Continuation Part 3 - Discussion of the Amanda Knox case

[Rolfe]

I wonder if the WHO is the right place to be raising these concerns. They might consider an individual case like this out of their remit, especially if the concerns come from an uninvolved third party.

I just listed my own concerns which arose from the situation as I'd heard it reported. The reports suggested a completely unacceptable series of events, and my preliminary conclusion was that there was no positive HIV result and it was just one more thing the cops invented to intimidate Knox and get more information out of her.

Of course, Machiavelli may tell us that it's perfectly OK for the cops to tell any lies they want when interrogating a suspect. Except he denied that they had told any lies.

I must be confused.

Rolfe.

 

[Mary_H]

I wonder if the WHO is the right place to be raising these concerns. They might consider an individual case like this out of their remit, especially if the concerns come from an uninvolved third party.

I just listed my own concerns which arose from the situation as I'd heard it reported. The reports suggested a completely unacceptable series of events, and my preliminary conclusion was that there was no positive HIV result and it was just one more thing the cops invented to intimidate Knox and get more information out of her.

Of course, Machiavelli may tell us that it's perfectly OK for the cops to tell any lies they want when interrogating a suspect. Except he denied that they had told any lies.

I must be confused.

Rolfe.

We considered sending it to health authorities in Italy, but considering the icy reception most communications with Italy had received by that time, we thought it best not to rock the boat. Besides, the prison did in fact violate a number of WHO guidelines, although most of these are not enforceable laws, except for doctor-patient confidentiality, which Amanda was able to recover some damages for.

ETA: One concern that was raised in the letter is something I think WHO should be concerned about:

In addition to any harms that may have come to Amanda Knox as a result of the HIV test, we are concerned that capricious misuse of HIV testing has the potential for creating fear of and disrespect for the efforts of legitimate public health efforts. The possible abuse of HIV testing as a means of torture trivializes the nature and purpose of AIDS awareness, as well as the international medical response to HIV/AIDS.

 

[Machiavelli]

So in other words as long as the prosecution wishes to maintain she's 'accused' Patrick Lumumba it can ignore everything she says or does and pretend its requirements aren't satisfied? Or that she is still 'lying' in which case again it can maintain the 'accusation' still stands?

Byzantium endures.

!? If she provided a consistent position nobody would ignore it.
But she did not provide any explantion, any version, any clarification.

 

[Mary_H]

!? If she provided a consistent position nobody would ignore it.
But she did not provide any explantion, any version, any clarification.

So they arrested an innocent man based on a suspect's inconsistent position.

 

[Rolfe]

I have to thank Mary_H for copying me in to the entire letter sent. I note two more concerns I overlooked in my post. First, whether or not Knox took the test voluntarily, and second, that she was apparently not accorded confidentiality (unless she was, and she herself chose to reveal the information?). (I didn't know that the WHO mandated that such testing of prisoners should be voluntary, or that confidentiality was also mandated. Good catch.)

I would be very keen to know what actual facts are known about this alleged test. Who said she was tested, what have the authorities said about it and so on?

At the moment I do not believe there was any test in the first place. I think the cops merely told her she had tested positive as part of the softening-up process. It might be something they do quite often, even part of a routine.

To play armchair critic for a moment, I think the letter you sent was too long, and too padded. In particular it majored on comment about the alleged test, without laying out the basic evidence underpinning the concerns. Is it indeed the case that all we have is Amanda's leaked diary entry? Mignini seems to be quoted merely as saying he knows nothing about it. Is there any other primary evidence relating to the test?

Just for a start, do we know if anyone ever actually took a blood sample from Amanda? If so, who, and was she told the purpose of the sampling? This seems to be the start of the inquiry. If no blood sample was collected, then the whole thing is a fiction. Was Amanda thinking clearly enough in November 2007 to work that out, though?

I very much doubt that prison officers are trained or permitted to collect blood samples from inmates. So if a blood sample was taken, that would imply the involvement of medical personnel. Then there is the question of which lab did the test, what the methodology was, what their accreditation status was and so on. Then, who issued a preliminary unconfirmed positive result, and to whom? This all stinks to high heaven.

I suspect the WHO don't believe there was any test, which may be part of why no answer was forthcoming. Certainly, the letter merely indicates that Amanda wrote in a diary that she was told she had tested positive. With no more information than that, this isn't a health issue at all. It's an issue of the Italian authorities lying to a prisoner.

It may be that Amanda will take this further now she has been released. At the very least, she should demand copies of all laboratory reports relating to any samples collected from her. On the other hand, this may be the least of her concerns. She may even be in a position to recall that she was never blood sampled in the first place.

Rolfe.

 

[Rolfe]

In addition to any harms that may have come to Amanda Knox as a result of the HIV test, we are concerned that capricious misuse of HIV testing has the potential for creating fear of and disrespect for the efforts of legitimate public health efforts. The possible abuse of HIV testing as a means of torture trivializes the nature and purpose of AIDS awareness, as well as the international medical response to HIV/AIDS.

That is a very good point. The difficulty may be that this isn't an abuse of testing at all, but simple lying. It may be difficult for the WHO to take any position on that.

The thing is, spurious positive results in first-line testing for HIV (ELISA, I imagine) are not that common. That's part of the reason I think this whole thing is simply fabrication. Such results would simply be far far too rare to be of any use to the authorities on a regular basis. (They would, or should, also not be known to the authorities if the testing was done in a reputable laboratory - only a confirmed positive result should go beyond the doors of the lab.)

So either Amanda was the victim of an extraordinary series of events.

• her sample was indeed positive on ELISA, even though she was not infected with the virus (RARE, I repeat)
• some highly unethical laboratory issued the ELISA result before the confirmatory test was complete
• a prison officer somehow got sight of what should have been a confidential document

Pull the other one, it plays Jingle Bells.

Rolfe.

 

[Mary_H]

I have to thank Mary_H for copying me in to the entire letter sent. I note two more concerns I overlooked in my post. First, whether or not Knox took the test voluntarily, and second, that she was apparently not accorded confidentiality (unless she was, and she herself chose to reveal the information?). (I didn't know that the WHO mandated that such testing of prisoners should be voluntary, or that confidentiality was also mandated. Good catch.)

I would be very keen to know what actual facts are known about this alleged test. Who said she was tested, what have the authorities said about it and so on?

At the moment I do not believe there was any test in the first place. I think the cops merely told her she had tested positive as part of the softening-up process. It might be something they do quite often, even part of a routine.

To play armchair critic for a moment, I think the letter you sent was too long, and too padded. In particular it majored on comment about the alleged test, without laying out the basic evidence underpinning the concerns. Is it indeed the case that all we have is Amanda's leaked diary entry? Mignini seems to be quoted merely as saying he knows nothing about it. Is there any other primary evidence relating to the test?

Just for a start, do we know if anyone ever actually took a blood sample from Amanda? If so, who, and was she told the purpose of the sampling? This seems to be the start of the inquiry. If no blood sample was collected, then the whole thing is a fiction. Was Amanda thinking clearly enough in November 2007 to work that out, though?

I very much doubt that prison officers are trained or permitted to collect blood samples from inmates. So if a blood sample was taken, that would imply the involvement of medical personnel. Then there is the question of which lab did the test, what the methodology was, what their accreditation status was and so on. Then, who issued a preliminary unconfirmed positive result, and to whom? This all stinks to high heaven.

I suspect the WHO don't believe there was any test, which may be part of why no answer was forthcoming. Certainly, the letter merely indicates that Amanda wrote in a diary that she was told she had tested positive. With no more information than that, this isn't a health issue at all. It's an issue of the Italian authorities lying to a prisoner.

It may be that Amanda will take this further now she has been released. At the very least, she should demand copies of all laboratory reports relating to any samples collected from her. On the other hand, this may be the least of her concerns. She may even be in a position to recall that she was never blood sampled in the first place.

Rolfe.

Thank you for your feedback, Rolfe. I agree that the letter was too long.

No, there is no primary evidence of the tests. The letter was an attempt to start an investigation of whether the tests actually were ever administered. We assumed the prison would not be willing to share this information with us.

As noted in the letter and my previous post, it reflects poorly on the prison medical staff whether they were the ones who perpetrated the fraud, whether they knowingly allowed the fraud, or even whether they were ignorant of the police perpetrating the fraud and found out about it later.

Amanda's health was the confidential business of the prison medical staff and should have been exclusively under their (and her) control. The news of the HIV tests was revealed in the media very early, so there is no way the medical staff could say they hadn't heard anything about it. Even if the police perpetrated the fraud without the knowledge of the medical staff, once the staff found out about it, they should have protested or filed complaints with some regulating body.

 

[Rolfe]

Wait. The cops or prison officers tell an inmate that he or she is HIV positive, in order to pressurise them to reveal information about their sexual contacts. Once that has been achieved, they tell the inmate that in fact it was a false positive, and the confirmatory test was negative.

You expect the prison medical authorities to do anything at all about this? Like tell the cops to stop with this nonsense?

Wake up and smell the coffee.

Rolfe.

 

[bri1]

!? If she provided a consistent position nobody would ignore it.
But she did not provide any explantion, any version, any clarification.

Are you kidding? Have you read this: http://www.internationalskeptics.com/forums/showpost.php?p=7673070&postcount=12747

So here we have:
a) an explanation as to where she was that night.
b) a clarification of how the 'accusation' arose.

Do you concede now?

 

[Machiavelli]

I can't be sure whether your representation of "how the law works" is correct; but I will say that if it is correct, then it means that the police can effectively make their own rules and do whatever they like in an interrogation.


Again, your knowledge of Italian law is greater than mine; but if this is true then it means that the rights of the little people don't really exist at all: "anything you say can be used as evidence against you, including 'I want a lawyer'."

Machiavelli, up to now you have have been making the case that what the police did on the night of 5-6 November was correct, and that Amanda's (and Raffaele's and Patrick's) rights were not violated. You would gain some credibility by making it clear what the limits of police action are, and what rights the "witness" really has. At the moment, by excusing everything the police did, you appear to be saying that there are no limits to police actions, and that witness "rights" (such as to a lawyer) only exist at police convenience.

My explanation about the law does not need any demonstration because the law is available to public knowledge. The police is excused simply because there is no matter for accusation, except the "hitting twice" there is no violation of any kind. There is also basically no difference between the police and witnesses' account of facts, and Knox's accout of facts (I am not talking bout the court interrogation, where there are contradictory statements), provided the only difference of the "hitting twice".

The basic limitation on police conduct - by the law - is definied by:
1) respect of inviolable human rights
2) do not delay the communication of evidence to a magistrate
3) do not operate the enforcing of measures without authorization of a magistrate
4) do not take initiatives after a magistrate intervened
5) the main limitation on police activity is not on their activity but is the non-usability in court of statements to the police. In the US "all what you say is usable against you"; in Italy it is not. This is the main protection tool in the Italian system about statements to the police.
However, this statute has a few limitations and exceptions. The main exception is a calunnia case.

The police have a small role and small powers in investigations. The huge investigation powers belong to the Procura, people who are basically judges. However on the other hand the police forces have also fewer limitations in dealing with the common citizen, or better these limitations are independant and not codified in the procedure code; above all their conduct is not considered directly related to the judiciary process.
The Italian systems tends to consider the police almost as militaries, external agencies and offices which are "used" by the Procura, not entirely as trustworth civil institutions. Until 1980 the State Police was still actually a military corp. Subsequently it has developed into paramilitary and then gradually a democratic government institute. The Carabinieri are still a sectarian, elite military branch, formally belonging to the armed forces. There is nothing actually "wrong" in this, but this an asset of a Republic. The same questions could be put about US agencies and corps operating abroad: to which democratic statutes do they abide? You cannot consider them preemptively as non-democratic.

 

[Mary_H]

That is a very good point. The difficulty may be that this isn't an abuse of testing at all, but simple lying. It may be difficult for the WHO to take any position on that.

The abuse resides in the effect Amanda's experience has on people's perceptions. If patients fear that authorities will lie about tests or will use fake test results to torture or extract information, it will decrease people's willingness to get tested, which is detrimental to prevention efforts.

The thing is, spurious positive results in first-line testing for HIV (ELISA, I imagine) are not that common. That's part of the reason I think this whole thing is simply fabrication. Such results would simply be far far too rare to be of any use to the authorities on a regular basis. (They would, or should, also not be known to the authorities if the testing was done in a reputable laboratory - only a confirmed positive result should go beyond the doors of the lab.)

So either Amanda was the victim of an extraordinary series of events.

• her sample was indeed positive on ELISA, even though she was not infected with the virus (RARE, I repeat)
• some highly unethical laboratory issued the ELISA result before the confirmatory test was complete
• a prison officer somehow got sight of what should have been a confidential document

Pull the other one, it plays Jingle Bells.

Rolfe.

LOL.

 

[Machiavelli]

Are you kidding? Have you read this: http://www.internationalskeptics.com/forums/showpost.php?p=7673070&postcount=12747

So here we have:
a) an explanation as to where she was that night.
b) a clarification of how the 'accusation' arose.

Do you concede now?

You are not seriously saying this gives a consistent explanation of things.
This is entirely contradictory ("I did not lie").
It also comes after the statement "the truth is I don't know what is the truth".

So if she did not lie, and if she doesn't know what is the truth, how is it that she knows for certain where she was that night?
And where is the explanation for why she gave two different versions during the previous 24 hours? first version: I remember about Patrick killing Meredith (05:54 statement); second version: I am not sure, I don't know what is the truth. Now whe have a third version more skewed towards one possibility: but where is the explanation for the previous two vrsions? And where is certainity, and what are her grounds for certainity? And what are the details of her acccount?

In her version there is nothing. It's a mystery for me how you can fail to see how inacceptable her position is.

 

[Mary_H]

Wait. The cops or prison officers tell an inmate that he or she is HIV positive, in order to pressurise them to reveal information about their sexual contacts. Once that has been achieved, they tell the inmate that in fact it was a false positive, and the confirmatory test was negative.

You expect the prison medical authorities to do anything at all about this? Like tell the cops to stop with this nonsense?

Wake up and smell the coffee.

Rolfe.

Legitimate doctors would be ashamed to allow this misuse of testing on their watch. Can you imagine them talking about it at the next meeting of the AMA (or similar body in other countries)? "Oh yeah, they did that at the prison where I work. Those cops! What're you gonna do?"

In the United States medical professionals who violate the Health Insurance Portability and Accountability Act of 1996 (HIPAA) are subject to enforcement and corrective action. Apparently, Italy has some similar regulations, because the journalist who published Amanda's diary had to pay damages for violating patient confidentiality. Why the case was left there, I don't know.

 

[Rolfe]

The abuse resides in the effect Amanda's experience has on people's perceptions. If patients fear that authorities will lie about tests or will use fake test results to torture or extract information, it will decrease people's willingness to get tested, which is detrimental to prevention efforts.

I agree. However, I think the chances of a small group of private individuals succeeding in getting the WHO to address this issue by expressing their concerns about an anecdotal account by a single prisoner are not high.

It may be a battle the WHO chooses not to fight at this time, given the wide range of health concerns in the world.

Rolfe.

 

[Paninaro]

!? If she provided a consistent position nobody would ignore it.
But she did not provide any explantion, any version, any clarification.

But the police never wanted any clarification. They wanted a confession and a confirmation of what they already knew. And they got a false one. This is ultimately the fault of the police. It's their job to get the explanation, the true version, the clarification. As I had said before, that makes them at least as guilty of calunnia as Knox, if she's guilty. And that is why calunnia laws are unjust and barbaric and a shame to your country, because they serve not as an instrument to assure truth, as they are intended to, but an instrument of power and a way to scare people.

Sure what Knox say can be defamation, but not as a direct result of a hard interrogation. You are obviously blind to the dangers of this, but why do you think other countries can make do without Calunnia? If Knox had stood by her accusations that's one thing, but she almost immediately retracted them. In your world that doesn't seem to make any difference. I can't for my life understand that view on life and justice. Either Knox is guilty as you believe or she is innocent like I believe. Either way the calunnia business is ridiculous, for this is not a trial were justice is supposed to put justice and judicial process at the stand. It's about a murder. I don't believe in it even if I believed that Knox was guilty.

Yes, I believe Knox lied. She told the cops what the wanted to hear, because it seemed the easy way out. Yes, it was wrong and Knox is morally culpable. But the cops are even more so. If they had conducted an interrogation in a democratic and human fashion, they wouldn't have got this kind of result. How can you fail to see this? You've been subjected to hard questioning yourself. Just because you are of a harder fiber and maybe with better moral than Knox doesn't mean you can't understand how weaker persons will budge under pressure. People lie all the time.

Despite what you say Knox could have lied for a variety of reasons, it doesn't have to include malice. Your reasoning is obviously based on the assumption already in place that Knox is guilty of murder. And then you are already deep inte circular reasoning; Knox is guilty, therefore she has intent and a malicious purpose to lie, therefore she is guilty and so on.

Ultimately I think you are prepared to see this another way, if only you could see there was a chance of innocence. As you yourself have said, if Knox is not guilty; how can there be intent. And if there is no intent, how can it be calunnia?
Well, the answer to a, non Italian is that the Italian justice system in some cases is in grave danger of punishing innocent people for its own shortcomings. If you can't agree in this case, try to think of it in a broader perspective. This is a barbaric inheritance from the inquisition.

By the way, good of you to participate in this debate and I agree that the personal attacks on you and speculation about identity are unnecessary. Any advice on the Ossobuco I'm preparing today?

 

[Rolfe]

Legitimate doctors would be ashamed to allow this misuse of testing on their watch. Can you imagine them talking about it at the next meeting of the AMA (or similar body in other countries)? "Oh yeah, they did that at the prison where I work. Those cops! What're you gonna do?"

I have to tell you I have no difficulty at all in imagining this, though in rather less colloquial language.

Bear in mind that we're not talking about the misuse of testing. We're talking about cops lying to a prisoner, that's all. We've been told that's absolutely SOP, and cops are totally allowed to say anything they like in order to advance their information gathering.

Even if lying about non-existent HIV results is something that makes some prison medical staff uncomfortable, I could well see them deciding it was none of their business.

In the United States medical professionals who violate the Health Insurance Portability and Accountability Act of 1996 (HIPAA) are subject to enforcement and corrective action. Apparently, Italy has some similar regulations, because the journalist who published Amanda's diary had to pay damages for violating patient confidentiality. Why the case was left there, I don't know.

I would like to know a lot more about this, starting with whether it's even possible that Amanda was tested at all - that is, did someone actually stick a needle in her arm and collect a blood sample? If they didn't, then that's the end of that.

It may be however that the Knox family and Amanda see this as a minor issue in the context of all the other stuff that went on. If they do intend any sort of legal action against the Italian authorities it may be something that is included, though.

For myself, I'm essentially content that there was no test and the cops lied about it to get her to write down those names. Chalk one more outrage to add to the rest.

Rolfe.

 

[Mary_H]

I agree. However, I think the chances of a small group of private individuals succeeding in getting the WHO to address this issue by expressing their concerns about an anecdotal account by a single prisoner are not high.

It may be a battle the WHO chooses not to fight at this time, given the wide range of health concerns in the world.

Rolfe.

Apparently you are correct.

Notice, though, that they have a section devoted specifically to prison concerns, and they have a section devoted specifically to AIDS concerns, and they have a section devoted specifically to gender, women and health. While policy is no doubt their main focus, I would hope that it is within their mission to address, at least from time to time, individual cases of heath care rights violations, especially in high profile cases that could be exploited for their educational value.

 

[Rolfe]

I think it is a question of how to approach the issue as a general principle. The WHO is a highly political organisation, and needs to be handled in that manner. I don't actually know how anyone would go about raising such an issue with them. I suspect it would have to start with an organised pressure group collecting a good number of well-documented example cases, and identifying in which jurisdictions the problem was common enough to require addressing.

In the present case, I think the remedy is for Amanda to take the matter up herself and demand to see the relevant lab reports.

Rolfe.

 

[Mary_H]

I have to tell you I have no difficulty at all in imagining this, though in rather less colloquial language.

Bear in mind that we're not talking about the misuse of testing. We're talking about cops lying to a prisoner, that's all. We've been told that's absolutely SOP, and cops are totally allowed to say anything they like in order to advance their information gathering.

Even if lying about non-existent HIV results is something that makes some prison medical staff uncomfortable, I could well see them deciding it was none of their business.

It becomes their business when it reflects on their reputations. It is their duty to protect patient confidentiality and to follow guidelines that ensure patient health. They failed. For this, I and other people think badly of them. Why allow damage to their reputations if they were not involved?

I would like to know a lot more about this, starting with whether it's even possible that Amanda was tested at all - that is, did someone actually stick a needle in her arm and collect a blood sample? If they didn't, then that's the end of that.

In my opinion, there were no HIV tests. However, blood may have been taken from Amanda at her initial physical upon entering prison.

It may be however that the Knox family and Amanda see this as a minor issue in the context of all the other stuff that went on. If they do intend any sort of legal action against the Italian authorities it may be something that is included, though.

It may be, as you say, that they don't want to bothered with it. Amanda shouldn't be required to have it brought it up for public examination again.

Regardless of Amanda's involvement, it stands to reason that regulating bodies would investigate whether there were violations and who was responsible for them. That's one of the functions of regulating bodies.

For myself, I'm essentially content that there was no test and the cops lied about it to get her to write down those names. Chalk one more outrage to add to the rest.

Rolfe.

Agreed.

 

[Rolfe]

There may have been a blood sample for drug testing.

As for the rest, I think the question of cops lying to prisoners isn't one that is going to get much traction in the grand scheme of things. Getting the medical authorities to care about cops lying about HIV test results might be harder than you think. Prison doctors may be in no position to protest. Getting higher authorities involved would require a number of well-documented cases I imagine, and at the moment it's questionable if we even have one.

Rolfe.