Current Practice in Forensic Medicine E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Wissenschaft und neue Technologien
• Sprache: Englisch

Seitenzahl: 672

Veröffentlichungsjahr: 2011

Beschreibung

Although forensic medicine has been in existence for centuries in one guise or another, it is only with the recent growth in international research that it has begun to be acknowledged as a specific discipline in its own right. Many areas of progress are being made and this text aims to provide a unique, in-depth and critical update on selected topics that are of direct relevance to those practicing in the field including lawyers, police, medical and dental practitioners, forensic scientists and postgraduate/undergraduate medical students and undergraduate law students preparing for forensic medicine examinations.

This volume is designed to cover the wider aspects of forensic medicine, including the law, science, medicine (forensic pathology, clinical forensic medicine and forensic psychiatry) and dentistry. Topics covered include subjects of debate and/or uncertainty in areas where significant advances have been made and in those of current relevance to the forensic profession, Chapters provide a variety of approaches to the areas under discussion with reviews of current knowledge, information on significant changes and pointers to the future that the reader should be aware of.

Features:

• An authoritative review, for forensic medicine practitioners throughout the world, from leading international experts in the field.
• Provides critical commentary and updates on current practice.
• Topics include: a guide to the presentation of forensic medical evidence, bioterrorism, the paediatric hymen, assessment and interpretation of bone trauma in children, adult sexual assault, genital photography, forensic photography, common errors in injury interpretation, self-inflicted injuries and associated psychological profiles, bite marks and the role of the pathologist in aviation disasters.
• Includes a wealth of four colour figures to illustrate key points discussed within the text.

Leseprobe

Contents

List of Contributors

Foreword

Preface

1 Expert evidence and healthcare professionals

Introduction

The adversarial system of justice

Expert reports

Evidentiary exclusionary rules

Pre-trial preparation for expert witnesses

Appearance

Timeliness

Giving of evidence

Managing cross-examination

Summary

References

2 Forensic investigation of biological weapon use

Introduction

A choice of words

Threat assessments

Presenting features

Forensic microbiology or microbial forensics?

Assembling evidence from e merging infectious disease biology

Current constraints

References

Appendix

3 The paediatric hymen

Introduction

Studies of normal anatomy

Studies of genital findings in sexually a bused girls

Studies of a cute injuries as they heal

A consideration of test reliability

Putting it all together

References

4 Assessment and interpretation of bone trauma in children

Introduction

How should I evaluate suspected bone trauma in children?

What radiological investigations identify bone trauma?

How do X-rays detect fractures?

How does ultrasound detect bone injury?

How do nuclear medicine scans detect bone injury?

How does MRI detect bone injury?

How are medical images presented and shared?

What forces cause bones to fracture?

Are some bone injuries diagnostic of child abuse?

What do we know about bone healing in children?

What tests detect fragile bones?

Neonates with fractures: what are the special considerations?

Can the time of bone injury be determined?

Why might an X-ray be reported as normal when bone trauma exists?

Why might an ultrasound appear normal when bone trauma exists?

Why might a nuclear medicine scan appear normal when bone trauma exists?

Why might an X-ray appear abnormal when no bone trauma exists?

Why might a nuclear medicine scan appear abnormal when no bone trauma exists?

How do I deal with correctly interpreted but discordant imaging findings?

A. Why might an X-ray appear normal and bone scan ‘hot’ when bone trauma exists?

B. Why might a fracture seem obvious on plain X-ray but bone scan is ‘cold’ when bone trauma exists?

When and why should I repeat X-rays?

How does the process of forming a forensic medical opinion differ from the process of diagnosis in clinical medicine?

Why do I need to be aware of my level of confidence in my medical diagnosis?

What factors should I consider w hen forming a diagnostic opinion about the cause of a child’s fracture?

References

5 Adult sexual assault

Introduction

Sexual assault settings and characteristics

Findings after sexual assault

Toxicology and sexual assault

Forensic science and sexual assault

Treatment after sexual assault

Summary

References

6 The ethical and medical a spects of photodocumenting genital injury

Introduction

Sexual assault

Imaging the body in the history of medicine

Photography

The evolution of the photography of genital injury

A particular Australian’s experience

Ethics of care

Why no ethical objection to children being photographed?

The difference that being a child makes and its relevance

Advancing the question of best ethical practice

Clinical forensic medicine and sexual assault

Conclusion

References

Appendix: Ethical best practice

7 The photography of injuries

Introduction

The image

Equipment

Illumination

Polarizing filters

Forensic scales

The photography of an injury

The colour control or reference

Cross - polarized photography

Reflected ultraviolet

Infrared

Long wave ultraviolet-induced fluorescence

Imaging file format

The audit trail

Conclusion

Acknowledgements

References

Further reading

8 DNA analysis: Current practice and problems

Introduction

DNA collection and storage

DNA extraction

DNA quantification

DNA amplification

DNA separation and detection

DNA genotyping

Standard loci sets and commercial STR kits

Statistical evaluation of a DNA match

Assessing STR profiles

Mixtures of DNA

Degraded DNA

Low-template DNA

Other genetic markers

Tissue identification

Use of DNA in the criminal justice system

References

9 Injury interpretation: Possible errors and fallacies

Injury visualization

Nomenclature

Photography

Aging of injuries

Force of injury

Medical limitations and considerations

Genito - anal injuries in the adult

Child abuse

Self-inflicted injury

Other specialist opinions

Opinions

How to avoid errors

References

10 Self-inflicted injuries and a ssociated psychological profiles

Introduction

Forensic aspects of self-harm

Psychiatric aspects of self-harm

Epidemiology

Classification of self-harm

The clinical dilemma

Management

Long-term outcome

Conclusion

References

11 Bite marks

Introduction and cautionary remarks

Animal bites

Other injuries mimicking bites

Bites in foodstuffs

Examination of injuries in the dead

Examination of the living

Examination of the suspect

Trends in bite-mark analysis

Acknowledgement

References

Further reading

12 Aviation disasters: The role the forensic pathologist

Introduction

The scene

The autopsy

Establishing the cause of death

Circumstances surrounding death

Forensic pathology report

References

Index

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Library of Congress Cataloguing-in-Publication Data

Current practice in forensic medicine/edited by John Gall and Jason Payne-James.

p.; cm.

Includes bibliographical references and index. ISBN 978-0-470-74487-1 (cloth)

1. Medical jurisprudence. I. Gall, John A. M. II. Payne-James, Jason. [DNLM: 1. Forensic Medicine-methods. W 700]

RA1051.C873 2011

614'.1-dc22

2010029811

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF ISBN 978-0-470-97316-5 Wiley Online Library

ISBN 978-0-470-97315-8.

Set in 10/12 pt Sabon by Toppan Best-set Premedia Limited Printed in Singapore by Markono Print Media Pte Ltd.

List of Contributors

Philip S.L. Beh MB, BS, FHKAM (Pathology), FFFLM, DMJ (Clin & Path)

Philip Beh is a forensic pathologist currently employed as an Associate Professor in Forensic Pathology at the Department of Pathology of The University of Hong Kong. He has been in forensic practice for nearly 30 years. He is an Associate Editor of theJournal of Forensic and Legal Medicine and also a member of the Editorial Board forMedicine, Science and Law and several other medical journals. He has been involved with the set-up of Hong Kong’s multidisciplinary rape crisis centre and continues to serve on their advisory committee. He currently teaches undergraduate pathology and forensic medicine to medical and criminology students. In recent years his research has focused on various types of homicides, particularly homicide-suicide.

Ian Berle MA, MA (Res), PGDip, MIMI, RMIP

Ian Berle is the former Head of Medical Illustration, Barts and The London NHS Trust (1982–2008). He is now a Consulting Medical Photographer, specializing in the ethics and practice of clinical photography in healthcare. His interest in the subject began during the collaborative writing (with Professor Len Doyal) of theBarts and London Code of Responsible Practice for Clinical Photography . This subsequently led to a Postgraduate Diploma in Healthcare Ethics from King’s College London, and to postgraduate degrees in bioethics (St. Mary’s College University of Surrey) and law (by research at Queen Mary & Westfield College, University of London), whereby he developed and formulated a rights-based approach to the use of photography in healthcare. He is a past council member of the Institute of Medical Illustrators and is an accredited medical illustration practitioner.

Stephen C. Boos MD, FAAP

Stephen Boos is a board-certified paediatrician and child abuse sub-specialist who read his bachelor’s degree in biology at the Massachusetts Institute of Technology, focusing on immunology. He then attended Columbia University College of Physicians and Surgeons, earning a Medical Doctorate in 1983. Steve trained in paediatrics at the David Grant USAF Medical Center. Thereafter, he practiced general paediatrics in multiple international assignments with the Air Force for eight years. In 1994 he returned to the David Grant Medical Center to join the teaching staff. In 1998, he was selected for a post-doctoral fellowship in child abuse paediatrics and studied with Dr John McCann at the Child and Adolescent Abuse Resource and Education Center at the University of California Davis Medical Center in Sacramento, California. From 2000 to 2003 he was on staff at the National Naval Medical Center in Bethesda, MD, and served as the medical consultant to the Air Force Surgeon General in Child Abuse and Neglect. Dr Boos has held many child abuse paediatrics positions since his retirement from the military in 2003, and is currently the medical director of Family Advocacy Center at Baystate Children’s Hospital in Springfield, MA. Dr Boos has written extensively on the subject of child abuse and is a member of the Ray Helfer Society, an honour society for experienced child abuse physicians. He is a fellow of the American Academy of Paediatrics and a member of both the Section on Child Abuse and Neglect and the Child Abuse Committee of the Massachusetts chapter of the American Academy of Paediatrics.

Patricia Brennan AM, MBBS, PhD, M Forens Med, FACLM

Patricia Brennan is a forensic physician currently appointed as a senior Staff Specialist in the Emergency Department of the Royal Prince Alfred Hospital, Sydney. As Medical Director of Sexual Assault units in her Health Area, she has been on the cutting edge of the academic and political reforms to advance forensic clinical medicine as a specialty in Australia, recently seconded to review the Clinical Forensic Medical Unit of the NSW Police Force as Acting Medical Director. She has wide experience in primary medicine, working as a surgeon and in public heath in Nigeria and Niger and at her own general practice in Sydney, with an interest in indigenous, women’s and men’s health. A PhD in gender and the medical encounter heightened her interest in human rights, sexual assault and domestic violence and the low priority these have been accorded in mainstream medicine, despite their impact on health.

Timothy Cain MBBS, FRANZCR, MBA

Tim Cain is the Director of Medical Imaging at the Royal Children’s Hospital. Tim is a graduate of the University of Adelaide Medical School. After completing his training in Diagnostic Radiology and Nuclear Medicine he joined a private radiology practice and worked at the Flinders Medical Centre in South Australia as a Visiting Specialist. He has also had appointments as Unit Head of Nuclear Medicine and Medical Chief, Division of Medical Imaging at the Women’s and Children’s Hospital in Adelaide. He completed a Masters of Business Administration at the University of Adelaide’s Graduate School of Business in 2006. In Melbourne, he provides paediatric imaging interpretation for the Victorian Forensic Medical Service. He has particular interests in patient safety, non-accidental injury, paediatric post-mortem imaging, medical management and radiation safety. His imaging interests include paediatric nuclear medicine and paediatric body imaging. His teaching commitments are with the University of Melbourne and include medical students, postgraduate physiotherapists and trainee radiologists.

John G. Clement PhD, BDS (Lond), LDS, RCS (Eng), FFFLM, RCP (Eng), Dip ForOdont, FICD

John Clement holds the Inaugural Chair of Forensic Odontology at the Melbourne Dental School. He is past President of both the British and Australian Societies for Forensic Odontology and pioneered graduate education in the UK and Australia in all aspects of forensic odontology. He is one of the world’ s most experienced Disaster Victim Identification experts, having investigated mass fatality events for more than 35 years. He is a member of the Scientific Steering Committee on Forensic Science Programs to the International Commission on Missing Persons in Sarajevo. He has published numerous book chapters and peer-reviewed articles on forensic odontology and co-edited and contributed to two textbooks on forensic identification.

Edward M. Eitzen Jr, MD, MPH, FACEP

Ed Eitzen is a Senior Partner in the Biodefense and Public Health Group of MartinBlanck and Associates, a medical consulting firm in Falls Church, Virginia, USA. He served in the United States Army Medical Corps for 28 years, retiring in 2004 to join Martin-Blanck. Colonel (Retired) Eitzen spent 11 years at the US Army Medical Research Institute of Infectious Diseases (USAMRIID) from 1991 to 2002, and was Commander of USAMRIID from 2000 to 2002. He also served from 2002 to 2005 as the Deputy Director of the Office of Research and Development, Office of Public Health Emergency Preparedness, in the US Department of Health and Human Services, working on civilian biological defence countermeasure development. Dr Eitzen is board-certified in Paediatrics, Emergency Medicine, Paediatric Emergency Medicine, Public Health and Preventive Medicine and Tropical Medicine and Travellers’ Health. He is an Adjunct Associate Professor of Military and Emergency Medicine at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

Ian Freckelton SC, BA (Hons), LLB, PhD, Dip Th M, FACLM (Hon)

Ian Freckelton is a Senior Counsel at the Victorian Bar in Melbourne, Australia. He is also a Professor of Law, Forensic Medicine and Forensic Psychology at Monash University and an Adjunct Professor at the National Institute of Public Health and Mental Health Research at the Auckland University of Technology in New Zealand. He is the Editor of theJournal of Law and Medicine and the Editorin-Chief ofPsychiatry, Psychology and Law . He has been a member of nine statutory tribunals, including Victoria’s Medical Practitioners Board and Mental Health Review Board. Ian is the author and editor of 37 books on criminal law, coronial law, causation, expert evidence, compensation law, disciplinary law and therapeutic jurisprudence, including the six volume loose-leaf service,Expert Evidence .

John A.M. Gall BSc (Hons), MB, BS, PhD, FACLM, FFFLM, DMJ (Clin & Path)

John Gall is a forensic physician in private practice, Director of Southern Medical Services, Principal of Era Health and is a staff specialist Forensic Physician in the Victorian Paediatric Forensic Medical Service, located at the Royal Children’s Hospital and Monash Medical Centre, Melbourne. He is a member of the International Editorial Board of theJournal of Forensic and Legal Medicine andInternet Journal of Forensic Medicine and Toxicology . John qualified initially as a biochemist, completed his doctorate in the Department of Pathology at the University of Melbourne and engaged in postdoctoral research in anatomy. He later read medicine at the University of Melbourne and undertook training in anatomical and forensic pathology and clinical forensic medicine. He has practised Clinical Forensic Medicine for 17 years, initially as a Forensic Medical Officer with Victoria Police and later as a consultant at the Victorian Institute of Forensic Medicine. John has been extensively involved in undergraduate and postgraduate education both at the University of Melbourne and Monash University. He was an Honorary Senior Lecturer in the Department of Forensic Medicine, Monash University, during which time he taught Custodial Medicine in the University’s Graduate Diploma of Forensic Medicine. He also devised, developed and administered an international continuing education programme in forensic medicine and, with co-authors, wrote and editedForensic Medicine Colour Guide . John has been involved in forensic medical research and much of these findings have been published. In addition to forensic medicine, he practices occupational and military medicine.

Robert Goldney MD, FRANZCP, FRCPsych

Bob Goldney is an Adelaide medical graduate who gained psychiatric qualifications in Australia, New Zealand and the United Kingdom in 1973. He has worked in hospital, private practice and academic environments and is now Emeritus Professor, having been Head of the Discipline of Psychiatry at the University of Adelaide. His main research has focused on depression and suicide prevention. He has received a number of awards for his work, including the Louis Dublin Award for lifetime achievements in suicide prevention from the American Association of Suicidology. He is a past President of both the International Association of Suicide Prevention and the International Academy for Suicide Research.

Tim J.J. Inglis BM, DM, PhD, FRCPath, FRCPA, FRGS, FACTM, DTM & H

Tim Inglis is a consultant medical microbiologist with PathWest Laboratory Medicine in Perth, Australia. He is Clinical Associate Professor of Microbiology and of Pathology and Laboratory Medicine at the University of Western Australia, and an Adjunct Associate Professor at the School of Biomedical Sciences at Curtin University in Perth, Australia. He is the Western Australian State Public Health Microbiologist and serves on the national Public Health Laboratory Network. He is a member of the editorial board of theJournal of Medical Microbiology and theBrazilian Journal of Infectious Diseases . Dr Inglis is the author of four books on medical microbiology and multiple peer - review microbiology and infectious diseases papers. He is Immediate Past President of the Australasian College of Tropical Medicine and serves as a pathologist with the Australian Defence Force. He has an ongoing interest in molecular biology methods for outbreak investigation and the detection of emerging infectious diseases.

John McCann MD, FAAP

John McCann has been working in the field of Child Abuse and Neglect for the past 30 years. Following his graduation from the University of Michigan’s Medical school, John spent two years in the Navy as the base paediatrician in Annapolis, Maryland. Following his discharge he entered into a private practice in Seattle, Washington. From there he joined the faculty of the University of Washington and was appointed Chief of Paediatrics at Harborview Medical Centre, a universityaffiliated hospital. It was there that he first became interested in the issue of child abuse and neglect through his colleague, Dr Shirley Anderson. Dr McCann moved to Fresno, California to help develop a Primary Care Training Program for the University of California, San Francisco. He and his colleagues developed a research project to determine the ‘normal’ genital anatomy of the prepubertal female.

Research on the healing of genital injuries, the use of the colposcope in the evaluation of the prepubertal and adolescent girl suspected of having been sexually abused or molested and the normal postmortem peri-anal findings in children and adolescents followed.

John spent the last 12 years of his medical career as the Medical Director of the Child Protection Centre at University of California Davis Medical Centre, where he continued his research into anal/genital injuries in both children and adolescents. With Dr David Kerns, he produced a DVD that is still being used by medical examiners throughout the western world to help in the evaluation of a child or adolescent suspected of having been sexually abused. As a member of the American Paediatric Society on the Abuse of Children (APSAC) he chaired the committee that developed the Practice Guidelines: Descriptive Terminology in Child Sexual Abuse Medical Evaluations. He also participated in the development of the child and adolescent sexual abuse reporting forms that are currently being used throughout the State of California.

Dr McCann has won numerous awards for his work in the field of child abuse and neglect, including the 2001 American Academy of Paediatrics section on child abuse and neglect award for Outstanding Service to Maltreated Children.

Nicholas P. Marsh

Nick Marsh trained in Scientific and Technical Photography and joined the Metropolitan Police Photographic Branch in 1986. Since then he has undertaken all types of forensic photography, both in the UK and overseas. He gives numerous lectures and talks on forensic imaging and, in particular, the use of specialist light sources for the detection of latent evidence. He is currently the Consultant Forensic Practitioner with the Evidence Recovery Unit. The Unit supports serious crime, child protection and sexual offence investigations across London.

Jason Payne-James LLM, MSc , FRCS, FFFLM, FFSSoc, DFM, RNutr

Forensic physician Jason Payne-James qualified in medicine in 1980 at the London Hospital Medical College. He has undertaken additional postgraduate education to higher degree level at Cardiff Law School, the Department of Forensic Medicine and Science at the University of Glasgow and with the University of Ulster, Northern Ireland.

He is Honorary Senior Lecturer at Cameron Forensic Medical Sciences, Barts and the London School of Medicine and Dentistry, University of London, UK. He is Director of Forensic Healthcare Services Ltd. He is external consultant to the National Policing Improvement Agency and to the National Injuries Database. He is Editor-in-Chief of theJournal of Forensic and Legal Medicine . His forensic medicine clinical and research interests include healthcare of detainees, deaths, harm and near misses in custody, torture, drugs and alcohol, wound and injury interpretation, sexual assault, neglect, non - accidental injury, restraint and use of force injury, police complaints and age estimation.

He has co-edited, co-authored and contributed to a number of books including theEncyclopedia of Forensic and Legal Medicine;Forensic Medicine: Clinical and Pathological Aspects;Symptoms and Signs of Substance Misuse;Artificial Nutrition Support in Clinical Practice;Symptoms and Early Warning Signs;Dr Apple’sSymptoms Encyclopaedia;Medicolegal Essentials of Healthcare;Colour Atlas of Forensic Medicine; andSexual Assault: Victimization across the Lifespan - a Colour Atlas;Age Estimation in the Living . He is lead author of the forthcoming 13th edition ofSimpson’s Forensic Medicine .

Andrew G. Robertson CSC, MB, BS, MPH, MHSM, FAFPHM, FRACMA

Andy Robertson is the Deputy Chief Health Officer and Director of Disaster Management, Regulation and Planning within the Public Health Division in the Western Australian (WA) Department of Health. With specialist qualifications in Public Health Medicine and Medical Administration, he served with the Royal Australian Navy from 1984 until 2003 including three tours to Iraq as a Biological Weapons Chief Inspector with the United Nations Special Commission in 1996 and 1997. In October 2003, he took up the position of Director of Disaster Preparedness and Management in WA Health. In December 2004, he led the Australian Medical Relief team into the Maldives post -tsunami and subsequently managed WA Health’s response to the 2005 Bali Bombing. He also led the WA Health team into Indonesia after the Yogyakarta earthquakes in June 2006. Since 2007, he has coordinated the WA Health responses to Cyclone George, the Varanus Island gas explosion, the Learmonth air incident, the Manjimup bus crash, the Mumbai terrorist attack, the Ashmore Reef incident and the public health system aspects of the H1N1 2009 pandemic.

Shelley Robertson MBBS (Melb), LLB (Melb), FRCPA, DMJ (Path), FACLM, FFFLM, DAvMed (Otago), MHealSc (AvMed)

Shelley Robertson has practised as a forensic pathologist for over 20 years. She graduated with Bachelor of Medicine, Bachelor of Surgery from the University of Melbourne in 1978, obtained Fellowship of the Royal College of Pathologists of Australasia in 1987, Bachelor of Laws from the University of Melbourne in 1995, Diploma of Medical Jurisprudence, Fellowship of the Australian College of Legal Medicine and Fellowship of the Faculty of Forensic and Legal Medicine, Royal College of Physicians. She developed an interest in fatal aviation accident investigation and completed a post-graduate diploma in Aviation Medicine and a Masters Degree in Health Sciences (Aviation Medicine) at the University of Otago. In 2006 she joined the RAAF Specialist Reserve with the rank of Squadron Leader, and was awarded full membership of the International Academy of Aerospace Medicine. Her current appointments are Senior Forensic Pathologist (Victorian Institute of Forensic Medicine), Senior Lecturer in Forensic Medicine (Monash University) and Honorary Senior Fellow (Department of Pathology, University of Melbourne).

J. Anne S. Smith MBBS, FRACP

Anne Smith is a paediatrician in private practice and the Medical Director of the Victorian Forensic Paediatric Medical Service. She is the immediate past Chair of the Chapter of Community Child Health, Royal Australasian College of Physicians (RACP). Her work with the RACP included education, serving as co-chair of the Child Protection Special Interest Group and chair of policy-writing groups and contributing to curricula in relation to training in forensic paediatric medicine. She is the unit coordinator for the Paediatric Forensic Medicine Unit at the Master of Forensic Medicine Programme, Monash University. Dr Smith maintains an active role in teaching medical students and postgraduates from Monash and Melbourne Universities and other health professionals including police and Child Protection workers. She has an ongoing active interest in enhancing forensic medical services for children.

Denise Syndercombe Court MSB, CBiol, FIBMS, CSci, DMT, PhD

Denise Syndercombe Court is a forensic haematologist and senior lecturer at Barts and The London School of Medicine and Dentistry in London. She trained as a specialist teacher in evidence-based approaches in medicine and has recently coedited and writtenClinical Sciences, a comprehensive text on the science of medicine. In addition to her medical teaching, Denise teaches forensic science at undergraduate and postgraduate levels and has been running a laboratory that specializes in family studies for over 20 years. She is an active researcher and publisher in the field of DNA, often working collaboratively with similar groups in Europe where she also represents the UK on the European DNA Profiling Group (EDNAP). Denise is a Council Member of the British Academy of Forensic Science and is science editor of their journal:Medicine, Science and the Law . As a specialist in forensic science she regularly conducts forensic examinations and attends court as an expert, working on behalf of both the defence and prosecution.

Foreword by Lord Carlile of Berriew Q . C .

This authoritative work contains contributions by no less than eighteen distinguished experts in their sub-specialist fields, under the editorship of two very experienced forensic specialists. Its focus is on current issues in a fast-developing evidential context. In Court, where I spend much of my time as an advocate, scientific and forensic medical evidence can be demanding, challenging, and confusing for judges, juries and lawyers. In times past much turned on the performance of experts in the witness box – an historic legacy that led to some major miscarriages of justice, and to confusion over the true role of the expert.

Today it is crystal-clear that the expert witness, whether forensic scientist or from some other expertise we may not have imagined 40 years ago, owes only a duty to the Court. Partisan experts are soon rooted out and scrapped by any sensible lawyer. Objectivity and accuracy are the names of the game. Experts who stray outside their core business are exposed – nowhere more so when statistical judgments are offered on an ill considered basis.

For practitioners, finding the right kind of expert can be a major challenge in an era of sub-specialisation. I commenced legal practice at a time when pathologists were basically generic. Then came the histopathologist, and the pathologist specialising in children. Recently I met a remarkable practitioner who is a histopathologist specialising in children. In one case I was able to call a scientist whose life’s work was focused on the lives of blowflies in cadavers. In some fields of study there are few experts, spread thinly around the world – but experts they are, and needed they are if we are to do justice and avoid miscarriages of justice in unusual cases. This book enables us, at the very least, to discover the correct sub-specialty and to be able to ask the right questions when appointing an expert witness.

Of course, the book goes much further, and as such will be a primary tool for all interested in forensic science. The issues challenging us in Court are everincreasing in their complexity. The public importance of cases of bio-terrorism cannot be overestimated, and it is invaluable to be able to anticipate and study the subject through the specialist chapter. The role of healthcare professionals and their duties is addressed in Chapter 1: this is another area of work which would barely have been considered a couple of decades ago, but is the stuff of public inquiries today. In Chapter 7 the photography of injuries is given an important methodological and scientific context: this is vital for practitioners who are troubled by the form or mode of photography in a case, and will teach much to the police. In Chapter 9 many conventional interpretations of injuries are questioned, and the potential range of errors and fallacies highlighted. These and other chapters provide essential reading.

I believe this to be a book of the highest standing, with an enduring shelf life. I commend the editors and all the authors.

Alex Carlile

House of Lords, London, UKJuly 2010

Preface

Forensic medicine is a broad and evolving field in which many points of controversy and change occur between the publication of standard textbooks, often because of new research in the field, new technology or new laws or regulations. This series of volumes aim to provide a critical update and provide a focus for debate in selected topics of forensic medicine that are affected by such changes and to illustrate other topics of relevance to the field. It is intended that this text will act as a forerunner to a regular, multivolume text addressing recent advances in the practice of forensic medicine. Each chapter, written by specialists within that field, is intended to give a sometimes stimulating and sometimes controversial general overview of the area under discussion, with reference to the published literature. The chapters contain details of significant changes or significant points that the reader should be aware of. In some cases, the chapter will cover areas that have not previously been satisfactorily discussed in existing textbooks or which are currently relevant to forensic practice. The chapters will endeavour to maintain a relevance to an international audience and provide a guide to current approaches to the subject area, although examples may be drawn from specific jurisdictions to enable readers to relate to their own practice.

This first volume contains a range of current or controversial subjects including chapters on bio-terrorism, genital photography, the paediatric hymen and DNA. Updates are provided on forensic photography, bone injuries in children, bite marks and the investigation of aviation disasters. Two areas not generally covered in standard forensic medical textbooks include the psychiatric profiles of persons who self- harm and a general discussion on some of the more common errors and fallacies in clinical forensic medicine.

The opinions expressed in this volume are those of the authors and do not necessarily represent those of either the editors or the publishers. We hope that this volume will stimulate discussion and reflection on practice, even if the reader may have different opinions to some of the views expressed herein.

JAMG Melbourne

JJP- J London

November 2010

1

Expert evidence and healthcare professionals

I. Freckelton

Introduction

Expert witnesses have the special entitlement of being permitted to give evidence in the form of opinions, not just facts. This makes determination by a court of who is and is not an expert important. Broad definitions as to who is an ‘expert’ (as opposed to a lay witness) are given for court purposes: a person who possesses specialized knowledge by reason of skill, experience or training. It is the substance of the specialized knowledge rather than its provenance that matters (Freckelton and Selby, 2009). The knowledge can have evolved as a result of a treatment or a third-party assessment relationship with a patient.

Even those with more experience and familiarity with giving evidence in court (e.g. forensic physicians and forensic pathologists) may find it difficult. For many doctors and other healthcare professionals, it is stressful and sometimes traumatic to give evidence to courts and tribunals as expert witnesses. To embark upon the forensic role involves departing from the familiar world of doctor–patient interaction and to cede a significant degree of authority to another profession in an environment that is generally not fully understood or appreciated by medical practitioners. Questions are asked which seem arbitrary, uninformed and disrespectful; opportunities for explanation and expatiation are often denied; and rules that rarely appear in medical textbooks govern all interactions. There can be little doubt that the forensic environment is one characterized by a longstanding level of mistrust of expert witnesses because of concerns that evidence may be biased (Beran, 2009; Andrew, 2003; Cooper and Neuhaus, 2000) and that their bias will not be effectively unmasked, leading to the potential for miscarriages of both civil and criminal justice (Freckelton, 2007). In the past, many of those giving expert evidence may not have understood their general duties within the court setting; the sense of an expert being a ‘hired gun’may have had some relevance. With limited facility for doctors to receive training in the unwonted arena of the courtroom, and the uncomfortable expectations of the law in relation to their writing of reports and their giving of evidence, it is not surprising that many prefer not to fulfil a forensic function and even make active efforts to avoid doing so.