Medical Justice does "case-work" and campaigning work.   Our work falls into 3 areas ;

1. Campaigning work
Includes lobbying against wrongful detention, against unjust immigration laws and policies, against obstruction to appropriate healthcare in immigration detention, and for medical care in detention centres to be transferred to the NHS. This includes resources to meet and negotiate with the Home Office etc., brief politicians and media, speak at public forums, write-up and publish our findings.

2. "Case-work"
Dawing on resources from within the MJ Network, taking into consideration the specialist's availability and the commitment they are able to give at any time.

3. Organisational work
In order to do "case-work" and campaigning effectively, MJ must devote some resources to building a robust and lasting organisation.   This includes establishing a legal entity, finding funding (donations and grants), establishing a physical presence (desk-space, computers, phone-line etc), building a flexible but robust referrals system, building databases, maintaining and enhancing the website, creating MJ literature, expanding the network (recruit, integrate, train and assist new members), and holding planning meetings.

Referrals to Medical Justice must take into account our limited resources and will be prioritised.

• About 25,000 people are detained each year, including 2,000 children, so demand will greatly exceed Medical Justice's capacity.  
• Referrals will be prioritised, especially considering children and those with particular vulnerabilities.
• It is easy for anyone in direct contact with detainees to acquire a long list of requests from detainees.   For the foreseeable future, there will be many cases that Medical Justice do not have the capacity to deal with.
• Where timely and competent engagement of Medical Justice resources will not make a significant difference to the outcome of the patient's case, it may have to be de-prioritised (e.g. an Medico Legal Report for a case in support of signs of torture scars when the Home Office already concede that torture took place)

Cases appropriate to refer to Medical Justice
An appropriate referral to Medical Justice is an urgent case that contains a significant medical need and for which no appropriate expert(s) from a larger / funded organisation can be mobilised in a timely manner.  

Referrals to Medical Justice must include

• Every Medical Justice referral form must include the name and contact details of a "case co-ordinator" that Medical Justice can work with.  
• The "case co-ordinator" will always work towards getting detainees with health problems out of detention and contributing to the patient's immigration case.
• People referring cases to Medical Justice must endeavour to engage resources of other, larger, funded organisations before trying to engage (further) Medical Justice resources.
• Everyone must endeavour to prevent duplication - because of the emotional and stressful nature of the work, many people may get involved in one case. This is a poor use of resources because it reduces Medical Justice's capacity.
• The "case co-ordinator" commits to gathering all relevant information about a case and keep Medical Justice informed.

Examples (not an exhaustive list) of MJ cases ...

• The detainee may need a medico-legal report (MLR) for his/her immigration case - a Medical Justice doctor may be able to visit the detainee and write an Medico Legal Report if it will significantly effect the detainee's case.
• The detainee may be sick (physically or mentally) or disabled and not getting appropriate care in detention - a Medical Justice doctor may be able to advise on appropriate treatment, including hospital admission.   This may or may not include needing to visit the detainee and, where appropriate, the work involved may involve a Medical Justice doctor.
• Detainee alleges assault during removal attempt - this could involve Medical Justice doctors, and input from immigration solicitors/barristers and civil action solicitor.   This may include a visit by doctor and an Medico Legal Report.
• Inadequate provision of essential travel medicine - may include input from Medical Justice doctors / nurses, and solicitors / barristers. This will not normally require a visit.
• A significant medical element requires specialised or experienced legal expertise

The MJ Referral Form
The referral form includes information about the detainee, where s/he is, their legal representatives (if any), info about their health, what care (if any) they are receiving, info about their immigration case, who else is involved in the case and what actions they are taking.

A well-completed referral form may "attract" a doctor within the Medical Justice network to take a case, confident that all aspects are being considered, and that the case will be well co-ordinated.

Because a medical visit is very time-consuming, the Medical Justice expert needs to know that they have the requisite skills (a report about depression or schizophrenia from a surgeon will not stand up in court), understand the degree of urgency, that their input will make a significant difference to the detainee and his/her immigration case, and if resources from other, bigger, funded organisations could be mobilised.  

One referral may include requesting help from a number of different Medical Justice specialists and the referral form is designed to provide the basics for those various specialists, in a single form that could be copied to all specialists in one go.  

The form also encourages the referrer to think about an initial "strategy" for the case (which may change over time as appropriate).   Often referrals are done in stressful circumstances and it's easy to overlook the primary purpose of the referral - drawing all the information together may help in getting the right overview and defining the purpose.

Some Medical Justice doctors feel that gathering background information already available to or known to the case coordinator is not the best use of their time and feel as much info gathering should be done by the case co-ordinator or referrer.

Referral forms have proved for some to be a useful tool for follow-on work - it provides a summary that can be passed (with the patient's consent) to others - e.g. Refugee Council, a journalist, an MP, a visitor, a GP after the detainee's release, etc., etc.

If a "case co-ordinator" is away on holiday or off sick, the referral form could be used by a colleague s/he passes it to who is standing in while they are away - this helps ensure continuity.

Medical Justice referral forms will enable quick analysis of our case history, facilitate pulling out case-studies, help in campaigning and media work, in seeing how effective Medical Justice interventions have been and where we need more focus.  

Medical Justice is unfunded and relies on voluntary efforts of people who are often very over-loaded and working in a stressful environment.   Comprehensively completed referral forms for appropriate cases and consistency from the "case co-ordinator" are a must.

Comprehensively completed Medical Justice Referral Forms ...

• To help ensure the referral has been prioritised appropriately
• To help ensure understanding of the real purpose of the referral
• To help ensure the most appropriate Medical Justice expertise is called on
• To help formulation of a strategy for the case
• To promote efficiency and avoid duplication
• To help ensure as little of the Medical Justice doctor's time is taken up on background info gathering
• To promote continuity in case of a "case co-ordinator" being on holiday or off sick
• To help getting visibility of the number and type of cases Medical Justice deals with, and with the outcomes.

The Medical Justice referral process

• Download the Medical Justice referral form
• Complete the form and email as an attachment to the relevant email address at the bottom of the form
• Medical Justice volunteers review the completed referral form, check if the referral is appropriate for Medical Justice, if all necessary info is included, if it is clear what the Purpose of the referral is, and which Medical Justice   expert(s) to refer to.
• Medical Justice will circulate the referral form to its appropriate experts within the network and update the referrer / "case co-ordinator" about any Medical Justice experts who may accept to help.
• If Medical Justice experts are found to help, the "case co-ordinator" must remain the co-ordinator for the case deal with the Medical Justice expert(s) assigned.

Please note : Medical Justice does not have enough doctors within the network to refer to
Even a well-complete referral form may not result in being able to pull in a Medical Justice medic or solicitor / barrister in the needed time-frame.   Everyone is asked to do what they can to encourage more medics or solicitor / barrister to join the Medical Justice mailing list.

Confidentiality issues around referral forms:
In addition to non-detained patients' confidentiality needs, immigration detainees may have further reasons for not wanting to broadcast their name and certain information - e.g. information that would increase risk if they were eventually to be removed from the UK (e.g. being gay, political affiliations, HIV status, etc) and info that could put their family or others at risk.

Such issues must be dealt with sensitively.   Some of the issues may be irrelevant for the purposes of the Medical Justice referral anyway.

The Medical Justice referral form deals with confidentiality of the patient's name by means of tick-boxes.   The patient's name can be left off the referral form until an Medical Justice specialist "takes the case", at which point the patients name can be revealed to that Medical Justice specialist.   This may require some extra admin time, but must be observed where the patient wants it.   Most patients have not required their name to be kept confidential in this manner.

In order to track cases and audit our performance, we must - wherever possible - include new referrals in an electronic database. We can only do this and remain compliant with the Data Protection Act if the patient agrees to the inclusion of their named (or anonymised) data on the database. Please use the tick box provided at the end of the form.

Total "time-cost" of a medical visit

• Getting in touch with the patient - Many detainees have histories which contain things (rape, for example) which they will find very difficult to reveal, but which - if possible - the doctor needs to find out about. They can only do so once there is a relationship of trust. Estimated time cost   = 30 minutes.
• Gaining access - Under the new arrangements for medical visits, negotiated with the Home Office on June 6 th 2006, the patient only has to write out that they wish to see the independent doctor and give it to the Health Centre. The doctor must then contact the centre manager and arrange the time and place for the visit. Estimated time cost   = 30 minutes
• Travel and time taken on "security" checks - this is variable, but a doctor based within 30 mins of the detention centre could budget between 2 and 4 hours for this. Estimated time cost   = 2 to 4 hours.
• The medical visit - Estimated time cost   = 60 to 90 mins
• Writing the report - Inclusive of seeking advice, checking facts with patient. Estimated time cost   = 3 hours.
• Follow-up - Liaison with patient, their lawyer and supporters, etc. Estimated time cost   = 1 hour
  

Total time-cost of a visit = 8 hours minimum

Detainee support after Medical Justice doctor's visit 
This is crucial and needs to be taken into account.   Ongoing support from the case co-ordinator, befriender/supporter/visitor is essential.   Some Medical Justice doctors may need to restrict post-visit support to clinical necessity, as they may feel their time is better spent on another case, rather than providing non-specific, but nevertheless vital emotional support to detainees.   This is not to say that Medical Justice doctors should not be emotionally supportive - of course they should, it is part of good quality care.   If this can safely and appropriately be done by supporters and visitors, it may make more sense for Medical Justice doctors to use their limited time on another case.

Medical Justice referral form