Role of the Forensic Practitioner

1. Role of the Forensic Practitioner Road Traffic Act 1988 (1) • Dr George Fernie • LLB MB ChB MPhil FFFLM FRCGP FRCP Edin DFM • georgefernie@nhs.net • FME Central Scotland Police • FME Lothian & Borders Police • Honorary Senior Lecturer in Forensic Medicine • University of Glasgow

2. PRG recommendations • Standardised training • Joint training • Field Impairment Testing • Standardised impairment testing • Drug sign recognition • Standardised examination form

3. Functions of the Forensic Practitioner • Ensure fitness for detention • - exclude illness and injury • Is there a condition present which might be due to a drug? • Determine whether or not there is impairment through drink/drugs • If there is no sign of impairment, are the findings still in keeping with earlier impairment? • Take a blood sample if required

4. Background information • From arresting officers • From custody officer • From custody record • PNC checks • Ensure officers familiarity with the procedures

5. Consent • Implied • Explicit • Verbal • Written • Competence • Refusal – make observations

6. History • Of presenting complaint and injury • Past medical and surgical • Psychiatric • Educational background • Medication –prescribed, OTC, illicit • Self harm • Time last ate and slept

7. Drug history • Prescribed/illicit/OTC • Length of usage • Route of administration • Daily quantity • Last dose • Injection sites

8. Prescribed drugs • Tranquillisers • Anti-depressants • Anti-psychotics • Anti-histamines • Narcotics • Analgesics • Anaesthetics

9. Physical examination • Pulse, BP, temperature • Examination of eyes • - conjunctiva • - pupil size • - nystagmus • Heart, lungs, abdomen • Signs of substance misuse • Mental state • Repeat impairment tests

10. Assessment of mental state • Demeanour • Orientation • Memory - chronology of that day • Thought processes • Hallucinations/delusions • Depression

11. Conclusions • Fit to detain and interview? • Condition that might be due to a drug? • Impairment? • Blood/urine option • Assist in filling in MGDD/E

12. Conclusions after assessment • Condition vs. impairment: • No formal definition • Doctor doesn’t have to establish impairment • What is a condition? – open to debate

13. F97 pro-forma • I hereby certify that, in my opinion at the time of examination, the ability of the above named person to drive a motor vehicle was/was not* impaired through drink or drugs. • *Delete as required

14. ROAD TRAFFIC ACT 1988 • (c) the suspected offence is one under section 3A or 4 of this Act and the constable making the requirement has been advised by a medical practitioner that the condition of the person required to provide the specimen might be due to some drug;

15. Interpretation of Section 7 (3)c of RTA 1988 • Condition that might be due to a drug • Conclusions drawn from relevant information from suspect or police • Can consider the findings of the arresting officer in coming to a conclusion re a ‘condition’ • When assessing a person’s clinical impairment, doctor will consider overall condition of the individual rather than rely on a single sign • It may be that the doctor feels a condition exists in the absence of abnormal clinical findings on the basis of police officer assessment • Stark MM, O’Keefe V and Rowe D • Letter to the Editor - JCFM (2000) 7 Page 59

16. Common conditions that may mimic impairment • Neurological: • - Head injury • - Stroke • - Cerebral tumour • - Multiple sclerosis • - Acute vertigo • - Fatigue

17. Common conditions that may mimic impairment 2 • Epilepsy • - Type of epilepsy • - ? drug/alcohol withdrawal • - Medication • - Last dose • - Most recent seizure • - Status epilepticus

18. Common conditions that may mimic impairment 3 • Cardiovascular • - Angina or infarction • - Hypertension or side-effects of treatment • - Arrhythmias • - Heart valve problems • - Heart block

19. Common conditions that may mimic impairment 4 • Endocrine • - Diabetes - insulin dependent • - NIDDM • - hypoglycaemia

20. Common conditions that may mimic impairment 5 • Respiratory • - Asthma • - COPD (bronchitis/emphysema) • - Neoplasms

21. Other useful points • Breath odour • - Alcohol • - Cannabis • - Solvent • - Ketones

22. Nystagmus • An abnormal oscillatory movement of the eyes • - Congenital • - Acquired • - Optokinetic • - Drug induced • ? Part of FIT

23. Needle phobia • An increasing problem? • Confirmed past history • Absence of body piercing • Repugnance v phobia • Bradycardia • Document findings carefully

24. Needle phobia • Key points • -Distinguish between ‘repugnance’ and ‘phobia’ • - Distinguish between ‘unwillingness’ and ‘inability’ • - History of the index event • - Foreign travel Immunisations? • - Body piercing or tattoos? • - Dental procedures?

25. Proformas • Scotland F97 • Faculty proforma in England, Wales and NI • www.fflm.ac.uk • Please use!