Clinical Examination

This should include general observations on demeanor and behavior, a note of any injuries, speech, condition of the mouth, hiccoughs, and any smell on the breath. The cardiovascular system should be examined and pulse, blood pressure, and temperature recorded. Signs of drug abuse should be looked for (e.g., needle marks). Examination of the eyes should include state of the sclera, state of the pupils (including size, reaction to light, convergence, and the presence of both horizontal or vertical nystagmus).

A series of divided attention tests should be performed including the Romberg test, finger-nose test, one-leg-stand test, and walk and turn test. A survey of forensic physicians' opinions within Strathclyde police demonstrated concerns regarding the introduction of standardized field sobriety tests with the walk and turn test and the one-leg-stand test, causing the highest levels of concern (90). The mental state should be assessed and consideration given to obtaining a sample of handwriting. Fitness for detention is of paramount importance, and any person who is not fit to be detained because of illness or injury should be transferred to hospital and not subjected to a Section 4 assessment. If the person refuses to consent to an examination, it is prudent to make observations on his or her manner, possible unsteadiness, etc. and make written note of these.

At the end of the examination, the doctor should decide whether there is a condition present that may result from some drug. In the case of short-acting drugs, the observations of the police officer or other witnesses can be of crucial importance. In a recent case, a person was found guilty of driving while unfit resulting from drug use on the basis of the officer's observations and the results and opinion of the toxicologist; the forensic physician was not called to give evidence (91). Similarly, if the police officer reports that the person was swerving all over the road but the doctor later finds only minimal physical signs, this may be sufficient to indicate that a condition may be present because of some drug (e.g., cannabis) and that it is appropriate to proceed to the next part of the procedure.

The doctor should inform the police officer whether there is a condition present that may be the result of a drug, and if so, the police officer will then continue with the blood/urine option. Consent will need to be obtained for a blood specimen. On this occasion, 10 mL of blood should be taken and divided equally into two septum-capped vials because the laboratory requires a greater volume of blood for analysis because of the large number of drugs potentially affecting driving performance and their limited concentration in body fluids; indeed, if the driver declines the offer of a specimen, both samples should be sent.

As a means of further validating FIT as an effective means of detecting drivers who are impaired because of drugs, the University of Glasgow is carrying out further research (92). Those drivers stopped under suspicion of impairment who are under the legal alcohol limit but still considered impaired will be offered a FIT test. If they fail, they will be considered as a suspect drug driver and examined by a forensic physician and a forensic sample obtained and analyzed if appropriate. Those who pass a FIT assessment will be asked to voluntarily supply a sample of saliva, which will be analyzed for drugs. The drug incidence in the two groups will then be compared, as will the police officers' and doctors' assessments using standardized proformas. The results are awaited with interest.

In Victoria, Australia (93), forensic physicians with relevant qualifications and experience act as experts for the court by reviewing all the evidence of impaired driving, the police Preliminary Impairment Test, the forensic physician's assessment, and toxicological results and provide an opinion. So far, no expert opinions have been challenged in court. However, there were several inconsistencies in the physical examination with the drugs eventually found on toxicological examination, cases where the individual were barely conscious, where a formal assessment should not even have been considered, and missed medical and psychiatric conditions.

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