Mid North Coast Local Health District (MNCLHD) centralised requests for expert witness certificates (EWCs) and developed a new review process in collaboration with staff and NSW Police.
Aim
To reduce the number of poor-quality EWCs released to police from Sexual Assault Services in MNCLHD to zero, by April 2017.
Benefits
- Improves the quality of EWCs across the local health district.
- Reduces the risk of miscarriages of justice for people in MNCLHD.
- Streamlines and centralises the request and review process.
- Enhances collaboration between NSW Police and Sexual Assault Services.
- Improves the skills and knowledge of staff to respond to EWC requests.
Background
Doctors working in sexual assault services provide medical and forensic assistance to people who have been sexually assaulted. When cases go to court, these doctors write EWCs which are used by prosecution and defence lawyers to prepare their cases. The quality of EWCs can impact the court’s decision and, if they are of a poor quality, can result in a miscarriage of justice.
Prior to the project, clinicians providing ongoing education for sexual assault doctors and nurses in MNCLHD were aware that the quality of EWCs varied and were sometimes poor. At least one complaint had been made to the Health Care Complaints Commission about a poor quality EWC, which was thought to have negatively impacted a criminal court case involving child sexual abuse. As a result, it was determined that a review process was required to improve the quality of EWCs in MNCLHD.
Implementation
- A central email address was set up for EWC requests, with a sexual assault manager and senior child protection health information officer allocated responsibility for monitoring incoming emails.
- A checklist was developed for staff responding to EWC requests, to ensure the doctor or sexual assault nurse examiner has all the information required to write the certificate.
- A database was created to measure the time taken to respond to EWC requests, ensuring there are no unnecessary delays.
- NSW Police was made aware of the changes to EWC requests, to ensure the new process is followed by all police staff and EWC requests are not sent directly to individual doctors.
- Staff position descriptions were updated to ensure responsibilities are consistent with the new process.
- Consultation with clinical leads at each sexual assault service in NSW was undertaken and a new form and process was developed. It provides doctors with a standardised approach for reviewing EWCs, such as whether the language is appropriate for the courtroom and whether bias has been avoided.
Status
Sustained – The project has been implemented and is sustained in standard business.
Dates
December 2016 – April 2017
Implementation Sites
Sexual Assault Services, MNCLHD
Partnerships
Clinical Leadership Program
Evaluation or Results
No EWC requests were received during the project. A number of requests for Director’s Certificates were received, however these are completed using a different process. As such, historic cases that were informally reviewed were used to measure the success of the new process. This was not ideal, as medical practice and case law have developed over time.
Five reviewed EWCs and five unreviewed EWCs were sent to an external specialist in forensic medicine and a lawyer with sexual assault expertise for independent assessment. Neither expert knew which certificates were reviewed and which were not. The lawyers and forensic physician unanimously described all five unreviewed certificates as not fit for purpose.
The physician found all five historic certificates were fit, with an overall quality score of 4/5. The lawyer felt only three were fit, with an overall quality score of 4/5. An internal review of the two non-fit certificates concluded that this was a reflection of their dated nature. Overall, the project showed that not reviewing certificates carries a significant risk of poor-quality EWCs. While it was unfortunate that current EWCs could not be reviewed, the retrospective data was useful.
Lessons Learnt
To review EWCs reliably, MNCLHD must have effective processes in place so that police can make requests through health channels and not by approaching doctors directly.
Further Reading
- Kramer K, Freedman E, Stevenson C. Medical and forensic management of adult sexual assault. Sydney: NSW Education Centre Against Violence; 2017.
- Kariyawasam U. The impact of peer review on paediatric forensic reports. Forensic and Legal Medicine 2016;43:42-7.
Contact
Dr Kathy Kramer
Medical Governance
Director Sexual Assault Service and Child Protection, MNCLHD
Phone: 02 6656 7200
Email: kathleen.kramer@ncahs.health.nsw.gov.au
