Current Practice in Forensic Medicine, Volume 3

John A.M. Gall is a consultant forensic physician, Director of Southern Medical Services, Principal of Era Health, Senior Consultant with the Victorian Paediatric Forensic Medical Service, Royal Children’s Hospital and Monash Medical Centre, Melbourne, and an Associate Professor, Department of Paediatrics, The University of Melbourne. He is President of the International Association of Clinical Forensic Medicine and a member of the International Editorial Board of the Journal of Legal and Forensic Medicine. Jason Payne-James is a Specialist in Forensic & Legal Medicine & Consultant Forensic Physician. He is Honorary Clinical Professor at the William Harvey Research Institute, Queen Mary University of London. He is Lead Medical Examiner at the Norfolk & Norwich University Hospital, Norwich, UK. He is Chair of the UK Scientific Advisory Committee on the Medical Implications of Less-Lethal Weapons and an Executive Board Member of the European Council of Legal Medicine. He is Medical Director of Forensic Healthcare Services Ltd, Southminster, UK.

List of Contributors

Preface xix

Chapter One: The new Medical Examiner System in England and Wales: its role in the medicolegal investigation of death 1

Introduction 1

Background 2

Structure and function of the Medical Examiner system in England and Wales 7

Medical Examiners 9

Medical Examiner Officers 11

How does a Medical Examiner Service work? 12

Relationships with other teams supporting the deceased and bereaved 16

Conclusion 16

References 17

Chapter Two: Who makes false allegations and why? The nature, motives, and mental health status of those who wrongly allege sexual assault 21

The nature of false allegations 21

Deliberate fabrication 22

Inadvertent allegations 27

Conclusion 33

References 34

Chapter Three: Disclosure of evidence in sexual assault cases 41

Introduction 41

Definition and interpretation 42

Disclosure and the medical professional 44

The Court of Appeal judgements in the context of forensic and legal medicine 49

Conclusion 51

References 52

Chapter Four: Current perspectives on the type and use of weapons used to police public assemblies around the world 55

Introduction 55

Less- lethal weapons 59

Kinetic impact projectiles 65

Conclusion 73

Acknowledgement 73

References 74

Chapter Five: Non- fatal strangulation 81

Introduction 81

Non- fatal strangulation and intimate- partner violence 81

Legal status of non- fatal strangulation 82

Non- fatal strangulation and assault 83

Symptoms and signs of non- fatal strangulation (acute and longer term) 86

Examples of findings and descriptions of NFS assaults 97

Management of non- fatal strangulation 104

Radiological imaging in non- fatal strangulation 104

Conclusion 106

References 106

Chapter Six: DNA: current developments and perspectives 109

Introduction 109

STR improved autosomal multiplexes used for criminal justice 110

Rapid DNA 113

DNA mixtures 116

Massively parallel sequencing 119

Forensic DNA phenotyping 124

Forensic genealogy 132

Conclusion 135

References 135

Chapter Seven: The utility of forensic radiology in evaluation of soft tissue injury 143

Introduction 143

Limitations 145

Types of cross- sectional radiological imaging 147

Types of injury 148

Injury patterns and causation 157

Gunshot injuries 160

Ligature soft tissue injuries 160

Conclusion 163

References 163

Chapter Eight: Abusive head trauma in children – a clinical diagnostic dilemma 167

Definitions 167

A brief history 168

Current hypothesis on the development of subdural haemorrhage, retinal haemorrhage, and hypoxic–ischaemic encephalopathy in AHT 170

The presentation and diagnosis of AHT 170

The development of a controversy 171

Clinical medicine and the medical diagnosis 173

Alternative hypotheses 173

Short- distance falls 174

The circular argument 175

Confession evidence 176

The missing biomechanical model 176

The clinician’s approach to a diagnosis of AHT 177

Terminology 179

Conclusion 182

References 182

Chapter Nine: The ageing population: needs and problems of the older person in prison 187

Overview 187

Introduction 187

Health and social care needs of older people in prison 188

Key steps in addressing the needs of the older person in prison 196

Where next? 201

References 201

Chapter Ten: Fitness to plead and stand trial – from the Ecclesfield Cotton Mill dam to Capitol Hill 205

Introduction 205

The application of the Pritchard test in England and Wales 212

Physical illness or disability and fitness to plead and fitness to stand trial in England and Wales 215

Related provisions in some other common law jurisdictions 215

A practical approach to assessment 220

Conclusion 220

Acknowledgements 221

References 221

Law reports 222

Chapter Eleven: Quality standards for healthcare professionals working with victims of torture in detention 225

Introduction 225

Why were quality standards needed? 226

Prevalence of torture 226

Clinical consequences of prior torture 226

Methods of torture 226

Detention in the United Kingdom and risks for patients’ health 228

Effects of detention on victims of torture 229

Professional responsibility 230

Outcomes 230

Conclusions 235

References 236

Chapter Twelve: A forensic approach to intimate partner homicide 239

Introduction 239

The ‘crime of passion’ discourse 241

Coercive control discourse 242

Medical narratives and discourse 243

IPH and IPA as expert knowledge 244

Response practices 245

Conclusions 249

References 250

Chapter Thirteen: Non- lethal physical abuse in the elderly 253

Failure to diagnose 254

The ageing process 254

Acknowledgement 275

References 276

Chapter Fourteen: Physical intervention and restraint 279

Introduction 279

The organisational approach to managing challenging behaviour, aggression, and violence 279

Minimising the risk of injury and death 281

Use of force in therapeutic environments 282

The use- of- force hierarchy 282

Organisational approaches to managing challenging behaviour and violence 283

Physical interventions in other (non- policing) environments 284

The range and risks of physical interventions 286

Conclusions 291

Acknowledgement 292

References 292

Chapter Fifteen: Medical and toxicological aspects of chemical warfare: the nature, classification, and management of chemical agents used in warfare 293

Introduction 293

OPCW and control and schedules 294

Hazard/threat assessment 294

Environmental indicators and detection overview 294

Bioanalytical detection overview 295

Classes of chemical weapons and casualty management 297

Pulmonary agents: chlorine and phosgene 305

Asphyxiants: cyanide and hydrogen sulphide 309

Blistering agents/vesicants: sulphur mustard chlorine and lewisite 311

Other chemical warfare agents 315

Opiates and opioids 317

Perfluoroisobutene (PFIB) 319

Bioregulators 320

Endorphins and enkephalins 321

Neurokinins, including substance P 321

Endothelins 321

Bradykinin 322

Angiotensin 322

Neurotensin 322

Other Bioregulators 323

Summary 323

References 323

Index 327