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O18. Drugs and driving — a comparison of observations made by police surgeons and police officers
Meeting abstracts and program the intention of providing a more effective outreach programme of advice and support for this vulnerable group.
O18. Drugs and driving - a comparison of observations made by police surgeons and police officers C. G. M. Fernie
Principal Police Surgeon XIK Division, Strathclyde Police and Department of Forensic Medicine and Science, University of Glasgow, Glasgow, UK The purpose of this study was to compare observations made by police officers in the Strathclyde Police area over one calendar year with examinations subsequently carried out by police surgeons using the F97 pro-forma. Previously, a number of sources 1 have expressed concern about the current system in the U K in respect of procedure under $4 of the Road Traffic Act 1988 where the police surgeon (forensic medical examiner) is asked to provide a view as to whether the ability of an individual to drive is impaired through drink or drugs. The F97 pro-forma in current use concludes with a specific requirement to reach a conclusion in relation to this diagnosis. Although approximately 50% of the typical workload of the police surgeon in the Strathclyde Police area involves seeing persons under the influence of drugs for custodial purposes, less than 2% are $4 procedures. Given that the clinical diagnosis of drunkenness is notoriously unreliable, 2 it would seem reasonable to question the relevance o f an examination procedure set out in a similar way as to that described on the F97 pro-forma in regard to a person under the influence of one or more drugs, as that procedure was developed over 30 years ago. Until recently in the U K 3 it had not been established if the Court were entitled to convict in the absence of the evidence of the police surgeon's opinion. Interestingly, in this case where the appellant's slurred and slow character of speech was described only by the police officers, the Appeal was dismissed. This is somewhat surprising in that previous studies 4 have shown that the relatively low number of only 32% of traffic officers who had received training were confident in identifying drug use in drivers, as opposed to alcohol. This compares with 61% of police surgeons. Due to the necessity of obtaining informed consent from the individuals assessed, there was only a 25% take-up in this study, with 69 questionnaires returned from the police and 58 from FMEs. Of those persons where observations were available from police officers, 81% were found to be moderately or severely impaired by the officers. However, in just over half (51.7) of
191
these cases the police surgeon subsequently concluded that their ability to drive was not impaired t~hrough drink or drugs. Although there are a number of reasons why this might be so, the conclusion of the author was that the marked discrepancy here was worrying, given that the Courts in the U K may not feel it necessary for the F M E to give evidence as to his findings post Leetham. Stark M M, Rogers D. Med Leg J 1995;63•4: 179-180. 2McLayW D S. ClinicalForensicMedicine,2nd edn. 1996:236. 3Leethamv DPP, 1998,unreported. Fleming P, StewartD. Drugs and Driving: Trainingimplications for PoliceOfficersand PoliceSurgeons,PoliceResearch Group, 1998.
O19. Consent under duress S. E. Josse
President, Association of Police Surgeons ( UK): Principal Forensic Medical Examiner, Metropolitan Police, London, UK In normal medical practice (and in this one includes non-therapeutic situations), the consent of the patient/client/party expressed or implied is looked upon as being a necessary preliminary before any medical activity proceeds. The consent has to be freely given and result from an informed judgement. There have been exceptions to this general rule, namely the treatment of a patient unable to give personal consent, e.g. young children (when a parent or guardian does so), an unconscious patient clearing requiring urgent treatment when it is assumed that had the patient been conscious he would have given consent, certain treatments to patients detained under the Mental Health Act. These particular examples revolve around therapeutic activities. Other examples are given where unwanted but avoidable consequences can occur unless consent (under duress) is given in which a medical intervention is involved, thereby questioning the validity of such consent.
020. Drugs and driving: a retrospective study of toxicology results and police reports concerning 75 drug impaired drivers. D. Ledingham
Lothian and Borders Police, Department of Forensic Medicine, University of Edinburgh, Scotland, UK There are significant problems for police and doctors in determining whether or not a driver is impaired by drugs and little knowledge as to whether such impairment is caused by prescribed or illicit drug use. A comprehensive review of 75 samples of both blood and urine from 72 different drivers, suspected of being
O18. Drugs and driving - a comparison of observations made by police surgeons and police officers C. G. M. Fernie
Principal Police Surgeon XIK Division, Strathclyde Police and Department of Forensic Medicine and Science, University of Glasgow, Glasgow, UK The purpose of this study was to compare observations made by police officers in the Strathclyde Police area over one calendar year with examinations subsequently carried out by police surgeons using the F97 pro-forma. Previously, a number of sources 1 have expressed concern about the current system in the U K in respect of procedure under $4 of the Road Traffic Act 1988 where the police surgeon (forensic medical examiner) is asked to provide a view as to whether the ability of an individual to drive is impaired through drink or drugs. The F97 pro-forma in current use concludes with a specific requirement to reach a conclusion in relation to this diagnosis. Although approximately 50% of the typical workload of the police surgeon in the Strathclyde Police area involves seeing persons under the influence of drugs for custodial purposes, less than 2% are $4 procedures. Given that the clinical diagnosis of drunkenness is notoriously unreliable, 2 it would seem reasonable to question the relevance o f an examination procedure set out in a similar way as to that described on the F97 pro-forma in regard to a person under the influence of one or more drugs, as that procedure was developed over 30 years ago. Until recently in the U K 3 it had not been established if the Court were entitled to convict in the absence of the evidence of the police surgeon's opinion. Interestingly, in this case where the appellant's slurred and slow character of speech was described only by the police officers, the Appeal was dismissed. This is somewhat surprising in that previous studies 4 have shown that the relatively low number of only 32% of traffic officers who had received training were confident in identifying drug use in drivers, as opposed to alcohol. This compares with 61% of police surgeons. Due to the necessity of obtaining informed consent from the individuals assessed, there was only a 25% take-up in this study, with 69 questionnaires returned from the police and 58 from FMEs. Of those persons where observations were available from police officers, 81% were found to be moderately or severely impaired by the officers. However, in just over half (51.7) of
191
these cases the police surgeon subsequently concluded that their ability to drive was not impaired t~hrough drink or drugs. Although there are a number of reasons why this might be so, the conclusion of the author was that the marked discrepancy here was worrying, given that the Courts in the U K may not feel it necessary for the F M E to give evidence as to his findings post Leetham. Stark M M, Rogers D. Med Leg J 1995;63•4: 179-180. 2McLayW D S. ClinicalForensicMedicine,2nd edn. 1996:236. 3Leethamv DPP, 1998,unreported. Fleming P, StewartD. Drugs and Driving: Trainingimplications for PoliceOfficersand PoliceSurgeons,PoliceResearch Group, 1998.
O19. Consent under duress S. E. Josse
President, Association of Police Surgeons ( UK): Principal Forensic Medical Examiner, Metropolitan Police, London, UK In normal medical practice (and in this one includes non-therapeutic situations), the consent of the patient/client/party expressed or implied is looked upon as being a necessary preliminary before any medical activity proceeds. The consent has to be freely given and result from an informed judgement. There have been exceptions to this general rule, namely the treatment of a patient unable to give personal consent, e.g. young children (when a parent or guardian does so), an unconscious patient clearing requiring urgent treatment when it is assumed that had the patient been conscious he would have given consent, certain treatments to patients detained under the Mental Health Act. These particular examples revolve around therapeutic activities. Other examples are given where unwanted but avoidable consequences can occur unless consent (under duress) is given in which a medical intervention is involved, thereby questioning the validity of such consent.
020. Drugs and driving: a retrospective study of toxicology results and police reports concerning 75 drug impaired drivers. D. Ledingham
Lothian and Borders Police, Department of Forensic Medicine, University of Edinburgh, Scotland, UK There are significant problems for police and doctors in determining whether or not a driver is impaired by drugs and little knowledge as to whether such impairment is caused by prescribed or illicit drug use. A comprehensive review of 75 samples of both blood and urine from 72 different drivers, suspected of being