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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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