”
– Is it possible that the physical injuries were self-
inflicted, by another inmate, or in the course of a
struggle with police/security forces.?
– Is it possible that other traumatic experience which
happened before or after the alleged torture are the
cause of the detainees psychological symptoms?
– Was a proper chain of custody maintained for the
collection of evidence?
– What are your conclusions regarding the detainee’s
allegations of torture and ill treatment?
PtD Project (IRCT, HRFT, REDRESS, PHR)
Mock Judicial Proceeding
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Consider the following questions for the “crossexamining lawyer:”
– Did you find the detainee credible? Why or why not?
– Were there any inconsistencies observed in your
evaluation? How do you explain these?
– How do you know that the detainee is not faking the
symptoms that he/she alleges?
– Do you have any additional recommendations?
PtD Project (IRCT, HRFT, REDRESS, PHR)