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Social aspects of chain of evidence. Dr Jan Welch King’s College Hospital. The Haven, Camberwell. 24/7 sexual assault referral centre Opened May 2000, 24/7, for adults initially 12 boroughs of South London Part of Department of Sexual Health

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Social aspects of chain of evidence

Social aspects of chain of evidence

Dr Jan Welch

King’s College Hospital


The haven camberwell
The Haven, Camberwell

  • 24/7 sexual assault referral centre

  • Opened May 2000, 24/7, for adults initially

  • 12 boroughs of South London

  • Part of Department of Sexual Health

  • Provided in partnership with the Metropolitan Police

    2 further centres opening 2004


Stis and rape
STIs and rape

  • STIs found in 4-56% of raped women

  • Often reflect pre-existing infection

  • Character denigration in court

  • STI evidence seldom useful in the sexually active


Stis as evidence
STIs as evidence

Likely to be relevant in:

  • abused children

  • sexually inexperienced adults or orifice

  • the elderly


Sti evidence and laws on disclosure
STI evidence and laws on disclosure

  • Historical protection of Venereal Diseases Acts limited

  • Identified infections may become available to courts

  • Prophylactic antibiotics increasingly used


Stis as evidence medico legal considerations
STIs as evidence: medico-legal considerations

  • Choice of tests

  • Management of the sample


Choice of tests
Choice of tests

Ideally:

  • Well validated

  • Capable of confirmation eg culture

    But newer methods (NAATs) increasingly used for eg chlamydia


Management of the sample
Management of the sample

  • Chain of evidence

  • Storage of sample (ideally in duplicate at –70o)

  • Additional tests eg reference laboratory for typing

  • Overseen by senior

  • Ideally ‘M/L’ protocol agreed with clinicians


Case study lucy aged 8

Case study: Lucy aged 8

Lucy presented to her GP with a discharge 5 days after a bicycle accident

Genital swab sent to laboratory

(no chain of evidence)

Result: +ve for chlamydia


Lucy 2

Lucy 2

Social services alerted

Lucy taken into care

Lucy assessed by community paediatrician and forensic medical examiner


Lucy 3

Lucy 3

Lucy denies being abused

Repeat swab taken for chlamydia

Result: negative

Lucy returns home


Stis in children
STIs in children

  • Sexual abuse – always consider

    but also

  • verticaltransmission

  • accidental transmission

  • close non-sexual physical contact

  • voluntary sexual activity


Stis in children management
STIs in children - management

  • Microbiology / GUM / paediatrics

  • Screen for other infections

  • M/L – chain of evidence and procedures

  • Tests – predictive value in population

  • Additional – biopsy / typing / cultures

  • Reference laboratory

  • Care with drugs


Case study saffron aged 4
Case study – Saffron aged 4

15th March

  • Childminder notices discharge on child’s underwear

  • GP treats for thrush and takes swab

    22nd March

  • Gonorrhoea culture positive - PPNG

  • Child given ciprofloxacin

  • Social services notified


Saffron 2
Saffron 2

26th March

  • Medical examination shows hymenal tear

    7th April

  • Child protection conference

  • Mother threatens to abscond to Jamaica

  • Saffron taken into police protection


Saffron 3
Saffron 3

April

  • Mother and estranged father attend different GUM clinics for tests

  • Mother has PPNG (recent partner from Jamaica but he had no contact with child)

  • Father has fully sensitive strain of GC


Saffron 4
Saffron 4

November

  • Proceedings heard in High Court

  • Father denied abuse

  • Mother shared bed, bath, towels and flannels with Saffron

  • Reference laboratory – typing showed father had unrelated strain


Saffron 5
Saffron 5

November

Decision by court

  • Evidence of abuse but father not implicated

  • Saffron returned to mother with support and supervision


Stis and evidence summary
STIs and evidence - summary

  • May not be straightforward

  • Diagnosis of an STI can have major implications

  • M/L procedures useful but laboratory procedures crucial

  • Need to determine role of new technologies

  • Multi-professional considerations


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