Teleconferencing model for forensic consultation, court testimony, and continuing education

Abstract

A medical center-based forensic clinic that provides the necessary comprehensive consultation, continuing education, court testimony, and clinical services through an applied model of teleconferencing applications is addressed. Telemedicine technology and services have gained the attention of both legal and clinical practitioners, examining trends and models of health care for underserved populations, and identifying where consultation with a team of professionals may benefit service providers in rural communities. The contribution offered herein provides an understanding of the history of the development of the clinic, a theoretical model that has been applied to a clinical forensic program that employs telepsychiatry services, and the ethical and malpractice liability issues confronted in using teleconferencing services. This model is examined through a child and adolescent forensic evaluation clinic. The goals of this model are offered, as are a number of applications within the broad spectrum of services utilizing telemedicine. Finally, changing patterns are addressed in clinically based health-care delivery for criminal justice, social services, and forensic mental health.

Forensic telepsychiatry : a possible solution for South Africa?

“…18 In the contexts of assessment of competence to stand trial or early identification of mental illness and diversion from the judicial system, as in the court diversion system in Australia, forensic telepsychiatry is currently limited to a few developed world countries. These services all appear to be driven by common needs, such as the high prevalence of mental illness among offenders 1 , poor facilities to manage mental illness in prisons, the shortage of beds assigned to the mentally ill in secure hospitals 1,19 , the shortage of skilled professionals to conduct forensic assessments which is worse in remote and rural areas 4,6,7,9,19 , and the practice of siting correctional facilities in rural areas. These are problems common to South Africa and many other African countries.…”

“…It improves timely access to specialist skills 1,4,9,12,19,20 , reduces costly transportation and escort of prisoners to urban areas and specialist hospitals for assessment, or transport of specialists to correctional facilities 1,7,10,12,19 , reduces unnecessary or inappropriate admission to hospitals 12 , and reduces risk to psychiatrists by allowing them to perform assessments without having to enter prisons or secure hospitals.…”

“…12 Costs can be contained by using existing infrastructure for other activities such as education, administrative meetings, other judicial activities and other clinical services 4,9,10,12,15,22,23 and avoidance of establishing stand alone forensic telepsychiatry services. In the United Kingdom 4 , Australia 1,11 and in many states in the US 5 , courts and prisons already have videoconferencing facilities used for judicial purposes and advantage is taken of this.…”

“…These include licensure, liability, informed consent, confidentiality, privacy, record keeping, prescription and data security and storage. 4,5,9,12,26 Licensure is an issue in those countries where practitioners are limited to practice in only certain jurisdictions within the country, such as in the United States. It is also an unresolved issue in the international practice of telemedicine across borders.…”

“…In those cases in which State and Federal prisoners had been involved in telemedicine or telepsychiatry, none attacked either the doctor involved or the use of videoconferencing. 9 In the US Military, one case was reported in which the use of videoconferencing was the basis of an appeal and, "The court ruled that the use of videoconferencing for a mental competency hearing did not violate due process and that there was no legal basis for appeal based on interview modality." 6,9 In the UK, Saleem states that, "...information attained during psychiatric interview will not be undermined by the legitimacy of video link as a means of interview" and goes on to quote the senior Presiding Judge for England and Wales on the use of telepsychiatry, "I can see no basis on which a sensible legal challenge to the process could be mounted, provided the interviews are conducted in circumstance of confidentiality and there are no issues over sufficiency of time and ability to communicate."…”