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Constitutional Validity of Narco-Analysis Test

Prepared by:  Urja. B. Dave

Nirma University of Science and Technology

Institute of Law

Ahmedabad

Constitutional validity of Narco Analysis Test

Introduction:

Development of new tool of investigation has led to the emergence of scientific tools of interrogation and criminal investigation like NARCO ANASLYSIS TEST. However, its application must be assessed objectively so that it can be replaced by existing conventional methods of interrogation. Narco analysis test can be effective as an alternative to barbaric third degree methods. Care should be taken that it is not misused or abused by investigation officer and should be correlated with corroborative evidence. Such test is a result of advancement not only in Forensic science but also in Science and Technology. It often Raises doubts regarding basic human rights and about their reliability.

Legal questions are raised bout validity with some of them holding in the light of legal Principles and Perceptive and some others rejecting it as a violence of constitutional Provisions.

Historical perspective:

In 1922, Robert House, an obstetrician from Texas, experiment the use of narco analysis in the interrogation of suspected criminals. He arranged to interrogate two Prisoners in the Dallas country jail by using Scopolamine1, whose guilt seemed clearly confirmed. Both the prisoners denied the crimes for which they have been detained and upon trial were [1]found not guilty. After the successful experimentation, House concluded that an accused under the influence of scopolamine could not lie.

The Narco analysis during past was used only by psychiatrists to find out the psychological reality. Nevertheless, the application of the Technique was adopted frequently in the criminal investigation from early 1950s.

Narco analysis was rather unheard in India until recent past. It was first used in 2002 in the Godhra Carnage Probe. Narco analysis test once again is in the limelight in the contest of Aarushi Murder case. It was also used in Nithari village serial killings case, Telgi Stamp paper Scam, Arun Bhatt Kidnapping case in Gujarat, and others.

What is Narco Analysis Test?

The term Narco-Analysis is derived from the Greek word “narke” meaning anesthesia and is used to describe a diagnostic and psychotherapeutic technique that uses psychotropic drugs, particularly barbiturates, which acts as Central Nervous System depressants, and by virtue of this, they produce a wide spectrum of effects from mild sedation to anesthesia.

Narco-Analysis tries to recall repressed materials. The therapist gives post-hypnotic suggestion to patient. Repressed material is recalled during influence of the drug and repressed conflict of the patient is located and cured.

Procedure of Narco-analysis test:

The narco analysis test is conducted by mixing 3 grams of sodium penthol or sodium amytal dissolved in 3000ml of distilled water. Narco test refers to the practice of administering barbiturates or certain other chemical substances, most often penthol sodium, to lower a subject’s inhibition, in the hope that the subject will more freely share information, a person is able to lie by using his imagination. Experts inject a subject with hypnotics like sodium penthol or sodium amytal under controlled circumstances of the laboratory. The dose is dependent on the person’s sex, age, health and physical condition. The subject, which is put in a state of Hypnotism, is not in a position to speak up on his own but can answer specific but simple questions after giving some suggestion. The answers are believed to be spontaneous as a semi-conscious person is unable to manipulate the answers. Wrong dose can send the subject into coma or even result in death.

The subject is then interrogated by the investigating agencies in the presence of doctors. The revelations made during this stage are recorded both in video and audio cassettes. The report prepared by the experts is what is used in the process of collecting evidence.

The procedure is conducted in government hospital after a court order is passed instructing the doctors or hospital authorities to conduct the test. Personal consent of the subject is also required.

It is established that in of the total number of the individuals subjected for narco analysis are found to be innocent. Therefore this technique not only helps to identify the real perpetrator of crime, conspiracies, displacement of evidentiary items etc. but also to identify the innocents within a short period.

Pros and Cons of Narco Analysis Test:

According to police Narco analysis is a scientific tool of investigation, it helps a lot in crime prevention and detection. It is definitely considered better than third degree treatment of the police to extract truth from an accused.

It is not possible to determine the correct dose of the drug, which varies according to the physical constitution of the subject, but also his mental attitude and will power. A wrong dose can send the subject into coma or even cause death, thus resulting in legal complication. The person to administer them has to be highly qualified physician.

The test can be misused by suggestive questioning by the investigating agencies. Psychiatrists hold that some individuals are suggestible even while fully conscious, meaning they can be made to believe events that never actually happened. Therefore, while patients under narco analysis may find it difficult to lie consciously, they can certainly say things that are on the surface on their mind. The patient may say things that he wished were true and not that are necessarily true.

Constitutional Validity:

Some legal experts consider that narco analysis test during the investigation is a blatant violation of Art. 20(3) of our constitution. Art. 20(3) says, “No person accused of any offence shall be compelled to be witness against himself”

The conditions for the applicability of Art. 20(3) are:

There must be a person accused of any offence. There must be compulsion against such person. Such compulsion must be to be witness and Such person must be compelled to be a witness against himself, in other words to incriminate himself by his evidence.

All these four ingredients must be necessarily co exist before the protection of Art. 20(3) can be claimed. If any of these ingredients is missing Art. 20(3) cannot be invoked.

The controversy regarding test is against the fundamental right is due to the modus operandi of the test. In the test, the drug is administered which suppress the reasoning power without affecting the memory and speech.

The test also goes against the maxim “Nomo tenetur se Ipsum Accusare” which means no man not even the accused himself can be compelled to answer any question, which may tend to prove him guilty of a crime of which he has been accused. The previously mentioned principle of the maxim is also incorporated in the section 161(2) of the code of criminal procedure.

Sec. 161(2) of Cr. P. C says that such person shall be bound to answer truly all questions relating to such case put to him by such officer, other than the questions the answer to which would have a tendency to expose him to a criminal charge or to a penalty or forfeiture.

The most important case in this regard is that of Nandini Satpathi v. P. L. Dani (AIR 1978 SC 1025).

Facts: Nandini Satpathi was a former chief minister of Orissa, against whom a case was registered under the Prevention of Corruption Act. She was asked to appear before the Dy. S. P for questioning. The police wanted to interrogate her by giving her a string of questions in writing. She refused to answer the questions because it was a violation of her fundamental right against the self-incrimination.

In the previously mentioned case Krishna Iyer, J. has widened the scope of the protection. The issue before the court was whether a potential candidate for accused can avail of the privilege. It was held that the right extends to witness & the accused alike. The expression ‘accused of any offence’ must mean formally accused in presenti not in futuro. It applies at every stage at which furnishing of information & collection of material takes place.

Thus, Right to Silence has been granted to the accused by virtue of the pronouncement in the case of Nandini Satpathi. No one can forcibly extract statements from the accused, who has right to remain silent during the course of interrogation (investigation). By administration of narco analysis test, forcible intrusion into one’s mind is being restored to, thereby nullifying the validity & legitimacy of the Right to Silence.

It is an accepted legal position that the protection of Art. 20(3) do not extend to compulsory production of material or compulsion to give specimen signatures, finger impression or blood samples. However, Narco analysis is still different & clearly distinguishable from giving specimen signatures or blood samples or even taking a polygraph test because except in case of a narco analysis, the accused retains his control over what he is doing or saying & at no point of time can he be compelled to disclose any such information that he wants to keep to himself. Giving blood sample or specimen signatures is much like allowing the investigation officer to search the residence of the accused & go through his belongings in search of evidence. That is very much permissible.

The legal & constitutional infirmity of narco-analysis lies in the fact that it takes away one’s control on one’s mind, which brings it in category of mental torture & torture of all kind fall foul with Art.21.

Now the question may arise that the so-called ‘consent form’ sign by the accused supplies the requirement of the ‘voluntary discloser’. It is incorrect as in the court mandated narco analysis, the ‘consent form’ has absolutely no relevance because the compliance of a judicial order passed by a competent authority to compel obedience. Therefore, if a competent court orders narco analysis the order has to comply with, unless it is challenged by the superior court. The accused has no choice against the court order. Therefore, there is ‘compulsion’, there is ‘testimony’, and it is surely ‘testimony by compulsion’. However, compulsion per se is not illegal. Therefore, the only one question is whether the compulsion is legally sound.

The Madras High Court in Dinesh Dalmia v. State of Madras held that subjecting an accused to undergo such scientific tests would not amount to breaking his silence by force. He may be taken to the laboratory for such test against is quite voluntary. Therefore, such process does not amount to compelling a witness to give evidence against him. When the human rights activist adopt third degree methods to extract information from the accused, it is high time the investigating agency took recourse to scientific methods of investigation.

The Bombay High Court in Abdul Karim Telgi case held that “certain physical tests involving minimal bodily harm” like narco analysis test and brain mapping does not violate Art. 20(3) and did not compromise the constitutional protection against self-incrimination. The important point is that the confession or statement made during narco analysis is not admissible as evidence in a court of law, and that is the reason why the protection against self-incrimination under Art. 20(3) is not breached. In the above-mentioned case Bombay High Court seems to have held that nacro analysis is permissible because it involves “minimal bodily harm”, which implies that all such methods of extracting information that inflict minimal bodily harm are legally permissible.

However, the final judicial pronouncement on the constitutional status of narco analysis is yet to come. In 2006, Supreme Court of India stayed the order of a metropolitan judge to conduct nacro analysis on K. Venkateswara Rao in the Krushi cooperative Urban Bank case. The issue required to be settled by a court decision because Mr. Rao refused to sign the consent form & hence the Forensic Laboratory at Gandhinagar declined to conduct a narco analysis test without a duly filled and signed consent form. The Supreme Court verdict is still awaited.

Conclusion:

Law is a living process, which changes according to the changes in society, science, and ethics and so on. Law is not static but it is dynamic. The legal system should imbibe developments and advances that take place in science as long as they do not violate fundamental legal principles and are for the good of the society. The criminal justice system should be based on just and equitable principles. The issue of using narco analysis test as a tool of investigation in India has been widely debated. The extent to which it is accepted in our legal system and our society is something, which will be cleared in the near future. In a situation where narco analysis is gaining judicial acceptances and supports despite being an “unreliable and doubtful” science, we have to seriously rethink about its legal and constitutional validity from human rights perspective.

The criminal justice system is based on the principle that “let hundred guilty go unpunished rather than an innocent is punished”. To uphold this principle narco analysis test has to be made compulsory in cases where the interest of public is involved. For this purpose, it is necessary to amend or to enact new laws for that purpose so that justice may be delivered in a fair manner.

[1] Scopolamine is also popularly known as tooth serum.

Nowadays, almost every job requires you to take a psychometric assessment as part of the job selection process. So, you may be required to take a numerical aptitude test. This is so because numerical or maths aptitude tests form an important part of the recruitment process. Maths aptitude tests are filled with numerical reasoning questions that are invariably made up of multiple choice questions. These tests are also strictly timed. You may also know that you will not be able to use a calculator on these tests unless it is specifically stated.

However, you need not be disappointed. There are a number of ways which would help you increase your score in maths aptitude tests. There are a number of web sites that offer free maths aptitude tests. These tests are categorised on the basis of their level of difficulty. You may start by taking the easiest level and then go on increasing your level. This would help you get acquainted with all the different kinds of questions that may be asked in maths aptitude tests; and once you get acquainted with different types of questions, you would be able to solve them correctly in no time.

Some of the categories in which questions would be found in almost all maths aptitude tests are:

?    Trigonometry, the science of measuring triangles, is found in almost all maths aptitude tests. Thus, to do well in any maths aptitude test you must have good knowledge of trigonometric ratios and basic identities.

?    Linear equations are part of all maths aptitude tests. They can be age related problems, upstream, downstream problems, and so on.

?    Questions from volume and surface area may be expected in all maths aptitude tests.

On the other hand, there are some companies that provide calculators to those giving the test. However, it is a better idea to take your own calculator. This is because you are familiar with your calculator and using it will ensure that you are familiar with the location of the buttons and so will save a few seconds on each question. This can give you a slight advantage over other candidates, not carrying their own calculators.

In order to make yourself stand out in any job aptitude test, you may also take help from e-books. These e-books provide you with examples of numerical reasoning questions and tips that will help you score better in these tests. There are a number of tips that you should take into consideration whilst preparing for maths aptitude tests.

Another factor that you may need to consider is that of negative marking. Many tests use negative markings. So, you must answer only those questions which you are confident about. There are examinations that do not use negative marking, but even while taking such tests, accuracy is a must. The companies use software to grade these tests which help them know how many questions a candidate got right. And many employers will hire employees that have accurate and consistent results. Thus, if you want to pass with flying colours, you must be consistent in your performance.

Make no mistake; nothing else mentioned in this book will help you grow like androgens, as they are the basic building block for increasing muscle size and strength. All other things only serve to enhance androgens. So whether you use a natural testosterone booster or a pro-hormone or real juice, you need the basics to build your genetic house. Androgens have been shown to create new muscle growth in multiple ways, both by increasing protein synthesis (filling up your muscle balloons) and increasing the differentiation of satellite cells (making more muscle balloons). That makes them the ultimate starting point for a genetic anabolic cocktail.

What are androgens? Quite simply they are testosterone and its derivatives, both legal and illegal. Guess when your body produces the most testosterone? You got it, puberty! That’s why you can gain mad muscle cells if you simply work out and eat right when you are in high school. Eating right is important because your body isn’t going to make new muscle cells if it doesn’t have the protein to fill up the ones it already has (which is why so many high school students work out without results). Growing muscle during puberty happens in the kitchen, not just the gym, but that is another book.

Androgens are the most potent muscle builders you can take. Luckily with our products you get the best of both worlds, increased androgen production without the negative side effects that SCARE the hell out of most people. You can start small and use something like Formadrol Extreme or you can jump up to our prohormones (Liquid Masterdrol and Methyl 1-D) or you can go the illegal route and hit juice (we don’t recommend this by the way). People doing our Trifecta Stack are routinely hitting 8-12lbs of muscle in a month without losing their gains. If you juice, you can probably increase that to 15-17lbs but when you grow that quickly, you rarely keep your gains. Slow, steady gains might not feel as exciting, but they are the way to build a body, not an ego! The combination of Stanolone (Liquid Masterdrol) plus Testosterone (Methyl 1-D) is a very powerful combination and gives you the ULTIMATE in safety and also gives REAL gains that you would see from a SANE steroid cycle, without the negatives!

So, how do you get a spike in androgens? Many ways… The first way is to use an herbal product that typically will trick your body into increasing output of Luteinizing Hormone. These were made popular with products like Tribulus

and have come a long way with the advent of newer ingredients like Long Jack and others out on the market. Some of them, like Horny Goat Weed only

serve to boost sex drive and have not been shown to enhance testosterone production.

Another way is to use a natural testosterone booster like LG Sciences Formadrol Extreme, which tricks your body into producing more testosterone by blocking estrogen in the body. This can give you levels above even the very highest natural range (a normal man ranges from 250 ng/dl of testosterone to 900 ng/dl). Formadrol Extreme and similar products trick your body into producing more testosterone and can be very useful as a natural anabolic booster, getting your testosterone levels into the 1400ng/dl range. It is also great for Post Cycle Therapy after a steroid or pro-hormone cycle. They are also useful in combating gynecomastia, commonly called “bitch tits”.

The third way to boost your androgen levels is the use of pro-hormones. First made popular by “Andro”, pro-hormones use the basic building blocks of testosterone to force your body into producing more testosterone through the action of enzymes. The first generation of testosterone boosters, like Andro, had tons of side effects and didn’t work very well. Newer pro-hormones like 1-AD were better, but were still not up to the full value of a steroid cycle. The latest crop of pro-hormones, like Methyl-1-D and Liquid Masterdrol by LG Sciences, reduce the side effects, prolong the half-life in the body and reduce conversion to unwanted, side effect producing by-products like Estrogen. The use of pro-hormones can give you testosterone levels that rival even the strongest steroids, raising your testosterone levels to 3000-3500 ng/dl if used properly.

Methyl-1-D from LG Sciences is a pro-hormone that is formulated to reduce side effects, provide maximum safety and give you AMAZING results. It’s the real basis for our genetics-changing stack. For a more advanced stack, use Liquid-Masterdrol along with Methyl-1-D for the best possible combination of prohormones that hit both the more androgenic (Liquid Masterdrol) and more anabolic (Methyl 1-D) aspects of growth.

The fourth way to boost androgen levels is to use artificial illegal steroids to boost your testosterone levels above even the highest legal levels that pro-hormones can give. I am not here to make a value statement about steroids, but I am just pointing out the option to anyone that is in a foreign country that allows steroid use or is using androgens with a doctor’s prescription.

We highly suggest that you do not use illegal anabolic steroids for obvious reasons and we hope that you respect the law and your body by using natural substances that are safer alternatives. If you do use steroids however, we recommend that you do so safely, cycling off them for at least a month at a time, taking supplements like Fish Oil to cleanse your liver and reduce the chance of cardiovascular side effects. Now, that being said, steroids are obviously not that dangerous, since prescription compounds, such as Testosterone Gel, are being pushed as the next great development (never mind that the Testosterone Gels on the market are loaded with side effects including conversion to DHT which

aggravates the prostate and estrogen that can promote breast cancer, even in men). Once the root of all evil, steroids are suddenly completely safe and side effect free when turned into a prescription drug. Wake up people! Again, we don’t encourage you to use steroids, but if you do, please consider doing them safely (there is a section at the end of good supplements to take with steroids that will offer some nice protection from their side effects).

So, if you are going to do a cycle of steroids, this is the perfect time to add in some serious genetic expression supplements to maximize your growth. One of the funniest things I see is the juice crowd bashing the supplement crowd, when in reality someone on a cycle will probably benefit the most from proper supplementation.

Studies show that androgens do indeed cause genetic changes that can benefit powerlifters and bodybuilders.

Here you see how increasing testosterone through natural boosting, pro-hormones or illegal anabolic steroids can vastly increase satellite muscle cell expression. This is the first real pathway that the body uses to increase muscle size and the number of muscle cells. By increasing the raw number of satellite cells, testosterone is the foundation of our genetic altering arsenal.

Skeletal muscle morphology in power-lifters with and without anabolic steroids.

Eriksson A, Kadi F, Malm C, Thornell LE.

Department of Integrative Medical Biology, Section for Anatomy, Umea

University, 901 87 Umea, Sweden.

The morphological appearance of the vastus lateralis (VL) muscle from high-level power-lifters on long-term anabolic steroid supplementation (PAS) and power-lifters never taking anabolic steroids (P) was compared. The effects of long- and short-term supplementation were compared. Enzyme-immunohistochemical investigations were performed to assess muscle fiber type composition, fiber area, and number of myonuclei per fiber, internal myonuclei, myonuclear domains and proportion of satellite cells. The PAS group had larger type I, IIA, IIAB and IIC fiber areas (p<0.05). The number of myonuclei/fiber and the proportion of central nuclei were significantly higher in the PAS group (p or = 5 myonuclei. The results of AS on VL morphology in this study were similar to previously reported short-term effects of AS on VL. The initial effects from AS appear to be maintained for several years.

Androgen receptor in human skeletal muscle and cultured muscle satellite cells: up-regulation by androgen treatment.

Sinha-Hikim I, Taylor WE, Gonzalez-Cadavid NF, Zheng W, Bhasin S.

Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California 90059, USA.

Androgens stimulate myogenesis, but we do not know what cell types within human skeletal muscle express the androgen receptor (AR) protein and are the target of androgen action. Because testosterone promotes the commitment of pluripotent, mesenchymal cells into myogenic lineage, we hypothesized that AR would be expressed in mesenchymal precursor cells in the skeletal muscle. AR expression was evaluated by immunohistochemical staining, confocal immunofluorescence, and immunoelectron microscopy in sections of vastus

lateralis from healthy men before and after treatment with a supraphysiological dose of testosterone enanthate. Satellite cell cultures from human skeletal muscle were also tested for AR expression. AR protein was expressed predominantly in satellite cells, identified by their location outside sarcolemma and inside basal lamina, and by CD34 and C-met staining. Many myonuclei in muscle fibers also demonstrated AR immunostaining. Additionally, CD34+ stem cells in the interstitium, fibroblasts, and mast cells expressed AR immunoreactivity. AR expression was also observed in vascular endothelial and smooth muscle cells. Immunoelectron microscopy revealed aggregation of immunogold particles in nucleoli of satellite cells and myonuclei; testosterone treatment increased nucleolar AR density. In enriched cultures of human satellite cells, more than 95% of cells stained for CD34 and C-met, confirming their identity as satellite cells, and expressed AR protein. AR mRNA and protein expression in satellite cell cultures was confirmed by RT-PCR, reverse transcription and real-time PCR, sequencing of RT-PCR product, and Western blot analysis. Incubation of satellite cell cultures with supraphysiological testosterone and dihydrotestosterone concentrations (100 nm testosterone and 30 nm dihydrotestosterone) modestly increased AR protein levels. We conclude that AR is expressed in several cell types in human skeletal muscle, including satellite cells, fibroblasts, CD34+ precursor cells, vascular endothelial, smooth muscle cells, and mast cells. Satellite cells are the predominant site of AR expression. These observations support the hypothesis that androgens increase muscle mass in part by acting on several cell types to regulate the differentiation of mesenchymal precursor cells in the skeletal muscle.

That being said, we can safely increase testosterone using supplements and don’t need illegal anabolic steroids! Pro-hormones boost natural testosterone by giving you the building blocks for testosterone and other steroid hormones. Pro-hormones are the safest, most effective way to boost testosterone without using drugs. The second way is to use natural testosterone boosters. There are many on the market, like tribulus, long jack and others. The best combination is an anti-estrogen that tricks your body into producing more testosterone. There are many of these products on the market, but the latest generations are far more effective and have fewer or no negative effects on the body. Here is what some peer reviewed journal entries say about using testosterone to activate satellite cells:

Testosterone-induced muscle hypertrophy is associated with an increase in satellite cell number in healthy,young men.

Sinha-Hikim I, Roth SM, Lee MI, Bhasin S.

Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California 90059, USA.

Testosterone (T) supplementation in men induces muscle fiber hypertrophy. We hypothesized that T-induced increase in muscle fiber size is associated with a dose-dependent increase in satellite cell number. We quantitated satellite cell and myonuclear number by using direct counting and spatial orientation methods in biopsies of vastus lateralis obtained at baseline and after 20 wk of treatment with a gonadotropin-releasing hormone agonist and a 125-, 300-, or 600-mg weekly dose of T enanthate. T administration was associated with a significant increase in myonuclear number in men receiving 300- and 600-mg doses. The posttreatment percent satellite cell number, obtained by direct counting, differed significantly among the three groups (ANCOVA P < 0.000001); the mean posttreatment values (5.0 and 15.0%) in men treated with 300- and 600-mg doses were greater than baseline (2.5 and 2.5%, respectively, P < 0.05 vs. baseline). The absolute satellite cell number measured by spatial orientation at 20 wk (1.5 and 4.0/mm) was significantly greater than baseline (0.3 and 0.6/mm) in men receiving the 300- and 600-mg doses (P < 0.05). The change in percent satellite cell number correlated with changes in total (r = 0.548) and free T concentrations (r = 0.468). Satellite cell and mitochondrial areas were significantly higher and the nuclear-to-cytoplasmic ratio lower after treatment with 300- and 600-mg doses. We conclude that T-induced muscle fiber hypertrophy is associated with an increase in satellite cell number, a proportionate increase in myonuclear number, and changes in satellite cell ultrastructure.

Androgen regulation of satellite cell function.

Chen Y, Zajac JD, MacLean HE.

Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Victoria 3084, Australia.

Androgen treatment can enhance the size and strength of muscle. However, the mechanisms of androgen action in skeletal muscle are poorly understood. This review discusses potential mechanisms by which androgens regulate satellite cell activation and function. Studies have demonstrated that androgen administration increases satellite cell numbers in animals and humans in a dose-dependent manner. Moreover, androgens increase androgen receptor levels in satellite cells. In vitro, the results are contradictory as to whether androgens regulate satellite cell proliferation or differentiation. IGF-I is one major target of androgen action in satellite cells. In addition, the possibility of non-genomic actions of androgens on satellite cells is discussed. In summary, this review focuses on exploring potential mechanisms through which androgens regulate satellite cells, by analyzing developments from research in this area.

Androgen receptor in human skeletal muscle and cultured muscle satellite cells: up-regulation by androgen treatment.

Sinha-Hikim I, Taylor WE, Gonzalez-Cadavid NF, Zheng W, Bhasin S.

Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California 90059, USA.

Androgens stimulate myogenesis, but we do not know what cell types within human skeletal muscle express the androgen receptor (AR) protein and are the target of androgen action. Because testosterone promotes the commitment of pluripotent, mesenchymal cells into myogenic lineage, we hypothesized that AR would be expressed in mesenchymal precursor cells in the skeletal muscle. AR expression was evaluated by immunohistochemical staining, confocal immunofluorescence, and immunoelectron microscopy in sections of vastus lateralis from healthy men before and after treatment with a supraphysiological dose of testosterone enanthate. Satellite cell cultures from human skeletal muscle were also tested for AR expression. AR protein was expressed predominantly in satellite cells, identified by their location outside sarcolemma and inside basal lamina, and by CD34 and C-met staining. Many myonuclei in muscle fibers also demonstrated AR immunostaining. Additionally, CD34+ stem cells in the interstitium, fibroblasts, and mast cells expressed AR immunoreactivity. AR expression was also observed in vascular endothelial and smooth muscle cells. Immunoelectron microscopy revealed aggregation of immunogold particles in nucleoli of satellite cells and myonuclei; testosterone treatment increased nucleolar AR density. In enriched cultures of human satellite cells, more than 95% of cells stained for CD34 and C-met, confirming their identity as satellite cells, and expressed AR protein. AR mRNA and protein expression in satellite cell cultures was confirmed by RT-PCR, reverse transcription and real-time PCR, sequencing of RT-PCR product, and Western blot analysis. Incubation of satellite cell cultures with supraphysiological testosterone and dihydrotestosterone concentrations (100 nm testosterone and 30 nm dihydrotestosterone) modestly increased AR protein levels. We conclude that AR is expressed in several cell types in human skeletal muscle, including satellite cells, fibroblasts, CD34+ precursor cells, vascular endothelial, smooth muscle cells, and mast cells. Satellite cells are the predominant site of AR expression. These observations support the hypothesis that androgens increase muscle mass in part by acting on several cell types to regulate the differentiation of mesenchymal precursor cells in the skeletal muscle.

Testosterone action on skeletal muscle.

Herbst KL, Bhasin S.

UCLA School of Medicine, Charles R. Drew University, Los Angeles, California 90059, USA.

PURPOSE OF REVIEW: To highlight recent data demonstrating direct anabolic effects of androgens on the mammalian skeletal muscle and review the mechanisms by which testosterone regulates body composition. RECENT FINDINGS: Testosterone increases lean body mass and decreases fat mass in young men; the magnitude of the changes induced by testosterone in lean and fat mass are correlated with testosterone dose and the prevalent testosterone concentrations. Older men are as responsive to the anabolic effects of testosterone on the muscle as young men, but have increased frequency of adverse events with higher testosterone doses. This reciprocal change in lean and fat mass induced by androgens is best explained by the hypothesis that androgens promote the commitment of mesenchymal pluripotent cells into myogenic lineage and inhibit adipogenesis through an androgen receptor mediated pathway. Resident muscle satellite cells increase in number with testosterone administration forming myoblasts leading to greater numbers of myonuclei in larger myofibers. Testosterone administration is associated with increased size of motor neurons. The roles of 5-alpha reduction and aromatization of testosterone into dihydrotestosterone and estradiol, respectively, in mediating testosterone effects on body composition are poorly understood. SUMMARY: Testosterone induces skeletal muscle hypertrophy by multiple mechanisms, including its effects in modulating the commitment of pluripotent mesenchymal cells. These changes in skeletal muscle lead to improved muscle strength and leg power; however, further studies are needed to determine the effects of testosterone on physical function and health-related outcomes in sarcopenia associated with aging and chronic illness.

Here you see how increasing testosterone through natural boosting, pro-hormones or illegal anabolic steroids can vastly increase satellite muscle cell expression. This is the first real pathway that the body uses to increase muscle size and the number of muscle cells. By increasing the raw number of satellite cells, testosterone is the foundation of our genetic altering arsenal.

Im a senior in high school and am planning on majoring in nursing. Im taking an anatomy class but it is boring me to death. So I dont know if i want to major in nursing now. What is a good online career test that I can take for free that will help me decide what is another career i would enjoy??

Career aptitude tests are useful for both employers and job applicants. These tests play a crucial role in the decision making process for employers who are flocked with resumes and help them find a suitable candidate for a particular position. The career aptitude test also helps candidates land into an ideally suited job according to their skill-set and abilities. Proper utilisation of job aptitude tests is a win-win situation for both employers and job seekers.

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The career aptitude test results show both the employer and potential employee whether the given job is a perfect fit or is it only something that the applicant could do but would prefer some other type of work. Being satisfied with the work profile is a crucial factor for being happy on the job. It is also an important key for keeping the employee turn over low. With the help of a well-structured aptitude test, the employer would be able to choose the right candidate for his company and the applicant would find a suitable job for himself.

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If the evidence provided by the claimant’s own medical sources is inadequate to determine if he or she is disabled, additional medical information may be sought by re-contacting the treating source for additional information or clarification, or by arranging for a CE.  The treating source is the preferred source of purchased examinations when the treating source is qualified, equipped and willing to perform the additional examination or tests for the fee schedule payment and generally furnishes complete and timely reports. Even if only a supplemental test is required, the treating source is ordinarily the preferred source for this service. SSA’s rules provide for using an independent source (other than the treating source) for a CE or diagnostic study if: The treating source prefers not to perform the examination; there are conflicts or inconsistencies in the file that cannot be resolved by going back to the treating source; the claimant prefers another source and has a good reason for doing so; or prior experience indicates that the treating source may not be a productive source. The type of examination and/or test (s) purchased depends upon the specific additional evidence needed for adjudication. If an ancillary test (e.g., X-ray, PFS or EKG) will furnish the additional evidence needed for adjudication, the DDS will not request or authorize a more comprehensive examination. If the examination indicates that additional testing may be warranted, the provider must contact the DDS for approval before performing such testing.

Fees for CEs are set by each State and may vary from State to State. Each State agency is responsible for comprehensive oversight management of its CE program.

Selection of a Consultative Examination Source

The DDS purchases consultative examinations only from qualified medical sources. The medical source may be the individual’s own physician or psychologist, or another source. In the case of a child, the medical source may be a pediatrician.

By “qualified,” we mean that the medical source must be currently licensed in the State and have the training and experience to perform the type of examination or test we request. Also, the medical source must not be barred from participation in our programs. The medical source must also have the equipment required to provide an adequate assessment and record of the existence and level of severity of the individual’s alleged impairments.

Medical professionals who perform CEs must have a good understanding of SSA’s disability programs and their evidence requirements. The physician or psychologist chosen may use support staff to help perform the consultative examination. Any such support staff (e.g., X-ray technician, nurse, etc.) must meet appropriate licensing or certification requirements of the State.

Generally, sources are selected based on appointment availability, distance from a claimant’s home and ability to perform specific examinations and tests.

Consultative Examination Report Content

The examination report should include the claimant’s claim number and a physical description of the claimant, to help ensure that the person being examined is the claimant.

The detail and format for reporting the results of the medical history, physical examination, laboratory findings, and discussion of conclusions should follow the standard reporting principles for a complete medical examination.

The report should be complete enough to enable an independent reviewer to determine the nature, severity and duration of the impairment, and, in adults, the claimant’s ability to perform basic work-related functions. The history and physical examination must be provided as a narrative of the findings.

Conclusions in the report must be consistent with the objective clinical findings found on examination and the claimant’s symptoms, laboratory studies, and demonstrated response to treatment and on all available information, including the history. The report, for adults, should include a description, based on the provider’s own findings, of the individual’s ability to do basic work-related activities. It should not include an opinion as to whether the claimant is disabled under the meaning of the law.

Signature Requirements

All CE reports must be personally reviewed and signed by the provider who actually performed the examination. The provider doing the examination or testing is solely responsible for the report contents and for the conclusions, explanations or comments provided. The source’s signature on a report annotated “not proofed” or “dictated but not read” is not acceptable. A rubber stamp signature or signature entered by another person, such as a nurse or secretary, is not acceptable.

How the DDS Reviews Consultative Examination Reports

The DDS is obligated to review the report of the CE to determine whether the specific information requested has been furnished.

The CE report must:

 

Provide evidence that serves as an adequate basis for disability decision making in terms of the impairment it assesses.

 

Be internally consistent. Are all the diseases, impairments and complaints described in the history adequately assessed and reported in the clinical findings?

 

Do the conclusions correlate the medical history, the clinical examination and laboratory tests, and explain all abnormalities?

 

Be consistent with the other information available within the specialty of the examination requested.

 

Did the report fail to mention an important or relevant complaint within that specialty that is noted in other evidence in the file (e.g., blindness in one eye, amputations, pain, alcoholism, depression)?

 

Be adequate as compared to the standards set out in the course of a medical education.

 

Be properly signed.

 

If the report is inadequate or incomplete, the DDS will contact the provider and ask the provider to furnish the missing information or prepare a revised report.

Elements of a Complete Consultative Examination

A complete CE is one that involves all the elements of a standard examination in the applicable medical specialty. When the report of a complete CE is involved, the report should include the following elements:

The claimant’s major or chief complaint(s);

 

Detailed description, within the area of specialty of the examination, of the history of the major complaint(s);

Description, and disposition, of pertinent “positive” and “negative” detailed findings based on the history, examination, and laboratory tests related to the major complaint(s), and any other abnormalities or lack thereof reported or found during examination or laboratory testing;

Results of laboratory and other tests (e.g., X-rays) performed in accordance with the requirements provided by the DDS.

Diagnosis and prognosis for the claimant’s impairment(s);

Statement about what the claimant can still do despite his or her impairment(s), unless the claim is based on statutory blindness. This statement should describe the opinion of the consulting physician or psychologist about the claimant’s ability, despite his or her impairment(s), to do work-related activities such as sitting, standing, walking, lifting, carrying, handling objects, hearing, speaking, and traveling; and, in cases of mental impairment(s), the opinion of the physician or psychologist about the individual’s ability to understand, to carry out and remember instructions, and to respond appropriately to supervision, coworkers, and work pressures in a work setting; and

The consultative physician or psychologist will consider, and provide some explanation or comment on, the claimant’s major complaint(s) and any other abnormalities found during the history and examination or reported from the laboratory tests. The history, examination, evaluation of laboratory test results, and the conclusions will represent the information provided by the physician or psychologist who signs the report.

 

Report Content by Specific Impairment

Internal Medicine

The detail and format for reporting the results of the history, physical examination, laboratory findings, and discussion of conclusions should follow the standard reporting principles for a complete internal medical examination.

Source of History

The physician should indicate from whom the history was obtained and should provide an estimate of the reliability of the history.

History of Present Illness

The chief complaint(s) alleged as the reason for not working should be discussed in detail, including:

 

Factors which increase the problem or impairment(s);

How long the problem has been present;

Factors which may provide relief; and

The claimant’s description of how the impairment(s) limits the ability to function.

 

Pertinent descriptive statements by the claimant, such as a description of chest pain, should be recorded in the claimant’s own words.

The information must be in a narrative, rather than “questionnaire” or “check-off” format.

Past History should describe other prior illnesses, injuries, operations, or hospitalizations and give the dates of these events.

Current Medication should be listed by name of drug and dose.

Review of Systems should describe and discuss:

 

Other complaints and symptoms the claimant has experienced relative to the specific organ systems, and

The pertinent negative findings, which would be considered in making a differential diagnosis of the current illness or in evaluating the severity of the impairment.

Social History should include pertinent findings about use of tobacco products, alcohol, nonprescription drugs, etc.

 

Family History should be presented, if pertinent.

Signs

The vital signs should include:

 

Blood pressure;

Pulse rate;

Respiratory rate; and

Height and weight without shoes.

 

The physical examination must provide a description of the claimant’s general appearance and pertinent behavior during the examination (e.g., for back complaint, how the claimant stood or walked, got up from a chair, and got on and off the examination table).

This description must be in narrative, rather than “questionnaire” or “check-off” form.

The report should present aspects of the examination dealing with the claimant’s major and minor complaints in particular detail, describing both pertinent negative and positive findings.

Pelvic examinations should not be performed unless specifically authorized.

Specific range of motion of a joint should be reported in degrees for joints in which there is a significant limitation of motion.

NOTE: If a joint is found to have no abnormality of range of motion on gross examination, that fact should be stated rather than reporting the degree of motion.

Laboratory Tests — The laboratory should provide:

 

Actual values for laboratory tests; and

Normal ranges of values in either the medical report or attached laboratory report.

Electrocardiographic and Spirographic Reports

Tracings must be provided when these tests have been performed.

 

The reported findings for pulmonary and electrocardiographic studies must meet the requirements of Section 3.00E and 4.00C, respectively, of the Listing of Impairments.

Interpretation

The interpretation of laboratory tests (e.g., electrocardiographic tracings) must take into account and be correlated with the history and physical examination findings.

Identify the physician providing the formal interpretation of the laboratory tests, when other than the physician who is signing the CE report.

If the interpretation is provided separately, the report sheet should state the interpreting physician’s name and address.

X-rays

Joints and other areas to be x-rayed are those that are specifically requested or those that the physical examination reveals to be the most involved by disease, after appropriate authorization by the DDS.

Rheumatology

In addition to the requirements for a general internal medical examination, the following specific information should be stated in a report of an examination in which the primary complaint is a rheumatological disorder.

General Observations

General observations in the physical examination should relate to common, everyday functions which may be observed in the examining physician’s office, such as:

 

Stance;

Gait;

Ability to:

Dress and undress;

Climb upon the examining table;

Grasp or shake hands; and

Write.

 

Joint Examination

Joint examination should include specific, detailed notations with respect to the presence or absence of:

 

Effusion;

Episodes of infection;

Periarticular swelling;

Tenderness;

Heat;

Redness;

Thickening of the joints;

Specific range of motion of the joints and back in degrees; and

Structural deformities.

 

Specific range of motion of a joint or spine should be reported in degrees for any joint or spine in which there is a significant limitation of motion.

If the range of motion is found to be restricted in any joint or spine, annotation should be made as to probable cause (e.g., due to pain and/or influenced by observable abnormality).

Joints/spine to be x-rayed are those that are specifically requested or those that the physical examination reveals to be the most involved by disease, after appropriate authorization by DDS.

For individuals alleging myalgias or other muscular complaints, evaluate the areas of muscle tenderness including tender points and trigger points. Go to Listing of Impairments – Adults: Immune System 14.00 for more information.

Orthopedic

History

The orthopedic examination, including the lumbar and cervical spine, should describe and discuss (where appropriate):

 

The major or chief complaint(s) alleged as the reason for not working. The discussion of the complaints must include:

A detailed historical description of the pertinent past history of the disease.

The claimant’s statement of current complaint.

 

Current and past therapy for this disorder, and response to therapy, should be reported. Hospitalizations, surgical operations, and significant investigative procedures (e.g., myelography, CAT scan, MRI, Bone Scan) should be reported with the dates of the hospitalizations and result of the procedures.

The symptoms alleged, including a description of:

 

The character, location, and radiation of pain;

Mechanical factors which incite and relieve the pain;

Prescribed treatment, including name, dose, and frequency of any medications which are used;

The claimant’s typical daily activities; and

Symptoms of weakness, other motor loss, or any sensory abnormalities.

 

The use of drugs or alcohol.

Other significant past illnesses, injuries, operations, particularly those involving the musculoskeletal system.

From whom the history was obtained and an estimate of the reliability of the history.

Physical Examination — The physical examination report should include a description and discussion (where appropriate) of:

 

The claimant’s general appearance and nutrition, any apparent skeletal or other musculoskeletal abnormalities.

 

The orthopedic and neurological findings. These should include a description of:

 

Muscle spasms, limitation of movement of the spine given quantitatively in degrees from the vertical position when there is significant limitation in motion, straight leg raising given quantitatively in degrees from the supine position and from the sitting position, motor and sensory abnormalities, and deep tendon reflexes. Deep tendon reflexes should be described as to intensity and symmetry.

 

If there is no abnormality of range of motion of any affected joint on gross examination, that fact, rather than the actual degree of motion, may be reported.

Motor function quantitated. The method of quantitation must be reported. The most widely used method involves recording from 0 to 5 as a fraction with the numerator representing the claimant’s performance and the denominator representing a normal performance (e.g., 3/5).

To what degree motor function is inhibited by spasticity, rigidity or pain.

The specific distribution of sensory deficit or pain.

Muscle bulk. When there is asymmetry, specific measurement must be reported.

Atrophy must be reported in terms of circumferential measurements of both thighs and lower legs (or upper or lower arms) at a stated point above and below the knee or elbow given in inches or centimeters.

A specific description of atrophy of hand muscles may be given without measurements of atrophy but should include measurements of grip strength.

Gait and station, including the claimant’s ability to:

 

Tandem walk;

Walk on heels and toes;

Hop;

Bend;

Squat;

Arise from a squatting position;

Dress and undress;

Get up from a chair;

Get on the examining table; and

Cooperate during the examination.

 

Laboratory Tests — X-rays or other laboratory tests

The physician providing the formal interpretation must be identified.

If the interpretation is provided on a separate report form, that report should be attached.

Findings

The physician’s examination findings must be determined on the basis of the physician’s observations during the examination. (Alternative testing methods should be used to verify the objectivity of the abnormal findings, when possible; e.g., a seated straight-leg raising test in addition to a supine straight-leg raising test.) Go to Listing of Impairments – Adults: Musculoskeletal System 1.00 for more information.

Respiratory

In addition to the requirements for a general internal medical examination, the specific information listed below should be stated in a report of an examination in which the primary complaint is a respiratory disorder.

General Examination

The report should note and describe:

 

The occurrence of cough, labored breathing, use of accessory muscles of respiration, audible wheezing, pallor, cyanosis, hoarseness, clubbing of fingers, or the presence of chest wall deformity. Respiratory rate should be observed and reported.

The diameter of the chest on inspiration and expiration, distention of neck veins and ankle edema.

Whether the expiratory phase of respiration is prolonged.

Breath sounds.

Diaphragmatic motion.

Presence or absence of adventitious sounds on auscultation of the chest.

 

The employment history, when relevant to the disease, should be reported (e.g., pneumoconiosis or exposure to physical irritants producing respiratory symptoms.)

Dyspnea

Characteristics — Dyspnea should be described with respect to:

 

Dates and mode of onset;

Seasonal influence;

Influence of infection and precipitating activities;

Whether it is associated with palpitation, wheezing, chest discomfort, or hyperventilation symptoms.

 

Respiratory Versus Cardiac Dyspnea — Inquiry should be made to determine whether the claimant has:

 

A history of heart disease;

Experienced paroxysmal nocturnal dyspnea or orthopnea; and

Associated peripheral edema, hypertension, past myocardial infarction, angina, rheumatic heart disease, cardiac murmur, etc.

 

Episodic Disorders — The report should include details as to:

 

Onset and precipitating factors;

Frequency and intensity;

Duration;

Mode of treatment and response; and

Description of severe respiratory attack.

 

Ancillary Studies

Chest X-ray, Spirometry, Diffusing Capacity of the lungs for Carbon Monoxide, and Arterial Blood Gas Studies will be requested in accordance with program criteria for the purpose of establishing the existence and extent of the disease process. Go to Listing of Impairments -Adults: Respiratory System 3.00 for more information.

Cardiovascular

In addition to the requirements for a general internal medical examination, the following specific information should be stated in a report of an examination in which the primary complaint is a cardiovascular disorder.

General Examination — The report must:

 

Provide a detailed description of the examination of the heart, including the heart sounds and rhythm and pulses.

 

Describe:

 

Any jugular vein distention, including angle of reclining at which distention occurs;

Adventitious lung sounds;

Hepatomegaly;

Peripheral or pulmonary edema; and

Cyanosis.

 

Describe the impact of the chest discomfort, dyspnea or other cardiovascular symptoms on physical activities.

Describe any drugs used (currently and in the recent past) for treatment of the cardiovascular disorder and indicate the dosage and the response to these drugs.

Note participation in a cardiac rehabilitation program (e.g., progressive physical activity, educational or psychological support).

Congestive Heart Failure — The history must include a discussion of:

The known factors in the development of the cardiac condition (e.g., myocardial infarction, rheumatic heart disease, hypertension, and congenital or other organic heart disease).

Recurrent or persistent symptoms such as:

 

Fatigue;

Dyspnea;

Orthopnea; and

Anginal discomfort.

 

Chest Discomfort and Other Symptoms — The report should describe:

 

Chest discomfort of myocardial ischemic origin or other symptom(s) in the claimant’s own words with respect to:

 

Presence;

Character;

Location;

Radiation;

Frequency;

Duration;

Usual inciting factors; and

Relief.

 

The historical character of the chest discomfort to ascertain whether:

 

There is a predictable stable pattern of occurrence; and

There is evidence of a recent change in the pattern of symptoms;

Whether therapy has been prescribed and how the claimant is responding to the therapy;

Whether the discomfort occurs at rest or awakens the claimant from sleep and whether it is related to ingestion of food or movement of the upper extremities; and

The usual duration of the symptoms, especially chest discomfort, how symptoms are relieved, and the time required to obtain relief (e.g., rest or after taking specific drugs such as nitroglycerin).

 

Laboratory Tests

Ancillary cardiac testing, such as ECG, Exercise Stress Testing and Echocardiogram, will be requested in accordance with program criteria for the purpose of establishing the existence and extent of the disease process. Go to Listing of Impairments – Adults: Cardiovascular System 4.00 for more information.

Neurological

Historical Source

The DDS will make arrangements to have a knowledgeable individual accompany the claimant to the examination, when prior information indicates incompetence on the part of the claimant.

The physician should indicate from whom the history was obtained and should estimate reliability of history.

History — The history should include a detailed description/discussion of:

 

Major or chief complaints with:

Detailed historical description of the disease state; and

Current complaints.

 

The mental or physical functional restrictions with specific examples.

Significant illness, injuries, or operations, particularly of the nervous system.

Current and past therapy for the disorder alleged, and any abuse or drugs or alcohol.

The family history with information on pertinent positive abnormalities, particularly hereditary familial conditions.

Physical Examination

General — The physical examination should provide a statement concerning the claimant’s:

 

General appearance;

Nutrition;

Body habitus;

Head size and shape;

Any skeletal or other abnormalities such as pigmentary or texture changes of the skin or changes in hair distribution; and

Dominant hand

The gait and station must be described in detail, including ability to:

Tandem walk;

Walk on heels and toes;

Hop;

Dress and undress;

Get up from a chair;

Get on the examining table; and

Generally cooperate during the examination.

 

Notation should be made of the function of the 12 cranial nerves (if the first cranial nerve is not tested, this should be noted). Lower cranial nerve function should be described in particular detail when dysphagia or dysarthria is a complaint.

Ocular motility and pupillary size and activity should be described even when normal. The visual acuity and visual fields by gross confrontation should be estimated, and the basis for the estimate must be stated.

Motor function — Should be quantitated, and the method of quantitation reported. For example, if a numbering system is used, the report must state which number represents normal strength and which number represents total paralysis.

The report must also describe to what degree motor function is inhibited by spasticity, rigidity, involuntary movements, or tremor.

Muscle bulk should be described, and when there is asymmetry, measurements should be reported.

The degree of fatigability following rapid, repetitive movements should be noted.

All modalities of sensation, including cortical, should be tested.

The method of testing should be recorded.

When sensory deficit or pain are described in a specific distribution, care should be taken to ascertain that the findings are consistent with neuroanatomical fact. Suspected non-physiological observations should be noted.

Coordination should be tested.

The ability to perform fine and dexterous movements of the hands should be described.

In-coordination or tremor at rest or during specific tests should be described in detail and quantitated.

NOTE: Examples should be given describing the functional loss that occurs because of these events.

Reflexes

Deep tendon reflexes should be described as to intensity and symmetry.

Superficial reflexes should be described when present and noted when absent.

Any pathological reflexes must be described in detail.

Any impairment of speech or language should be described in detail with a discussion of how much ability the claimant retains and how the physician determined this. The report should discuss:

 

Aphasia;

Dysarthria;

Stuttering (fluency);

Involuntary vocalizations;

Whether speech is intelligible.

 

Mental Status Examination — should be reported and be extensive when mental capacity is in question. The physician should provide:

 

Examples of responses in testing orientation, memory, calculation, insight, general understanding, and fund of knowledge; and

A detailed description of mood and behavior during the examination, and any significant abnormalities. Go to Listing of Impairments – Adult: Neurological 11.00 for more information.

 

Mental Disorders

The psychiatric or psychological examination report should show not only the claimant’s signs, symptoms, laboratory findings (psychological test results), and diagnosis, but also describe the effect of the emotional or mental disorder on the claimant’s ability to function at the usual and customary level of adjustment — personal, social and occupational.

General Observations — Include in the CE report general observations of:

 

How the claimant came to the examination:

Alone or accompanied;

Distance and mode of transportation; and

If by automobile, who drove.

General appearance:

Dress; and

Grooming

Attitude and degree of cooperation.

Posture and gait.

General motor behavior, including any involuntary movements.

 

Informant

The psychiatrist or psychologist should identify the person providing the history (usually the claimant) and should provide an estimate of the reliability of the history.

Chief Complaint

This usually will consist of the claimant’s allegations concerning any mental and/or physical problems.

History of Present Illness

This should include a detailed chronological account of the onset and progression of the claimant’s current mental/emotional condition with special reference to:

 

Date and circumstances of onset of the condition;

Date the claimant reported that the condition began to interfere with work, and how it interfered;

Date the claimant reported inability to work because of the condition and the circumstances;

Attempts to return to work and the results;

Outpatient evaluations and treatment for mental/emotional problems including:

Names of treating sources;

Dates of treatment;

Types of treatment (names and dosages of medications, if prescribed); and

Response to treatment.

 

Hospitalizations for mental disorders including:

 

Names of hospitals;

Dates; and

Treatment and response.

Information concerning the claimant’s:

Activities of daily living;

Social functioning;

Ability to complete tasks timely and appropriately; and

Episodes of decompensation and their resulting effects.

 

Past History should include a longitudinal account of the claimant’s personal life including:

 

Relevant educational, medical, social, legal, military, marital, and occupational data and any associated problems in adjustment;

Details (dates, places, etc.) of any past history of outpatient treatment and hospitalizations for mental/emotional problems; and

History, if any, of substance abuse, and/or treatment in detoxification and rehabilitation centers.

 

Mental Status

The individual case facts will determine the specific areas of mental status that need to be emphasized during the examination, but generally the report should include a detailed description of the claimant’s:

 

Appearance, behavior, and speech (if not already described);

Thought process (e.g., loosening of associations);

Thought content (e.g., delusions);

Perceptual abnormalities (e.g., hallucinations);

Mood and affect (e.g., depression, mania);

Sensorium and cognition (e.g., orientation, recall, memory, concentration, fund of information, and intelligence);

Judgment and insight; and

Capability (i.e., is the individual capable of handling awarded benefits responsibly?)

 

Diagnosis

American Psychiatric Association standard nomenclature as set forth in the current “Diagnostic and Statistical Manual of Mental Disorders.”

Prognosis

Prognosis and recommendations for treatment, if indicated; also, recommendations for any other medical evaluation (e.g., neurological, general physical), if indicated.

Additional Requirements by Mental Disorder

Schizophrenic, Delusional (Paranoid) Schizo-Affective, and other Psychotic Disorders — The report should reflect:

 

Periods of residence in structured settings such as half-way houses and group homes;

Frequency and duration of episodes of illness and periods of remission; and

Side effects of medications.

Organic Mental Disorders — The report should reflect:

The source of the disorder, if known, the prognosis; and

Whether there is an acute or chronic process;

Whether stable or progressive; and

Changes at various points in time.

 

The results of any psychological or neuropsychological testing that could serve to further document an organic process and its severity.

Information regarding the results of any neurological evaluations.

Information about any neurological testing (e.g., EEG, CT scan) that may have been performed and the results, if available.

In Mental Retardation cases, the report should reflect:

 

Current documentation of IQ by a standardized, well-recognized measure. Acceptable instruments will have a representative normative sample, a mean of approximately 100 and standard deviation of approximately 15 in the general population, and cover a broad range of cognitive and perceptual-motor functions (e.g., the Wechsler scales);

Verbal IQ, performance IQ, and full scale IQ scores, together with the individual subtest scores;

Interpretation of the scores and assessment of the validity of the obtained scores, indicating any factors that may have influenced the results such as the claimant’s attitude and degree of cooperation, the presence of visual, hearing or other physical problems, and recent prior exposure to the same or similar test; and

Consistency of the obtained test results with the claimant’s education, vocational background, and social adjustment, especially in the area of personal self-sufficiency.

 

What should be the defining principle of the Koroma administration National Development Strategy is balance. President Koroma cannot expect to eliminate national development challenges through a unilateral political agenda, to do everything and coordinate everything based on his All People’s Congress (APC) party ideology. His APC party with its “corporate agenda” for Sierra Leone rolled over the incumbent Sierra Leone People’s Party (SLPP) in a run-off that reflected the expectations and desires of a majority of Sierra Leoneans for far-reaching socio-economic change, institutional reform and full inclusion of the mostly youth and indigenous poor. If Koroma is to succeed to reduce Sierra Leone’s grinding poverty and the creation of a more effective, inclusive and just state, however—and he must if his leadership is going to be different from the SLPP administration it replaced—he will need to set priorities and consider trade-offs and show understanding and offer support as he grapples with explosive issues of judicial reforms, corruption and development policy.

The strategy strives for balance in three areas: between trying to prevail in eliminating corruption in his government and preparing for other contingencies; between institutionalizing capabilities such as nongovernmental engagement and supporting the relevance of NGOs as development stakeholders and maintaining NGO’s existing organizational independence and strategic edge in terms of advancing national development objectives through community involvement; and between retaining those cultural traits that have made grassroots involvement in development work possible and discouraging behaviors of NGOs that hamper their ability to do what needs to be done. “In its broadest sense, the term “nongovernment organization” [NGO] refers to organizations (i) not based in government; (ii) not created for financial or material gain; but (iii) created to address concerns such as social and humanitarian issues of development, individual and community welfare and well-being, disadvantage, and poverty, as well as environmental and natural resources protection, management, and improvement” (Asian Development Bank).

Strategic Thinking

The Koroma administration’s ability to deal with performance problems of NGOs will depend on its capacity in handling corruption in government. To be blunt, to fail—or to be seen to fail—in addressing corruption in government would be a disastrous blow to the APC party credibility, both among party supporters and voters and among opposition adversaries. Sierra Leoneans want to see serious effort to address corruption and the injustices of the legal system in the country—and the people of Sierra Leone have lost all patience in this regard. Still, there will continue to be high expectations for Koroma’s zero-tolerance against corruption to be seen to work in Sierra Leone.

Given its endemic nature, corruption, poverty, and the tragic history of violence, Sierra Leone in many ways poses an even more complex and difficult long-term challenge—one that, despite a strong rhetorical effort, will require significant determination and commitment to punish drastically for crimes of corruption for some time. And given the country’s ever changing political game, the resounding victory of Ernest Koroma in the 2007 run-off elections could prove just another wrong turn along the road going nowhere. Sierra Leoneans have already started to question the leadership of Koroma, who in his inauguration in September 2007 announced his zero-tolerance stance against corruption, but “has not had a lot of luck with his cabinet” (The Africa Report). The instances of presumed corruption and shady dealings [the controversial Income Electrix power deal, the suspended Transport Minister Ibrahim Kemoh Sesay 700kg haul of cocaine deal, and the Attorney General Abdul Serry-Kamal Seventy Five Billion Leones Wanza saga] confirm the self-seeking and predatory activities of APC officials, “and that despite the best intentions announced by President Koroma, he [seems to] lack the moral standing and political backbone to implement his ‘zero-tolerance’ policy for corruption and his call for accountability of his cabinet” (The New People Newspaper).  Koroma still has to demonstrate he is following a drummer different from that of every Sierra Leonean leader of the past 45 years.

What is dubbed the war on corruption is, in grim reality, a prolonged, nationwide conventional campaign—a struggle between the forces of blatant corruption and those of moderation. Direct ACC engagement will continue to play a role in the long-term effort against corrupt officials in government and the private sector. But over the short term, a determined leadership may have to use draconian rules of engagement to ending corruption in Sierra Leone. Where possible, what the ACC calls prompt service in addressing corruption cases  should be subordinated to concrete measures by a strong presidency aimed at definitely promoting better governance, economic programs that spur development, and efforts to address the grievances among the discontented which justified the civil conflict that so badly destroyed the social fabric of Sierra Leone over the years. It will take the active engagement as well of NGOs in a collaborative effort over a long time to educate, rebuild and advance infrastructural development objectives.

Sierra Leone is unlikely to experience another civil war—justifiable by the injustices resulting from bad governance and rampant corruption—anytime soon. But that does not mean it may not face similar challenges in a variety of locales. Where possible, a government strategy is to employ indirect approaches—primarily through building the capacity of partner NGOs and their administrative processes—to prevent festering problems from turning into crises that require costly and controversial direct civil conflict. In this kind of effort, the capabilities of the government’s allies and NGO partners may be as important as its own, and building their capacity is arguably as important as, if not more so than, the partisan bickering the government has to deal with.

The recent past vividly demonstrated the consequences of failing to address adequately the dangers posed by bad governance. Rebel networks found sympathy among Sierra Leoneans and strength within the chaos of social breakdown. The small-arms infested State quickly collapsed into chaos and criminality and the worst of catastrophes befell the Sierra Leone homeland—towns and villages were reduced to rubble by rebel attacks as a result of the failed State. The kinds of capabilities needed to deal with such a historically dismal scenario cannot therefore any longer be played down with political rhetoric. Even the smallest of crimes of corruption should require stringent and uncompromising methods of investigations and punishment to avoid this failed State scenario. As Transparency International chair Huguette Labelle has noted, “Stemming corruption requires strong oversight through parliaments, law enforcement, independent media and a vibrant civil society. When these institutions are weak, corruption spirals out of control with horrendous consequences for ordinary people and for justice and equality in societies more broadly” (NGLS Go Between).

In many ways, the country’s national development capabilities are still coping with the consequences of the 1990s, when, with the complicity of the civil war, key instruments of the government of Sierra Leone regulatory mechanisms were reduced or allowed to wither on the corridors of power.  

“Sierra Leone has been a major recipient of foreign aid since the end of a devastating 11-year civil war in 2002. But government, donors and citizens are all questioning how effectively this aid is being used. Allegations of misappropriation of donor funds, both by government actors and NGOs, threaten this inflow. One of the government’s principal partners, the British Department for International Development, withheld aid in protest against such anomalies, for most of 2007 and early 2008 (Fofana/IPS, Freetown). Besides, the Government of Sierra Leone has not maintained a constructive relationship with NGOs.  However, the global push towards reducing poverty has created a new convergence among development practitioners and policymakers as the means of increasing access to new initiatives that will promote good governance and help reduce poverty. Citizen participation has increasingly been taken seriously to increase opportunity for lower income and other excluded populations whose interest are marginalized in classic representative institutions to influence policymaking processes. The government is beginning to appreciate the relevance of civil society in development—that community development lies at the heart of a strong, association-based civil society.

In this regard, the Koroma administration can assume more of the tasks of fostering effective collaboration with local and international NGOs for peace, security and development. To truly achieve victory as the High Level Forum on Aid Effectiveness defined it –“to bring new voices into a review of how aid is managed, and to sketch out a course for greater transparency, accountability and ultimately impact on the lives of the world’s poor—to attain a political objective” (Fofana/IPS, Freetown)–the Sierra Leone Government needs an NGO Coordination Unit whose ability to facilitate the diversion of huge donor funds to the NGO community is matched by its ability to use active evaluations and reviews as learning tools for itself and its development partners.  “The role of the Sierra Leone Association of NGOs (SLANGO), formed in January 1994, to coordinate NGO activities in order that efforts are not duplicated and resources not wasted” (BNET Business Network) has to be differentiated from what the NGO Unit at MODEP is doing; also to understand SLANGO’s relevance in development work.

Given these realities, the NGO Unit of MODEP has, however, been seen to make some impressive strides in recent years. “The revised National NGO Policy following the wide range of consultations held at national and regional levels with the involvement of all stakeholders especially the NGO Community, Line Ministries and Civil Society in the preparation of the policy [was a laudable effort]. The NGO Unit facilitated several meetings with other ministries particularly the Ministry of Finance, the National Revenue Authority (NRA), the Ministry of Labor and other stakeholders to discuss among other things: Duty Free Concessions, Resident/Work Permits and Taxation etc.” (NGO Unit/MODEP).

It can also be suggested that a New Development Operations Manual for a New National Development Strategy is developed to incorporate the lessons of recent years in NGO service delivery doctrine. “Train and equip” programs will allow for quicker improvements in the development capacity of partner organizations. And various initiatives should be undertaken that will better integrate and coordinate government efforts with civilian society agencies as well as engage the expertise of the private sector, including nongovernmental organizations and academia.

Organizational Problems in Perspective

Even as international NGOs hone and institutionalize new and modern management methods, the Sierra Leone Government still has to contend with the organizational challenges posed by local NGOs. The images of NGOs seen by many local people as corrupt and undeserving of support are a reminder that these Civil Society Organizations (CSOs) and their management processes do still matter.  NGOs in the country should be seen to improve their and several partners’ documentation of results, including the development of good monitoring indicators.

In addition, there is the potentially toxic mix of inadequate financial management of NGOs and inadequate reporting on budgetary issues to the Government of Sierra Leone’s NGO Unit. What all these problems portend is that the monitoring of development aid continues to be a major challenge for Sierra Leone and that a thorough framework of monitoring both recurrent and development activities must be put in place. The Government of Sierra Leone cannot take these organizational issues of NGOs for granted and needs to invest in the programs, platforms, and personnel that will ensure their relevance as development stakeholders.

But it is also important to keep some perspective. As much as the MODEP’s NGO Unit has come up with revised policy regulations with collated information in respect of funds disbursed by donors to NGOs for the implementation of programs it must be remembered that what is driving MODEP is a desire to exorcise the sloppy performance of NGOs over the years and to make them more relevant as development stakeholders—not an ideologically driven campaign to micro manage NGOs in the country. “Understandably, the logic behind massive NGO presence in Sierra Leone was to create a civic culture, pluralize the political, economic and social arena and bridge the gap between the masses and the State. So NGOs thus act as intermediaries between, what donors call ‘the unorganized masses’ and the State and are expected to represent the people and express their voices in policymaking. In fact, among NGOs is a small sector of voluntary organizations that genuinely monitor regimes, engage in advocacy on behalf of the poor and serves as watchdogs in ensuring that government contractors deliver services”.

It is true that the Poverty Reduction Strategy Paper (PRSP) with clear link to the Millennium Development Goals (MDGs) is the main focus of Government and its development partners. “The PRSP calls for pro-poor sustainable growth. However, achieving this means maintaining macro-economic stability IMF-style with low inflation and strict fiscal deficits, despite research by CSOs and development agencies which seriously question the poverty impact of these types of policies” (European Network on Debt and Development). NGOs’ participation was recognized in the process. NGOs could now play an active role in the implementation process by shifting their interventions and assistance from relief/humanitarian programs to sustainable infrastructural development programs. Answerability and transparency, adequate financial management and adequate budgetary reporting are to be the watch words in the new dispensation.

NGOs in Sierra Leone may have their organizational problems, but they can be quite relevant stakeholders in promoting people’s participation in poverty reduction programs. Use of funds has not been cost effective for most NGOs but the thematic areas most of these NGOs focus on (health, education, skills development, micro-finance, skills training, etc.), are relevant for the end users that are often poor and vulnerable children, youth and women. These are priority support areas that are in accordance with Sierra Leone’s development priorities and the PRSP as well international development agencies’ priorities.

Now that the performance bar has to be raised for the government and NGOs following their dismal performance in terms of handling aid money, the Sierra Leone Government must now endeavor to maintain a credible strategic relationship with NGOs through effectively evaluating, reviewing and monitoring their activities. Toward this end, the steps the NGO Unit at MODEP is taking to return excellence and accountability to NGO stewardship are commendable. Presidential and Parliamentary oversight may also be necessary for a more reliable and sustainable NGO Unit coordination effort.

When thinking about the range of strengths, weaknesses, opportunities and threats (SWOT) of non-governmental organizations as development partners in Sierra Leone it is reasonable to understand that NGOs come in many shapes and sizes. Data used in the SWOT analysis stem from multiple sources including statistical reports, literature review, regulations and policies, and research articles by NGO professionals. These findings should provide a valuable reference for the Government and the international development community who are interested in developing excellence in the civil society organization which interestingly can provide some feed back into the effectiveness aspects of the development analysis.

Strengths

Grassroots (local) NGOs

Have a positive presence on the ground.
Demonstrate ability to seek common ground and commitment to poor and marginalized grassroots populations.
Enjoy confidence and trust of local populations.
Have experience-based knowledge of cultural, political and socio-economic conditions of indigenous populations.
Understand vulnerabilities unique to local beneficiaries.
Can achieve extreme flexibility with fewer resources and lower costs.
Possess valuable experience, content and fundamental working knowledge about local trade issues and business contacts in their field.

International NGOs

Have global appeal and have developed industry-wide reputation for positive work.
Good at generating and mobilizing resources and core competencies for their operations.
Ability to resolve issues of legitimacy and to address political and policy constraints.
Ability to harness expert opinion to influence public opinion and policy-makers.
Have paid core staff to ensure the quality of project work.
Possess valuable experience, content and fundamental working knowledge about international trade issues and the labor market and business contacts in their field.

Weaknesses

Grassroots (local) NGOs

May have limited financial and expert resources to support end-user development.
May have limited strategic perspectives and weak linkages with other actors in development.
May have limited managerial and organizational capacities.
May sometimes miss the big picture on macro perspectives on capital markets, economy and geopolitics vis-à-vis community development.
Indigenous NGO operators may be prone to corruption.
Because of their voluntary nature, there may be questions regarding their accountability and credibility.
May have difficulty managing operations on financially sustainable basis.
Are not sustainable on membership fees alone.

International NGOs

Some advocacy NGOs working to influence the policies and practices of governments, development institutions have limited implementation capacity.
Questions sometimes arise concerning their motivations and objectives, and the degree of accountability they accept for the ultimate impact of policies and positions they advocate. Sometimes accused of “selling out” when they work with government or corporations.
May find it hard to placate or manipulate special interests.
 Suffer fluctuations in maintaining non-profit donations revenue streams.
May have limited experience with poor populations and operations may not reflect the needs of communities.

Opportunities

Grassroots NGOs

Can effectively work with community partners to assess local problems and opportunities and to promote export development programs.
 Ability to implement successful training programs and advance participatory development.
Ability to integrate their local expertise and experience in health and education initiatives in community development programs.
Can be clearing-houses for local trade information.

International NGOs

Ability to work out credible partnerships with government and private corporations to mobilize public opinion to increase influence on poverty reduction programs and trade issues.
Effective at bringing the voice of efficient organizational practices into NGO work in developing countries.
Ability to contribute sector-specific expertise to help producers add value, improve quality and find new export markets.
Quite familiar with political and social accountability mechanisms that complement their interventions and advocacy work.

Threats

Grassroots NGOs

Isolated and poorly coordinated efforts may have negative program outcomes.
Lackluster relationship with trade and export development corporations causing unsustainable initiatives and lack of trade development solutions.
Lacks technical capacity to connect poor people with trade and export opportunities.I

International NGOs

Tendency to ignore the voices of the poor represented by the experience and professional input of local agencies when defining the dialogue and public understanding of trade and development issues.
Inclination to compete by lobbying against one another thereby distracting policy-makers on major issues.
Often accused of hijacking the macroeconomic policy making dominated by technocrats and external consultants in the process.

Overall, by sorting the SWOT issues of grassroots (local) and international NGOs into planning categories one can obtain a system which presents a practical way of assimilating the internal and external information about NGO work in Sierra Leone, delineating short and long term priorities, and defining and developing coordinated, goal-directed actions, and allowing an easy way to build management teams which can achieve the objectives of development growth and the essence of civil society. In reality, as the philosopher Michael Ignatieff has noted “without civil society, democracy remains an empty shell”. One can expect to see the efficacy of Civil Society Organizations to influence members of the wider public that adhere to their values and beliefs to engage in development programs at State and community levels.

Therefore, notwithstanding local NGO’s relatively dismal record they are still clearly quite relevant to the development equation. NGOs strengths can be harnessed with well coordinated capacity building programs.  Conversely, international NGOs can develop a partner strategy of supporting and working through strong professional local partners as an effective tool for having a greater development impact than being a self-implementing agency. NGOs can also be very effective as learning organizations by providing important support to build their own staff’s and partners’ capacities, through individual training activities, annual partner meetings and conferences, learning exchange between partners, and partner self-assessments of training needs.  Moreover, NGOs can also be very effective with regular active evaluations and reviews as learning tools for themselves and their partners.

Just as one can expect learning should be at the heart of these organizations, so too, should the Government of Sierra Leone seek a better balance in the portfolio of capabilities it has—the types of programs against corruption in government fielded, the punishment in place for crimes of corruption, the training done.

Moreover, given the development challenges Sierra Leone is struggling with—and given, for example, the struggles to field up hospitals and clinics, schools and colleges, maintenance of urban and rural roads, and the HIV threats to the society—the time has come to think hard about how to institutionalize the capabilities of NGOs and get them adequately fielded quickly. The NGO policy modernization programs of the NGO Unit at MODEP should seek a 99 percent solution to the organizational limitations of NGOs in the country and to build the kind of innovative thinking and flexibility capable of supporting rigid development processes.

Sustaining Organizational Performance

The ability to fight corruption in government and empower NGOs sometimes simultaneously fits squarely within the finest traditions of good governance, more so because adequate financial management, including adequate reporting on budgetary issues is key to sustained organizational performance of NGOs. For most NGOs in Sierra Leone, unsatisfactory practices with regard to vehicle and fuel use, procurement procedures and weak financial reporting and accounting are weaknesses which are also typical issues in bad government. Improving documentation of results, including the development of good monitoring indicators is also essential for sustaining organizational performance. The non performance of NGOs is coming at a frightful human, financial, and political cost. There has to be organizational improvements in government so that NGOs can be more resourceful and relevant to the development equation.

One of the enduring issues the NGO Unit at MODEP’s struggles with is whether personnel and organizational systems designed to coordinate the work of NGOs in the country will be able to reflect the importance of advising, training, and equipping NGOs in Sierra Leone—something still not considered a career-enhancing path for the best and brightest organizational development experts.  Another is whether the revised policy regulations can be adapted well enough and fast enough to empower NGOs—or, more significant, to build the capacity of local NGOs to make them more resourceful.

One can make the argument in favor of institutionalizing NGO skills and the ability to conduct stability and support operations. This has to be done and is necessary for maintaining the current advantage of the relevance of NGOs as development partners. Apart from recent revisions of NGO policy regulations there has been no strong, deeply rooted constituency inside MODEP or elsewhere for institutionalizing the capabilities necessary to support NGO work in Sierra Leone—and to quickly meet the important needs of civil society organizations engaged in development work in Sierra Leone.

Think of the important work of NGOs in Sierra Leone.  NGOs often make the impossible possible by doing what governments cannot or will not do especially when new challenges crowd the national agenda. Increasingly, NGOs operate outside existing formal frameworks, moving independently to meet their goals and establishing new standards that governments, institutions, and corporations are themselves compelled to follow through force of public opinion.

Some humanitarian and development NGOs, for instance, have a natural advantage because of their perceived neutrality and experience. Amnesty International – Sierra Leone Section, for example, (as listed on the webpage directory of NGOs maintained by UNDP Sierra Leone promotes and protects human rights through advocacy and human rights education—maintaining documentation on human rights abuses and violations carried out during the ten year rebel war in Sierra Leone which proved helpful to the TRC in Sierra Leone. Other groups such as the Campaign for Good Governance (CGG) is a democracy-supporting NGO in Sierra Leone which promotes the building of democratic institutions, transparency and accountability in government, active citizen participation in the political process, voter education, human rights, and the rule of law. The Catholic Youth Organization (CYO) organizes religious, educational, social and cultural programs to meet the spiritual, mental and recreational needs of members. The Centre for Coordination of Youth Activities provides training in leadership, peace building, skills development, and community development. The Kailahun District Development Foundation (KADDF), a district-wide non-governmental organization offers viable solutions to the pervasive problems of poverty and serves as a clearinghouse for outside agencies interested in carrying out programs in the Kailahun district. The Sierra Leone Adult Education Association (SLADEA) helps to reduce the high rate of illiteracy among adults in the non-formal sector; to enlist the co-operation and support of other NGOs with a view to motivating various forms of people’s participation especially women and youth in national development; to achieve public recognition and support for non-formal education sector. FORUT’s thematic areas (health, education, skills development, micro-finance, skills training, etc.), are relevant for the end users that are often poor and vulnerable children, youth and women. Action Aid is one of the largest NGOs operating in Sierra Leone promoting food security through agricultural programs to ensure seeds are available and crop production continues.

There is no doubt, therefore, that modernization programs will continue to have, and deserve, strong institutional and parliamentary support. There has to be the enabling environment needed to make sure that the capabilities needed for the complex organizational issues of NGOs also has strong and sustained institutional support over the long term. The need for an NGO Unit establishment that can make and implement decisions quickly in support of NGOs working in Sierra Leone is necessary.

In the end, the NGO capabilities needed cannot be separated from the cultural traits and the management structure of the institutions the Sierra Leone Government has: the signals sent by how funds are managed, what projects are funded, what skills are used to implement projects and how personnel are trained. As Foreign Minister Lloyd Axworthy has said, “Clearly, one can no longer relegate NGOs to simple advisory or advocacy roles. . . . They are now part of the way decisions have to be made.”

As Yale professor Steve Charnovitz has observed, NGO involvement seems to depend on two factors: the needs of government and the capabilities of NGOs. A good democracy encompasses all NGOs which strive to create formal but flexible systems fostering dynamism and self-adjustment. NGOs ought to be a part of the alternative development paradigm, because the State, its institutions, and public policy, are unable to address a host of issues of underdevelopment all alone.

Evidently, there are many NGOs today in Sierra Leone in different shapes and forms with substantial amounts of donor and individual funds being diverted through them for developmental purposes. These NGOs are thought to be participatory, community-oriented, democratic, cost effective, and better at targeting the poorest of the poor, although in recent years, the nimbus of righteousness around NGOs has almost disappeared, and there is wide acknowledgement of their inability to deliver what is expected from them. Many lessons, however, about NGOs in Sierra Leone present themselves. Two of the most important are an understanding of organizational challenges and a sense of determination to change. The determination and national reach of NGOs has been an indispensable contributor to national peace and stability. The NGO Unit at MODEP should be clear about what effective organizational management by competent operators of NGOs can accomplish. No matter what their aims, all organizations share two things in common: They are made up of people, and certain individuals are in charge of these people. NGOs therefore need strong managers to lead its staff toward accomplishing development goals. And these managers are more than just leaders—they are problem solvers, cheerleaders, and planners as well.

Think of the intricacies of management, for instance. No matter what type of organization they work in, NGO executives are generally responsible for a group of individuals’ performance. As leaders, they must expect their fellow workers to work earnestly to reach common NGO goals. As the management guru Peter Drucker said, “Executives owe it to the organization and to their fellow workers not to tolerate nonperforming individuals in important jobs.”

In national affairs, “aid can work where there is good governance,” the United States Congressional Representative Lee H. Hamilton wrote in his book on – A Legacy of Honor: The Congressional Papers of Lee H. Hamilton, U.S. House of Representative 1965-1998 Indiana Ninth District, “… and usually fails where governments are unable or unwilling to commit aid to improve the lives of their people.” It is thus believed any responsible National Development Strategy for Sierra Leone should provide a balanced approach to enhancing responsibilities and preserving the relevance of NGOs as development partners.

Claimants who have successfully proved liability in an action for patent infringement, either actual or anticipated, are entitled to elect their remedy. Successful litigants will discover that the measure of the award for compensation may vary widely depending upon their election between damages and an account of profits.

Comparison of the Remedies

The variance between an account of profits and damages exists because the focus is on the affairs of different parties: in one instance that of the claimant and the other on the defendant.

Damages

An award of damages focuses on the losses sustained by the claimant. There is no upper limit on the measure of damages that may be awarded. Relief for patent infringement may overlap with other areas of intellectual property; for instance the copyright of the claimant may have also been infringed (an instance being software). In calculating the sum to be paid in damages, a court will disregard whether the defendant could have avoided infringement by using substitute process and thus avoided a charge of infringement altogether. It is irrelevant. Losses not caused by the infringement are not recoverable.

An Account of Profits

On the other hand an account of profits focuses on the profits made by the defendant, without reference to the damage suffered by the claimant at the hands of the defendant. The purpose of the account is to prevent the unjust enrichment of the defendant by the use of the claimant’s invention. The claimant is treated as if they were conducting the business of the defendant, and made the profits of the defendant. As such, the upper most limit of an award is the sum of profits made by the defendant caused by the infringement. In most cases, an award of damages will equal or exceed the maximum award in an account of profits; however an account of profits may greatly outstrip an award of damages in the right case. When assessing an award, to say that a defendant should have generated higher profits is immaterial: the claimant must take the defendant as he finds them.

The profits must have been earned from the use of the claimant’s invention, and if the infringed invention formed only part of the overall product or process, then only that part of the profit attributable to the patented invention is recoverable. This is where most difficulty is experienced in assessing the profits earned by the defendant and a number of approaches may be taken during the assessment. Courts take the view that this would be unfair upon the defendant for the claim to be awarded all of the profits where attribution of profits is possible. Manufacturing processes that use the patent in question as a small step in the manufacturing process provide a typical example, in that it clearly cannot be said that the entire profit of the application of the process is attributable to the infringement. Where it is appropriate to apportion losses, the reference for the assessment will involve splitting the profits between infringing and non-infringing parts of the process.

On the other hand, there are instances where it is appropriate for the claimant to recover all of the profits of an invention, however whether this is so turns on the facts of the case.

Making the Calculations
Damages

It is trite to say that the claimant is entitled to be placed in the position they would have been had the infringement not taken place in the context of damages. The test for the measure of damages in patent cases is seen in the application of the ‘but for’ test, and the damage must be the natural and direct consequence of the defendant’s acts. Although the claimant must prove their loss, they are assessed liberally. Courts recognise that monopoly rights lead to higher prices or license fees, so this is the peg to which damages are assessed.

A court is generally prepared to imply that inference with the claimant’s monopoly will cause damage in the ordinary course of events, and the absence of a precise means to calculate damages will not necessarily result in an award of nominal damages, but a fair sum of what a reasonable person may expect to have lost, with reference to the general trade that has been interfered with by the defendant.

There are two ways to calculate the damages suffered by a defendant, and the method turns on whether the claimant manufactures the patented invention or whether manufacturing of the invention is licensed to others.

The Reasonable Royalty

Where the patent owner licenses the production or use of the invention to others, the measure of damages is the lost royalty profits.

A court is usually inclined to award a reasonable royalty to the claimant, notionally asking: if the claimant did grant a licence to use the patent, what would they reasonably be expected to obtain in the market?

The damages are limited to the lost license fees that would have been payable by the defendant. Where previous licensing fees have been agreed, the determination of the price as it has been determined in the free market will be persuasive evidence of the proper sum payable, as that is the sum that the infringer will be presumed to be asked to pay. The sum may be increased where standard license fees impose restrictions upon the licensee which are not similar to the conduct of the defendant when committing the infringing acts. Thus when a product is usually made available on a usage only basis, and the infringer has manufactured and sold the product with purported licenses to further develop the invention to its licensees, an uplift in the award payable is likely.

Where there is no precedent of licensing by the claimant, calculation of a reasonable royalty may take into account:

1. the patent owners’ previous conduct in pricing and terms

2. Percentages standard in the trade

3. cost of designing around the patent monopoly rights

The proper sum for the notional license fee is the sum that a potential licensee would be willing to pay to enter the market.

Where there is no licensing activity, the court may use this notional license fee to calculate damages. Evidence of the quantum to be awarded may be a quoted license fee by the claimant. Where there is no quote for a reference point, the measure will be the rate that a licensee who is not in the market would pay, regardless of whether they might have been able to make non-infringing equivalents.

Manufacturers of Patented Inventions

When the patent owner manufactures the product, the patentee is entitled to lost manufacturing profits.

When the patent owner is a manufacturer rather than a licensor, it has often been said that the appropriate figure cannot be arrived at with mathematical precision. It is the profit that the claimant could have made that sets the baseline for the award. Some allowance may be made for the exertions made by the defendant, as it is presumed that not all sales made by the defendant would have been made by the claimant had there been no infringement.
Heads of Damages

Depending on the type of case, the following heads of damage have been established by previous case law:

1. Loss of profits

a. in the form of sales diverted away from the claimant by reason of the infringement;

b. lost margins on sales not made due to the pressing need to reduce prices due to price depression caused by the infringer.

2. Loss of goodwill and reputation to the claimant, which arguably has several dimensions;

3. Sums representing the benefit of the use of the invention by defendant in the market, which is qualified by taking the market value of the use. It is damages for the unauthorised use, which resonates as a license fee for the use and restitutionary damages (sometimes referred to as ‘gain based damages’), an area of damages law rarely pressed.

4. Lost profits on sales lost on goods that are commonly sold with the invention

5. Springboard Damages: damages that are suffered after the infringement by establishing a market presence through infringement and early entry into the market.

6. Diminution of value in subsidiary companies owned by the patent owner due to the loss of sales by them where the profits flow through to the holding company.

7. Depending on the nature of the patent, there may be losses sustained by loss of sales on products commonly sold with the patented products, provided it is foreseeable and caused by the infringement.

8. As a general rule a claimant was entitled to recover for losses and expenses reasonably incurred in mitigation.

Where the patent owner has reduced prices in a competitive market, a court may have regard for the argument that the patent owner could not have maintained their sales at current prices in that environment. This is a matter that goes to causation of damage – the claimant is not entitled to recover losses unless the defendant caused them.

In the case of infringement of a product, a good starting point for assessing damages is to obtain evidence of the number of infringing products made and in the alternatives sold, the sums received and the approximate costs incurred. This creates a reference point for the calculation.

The point needs to be made that the damages recovered in any particular case depends on the facts of the case. The general principle of awarding tortuous damages applies – that any losses caused by the infringement are recoverable, whether or not the particular heads appear in the list above. A defendant is said to take the claimant as they find them, and thus damages outside these heads of damages which are peculiar to the claimant will be recoverable in the appropriate case.

Making an Accounts of Profits

Defendants are not obliged to hand over the gross profit obtained by reason of the infringement. In keeping with the approach that the claimant is said to stand in the shoes of the defendant, a court will make allowances to the defendant for parts of the gross profit that are attributable to proper expenses associated with making sales, such as advertising and marketing; increases in value of goods or services once sold or provided and additional features of the product or service that are outside the infringing invention (such as value added services).

In the event an infringer makes a loss in a manufacturing process, the sum by which the infringing process reduces those losses are recoverable on an account.

Where it is difficult to separate out the different components of a process in order attribute a proportion of the profits, courts may decide to assign a percentage of the profits on the same percentage that the costs and expenses are attributed to them by adopting an accounting approach. A judge will make a reasonable approximation. Account may then be taken of the relative importance of the relative attractions of different parts of an infringing product. In this way the courts reserve a discretion to grant a larger slice of the profits where the infringement can fairly be said to play an important role in the profits obtained by the defendant. This approach takes a ‘base allocated profit’ percentage and then that percentage is weighted for the importance to the profits obtained.

There are cases where the patented invention has readily discernable impact on profits, either positively or negatively. For instance, the patented invention may reduce the costs associated with the manufacturing process, making the process more efficient. In that case a larger share of the profits would be payable to the claimant on an empirical basis. It involves a comparison between the profitability achieved when the patented invention is used and on the other hand when it is not used. This brings consideration of efficiencies introduced by the invention into consideration for the calculation of the slice of the profits to be awarded to the claimant.

Making assessments of damages and accounts of profits frequently require the involvement of forensic accountants with some knowledge of the industry in which the infringement has taken place. As a general rule, an account of profits will probably be preferred in cases where the claimant cannot point to any damage in their own business. This will usually be the case where the margins of the defendant outstrip the profits that of the claimant.

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