The potential for the use of personal computers in clinical forensic medicine

The potential for the use of personal computers in clinical forensic medicine M. R. Moore, S. R. Moore Weyhridge Health Centre, Wevhridge, Surrey, UK SUMMAR Y. This paper describes the use of a personal computer in clinical forensic medicine. It shows how a database can be easily created, updated for each new case by unqualified personnel, and then used to provide statistical data with a minimum resource input, without the need for great computer expertise. Databases will only recognise exactly identical abbreviations. Once created they can cross-reference data and provide individually tailored statistics. Registration with the Data Protection Agency is required in the UK in order to hold personal information on file. The results of 2201 cases entered on the database of one forensic physician show high levels of drug and alcohol abuse co-existing with unemployment and homelessness. 53% of individuals brought to police stations as a place of safety (under Section 136 of the Mental Health Act 1983) were in need of admission to a psychiatric hospital. 12% of those individuals were of no fixed abode. The potential for a national database linking forensic physicians on a national basis, pooling their data thereby creating a powerful statistical tool is clear. Journal qf’Clinica1 Forensic Medicine (1994) 1, 1399143

Personal computers now widely available offer unique opportunities for forensic physicians to compile data from the cases they see, to provide useful information, and provide statistics on a range of social and demographic issues. As a Forensic Medical Examiner for the Metropolitan Police Service in London and a police surgeon for the Home Counties in the UK who started with very little knowledge of computers, the author (M.R.M.) has used a database successfully since 1991 to record his personal police caseload. Data collected since 1991, even with very limited analysis, have shown the potential in such ‘number crunching’. Databases allow a computer to sort, arrange and store information at very high speed. The information can then be accessed using criteria chosen by the operator, for example by name, date of birth or occupation. The potential this offers forensic physicians is apparent if extended nationally. Patterns of disease, social change, crime and resource allocation would be instantly available. Furthermore, the same database would hold all the information, allowing instant cross referencing of data. This article shows the ease with which personal computers can be used to undertake analysis of large

volumes of data to do ‘numerical acrobatics’. which would have previously been extremely time consuming.

METHODS Figure 1 illustrates the standardised form on which contemporaneous medical notes are recorded. The computer that was used in preparation of this study is a 386 Amstrad Personal Computer with Microsoft Works version 2.0 (Microsoft Corporation. Redmond, WA, USA) as the software. At the end of a session on duty the new records are transferred to the database (each case taking 223 minutes), following which the records are filed away in the usual manner. The database constructed by the author holds the information that was of particular relevance in his clinical practice. The database can easily be expanded to include any other factors that are deemed to be appropriate. The database has been kept simple so that the information can be easily transferred from the contemporaneous notes. Table 1 lists the information recorded for each case. As the database only recognises exactly the same configuration of symbols, it is imperative to have a set of abbreviations that are used in the same way. For example if ‘Confirmation of Death’ is abbreviated to

Correspondence to: Dr Michael R. Moore MB, BS, D(Obst)RCOG, Weybridge Health Centre. Minorca Road, Weybridge. Surrey KTl3 8DU. L’K. 139

140

Journal

of Clinical

Forensic

Medicine

Police Station Location

Surgeons Room/Cell

Name

Date

Address

sex

Age

Nationality

Occupation

Purpose of exam

Permission to exam

Police Officers pres:

Notes Completed

Exam completed

Start Exam

Time of Arrival

MHA S4 CD S5

History

RS RV IA CA CSA FI

Past History

G.P.

Drugs History Weight Eye colour

Height Hair colour Blood Site

Nystagmus Confabulation

Foeter Speech Co-ordination coins

Picking up

Mental State Temp Clothhrg Reflexes Other CNS Findings CVS

Physique Spectacles

Last meal

Time Taken

No.

Pupils Finger/Nose Finger/Finger Counting Writing

Conjunctivae Gait

Tongue

Ear Drums

Fundi

Pulse

B.P.

Respiratory System Head and neck

Abdomen Genitalia Perineum Anus Findings FI FFD I DC

NFI NFFD NI C

Drugs Fig. l-The

standardised

FD S IE NC

Opiates

LD HD LN HN

NFD NS

Alcohol

Sex Crime

form on which contemporaneous

Mileage

medical notes are recorded.

12 12 12 12

AA IOD CAP CAP0 CID FD

Computer

Table 1. Information

recorded

Detail Urban,

suburban.

rural

Month

Date Time Police station

Location Name

for each case

Sex crime Alcohol

Drugs Opiates Findings Observations

141

used in database

Abbreviation

Explanation

All the authors cases are from urban or suburban areas. Must be recorded separately in addition to date so that monthly figures can be analysed and identified.

FD NFD FI NFI AA S4

Where examination undertaken (or source of call) and whether person seen in the medical examination room or in a cell. Place where seen if not at the police station. Not used generally but necessary to have on the original database for identification and search purposes.

s5

Fit to be detained Not fit to be detained Fit to be interviewed Not tit to be interviewed Allegation of assault Examination under Section 4 of the Road Traffic Act Examination under Section 5 of the Road Trafic Act Impaired through alcohol or drugs and unfit to drive Not impaired through alcohol or drugs Insufficient evidence of impairment through alcohol or drugs Child abuse Child sex abuse Rape victim Rape suspect Indecent assault Mental Health Assessment for persons brought to the Police Station as a place safety Requiring admission to a psychiatric hospital. either formal or informal admission Not requiring admission to a psychiatric hospital Injured on duty Fit for duty Not fit for duty Complaint against the police Complainl against the police in which the alleged assaulting police officer is examined Confirm death Death confirmed Examination at the request of the CID if not falling into a specific category above Unemployed No fixed abode Low day (working hours) fee first case Low fee in working hours, subsequent caseis Low night (out of hours) fee first case Low fee out of working hours. subsequent case/s High fee in working hours, first case High fee in working hours subsequent case/s High fee out of hours. first case High fee out of hours. subsequent caseIs

Sex

Occupation Reason for attendance

for police surgeons

Note

Age Address

Table 2. Abbreviations

potential

General area (e.g. postcode) rather than full address. ( Unemployment also noted ) e.g. ‘fitness to detain’ or ‘fitness to interview’. It is assumed that if a person is fit to be interviewed then he is fit to be detained. Whether the examination was concerned with a sex related crime. If it is thought that a significant amount of alcohol has been drunk and that this relates to the reason for the examination, this is stated in the original notes. This is noted specifically rather than simply commenting that the prisoner was drunk or even under the influence of alcohol at the time of the examination. Whether the person seen has a drug habit. Whether the drug habit includes opiates. Whether they were found fit to be detained/interviewed etc.

of interest

‘CD’, the database will only pick up that confirmed death if ‘CD’ is keyed in, not ‘CD.’ or ‘CD:’ or any other variation. If variations on the abbreviation are used, each will be stored separately, thus the resulting statistics will not give an accurate picture. Table 2 lists the abbreviations used in this database.

DATA PROTECTION When this database project was first started, there was concern both by the author and colleagues about the issue of data protection. It is required in the UK, under the Data Protection Act 1984, that data users (and computer bureaus) are required to register certain details with the Data Protection Registrar. It is a criminal offence to hold personal data without being registered as a data user. Thus, it is of extreme importance that registration is undertaken. Further details for regis-

I NI IE CA CSA RV RS IA MHA S NS IOD FFD NFFD CAP CAP0 CD DC CID UE NFA LD1 LD2 LNI LN2 HDl HD2 HNl HN?

of

tration in the UK may be obtained from The Office of the Data Protection Registrar, Wycliffe House, Water Lane, Wilmslow, Cheshire. This applies to databases such as those containing personal information. When presenting findings to a public audience. care must be taken to ensure that no names are used, and that with any well publicised cases an individual’s identity is not detectable from other information on the database. Specifically, the activities covered in this report are covered by the Standard Purpose Titles: l l l l

PO16 ~ Research and Statistical analysis PO01 Personal/Employee Administration PO62 -~ Provision of Health Care PO67 ~~Health Care Administration.

142 Journal of Clinical Forensic Medicine

RESULTS

% of examinees 100

Between August 1991 and June 1994 the author saw 2201 cases for the police. Table 3 shows reasons for attendance. Table 4 shows further sub-group analysis of certain categories of examination/attendance. A comparison of reasons for detention at a police station with various social factors (unemployment, homelessness, gender) in all prisoners was undertaken, using the following headings: 1. 2. 3. 4.

Drink Drive arrests As a place of safety for Mental Health Assessment Drug users Individuals who have had a significant amount of alcohol. Figure 2 illustrates these findings.

Table 3. Reasons for attendance Reasons

No.

Fitness to detain Fitness to be detained and interviewed Section 4 and 5 (Road Traffic Act 1988) drink drive Allegation of assault Child abuse Child sex abuse Sex crimes Mental Health Assessments (under the Mental Health Act 1983) Police injured on duty Complaints against the police in which complainant examined Complaints against the police in which police personnel examined Confirmation of death Examinations at the request of the CID not fitting into above categories

964 473 207 160 5 14 37 75

(44%) (21%) (9%) (7%) (0.2%) (1%) (2%) (3%)

86 (4%) 25 (1%) 66 (3%) 71 (3%) 20 (1%)

60

60

OWrdl

Drink drive

Fig. 2--Incidence

Psychiatric

Drugs

Alcohol

of social categories within particular sub-groups.

DISCUSSION

These figures have been recorded over a period of nearly 3 years, and during that period, the numbers involved under each category, year by year, have been remarkably consistent. Certain trends have developed over the whole 3-year period. There has been a decrease in the number of rape victims and victims of child sex abuse examined, as more of these examinations are being performed in this locality by female forensic physicians. The Metropolitan Police Service (London, UK) have also established a rota of female forensic medical examiners to be called solely for this purpose. The figures produced from the 2201 cases show that examinations for fitness to detain and fitness to interview are by far the largest part of the workload and also confirm that males are seen much more frequently than females (four times more frequently in this study). With regard to people seen at the police station as a place of safety, 12% were of no fixed abode. As com-

Table 4. Sub-group analysis of certain categories of examination/attendance n (%)

Categories Total

Male

Unemployed

No fixed abode

Additional comments

1437

946 (66%)

672 (47%)

95 (7%)

Alcohol was a significant factor in 563 (39%) drugs in 340 (24%)

Drink Drive Section 4 examinations for fitness to drive Mental Health Assessments

207 87

178 (85%) 76 (87%)

37 (18%) 37 (43%)

3 (1%) 3 (3%)

66

43 (65%)

28 (42%)

8 (12%)

Illicit drugs Opiates

362 304

297 (82%) 247 (81%)

217 (60%) 118 (62%)

19 (5%) 17 (6%)

Cases in which alcohol significant factor

730

647 (89%)

2246 (34%)

37 (5%)

Fitness to be detained

66/87 individuals were found to be impaired Requiring admission to a psychiatric hospital 35 (53%) Number aged 40 yearsold or older 14 (5%)

Computer

munity care for the mentally ill increases it would be of interest to see if the number of mentally ill people brought to the police station becomes greater and if there is an increase in homelessness in this group. The high incidence of unemployment (60%) in drug users is considerably more than that in other sub-groups and it is of interest to consider whether their unemployment is the cause or the effect of their misuse of drugs. The database also has the capability of assessing issues such as recording mileage and of documenting whether fees have been claimed and/or received appropriately.

DATABASE EXPANSION It is not possible on the figures presented to show any significant trends, as the numbers are too small and the locality too limited, but a network around the country would be able to show national trends and would hold statistical weight. In order to achieve this, it is felt important to keep the database simple or it could fail by default. Several studies of caseload assessment have been reported previously in the UKlw4 - each using slightly different criteria. A study done on a nationwide basis to cover the main aspects of a police surgeon’s work would not be difficult because of the ease with which data can be collected, recorded and collated. It would. in theory, be possible to collect data from around the UK if interested police surgeons were to have a copy of the database on disc together with the standardised proforma, to fill in the disc case-by-case on their own computers, and then to return the disc each year for collation. To achieve this, the disc would be sent to the author, the database put on together with the standardised proforma (with no personal identifiers for patients seen) and the disc returned. As previously discussed, the sender would need to have Microsoft Works on the hard disc of their computer for the database to function. It would be important that the

potential

for police surgeons

143

form of the database was not altered in any way - (this could be ‘locked’ to protect it). Police surgeons could then produce their own figures for their own interest, and yearly return the disc to be collated by a dedicated computer and secretary for which hopefully funding could be found. Clearly there would have to be some form of agreement about data to be collected, the selection of appropriate areas to achieve representative samples and a regular need to up-date the database. It would be an opportunity for police surgeons and forensic medical examiners to audit their workload as is now accepted in all the medical specialties. Much consultation would be required to achieve these objectives. A nationwide database would be able to compare incidence of various categories of interest in rural, suburban and inner city areas, to compare seasonal changes and to note important trends. Subjects of particular interest (and possibly political consequence) include the incidence of people brought to police stations as a place of safety and the percentage of these requiring psychiatric admission, being of no fixed abode, chronic alcoholics or drug abusers. The database would hold information such as correlations between alcohol abuse, drug abuse. unemployment, living conditions. sex related crimes and psychiatric illness. It would enhance information already available in many other areas including regional trends in urban, suburban and rural areas and specific local problems. It would be a statistical step forward for police surgeons, potentially providing a whole array of information from a very small resource input. References Quinn B N. Applications of a computer in the police surgeon’s work. The Police Surgeon 1985: 27: 53 -60. Manser T I. Findings in medical examinations of victims and offenders in cases of serious sexual offences a survey. The Police Surgeon 1992; 38: 21-24. Payne-James J J. Work patterns of a forensic medical examiner for the Metropolitan Police. The Police Surgeon 1992: 42: 3-l -24. Franklin P J. Sexual asphyxia and acetylene. The Police Surgeon 1987: 31: 66669.