An Avoidable Death in Police Custody?

Traumatic Epidural and Subdural Hematoma: Epidemiology, Outcome, and Dating

Epidural hematomas (EDHs) and subdural hematomas (SDHs), or so-called extra-axial bleedings, are common clinical entities after a traumatic brain injury (TBI). A forensic pathologist often analyzes cases of traumatic EDHs or SDHs due to road accidents, suicides, homicides, assaults, domestic or on-the-job accidents, and even in a medical responsibility scenario. The aim of this review is to give an overview of the published data in the medical literature, useful to forensic pathologists. We mainly focused on the data from the last 15 years, and considered the most updated protocols and diagnostic-therapeutic tools. This study reviews the epidemiology, outcome, and dating of extra-axial hematomas in the adult population; studies on the controversial interdural hematoma are also included.

Understanding death in custody: a case for a comprehensive definition

Prisoners sometimes die in prison, either due to natural illness, violence, suicide, or a result of imprisonment. The purpose of this study is to understand deaths in custody using qualitative methodology and to argue for a comprehensive definition of death in custody that acknowledges deaths related to the prison environment. Interviews were conducted with 33 experts, who primarily work as lawyers or forensic doctors with national and/or international organisations. Responses were coded and analysed qualitatively. Defining deaths in custody according to the place of death was deemed problematic. Experts favoured a dynamic approach emphasising the link between the detention environment and occurrence of death rather than the actual place of death. Causes of deaths and different patterns of deaths were discussed, indicating that many of these deaths are preventable. Lack of an internationally recognised standard definition of death in custody is a major concern. Key aspects such as place, time, and causes of death as well as relation to the prison environment should be debated and incorporated into the definition. Systematic identification of violence within prison institutions is critical and efforts are needed to prevent unnecessary deaths in prison and to protect vulnerable prisoners.

Reported assaults and observed injuries in detainees held in police custody

The deprivation of liberty in police custody can be associated with violent situations and traumatic injuries. The rare available data did not mention whether alleged assaults occurred at the time of the arrest or during custody. Our objectives were to describe the frequency of recent traumatic injuries observed in detainees at the time of medical examination and to record detainees' self-reports of received physical violence, either before being arrested, at the time of the arrest, or during custody. In 2694 consecutive detainees examined in a suburban area near Paris, we compared persons' characteristics in four groups, according to the existence of alleged assaults or the presence of recent traumatic injuries, or both. Detainees reported to be victims of physical assaults in 25% of cases (686 of 2694): 374 assaults of 686 (55%) occurred at the time of arrest and 87 of 686 (13%) during custody. The opinion of assaulted detainees on custody was worse than non-assaulted detainees. Detainees alleging assaults by the police, whatever the time of the assault, accounted for 396 cases (15%). Three quarters of detainees (547 of 686, 79%) alleging assaults had recent traumatic injuries. When we considered all detainees, medical examination showed recent traumatic injuries in 724 of 2694 (27%). Injured detainees were declared unfit for detention more frequently than non-injured non-assaulted detainees (P<0.05). These results strengthen the need and usefulness that the attending physician systematically takes note of detainees' self reports of assaults and investigates recent traumatic injuries at the time of custody.

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.