A Training on Domestic Violence Strangulation Cases
Detecting Strangulation Cases – Investigation through Prosecution
“Never Let a Victim Die in Vain”
Presented by David R. Thomas M.S. Johns Hopkins University and the Maryland Network Against Domestic Violence StrangulationTHIS LESSON PLAN Training IS BASED Institute ON THE WORK OF:
Project of the Family • Casey Gwinn, San Diego City JusticeAttorney Center Alliance • Gael B. Strack, San Diego Assistant City Attorney Launched October • Dr. George E. McClane, Emergency Physician 2011 • Dr. Dean A. Hawley, Forensic Pathologist Sponsored by the Office on the Violence Against Women To Provide Training and Technical Assistance National Strangulation Training Institute – A Project of the Family Justice Center Alliance © www.strangulationtraininginstitute.org
IN MEMORY OF CASONDRA STEWART & TAMARA SMITH
SHEDDING LIGHT
• Two teenagers died in 1995. Casondra Steward 17 and Tamara Smith 16. • We wanted to learn from their tragic deaths. • The common denominator in their cases was strangulation. • We asked ourselves, what do we really know about detecting, documenting and prosecuting attempted strangulation cases? • We discovered, we didn’t know much at the time. But now….
WHAT’S REALLY GOING ON? A study in San Diego, CA revealed:
• 300 strangulation cases studied • Victims were all women • 99% suspects were men • 89% of cases had domestic violence history • All reported being choked by their male partners with bare hands, arms or objects • In 50% of the cases children were present STUDY FINDINGS
7 National Strangulation Training Institute – A Project of the Family Justice Center Alliance © 56 www.strangulationtraininginstitute.org STUDY FINDINGS
National Strangulation Training Institute – A Project of the Family Justice Center Alliance © 57 8 www.strangulationtraininginstitute.org STUDY FINDINGS
9 STUDY FINDINGS
10 SIGNS & SYMPTOMS DOCUMENTED IN SAN DIEGO POLICE REPORTS
• Redness to neck • Pain to neck/throat • Scratch marks • Coughing • Rope burns • Raspy voice • Thumb print bruising • Nausea or vomiting • Red eyes • Unconsciousness • Spasm • Ears ringing • Urination & • Head rush defecation • Miscarriage
11 NEXT STEPS
• Recognition of indicators. • Therefore, investigating officers should understand that strangulation cases may not always have visible signs or symptoms. • Officers need to understand how to determine and investigate strangulation cases. THE DV CONNECTION
•Strangulation is more likely to occur in domestic situations than in non- domestic situations. STUDY FINDINGS
• Focusing on symptoms, police reports showed police often neglected to clearly document what, if any, symptoms victims experienced. • This lead to conclusion that either officers failed to ask and/or victims failed to report symptoms. • Reported symptoms included pain to throat, hoarseness, nausea, loss of consciousness, hyperventilation, defecation, uncontrollable shaking, or loss of memory.
STRANGULATION & SEXUAL ASSAULT
• At least 50% of all DV cases include sexual assault. • At least 25% of all DV cases include strangulation. • At least 25% of all sexual assault cases include strangulation. • It’s difficult for victims to talk about sexual assault and it’s difficult for professionals to ask.
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SAN DIEGO STRANGULATION STUDY GAEL STRACK AND DR. GEORGE MCCLANE
In 50% of the Strangulation Cases……. Children were present
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THE CHANCES OF BECOMING A VIOLENT OFFENDER LATER IN LIFE.
Young boys who are Young boys physically who wit.DV in abused are the home are 6X more likely 3 X more likely
Kalmuss, D. (1984).
National Strangulation Training Institute – A Project of the Family Justice Center Alliance © www.strangulationtraininginstitute.org LISA TAPE
• What type of violence do you think was going on?
19 STRANGULATION AND PREGNANCY
• 34% of abused pregnant women reported being choked (Bullock 2006) • In 2010, a 10-year Kentucky Study of 102 strangulation victims showed 9% of victims were strangled at the time of pregnancy. (Shields) • In 1995 San Diego City Attorney Study of 300 cases, 10 cases involved pregnant victims being strangled. (Strack, McClane, Hawley, JEM 2001)
STRANGULATION POTENTIALLY LETHAL SYMPTOMS Ask victim if she is pregnant. Oxygen deprivation can affect the pregnancy.
240,000 pregnant women are subjected to domestic violence each year. 40% of assaults begin during the first pregnancy and pregnant women are at twice the risk of battery than non-pregnant women. 2000- 2004 data. www.Americanpregnancy.org/main/statistics/html
Treat Strangulation Cases Seriously “When a victim is strangled, she is at the edge of a homicide” •Surviving Victims 700% more likely to experience subsequent attempted homicide by their partner; & •800% more likely to be killed by that same partner. SIGNIFICANT FINDINGS:
• Lack of injuries caused us to minimize the seriousness of strangulation. • Suspects were not being held accountable for the crimes they committed. • An attempted strangulation should be prosecuted as a felony. • When prosecuted as a misdemeanor, we must treat it as one of the most serious misdemeanor case our office handles.
24 UNDERSTANDING LETHALITY
25 What does it mean to us when the victim says her boyfriend choked her?
26 CONTINUUM OF VIOLENCE
STRANGULATION?
27 STRANGULATION IS A RED FLAG…
• When battered women were asked what made them believe they were in danger or not -- the majority of women perceiving a great amount of danger in both a shelter & a hospital study mentioned “choking” as a tactic used against them that made them believe their partner might kill them. • Stuart & Campbell, 1989
28 “CHOKING” VS. “STRANGULATION”
29 TEMPORARY OBSTRUCTION OF THE CAROTID ARTERIES, OR THE JUGULAR VEINS (STRANGULATION), OR THE AIRWAY (SUFFOCATION) WILL PRODUCE ASPHYXIATION -- AN INTERRUPTION OF OXYGENATION. THE CHOKING GAME
IT IS ESTIMATED 1,000 YOUNG PEOPLE DIE EACH YEAR AS A RESULT OF THE CHOKING GAME BUT NO ONE IS TALKING ABOUT IT!
31 32 SIGNS OF THE CHOKING GAME
• Unexplained marks on the neck. • Bloodshot eyes. • Ropes, scarves or belts tied to bedroom furniture or doorknobs. • Bent closet rods. • Out of place leashes or bungee cords. • Bleeding under the skin on the face, especially the eyelids. • Talking about the choking game. • Disorientation, especially after being alone • Severe Headaches
33 MEDICAL SIGNIFICANCE
• Dr. George McClane, Speacialist on Emergency Room Medicine • Dr. Dean Hawley, Forensic Pathologist
Start by making it an agency policy to use the word “strangle” as opposed to the word “choke”.
“To Strangle” is an intentional act which seriously or fatally obstructs the normal breathing of a person
“To Choke” is an accidental blockage of the windpipe entirely or partly by some foreign object like food
USE OF FORCE CONTINUUM
Officer Presence Uniformed Officer Verbal Commands Provision of verbal directives Empty Open Hands Wrist locks, pressure point compliance, neck restraints Protective Implements Batons, pepper spray, taser Deadly Force Firearms, deadly strikes and or manuvers LATERAL VASCULAR NECK RESTRAINT NECESSARY FORCE
1.Location of 2. Quantity Force of Force
3. Duration of 4. Surface Force Area LATERAL VASCULAR NECK RESTRAINT
Neck Restraint vs. Choke Hold Step by step instruction Emphasis on arm placement Sides of neck vs. Across windpipe 7 seconds Face down & cuff Seated position Consciousness 15 – 30 seconds 3 strikes to the back Contact EMS start CPR CAROTID RESTRAINT: PROHIBITED OR RESTRICTED BY MANY POLICE DEPARTMENTS NATIONWIDE
• Many police agencies do not allow officers to use carotid restraint. • SDPD: No more than 30 seconds (7/92) • POST: First aid protocol. • “... subject should be checked by medical personnel” 43 STRANGULATION
• Can be a quick and lethal assault method
• The victim can lose consciousness in seconds and death can occur in mere minutes if the strangulation persists.
MINIMIZATION BY VICTIMS
• Victims may not understand the danger and maybe reluctant to seek medical attention.
“He didn’t really choke me, he just had me in a headlock and I couldn’t breathe”. Plattsburgh, NY • Santa Clara County policy to roll out the paramedics on each case MINIMIZATION BY PROFESSIONALS
• Positive Aspects
• Negative Aspects
7-47 MINIMIZATION BY DEFENDANTS
• San Diego, California case: • Why are you arresting me? All I did was choke her. • Portland, Oregon case: • “Officer, I swear I didn’t hit her. All I did was choke the living shit out of her once or twice. I swear I didn’t hit her.” • Thank you Officer Pam Moen (5/99)
48 MINIMIZATION BY POLICE & PROSECUTORS
• The cases submitted for misdemeanor prosecution were shocking. • The cases we didn’t issue were heart breaking • The dispositions of some of the cases were embarrassing
49 MINIMIZATION AT COURT
• Don’t expect your judges or jurors to understand the seriousness of strangulation • Without an expert, jurors are likely to think it didn’t happen because the injuries were too minor (San Diego Jury) • With an expert, jurors wanted to know why the case was only prosecuted as a misdemeanor (Orange County Jury)
50 DOCTORS MAY NOT RECOGNIZE THE SIGNS OR SYMPTOMS
• Escondido, CA Case: • Victim sought medical attention for dramatically red eyes caused by strangulation • Doctor told her she had “pink eye.” • Later victim disclosed to nurse and police were called.
INCIDENCE
• 10% of violent deaths • 12% of femicides • Experts suggest 20% of all femicides • Male assailants are often intoxicated
FORMS OF STRANGULATION
• Ligature
• Manual INJURY DURING STRANGULATION ASSAULT
• External signs of strangulation are absent in over half of all victims, even when examined by skilled medical personnel appropriately alerted to the possibility of strangulation injury. • Again, half of all assaults do not produce discernible external physical findings. Death can occur without any external marks at all. INJURY DURING STRANGULATION ASSAULT
• It is, of course, possible to touch the neck without causing strangulation injury or having a risk of serious injury or death • Touching the neck becomes strangulation if there is sufficient pressure to cause internal injuries that promote asphyxiation WAS IT A STRIKE?
58 WHAT’S THE DIFFERENCE BETWEEN A STRIKE AND A GRAB?
59 INJURY DURING STRANGULATION ASSAULT
• The internal injuries of strangulation involve the larynx, and the anatomic structures adjacent to the larynx • The larynx is the air passage. The top of the larynx opens to the mouth and nose. The bottom of the larynx opens to the trachea and then the lungs. The vocal cords are within the larynx. The esophagus for swallowing food is behind the larynx. LIGATURE STRANGULATION LIGATURE MARKS
MANUAL STRANGULATION - MOST COMMON METHOD USED MOST COMMON SYMPTOMS
• Changes in breathing • Changes in speech • Sore throat, raspy, scratchy voice • Changes in swallowing OTHER STRANGULATION AND SUFFOCATION SIGNS AND SYMPTOMS
• Skin abrasions (scratch marks, fingernail marks) and tiny red spots (petechiae) just over the face in strangulation, or generalized in the skin in suffocation • Abrasions over nostrils • Lip incised abrasions where lips are pushed against teeth • Red linear ligature marks or bruising • Light-headed or head rush • Fainting or unconsciousness • Loss of control of bodily functions INJURY DURING STRANGULATION AND SUFFOCATION ASSAULTS
• Victims may not seek medical attention, and victims may die up to several days after the assault, even with medical care, due to progression of internal injuries • Properly-treated survivors of strangulation assault probably will survive without long-term morbidity (other than post-traumatic stress disorder, which is common) ANATOMY
4 IMPORTANT STRUCTURES
• Muscles • Vessels • Bones • Cartilage
MUSCLES Hyoid Bone
Larynx Cartilage
Tracheal Rings VESSELS: ARTERIES & VEINS
• HYOID BONE
CAROTID THYROID ARTERY CARTILAGE (with fracture shown)
JUGULAR VEIN TRACHEAL RINGS
Jugular Vein Occlusion Lateral neck 4.4 pounds of pressure for 10 seconds
Unconsciousness Carotid Artery Occlusion Anterior neck 11 pounds of pressure for 10 seconds
Unconsciousness
It takes only 33 pounds of pressure to completely occlude (block) the trachea.
It takes at least 33 pounds of pressure or more to fracture tracheal cartilage. POINT OF NO RETURN
• 50 seconds - “Point of no return” • After 50 seconds of oxygen deprivation due to continuous strangulation, victims rarely recover. • “Bounce back” reflexes become inoperative • Resuscitation requires emergency medical intervention LETHAL PROGRESSION
10 seconds – Unconscious 30 seconds – Begin reviving 50 seconds – Point of no return
4 minutes Brain Dead
Neuro Praxia
• 50% of victims • larynx injury • Hoarseness (May be permanent) • Loss of voice Swallowing Changes
• Due to larynx injury • Difficult to swallow • Painful to swallow Breathing Changes
• Due to laryngeal fracture or swelling • Difficult to breathe • Inability to breathe • May appear mild but may kill within 36 hours
Behavioral Changes
. Early: Restlessness and violence • Victims may appear to be hostile toward officers at the scene
. Long term: Psychosis and Amnesia • Changes in personality • Rape case AUTONOMIC NERVOUS SYSTEM PARALYSIS
• Involuntary Urination or Defecation
(Dr. Dean Hawley, San Diego, August 2012) NECK LESIONS 1
• Impression marks • Abrasions • Scratches • Scrapes • Claw marks IMPRESSION MARKS
Courtesy of San Diego District Attorney’s Office, DDA Dan Goldstein SCRATCHES SCRATCHES
CLAW MARKS NECK LESIONS - II
• Red marks • Bruising • Finger outline impressions • Rope burns • Pattern injuries
REDNESS BRUISES BEHIND THE EAR THUMB-PRINT BRUISE
RED MARKS - OFTEN 3.
This victim was strangled repeatedly with two hands. Can you see the finger marks & bruising? PETECHIAE
PETECHIAE PETECHIAE PETECHIAE - ONE RED SPOT IN EYE PETECHIAE – EYELID & INSIDE THE EYE Petechiae – around the eye Petechiae – on the neck BLOOD RED EYES
• Blood red eyes are due to capillary rupture in the white portion of the eyes. This phenomenon suggests a particularly vigorous struggle between the victim and assailant • Intermittent compression, release of victim’s neck by assailant (peaks & valleys) SUBCONJUNCTIVAL HEMORRHAGE
FIRST RESPONDERS PRELIMINARY INVESTIGATION
Strangulation victims may have: No visible injuries at all Only temporary symptoms
BUT – because of brain damage due to lack of oxygen during the assault, they can die up to several weeks later! SELF-DEFENSE DETERMINATION
• What did you think was going to happen? • What were you thinking when you picked up the knife? • What made you think that? • Why weren’t you going to let him come near you? • What did you think would happen?
Remember: always make a self-defense determination before doing a predominant aggressor determination. Predominant aggressor only applies to when the officer had determined that both parties acted illegally and neither acted in self- defense. DEALING WITH THE BULLY
• Your child comes home complaining of being picked on at school • How would you determine they are in fact being bullied? • Who would you have them tell about the problem? • How would you tell them to handle the problem? • How would you attempt to get them out of the relationship with the bully?
HOW IS THIS ACCOMPLISHED?
Predominant Aggressor Determination: (Bully Determination)
Look at context, and not just the specific event. FIRST RESPONDERS PRELIMINARY INVESTIGATION
• Be aware that there are many ways a perpetrator can strangle a victim.
• The level of injuries and symptoms will depend on many different factors including:
• Method • Age and Health • Victim struggled • Size and Weight of Perpetrator • Amount of Force • Etc. DESCRIBE THE METHOD OF STRANGULATION
118 FIRST RESPONDERS PRELIMINARY INVESTIGATION
Look for injuries consistent with the method of strangulation
• Carotid restraint: shoulders • One hand, C-clamp: neck • Two hands: neck, chest, behind the ear, jaw • Ligature
120 WAS IT THE CAROTID RESTRAINT? WAS IT ONE HAND? WAS IT TWO HANDS? 124 ONE ARM? FROM THE FRONT OR BEHIND? WAS A LIGATURE USED? ASK THE VICTIM TO REMOVE HER BLOUSE
• Remember injuries can be at different locations: • Chest • Shoulder • Back of the neck TO DETERMINE INTENT:
• How long? • To avoid: “he grabbed me briefly” • Det. Agnew suggests to ask the victim to close her eyes and tell you “when” to indicate how long the defendant applied pressure to her neck. The officer then monitors the time. • How hard, on a scale from 1 to 10 with 10 being the hardest? • “it must have been 9, otherwise I would be dead right now.” HOW PAINFUL?
• Use the scale below to better estimate the level of the pain you are experiencing:
DID ANYONE HAVE JEWELRY?
• The Victim? • The Suspect? • Still on the victim? Suspect? • Broken? • Where was it located? • Photographed? FIRST RESPONDERS PRELIMINARY INVESTIGATION Identify Visible Injuries
BLOOD RED EYES
NECK RED SPOTS SWELLING
SCRATCHES BRUISING ROPE BURNS LIGATURE STRANGULATION
• Any object(s) used? • Photograph & Impound. • How did the object get there? • To prove intent
IF VICTIM REPORTS ANY SYMPTOMS, CALL THE PARAMEDICS!!
• Any trouble breathing? • Any trouble swallowing? • Any pain or tenderness? • See IACP protocol
HOW DID YOU FEEL?
• “fuzzy,” “dizzy” • “head rush” • “I saw stars.” • “I saw black and white.” • “I couldn’t breathe” • “I passed out” • “I vomited several times” • “I had trouble swallowing” • “I felt like my head was going to explode” • “I felt a rush of blood to my head”
Discussion Paper on IACP's Model Policy on Domestic Violence • March 2005 • • I. INTRODUCTION • • A. Purpose of Document • • This paper supports the Model Policy on Domestic Violence established by the IACP. As law enforcement administrators tailor this policy to their specific agencies, it will need to be redrafted in the context of existing local ordinances and all other state and federal laws. Departments must ensure that all other related policies are updated to be consistent with the provisions of this new policy and that other forms of family violence, including elder, child, and animal abuse, are addressed in a parallel manner.
SYMPTOM QUESTIONS • Did you urinate? • Did you vomit? • Did you defecate? QUESTIONS
• What were you • Make it normal. wearing at the time • Sometimes victims of the incident? who have been • Have you changed strangled report your clothes? they have urinated • Thrown them away? or defecated. Did • Put them in the that happen to washing machine? you? • Put them in laundry basket? DID THE VICTIM SUFFER A POSSIBLE CONCUSSION? WWW.CDC.GOV
• A blow or jolt to the head can cause a type of mild brain injury called a concussion. • Sometimes whiplash can cause a concussion. • The signs can be subtle and missed.
COUP CONTRE COUP “THE MORE YOU KNOW, THE MORE YOU SEE AND THE MORE YOU DOCUMENT”.
• Officer wrote: “red mark and bruising to neck” • Detective wrote: “red mark and bruising to neck” • Victim also had… WHAT DID HE SAY?
• “I’m going to kill you, you fucking bitch”
• “Die Bitch die” • “No judge, no cop, no attorney will keep you safe” • “I’m going to pop your neck” • “I’m going to do an OJ and leave no evidence” • “I didn’t mean to squeeze so tight” • “I don’t need a fucking gun to kill you” WHAT DID YOU SEE?
• “I saw anger, madness and hatred in his eyes.” • “He had the eyes of a demon. They were full of hate. He was my husband.” • “He seemed possessed” WHAT DID YOU THINK WAS GOING TO HAPPEN?
• “I thought I was going to die.” • “I was afraid he would kill me. He wouldn’t mean to kill me, but it was getting worse, he wouldn’t know when to stop.” • “I began saying “Hail Mary’s” … I thought I was going to be seeing my mother who died two weeks ago” HOW DID IT STOP?
• I escaped. • I passed out • My kids started screaming. • Police arrived. • What did you say? • I can’t breathe. • Let me go. • Stop, you’re killing me.
ANY SWELLING OR LUMPS TO NECK?
• Look for neck swelling or lumps especially if victim reported multiple attacks or prior strangulation assaults. • Ask victim to look in the mirror. • Ask victim if her neck looks swollen? • Ask victim to gently feel her neck and if there are any lumps that were not there before? • If so, call paramedics immediately and insist on medical attention immediately. Do not ask. HOW CAN WE MEASURE SWELLING TO THE NECK?
• Day of the incident • Daily • From the same exact spot • Skin marker • Measuring tape • Photos
National Strangulation Training Institute – A Project of the Family Justice Center Alliance © www.strangulationtraininginstitute.org SPECIALIZED DV FORM - FRONT
• Spontaneous Statements • History of DV • Photos • Evidence Impounded • Medical Treatment • Paramedics • Use of drugs/alcohol SPECIALIZED DV FORM - BACK
• Information about Children • Names, ages, statements & demeanor • Body chart • Restraining orders • Victim information • Medical release
WE NEED TO USE A SPECIALIZED MEDICAL CHART FOR STRANGULATION CASES
LIST OF QUESTIONS
• One page • Law enforcement brochure (Agnew) • List of Questions (Thomas)
COLLECT THE DNA UNDER FINGERNAILS TAKE PLENTY OF PHOTOGRAPHS
• Victim: • Defendant: • Full body • Full body • Close up of face • Close up • Neck • Arms • Eyes • Hands • Shoulders
THE FOLLOW-UP INVESTIGATION VIDEO CLIPS
• Many digital cameras also have video capability. • Good way to document voice changes, difficulty swallowing and/or drooling. • Expressions of pain. • *Don’t forget your cell phones.
FOLLOW-UP CALL TO VICTIM
• Call the victim a few days later to document symptoms • voice changes • trouble swallowing, • difficulty eating • difficulty sleeping • Headaches. ASK VICTIM ABOUT TEXT MESSAGES PARAMEDIC RECORDS
• Obtain copy of paramedic’s call to the hospital • Many of the symptoms will be recorded in records • May not require victim’s release
David R. Thomas M.S. Johns Hopkins University Division of Public Safety Leadership 410-516-9872 [email protected]