For the Defence Book Review

I recently had the opportunity to attend the 19th World Meeting of the International Association of Forensic Sciences on the island of Madeira, Portugal.  The program included speakers from over 100 countries and was attended by over 1000 registrants.

One of the sessions of most relevance to a Canadian criminal defence lawyer was the presentation by John Gall on the intriguing topic, “Injury Interpretation in Adult and Paediatric Forensic Medicine: Potential for Errors and Fallacies and How to Avoid Them”.

In the short time allotted to him, John outlined several areas to challenge forensic evidence, including the methodology used to photograph the injuries, opinions on the force required to cause and injury and the time frame within which it may have been sustained and evidence on child abuse cases.  He mentioned that he and Jason Payne-James had edited a book on the topic and, when the time came for questions, I had to ask how I might get a copy.

The free plug paid off.  Jason promised to send me not only this book but several others he’d been involved in as well and he was as good as his word.  He’ll make an outstanding President of the World Police Medical Officers, a position he was elected to at the close of the Meeting.

“Current Practice in Forensic Medicine” is intended as the first of a series of regular, multivolume texts addressing recent advances in the field.  The intention is to cover significant topics not otherwise addressed in forensic texts in a satisfactory way as well as to discuss the critical updates and changes reflected in the development of forensic medicine.  Specialists in the particular topics are enlisted to provide the necessary overview, discussion and literature references in a manner designed so as to be relevant to an international audience.

Being cognizant of the numerous texts, and attendant costs, which are available for purchase by defence counsel, I examined this volume from the standpoint of the following criteria:

a.     Are the topics addressed the kinds of issues we have to deal with from time to time in our practice in Ontario:

b.     Are the passages which may be of use to us in cross-examining prosecution witnesses expressed with sufficient clarity and force 

        as to be useful in cross-examination, assuming that the expert is prepared to accept the text as a recognized authority in the

        field?

c.     Are there sufficient references to the literature to enable counsel to do some research for additional authorities on the subject?

I’m pleased to advise that “Current Practice in Forensic Medicine” fills the bill on all counts.

By way of example, the chapter on “Injury Interpretation: Possible Errors and Fallacies” details studies on findings alleged to be abnormal and indicative of sexual abuse, whether involving children or adults.  A series of studies is reviewed with the authors concluding:

   “(the first important message is) “even with some degree of experience in assessment of child sexual assault, there remains a    

    significant variation of opinion as to the nature of the injuries seen…Many findings once thought to be diagnostic of sexual assault

    have been identified in the normal, non-abused population.” 

Dealing with adults,they go on to detail findings which may be supportive of penetration but not diagnostic of non-consensual sexual activity.  The potential for photos of injuries to be misleading is discussed at length, the authors noting that elements such as the proper use of colour balance and scale, exposure and uniform lighting must be considered carefully by the photographer.

Timing of injuries based on colour of bruising is described as having “no scientific basis and should be avoided in child protection proceedings”, and “venturing into an opinion on the force required to cause an injury in all but the most general terms is hazardous at best”.  The authors emphasize the importance of a reasonable differential diagnosis which might otherwise account for the findings and provide a comprehensive table detailing alternative explanations for bruising, burns, fractures, genital injuries and anal fissures in children and adults.

The chapter on bone trauma in children details that “there are no particular bone injuries that are pathognomonic of child abuse” and cautions readers of the “perils incumbent in using fracture pattern alone to determine a diagnosis of child abuse.” They provide a table listing the abnormalities of mineralization, protein formation, tumours, infections and drugs which may affect bone strength in children and recommend consultation with an expert in metabolic and genetic conditions when such alternative explanations for bone fractures appear worthy of consideration.

Other chapters deal with topics such as the paedatric hymen; DNA analysis, practice and problems; self inflicted injuries and associated psychological profiles and; bite marks, the latter highlighting the involvement of Ontario’s own Charles Smith in the prosecution of Louise Reynolds.  The text includes numerous colour photos detailing the features discussed and each chapter concludes with extensive references to the literature.

And it goes beyond what one might anticipate for a text of this sort, discussing additional subjects such as the presentation of expert testimony, the ethical and medical aspects of photodocumenting genital injury, forensic investigation of biological weapon use and even the role of the forensic pathologist in aviation disasters.  Contributors including forensic pathologists and pediatricians, medical photographers and odontologists and even a Professor of Law and Forensic Medicine.

It should be pointed out that “Current Practice in Forensic Medicine” is not intended to serve as a comprehensive text on all aspects of the subject.  That being said, given the challenges in locating an expert willing and able to be called by the defence on an issue involving forensic medicine, this text would certainly be a valuable addition to the criminal practitioner’s library.  It can readily be anticipated that developments in forensic science will continue to call into question long-held beliefs that may not have received sufficient study to be considered reliable within the principles of evidence-based medicine.  Accordingly, we will need to rely on the editors to continue with their efforts in bringing such advances to the attention of those who may most benefit from this valuable form of enlightenment.