Surely the correct answer has to be that in every case we have to be sure
that the results we send out can be attributed to samples collected from the
patient specified in the report at the date and time specified. Our prime
duty is to the patient. That duty implies the need for a clear and
demonstrable audit trail for the whole analytical cycle. It is not (yet)
however the job of health care professionals to act as agents of the police.
Our first duty to is to the care of the patient and N O T to those who might
wish to prosecute him by the use of samples collected from him for the
purposes of his care when he is brought into hospital injured after a road
traffic accident. If he is capable of giving consent to sample collection
for judicial purposes then the police, with the consent of the doctor in
charge of his case can ask him for a sample for their own purposes. If he is
not capable of giving consent, then the police can approach a Judge with a
request to seize the samples collected from him for him as part of his
medical care. Every sample deserves to have an audit trail capable of being
retrospectively scrutinised so as to provide evidence of continuity that
would stand up to a searching examination in a criminal trial.
I would very strongly resist any CPA guideline that suggests certain
patients should be labelled by health care staff as the potential targets of
a criminal investigation so that their samples can be handled differently.
Robert Forrest
A R W Forrest LLM, FRCP, FRCPath,
Professor of Forensic Toxicology
University Dept of Forensic Pathology
Medico-legal Centre
Watery Street
SHEFFIELD
S3 7ES
UK
Voice +44 (0)114 2738721
Fax +44 (0)114 279 8942
> -----Original Message-----
> From: [log in to unmask]
> [mailto:[log in to unmask]]On Behalf Of David
> Williams
> Sent: 05 October 1999 19:11
> To: [log in to unmask]
> Subject: Chain of custody
>
>
> Dear colleagues,
>
> I and a number of others are in the process of carryin out a
> major revision
> of CPA's
> laboratory accreditation standards in order to ensure that they
> do not fall
> short of the ISO
> document 15189 and the relevant parts of ISO 9002.
>
> One of the topics that has cropped up is that of "chain of custody"
> documentation.
> We use this system in our own hospital where it is thought that a
> sample may
> be needed
> subsequently for medico-legal reasons, e.g. when a young child has been
> brought in
> semi-comatose and there is a possibility that he or she may have
> had a toxic
> drug
> administered by a member of the family or when a driver involved in a
> traffic accident is
> brought in with injuries and thought to be under the influence of
> alcohol to
> such an extent
> that it would have impaired their ability to drive a vehicle safely.
>
> (There is of course the added problem of the procedure through which the
> police might
> obtain either the sample or a result from it when that sample has been
> collected purely
> for medical purposes. But I am not concerned with that at present.)
>
> Should it be incumbent on hospitals under such circumstances to identify
> cases with
> possible medico-legal consequences and, in the interests of
> judicial truth,
> to institute
> a "chain of custody" policy that would stsnd up agaist cross
> exemination in
> the court
> room?
>
> I should be grateful for any views you might have.
>
> David Williams.
>
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