Doctors may be asked by the police to assess the fitness of adults and juveniles who are arrested in connection with an offense, are detained by immigration, require a place of safety (children and the mentally ill), or are remanded or sentenced (convicted) prisoners. A person in police custody is referred to as a detainee in this chapter. Detainees may have to be interviewed regarding their involvement in an offense and possibly further detained overnight for court; guidance may therefore have to be given to the custodians regarding their care.

Although various laws govern the powers of the police in different jurisdictions (1), the basic principles remain the same (2,3). If an individual who is detained in police custody appears to be suffering from a mental or physical illness and needs medical attention or has sustained any injuries whether at arrest or before arrest, such attention should be sought as soon as possible. Increasingly, the police have to deal with individuals who misuse alcohol and drugs or are mentally disordered; if the detainee's behavior raises concern, medical advice should be sought.

Custody staff should also seek medical advice if an individual requests a doctor or requires medication or if the custody staff members suspect that the detainee is suffering from an infectious disease and need advice. In some areas, when a person under arrest is discharged from the hospital and taken to a police station, a doctor is called to review the detainee and assess whether he or she is fit to be detained and fit for interview (4).

From: Clinical Forensic Medicine: A Physician's Guide, 2nd Edition Edited by: M. M. Stark © Humana Press Inc., Totowa, NJ

Table 1 Briefing on Arrival

• Discuss reason called (physical or mental illness/medication/injuries).

• Obtain details from the custody record and any risk assessment performed by police personnel or other health care professional, including reason for arrest (may be related to drugs).

• Ask the arresting officer for information regarding the circumstances of arrest (concerns regarding behavior/use of force).

• Other information may be obtained from relatives/friends/family doctor/hospital/ police computer.

• Is request to assess fitness for detention only?

• The anticipated length of detention, if known.

• Is the detainee to be interviewed?

• Are any samples required?

• Whether the detainee will be in custody overnight._

Medical assessments of detainees may be performed by either a doctor or a nurse retained to attend the police station (5,6) or by staff in the local hospital accident and emergency department (7). The basic principles on which doctors should base their conduct have already been outlined in Chapter 2. The health and welfare of detainees should be paramount, with any forensic considerations of secondary importance. The role of any physician in this field should be independent, professional, courteous, and nonjudgmental.

If the police bring a detainee to the accident and emergency department or if the health professional is contacted by the police to attend the police station, it is important to find out why a medical assessment is required. It is essential that the doctor or nurse be properly briefed by the custody staff or investigating officer (Table 1).

Fully informed consent from the detainee should be obtained after explaining the reason for the examination. Detainees should understand that they are under no obligation to give consent and that there is no right to absolute confidentiality. Notwithstanding the latter, custody staff should be given only that information necessary for them to care for detainees while they are in police detention. Such information will include details of any medical concerns, required observations, medication, and dietary requirements.

Although those detained in police custody are usually young, there remains the potential for considerable morbidity and mortality among this group. Therefore, it is essential that a full medical assessment be performed and detailed contemporaneous notes made. Obtaining an accurate account of a detainee's drug

Table 2 The DRUGS Mnemonic

Any medication prescribed by a registered medical or dental practitioner Tobacco, alcohol, illicit drugs, anabolic steroids, etc Over-the-counter purchases/alternative medicine/homeopathy Contraceptive or hormone replacement treatment Including the exact nature of the response

D octor R ecreational U ser

G ynecological S ensitivities history, including prescribed and illicit drugs, can be difficult. A useful aid to obtaining a better drug history has been described (Table 2) (8).

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