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Role of the Forensic Practitioner

Role of the Forensic Practitioner. Road Traffic Act 1988 (2). 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. CONCLUSIONS.

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Role of the Forensic Practitioner

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  1. Role of the Forensic Practitioner Road Traffic Act 1988 (2) • 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. CONCLUSIONS • 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

  3. 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;

  4. GENERAL DEMEANOUR

  5. PUPIL SIZE

  6. GAIT

  7. SLURRING OF SPEECH

  8. MEMORY OF RECENT EVENTS

  9. OFFICERS’ OPINION OF LEVEL OF IMPAIRMENT

  10. It has been found that the average delay in blood sampling is in the region of two hours and 12 minutes from the driver being seen driving to a blood sample being taken[1] [1]Ledingham D. Journal of Clinical Forensic Medicine 1999; 6/3 133-139.

  11. DRUG DRIVING - EVIDENCE • Suspicions/driving • Drug influence recognition • Field Impairment Tests • Police Surgeon Examination • Toxicology

  12. DRUG INFLUENCE RECOGNITION • Depressants • Opiates • Inhalants • Hallucinogens

  13. FIELD IMPAIRMENT TESTS • Pupil examination • Romberg • Walk & Turn • One-leg-stand • Finger to nose

  14. CASE OF JOHN DOE 6 JULY 2001 BY DR C GEORGE M FERNIE LLB MB ChB MPhil MRCGP DFM

  15. INFORMATION FROM FISCAL 36 year old man. Seen driving lorry without lights by civilian witness at 2250 on 14 September 2000 followed by antisocial driving. Lorry found on verge by police having demolished road sign. Started singing and dancing. “Rhythmic” body movements in police vehicle. Negative roadside screening breath test.

  16. INFORMATION FROM DOCTOR’S REPORT Examination on 15 September 2000 @ 0045. Informed that he had been involved in a Road Traffic Incident. Queried whether he was psychiatrically unwell or under the influence of a substance. Overall mood happy and fully alert. No medication and no PMH. Cheerful and frequently joking. Police Surgeon believed this was inappropriate. Detainee stated he took cannabis at times and also “fast drugs”. Mates tried to stop him getting into the cab.

  17. EXAMINATION FROM DOCTOR’S REPORT Pulse 94/minute, regular. BP 168/104. Chest clear. “Pupils were dilated but reacted to light. I further tested his co-ordination when he was able to walk a straight line fairly adequately. I asked him to walk across the room placing heel in front of toe and he was slightly unsteady doing this. Finger nose co-ordination was satisfactory, as was hand turning. The tests of cerebellar function appeared intact. Both plantar reflexes I was unable to elicit”.

  18. CONCLUSION FROM DOCTOR’S REPORT “My overall assessment of this patient that his mood was elevated and elated, but he did not exhibit characteristics of hypomanic psychiatric illness. My overall impression of observation and my conversation with the above gentleman was that he had taken some sort of substance which had resulted in elevation of mood”.

  19. 1.0 INTRODUCTION 1.1 My full name is Crawford George MacDougall Fernie and I am 49 years of age, having been born in Glasgow on 05 October 1954. 1.2 I am a Principal Police Surgeon with Strathclyde Police whom I advise through the Technical Sub Group and Medico-Legal Adviser at the Medical & Dental Defence Union of Scotland. I am an Honorary Senior Lecturer at the University of Glasgow where I lecture at both undergraduate and postgraduate levels. Further, I have an organisational and participatory role in relation to joint child sexual abuse examinations with paediatricians at the Fred Stone Unit in the Royal Hospital for Sick Children, Glasgow. I am current Council member for Scotland for the Association of Police Surgeons, where I am also a member of the Education and Research Sub-Committee. In addition, I am an examiner for the Diploma of Forensic Medicine for the Society of Apothecaries of London. I currently Chair the Forensic Medicine Committee of the BMA. My qualifications are LLB, MB, ChB, MPhil, MRCGP and DFM.

  20. 1.3 I have been a medical practitioner for twenty-six years and Police Surgeon for over fifteen years; initially as deputy Police Surgeon with Q Division Strathclyde Police, then Principal Police Surgeon for Dumfries & Galloway Constabulary and now Principal Police Surgeon with K Division Strathclyde Police. 1.4 In my annual workload for Strathclyde Police I would anticipate seeing approximately 800 cases, 2.5% of these would be procedures under section 4 of the Road Traffic Act 1988. 1.5 I have lectured both nationally and internationally on the subject of assessment of persons where it has been alleged that their ability to drive is impaired through drink or drugs. 1.6 I have been asked to review the papers in this case and provide an expert opinion for the Court by Mr A B Simpson of the Procurator Fiscal’s Office, Anycity.

  21. 2.0 DOCUMENTS CONSIDERED • 2.1 In order to assist me in this matter I have been allowed access to the following documents: - • Letter of Instruction dated 6 June 2001 from the Procurator Fiscal Depute. • The Complaint. • Witness statement from Mr Ernest Hendry dated 15 September 2000. • Witness statement by PC Anne Jones in relation to John Doe in respect of the incident on 14 September 2000. • Witness statement by PC John Smith in relation to John Doe in respect of the incident on 14 September 2000. • Medical report by Dr Ruth Neilson in relation to John Doe in respect of the examination undertaken of him on 14 September 2000. • Drug screen performed by Dr John Oliver in relation to the urine sample obtained from John Fleming Doe on 15 September 2000.

  22. 3.0 HISTORY 3.1 Mr Doe was witnessed by Ernest Hendry driving without lights in a Luton style lorry at approximately 2250 on 14 September 2000. Despite flashing lights at him he continued to drive without lights and as Mr Hendry was concerned about the nature of the driving, he telephoned the police. 3.2 PC Jones and PC Smith found the lorry driven by Mr Doe mounted on the verge, having destroyed a road sign at about 2300 on 14 September 2000. 3.3 A roadside breath test was negative for alcohol and the officers concerned formed the view that Mr Doe was under the influence of some other substance. 3.4 At approximately 0050 the accused was examined by Dr Neilson who concluded that his condition might be due to some drug and advised accordingly.

  23. 3.5 Two urine samples were obtained in keeping with procedure, the first at 0125 being discarded and the second at 0145 being forwarded to the Department of Forensic Medicine & Science at the University of Glasgow for analysis. 3.6 The sample obtained contained 0.12 milligrammes of amphetamine per litre of urine but was negative for all other analyses undertaken as a drug screen

  24. 4.0 EXAMINATION BY DR RUTH NEILSON 4.1 Dr Neilson has submitted a type written report. It is unclear whether she made any handwritten notes that have been retained or completed a F97 pro-forma that is in current use by police surgeons throughout Scotland. 4.2 Mr Doe was found to be “very happy and he was fully alert”. There was no past medical history of note and Mr Doe was on no prescribed medication. The accused was said to be “very cheerful and frequently joking” that Dr Neilson felt was inappropriate for the circumstances. 4.3 Examination revealed that Mr Doe’s pulse rate was slightly fast at 94/minute and blood pressure elevated at 168/104. Dr Neilson details that Mr Doe’s pupils were dilated but does not record their diameters.

  25. 4.4 Although Mr Doe was able to walk along a straight line “fairly adequately” he was unsteady in walking heel to toe. Finger nose co-ordination and hand turning was found to be satisfactory. Dr Neilson considered that “these tests of cerebellar function appeared intact” and it was not possible to elicit plantar reflexes. 4.5 Subsequent questioning of Mr Doe by Dr Neilson produced a history that he took cannabis at times and at times“fast drugs”. 4.6 Dr Neilson concluded that Mr Doe’s mood was elevated and elated but “he did not exhibit characteristics of hypomanic psychiatric illness”. Her overall impression was that Mr Doe had taken a substance resulting in elevation of mood.

  26. 5.0 OPINION 5.1 There is no obligation to complete a F97 pro-forma and this document makes clear that it is unnecessary to undertake all the tests detailed therein, nor are they considered exhaustive.  5.2 General clinical parameters were taken with the exception of temperature but there is no suggestion that Mr Doe was suffering from a toxic illness that required to be excluded.  5.3 No true divided attention tests appear to have been undertaken but even simple co-ordination assessments were abnormal at the time of examination.

  27. 5.4 With ‘walk and turn’ in the standardised field sobriety testing, should 2 out of 8 recognised impairment indicators be present, this tends to indicate impairment[1]. Unsteadiness walking ‘heel to toe’ and stepping off the line i.e. only walking “fairly adequately” would constitute impairment on this basis.  5.5 Normal pupil sizes in room light vary from 3.0 to 6.5 mm diameter[2]. The usual causes for constriction are opiates and dilatation a stimulant type amphetamine drug.  [1] Stark M M A Physician’s Guide to Clinical Forensic Medicine, 2000, Humana Press, New Jersey, 10.270. [2] Fleming P, Stewart D. Drugs and Driving: Training implications for Police Officers and Police Surgeons, Police Research Group 1998, Appendix D.

  28. 5.6 There are certain signs and symptoms associated with amphetamine usage[3] including euphoria, feeling of self confidence, raised self-esteem, lowered anxiety, increased energy, greater concentration, irritability and restlessness. Examination will reveal tachycardia (a rapid heart rate), hypertension (raised blood pressure) and dilatation of the pupils. 5.7 Over 75% of my practice as a police surgeon involves assessing persons in custody for fitness to be detained and fitness to interview. My invariable habit is to take a drug history and look for signs of drug usage or persons under the influence of drugs. Thus, I am familiar with signs and symptoms of stimulant amphetamine type drugs as these are commonly abused in Scotland. [3] Stark M, Payne-James J. Symptoms and Signs of Substance Misuse, Greenwich Medical Media, London,1996; 18.

  29. 5.8 The findings by Dr Neilson during her examination of Mr Doe are those of amphetamine usage and her examination revealed signs that I would also have categorised as impairment. 5.9 Consequently, in the same circumstances I would have informed the police officers “that the condition of the person required to provide the specimen might be due to some drug” and also that the ability of the above named person to drive a motor vehicle properly was impaired through drink or drugs. 5.10 One of the primary functions of the police surgeon is to exclude illness and injury and I believe that Dr Neilson was able to do this.

  30. 5.11 The relevance of the actual urine level is more within in the sphere of expertise of a toxicologist but my firm understanding is that this substance does not naturally occur within the body. Therefore, there should have been a nil level for this drug.  5.12 Amphetamine is a prescription only medicine controlled under the Misuse of Drugs Act 1971, Class B under Schedule 2. The only legal uses I am aware of are for the treatment of hyperactivity in children and for narcolepsy, neither of which applies to Mr Doe.

  31. 6.0 CONCLUSION 6.1 The symptoms and signs exhibited by Mr Doe on 15 September 2000 were in keeping with amphetamine use. 6.2 Dr Neilson’s findings during her examination of Mr Doe constituted impairment.

  32. 7.0STATEMENT OF DUTY TO THE COURT 7.1 I understand my duty to the Court is to help the Court on the matters within my expertise and I have complied with that duty. 7.2 I understand that this duty overrides any obligations to those by whom I have been instructed or by whom I am paid. 8.0 STATEMENT OF TRUTH 8.1 This opinion (consisting of 5 pages each signed by me) is true to the best of my knowledge and belief. I certify this on soul and conscience.

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