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Tuesday, September 21, 1999 Published at 01:56 GMT 02:56 UK


Better training 'prevents custody deaths'

The mentally ill and drug users are most likely to die in custody

Doctors who assess people detained by the police need better training to prevent deaths in custody, according to a forensic medicine specialist.

Dr Margaret Stark will tell a conference at the Royal Society of Medicine (RSM) on Tuesday that forensic medical examiners need more training to be able to deal with the increased number of people with drug and mental health problems found in police cells.

These run the highest risk of dying in custody.

She says changes in the law, particularly the introduction of the Police and Criminal Evidence Act in the 1980s, the care in the community policy and the increase in drug abuse, have made the job more demanding.

Forensic medical examiners now have to assess not only the physical health of a person in custody, but their mental health, any alcohol or drug problems they might have and whether they are fit to undergo questioning.

"The role has changed quite dramatically in the last few years," said Dr Stark.


She said the Metropolitan Police force in London had negotiated a new contract with doctors in the last three years which emphasised on training and continuing education.

"This is a very good initiative, but it is very variable what happens in the rest of the country," she said.

"Some areas have highly skilled doctors working with the police, but in other areas, doctors are only called out once a week or so and if they haven't got the appropriate training there may be problems.

"They only get paid per call-out so they may not consider it worth their while to be trained."

She wants to see the profile of forensic medical examiners raised and the challenges of the job emphasised to attract more recruits.

She says they have a vital role to play in helping not only those in custody, but victims of crime.

"They need to ensure the right medical evidence is taken and note injuries competently," she said. "This can be crucial for the outcome of a trial."

She added: "It is a demanding job with unsocial hours. There is the stress of being held up to scrutiny in court and people in custody may not want to see a doctor."


Dr Stark said it was also important that there was good communication between police officers and forensic medical examiners and that police officers were properly trained to spot potential health problems.

"We are dependent on them reporting potential problems to us accurately, such as if a person is asthmatic," she said. "We can then know if it is a priority case."

She says the Metropolitan Police force has a form which officer fill in regarding potential health problems.

"It is a check list and ensures the right questions are asked," she said.

The two-day RSM conference, entitled Medical Aspects of Death in Custody, will also hear from the Revolving Doors Agency which has set up three experimental projects providing support to people with mental health problems who are detained by police.

And US doctor Stephen Karch will talk about "excited delirium", a cocaine-related syndrome which he says is responsible for some deaths in custody being wrongly attributed to police brutality.

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