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The J88: Not just another medical form

Even though we loathe the J88 form, it plays a crucial role in the criminal justice system, says Dr Kyle Wilson

It’s 10.30 at night. The smell of alcohol and blood fills the Emergency Department. Orlando Pirates have just lost a soccer match to Kaiser Chiefs and, unfortunately for you, the battle continues into the taverns. There doesn’t seem to be an end to the stream of injured supporters moving through the triage area.

With one hand you are inserting an IV line, whilst passing a nasogastric tube with the other, and over the phone the radiologist wants to know exactly why it is they need to do the CT scan so urgently. And then, from out of the blue, you are presented with a J88; the fungal infection of hospital forms – and just like any good fungal infection, we are all trying our best to avoid them. But once you get one, they don’t go away very easily. For some, they come back to get you at a later stage.

Dr Jessica Meddows-Taylor, Senior Medical Officer at Roodepoort Forensic Laboratory, has more than ten years’ experience in forensic medicine and offers us some practical advice when filling in the J88 form, as well as an important insight into the legal processes that may follow:

The last thing I want to do is fill out a J88. How is it different from any other medical form?

The J88 is a legal document that is completed by a medical doctor or registered nurse, documenting injuries sustained by the victim in any circumstance where a legal investigation is to follow. It may be the only objective information available in a legal case. It may be integral in: 

  1. The charge itself
  2. The validity of the accusation
  3. The severity of the injuries sustained
  4. The level of punishment to be handed down. How does the J88 fit into the process of investigating a crime?

The victim, or family, will open a case at the police station in the district where the injuries were sustained. The case will be issued a case number and an investigating officer (IO), who will collect corresponding oral testimony and evidence from the victim, the alleged perpetrator and any witnesses. They will also ask you to fill out the J88 to document the injuries sustained by the victim, and in doing so you will provide written and/or pictorial evidence. This carries substantial clout in any case. The completed document will then be added to the docket.

What are the common mistakes that doctors make when completing the J88?

It is most often found that the doctor asked to complete the J88 is not the same doctor that examined the patient. When we examine the patient in the Emergency Department it is imperative to be descriptive in our notes. Note the site and approximate size of the wounds. Draw them as best to scale in the margins of the notes you make in the patient’s file. As clinicians, we are most concerned with life-threatening injuries, but it is important to document all injuries. Other, possibly minor, injuries may show intent, type of weapon(s) used and possibly chronic injuries or abuse. Neurological findings are very important, especially in motor vehicle accidents and assault cases. Be thorough in your neurological exam.

Doctors often don’t understand the medical terminology they want to use. If you look at a wound and it has clear margins and no tissue bridges, it is an incision and has been sustained by a sharp object. If it has irregular edges and tissue bridges it is a laceration (a tear in the layers of the skin) and has been sustained from a blunt object. Remember a bullet wound is a lacerated wound. A scrape abrasion shows directionality and irregular surface application to the skin, whilst imprint abrasion indicates direct application of a surface perpendicular to the skin. An imprint abrasion may be patterned, and therefore indicates a weapon or object applied to the skin. Contusions may also be patterned and give an idea of their origin.

What tips do you have for completing the J88?
  • Write legibly, as the court may call you simply to read what you wrote. If you are asked to complete the J88 based on someone else’s notes, write clearly on the form that you were not the examining doctor and then write verbatim what is in the notes. Be careful not to manipulate the information, even with the best intentions in mind. Remember to be honest, even if you have inadequate information on hand. You are compiling a legal document and are bound by that statute.
     
  • Document the relevant history: any pre-existing illness or medication they may be taking that may have an effect on their clinical state. Always mention any indication of intoxication. Then, as best you can from the victim and/or escorts, get the time and date of injury, who, where, and progression of the events. For example, “an assault on the right temporal area with a brick 3 hours ago by unknown male, after which he became restless and has started to vomit”. Your clinical findings should correlate with the history. 
     
  • When describing the wound, try to be as descriptive as possible and understand the forensic jargon that you are using. 
     
  • Try to understand the age of the wounds. It would be grossly unfair for someone to be charged for old bruises and injuries sustained prior to the incident in question.

For injuries, as a general guide:

  • Initially, the wound has a red inflamed margin and base (6-12hrs).
  • Healing begins with granulation tissue and the beginning of a scab is noted (two days later).
  • After 3-4 days the scab is now hard and thick.
  • By six days it is ready to fall off.

Bruises progress through the following colour changes:

  • Red/purple: day 0-1
  • Blue/brown: day 2
  • Green/brown: day 3
  • Green: day 4-5
  • Yellow: day 7-10
  • Fading: days 12-15.
I have been called to testify in court. Why was I called to testify? Am I in trouble?

You are not in trouble. Your J88 may have provided the only untenable, irrefutable evidence in a case. Usually the lawyers, victims and even the judge have a “layperson’s” understanding of medical terminology. So in most cases you are asked simply to interpret your findings for them.

I’ve only ever seen courtroom drama on TV. What can I expect in real life?

You will be served with a subpoena from the investigating officer specifying the date, time and court at which you are to present yourself. It is a good idea to ask for the prosecutor’s details as they may be able to give you a particular time to arrive, and save you having to wait as the court moves through other witnesses. Ask for a copy of the completed J88 so that you may familiarise yourself with your notes. Make sure you are professionally dressed and your phone is off.

Once in the courtroom, you will be shown to the witness box. On entering and leaving the courtroom, bow once as a sign of respect. The court police officer will order everyone to stand as the judge enters from his/her chambers. Stay standing as they sit. You will be asked to take an oath, whilst raising your right hand. Thereafter, the judge may ask if you wish to stand or be seated for your testimony.

The prosecutor will lead the questioning. They will ask your qualifications, and then ask for you to recite the J88. Then they will ask pertinent questions. When answering questions you are directing your answers to the judge, so refer to them as “your Worship” in regional and district courts and “my Lord or Lady” in high court.

When you have given your evidence, the defence lawyer will ask you their questions. Talk slowly – in many cases the accused will have an interpreter, and they will have to interpret exactly what you say. Don’t get verbose, answer succinctly giving only pertinent information. Never feel obligated to say more than you feel comfortable to do so, or feel you must give a particular slant on information in the case. You are impartial in every aspect, and simply provide factual input.

Remember, it is not your job to prove, or disprove guilt, only to state the facts contained in the J88 that you completed. The defence will often try to discredit you if it serves their case, or even just get you flustered enough to make a mistake. Try not to take it personally. The judge will not take kindly to your irritation. If you feel you are being pestered by the defence, ask the judge to intervene.

Once the defence has finished their questioning, either the prosecution will requestion you, or the judge will ask questions. When they have finished questioning you, the judge will excuse you. Stand down from the box, bow once and then leave the court.

Even though we loathe the J88 form, it plays a crucial role in the criminal justice system, as it is an important piece of evidence in the investigation of a crime. Therefore as doctors, it is in our, the patient’s and the public’s best interest to appreciate the importance of such documents and complete them appropriately.

References: Muller K and Saayman G, Clinical Forensic Medicine: Completing the Form J88 – what to do and what not to do, SA Fam Pract 45(8) (2003)

With thanks to Dr Jessica Meddows-Taylor. Dr Kyle Wilson is Community Service Medical Officer in anaesthetics at Helen Joseph and Rahima Moosa Mother and Child Hospitals.

  
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43 comments
  • By Alice on 25 October 2017 03:56 Many thanks for your recent comments. If you are a member of Medical Protection, please do not hesitate to contact us directly for more specific advice to your situation. With best wishes, The Web Team
  • By megan on 05 August 2017 11:00

    Does the date on a J88 need to be the same as when the person went to his medical practioner.  There are also pages missing of the J88. The victim claims he was bleeding profusely from his lip and had to get stitches but only goes to the doctor more then 24 hours over incident.  The date that the victim went to the doctor and the date that the doctor signed the J88 differs 8 days apart. Will this stand as evidence in court.

  • By Cynthia on 21 April 2017 09:43 Hello how long is a J88 valid for?  If a person is assaulted and a J88 completed and a few years the perpetrator later starts to harass or threaten again, can the J88 still be used from anfew years earlier???
  • By Alice on 07 April 2017 03:30 Thanks for your post Group B1. I’ve checked with a professional colleague, and he advised as follows: “You would have to make it clear that it is not your evidence or that when you filled it in it was based on another doctor’s notes.” I hope this is helpful. If you are a Medical Protection member, please do not hesitate to contact us if you would like more specific advice. With best wishes, The Web Team
  • By Alice on 07 April 2017 03:30 Thanks for your post Group C9. I’ve checked with a professional colleague, and he advised as follows: “If the J88 form has been lost then you can only comment on the records or your recollection. It is not your responsibility if the J88 form has not been followed up by the appropriate legal authority.” I hope this is helpful. If you are a Medical Protection member, please do not hesitate to contact us if you would like more specific advice. With best wishes, The Web Team
  • By Alice on 07 April 2017 03:29 Thanks for your post Group C7. Unfortunately, we cannot comment on this as it is a clinical question. With best wishes, The Web Team
  • By Alice on 07 April 2017 03:29 Thanks for your post Judith. I’ve checked with a professional colleague, and he advised as follows: “Yes, you should have access to the relevant documents when you are called to testify.” I hope this is helpful. If you are a Medical Protection member, please do not hesitate to contact us if you would like more specific advice. With best wishes, The Web Team
  • By Group E1 GEMP I on 30 March 2017 01:09 Thank you! this article was very informative, especially the information about what we can expect as an expert witness in court.
  • By E3 on 30 March 2017 01:06 Dankie!
  • By Group E6 University of the Witwatersrand on 30 March 2017 12:50 This article was extremely useful to us as we are inexperienced medical students who will soon have our first real contact with a rape survivor. It has comforted us to know that we are not the only ones who feel intimidated by and fearful of this form and possible subsequent subpoena. Thanks for making it easier for us to complete. Also, it really emphasized to us what an extremely important role doctors play in prosecuting accused rapists which we did not realize before.
  • By Judith Bouwer (GEMP1 E1) on 30 March 2017 11:04

    This article is without a doubt something that I will be referring back to in my future years when needing to fill in a J88 form. The wound aging guide is particularly useful. I also appreciated the detailed description of the procedure when subpoenaed to court.

    I would like to enquire if we are permitted to have a copy of the J88 form in front of us at all times when we are called to testify because I understand that it can take a while before the cases reaches court and this document is quite a detailed document to try and recall, especially if we have filled in multiple forms in the time prior to the trial.

  • By Group A2 on 29 March 2017 12:31

    Thank you for an interesting and informative article.  Not many doctors know what to expect from a courtroom situation, thus it was helpful to learn more of what to do when one is subpoenad to court. It helped us realize the true value of the J88 form. 

    Thank you. 

  • By Group A1 on 29 March 2017 12:23 Thank you for your article. We found this helpful and informative in relation to the expectations and implications of this form. The description of the legal setting is reassuring. 
  • By Siphumelele Makhanya on 28 March 2017 04:34 This has been a very informative post. 
  • By Siphumelele Makhanya on 28 March 2017 04:32

    This has been a very informative post. Thanks 

  • By Karabo Khateane on 28 March 2017 02:20 I'm glad that this article was as I can supplement it with my lectures and how to do my best for my patient and that they get adequate medical attention and justice.
  • By C4 Wits on 28 March 2017 02:02 This is a very insightful document.As future Doctors currently learning about rape this explanation provided clarity on what is expected of us and made the emotionally trying task of filling out the J88 form seem less daunting. Thank you 
  • By Group C7 on 28 March 2017 01:15 Thank you very much for your advice. How would you, if you should, collect specimens in the case of oral penetration? And where would you record your findings on the form?
  • By Group C9 on 28 March 2017 12:55

    What is the medico-legal responsibility of the medical practitioner, after having filled a J88 form that is lost or not followed up by the appropriate legal authorities?

    Thanks in advance.

  • By Group D2 on 28 March 2017 12:52

    Thank you for the informative article. It helped to shed light on some misconceptions that we had previously.

  • By C4 Wits on 28 March 2017 12:46 This is a very insightful document.As future Doctors currently learning about rape this explanation provided clarity on what is expected of us and made the emotionally trying task of filling out the J88 form seem less daunting. Thank you 
  • By C8 on 28 March 2017 12:39 Medical students, C8, educational and enlightening. It allowed us to understand the importance of the J88 form with regards to the medico-legal aspects of the tragedy. 
  • By Group B1 on 28 March 2017 12:39 This article has been highly informative and beneficial to our learning experience as current medical students. As future doctors within the South African context it has been key to understand the crucial role of the J88 form as well as the importance of the accuracy and detail required for the form to be of value. However, we would like to inquire regarding the ability to complete a J88 form using notes from someone else who completed the examination. Would it be justified within the criminal justice system to testify (if the need arose) on a case for which you yourself did not actually complete the examination although you filled out and signed the form? 
  • By Aqeel Wadee on 28 March 2017 12:35 Very informative article. It speaks to the imperative role that doctors play in legal cases and therefore the distribution of justice. Consequently this indicates the level of care that doctors have to take when completing the form. 
  • By Jessie Hayes on 28 March 2017 12:34 I found this article very informative and it provided much needed insight into how and why it is important to fill out the J88 form thoroughly and as accurately as possible.
  • By B3 on 28 March 2017 12:32 As group B3 we now understand why it is necessary to fill in the J88 form accurately since justice depends on it. it is more than just a medical form so we have to be honest at all times to avoid legal complications 
  • By group b7 on 28 March 2017 12:31 Article was very informative. It speaks to the necessity of doctors to understand their responsibility to patients as part of their care, specifically the legal and judicial implications thereof. Further it highlights the imperative for medico-legal understanding for all doctors and their role in the justice system.
  • By Wits Medics D4 on 28 March 2017 12:31

    We are a group of 3rd year medical students from Wits.  This is a very informative article, and we will definitely benefit from this information.  Thank you.

  • By Group B6 on 28 March 2017 12:29 Thank you for this valuable information, it was extremely helpful.
  • By Group B6 on 28 March 2017 12:28 We found this article to be extremely helpful. Thank you so much for this guidance. We really appreciate it.
  • By Group D5 on 28 March 2017 12:25

    As a third year medical student, my colleagues and I found this article very useful. It provides a very concise explanation of the J88 form, a form that will be very important for us to understand in our future clinical work. This article didn't just tell us how to fill in the form, but rather provided us with examples of how clinicians go wrong and how we can prevent following in their footsteps. This is a good clinical article for those who are studying and even for those who are already in practice. 

    GEMP 1 Group D5 - Wits Medical School 

  • By Group B5 on 28 March 2017 12:24 Thank you. This was very helpful and the legal advice and advice on conduct is much appreciated!
  • By GEMP 1 C3 on 28 March 2017 12:21

    We found the article useful background to the J88 form. 

    It highlights the importance of a detailed and accurate note taking during the examination and consultation. This will decrease the risk of inaccurate completion of the J88 form and possible incorrect evidence provided in court. 

  • By group B9 on 28 March 2017 12:18 This was an incredibly insightful article which really helped us understand the complexities of the form and task at hand. It also reminded us of the importance of proper adherence to rules and regulations for correct practice.  
  • By Fusi on 08 March 2017 09:47 Thanx...helpfull
  • By Alice Gorecki on 08 February 2017 08:19

    Thanks for your post Christa. I've checked with a professional colleague, and he has advised as follows:

    "The J88 is filled in acutely at the time of the assault or later, based on the notes taken when the patient first seen. It would be difficult to envisage that there would be knowledge of seroconversion, so in the absence of further facts, the idea is to fill in only information salient to the examination at the time of, or soon after, the assault."

    I hope this is helpful. If you are a Medical Protection member, please do not hesitate to contact us if you would like more specific advice. With best wishes, The Web Team

  • By Christa on 02 February 2017 08:28 In the case of a raped child victim, who have contracted HIV from an unknown assailant (both parents are HIV negative), can I disclose the child's HIV status in the Medical History section?
  • By Alice on 10 January 2017 03:59 Thanks for your recent posts. If you are a Medical Protection member, please do not hesitate to contact us directly for specific advice on 0800 982 766. With best wishes, The Web Team
  • By Wesley Abboy on 09 January 2017 02:33 Please help me.  Is a j88 valid if the name of patient is correct but the date of birth incorrect.  In medico legal cases of malpractice this is tantumount to negligence for incorrectly identifying patient 
  • By Justin on 09 June 2016 07:53 What is number 4 for time date month and year what do you put in there
  • By Alice on 23 September 2015 10:46 Thank you for your comment Bhe. I checked with a professional colleague here and he has suggested that a clinician who refuses to complete the form may be vulnerable to criticism by the HPCSA. I hope this is helpful. Best wishes, The Web Team
  • By Bhe on 21 September 2015 08:56 Can a Doctor or a Private Medical Center refuse to fill the J88 form?
  • By Dr. Kom on 22 May 2015 12:41 Doctors do dread filling the J88 forms. It is at best considered a nuisance in the `important` tasks of the day and at worse, many fear going to court. It is thus important to be well-prepared and understand the implications of everything that one writes. The problem is also that in many CHCs and hospitals, files are getting lost and misplaced and that poses a serious challenge. i would contend that, better file management is the first step to help doctors and nurses comply fully to this most important legal requirement.
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