The importance of a urine sample in persons intoxicated with flunitrazepam--legal issues in a forensic psychiatric case study of a serial murderer

The sedative-hypnotic benzodiazepine flunitrazepam (FZ) is abused worldwide. The purpose of our study was to investigate violence and anterograde amnesia following intoxication with FZ, and how this was legally evaluated in forensic psychiatric investigations with the objective of drawing some conclusions about the importance of urine sample in a case of a suspected intoxication with FZ. The case was a 23-year-old male university student who, intoxicated with FZ (and possibly with other substances such as diazepam, amphetamines or cannabis), first stabbed an acquaintance and, 2 years later, two friends to death. The police investigation files, including video-typed interviews, the forensic psychiatric files, and also results from the forensic autopsy of the victims, were compared with the information obtained from the case. Only partial recovery from anterograde amnesia was shown during a period of several months. Some important new information is contained in this case report: a forensic analysis of blood sample instead of a urine sample, might lead to confusion during police investigation and forensic psychiatric assessment (FPA) of an FZ abuser, and in consequence wrong legal decisions. FZ, alone or combined with other substances, induces severe violence and is followed by anterograde amnesia. All cases of bizarre, unexpected aggression followed by anterograde amnesia should be assessed for abuse of FZ. A urine sample is needed in case of suspected FZ intoxication. The police need to be more aware of these issues, and they must recognise that they play a crucial role in an assessment procedure. Declaring FZ an illegal drug is strongly recommended.     

Contracting Out and Public Values: A Symposium

The three papers that constitute this symposium were first commissioned for a workshop entitled Citizenship and Contractualism held in October 2000. The theme of that workshop centred on the contractualisation of the relationship between service deliverers and their clients. 1 They have been published elsewhere in a special issue of Law in Context, March 2001, co‐edited by Terry Carney, Gaby Ramia and Anna Yeatman.
These three papers did not fit that theme. They are concerned more with the general use of contracting out as a tool of contemporary governance. I have used the title contracting out and public values because all three of these papers raise fundamental questions about the implications of contracting out for public values.     

A Call to Action—The Essential Role of Advocacy

Editor's Note: The Perspectives featured in this issue of Public Administration Review were adapted from May 2016 commencement addresses: Anna Maria Chavez, the CEO of the Girl Scouts of the USA, spoke on the 12th at Arizona State University's College of Public Service and Community Solutions; Nancy Pelosi, the Democratic Leader in the United States House of Representatives spoke on the 7th at New York University's Wagner School of Public Service; and Tommy Thompson, the former Governor of Wisconsin and Secretary of Health & Human Services, spoke on the 15th at the University of Wisconsin's La Follette School of Public Affairs. These Perspectives reaffirm the highest principles of American public administration: that by and large, government is NOT the problem, and quite often indeed holds the solution; that effective and helpful public policy depends on informed expert opinion and research; and that those who enter public service should do so with a commitment to the notion that America best fulfills its promise when we seek the well‐being of all people, including the least fortunate. We chose these messages from among a wealth of commencement speeches because while they come from leaders with quite different political views, background, and experience, taken together they offer a coherent and inspiring call to public service. Dan Feldman, Perspective and Commentary Editor