We are frequently tasked with providing photography analysis for photographic evidence found in a wide range of case types. Photography of body injury is extremely problematic for the Lawyer and the Forensic Nurse Analyst for many reasons.
Very few of the photographs we receive are taken in appropriate lighting, from an appropriate distance, using an appropriate camera, and usually without using a measure reference. If a measure reference is used, it is generally placed incorrectly or is the wrong measure for the injury being referenced. Additionally, there is rarely serial photography done over the following week after an injury which allows the analyst to see injury progression. All of this leads to the forensic analyst being unable to make any type of accurate assessment beyond generalities at best. We are then usually left with explaining how the image is badly distorted or even falsified.
Rarely do police and medical providers follow recommended photographic standards. These standards are extremely specific and with good reason. Poorly done photography can cause a guilty party to go free or an innocent party to be convicted. Photography of injury is so significant that the entire case can rise or fall on the basis of photography alone.
Photography analysis is important not only in criminal cases, but civil cases as well (think skin breakdown) and requires the Nurse Analyst to be exquisitely aware of the required photographic standards and if they are not met, inform the attorney that they might want to bring a forensic photographic expert to the case. An excellent reference for understanding the requirements for injury photography and how a “simple” photograph can be so distorted as to make a simple injury look life threatening to the non-medical person can be found here.[1]
One of the most significant issues with injury photography as taken by an alleged victim, with no associated medical record, is falsification. It is incredibly easy with the use of cheap drug store makeup to create incredibly realistic injury, at least to the eye of a camera. A simple search of Amazon shows “bruise and injury” make up kits for as low as $8 dollars; the results of the ‘makeup kit bruising and injuries’ are fortunately more often than not, able to be refuted.
Poorly performed police photography without medical examination is also treated to the same analysis as alleged victim supplied photography.
QUESTIONS that we as Nurse analysts have to ask ourselves as we examine this type of photography include:
Causation
Does the bruise or injury fit the causation narrative being told. This is one of the most important aspects of the analysis. If someone claims an extreme level of violence including the use of tools or weapons there is an expectation based on a few hundred years of research and documentation of what, exactly, the resulting injury would most likely appear as. The body does not lie. The body tells the truth.
Toolmarks
Different objects or weapons, hands, fingertips, fists, etc. can and do leave different types of injury patterns. Are these patterns present? Should they be present? If they are present, do they match the narrative being told.
Age of Injury
Bruises CANNOT be aged with any accuracy. We can tell if it is “fresh” (less than 2 hours) or not fresh. Beyond that, you cannot accurately age any bruise. External bruises can take up to 48 hours to appear. Every person bruises differently and at different rates, dependent especially on their age, health history and medication usage. You cannot age bruises, period.
Falsification
Bruising is easily falsified for photography. Minor scrapes, scratches and other alleged skin injuries are easily falsified for the camera. Poorly performed photography can make a normally found skin flaw appear to be a significant injury. It can and will cause “bruising” to appear where there is nothing but shadow and it can and will distort the size, color and shape of an injury.
Self-Inflicted
An unfortunate aspect of what we see as Nurse analysts is the self-infliction of injury in order to place a false claim against someone. This type of injury seems to be more common in divorce/personal relationship situations but can occur in other situations.
In our next post, we will show a case study and how we applied the above critical thinking to achieve the final analysis.
[1] Guidelines for photography of cutaneous marks and injuries: a multi-professional perspective.