1 Wednesday, 9 January 2002
2 [Open session]
3 [The accused entered court]
4 [The witness entered court]
5 --- Upon commencing at 9.33 a.m.
6 JUDGE HUNT: Call the case, please.
7 THE REGISTRAR: Good morning, Your Honours. Case number
8 IT-98-32-T, the Prosecutor versus Mitar Vasiljevic.
9 JUDGE HUNT: Welcome to the new year, thank you for being here.
10 We are in a very much larger court; I'm not sure that I feel very
11 comfortable in it after being locked away in the shoe box for so long. We
12 are here for at least this week, and we may have to change next week.
13 Now, doctor, you're still bound by the solemn declaration you made
14 when you were giving evidence before, do you understand that?
15 THE WITNESS: [Interpretation] Yes, Your Honour.
16 JUDGE HUNT: Thank you. Yes, let's proceed.
17 WITNESS: CEDOMIR VUCETIC [Resumed]
18 [Witness answered through interpreter]
19 JUDGE HUNT: Have you finished, Mr. Domazet, with the witness?
20 MR. DOMAZET: No, Your Honour, I didn't finish.
21 JUDGE HUNT: There is his further statement which I think could
22 become an exhibit, rather than him having to give that evidence.
23 MR. DOMAZET: [Interpretation] Yes, Your Honour. In the meantime,
24 we have handed over another additional report, if I can call it, by Dr.
25 Vucetic. So I should like to tender it into evidence. I don't have the
1 number at hand. It's D --
2 JUDGE HUNT: Your next number, I believe, is 39, unless you
3 reserved that number for something else.
4 MR. DOMAZET: [Interpretation] No, I think that would be fine, D39.
5 JUDGE HUNT: Any objection, Mr. Groome?
6 MR. GROOME: No objection, Your Honour
7 JUDGE HUNT: Thank you very much. That further statement by the
8 doctor will be Exhibit 39.
9 Mr. Domazet, I'm grateful that this is being done this way,
10 because it's very much easier to read it. But there was one further
11 matter that I raised with you just before the adjournment which I said had
12 to be dealt with. That was the shape of the heel bone. You may remember
13 that Dr. de Grave had something to say about the different shapes of the
14 heel bones. It may be that you can leave that for Mr. Groome to raise in
15 cross-examination but if you want to deal with it, now is the time.
16 MR. DOMAZET: [Interpretation] Yes, Your Honour. During the last
17 hearing, that is roughly as far as we got, so perhaps we could look into
18 that now before going on to what the doctor said in his report.
19 Examination by Mr. Domazet: [Continued]
20 Q. [Interpretation] So, doctor, you have certainly seen the findings
21 of Dr. de Grave regarding the heel bone and the other bones around the
22 heel which he considered to be relevant for this case. So, do you
23 remember that part of his report and could you comment on it, of Dr. de
25 A. Yes, of course I remember. One might say that there is a certain
1 difference viewing the x-rays nine years before and nine years after.
2 Those differences are possible both morphologically, that is, in terms of
3 the shape of the bone and the structure of the bone. Those differences
4 may be attributed in the first place to the number of years that have
5 elapsed, to which is a period of more than nine years, and these are quite
6 normal. They are normal over this period of time and they are of a
7 degenerative nature and also affect the structure of the bone so that can
8 be the explanation.
9 Another fact confirming that the same bone is in question is the
10 question of traction that Mr. Mitrovic [as interpreted] was subjected to
11 during treatment, and the traces of that traction according to the finding
12 of Dr. De Grave match to the findings on the scar, and they fit in with
13 the facts that we have concerning the treatment of Mr. Mitrovic -- I'm
14 sorry, Mr. Mitar Vasiljevic.
15 Q. Doctor, you have certainly seen the significance attributed to
16 Dr. De Grave to this, because at least according to my own understanding
17 of his report, it follows that on the basis of his findings in the heel
18 bones, he says that those cannot be the x-rays of the same person taken in
19 1992 and 2001.
20 A. We have to agree over a few points. The differences can be
21 confirmed but they are not so pronounced nor of such a degree as to make
22 it certain that these are two different persons, and that is why I am
23 giving this explanation, that a time period of nine years is a very long
24 period of time when there are changes in the bone structure of each
25 individual, be he injured or not, both in the structure and in the
1 morphology or form and shape.
2 Q. Does that mean, doctor, that in your opinion these heel bones that
3 you have examined do not lead you to believe that these are different
4 heels, or rather different persons that were x-rayed, in view of the
5 explanation you have just given?
6 A. I think it is very difficult to make any conclusions based on the
7 heel alone. We have to observe the x-ray of the entire extremity, and it
8 would be extremely unreliable to claim that those are not the same person
9 simply because there are certain differences.
10 Q. Apart from this, in Dr. De Grave's findings, when he talks about
11 difficulties in establishing the fracture planes, which is another very
12 important part of his report, you also told us last time that you disagree
13 with the way in which he established those fracture lines and fracture
14 planes. So could you please elaborate on that a little?
15 JUDGE HUNT: Don't you think, Mr. Domazet, that we have got a very
16 elaborate explanation already? If he wants to add something new to it, by
17 all means. But the whole purpose of putting the statement into evidence
18 is to save the doctor having to tell us all about it again.
19 MR. DOMAZET: [Interpretation] Yes, Your Honour, but you yourself
20 suggested last time that the doctor, in addition to what he has already
21 done, should also try to make drawings which would explain this better,
22 and the doctor has brought with him drawings which explain his findings
23 and with the help of which he will be able to explain, in practical terms,
24 what he has told us in his written report. So that is why I asked him
25 this question, because I thought that with the help of these drawings, it
1 would be much easier for all of us to understand better his findings in
2 this case.
3 JUDGE HUNT: Of course, Mr. Domazet, but why don't you just ask
4 him to produce them. Ask him to elaborate means he will have to tell us
5 everything that is in the statement already. So just ask him for the
6 drawings and then if he wants to add something to what he's already said,
7 he will be very welcome to do so. I want to make it very clear that we do
8 not want him to tell us simply what's in the report. Because it's there
9 and it's in evidence.
10 MR. DOMAZET: [Interpretation] Thank you, Your Honour.
11 Q. Dr. Vucetic, could you please show the Court the first of the
12 drawings that you have made, and could you explain the one entitled
13 "Correlation of bone fragments at fracture site of tibia dated 1992." If
14 you could place it on the ELMO, please.
15 MR. DOMAZET: [Interpretation] Your Honour, I have copies for the
16 Trial Chamber, and could I ask the usher to give them to you for you to be
17 able to follow more easily?
18 JUDGE HUNT: Yes. And have you given these to Mr. Groome already
19 or is this the first he's going to see of them?
20 MR. DOMAZET: [Interpretation] I received them too just before
21 arriving at court. The doctor brought them with him.
22 Q. Just a moment, please, until we distribute copies to Their
24 JUDGE HUNT: Mr. Groome we will leave it until you've had a chance
25 to look at them before we worry about putting them in evidence but you
1 have no objection to him being asked questions about them now, do you?
2 MR. GROOME: No, Your Honour.
3 JUDGE HUNT: Thank you.
4 MR. DOMAZET: [Interpretation]
5 Q. Dr. Vucetic, you have before you your first drawing, so will you
6 please explain what it is it shows?
7 A. To be able to understand what we are talking about, it is very
8 important to explain the fracture itself. It is a spiral fracture with a
9 certain shifting as is shown on this diagram of the x-ray from 1992. It
10 is important to note the upper point of the lower fragment, the upper
11 point of the fracture, and the lower point of the lower fragment, and the
12 lower point of the fracture and this is shown in both these projections,
13 the AP and the profile.
14 JUDGE HUNT: Sorry, doctor, let's just -- so we can note them on
15 our copies. The left is the front view and the second is the profile, is
16 that -- the one on the right is the profile; is that right?
17 THE WITNESS: [Interpretation] That's right, yes. Precisely.
18 Because of the shortening that occurs because of a fracture, there is an
19 overlapping, and these points shift and these overlapping surfaces are
20 shown here with diagonal lines.
21 I have also prepared a model to show the tibia. This is the
22 internal side of the tibia, this is the front edge of the tibia, this is
23 the fracture, which is a spiral one, and it looks something like this.
24 When a fracture occurs, there -- a shortening happens and the bones adopt
25 this position, and that is what we see here in two projections. So this
1 lower point of the upper fragment and the upper point of the lower
2 fragment overlap and in the measurement and determining which is the lower
3 point of the fracture is debatable, whether it is the point at the top
4 of -- at the bottom of the upper fragment or the top point of the lower
5 fragment. And we will talk about that further, the same applies to the
6 lower fragment.
7 On this diagram, we can see comparative demonstration of the
8 measured values by experts who have been analysing this fracture. We have
9 the x-rays from 1992 and the x-rays from 2001, and the findings by
10 De Grave are marked with one star; Dr. Bollen, two stars; Dr. Raby, three
11 stars, and Dr. Vucetic with a plus. It is important to note here that the
12 findings of the three Prosecution experts very frequently differ
13 significantly, though they do agree that their finding is the same.
14 I have also shown this in the form of a table.
15 That is now before you. It is also of particular importance for
16 this case determining these points of significance on the x-rays from 1992
17 is relatively simple but it is on those x-rays that we have different
18 measurement results by the Prosecution witnesses. Shall I continue?
19 MR. DOMAZET: [Interpretation]
20 Q. Dr. Vucetic, I notice that when referring to the Prosecution
21 experts, you focus in particularly on Dr. De Grave and Dr. Bollen. He is
22 not actually an expert of the Prosecution; he assisted Dr. De Grave. So
23 that his finding, Dr. Bollen's finding was used within the testimony of
24 Dr. De Grave, but nevertheless, are there differences between them?
25 Because Dr. De Grave asked Dr. Bollen to do the radiological part as Dr.
1 De Grave is not a radiologist but you still find differences between the
2 findings of Dr. De Grave and Dr. Bollen; is that right?
3 A. In preparing this report, I used the documents signed by Dr.
4 De Grave and Dr. Bollen and the other experts, and I took these figures
5 from those documents. And those facts and figures are to be found marked
6 here as well as the source from which they were taken. It is true that
7 Dr. Bollen's report is a component part of Dr. De Grave's report, but I
8 used Dr. De Grave's report of the 24th of July 2001 and Dr. Bollen's
9 report of the 15th of August 2001 separately, and these facts and figures
10 are taken from those reports.
11 Q. Dr. Vucetic, in addition to these drawings, you have also attached
12 two photographs which are not linked to Mitar Vasiljevic's x-rays, as far
13 as I understand, but simply as an explanation for your findings. Could
14 you explain to us with the help of those photographs the differences in
15 the findings of the various experts?
16 A. Yes. In my previous testimony I pointed out that these
17 differences probably emanate from different methodologies applied, which
18 are not only different but were -- was often erroneous and that is why we
19 have different data.
20 What I would now like to show you has to do with the healing of
21 the bone. Before I do that, could I show this? The bone heals not only
22 by the gap between the fragments being filled in but also at the point of
23 the fracture a new bone is formed in an elongated form which covers the
24 healthy part of the bone, and this can be seen very well on these photos
25 25 months after the fracture and 40 months after the fracture, how the
1 bone changes. And it covers an increasingly wide zone and covers the
2 fracture so it is difficult to determine the exact point of the fracture.
3 This can also be seen on this example taken from literature, and these two
4 comparative photographs show how the callous or the healing of the bone
5 depends on the method of treatment. The way Mitar Vasiljevic was treated,
6 in those cases, the place of the fracture is covered up by the newly
7 formed bone, and that is the situation that we have on the x-rays from
8 2001, and that is why it is difficult to determine the extreme points, the
9 ends, of the healed fracture, and that is why we have such divergent
11 I should also like to draw attention to the determination of the
12 fracture line as was done by Dr. De Grave. We have before us a schematic
13 drawing made by Dr. De Grave. He shows here the fracture lines or
14 fracture planes on the x-rays from 1992 and 2001. This is the fracture
15 line from 1992 and the fracture line from 2001. What is of importance
16 here? To determine the fracture line, he used the upper point and the
17 lower point of the fracture when determining the fracture line for the
18 year 2001. When determining the fracture line for 1992, he showed the
19 upper point of the fracture and the lower point of the fracture in 1992
20 and the lower point of the fracture in 1992, and he drew the fracture line
21 below the upper point, this is the upper point, and this is where the
22 fracture line passes through, which should pass through the upper point.
23 So this is quite different from the method of showing the fracture line on
24 the x-ray for 2001. And this certainly requires an explanation.
25 The explanation that I'm able to offer is that he used only a part
1 of the fracture line, the central one, which has a certain inclination
2 which is of a different angle, and on the basis of that inclination of the
3 central part of the fracture line, he drew this fracture line, which does
4 not correspond to what it should be.
5 Those would be my comments.
6 Q. Dr. Vucetic, you have used this pointer to show what you wish to
7 show us but perhaps that's not precise enough. Could you please make a
8 sketch for us which would depict what Dr. De Grave concluded and on the
9 other hand, could you show what you view as a mistake in terms of the
10 angle that he perceived? So could you try to depict the explanation that
11 you have just given us.
12 A. I'll try.
13 JUDGE HUNT: It will be difficult, though, Mr. Domazet, because as
14 the doctor has pointed out, Dr. De Grave has ignored, he says, the top
15 part of the actual fracture. He's taken only the middle part of the
16 fracture. The point that this doctor makes about the line being in the
17 wrong place, even on Dr. De Grave's figures and demonstration, is pretty
18 obvious. He hasn't taken the top of the fracture even as he saw it, but
19 the real point that this doctor is making, as I understand it, is that Dr.
20 De Grave ignored the very top of the fracture. It may be because he was
21 unable to see it properly. But that's another matter, and I'm not sure --
22 and he will have to redraw really the whole thing to express what he sees
23 to be the main point. He's already drawn it now, I see, which takes it
24 through the actual top of the fracture as Dr. De Grave has shown it.
25 That, if I may say so, is a very obvious point but it's the other one
1 which I think this doctor thinks is the more important one.
2 MR. DOMAZET: [Interpretation] Yes, Your Honour. But to the extent
3 to which I understood Dr. Vucetic, Dr. De Grave explained that he found
4 the upper part of the fracture, which is also contested in this case, and
5 the drawing does not correspond to that. That was my understanding of the
6 present explanation given by Dr. Vucetic because it emanates from the
7 drawing itself. And I think that he managed to explain in some way where,
8 according to De Grave, this angle should be shown. I don't know if I have
9 understood the point of what Dr. Vucetic was trying to say.
10 THE WITNESS: [Interpretation] That's all right. I managed to draw
11 a line here which would correspond to the postulates that were put forth
12 by Dr. De Grave himself and after all that is what is drawn here, but he
13 did draw a different line when determining the fracture of 1992.
14 MR. DOMAZET: [Interpretation]
15 Q. Dr. Vucetic, I think you brought yet another diagram which you
16 haven't shown us yet and that is remodulation, if I remember correctly, so
17 I would kindly like to ask you, could you show this diagram to us, the one
18 that has to do with remodelling and could you please explain it to us?
19 A. The notion of remodelling or the reorganisation of the primary
20 bone is something that I've already referred to. However, what is
21 significant in order to understand the x-rays from 2001 when the fracture
22 heals there is a restructuring of bone tissue, and therefore all traces of
23 the fracture are erased as well as of the growing back of the bone. That
24 is something that is always present and that goes on for years to a
25 greater or smaller extent. That is what makes it more difficult for us to
1 have a proper orientation in ascertaining the fracture line on the
2 fracture after it healed ten -- nine years later, in particular.
3 Q. Thank you, doctor. If you have nothing to add to these diagrams
4 at this point in time, I would kindly ask, since they are in a way an
5 integral part of your report, that they be admitted into evidence as part
6 of D39, as D39.1 as far as this first diagram is concerned, and then the
7 second diagram would be 39.2, that is, the second diagram that explains
8 the difference between 1992 and 2001, fracture healing would be 39.3 and
9 39.4, and this last one that you explained would be 39.5.
10 JUDGE HUNT: Any objection, Mr. Groome?
11 MR. GROOME: No, Your Honour.
12 JUDGE HUNT: Thank you. They will be as indicated by Mr. Domazet.
13 There is actually a list of them which came with the copies of the
14 documents, Mr. Domazet, so we may put the whole lot in. We can put that
15 at the end, that would be number D29.6. And there was the model that
16 the doctor has prepared. Do you want to tender that as well?
17 MR. DOMAZET: Yes, Your Honour.
18 JUDGE HUNT: Any objection to Mr. Groome?
19 MR. GROOME: No, Your Honour.
20 JUDGE HUNT: We will make that D40, I think, as a separate one.
21 The chart that the doctor has handed us is actually already in the
22 statement, which is Exhibit D29, but this is a very much clearer version
23 of it. It need not be made a separate exhibit.
24 MR. DOMAZET: [Interpretation] It is contained in the report.
25 JUDGE HUNT: Yes. You proceed, Mr. Domazet.
1 MR. DOMAZET: Thank you, Your Honour.
2 Q. [Interpretation] Doctor, in the case of the type of traction that
3 was applied in the case of Mitar Vasiljevic, Dr. De Grave said here in
4 court that this must have been done by a doctor with vast experience in
5 view of the way in which this was done. Can you explain to us in the
6 briefest possible terms what traction is and whether that is really the
7 way things stand as Dr. De Grave had put it? Because this was actually
8 performed by a doctor who was still an intern at the Uzice hospital.
9 A. Skeletal traction is simple surgery. A wire, a very strong wire,
10 or a nail, is pulled through part of a bone that is very accessible. The
11 method has been applied for over 100 years for treating bone fractures as
12 temporary immobilisation or permanent immobilisation until there is total
13 healing. This procedure is taught to very young physicians or physicians
14 who are doing their specialist training. This is one of the surgical
15 procedures that they learn among the first in terms of bone surgery, and
16 with which they start their own practice in the surgery of bones and
17 ligaments or their specialization in this area. Complications are
18 possible in this kind of surgery but they are quite exceptional, and they
19 can always be avoided if due attention is paid to the way in which the
20 procedure is carried out.
21 Q. Dr. Vucetic, this procedure, that is, traction, is it applied only
22 when both bones are fractured or is it feasible when only the bigger bone,
23 the tibia, is broken?
24 A. It can be said, when speaking of treatment by skeletal traction
25 which is only one of the ways in which such problems can be treated, that
1 skeletal traction is more necessary when both bones are fractured.
2 However, it is equally applied whenever we wish to improve the position of
3 the fragments, and to correct the shortening involved in cases of
5 Q. I would like to ask you something else now, Dr. Vucetic. You
6 personally have been working in such hospitals where such problems are
7 treated, and I would like to draw your attention to medical reports that
8 are made. What does fractura cruris mean when a patient is released from
9 hospital, et cetera? Does that mean that this necessarily implies the
10 fracture of both bones of the lower leg area, or is it possible that it
11 may refer to only one of the bones in the lower leg?
12 A. Fractura cruris is a notion denoting the fracture of the lower leg
13 bone. It mostly refers to the fracture of both bones but in some cases,
14 although I must say it is sometimes used imprecisely, to denote the
15 fracture of the tibia only. It is more correct to write fracture of the
16 tibia and fibula, rather than to denote it as cruris. Sometimes it seems
17 simpler to put it that way. And it often happens in practice in our
19 Q. When speaking of this practice of writing medical histories and
20 discharge reports from hospitals, can you tell us whether it is usual to
21 enter other specific details in addition to the date, that is to say, the
22 exact hour or minute, that is to say, more specific information than the
23 date itself, especially when speaking of the period that is involved here
24 and, of course, referring to the later period until the present day?
25 A. I can say to you that it is very exceptional to find information
1 on the minute and hour of the injury sustained. In most cases, of course,
2 it is compulsory to enter the date of injury and also whether the injury
3 took place at the workplace or generally speaking the circumstances under
4 which the patient was injured are described. Only in the largest
5 emergency hospital in Belgrade, when patients are received, the date, hour
6 and minute are registered when the patient reported to the emergency
7 hospital. Otherwise, this information is not registered in other
8 institutions, in terms of minutes and hours. I am familiar with this
9 because I personally receive patients for treatment, as does the
10 institution where I work, where treatment had started in other
11 institutions, and then, due to the nature of their injuries, their
12 treatment has to be continued in the institution where I work, and I never
13 find any information regarding the minute or hour of injury, either in the
14 pre-war times or in the time of war or even now after the war.
15 Q. Dr. Vucetic, one of the important facts involved here was the
16 question of refracture, since Mitar Vasiljevic sustained a refracture
17 within less than a year after the first fracture, you saw this in the
18 opinion of Dr. De Grave, and especially what he thought about refracture
19 in two year periods. So I would kindly ask you to present your point of
20 view with regard to this particular matter.
21 A. Refracture always occurs at the point where the previous fracture
22 had taken place, especially within a period of less than one year. This
23 can be explained in the following way. The place where the first fracture
24 had healed, until there is definite remodelling or regrowth, is a weak
25 point. Also, another thing that shows this, that refracture occurs at the
1 point where the previous fracture had taken place, is the possibility of
2 the appearance of some other fragments which does happen sometimes,
3 probably as more time goes by, there is more of that, that is to say, more
4 time since the first fracture had healed. So when there is a case of
5 refracture, it occurs in the place where the original fracture had
6 occurred, if there is more than -- if more than one year had elapsed since
7 the first fracture, then we can expect more fragments, those that were not
8 there in the case of the first fracture.
9 Q. What about the treatment of refracture? Is it as a rule more
10 difficult or, as it was stated here, much more difficult, than treating an
11 original fracture?
12 A. There are different fractures. The treatment of the refracture of
13 a fracture that was difficult to heal, that took more than a year to heal,
14 is indeed difficult. However, the treatment of refracture in the case of
15 the fracture that was sustained by Mitar Miric [as interpreted] and where
16 the treatment had been regular is not difficult. Practically, there
17 should be repetition or rather extension of the immobilisation period of
18 three or more months until the refracture heals.
19 Q. Doctor, this period that is often referred to of one year or two
20 years, is that due to the fact that this is the period of healing, so it
21 is therefore important in terms of assessing whether there can be a
22 refracture or whether there can be traces of that that can be seen later?
23 A. One year after the fracture is the period during which the
24 fracture heals, and this is when a fracture heals regularly, in a regular
25 fashion. So fractures that occur in that period would certainly occur
1 where the first fracture had taken place or along that line. However,
2 refractures that take place later may possibly affect other parts of the
3 bone that have nothing to do with the fracture line.
4 Q. Dr. Vucetic, you have certainly seen from Dr. De Grave's report
5 and his testimony that the x-ray does not contain elements which would
6 lead him to believe that there was a refracture. Could you comment on
7 that, please?
8 A. When a refracture heals, it is not possible to establish with
9 reliability whether it is a healed refracture or a healed fracture because
10 the appearance is the same once it is healed, so it is virtually
11 impossible to distinguish between a healed fracture and a healed
12 refracture, especially it is not possible to establish that on the basis
13 of an x-ray taken many years later.
14 Q. Dr. De Grave states that two years later it is not possible to say
15 whether the leg was broken once or several times at the same place. Would
16 you agree with that?
17 A. Indeed, looking at a healed fracture, after more than two years'
18 time, it is not possible to establish whether the leg was broken once or
19 several times at that particular place.
20 Q. Dr. Vucetic, when it is stated that a fracture is normal or
21 normally healed, this -- does this notion exist in professional
22 orthopaedic surgery or is it just an explanation for normal healing as
23 opposed to any other kind of healing?
24 A. Yes. The concept of a normal fracture, as such, does not exist.
25 There is a fracture resulting from a commensurate force in relation to
1 pathological fractures. So we are talking of a fracture here provoked by
2 a trauma which makes it a fracture. Then there is a normal or regular
3 course of healing, then there is an extended course of healing or failure
4 of the fracture to heal. These are the concepts known to orthopaedics as
5 a science. Also, the concept of an irregular fracture is something that
6 can be used only loosely or colloquially. There is an
7 expression "irregular fracture line" which helps us to explain whether the
8 line is spiral, horizontal or diagonal. These are the terms used in
10 Q. Dr. Vucetic, when you were reviewing the reports and the testimony
11 of Dr. De Grave, you certainly noted his comments on the x-rays of 1992,
12 which you yourself have been able to review, and his comments regarding
13 the stickers or parts of stickers or labels found at the bottom of that
14 x-ray. In view of your own experience and your work in hospitals in
15 Yugoslavia or Serbia, could you comment on that and say whether this x-ray
16 from 1992 that you have had occasion to see is unusual in any sense with
17 regard to the labels attached to the bottom of those x-rays?
18 A. I understand your question. This was something that I noted
19 prompted by Dr. De Grave's comments, and I inquired with a number of
20 radiologists and doctors and x-ray technicians to find an explanation.
21 They showed me the boxes where they keep the x-rays and the method of
22 marking those x-rays. All of them agreed in the explanation that these
23 are plastic parts, there are slits, there are windows on those metal boxes
24 closed with plastic sliding covers, and on which it is possible to write
25 out the name and the shape of those plastic windows, or traces can be seen
1 on the x-rays. This is an absolutely customary procedure on virtually all
2 x-rays that we see.
3 Q. In that case, could it be possible for these labels to be stuck on
4 later? Have you checked on that too?
5 A. Yes. I put this question in the same way that you have just now,
6 whether -- as to whether it was possible at all, not in the context that
7 we are talking in here now, and the explanation I was given was that it is
8 impossible subsequently to intervene on x-rays taken, to interfere in the
9 sense of marking, covering up or correcting the original.
10 Q. And finally, Dr. Vucetic, let me ask you: You have also had
11 occasion to comment on the report of the radiologist from the hospital in
13 A. Yes. That report left a very good impression on me for several
14 reasons. It is the product of an expert radiologist, and that report
15 fully coincides with my own findings. I would just like to mention in
16 this connection two points from that report. A healed tibia fracture
17 coincides with the original tibia fracture from 1992, and a second finding
18 that the fibula fracture can be the consequence of a trauma from 1993. So
19 that report fully coincides with mine and I agree with everything it says.
20 JUDGE HUNT: Mr. Domazet, is that report in evidence? I'm not
21 sure whether it went in or not. That's the one from the radiologist in
22 the hospital at Gouda, I understand.
23 MR. DOMAZET: [Interpretation] Yes, Your Honour. That is the
24 report which I received and which I gave to Dr. Vucetic for his review,
25 among the other documents.
1 JUDGE HUNT: But is it an exhibit; that's all I'm trying to find
2 out. It isn't according to my list and it should have been, I think,
3 because it formed part of Dr. De Grave's general approach but I'm not sure
4 it was actually tendered.
5 MR. DOMAZET: [Interpretation] I think it was not tendered, that
6 the Prosecution that obtained the report and disclosed it to me, has not
7 tendered it into evidence officially yet and in my opinion too it should
8 be admitted, since it has also been reviewed by Dr. Vucetic, and I think
9 it is significant for Mr. Vasiljevic's defence.
10 JUDGE HUNT: Are you able to help us, Mr. Groome?
11 MR. GROOME: I do not believe that it is in evidence. I provided
12 the report as soon as I received it because it would clearly be Rule 68
13 material. Under 94 bis, if Mr. Domazet wants to introduce that report, I
14 would have to agree not to cross-examine. I would want to cross-examine
15 this doctor from Gouda. There were a number of, I believe, obvious flaws
16 in that report and in the methodology used. If Mr. Domazet is going to
17 seek to introduce that report, I would want to cross-examine that doctor.
18 JUDGE HUNT: I understand that but would you object to the tender
19 of it at this stage? Subject to your right to cross-examine the doctor.
20 MR. GROOME: Yes, Your Honour.
21 JUDGE HUNT: Very well, then. 41, D41. I think, Mr. Groome, as a
22 matter of convenience, seeing that the Prosecution has been in touch with
23 him, you better arrange for him to attend, it may be difficult from Mr.
24 Domazet's point of view to do so.
25 MR. GROOME: Well, Your Honour, I provided all the contact details
1 to Mr. Domazet when I gave him the report so I thought Mr. Domazet might
2 want to call him as a witness and that's why I provided that several
3 months ago.
4 JUDGE HUNT: Well, Mr. Domazet, it will be an exhibit but subject
5 to you producing the doctor for cross-examination. If you speak to the
6 Victims and Witnesses Unit, I'm sure they will arrange it for you.
7 MR. DOMAZET: [Interpretation] I agree, Your Honour.
8 JUDGE HUNT: Whilst we are on that particular issue, that document
9 that you filed I think last Friday in which you raised the issue about
10 visas, you had not in fact drawn that to the attention of the victims and
11 witnesses section. I read it last Friday, I made inquiry and they said
12 they had not been -- that you had not been in touch with them about it.
13 Merely filing documents, I'm afraid, do not -- does not ensure that people
14 such as the victims and witnesses section see them; they are only sent to
15 the Trial Chamber. So if you have those sorts of problems again, would
16 you please speak directly to the section? You can send them a fax, I
17 suppose, but you have to send them something directly. Merely filing a
18 document for the Trial Chamber will not do so. I'm not trying to be smart
19 when I say we are not a post box. It's simply a matter of ensuring, if
20 you want them to see it, that you take some steps to ensure that they do
21 see it.
22 MR. DOMAZET:
23 Q. [Interpretation] Dr. Vucetic, finally, on the basis of everything
24 that you have been able to see and review and the testimony you have
25 given, in your opinion is there any reasonable doubt that in this case,
1 these are x-rays of two different persons? I'm talking about the x-rays
2 from 1992 and 2001.
3 A. I am personally convinced that these two x-rays are x-rays of the
4 same person. That is, that they show one and the same fracture. And all
5 differences and doubts, differences of opinion, are conditioned by the
6 fact that the x-ray from 2001 was taken nine years after the fracture, and
7 all the changes that occurred in the meantime have been such that it is
8 not simple to compare the x-ray from 1992 with the one from 2001.
9 Q. Just one more question, doctor: In your opinion, would it have
10 been easier if there had been more x-rays from 1992 or, if I can put it
11 that way, if the x-rays had been of a better quality?
12 A. We lack x-rays from a later period. It is customary for patients
13 to be monitored over a period of several months during treatment, and also
14 upon the completion of treatment, which was not the case here, so this is
15 understandable up to a point in view of the circumstances and the
16 conditions under which Mitar Vasiljevic has been living over the past ten
17 years, and the material and economic difficulties that the health service
18 has had, as well as his own personal attitude towards his own health.
19 Q. I was referring to the 1992 x-ray, I meant that we only have one
20 x-ray taken from one perspective so my question was: Would it have been
21 easier to establish this if we had more x-rays taken from different
22 angles, because from your testimony and that of others, I have gathered
23 that it is very important, the angle from which the x-ray is taken
24 especially with regard to the smaller bone, or the fibula.
25 A. All that is important, but I have to say that on the basis of the
1 x-rays that we have from 1992, there are no signs at all, in fact, that
2 the fibula was broken, which again is not unusual. I have even, to
3 corroborate this statement, I have brought an x-ray from my own
4 experience, an x-ray taken a couple of weeks ago, in which I have a fibula
5 fracture, at the end of the fibula, and from one angle, the fracture can
6 be seen and from another, that fracture cannot be seen at all. I have
7 those x-rays in my possession here, and if there is a way, I can show them
8 to you. You can see here the fracture.
9 JUDGE HUNT: I'm afraid we can't see anything from here, doctor.
10 You could try it against a white sheet on the ELMO but I doubt whether we
11 will get very much from it.
12 THE WITNESS: [Interpretation] Let me try. You can see here the
13 date when the x-ray was taken, the 24th of December last year, so what I
14 am saying is that it is not rare that on one -- in one perspective we can
15 see the fracture and from another perspective it can't be seen. That's my
17 I think this will be sufficient for me to show it to you. What
18 I'm showing you now is an x-ray, this is the fibula and the fracture is
19 here, but it is not visible on this x-ray at all. With the tip of my pen
20 I will show you the fracture line. This is far more visible when one
21 views it directly against the light, but I have said all this to show that
22 it is quite frequent for a fracture to exist which can noted -- can be
23 noted only if an x-ray is taken from one angle and sometimes not at all.
24 In connection with Mitar Vasiljevic, the fibula fracture in my mind is
25 linked to his information about an injury in 1993.
1 MR. DOMAZET: [Interpretation] Thank you, Dr. Vucetic. I thought
2 this would be my last question. My question was whether there is any
3 reason to doubt that these could be the same person or two different
4 persons, so I don't think you have -- I think you have answered my
5 question. Thank you. I have no further questions for this witness.
6 JUDGE HUNT: Yes. Mr. Groome just before you start, you should
7 all have got a message that we are going to sit an extra hour a day as
8 between 4.30 and 5.30. We are very grateful to the Court reporters and
9 the interpreters for cooperating but we are desperate to get this case
10 finished by the end of next week. Yes, Mr. Groome?
11 Cross-examined by Mr. Groome:
12 Q. Doctor, we are about to take a break. I'll ask you a few
13 questions, but if possible could you leave the two x-rays available that
14 you tried to show us that I could look through the light during the break?
15 Thank you. If you leave them on the ELMO and with your permission I'll
16 look at them during our break.
17 A. Yes, of course.
18 Q. Doctor, now I want to go back to, or start with something that you
19 said that I found interesting. You said that -- well, let me ask you, as
20 an orthopaedic surgeon, are you saying that it is not important for you to
21 know the time when somebody was injured?
22 A. It is very important for us to know when someone was injured.
23 When I was speaking about this, we do not get the information about the
24 hour and minute of the injury but certainly we have to know when the
25 injury occurred, how many days or weeks, but of course days, prior to the
1 patient reporting to the doctor, so days are important. The hours are of
2 a secondary importance if we are talking about this kind of fracture. If
3 we are talking about injuries of blood vessels or if an injury involves --
4 affects the blood vessels, then also the hour is important.
5 Q. And when you testified that in your experience in Yugoslavia
6 except in one of the largest emergency hospitals in Belgrade, it's been
7 your experience that the time that a patient comes to an emergency ward is
8 not recorded typically, is that what you've told us earlier in your
10 A. The hours and minutes, the day certainly, yes, but in the case
11 history, we do not have information about the hour. We do have
12 information as to when the injury was sustained and when the patient was
13 admitted to hospital, but we do not have the hour when he reported to the
14 doctor. I know that this is recorded only in the emergency centre in
15 Belgrade when there is a special column that is filled in regarding the
17 Q. Doctor, let me read back a sentence of your testimony and it's at
18 the bottom of page 14 and on to 15: You testified, and I'm quoting, "Only
19 in the largest emergency hospital in Belgrade, when patients are received,
20 the date, the hour and minutes are registered. When the patient reported
21 to the emergency hospital." Do you recall saying that just a few minutes
22 ago? You need to just say "yes" or "no" for the mike.
23 A. Yes.
24 Q. So can I conclude from that statement that in other hospitals in
25 Yugoslavia, it is quite typical that the time that a person is received
1 into the emergency room is not recorded in the medical records?
2 A. Let me make myself even clearer. What I have insight into is the
3 discharge paper and possibly the case history. As for the protocol, the
4 book, which is kept in the emergency service of other institutions, is a
5 document that I don't have insight into. What I am claiming is that in
6 the case history, the document that accompanies the patient, there is no
7 indication or only very rarely, but as a rule there is no indication of
8 the hour and minute of the injury when the injury was sustained.
9 JUDGE HUNT: I think we better take the break now and we will
10 resume again at 11.30.
11 --- Recess taken at 11.00 a.m.
12 --- On resuming at 11.37 a.m.
13 JUDGE HUNT: I apologise for the late start. It's my fault. I
14 got involved in something which was urgent and which, as always, takes
15 longer than promised. However, we are back. Yes, Mr. Groome?
16 MR. GROOME:
17 Q. Doctor, I would just like to ask you a few more questions about
18 the time before I move on. What you said at the end of your testimony
19 before the break is a little bit different than what you said earlier this
20 morning. At the end of the break, you said that it's rare to find the
21 time of the injury, and what you said earlier in the day was that it was
22 rare to find the hour and the minutes of when a patient was registered as
23 having reported to the emergency hospital. So I want to return to my
24 original question. Is it your experience that it is rare on these case
25 histories for the time a person has reported to the hospital to be
2 A. The word "time" in the Serbian language, so to speak, refers to
3 time in the sense of the day or the hour and the minute as well, so
4 perhaps that is the source of this misunderstanding. So there is the day
5 when the injury was sustained and then there is the day when the patient
6 reported to the doctor. However, the hour and minute are very rare in
7 medical documents such as case histories and discharge papers. That's
8 what I'm referring to. And that is what I usually have in my hands.
9 Q. Now -- thank you for that answer. Now, are you saying that even
10 if there is a space to record the time, that in your experience, it's left
12 A. Often.
13 Q. Now, doctor, I just want to ask you a few questions about your
14 report. I'm just reading a portion of your report and I'm going to ask
15 you if you could explain what exactly you meant. In your report you say
16 the x-ray made on the 14 June 1992 of the lower leg is labelled with L in
17 the circle in the bottom left part. And then you refer to a call number,
18 and you draw attention to the fact that Dr. De Grave did not see a call
19 number also written on the x-ray. Do you recall what -- do you know what
20 I'm speaking about?
21 JUDGE HUNT: Call or code? I'm sorry, your reported as having
22 said call.
23 MR. GROOME: Yes, I'll read the precise quote from the report.
24 JUDGE HUNT: Perhaps, Mr. Groome, can you move your microphone a
25 bit closer? We are getting a terrible echo here. Thank you.
12 Blank page inserted to ensure pagination corresponds between the French and
13 English transcripts.
1 MR. GROOME:
2 Q. The report says, "The black marker is poorly visible in the dark
3 part of the x-rays so it is understandable that the expert witness, Dr.
4 Yvan De Grave, did not notice call number..." and then you have a
5 reference to Dr. De Grave. What call number did you notice that Dr.
6 De Grave did not notice?
7 A. I don't quite understand this word that I keep hearing in the
8 translation, "call number". I am speaking of the designation, of the
9 designate. I'm talking about the front view and the profile or rather the
10 left and right leg; "L" is the left leg, "R" is the right leg. That's
11 what I've been talking about. That is what Dr. De Grave refers to as well
12 in his report, and he also says that he could not find whether it was the
13 left leg or the right leg. I found that designation and that's what I
14 wrote about, and I imagine that this is what you've been referring to just
15 now. Nothing else. Just this designation. That is to say, that it was
16 designated that it was the left leg that was x-rayed. It is barely
17 visible but it is visible.
18 Q. Okay. Now, doctor, on your diagram -- and I'm referring to D39,
19 I'm not sure what the suffix number is but it's the diagram of the entire
20 leg, and what I want to ask you is on the diagram that you've provided us
21 the fibula is on the left side of the bone, and yet on the x-rays the
22 fibula appears on the right side of the bone. Can you explain why the
23 fibula is drawn differently than the x-rays?
24 A. [In English] Excuse me, can I see the x-rays?
25 A. Actually may I see the x-rays.
1 MR. GROOME: Actually, Your Honour, if I may, I handed up before
2 the session the copies of the x-rays. I ask that they be distributed now
3 to everybody. I will be using them in the course of my examination, as
4 well as two other documents on. Perhaps it would save time to distribute
5 them all at this point.
6 JUDGE HUNT: When you say, "Copies of the x-rays," you mean the
7 two that you examined just before -- that you asked for just before the
9 MR. GROOME: No, not copies of those. Copies of Exhibits already
10 in evidence. I believe it's 159 and 21. It's marked on the bottom of the
12 JUDGE HUNT: Thank you very much.
13 MR. GROOME: I'd ask that that all be given to the doctor.
14 Q. Doctor, I'd ask you to take a look at the photocopy of the x-ray
15 that's marked P151 on the bottom. And on P151, we see the fibula on the
16 right side of the tibia, yet on your diagram we see the reverse. Can you
17 explain why?
18 A. Yes. This is the way it is. Basically, there is no difference.
19 The x-ray that you have just offered, or rather the photocopy, according
20 to the way it was oriented and according to what was written on it is the
21 way these things are designated in medical documents, that is to say, in
22 anatomy atlases and things like that, precisely the way you have just
23 offered this. However, most often the left side is on the left side and
24 the right side is on the right side. So there is no basic difference
25 involved between the two. It depicts the same thing but it's just as if
1 it were viewed in a mirror. It's not really different. It shows the same
2 thing. It's just as if you were seeing a reflection in the mirror. What
3 you showed me here is perhaps more correct in a medical sense but what I
4 offered to the Court is perhaps simpler, for understanding what is on the
5 left side and what is on the right side. This is the way things are in
6 every day life, and it's easier for people who do not belong to the
7 medical profession to view things this way. What is left is on the left
8 side, what is right is on the right side. The fibula is on the left side
10 Q. Let me see if I understand you. What you're saying is that the
11 fibula is on the outer part of the leg?
12 A. Exactly.
13 Q. So this would be the view if we were looking down at our own legs,
14 is that what you're saying? The view that you've done in your diagram on
16 A. As in a mirror.
17 Q. Okay. Can you tell us what exactly just the word "cruris", what
18 does that word by itself mean?
19 A. The lower leg below the knee.
20 Q. Now, you also said at the end of Mr. Domazet's examination of you
21 that in your mind you have no doubt that the x-ray from 1992 and the x-ray
22 that we know to be of Mr. Vasiljevic from 2001, that they are the same
23 person, is that correct?
24 A. There can always be doubts. However, according to all the
25 indicators that I managed to find and that could help me in this
1 comparison, in this assessment whether it was the same fracture and the
2 same x-ray, the conclusion was that it was the same fracture and the same
3 leg and this fracture had healed since 1992.
4 Q. Now, you've told us in great detail all the indicators that --
5 you've testified about all of the indicators that the three other experts
6 talked about, the indicators that they used to determine that it was a
7 different person. Can you tell us specifically what are the indicators or
8 the features of the two bones which you point to that are so similar that
9 draw you to the conclusion that it is of the same person?
10 A. It is the form of the fracture. It is a spiral fracture, and that
11 is not contested in the 1992 x-ray and in the 2001 x-ray. Furthermore,
12 the orientation of the fracture, the fracture line also is not contested.
13 Then also the localisation of the fracture. There are certain differences
14 in the measurements involved that can be understood because we are
15 comparing a fracture that was healed to the fracture as it was initially
16 x-rayed. However, these differences can be taken as such. It can be
17 understood as being one and the same fracture but after all this time,
18 after the healing process, it is not exactly possible to recognise on the
19 healed fracture what kind of a fracture it had been. Furthermore, the
20 other parameters in terms of the form and structure of the bone do not
21 involve such major differences that we could ascertain that these are
22 different persons, or different bones rather.
23 Q. But, doctor, you would agree with me that it's very different to
24 conclude that it is impossible to say they are different people; that's a
25 very different statement than saying that it is the same person. You
1 would agree with me on that, wouldn't you?
2 A. Absolutely, absolutely. These are quite different assertions.
3 Q. Now let's talk about your assertion that it is the same person.
4 Can you give us an idea about how certain you are of that? Are you
5 certain that it's a 50 per cent probability it's the same person, a 90
6 per cent probability? Can you help us understand how sure you are that
7 it's the same person?
8 A. It is hard to put it that way. However, if necessary, in order to
9 have a better understanding of this, I would place it at, say, around 90
10 per cent, 90 per cent probability.
11 Q. Now, doctor, I want to move and speak with or -- ask you a few
12 questions regarding the plane of the fracture, and I'd like to begin, you
13 made some markings with a green pen on a diagram that you brought. I'd
14 ask you to take out that diagram at this point.
15 JUDGE HUNT: That was the copy of Dr. De Grave's schematic
17 MR. GROOME: Yes, Your Honour.
18 JUDGE HUNT: Yes.
19 MR. GROOME:
20 Q. Now, doctor, you made the mark with a green pen and unfortunately
21 that will wipe off very easily. There is a black permanent marker in
22 front of you, and I would ask you to retrace your mark with the black
23 permanent marker so that it doesn't dissolve after you draw it. It was on
24 the desk there during the break, the black marker to the far right, to the
25 far right.
1 A. They are the same quality.
2 Q. With that marker I'd ask you to draw the general plane of the
3 fracture as you would have determined it.
4 JUDGE HUNT: Wait a moment, what he drew was what he says Dr.
5 De Grave should have drawn on Dr. De Grave's own measurements. Because
6 you'll see that the line Dr. De Grave has drawn does not pass through the
7 intersection. This doctor has a completely different view as to where the
8 fracture began and ended. So that if you are asking him -- this is of
9 course what I think Mr. Domazet was also asking him -- he will have to now
10 drawn into this Exhibit P21.3 where he says the fracture begins and ends
11 before he could draft the plane or the general direction of the fracture,
12 as he says it should be shown.
13 MR. GROOME:
14 Q. Doctor, the line that you have just drawn now, is that -- is the
15 Judge correct, do you agree with what the Judge has said about what that
16 line indicates?
17 A. The Judge is quite right. He has completely understood this.
18 Q. Can you draw for us on that diagram the general plane that you
19 believe that the fracture took? Can you do it on the diagram?
20 A. This is what I'd like to say. This was marked according to the
21 values measured by Dr. De Grave, and I am going to look at the values that
22 I presented here for 1992, 5, 8, .4, and -- the differences may involve a
23 millimetre. However, I think that it coincides with the line the way I
24 draw it, yes.
25 Q. So it's clear, could I ask you to put just "V" to indicate that
1 you are in agreement with the line that you drew as being the approximate
2 fracture plane of the 1992 fracture. Could you just put a "V" next to the
3 line, in the same black pen? The black pen right at your right hand.
4 A. [Marks].
5 Q. Now, could I ask to you draw an approximation of the plane of
6 fracture that you observe on the 2001 x-ray of Mr. Vasiljevic? Can you
7 draw that on the same document?
8 A. I'll try.
9 JUDGE HUNT: Mr. Groome, the doctor is obviously writing on
10 something which I think is plastic and that's why you are saying it's
11 going to disappear. Would it be easier for you if he drew on the document
12 underneath the plastic, which is a copy of Exhibit P21.3.
13 MR. GROOME: Actually, what he has, Your Honour, is the image is
14 on the plastic with just a cover sheet underneath it.
15 JUDGE HUNT: Oh, I see. Because I'm watching it on the screen
16 here, it's like the Ganges river coming in and out.
17 MR. GROOME: I was hoping to save a bit of time with starting with
18 what he had already drawn but we can give him another copy of it if Your
19 Honour thinks it's a better way to proceed.
20 JUDGE HUNT: I think you'll find it will be easier for him and for
21 you if you just take a copy of P21.3, which is Dr. De Grave's schematic
23 MR. GROOME: Your Honour, the only copy I have has a mark on it.
24 JUDGE HUNT: It was amongst the documents which you circulated
25 this morning.
1 MR. GROOME: No, it wasn't, Your Honour, I apologise.
2 JUDGE HUNT: I'm afraid my copy is very written on too.
3 MR. GROOME:
4 Q. Doctor, perhaps the Judge is right. Let's move on to another
5 area. We will try to get a paper copy for you to work with in the next
6 few minutes, and we will come back to this.
7 Now, doctor, in your report that you did in December, when you
8 spoke about the plane of the fracture, you said that it actually changes
9 somewhat as it travels from front to back of the bone; is that correct?
10 A. It could be put that way. If viewed in individual segments. The
11 resulting plane is determined by the upper point of fracture and the lower
12 point of fracture and a series of individual points are at a different
13 angle. The fracture line looks like an extended letter "S", and therefore
14 the angle is more or less slanted at different points. So the fracture
15 line or the fracture plane is determined by the upper and lower points of
16 the fracture. It moves from one point on the bone to the other, the
17 opposite point, and that is how the fracture line is determined. If we
18 were to follow the line itself the way it goes, and if we were to put a
19 plane through that line, it could be in different positions. What I
20 observed and what is presented here on the schematic of Dr. De Grave, he
21 used one segment of this spiral which is clearly seen on the x-ray and
22 which has this slant, this angle, that he shows. However, what is valid
23 for us is this average value, the mean value, that is determined by the
24 lower and upper points of the plane. That is to say, if we were -- if we
25 could put a plane through this; that's what I've been trying to explain.
1 I don't know how clear I've been.
2 Q. I think you've been very clear, and as far as the average plane or
3 the general plane, we will return to that and I'll ask you to draw it.
4 But for the next few minutes I want to ask you about the variations in the
5 plane. And in your report, isn't it true that you say that at the front
6 of the bone the fracture plane begins somewhat level and then sharply
7 inclines towards the back of the bone as it travels to the back of the
8 bone? Is that correct? Again, we need to hear your answer to be
10 A. Yes. Yes. That is the way it is approximately. It is hard, and
11 perhaps it's not all that important for us to discuss individual segments
12 of this line. What is important is that we try to simplify this line,
13 which is of a relatively irregular shape but to put it in simplified
14 terms, it has the shape of a letter "S". That is what is referred to in
15 medical literature as well, this type of fracture. So in order to
16 simplify this, and in order to make it more understandable also like this
17 effort of Dr. De Grave's, was to present it through a schematic diagram.
18 The point is that this plane is determined by the extreme points, the
19 lower and upper points of the fracture, and that is what we should be
20 referring to.
21 Q. Okay, doctor, let's talk about, go back to talk about the general
22 plane. We now have a paper copy. I would ask that you -- you now have a
23 paper copy of Prosecution Exhibit 21.3. I'd ask you first just to write
24 your name at the bottom so that we'll know that it's your markings that
25 you are making.
1 A. [Marks].
2 Q. And I'll ask you to draw two general lines and you can draw it and
3 then we will place it on the ELMO for the rest of us to see. I would ask
4 you to draw a line to indicate the general fracture plane that you
5 observed in the 1992 x-ray.
6 A. [Marks].
7 Q. I would ask you to write the number "92" next to the line for 92,
8 so that we know what it indicates.
9 A. [Marks].
10 Q. So, doctor, the two lines that you have drawn have similar
11 fracture planes, and they fall somewhere between the two lines drawn by
12 Dr. De Grave; is that correct?
13 A. That is correct. You have also here the values. That is, the
14 distance in millimetres measured from the lower end of the tibia as
15 De Grave measured, and here we have the values on the x-rays from 1992 and
16 I have also drawn a plane for the x-ray from 2001, but the one from 2001
17 does not have the same kind of precision that we have determining the
18 fracture plane for 1992.
19 Q. But, doctor, just for clarity, what is -- is there a name for the
20 point in the tibia that everybody is taking these measurements from? Does
21 it have a name? What is the name of the point in the tibia that both you
22 and Dr. De Grave are taking your measurement from?
23 A. That point is the lower point of the lower fragment, the lower
24 part of the tibia, the lower point of the fracture line of -- on the lower
25 part of the tibia.
1 Q. Doctor, I'm not talking about the fracture line but the portion,
2 the reference point, that everybody is pointing to where the tibia, I
3 believe, meets the talus?
4 A. That's what I'm talking about. That point is on the fracture line
5 so we are talking about the lower point on the fracture line, the lower
6 point of the fracture line on the lower part of the tibia. And the upper
7 point of the lower part of the tibia.
8 Q. Doctor, looking at the drawing that you have made or the drawings
9 you've made on Dr. De Grave's diagram, it seems that the difference
10 between the two diagrams is that Dr. De Grave has chosen a point higher on
11 the bone as the beginning of the fracture or the upper most part of the
12 fracture. Does that explain the difference between the two fracture
14 A. There is a difference. Let me explain. I would agree with the
15 findings of the Prosecution experts if, for the lower point, what they
16 have marked as 8.4, if that is the lower point of the fracture on the
17 lower fragment of the tibia. And with that regard, there is no difference
18 virtually between my finding and the findings of the Prosecution witness.
19 The difference does exist in the marking of the upper point of the
20 fracture. There is a difference between me and Dr. De Grave. The
21 difference is minimal on the x-rays from 1992, if you look.
22 Q. Doctor, the difference between you and Dr. De Grave on the upper
23 most part of the fracture is two millimetres; is that correct?
24 A. That is correct, yes.
25 Q. And is that accurately reflected on the diagram that you have just
1 provided for us?
2 A. No, it isn't. I have made a mistake. I shall have to correct
3 myself. This would be 8.4. Yes. I have entered the correction now. So
4 there won't be any difference but he'll see where the difference is. What
5 Dr. De Grave offers as a line, he has drawn the line below the point
6 through which I have drawn the line, so this is the line that he should
7 have drawn. This is the line that he should have drawn. If he had drawn
8 that line through the points that he has marked, then it would coincide
9 with my own finding.
10 Q. Okay.
11 A. The main difference occurs in indicating the fracture plane on the
12 x-ray of 2001, between Dr. De Grave and myself, regarding the fracture
14 Q. Let's just move slowly here. So you agree with Dr. De Grave's
15 measurements of the 1992 x-ray. It's just that when he drew it on the
16 schematic here, he made an error in the line? And you've corrected that
17 for us?
18 A. One could put it that way, yes.
19 Q. Now, doctor, let's stay with the 1992 x-ray for a minute. In your
20 table that you provided us for the lower fracture point, you have two
21 numbers, you have 5.7 and then you have 8.4 which is the same value that
22 Dr. De Grave assigned to the lowest point. Can you explain why you have
23 put two values in that particular box?
24 A. These two values show the following: The lower point of the
25 fracture line of the distal fibula -- tibia, this is 8.4. That is, this
1 point here that I'm pointing to now, the lower point of the distal tibia,
2 that value is 8.4, according to my measurements. And according to
3 Dr. De Grave. However, this point here, the lower point of the upper part
4 of the tibia, is somewhat lower, and its value is 5.7.
5 Q. So you would say that the lowest point of the fracture is 5.7 and
6 not 8.4?
7 A. Yes.
8 Q. And when you drew the fracture plane the way you had described it
9 for us is that you would draw from the lowest point to the highest point.
10 Why did you draw it from 8.4 rather than 5.7?
11 A. That is a good question. And that is where there may be some
12 dispute in explaining the fracture plane. It could be, or it should be
13 determined by the upper point, and the lower point of the fracture line.
14 However, as we have the situation that there is a shortening when a
15 fracture occurs, there is a shortening, and if we are determining this
16 fracture plane according to the upper point and the lower point of the
17 fracture, it will be determined irrespective of the upper fragment, but if
18 we put it this way and the lower point of the fragment will be lower down
19 and that is the point 5.7, that is what we have here.
20 Q. Doctor let me see if I understand you correctly. When the bone is
21 broken we have two parts, the upper part and the lower part, correct?
22 Let's ignore the upper part for a minute. The distance between the bottom
23 of the tibia and the lowest part of the fracture on the lower part, that
24 measurement is 8.4 centimetres, according to you, correct? Please yes or
1 A. Yes, correct.
2 Q. And that is the same measurement that Dr. De Grave calculated for
3 that same distance, the bottom of the tibia to the lowest point in the
4 fracture, correct?
5 A. Yes.
6 Q. Now, what you're saying to us now is, and perhaps if I could have
7 the model that the doctor has made for us? Is that when a bone breaks,
8 they overlap; is that correct?
9 A. Correct.
10 Q. And this other measurement that you have, 5.7, is the distance
11 between the lowest point of the upper bone to the same reference on the
12 tibia, correct?
13 A. Yes, correct.
14 Q. Now, doctor, when Mr. Vasiljevic was put in traction, the whole
15 idea of the traction was to drawback the bone so that it resumed its
16 original place, correct?
17 A. Correct.
18 Q. So the distance that hasn't changed is the distance between the
19 bottom of the tibia to the bottom of the or the lowest point in the
20 fracture of the bottom fragment of the bone, the 8.4, that has not
21 changed, correct? Yes or no?
22 A. We are talking about the 1992 x-rays? Are we still talking about
24 Q. Just the 1992 x-ray, okay? So the measurement that will never
25 change is the measurement from the bottom of the tibia to the lower most
1 portion of the fracture on the lower fragment of the bone, correct?
2 A. Correct. The lower fragment, yes, correct.
3 Q. And the measurement that you have, 5.7, that measurement could
4 change depending on whether we were pulling back or forth on the bone,
6 A. Yes, correct.
7 Q. So would you agree with me that the better measurement for us to
8 use in the analysis of this bone is the measurement that 8.4 that both you
9 and Dr. De Grave put in your values? Correct?
10 A. If we are talking about the x-rays from 1992, then there is no
11 doubt that that is so, but the point on the x-ray from 2002 is something
12 that we cannot see well.
13 Q. Okay. Let's just confine ourselves to 1992. So both you and
14 Dr. De Grave have the same measurement for the lower -- lowest point of
15 the fracture and your value for the uppermost part of the fracture, the
16 difference is minimal, it's 2 millimetres, correct?
17 A. Yes, correct.
18 Q. So you would agree with Dr. De Grave's findings regarding the
19 plane of the fracture in 1992?
20 A. Yes.
21 Q. Now, --
22 A. But in as far as the designation of the points is concerned, but
23 the plane he has drawn and the graphic presentation by Dr. De Grave does
24 not correspond and does not coincide with the values he himself measured.
25 Q. And you've corrected that for us on the exhibit. Okay?
1 A. Yes, correct.
2 Q. Now, and what you're telling us about the 2001 x-ray is that you
3 are able to draw a similar plane or you are unable to because the bone
4 has changed?
5 A. To do that with precision is extremely difficult. We can draw a
6 line which can help us to make a comparison but to do so with precision is
7 very difficult to do, and we can only determine a range within which that
8 plane may be. An approximation, in other words, an approximate value can
9 be given.
10 Q. So I'd ask you on -- I'm sorry, I'd ask you to look at the angle
11 of plane that you've written on your -- that exhibit in front of you and
12 do you still say that that is the best estimate that you can give
13 regarding the plane of the fracture in the 2001 x-ray?
14 A. What I have done here, the line drawn on this diagram, is an
15 orientation, a visual presentation of the data that we have. It would
16 require more precision if we were to compare these lines but on the basis
17 of the values given in the table, which is a component part of the
18 document, it is possible to make a graphic presentation.
19 Q. And the difference between your findings and Dr. De Grave's
20 findings, on the 2001 x-ray is -- are or is that you believe he's
21 estimated the highest point on the fracture to be too high; is that
22 correct? You believe he's picked a point higher than the actual fracture
24 A. Correct.
25 Q. And when you look at the point of the bone that is 20.3
1 centimetres above the bottom of the tibia, you see no evidence of any
2 fracture having been at that location; is that correct?
3 A. The way you put it, evidence that there was a fracture, by means
4 of x-rays, there are signs of bone reaction. That bone reaction has
5 manifested itself with the formation of new bone and that newly formed
6 bone or callous appears where the injury occurred, that is where the
7 fracture occurred, and covers a broader area than the actual fracture
9 Q. Now let me ask you a question about that principle. What is the
10 greatest distance that you would expect to see a change in the bone past a
11 fracture, so if a fracture is, let's say, at 0, would we expect to see a
12 change in the bone 1 centimetre above it, 1.5 centimetres? What is the
13 distance we would expect to see a reaction in the bone above the fracture?
14 A. That distance may be half a centimetre, 1 centimetre or 2
15 centimetres as can be seen on this example that I'm showing you. You can
16 see the fracture line, you can see the newly formed bone, and here it is
17 indicated that this was taken 25 months after fracture and the other one
18 40 months after fracture, and you can see for yourself the difference and
19 the changes that occur.
20 Q. Now, doctor, what would be the typical -- you've given us a
21 range. What would be the maximum amount of distance that you would expect
22 to see bone reaction from a fracture? Is 2 centimetres the maximum
24 A. One could agree that it could be 2 centimetres or a little more on
25 one side of the fracture line and as much on the other side of the
1 fracture line so if Dr. De Grave fixed the point or a value of 20.3
2 centimetres as the highest point where he saw bone reaction we can safely
3 say that the fracture must have been at least 18.3 centimetres above the
4 bottom of the tibia; is that correct?
5 A. We cannot assert that but an assumption may be such as what I have
6 said that that point is fixed at 16.5 centimetres. I may also have made
7 an error, perhaps, because this is just an estimate made by whoever is
8 doing the analysis.
9 Q. Well, let me ask you about your value of 16.5. Is that the
10 highest point on the bone that you see evidence of bone reaction or is
11 that your estimate of where you think the fracture was?
12 A. It is my estimate as to where I think the fracture occurred.
13 Q. And therefore there is some evidence of bone reaction above 16.5;
14 is that correct?
15 A. Yes.
16 Q. But if we were to sit down and recalculate this, we should not
17 see any evidence of bone reaction above 18.5 centimetres; is that correct?
18 A. If we want to explain in simplified terms, as I have said, the
19 reaction can be 1 centimetre, 2 centimetres and more. Therefore those 2
20 centimetres are also an orientation value only.
21 Q. So it seems that you're changing now what you said a minute ago,
22 it can be more than 2 centimetres? Is that what you're saying?
23 A. Even more than 2 centimetres, yes.
24 Q. Well, let me ask you again what is the maximum amount of distance
25 that you would expect to see from a fracture to see bone reaction?
1 A. It is very difficult to give you an answer to that question. I
2 see that you're insisting on an answer so, well, let's say to simplify
3 things, 2 centimetres, 3 centimetres.
4 Q. Doctor, I want to go back now to the specifics variations in the
5 plane of the fracture. Let's put aside everything that we have talked
6 about now about the general plane and let's talk about the specific
7 variation of the plane. And to help you illustrate what you've said in
8 your report about the plane, I'm going to ask you and I must confess I am
9 very embarrassed to give you my drawing of a leg, it's P190, it's on your
10 desk somewhere there. It's a very crude drawing of a leg bone.
11 JUDGE HUNT: What number did you say it was?
12 MR. GROOME: I'm sorry, P190 is one of the documents that was just
13 distributed. It's a very crude drawing of a rectangle and a triangle.
14 JUDGE HUNT: It's not an exhibit yet.
15 MR. GROOME: I'm sorry.
16 Q. Now, doctor, in your report you describe the variations in the
17 fracture plane as being somewhat less acute in the beginning, in the front
18 of the leg, and then moving sharply up towards the back of the leg. I
19 would ask you to represent that on the drawing for 1992. Can you give us
20 an approximation of what the fracture, the variation in the fracture plane
21 as you've described in your report?
22 A. If I understand your question correctly, you want me on this
23 lateral projection to indicate the fracture line.
24 Q. Yes. With the variations, not the general one but with that
25 variation that you describe in your report.
1 A. I understand.
2 Q. Doctor, I'd ask you just to write your name at the bottom there so
3 we know that you did that drawing?
4 A. [Marks]
5 Q. And, Doctor, I would ask you now to make the same representation
6 on the 2001. What did the shape of the fracture plane look like on that
7 x-ray? If you need to refresh your memory there is a copy of the 2001
8 x-ray in the materials that I provided you. 21.1.
9 A. [Marks]
10 Q. Okay. Your Honour, at this time I would ask that the first
11 drawing where the doctor drew on 21.5 -- I'm sorry, on 21.3, I would ask
12 that that be tendered into evidence as 21.5. And this diagram now that
13 the doctor has just done, I would tender that as Prosecution number 192.
14 I'm sorry, 190.
15 JUDGE HUNT: Heaven's, your last number was 165 but all the other
16 numbers are assigned, are they?
17 MR. GROOME: The network was down earlier so we jumped up safely
18 not to overlap.
19 JUDGE HUNT: I'm glad you're having trouble with the network. We
20 were too. Very well. Any objection to that, Mr. Domazet?
21 MR. DOMAZET: No, Your Honour.
22 JUDGE HUNT: The copy of Exhibit P21.3 upon which the doctor has
23 drawn some lines and made some notes will now be Exhibit P21.5. And
24 Mr. Groome's representation of a foot will be Exhibit P190.
25 MR. GROOME:
1 Q. Now, Doctor, as you have noted in the reports, there were also
2 some findings regarding the fibula, and I would ask you, do you see any
3 fracture of the fibula in the 1992 x-ray?
4 A. Radiologically there are no signs or there are no visible signs of
5 a fracture of the fibula. However, the possibility is not precluded, that
6 is to say of the existence of a fracture which radiographically or at
7 least in the projections that we have here can be seen.
8 Q. And you were kind enough to allow me to look at two -- an example
9 of a case that you had recently where a fibula fracture showed up in one
10 view but did not show up in the other view; is that correct?
11 A. That's right.
12 Q. And the x-rays that you brought with you to court, would it be
13 fair to say that one of them is a straight-on view or an AP view, I
14 believe is being termed, and the other is a lateral view? Is that
16 A. Correct.
17 Q. And is it because of this fact that it is standard protocol to
18 always take this AP view, a lateral view, so that we -- so a doctor can
19 properly diagnose the tibia? Is that correct?
20 A. Exactly.
21 Q. And in this particular case, we have both an AP view, a front-on
22 view, and a lateral view of the accused's, Mr. Vasic -- oh, I'm sorry, of
23 the person in 1992?
24 A. Yes.
25 Q. Now, doctor, I'm going to ask you to suffer through one other very
1 crude drawing, I ask that it be placed on the ELMO, and I ask that it be
2 designated Prosecution document 191. Doctor, let me explain this very
3 briefly before I ask you a question about it. Let's assume that the
4 circle in the middle is the fibula, and let's assume that the point where
5 the two lines meet is the x-ray head, okay? And the "L" stands for
6 lateral view of the bone, and the "AP" would stand for the frontal view of
7 the bone; is that correct? I'm sorry, do you agree with that, okay?
8 A. Yes.
9 Q. Now, according to this very crude diagram, if those two -- if
10 x-rays are taken from those two different positions, you as an
11 orthopaedist would have a picture of 75 per cent of the bone; is that
13 A. I don't know what 75 per cent means but practically we can see the
14 bone. I mean that segment that is shown on the x-ray can be seen from the
15 side and from the front.
16 Q. So the portion of the bone that cannot be seen with these two
17 views is the portion in the bone -- the portion of the fibula that's at
18 the upper right hand section of this representation of a fibula; correct?
19 A. If I've understood you correctly, I don't think that that is the
20 core of the matter. The point of your question is to explain how come it
21 can be seen from one view and cannot be seen from another view, from
22 another angle. You see, I'll try to show you on this model viewed from
23 this perspective that I'm showing you. This is obviously separated,
24 right? Now, viewed from this angle, 90 per cent rotation involved, you
25 will not see that these two are separated. And that is the reason why it
1 can be seen from one perspective and cannot be seen from the other. And
2 the other reason is the quality of the x-rays themselves.
3 Q. So doctor, am I correct in understanding from your explanation
4 that once we have the two views, we can be quite certain whether or not
5 there is a fracture in the tibia; is that correct? I'm sorry, the fibula.
6 A. That is most often correct, but in order to be quite certain, in
7 orthopaedic practice, additional x-rays are made and supplementary x-rays
8 are made.
9 Q. And in your analysis of the 1992 x-ray, you find no evidence of a
10 fibula fracture, correct?
11 A. Yes.
12 Q. Now, when you studied the 2001 x-rays, and you have it in front of
13 you as P21.1, would you agree with me that there is significant bone
14 reaction on the fibula in the 2001 x-ray?
15 A. Yes, correct.
16 Q. So in your mind, at some point, this fibula of Mr. Vasiljevic's,
17 which we are looking at in 2001, had a complete fracture that would show
18 up on a radiograph; is that correct?
19 A. Yes. That fracture, the way it looked in 2001, would have to have
20 been shown initially as well. There is a piece of information that I also
21 had; namely, that Mr. Mitar Miric [as interpreted] had a fracture -- had
22 sustained a fracture in 1993 as well, so this piece of information that we
23 have, or rather the findings that we have that the fibula fracture had
24 healed is something I relate to this fact, that he had a fracture of the
25 lower leg bone in 1993. That is my explanation.
1 Q. And do you think it's possible that any orthopaedist could have
2 looked at the 1992 x-ray and have made a diagnosis that the fibula was
4 A. I don't know if we understand each other now that we have been
5 discussing this. Are you trying to ask me whether every orthopaedic
6 surgeon would not have seen the fracture in 1992, whether no surgeon would
7 have seen it then? Could you please repeat your question.
8 Q. Yes, I apologise. What I'm asking you is you've said pretty
9 categorically that there is no fracture, and I'm what I'm asking you, is
10 it maybe something other orthopaedists would dispute, or are you pretty
11 confident that every orthopaedist would look at the fibula on the 1992
12 x-ray and say there is no fracture here?
13 A. I'm trying to say this: It is one question whether there was a
14 fracture at all and it is a different question whether there are x-ray
15 signs of the fracture concerned. This is what I've been speaking about,
16 that there are no x-ray signs on the x-ray from 1992 showing that there
17 was a fracture, and I think that any other orthopaedist would have the
18 same finding by viewing the x-rays from 1992, namely that there was no
20 Q. Doctor let me ask you this now: If a patient presented himself
21 to you in the hospital with the 1992 x-ray and it was a condition of
22 wartime and beds were scarce, how would you have treated the person who
23 presented themselves with the 1992 x-ray that you had before you? Would
24 you have placed the person in traction or would you have put the person in
25 a cast and allowed them to go home?
1 A. From a professional point of view, the dilemma is not a major one
2 although there are different options of treatment. You mentioned two of
3 them right now. One thing is for sure. A patient who has a fractured
4 lower leg has to undergo a special regimen of immobilisation with his leg
5 put up, that is to say, in hospital. If it is the doctor's estimate that
6 it is not indispensable to have a correction made in terms of the position
7 of the fragments, the patient can be left in a cast only, but in a
8 reclining position without getting up and with the leg at a -- raised at
9 least 20 to 30 centimetres. That is the simplest form of treatment. And
10 also, the development of swellings, circulation and other important
11 factors are monitored. And the other possible way of treating this is
12 precisely the way in which Mitar Miric [as interpreted] was treated. And
13 that also has to do with hospitalisation, hospital treatment. This makes
14 the patient absolutely bedridden. The patient cannot get up. If he is
15 treated by skeletal traction of the fracture.
16 Q. Doctor, let me go back to my original question: If you saw this
17 x-ray presented with the circumstances I've given you, what would you have
19 A. I think I would have treated him the same way.
20 Q. You would have put him in traction as well?
21 A. Yes, the same way.
22 Q. Doctor, am I correct in understanding that the primary function of
23 traction is or in the case where both the tibia and the fibula are broken,
24 it's to prevent the overlapping of the bones as you've described and the
25 bones healing in such a way that the leg is shorter than the uninjured
1 leg? Is that correct?
2 A. Yes.
3 Q. And am I also correct in saying that one of the reasons you have
4 an option when the fibula is not broken is that the fibula will maintain
5 the proper length of the leg during the healing process of the tibia; is
6 that correct?
7 A. In principle, yes. In orthopaedics, two centimetres are tolerated
8 in terms of shortening. In some situations, this may be acceptable,
9 taking into account the age of the patient, his general condition, other
10 injuries, et cetera. So this estimate can be quite different.
11 Q. Now, one of the things you said when we were talking about medical
12 records was that in your mind, it was very important to know the
13 circumstances under which a patient fractured their bone; is that
15 A. Yes.
16 Q. And if I were a patient and you were interviewing me for the first
17 time regarding an injury, if I told you that I got hit by a car, are there
18 any set of circumstances that you think or you can tell me in which you
19 would write down something different, you would write down something that
20 wasn't true?
21 A. No. Information is entered into medical documents that is
22 received either from the patient, if he is in a position to speak, or
23 persons who are accompanying the patient. The doctor never goes into the
24 truthfulness of the information received. The doctor simply records the
25 information he received from the patient.
1 Q. So, doctor, what you're saying is if you looked at after examining
2 me, if you had a clear opinion that I wasn't hit by a car, you would still
3 write down, patient says he was hit by a car; is that correct?
4 A. This is the way it's done: If there is evident suspicion of this
5 nature, as you had put it in this example, the doctor would write more or
6 less this, "According to the patient himself, he was injured in a car
7 accident." And then in a separate entry, where he speaks of his own
8 clinical findings he would write that, "According to clinical
9 characteristics, the fracture corresponds to or does not correspond to the
10 injury that was mentioned." You mentioned the car. You mentioned a car
11 accident and that is quite different from the way Mitar was injured. In
12 traumatology low intensity and high intensity forces are taken into
13 account very seriously. What you mentioned is high intensity and then
14 ballistic injuries and falls from high altitudes et cetera are high
15 intensity forces. However the way Mitar Miric [as interpreted] was
16 injured is different. That is a result of low intensity forces, like
17 falling on flat ground, et cetera.
18 Q. Doctor as a purely hypothetical question, I want to ask you the
19 way that it's been described to us by Mr. Vasiljevic himself is that he
20 fell off a horse and a horse fell on him. Is that account significant or
21 consistent with the -- what you observe in the 1992 x-ray? Could a person
22 have injured themselves by having a horse fall on their leg in that
24 A. I think that that is in line with that story.
25 Q. Now, you've told us several times that this is a spiral fracture.
12 Blank page inserted to ensure pagination corresponds between the French and
13 English transcripts.
1 My question to you is: Isn't it a fact that the way one receives a spiral
2 fracture is that their foot is firmly planted on the ground and something
3 causes their body to twist with such force that their bone actually twists
4 and breaks; is that not correct?
5 A. That is the typical way, yes.
6 JUDGE HUNT: I suppose, Mr. Groome, that if you looked at the way
7 you often hear about spiral fractures when people are wearing skis and
8 their ski is caught in a particular angle and their leg keeps on moving,
9 that can cause a spiral fracture. I wouldn't like to you depend upon
10 solely the foot being put on the ground.
11 MR. GROOME: I guess what I'm trying to say, it's a twisting force
12 that causes the fracture in a spiral fracture, correct?
13 A. Yes.
14 Q. Now, if I were standing still right now and a car hit me with
15 sufficient force straight on to break my leg, you would expect a different
16 type of fracture; correct?
17 A. Yes.
18 Q. And I'm -- let's not use the example of this high force, let's go
19 with the low force. If somehow a horse was to fall against the side of
20 my leg right now, would you expect a see a different fracture?
21 A. You asked me if a horse was to hit you, we are not talking about
22 this fall off a horse. We are talking about a man who is standing and a
23 horse hits him from the side; is that your question?
24 Q. What Mr. Vasiljevic has testified to is that he fell off the
25 horse, and while on the ground, the horse fell on to his leg, fell on to
1 him, on to his leg.
2 A. I understand now what seems unclear now. Your assumption is that
3 the injured person is lying on the ground. He is just lying there and the
4 horse falls. However, the situation is a bit different. He falls, the
5 horse falls, the patient probably tries to move from the place where he
6 had fallen or he is -- he still has energy of motion. Since he was in
7 motion. He fell off a horse. He is probably still moving, but part of
8 his body is still on the ground so part of this motion is in the form of
9 rotation. He's trying to turn over, either the horse is turning him as he
10 falls or he himself turns but there is this component of rotation. These
11 injuries are usually very complex. Sometimes indeed there is only the
12 effect of a force in one direction, indeed, however, sometimes there is a
13 more complex effect. There is also this lateral effect. There is also
14 this rotation involved.
15 Q. Doctor, I just want to ask you one or two questions about what
16 Mr. Domazet inquired regarding the labels, and you've described that after
17 speaking with other people in your field and related fields, it seems that
18 a logical explanation for this is this window in the cassette that is used
19 for the x-ray as well as a plastic device that is used to put the name of
20 the person onto the x-ray; is that correct?
21 A. This x-ray cassette is actually a metal box that has a slit here
22 on this metal surface which is closed by plastic. Because there cannot be
23 any light inside, because the x-ray has to be protected from light. So
24 then it is covered by this plastic, and then this involves a certain
25 surface. Sometimes the x-ray itself is a bit disfigured and to put it
1 quite simply, nobody has ever thought of the possibility of that being
2 changed subsequently.
3 Q. Let me ask you a very obvious question. An x-ray film is only
4 used one time; is that correct?
5 A. That's correct.
6 Q. So your explanation would account for one shadow on the x-ray film
7 but it doesn't account for multiple shadows on the x-ray film, does it?
8 A. What I'm trying to say to you is the following: Each shadow, as
9 far as I could understand what they showed you, this plastic cover is of a
10 different thickness so that it could fit into this metal part. It is
11 gauged in a certain way so this different thickness of plastic is depicted
12 radiographically and that is what we see as different surfaces.
13 MR. GROOME: Your Honour, I wish to pause here.
14 JUDGE HUNT: Right. We will resume again at 2.30.
15 --- Luncheon recess taken at 1.00 p.m.
2 --- On resuming at 2.32 p.m.
3 JUDGE HUNT: Mr. Groome.
4 MR. GROOME:
5 Q. Good afternoon, doctor. Doctor, we ended our session earlier
6 talking about the label on the x-ray cassette and how it was the opinion
7 of you, after talking to some other people in the field, that that was
8 responsible for the shadow or the white area that we see on the bottom of
9 the 1992 x-ray, and what I would ask you is, if a film is used only one
10 time, it appears that there are at least three different images of these
11 labels that you are talking about and I'm asking you, is the explanation
12 that you've given us, does that satisfactorily account for the several
13 images that we see?
14 A. I do not consider myself to be sufficiently qualified to interpret
15 everything in the technical sense, as to what is on the x-rays, but I have
16 spoken to people who are qualified and this was the explanation I was
17 given. In summary form, that explanation is that what we notice is
18 something that is customary on x-rays which are treated in that way
19 throughout Yugoslavia, and a second point is that it is not possible to
20 make any subsequent corrections or manipulations with such x-rays. That
21 is as much as I know about that, and I was given this information from
22 people who I think are better qualified than me, who are involved in the
23 actual technical procedure of making and storing x-rays.
24 Q. Let me ask you this, then, doctor. You apparently have an awful
25 lot of experience in working with x-rays in Yugoslavia. Have you come
1 across this phenomenon before and if so, how often?
2 A. Yes, quite frequently. I think it can be seen on the couple of
3 x-rays that I've brought with me that were done in the emergency centre in
5 Q. And on the x-rays that you brought with you, is there more than a
6 single image that is imprinted on the x-ray film?
7 A. I wouldn't say that there were more than one, but the traces have
8 the same characteristics, though indeed it is true that there are several
9 on the x-ray that we have from 1992, but --
10 Q. In your experience, then -- and when I say, "Your experience,"
11 let's include the two x-rays you brought with you, it is common to see one
12 of these white areas at the bottom of an x-ray; correct?
13 A. One or several. It's not something that was of any significance
14 for me, for me to look into in the past, nor did it attract my attention,
15 so it's not something that we attach any importance to.
16 Q. Doctor, I'm going to ask you to look at the 2001 x-ray; it's 21.2.
17 You were provided a copy earlier in the day. The usher says that you kept
18 it over lunch. I'd ask that it be placed on the ELMO. Now, doctor, I'm
19 going to ask you to focus on the right radiograph on Prosecution
20 Exhibit 21.2, and you can see some markings on that and those markings
21 were made by Dr. De Grave to indicate the lowest point of the fracture and
22 the highest point of the fracture. Now, in your testimony earlier today,
23 it is clear that you have some disagreement with Dr. De Grave over the
24 positions that he has selected. I'm going to ask you to take a red pen
25 that's in front of you, and I'm going to ask you -- maybe the fine -- I
1 think the fine point marker that the usher is giving you will probably be
2 best suited. I'm going to ask you to mark on the exhibit that's on the
3 ELMO, will you mark where you believe the lowest point of the fracture is
4 on the 2001 x-ray?
5 A. I'll do my best. [Marks] I've marked it. The top point is 16.5
6 centimetres and the lowest is 5.5. That is the AP view.
7 Q. But, doctor, I'm not so concerned with the measurements but I'm
8 more interested in you marking on the bone where you see whatever feature
9 you see on the bone that leads you to the conclusion that that's where the
10 top of the fracture is. So if you would mark right on the bone itself,
11 just as Dr. De Grave has done.
12 A. [Marks].
13 Q. And I'd ask you maybe just to put your initials there to
14 indicate --
15 A. [Marks].
16 Q. Now, the circle that you've put at the top of the bone, can you
17 explain to us non-medical people what do you see there that leads you to
18 believe that that is where the fracture -- the highest point of the
19 fracture is?
20 A. You can see here certain traces of a slanting line and that would
21 roughly be the direction of the fracture, and you can see here a certain
22 thinning of the bone and this would be the central line between the lower
23 slanting line and the upper slanting line, which could determine the
24 direction of the fracture plane, and that is what I was guided by in
25 making these markings. Furthermore, what we are looking at on this
1 radiograph, the points that we are observing, we have to try and see them
2 from a different angle as well, which would serve to check the correctness
3 of what we see on this radiograph. So to assess these radiographs
4 independently, one may make an error. So they have to be assessed
6 Q. I'm just asking to you mark this particular radiograph and what's
7 visible from this radiograph. We can look at other ones or Mr. Domazet
8 can ask you about other ones but on this particular radiograph you've
9 circled the upper point. Can you describe for us the lower point that you
10 circled, what is it inside that circle or that portion of the bone that
11 you observe that makes you indicate that as the lowest point of the
13 A. Trace here, and which shows that that is the line of the fracture
14 but there are also other changes in the bone structure in linear form here
15 which, at first glance, may also appear to be a fracture trace but they
16 can be due to a change in the bone structure and to certain unevenness on
17 the surface. What I see here as the fracture line is this line, which can
18 be seen along the entire central part of the bone in a slanting form. I
19 have now marked it with a dotted line.
20 Q. Okay. Now, doctor, I'd ask you to look at Prosecution
21 Exhibit 21.1, or a copy of that exhibit, that is the lateral view of the
22 same leg in 2001. I'd ask you just to write your name on the bottom of
23 that and then I would ask you to do the same exercise, mark the uppermost
24 portion of the fracture and the lowermost portion as you have determined
25 it. And again the markings on that particular diagram are also of Dr. De
2 A. [Marks].
3 Q. And on the upper -- your indication of the upper parts of the
4 fracture the highest point, what is it about this that we should be
5 looking at that you determined was the start of the fracture? What is the
6 feature on the bone there?
7 A. There are two things that I would like to point out here. One is
8 of a linear structure or certain traces that can be noticed in the bone
9 structure and another is that a fracture that would be so slanting or so
10 steep is very rarely encountered so that a point marked at 20 centimetres
11 and beginning at 3 centimetres would mean that the length of the structure
12 would be 16 centimetres, which is very, very unusual for a fracture. It
13 is something that one does not come across, at least as far as I know. So
14 that is one matter, that this line is so long and so steep is something
15 that is rarely encountered. And the second is the change in the bone
16 structure. The points as they have been offered are the extreme ends
17 where change in the bone structure can be seen, and this is due to the
18 formation of new bone in the process of healing, and that is the
19 methodological difference which is certainly obviously in dispute.
20 Q. Can you, if it's a different place, can you show us on that
21 picture where is the highest point on the bone that you see bone reaction
22 or bone reformulation?
23 A. If that is what you're asking me, that is the point that has been
24 marked by the experts who have marked it as 20. That is the extreme end
25 where one can notice bone reaction.
1 Q. So your determination of where the fracture line is, is to find
2 the highest point of reformation of bone and then to estimate downward to
3 where you believe the fracture would have been? Is that how you reached
4 your determination?
5 A. No, no. That is how the authors, Dr. De Grave and Dr. Bollen and
6 Dr. Raby, that is the method they applied, the one you have described.
7 They used the extreme point on the radiograph where one can see changes on
8 the bone, and it is due to the healing of the fracture and the newly
9 formed bone which is the way in which a fracture heals, whereas the
10 fracture itself, if you're asking me where the end of it was, it is
11 certainly below that point, and it can be assumed or intimated on the
12 basis of the traces in the bone structure, and that is how I have
13 determined it through my measurements at the level of approximately 16.5.
14 Q. Doctor, would you, before we finish with that exhibit, would you
15 please trace the line of the fracture as you believe it to be on that view
16 of the leg?
17 A. [Marks].
18 Q. Thank you, doctor.
19 MR. GROOME: Your Honour, at this time I would tender the copy of
20 Prosecution documents 21.1 and 21.2 that the doctor has written on as
21 Prosecution Exhibits 21.6 and 21.7.
22 JUDGE HUNT: Yes, Mr. Domazet, any objection?
23 MR. DOMAZET: No objection, Your Honour.
24 JUDGE HUNT: Thank you. They will be Exhibits P21.6 and P21.7.
25 MR. GROOME:
1 Q. Doctor, just my final few questions for you. I would ask to you
2 take a look at a copy of Prosecution Exhibit 21.4. It's a picture of the
3 heel structure as viewed of both the 1992 and the 199 -- or the 2001
4 x-ray. Now, Dr. De Grave found some significant differences between the
5 calcaneus bone in both x-rays. If I understand your testimony correctly,
6 you also agree, or you agree with Dr. De Grave that there are differences
7 in the calcaneus bone but what you are telling us is that those changes
8 are a normal function of bone regeneration and deterioration over the
9 course of the nine years that transpired between the taking of the two
10 x-rays; is that correct?
11 A. Yes.
12 Q. But you do not dispute that looking at those two, the heel bone or
13 the calcaneus, there are differences between them? You agree with that?
14 A. One can say so, yes.
15 Q. Now, I'd ask you to look at the talus bone, and I'd ask you to
16 look at the head of the talus bone and compare the two of those. Would
17 you agree that there are also differences between the head of the talus
18 bone in both of these x-rays?
19 JUDGE HUNT: You're, of course, speaking to an expert but there
20 are others of us here who are not experts. I've got a medical dictionary
21 but can you tell us where you're referring to?
22 MR. GROOME: I apologise, Your Honour, I handed up 167. This is a
23 diagram and the names of all the bones.
24 JUDGE HUNT: I'm sorry, thank you very much. Yes, you did indeed.
25 MR. GROOME:
1 Q. I'd ask you to point to the head of the talus bone.
2 A. [Indicates].
3 Q. And would you agree that there are differences in the shape of the
4 talus bone between both the 1992 x-ray and the 2001 x-ray?
5 A. Those differences are so minimal that I don't think they should be
6 of any real significance in this -- these proceedings, especially as one
7 should take into account, as has been marked here, the rear end of the
8 talus. It is due to degenerative changes, changes on the bone as a result
9 of the passage of time, because nine years is a long period, which
10 necessarily entails changes in the bones, and this fully fits into what
11 one would expect after such a long period of time in the bones.
12 Q. Well, let me ask you now to look at one particular feature, and
13 would it -- isn't it remarkable that all these other features of the
14 calcaneus bone have changed over the course of nine years but yet if we
15 look at the hole made by the traction in 1992, that it is, quite
16 remarkably, still perfectly round and looks quite clean? Would you agree
17 with my description of the traction hole?
18 A. Yes, it is true that holes are often made in the bones because of
19 fixation and traction and so on, and they persist for quite a long time,
20 as circular formations with a characteristic sclerotic edge and lighted up
21 in a sense, so that is the only explanation I can give you that this is
22 due to skeletal traction. It has a very typical appearance, it is in a
23 typical position, and it is also typical that they can be seen for a long
24 time. A fracture may heal but these traces may persist for years,
25 whether it was due to traction or external fixation of screws even.
1 Q. But you agree with me that there are significant changes to this
2 calcaneus bone but for some reason, the traction hole has remained
3 constant over the nine years?
4 A. I know that may appear strange in comparison with what I have said
5 that changes do occur, yet the hole is visible. It has changed however.
6 It didn't look exactly like that in 1992 but the trace of the hole
7 remains. It's another matter, however, that bones do not change equally
8 in all places. There are certain places where it changes in a particular
9 way. That is the biological reaction. That is something quite specific.
10 And it is up to the medical profession to judge, because we simply know
11 how a particular biological structure reacts to a certain impact or
12 influence, to make a very simple analogy, and to say if one thing happens
13 in one particular bone, if it heals in three weeks and another bone in six
14 months or even longer, so to make any generalisations is not a good method
15 in making any judgements in medicine.
16 Q. Doctor, my final question is this: If what you say is true, let's
17 say I accept that you are correct and that bones really aren't fixed
18 structures but are continually changing over time, if I accept that as
19 true, then that seems to support your conclusion that the other experts
20 may not be able to reach the conclusions that they have. What troubles me
21 is if bones are changing so constantly over time, how is it you are able
22 to testify here that you are 90 per cent certain that these bones that
23 appear differently are of the same man, Mr. Vasiljevic?
24 A. Those changes are obvious. That is not in dispute. And that I
25 said that I was 90 per cent sure, I did so because you insisted on me
1 giving you a numerical probability that these were the radiographs of the
2 same person. That was my effort to be of assistance in telling you
3 whether they were one and the same person or not. Let me say once again
4 that on the basis of my medical knowledge and experience in clinical
5 practice, that all the comparisons made indicate with a high degree of
6 probability -- let me not be -- let me not commit myself absolutely but
7 with a high probability that those are radiographs of the same fracture or
8 the same patient.
9 Q. And you say that even though there are all these differences
10 between the two radiographs of the bones?
11 A. When you say that there are differences, it is normal that there
12 should be differences because we are comparing a fracture when it occurred
13 and a fracture that has healed, and then again we are comparing a healed
14 fracture eight years later. So we are not comparing the same things. It
15 is up to us here to estimate whether what we see on the present day
16 radiograph corresponds to what we see on the radiograph from 1992, and it
17 is on that basis that I make my assertion that it can be considered or
18 rather that these are radiographs of the same patient. There must be
19 differences inevitably.
20 MR. GROOME: Thank you, doctor.
21 JUDGE HUNT: Re-examination, Mr. Domazet?
22 MR. DOMAZET: No, Your Honour.
23 JUDGE HUNT: Thank you, doctor, for coming along twice to give
24 evidence. We are grateful for you coming to give evidence. You are now
25 free to leave.
1 THE WITNESS: [Interpretation] Thank you.
2 [The witness withdrew]
3 JUDGE HUNT: Now, Mr. Domazet, while we are waiting for the next
4 witness I see in your list you've named Mr. Savic again as a witness in
5 rejoinder. How have you got a case in rejoinder here? He was called by
6 you, the case -- the Prosecution case was put to him. What new arose in
7 the Prosecution's case in reply which would give you a right to recall
9 MR. DOMAZET: [Interpretation] Your Honour, as for Mr. Savic, I
10 asked for a Dutch visa to be provided to him in case he needs to come. I
11 thought that he might be a witness yet again. I had established that he
12 no longer had a visa, that the visa he used before had expired. Witness
13 VG81, who testified here in connection with -- connection with the tape,
14 was called again, and then I saw that the Prosecutor intended to call a
15 few more witnesses with regard to these circumstances, so I thought that
16 it might be necessary to hear Witness Savic again after these witnesses
17 were heard, that is to say, after the Prosecution witnesses were heard.
18 Now, on the basis of what I just received from the Prosecutor --
19 JUDGE HUNT: Yes?
20 MR. DOMAZET: [Interpretation] In this last proposal, I mean, in
21 all fairness, it seems to me that only one witness has been called with
22 regard to this particular circumstance, so perhaps it indeed won't be
23 necessary for Witness Zivorad Savic to come again, however I wanted to
24 provide for this possibility that he obtains a visa on time, so that if
25 necessary, his arrival here could be organised once the Prosecution
1 witnesses were heard.
2 JUDGE HUNT: Well, I can understand you wanting to be ready but I
3 myself can see no basis yet upon which you would be justified in calling
4 him but certainly you go ahead and keep on making arrangements in case
5 something happens, because I see that there is a VG97 who is coming along
6 to give evidence about the making of the tape but the tape was put to him
7 quite categorically and he denied it was him, he was asked a number of
8 questions about it and so far, the Prosecution case in reply has not gone
9 beyond what was put to him in cross-examination, except in relation to the
10 allegation that your client kept a number of people in his cellar but
11 we've already made it very clear we are not going to give any credence to
12 that particular material our judgement. But if you're only doing it as a
13 precaution, that's all right, but so far, I don't want you to have any
14 hope that you're going to be able to call him.
15 MR. DOMAZET: [Interpretation] I agree, Your Honour. This was
16 really a precaution on my part, if necessary, because the Prosecutor had
17 intended to call some witnesses in this regard so I thought that the Trial
18 Chamber might conclude that it would be necessary to hear Zivorad Savic
19 again. However, for the time being, in my opinion, this isn't necessary
21 JUDGE HUNT: I'm glad we agree. Yes, Mr. Groome?
22 MR. GROOME: A related matter. Yesterday I received a copy of a
23 voice expert or a person who analysed the audiotape. I believe we can
24 maybe shorten the trial a bit if -- I just want to clarify my
25 understanding of how 94 bis operates. Within 21 days I should be
1 notified -- or 14 days notifying the Court whether I wish to accept the
2 report and cross-examine the witness. My understanding of "accept" is
3 that I would relinquish my right to cross-examine the witness but I'm
4 still free to argue that there are flaws in the report or it's not a
5 credible report. If -- so if by accepting the report I am still free to
6 challenge it, I will not wish to cross-examine the witness and there will
7 be no necessity to bring the witness. The only thing that I would ask is
8 if that a curriculum vitae of the expert could also be provided. If that
9 were provided, I would accept the report and not seek to cross-examine
10 this witness.
11 JUDGE HUNT: The only obligation you have to cross-examine a
12 witness is where you propose to lead some evidence to contradict it,
13 that's of a factual nature, or where there is something stated by way of
14 inference and you want to put -- I'm sorry, or where you want to put
15 something by way of inference from the evidence which a witness gives
16 which that witness has not been given the opportunity of dealing with.
17 None of that seems to me, frankly, to apply to a report such as this.
18 That report either stands or falls on what is stated in it. I'm not --
19 I'm not sure where we are going to go upon her expertise but that may be
20 resolved from her CV. Have you got a CV for that particular witness, the
21 linguistics expert, Mr. Domazet? Is she a psychiatrist as well as a
22 linguistics expert?
23 MR. DOMAZET: [Interpretation] Yes, I do have a CV. I thought that
24 it had been provided but I shall do this and submit this to the Court and
25 to the Prosecutor. I think it's a rather extensive CV, as a matter of
1 fact, and I thought that it had already been attached. Thank you.
2 JUDGE HUNT: Do you want to say anything about Mr. Groome's
3 proposition that he should be entitled to say that we should not accept
4 the views expressed in that report, even though he has not cross-examined
5 the witness?
6 MR. DOMAZET: [Interpretation] I concur with that possibility, if
7 this is what it is; namely, that this be admitted into evidence, the
8 opinion be admitted into evidence, even without hearing the witness. I
9 fully agree that Mr. Groome can object to the findings and to that opinion
10 in this way.
11 JUDGE HUNT: There are a number of things in which there are what
12 I would call common sense propositions that something said to an
13 investigator in the calm of a little room downstairs somewhere may be said
14 in a different way to the way somebody would say it at a -- I wouldn't
15 call it a cocktail party as the witness does but at some sort of a social
16 function where there is a lot of noise. But there may be far more basic
17 matters than that which Mr. Groome wants to say we should not accept. My
18 own view is he does not have to cross-examine her simply to say, "I
19 challenge you on this." You realise that her views are at issue and that
20 Mr. Groome is going to attack them, so you may take what steps you prefer
21 to take in relation to her giving evidence. But I would certainly hope
22 that even if you felt that it was necessary to call her, that her report
23 could go in without it being repeated in the evidence itself. So can we
24 leave that particular problem with you?
25 MR. DOMAZET: [Interpretation] If I understand this correctly, Your
1 Honour, this is not a female, this is a male person.
2 JUDGE HUNT: I'm sorry, then.
3 MR. DOMAZET: [Interpretation] Yes. I understand it's because of
4 the name. The first name does not end with a vowel, it ends with a
5 consonant. That's rare in the Serbian language but anyway, if it is
6 possible to have this admitted into evidence without actually hearing the
7 witness here, I agree with that and in order to speed up the proceedings,
8 I believe it is quite acceptable that this witness not be called to
9 testify here, so I accept that possibility as well.
10 JUDGE HUNT: Well, then you don't object to the tender of the
12 MR. GROOME: No, Your Honour.
13 JUDGE HUNT: Thank you. The report of Professor Ostoja Krstic
14 will be Exhibit 42; it's dated the 4th of January 2002. I'm glad you're
15 teaching me about the linguistics of the way names are given to Serbs,
16 Mr. Domazet. I always thought that something that ended in "A" was a
17 female but I'm learning now to the contrary.
18 Have we got the next witness? Thank you.
19 [The witness entered court].
20 JUDGE HUNT: Now, Madam, would you please take the solemn
21 declaration set out in the document which the Court usher is showing you?
22 THE WITNESS: [Interpretation] I solemnly declare that I will speak
23 the truth, the whole truth, and nothing but the truth.
24 WITNESS: ZORKA LOPICIC
25 [Witness answered through interpreter]
1 JUDGE HUNT: Sit down, please, Madam.
2 THE WITNESS: [Interpretation] Thank you.
3 JUDGE HUNT: Mr. Domazet?
4 Examined by Mr. Domazet:
5 Q. [Interpretation] Mrs. Lopicic, good afternoon. Please introduce
6 yourself to us, to the Court now, and please give us your personal
7 details, give us your CV from a professional point of view?
8 A. My name is Zorka Lopicic. I was born in 1947 in Belgrade. I have
9 two sons. I have a degree in psychiatry; I graduated in 1972. I beg your
10 pardon, I got a degree in medicine in 1972, and since then I have been
11 employed in the institute for mental health. This is a psychiatric
12 institution where I also did my specialised training, and I have been
13 working in that institution since then.
14 As for clinical practice, I have been involved in that for 28
15 years now. After 20 years, I worked at the clinical department in the
16 institute of mental health, and over the past ten years I have been
17 teaching in addition to that. I have been teaching psychopathology at the
18 department of psychology at the faculty of philosophy in Belgrade and also
19 I am involved in teaching psychoanalytical psychotherapy and post-graduate
20 courses at the faculty of medicine at the University of Belgrade. Over
21 the past ten years, I have also been a consultant for UNICEF at a major
22 project that protects children from neglect and abuse.
23 JUDGE HUNT: You're speaking so quickly that the interpreters are
24 having trouble keeping up with you. If you could just pause at the end of
25 the sentence, they will be able to keep up with you.
1 THE WITNESS: [Interpretation] Yes, I can, of course.
2 In addition to this cooperation with UNICEF, I have been working
3 if the UNHCR in psychosociological programmes of assistance to displaced
4 persons and refugees, and over the past two years, I have been working as
5 a consultant for the International Committee of the Red Cross also for
6 giving psychosocial help to displaced persons.
7 MR. DOMAZET: [Interpretation].
8 Q. Thank you, Dr. Lopicic, indeed. I should have said what I usually
9 say to witnesses at the very outset. Please do speak slower because of
10 the fact that all of this is being interpreted and that there is a
11 transcript of everything that is said in this courtroom, so you have a
12 monitor in front of you, and you can follow the transcript there so you
13 can see when the interpretation of the question finishes and then when the
14 interpretation of the answer finishes. So please try to answer my
15 questions a bit more slowly because we are speaking the same language, as
16 I'm putting my questions and you're giving your answers in one and the
17 same language.
18 You have explained your professional career to us, that you have
19 been involved in practical work and that you're also a university
20 professor. I only have one question in relation to this: Have you had
21 anything to do with courts of law so far? Have you been a court expert, a
22 forensic expert?
23 A. Since working on this UNICEF project, I am protecting children
24 from abuse and neglect. In the institute, a unit was established that
25 deals with such matters, and I'm a member of this team so this team of
1 ours actually does provide expertise for courts of law in such situations.
2 Q. Thank you. I have another question for you now. At the request
3 of the Defence, you looked at the documents concerned and you also had an
4 interview with the accused Mitar Vasiljevic, and after that you provided
5 your own expert opinion; isn't that correct?
6 A. Yes.
7 Q. Is that the expert opinion that we have here in the courtroom and
8 is it dated the 3rd of December 2001? Is that when it was dated? Is this
9 when it was admitted?
10 A. Yes. I have the Serbian version in front of me here.
11 MR. DOMAZET: [Interpretation] Your Honour, I would like this
12 expert opinion to be admitted into evidence as Defence Exhibit number 43.
13 JUDGE HUNT: Any objection?
14 MR. GROOME: No objection Your Honour.
15 JUDGE HUNT: Thank you. It will be Exhibit D43.
16 MR. DOMAZET: [Interpretation] Thank you.
17 Q. Please, since this expert opinion of yours has been admitted into
18 evidence, the Court received this earlier on, so it is here, there is no
19 need for you to tell us all of this yet again. We just want you to point
20 out what is characteristic as concerns this particular case. So I would
21 kindly ask you to answer my questions first and then the questions put by
22 the Prosecutor. In the expert opinion itself, you mentioned which
23 documents you bore in mind when making these findings?
24 A. Yes.
25 Q. I'm primarily referring to the case histories that you mentioned
1 here, so could you please briefly explain to us what it is that you
2 established on that basis as essential?
3 A. I received three case histories. The first one is number 6477
4 from 1984. The second case history is number 17099/84, and the third case
5 history is 10014/92; that is from 1992. On the basis of these case
6 histories, we can see, or rather on the basis of the first case history we
7 can see that Mr. Vasiljevic was referred to the Uzice hospital with one
8 diagnosis and then the second one was aethylismus and then he was released
9 with another diagnosis. That is alcohol addiction. I wrote the entire
10 expert opinion after seeing Mr. Vasiljevic in the detention unit and that
11 is when I conducted an anamnesis which confirmed these findings. The
12 second case history also -- was also related to alcoholism. It was
13 related to alcohol addiction and then again that same year only a few days
14 later, Mr. Vasiljevic left the hospital. He did not want to be treated.
15 The third history was related to 1992. This is the orthopaedic ward of
16 the hospital, with a fracture of the left lower leg. Surgery was
17 conducted the next day, and a few days after that he already became
18 anxious and that is why he was transferred to the psychiatry ward. These
19 three case histories, especially the last one, could --
20 JUDGE HUNT: Doctor, whether you're reading --
21 THE WITNESS: Yes, I have to --
22 JUDGE HUNT: When you're reading, you do speed up. Everybody does
23 it quite unconsciously, so when you're reading, please talk more slowly.
24 THE WITNESS: [Interpretation] I beg your pardon. I should
25 particularly like to make a comment with regard to the third case history
1 because I think the first two case histories could easily lead to a
2 conclusion that there are changes due to alcoholism only. However, in the
3 findings that do exist in the case history that are not presented in
4 sufficient detail, there is a suspicion that this might be a psychosis
5 involving deliria. The psychiatrist who saw him at the orthopaedic ward,
6 who was not actually a specialist in psychiatry, he wrote in a note that
7 the patient is becoming increasingly anxious, and therefore this doctor
8 thought that this was a stage of pre-delirium and therefore required the
9 advice of a psychiatrist. The patient was then referred to the psychiatry
10 ward. However, the diagnosis was not delirium tremens but rather
11 psychosis. Of course, delirium tremens does belong to the category of
12 psychosis as well. However, this diagnosis, without a marked psychosis,
13 could also give scope to a different kind of interpretation.
14 Q. Before you perhaps continue along these lines, I think it would be
15 a good thing if you told us something from this professional point of view
16 about delirium tremens, or rather psychosis, and possible differences
17 between the two. When I proposed the elaboration of this kind of expert
18 opinion, my assumption was it was a case of alcoholism that had to be
19 investigated and now we have come to some other information.
20 A. I would just like to say quite briefly that delirium tremens is a
21 psychosis which is caused by the use of alcohol, and the main clinical
22 signs of delirium tremens are disorientation, that is to say, the patient
23 cannot orient himself or herself, most often in space and time, and also
24 vis-a-vis other persons. Often during delirium, there can still be an
25 orientation towards oneself. That is to say, the person involved can
1 still be able to give his own name and surname. Then also, there are
2 perceptive deceptions, illusions and hallucinations. The most frequent
3 hallucinations are of the optical nature, that is to say, by the eyes and
4 also there are somatic symptoms, febrility, excessive perspiration,
5 massive dehydration, and also a tremor, an intensive tremor, and that is
6 why the clinical symptom itself is called by it and also there is partial
7 amnesia with such patients. Also what is typical for delirium is that
8 type of delirium lasts for a few days and then it ends in something that
9 we call terminal sleep. That is to say, that after such excessive
10 anxiety, the patient falls asleep under the influence of medication but
11 also toxins from the alcohol concerned, and this sleep can go on for 24
12 hours or perhaps even later. In the case history that I saw, I did not
13 have all the necessary signs in order to decide myself that the right
14 diagnosis would be the psychosis called delirium tremens.
15 Q. Could you explain why, please?
16 A. Because during my conversation with Mr. Vasiljevic in the
17 detention unit, when we spoke about this period, I was given some
18 information which led me to believe that this diagnosis of psychosis that
19 was given at the time had been provoked by another factor and not just by
20 alcohol. The information that I obtained regarding his mother's suicide
21 is a fact which is of great significance for us psychiatrists, and
22 particularly so when Mr. Vasiljevic told me that his mother committed
23 suicide after giving birth to his youngest brother, which means two months
24 after delivery. It is well known in psychiatry that post-partum psychoses
25 in themselves do not have -- have a very great importance because they are
1 due to an earlier psychotic potential. I also learned from the
2 conversation that Mr. Vasiljevic's grandfather had a year or slightly more
3 after that taken his late mother out of the Drina river, which means that
4 she had psychological problems even then, so a year earlier. So this kind
5 of depressions leading to suicide are always linked to the existence of
6 affective psychosis, in this case of a depressive kind.
7 Q. Did you talk about this to any of the doctors who were involved in
8 the treating of Mitar Vasiljevic in the past?
9 A. During my stay here, and this was on the 24th, a Monday, I'm not
10 quite sure, no, the 24th and the 25th, so it was Saturday and Sunday when
11 I saw Mr. Vasiljevic in the detention unit, and on the 25th, as I was
12 leaving on the 26th, that is when I had my return flight, I had occasion
13 to meet here with a colleague, Dr. Vasiljevic, who had seen Mr. Vasiljevic
14 in Uzamnica, in the prison part sometime at the beginning of June, and he
15 told me that already then he had manifested certain mental problems and
16 that he had mentioned, according to his understanding, certain
17 hallucinations, that he spoke about, devils and demons and angels. When I
18 returned to Belgrade, as I had heard that a colleague of mine testified
19 here, a colleague who had seen Mr. Vasiljevic in Uzice, his name is
20 Dr. Simic, I had occasion to meet with him and talk to him and he told
21 me -- I asked him why he had placed the diagnosis psychosis on the basis
22 of which factors. At the time, he hadn't known anything about this prior
23 history of suicide, nor had Mr. Vasiljevic apparently ever told anyone
24 about that before. He told me that I was the first to hear it from him.
25 And a colleague Simic told me what we psychiatrists know often, that we
1 are merely an instrument in determining a diagnosis.
2 I had the feeling that this simply was not just a delirium tremens
3 but a much stronger psychosis as a result of certain pathological
4 potential that he carries inside, and that is the contact I had with my
6 Q. After writing this expert report, did you try to learn more about
7 things of relevance that would be important for your opinion?
8 A. I did, because not only after I had heard about this hereditary
9 fact on the mother's side but also on the father's side, I have some
10 documents here that I should like to offer to the Court as evidence and
11 that is a discharge paper of Mr. Vasiljevic's aunt, Mrs. Stojanka
12 Blagojevic, who was admitted to the Uzice hospital on the 30th of
13 September, 1984, and who died in hospital on the 25th of October, 1984,
14 after trying and succeeding in committing suicide by drinking a very
15 strong concentration of vinegar. So that is his aunt on the father's
16 side. And she was treated under the diagnosis of depression,
17 intoxication, insufficiency of the kidneys. Laparatoma, pro dyalisis
18 peritonealis, urosepsis and exitus letalis on the 25th of October at 2100
20 JUDGE HUNT: It would be of some assistance, I think, if the
21 doctor could translate that into layman's language. It may be Latin and
22 Latin May be an international language but very few of us understand those
24 THE WITNESS: Yes. I'm sorry. [Interpretation] I will.
25 Depressive psychosis is a diagnosis that belongs to the group of
1 affective psychosis. In those days we had the old classification, and the
2 number was 296.1. Then there is attempted suicide, intoxication with this
3 strong vinegar or acid, kidney insufficiency, and this is a frequent
4 complication in the case of such poisoning. They try to administer
5 peritoneal dialysis, which appeared to be successful for a few days.
6 Later, the condition deteriorated. The patient developed a sepsis, that
7 is intoxication provoked by bacteria, and she died on the 25th of October,
8 1984, at 2100 hours.
9 JUDGE HUNT: Now, Mr. Domazet you've asked for this to go into
10 evidence, but I myself would be grateful if the doctor could tell us why
11 she thinks that the aunt's suicide on the father's side is important to
12 her opinion and relevant to it. That was the question you asked her.
13 THE WITNESS: [Interpretation] This information about hereditary
14 influence on the mother's and father's is are very important for us
15 psychiatrists in the case of affective psychosis because it is common
16 knowledge that general genetics and the hereditary factor have been
17 proven. In fact, in more than 50 per cent of cases, it has a direct
18 effect. So this hereditary factor can be direct or lateral.
19 In this family, there is another member of the family on the
20 grandmother's side or, rather, the mother's side of Mr. Vasiljevic - that
21 would be his niece - is also suffering from psychosis, and I gained
22 possession of that documentation in the institute for mental health where
23 she was treated from the beginning of 1977 until 1999. And I was told
24 that the treatment continues at the medical academy in Belgrade, and I was
25 not able to obtain those documents because of the New Year and Christmas
12 Blank page inserted to ensure pagination corresponds between the French and
13 English transcripts.
1 holidays, but I think it would not be a problem to obtain those documents
2 too. And I wish also to offer these documents to the Court.
3 MR. DOMAZET: [Interpretation]
4 Q. As I have seen from your report and from what you have testified
5 today, Mr. Vasiljevic told you for the first time about his mother's
6 suicide because it is something he did not disclose here in court either.
7 Is that true?
8 A. Yes.
9 Q. But in the report itself, you haven't said whether he mentioned
10 these other members of his family, that there were other people with
11 similar problems in the family.
12 A. I learned about this subsequently, and I must tell you how I
13 learned about it. On television, I saw that Mr. Vasiljevic is appearing
14 in court again. These were a few clips on television, and in some of
15 those clips, he mentioned this hereditary factor and then I made some
16 inquiries to find out more specifically. As to why he didn't tell me
17 about that at the time, I can't say.
18 In my interview with Mr. Vasiljevic, I spoke to him in the form of
19 a classical psychiatric interview, beginning with introducing myself and
20 telling him what the purpose of my interview was. After that, information
21 is taken about the personal and family case history. We go into those
22 things in great detail, learning more about immediate family members and
23 also about parents and siblings. That is when I was told about his
25 Q. If I understood you correctly before coming here and after that
1 interview, you got in touch with members of the family and you obtained
2 some information which helped you to gain possession of the documents you
3 have referred to. Am I right?
4 A. Yes. The discharge document from the hospital for his aunt was
5 brought to me by her son. As for the documents regarding his niece, I
6 found those documents in the institute for mental health. And we keep the
7 documents in very good order, and in the files I found the document. And
8 with the permission of my director and head of the dispensary, I have
9 brought them with me today to make them available to the Court.
10 Q. In view of the fact that Mr. Vasiljevic did not mention this at
11 first, but that at your -- he was questioned about this afterwards by
12 Mr. Groome, did you try to check out this fact, to make sure that it was
14 A. Yes, I tried to check. Actually, I asked the attorney from
15 Visegrad to get for me the death certificate from the Court Registrar for
16 his mother, and I think you have that document. And the mother was
17 declared dead, but in the explanation, it says that she committed suicide
18 and that she was mentally ill.
19 Q. Did you talk about this with Mr. Vasiljevic's father, the wife of
20 his -- I mean the husband of his mother?
21 A. No, I had no contact with him.
22 Q. I didn't mean a personal contact but perhaps by phone, since there
23 is quite some distance between you.
24 A. No, I didn't have any contact with him whatsoever.
25 Q. With regard to these documents, about family members, is there
1 anything else you would like to add, or perhaps do you consider certain
2 information not to be suitable for a public hearing? Maybe we could go
3 into a private session for that purpose.
4 A. All medical documents and our case histories are certainly
5 something that is considered a document that is not made public, and I
6 hope that what I have said so far is something that will remain
7 confidential. Of course, if there are any particular details that need to
8 be looked into, such as the psychological findings, the degree of the
9 disease, the damage of the niece, if this may be of significance, this is
10 a young woman, who was born --
11 Q. Will you please, as you have started giving us information about
12 this person, I would ask Your Honour for us to go into private session to
13 continue as certain information may be revealed which could identify
14 members of the family or people who know them well, and this could damage
16 MR. DOMAZET: [Interpretation] So could we please go into private
17 session for the questions and answers in this area?
18 JUDGE HUNT: If we do so, Mr. Domazet, I think it should be made
19 very clear to you to that when we come to write a judgement, if we enter
20 into this particular issue about your client's mental state, on either the
21 question of sentence or the question of conviction, there are details
22 which we are going to have to reveal. We may be able to do it without
23 identifying the particular person and hopefully without describing that
24 person in such a way they can be identified, but the mere fact that this
25 material has been given in private session, if that is to be the case,
1 doesn't mean that it will be kept wholly confidential.
2 The purpose of going into private session in relation to medical
3 issues such as this is hopefully to contain the identity of the persons of
4 whom we are speaking where they are not the accused. But there may be
5 findings that would have to be made which will have to be made public. A
6 judgement can't be given in private session.
7 I should also add that so far it has all been in public session.
8 MR. DOMAZET: [Interpretation] Your Honour, as far as I can
9 remember, regarding these facts, these very facts, I think that Mitar
10 Vasiljevic requested and was allowed to testify about some of these things
11 in private session. Regardless of that, I wouldn't spend much time in
12 private session, but as we are talking about the particulars of a third
13 person here that the doctor started talking about, that we should, if
14 possible, protect that person, as it is a young woman. But I agree with
15 you that it is quite impossible to provide complete protection, but maybe
16 even this would be sufficient, as this is a young woman and of course, if
17 possible, we would like to protect her and her personality.
18 JUDGE HUNT: I agree with you entirely. I just wanted to make it
19 clear to you the basis upon which we would be treating the evidence if we
20 have to deal with it in a judgement. Have you got any objection,
21 Mr. Groome?
22 MR. GROOME: No, Your Honour.
23 JUDGE HUNT: Thank you. We will go into private session.
24 [Private session]
13 Page 4123 – redacted – private session.
13 Page 4124 – redacted – private session.
13 Page 4125 – redacted – private session.
4 [Open session]
5 JUDGE HUNT: We are now in public session.
6 MR. DOMAZET: [Interpretation]
7 Q. Mrs. Lopicic, we will continue in relation to your expert opinion
8 and findings. You spoke of the documents that you got before and after.
9 I would also like to ask you about your personal psychiatric examination
10 of Mitar Vasiljevic here in The Hague. Is this customary and necessary in
11 such examinations, and did you have everything you needed for it, and in
12 general, what is your assessment of this examination?
13 A. My psychiatric examination is based on an interview that I
14 conducted with Mr. Vasiljevic and the observations that I made during that
15 interview. If you are asking about a complete psychiatric evaluation,
16 then this examination would have to be supplemented by the findings of a
17 clinical psychologist, and I will explain why, As well as with an
18 examination by a radiologist would have to conduct a MNR, and this would
19 either confirm or refute some of the symptoms that we have seen here.
20 Q. Before I continue in respect of your personal examination, I would
21 like to ask you, in connection with what you have just said, why you
22 believe that perhaps it would be a good thing if we were to conduct a
23 radiological examination of the brain, if my understanding is correct?
24 A. Yes. In view of the case histories that I received and the fact
25 that there is a long-standing history of alcoholism, almost 30 years, that
1 is, it can be assumed that it has left certain consequences on the cells
2 of the central nervous system. What we know from clinical practice, from
3 literature, and of course from the findings that we have is that alcohol
4 has the most toxic affect on the cells of the hepatocyte, that is to say
5 of the liver, and neurocytes, rather, brain cells.
6 I did not have the opportunity of seeing Mr. Vasiljevic's lab test
7 results. However, my colleague Vera Folnegovic gave certain findings, and
8 I saw there some lab tests showing that the function of the liver has been
9 damaged and that there is a higher presence of gamma enzymes that show
10 that the liver is damaged.
11 After this period of time, now that since -- now that
12 Mr. Vasiljevic has not been drinking for a while, if there are no changes
13 on the liver, then it should be necessary to conduct a computerised
14 examination of the brain to see whether brain cells are being damaged,
15 especially in the frontal lobe.
16 Now, why is this the case? During the interview I had with
17 Mr. Vasiljevic, he spontaneously showed a neurological symptom that we
18 call a particular phenomenon. That is a phenomenon that involves a
19 pouting of the mouth and licking his lips, and this frequently shows
20 damage to frontal brain cells. Also, it is possible to see that it is not
21 only the frontal lobe but also other parts of the brain that have been
22 damaged, but this can be ascertained only in such a way.
23 Another finding that could show whether there is any kind of
24 damage is an examination by a psychologist. In this case, it would be
25 helpful, both in terms of hereditary, the hereditary factor, to help us
1 evaluate the structure of the personality, because we psychiatrists, in
2 our clinical practice when we establish a diagnosis, we can establish it
3 at three levels. The first level is the clinical diagnosis the second
4 level is a dynamic --
5 JUDGE HUNT: Just slow down, please, Doctor.
6 THE WITNESS: Yes. [Interpretation] The second level of
7 establishing diagnosis is dynamic diagnosis that we can also get from the
8 anamnesis or from heteroanamnesis, that is to say, the information we
9 receive from the patient and the family, the persons who are closest to
10 the patient. And the third level is structural diagnosis and that is
11 established by a clinical psychologist. In this case it would have a
12 certain significance because of all of these factors that we have already
13 referred to previously. What I think is equally important is that a
14 psychologist's findings would be important here not only for the
15 structural diagnosis but also for indicators that would show us whether
16 there is an organic damage involved, that is to say, what I showed a few
17 minutes ago when there are IQ tests, then there is the possibility of
18 measuring the verbal and the manipulative, and if there is a major
19 discrepancy between those two values then this is one of the indicators of
20 organic damage. Also there are two tests that are -- two significant
21 tests, the Bender [phoen] and the --
22 THE INTERPRETER: The speaker will have to slow down for the
24 JUDGE HUNT: Doctor, the interpreters are still having enormous
25 trouble. Remember, you are using technical terms and you never --
1 THE WITNESS: I'm sorry, yes.
2 JUDGE HUNT: And you never pause at the end of a sentence. Now,
3 please, just take it quietly.
4 THE WITNESS: [Interpretation] I'm sorry. In that sense, the
5 findings of a psychologist would be helpful.
6 MR. DOMAZET: [Interpretation].
7 Q. Some of the tests that you mentioned, were they perhaps carried
8 out in this particular case?
9 A. I did not conduct these tests. I only did one particular test.
10 We psychiatrists are not qualified for this type of test, an examination.
11 It is clinical psychologists that are qualified to do this. We give
12 questionnaires and other such things that involve simple "yes" or "no"
13 answers. And I did conduct such a test that had to do with alcoholism
14 because in the previous case histories I saw that this was alcoholism, and
15 I therefore took that from one of the previous case histories as well.
16 However, if I could comment upon this test.
17 Q. Please go ahead.
18 A. In this test, the commands, the orders, are very simple. The
19 instructions are very simple. Mr. Vasiljevic was instructed to say "yes"
20 or "no" to the questions that were put here. There are 21 questions that
21 are put. So this is not a big test. It should not be very tiring. What
22 I got is an indicator that was of interest to me. It probably had to do
23 with his attention and with his cognitive abilities. In response to the
24 21st question, "Were you punished or taken out of traffic or was your
25 licence taken away because of driving in a drunken state," the answer was
1 yes, and in all the histories I received I saw that he never drove a car
2 and that he never had a driver's licence. So this is one of the ways in
3 which we can see that either his attention level dropped at that point or
4 perhaps he simply did not understand some of the questions sufficiently.
5 Q. Now that we are on the question of this test, what are the other
6 ways in which this test can be helpful to you when establishing your
8 A. At this test, I got not only confirmation, which was to be
9 expected, that he is a person who took alcohol. I also got another table
10 that showed alcohol intake and this shows chronologically when the
11 drinking started, the kind of alcoholic drink that he took and also what
12 we call complications that may occur or rather what the consequences of
13 the drinking were. I have attached this to my report.
14 Q. In addition to these tests that you carried out, during those two
15 days, you had conversations with him. Did he cooperate with you, and what
16 is your assessment of his answers and also what he had to say in response
17 to your questions?
18 A. Mr. Vasiljevic showed a readiness to talk. He was very
19 cooperative. I think that when we first met I had a threefold
20 interpretation of everything that happened. I'm going to tell you now how
21 I interpreted his readiness. He met me and offered me coffee, fruit
22 juice. He asked me whether I was hungry. He had something to eat. He
23 wiped the table clean. He was preparing this. He was doing all of this
24 in a bit of haste. So my interpretation of this was that he was tense,
25 that he was anxious, that he is expecting something that is new to him,
1 and this is a normal reaction to such situations. On the other hand, I
2 did not forget that that is his vocation, that he is a waiter, and perhaps
3 this is also a learned pattern of behaviour from that period. And
4 thirdly, there was something that left the impression that he is a person
5 who in a way does not hesitate, does not really have any breaks of this
6 sort, in his stream of associations he would digress, go into details,
7 which, for me at that point in time, were perhaps not even important but
8 it was hard to interrupt him once he'd start talking, so he was a bit
9 hasty. However, soon afterwards, when I was setting the guidelines, so to
10 speak, when I said that we'd sit down and have a cup of coffee and we'd
11 talk then, he immediately accepted that and then we started a conversation
12 that was spontaneous. I was given -- I was giving the initiative, and I
13 was also, as I said, setting the guidelines for this conversation
15 Q. Mrs. Lopicic, when talking about the written documents, about the
16 case histories that you looked at, do you recall, did you see, those
17 documents from the psychiatry ward in 1992? I'm referring to therapy
18 lists and everything else that he then had, both as therapy and, generally
19 speaking, during the period of his treatment?
20 A. Yes. I did see that, and that is the part which, for us
21 psychiatrists and in clinical practice in general, was a diagnostic
22 question. We often give sedation to delirious patients, and this has been
23 said in heminephrine [phoen] and other such medication. We usually do not
24 give neuroleptics primarily.
25 In these discharge papers, I saw that he was receiving neuroleptic
1 therapy. One should not also lose sight of the fact that 1992 was a year
2 when we had major problems with drugs, with medicines. Unfortunately,
3 this is an ongoing problem.
4 So it is possible that the neuroleptic therapy that he received
5 was therapy that was indicated due to the condition in which the patient
6 was. It was required because he was very anxious from a psychomotoric
7 points of view, and there is even documentation stating that he was
8 affixed to a certain place and that is very rare in our hospitals.
9 And may I just add that there is another thing that was included
10 in the recommendations and that is that neuroleptic therapy was continued.
11 Q. When you say "fixed," could you please explain this, what this
13 A. When patients are highly disturbed and when there is a major risk
14 involved of them hurting themselves or someone else but usually it
15 self-infliction. Then patients are tied usually across the abdomen.
16 Usually there is a band that is put over the abdomen, but I imagine that
17 that is the band that is usually used for this kind of affixation, as I
18 said, and that means that his hands are free. And usually the patient is
19 then in a ward or in a room where he is under the control of medical
20 staff, a nurse in particular.
21 Q. You mentioned today that you inquired about Mitar Vasiljevic and
22 that you got information from Dr. Simic as well, who at that time was a
23 physician in the Uzice hospital; isn't that right?
24 A. Yes.
25 Q. Did you perhaps receive some information from him in respect of
1 what he remembered, especially with regard to the diagnosis that was made
2 then and what he and his colleagues testified about here, that is to say
3 whether in that case, in the case of Mitar Vasiljevic, whether at that
4 time he did or did not have delirium tremens?
5 A. The colleague I talked to said that this level of psychomotoric
6 agitation was so strong that this can be seen in psychotic patients.
7 However, I cannot speak on behalf of anyone else now, but my colleague was
8 in a way inclined to interpret this by the energetic potential that was
9 displayed, especially in terms of this psychomotoric restlessness. The
10 assumption is that there was enormous fear involved, and this exceeded the
11 usual level of delirious psychosis only. And also another factor that led
12 him to believe that it was not only delirious psychosis was its duration.
13 His estimate was that this lasted longer than deliria usually last.
14 Q. I remember that I put a similar question to the other doctors who
15 testified here and that they spoke rather exhaustively of delirium tremens
16 and its characteristics, and they said that Mitar Vasiljevic did not have
17 that at the time and they excluded that possibility.
18 On the basis of the information that you have received can you
19 state your view?
20 A. I have already said the clinical picture is untypical of delirium
21 tremens, but it is also untypical for an endogenous psychosis. So it
22 would be difficult to come to that diagnosis too.
23 Now knowing the case history involved and having observed the
24 patient over a certain period of time, we can say that it is certain that
25 a significant role in the creation of this kind of psychotic reaction is
1 displayed by the biological factor, but also, we should not disregard the
2 factor of 30 years of alcoholism, as well as other circumstances that are
3 no less important, that is the trauma he had, that is to say the
4 fracture. In such situations a patient can go through delirium because of
5 the pain involved itself. And here we have various factors including this
6 biological factor, and of course there is also the factor of the living
7 conditions involved and the stress under which Mr. Vasiljevic lived at
8 that time.
9 Q. Mrs. Lopicic, in your opinion -- you mentioned, first of all, that
10 in your opinion, Mr. Vasiljevic is a psychiatrically changed person, with
11 a psychopathology that was diagnosed, and you are of the opinion that this
12 is proven by the documents already existing, and you believe that three
13 factors were relevant in this psychopathology, you mentioned the
14 biological factor, chronic alcoholism and stress. This changed
15 personality of his, from a psychiatric point of view, and his illness,
16 could it have been caused by one of these factors only or do these factors
17 necessarily have to supplement each other, so to speak, or does one affect
18 the other in such a way that it only aggravates the intensity of such an
20 A. I think that this situation was caused by a multitude of factors,
21 absolutely. If we were to try to establish this through development, what
22 he got through his genes when he was born and what he got through biology
23 is the first, and then alcoholism certainly adds to this, which started at
24 the age of 18, when Mr. Vasiljevic was 18. This is 1973. I think that
25 this should not be forgotten. Yes, that's right, 1973. So all these
1 years of drinking and also his living conditions later, the stress
2 involved, and also the injury that was sustained towards the end of this
3 period before the psychosis actually appeared as such.
4 Q. Does that mean that this illness and this change could have taken
5 place if we can imagine this, could have taken place even without the
6 alcoholism, that is to say, even if he had not been an alcoholic, or is
7 this just another factor that contributed to the aggravation of the
8 illness and conversely, is it possible that this was only due to chronic
9 alcoholism, that particular illness?
10 A. We could not say that it is only alcoholism if we are aware of
11 all these elements, and now, whether this kind of a psychosis would have
12 developed had it not been for the alcoholism, at this point in time, it is
13 hard for me to say which form of psychosis and under which conditions. We
14 are talking about a premorbid personality, a premorbid structure that we
15 could discuss only after a psychologist had made his evaluation. We can
16 speak of this hypothetically, that after a major stress, a psychotic
17 reaction develops, the probability is there in this case because of the
18 predisposition involved, but now, whether it would have developed as such
19 or not is something I cannot say. I can only speak of what we have here
20 and we have here 30 years of alcoholism, which gave a major contribution
21 to the clinical picture being the way it is right now.
22 Q. With regard to this third factor that you have listed, the factor
23 of stress, how does that affect the onset or the aggravation of the
25 A. I mentioned this stress factor because when I was conducting the
1 interview and when he was talking about the conditions of life at the
2 time, he spoke about the fear, which was enormous, and which was
3 heightening as the circumstances changed specifically when he was speaking
4 about the period when he was mobilised and when he had to participate in
5 obtaining food as part of the Territorial Defence and in organising the
6 canteen, he was fearful because he had to pass through territories which
7 were unsafe, and especially during a period of time when the front line
8 changed and when he had to pass through the woods and other areas where
9 the risk was even greater, and the very general circumstances of life, not
10 just his own assignments but the living conditions were a stress factor.
11 He had been separated from the family for a time, they haven't been
12 transferred to Belgrade, he visited them. He took care of them but one
13 must not forget that throughout that time he kept drinking more and more
14 because he was alone and because he was more and more fearful, so it was a
15 kind of vicious circle which he managed to close in this way.
16 Q. When you were talking about these circumstances, you're talking
17 about his personal circumstances, what he was doing, and the fear and
18 stress he was under as a result. But were you also taking into
19 consideration the general circumstances of an area swept by war, where
20 there were killings and people disappearing and many other such events
21 that accompany such an armed conflict?
22 A. Yes, I had that in mind because one of the reasons why he had
23 moved his family -- they were separate for a while, his wife and children,
24 were in the vicinity of Belgrade, precisely because he feared that
25 something might happen to them because of those circumstances.
1 Q. And in your opinion, that also one of the factors contributing to
2 this stress category. Would you include there in this category of stress
3 the loss of a close relative or generally the death of other people to
4 whom he was not related?
5 A. Yes. On the harms scale of stress, I don't have it with me here,
6 but I can send it, one of the most stress-provoking factor is the loss of
7 a dear one. So if on the scale, the numerical scale is zero to 100 then
8 this loss carries 100 points. Of course it depends on the closeness to
9 that person. So certainly the loss of this person, who was a cousin,
10 certainly affected his condition.
11 Q. Yes, but my question included other persons, should they be
12 friends or colleagues or people that he was close to in the past. So
13 would the loss of those people also contribute to such a deterioration?
14 A. It certainly has an influence, but depending on the emotional
15 link, the greater the loss, and the closer we are to the person we are
16 losing, the stress is greater. There is a direct correlation.
17 Q. When we are talking about such a loss or a death, in most cases a
18 person is not present. He may learn about it and this may be stressful,
19 But could being present at an event when, before his very eyes, in this
20 case, Mitar Vasiljevic, people are being killed, whether he knows them or
21 not, and especially if among them there are some that he considers close?
22 A. Certainly, yes, this is a stressful event. Any sudden situation
23 which we cannot control and which provokes an emotional reaction from us
24 is a stress factor.
25 Q. In your opinion, you have said that chronic alcohol abuse over a
1 long period of time covered up the outbreak of possible affective or
2 paranoid disorders and that alcoholism can be interpreted as a symptomatic
3 and, in brackets, defence of earlier emergence of psychoses? Could you
4 explain this part of your opinion, which is a medical one and we are
6 A. I had in mind, in the first place, the existence of this
7 biological factor and the very fact about his mother, and I repeat, and
8 wish to emphasise because I consider it to be very important, a mother who
9 kills herself two months after childbirth. This can only be done by a
10 person who is sick. We know very well what the relationship between a
11 mother and child is, and what it means to leave somebody who is so totally
12 helpless. So for me, this was a piece of information that I attach very
13 great importance to, even now.
14 If we were to assume, and we have been told, that she committed
15 suicide, that she was treated, that she was sick, that she was psychotic,
16 that she suffered from affective psychosis, then this was one much my
17 assumptions, that if chronic alcohol abuse had covered up the possible
18 outbreak of an affective disorder, what I obtained from the interview with
19 the patient, and that is certain changes in the thinking process, this is
20 some unclear psychopathology where he had exaggerated ideas about the
21 significance of, shall we say, birds. If he sees a crow, it's a bad
22 omen. If he sees a dove, it's a good sign. And this -- these various
23 actions of his could be attributed to this paranoid disorder, like he said
24 that he could communicate with his wife subconsciously. So this is what I
25 attribute to provoking these reactions on his part.
1 Q. Further on, in your opinion, you said that you considered what you
2 called decades-long alcohol abuse had provoked organic changes, and you
3 mention the brain, the peripheral nervous system, the gastrointestinal
4 tract, as well as permanent changes of personality, and that this period
5 with manifest development phases up to the addiction phase can be followed
6 chronologically. Could you explain this part of your opinion?
7 A. This drinking went on since 1973. What we have in the case
8 history and also in some of the findings is that Mr. Vasiljevic provides
9 the information that he had black feces. He didn't at the time have an
10 explanation. It was probably due to bleeding from the upper parts of the
11 digestive tract, but he attributed it to drinking Vlaho [phoen] which is a
12 strong alcoholic beverage in dark -- which has a dark colour. It was
13 black and that was his explanation why his stool was black. And when he
14 had these gastrointestinal problems, he must have taken large quantities
15 of what he called shampoos, which reduce acidity in the intestines, and he
16 obviously tried to treat this bleeding problem in that way.
17 As for the peripheral nerves, he said that he had big problems
18 walking and that he had pain in his legs. He even said that he walked
19 around like a duck, which is very frequent. And when I was there, I did
20 make an examination, and he has painful areas in the lower leg, and this
21 is very typical of chronic damage to the peripheral nervous system.
22 As for the laboratory tests, these also speak of liver damage,
23 that is, the gastrointestinal tract.
24 These are all elements indicating damage due to long years of
25 alcohol abuse.
1 Q. In your opinion, you said that this psychotic period is obvious in
2 hospital conditions, and you also -- you referred to information obtained
3 during your interview. When you are talking about hospital conditions and
4 your opinion about it, is it based on the obvious proof about his
5 treatment at the time or is it based on the way in which that disease
7 A. I am basing my opinion primarily on the psychiatric report from
8 the time and that was given by the psychiatrist who examined the patient.
9 Also, Mr. Vasiljevic did give me some data about the psychopathology that
10 he manifested in that period and prior to coming to hospital. In his case
11 history, there is not that much information regarding the contents, the
12 substance, of his psychosis, not nearly as much as I obtained from this
14 In the case history, we were simply able to establish his
15 disturbance, his disorder, in terms of orientation, incoherent speech and
16 probably thought. The thought process was accelerated too. Was this the
17 cause of accelerated speech?
18 These are things that can be found in the report. But the other
19 aspects and problems in the thought process, I would call them exaggerated
20 ideas, with magical connotations, and we have no information about that in
21 the case history. The information is obtained through the interview, and
22 it relates to the hospitalisation period, but also even before he was
23 hospitalised, when he had this urge to blink, which was linked to thought
24 disorder and symbolism.
25 Q. With respect to this last matter that you referred to, that is
1 that you obtained this information from the interview with him, do you
2 believe that the information he gave you was truthful, since he -- as you
3 said, you were the first person to learn about these things?
4 A. I have to say that my subjective impression was that the interview
5 and the talk we had over the two-day period was extremely authentic. Why
6 he didn't speak about these things to anyone else, I can only assume. He
7 gave me a detail which he described as a prohibition from God but he's not
8 firmly fixed on this, so I wouldn't call it an insane idea but an
9 exaggerated idea. Because he was not under the influence of alcohol for
10 so long, and since he was in a protected environment, he is now in a
11 situation where he can distance himself from all these things and he does
12 so. And he said, "I thought what I experienced then was not normal." And
13 then he checks this out with me by asking me whether I think so too.
14 Q. Is that what you are referring to when you say that the patient is
15 now distancing himself from these contents?
16 A. Yes. He now has an insight into his psychological pathology.
17 Q. From the case histories, and I'm thinking, in the first place, of
18 the one from 1992, you were able to see the diagnosis at the time, and you
19 spoke about this mental disease, psychosis, which has several subsections
20 and subtypes, could you tell us a little about psychosis itself, what it
21 is, of course if that is what we are talking about, if that is the mental
22 disease we are talking about?
23 A. In very clear terms, psychosis is a condition when the patient is
24 out of reality. A psychotic condition implies a disturbed relationship
25 with reality, and that is the period that I referred to as the period of
1 hospitalisation. He did not have a good connection to reality. A
2 psychosis may also lead to loss of memory, so he need not necessarily
3 remember everything that he did while he was psychotic or when he had this
4 psychotic episode.
5 In Mr. Vasiljevic's case, that is precisely what happened. He
6 cannot link all the events during his hospitalisation and give a clear
7 picture or a precise description. He gives a fragmentary information from
8 the period when he was at the psychiatric ward. He remembers only that he
9 was tied. He doesn't remember much about what he said or what he did. He
10 just remembers that he was tied up.
11 Q. You said that it was possible and that it was typical of
12 psychosis, to have a loss of memory. On the other hand, remembering
13 certain facts or saying that he remembered certain facts, can they be
14 fully reliable, less reliable, or unreliable as compared to the memories
15 of someone who is not suffering from such a disease?
16 A. Just as a patient does not remember, he also may remember. So it
17 is something dynamic within us. At one point in time, we can remember
18 something, and at another point, not remember something. It depends on
19 the focus of our attention, the effective condition, because fear can
20 change the ability to memorise. Therefore, this is something that cannot
21 be simply put. If he's psychotic, he doesn't remember anything; and if
22 he's not psychotic, he does remember. It is very difficult to draw a firm
23 line, but if we know that a generator for the development of a psychotic
24 process is a state of fear, then this state of fear may, in a certain way,
25 affect memory.
1 Q. When I asked you this, I also had in mind those memories which he
2 may refer to or what he may have spoken of at the time, as testified by
3 other people, to what extent could that be reliable and correct?
4 A. If it co-relates with what other people have said, if somebody
5 said that somebody did such and such a thing and he also says that that
6 person did such and such a thing, then that is proof that that was how it
7 was indeed.
8 Q. Is it possible for those persons to accept something that somebody
9 else has said? In other words, are they as, a result of their disease,
10 easily influenced?
11 A. The degree of suggestibility can exist among certain psychotic
12 persons but in this case, if we are talking about the degree of
13 suggestibility, we are able to also link it to alcohol, because alcohol is
14 something that changes a personality.
15 Now I come to something that is very difficult to tell: What is
16 the premorbidity structure and what is the consequence of such protracted
17 alcoholism? But it is the fact that there is a certain degree of
18 suggestibility. Even in my own opinion it may be due to loss of
19 concentration, but what is characteristic of delirium tremens, one of the
20 tests we give our patients, is to give them a completely clean piece of
21 paper and tell the patient read out what it says there. And if you start
22 with a first sentence or a word, he will continue as if he was really
23 reading, and so this is one of the traits which becomes part of the
24 character of an alcoholic.
25 Q. In addition, these persons, can they seek to be more prominent, to
1 draw attention to themselves, to pretend to organise, to lead, and
2 generally speaking, is that a characteristic of this kind of behaviour or
4 A. I wouldn't say that that would be directly linked to psychosis.
5 These are certain character traits which are linked to emotional maturity
6 or immaturity, and it is in that context that we may say that some
7 persons, such as emotionally immature persons, are uncritical,
8 suggestible, inclined to make fools of themselves, to be in the centre of
10 Q. As for memory, you said that the period of his hospitalisation,
11 that is when he was treated, that that is a period that he remembers very
12 little about. You said that he remembers being tied up but very little
14 In view of his medical condition at the time, would it be possible
15 for him to talk about things that never happened or could have happened
16 and which may have hurt him in a sense, because he makes such public
17 statements under those conditions?
18 A. Very frequently, a patient claims -- their psychotic contents are
19 not real, are not correct, that is why they are outside reality.
20 Therefore, in a psychosis patients very often say things which absolutely
21 have nothing to do with reality. Now, it depends how they systemise
22 things. If they consider that they are being persecuted or something like
23 that, this is not -- this may not be happening or correct at all. It
24 depends, the content may vary but it is quite possible for people to say
25 things which are absolutely not true.
1 Q. Would this apply only to the period of hospitalisation in 1992,
2 for which you have the necessary documentation, or could it also apply to
3 the period prior to that?
4 A. Not a single psychosis can manifest itself as if you were to press
5 a button. For the development of any psychosis, there is a prodromal
6 period, as we call it, a period when the patient is suffering from
7 psychopathology which may not be manifest. And this is something that in
8 this case can be said to have existed in view of the fact that alcohol as
9 a factor was present throughout this period prior to the outbreak of the
10 psychosis, that is one reason, and a second reason is the factor of fear,
11 as something which could also precipitate, generate or trigger
12 psychopathology. That was present too. And therefore, it is possible to
13 say that there were certain signs and elements of changed behaviour but
14 far more changed subjective experiences which Mr. Vasiljevic did refer to
15 to some extent in this interview I had with him.
16 MR. DOMAZET: [Interpretation] I think this is the time.
17 JUDGE HUNT: We will adjourning now to 9.30 tomorrow.
18 MR. GROOME: Your Honour, just one quick point. The Prosecution
19 received its report from its psychiatric expert before the holiday and --
20 in B/C/S and that was given to Mr. Domazet and filed. We just received a
21 draft translation of it in English a half hour ago and the final
22 translation will be done tomorrow. If it's of any assistance to the
23 Court, we will provide copies to the Court of the draft translation, if
24 the Court wishes.
25 JUDGE HUNT: That would be of great assistance. I have put that
1 to one side, that document, until we get something in English. It would
2 be of great help to have it whilst this witness is giving evidence.
3 MR. GROOME: It will be delivered to your legal secretary.
4 JUDGE HUNT: Thank you very much. We will adjourn now.
5 --- Whereupon the hearing adjourned at
6 5.30 p.m., to be reconvened on Thursday,
7 the 10th day of January, 2002, at 9.30 a.m.