Bite marks: To opine or not to opine?

Much has been written about bite mark comparisons and bite mark analysis. It has largely been written for, and remained within the domain of, the forensic odontologist despite the limited number of such specialists and the even smaller subset who have expertise in this area. For those health professionals who work in the field of clinical forensic medicine, most will not have access to a forensic odontologist. Courts can be reticent about the costs involved in obtaining another expert opinion. For health professionals, who will likely encounter more bite marks in their career than forensic odontologists, the difficulty is knowing what can legitimately be opined about such injuries.

Preparing semen slides in cases of sexual assault: Do they who smear first smear best?

When providing a forensic assessment for a victim of sexual assault, a smear is made from any swab that has been collected with the purpose of finding sperm. A smear is made to assist the laboratory identify the optimal swab for DNA testing, to aid in the selection of downstream DNA testing options, to evaluate morphology and quantity of sperm in order to provide time since intercourse assessments, and to contribute additional information to the crime scene case when trying to determine how an offender's DNA came to be at the site where it was located. In the majority of Australian states, the forensic examiner makes the smear at the time of the forensic assessment (forensic history, examination, collection of specimens, documentation of injury and prophylactic treatment for sexually transmitted infections and pregnancy). The smear could be made, however, at a later time by forensic laboratory staff. There are some jurisdictions (for example in Queensland, Australia) where this is the preferred process. This research paper compared smear preparation by the forensic examiner with that prepared, at a later time, by the laboratory scientist. 143 pairs of high vaginal smears were analysed over a two and a half year period. Smears made by the examiner contained, for the most part, higher numbers of sperm, more background material and more intact sperm than smears made at a later date by laboratory scientific staff.

Forensic photo-documentation in adult sexual assault- what do patients think?

Historically, some forensic practitioners and policy makers have viewed the use of photography in forensic documentation for adult victims of sexual assault as controversial. Some argue that diagrams and verbal descriptions of injury are sufficient, suggesting that sexual assault victims are so traumatised at time of examination that they are not able to provide valid consent, that the imaging process itself is humiliating, and that any decision to have photographs taken might be later regretted. Objectively, a patient capable of consenting to a forensic examination has an equal capacity to consent for forensic imaging, even when this involves sensitive areas of the body, and the process of forensic photography is not inherently problematic. Literature on forensic photography is sparse, particularly from the patient perspective. Our Forensic Medical Unit is in an excellent position to investigate this issue, as it is one of the few services in Australia that routinely offers sexual assault forensic photography, including genital, as part of its standard procedures for injury documentation. Photographs, in adult sexual assault cases, are not routinely taken of normal anatomy nor are they ever taken without patient consent. This study explores the immediate and short-term experiential impacts of forensic photography from the victims' perspective. Capacity to consent was assessed using a trauma informed, evidence-based interviewing tool at the start of their forensic assessment. Participants also completed questionnaires at the conclusion of their examination and on follow-up. Results show that victims not only have the capacity to provide informed consent but also found forensic photography, and the reasons for it, quite acceptable. A majority [80%; n = 87/108] indicated the photographic process had either been not at all or only a little embarrassing. When asked how they felt about having photographs taken, the majority 93.4% [n = 99/106) indicated that as well as having no regrets they were also happy with the way the images had been taken. 4.7% [n = 5] expressed some doubt about whether they had made the right decision. A similar pattern of responses was observed at follow-up which occurred, on average, seven weeks post examination. 72% [n = 26/36] said they did not think about the photographs at all or did so rarely. While 14% [n = 5/36] said they thought about them a fair bit or a lot of the time, most stated they had no concerns regarding the images that had been taken. Given its evidentiary salience and other benefits, such as its potential to promote greater transparency in the provision of forensic opinions and its usefulness in teaching, this study supports the case for the routine use of forensic photography in adult Sexual Assault Units more broadly.

An unusual case of hypothermia and paradoxical undressing.

The case presented is that of an elderly woman found in her home, confused and with multiple body injuries. A forensic assessment was conducted based on the preliminary information that she was found with her pants pulled down to her ankles, an electrical cord laying across her neck, reported genital bruising, and that the back door of her home was open. Police initially treated the matter as a home invasion with physical and sexual assault but this was later considered incorrect. This case highlights that not all women found in a state of partial undress have been sexually assaulted, that initial information should be corroborated from its source, and the value of a multi-disciplinary approach when analyzing information to determine a possible sequence of events.

Eradicating the legacy of Othello: Western Sydney University's attempt to raise awareness of intimate partner violence.

In Australia scant attention is given to teaching medical students how to identify and manage intimate partner violence (IPV) and sexual assault (SA). In Australia one woman dies weekly from IPV and the prevalence of IPV in Australian women is 29 percent. The Australian Prime Minister labelled it a 'national disgrace' and yet, of the five World Health Organisation (WHO) regions, the Western Pacific Region has the lowest rates in the world.1 Since 2015 reducing IPV has become a national strategy. In undergraduate medicine the obstetric and gynaecological curriculum is a logical and appropriate place for such education given the predominance of female victims. Western Sydney University (WSU) commenced this training as a 1 day practical multidisciplinary workshop on IPV and Management of Sexual Assault in 2017. Prior to that time the University provided less than 2 h of training in IPV or SA in a 5 year undergraduate degree course. The preliminary results suggest that medical students are predominantly positive towards developing skills in dealing with IPV and their enthusiasm and knowledge increases after the workshop.

New oral cut-off time limits in NSW.

Standard collection procedure for the investigation of allegations of penile - oral assault has traditionally been the oral swab. Review of both the literature and NSW forensic laboratory results from oral swabbing has highlighted the sub-optimal nature of this method for the recovery of both sperm and offender DNA. 554 oral swabs, collected in NSW from 2010 to 2015, were analysed. Sperm detection occurred in only 4.2%. In the same period there was analysis of 104 oral rinses (of which 16.4% were positive for sperm) and 71 peri-oral samples (of which 18.3% were positive for sperm). As a result, a decision was made to revise forensic collection guidelines for sample collection in cases of penile - oral assault. Oral swabbing is no longer recommended. Current NSW forensic collection guidelines recommend the collection of both an oral rinse and a peri-oral (lip) swab. Samples are to be taken in the first 12 h after a penile - oral assault in all cases where there is a suspicion of oral assault. Oral collections may be extended to 24 h post penile - oral assault in those cases where there is either a clear recollection of ejaculation into the mouth (or ejaculation elsewhere prior to penile penetration of the mouth) or in those cases where a complainant is clear that there had been penile penetration of the mouth but is unable to recall whether or not ejaculation has taken place.

Evidence based practice: laboratory feedback informs forensic specimen collection in NSW.

The importance of having clear, evidence-based guidelines for the taking of forensic samples from suspects detained in police custody (persons of interest) and complainants of crime is essential for forensic practitioners. The need for such guidelines was seen as desirable in New South Wales (NSW) and a working group was set up comprising scientists, practitioners and police. Feedback from the laboratory regarding the results of the specimens taken by forensic practitioners throughout the State was received and analysed. This has resulted in changes to current practice and highlighted the need for further research in this area. It has also highlighted areas that have not changed in response to evidence A quality service demands transparency, process review, relevant research and feedback in order to progress. Examiners need to obtain the results for their cases in order to reinforce the value of the service they provide as well as to monitor and, where necessary, improve their forensic collection skills.

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.

Domestic violence documentation project 2012.

One in four women presenting to Emergency Departments in Australia have experienced domestic violence in their lives but there are no specialist services for victims of domestic violence in the state of New South Wales, population of 7.25 million. Fundamental forensic medical and nursing skills developed for the comprehensive assessment of complainants of sexual assault were utilised in the examination of victims of domestic violence in a trial project at Nepean Hospital, Sydney. The project was then reviewed via a series of qualitative patient and police interviews along with an analysis of court outcomes. Assessment by specialists in forensic documentation and interpretation of injuries with the provision of balanced expert opinions for court purposes can result in a number of benefits for the victims and the criminal justice system, including an increase in the rate of successful prosecutions.

Opioid dependent patients' experiences of and attitudes towards having their injecting sites examined.

BACKGROUND: This study explored the attitude towards, and experiences of, injection site examination among injecting drug users in opioid treatment and the potential impact of this routine examination on information disclosure and future injection practices. METHODS: A self-complete, anonymous, cross-sectional questionnaire was used with 153 patients recruited from three public clinics in Sydney, Australia. RESULTS: The vast majority (97%) had ever injected in their upper limb, 19% in their leg, 16% in their neck, and 7% in their groin. The majority were 'happy to have their sites inspected' (78%), and felt it was an 'appropriate part of routine examination' (72%). Seventy-seven percent said they would be more honest about recent injecting, and 25% would inject in other sites if upper limb inspection occurred at every clinical review. CONCLUSIONS: The examination of injecting sites can provide useful corroboration of self-reported injecting drug use and an opportunity to offer harm reduction advice. The inspection of injecting sites was acceptable to most patients and should form part of routine clinical reviews.