Know the Law: Resource
 Materials on Strangulation

  See Resource Materials on Stalking

  In August,  2000, the District Attorney's Office obtained a conviction after jury trial for "reckless depraved" Assault 1st degree, a violent felony, in a Clinton County Court case using the expert medical testimony and legal theory discussed here.  The defendant was sentenced to five years in state prison.  Before the Strangulation Conference, it is likely he would have been charged with only a violation or a misdemeanor.

That 2000 Clinton County conviction for Assault 1st Degree was affirmed on appeal. The official citation is: People v Scott M. Miller, 290 AD2d 814, 736 NYS2d 773 (3rd Dept 2002).

Penny Clute and Plattsburgh Emergency Physician Dr. Alexander Kuehl spoke on Strangulation at the June 23, 2000 New York State Coalition Against Domestic Violence Conference in Albany, New York, passing on what we learned last fall from Gael Strack and Dr. George McClane.


September 28-30, 1999 Plattsburgh Conference Materials Available Here


Strangulation Conference

On September 28-30, 1999, the Clinton County District Attorney's Office and the New York Prosecutor's Training Institute sponsored a conference on Detection and Prosecution of Strangulation  in Domestic Violence and Sexual Assault Cases.  Funding was provided by the United States Department of Justice Violence Against Women Grants Office and the New York State Division of Criminal Justice Services.

The leading experts on this subject, Assistant City Attorney Gael Strack of the San Diego City Attorney's Office and George E. McClane, M.D., Emergency Physician at Sharp Health Care in San Diego, came to Plattsburgh and conducted three days of training for more than 350 physicians, nurses, emergency responders, law enforcement, prosecutors, case workers and others.

Gael Strack & George E. McClane

"Strangulation" refers to the behavior of one person placing one or two hands around the neck of another person and squeezing or applying other pressure.  This can kill.

We presented training on detecting and prosecuting strangulation because, in reviewing the Domestic Incident Reports (DIRs) filed by the police and interviewing victims, we repeatedly came across descriptions of the incident that included the complainant being choked - hands put on her throat, sometimes until she passed out!  There might have been other physical violence, as well, sometimes not.

In examining this more closely, we found that in about 10% of the DIRs, choking was part of the specific incident.  Reports made to the STOP Domestic Violence program by women, about 40% described "choking" as part of the abusive conduct at one or more points in their relationship.

Despite this frequency, rarely was there an arrest for the choking behavior.  Seldom were there any marks or visible injuries seen by the police, and the victims themselves often described the choking aspect as minor in relation to the other violence used against them.

In New York, a person cannot be charged with criminal assault unless "physical injury" is actually caused.  That is defined in the Penal Law as "impairment of physical condition or substantial pain."  The choking cases did not really seem to meet this standard;  it was understandable that the police did not make an arrest.

But, we wondered whether there were internal injuries caused by being choked - strangled - that did not leave outward visible signs.  Or maybe the signs were there, but we did not know what to look for.

In our search for more information, we found some people around the state asking the same things, but no real answers.  Eventually, through an internet search, we made progress.  When the key word was "choking," it brought articles about medical conditions or choking on food.  "Strangulation" first led to some guy's personal web page that suggested the sexual benefits of that conduct!

In refining the search to "manual strangulation," we came up with articles by pathologists, describing the evidence of strangulation found during autopsies.  Hoping for someone who could identify such signs in living people who had been strangled, we pressed on and learned of Gael Strack and Dr. George McClane in San Diego.

We learned that they struggled with the same kinds of problems a couple of years earlier in San Diego, in cases that started with what looked like minor abuse, including choking, and led to homicide.  As a consequence, they taught themselves and other law enforcement and medical personnel what to look for to detect whether injury was caused.

As a prosecutor, I know that I can only be effective if there is a good investigation.  I depend upon the police, the EMTs, the nurses and doctors for the evidence I use in court.

We now realize that we may be overlooking serious crimes, because we did not know what to look for.  The frequency with which manual strangulation is used in domestic violence incidents is surprising:  in San Diego, in Plattsburgh, and very likely, everywhere else.

Because we all see it but have not known how to deal with it, we brought the experts from San Diego to train us.  We want to learn how to better do our jobs;  how to better protect our community. 

The three days of training were outstanding - all we hoped for and more.  The presentations of Gael Strack and Dr. Geroge McClane are summarized in the New York Prosecutors Training Institute Newsletter which follows. 



New York Prosecutors Training Institute, Inc. 

150 State Street, 5th Floor Albany, New York 12207

The Continuing Legal Education and Mutual Assistance Division
of the New York State District Attorneys Association



 "He choked me - but there are no marks "


Strangulation has only recently been identified as one of the most lethal forms of domestic violence. When perpetrators use strangulation to silence their victims, this is a form of power and control. This form of power and control has a devastating psychological effect on victims and a potentially fatal outcome.

      Historically, "choking” was rarely prosecuted as a serious offense because victims minimize the level of violence; and, police and medical personnel fail to recognize it.

Clinton County district Attorney's Office and NYPTI recently hosted the nation's lending experts in the prosecution and investigation of strangulation cases. Assistant City Attorney Gael Strack and George McClane, MD, both from San Diego, California, presented their findings and lectured on this important aspect of domestic violence and sexual assault cases. Our thanks to the presenters for their willingness to share their time and expertise and their willingness to permit reproduction of their materials. The following is a condensed portion of their presentation

           Strangulation is defined as a form of asphyxia and is characterized by closure of the blood vessels and/or air passages of the neck as a result of external pressure on the neck. It is often incorrectly referred to as choking which involves blocking, or obstructing the windpipe. Ten percent of violent deaths in the U.S. each year are due to strangulation, with six female victims to every male.

           Strangulation by ligature is done with a cord like object that could include anything from a telephone cord to articles of clothing.  Manual strangulation is done with the hands, forearms (as in the classic police chokehold), or standing or kneeling on the victim's throat.

           Clinically a victim who is being strangled first experiences severe pain, followed by unconsciousness, and then brain death. The victim will lose consciousness by any one or more of the following: blocking of the carotid arteries (depriving the brain of oxygen), blocking of the jugular veins (preventing deoxygenated blood from exiting the brain), and/or closing off the airway, causing the victim to be unable to breathe. Only eleven pounds of pressure placed upon both carotid arteries for ten seconds is necessary to cause unconsciousness. If pressure is released immediately, consciousness will be regained within ten seconds. After 50 seconds of continuous oxygen deprivation the victim rarely recovers. To completely close off the trachea, three times as much pressure (33 lbs.) is required. For comparison purposes it only takes 8 1bs. of pressure to pull a trigger on a gun.

           Fifty percent of victims report symptomatic voice changes which may be as mild as simple hoarseness or a complete loss of voice. Many victims also report that it is difficult or painful to swallow. This is due to injury of the larynx cartilage and/or hyoid bone, a small horseshoe shaped bone in the neck. Difficulty getting a breath may be due to the hyperventilation that normally accompanies a terrifying event, but more importantly may be secondary to underlying neck injury. It is critical to know that breathing changes may initially appear to be mild, but underlying injuries may kill the victim hours or days later due to decompensation of the injured structures. Involuntary urination and defecation often occurs and officers should inquire about such because victims may be embarrassed and reluctant to disclose these facts unless asked.

            Visible injuries to the neck may include scratches, abrasions, and scrapes. These may be from the victim's own fingernails as a defensive maneuver, but commonly are a combination of lesions induced by both the victim and .the assailant's fingernails. Lesion location varies depending upon whether the victim or assailant used one or two hands, or whether the assailant strangled the victim from the front or back. When fingernails cut into the skin, impression marks occur and are shaped like commas or semicircles.

           Scratch marks are usually superficial and long, and may be narrow or as wide as the fingernail itself. Redness on the neck may be fleeting, but may demonstrate a detectable pattern. These marks may or may not darken to become a bruise. Bruises may not appear for hours or even days. Bruises made by fingertips are circular or oval, and often faint. A single bruise on the neck is most frequently caused by the assailant's thumb. However, frequently bruises may run together, clustering at the side of the neck, as well as along the jaw lines and may extend onto the chin, and even the collarbone.

            Chin abrasions are also common in victims of manual strangulation. The victim lowers the chin in an instinctive effort to protect the neck, and in so doing, scrapes the chin against the assailant's hands.

            Tiny red spots (petechiae) are characteristic in many cases. They are caused by ruptured capillaries - the smallest blood vessels in the body. They may be found around the eyes, under the eyelids, anywhere on the face, and on the neck above the area of constriction. Petechiae tend to be most pronounced in ligature strangulation. Blood red eyes are due to capillary rupture in the white portion of the eyes. This phenomenon suggests a particularly vigorous struggle between the victim and assailant.    

           In 70 to 80 percent of all domestic violence cases, the victim will recant. Therefore law enforcement should anticipate this and plan on prosecution based on the evidence, just like in a murder case. Efforts should be made to investigate the cases like an attempted homicide case. It is important to ask as many questions as possible at the earliest time possible. Click here for specific questions and checklists to assist in detecting and investigating strangulation cases.

           Prosecutors, be sure to write the officers a commendation letter if the report contains the answers to the above questions.

           San Diego trained their law enforcement officers, dispatchers, medical personnel and prosecutors. Immediately thereafter prosecutions
and convictions increased dramatically.

           Contact NYPTI at (518) 432-1100.

Condensed by Caran Curry, CLE Coordinator

This project was supported by a Violence Against Women Act grant administered by the New York State Division of Criminal Justice Services. The points of view or opinions stated in this publication are those of the particular author and do not represent the official position of the Division of Criminal Justice Services. Information dealing with a specific legal matter should be researched in original and current sources of authority.

Contact & Conference Materials

"How to Improve Your Investigation and 
Prosecution of Strangulation Cases"

by Gael B. Strack, San Diego Assistant City Attorney 
and Dr. George McClane, Emergency Physician 
October 1998, updated May 1999

This excellent article is also very useful for training and can be obtained by request from:

Gael B. Strack 
Assistant City Attorney
Domestic Violence & Special Projects
1200 Third Avenue, Suite 700
San Diego, CA  92101
619-533-5515 phone
619-533-5507 fax