The Detective Work of Asylum Cases: How Surgeons Can Help

10/19/18 Asylum

Clients seeking asylum in the United States are often victims of acts of violence that left them scarred both emotionally and physically. As immigration attorneys we rely on expert opinions to corroborate our clients’ stories of persecution, and commonly use psychologists to document the psychological trauma our clients suffered. But what about the physical trauma? Who can corroborate the etiology and age of the scars of our clients?

As practitioners of law and not medicine, it is easy to overlook a very important source of supporting documentation for our clients seeking asylum. As the spouse of an orthopedic hand surgeon with many years of experience in wound healing secondary to trauma, I am at advantage when it comes to medical experts. So, if I am working on a case and I have questions that require a medical opinion, I first consult with my own in-house medical expert. That experience has taught me some valuable lessons. One such lesson is that a medical expert may be able to offer an opinion as to the approximate time frame during which the injury occurred and/or whether the scar could have resulted from the specific act of violence described by the client. First, however, we must know WHAT we are looking at, and then we must know the RIGHT medical expert to ask for an opinion.

For example, in a pro bono asylum case that I took from the Immigration Justice Campaign, I met with my client at the detention center and did all the usual lawyerly things, including eliciting a detailed account of why the client fled his home country. He described an incident that occurred four months prior where he was beaten with sticks and dragged until he lost consciousness. I asked if he had any scars from the incident, and he showed me several scars on his foot and knee. They were wide, slightly raised, and reddish.

Later that night, I returned home and began to plan out my client’s case. As is often the case with acts of violence, he had very little to corroborate his story. I thought about the ways in which his scars could be used as supporting evidence. So, I consulted with my in-house medical expert, who advised me to talk to a surgeon who commonly sees traumatic injuries, such as an orthopedic surgeon, plastic surgeon, or general surgeon working at busy trauma centers. My in-house medical expert explained that these physicians could examine a scar and determine how old it is and whether it is consistent with the type of injury or act of violence described.

I contacted a plastic surgeon at a level 1 trauma center who agreed to look at some images of my client’s scars and write a declaration.  I obtained permission from the detention center to take pictures of my client’s scars and gave the images to the surgeon for review. The surgeon provided me with a declaration describing his opinion and said that he wished he could help more. However, what he thought was insignificant, I thought was a goldmine. He stated:

The submitted photographs of -’s knee and foot demonstrate healed wide hypertrophic scars. This type of wound is produced from a partial thickness injury to the skin over a wider area as when the skin is abraded over a rough material. Examples of this type of injury would include a person being dragged over the ground which would corroborate with -’s story. The scars demonstrated in the pictures of the knee and foot are also red, raised and thick which is seen with a hypertrophic scar secondary to increased collagen deposition. Hypertrophic scars usually mature over 1-2 years and lose this appearance becoming flat and paler. The photographic appearance of these scars also corroborates with – suffering these wounds in February of 2018 because the hypertrophic scars have not yet matured.

As an attorney, part of my job is to corroborate my client’s story of persecution. This declaration placed the scars from an injury that occurred in the right timeframe and resulting from an etiology consistent with what my client claimed happened to him.

While our untrained eyes may see nothing more than the remnants of an unknown injury, a surgeon can see so much more. If you have a client with scars from an injury they claim occurred fairly recently and this injury is germane to their claim of asylum, it may be worth consulting with a surgeon—it’s possible they’ll see more than what meets the eye, and in so doing, protect your client from further harm.

by Nikki Lyons