Novel recovery methods for biological materials in cases of alleged sexual assault: A word of caution.

Many believe that an increase in the public confidence in the investigation of sexual crimes, and in conviction rates, will lead to an increase in the reporting of these crimes. Consequently, Forensic Science Providers are continually striving to make improvements in evidence recovery and examination and the subsequent interpretation of evidence. One development is in methods that enable an individual to self-sample. However, in cases where a complainant has self-sampled, questions of when the samples were taken, how they were stored and so on, can be legitimately raised. Additionally the continuity and integrity of evidential samples may be questioned resulting in them not being acceptable to the courts and potential evidence could therefore be lost. There is a large emotional and psychological impact of sexual assault and rape and no complainant who reports a sexual assault and recovers material should have that evidence inadmissible to a court. Specialised units for victims of alleged sexual violence are available and offer far more than the recovery of evidential samples. This commentary on behalf of the Faculty of Forensic & Legal Medicine (FFLM) and the Association of Forensic Science Providers Body Fluid Forum (AFSP BFF) highlights the need for after care for the victims of sexual assault and why all evidence recovered in cases of alleged sexual assault and sexual violence should be obtained in line with best practice protocols.

Quality standards in forensic medicine.

Forensic clinicians work with some of the most vulnerable members of society. Despite this it is one of the few areas of front line, undifferentiated healthcare in the UK that does not come under the National Health Service. The Faculty of Forensic & Legal Medicine (FFLM) has produced quality standards guidance for over a decade to support good practice in clinical forensic medicine. In April 2021 we surveyed their membership to ascertain whether clinicians working in the field felt that adequate standards were being maintained. The results demonstrate significant variability in the implementation of standards in both general forensic and sexual offence medicine for both adults and children. They highlight that despite some pockets of excellent practice there are significant areas of concern.

Evaluation of a 'decontamination kit' in NSW.

Dedicated facilities of a high standard should be available for the examination of complainants and suspects where forensic samples are to be taken to ensure that the risk of contamination is kept to a minimum. The need for a decontamination kit came about because of the variable quality of examination facilities for complainants of sexual assault and suspects (persons of interest) within NSW. Overall the kit has been found to be useful and easy to use but there is still a need to increase awareness of its availability.

Provision of clinical forensic medical services in Australia: a qualitative survey 2011/12.

The provision of clinical forensic medicine services is dependent on jurisdiction and relevant legal instruments. A needs analysis was performed to understand the current service provision within NSW and compare and contrast the service with other jurisdictions in Australia. The aim of this study was therefore to identify the roles, functions and clinical forensic medical services currently provided in the different Australian jurisdictions.

Training in clinical forensic medicine in the UK--perceptions of current regulatory standards.

As clinical forensic medicine (CFM) is not currently recognised as a speciality in the UK there are no nationally agreed mandatory standards for training forensic physicians in either general forensic (GFM) or sexual offence medicine (SOM). The General Medical Council (GMC), the medical regulator in the UK, has issued clear standards for training in all specialities recommending that "trainees must be supported to acquire the necessary skills and experience through induction, effective educational supervision, an appropriate workload and time to learn". In order to evaluate the current situation in the field of clinical forensic medicine, doctors who have recently (within the last two years) started working in the field "trainees" (n = 38), and trainers (n = 61) with responsibility for clinical and educational supervision of new trainees, were surveyed by questionnaire to gather their perceptions of how the relevant GMC standards are being met in initial on-the-job training. Telephone interviews were performed with eleven doctors working as clinical or medical directors to determine their views. It is clear that currently the quality of training in CFM is sub-standard and inconsistent and that the published standards, as to the minimum requirement for training that must be met by post-graduate medical and training providers at all levels, are not being met. The Faculty of Forensic and Legal Medicine (FFLM) needs to set explicit minimum standards which will comply with the regulator and work to pilot credentialing for forensic physicians. A number of recommendations are made for urgent FFLM development.

Training of assistant forensic medical examiners in London, UK.

The overall aim of this pilot study was to evaluate the quality of current practical training in London with a view to improving future training as part of faculty development. New trainees in clinical forensic medicine (CFM), Assistant Forensic Medical Examiners (AFMEs), were interviewed to gather their views of their recent training experience and to attempt to identify problems with implementing the training as it stands. An overwhelming theme emerged that there should be a more formal structure to the training of newly appointed FMEs. Each trainee should have a named clinical and educational supervisor during the training period. Furthermore it should be mandatory for educational supervisors to undergo training and review of performance.

Principal forensic physicians as educational supervisors.

This research project was performed to assist the Faculty of Forensic and Legal Medicine (FFLM) with the development of a training programme for Principal Forensic Physicians (PFPs) (Since this research was performed the Metropolitan Police Service have dispensed with the services of the Principal Forensic Physicians so currently (as of January 2009) there is no supervision of newly appointed FMEs or the development training of doctors working in London nor any audit or appraisal reviews.) to fulfil their role as educational supervisors. PFPs working in London were surveyed by questionnaire to identify the extent of their knowledge with regard to their role in the development training of all forensic physicians (FPs) in their group, the induction of assistant FPs and their perceptions of their own training needs with regard to their educational role. A focus group was held at the FFLM annual conference to discuss areas of interest that arose from the preliminary results of the questionnaire. There is a clear need for the FFLM to set up a training programme for educational supervisors in clinical forensic medicine, especially with regard to appraisal.

Near miss incidents in police custody suites in London in 2003: a feasibility study.

INTRODUCTION: Potentially preventable deaths in police custody include those which involve illicit drugs, alcohol and deliberate self-harm. Near miss incidents (NMI) that did not result in death have a crucial role in understanding risk factors in custody. Such research has not previously been undertaken. A program of research has been developed to study NMI, in order to better identify those at risk in police custody. For the purposes of this research, NMI have been defined as 'an unplanned and unforeseeable or unforeseen event that could have resulted, but did not result, in human death or may have resulted in injury or other adverse outcomes'. It was intended that the definition although broad, would not include simple accidents (e.g. slipping on urine in a cell) or trivial injury. AIMS AND METHODS: The two aims of the study are (a) to determine whether it is realistic to attempt to assess NMI with the intention of identifying information of use in enhancing detainee care and (b) to assess how frequently NMIs occur and whether there are specific patterns. Pilot interviews were conducted with three forensic physicians practising in London, UK to create a structured questionnaire for all forensic physicians working in London. The questionnaire provided the basis of a retrospective recall survey of all forensic physicians working in London as Forensic Medical Examiners. The questionnaire was designed to assess the numbers of NMI, patterns in occurrence and relevant learning points within the previous 6 months. A covering letter, background questionnaire (exploring the background of the medical practitioner), copies of the survey, and reply paid envelopes were sent to each Forensic Medical Examiner (n=134) in London, contracted to provide forensic medical services for the Metropolitan Police Service. Data about all incidents were anonymized. RESULTS: Ninety six (73%) Forensic Medical Examiners responded. Of these 18% were Principal grade, the remainder were Senior (24%), Standard (35%) and Assistant (23%). Thirty eight NMI were reported by 27 Forensic Medical Examiners (of all levels). The initial reason for police contact was recorded as alcohol (n=8), theft and robbery (n=7), warrants (n=4), violence (n=3), traffic violations (n=2) and single cases of drugs, murder and immigration offences. Of the main perceived cause of each NMI, illicit drugs were involved in 12/38, alcohol in 17/38, deliberate self-harm in 11/38, issues concerning searches, checks or rousing in 8/38, failure of inter-agency communications in 5/38, and possible resource issues in 4/38. In a number of cases more than one factor was involved. CONCLUSIONS: The information established about NMI is broadly consistent with documented patterns of deaths in police custody in England and Wales which supports the validity of the data. The next stage of this research will be a prospective six month study in which NMI will be analysed in order to learn lessons which may be utilised to attempt to prevent potentially avoidable deaths in police custody.

The clinical management of substance misusers in police custody -- a survey of current practice.

Large numbers of substance misusers are seen in police custody. Their management remains a significant part of a forensic physician's workload. Substance misuse, including alcohol, is a factor in a substantial number of deaths in custody. Guidelines have been produced on the acceptable minimum standards for assessment and treatment. The aims of this study were to determine the current attitudes and practice of forensic physicians to see whether there had been any change in practice since their publication. The results suggest that the majority of respondents had read the guidelines. However, there were still considerable variations in practice and circumstances where the minimum standards were not being achieved. Whilst 90% of respondents felt confident in dealing with substance misusers, many commented that further information on specific drugs and further training on management of substance misusers would be beneficial.