Good-Practice Example: Netzwerk Probeweis – How It Can Work

Good-Practice example: Netzwerk ProBeweis – How it can work

Michael Klintschar Department of Legal Medicine Hannover Medical School

RiVi: This project is co-funded by the Justice Programme of the European Union (2012- 2020) Rechtsmedizin RIVI 26.11.2020 Traditional procedure with suspected domestic or sexual violence

Criminal complaint No (initial) criminal complaint Police investigation No investigation with medicolegal examination by a forensic No medicolegal examination physician

Anamnesis | Documentation of findings | Asservation of stains, blood sample etc. | Storage of the evidence | therapeutic and/or prophylactic multiple contusions of the whole body….. measures | Written expert opinion Rare….. Investigative authorities Common….. Indictment or termination

Rechtsmedizin RIVI 26.11.2020 Why does the victim so rarely file criminal complaint? • Domestic and sexual violence are sensitive, private issues • Reasons are complex – Fear to terminate a relationship – Fear to start an investigation that cannot be terminated easily • The victims need time and counseling • However, evidence can be collected only for a short time….

Rechtsmedizin RIVI 26.11.2020 Traditional procedure with suspected domestic or sexual violence

Criminal complaint No (initial) criminal complaint Police investigation No investigation with medicolegal examination by a forensic No medicolegal examination physician

Prosecution impeded Investigative authorities Retraumatisation of the victim Indictment or termination

Rechtsmedizin RIVI 26.11.2020 How to overcome this obstacle?

• Every victim must have access to a medicolegal examination and preservation of evidence • Regardless of a complaint • The results must be confidential • The victim may file a complaint any time and authorize the transfer of the evidence to the police

Rechtsmedizin RIVI 26.11.2020 But… • Examination must be available 24/7 • It must be free for of charge • Examination must be performed close to the place of residence • Physicians need to have training in forensic medicine

Lower Saxony 8 Million inhabitants Distance up to 400km

Rechtsmedizin RIVI 26.11.2020 https://de.wikipedia.org/wiki/Niedersachsen 6 Aim of Netzwerk ProBeweis

• To create a comprehensive network (covering all of Lower Saxony) in that

• judicially usable evidence is secured, and

• professional and competent documentation of injuries is performed

• according to the standards of forensic medicine

• BEFORE filing a criminal complaint

Rechtsmedizin RIVI 26.11.2020 Victim reports to the police Release from the Police/prosecution medical confidentiality

investigation physician Victim support organisation ………

Physical inspection Documentation, Expert opinion preservation of evidence

Storage of evidence DNA

channelling of further medical procedures Toxikology

Channelling support from a victim support organisation

Rechtsmedizin RIVI 26.11.2020 Flyer, articles Victim reports to the police in journals, Release from the Police/prosecution medical confidentiality meetings, advertisement investigation physician Victim support organisation ………

Training of physicians, Standard procedures aim: same Based on pictures, Kits standards as for documentation. HandbookPhysical inspection forensic Only if commissioned by the police Documentation, examinationsExpert opinion Postpreservation of evidencecommissioned by Courier the prosecution DNA Storage of Storageevidence of evidence at MHH channelling of further medical procedures Toxikology Based on blood, urine, swabs. Channelling support from a victim support Only if commissioned by organisation the police Rechtsmedizin RIVI 26.11.2020 2012

MHH Außenstelle Rechtsmedizin

Niedersachsen

Medizinische Hochschule Hannover Untersuchungsstelle Rechtsmedizin Klinik für Frauenheilkunde

Helios-Albert-Schweitzer-Klinik Northeim

Universitätsmedizin Göttingen

Rechtsmedizin RIVI 26.11.2020 2014

Rechtsmedizin RIVI 26.11.2020 2016 Ubbo-Emmius-Klinik Aurich Elbe Kliniken Stade

Krankenhaus Buchholz

MHH Außenstelle Rechtsmedizin Städt. Klinikum Klinikum Oldenburg Lüneburg Ev. Krankenhaus Oldenburg

21 Marien Hospital Papenburg Aschendorf Helios Klinikum Uelzen

Aller-Weser-Klinik Verden

Heidekreis-Klinikum Walsrode Krankenhaus Ludmillenstift Meppen Niedersachsen Allgemeines Krankenhaus Celle

St. Marienhospital Vechta Medizinische Hochschule Hannover Untersuchungsstelle Rechtsmedizin Städt. Klinikum Klinikum Wolfsburg Klinik für Frauenheilkunde Braunschweig Marienhospital Osnabrück

Helios Klinikum Salzgitter

Asklepios Klinik Agaplesion Evangelisches Goslar Krankenhaus Holzminden

Helios-Albert-Schweitzer-Klinik Northeim

Universitätsmedizin Göttingen

Rechtsmedizin RIVI 26.11.2020 Comprehensive Network

 40 clinics  37 hospitals

 36 cities  25 Landkreise  7 kreisfreie Städte



Rechtsmedizin RIVI 26.11.2020 13 Examination kit

Rechtsmedizin RIVI 26.11.2020 Blood and urine Bags for nail Bag for clothing tubes clippings

Disposable panties

Aqua dest. Documentation sheet

SD-card

Swabs long Swabs short scale

Rechtsmedizin RIVI 26.11.2020 1100 Untersuchungen bis 07.08.2020

220 Rechtsmedizin 200 Partnerklinik 180

160

140

120

100 Anzahl 80

0 2012 2013 2014 2015 2016 2017 2018 2019 2020 (August)

Rechtsmedizin RIVI 26.11.2020 16 Evaluation: Questioning the physicians Would you recommend other hospitals to join Netzwerk ProBeweis?

Probably not Rechtsmedizin RIVI Yes probably Not at all 26.11.2020 Questioning the vicitms

How satisfied are you with ...

The course of examinationdem Verlauf der Untersuchung 19 7

den Informationen über die Untersuchung 19 7 The informations about the examination sehrVery zufrieden much eherQuite zufrieden much eherNot unzufrieden much sehrNot unzufrieden at all The waiting timeder before Wartezeit the vor examinationder Untersuchung 15 5 4 2

The first contact dem ersten Kontakt 17 9

0 5 10 15 20 25 30

Rechtsmedizin RIVI 26.11.2020 Questioning the victims

During the examination….

23 3 I was taken seriouslyvon Arzt/Ärztin by the ernstgenommen doctor trifftVery voll muchund ganz so zu trifftQuite eher zuso trifftRather eher nicht not zu trifftNot gar at nicht all zu k.A.No response

23 2 1 The doctorArzt/Ärztin had hat enoughsich genügend time Zeit genommen

0 5 10 15 20 25 30

Rechtsmedizin RIVI 26.11.2020 Would you recommend the examination to a friend?

8 6

2 1 1

0 ja, ganz ja, vermutlich nein, vermutlich nein, bestimmt k.A. bestimmtYes probably Probablynicht Notnicht at all No response not

Rechtsmedizin RIVI 26.11.2020 Criminal charges and requests by the police

220 Gesamt All 200 n AnzeigeCharge filed 180 AnforderungEvidence entered into the proceedings

160

140

120

Anzahl 100

0 2012 2013 2014 2015 2016 2017 2018 2019 n=1035

Rechtsmedizin RIVI 26.11.2020 21 Details of the Criminal Charges

• Rate of charges: 18,1 % (n=1035)

• Interval > 72 h incident - examination: few hours up to several years (n=187) < 72 h

• Interval • examination - charge : 0 days – 1131 days Median: 15 days (n=44)

Rechtsmedizin RIVI 26.11.2020 22 Status of proceedings in criminal charges (information for 72 of 187 cases)

conviction 20,8 %

72 criminal proceedings termination 75 %

Rechtsmedizin RIVI 26.11.2020 23 Medicolegal examinations should be organized with medical practitioners in hospitals, rather than in private practice. Too many physicians in private practice: E.g. 198 gynecologists in Hannover

Not 24/7

Not a sufficient case number in private practice

Rechtsmedizin RIVI 26.11.2020 Regular training of the physicians is crucial, especially when the case numbers are low and the staff changes on a regular base.

Rechtsmedizin RIVI 26.11.2020 Medicolegal examination is dependent on collaboration with victim support organizations and should seek support for the office of the respective equal opportunities commissioner

Rechtsmedizin RIVI 26.11.2020 A central storage of evidence is necessary

Rechtsmedizin RIVI 26.11.2020 3 major problems:

First Problem How to motivate physicians to document/collect evidence?

There is a high intrinsic motivation in Physicians to help vctims They just need the tools to do so…

Rechtsmedizin RIVI 26.11.2020 Second Problem

How to motivate patients to have evidence documented/collected?

Rechtsmedizin RIVI 26.11.2020 1. A strategy to inform the general public of the service needs to be implemented

2. professionals in this field (general practitioners, gynaecologists, victim support units etc.) need to be informed of the medicolegal documentation service

Rechtsmedizin RIVI 26.11.2020 Third Problem: k.o. drugs

The victim unit must develop a operation procedure how to proceed with suspected knock out drugs (incl. Liquid Ecstasy: gamma- Hydroxybutyric acid)

Rechtsmedizin RIVI 26.11.2020 Thank you for your participation

Rechtsmedizin RIVI 26.11.2020