Lawyer Monthly Magazine - July 2019 Edition

JUL 2019 50 Expert Witness www. lawyer-monthly .com Can you briefly explain what Clinical Forensic Medicine is? Clinical forensic medicine is the application of clinical knowledge to the law. An expert can take a clinical concept that is within his experience and explain it in plain language so that everyone can understand it. Clinical forensic medicine covers a range of medical topics including the examination of victims of crime, interpretation of injuries and the effects of drugs on human behaviour. Clinical Forensic Medicine differs from Forensic Pathology which is primarily concerned with understanding causes of death. Clinical Forensic Medicine is primarily concerned with the living: interpretation of injury including assault, sexual assault and child abuse. An important part of the discipline is understanding the impact of drugs and alcohol on human behaviour. We are sometimes asked about the fitness of a suspect for interview. A significant speciality is the provision of health care for people in the custody of police who have specific medical issues. There is some overlap with forensic pathology when considering drugs and medical conditions causing death. My background in clinical practice combined with over 30 years working in various roles in law enforcement and research gives me unique expertise. I have delivered babies, “Clinical forensic medi- cine is the application of clinical knowledge to the law. An expert can take a technical idea within his experience and make it accessible to all.” - Professor Edward Ogden PSM given anaesthetics, worked in emergency medicine, administered a private hospital, been medical director of an ambulance service and taught at three universities. I currently have an active clinical practice in addiction medicine, teach medical students and junior medical officers and conduct research. How has Clinical Forensic Medicine progressed since the beginning of your career? Clinical Forensic Medicine is now a recognised speciality with specific training courses. The basics of interpretation of injury and understanding human behaviour have not changed. Many aspects of clinical medicine remain unaltered over time but there have been many technological changes that influence current practice. Over the past fifty years methods have been developed to detect and measure increasingly tiny quantities of drugs in hair. This provides the ability to detect drug use over a period of weeks to months, depending on the length of hair available. It is relatively easy to collect and does not require special conditions to transport. Most drugs are stable in hair for months. At the beginning of my career, breath alcohol concentrations were estimated with the old Breathalyzer 900 looking at changes in the colour of potassium dichromate solution. Since then we have seen the development of fuel cell technology and infrared absorption leading to the modern sophisticated instruments with accurate roadside detection. This has allowed both law enforcement and civil litigation to move from considering gross signs of intoxication to interpreting the likely effects of blood alcohol concentrations on risk. The interpretation of drugs in oral fluid is a relatively newchallenge. There are uncertainties about the technology, cross reaction between drugs like the amphetamines with medication and challenges in interpretation. There is a misconception that these problems are confined to the young. In many forensic cases, older alcoholics and people who misuse prescription medicationareoverrepresented in insurance claims. Have there been any significant advancements in Clinical Forensic Medicine recently? Blood alcohol concentrations dominated the early years of my practice in traffic medicine. Over the past 20 years, there has been increased recognition of the role of other drugs causing impairment. The focus in many jurisdictions is on illicit drugs because it is easier to proscribe driving with substances that are illegal anyway. It is now possible to measure hundreds of drugs that can affect safety not just on What Does an Expert in Clinical Forensic Medicine Do? FORENSIC MEDICINE Forensic Medical Consultants PO Box 2019, Templestowe heights, Victoria 3107, Australia T: +61 3 9855 9699 E: mail@forensicmedical consultants.com CONTACT