Current Practice in Forensic Medicine, Volume 2 E-Book

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

Seitenzahl: 667

Veröffentlichungsjahr: 2016

Beschreibung

Forensic medicine is a broad and evolving field with areas of rapid progress embracing both clinical and pathological aspects of practice, in which there may be considerable overlap. This is the second volume in a series that provides a unique, in-depth and critical update on selected topics of direct relevance to those practising in the field of clinical forensic medicine and related areas including lawyers, police, medical practitioners, forensic scientists, and students.

The chapters endeavour to maintain a relevance to an international, multi-professional audience and include chapters on:

• DNA decontamination,
• The toxicity of novel psychoactive substances,
• The relevance of gastric contents in the timing of death,
• The effects of controlled energy devices,
• The main risk factors for driving impairment,
• The risk factors for harm  to health of detainees in short-term custody,
• Autoerotic deaths,
• Child maltreatment and neglect, and
• The investigation of potential non-accidental head injury in children.

Also included are chapters on excited delirium syndrome, automatism and personality disorders. Two topics not generally covered in standard clinical forensic medical textbooks include a forensic anthropological approach to body recovery in potential crimes against humanity and risk management and security issues for the forensic practitioner investigating potential crimes against humanity in a foreign country.

Leseprobe

Table of Contents

Cover

Title Page

List of Contributors

Preface

1 DNA contamination – a pragmatic clinical view

Contamination considerations

DNA profiling

DNA deposits

Decontamination

General approach to DNA decontamination

Contamination

Cleaning and the DNA laboratory

Cleaning and decontamination of forensic examination suites – the way forward

References

2 The toxicity of the novel psychoactive substances

Introduction

Acute toxicity

Chronic toxicity

Deaths

References

3 Postmortem gastric content analysis: its role in determining time since death

Introduction

The physiology of gastric emptying

Gastric motility and emptying

Methods for measuring gastric emptying

Experimental studies

Factors affecting gastric emptying (in adults)

Analysis of gastric contents

Usefulness of gastric contents in time of death estimations

Conclusion

Acknowledgments

References

4 Conducted energy devices

Overview

What are conducted energy devices?

Modes of use of the TASER® X26, TASER® X26P and TASER® X2

The electrical outputs of the TASER® X26, X26P and X2

Operationally exploited effects of TASER® CEDs: pain and neuromuscular incapacitation

Adverse effects associated with use of the TASER® X26

Conclusions

References

5 Autoerotic deaths

Historical context

Definition

Incidence

Investigation of autoerotic deaths

Typical methods of autoerotic death

Atypical methods of autoerotic deaths

Typical and atypical victims

Summary

References

6 Excited Delirium Syndrome

Introduction

Aetiology

Diagnosis

Initial approach and work‐up

Medication treatment options for ExDS

Supportive treatment

Conclusions

References

7 Automatism – wading through the quagmire

Introduction

Definitions of automatism

The law

Medical conditions capable, or possibly capable, of founding a defence of automatism

Sentencing and mitigation

Proposals for reform in England and Wales

Acknowledgments

Law reports

References

8 Classification of personality disorders, clinical manifestations and treatment

Introduction

What is personality disorder?

Dimensional or categorical diagnostic approaches?

Prevalence

The hybrid model

Assessment

Specific issues in forensic medicine settings

References

9 Driving impairment

Introduction

Legislative approaches

Sobriety assessment

Specific drugs

Forensic specimens in drug driving cases

Medical conditions and fitness to drive

Sleep deprivation

Conclusions

References

10 Risk factors for death or harm to health for detainees in short‐term police custody

Introduction

The background to healthcare in police custody

The nature of health problems of detainees

Deaths and harm in police custody

Excited Delirium Syndrome

Broad principles of care

Identification and diversion

Prevention of death and harm in police custody

References

11 The utility of radiological investigation of suspected abusive head trauma in children

Introduction

Injury patterns

Anatomy of the head

Scalp injury

Skull injury

Estimate of time of injury of skull fractures

Mimics of skull fractures

Tips for investigating suspected skull fracture

Intracranial manifestations of head injury

Subdural haemorrhage

Subarachnoid haemorrhage

Extradural haemorrhage

Cortical contusions

Diffuse axonal injury (shear injury)

Brain oedema, swelling and hypoxic ischaemic brain injury

Conclusion

References

12 Child maltreatment

Introduction

Defining child abuse and neglect

The physician’s role in detecting child abuse

Contributing and risk factors for child abuse

General signs and symptoms of child abuse

Physical signs of child abuse

Fabricated or induced illness

Specific clinical presentations suspect for child abuse

Recognizing neglect

Screening instruments for detection of child abuse in Emergency Departments

Medical conditions that mimic child abuse

Summary and conclusion

References

13 Recovery of remains in potential crimes against humanity investigations – a forensic anthropological approach

Forensic anthropology and investigations into human rights violations and crimes against humanity

The characteristics of forensic anthropological investigations into human rights violations and crimes against humanity

The main mistakes made in forensics

Phases of the forensic anthropological investigation in the context of human rights violations

A multidisciplinary approach

Complex cases

Lessons learned and considerations

Conclusions

Acknowledgments

References

14 Field missions

Introduction

S: Situation

M: Mission

E: Execution

A: Administration and logistics

C: Communications and command

S: Security

Other mission‐related matters

Strategic security assessments

Conclusion

Appendix A‐Mission plan template

Appendix B‐ Example of team functions for personnel required for the exhumation of human remains from a mass grave

Index

End User License Agreement

List of Tables

Chapter 01

Table 1.1 Summary and comparison of sterilization and effective cellular DNA decontamination.

Chapter 02

Table 2.1 Main classes of new psychoactive substances (NPS).

Chapter 03

Table 3.1 Gastric emptying times of different sized meals, as stated in the literature. The validity of these is questionable, particularly for ‘larger’, ‘heavy’ and ‘gigantic’ meals since estimates are not consistent with controlled physiological studies. Determination of gastric emptying time should not be made from meal size alone.

Table 3.2 Factors that may (not necessarily will) affect gastric emptying.

Table 3.3 Perper’s protocol for analysis of gastric contents.

Chapter 06

Table 6.1 2013 ICD‐10 diagnostic codes.

Table 6.2 ExDS brief differential diagnosis.

Table 6.3 SMASHED: mnemonic for differential diagnosis of altered mental status.

Table 6.4 AEIOU TIPS: mnemonic for abbreviated differential diagnosis of altered mental status.

Table 6.5 Sedative medications for use in ExDS.

Chapter 08

Table 8.1 Features to assist identification of personality disorder.

Chapter 09

Table 9.1 Estimated road traffic death rate per 100,000 population, 2010.

Table 9.2 UK proposals for drug threshold limits.

Chapter 11

Table 11.1 Evolution of subdural haemorrhage on CT.

Table 11.2 Evolution of intracranial blood on MRI.

Chapter 12

Table 12.1 Risk factors for child maltreatment.

Table 12.2 General signs and symptoms of child abuse.

Table 12.3 Fractures likely to be caused by inflicted trauma.

Table 12.4 Features alerting for fabricated or induced illness.

Table 12.5 Clinical presentations of child neglect.

Table 12.6 Medical conditions that have been mistaken for child abuse.

Chapter 13

Table 13.1 Examples of Truth Commissions around the world.

Table 13.2 Comparison of two types of investigation.

Table 13.3 Examples of different sources of background information

.

Table 13.4 Recommendations for investigations.

List of Illustrations

Chapter 03

Figure 3.1 Emptying patterns of a test solid meal in normal males and females.

Note

: Females are represented by the open squares and males by the filled squares.

Figure 3.2 Scanning electron micrograph (× 280) of chewed onion cells showing their characteristic elongate rectangular shape.

Figure 3.3 Dispersed raphides from pineapple. Raphides occur as neat bundles within intact pineapple parenchymal cells.

Chapter 05

Figure 5.1 This man was found hanging in the basement of his secured house after family members went to check on his welfare. The decedent was suspended by a large chain, hooked through a sawed hole in an upstairs floor board, and secured to a wooden basement ceiling beam. The decedent was also suspended by a ratchet strap attached to the large chain near the beam via a steel hook. Both the chain and strap were tied to his waist; the decedent was wearing a plastic refuse bag at his waist, which covered the chain and strap tied to his waist. His right wrist was chained and locked to the waist chain. His left arm was free. His legs were secured with duct tape at the knees and strapped at the ankles. Parts of a plastic bag were found on his head. This was secured at the neck with duct tape (the plastic bag was already open at the face when the decedent was found). The duct tape and plastic bag at the neck acted as a ligature and the cause of death was hanging.

Figure 5.2 The decedent was found in the bathroom. The mother, worried about the welfare of her son, had asked the decedent’s brother to force open the door. The decedent was found fully suspended by two ligatures. One was tied bilaterally from his ankles to the shower stall; the second was tied from the shower stall to his neck. The second ligature was cut by the brother after forcing the door. The decedent’s right wrist was bound to an elastic material tied to his upper thighs. The left wrist and arm were free. A trolley was found nearby, with multiple towels. The trolley was apparently use by the decedent to set up the suspension and then pushed away. The cause of death was hanging.

Chapter 06

Figure 6.1 ExDS response measures and indicators.

Chapter 08

Figure 8.1 The interpersonal circumplex and personality disorders.

Chapter 10

Figure 10.1 Total number of deaths in or following police custody (England and Wales), 1998/9–2008/9.

Figure 10.2 Primary cause of death in custody in England and Wales, 1998/9–2008/9.

Figure 10.3 Excited Delirium Syndrome pocket card (front and back) for law enforcement and EMS providers created by the work of the National Institute of Justice Technology Working Group (TWG) on Less‐Lethal Devices.

Figure 10.4 Example of a completed Risk assessment questionnaire used in the Metropolitan Police Service, London, (modified continuously): similar to many across the United Kingdom.

Figure 10.5 Reasons why the deceased was taken to hospital following an arrest, England and Wales, 1998/9–2008/9.

Figure 10.6 PolQuest.

Figure 10.7 Pathways following the PolQuest questionnaire.

Chapter 11

Figure 11.1 Diagrammatic representation of a sagittal midline section through the brain demonstrating the relationship of the major venous sinuses, cerebrospinal fluid spaces and meningeal layers.

Figure 11.2a Lateral skull radiograph in a young infant demonstrating multiple complex, diastatic occipital and posterior parietal skull fractures (white arrows).

Figure 11.2b Lateral skull radiograph demonstrating a large parieto‐occipital scalp haematoma (A) overlying a posterior parietal (B) and occipital (C) skull vault fractures.

Figure 11.2c Three‐dimensional CT model of the skull vault demonstrating multiple complex diastatic skull vault fractures (arrows) of the parieto‐occipital region.

Figure 11.3a Frontal Townes view skull radiograph demonstrating multiple bilateral skull vault fractures (arrows) which cross sutures.

Figure 11.3b Posterior view of a three‐dimensional CT model of the skull vault demonstrating multiple bilateral skull vault fractures (arrows) extending to the asymmetrically widened sagittal suture (A).

Figure 11.4 Lateral three‐dimensional CT model of the skull vault demonstrating a curvilinear frontal fracture (single arrow) and a diastatic posterior parietal fracture (two arrows).

Figure 11.5 Axial CT slice of the skull vault demonstrating a depressed right parietal fracture (arrow).

Figure 11.6 Three‐dimensional CT model of the skull vault demonstrates indentation in the right posterior parietal region, the so‐called ping‐pong fracture (arrows).

Figure 11.7 Frontal skull radiograph demonstrating normal cranial vault sutures (arrows), which should not be mistaken for fractures.

Figure 11.8 Frontal skull radiograph demonstrating bilateral, short, linear lucencies (arrows) which persisted, confirmed to be accessory sutures.

Figure 11.9 Lateral skull radiograph demonstrating a branching linear lucency in the frontal region from a prominent vascular impression.

Figures 11.10a and 11.10b Three‐dimensional CT reformats demonstrating the presence of Wormian bones in the lambdoid sutures bilaterally (arrows).

Figure 11.11a Frontal skull radiograph demonstrating the presence of two well‐defined parasagittal lucencies at the apex of the skull vault consistent with parietal foramina (arrows).

Figure 11.11b Posterior view of a three‐dimensional CT reformat of the skull vault demonstrating bilateral parasagittal parietal foramina (arrows).

Figure 11.12 Diagrammatic representation of the membranes and meningeal coverings around the brain.

Figure 11.13 Diagrammatic representation of the spaces into which haemorrhage occurs around the brain.

Figure 11.14a Axial T1‐weighted MRI image demonstrating bilateral low‐signal chronic subdural collections (arrows).

Figure 11.14b Axial T2‐weighted MRI image demonstrating bilateral high‐signal subdural collections (arrows) with signal slightly lower than that of CSF in the ventricles due to the presence of blood products.

Figure 11.15 Axial CT slice through the parietal lobes demonstrating a bright and irregularly thickened interhemispheric fissure due to the presence of interhemispheric fissure subdural blood (arrow).

Figure 11.16 Axial CT slice through the parietal lobes demonstrating acute on chronic subdural haemorrhage. Left parietal fracture associated with overlying high‐density scalp haematoma (A). Right frontal low‐density, chronic subdural collection (B). High‐density material in the left frontal subdural space represents acute fresh subdural blood (C). Linear high‐density aligning the left frontal cortex represents acute subarachnoid haemorrhage (D).

Figure 11.17 Axial CT of the brain through the temporal lobes demonstrating enlarged, bilateral, low‐density subarachnoid spaces (arrows), which can be difficult to distinguish from chronic subdural collections.

Figure 11.18 High‐resolution coronal ultrasound image of the frontal lobes through the anterior fontanelle. Colour Doppler demonstrates a bridging vein crossing the subdural space (A). Ultrasound clearly differentiates between the chronic low‐density subdural collection (B) and the subarachnoid space aligning the brain parenchyma (C) and the intervening arachnoid mater.

Figure 11.19a Axial CT image through the brain on conventional soft tissue window settings.

Figure 11.19b Axial CT image through the brain at the same level after manipulation of the window to maximize detection of small amounts of blood. The small left frontal SDH is now clearly apparent (arrow).

Figure 11.20 Axial imaging through the parietal lobes using the gradient echo sequence which maximizes detection of blood products as extremely low‐signal foci, the so‐called blooming artefact (arrows).

Figure 11.21a Axial diffusion‐weighted image (DWI) through the occipital lobes demonstrating the areas of ischaemia depicted as abnormal high signal in the occipital lobes and lateral left thalamus (arrows).

Figure 11.21b The areas of abnormal high signal on DWI are matched by a reduction in signal on the apparent diffusion coefficient (ADC) map (arrows), confirming that this is true ischaemia and not artefact.

Figures 11.22a and 11.22b Axial images through the parietal lobes of two patients using the FLAIR sequence highlighting the higher‐signal subdural haemorrhages against the low‐signal CSF in the ventricles and subarachnoid space (arrows).

Figure 11.23a Coronal T2‐weighted sequence through the posterior parietal lobes demonstrating the presence of differing signal intensities in the subdural space. There is a large intermediate‐to‐low signal intensity collection around the left cerebral hemisphere (arrow A) and mixed high‐ (arrow B) and low‐signal collection around the right hemisphere.

Figure 11.23b Axial T2‐weighted image through the parietal lobes demonstrating bilateral mixed‐signal subdural collections due to haemorrhages of differing ages (arrows A, B and C). There is mass effect with compression of the underlying parietal lobes.

Figure 11.24 Axial T1‐weighted image through the parietal lobes demonstrating acute on chronic subdural haemorrhages on a background of parenchymal atrophy and encephalomalacia from prior ischaemic injury. There are bilateral, low‐signal subdural haemorrhages (arrow A). Acute subarachnoid haemorrhage seen as a high‐signal focus is evident on the left (arrow C) aligning with the encephalomalacic parietal lobe (arrow B).

Figure 11.25 Coronal CT image through the posterior parietal lobes demonstrating a large, acute, high‐density left parietal extradural haemorrhage (arrow A) associated with high‐density overlying scalp haematoma. There is significant mass effect and the linear high density of the displaced dura is evident (arrows).

Figure 11.26 Axial CT demonstrates two small high‐density haemorrhages in the posterior right thalamus (arrow). There is associated scalp haematoma on the right.

Figure 11.27 Axial CT image demonstrates brain oedema and swelling with effacement of the sulci and CSF spaces. There is diffuse low density throughout the parenchyma and loss of grey–white matter differentiation.

Figure 11.28 Axial CT through the temporal lobes demonstrates increased attenuation within the basal cisterns, the pseudo‐subarachnoid sign (arrows) in association with diffuse brain swelling, sulcal effacement and loss of grey–white matter differentiation.

Figure 11.29 Axial CT through the parietal lobes demonstrates the acute reversal sign with abnormally reduced parenchymal density and loss of grey–white matter differentiation, with relative preservation of the density of the thalami centrally. There is a small, low‐density right frontal subdural collection (A), a small left posterior parietal scalp haematoma (B) and high density along the posterior interhemispheric fissure due to the presence of a small acute falx subdural (C).

Figure 11.30 Axial CT through the parietal lobes in a patient with diffuse hypoxic brain injury with abnormal parenchymal attenuation (B). There is a bright and irregularly thickened falx due to the presence of an interhemispheric fissure subdural (C). There is a left frontal skull vault fracture (A) associated with a left fronto‐parietal scalp haematoma associated with subarachnoid blood (B).

Figure 11.31 Axial CT of a diffusely oedematous brain with loss of grey–white matter differentiation associated with a thin interhemispheric fissure subdural in the midline. There is splaying of the anterior fontanelle (A) and widening of the cranial sutures (B) from the raised intracranial pressure.

Chapter 12

Figure 12.1 Large haematoma of the cheek. This patient was said to have fallen in the bath for the second time.

Figure 12.2 Same patient as in Figure 12.1 with bilateral periorbital haematoma.

Figure 12.3 Bruising on the face and forehead without any explanation from the parents.

Figure 12.4 Five‐month‐old baby with multiple bruises on the face. She was found in the home of an inebriated mother who had been detained by the police in the street.

Figure 12.5 A typical belt mark.

Figure 12.6 A 14‐month‐old boy with an unexplained distal fracture of the right humerus, with periostal reaction.

Figure 12.7 The same boy as in Figure 12.16 with fractures of the olecranon and ulna with shortening of the radius and distal humerus of the left arm. The fractures of the olecranon and ulna are considered to be older than the humerus fracture.

Figures 12.8 An eight‐year‐old girl burned with a fork at multiple sites as punishment for bedwetting.

Figures 12.9 An eight‐year‐old girl burned with a fork at multiple sites as punishment for bedwetting.

Figure 12.10 A five‐year‐old girl placed on a gas‐heated radiator as a punishment for bedwetting. The parents said that they did not know the radiator was hot and that the girl did not cry.

Figure 12.11 A boy burned on the face with an iron.

Figure 12.12 Cigratte burns.

Figure 12.13 A one‐month‐old baby with an unexplained mid‐diaphyseal fracture of the left humerus.

Figure 12.14 The same infant as in Figure 12.13 one month later, with a fracture of the left femur and a diagnosis of osteogeneis imperfecta type III.

Guide

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Current Practice in Forensic Medicine, Volume 2

Edited by

John A.M. Gall and J. Jason Payne‐James

This edition first published 2016© 2016 by John Wiley & Sons, Ltd

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Names: Gall, John A. M., editor. | Payne‐James, Jason, editor.Title: Current practice in forensic medicine / [edited] by John Gall, Jason Payne‐James.Description: 2nd edition. | Chichester, West Sussex, : John Wiley & Sons, Ltd, 2016. | Includes bibliographical references and index.Identifiers: LCCN 2016011603 | ISBN 9781118455982 (cloth)Subjects: | MESH: Forensic Medicine–methodsClassification: LCC RA1051 | NLM W 700 | DDC 614/.1–dc23LC record available at http://lccn.loc.gov/2016011603

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Cover image: Gettyimages/agsandrew

List of Contributors

Paul I. Dargan MB BS, FRCPE, FACMT, FRCP, ERT, FAACT, FEAPCCT, FBPhSPaul Dargan is a consultant physician and clinical toxicologist, and clinical director at Guy’s and St Thomas’ NHS Foundation Trust, London, UK. He is also Professor of Clinical Toxicology at King’s College London. He has an active research and teaching programme, with a focus on recreational drug toxicity, self‐poisoning and heavy metal toxicity. He has published over 220 peer‐reviewed papers and numerous book chapters, and is a member of the editorial board of a number of medical journals. Paul sits on the Advisory Council on the Misuse of Drugs (ACMD) and the Scientific Committee of the European Monitoring Centre for Drugs and Drugs Addiction (EMCDDA). He is an expert adviser on numerous other bodies, including the US Food and Drug Administration (FDA), Médecins Sans Frontières (MSF) and the World Health Organization (WHO).

John A.M. Gall BSc (Hons), MB, BS, PhD, FACLM, FFFLM (RCP Lond), FFCFM (RCPA), DMJ (Clin & Path)John Gall is a consultant forensic physician. He is an Associate Professor, Department of Paediatrics, The University of Melbourne, 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 the Journal of Forensic and Legal Medicine, Egyptian Journal of Forensic Sciences and Internet Journal of Forensic Medicine and Toxicology. John is the current President of the World Police Medical Officers and was Vice President of the Australasian Association of Forensic Physicians. 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 over 20 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 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 edited Forensic Medicine Colour Guide and the first edition of this series. John has been involved in forensic medical research and much of these findings have been published. In addition to forensic medicine, he practises occupational and military medicine.

Clare M. Legge BSc, MSc, DipFHIDClare Legge is a Publishing Editor at SAGE Publications, London where she works in the STM Journals editorial department on a diverse list of engineering and materials science journals. Clare graduated from Bournemouth University in 2008 with a first class BSc honours degree in forensic and crime scene science. She subsequently obtained an MSc in forensic medical sciences from Cameron Forensic Medical Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University London, where her thesis focused on the use of gastric contents in estimating time since death. In 2012 Clare was awarded a diploma in forensic human identification from the Faculty of Forensic and Legal Medicine, The Royal College of Physicians.

Johan Marchand MDJohan Marchand is a general paediatrician and consultant in child abuse at the University Hospital for Children of the Brussels Free University. He studied medicine at Brussels Free University and was trained in paediatrics in Brussels and Paris. Formerly he worked as confidential doctor in the Child Confidential Centre for Child Abuse of Ghent, and was director and paediatrician of the Child Confidential Centre, Brussels. He also worked in the Medical Institute Clairs Vallons, Ottignies, as head of a multidisciplinary team caring for abused children in residential care. He is a clinical tutor at the Brussels Free University and participates in the study programme for medical students (child abuse, psychosocial medicine). Johan is a frequent speaker at conferences on child abuse in Belgium, and organizer of a three‐day course on forensic aspects of child abuse in the past. He actively participates in many European and world conferences on child abuse organized by the International Society for Prevention of Child Abuse and Neglect.

Willie NugentWillie Nugent is the founder and managing director of Eurocheck Security Consultants Limited. Willie served in the Irish Defence Forces for over 20 years, retired with the rank of captain in 2001 and set up Eurocheck Security Consultants Limited. While serving in the Irish Defence Forces, he served in the Military Police, Army Ranger Wing and the Cavalry Corps. He served three years in South Lebanon as part of UNIFIL (the United Nations Interim Force in Lebanon). While he was heavily involved in security, operational and training aspects, he also has extensive experience in the areas of logistics and transport. Willie is strongly committed to human rights and democracy and served as special security officer with rhe European Union Border Assist Mission at Rafah, in Gaza and Israel in 2009. In recent years he has conducted hostile environment, security awareness and war crimes investigation training throughout Europe, Africa, the Middle East and South America. Willie holds a Level 7 certificate in further education from the National University of Ireland at Maynooth.

J. Jason Payne‐James LLM MSc FRCS PFFLM FCSFS FACLM FCLM DFM MediatorJason Payne‐James is an independent specialist in forensic and legal medicine with a range of research and clinical interests. He qualified in medicine in 1980 at the London Hospital Medical College. He has undertaken additional postgraduate qualifications 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 has been a forensic medical examiner with the Metropolitan Police for almost 25 years. His clinical and research interests include healthcare in custody, restraint and less‐lethal systems, harm and death in custody and torture. He has published peer‐reviewed research on a wide range of subjects, including healthcare in custody, use of force, TASER®, and irritant spray.

Jason is honorary senior lecturer at Cameron Forensic Medical Sciences, Barts and the London School of Medicine and Dentistry. He is honorary consultant in emergency medicine at St George’s Hospital, London. He is external consultant to the UK National Crime Agency and National Injuries Database. He is editor‐in‐chief of the Journal of Forensic & Legal Medicine. He is president of the Faculty of Forensic and Legal Medicine of the Royal College of Physicians. In addition to Current Practice in Forensic Medicine he has co‐edited and co‐authored other publications, including the Encyclopedia of Forensic and Legal Medicine,Forensic Medicine: Clinical and Pathological Aspects and Symptoms and Signs of Substance Misuse. He is lead author of the 13th edition of Simpson’s Forensic Medicine; he co‐authored the Oxford Handbook of Forensic Medicine and co‐edited Age Estimation in the Living. He is currently co‐editing Monitoring and Documenting Conditions of Detention and Custody, Torture and Ill‐Treatment.

Mercedes Salado Puerto PhDMercedes Salado Puerto first qualified as a biologist and completed her doctorate in the Department of Biological Anthropology, Universidad Autónoma de Madrid, Spain. As a forensic anthropologist, she was member of the Guatemalan forensic anthropology team from 1998 to 2003. Since 2003 she has been a member of the Argentine Forensic Anthropology Team (EAAF), where she currently works as identification coordinator. She specializes in the historical investigation of cases of political violence (analysis of written and oral sources, collecting ante‐mortem data from relatives of the missing, interviewing witnesses, information management and databases), archaeological exhumation of individual and mass graves, and analysis of skeletal human remains in order to identify them and determine the cause of death. She has been involved in forensic investigations and training in Argentina, Bosnia‐Herzegovina, Burundi, Colombia, Cyprus, Chile, Guatemala, Iran, Iraq, Morocco, Mexico, Nepal, Panama, Peru, South Africa, Sudan, Thailand, Timor‐Leste, Togo, Uruguay and Vietnam. She has been lecturer in the postgraduate diploma in forensic anthropology and human rights (Universidad Nacional Mayor de San Marcos, Perú), the master’s degree in forensic anthropology and bioarchaeology (Graduate School of the Pontificia Universidad Católica del Perú) and the doctorate in anthropology at the Universidad Nacional de Córdoba, Argentina. She is a member of the Latin American Association of Forensic Anthropology and the International Committee of the Red Cross Forensic Advisory Group.

John W.L. Puntis BM (Hons), DM, FRCP, FRCPCHAs an undergraduate, John Puntis attended Southampton School of Medicine before undertaking postgraduate paediatric specialty training in Birmingham, UK, where he developed an interests in neonatology, gastroenterology and clinical nutrition. In 1990 he moved to Leeds as director of Neonatal Services for Yorkshire, and subsequently developed a multidisciplinary nutritional support team for the Leeds Children’s Hospital. He now works as a paediatric gastroenterologist helping to provide a regional service to a population of around three million; this includes a home parenteral nutrition programme (currently with eighteen patients). John has been a member of the nutrition committee of the British Society of Paediatric Gastroenterology, Hepatology and Nutrition, the Royal College of Paediatrics and Child Health and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition. His research interests have included the development of gastrointestinal function, non‐invasive assessment of pancreatic exocrine function, and the delivery of safe and effective nutritional support. He is an associate editor of Archives of Disease in Childhood, and has published over 220 papers, letters and book chapters on gastroenterology and nutritional topics.

John RalstonJohn Ralston is an executive director of the Institute for International Criminal Investigations. He served for several years as the chief of investigations with the Office of the Prosecutor at the International Criminal Tribunal for the Former Yugoslavia (ICTY) with overall responsibility for the investigation of alleged atrocities in the Balkans. John was a foundation member of the ICTY. Joining as an investigation team leader, he was responsible for establishing the tribunal’s first investigations and preparing its standard operating procedures. In 2014 he was chair of the International Crimes Evidence Project which examined alleged crimes in the closing stages of the war in Sri Lanka. A former homicide detective in Australia, he spent several years investigating Nazi war criminals for the Commonwealth Attorney‐General’s Special Investigations Unit. In 2004–2005 he served as chief investigator for the UN Independent Commission of Inquiry for Darfur, Sudan. He also spent four years leading organized crime investigations and criminal asset recovery actions with the New South Wales Crime Commission.

Padma Rao BSc Hons, MBBS, MRCP, FRCR, FRANZCRPadma Rao is a UK‐trained physician and radiologist and has specialized in paediatric radiology since 1996. Padma underwent subspecialty paediatric radiology training at Alder Hey Children’s Hospital, Liverpool, and Westmead Children’s Hospital, Sydney, before being appointed as a consultant paediatric radiologist at the Royal Children’s Hospital, Melbourne and honorary senior lecturer at the University of Melbourne in 2002. Padma has particular interests in imaging of the paediatric urinary tract and in the area of non‐accidental injury. Padma has authored many journal articles and presentations, along with several book chapters on the topic of non‐accidental injury, and has been a speaker at many national and international meetings. Padma works closely with the Victorian Institute of Forensic Medicine reporting the postmortem imaging in children in Victoria. Padma is a member of the International Society of Forensic Radiology and Imaging and is on the paediatric post mortem imaging task force. Padma maintains an active teaching role and is an examiner for the Part II Fellowship of the Australian and New Zealand College of Radiologists Board examinations. She has contributed to the teaching units for the masters in forensic medicine degree at Monash University. She is actively involved in the Executive of the Australian and New Zealand Society for Paediatric Radiology having completed a three year term as Treasurer. In her present role at the Royal Children’s Hospital, she is Director of Medical Imaging. Padma has a keen interest in quality in healthcare and is on the Royal Children’s Hospital Executive Innovations and Improvement Committee.

Keith J.B. Rix BMedBiol (Hons), MPhil, LLM, MD, FRCPsych, Hon FFFLMKeith Rix is an honorary consultant forensic psychiatrist in the Norfolk and Suffolk NHS Trust. His involvement in the forensic field began in the 1960s when he lived in hostels in London with ex‐offenders and assessed prisoners for hostel admission. He qualified in medicine in Aberdeen in 1975 and trained in psychiatry in Edinburgh and Manchester. In Manchester he was a lecturer in psychiatry and carried out his doctoral research under the supervision of Professor Sir David Goldberg. In 1983 he moved to Leeds as senior lecturer in psychiatry and became a visiting consultant psychiatrist at HM Prison, Leeds. He established the Leeds Magistrates’ Court Mental Health Assessment and Diversion Scheme and the city’s forensic psychiatry service. His research has included studies of drunkenness offenders in a Scottish burgh police court, arson and psychiatric disorder in prisoners. He has provided expert evidence to the courts for 30 years, including evidence on a pro bono basis in capital cases in the Caribbean and Africa. He is the author of Expert Psychiatric Evidence, editor of A Handbook for Trainee Psychiatrists and co‐author, with his wife, Elizabeth Lumsden Rix, of Alcohol Problems. Until recently he was chair of the Fitness to Practise Panel of the Medical Practitioners Tribunal Service and a part‐time lecturer in the Department of Law, De Montfort University, Leicester. He is now Visiting Professor of Medical Jurisprudence, Institute of Medicine, University of Chester. He also has an interest in medical ethics and has recently published on the subject of the involvement of health professionals in capital punishment.

Anny Sauvageau MD MSc FRCPCAnny Sauvageau started her career as a forensic pathologist in Montreal in 2002. In 2009, she moved to Alberta where she was deputy chief medical examiner (2010) and chief medical examiner (2011–2014). She is an associate clinical professor at the University of Alberta and the University of Calgary, and is a well‐known expert on asphyxia. Anny received her medical degree from the University of Montreal in 1996 and is board certified in anatomical pathology. She has a founder designation in forensic pathology from the Royal College of Physicians and Surgeons of Canada in recognition of her contribution to the development of this new specialty in Canada. She was vice president of the forensic pathology examination board of the Royal College of Physicians and Surgeons of Canada (2007–2012). She was also the founder of the residency programme in forensic pathology at the University of Alberta, and the programme director from 2011 to 2015. Anny is the author of more than 75 papers in peer‐reviewed forensic journals and a highly sought international speaker. She is the founder of the working group on human asphyxia. Her innovative approach to forensic research has significantly improved understanding of the pathophysiology of hanging and other types of strangulation.

Robert D. Sheridan BSc (Hons), PhD, CBiol, FRSBBob Sheridan is a life scientist with a background in physiology and pharmacology. After obtaining his doctorate in central nervous system neuropharmacology from the University of Bath, UK in 1982, he went to work as a postdoctoral CNS electrophysiologist in the Department of Psychiatry, University of Manchester and then in the Institute of Physiology, Ludwig‐Maximilians University, Munich. In 1989, he moved from academia to the pharmaceutical industry, becoming a research pharmacologist at the Syntex Research Centre, Edinburgh, and later at Quintiles Research, Edinburgh. Since 1998, he has worked as a researcher at the UK Defence Science and Technology Laboratory (Dstl). His introduction to less‐lethal weapons came in 2001, when Dstl were commissioned to assess the medical effects of conducted energy devices (CEDs) to support a review of this technology by the UK’s independent Defence Scientific Advisory Council sub‐committee on the Medical Implications of Less‐Lethal Weapons (DOMILL). The TASER® CED was subsequently introduced into policing in England and Wales in 2003, Scotland in 2005 and Northern Ireland in 2008. Bob continued to provide impartial advice to DOMILL until it was replaced in 2012 by the Scientific Advisory Committee on the Medical Implications Less‐Lethal Weapons (SACMILL). He continues to advise SACMILL on CEDs and other less‐lethal weapons. He is a member of the police National (formerly ACPO) Less‐Lethal Weapon Working Group, serves on the editorial board of the Journal of Forensic and Legal Medicine, and is a chartered biologist and Fellow of the Royal Society of Biology.

Sara L. Short BSc, PhD, MCSFSSara Short is a highly experienced expert witness in the area of crimes against the person involving DNA profiling, body fluid analysis, blood pattern analysis, damage assessment, hairs and examination of stomach contents. She is director of a small forensic firm providing services for the defence, acts as a consultant for a main forensic provider in the UK and occasionally works directly with police forces. She has given evidence on numerous occasions in Magistrates’ and Crown Courts in England and Wales and from time to time in other jurisdictions. Sara obtained a first class honours degree in biology from the University of Durham and studied blood groups in body fluids at the Forensic Science Unit at the University of Strathclyde for her doctorate. She has a certificate in management from Bristol Polytechnic Business School. She was employed by the Forensic Science Service and her career has run alongside the development of DNA profiling analyses. She provides visiting lectures to the forensic programmes at a number of universities, but principally at the University of Wolverhampton. Sara is a professional member the Chartered Society of Forensic Sciences. Sara became a reviewer for the Journal of Forensic and Legal Medicine (formerly Journal of Clinical Forensic Medicine) in Spring 2008 and has published on a range of different topics in forensic science and its teaching.

J. Anne S. Smith MBBS, FRACP, MForens Med, FFCFM (RCPA)Anne Smith trained as a paediatrician in Melbourne and has worked in the field of child abuse and in private practice as a general and community paediatrician since 1989. She has been director of the Victorian Forensic Paediatric Medical Service since July 2006. She has a longstanding interest in medical education. She developed three units for the master’s in forensic medicine degree at Monash University, including a unit in child and adolescent sexual abuse and a unit in physical child abuse which were modified from an existing single unit of study in child abuse. Anne also produced a new unit titled ‘Advanced issues in child abuse’. She has coordinated and taught all three units, and is currently teaching the advanced unit after handing on to others the teaching role for the first two units.

Over the last 25 years she has taught medical students at the University of Melbourne, local, national and international paediatricians, GPs, nurses, child protection workers, police and allied heath professionals about the medical aspects of child abuse and neglect. She has published articles and book chapters, produced seminars and workshops and  has also been involved in developing training programmes for building doctors’ clinical expertise in the medical evaluation of suspected child abuse and neglect. She has presented at national and international conferences. She has been involved in several committees of the Royal Australasian College of Physicians, including the Division of Paediatrics Council when she was chair of the Chapter of Community Child Health. She is currently a member of the governing committee of the Australasian Association of Forensic Physicians and is a member of the Faculty Committee of the Faculty of Clinical Forensic Medicine, Royal College of Pathologists, Australasia. Anne has been involved in writing policy and developing practice guidelines regarding child abuse and neglect for the RACP and for the services in which she has been employed. She has served on several committees and advisory groups for local government, including the Victorian Child Death Review Committee. Her international work includes training and lecturing in Vietnam and Cambodia.

Margaret M. Stark LLM MSc (Med Ed) MB BS FFFLM (Founding) FACBS FHEA FACLM FRCP FFCFM (RCPA) DGM DMJ DABMargaret Stark is the clinical lead for Tascor Medical Services, UK providing clinical forensic medical services for Surrey Police and a forensic medical examiner for the Metropolitan Police Service (MPS), London. She is the chair of the forensic science sub‐committee of the Faculty of Forensic and Legal Medicine (FFLM) and a member of the academic committee. She worked in Sydney as director of the Clinical Forensic Medicine Unit for New South Wales Police Force for three years and was an adjunct professor in the Faculty of Medicine, University of Sydney from 2012 to 2015. Before working in New South Wales she worked as a forensic physician with the Metropolitan Police Service for 22 years and was the first medical director of the Forensic Health Care Service, Southminster, UK from 2010 to 2011. She was instrumental in establishing the FFLM and the founding academic dean, a post she held from 2006 to 2011, leading the team responsible for establishing the faculty membership examination. She was also a member of the Australasian Association of Forensic Physicians’ committee working with the Royal College of Pathologists of Australasia to establish a faculty of clinical forensic medicine to cover Australasia. She was awarded the David Jenkins Professorship in Forensic and Legal Medicine in 2011. Margaret has written extensively in the field of clinical forensic medicine, including the third edition of Symptoms and Signs of Substance Misuse (September 2014) and has also been involved in a number of collaborative quantitative and qualitative research projects, including the UK government’s research into drugs and driving.

Danny H. Sullivan MBBS, MBioeth, MHlthMedLaw, AFRACMA, FRCPsych, FRANZCPDanny Sullivan is a consultant forensic psychiatrist. His medical qualification was from the University of Melbourne and he later obtained postgraduate degrees in bioethics and in medical law. He trained in psychiatry at the Maudsley Hospital, London and the Institute of Psychiatry, and was awarded the Laughlin Prize of the Royal College of Psychiatrists. Danny subsequently completed psychiatry training in Australia and has since worked at the Victorian Institute of Forensic Mental Health (Forensicare). He is responsible for the statewide community forensic mental health service and has interests in intellectual disability and in sexual offending. He has worked in a number of prisons in the United Kingdom and Australia. He provides expert psychiatric evidence in criminal and coronial jurisdictions. In addition, he holds honorary academic appointments and is involved in teaching and research, with fifteen book chapters and over twenty academic publications.

Denise Syndercombe Court MSB, CBiol, FIBMS, CSci, DMT, MFSSoc, PhDDenise Syndercombe Court is a reader in Forensic Genetics at King’s College London and Honorary Research Fellow in Haematology at Barts Hospital and the London School of Medicine and Dentistry, both in London. She trained as a specialist teacher in evidence‐based approaches in medicine and has recently coedited and written Medical 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 runs a laboratory that specializes in complex family relationships. She is an active researcher works collaboratively across Europe as part of the Euroforgen Network of Excellence in Forensic Genetics. She represents the United Kingdom on the European DNA Profiling Group (EDNAP) and as a member of the International Society for Forensic Genetics she represents the society on the UK Forensic Regulator’s DNA working group. 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 witness, working for both the defence and prosecution.

Gary M. Vilke MD, FACEP, FAAEMGary Vilke is a professor of clinical emergency medicine on the faculty in the Department of Emergency Medicine, University of California, San Diego (UCSD) and is the former medical director for the County of San Diego Emergency Medical Services. Gary currently serves as the co‐director for custody services at UCSD as well as the director for clinical research for the Emergency Department. He currently serves as the medical director for risk management for the UC San Diego Health System. He did his undergraduate training at the University of California, Berkeley and attended medical school at UCSD. He finished his residency in emergency medicine at UCSD in 1996 and has been on the emergency medicine faculty since then. His research focus has been in the areas of tactical medicine and prehospital care and has published over 180 articles and 45 book chapters, including over 50 publications on topics including positional asphyxia, weight force on the back, OC (irritant) spray, neck holds, restraint chairs, Excited Delirium Syndrome and the TASER®. He has lectured internationally on the topics of in‐custody death syndrome. He has been funded by several national organizations, including the National Institute of Justice, the Police Executive Research Forum (PERF) and the Institute for the Prevention of In‐Custody Deaths (IPICD), to udertake research in these fields.

David M. Wood MD, FRCP, FACMT, FEAPCCT, FBPhSDavid Wood is a consultant physician and clinical toxicologist, and service (clinical) lead for medicine at Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London. He is also an honorary senior lecturer in teaching and research at King’s College London. He has an active research and clinical interest in the epidemiology of use and acute harms associated with classical recreational drugs and novel psychoactive substances. He has published just over 170 peer‐reviewed papers and review articles, numerous book chapters and co‐edited a textbook on novel psychoactive substances. He is on the editorial board of the Journal of Medical Toxicology. David is an expert adviser to the European Monitoring Centre for Drugs and Drugs Addiction (EMCDDA) and sits on the UK Advisory Council on the Misuse of Drugs (ACMD) technical committee and novel psychoactive substances (NPS) working groups and is the clinician member of the ACMD NPS watch list.

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, new technology or new laws or regulations. There is considerable overlap between the clinical and pathological aspects of this area of practice. This is the second in a series of volumes aimed at providing a practical update on areas relevant to clinical practice and a focus for debate in the selected topics. Each chapter, written by specialists within their respective fields, is intended to give a 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 covers areas that have not previously been fully discussed in existing textbooks or that are currently highlighted in forensic practice. The book aims to be of direct relevance to a multiprofessional, 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 volume contains a range of current, new and often controversial subjects, including chapters on DNA decontamination and forensic sample collection, the toxicity of novel psychoactive substances, the use of gastric contents in the timing of death, the physiological and physiological effects of controlled energy devices, the main risk factors of driving impairment, the risk factors for harm to health of detainees in short‐term custody, autoerotic deaths, child maltreatment and neglect, and the investigation of potential non‐accidental head injury in children. Also included are chapters on Excited Delirium Syndrome, automatism and personality disorders, each of which is relevant to everyday clinical practice. Two topics not generally covered in standard clinical forensic medical textbooks include a forensic anthropological approach to body recovery in potential crimes against humanity, and risk management and security issues for the forensic practitioner investigating potential crimes against humanity in a foreign country.

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

John A.M. Gall, Melbourne

J. Jason Payne‐James, Southminster

May 2016

1DNA contamination – a pragmatic clinical view

John A.M. Gall and Denise Syndercombe Court

Contamination considerations

Forensic DNA testing has had a significant impact on the investigation of crimes. Initially developed in the mid‐1980’s by Alec Jeffreys and his group (Jeffreys, Wilson and Thein, 1985), the original ‘fingerprinting’ procedure has been modified and refined to the point where ‘DNA profiling’ has seemingly attained infallibility status (Koehler, 1993; National Research Council, 1996; Thompson, 1997). This status has been acquired and/or enhanced by its use in the exoneration of persons falsely convicted of various crimes and the subsequent successful conviction of the apparent perpetrators (Innocence Project, 1992). The concept of DNA infallibility in the investigation of crimes has, however, led to some significant miscarriages of justice. It is these exceptions that serve as a warning that the use of DNA profiling in criminal investigations requires a full understanding of the process by those employing the technology, and caution in the interpretation of the findings and their subsequent application in the legal system.

Different types of error may occur in any scientific procedure; DNA testing is no exception. DNA profiling is not and never has been infallible. There are many potential sources of error in its application. If it is to be applied competently within the legal system, all persons utilizing DNA data must have some understanding of the science behind it and of its potential sources of error. What is apparent is that many involved in the process, whether for specimen collection, testing, interpretation, application or presentation in court, have a poor understanding of DNA technology and its limitations, the potential for both error and misinterpretation, and the consequences of these when judged in a court of law. The sources of error are many and it is not our intention to examine them all. Instead, this chapter will address the issue of DNA contamination of items – other than their deliberate contamination – and consider this in relation, in particular, to the work of the forensic physician.

Does DNA contamination occur? The answer is yes, and there are some very high‐profile cases to demonstrate its occurrence – probably it occurs far more frequently than we appreciate. The following examples of accidental contamination illustrate how easy it is for contamination to occur and how DNA profiling results may too readily be accepted without question.

The ‘Phantom of Heilbronn’

Between 2007 and 2009, the German police were confronted by an apparent unknown female criminal who had been linked by DNA to some 40 crime scenes over a fifteen‐year period (BBC News, 2009; Himmelreich, 2009). These crimes, which included six homicides and various burglaries and break‐ins, had occurred in locations across Austria, France and Germany. Dubbed the ‘Phantom of Heilbronn’ following the murder of a young policewoman, Michele Kiesewetter, in Heilbronn in 2007, the hunt for this mystery female intensified and a substantial reward of €300,000 was offered for information leading to her capture. In 2009, the German police eventually unearthed the identity of the murderer and thief. The answer had been in plain sight all the time and is a stark reminder of the fallibility of DNA profiling.

In March 2009, while investigating the case of an unidentified, burned, deceased male from 2002, the Phantom’s DNA profile was detected when re‐examining the fingerprints of a male asylum‐seeker taken years earlier in order to reveal his DNA profile. The improbability of this finding resulted in the DNA test being repeated using a second swab to collect more DNA from the specimen. This time the Phantom’s DNA was not identified. The problem was revealed as one of DNA contamination and the identified DNA was that of a female worker on a production line for cotton‐tipped swabs – swabs used by various police forces across Europe to collect specimens at crime scenes.

Stefan König of the Berlin Association of Lawyers was reported (Himmelreich, 2009) to have made a very pertinent comment in relation to placing too much credence on identifying trace amounts of DNA:

What we need to avoid is the assumption that the producer of the traces is automatically the culprit. Judges tend to be so blinded by the shiny, seemingly perfect evidence of DNA traces that they sometimes ignore the whole picture. DNA evidence on a crime scene says nothing about how it got there. There is good reason for not permitting convictions on the basis of DNA circumstantial evidence alone.

His comment has proved to be correct and the question of how the DNA ‘got there’ is particularly pertinent.

The Jama case

On 21 July 2008 a young Somalian male, Farah Abdulkadir Jama, was found guilty and imprisoned for the rape of a 48‐year‐old female in a Melbourne nightclub on 15 July 2006. The sentence was for six years with a non‐parole period of four years. It was alleged that Mr Jama had sexually assaulted the woman, who had been found unconscious in a toilet cubicle, locked from the inside. Although the woman had consumed alcohol that evening, its effects were in excess of her expectations and raised the possibility that she had been drugged, presumably by her drink or drinks being spiked. Subsequent toxicological analysis did not support this assumption but did show a high blood alcohol level.

The normal procedure for cases of acute alleged sexual assault in the State of Victoria is that victims are taken to one of several designated examination suites located within some of the major metropolitan hospitals. Within these suites a forensic examination is undertaken by a forensic medical officer (FMO) or forensic physician (FP) and specimens are collected and provided to the police. This occurred in the case of this female and Mr Jama’s DNA was identified during subsequent forensic laboratory testing of biological specimens from the alleged victim. As a result, Mr Jama was found guilty of a sexual assault and sentenced to imprisonment, of which he completed approximately fifteen months prior to his being acquitted by the Court of Appeal.