Remote medico-legal assessment by telephone during COVID-19: Monitoring safety and quality when documenting evidence of torture for UK asylum applicants

Authors

  • Dr. Juliet Cohen Freedom from Torture
  • Dr. Bernadette Gregory Freedom from Torture
  • Kate Newman Freedom From Torture
  • Emily Rowe Freedom From Torture
  • Deborah Thackray Freedom From Torture

DOI:

https://doi.org/10.7146/torture.v31i1.121832

Keywords:

medico-legal, torture, COVID-19, asylum, remote

Abstract

Due to the Covid-19 pandemic, we developed remote assessment to provide interim medicolegal reports, ensuring people could obtain medical evidence to support their asylum claim. The Freedom from Torture research ethics committee approved the project.

To audit this new way of working we collected feedback from the doctors, interpreters, individuals being assessed, and senior medical and legal staff who reviewed the reports. This paper presents findings from the first 20 assessments.

Individuals reported that the doctors developed good rapport, but in 35% of assessments reported that there were some experiences they felt unable to disclose. In 70% of assessments, doctors felt that rapport was not as good as when face-to-face. In a majority of assessments the doctor was unable to gain a full account of the torture or its impact. Doctors reported feeling cautious about pressing for more information on the telephone, mindful of individuals’ vulnerability and the difficulty of providing support remotely.

Nevertheless, in 85% of assessments doctors felt able to assess the consistency of the account of torture that was given with the psychological findings, in accordance with the Istanbul Protocol.

The surveys indicated factors that hindered the assessment: inability to observe body language, the person’s ill health, and confidentiality concerns. 

The limitations of these assessments underline the need for a follow-up face-to-face assessment to expand the psychological assessment and undertake a physical assessment.

This research indicates that psychological medico-legal reports can safely be produced by telephone assessment, but are more likely to be incomplete in terms of both full disclosure of torture experiences and psychological assessment.

References

Bail Observation Project. (2013). Still a travesty:

Justice in immigration bail hearings. https://

bailobs.files.wordpress.com/2015/03/2nd-bopreport.

pdf

Burton, M. (2018). Justice on the line? A

comparison of telephone and face-to-face

advice in social welfare legal aid. Journal of

Social Welfare and Family Law, 40 (2). pp.

-215. https://eprints.mdx.ac.uk/23831/1/

Justice%2520on%2520the%2520Line%2520-

%2520author%2527s%2520version.pdf

Greenhalgh, G. & Kok, G. (2020). COVID-19:

a remote assessment in primary care. British

Medical Journal 368:m1182. https://doi.

org/10.1136/bmj.m1182

Istanbul Protocol Manual on the effective

investigation and documentation of torture and

other cruel, inhuman or degrading treatment

or punishment. United Nations 2004 https://

www.ohchr.org/Documents/Publications/

training8rev1en.pdf

Royal College of Psychiatrists. Digital COVID 19

guidance for clinicians. 21.05.20 https://www.

rcpsych.ac.uk/about-us/responding-to-covid-19/

responding-to-covid-19-guidance-for-clinicians/

digital-covid-19-guidance-for-clinicians

Seuren, L. M., Wherton, J., Greenhalgh, T.,

Cameron D., A’Court, C. & Shaw, S. E. (2020)

Physical examinations via video for patients with

heart failure: qualitative study using conversation

analysis. J Med Internet Res 22:e16694

https://www.jmir.org/2020/2/e16694/

Transform Justice. (2017). Defendants on videoconveyor

belt justice or a revolution in access.

http://www.transformjustice.org.uk/wp-content/

uploads/2017/10/Disconnected-Thumbnail-2.pdf

Freedom from Torture and Helen Bamber. (2020).

Tribunal courts and COVID recommendations

https://www.freedomfromtorture.org/sites/default/

files/2020-08/Tribunals-courts-and-COVIDrecommendations-

Final.pdf

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Published

2021-05-11

How to Cite

Cohen, J., Gregory, B., Newman, K., Rowe, E., & Thackray, D. (2021). Remote medico-legal assessment by telephone during COVID-19: Monitoring safety and quality when documenting evidence of torture for UK asylum applicants. Torture Journal, 31(1), 37–52. https://doi.org/10.7146/torture.v31i1.121832