[DGSOM-AC] ACTION REQUIRED: Essential information for introduction Forensic Medical Examinations Saturday, Sept 22, 2018 8:30AM - 4PM

Hi everyone! We are so excited to have you registered to join us on Saturday, Sept 22, 2018 from 8:30AM-4PM for Introduction to Forensic Medical Examination of Asylum Seekers.

This is a long email but it is meant to serve as a reference for you and to answer many detailed questions that we have been asked. We will be sending an email next week with logistics (parking, directions, food, etc) for the actual training itself.

There are five sections to this email, the first two are short and we ask that you take a look at now while the final 3 are detailed information about each clinic you can look anytime before the training when you would like more information.

  1. Introduction

  2. Required pre-training survey **ACTION REQUIRED

  3. FAQs about the training pertaining specifically to the DGSOM Asylum Clinic

  4. FAQs about the training pertaining specifically to the OVMC Human Rights Clinic

  5. FAQs about the training pertaining specifically to the USC-Keck Human Rights Clinic

Section 1: Introduction

Before we get into the details, we would like to confirm that you are still able to attend the training.  There is a wait list of more than 30 people and we are at capacity, so if you are no longer able to make it, please let us know by replying to this email. Thank you in advance!

*Important Note: The DGSOM Asylum Clinic cannot make guarantees about when we will have cases available for you to perform. We typically have 3-6 cases per month that are distributed amongst our active volunteer clinicians and medical students.

Even if you are not planning on volunteering with us or you do perform a case, we believe that this training is an intrinsically valuable educational experience.  It will provide a strong background on asylum law and forensic examination, and can serve as a springboard for advocacy, research and improved care to this undeserved population. We just want to be fully clear so that you can have reasonable expectations before the training.  Please see DGSOM FAQ's for more information.

Section 2: Required Pre Training Survey

Please fill out this 5-10 minute survey: LINK TO REQUIRED SURVEY: https://goo.gl/forms/1BSdJy9JB7kYMenm1

Because we have received several funding grants to make this training possible, it is required that we collect pre and post test data from all attendees. Completing this survey will also help us provide a better service to you at the training and to our clients after wards.

Section 3: Training FAQ’s for DGSOM Asylum Clinic

1. What is the DGSOM Asylum Clinic?

We are a group of students and clinicians working to provide forensic medical evaluations that provide expert evidence to support individual’s claims of asylum. An individual may claim legal asylum if they have a credible fear of harm if they were to return to their home country. We are a Physicians for Human Rights affiliated clinic, which means we have the support of one of the largest and most well-respected human rights organizations in the world. We also work in areas of research, policy and advocacy, and are currently developing continuity of care programs for our clients.

2. What is the clinician’s role?

Please note, this information pertains only to the DGSOM Asylum Clinic. At this time, only clinicians with UCLA affiliation are able to volunteer with us.  For our clinic, we will send out an availability form quarterly to assess your general availability. Once specific cases come in, we will reach out to you to inquire whether you would be interested/available for this particular case. We will then provide you with everything you need to prepare, put you in touch directly with the client’s lawyer to discuss the case, and pair you with a medical student who can assist in preparing the affidavit (see students role below)

3. Information for first time clinicians

If you have never performed an evaluation before, you will have an experienced faculty member guiding you through the process.  More details on mentorship, including the different types of mentorship we offer, will be discussed during and after the training.

Our goal, contingent on availability, is that everyone will be able to observe 1-2 evaluations performed by experienced clinicians before doing one on their own.  

4. How many cases can I expect to perform in a year?

As we are just getting started (this is the first full year of our clinic), it is hard to predict what our capacity will be. Moving forward, our caseload will be dependent on the number of cases we receive from our legal colleagues and the number of volunteers that sign up.  On average, over the past 4 months we have been doing 3-6 cases per month, or between 36-72 cases per year. We are expanding our legal network rapidly as well. We estimate that newly trained clinicians will perform about 1-2 cases in their first year with us.

We want to be fully transparent and make it clear that we cannot make any guarantees about the specific number of cases we will have on a monthly basis. Cases are referred to us from attorneys as they arise and there is no way to predict our monthly caseload. This is also our first year and we’re learning as we go and hope that you can both bear with us as we do so and be a part of this unique opportunity to get involved with our clinic just as it is starting out!

As stated above, all of us, having gone through this training, truly believe that this is a valuable education experience in and of itself, even if you do not plan on performing cases, as it exposes you to issues and patients you may not regularly interact with.  It can be a springboard for research and advocacy efforts in these important issues as well.  

5. Where and when do evaluations take place?

Evaluations are scheduled at times that are mutually agreed upon by the clinician, client, and student involved on the case. Evaluations last an average of two to three hours and can take place at an attorney's or physician's office or clinic space.  Some evaluations also may take place in detention facilities, such as Adelanto, if you are interested in traveling there for an evaluation. More information on specific locations, including a possible clinic site in Westwood will be forthcoming.

6. What is the student’s role?

For each evaluation, a medical student will be paired with a clinician and accompany them to conduct the evaluation

During the evaluation, the student volunteer will work with the clinician to illicit a full history by asking questions at times designated by the clinician, take notes, and document photographic evidence. Following the evaluation, the student will draft an affidavit to be reviewed by the clinician. A well-written affidavit draft is the most important aspect of the student's involvement in the evaluation process, as it lightens the clinician’s workload and provides students with valuable experience in synthesizing client history and medical/physical exam findings. The final affidavit is submitted in court as evidence to support the client's case.

The training will include tips on how to write an affidavit that best serves each client's case.

Section 4: Training FAQ’s for OVMC Human Rights Clinic

What is the OVMC Human Rights Clinic?

The Olive View-UCLA Medical Center Human Rights Clinic is run in partnership with Physicians for Human Rights, a national organization that, as one of its key endeavors, facilitates an asylum network linking health care providers with immigration attorneys. . The OVMC Human Rights Clinic provides unbiased forensic medical examinations by trained health professionals, who document objective physical and/or psychological sequelae of trauma faced by asylum seekers. These findings are documented as affidavits that may be presented in the court of law as evidence during asylum proceedings. These affidavits are often utilized in immigration cases as a means of corroborating or contradicting the accounts of immigrants seeking asylum.

Cases are referred to us by Physicians for Human Rights, who accepts referrals from immigration attorneys- we do not take direct referrals unless an individual has legal representation.

What is the clinician’s role?

The OVMC HRC is a a teaching site for UCLA Primary Care residents and Internal Medicine residents at Olive View – UCLA Medical Center. Attending physicians and residents perform evaluations. Residents are integrated into the entire evaluation process, from contacting the lawyer to writing the initial affidavit. Technical assistance is available from the clinic’s core faculty members.

All other clinical logistics are coordinated by the clinic directors so our volunteers can focus on the evaluations and affidavits.

Information for first time clinicians

We believe in a mentorship model for first time clinicians. Attending physicians new to asylum evaluations are paired with more experienced attendings for ~3 evaluations (based on attending comfort) before being paired with residents. We aim to have new attending physicians complete these cases within the 6 months of joining our clinic. Technical assistance is always available for newly trained and more experienced attendings alike.

How many cases am I expected to perform a year?

Resident physicians can aim to complete 1-2 cases per year. Attending physicians can aim to complete 3-5 evaluations per year based on availability and interest.

Where and when do evaluations take place?

Clinics are held on the second Tuesday evenings of the month at Olive View. Attending physicians with appointments at UCLA or Olive View are eligible for credentialing. Residents in other specialties credentialed at Olive View are also welcome to join us!

What is the resident physician role?

Residents are encouraged to participate in the full evaluation process, including connecting with the client’s lawyer, conducting the evaluation and writing the initial affidavit. Residents will be paired with an attending preceptor for each evaluation. The attending and resident will discuss the evaluation process prior to the clinic and debrief after the clinic. Residents will send their draft affidavit to the attending for feedback and revision.

Please email Dr. Sural Shah (sshah9@dhs.lacounty.gov) and Dr. Arash Nafisi (anafisi@dhs.lacounty.gov) with any questions.

Section 5: Training FAQs for USC-Keck Human Rights Clinic

What is the USC-Keck Human Rights Clinic?

The USC-Keck Human Rights Clinic (KHRC) is a medical student-run clinic that coordinates forensic medical, psychological, and gynecological evaluations for any immigrant or displaced individual who requires documentation of maltreatment. We are affiliated with Physicians for Human Rights (PHR), an internationally recognized human rights organization, and we accept referrals from PHR and local legal partners. The KHRC is a program within USC's Department of Family Medicine and was founded by a group of Keck medical students committed to improving access to forensic documentation for asylum seekers living in the Los Angeles area. Dr. Cynthia Willard, a USC faculty physician experienced in human rights and forensic documentation, supervises the clinic.

What is the clinician's role?

We encourage our volunteer clinicians to take 2-3 cases a year if possible. Once a case has been placed with you, the KHRC team will link you to the legal representative and student observer. You will receive documents on the client’s case and can consult with the attorney prior to meeting with the client. The KHRC helps coordinate the scheduling of the case, and interpreters are provided by the referring legal partner. Most clinicians use our office space in Alhambra but exams may also be conducted in your clinical space or another mutually agreed upon space if you prefer. You may be offered a detention center case. If you are able to take a detention center case, the referring attorney will work with you on the logistics. We advise clinicians to plan on spending 2-3 hours with each client. After performing the exam, you will work with your medical student observer to draft the report for the case, and you will send this document to the client's attorney.

Information for first-time clinicians.

We prefer that clinicians who wish to volunteer with us complete PHR training and register with the PHR Asylum Network. Dr. Willard is available to provide technical assistance and support as needed. We can also arrange for additional mentoring if desired.  

The forensic exam does not constitute medical care and therefore does not require malpractice coverage. The exam and report are voluntary for each client, and the report becomes the property of the attorney and client, who will decide how best to use it for upcoming legal proceedings.

In most cases, our clinicians will not be asked to testify in court. If you are asked to do so, we encourage you to provide testimony. Most of the time, testimony can occur over the phone at a time convenient for you. The referring attorney will work with you in advance on what to expect. Giving testimony usually takes 15 minutes.

How many cases can I expect to perform per year?

We hope each volunteer is willing and able to complete 2 cases a year. However, due to the fact that we can’t predict what types of cases we will receive during the course of a year, we can't guarantee a specific number of them for each volunteer.

Where and when do evaluations take place?

We try to arrange the exam during a time that works best for the clinician, client, and student. Exams can take place in our USC office space in Alhambra, a local community health center, your clinical space, detention centers, or the referring attorney’s office.  Most clinicians use our office space but we are flexible. We prefer to use our space for exams on Friday afternoons or Saturday mornings. Exams may be arranged at other times as well.

What is the medical student observer's role?

The role of the medical student observer is variable in our clinic. It is customary for student volunteers to take notes that are instrumental in drafting the medical affidavit for the client's case, to assist in taking photographs (if it is a medical evaluation), to reflect on the case with the clinician during breaks to enhance the student's learning, and to offer information regarding relevant community resources to the client. We encourage the volunteer clinician to meet with their student observer for 15 minutes prior to the exam to preview issues important to the case and to clarify the role the medical student will have for the case.

Thank you! See you Saturday 9/22 at 8:30AM.
For any other questions, please simply reply to this email.

Thank you!

We are incredibly grateful to our partners and sponsors, for a complete list, please visit: https://dgsomasylumclinic.org/training/

Simon Levinson