ATOS & HMC&TS Appeal

[CerberusSco]

Hi,

 

Quick question. I'm helping a friend with his appeal (which is due to be heard August 6th) after scoring 0 points at his ATOS medical. He was misusing alcohol and suffering from anxiety, stress & depression and claimed ESA from late 2011. He had his ATOS medical in March 2012 and was decided that he was fit to work in April 2012. He immediately appealed.

 

I've been looking at an exemption, regulation 27(b), which states that you can be found incapable of work if:

‘there would be a substantial risk to the mental or physical health of any person if he were found capable of work’’

 

Given that he was previously misusing alcohol & suffering from anxiety, stress & depression and also adding to the fact that he tried to take his own life in February 2012, is it likely he can win an appeal using the above regulation. If so, how does one go about explaining it at the actual appeal?

 

I will be attending with him so I would appreciate any help or advice that people can give regarding the above or anything else that may be relevant to bring up at the appeal.

 

Thanks in advance.

[honeybee13]

Hello there.

 

Here's a link to the forum stikky on appeals and tribunals, based on what I did with my OH's help. We were successful.

 

You need to have a copy of the Atos report on your friend and demonstrate why it was wrong or where it contradicts itself. And check out the DWP descriptors for inablility to work, there's a link in the stikky.

 

http://www.consumeractiongroup.co.uk/forum/showthread.php?251737-Appealing-or-going-to-a-Tribunal-Some-useful-information

 

My best, HB

[CerberusSco]

Hi honeybee13,

 

Thanks for your reply.

 

I have in front of me a ESA85 ESA Medical Report Form.

 

Having spoken to my friend and having looked through the form, it would seem that the registered nurse (

 

I'll have a look at the sticky, but I'm pretty much looking at approaching ti from the above 2 angles.

 

If I have any further questions, I'll be sure to ask. Once again thanks for your reply.

[**Margaret**]

:CerberusSco:

 

The ESA85 form is the Atos report that :honeybee13:'s mentioned and your friend's sounds par for the course. Nothing 'medical' about either the reports, or the assessors who produce them when they're working for Atos.

 

Employment n support allowance isn't about bad days, good days, or how the claimant feels. It's about meeting the legal criteria, which are explained on pages 10 - 12 and 17 - 27 of the sixth link in the sticky, for an award. By all means trash errors in the ESA85 that are relevant to your friend's appeal, but it's far more important for him to explain to the tribunal panel why his capability for the prescribed activities is limited, and what happens when he attempts them. Does anxiety preclude new friendships? Has the alcohol caused unacceptable behaviour?

 

Tribunal panels have to decide whether an appellant meets any of the descriptors listed on pages 17 - 27 of the ESA214 booklet before they consider (reg 27?). Think you're actually looking at reg 29?

 

Burden of proof for reg 29 (or reg 35) is on the claimant. You need to think about how your friend would cope with looking for work. What's likely to happen if he's asked to do work related activity? Self-neglect cos he incurs a sanction? Aggression towards his adviser? An argument for reg 29 usually needs medical opinion that harm to the claimant, or someone else, is more likely than not.

 

Best wishes, Margaret.

Edited June 30, 2013 by **Margaret**

[CerberusSco]

Hi Starryeyes52, thanks for your reply.

 

All this seems terribly confusing, but just so that I think I'm on the same page at the appeal tribunal I could argue (as an example) that my friends depression, stress, axiety/panic disorder & alcohol misuse could cause issues based on the following descriptor:

 

17. Appropriateness of behaviour with other people, due to cognitive impairment or mental disorder

 

17 (b) Frequently has uncontrollable episodes of aggressive or disinhibitedbehaviour that would be unreasonable in any workplace.(= 15 Points) or 17 © Occasionally has uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace.(= 9 Points)

 

Argument:

 

He has a problem with anxiety and depression and a long standing problem with abuse of alcohol (even though he has now been dry & sober for over 12 months). He can be abusive towards people, both physically and verbally, however, at the time of the medical report he was a lot calmer had not been drinking. However, he can still lose his temper over very minor things, even though he has stopped drinking. However, at the time of the medical when he was coming off drinking and after an attempt to take his own life with a mixture of tablets & alcohol, he was still abusive towards people and rarely remembers events of an abusive nature happening. It is only when he is told of them by people that he feels regret & remorse for his actions.

 

-Edit-

 

Having looked at both his ESA50 & the ESA85 The Decision Makers Scoresheet, my friend had filled in the ESA50 and checked the box, Often, for 17. Behaving appropriately with other people. As a result of his ATOS medical he was awrded 0 points for this and the decision maker agreed. So, if we can prove, substantiate the above then (preferably Descriptor 17 (b)) then he would be awarded 15 points and win his appeal?

 

I also note that his ESA50 was filled in before his depression became worse and the fact that alcohol misuse was identified. So my friend has therefore answered No to quite a lot of these questions. How easy would it be to argue that there were underlying issues which hadn't been identified at the time of completing his ESA50 which caused him to answer No to the majority of the questions?

Edited June 30, 2013 by CerberusSco

[**Margaret**]

:CerberusSco:

 

Employment n support allowance has to be the most benefit in history, and the current dearth of welfare rights advice means there's little help for appeals. But, you're getting there.

 

The test for the benefit is how well, or not, claimants can cope with prescribed activities, mobilising, learning, interacting with other people, etcetera that are relevant to the workplace. Inevitably a few claimants will be capable of all the activities so no points, but for a variety of reasons it's unreasonable to expect them to work, hence regs 29 and 35.

 

Lots of us plan an appeal submission on blank sheets of A4, or word docs, headed up with the descriptor(s) we believe we satisfy. Then we write paragraphs to explain the problem (abusive behaviour), the cause (alcohol and anxiety), and describe what happened last time we went to a supermarket or tried to cope with a queue jumper or whatever. Plus a paragraph (or several) about where Atos got it wrong. Personally, if there's time, I aim to deal with one descriptor per day. There's no one correct way to put the paragraphs into your written submission.

 

Either use :honeybee13:'s template;

 

Quote the Atos assessor. Say that s/he was wrong, then explain the true situation. If there's evidence from your friend's doctor/psychiatrist to confirm his version of his problems refer to it in rebuttal of the ESA85.

 

Or;

 

Write the whole lot into one long statement with a section for each descriptor your friend believes he meets. Again, support your assertions with professional evidence, specially if the evidence contradicts the ESA85.

 

Use whichever format you and your friend find easiest. I've used both successfully. Should he be struggling for medical evidence, subject access request his general practitioner. There may be a useful report among his medical records. A witness statement from a carer/flatmate describing abusive behaviour can help. Include a paragraph about how he may satisfy reg 29. You'll probably need medical evidence to 'prove' (on mental health grounds) that the ESA50 wasn't completed correctly.

 

There's some general info about appealing a Work n Pensions decision at;

 

http://disabilityrightsuk.org/appeals-and-reconsiderations

 

Good luck with the , Margaret.

Edited July 2, 2013 by **Margaret**

[CerberusSco]

:CerberusSco:

 

Employment n support allowance has to be the most benefit in history, and the current dearth of welfare rights advice means there's little help for appeals. But, you're getting there.

 

The test for the benefit is how well, or not, claimants can cope with prescribed activities, mobilising, learning, interacting with other people, etcetera that are relevant to the workplace. Inevitably a few claimants will be capable of all the activities so no points, but for a variety of reasons it's unreasonable to expect them to work, hence regs 29 and 35.

 

Lots of us plan an appeal submission on blank sheets of A4, or word docs, headed up with the descriptor(s) we believe we satisfy. Then we write paragraphs to explain the problem (abusive behaviour), the cause (alcohol and anxiety), and describe what happened last time we went to a supermarket or tried to cope with a queue jumper or whatever. Plus a paragraph (or several) about where Atos got it wrong. Personally, if there's time, I aim to deal with one descriptor per day. There's no one correct way to put the paragraphs into your written submission.

 

Either use :honeybee13:'s template;

 

Quote the Atos assessor. Say that s/he was wrong, then explain the true situation. If there's evidence from your friend's doctor/psychiatrist to confirm his version of his problems refer to it in rebuttal of the ESA85.

 

Or;

 

Write the whole lot into one long statement with a section for each descriptor your friend believes he meets. Again, support your assertions with professional evidence, specially if the evidence contradicts the ESA85.

 

Use whichever format you and your friend find easiest. I've used both successfully. Should he be struggling for medical evidence, subject access request his general practitioner. There may be a useful report among his medical records. A witness statement from a carer/flatmate describing abusive behaviour can help. Include a paragraph about how he may satisfy reg 29. You'll probably need medical evidence to 'prove' (on mental health grounds) that the ESA50 wasn't completed correctly.

 

There's some general info about appealing a Work n Pensions decision at;

 

http://disabilityrightsuk.org/appeals-and-reconsiderations

 

Good luck with the , Margaret.

 

Thanks again for your reply. The trouble I will have is proving the ESA50 wasn't completed correctly. However, I'll do exactly as said and start going through things one by one on a word document. I think he also plans to take his girlfriend as support/witness as she has witnessed the alcohol misuse and the aggressive behaviour first hand. Although I must point out he has never been abusive towards her.

 

Once again a big thanks and I'll let you know how he gets on.

[honeybee13]

Hello Cerberus.

 

At your request, I'm moving this to the main benefits forum. You might like to send starryeyes a link so she can find it easily.

 

HB

[CerberusSco]

Thanks very much honeybee13.

 

Just to inform any viewers of this thread that his GP apparently cannot give any evidence to an appeal tribunal as their superiors have told them not to. He could SAR it, but that will take 40 days (max) and the tribunal is dated for August 6th.

 

So, I am a bit stumped at the moment.

 

Also to elaborate on what I'm doing at the moment. I am just preparing a personal statement, to submit to the appeal tribunal prior to the actual hearing, on a word document explaining the details of his condition, his attempts at self harm (which I also think is a reason for exceptional circumstances given his mental health problems), listing the reasons why he thinks he meets the following descriptors 16. Coping with social engagement due to cognitive impairment or mental disorder - © Engagement in social contact with someone unfamiliar to the claimant is precluded for the majority of the time due to difficulty relating to others or significant distress experienced by the individual – 6 points & 17. Appropriateness of behaviour with other people, due to cognitive impairment or mental disorder - (b) Frequently has uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace – 15 points

 

I'm also listing the 3 different anti-depressants he has been prescribed since November 2011 and the subsequent side effects he has experienced because of them. I also intend to mention how his depression has had an effect on his type 1 diabetes.

 

I know his girlfriend will be attending his hearing as well to give her view on his aggressive behaviour and his overall depression.

 

Thanks.

[estellyn]

You can ask for a postponement of the hearing in order to obtain medical evidence - you just need to put it in writing. They don't have to agree to the postponement but usually do as long as it isn't short notice.

[CerberusSco]

You can ask for a postponement of the hearing in order to obtain medical evidence - you just need to put it in writing. They don't have to agree to the postponement but usually do as long as it isn't short notice.

 

Which was what I was thinking next. The only trouble is, is he going to be waiting months again or will it be a matter of weeks. It's already taken over a year to get to appeal stage as it is (obviously because of the amount of appeals that are being heard).

[estellyn]

Which was what I was thinking next. The only trouble is, is he going to be waiting months again or will it be a matter of weeks. It's already taken over a year to get to appeal stage as it is (obviously because of the amount of appeals that are being heard).

 

It's hard to tell how long, but if you're specific about the amount of time you need, say ask for a rescheduling for a month later in order to allow for the dr to respond to the SAR, then this might mean a sooner date than an open ended postponement - but it really depends on how far ahead they're booking the hearings. If you turn up at the hearing without medical evidence, then there is a far lesser chance of success. There is also the possibility of the hearing being adjourned so the judge can request the medical records themselves, which means a longer delay and more stress. In my experience, it is better to have a delay and go better prepared, than go ahead with an earlier date and fail due to no medical evidence to back up the appellant's evidence. But in the end, it's your friend's choice.

[CerberusSco]

That's great advice, thanks.

 

One final thing in the meantime about a postponement. Does he have to request this in writing or is he able to telephone HMC&TS and get a postponement?

 

Thanks again.

[estellyn]

That's great advice, thanks.

 

One final thing in the meantime about a postponement. Does he have to request this in writing or is he able to telephone HMC&TS and get a postponement?

 

Thanks again.

 

It needs to be in writing.

[CerberusSco]

I have it on very good authority that it is unlikely they'll postpone

[estellyn]

I have it on very good authority that it is unlikely they'll postpone

 

who??

 

Not allowing an appellant enough time to obtain medical evidence, could be seen as a breach of natural justice and make the Tribunal decision appeallable to the upper court if lack of medical evidence is cited as a reason for the appeal being disallowed.

[CerberusSco]

who??

 

Not allowing an appellant enough time to obtain medical evidence, could be seen as a breach of natural justice and make the Tribunal decision appeallable to the upper court if lack of medical evidence is cited as a reason for the appeal being disallowed.

 

I was told by an ex volunteer from the CBA, but that's another story.

 

This is what I have so far regarding a personal statement:

 

xxxxx, 6th August 2013, HM Courts & Tribunals Service, Wellington House, Glasgow

NINO

 

 

Introduction

 

I, xxxxx am appealing against the decision made on 19th April 2012 to decline the award of Employment and Support Allowance on the grounds that I have not attained 15 points from the combined Physical and Mental Health descriptors following my Work Capability Assessment (for ESA) on 25th March 2012.

 

I believe and I will demonstrate below that by scoring the descriptors relevant to my condition correctly that I do attain the required threshold of 15 points.

 

I hope that the Tribunal will support my appeal and that the Tribunal will authorise the re-instatement of my award.

 

_____________________

 

I would like to refer the Tribunal to the ESA85 & ESA50 in the Appeal Submission –

I shall now explain where the report’s content is inaccurate.

 

Activity 17, Appropriateness of behaviour with other people, due to cognitive impairment or mental disorder– ESA85 Medical Report

 

The report does not reflect accurately those matters discussed and assessed at the medical examination that I attended on 25th March 2012. Referring to the content of the Medical Report Form – ESA85, on Page 34:

 

I note that the Medical Services doctor has indicated that the above does not apply. However, I feel that this is incorrect and I find it difficult to understand how the Medical Services doctor, who carried out the assessment, can disagree with my opinion. I had also clearly stated on the ESA50 form that I have a problem with my appropriateness of behaviour with other people, due to cognitive impairment or mental disorder. Whilst I didn’t elaborate on that in the ESA50 form, this ability was not tested nor questioned as part of the assessment.

 

 

 

 

17. Appropriateness of behaviour with other people, due to cognitive impairment or mental disorder

 

(b) Frequently has uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace – 15 points

 

Reason(s):

 

• My alcohol abuse had reduced my ability to think straight. If someone provoked me whilst I was drunk, then I didn’t take other factors into account, such as the consequences of reacting to provocation or criticism. This has lead to violent reactions from me when I would usually dismiss such instances. On February 15th 2012. I had been abusing alcohol all day, mainly 2x 1 litre bottles of vodka and numerous cans of lager. My girlfriend had asked me not to buy anymore alcohol. I dismissed her request and concern and then proceeded to smash up her kitchen, washing machine, kettle, plates and cups. This is something I have never done before, even when I wasn’t aware of my alcohol abuse or even when I hadn’t been drinking alcohol. Following this aggressive outburst I then proceeded to overdose on Co-Codamol, Glucose & Insulin. I was assisted into an ambulance by the local police has I had initially refused to go to hospital. The police assisted due to a fear for welfare.

 

• My anti-depressant medication has given me side effects that although rare in some cases, it has caused me behavioural problems such as feelings of hostility, anger, aggression. This has been the case with my original anti-depressants, Citalopram and Mirtazipine and also my current anti-depressant, Sertraline. Aggressive behaviour due to the side effects of my medication would not be acceptable in the workplace and this is why I had specifically mentioned this on my ESA50 form. I feel this is why I have a limited capability for work and I don’t think the Medical Services doctor has taken this fully into account within the ESA85 form and at my initial assessment.

 

I believe that being found as not having a limited capability for work would have made my depression, anxiety & stress deteriorate resulting in more suicidal tendencies and further aggressive behaviour. Also, I believe that it would have also had an impact on my recovery from alcohol abuse. Furthermore, I believe the above demonstrates that I frequently have uncontrollable episodes of aggressive behaviour and that it would be unreasonable and unacceptable in any workplace and that I should be awarded 15 points on that basis.

 

I would like to refer the Tribunal to the ESA85 Medical Report in the Appeal Submission –

 

Referring to the content of the Medical Report Form – ESA85, on Page 39:

 

I note that the Medical Services doctor has indicated that her prognosis is that a return to work can be considered within 3 months and also there is no significant functional impairment.

 

 

 

 

 

I would like to ask the Tribunal what reason does the Medical Services doctor have for this prognosis.

 

• If the Medical Services doctor has decided that I don’t have a limited capability for work and no significant functional impairment, then why has a return to work been suggested within 3 months and not immediately?

 

• Does the Medical Services doctor acknowledge that I do have a Mental Health Condition which does limit my capability for work in the short term? If so, then I am required to ask the Tribunal that the decision from the

 

 

 

When scoring the Work Capabilities Assessment I feel that both the Medical Services doctor and Decision Maker have over-estimated my level of ability. By revising the Score card to take account of my actual Mental Health conditions, I am of the view that I satisfy the threshold of 15 points required for the award.

 

Conclusion

 

In conclusion, I believe that the scoring of my Work Capability Assessment should be revised to take account of my actual Mental Health abilities.

 

I hope the Tribunal will support and find in favour of my appeal, determining that I am incapable of work from 19th April 2012.

 

 

 

 

 

_________________________ _________________

 

I declare that the content of this Summary forms the basis for my appeal and that the information is correct and complete as far as I know and believe.

 

 

 

 

_________________________ _________________

Signed xxxxx

 

2nd July 2013

 

There is more to add I feel, anti-depressant side effects and with especially coping with change. Although I'm not 100% on how to approach that given that my friend didn't fill that section of the ESA50 form in.

 

I have the appeal papers uploaded if anyone can take a look and pick out anything else that might be of use.

 

Thanks.

[paulb1310]

Regarding the "incomplete" ESA50 you could try this:

Commissioner Howellin CIB/14442/96 (*/97) - at paragraph 15 the Commissioner says:

“I do not think that a Tribunal should regard the scope oftheir enquiries as circumscribed by the boxes claimants may or may not haveticked at an earlier stage on the long and very complicated forms they are nowexpected to fill out.”

 

[honeybee13]

That's useful Paul, thank you.

 

My best, HB

[CerberusSco]

Regarding the "incomplete" ESA50 you could try this:

Commissioner Howellin CIB/14442/96 (*/97) - at paragraph 15 the Commissioner says:

“I do not think that a Tribunal should regard the scope oftheir enquiries as circumscribed by the boxes claimants may or may not haveticked at an earlier stage on the long and very complicated forms they are nowexpected to fill out.”

 

 

Thanks for that, very much appreciated indeed.

 

Regarding this:

 

I would like to ask the Tribunal what reason does the Medical Services doctor have for this prognosis.

 

• If the Medical Services doctor has decided that I don’t have a limited capability for work and no significant functional impairment, then why has a return to work been suggested within 3 months and not immediately?

 

• Does the Medical Services doctor acknowledge that I do have a Mental Health Condition which does limit my capability for work in the short term? If so, then I am required to ask the Tribunal that the decision from the

 

I'm going to leave that out completely and just purely concentrate on evidence.

[estellyn]

 

 

 

I'm going to leave that out completely and just purely concentrate on evidence.

 

Yes, I think that's best.

 

By the way who's the CBA?

[estellyn]

Oh and in reference to the submission there are a few things that may cause problems in the Tribunal:

 

1) there seems to be confusion over what the condition of your friend was on the day of the assessment - was he drinking at that time? If so this needs to be made clear. If not, yes it's important to show the effects of the drinking, but also are there any other times that you could give as an example where your friend attempted to stop drinking, but then continued due to a stressor?

 

2) I believe there has been guidance to not take into account medication side effects in assessments, but in a quick look couldn't find it in the regs, so you should definately include medication side effects, but also include what the effect would be if he were to not take a medication for depression.

 

3) Were there any inaccuracies in the report, even if they have no relevance to the descriptor your friend meets.

 

4) Does he meet any other descriptors, even lower points, just in case less points are scored on this descriptor - for instance issues dealing with change etc.

 

5)are there police reports, hospital discharge letters etc that you can refer to?

[CerberusSco]

Yes, I think that's best.

 

By the way who's the CBA?

 

Lol, I mean't to say CAB, not CBA. It was late when I posted so probably CBA anyway lol!

 

Oh and in reference to the submission there are a few things that may cause problems in the Tribunal:

 

1) there seems to be confusion over what the condition of your friend was on the day of the assessment - was he drinking at that time? If so this needs to be made clear. If not, yes it's important to show the effects of the drinking, but also are there any other times that you could give as an example where your friend attempted to stop drinking, but then continued due to a stressor?

 

2) I believe there has been guidance to not take into account medication side effects in assessments, but in a quick look couldn't find it in the regs, so you should definately include medication side effects, but also include what the effect would be if he were to not take a medication for depression.

 

3) Were there any inaccuracies in the report, even if they have no relevance to the descriptor your friend meets.

 

4) Does he meet any other descriptors, even lower points, just in case less points are scored on this descriptor - for instance issues dealing with change etc.

 

5)are there police reports, hospital discharge letters etc that you can refer to?

 

1) No he was sober at the time of the assessment. However, he did say it was very early in his recovery and was tempted to drink both before the assessment due to being anxious and afterwards due to the way the assessment was handled.

 

2) Will include that information as well as it's likely he would still be suffering from anxiety, panic attacks & depression if he wasn't taking the medication. It's also highly likely (in his view) he would still be drinking. Even though his overall condition has improved somewhat he steel feels as though he isn't quite there yet.

 

3) This is an odd one. Like I say I have a copy uploaded for reference, but I am miffed why the registered nurse who took the assessment recommended a return to work in 3 months and not immediately. She also didn't think he had any aggressive behaviour, probably as he was calm at the time of the assessment, but his aggressive behaviour isn't an everyday thing. It is quite frequent so I am at a loss as to how nothing has been said about that in great detail.

 

4) I'm looking at other descriptors. Another side effect of his medication is memory issues. Odd I know, but I have been with him when he has taken his insulin, then 5 minutes later he's in a panic asking if he actually took it. Concentration issues, coping with change. So I am looking at this in a bit more detail later on this evening, but if you'd like a quick look at the ESA85, then I'd be happy to drop you a PM with a link for you to have a quick look at, provided you don't mind and you could do that?

 

5) He wasn't given a discharge letter when he was last admitted in Feb 2012. I am under the assumption that this would of been sent from the hospital directly to his GP. The amazing thing is though, after quoting some facts about GP's supporting claimants in their ESA appeals by the BMA, the GP has relented and asked for him to make an appointment to discuss his request. His GP was acting under the instructions of the Glasgow Local Medical Committee, who advised GPs to decline these requests. These guidelines have been withdrawn for the moment. I'm sure there would of been a record of the police attending his girlfriends address in Feb 2012, but I'm pretty sure that's going to be a SAR to get that information.

 

The information regarding the BMA is as follows:

 

May 2012, the BMA passed a motion calling for the WCA to be scrapped with immediate effect. The WCA involves the administration of a battery of questions contained in the LIMA computer programme that comprehensively fails to adequately and accurately assess a patient’s ‘fitness for work’. The operation of the assessment system has been universally condemned for failing to take into account the disproportionate medical, social and other barriers that sick and disabled people face in the job market as a direct result of their disabilities. Also according to the BMA, GPs should be asked to provide factual information for every Work Capability Assessment to enable ‘better-informed decisions’ to be made about their patient’s eligibility for benefits.

Edited July 4, 2013 by CerberusSco

[estellyn]

Regarding the CAB volunteer and postponements - I was a paid appeals worker, and the only postponements I ever had refused were those that were considered too short notice (and not emergency in nature), the others were all approved. In any case nothing is lost by making the request.

 

The return to work within 3 months is the minimum option on their tick box menu, so sounds silly but they still put it down.

 

I'd be happy to look at anything, but can't do it by PM as that is not allowed on this site - in any case, me looking the esa85 is unlikely to bring up anything, it's just a case of picking up obvious errors or contradictions - there is a list of 'observations' which they use to make their assessment, so start by looking under the descriptor ou want to score points on, and explain why those particular 'observations' are irrelevant to the descriptor - they often are. Then go back to the beginning with the more general observations and see if there is anything else idiotic that stands out.

[CerberusSco]

FAO - estellyn

 

I have uploaded the ESA85 - Medical Report. All personal details including those of the medical examiner have been removed.