A forensic examination confers no immediate health benefit to the patient. There is an argument that
the examination of a victim of assault of any type, may have a therapeutic effect in the gathering of
supportive evidence alone, though this could, in the long term, with the absence of a conviction,
have a deleterious effect. There appears to be no research which has been done with this in mind.
The immediate forensic examination does give the caring, compassionate and competent forensic
clinician the opportunity for early counselling and reassurance. However the forensic examination is
performed to gather evidence, for the benefit of the community, through the courts, which will
support or refute an allegation in criminal proceedings. It is not made for therapeutic reasons.
The consent should be written. Though verbal consent is just as valid in theory it can never replace
the evidential value of the written word. The consent should include the reasons for performing the
examinationa and also preferably include the taking of samples. Photography can be useful as an
adjunct to the handwritten records and/or sketches and is extremely useful as a teaching accessory
later. If photography is considered necessary for evidential purposes then the FME should
contact the Senior Investigating Officer with regard to use of the professionally trained police
photographer. The consent should include this aspect of the record as a separate item which can be
deleted if inappropriate or if the consent is withheld. The use of photography,b for the clinical
record, should be a matter between the doctor and the patient alone. Only the latter has the right to
consent (and/or parent if appropriate) and only the former is fit to judge whether it would be a useful
way of recording part of the clinical record or useful for forensic education. Arguments have been
offered to suggest that police surgeons should not take their own photographs, as these are
essentially amateur by nature. The argument progresses by suggesting that such photographs could
be used adversely in any subsequent court case. Such an argument is fallacious so long as it is made
clear that the photographs were only an adjunct to the written clinical records. The photograph
should no
a By examination I refer to the whole medical interface, including history, record keeping, clinical examination
and obtaining samples.
b By photography I also include electronic visual recording devices and not just photographic ones.
circumstances (see "OPINION" in Chapter 4). A copy of any statement so issued should be
available for the CPS at the same time as it is provided to the defence.
In the absence of criminal proceedings, and if it is suspected that any civil action is contemplated by
the examinee, take advice from your Medical Defence Organisation (MDO) before releasing any
information. Though police surgeons are independent of the police forces who contract them and are
there to serve the community and the courts above all else, it would be unprofessional and
imprudent to release information to a "fishing expedition" which then resulted in a civil case against
oneself or the Chief Constable, without first taking appropriate legal advice oneself. Do not be put
off with indefinite advice from the MDO on the lines of "say nothing". Forensic clinicians have a
duty to be totally impartial and detached from the cases they serve and not to appear to be playing a
part in "protectionism".
A difficulty may arise in the case of an unconscious patient. A particular case illustrates this point.
A male was in Intensive Care in hospital after a head injury. A bloody battle had occurred involving
more than two people and in which one had already died. The unconscious patient had blood stains
on his skin, and he was a suspect for the alleged murder. The advice was to take swabs of the blood
stains, including control swabs, and for these to be kept by the FME in a suitable freezer of his/her
own. If the patient regained consciousness, consent could be sought later from the individual with
regard to use of these samples.
It is possible that evidence, which would otherwise be lost, may just as easily aid the acquittal of the
patient as well as the conviction, and the FME would be acting in good faith in obtaining the
specimens. If consent were withheld, then the samples could be destroyed and the situation is
exactly that which would have existed had the patient been conscious all the time and had not
consented to the samples being obtained. If the patient died the sample should not be destroyed
without confirming with the coroner that coronial jurisdiction does not require the sample.
The main pitfall with this approach is that the swabs, once obtained, are likely to be deemed
"unused" material. Their production and analysis may be ordered by a court, ignoring completely
the consent of the individual. This places the doctor in a dilemma. The important question to be put
by the clinician to him/herself at the time is "Have I got the interest of the patient in mind when I
perform this procedure"
Police Complaints Authority
Until July 1994 an examination performed in connection with a case of alleged police assault gave
rise to a unique doctor/patient relationship. It appeared that the findings of that examination when
produced in a report form could not be disclosed to another party (i.e. other than the Police
Complaints Authority (PCA)) in a civil action without the courts having decided that the interests of
justice overruled the Public Interest Immunity.
the examination of a victim of assault of any type, may have a therapeutic effect in the gathering of
supportive evidence alone, though this could, in the long term, with the absence of a conviction,
have a deleterious effect. There appears to be no research which has been done with this in mind.
The immediate forensic examination does give the caring, compassionate and competent forensic
clinician the opportunity for early counselling and reassurance. However the forensic examination is
performed to gather evidence, for the benefit of the community, through the courts, which will
support or refute an allegation in criminal proceedings. It is not made for therapeutic reasons.
The consent should be written. Though verbal consent is just as valid in theory it can never replace
the evidential value of the written word. The consent should include the reasons for performing the
examinationa and also preferably include the taking of samples. Photography can be useful as an
adjunct to the handwritten records and/or sketches and is extremely useful as a teaching accessory
later. If photography is considered necessary for evidential purposes then the FME should
contact the Senior Investigating Officer with regard to use of the professionally trained police
photographer. The consent should include this aspect of the record as a separate item which can be
deleted if inappropriate or if the consent is withheld. The use of photography,b for the clinical
record, should be a matter between the doctor and the patient alone. Only the latter has the right to
consent (and/or parent if appropriate) and only the former is fit to judge whether it would be a useful
way of recording part of the clinical record or useful for forensic education. Arguments have been
offered to suggest that police surgeons should not take their own photographs, as these are
essentially amateur by nature. The argument progresses by suggesting that such photographs could
be used adversely in any subsequent court case. Such an argument is fallacious so long as it is made
clear that the photographs were only an adjunct to the written clinical records. The photograph
should no
a By examination I refer to the whole medical interface, including history, record keeping, clinical examination
and obtaining samples.
b By photography I also include electronic visual recording devices and not just photographic ones.
circumstances (see "OPINION" in Chapter 4). A copy of any statement so issued should be
available for the CPS at the same time as it is provided to the defence.
In the absence of criminal proceedings, and if it is suspected that any civil action is contemplated by
the examinee, take advice from your Medical Defence Organisation (MDO) before releasing any
information. Though police surgeons are independent of the police forces who contract them and are
there to serve the community and the courts above all else, it would be unprofessional and
imprudent to release information to a "fishing expedition" which then resulted in a civil case against
oneself or the Chief Constable, without first taking appropriate legal advice oneself. Do not be put
off with indefinite advice from the MDO on the lines of "say nothing". Forensic clinicians have a
duty to be totally impartial and detached from the cases they serve and not to appear to be playing a
part in "protectionism".
A difficulty may arise in the case of an unconscious patient. A particular case illustrates this point.
A male was in Intensive Care in hospital after a head injury. A bloody battle had occurred involving
more than two people and in which one had already died. The unconscious patient had blood stains
on his skin, and he was a suspect for the alleged murder. The advice was to take swabs of the blood
stains, including control swabs, and for these to be kept by the FME in a suitable freezer of his/her
own. If the patient regained consciousness, consent could be sought later from the individual with
regard to use of these samples.
It is possible that evidence, which would otherwise be lost, may just as easily aid the acquittal of the
patient as well as the conviction, and the FME would be acting in good faith in obtaining the
specimens. If consent were withheld, then the samples could be destroyed and the situation is
exactly that which would have existed had the patient been conscious all the time and had not
consented to the samples being obtained. If the patient died the sample should not be destroyed
without confirming with the coroner that coronial jurisdiction does not require the sample.
The main pitfall with this approach is that the swabs, once obtained, are likely to be deemed
"unused" material. Their production and analysis may be ordered by a court, ignoring completely
the consent of the individual. This places the doctor in a dilemma. The important question to be put
by the clinician to him/herself at the time is "Have I got the interest of the patient in mind when I
perform this procedure"
Police Complaints Authority
Until July 1994 an examination performed in connection with a case of alleged police assault gave
rise to a unique doctor/patient relationship. It appeared that the findings of that examination when
produced in a report form could not be disclosed to another party (i.e. other than the Police
Complaints Authority (PCA)) in a civil action without the courts having decided that the interests of
justice overruled the Public Interest Immunity.
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