Responsibilities of the Radiographer in NAI Sherril Spencer Associate Professor Radiography, Kingston University &St Georges University of London Education and Research Officer IAFR

Aim: IAFR position is to promote best practice in forensic radiography through education and research. Risk Management Establishing a protocol

Risk Management Activities Protocol Production Compliance Assurance Decision making Effective operation of the imaging process and production and continuity of evidence.

Legal Responsibility of the Radiographer Responsibilities defined into two categories: Personal & Professional protection of the child Conform to child protection procedures ( available in the trust) Children Act (2004) Section 11 SoR Oct (2005) – child and the law

Undertaking imaging for diagnostic, clinical and evidential purposes. Images produced and signed record form part of the significant evidential documents (Rigney & Davis,2004; Handcock et al, 1997)

UK regulatory and legal obligations Each trust has a named doctor and named Nurse as a point of contact Radiology departments have a lead paediatric radiographer and radiologist List of named radiographers trained and willing to participate Radiographers must undertake training and yearly updates Lord Laming, RCR, SCoR,

Scope of Local service Referral pathways Relevant contact details Specific care pathways and protocols

Personal and Professional Responsibilities Exchange of information within and between agencies imperative to ensure children are safeguarded. Staff must be held accountable for the quality of the information they provide. Lord Laming, Climbe Inquiry, 2002

House of Lords ruled: “1st April 2005 Parents wrongly accused of abusing a child cannot sue doctors or social workers. That in raising such a suspicion the doctor’s sole concern should be the welfare of the child. The health professional’s common law duty of care is to the child and not to the parent. The above is also relevant to radiographers.

In event of concerns (SCoR 2004) Follow Hospital protocol for reporting concerns Immediately make detailed record of observations- show time, date and observation – signed and witnessed – keep a copy in the department. Contact the named child protection person in the trust – provide copy of observations Verbal admissions by the child should be accurately recorded

DO NOT question or interrupt the child as this may be misconstrued in a court of law Do NOT discuss with the child’s parents/carer at any stage Child protection team will decide if there should be a referral to social services. Expect feedback form child protection services. Students suspecting abuse should inform supervisor immediately and supervisor should then continue with the procedure

Producing Images and Continuity of Evidence Images produced are documentary evidence Anatomical markers placed on image prior to exposure, may consider using 2 markers If no marker on image a joint radiographer/radiologist decision to repeat Image must clearly display name, date and time of examination Initials and name of radiographer recorded on image as well as name of a witness. (2nd Radiographer)

Continuity of Evidence Authentification Identification, anatomical markers Image annotated - forensic examination 2 x Harcopies printed if digital Radiographer to sign and date hardcopy Witness to sign and date hardcopy

Hard copies produced & securely stored Witness may be health care worker or police officer/ social worker- termed appropriate witness In the case of a cadaver – responsible witness- coroners officer Appropriate witness should be present at all times during examination and at reporting Procedure for dealing with and storage of images while sub-judice Hard copies produced & securely stored Evidence of transfer of hardcopies

Authorised referral of request forms Live subjects – NHS medical officer or medical officer representing home office under legal instruction Cadavers/specimen – Instruction from coroners office

Consent Consent – Written consent required Consent withheld = N0 examination undertaken Children and vulnerable individuals may be appointed wards of court and third party consent obtained from the legal guardian

Requirements for acting as an expert witness Role: to provide a specialist opinion within the witness’s expertise Give expert testimony within professional competence only. Understand questions being asked. DO NOT provide an opinion if question is unclear or outside of competence.

State facts If asked to give an opinion it should be objective & unbiased If you change your view – ensure the instructing solicitor, the other party and the judge are made aware without delay Respect other professionals evidence – do not be affected your professional opinion.

Professional Witness – witness of fact Provide evidence of observations, actions and reasons for doing them Written or oral evidence –clear & concise Based on record of notes made at the time May include opinion but you MUST differentiate between factual evidence and opinion based on professional judgement/experience

Consider undertaking training How to write a report How to give oral evidence Declare any conflicts of interest Be aware of information security Confidentiality

References Davis. M and Reeves. P (2004) Maintaining the chain of evidence in child abuse cases. Journal of Diagnostic Radiography and Imaging 5(2) 61-68 GMC (2013) Acting as a Witness in Legal Proceedings. Available at: http://www.gmc- uk.org/guidance/ethical_guidance/21188.asp Handcock.V., Sudberry. J., Eaton. C. & Hogg. P (1997) Child Protection and Radiography: Social and emotional context. Child Abuse Review 6, 283-290 HCPC (2008) Standards of Conduct, Performance and Ethics. London: Health Care Professions Council. Hopkin. P (2012) Fundamentals of Risk Management; Understanding, Evaluating and Implementing effective Risk Management. London: Kogan Page IAFR (2013) Constitution available online to members at: http://www.iafr.org.uk/members-area/members/iafr- constitution?stage=Stage Legislation.gov.uk (1998) the Human Rights Act. Available online: http://www.legislation.gov.uk/ukpga/1998/42/contents Rigney. D & Davis. M. (2004) Radiographers in Non-Accidental Injury in Children – An Irish Perspective. Radiography 10, 7-13

SCoR (2005) The Child and the Law: the Roles and Responsibilities of the Radiographer. London: Society and College of Radiographers. SCoR (2013) Code of Professional Conduct. London: Society and College of Radiographers SCoR and AFR (2014) Guidance for Radiographers providing Forensic Radiography Services. London: Society and college of Radiographers and Association of Forensic Radiographers. Available at: http://www.sor.org/learning/document- library/guidance-radiographers-providing-forensic- radiography-services RCR/RCPCH (2008) Standards for Radiological Investigations of Suspected Non-accidental Injury. London: Royal College of Radiologists/Royal College of Paediatricians and Child Health.