Fitness for detention in police custody: a practical proposal for improving the format of medical opinion.

Health issues among arrestees are a worldwide concern for which only local policies have been established. Physicians attending detainees in police custody are expected to decide whether the detainee's health status is compatible with detention in a police station and make any useful observations. A high degree of heterogeneity in the information collected by the physician and transmitted to the police has been observed. We analyzed the content and limitations of available documents and developed a model that could serve as a guide for any attending physician. The document presented here has been used in France on over 50,000 occasions since June 2010. We developed a two-page template consisting of (1) a standard medical certificate to be sent to the authority who requested the doctor's attendance and (2) a confidential medical record, not sent to the requesting authority. We evaluated perceived health by the three global health indicators of the Minimum European Health Module and used DSM IV criteria for the evaluation of addictive disorders. In the case of recent traumatic injuries, the certificate has also included the collection of data on traumatic injuries and the contexts of their occurrence. The proposed certificate achieved several goals, by protecting the interests of the person examined, in case of poor conditions of arrest or detention, protecting doctors in cases of legal proceedings, and allowing epidemiological data to be collected. The certificate may also contribute to an international awareness of medical care for detainees in police custody.

[Physicians attending detainees in police custody: an improved format of the doctor's opinion]. / Intervention du médecin en garde à vue : proposition d'un certificat médical amélioré

OBJECTIVE: Physicians attending detainees in police custody should decide whether the detainee's health status is compatible with detention in a police station. According to a recent French law on police custody (April 14, 2011), the physician is expected to make any useful observations. Standard documents have been proposed since 2004. They have not been extensively used so far. Our objective was to analyze the content and the limitations of such documents and to elaborate a new model. METHODS: We analyzed available models, studied how they fit to national guidelines, and proposed a new model which was more in accordance with the existing guidelines. RESULTS: Recommended format of the doctor's opinion consists in two parts: a standard medical certificate to be sent to the authority who requested the doctor's attendance and a confidential medical record, which is not sent to the requesting authority. Some guidelines were not followed, e.g. detection of psychiatric illnesses and addictive behaviours, and a systematic record of traumatic injuries. The new model has been tested for 18 months by a group of 25 forensic physicians. It includes the description of traumatic injuries and suggests that the doctor systematically assesses a duration of total incapacity to work, even if an extensive description is not requested by the authority. The confidential medical record mentions psychiatric history and addictive behaviours. CONCLUSION: The proposed model could help detainees to assert their rights. It could also take part in characterizing health hazards to which detainees can be exposed.

Evaluating the functional impairment of assault survivors in a judicial context - A retrospective study.

BACKGROUND: The description of traumatic injuries and the outcome on functioning are major items of the evaluation of assault survivors. French law quantifies the seriousness of committed violence through the duration of the victims' inability to fulfil their usual daily activities, in days of 'Total incapacity to work' (TIW). Physicians are provided with a limited number of recommendations. In this study, we searched for determinants of TIW. METHODS: We reviewed 1145 consecutives files of victims evaluated between 10/01/2010 and 11/22/2010. People reporting repeated assaults, or assessed more than 30 days after the facts were excluded. Data collected were: gender, age, TIW, type of traumatic injuries, time to evaluation, patient category, type of assailant, and presence of aggravating factors. Univariate associations with TIW were assessed, while generalised linear models including relevant covariables were proposed. RESULTS: The population (718 men, 427 women, median age 29) included 236 detainees, 74 police officers, and 835 other individuals. Mean duration of TIW was 4.3 days. The time to evaluation was correlated to TIW. Patient category (police officers, detainees, or other individuals), presence of traumatic injuries, and type of assailant were associated with TIW. In patients presenting no evidence of bone fracture, duration of TIW (2.0 days vs. 2.6 and 3.8, p < 0.001) and time to evaluation (10.9 h vs. 21.2 and 58.5, p < 0.001) differed in detainees, police officers, and other individuals. CONCLUSION: We suggest that the outcome of assaults should be evaluated in similar conditions in all victims, including time to evaluation.