Fitness to be Detained

The booklet Health Care of Detainees in Police Stations reported jointly by the British Medical
Association (BMA), Ethics Committee and the Association of Police Surgeons and available from
the BMA should be mandatory reading for all police surgeons.
The request by a custody officer to see if a prisoner is fit to be detained is probably the commonest
problem a police surgeon encounters. Most cases are relatively straightforward but some can pose
difficult problems. Occasionally the surgeon will be called to court to assess a case or to see
individuals who are assisting the police but who are not under arrest.
In all cases the FME is duty bound:-
1. To practise good medicine and treat all persons with courtesy and respect
2. To obtain appropriate consent and explain to the patient the implications of the examination (see
Chapters 2 & 3)
3. To respect confidentiality within the constraints of personal safety and public duty
4. To provide proper instructions to the police
4.1 To enable them to care for the patient
4.2 To advise the police about potential bio-medical hazards
These are difficult criteria to fulfill and at times may appear to present great conflict. The source of
prevention of this conflict is the maintenance of high levels of communication and professional
integrity, wherever possible.
This chapter will deal with the detainee in custody, but the advice is just as relevant for the other
areas where fitness to be detained is the issue.
It is now common for police surgeons to be requested to assess whether a detainee is fit to be
interviewed and this is dealt with in the next chapter.
General Information
There are various conditions with which the police surgeon may be faced:
1. The police surgeon is called because of the requirements of the Police and Criminal Evidence Act
1984 (PACE).
2. Existing disease, with or without medication
3. Detainees exhibiting substance abuse
4. Observed signs, injuries or abnormalities of behaviour requiring assessment.
With regard to the last of these, abnormalities of behaviour may indicate a psychiatric problem and
this subject is dealt with in Chapter 11.
There is no intention of this advice becoming a large tome of internal medicine.
It will however approach the subject from a general point of view and also focus on a few common
conditions which may cause problems.
Procedures
Discussion with Custody Officer
On arrival at the police station it is imperative to discuss the case with the Custody Sergeant. This
establishes:-
• How or why the person is detained
• What the custodian is concerned about
• What questions need to be answered, i.e. fit to be detained, fit for interview, disposal
• What are the time constraints and any other problems faced by the custody.
It is also sensible to discuss the case with the arresting officer, if possible, to hear the circumstances
of the arrest and the reason for detention. This enables one to have a clearer idea of the avenues of
disposal available, i.e. home circumstances, relatives at home, etc.
It is then important to decide where you are going to see the patient/prisoner. It is usually
appropriate to see them in the medical room. Violent, aggressive detainees or those with a degree of
stupor are often best seen where they are, either in the cells, or holding rooms. The Custody
Officer's opinion must be taken into consideration, particularly with potentially violent patients as
he/she has responsibility for the safe running of the whole custody suite including other detainees.
There is no room, however, for the abrogation of the FME's clinical responsibilities.
Any instructions given about the care necessary should be written. This may be done on the custody
record or on special forms, designed for the purpose (see Appendix 3c for an example). The police
surgeon should keep a copy. If a sepa
General Information
There are various conditions with which the police surgeon may be faced:
1. The police surgeon is called because of the requirements of the Police and Criminal Evidence Act
1984 (PACE).
2. Existing disease, with or without medication
3. Detainees exhibiting substance abuse
4. Observed signs, injuries or abnormalities of behaviour requiring assessment.
With regard to the last of these, abnormalities of behaviour may indicate a psychiatric problem and
this subject is dealt with in Chapter 11.
There is no intention of this advice becoming a large tome of internal medicine.
It will however approach the subject from a general point of view and also focus on a few common
conditions which may cause problems.
Procedures
Discussion with Custody Officer
On arrival at the police station it is imperative to discuss the case with the Custody Sergeant. This
establishes:-
• How or why the person is detained
• What the custodian is concerned about
• What questions need to be answered, i.e. fit to be detained, fit for interview, disposal
• What are the time constraints and any other problems faced by the custody.
It is also sensible to discuss the case with the arresting officer, if possible, to hear the circumstances
of the arrest and the reason for detention. This enables one to have a clearer idea of the avenues of
disposal available, i.e. home circumstances, relatives at home, etc.
It is then important to decide where you are going to see the patient/prisoner. It is usually
appropriate to see them in the medical room. Violent, aggressive detainees or those with a degree of
stupor are often best seen where they are, either in the cells, or holding rooms. The Custody
Officer's opinion must be taken into consideration, particularly with potentially violent patients as
he/she has responsibility for the safe running of the whole custody suite including other detainees.
There is no room, however, for the abrogation of the FME's clinical responsibilities.
Any instructions given about the care necessary should be written. This may be done on the custody
record or on special forms, designed for the purpose (see Appendix 3c for an example). The police
surgeon should keep a copy. If a sepa