Clinical Forensic Medicine

446 Pages·2007·2.64 MB·English

Clinical Forensic Medicine
F O R E N S I C
S C I E N C E - - M E D I C I N E
A N D
Steven B. Karch, MD,SERIES EDITOR
CLINICAL FORENSIC MEDICINE:A PHYSICIAN'S GUIDE, SECOND EDITION
edited byMargaret M. Stark,2005
DRUGS OF ABUSE:BODY FLUID TESTING
edited byRaphael C. Wong and Harley Y. Tse,2005
FORENSIC MEDICINE OF THE LOWER EXTREMITY: HUMAN IDENTIFICATION AND TRAUMA
ANALYSIS OF THE THIGH, LEG, AND FOOT,byJeremy Rich, Dorothy E. Dean,
and Robert H. Powers, 2005
FORENSIC AND CLINICAL APPLICATIONS OF SOLID PHASE EXTRACTION,byMichael J.
Telepchak, Thomas F. August, and Glynn Chaney, 2004
HANDBOOK OF DRUG INTERACTIONS:A CLINICALAND FORENSIC GUIDE,edited by
Ashraf Mozayani and Lionel P. Raymon, 2004
DIETARY SUPPLEMENTS:TOXICOLOGYAND CLINICAL PHARMACOLOGY,edited by Melanie
Johns Cupp and Timothy S. Tracy, 2003
BUPRENOPHINE THERAPY OF OPIATE ADDICTION, edited by Pascal Kintz and Pierre
Marquet,2002
BENZODIAZEPINES AND GHB: DETECTIONAND PHARMACOLOGY, edited by Salvatore J.
Salamone,2002
ON-SITE DRUG TESTING, edited by Amanda J. Jenkins and Bruce A. Goldberger, 2001
BRAIN IMAGING IN SUBSTANCE ABUSE:RESEARCH, CLINICAL,AND FORENSIC APPLICATIONS,
edited byMarc J. Kaufman,2001
TOXICOLOGY AND CLINICAL PHARMACOLOGY OF HERBAL PRODUCTS,
edited byMelanie Johns Cupp,2000
CRIMINAL POISONING:INVESTIGATIONAL GUIDEFOR LAW ENFORCEMENT,
TOXICOLOGISTS, FORENSIC SCIENTISTS,AND ATTORNEYS,
byJohn H. Trestrail, III,2000
A PHYSICIAN’S GUIDETO CLINICAL FORENSIC MEDICINE,edited byMargaret M. Stark,2000
C F
LINICAL ORENSIC
M
EDICINE
A Physician's Guide
S E
ECOND DITION
Edited by
Margaret M. Stark, , , , , ,
LLM MB BS DGM DMJ DAB
The Forensic Medicine Unit, St. George's Hospital Medical School,
London, UK
Foreword by
Sir John Stevens
Commissioner of the Metropolitan Police Service,
London, UK
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Library of Congress Cataloging-in-Publication Data
Clinical forensic medicine : a physician's guide / edited by Margaret M.Stark.-- 2nd ed.
p. ; cm. -- (Forensic science and medicine)
Rev. ed. of: A physician's guide to clinical forensic medicine. c2000.
Includes bibliographical references and index.
ISBN 1-58829-368-8 (alk. paper)
1. Medical jurisprudence.
[DNLM: 1. Forensic Medicine--methods. W 700 C641 2005] I. Stark,
Margaret. II. Physician's guide to clinical forensic medicine. III. Series.
RA1051.P52 2005
614'.1--dc22
2004024006
Dedication
In memory of Smokey and to Amelia and Feline Friends once again!
v
Foreword
The Metropolitan Police Service (MPS), now in its 175th year, has a
long tradition of working with doctors. In fact, the origin of the forensic phy-
sician (police surgeon) as we know him or her today, dates from the passing
by Parliament of The Metropolitan Act, which received Royal Assent in June
of 1829. Since then, there are records of doctors being “appointed” to the
police to provide medical care to detainees and examine police officers while
on duty.
The MPS has been involved in the training of doctors for more than 20
years, and has been at the forefront of setting the highest standards of work-
ing practices in the area of clinical forensic medicine. Only through an aware-
ness of the complex issues regarding the medical care of detainees in custody
and the management of complainants of assault can justice be achieved. The
MPS, therefore, has worked in partnership with the medical profession to
ensure that this can be achieved.
The field of clinical forensic medicine has developed in recent years
into a specialty in its own right. The importance of properly trained doctors
working with the police in this area cannot be overemphasized. It is essential
for the protection of detainees in police custody and for the benefit of the
criminal justice system as a whole. A book that assists doctors in the field is
to be applauded.
Sir John Stevens
vii
Preface to the Second Edition
The field of clinical forensic medicine has continued to flourish and
progress, so it is now timely to publish Clinical Forensic Medicine: A
Physician's Guide, Second Edition, in which chapters on the medical aspects
of restraint and infectious diseases have been added.
Police officers are often extremely concerned about potential exposure
to infections, and this area is now comprehensively covered. The results of the
use of restraint by police is discussed in more detail, including areas such as
injuries that may occur with handcuffs and truncheons (Chapters 7, 8, and 11),
as well as the use of crowd-control agents (Chapter 6). The chapter on general
injuries (Chapter 4) has been expanded to include the management of bites,
head injuries, and self-inflicted wounds.
Substance misuse continues to be a significant and increasing part of the
workload of a forensic physician, and the assessment of substance misuse
problems in custody, with particular emphasis on mental health problems (“dual
diagnosis”), has been expanded. Substance misuse is too often a cause of death
in custody (Chapter 10).
Traffic medicine is another area where concerns are increasing over the
apparent alcohol/drugs and driving problem. There has been relevant research
conducted in this area, which is outlined Chapter 12.
Forensic sampling has undergone enormous technological change, which
is reflected in the chapter on sexual assault examination (Chapter 3).
The chapter on the history and development of clinical forensic
medicine worldwide has been updated (Chapter 1). Chapters on fundamental
principles (Chapter 2), nonaccidental injury in children (Chapter 5), and care
of detainees (Chapter 8) are all fully revised, as are the appendices (now
containing a list of useful websites). Although the subject is constantly
evolving, some fundamental principles remain.
I was very pleased with the response to the first book, and there appears
to be a genuine need for this second edition. I hope the good practice outlined
in this book will assist forensic physicians in this “Cinderella speciality.”
Margaret M. Stark
ix
Preface to the First Edition
“Clinical forensic medicine”—a term now commonly used to refer to that
branch of medicine involving an interaction among the law, the judiciary, and the
police, and usually concerning living persons—is emerging as a specialty in its
own right. There have been enormous developments in the subject in the last
decade, with an increasing amount of published research that needs to be brought
together in a handbook, such as A Physician’s Guide to Clinical Forensic
Medicine. The role of the health care professional in this field must be indepen-
dent, professional, courteous, and nonjudgemental, as well as well-trained and
informed. This is essential for the care of victims and suspects, for the criminal
justice system, and for society as a whole.
As we enter the 21st century it is important that health care professionals are
“forensically aware.” Inadequate or incorrect diagnosis of a wound, for example,
may have an effect on the clinical management of an individual, as well as a
significant influence on any subsequent criminal investigation and court
proceedings. A death in police custody resulting from failure to identify a
vulnerable individual is an avoidable tragedy. Although training in clinical
forensic medicine at the undergraduate level is variable, once qualified, every
doctor will have contact with legal matters to a varying degree.
A Physician’s Guide to Clinical Forensic Medicine concentrates on the
clinical aspects of forensic medicine, as opposed to the pathological, by
endeavoring to look at issues from fundamental principles, including recent
research developments where appropriate. This volume is written primarily for
physicians and nurses working in the field of clinical forensic medicine—forensic
medical examiners, police surgeons, accident and emergency room physicians,
pediatricians, gynecologists, and forensic and psychiatric nurses—but such other
health care professionals as social workers and the police will also find the
contents of use.
The history and development of clinical forensic medicine worldwide is
outlined, with special focus being accorded the variable standards of care for
detainees and victims. Because there are currently no international standards of
training or practice, we have discussed fundamental principles of consent,
confidentiality, note-keeping, and attendance at court.
The primary clinical forensic assessment of complainants and those
suspected of sexual assault should only be conducted by those doctors and nurses
xi
xii Preface
who have acquired specialist knowledge, skills, and attitudes during both
theoretical and practical training. All doctors should be able to accurately
describe and record injuries, although the correct interpretation requires
considerable skill and expertise, especially in the field of nonaccidental injury in
children, where a multidisciplinary approach is required.
Avoidance of a death in police custody is a priority, as is the assessment of
fitness-to-be-detained, which must include information on a detainee’s general
medical problems, as well as the identification of high-risk individuals, i.e.,
mental health and substance misuse problems. Deaths in custody include rapid
unexplained death occurring during restraint and/or during excited delirium. The
recent introduction of chemical crowd-control agents means that health
professionals also need to be aware of the effects of the common agents, as well
as the appropriate treatments.
Custodial interrogation is an essential part of criminal investigations.
However, in recent years there have been a number of well-publicized
miscarriages of justice in which the conviction depended on admissions made
during interviews that were subsequently shown to be untrue. Recently, a
working medical definition of fitness-to-be-interviewed has been developed, and
it is now essential that detainees be assessed to determine whether they are at risk
to provide unreliable information.
The increase in substance abuse means that detainees in police custody are
often now seen exhibiting the complications of drug intoxication and withdrawal,
medical conditions that need to be managed appropriately in the custodial
environment. Furthermore, in the chapter on traffic medicine, not only are
medical aspects of fitness-to-drive covered, but also provided is detailed
information on the effects of alcohol and drugs on driving, as well as an
assessment of impairment to drive.
In the appendices of A Physician’s Guide to Clinical Forensic Medicine, the
relevant ethical documents relating to police, nurses, and doctors are brought
together, along with alcohol assessment questionnaires, the mini-mental state
examination, and the role of appropriate adults; the management of head-injured
detainees, including advice for the police; the Glasgow Coma Scale, and an
example of a head injury warning card; guidance notes on US and UK statutory
provisions governing access to health records; an alcohol/drugs impairment
assessment form, along with a table outlining the peak effect, half-life, duration
of action, and times for detection of common drugs.
Margaret M. Stark