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Clinical Forensic Medicine - A Physician's Guide, 2ndEdition, Edited by Margaret M. Stark. Hard Bound, 6" x 9". [Includes eBook/PDA on CD-ROM]. Foreword by Sir John Stevens, former Commissioner of the Metropolitan Police Service, London, UK
Humana Press Inc., 999 Riverview Drive, Suite 208, Totowa, New Jersey 07512; Publication Date: 11 April 2005. xvii + 438 pages, ISBN 1-58829-368-8, E-ISBN 1-59259-913-3. List price US $99.50 (10% discount with online order).
Amazon Link: Click here to visit
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The editor and contributor to this book is Dr Margaret M Stark. Dr Stark has worked as a Forensic Medical Examiner (FME) with the Metropolitan Police in South London since 1989. She is Principal FME and an Area Medical Adviser to the Commissioner of Police of the Metropolis. She is a Honorary Senior Lecturer in the Forensic Medicine Unit at St. George's Hospital Medical School, and was a former President of the UK Association of Forensic Physicians (formerly Association of Police Surgeons. Her principal forensic interest is the management of substance misuse especially relating to those detained in police custody.
The other contributors include Dr Jason Payne-James (a consultant forensic physician in London), Dr Roy Palmer (HM Coroner for Southern District of Greater London), Dr Deborah Rogers (Dr Stark's colleague at the Forensic Medicine Unit), Mary Newton (Forensic Sexual Assault Advisor at the Forensic Science Service London Laboratory), Prof Jack Crane (State Pathologist for Northern Ireland), Judith Hinchliffe (Forensic Odontologist in Sheffield, UK), Amanda Thomas (Consultant Community Paediatrician at St James' University Hospital in Leeds, UK), Dr Kari Blaho-Owens (an administrator at the University of Tennessee, USA, who I think is a pharmacologist based on his chapter), Dr Nicholas Page (Forensic Physician and GP in Nottingham, UK), Dr Guy Norfolk (Forensic Physician and GP in Bristol, UK), Dr Felicity Nicholson (Infectious Diseases Consultant in London), Dr Richard Shepherd (Forensic Pathologist & Senior Lecturer at St George's Hospital Medical School in London), Dr Ian Wall (Forensic Physician in Kettering, UK), and Dr Steven Karch (Assistant Medical Examiner, San Francisco, California).
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Clinical Forensic Medicine (CFM) is that branch of medicine which usually deals with the examination of living persons in relation to the law. The book is aimed at physicians and nurses working in the field of CFM, and serves as a good guide.
 ...In the preface to the 1st edition (published 2000), Dr Stark stated the purpose of the book - to make healthcare professionals "forensically aware" that Inadequate or incorrect diagnosis can have an effect on management, but also on criminal investigation and court proceedings. Thus through the 10 chapters of the book, Dr Stark and the various contributors achieve this purpose admirably well...
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In the preface to the 1st edition (published 2000), Dr Stark stated the purpose of the book - to make healthcare professionals "forensically aware" that Inadequate or incorrect diagnosis can have an effect on management, but also on criminal investigation and court proceedings. Thus through the 10 chapters of the book, Dr Stark and the various contributors take the reader through (1) the development of CFM mainly in the UK; (2) the fundamental principles of CFM; (3) sexual assault examination; (4) injury interpretation; (5) non-accidental injury in children; (6) crowd control agents; (7) care of detainees; (8) substance abuse; (9) deaths in custody; and (10) traffic medicine.
There are two reviews of the 1st edition elsewhere in this Internet journal (Volume 3, number 2, 2002) and an interview with the editor Dr Stark.
In the 2nd edition, there are 2 new chapters on topics which police officers are increasingly concerned about - restraint and infectious diseases. In addition, there has been an expansion in the several chapters - Chapter 4 on injury interpretation (a comprehensive section on bite marks added); Chapter 6 on crowd control agents (expanded details on the effects of the agents); Chapter 8 on care of detainees (useful table on head injury indications for hospital assessment added.
Chapter 1 (The History and Development of Clinical Forensic Medicine) gives an account of the development of CFM in England and Wales. There is a section on how CFM operates in some other countries, based on a questionnaire that was sent out in 2003. One of the most important conclusions mentioned in this chapter is that forensic physicians and other forensic healthcare professionals must be of an acceptable and measurable standard. It would have been good if the chapter had addressed this more comprehensively, using the UK experience.
...There is a section [in the book] on how CFM operates in some other countries, based on a questionnaire that was sent out in 2003. One of the most important conclusions mentioned in this chapter is that forensic physicians and other forensic healthcare professionals must be of an acceptable and measurable standard...
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Chapter 2 (Fundamental Principles) covers topics like consent, confidentiality, note keeping, access to health records, preparation of reports, attendance at court, duties of expert witnesses, and the potential pitfalls of forensic medical practice. This chapter is heavily (but understandably) oriented to UK law, but the principles are universally applicable.
Chapter 3 (Sexual Assault Examination) starts with the basic principles of medical examination and forensic analysis. This is followed by a methodical systems overview of forensic evidence - skin, hair, nails, oral cavity, female genitalia, male genitalia, perineal/anal area. This is followed by sections on lubricants, blood and urine analysis, and care of the complainant. The evidence base is well referenced, but I would like to see a recommended bibliography of good textbooks on the subject, particularly atlases, for the practitioner to refer to.
Chapter 4 (Injury Assessment, Documentation and Interpretation) provides a concise summary on the topic of injuries. The section on bite marks is a particularly useful introduction.
Chapter 5 (Non-accidental Injury In Children, NAI) provides a good point form introduction to the subject of NAI. It is understandable that the topic is not more comprehensively covered in a book of this nature. I would like to see a section on making practitioners aware of the controversies in relation to the medical diagnosis of physical child abuse, for example, inborn errors of metabolism, bleeding tendencies, skeletal disorders, retinal haemorrhages, falls from short heights, shaking, Munchausen syndrome by proxy.
...The chapter on Non-accidental Injury In Children, NAI, provides a good point form introduction to the subject. It is understandable that the topic is not more comprehensively covered in a book of this nature. I would like to see a section on making practitioners aware of the controversies in relation to the medical diagnosis of physical child abuse, for example, inborn errors of metabolism, bleeding tendencies, skeletal disorders, retinal haemorrhages, falls from short heights, shaking, Munchausen syndrome by proxy...
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Chapter 6 (Crowd Control Agents) covers the use of chemical restraints - pepper spray, mace, and tear gas. The discussion on treatment options is brief but useful.
Chapter 7 (Medical Issues Relevant to Restraint) deals with a topic that police officers and forensic physicians should justifiably be very concerned about. A more in-depth discussion of highly risky restraint techniques would have been useful.
Chapter 8 (Care of Detainees) reviews the physical and mental problems relating to fitness to be detained in police custody. The section on fitness to be interviewed gives a useful outline of the assessment process.
Chapter 9 (Infectious Diseases) is a much needed one that discusses the role of the forensic physician in dealing with detainees and police officer who have contracted a disease and may be unwell or infectious; and dealing with assault victims and police officers potentially exposed to an infectious disease. Diseases discussed include Hepatitis B, Hepatitis C, Hepatitis D, HIV, chicken pox, herpes zoster, scabies, lice, fleas, bedbugs, MRSA and other bacteria infections among injection drug users, infections related to human and dog bites, meningococcal meningitis, TB, SARS, Hepatitis A. In the section on universal precautions, there is a short reference to what to do when cells are contaminated with body fluids - "a professional company should be called to attend as soon as possible. Until such time, the cell should be deemed out of action". This could be expanded to be more useful, by giving an idea of what are the acceptable forms of decontamination available.
Chapter 10 (Substance Abuse) is a well-written chapter on general medical principles, and also specific drugs. The sections on opiate and alcohol abuse are particularly comprehensive. The section on Subutex could include an alert to practitioners on the potential fatal result of mixing buprenorphine and benzodiazepines.
Chapter 11 (Death in Custody) starts off with the definition and legal framework for the investigation of a death in custody. The types of death are then briefly dealt with - from natural causes, from accidental trauma, from alcohol and drug use, self-inflicted, from deliberate injuries, excited delirium (of which the definition remains elusive), and rapid unexplained death during restraint. In the last group, the patho-physiological causes include natural disease, asphyxia due to limitation of breathing (postural, hog-tieing, being sat or knelt on), and unexplained mechanism.
Chapter 12 (Traffic Medicine) deals with the medical aspects of fitness to drive - cardiovascular disease, epilepsy, diabetes, vision. The section on alcohol and driving is understandably dealt with in relation to the UK Road Traffic Act - the legal driving limit (blood, serum, plasma, urine, breath), hospital and police procedural matters, failure to provide samples - and also discussed post mortem alcohol measurements. There is also a section which deals with the effect of drugs on driving - cannabis, opiates, cocaine, methamphetamine, sedative-hypnotics, multiple drug use, antidepressants, over-the-counter preparations. The last section deals with the assessment in the field by the police (field impairment tests), and the examination to be carried out by a medical practitioner (on whether there is a condition present that may be the result of a drug).
Of the appendices, I only found appendix 6 (Drink/Drugs Driving Impairment Assessment Form) practically useful. Appendix 7 (Useful Website Addresses) only gives URL to general CFM type sites (eg Association of Forensic Physicians. General Medical Council, Medical Protection Society), and does not recommend URLs related to specific topics covered in the book. But I suppose that the determined reader would do an internet search anyway.
I was not able to assess the CD-ROM as this was not provided for review.
Overall, this is a good introductory book to Clinical Forensic Medicine, and I would recommend it as such. Experienced forensic physicians who are seeking more detailed information on specific topics would need to turn to other sources. A bibliographic reference on suitably relevant textbooks and atlases would be helpful. Understandably, there is a heavy medico-legal slant towards the practice of CFM in the United Kingdom. In jurisdictions where CFM as a specialty is less established, I would strongly recommend this as required reading for emergency physicians, trainee forensic pathologists, police officers dealing with detained personnel, and doctors who deal with assault and child abuse examination.
-Dr. Teo Eng Swee Cuthbert
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-Dr. Teo Eng Swee Cuthbert
Consultant Forensic Pathologist Singapore Email: TEO_Eng_Swee@hsa.gov.sg Dr. Cuthbert is a consultant forensic pathologist with the Health Sciences Authority, Singapore. He has a special interest in clinical forensic medicine, particularly in the areas of child abuse and family violence, and also in medical ethics and professionalism. His other appointments include Clinical Lecturer in Forensic Medicine (National University of Singapore), Visiting Consultant (Emergency Department, Changi General Hospital), and Faculty Lecturer of the Singapore Medical Association's (SMA) Professional Development Programme (Medical Ethics, Professionalism and Health Law). He is Vice-President of the Medico-Legal Society, Honorary Secretary of the Chapter of Pathologists (Academy of Medicine, Singapore). He sits on the Research and Advocacy Standing Committee and Executive Committee of the Singapore Children's Society. He is a contributing author in chapters in the textbooks The Pathology of Trauma, (Arnold 1999), Families in conflict (Subordinate Courts / Butterworths 2000), Medical Malpractice in Singapore (SMA 2002), and Forensic Medicine (Greenwich Medical Media 2003). He received a Ministry of Health commendation for work in SARS in 2003, a Service Award (Ministry of Community Development, Youth and Sports) in 2004, and the Singapore Police Force Overseas Service Medal (Tsunami) in 2005. He writes this review in his personal capacity. |
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