It’s Not Just a Slap in the Face: Detection and Prosecution of Strangulation in Domestic Violence CasesIn March of 1995, Casondra dialed 911 and reported to the San Diego Police Department that her formerboyfriend was choking her. By the time the police arrived, the victim was recanting and her injurieswere beginning to fade. The only remaining visible sign of injury was redness to the neck. The suspectimmediately claimed self-defense and the victim refused to give any additional statements. While, thelack of independent corroboration prevented an arrest, the police took a report of the incident andsubmitted it to the Domestic Violence Unit of the San Diego Police Department for further investigation.The detectives followed up with the victim, provided her with referrals and information about domesticviolence and closed the case. One week later, her former boyfriend stabbed her to death.Six months later, also in San Diego, Tamara died as a result of domestic violence. She was found deadin a dirt field, having been strangled to death and set on fire by her former boyfriend. The unnecessary and horrifying deaths of these two women were the impetusfor San Diego City Attorney, Casey Gwinn, to improve the Criminal Justice System’shandling of strangulation cases. He began this effort with a study of the existingstrangulation cases being prosecuted through his office. The findings from thisresearch and its implications for effective case handling were presented in aworkshop sponsored by the Clinton County District Attorney’s office entitled,“Detection & Prosecution of Strangulation in Domestic Violence & Sexual AssaultCases.” The two presenters were leading experts in the field; Gael Strack, AssistantCity Attorney with the San Diego City Attorney’s Office and George E. McClane,M.D., Emergency Physician at Sharp Health Care in San Diego. The study sample was comprised of 100 strangulation cases that wererandomly selected from police reports submitted over a five-year period. All of thevictims were women who reported having been choked by their partners with barehands, arms, or objects such as electrical cords, rope, belts, bras or bathing suits.There was a history of domestic violence in 90% of the cases, and children werepresent in at least 50% of the cases. The research revealed that clear documentation of strangulation method andduration, articulated threats and victims’ symptoms was absent from most policereports. Sadly, the study indicated that unless the victim had significant visibleinjuries or required medical attention, the police handled the incident as though shehad been slapped in the face rather than strangled. Further, victims often failed tomention their symptoms or declined necessary medical attention. Like lawenforcement, victims were likely unaware of the seriousness of the attack and thedanger involved. In fact, strangulation is terribly serious. Strangulation can result inunconsciousness within seconds and death within minutes. Strangulation isdefined as a form of asphyxia, or lack of oxygen, characterized by closure of theblood vessels and air passages of the neck resulting from external pressure. Itdiffers from choking, in which the windpipe is blocked by some foreign object. Eachyear in the U.S., strangulation accounts for 10% of all violent deaths. Six females toevery one male are victims of fatal strangulation. The three forms of strangulation are hanging, ligature and manual. Almostall attempted or actual homicides are a result of the latter two forms. In ligaturestrangulation, an object such as a telephone cord or an article of clothing is used
like a rope and pulled around the neck. Bare hands are the most common weaponsin manual strangulation, although by definition any body part can be used. The typical clinical sequence of a victim who is being strangled is one ofsevere pain, followed by unconsciousness, followed by brain death. The victim willlose consciousness by any one or all of the following: blocking of the carotid arterieswhich deprives the brain of oxygen, blocking of the jugular veins which preventsdeoxygenated blood from exiting the brain, and closing off the airway which inhibitsbreathing. Only eleven pounds of pressure on both carotid arteries for ten seconds or 4.4pounds of pressure on the jugular veins is necessary to cause unconsciousness. Toput this in perspective, approximately eight pounds of pressure are exerted by anindex finger to pull the trigger of a gun. Fifty seconds of oxygen deprivationresulting from continuous strangulation is considered the point of no return afterwhich victims will rarely recover. If strangulation persists, brain death will occur ina mere four to five minutes. Even if death does not occur from strangulation a victim may suffer seriouslong-term injuries or residual symptoms. Given the enormous threat of death fromstrangulation, and therefore, the seriousness of the offense, it is imperative thatanyone in an investigative capacity be aware of these symptoms as well as anyobjective external signs of strangulation. Voice changes are one of the most common symptoms experienced bystrangulation victims, occurring in as many as 50% of cases. Severity ranges fromhoarseness to complete loss of voice. Difficulty or pain in swallowing is anothercommon complaint. Strangulation victims may also experience breathing troubleranging from mild difficulty to complete inability. Although breathing changes mayappear mild, they could be the manifestation of an underlying neck injury thatcould decompensate and kill the victim hours or even days later. Strangulationvictims may also suffer lung damage resulting from vomit inhaled during the attack.Finally, victims may experience mental status changes resulting from lack of oxygento the brain or a reaction to the severe stress that was endured. Mental statuschanges may manifest in the short term as restlessness and combativeness andsubsequently resolve. Changes can also be long-term, however, resulting inamnesia and psychosis. The most frequently observed objective signs of strangulation are scratches,abrasions and scrapes to the neck. These may originate from a victim’s ownfingernails as a result of a defensive maneuver, but commonly are a combination oflesions caused by both the victim and the perpetrator. Redness on the neck iscommonly observed and though fleeting, may demonstrate a detectable pattern asfrom fingers. These marks can darken to become bruises appearing hours or evendays later. Subtle ligature marks may be visible which mimic the natural folds ofthe neck. Sometimes these marks are more dramatic, reflecting the type of ligatureused. Neck swelling may result from internal bleeding, injury to an underlying neckstructure, or fracture of the larynx allowing air to escape into the neck tissues.Chin abrasions are also common in victims of strangulation, as the victim lowersthe chin in an instinctive effort to protect the neck, and in so doing, scrapes orotherwise injures the chin. Less predictable objective signs that may be observed include tiny red spotsknown as petechiae located under the eyelids, around the eyes, or anywhere on the
face and neck above the area of constriction. Victims may also suffer capillaryrupture in the white portion of the eyes resulting in blood red eyes. Strangulationvictims sometimes experience involuntary urination and defecation. Finally,miscarriages have been anecdotally reported to occur hours and even days later. Even without any visible injuries and only transient symptoms, underlyingbrain damage due to lack of oxygen during the strangulation may kill a victim up toseveral weeks after the attack. It is always good procedure, therefore, for policeofficers at the scene to encourage a medical evaluation of all victims who reportbeing strangled. The workshop presenters developed a comprehensive training curriculum toassist professionals to understand the seriousness of attempted strangulation andto identify the signs and symptoms common in strangulation cases. Part of thiscurriculum is the following list of follow-up questions. The authors encouragequestions or suggestions for adding to their list and can be contacted at thefollowing e-mail addresses: Gael B. Strack (email@example.com) and George E.McClane, M.D. (firstname.lastname@example.org). Please share this list with your local lawenforcement in addition to drawing from it on your own in cases wherestrangulation has occurred but has not been properly documented.Evidence Gathering for Strangulation Cases 1) Ask the victim to describe and demonstrate how she was strangled. Take photographs. 2) Document whether the victim was strangled with one or two hands. Forearm? Objects? 3) Locate, photograph, and impound any objects used to strangle the victim. 4) Determine if the suspect was wearing any jewelry, such as rings or watches. Look for pattern evidence. 5) If an object was used, how did it get there? Determine if the suspect brought the object with him to the crime scene. This information may be used to show premeditation. 6) What did the suspect say when he was strangling the victim? Use quotes. 7) Describe the suspect’s demeanor and facial expression. 8) Was the victim shaken simultaneously to being strangled? 9) Was the victim thrown against the wall, floor, or ground? Describe the surface. 10) How long did the suspect strangle the victim? 11) How many times and by how many different methods was the victim strangled? 12) How much pressure was exerted or how hard was the grip? 13) Did the victim have difficulty breathing or hyperventilate? 14) Was there any complaint of pain to the throat? 15) Did the victim have any trouble swallowing? 16) Were any voice changes experienced? Did the victim complain of a hoarse or raspy voice? 17) Did the victim experience any coughing? 18) Did the victim feel dizzy, faint, or lose consciousness? 19) What did the victim think was going to happen? (e.g. Did she think she was going to die?)
20) Did the victim urinate or defecate as a result of being strangled?21) Was the victim pregnant at the time?22) Did the victim feel nauseated or vomit?23) Were there any visible injuries, however minor? If so, take photographs at the scene and during follow-up.24) Were there any prior incidents of strangulation?25) Did the victim have any pre-existing injuries?26) Were injuries shown to anyone? Were any subsequent photos taken?27) Did the victim attempt to protect her or himself? Describe.28) Was any medical treatment recommended or obtained? If so, obtain medical release from victim.29) Were there any witnesses? Only recently has strangulation been identified as one of the most lethalforms of domestic violence. Historically, “choking” was minimized and rarelyprosecuted because victims minimized the level of violence and uninformedcriminal justice professionals failed to recognize it. In fact, when strangulation isused to silence victims there is a devastating psychological effect and apotentially fatal outcome. The goal of the workshop and its presenters was toprovide training and education so that communities can improve documentation,investigation and prosecution of strangulation cases. Most importantly however,if their cases prompt an improvement in the handling of strangulation cases,Casondra Steward and Tamara Smith will not have died in vain.