1 Tuesday, 27 November 2001
2 [Open session]
3 [The accused entered court]
4 --- Upon commencing at 9.30 a.m.
5 JUDGE HUNT: Call the case, please.
6 THE REGISTRAR: Case number IT-98-32-T, the Prosecutor versus
7 Mitar Vasiljevic.
8 JUDGE HUNT: What's happened?
9 MR. GROOME: Your Honour, I've asked to make an application before
10 the witness continues, and I ask to do that now.
11 JUDGE HUNT: Yes.
12 MR. GROOME: I want to make an application regarding the Defence's
13 special defence involving the accused's mental capacity. Rule 67 requires
14 notification of such defence as early as practicable and, in any event,
15 prior to the commencement of trial. When I saw that the accused,
16 according to the case history --
17 THE INTERPRETER: Slow down, please, Mr. Groome.
18 MR. GROOME: Yes. When I saw that the accused, according to the
19 case history, had been treated in a psychiatric facility around the period
20 of the crime, I became concerned and, approximately one year ago, asked
21 whether there would be a psychiatric defence and was told that there would
22 not. The first time any type of notice was given of this defence was in
23 the Defence Pre-Trial Conference, after the Prosecution had rested.
24 However, that notice was vague and did little to provide the information
25 the Prosecution needs in order to conduct a proper inquiry into the
2 JUDGE HUNT: What page was this said?
3 MR. GROOME: On the Pre-Trial Conference, Your Honour?
4 JUDGE HUNT: Is it the Pre-Trial Conference? You said after the
5 Prosecution had rested, I thought you must have meant the Pre-Defence
7 MR. GROOME: I'm sorry. Yes. I stand corrected, Your Honour, the
8 Pre-Defence Conference.
9 JUDGE HUNT: Can you give us the page reference?
10 MR. GROOME: I can't at this point, Your Honour. I will after the
12 JUDGE HUNT: Can you tell us what was said?
13 MR. GROOME: Mr. Vasiljevic -- I mean, Mr. Domazet stated that
14 there would be evidence of the psychiatric condition of the accused. I
15 had objected at that time and raised the requirements of Rule 67. The
16 Court --
17 JUDGE HUNT: My recollection was we referred specifically to
18 whether there was a defence of diminished responsibility being raised,
19 so-called defence perhaps I should describe it, because it goes only to
20 sentencing, and I was told there was not.
21 MR. GROOME: Well --
22 JUDGE HUNT: That's why I'd like to have a look at what was said.
23 This seems to proceed upon the assumption that my understanding was wrong.
24 MR. GROOME: I guess, Your Honour, what's concerning me at this
25 stage is that we've already heard the accused say that at the time the
1 crimes were committed, he had spoken with the devil and with God. We've
2 heard from Dr. Vasiljevic say that, on the 2nd of June, it was his
3 assessment that he was suffering from psychoses. My concern is, to me it
4 wasn't clear that this is not a defence. In fact, I'm under the
5 impression that all of these witnesses here are being called to testify
6 regarding his mental condition at the time of the commission of these
8 JUDGE HUNT: But we still haven't been given notice, and if we
9 haven't been given notice, then the Defence has to establish why they
10 should be entitled to rely upon such a defence. But my concern at the
11 moment is it may not be a defence of diminished responsibility. In my
12 experience of these cases to date in this Tribunal has been that some sort
13 of inchoate, indescribable mental state is asked to be taken into account
14 in order to explain that the accused may have done something which he
15 ordinarily would not have done. That goes to sentencing still; it does
16 not go to any question of criminal responsibility.
17 MR. GROOME: Well, my main concern is, and perhaps Mr. Domazet can
18 clear up this fact at this point, is whether this defence is being raised
19 as a special defence to negate the mens rea of the crime.
20 JUDGE HUNT: Well, it doesn't negate the mens rea of the crime.
21 Insanity would. But that's not even suggested. We are waiting, are we
22 not, for a report from the psychiatrist who examined the accused over the
24 MR. GROOME: Yes, and that is part of my application.
25 JUDGE HUNT: May I suggest that's where we should go. Let's find
1 out what's in the report instead of trying to conjure up all sorts of
2 issues from the way in which this evidence is being led, let's find out
3 what the psychiatrist says, and if there's a problem about it, then there
4 will be a lot of trouble if it does amount to something which has been
5 denied throughout by Mr. Domazet.
6 MR. GROOME: And the difficulty that the Prosecution is having is
7 that I'm being called upon to cross-examine these witnesses without the
8 benefit of this report yet. I would ask, can Mr. Domazet give us some
9 kind of preliminary assessment? He certainly must have talked to this
10 expert since the weekend. Can we have some idea of what the findings of
11 this expert are so that I may be able to cross-examine --
12 JUDGE HUNT: That's what I asked him to do on Friday. But none of
13 these witnesses so far have suggested that any such psychoses had any
14 effect upon his understanding of what he was doing or his intention to do
15 whatever he did. Not one of them has; and they're all doctors, they
16 could have said so. And the fact that they haven't will certainly tend
17 against any case that is put up to the contrary later. He's had two
18 doctors there, and each of them could have given an opinion and they
19 weren't asked. Now, that's a fairly good start to a rejection of anything
20 that may come up later.
21 But nevertheless, you are certainly entitled. I thought this is
22 something that could have been done between counsel. Why it has to be
23 done by us, I don't know. Have you asked Mr. Domazet what is the issue?
24 MR. GROOME: Yes, Your Honour.
25 JUDGE HUNT: When?
1 MR. GROOME: I've asked him to let me know --
2 JUDGE HUNT: No, no. Have you asked him since the weekend?
3 MR. GROOME: I talked to him yesterday about it.
4 JUDGE HUNT: All right. Now, what did he say?
5 MR. GROOME: He said that he will be speaking with the expert last
7 JUDGE HUNT: Right. Let's just simply ask, "What are the issues?"
8 and then we'll find out.
9 MR. GROOME: And there's just one other matter, Your Honour. As a
10 precautionary matter, I requested from Uzice hospital through the RS
11 government any medical records and received a reply that there were no
12 additional records aside from the ones that were seized pursuant to an
13 order of the Chamber. Yesterday and on two different occasions, it became
14 -- or documents were produced here in Court and eventually tendered into
15 evidence comprising those records from Uzice. I would ask that I be
16 provided immediately with all documents that the Defence is going to rely
17 on, either for alibi or for this special defence if it is being raised,
18 and that I be provided with translations.
19 I was provided with four documents yesterday afternoon, and I had
20 translators work overtime last night, but it certainly makes it difficult
21 for the Prosecution to adequately prepare its case when it's provided
22 these untranslated documents hours before it's expected to cross-examine
23 witnesses. Thank you.
24 JUDGE HUNT: Yes. Well, Mr. Domazet, I have already remarked upon
25 the fact that you've been in this case for well over a year and all of
1 these issues had become apparent during that time and it is, if I may say
2 so, very unhelpful to be met with documents at this stage which have never
3 been translated and which should have been given, pursuant to the Rules,
4 at least a year ago.
5 First of all, have you got any more medical records?
6 MR. DOMAZET: [Interpretation] Your Honour, as I said yesterday,
7 the books that we brought today are the last we have, and only four pages
8 out of those books are, in our opinion, relevant for the Vasiljevic case,
9 which I yesterday gave to Mr. Groome photocopies of, and those are
10 probably the four pages that he mentioned were being translated. That is
11 all we have as documentary evidence.
12 However, I would like to add something in connection with this
13 evidence from Uzice. The request mentioned by Mr. Groome through the
14 government of Republika Srpska is something I know nothing of, but the
15 Government of Republika Srpska is not competent for Uzice as Uzice is in
16 Serbia, that is, the Federal Republic of Yugoslavia. So the request could
17 only have gone through the Yugoslav government and not Republika Srpska.
18 As far as Uzice is concerned, I must inform you of a major problem
19 that we had when, on November the 1st last year, when these documents were
20 seized from Dr. Moljevic when he brought the originals to Visegrad and
21 since he thought that all that would be needed was him to show those
22 documents and to give photocopies. After that, we really were not able to
23 obtain anything from Uzice, and the situation has changed only recently,
24 and we managed to have these witnesses personally bring these documents.
25 So I really am sorry that this occurred in this way, but I have
1 nothing else than what I gave Mr. Groome yesterday and which we intend to
3 JUDGE HUNT: I can certainly understand the reluctance of the
4 Serbian hospital at Uzice to produce any more documents after the seizure,
5 but that's a risk which the Prosecution ran in seeking the order which
6 they obtained. And certainly Republika Srpska, apart from its general
7 unhelpfulness, would not have been likely to be able to get anything from
9 My concern at this stage, though, is you have said twice those are
10 the only documents you have. Do you expect any others to come or have you
11 requested any others to come?
12 MR. DOMAZET: [Interpretation] No, Your Honour, unless the
13 Prosecution raises the issue of making further requests from the Uzice
14 hospital. Then I would make an effort to obtain them. But as far as we
15 are concerned, we have no other documents, nor have we made any requests
16 for additional documents.
17 JUDGE HUNT: Right. Well, that's that one out of the way.
18 Now, what has happened in relation to your psychiatrist?
19 MR. DOMAZET: [Interpretation] I spoke to Mrs. Lopicic yesterday,
20 who interviewed and examined the accused on Saturday and Sunday. She
21 carried out the various interviews and tests, everything that was
22 necessary. She has compiled documents, and I asked her to prepare a
23 written report as soon as possible, to have to translated into English. I
24 hope that that will be in a day or two, and certainly before the end of
25 the week. She left for Belgrade this morning, and she promised that she
1 would be working on the report today and tomorrow and send it to us. As
2 soon as I receive it, I will provide copies for Mr. Groome and Your
3 Honours immediately.
4 JUDGE HUNT: But has she indicated to you what the general nature
5 of her conclusions are? I think we're entitled to ask this. You've
6 waited 12 months to have this done, and we are now getting towards the end
7 of the trial, so I really do think we are entitled to find out from you
8 what your understanding is of what issue is going to be raised, if any.
9 MR. DOMAZET: [Interpretation] Your Honour, it really is very
10 difficult for me to say when she didn't tell me what her final finding
11 would be. She didn't wish to do so before she examined all those
12 documents, so that I really am unable to say what her conclusion will be.
13 I know that she told me that the disease described here as psychosis was
14 not only due to alcoholism, that it is a mental disease. To what extent
15 that will affect her conclusion, that is, that at the critical time he had
16 diminished responsibility or significantly diminished responsibility which
17 would affect the sentence should the guilt of Mr. Vasiljevic be proven, or
18 his total irresponsibility, I'm afraid that I am unable to say until I get
19 that report.
20 JUDGE HUNT: It may be that we will have to, in effect, hive off
21 the sentencing proceedings because we cannot allow this to keep on as a
22 running issue of which the resolution is not yet in sight. It is
23 something which really has caused immense problems. It may mean that in
24 such sentencing proceedings, if it comes to that, that these doctors who
25 saw him at the time will have to be recalled. But the Prosecution can't
1 be put in the place, by your failure to do the organisation of this 12
2 months ago, that they are embarrassed because they have not had the
3 opportunity of exploring these issues with the very doctors who saw him at
4 the relevant time.
5 MR. DOMAZET: [Interpretation] I understand, Your Honour, should
6 that be the conclusion of the report, but all I can do is promise that I
7 will do my very best to have that report in the next few days and
8 certainly before the end of the week.
9 JUDGE HUNT: Yes. Thank you, Mr. Domazet. Yes, Mr. Groome.
10 MR. GROOME: Just to correct, I misspoke earlier. The request to
11 Uzice hospital was made through the Federal Republic of Yugoslavia, and
12 the transcript reference would be 1820 for the Pre-Defence Conference.
13 JUDGE HUNT: I'm not sure what on 1820 is relevant. We're talking
14 about the problems that Mr. Domazet had about continuing for four weeks
15 unbroken. Page 1821 is where you raise it.
16 Yes. Well, at that stage, it was clearly pointed out that if
17 there was anything in this report that was to be obtained from the
18 psychiatrist relating to the so-called special defence, you would be
19 entitled to have the accused and any other witnesses recalled.
20 MR. GROOME: Yes, Your Honour. I'm simply requesting at this
21 time, since we have a line-up of psychiatric doctors and nurses who
22 treated him, if I could have some indication -- I mean, I think we've
23 heard Mr. Domazet's response, but --
24 JUDGE HUNT: Mr. Domazet's response is rather like that of a
25 character in a famous television series of "I Know Nothing, I come from
1 Barcelona," I think was the expression. He simply says he doesn't know.
2 Well, this is very unfortunate and, as I've pointed out on a number of
3 occasions, this is something that should have been investigated 12 months
5 But we can't prevent the accused running that issue, but I want to
6 emphasize throughout that it is something which, at this stage, could
7 go only to the issue of sentencing, and if necessary, bearing in mind the
8 time constraints that we have, if when this report comes and it does go
9 only to the issue of sentencing and if you do need to ask the accused
10 further questions, and the doctors, then we'll hive off that as a separate
12 MR. GROOME: Yes, Your Honour.
13 JUDGE HUNT: That seems to me, from a practical point of view, the
14 only way to deal with it.
15 MR. GROOME: Yes.
16 JUDGE HUNT: But if it comes up with something worse than that, if
17 it comes up to some form of insanity, which would go to the issue of
18 criminal responsibility, then we'll just have to grind to a halt. I don't
19 know when we're going to finish the case, but it's going to have to be
20 fitted in, with some difficulty, during the course of six cases running at
21 once during the course of next year. At the moment, we have a window of
22 two weeks at the beginning of the year to deal with it.
23 MR. GROOME: Thank you, Your Honour.
24 JUDGE HUNT: Was that the only matters that you wanted to raise?
25 Can we go on with the witness?
1 Yes. Bring Dr. Simic in, please.
2 Mr. Groome, there's something in the opening address at pages 1836
3 to 1837 which, unfortunately but perhaps understandably, leaves it
4 completely open about a reference to a mental state and accountability at
5 the critical time. So you can put that down as a reference that you
6 should go to.
7 MR. GROOME: Thank you.
8 [The witness entered court]
9 JUDGE HUNT: Sit down, please, Doctor.
10 WITNESS: SLOBODAN SIMIC [Resumed]
11 [Witness answered through interpreter]
12 THE WITNESS: [Interpretation] Thank you.
13 JUDGE HUNT: I'm sorry to have kept you waiting. We had to
14 resolve yet another problem that keeps arising in this case.
15 Mr. Domazet, you were examining the doctor.
16 MR. DOMAZET: Thank you, Your Honour.
17 Examined by Mr. Domazet:
18 Q. [Interpretation] Good morning, Mr. Simic.
19 A. Good morning.
20 Q. We shall continue the discussion we had yesterday afternoon. If
21 you remember, I was asking you questions about your recollections about
22 Mitar Vasiljevic as your patient at your ward in July 1992. Could you
23 tell me what you remember about this patient.
24 A. I think I have said the most important things that I do remember.
25 One must bear in mind that ten years has gone by and that virtually all
1 patients at the psychiatric ward have a very similar clinical symptoms.
2 What separated him out from the rest and what makes me remember him better
3 is that he was transferred from a different ward of our own hospital,
4 which is not so frequently the case.
5 Q. Could you please look at the case history document and the
6 diagnosis entered in the case history so that you can comment, briefly.
7 MR. DOMAZET: [Interpretation] Could the witness please be shown
8 Exhibit P136.
9 Q. Is that the case history?
10 A. No. This is an abstract from some document from a book.
11 Q. I apologise. P138. I do apologise.
12 Have you had a look at it, please?
13 A. Yes, I have.
14 Q. Could you tell us, please, has this refreshed your memory in any
15 way? Could you tell us a little more about the diagnosis entered in the
16 case history?
17 A. This diagnosis is psychosis 298.9. This is on the basis of the
18 Ninth International Classification of Disease, which has now been changed.
19 298.9 are so-called undefined or unclassified psychoses. This diagnosis
20 was established most frequently when there was no specific
21 psychopathological substratum which could be separately classified, so
22 that this diagnosis indicates that there was a serious mental disorder
23 which, in this case, was manifested by disturbed behaviour, agitation,
24 disquiet, a disturbance of his thought process, and that is what was
25 dominant in this case.
1 In the case history, one can see the amnesia when the patient's
2 wife was consulted and it was established that he consumed a lot of
3 alcohol and that he was treated three times at the ward because of
5 In addition to that, mention is made of the death of a close
6 relative. These are all factors which could have contributed to this
7 grave mental disorder.
8 Q. Dr. Simic, according to you, this diagnosis is an indication of a
9 grave mental disorder. My question is: Is this linked to alcoholism, if
10 we are dealing with an alcoholic, or may that be the case or not
11 necessarily so? So could you comment on that, please.
12 A. To be quite certain that this was a case of alcohol-provoked
13 psychosis, we would need to have information of his previous treatment,
14 and this has not been attached to this case history for us to be able to
15 see how the disease of alcohol abuse developed in the patient and what
16 degree of damage it provoked, leading to this disorder. We would also
17 need to have the follow-up of this case history, that is, his subsequent
18 treatment, to see how his disease developed further; whether he had any
19 fresh disorders, whether he was treated later on or admitted to medical
20 institutions for similar conditions. So that in this specific case, there
21 is a high degree of probability that this psychosis could have alcohol in
22 its etiology, that is, that alcohol abuse may have provoked it.
23 Q. As far as his condition then is concerned, that is at the time he
24 was brought to your ward, could you tell us, on the basis of what you know
25 now, anything about his ability to comprehend acts and consequences of
12 Blank page inserted to ensure pagination corresponds between the French and
13 English transcripts.
1 those acts when he was admitted to your ward in the condition in which you
3 A. It can be clearly seen here, regarding his psychological state,
4 that is, his mental condition, that he was extremely agitated, that his
5 thought process was upset, that he cannot concentrate, that he is able to
6 answer only a question here and there, that it is difficult to establish
7 contact with him; that he was singing, shouting, resisting control, and
8 that other functions could not be assessed.
9 And as a result, the patient was tied up, which is something we
10 described and went into yesterday, how this is done and why, which is an
11 indication that, at that point in time, he was not able to control his
12 behaviour or to be conscious of his actions.
13 Q. Thank you. Would you now take a look at the same exhibit, on page
14 -- I think it's page 3, and it refers to the patient's discharge. You
15 have the page in front you. Would you please read through it and tell me
16 what it says, what it's about.
17 A. The patient is calm but still a little accelerated. The date is
18 the 28th of July 1992. At the request of his wife, he is being
19 discharged, sent home for further treatment in outpatient -- as an
20 outpatient. And the signature is Vasiljevic Milojka.
21 Q. Dr. Simic, does this mean that, at that point in time, he had been
22 relatively cured or not, or was he just being released because of the
23 request made by his spouse?
24 A. Well, I would like to say he was partially cured; not cured,
25 partially cured. So he -- it was necessary for him to remain in hospital
1 a little while longer. However, by law, the next of kin - that is to say,
2 parents, guardians, or spouses - have the right to take the patient out of
3 hospital, out of the ward, at their own personal request and at their own
4 responsibility, at their own risk, and that was this case.
5 Q. Does that mean that his condition had improved compared to what it
6 had been previously, or had it not been the case, would you have been able
7 to prevent his next of kin taking him out of hospital?
8 A. Well, it says here that the patient is calm and orderly, which
9 speaks of his conduct, his behaviour. And at that time, that means that
10 his conduct was satisfactory. Mention is only made of the fact that he is
11 accelerated and the term used in our terminology means that effective
12 behaviour is a little raised in the sense of greater psycho-motor
13 functions. However, I assume that this state was also satisfactory in
14 terms of his wife, so that she decided to take him out of hospital because
15 very rarely does somebody take a patient out who is not feeling well or is
16 showing marked signs of still being sick. So this was a patient who was
17 visibly -- whose condition was visibly improved, and they did not have the
18 patience for waiting for end of treatment to be completely cured.
19 Q. Would you now take a look at the first page of the exhibit,
20 please, and tell me, first of all, how the case history was filled out and
21 how it goes -- is moved from ward to ward. Do -- are entries made on each
22 ward? In this particular case history, regardless of what was written in
23 the previous ward, for example, orthopaedics in this case?
24 A. Here we can see that the case history was opened at the
25 orthopaedics department. They opened the case history form, printed form.
1 They began writing in entries. And in the case history, we see that it
2 says that the patient was transferred to the psychiatric ward.
3 After the psychiatric ward, he was moved to a third ward -- had he
4 been moved from the psychiatric department to a third ward, they would
5 have continued writing in entries in this same case history form.
6 Q. In concrete terms, Dr. Simic, would you take a look at the columns
7 and tell us whether column 12 was filled in in your ward, and also column
8 11. Were columns 11 and 12 filled in in your ward?
9 A. Column 12, where it says "Psychosis," that was filled in at our
10 ward. And I think I typed this out myself. It looks like the typewriter
11 I used at the time. And also, there's my signature at the bottom. Using
12 that same typewriter, it is printed out and typed out using the same
13 letters. And I also filled in the date of discharge. Probably there
14 should be a discharge list which I wrote too, but I can't see it here.
15 Q. I have here a discharge list which is from your particular ward.
16 Now, I'm going to show it to you to see whether that is the discharge list
17 and whether it refers to this particular patient.
18 MR. DOMAZET: [Interpretation] Could I ask the usher to show the
19 original and the photocopy.
20 JUDGE HUNT: Is there an English version of this?
21 MR. DOMAZET: I don't believe, no. No.
22 MR. GROOME: Your Honour, I had a draft drawn up last night. I'll
23 have copies made. But it's simply a draft.
24 JUDGE HUNT: Thank you. Really, Mr. Domazet, this is not well
1 MR. DOMAZET: [Interpretation] Your Honour, it is the document the
2 photocopy of which I gave to Mr. Groome yesterday. I omitted to mention
3 that. And there are really no more exhibits, pieces of evidence that have
4 not been handed over. So I omitted to say that I gave him this photocopy
5 yesterday, actually.
6 JUDGE HUNT: It's probably only stating the obvious, Mr. Domazet,
7 but you have not produced an English version, which you are required to
8 do. And you may have produced it to Mr. Groome in order for him to have
9 it translated, but you haven't given us any translation. We shouldn't
10 have to rely upon Mr. Groome to give them to us.
11 Anyway, you proceed, and we'll have to rely upon the interpreters
12 when you read matters to the witness.
13 MR. DOMAZET: [Interpretation]
14 Q. Have you had a look, Doctor, at this discharge list?
15 A. Yes.
16 Q. Is it the discharge list that you mentioned a moment ago?
17 A. Yes.
18 Q. Can you read what it says on the discharge list, the diagnosis,
19 and the description underneath, so that we can have it interpreted.
20 A. Discharge diagnosis of the patient, Mitar Vasiljevic, psychosis
21 298.9. In the epicrisis, it states that the first hospitalisation, the
22 first hospitalisation existed, then he was transferred to orthopaedics.
23 Upon admission he was exceptionally restless, agitated; he was singing,
24 shouting, resisting -- offering resistance upon arrival; his train of
25 thought was disturbed by incoherent speech.
1 After receiving treatment, his condition improved so, at the
2 request of his wife, he is being released home to be given further
3 treatment as an outpatient.
4 Laboratory findings within normal limits. Suggestion for
5 treatment: Largactil tablets, 100 milligrams, three times a day one
6 tablet, a control check-up with the relevant psychiatrist in 14 days.
7 Until then, to be relieved of duty. Control check-up with the
9 It is signed by the unit doctor, Dr. Slobodan Simic, and the head
10 doctor of the ward or unit, Dr. Borislav Martinovic, neuropsychiatrist.
11 JUDGE HUNT: Now, Mr. Domazet, just one moment, please.
12 Doctor, can you help us with this word "epicrisis"? According to
13 my medical dictionary, its meaning depends upon its pronunciation, which
14 is never a good start, but I think this is the relevant one and I'd like
15 you to confirm it. It means a critical summary or analysis of the record
16 of a case. Is that correct?
17 THE WITNESS: [Interpretation] Yes. A summary would be closest to
18 the meaning.
19 JUDGE HUNT: Thank you.
20 MR. DOMAZET: [Interpretation]
21 Q. Dr. Simic, with respect to treatment and medicaments, can you tell
22 us what kind of drugs were suggested and was that sufficient, in your view
23 at that time, the drugs that were suggested?
24 A. The patient was given what we call -- the generic term is
25 Chlorpromasin, which is an anti-psychotic, in fact. Its dominant effect
1 is a sedative. The optimum dosage is 300 milligrams per day. At that
2 time, it was the drug that we prescribed to patients suffering from the
3 kind of clinical picture that Mr. Vasiljevic had, where there was a
4 predominance of agitation and restlessness.
5 Q. Dr. Simic, you see for yourself from the case history what the
6 patient was like, and you said that he was transferred from the
7 orthopaedics ward. Do you happen to remember, from what he said or from
8 what others said, how Mitar Vasiljevic had been injured? How was he
10 A. Well, we heard the story about the patient who had fallen off a
11 horse and was, as a result, brought to the orthopaedics ward and was very
12 restless and agitated there, and because of his behaviour, he was
13 transferred to the psychiatric ward.
14 Q. Just one more point. Would you take a look at page 1 of Exhibit
15 138, the case history. Do you have it before you?
16 A. Yes.
17 Q. Take a look at the top, and underneath the words "Case history,"
18 what has been typed out immediately underneath that heading. It says:
19 "Injury on the battlefield in Visegrad." That's what it case in the case
21 Can you explain what the term "Ratiste" or "battlefield,"
22 "battleground," "front," what it meant.
23 A. Well, that's not a highly professional question. For all of us,
24 the battleground or battlefront was any territory where fighting took
25 place for -- and especially for us in Serbia, at that time, the
1 battlefield was Bosnia, because this patient was brought to us from Bosnia
2 and we were Serbia.
3 Q. Does that mean that when it says "battlefield," that that, for you
4 working in your hospital, meant people who were in the theatre of war, and
5 in this concrete case, that was Bosnia-Herzegovina; is that right?
6 A. Yes.
7 Q. Doctor, was this what you wrote for all patients coming in with
8 injuries from that territory or did it apply to those who were actually
9 injured during the fighting?
10 A. I really couldn't say. I was not an administrative worker in
11 charge of the administration. I can't answer that.
12 Q. And the terminology that you used when you saw the word "Ratiste"
13 or "battlefield," it meant what you have just explained to us; is that
15 A. Yes.
16 Q. Thank you, Mr. Simic.
17 MR. DOMAZET: [Interpretation] I have no further questions.
18 JUDGE HUNT: Mr. Groome.
19 Cross-examined by Mr. Groome:
20 Q. Good morning, Dr. Simic.
21 A. Good morning.
22 Q. My name is Dermot Groome and I will be asking you questions on
23 behalf of the Prosecution.
24 Regarding the question of when Mr. Vasiljevic first entered Uzice
25 hospital, you yourself have no personal knowledge about when that
1 occurred; is that correct? You just know when he arrived at the
2 psychiatric facility.
3 A. Yes.
4 Q. Now, in 1992, you said that you were, I believe, a general
5 practitioner on the psychiatric ward. Can you tell me, at that point in
6 time, were you treating the patients for their psychiatric illnesses or
7 were you simply treating them for other ailments and other doctors were
8 treating them for their psychiatric maladies?
9 A. I was what we call a secondary doctor, that is to say, a doctor
10 preparing to specialise in the field of psychiatry, but he has not been
11 accorded the -- a psychiatric specialist training yet. So I did treat
12 psychiatric patients along with direct -- in direct cooperation with my
13 mentor, the psychiatrist. So I was waiting to get a place for the
14 psychiatric specialisation.
15 Let me also say that there were very few of us so that I was the
16 only secondary doctor or young doctor on the ward, and the ward had 50
17 beds and, at the time, only four specialists.
18 Q. So would I be correct in saying that you were treating these
19 patients for their psychiatric ailments but it was under the supervision
20 of your mentor? Is that correct?
21 A. Yes.
22 Q. Would they have to approve any medication that you sought to
23 prescribe or any other therapies that you sought to prescribe to a
25 A. Yes. Yes.
1 Q. Who would you say had the most direct contact with Mr. Vasiljevic
2 -- I'm sorry. Which doctor would you say had the most direct contact
3 with Mr. Vasiljevic during his time on the psychiatric ward?
4 A. I had the most direct contact and, through me, my mentor, Dr.
5 Slavica Jevtovic, the lady doctor.
6 Q. So would it be fair to say that all aspects of Mr. Vasiljevic's
7 treatment, you would have been the primary person who was made aware of
8 whatever was occurring with Mr. Vasiljevic at that time?
9 A. Yes.
10 Q. Now, I want to ask you about this classification of 298.9. You
11 told us that that was an old classification, meaning unclassified
12 psychoses, from the Ninth International Classification of Disease. What
13 I'd ask you is can you tell us, if you were classifying these symptoms
14 today, what would be the classification that you would use?
15 A. Today's classification, the Tenth International Classification of
16 Disease, the code would be F23, acute transient psychotic disorders. That
17 would most probably be the diagnosis for this patient.
18 Q. Now, you've used the word "transient." Does that mean that this
19 is a passing psychosis?
20 A. F23 in the classification is explained as acute and transient,
21 depending on the type, the case. But at all events, an acute psychosis,
22 acute psychotic disorders are transient, but in a certain number of cases,
23 they represent a manifestation of a more serious psychological disorder,
24 and in certain cases, a reaction to certain conditions or factors.
25 Q. Are there any subcategories of this F23 which would more aptly
1 describe the condition of Mr. Vasiljevic or is it one general category?
2 A. There are subcategories. However, essentially it is a general
3 diagnosis. The subcategories, if you're interested in hearing them -- do
4 you --
5 Q. Only those subcategories that you may feel more accurately
6 describe the condition of Mr. Vasiljevic at the time you treated him.
7 A. He would probably have been diagnosed as F23.1. Sorry, .0.
8 THE INTERPRETER: Interpreter's correction.
9 Q. And could you give us the name of that subcategory?
10 A. It's all the same category but subcategories of acute transient
11 psychotic disorder.
12 Q. Now, you've just told us that in certain cases, this transient
13 psychosis is a reaction to certain conditions or factors. Can I take from
14 that that this can be brought on by a particular precipitating event that
15 happens in the life of a person? Is that correct?
16 A. Yes.
17 Q. So is it possible that somebody who had suffered the loss of
18 somebody close to them could be affected in this way?
19 A. Yes.
20 Q. Could it also be true that a person who perhaps did something
21 terrible, the guilt and the realisation of what they had done caused them
22 to react in this way? For example, let's say a man killing his wife.
23 Could that be the type of event that could bring on this type of
25 A. There are categories of stressful events which may trigger it, but
1 such a case is not mentioned as being one in that category. It probably
2 hasn't been encountered in practice.
3 Q. So if somebody were to lapse into psychosis because of the
4 realisation of something that they had done, are you saying that you would
5 classify that differently than the F23.1 or .0?
6 A. If the patient gave a psychotic picture, then he would be
7 classified as a F23.0 and the other subcategories, but we would have to
8 see the etiological factor that led to the manifestation of this psychotic
9 disorder. It is far more frequent in practice - as I used to work in a
10 prison hospital with psychiatric patients who had committed a crime - in
11 an enormous number of cases, the patient first develops this psychotic
12 disorder and only then commits the felony or the crime.
13 Q. In your experience, have you come across cases where the person
14 has committed the crime and subsequently develops a mental disorder?
15 A. I have not had occasion to come across a patient in the prison
16 hospital who first committed the crime and then developed psychosis. All
17 the patients had either -- either developed this psychosis and then
18 committed the act or committed the act without suffering from the
19 psychosis but having some other mental disorder.
20 Q. In Serbia, are there provisions for committing patients who a
21 doctor may feel are a threat to himself or to other people? In other
22 words, be sufficiently insane that a doctor can apply to have the person
23 committed for treatment? Is there a provision under Serbian law?
24 A. We can address that issue at two different levels. If the patient
25 falls ill from a psychotic disorder and if this is manifested in his case
1 by aggressive and out of the ordinary behaviour, he is hospitalised, put
2 in a hospital, and treatment is undertaken. After treatment, he is
3 discharged home.
4 However, in cases when the patient suffering from psychosis
5 commits a criminal offence - manslaughter or attempted manslaughter or is
6 a threat to the environment - the so-called security measure is
7 prescribed, which means treatment and commission to a closed-type
8 institution. And this ruling is made by the court upon the proposal of
9 the doctor or upon the request of the family and the damaged party.
10 Q. Now, under Serbian law, you would have been entitled, if you
11 thought that Mr. Vasiljevic's mental disorder were serious enough, you
12 would have been entitled to invoke this procedure through your mentor to
13 have him committed for treatment; is that correct?
14 A. He was not admitted to the ward after any criminal offence but
15 because of his restlessness and agitation, both of which, restlessness and
16 agitation, were treated during hospitalisation. So that at the moment he
17 was discharged, he was no longer dangerous for the environment. Had there
18 been such a danger, I would have certainly informed my mentor, and we
19 would have, through legal proceedings, prevented his discharge, the
20 discharge of a dangerous patient.
21 Q. Now, Mr. Domazet asked you whether or not the mental disorder that
22 he was suffering at the time could have been provoked by alcohol, and you
23 used the term "alcohol-provoked psychosis," and you said that you would
24 need other reports to make that determination.
25 As the person who was the primary mental health caregiver to Mr.
1 Vasiljevic, absent those reports, I ask you to rely on your recollection
2 and ask you: Is it possible that the disorder that you observed was the
3 result of his alcoholism?
4 A. On the basis of the existence of case histories from earlier
5 courses of treatment, it may be assumed that the disease alcoholism, given
6 uninterrupted consumption under extraordinary conditions and a high level
7 of stress when life is at risk, coupled with the loss of loved ones, can
8 result in the development of a psychotic disorder.
9 In this case, I was not able to comment in any great detail about
10 this because I simply have not had access to documents about his earlier
11 treatment because the patient came from another state where there was a
12 state of emergency and his wife did not bring the necessary documents with
13 her, so that at that point in time, we didn't have complete insight into
14 his disease. And this is also noted in the discharge document that I
15 myself wrote out. I said that the first -- that this was the first
16 hospitalisation, though there is evidence of earlier treatment, though --
17 but I didn't see it. I didn't have access to the appropriate document.
18 So that, having what I had, all I could suggest was unspecific psychosis,
19 giving a picture of an acute and transient psychotic disorder.
20 Q. Would you agree with me that, during your treatment of Mr.
21 Vasiljevic, it would have been helpful to have had these documents and
22 records from his earlier treatments?
23 A. It would. The documents could assist possibly in determining the
24 etiological factor with greater precision, that is, the cause of the
25 development of the psychotic disorder, which means that his psychotic
12 Blank page inserted to ensure pagination corresponds between the French and
13 English transcripts.
1 disorder could be categorised as so-called alcoholic psychosis.
2 Q. Had you known then that he had been treated on a number of
3 occasions for his alcoholism, would that have changed your diagnosis, this
4 289.9, I believe it was, this -- sorry, 298.9, this diagnosis you wrote in
5 the case history? Might that have altered what you wrote as your
6 concluding diagnosis?
7 A. According to the Ninth Classification of Disease, alcoholic
8 psychoses of that kind were grouped under this code 298.9, unspecific
10 Q. Do you have a specific recollection today whether when you wrote
11 or when you classified him as 298.9, whether it was your opinion that he
12 had alcoholic psychosis or whether he had this unclassified psychosis
13 unrelated to alcoholism? Do you have a clear memory of your determination
15 A. 298.9, this diagnosis is a diagnosis which combines into one all
16 psychotic disorders which produce a similar clinical picture regardless of
17 the etiology.
18 Q. Now, under the Tenth Classification, the current classification,
19 would it still be considered F23.0? I'm sorry, alcoholism -- alcoholic
20 psychosis, would that also be classified as F23.0?
21 A. In the new Tenth Classification, if one has all the documents and
22 full insight into the treatment given to the patient, most probably he
23 would have been diagnosed F10.3 -- .5. Sorry. These are alcoholic
24 psychoses. F10.3 -- .5. I beg your pardon.
25 Q. Now, Doctor, I took a few notes when you were describing the
1 symptoms. I want to go through them with you and ask you have I missed
2 any. The symptoms, I believe you said, were agitation, disquiet, and
3 disturbance of thought process. Were there any other symptoms that you
4 observed of Mr. Vasiljevic during your treatment of him?
5 A. Judging by what one could see and hear when the patient was being
6 admitted at the time, the other functions could not be judged.
7 Q. Are you -- maybe you can clarify that answer. Are you saying that
8 there were other symptoms that you were not able to judge?
9 A. Mental functions can be tested in detail only if the patient is
10 capable of controlling his behaviour and if he is not restless in terms of
11 psycho-motor functions. Later, upon discharge, we see that he was
12 regular, that he was quiet, and that the only visible symptom was that of
13 a certain degree of acceleration, which most frequently means that his
14 speech was rather accelerated and his movements were fast.
15 Q. Doctor, you used the word "controlling his behaviour," and could
16 you distinguish for us the difference between somebody who is angry and is
17 being intentionally disruptive as opposed to somebody who has the
18 inability to control his behaviour? Can you distinguish what you would
19 look for to make that determination?
20 A. Someone who is intentionally disruptive has to make a pause. He
21 cannot continue to simulate abnormal behaviour continuously for a long
22 time, whereas a sick man, a patient, he shows disruptive behaviour
23 continuously and pronounced restlessness which can be remedied only by
24 applying the adequate therapy.
25 Q. And in the case of Mr. Vasiljevic, can you describe -- was this
1 symptom that you're describing now, was it interrupted or not interrupted?
2 A. Judging by everything, one can conclude that it was uninterrupted.
3 Q. And is that diagnosis indicated anywhere on the papers that you
4 now have before -- before you?
5 A. 298.9, on the case history. On the case history and also on the
6 discharge document.
7 Q. Well, you've told us now that 298.9 could have been alcoholic
8 psychosis. If it were that, would these behaviours continue uninterrupted
9 as well?
10 A. I'm afraid I didn't quite understand your question.
11 Q. Well, it seems that 298.9, at this period of time, could cover a
12 range of different psychoses, and my question is: Does inability to
13 control one's behaviour over an uninterrupted basis, would that also be a
14 symptom that one would expect to see in alcoholic psychoses?
15 A. 298.9 was a so-called service diagnosis, which means it covered a
16 wide range of psychotic disorders, and it was very frequently used in
17 classifications. His alcoholic psychosis came under that category, but
18 all psychoses have their beginning treatment with identical medication.
19 Regardless of the etiology in this case, alcoholic psychosis is treated
20 with the same medicines as other psychoses, and it has a duration similar
21 to that of other psychoses.
22 Q. Now, Doctor --
23 JUDGE HUNT: Just before we adjourn, Mr. Domazet, what do you want
24 to do with these documents that you have produced, or should I say the one
25 in B/C/S which you produced and the English translation which the
1 Prosecution has produced?
2 MR. DOMAZET: [Interpretation] Your Honour, I should like to tender
3 them as Defence Exhibit D30, if I'm not mistaken.
4 JUDGE HUNT: Any objection?
5 MR. GROOME: No, Your Honour.
6 JUDGE HUNT: Well, the B/C/S original will be Exhibit D30, and the
7 English translation will be D30.1.
8 We will adjourn until 11.30.
9 --- Recess taken at 11.00 a.m.
10 --- On resuming at 11.30 am
11 JUDGE HUNT: Mr. Groome.
12 MR. GROOME: Thank you, Your Honour.
13 Q. Dr. Simic, I'd like to go back to your diagnosis of 298.9. Would
14 every different type of psychosis classified under this 298.9 necessarily
15 have what you've described as uncontrolled -- inability to control
16 behaviour for an uninterrupted period of time? Would every diagnosis
17 fitting into that category have to share that particular symptom?
18 A. Yes.
19 Q. The other symptoms you mentioned were agitation. Can you give us
20 an idea more precisely what you mean by agitation? How did it manifest
21 itself in the behaviours of Mr. Vasiljevic?
22 A. Agitation is increased uncontrolled behaviour. For example,
23 agitation, as I say, means increased uncontrolled behaviour.
24 Q. And would that symptom be also consistent with somebody suffering
25 from alcoholic psychoses?
1 A. A psychotic picture would be almost identical, we have already
2 said that, with manifestations and symptoms. Only later can we look at
3 the etiology or, rather, the causes. But the clinical picture of acute
4 psychosis, of acute psychotic disorder, in the vast majority of cases is
5 either very similar or identical, regardless of etiology.
6 Q. Now, this symptom of agitation, can you give us, during the period
7 he was on the psychiatric ward, during what period of time did he suffer
8 from that symptom, particular symptom?
9 A. What is certain is that it was visible upon admission. As to the
10 rest, it wasn't very precisely recorded in the case history, but a
11 customary period for the duration of this kind of clinical picture, along
12 with adequate therapy, would not be longer than one or two days.
13 Q. And when you say "therapy," is that drug therapy, some medicines?
14 A. Yes.
15 Q. Now, you say -- you used the word "visible." Would the
16 manifestation of this symptom be only visible to somebody like yourself
17 with specialised training or would other doctors and nurses in the
18 hospital also be able to recognise these symptoms? Would they be visible
19 to other medical personnel as well?
20 A. Those symptoms are visible to anybody because the picture and
21 expression of it is truly drastic. It is exceptionally conspicuous
22 behaviour with a great deal of agitation and restlessness, and everybody
23 would be able to recognise it without having any medical training at all.
24 But perhaps they wouldn't know that it was a psychotic disorder. Usually
25 people would say, "He's mad," something like that.
1 Q. And in your experience, the onset of this symptom, is it something
2 that happens rapidly or is it something that happens gradually over a
3 period of time?
4 A. Psychotic disorder to that degree, in that intensity in which he
5 was in quite certainly was at its peak then, and that is precisely why he
6 was transferred to the psychiatric ward. However, it may happen with a
7 certain number of disorders - and alcoholic disorders come under that
8 category - that he had certain manifestations of conspicuous behaviour
9 which would -- and this could come from the environment, the family. But
10 here in the case history, judging by the statements of his spouse, he was
11 conspicuous, restless, and agitated. He would stay at work longer than
12 was necessary. He behaved in a way which differed from his usual conduct,
13 from what his behaviour had been up until then, before he was admitted
14 into hospital.
15 Q. Doctor, are you saying that, based upon his wife's observations
16 that he stayed at work longer than necessary and that his behaviour had
17 changed, that you were able to say that he was suffering from psychoses
18 before he arrived at the psychiatric ward?
19 A. No. I didn't say he suffered from psychosis before he came to
20 hospital. What I said was that, judging by what his wife said, his wife's
21 statements, his behaviour had been different and conspicuous. He wasn't
22 hospitalised during that period but only when he came to the ward, so that
23 we can only speak about the clinical picture upon admission because we
24 didn't see him before that. We weren't able to see and assess him before
1 JUDGE HUNT: Mr. Groome, I don't want there to be some problem
2 later about this. Your question was whether he -- the accused had been
3 suffering from psychoses before he arrived at the psychiatric ward. The
4 doctor has answered, as I understand it, before he came to the hospital.
5 It may or may not be important.
6 MR. GROOME: Yes, Your Honour.
7 JUDGE HUNT: I think the doctor's answer probably encompasses what
8 you're asking, but I don't want there to be any problem later about this.
9 MR. GROOME: Thank you, Your Honour.
10 JUDGE HUNT: By the way, can you just remind me, I can't find the
11 document here, if he was admitted on the 14th of June, what date was it
12 that he was transferred to the psychiatric ward?
13 MR. GROOME: I believe it was the 7th -- he arrived on the 7th and
14 an entry was made on the 8th of July.
15 JUDGE HUNT: Sorry, the 7th of July, that's right.
16 MR. GROOME: Yes.
17 JUDGE HUNT: So it was about three weeks after he is said to have
18 been admitted to the hospital.
19 MR. GROOME: Yes.
20 Q. Doctor, let's go back to the symptoms that you've described. Am I
21 correct in characterising them as readily apparent to both medical
22 personnel and non-medical personnel? Is that correct?
23 A. Yes.
24 Q. Now, can you tell us, what is the hospital procedure in a case
25 where a patient presents themselves and they have both a serious mental
1 disorder as well as a serious physical disorder? What procedure is
2 followed in Uzice hospital?
3 A. In the case of a patient who is psychotic and exceptionally
4 agitated, he is hospitalised in the psychiatric ward. Now, if he has an
5 accompanying somatic disorder, then the relevant specialist service is
7 Q. So can we conclude from the case history of Mr. Vasiljevic that at
8 the time that he was brought -- initially brought to Uzice hospital, there
9 was no readily apparent symptoms of a psychological disorder?
10 A. We can conclude that he was admitted to another ward because of
11 another disorder but that the psychiatrist did not examine him when he was
12 actually admitted. He was only examined by a specialist of that branch of
13 medicine for which he had a referral letter with the referral diagnosis.
14 So when a patient comes to us with a referral letter for a certain
15 specialist's service, he is examined by that particular specialist, and on
16 the basis of that, a conclusion is drawn. Not all the specialists get to
17 examine him upon admission, only the specialist for which he has received
18 the referral diagnosis and referral letter.
19 Q. But wouldn't we be correct in concluding that, upon his initial
20 admission to Uzice, the admitting doctor saw no need for a psychiatric
21 referral, to have somebody from your department go down and make an
22 assessment of his psychological condition? We can conclude that from the
23 record, can't we?
24 A. From the records, we can conclude that a psychiatrist was not
25 consulted upon admission.
1 Q. And can we also conclude that, had he visibly demonstrated the
2 symptoms you've described at the time of his admission to Uzice hospital,
3 that the probable course of treatment would have been to assign him to the
4 psychiatric ward and then to see to it that orthopaedic specialists took
5 care of whatever orthopaedic injuries needed tending to? Can we conclude
7 A. We can conclude that the patient was admitted at the orthopaedic
8 ward, and judging by what could be seen, he had a grave injury. With a
9 grave injury of that kind, even if he was psychotic, he could not have
10 done -- he could not have expressed his psychotic condition much because
11 he was probably under the effects of pain and immobilisation and the fear
12 he had of the injury sustained. So that his agitation could have passed
13 as being a reaction to the injury itself. And then injuries of that kind
14 are emergency states, so that is why he was admitted immediately, operated
15 on, and therefore, the psychiatrist was consulted only later, once he had
16 begun to show manifest signs of psychotic behaviour in the course of his
18 Q. Well, Doctor, you're speculating now about what may or may not
19 have been done regarding his treatment initially; correct? You do not
20 know this by personal knowledge, do you, or by any record that you have?
21 A. Nobody examined him. None of the psychiatrists examined him upon
22 admission. I don't think I'm speculating. I am just -- I am basing my
23 statement and opinion on the recorded entries in the case history where we
24 see that it was a serious fracture where surgery was administered. He was
25 operated on. So I was not speculating as to his physical somatic state.
1 Q. But are you suggesting that, over the course of three weeks, that
2 he may have received painkillers that could have suppressed or masked the
3 psychotic symptoms which you've described for us? Is that what you're
5 A. Analgetics, certainly not. They would not. Not analgetics.
6 Q. And do you know of any medication or drug that he was receiving at
7 that time which, in your opinion, would have masked or suppressed the
8 symptoms of psychoses?
9 A. I do not have an insight into his therapy list.
10 Q. Now, Doctor, one of the things we've heard here in this case is
11 that he was in traction. Now, given that, when he arrived at the
12 psychiatric ward he needed to be tied up, would you not agree with me that
13 if he was so agitated and so nervous and exhibiting these symptoms, that
14 he would have been causing injury to his leg that was being immobilised
15 through traction? Would you not agree with that?
16 A. When he was immobilised, is that what you're asking? I'm not sure
17 I followed you.
18 Q. I'm -- it seems that you're unable to tell us precisely when, but
19 soon after his arrival in the psychiatric ward, he was actually tied to
20 his bed; correct?
21 A. Yes.
22 Q. Now, would you agree with me that whatever behaviours that he was
23 engaged in that required you direct the staff to tie him to his bed, that
24 if he were exhibiting those same behaviours at the time when he was placed
25 in traction, his leg was in traction with the weight, that those same
1 behaviours would have jeopardised his recovery, the recovery of his broken
2 leg? Would you not agree with that?
3 A. Well, that is a sort of an assumption as well. We cannot speak
4 with any precision about that because nobody examined him. None of the
5 psychiatrists examined him at that time. And in the realm of speculation,
6 the staff of the orthopaedics ward might not have recognised psychotic
7 behaviour as such so that it is -- they would not have been duty-bound to
8 recognise a psychosis. But quite obviously, they did react when this took
9 on larger proportions, when the -- when his behaviour was unhinged to a
10 greater extent, and then they consulted psychiatrists.
11 Q. Now, I want to go to the alcoholic psychosis that you've told us
12 about, and the question I want to ask you: Is it not true that that
13 particular psychosis is triggered when the person abstains from alcohol?
14 When they cease their daily intake of alcohol, that's when we start to see
15 the onset of that particular type of psychosis?
16 A. At the foundations of all types of psychotic disorders. So this
17 is a global disturbance or impairment of the central nervous system. So a
18 global impairment of the central nervous system which is manifest in the
19 symptoms described where disturbed behaviour, loss of control of impulse,
20 restlessness, agitation, and other symptoms come into play, depending on
21 whether the psychosis was caused by alcohol. Alcohol is a factor which
22 led to this global impairment of the central nervous system.
23 If the patient is a dependent, is alcohol dependent, then he
24 always has what we call the abstinence syndrome or withdrawal syndrome;
25 that is to say, the appearance of the lust for alcohol and the need for
1 the substance upon which he is dependent. It can happen that when the
2 quantity of the substance is reduced that the manifestations of abstinence
3 become visible. However, the most frequent cause of a psychosis is a
4 global impairment to the brain and not the abstinence syndrome.
5 Q. Well, would I be correct in saying that one of the symptoms of --
6 brought on by alcohol abstinence, by a person who is a severe alcoholic,
7 would be agitation? Wouldn't that be a symptom you would expect to see
8 when the person no longer has alcohol? Yes or no, please.
9 A. Once again, please, could you repeat that.
10 Q. Would the symptom of agitation not also be a symptom which we see
11 when a person who is heavily dependent on alcohol no longer has alcohol,
12 one of the withdrawal symptoms? Wouldn't agitation be one of those
14 A. That isn't the rule. It is individual, depending on the person
15 and depending on the state of the central nervous system in the first
16 place, the length that alcohol has been consumed, the intensity, the
17 general condition of the body, and many other factors both internal and
18 external, so that you cannot set clear hard and fast rules, because each
19 patient is a case in himself.
20 Q. I'm not asking you to set clear and hard, fast rules. What I'm
21 asking you, is the symptom of agitation a possible symptom of withdrawal
22 syndrome, as you put it?
23 A. It is possible. The abstinence syndrome or withdrawal syndrome,
24 manifestation of that can sometimes be a certain degree of restlessness,
25 tenseness, but the abstinence syndrome does not absolutely imply psychotic
1 -- a psychotic condition. It is a separate entity. The abstinence
2 syndrome has its own level, and it is a level of restlessness, tension,
3 nervousness, and need for the substance. But a psychotic disorder is
4 drastically -- on a drastically higher level and much stronger, and when
5 that appears, it is classified in quite a different way. So this was not
6 an abstinence syndrome.
7 Q. Are you saying that your observations of Mr. Vasiljevic, that it
8 is your opinion that he was not suffering from alcohol abstinence?
9 A. If he was suffering from it, if he did have the symptoms of
10 abstinence, they were not recorded, because upon arrival at the ward,
11 about three weeks went by and the abstinence -- he should have felt the
12 abstinence syndrome as soon as he stopped taking the substance, not three
13 weeks later, not after spending three weeks in hospital.
14 Q. Well, Doctor, let me ask you for the purposes of my question to
15 assume something different, not that he had been in the hospital three
16 weeks, but let's say he had been in the hospital a matter of days and he'd
17 only ceased to have alcohol for a matter of days before you saw him.
18 Would the symptoms that you saw in him be consistent with the symptoms one
19 would expect to find of somebody in the process of withdrawal from
21 A. This was a psychotic disturbance and not an abstinence syndrome.
22 Q. So you can say to us with certainty that none of the symptoms that
23 you observed in Mr. Vasiljevic had anything whatsoever to do with
24 withdrawal from alcohol?
25 A. Nobody can say that, but what in a psychotic disorder is manifest
12 Blank page inserted to ensure pagination corresponds between the French and
13 English transcripts.
1 is a drastic, drastic level of disorder and disturbance so that there is
2 nobody who would be able to differentiate and say whether a psychotic
3 patient also has elements of abstinence, because the psychosis is an
4 enormous global disorder. What we have here is a patient who, after three
5 weeks, was brought to the psychiatric ward, so that means that abstinence
6 syndromes must have appeared and become manifest earlier on.
7 Q. Doctor, can you tell us, once somebody ceases to have alcohol, how
8 much time passes before we can see the onset of withdrawal symptoms?
9 A. Firstly, he would have to have been suffering from dependence, a
10 sick -- dependence sickness for an abstinence syndrome to set in, and it
11 is a diagnostic criteria for a dependency disease or addiction.
12 Some patients who take in alcohol do not develop the addiction or
13 dependence disease. Where the dependency disease is involved, abstinence
14 comes into play very soon afterwards, that means between 24 and 48 hours
15 after they have ceased to take the substance. In drastic cases, it would
16 set in, that is to say, the pre-delirium syndrome would set in, which
17 means a trembling and shaking of the hands, increased perspiration, fear.
18 Q. Did you see any of these symptoms manifest themselves in Mr.
20 A. Those symptoms were not seen in Mr. Vasiljevic.
21 MR. GROOME: I want to show you a document, and I ask that it be
22 marked as Prosecution document number 165. I'll ask that the doctor be
23 shown the original and the copies are for the Court. There is an English
24 translation at the end of this document. I apologise that it is not
25 marked, but I would ask that that be deemed Prosecution document 165.1.
1 Q. Doctor, do you recognise the document --
2 JUDGE HUNT: Just a moment. Is 165 three pages long and then this
3 document attached to the back, that's intended to be 165.1?
4 MR. GROOME: Yes, Your Honour.
5 JUDGE HUNT: Thank you. Well, make sure the doctor's got the
6 English translation, because he seems to have all the yellow sheets. Oh,
7 he probably doesn't need the translation so it doesn't matter.
8 MR. GROOME: Yes. I believe it's his document.
9 Q. Doctor, do you recognise Prosecution document 165?
10 A. [In English] Yes. Yes.
11 Q. Can you tell us what it is?
12 A. [Interpretation] This is the therapy list.
13 Q. And does this sheet or list indicate all of the medications that
14 Mr. Vasiljevic received while he was in the psychiatric ward?
15 A. Yes.
16 Q. Am I correct in saying that the earliest page is the last page,
17 that we're in reverse order? This document is in reverse order; is that
19 A. This has just been attached in that way, joined. Otherwise, the
20 order goes from the last page towards the front page. Otherwise, that's
21 it. The order has just been changed.
22 Q. I'd ask you to go to the third page, to the date of the 8th of
23 July, and ask you is that the first time that medications were
24 administered to Mr. Vasiljevic on the psychiatric ward?
25 A. As soon as a patient is admitted, this therapy list is prepared
1 and all the medicines administered necessarily have to be entered. And we
2 see here that the list was opened on the 7th, on the 7th of July, and that
3 the patient received vials, injections, in this case Topral, which is a
4 very strong anti-psychotic, every eight hours, which supports his
5 condition of pronounced restlessness, because this is therapy for very
6 grave restlessness. And we see that he received these injections for
7 another six days.
8 Q. Doctor, before I ask you specific questions about this, is this
9 the therapy sheet that was used in the treatment of Mr. Vasiljevic and
10 which you and other staff recorded the treatments on?
11 A. Yes.
12 Q. Do you see any strange markings or markings that you do not
13 believe were on the original document?
14 A. No. This is the original document, and this Largactil is in my
15 handwriting, and I added on these -- the medicines. Largactil was written
16 out by me, and the Novalgetol vials, probably because of pain on the 21st,
17 was also written by me. And this other handwriting -- do I need to
19 Q. I'll ask you a few questions in a minute.
20 MR. GROOME: Your Honour, at this time I would tender Prosecution
21 document 165 and 165.1 into evidence.
22 JUDGE HUNT: Any objection?
23 MR. DOMAZET: No, Your Honour.
24 JUDGE HUNT: Thank you. They will be exhibits P165 and 165.1.
25 MR. GROOME:
1 Q. Now Doctor, let's go back to Topnal [phoen] first. Is Topnal
2 [phoen] a sedative?
3 A. It is an anti-psychotic.
4 Q. And can you describe for us what effects it has on the patient?
5 A. It is one of the strongest anti-psychotics, and it affects -- its
6 effect is to calm psycho-motor disturbance and agitation.
7 Q. Is it used to treat any other type of illness or psychological
8 problem other than outright psychoses?
9 A. No.
10 Q. Now, the next drug on this list, can you please tell us what that
12 A. It is called Nozinan. Generically, it is Levomepromazin.
13 Q. Doctor, for the benefit, to make sure that the record is accurate,
14 could I ask you to first spell Topnal, the correct spelling of Topnal.
15 A. T-O-P-R-A-L.
16 Q. Can I ask you to spell this next drug, Nozinan.
17 A. N-O-Z-I-N-A-N.
18 Q. And can you spell its generic equivalent?
19 A. [No translation].
20 THE INTERPRETER: The interpreter apologises. Could the witness
21 repeat the word, please.
22 MR. GROOME:
23 Q. Could you?
24 A. L-E-V-O-M-E-P-R-O-M-A-Z-E-N. L at the end.
25 Q. Doctor, do you read English?
1 A. Yes.
2 Q. I'd ask you, is it correctly spelled on the monitor in front of
4 A. First is L.
5 Q. And other than that, it's correctly spelled?
6 A. Yes.
7 Q. Now, Doctor, can you --
8 A. Excuse me, excuse me. After Z, E-N.
9 JUDGE HUNT: Perhaps you could start again, Doctor. But before
10 you do, I'm glad to say that it was not me in the transcript who tried to
11 pronounce it earlier. Could you just spell it from the beginning, slowly,
12 Doctor, so we can get the whole thing down.
13 A. L-E-V-O-M-E-P-R-O-M-A-Z-I-N.
14 JUDGE HUNT: Have a look at it in the transcript, if you would, at
15 line 11. Is it correctly spelt there?
16 THE WITNESS: [In English] Perfect.
17 JUDGE HUNT: Congratulations to the booth.
18 MR. GROOME:
19 Q. Doctor, Topral, could you tell us what the generic equivalent of
20 Topral is?
21 A. I'm afraid I can't tell you. It is a drug that we obtained
22 through humanitarian aid so that now I'm unable to give any details about
23 it. We used it at the time. It is no longer used in clinical practice.
24 For the last ten years, I haven't come across this drug.
25 Q. And the last drug that's indicated on this therapy sheet, can you
1 please tell us the name as it appears here and spell it for us.
2 A. H-L-O-R-P-R-O-M-A-Z-I-N.
3 Q. Now, Doctor, is that the drug that's written on line 3 of the
4 earliest sheet of the therapy sheet?
5 A. Yes.
6 Q. And is that the name that it was referred to in Uzice or is that
7 the generic name?
8 A. Is the generic name.
9 Q. And can you tell us what is the name -- what is the word that we
10 see on line 3? What was it referred to in Uzice?
11 A. Largactil. Largactil. That is the drug he used. And the generic
12 name of that medicine is Chlorpromasin.
13 Q. Could I ask you to spell Largactil?
14 JUDGE HUNT: It's a very, very well known medicine for this
15 particular problem in most English-speaking countries, I would suspect.
16 It certainly is in those with which I have been associated. And having to
17 hear this sort of evidence...
18 MR. GROOME:
19 Q. Doctor, on the second sheet of this therapy, is there a different
20 drug that is not on the first sheet? Is there an additional drug that was
22 A. We have Flormidal.
23 Q. I'm going to ask you to spell that, please.
24 A. F-L-O-R-M-I-D-A-L.
25 Q. Now, Doctor, you've told us what Topral does. Can I ask you -- I
1 must confess, I'm getting confused with the different names here now, the
2 first sheet, the second line, Nozinan, I believe it was, can you tell us
3 what is that drug used for?
4 A. It is in the group of anti-psychotics with a pronounced sedative
6 Q. And for what period of time did Mr. Vasiljevic receive that
8 A. It says here that he received it for five days, together with
9 Topral injections.
10 Q. The third medication there, Largactil, what does that do?
11 A. It has almost an identical effect to Promazin, only it is less
13 Q. And for what period of time --
14 JUDGE HUNT: Wait a minute. The spelling of that third medication
15 in the transcript, although it has the circumflex, which means it is going
16 to be checked, nevertheless it is spelt wrongly and we better get it
17 correctly spelt. It is a bit difficult to hear the difference in the
19 MR. GROOME:
20 Q. Doctor, could you oblige us and spell Largactil for the
22 A. L-A-R-G-A-C-T-I-L.
23 Q. And for what period of time did Mr. Vasiljevic receive that
25 A. It says here from the 13th of July until his discharge on the
2 Q. Now, Doctor, Flormidal, what does that medication do?
3 A. Flormidal belongs to the group of hypnotics. These are drugs for
4 sleep disorders.
5 Q. And what is their effect on a patient who is given them?
6 A. It helps them sleep. In this case, we see that it was
7 administered only on the 18th and 19th, in the evening, which means that
8 the patient couldn't sleep on those days, having been given this regular
9 therapy, and then this was added and then it was excluded.
10 Q. Now, Doctor, on line 3 of the second sheet, what is that drug?
11 A. Novalgetol vials.
12 Q. And you haven't mentioned this drug before in your testimony, have
14 A. Novalgetol vial was given on the 21st of July. It is an
15 analgetic, a painkiller.
16 Q. Can I ask you to spell that drug?
17 A. N-O-V-A-L-G-E-T-O-L.
18 Q. Now, Doctor, can I ask you to tell us, what is your assessment of
19 Mr. Vasiljevic's progress in the psychiatric ward? Was he improving over
20 the course of the several weeks he was there?
21 A. Mitar Vasiljevic was, judging by the therapy sheet, from the 7th
22 of July until the 28th of July at the hospital, and from the therapy sheet
23 one can conclude that in the period from the 7th until the 12th, he was
24 very clearly agitated because this is the maximum therapy that we ever
25 administered for such cases.
1 From the 13th of July until the 19th of July, he had a somewhat
2 higher measure of medicines than is the standard; and from the 19th of
3 July we see an obvious deterioration because he was then given twice the
4 same therapy plus a hypnotic for -- to help him sleep.
5 Q. Now, Doctor, going back to the Tenth International Classification
6 of Disease, that F23, and you told us it was the acute transient psychotic
7 disorder, would I be correct in stating that the acute period of this
8 transient psychosis would be between the 7th and the 12th of July? Would
9 that be a correct analysis of your testimony?
10 A. No, it would not. No, it would not, because clearly the patient
11 was under strong therapy, then we see a deterioration here, and he was
12 discharged partially treated, not fully cured, which means the psychosis
13 comes on in bouts or episodes, and those episodes have their duration, and
14 it is -- it takes, on average, six weeks for the psychotic episode to be
15 fully treated. Here we see that he was hospitalised for three weeks and
16 only the most obvious symptoms withdrew, so that the therapy should have
17 been continued, and he was advised to continue treatment as an outpatient.
18 Q. What would his treatment -- are you saying -- when you say his
19 treatment should continue, is it simply that his treatment would be this
20 milder form, this Largactil? Is that all of the -- the sum total of all
21 his treatment or were there other therapies that he needed to engage in,
22 such as counselling or monitoring by a psychiatric worker?
23 A. It was stated in the discharge document that therapy was
24 recommended three times 100 milligrams of Largactil, which is quite a
25 large dose, and that he should check in with the relevant psychiatrist for
1 continued treatment and checkups.
2 Q. But is it not correct that, in that discharge, you didn't feel it
3 was necessary for him to check in with another psychiatrist until two
4 weeks after you discharged him from the hospital? Is that not correct?
5 A. Yes.
6 Q. So his therapy after he left the hospital was to self-administer
7 these pills however many times a day as you had prescribed them.
8 A. Yes. Yes.
9 Q. And is it your testimony that, given that he was still in a state
10 of transient psychosis at that period of time?
11 A. He had certain milder disorders which manifested themselves
12 through fast speech and fast movements as a result of the psychotic
13 disorder which was slowly receding so that it was sufficient for him to
14 take the prescribed therapy for the recommended period of time and a
15 checkup was needed when the doctor would examine his condition and
16 prescribe further therapy. I have no information as to whether he went
17 for that checkup and what his condition was then.
18 Q. Doctor, is it your testimony that you recall today now that he
19 spoke fast and he moved fast at the time he was discharged from the
20 hospital? Do you have an independent memory of that or is there a record
21 here that you're referring to to help you recall that?
22 A. On the basis of documents I can say that, because that is my own
23 sentence, it is what I wrote down, so that I can assume what I meant when
24 I put that down.
25 Q. Can you please refer me to the sentence that you're talking about
1 now from which you are assuming that he spoke fast and he moved fast at
2 the time of his discharge? Can you point me to the document and to the
4 A. "Slightly accelerated."
5 JUDGE HUNT: Mr. Groome, I'm sorry to interrupt, but I'm getting
6 worried about an answer that the doctor gave to your question a little
7 while ago. You put to him dates that, judging by the therapy sheet, Mr.
8 Vasiljevic was, from the 7th of July until the 28th of July, very clearly
9 agitated. Now, the doctor went on to deal with the dates, but I don't see
10 that he's dealt with the first of them. I think maybe it's not
11 particularly at issue, but that date, the 7th of July, wasn't accepted by
12 him, it wasn't rejected by him.
13 MR. GROOME: Yes. Thank you for pointing that out, Your Honour.
14 Q. Can we go back to the 12th of July. Is it your testimony that,
15 during that period of time, he was fully involved in this transient
16 psychosis, that he continued past that, gradually diminishing?
17 JUDGE HUNT: We're getting an awful lot of feedback from inside
18 the booths there.
19 MR. GROOME:
20 Q. Was my question translated?
21 A. Yes. Precisely so. There was a very powerful psychotic episode
22 which was manifested very clearly until the 12th, then it was gradually
23 declining, then it had a fresh deterioration on the 19th and the 20th, and
24 then later, slowly, from the 21st it was receding until the 28th without
25 further aggravation; and on the 28th, he was discharged at the request of
1 his wife.
2 Q. Now, Doctor, if you were asked to fix a point when he was clearly
3 within this transient psychosis, would it be the point in time when the
4 medical personnel at Uzice contacted the psychiatric ward and advised them
5 of symptoms that they were observing in Mr. Vasiljevic? Would that be the
6 clearest boundary of when he was in this psychosis?
7 A. When he was observed by the psychiatrist, I've already said --
8 told you about his wife's hetero-anamnesis, that there were indications
9 that he manifested a deviant behaviour to a certain extent even before he
10 was admitted into hospital, but this was not recorded medically speaking.
11 Q. Doctor, I want to go back to what you're calling deviant
12 behaviour. His wife, once again, said that he was staying at work late,
13 and she had noticed some changes in his behaviour; is that not correct?
14 A. Yes, she said something along those lines.
15 Q. Now, many of us here at trial engage in similar behaviours,
16 staying at work late and different behaviours, and while our wives might
17 think we're crazy, it certainly wouldn't be the basis for a diagnosis that
18 we're all suffering from psychoses, would it
19 A. Conspicuous behaviour, that is to say, behaviour that is not
20 usual. Your wife probably wouldn't say that you were conspicuous because
21 you probably do that kind of thing all the time, but in Mitar Vasiljevic's
22 case, the situation was quite the opposite, and therefore, he was
23 conspicuous due to his restlessness and -- well, I can't quote what she
24 said, it's written down in the document and I always rely on what it says
25 in the case history. So what she wrote down, she was answering and
1 responding to a question that we usually ask, and that question is: "Was
2 the patient conspicuous in any way compared to his previous behaviour?"
3 So she did notice a kind of behaviour that was not customary for him and
4 told the doctors that. It was out of the ordinary.
5 So on the basis of that, although I couldn't say that then because
6 I was a general practitioner just training in psychiatry, but I can say
7 that now, that it is -- it resembles and reminds one of what we would call
8 a hypermanic episode, that is to say, a disturbance in affective
9 behaviour, judging by its intensity. That is to say, there is greater
10 energy, heightened movements and moods. I just recorded that in the case
11 history at the time.
12 JUDGE HUNT: Doctor, it's a term of art, "affective behaviour."
13 Could you just explain to us what it is. It's not actually in the
14 transcript, I notice, but it is a word that you used.
15 THE WITNESS: [Interpretation] According to what the clinical
16 picture of the patient showed, that is to say, his wife noticed a marked
17 -- that is to say, he was restless. He had to move around. He had to
18 keep going somewhere. He couldn't sit still. He stayed at work longer.
19 He was distraught. That is the picture and -- those are the symptoms of a
20 heightened mood or hyperthymia. Hypermanically-polarised, that's what the
21 medical term is. In practical terms, it means a heightened amount of
22 energy which reaches such a level that the patient cannot control this
23 burgeoning of energy. He has to move around. He is continuously moving.
24 He is talkative. He is on the move all the time. He is communicative.
25 He has the need to keep releasing this energy through various activities.
12 Blank page inserted to ensure pagination corresponds between the French and
13 English transcripts.
1 And later on, at the ward, when he was admitted to the ward,
2 within the frameworks of this psychotic picture and psychotic symptoms,
3 there is a piece of information that tells us that he sang. So once
4 again, this heightened mood. We have a heightened energy and an excess of
5 energy what he was admitted into hospital and this heightened mood within
6 the frameworks of this psychotic condition when he was admitted to the
7 psychiatric ward. So this is a component of disturbed affectivity in the
8 sense of hypermanic and manic. That was present.
9 MR. GROOME:
10 Q. So, Doctor, is it your testimony that, based on your reading of
11 the case history or the wife's description of her husband's behaviour, you
12 would fix a point at prior to hospitalisation as the point in time that he
13 was suffering from this transient psychosis? Is that what you're saying?
14 A. No. I only wanted to say -- what I was trying to say was that
15 there are certain symptoms which can indicate to us that somebody is
16 drawing close to a psychotic episode, nearing a psychotic episode.
17 Q. Doctor, Mrs. Vasiljevic's description is four sentences long. I
18 will read each one to you and could I ask you to indicate to me precisely
19 what it is in her statement that you draw these conclusions regarding his
20 mental state? "He used to drink a lot of alcohol but was never
21 aggressive." Do you draw any conclusion from that?
22 A. Well, I concluded that because he was admitted, among other
23 things, because of his aggressiveness to the psychiatric ward. So that
24 meant that it was a patient who usually drank, but judging by what his
25 wife had said, and she is a relevant witness of these cases, he did not
1 have any aggressiveness in him before when he was drunk whereas now we see
2 him as being exceptionally aggressive and distraught and restless.
3 Q. And what aggressive behaviours were you aware of at the time that
4 you were treating Mr. Vasiljevic?
5 A. He was transferred from the orthopaedics ward, among other things,
6 because of having maltreated the staff and patients in the ward in the
7 sense of aggressive behaviour towards them.
8 Q. The second sentence is: "Since the beginning of the fighting, he
9 has always been engaged, agitated, impatient." What do you draw from
10 that? Do you conclude from that sentence that he was suffering the onset
11 of psychosis prior to his hospitalisation?
12 A. No, not of psychosis but of a heightened level of energy and
13 mobility and restlessness, that I could say, yes.
14 Q. But, Doctor, a war was breaking out. Weren't normal people
15 experiencing a heightened level of nervousness and energy and
16 excitability? Wouldn't that be a normal reaction to the outbreak of a
18 A. That depends on the make-up of each person. Some individuals
19 might react by manifesting depression. Others would be aggressive. Yet
20 others might be like this patient, hypermanic, with a heightened level of
21 energy. Some people flee, some people become paranoid, and other people
22 succeed in getting through all this and adapting, depending on your
23 personality structure and traits. There are no rules of how you will
24 behave in an extraordinary, out of the ordinary, situation.
25 Q. And because of that, we cannot conclude or no doctor could
1 conclude that he was suffering from psychosis at this time because of the
2 simple elevation of energy and agitation; correct? That would be improper
3 to base a diagnosis of psychosis on that; correct?
4 A. We cannot claim that he was suffering from psychosis because he
5 was not examined by a single psychiatrist, but we can claim that he had
6 certain behaviour that was out of the ordinary, based on the impressions
7 of his wife, and we can conclude that it was an extraordinary situation
8 and circumstances in which the health service, health protection and so on
9 were not functioning as they would in normal times.
10 Q. I'll just read you the final two sentences and ask you a question.
11 "He is always going somewhere and remains in the unit, even when
12 his shift is over. He was particularly upset by the death of a close
13 relative." There's nothing in those two sentences in and of themselves
14 that could lead a psychiatrist to conclude that he was suffering from
15 psychosis at the time that these behaviours were observed; correct?
16 A. And we're not saying that. We're not saying that it was a
17 psychosis but that it was noticeable, out of the ordinary behaviour, and
18 this -- his constantly going somewhere, that is out of the ordinary
19 behaviour if he didn't use to do that before. And if he stays longer on
20 his shift, that's something that one rarely does. Even in extraordinary
21 situations, everybody just can't wait for it to be over and to go home.
22 So that, for him, this might be an expression of heightened energy, the
23 fact that he kept working, he stayed on his shifts longer. That is
24 possible. But we can only assume that. But officially, medically, he was
25 not examined and it was not realistic to think that in extraordinary
1 situations of this kind that somebody would be examined by a physician
2 just because he had this heightened energy level.
3 Had he entered into a state of extreme agitation, he would
4 probably have been taken to the psychiatric ward straight away. But
5 similarly, he could have had a lower register of disorder and disturbance,
6 a less marked form which is not manifest of a psychotic level but it is
7 conspicuous behaviour, out of the ordinary behaviour.
8 Q. Dr. Simic, was it you who spoke to Mrs. Vasiljevic regarding her
9 observations of her husband?
10 A. Well, I'm certain that I talked to her and wrote it down, made a
11 note of it, but I can't remember the details now.
12 Q. Let me ask you about a particular word that was used in her
13 description, and it is, "remains in the unit even after the shift is
14 over." In that context, what did you perceive the word "unit" to mean?
15 A. "Unit." Well, they were people probably who had been mobilised, I
16 assume, in those parts and that they were all in some units. Where we
17 were, people were in their units all the time. So every person has his
18 assignment and distribution. I'm in a unit myself. We were all in units,
19 so that was customary for me and quite usual to have people belong to a
20 unit. That was customary and what was done in -- given the circumstances
21 in my country.
22 Q. So what you understood Mrs. Vasiljevic to be telling you was the
23 following: That Mitar Vasiljevic was remaining in his unit, some type of
24 mobilised or fighting unit, that he was remaining in that unit even after
25 his shift was over, when he didn't have to be with that unit. Is that
1 what you understood her to mean?
2 A. Yes. I understood her to mean that this was conspicuous behaviour
3 on his part. And among other things, she explained those were one of the
4 things that he did, that he stayed on longer than he need have. But all
5 this was within the context of this out of the ordinary behaviour or
6 conspicuous behaviour.
7 Q. Did she give you any details about what type of unit he was
8 engaged in or what area of Bosnia the unit was engaged in military
9 activity? Did she give you any indication of that?
10 A. Well, first, let me say I don't remember, quite frankly, and if it
11 isn't recorded in the case history, it is not essential for psychiatry
12 what unit he was in. Medically speaking and from the psychiatric point of
13 view, that was irrelevant.
14 Q. Doctor, I'm going to show you something else from the medical
15 record of Mr. Vasiljevic. I'm going to ask that it be marked as
16 Prosecution document 161 for the actual letter written in the accused's
17 own hand and then 161.2 for the English translation of that. And I would
18 ask that the doctor be shown the original.
19 JUDGE HUNT: 161.1 or 160.1? It's not clear.
20 MR. GROOME: 161.1, Your Honour, for the B/C/S original.
21 THE INTERPRETER: The interpreters note that the English
22 translation is practically incomprehensible.
23 JUDGE HUNT: Sounds like some of the motions we receive.
24 MR. GROOME: Your Honour, that could well be that the handwriting
25 is illegible.
1 JUDGE HUNT: No. Having looked at it, I can see what they mean.
2 It is incomprehensible, not illegible. That may be because the original
3 is incomprehensible.
4 MR. GROOME:
5 Q. Doctor, this is a letter that was part of the medical files of the
6 accused and the accused, in his statement, tells us that he wrote this
7 letter to his doctors. Do you recognise this letter?
8 A. No, I don't think I can say that I have seen it. I haven't seen
9 that, no. I don't know.
10 Q. I'm going to ask you to read the first side of that letter now,
11 and I want to ask you a question regarding it. So if you'd let me know
12 when you've finished reading it.
13 A. You want me to read the letter; is that right?
14 Q. Not out loud. If you would just read it to yourself, I will
15 tender it into evidence so that we will have it as part of the record.
16 JUDGE HUNT: I can agree with the interpreters as to the spelling
17 of some of those words, but we can probably work out what they mean. I'm
18 talking of the English version.
19 MR. GROOME:
20 Q. Doctor, I will ask you questions about the reverse side
21 separately, if we can just work on the first side now. Would you agree
22 with me that, in this letter from Mr. Vasiljevic, it appears that he has
23 been accused of doing something wrong and he is offering an explanation
24 for his conduct regarding -- regarding that act? It appears to be of
25 taking something from somebody. Would you agree that that's a fair
1 characterisation of what this letter from Mr. Vasiljevic is purporting to
3 A. Well, this letter doesn't say anything special. I have the
4 feeling that he wants to explain to Dr. Slavica why he came. He probably
5 had some conflicts and arguments over there, or wherever he was, and now
6 he is trying to explain himself. But I don't see what this letter would
7 mean, whether it has any -- whether there is any concrete reason or
8 anything that is specifically interesting in this letter.
9 Q. Well, Doctor, let's me ask you this question: Isn't it clear from
10 this letter written on the 13th of July that Mr. Vasiljevic has some
11 appreciation for being accused of doing something wrong and is attempting
12 to explain or justify his conduct? Doesn't it evidence some appreciation
13 that he has been accused of doing something wrong?
14 A. What can be seen here, or could be seen here, is that he went to
15 buy something and there was no small change to give him back, and that he
16 went to buy some sweets, some candies for some young girls, and he asked
17 if he could be given the chocolates and not to have to pay for them, that
18 is, on trust. So what we conclude is that he went to a regular store and
19 he wanted them to give him the candies free of charge so that he could
20 take the candies with him.
21 Q. If you look at the last line on the sentence, in his promise to
22 pay back the money for these candies, doesn't it evidence an appreciation
23 that it would be wrong not to and in fact, isn't the last line, "If I
24 don't do it -" meaning pay back the money - "then God grant me to pry like
25 Turk man, of course if I am still alive." Isn't that evidence that he
1 appreciated that it was the correct thing, the right thing to do was to
2 pay back whatever money he had been extended for these candies; correct?
3 A. It seems to me that he had caused general disturbance over there
4 because he probably asked to take the chocolates without paying and that
5 he promised to pay, but he's a little confused here. And this last bit,
6 Let God make me pray like a Turk, that is a cultural trait, that is to
7 say, it speaks -- that is, in translation, it would mean that something
8 bad would happen to him. So this isn't linked to any Turk or anything
9 else. It just means -- the meaning of that is that -- that something bad
10 will happen to him if he doesn't do what he promised to do.
11 So he is justifying himself to the doctor, and this letter tells
12 me that he is not well, he is not a well man. A patient who can write
13 this kind of letter in this form needs to carry on taking medicaments.
14 Yes. The 13th of July, that's right. He wasn't well at the time, and he
15 was under therapy. He was taking the prescribed drugs.
16 Q. But doesn't this letter show the capacity that Mr. Vasiljevic had
17 at that time to understand the difference between right and wrong?
18 A. It brings to mind a joke which I'm not going to tell you here in
19 the courtroom, but it ends by two mental patients -- two mental patients
20 are talking and one of them says to the other, Well, if I'm mad, I'm not
21 stupid. So the fact that he was psychotic does not mean that he does not
22 know elementary things related to behaviour; when you have to -- when you
23 go to get some goods from a store, you have to pay for them. So a
24 psychotic disorder in its acute state jeopardises function, that is true,
25 but on the 13th, he was reaching the end of that drastic episode, and he
1 is, of course, fully capable of speaking about things like the purchase of
2 objects and the payment for them. It does not mean that he is not aware
3 of elementary fact -- the elementary facts of life.
4 Q. So whatever his psychiatric condition was at that point in time,
5 he still had the capacity to recognise the elemental facets of right and
6 wrong; correct?
7 A. In this concrete example, he promised to return the money, to pay
8 for the chocolates, the candies. There, he was able to differentiate and
9 distinguish, yes.
10 Q. During any time during your treatment of him, did you ever see any
11 indication that he had lost that ability to differentiate between what was
12 right and what was wrong in this elemental way?
13 A. That is a debatable point. Nobody can actually say with any
14 degree of certainty, nor do we in psychiatry delve into those matters,
15 whether people can differentiate between good and evil. We deal in
16 psychological disturbances, disorders. So if the patient has the proper
17 -- a proper behaviour, if he's able to control his impulses and if the
18 psychopathological phenomenon have receded, as far as we are concerned, he
19 is well. He is all right.
20 Now, whether he differentiates between good and bad, good and
21 evil, those do not fall within the realms of psychiatry.
22 Q. Let me rephrase it in the terms of law. Did you see at any time
23 any indication from Mr. Vasiljevic that he lost his capacity to recognise
24 what was legal and what was not legal, take any serious crime --
25 JUDGE HUNT: I don't think that's the legal test, if I may say so.
1 What is right and what is wrong is the usual test. May I suggest you put
2 that to him, because it is not somebody who recognises that what he's
3 doing is illegal, it is whether he recognises that what he is doing is
5 MR. GROOME:
6 Q. Doctor, let me put it to you again: Did you yourself see any
7 indication that Mr. Vasiljevic had lost his ability to distinguish between
8 what is acceptable or right behaviour in our society and wrong or
9 unacceptable behaviour in our society? Did you see any concrete
10 indication of that during your treatment of Mr. Vasiljevic?
11 A. I did not see it, but I must say that psychotic disorders are
12 serious psychological mental disorders because the patient cannot evaluate
13 very well and control his behaviour in the stage of acute disease.
14 JUDGE HUNT: Perhaps, Mr. Groome, to be safe, because I'm not sure
15 that the issue has ever been determined in international law, you may ask
16 him, when we resume, about legal and illegal acts, because I don't want
17 there to be some problem later on if an examination of the law that should
18 be applied in an International Tribunal has some different test to what is
19 usually understood.
20 MR. GROOME: Yes, Your Honour.
21 JUDGE HUNT: I don't want to bar you from wanting to argue that if
22 we ever get to it.
23 MR. GROOME: Your Honour, just before we break, can I tender that
24 document into evidence as P161.1 for the B/C/S and .2 for the
1 JUDGE HUNT: Any objection, Mr. Domazet?
2 MR. DOMAZET: No, Your Honour.
3 JUDGE HUNT: Thank you. It will be Exhibits P161.1 and
4 161.2. We will now adjourn until 2.30.
5 --- Luncheon recess taken at 1.00 p.m.
1 --- On resuming at 2.32 p.m.
2 JUDGE HUNT: Mr. Groome.
3 MR. GROOME: Thank you, Your Honour.
4 Q. Good afternoon, Dr. Simic.
5 A. Good afternoon.
6 Q. Doctor, I want to go back to that joke you told us the punch line
7 to, and ask you, the point you were trying to make when the one mental
8 patient says to the other, "I might be crazy but I'm not stupid," the
9 point you were trying to make was that Mr. Vasiljevic, for whatever
10 psychological problems he was having at the time, he realised that it
11 would have been wrong to have taken candy and not have paid for it;
12 correct? That was the point you were trying to make?
13 A. I wanted to say that, in the case of psychotic disorders,
14 intelligence is not damaged as a mental function.
15 Q. And in most cases nor is the ability to distinguish between what
16 is right and what is wrong according to society's standards; correct?
17 A. A psychotic disorder in itself is a serious mental disease
18 precisely because behaviour is disrupted, and within the framework of
19 disruptive behaviour and loss of control over behaviour, the acts by the
20 patient may be in disharmony with social norms so that his behaviour
21 becomes conspicuous to his surroundings and that is why, in most cases,
22 such patients are brought in for treatment.
23 Q. But what you're talking about now is more one's ability to control
24 one's impulses; right? Isn't that what you're describing now, that in
25 some severe psychoses, a person loses their ability to control impulses
1 that they may have; correct?
2 A. Disturbed behaviour, yes.
3 Q. But even in cases where somebody may not be able to, let's say,
4 control their behaviour, they may still retain the ability to distinguish
5 between what is right and what is wrong; is that not correct? In other
6 words, they realise they're doing something wrong but they may not be able
7 to stop themselves from doing it.
8 A. This question of good and evil is an ethical problem. However, in
9 this specific case, we have a behavioural problem, control of behaviour,
10 organisation of behaviour, because the central nervous system has been
11 disturbed. So there's no link between ethical norms and the mental state
12 of psychosis. A person who has disturbed ethical norms in his life, he
13 will have them before and after a psychosis. A person who has adequate
14 ethical norms, he will retain them and continue to observe them.
15 Q. Let's talk about the case specifically of Mr. Vasiljevic. Would
16 you not agree with me that that letter indicates that, at the time that
17 Mr. Vasiljevic wrote that letter, he could appreciate the difference
18 between right and wrong?
19 A. On the basis of that letter of which I was able to establish that
20 it was written by a patient, by someone who is sick, very little can be
21 concluded except that the disease is still present, so that that letter
22 doesn't have any particular significance except for the doctor. It is an
23 indication that therapy should be continued.
24 Q. So is it your testimony here that Mr. Vasiljevic's recognition
25 that he had to pay for the candy or he's even inviting punishment upon
12 Blank page inserted to ensure pagination corresponds between the French and
13 English transcripts.
1 himself if he doesn't pay for the candy, that -- is it your testimony that
2 that does not show that Mr. Vasiljevic recognised that stealing this candy
3 or not paying for it would have been wrong? Is that your testimony?
4 A. That letter was written by a patient who was at the psychiatric
5 ward to a doctor that he saw visiting, making her rounds, and she is Dr.
6 Slavica. He is addressing that physician, probably believing that she
7 held a position of responsibility or for some other reason, as Dr.
8 Jevtovic was my mentor so she spoke in greater detail with him, and quite
9 a number of silly things are written there. He's addressing an unknown
10 physician. This shows that he is acting inadequately on that occasion
11 too, and there is nothing more that that letter can prove. Writing
12 letters by patients is quite frequent, particularly when their mental
13 condition is deteriorating.
14 JUDGE HUNT: Mr. Groome, I think that we're running into a
15 terrible problem here which happens in every one of these cases, that the
16 medical profession and the legal profession are dealing in completely
17 different terms. We run into it if we ever have to deal with diminished
18 responsibility all the time. The doctor sees the letter one way. You
19 have asked him a question which he says it does not assist him, but I
20 think the problem the doctor is having is not with the letter but with the
21 concept. The lawyers talk about whether somebody knows the difference
22 between right and wrong. It's not really a medical issue in the end.
23 MR. GROOME: Perhaps if I can give it one more stab, Your Honour,
24 and --
25 JUDGE HUNT: Well, you can try, but the doctor wants to explain to
1 you all the time what he sees the relevance of the letter is. It might
2 be, if I may suggest, a better way of putting it is, is there any
3 suggestion in that letter that he did not know the difference between
4 right and wrong? It's a matter for you.
5 MR. GROOME: Thank you, Your Honour.
6 Q. Doctor, I know that there are many things that a trained person
7 like you can draw from a letter such as this. I'm seeking just to
8 identify one of those things now and I ask you to confine your answer just
9 to the very particular point that I'm asking you.
10 At the end of the letter, Mr. Vasiljevic says that if I don't do
11 it, then may God grant me to pray like a Turk man, which you've explained
12 to us it's his -- him stating if I don't do this, may I be punished, may
13 bad things happen to me.
14 Now, I question to you is: Does that not -- is there anything --
15 does that indicate to you, just that final piece of the letter, that he
16 did not -- he could not appreciate the difference between right or wrong
17 or that he could? Is there anything that indicates that he could not
18 appreciate right from wrong in that last sentence?
19 A. I will have to repeat once again: That is a letter written by a
20 psychotic patient.
21 JUDGE HUNT: Please. We understand what you interpret that letter
22 as. If you can't answer that question, then you just say you can't answer
23 it, but repeating what you've said before is no answer to the question.
24 Is there anything in that letter which suggests that Mr.
25 Vasiljevic, at that stage, was unable to appreciate the difference between
1 right and wrong? Now, if it's not matter that you can help us with, just
2 say so.
3 THE WITNESS: [Interpretation] I apologise if I'm repeating
4 myself. Obviously, from the letter, he knew that candy had to be paid
5 for. That can be seen from the letter. And more than that, I really am
6 unable to say about that letter and about that situation.
7 JUDGE HUNT: I suggest you move on, Mr. Groome.
8 MR. GROOME: Yes. Thank you.
9 Q. I am going to ask you to look at the reverse of that page, and
10 that's Prosecution Exhibit 161.1. I'm going to ask that that be handed to
11 the witness.
12 Once again, Doctor, I'll ask you to read the second portion of the
13 letter that Mr. Vasiljevic wrote, and when you finished, if you'll let me
14 know. I want to ask you a specific question regarding that.
15 A. I've looked at it.
16 Q. Now, would you agree with me that the person who wrote this
17 letter, Mr. Vasiljevic, at the time that it was written, had the ability
18 to be aware -- had self-awareness, was aware of certain ailments that he
19 was suffering from? Would you agree with that?
20 A. Yes, he was aware.
21 Q. And would you agree with me that, recognising these ailments, he
22 was asking for help, he was asking the doctor for help with these
23 ailments; correct?
24 A. Yes.
25 Q. And he was asking for help in two ways. The first was to write
1 this letter and give it to the doctor; correct?
2 A. Yes.
3 Q. And the second way that he was asking for help was, in the letter,
4 he makes a threat that if he's not given the help that he's requesting,
5 he's going to stop eating; is that correct?
6 A. Yes.
7 Q. Will you agree with me that this portion of the letter evidences
8 or shows us that at this point in time, Mr. Vasiljevic had the capacity to
9 form an intent about a certain matter and then to act upon that intent?
10 Would you agree with me that this letter shows that he had the ability to
11 do that on the 13th of July?
12 A. Would you agree with me that a patient who asks for an examination
13 of his symptoms and asks for his legs and arms to be tied if his requests
14 were not met, that that would be a patient who was conscious of his
16 Q. Well, that's not my question to you, Doctor. My question to you
17 is: Can we conclude from this -- you've told me that this does show he
18 was able to form an intent, and you have agreed that this letter shows
19 that he was able to act upon that intent, and my question now is simply to
20 put that together. Do you agree that he was able to both form an intent
21 and to act upon that intent, irregardless of whether the means that he was
22 going to employ was an appropriate means or not? Was he -- did he have
23 the capacity to form an intent and then act upon it?
24 A. He obviously was aware of his health problems, but definitively,
25 he was not aware of the way in which he might be able to achieve what he
1 wanted, because he is addressing a doctor who is not directly responsible
2 for him.
3 Q. Doctor --
4 A. He is threatening to go on a hunger strike, which is quite
5 contrary to customary procedure for any patients who complain of certain
6 problems are sent for medical examination. And the last sentence fully
7 reveals the state of his mental disturbance because he begs for his hands
8 and legs to be tied, which is an indication of his inadequacy at that
9 particular point in time.
10 JUDGE HUNT: Again, you see, we're dealing with a problem in
11 language, I think.
12 Doctor, the questions that are being asked of you are not designed
13 to elicit an admission or a concession by you that this man was not
14 suffering from some psychosis. They are designed to obtain your opinion
15 in relation to various legal issues which arise or which may arise. One
16 of them was whether he knew the difference between right and wrong, and
17 even a person who is suffering from a psychosis you may think, I would
18 have thought myself, could still understand the difference between right
19 and wrong. A person who is suffering from a psychosis could,
20 nevertheless, know precisely what it is he is doing, he is just acting
21 inappropriately. He may go up and punch somebody, and he does it because
22 he intends to punch that person. It may be the psychosis which helped him
23 to form the intention to punch him, but the question is whether he still
24 was able to reason in his own mind and form an intention to quite
25 deliberately punch somebody. I'm giving you an example right away from
1 the facts of this case.
2 Now, these questions are designed to get your opinion as to
3 whether, notwithstanding his psychosis, he was able to form an intention
4 to do something and then, having done it -- having formed that intention,
5 to carry out that intention. Now, that's what the questions are designed
6 to obtain from you.
7 Now, if you could look at it without all the time trying to defend
8 your own analysis of this man's mind as having a psychosis, I think we'll
9 get along much more quickly, because we're not challenging, at this stage,
10 any finding that he was suffering from a psychosis. Do you understand
12 THE WITNESS: [In English] Okay.
13 JUDGE HUNT: Start again, Mr. Groome, and I think we'll get an
15 MR. GROOME:
16 Q. Let me put it, in light of what the Chamber just said: Was Mr.
17 Vasiljevic capable of intentional, deliberate action despite all the other
18 problems he was suffering from?
19 A. [Interpretation] According to our law, acute psychotic disorder is
20 considered a disorder which is considered complete irresponsibility, so he
21 was not able to control his behaviour, nor was he conscious of the
22 consequences of his acts.
23 Q. Doctor, is it your testimony that Mr. Vasiljevic was -- had this
24 acute psychotic disorder which would have legally, in Serbia, made him
25 criminally not responsible for his acts? Is that your testimony here
2 A. In the period of an acute psychotic disorder.
3 Q. Are you saying that Mr. Vasiljevic had that disorder during an
4 acute period in July of 1992?
5 A. Yes.
6 JUDGE HUNT: But we've got to get away from this question of what
7 the Serbian law provides. We want to know, if the doctor is able to
8 assist us on it, whether he believes, whatever the law might say, that
9 this man in fact was unable to control his actions. Now, that's really
10 what we're dealing with here, isn't it?
11 MR. GROOME: Yes, Your Honour.
12 Q. And I would put the question that the court has just raised to
14 A. A patient --
15 Q. Not a patient; Mr. Vasiljevic.
16 A. Patient Vasiljevic, during the acute phase of psychotic disorder,
17 was not capable of controlling his behaviour.
18 Q. And in your treatment of Mr. Vasiljevic, can you give us a start
19 date, your best estimation of a start date and your best estimation of the
20 end date of this acute episode?
21 A. According to the records, it would be the 7th of July until the
22 28th of July, while he was at the ward.
23 Q. And is it your testimony then, or can we conclude from that, that
24 on the 28th of July, a person who, under your opinion under Serbian law,
25 could have walked out of the hospital, killed people, and would have been
1 criminally not responsible for it, would you have us believe that you
2 permitted that person to leave the hospital? Is that what you're telling
4 A. No.
5 Q. But you did permit Mr. Vasiljevic to leave, did you not, even
6 though you told us earlier you had the legal mechanism to commit him if
7 you felt he was going to be a danger to himself or to others; correct?
8 A. If he represented a danger for himself and others. He was
9 released when he no longer represented a danger to himself and others.
10 Q. So you're saying that on the 28th of July, when Mrs. Vasiljevic
11 arrives, he somehow on that day makes this tremendous improvement in his
12 condition and is permitted to leave.
13 A. It wasn't tremendous, but there was a certain improvement. And as
14 we've already said, he was discharged at the request and upon the
15 responsibility of his wife. He was in a stage of partial remission, but
16 at that point in time, he was not dangerous for others, nor was he a
17 threat to safety. So that is how we released him, on that basis.
18 Q. Did you still consider him criminally insane at the time of the
19 28th of July?
20 A. If he had showed signs of threatening or aggressive behaviour, he
21 would certainly not have been released from the ward.
22 Q. But you've told us that it was your belief that under Serbian law,
23 he would have been criminally not responsible. At what point did you feel
24 that he no longer would have met the test under your own law, under your
25 own standards? At what point did you believe he was now sufficiently
1 improved to be responsible for his own actions?
2 A. The moment when he was discharged. He is responsible for his acts
3 upon leaving the psychiatric ward, coupled with adequate control,
4 treatment, and heightened attention by his wife.
5 Q. Let me ask you this, Doctor: If his wife didn't show up to sign
6 him out and instead Mr. Vasiljevic said, "Dr. Simic, today I'd like to
7 leave and I'm willing to sign myself out," would you have permitted him to
9 A. In our country, a patient never goes alone. A member of the
10 family always has to take him out, or his spouse, so that patients never
11 leave the hospital alone. And in this case, as in any other similar case,
12 the spouse of Vasiljevic and anybody else's spouse is fully familiar with
13 the nature of the disease as well as the need and duration of the
14 treatment. And having been told about that, she decided to take the
15 patient out, to give him greater care, to administer the therapy, and to
16 take him for the necessary checkups, so that, at that particular point, he
17 was in a satisfactory mental condition, and he could control his acts and
18 be responsible for his behaviour.
19 Q. And that happened on the 28th. That's what you're telling us.
20 A. Yes, yes, on the 28th.
21 Q. Doctor, before we finish with Prosecution Exhibit 161.1, could you
22 tell us, for those of us who do not know, what does the cross and the four
23 Cs symbolise on the bottom of that letter?
24 A. It is a Serbian symbol.
25 Q. And would I be correct in saying that, around this period of time,
1 Serbs that had engaged in ultra nationalist behaviour, that this was kind
2 of a popular symbol among them?
3 A. Probably a Jewish psychiatric patient would have drawn the David
4 star. That would be more or less the significance of this symbol, not
5 necessarily a nationalistic symbol
6 Q. This symbol was not simply used by psychiatric patients, this was
7 a very common symbol used in 1992 among Chetnik movements and other Serb
8 nationalist movements; correct?
9 A. And it is to be found on the coat of arms too. It is a coat of
11 Q. Doctor, if I can just ask you --
12 A. These are the four Ss.
13 JUDGE HUNT: That's the Serbian coat of arms, is it?
14 THE WITNESS: [Interpretation] Yes.
15 MR. GROOME:
16 Q. Just please get an answer to my question. Was that a symbol that
17 was used during this period of time, used especially by Serb nationalists
18 and Chetnik movements?
19 A. No, not only by them, it's a universal Serbian symbol
20 Q. And when you yourself would write a letter to somebody, would you
21 put a similar symbol at the bottom of that letter?
22 A. I don't write symbols at the end of a letter.
23 Q. Now, your diagnosis of 298.9, I want to give you some hypothetical
24 questions and ask you if it would be consistent with this diagnosis.
25 Would somebody suffering from this acute transient psychosis, would they
1 be able to engage in a discussion with a group of people and that group of
2 people not perceive any type of mental illness or mental problem
3 whatsoever? Could they engage in discussion and not be perceived to have
4 some problem with their mental state?
5 A. In this particular case, this level of psychosis is very
6 conspicuous, and it can be noticed quite easily.
7 Q. And --
8 A. But as we have already said, there may be certain symptoms prior
9 to the beginning of the psychosis of low intensity and of a lower level
10 and lower scope which have not attained the psychotic level but which are
11 noticeable but not necessarily by someone who is not a professional.
12 Q. And would a person, for example, with this diagnosis, would this
13 person be able to have a discussion with somebody about, let's say, a
14 horse, make a commitment to go up and get a horse, get that horse, bring
15 it down to a place where they thought it would be safe? Would that be the
16 kind of behaviour that you would expect from somebody who was acutely ill
17 at that time, with your diagnosis?
18 A. Even a psychotic patient can do a lot of things in a normal and
19 organised manner. It doesn't mean to say that whatever he does is quite
20 inadequate and irresponsible. So hypothetically, a psychotic patient
21 could also take a horse someplace.
22 Q. Doctor, now, during this time of war, would it be fair to say that
23 some of the patients that were in the psychiatric ward were what we would
24 call -- I'm not sure how this word will translate, but malingerers, people
25 who were afraid of going to the front and were feigning or faking a
1 psychiatric disorder in order to try to avoid being forced to go fight on
2 the front lines?
3 A. I don't know of any such case, of a single such case in the course
4 of my work at the ward.
5 Q. So can you give us an idea of approximately how many patients you
6 would have been directly responsible for their treatment in the years
7 during the war? Let's say 1992 to 1995.
8 A. It's hard to say. We had 50 beds in 1992 and 1993. I had a lot
9 of patients. Maybe half of those that were admitted I took care of. The
10 annual turnover is about 600 to 700 a year at the ward, so that I never
11 made any such statistics, but roughly, therefore, out of the 600 or 700 a
12 year, maybe statistically I took care of one-quarter of them.
13 Q. And at none of these -- you can say with certainty that none of
14 these patients at any time were people who may have been faking a mental
15 disorder in order to have you sign a letter saying that they would be
16 relieved from duty? You can say with that certainty?
17 A. Yes. Yes, I can.
18 Q. Would it change your opinion if you have the following two
19 additional pieces of information: That just prior to the hospitalisation
20 of a patient, that this person was put in gaol by his commander for
21 failing to obey an order to go to the front and that, immediately after or
22 soon after their hospitalisation, when they were required to go back to
23 the front, that they shot themselves in the foot and it was alleged that
24 they did that intentionally in order to avoid going to the front. If you
25 had those two additional pieces of information, would it make you question
1 whether or not their presence in the hospital was perhaps somehow an
2 intentional act to avoid military service?
3 A. If somebody shot himself in the foot, he certainly had to be
4 admitted to the surgery or the orthopaedic wards and not to the
5 psychiatric ward.
6 Q. I'm saying, Doctor, in between those two events, if that person
7 was in the hospital, displaying some of the symptoms you've described,
8 taken their hospitalisation plus the event at the beginning and the event
9 at the end, would that change your mind as to whether it is possible that
10 that person may have been attempting to avoid military service by
11 pretending or displaying mental -- symptoms of mental illness?
12 A. Among the patients I looked after, I can say with certainty there
13 were no malingerers pretending to be ill, because we would never have
14 issued an official document about this.
15 Q. Well, Doctor, now, in the case of Mr. Vasiljevic, you've told us
16 that on the 28th of July, you made the determination that he was
17 sufficiently well to go home. But isn't it also true that you signed the
18 document that allowed Mr. Vasiljevic to avoid further military duty?
19 Didn't you also sign a document to that effect?
20 A. A patient who is diagnosed with psychosis is exempt from military
21 service during the period of his convalescence, and after this, his
22 ability to work is established by a psychiatrist who approves his return
23 to work.
24 In this case, he was evidently exempt from activities, both work
25 and military obligation. This is quite normal and usual, because there is
12 Blank page inserted to ensure pagination corresponds between the French and
13 English transcripts.
1 no army in the whole world which would allow a psychotic person to become
2 a soldier.
3 Q. And it was you that made that determination and signed the
4 document that relieved him of his obligation to military service; correct?
5 A. Well, in the discharge note, it does say that he is exempt until
6 his checkup.
7 Q. Now, as part of his therapy, did you have counselling sessions
8 with him? Did you discuss what he perceived to be his problems?
9 A. I probably did, because I always have a session with each patient,
10 but I cannot remember this one with any certainty.
11 Q. Do you make notes about what is discussed at these sessions?
12 A. No. No.
13 Q. Let me see if I can refresh your memory. There's a witness that
14 will testify here in a couple of days who was a patient sharing a room
15 with Mr. Vasiljevic in the orthopaedic ward, and he will testify, I
16 believe, to the fact that Mr. Vasiljevic was talking about killing a large
17 number of Muslims on the old Visegrad bridge. Does that refresh your
18 recollection as to whether or not Mr. Vasiljevic may have said something
19 to you during those sessions regarding him killing Muslims on the old
20 Visegrad bridge?
21 A. I don't remember this, and I'm sure I would remember because it
22 would be something that would stick in my mind.
23 Q. I believe this witness will also testify about Mr. Vasiljevic
24 saying that he killed a hodza and took his horse, and that is the horse
25 that he fell from. Does that refresh your recollection as to whether or
1 not Mr. Vasiljevic said something to that effect to you during your
2 counselling sessions with him?
3 A. I really don't remember, and these are important events so I would
4 probably remember. I can say that there are also megalomaniac disorders
5 connected with this disorder, people imagining themselves to be powerful,
6 important, and probably in wartime conditions this state could take on a
7 form like this. A patient might imagine that he was someone very powerful
8 and that he had committed terrible crimes.
9 Q. Do you wish to tell us now that you believe Mr. Vasiljevic was
10 also a megalomaniac?
11 A. Megalomaniac tendencies may exist as part of certain types of
12 psychoses, and if he said something to the effect that you have said, this
13 could have been part of his psychotic disorder.
14 Q. You yourself witnessed no such evidence or behaviours that would
15 lead you to believe he suffered from this particular malady, did you?
16 A. No. No.
17 Q. Now, finally, Doctor, I just want to ask you, you told us there
18 were only two doctors such as yourself, you and one other person, on the
19 ward, correct?
20 A. At the time, Dr. Slavica Jevtovic was my mentor. The head was
21 Dr. Borislav Martinovic. They all came. And there was also Dr. Radosava
22 Bukvic and Dr. Dimitrijevic. All four of them were neuropsychiatrists,
23 and I, as I have already said, was a general practitioner preparing for a
24 specialisation in psychiatry.
25 Q. And you've told us that there was approximately 700 patients
1 throughout the year. Can you give us an estimation of how much time that
2 you spent with Mr. Vasiljevic on a daily basis or a weekly basis during
3 the time that he was there? How much time did you actually have in direct
4 contact with Mr. Vasiljevic?
5 A. At the time, there were daily rounds every morning at the
6 psychiatric ward, which means that I saw him every morning, as did my
7 mentor, Dr. Jevtovic. And at least once a week, I was able to have a
8 session with him. That would be on the average.
9 Q. And how long would this weekly session be?
10 A. I couldn't tell you now with any precision, because we have to
11 bear in mind that it was an unusual time and there were many patients.
12 There was a lot of pressure. So we certainly had less time to devote to
13 each patient, much less than we have today, because the situation was
14 actually a situation of emergency. It was wartime and we were dealing
15 with an emergency situation.
16 Q. Would it be fair to say that the weekly session you had with Mr.
17 Vasiljevic was either an hour or less?
18 A. Well, up to an hour. Not more than an hour.
19 Q. And would I be correct in saying that the morning rounds that you
20 did with Mr. Vasiljevic, that that would just be a few minutes; correct?
21 A. Yes, depending on his condition.
22 Q. And out of the five days in the week that you worked, that would
23 amount -- the morning rounds would amount to no more than another hour;
25 A. I didn't understand you.
1 Q. If we added up the morning round from Monday to Friday, if we put
2 them all together, together they would not amount to more than an hour;
4 A. Probably. I don't know. Probably.
5 Q. In any given week, the total time that you had in direct contact
6 with Mr. Vasiljevic was no more than two hours; correct?
7 A. Yes.
8 Q. Now, you've testified that, in part, your conclusions were based
9 on behaviours that you observed in Mr. Vasiljevic that were uninterrupted;
11 A. Yes.
12 Q. Now, out of the 168 hours that exist in a week, will you agree
13 with me that the 166 hours that you did not see Mr. Vasiljevic that it was
14 entirely possible that some of the behaviours that you were observing had
15 subsisted or were interrupted? Will you grant me that possibility?
16 A. Well, there is a duty ledger that's kept, and the patient's
17 behaviour, any conspicuous behaviour is entered in that ledger so that any
18 alteration in a patient's behaviour would be registered in these ledgers
19 and then therapy is administered in accordance with this or counselling
20 sessions are held.
21 Q. Doctor, will you grant me that of the 166 hours a week that you
22 did not see Mr. Vasiljevic, that it is entirely possible that the
23 behaviours that you're describing were not manifesting themselves? Yes or
24 no, please.
25 A. No.
1 Q. And these ledgers that you're referring to now which may indicate
2 otherwise, they are not here before the Court at this time, and you
3 yourself have not looked at them prior to your testimony here today, have
5 A. No.
6 MR. GROOME: No further questions.
7 JUDGE HUNT: Re-examination, Mr. Domazet.
8 MR. DOMAZET: Thank you, Your Honour.
9 Re-examined by Mr. Domazet:
10 Q. [Interpretation] Mr. Simic, I will put a few questions to you
11 which concern the questions put to you by Mr. Groome. I will begin with
12 the last set of questions he put to you which are probably the freshest in
13 your memory and then I will go back to something else.
14 When Mr. Groome asked you about the number of hours you spent with
15 a patient, a calculation was made and you confirmed it. I understood this
16 to be hours of counselling or of conversation with Mr. Vasiljevic; is that
18 A. Yes.
19 Q. After your reply, however, there was another question put to you
20 referring to the other times outside the time of counselling or
21 conversation, and you did not see the patient outside those hours. Is
22 talking and seeing the same? So did you see the patient only when you
23 actually talked to him or did you see him at other times?
24 A. I did see him during my working hours, and I would come across
25 him. But the discussions, the talks were at the times indicated.
1 JUDGE HUNT: Now, the translation is only just finished. Both of
2 you, I remind you, to please pause before the answer and before the
4 MR. DOMAZET: Yes.
5 Q. [Interpretation] Dr. Simic, does this mean that the weekly time
6 calculated in hours of conversation with Mr. Vasiljevic, does this mean
7 that you did not see Mr. Vasiljevic only at those times but you actually
8 saw him more often?
9 A. Yes.
10 Q. Does this mean that you were personally able to observe if there
11 was any kind of behaviour on the part of a patient that would be
12 characteristic of his illness without actually talking to him?
13 A. Yes.
14 Q. You mentioned, Dr. Simic, that the nurses in your ward kept a
15 ledger about the behaviour of the patients. Is that correct?
16 A. Yes.
17 Q. Did they enter in that ledger the reactions of the patient or the
18 behaviour of a patient which was different from let's call it his normal
19 behaviour, so incidents that were extraordinary?
20 A. Yes.
21 Q. Were your patients able to receive visits from others and under
22 what conditions, if they could?
23 A. They were allowed to receive visits with the approval of a doctor,
24 depending on their state of health and the situation in the ward.
25 Q. Were these visits monitored in any way by your staff or the
2 A. Yes.
3 Q. If any incidents occurred during those visits, would the nurses
4 have had to enter this into the ledger they kept and not just things that
5 happened while the patient was in bed or in the room?
6 A. Yes.
7 Q. In an earlier testimony, it was said that some patients had the
8 right to go home over the weekend and that they were given permission to
9 do so. Was there such a possibility?
10 A. Yes.
11 Q. Did the patient Mitar Vasiljevic fulfil the conditions for
12 something like this, in view of his condition?
13 A. He did not go home for the weekends.
14 Q. Dr. Simic, to a question put to you by Mr. Groome, you replied
15 mentioning megalomaniac disorder. Did you notice things in your
16 conversations or, rather, did you notice two incidents mentioned by the
17 patient involving the killing of people on a bridge and probably throwing
18 them from the bridge and the killing of a hodza or imam in Visegrad, and
19 you said you did not remember anything like this happening, and then you
20 mentioned this possibility. I'm asking you now would this be compatible
21 with his diagnosis? Would saying such things to a patient whom he knew to
22 be a Muslim be compatible with his illness if nobody else ever mentioned
23 such things? So would it be possible for him to have told falsehoods
24 because the imam was never killed and nobody ever mentioned this other
25 event in this courtroom? So would that be part of what you described as
1 megalomaniac disorder?
2 A. It's possible although not necessarily so. This is speculation,
3 and I would not be able to say with certainty that he was suffering from
4 this disorder because I did not examine him at the time.
5 JUDGE HUNT: Mr. Domazet, that was a very broad assumption on your
6 part that was false, because nobody's given any evidence about it in
7 court. If you want to ask him a question based on a more realistic
8 situation that it may have been true, it's another matter, but you can't
9 just simply assume it's false because it hasn't even been raised as an
10 issue in the case for determination. It's a matter for you whether you
11 think the answer you got is going to be of any value, but as it stands,
12 it's very difficult to see how it could have any value.
13 MR. DOMAZET: [Interpretation] Your Honour, my question referred to
14 a question by Mr. Groome, who asked about matters that have not been
15 raised before this court from statements which we know have not been
16 adduced into evidence.
17 JUDGE HUNT: But, Mr. Domazet, Mr. Groome equally took a big
18 plunge because he said evidence will be given by a witness shortly as to
19 these matters. I assume that one of the witnesses you are to call has
20 said it in his statement. But you are asking the doctor to simply assume
21 that it's false. Somebody may give evidence that that's what he did say.
22 It's a matter for you. I'm not trying to tell you how to run it, but I'm
23 just suggesting to you that the answer you obtained from the doctor
24 doesn't have very much value as it stands because of that very large
25 assumption that you asked him to make.
1 MR. DOMAZET: [Interpretation] I may have to disappoint Mr. Groome,
2 but I have to say that this witness will not testify as a Defence witness.
3 So he will not be examined, at least not as a Defence witness, although I
4 had planned this. However, I will not dwell on this, and I will
5 reformulate my question.
6 Q. Dr. Simic, when you were explaining about megalomaniac symptoms,
7 could you say that a patient who was in your ward with a diagnosis that
8 you know later spoke of having committed terrible atrocities, enormous
9 crimes in front of people belonging to the ethnic group against whom he
10 had allegedly committed crimes, would you describe this as normal
11 behaviour or could this be described as the megalomaniac disorder you
13 A. I have no information about this and it's not in the case history.
14 Q. Do you wish to say that because this happened before he came to
15 your ward and was examined by a psychiatrist, you cannot answer? Is that
16 what you're saying?
17 A. Yes. Yes.
18 Q. Dr. Simic, to Mr. Groome's question, you said, referring to the
19 activating of these symptoms, that some manifestations of conspicuous
20 behaviour are necessary. Did I understand that part of your testimony
22 A. I didn't understand you very well.
23 Q. Did I understand you correctly when you spoke of the activation,
24 the triggering of symptoms of the illness that some forms of conspicuous
25 behaviour by the patients precede this?
1 A. In some cases, episodes of conspicuous behaviour may occur which
2 need not be as intensive as psychotic manifestations.
3 Q. Would such behaviour include possibly, let us say, a refusal to
4 obey orders, handing weapons back in, being afraid to go to the front
5 lines as a soldier and distribute food?
6 A. Well, fear accompanies psychotic disorders, so fear of this kind
7 could occur.
8 Q. Doctor, if, after that, he were to be entrusted with the
9 organisation of the cleaning of the town of garbage, the fact that he wore
10 some kind of a mark as being that and presenting himself to be something
11 far more important than he was, could that be one such manifestation of
12 conspicuous behaviour?
13 A. If he falsely presented himself as being somebody important and if
14 this was drastic and conspicuous, then it could be taken into
15 consideration as a certain manifestation of the disorder.
16 Q. Finally, a manifestation through what preceded his admission to
17 hospital, he was riding a horse from a hamlet through the whole of the
18 town of Visegrad, in the rain, without adequate clothing, an unsaddled
19 horse without horseshoes, on the asphalt and in rainy weather, at some
20 speed, could that also be a manifestation of conspicuous behaviour which
21 oversteps the borders of ordinary behaviour?
22 A. That is reminiscent of conspicuous behaviour, especially as it is
23 not a customary pattern of behaviour of him himself or the environment in
24 which he lives.
25 Q. When you insisted several times on the fact that you can comment
1 only on things after the initial examination of the patient, in this
2 specific case, in the case of Mitar Vasiljevic, would that be the day when
3 he was first examined by the psychiatrist? I don't know whether you have
4 the discharge document to check the date, whether that is the date you are
5 referring to or do you perhaps remember that date?
6 A. As soon as he was transferred to the psychiatric ward, he had to
7 be examined by a psychiatrist. That is the procedure.
8 Q. So in your opinion, that was the day he was transferred, that
9 would be the 7th of July, 1992.
10 A. Yes.
11 Q. I was mentioning a few incidents that preceded his
12 hospitalisation, as testified by the accused and others, that occurred
13 some 15 days prior to his admission, but from the moment he was admitted
14 until he arrived at your ward, if it is proven that, while hospitalised,
15 your patient sang, insulted other patients and behaved in a way that stood
16 out from the behaviour of other patients, would that also be a preliminary
17 symptom of the disorder that developed later, on the 7th of July at the
19 A. That is conspicuous behaviour, and it can be an indication of the
20 gradual development of a psychosis.
21 Q. In view of the fact, Dr. Simic, that this disorder or disease has
22 been identified by you as a serious mental illness, could it have set in
23 suddenly, on one particular day, be it the 7th of July or some other day,
24 or do the preceding events gradually lead to the outbreak of the disease?
25 A. The psychotic level of his behaviour or drastic disturbance was
1 experienced the moment he was admitted, but the conspicuous behaviour
2 certainly fits within his basic behavioural disorder; singing, shouting,
3 aggressiveness. And on the 7th of July, this reached a climax.
4 Q. Dr. Simic, when you were answering questions before you were shown
5 exhibit -- that is, the therapy sheet that you reviewed and commented on
6 later on, before you saw any written document, on the basis merely of your
7 recollection, you said that in such cases, with adequate treatment, a
8 patient, in one or two days, recovers to a point and is no longer in a
9 condition that he has to be tied up. When you saw the documents and
10 everything that was done with respect to this specific patient, Mitar
11 Vasiljevic, do you still abide by what you said or was his case more
12 serious than you thought, requiring a stronger therapy?
13 A. Judging by the therapy sheet, he was for six days extremely
14 restless, which is a little longer than is usual.
15 Q. So what you said before, was that the average or customary in the
16 case of such patients and later on your comments were based on the actual
17 documents you had before you?
18 A. Yes.
19 Q. Thank you, Dr. Simic.
20 MR. DOMAZET: [Interpretation] I have no further questions.
21 Questioned by the Court:
22 JUDGE TAYA: Doctor, I have several questions concerning Exhibit
23 138. Please look at Exhibit 138, page 1.
24 JUDGE HUNT: Have you got it there, Doctor?
25 THE WITNESS: [Interpretation] No. No, I don't have it. I don't
1 have it.
2 JUDGE HUNT: It will be produced for you in a moment.
3 JUDGE TAYA: Please look at page 1. You said you typed the
4 figures in column 12. That is to say, "Psychosis," and "298.9." Is that
6 A. Yes.
7 JUDGE TAYA: Does that mean that those figures in columns other
8 than 12 were typed into by other doctors or nurses?
9 A. I typed in "Psychosis" in column 12, also the date, that is column
10 13, and I am the second signatory under column 17, the doctor who treated
11 the patient. My name is there.
12 JUDGE TAYA: Then please look at column 3. Usually who, what kind
13 of doctor or nurse, is entitled to type into column 3?
14 A. All of this is typed in by the admissions service, the nurse in
15 the admissions or the reception, and the diagnoses are typed in by the
16 doctors. The discharge is also typed by doctors. The date and type of
17 operation is also typed by doctors, and the signatures are also typed by
19 JUDGE TAYA: By looking through Exhibit 138, can you tell who
20 typed column 3 in this case?
21 A. I couldn't tell you. Probably the nurse who was on duty at the
22 admissions department.
23 JUDGE TAYA: The figures in columns other than 12 seem to be typed
24 by the same kind of typing machine of yours. The same type of typing
25 machines as yours were used by other doctors and nurses in Uzice hospital
12 Blank page inserted to ensure pagination corresponds between the French and
13 English transcripts.
1 in 1992?
2 A. I really don't know that, but I think that the typewriting
3 differs, if we look closely. I don't think it's the same.
4 JUDGE TAYA: Even now, you use the same typing machine?
5 A. The typewriters are 20 to 30 years old, so that probably they're
6 still using them. But I'm in a different hospital now. But my
7 typewriter, this typewriter, is probably still in that hospital.
8 JUDGE TAYA: Thank you.
9 JUDGE HUNT: Do counsel want to ask questions arising out of that?
10 Mr. Groome.
11 MR. GROOME: No, Your Honour.
12 JUDGE HUNT: Mr. Domazet?
13 MR. DOMAZET: No, Your Honour.
14 JUDGE HUNT: Thank you, Doctor, for coming along to give evidence
15 and for the evidence which you gave. I'm sorry you've had such a long
16 time but it's been a very important issue that you've been discussing and
17 we are very grateful to you for your assistance. You're now free to
19 [The witness withdrew]
20 MR. GROOME: Your Honour, while we're waiting for the next
21 witness, might I inform that Court we are in possession of the ledgers
22 now. Unfortunately, because of some personal problems, I've not been able
23 to look at them last night or at lunchtime today. I will endeavour to
24 look at them tonight and tomorrow morning. I would advise the Court that
25 we have attempted to contact the forensic examiner for the last three days
1 and have been unable to. As soon as we contact him, we will try to get an
2 estimate of how long it will take and give that to the Court. And I
3 believe now the only documents I would -- I don't believe that I'll be
4 seeking to examine any additional documents than were put in the original
5 order, although I would like to reserve final determination on that until
6 I've had an opportunity just to look at those other books.
7 JUDGE HUNT: Well, I gather that the next witness is a nurse in
8 the orthopaedic department. I don't know whether we're going to take her
9 through all of those documents. I hope we're not. But if we are, they
10 better stay in the courtroom, that's all.
11 MR. GROOME: We have the psychiatric one, and I will have somebody
12 sent up to bring down the other ones now so they're available.
13 JUDGE HUNT: Yes.
14 [The witness entered court]
15 JUDGE HUNT: Now, madam, will you please make the solemn
16 declaration in the document which the court usher has handed you.
17 THE WITNESS: [Interpretation] I solemnly declare that I will speak
18 the truth, the whole truth, and nothing but the truth.
19 JUDGE HUNT: Sit down, please, madam.
20 WITNESS: Slavica Pavlovic.
21 JUDGE HUNT: Mr. Domazet.
22 MR. DOMAZET: Thank you, Your Honour.
23 Examined by Mr. Domazet:
24 Q. Good afternoon, madam.
25 A. Good afternoon.
1 Q. I will be asking you questions on behalf of the Defence of Mr.
2 Vasiljevic, so will you please, when you hear my question, pause a little
3 before giving your answer because of the interpretation and since we both
4 speak the same language.
5 Let me first ask you to introduce yourself to the Court and give
6 us your basic particulars; your name, date and place of birth.
7 A. My name is Slavica Pavlovic. I was born in Uzice on the 18th of
8 August, 1957.
9 Q. Tell us, please, Mrs. Pavlovic, what is your educational
11 A. I have eight years elementary schooling and secondary medical
13 Q. Where are you employed now?
14 A. I'm employed at the general hospital in Uzice.
15 Q. Since when have you been working in the general hospital in Uzice,
16 Mrs. Pavlovic?
17 A. I have been working since the 1st of December, 1986.
18 Q. Does that mean that you have been fully employed without
19 interruption since 1986 at the Uzice general hospital?
20 A. Yes.
21 Q. In the course of 1992, in which ward at the hospital were you
23 A. I was working in the ward for orthopaedic surgery and
25 Q. After that, are you still working in the same ward or department?
1 A. Yes.
2 Q. Could you please describe your ward in 1992, as far as you can
3 remember; which were the doctors working there, how many rooms you had,
4 and which part of the hospital you occupied.
5 A. In 1992, our ward was on the fourth floor of the hospital, and it
6 is still there. We had 18 rooms. They were numbers from 401 to 418.
7 They still bear the same numbers but two of those rooms are not patients'
8 rooms. Then we had doctors, Dr. Milosavljevic, who was head of the
9 department at the time; Dr. Jovicevic who, in those days, was also the
10 director of the hospital; Dr. Vojkan Krnjic; and also Dr. Djordje
11 Stojkovic. Those were the orthopaedics. And in addition to them, there
12 were doctors who were preparing for specialisation courses or were already
13 specialising in orthopaedics; Dr. Ivan Jovanovic and Dr. Vladimir Gordic.
14 Q. Have you remembered the names of all the doctors or have you
15 omitted anyone?
16 A. I am sure I told you the names of all the orthopaedists who were
17 there. May I do it again?
18 Q. No. Let me ask you specifically about one. Was he working in
19 your department or some other department?
20 A. I am sorry. I omitted to mention Dr. Moljevic. Yes, I forgot him
21 for a moment. He was working in our department at the time.
22 Q. Thank you. So he was working in your department as well?
23 A. Yes.
24 Q. Could you please tell us, what were your duties as nurses
25 regarding keeping records of patients?
1 A. Patients came to our department with their case history already
2 issued, and these case histories are opened at the admissions department
3 of our hospital. Once they arrive to our department, it is our duty to
4 register them in our notebook if they arrive prior to 1300 hours. We also
5 open temperature charts. And if they arrive after 1.00 p.m., then the
6 shift registers them in the handover/takeover notebook, handover/takeover
7 of duty notebook.
8 Q. Just a moment, please. Before you continue, will you please
9 explain what kind of shifts you had, how many shifts there were, and were
10 there records of those shifts?
11 A. Of course there were records. The nurses worked in shifts and
12 there were three shifts.
13 Q. Tell us how they went.
14 A. The first started at 6.00 a.m. and went on until 1.00 p.m. The
15 second shift started at 1.00 p.m. and ended at 2000 hours, at 8.00 p.m.
16 And the third shift started at 8.00 p.m. and ended at 6.00 a.m. That was
17 the work in shifts of the secondary medical staff, medical staff with
18 secondary education.
19 Q. Did this first shift coincide with the regular working hours of
20 doctors and nurses in your hospital?
21 A. This was work in shifts, but the people who only worked the first
22 shift, they worked until 2.00 p.m., doctors from 7.00 a.m. until 2.00 p.m.
23 Q. So the regular working hours of both doctors and nurses, excluding
24 the shifts, were from 7.00 a.m. until 2.00 p.m.
25 A. Yes, for the doctors; but for the nurses, from 6.00 a.m. until
12 Blank page inserted to ensure pagination corresponds between the French and
13 English transcripts.
1 1.00 p.m.
2 Q. Was there a separate record book of the handover of shifts? Was
3 there a special notebook for that?
4 A. Yes, there was a notebook. This notebook would be filled in by
5 the second and third shifts. There was a special notebook which we
6 referred to as the handover/takeover notebook.
7 Q. Could you tell us why such records were not kept during the first
9 A. In the first shift, we had another notebook for results where we
10 entered the patients who were received, admitted in the course of the
12 Q. Thank you.
13 MR. DOMAZET: [Interpretation] Your Honour, I think this might be a
14 convenient time for us to adjourn.
15 JUDGE HUNT: We'll resume again at 9.30 in the morning.
16 --- Whereupon the hearing adjourned at 4.00 p.m.,
17 to be reconvened on Wednesday, the 28th day of
18 November, 2001, at 9.30 a.m.