The relationship of victim injury to the progression of sexual crimes through the criminal justice system

Sexual assault and abuse committed against family members: An analysis of 1342 legal outcomes and their motivations

Background

Over the past years medical centres specifically addressed in gender-based violence have developed protocols for the collections of evidence useful in the courtroom, including accurate documentation of physical and psychological states of the victim and collection of samples. Previous studies showed an association between documented physical trauma and conviction but unfortunately, few studies in the recent literature analysed the factors that influence the legal outcome and final judgement. The present study focused on the elements that appeared of significance in the legal outcome, including medico-legal evaluation, source of the crime report and circumstance of the assault.

Methods

It was conducted a retrospective analysis of all the judgments issued by the Public Prosecutor’s Office at a Court of a Metropolitan Italian city regarding sexual and domestic violence, from January 1^st 2011 to 31st December 31^st 2015. Examination regarded the demographic information of the victim and of the defendant, information on the crime, the circumstances of the aggression and medical information retrieved. Sentences were subsequently divided into two categories based on the legal outcome (conviction vs acquittal) and the different characteristics of the two sub-populations were compared to verify if there were variables significantly associated to the judge’s final judgment.

Results

Over the 5 years taken into consideration, there have been 1342 verdicts regarding crimes of sexual violence (374 cases) and regarding abuses against family members or cohabitants (875): other 93 cases regarded both sexual violence and abuse. 66.3% ended in conviction of the offender and 33.7% in acquittal of the accused. Cases of conviction were more frequent when they involved: use of a weapon by the assailant, as well as if the assailant had a criminal record and had a history of drug abuse or other addictions; duration of proceeding less 22 months and a civil party involved; presence of clinical documentation together with other deposition in addition to victim’s deposition; also frequent episodes of violence and application of precautionary measures were associated to conviction.

Conclusions

Many factors seem able to influence the judge’s judgment, although clearly each case must be singularly evaluated. The mere presence of medical documentation, without the support of other sources of evidence, such as the victim’s statement or further declarations, however, is almost always not definitive for the verdict. Despite so, in cases where there are multiple sources of evidence, clinical documentation can provide useful elements and can give clues on the consistency between the history told and injuries observed.

Sexual Assault: Forensic Examination in the Living and Deceased

The forensic examination of a person suspected of having been sexually assaulted encapsulates the breadth of forensic medicine possibly more completely than any other situation in forensic practice. Whether in the living or deceased, detection of injury and biological material to support or exclude sexual activity requires a careful, methodical approach to ensure robust evidentiary value and an understanding of genito-anal anatomy and sexual physiology to interpret its significance for the courts. This paper is not intended as an exhaustive guideline but aims to provide a general overview of the key components of forensic sexual assault examination highlighting the common and different aspects in living and deceased persons.

[Study of the factors associated with the delay of health consultation of victims of rape in Senegal]

INTRODUCTION

Rape remains one of the most serious forms of sexual violence because of its negative impact on the physical and mental health of victims. The objective of this study is to identify the factors associated with the delay in rape victims seeking medical assistance from healthcare professionals in Senegal.

METHODOLOGY

A retrospective, descriptive and analytical observation study was conducted. The study population consisted of all the court files of girls or women victims of rape recorded by the investigators at the 11 high courts of Senegal during the period from 2006 to 2015. An exhaustive recruitment of the full records of rape victims meeting the inclusion criteria were completed. The uni and multivariate analyses were carried out with Epi Info 2000 and R 2.2.9 software respectively.

RESULTS

At the end of the collection, 1,037 cases of rape were included in the study population. The average age of the victims was 16.3±7.9 years (range 1-72). Minors (<18 years) accounted for 24.8 %. The median time from rape to consultation at a health facility was 24hours. Long delay in consultation (>24hours) was noted for 38.6 % of victims. Risk of late consultation after rape was higher among victims residing in the southern areas (ORaj=4.31 [1.15-16.14]), or northern areas (ORaj=4.22 [1.26-14.14]), who were major (ORaj=1.67 [1.04-2.68]) or married (ORaj=3.44 [1.58-7.5]) or who were pregnant after the aggression (ORaj=34.03 [15.47-74.85]) or had an abortion (ORaj=5.45 [1.04-24.47]).

CONCLUSION

Medical and judicial assistance are more difficult if there is a long delay between the aggression and consultation. Thus, it is important for the health and judicial authorities to raise awareness about the harmful consequences of sexual violence, and to put forward the benefits of therapeutic care, compensation for the harm suffered by rape victims, as well as the availability of holistic care services 24hours a day.

The significance of the forensic clinical examination on the judicial assessment of rape complaints - developments and trends

OBJECTIVE

The aim of this study was to investigate the role of the forensic clinical examination in the judicial assessment made by the Prosecution Service in cases of rape.

METHODS

All cases of police-reported sexual assault in the county of Funen, Denmark in a six-year period were reviewed, and the retrospective data was collected. Cases in which a forensic clinical examination was performed were included.

RESULTS

The Prosecution Service in the county of Funen received 348 police-reported rape cases and of these 184 cases were included. The Prosecution Service stated that the forensic clinical examination (FCE) was important for the decision-making process in approximately half of the cases. The Prosecution Service finding an FCE important due to the presence of relevant findings was significantly associated with the case going to trial, whereas importance due to absence of relevant findings was significantly associated with the cases not going to trial. The only single factor associated with a case going to court and a guilty verdict was an FCE of the alleged perpetrator. There were no crude associations between any other factors i.e. the type of assault, victim injuries or alcohol consumption. In a logistic regression model, however, it was significantly more likely (p < 0.05) that a forensic clinical examination of the victim was used in the Prosecution Service's decision if there were both anogenital and extra-genital injuries documented, that could originate from the alleged crime. The odds were 7.83 times higher compared to if no injuries were detected. The Prosecution Service's use of the clinical examination in their argumentation of the decision of a rape complaint has been significantly increasing from 2003 to 2015.

CONCLUSION

The results of the first in-depth analysis of the overall importance of a forensic clinical examination in cases of rape and sexual assault shows that we need to continuously focus on the documentation of sexual assault, as documentation is part of the decision-making process at all stages of the judicial process.

[Forensic medical examination of adolescent and adult victims of sexual assault or intimate partner violence who do not complain to the police - An observational study in Seine-Saint-Denis, France]

OBJECTIVES

to identify characteristics of victims of sexual assault or domestic violence who consulted in a Department of Forensic Medicine without a formal complaint to the police.

METHODS

observational study (03/01/2014-08/31/2015) of individuals (age>15years) consulting in a Department of Forensic Medicine near Paris, France, after a sexual assault or domestic violence. Among the individuals who were examined in the department of Forensic Medicine, we compared the individuals who had not complained to the police to those who had complained to the police.

RESULTS

A hundred and nine individuals have consulted without a prior complaint to the police, including 73 persons after domestic violence (i.e. 4% of all persons examined with or without a complaint to the police) and 36 persons after a sexual assault (i.e. 8% of all persons examined). Regarding domestic violence, the proportion of persons presenting recent traumatic injuries was lower among those who did not complain to the police than among those who did (64% vs. 78%, P=0.008). Regarding sexual violence, the persons who did not complain to the police were more frequently uncertain about the assault (42% vs. 13%, P<0.001), reported more frequently a recent alcohol or drug intake (42% vs. 26%, P=0.039) and less frequently showed extragenital traumatic injuries than the persons who did complain to the police (22% vs. 43%, P=0.016).

CONCLUSION

the persons examined who had not complained to the police accounted for less than one in 20. The extension of the activity of a Department of Forensic Medicine to persons who do not want to be involved in a judicial process is not sufficient for the majority of victims to consult a forensic physician.

A retrospective study of sexual offences in Zambia

Zambia has recently reported high incidences of sexual abuse against women and children. Zambian law categorises sexual offences into rape, defilement, incest and others, with defilement constituting the majority of the reported cases (>89%). Between 2010 and 2012, convictions of defilement cases were achieved in only 13% of cases reported to the police. DNA evidence has shown prominence in resolving crimes, specifically as an identification tool in sexual offences. Currently there is no empirical evidence describing the role of forensic evidence in sexual crimes in Zambia; as such a retrospective study was conducted to evaluate this between 2007 and 2014 (n = 1154). Only 14 (0.1%) of the cases had forensic samples collected in the form of a vaginal swab for semen analysis. In all cases where a suspect was identified (60%), identification was based on the witness/victim testimonies, and in no case, was forensic DNA evidence used to assist in identification or corroborate the testimonies. Overall, 28.1% of cases were taken to court and the conviction rate was 12.4%. These findings support the use of employing DNA evidence in sexual offence cases to aid the identification of suspects, which is hypothesised to increase the number of cases prosecuted in Zambia.

Reliability of tristimulus colourimetry in the assessment of cutaneous bruise colour

BACKGROUND

Bruising is one of the most common types of injury clinicians observe among victims of violence and other trauma patients. However, research has shown commonly used qualitative description of cutaneous bruise colour via the naked eye is subjective and unreliable. No published work has formally evaluated the reliability of tristimulus colourimetry as an alternative for assessing bruise colour, despite its clinical and research applications in accurately assessing skin colour. The purpose of this study was to systematically evaluate the test-retest and inter-observer reliability of tristimulus colourimetry in the assessment of cutaneous bruise colour.

METHODS

Two researchers obtained repeated tristimulus colourimetry measures of cutaneous bruises with participants of diverse skin colour. Measures were obtained using the Minolta CR-400 Chomameter. Commission Internationale d'Eclairage (CIE) L*a*b* colour space was used. Data was analysed using intraclass correlation coefficients (ICC), Cronbach's alpha, and minimal detectable change (MDC) on all three L*a*b* values.

RESULTS

The colorimeter demonstrated excellent test-retest or intra-rater reliability (L* ICC=0.999; a* ICC=0.973; b* ICC=0.892) and inter-rater reliability (L* ICC=0.997; a* ICC=0.976; b* ICC=0.982).

CONCLUSIONS

With consistent placement, the tristimulus colourimetry is reliable for the objective assessment and documentation of cutaneous bruise colour for purposes of clinical practice and research. Recommendations for use in practice/research are provided.

The (in)significance of genital injury in rape and sexual assault

The forensic significance of genital injury following rape and sexual assault has been the subject of considerable academic and research interest, in terms of the contribution it may provide to the body of evidence in criminal proceedings. This essay takes a critical look at such research, in the context of modern understandings of what actually constitutes rape and sexual assault. Written from the author's perspective as a forensic physician practising in Scotland, it illustrates the fascinating interface between medical evidence and the legal system.

Strategic categorization of available research relating to sexual assault and rape facilitates more accurate interpretation of injury data

The available research evidence pertaining to anogenital injury in victims of sexual violence presents a very wide range of injury prevalence data. As such, it is extraordinarily challenging for health care practitioners involved in clinical forensic examination of victims of sexual violence to place their examination findings in to context. It is generally accepted that the broad range of existing injury prevalence data is reflective of heterogeneous research study methodologies and clinical practice techniques. Thus, health care practitioners should be encouraged to present their evidence in the context of the prevalence data that are most representative of their clinical practice. Presented herein is a simple categorization of existing prevalence data in accordance with national clinical practice guidelines. The range of anogenital injury prevalence is narrower when presented in this manner than when taken as a whole. This will facilitate health care practitioners in presenting their examination findings in the context of research literature that is most representative of their clinical practice.

How teaching on the care of the victim of sexual violence alters undergraduate medical students' awareness of the key issues involved in patient care and their attitudes to such patients

Sexual violence is known to be highly prevalent, albeit the majority of incidents are not reported to the authorities. It is therefore likely that medical students will encounter very many patients who have experienced sexual violence during their postgraduate careers, although this history may never be disclosed to them. Numerous highly regarded sources have advocated for the inclusion of instruction on the care of the victim of sexual violence in undergraduate medical curricula. Moreover, there has been a call for research to measure the effectiveness of educational strategies addressing the issue of sexual violence at undergraduate level. We present an evaluation of the effectiveness of a reproducible teaching session on care of the victim of sexual violence appropriate for undergraduate medical students, looking specifically at alterations in students' awareness of the key issues involved in patient care and their attitudes to such patients. This research demonstrates that such an educational intervention significantly enhances undergraduate medical students' awareness of the issues involved in patient care and their insight in to myths surrounding sexual violence.