Provision of clinical forensic medical services in Australia: A qualitative survey 2011/12

Evaluation of forensic medical history taking from the child in cases of child physical and sexual abuse and neglect

BACKGROUND

Suspected child physical abuse, sexual abuse and neglect are not uncommon presentations. As part of the assessment of these cases, a forensic medical history may be taken. This forensic history is used not only to determine the steps necessary to address the child's wellbeing but also to direct the forensic examination. Currently, there is no clear consensus on whether or not a forensic medical history should consistently be considered an integral element within the paediatric forensic evaluation. This study examines the value derived by the medical practitioner taking a forensic medical history rather than relying on hearsay evidence when a child presents for an assessment.

METHODS

A retrospective review of paediatric cases seen by the Victorian Forensic Paediatric Medical Service (VFPMS) between 2014 and 2015 was undertaken. 274 forensic case reports were reviewed and the data was entered into an Excel spread sheet and analysed using chi squared tests within STATA^®.

RESULTS

With increasing age of the child, a forensic medical history is significantly more likely to be taken. Additional information is made available to the medical practitioner what would otherwise have been provided if the medical practitioner relied only on the interview conducted by the police. Discrepancies observed between the official third parties (police or child protection) report of what a child has said and what the child says to the medical practitioner decrease with age, as do discrepancies observed between the child's version of events and a third party's (eg. parents, caregivers, friends) version of events.

CONCLUSIONS

The study showed that by taking a forensic medical history from the child additional information can be obtained. Further, that there is a value in the examining medical practitioner taking a forensic medical history from children in cases of child physical and sexual abuse and neglect.

Does the forensic physician have a role beyond injury documentation and specimen collection in Australia? A personal view

Clinical forensic medicine (CFM), as a single discipline, encompasses a number of areas of medico-legal practice including injury interpretation, management of sexual and physical assault cases (both adult and child; alleged victim and offender), mental health issues, traffic medicine, custodial medicine and toxicology. The cases are usually alive but in some jurisdictions the forensic practitioner also engages in death investigation with some undertaking autopsies. During the last 20-30 years, the discipline has fragmented with areas being hived off to other medical specialist disciplines and, importantly, to nurses. Any user of forensic services wants the best value for money particularly when under financial pressure. To this end, governments have sought savings through privitisation of services and/or the utilisation of less qualified personnel to undertake some or all of the tasks. This places CFM at a crossroads. To ensure survival, the discipline needs to reconsider its direction and performance, convince stakeholders of its relevance and importance, and lift its profile within the legal, academic and medical world. It will need to think outside the square, place greater emphasis on the 'clinical' and relinquish those activities that are better undertaken by less expensive and qualified personnel. The establishment of meaningful research and academic centres are essential. The loss of and/or failure to grow CFM will result in the loss of a skills base and the subsequent potential for the miscarriages of justice.