1. Testifying in Child Abuse Cases: APSAC June 1996 James E. Butler, J.D. Catherine W. Gouldin, M.D. Charles J. Schubert, M.D. Robert A. Shapiro, M.D. Children’s Hospital Medical Center Cincinnati, Ohio 513-636-7966

2. Robert A Shapiro, MD, Patricia A. Myers, MSW Objectives Increase understanding of the legal system. Develop testifying skills in child abuse cases. Increase awareness of medical diagnostic possibilities

3. Robert A Shapiro, MD, Patricia A. Myers, MSW Legal Glossary Subpoena Adjudicatory hearing Deposition Direct examination Cross examination Reasonable degree of medical certainty Hearsay

5. Robert A Shapiro, MD, Patricia A. Myers, MSW Paths to Trial

6. Robert A Shapiro, MD, Patricia A. Myers, MSW Expert Witnesses A witness is qualified by knowledge, skill, experience, training or education. A witness may offer an opinion or conclusion if scientific, technical or other specialized knowledge will assist the trier of fact. May act as a teacher to court

7. Robert A Shapiro, MD, Patricia A. Myers, MSW When you are subpoenaed You are legally hooked to appear Obtain the names of those involved Review your records Prepare your Curriculum Vitae Consider a literature review

8. Robert A Shapiro, MD, Patricia A. Myers, MSW Testifying Basics Demeanor –tone of voice –body language –dress Credentials –training –previous court experience –number of previous evaluations/cases

9. Robert A Shapiro, MD, Patricia A. Myers, MSW Testimony Pearls Listen carefully to questions Admit you don’t know Answer only the question Summarize your findings Have confusing questions rephrased

10. Robert A Shapiro, MD, Patricia A. Myers, MSW Testimony Pearls Use simple, concise, clear language Make eye contact Refer to the literature Appear confident and objective Avoid hostilities or arguments

11. Robert A Shapiro, MD, Patricia A. Myers, MSW Direct Examination Refer to your records Express your degree of certainty Offer an opinion if asked Offer a recommendation if asked

12. Robert A Shapiro, MD, Patricia A. Myers, MSW I have no recollection of that. Cross Examination Answer honestly Don’t be forced into a response Don’t loose your cool Don’t make jokes

13. Robert A Shapiro, MD, Patricia A. Myers, MSW Mean & Nasty Defense Strategies Discrediting Misquoting Nit-picking Summarizing Insisting on yes or no Pointing out bias, fees Quoting authoritative sources Eliciting speculation –“Isn’t it possible...” Suggesting facts –“If you had known...”

14. Robert A Shapiro, MD, Patricia A. Myers, MSW Medical Evidence of Abuse Sexual abuse – injuries – STD – body fluids – sperm – hair – fibers, skin, etc Physical abuse –photographs –bone scans –C-T, MRI –eye exams –labs

15. Robert A Shapiro, MD, Patricia A. Myers, MSW Medical to Forensic Diagnoses

16. Robert A Shapiro, MD, Patricia A. Myers, MSW Suggested Physical Abuse Diagnoses No evidence of abuse: Injuries/findings are consistent with the stated history and do not appear to be due to abuse. Potential abuse: Injuries/findings are not consistent with the history and are suspicious of child abuse. Probable child abuse: Injuries/findings are not consistent with the history and child abuse is likely.

17. Robert A Shapiro, MD, Patricia A. Myers, MSW Suggested Sexual Abuse Diagnoses Normal examination: Lack of findings does not exclude abuse. No physical indication of sexual abuse. Non-specific anatomic changes are present: These findings are frequently noted in abused and non-abused children. Specific anatomic changes are present: These findings are almost always caused by trauma & abuse is very likely.

18. Robert A Shapiro, MD, Patricia A. Myers, MSW Suggested Sexual Abuse Diagnoses An STD has been diagnosed which can be associated with sexual abuse: Sexual abuse should be suspected but has not been substantiated in many children with this infection. An STD has been diagnosed which is almost always associated with intimated sexual contact: Sexual abuse is usually substantiated in children with this infection.