Rape already arouses serious anxiety because so few attacks are reported to the police, conviction rates are low, and victims are subject to intrusive questioning in court. But now concerns are growing that rapists are escaping justice because doctors are failing to properly examine victims or record their injuries, depriving police of crucial forensic evidence. In other words, senior doctors fear that some forensic medical examiners (FMEs) are simply not up to the job.
Examining sexual assault victims requires skill, sensitivity and attention to detail, according to Dr George Fernie, president of the Faculty of Forensic and Legal Medicine. He explains: "They could have bruising to the body or injuries to the genitalia, or bruising consistent with being grabbed by the upper arms and held, or a woman may have had her legs forced apart. The person needs to be carefully examined to ensure you don't miss those injuries, and that you take the correct swabs for signs of an assailant's DNA."
Specialist police doctors or police surgeons, as forensic medical examiners are also known, look after the victims of crime as well as the health of suspects in custody. But Fernie is worried at the number of cases in which the forensic doctor has missed injuries, failed to take swabs, or has not documented their findings fully – undermining a prosecution. "The Crown Prosecution Service tell us that sometimes in a sexual assault case they can't proceed with criminal charges because of poor- quality medical evidence," says Fernie. "Some perpetrators are going free because there isn't enough evidence to prosecute – because the examining doctor hasn't done his job right."
Police forces used to employ their own regular medical examiners who were often experienced local GPs. But Dr Michael Wilks, chairman of the British Medical Association's forensic medicine committee, says they are increasingly outsourcing to private firms to save money – a policy that has coincided with a drop in standards.
Wilks, a forensic physician for both the Metropolitan and Thames Valley forces, says: "We are seeing extreme variation in the quality of the service provided. Thames Valley has its own team of doctors, but the Met abandoned that system in 2009 and instead now contracts with doctors independently. It is meant to have 17 FMEs on duty across London 24/7 to deal with offenders' and victims' health, but at night it's quite common to only have 10."
While Fernie also calls this process "outsourcing", it is, in effect, privatisation. More than half the 43 police forces in England and Wales have made that switch, he believes. "Outsourcing has perpetuated the fiction that 'any old doctor will do' when it comes to forensic medical examination. That has led to a potential lowering of standards when the doctor concerned hasn't the necessary knowledge, skills and experience," he says.
Delays in treating prisoners are also now sometimes so long that some custody officers send them to the local A&E unit. So both offenders and victims can end up paying the price of a system that needs urgent repair.
The General Medical Council has investigated 16 complaints against 15 different FMEs in the past five years. It is a small number, but suggests problems are arising in at least some cases where details of the victim's injuries help decide if someone is convicted. Last year the GMC suspended Dr Edet Etop Ukpong Dan from working for a year after serious errors in his handling of two victims in 2007. He was working with a doctors agency called Medacs for the local police force. In both cases Ukpong Dan admitted he did not take important swabs or specimens from the victims. Senior doctors say too many FMEs are poorly trained, and the GMC's conclusion in this case seems to bear this out. "The panel has noted that prior to your work with Medacs you practised for over 20 years in the field of orthopaedics and therefore had no obvious experience, which might be regarded as relevant to the practice of forensic medicine," the GMC said. "Given this lack of relevant experience, it might be said that your decision to respond to Medacs' search for FMEs was unwise, and it might also be wondered why Medacs thought it appropriate to employ you. In short, you were out of your depth."
Dr Kameron Kader, who worked for Medacs as an FME in Bradford, was struck off by the GMC in 2007 after he threw into a rubbish bin carrier bags containing records of scores of blood tests, statements and the intimate examination of many victims of sex crimes. Although the records were torn into two or four pieces, all the victims were identifiable. It was a huge breach of patient confidentiality which, the GMC said, "had the potential for serious harm to a large number of people".
In April, Dr Imraan Jhetam, who worked for Devon and Cornwall Constabulary as an FME through Medacs, received a warning from the GMC over his performance in a sexual assault case, including an inadequate examination, lack of detailed notes and failure to take the right samples. Last year Dr Edward Oshinyemi had conditions imposed on his work as a doctor, including a ban on working as an FME, after the GMC labelled his behaviour in a case involving the alleged sexual assault of a three-year-old girl "inadequate, inappropriate, misleading [and] dishonest". He too worked for Medacs. Dr Hisham El-Baroudy, an ex-FME, is currently facing criminal charges of gross negligence manslaughter over the death of a man in police custody in London in 2009.
One solution to this problem may be for more sexual assault referral centres, specialist 24/7 centres for victims of rape and sexual attacks. Says Fernie: "FMEs' ability to document and interpret injury while working in a sexual assault referral centre, which physically may be minor – although the consequences can be major – must be an advantage."
