Milestones - Forensic Medicine
The history of the Forensic Medicine Division dates back to the 1960s, when the late Professor Chao Tzee Cheng (below), deemed to be the “Father of Forensic Medicine” of Singapore, established the Forensic Pathology section under the Department of Pathology, within the Support Services Division of the Ministry of Health.
In 1983, the mortuary was relocated to Block 9 of the Singapore General Hospital, and in 1989, it became known as the Department of Forensic Medicine (DFM) within the Institute of Science and Forensic Medicine (ISFM). The late Prof Chao Tzee Cheng was its first professional head from April 1989 to September 1997 before Dr Wee Keng Poh (below) took over the helm from September 1997 to March 2001.
When the Health Sciences Authority (HSA) of Singapore was established on 1 April 2001, DFM was renamed the Centre for Forensic Medicine (CFM) and became one of the centres within the Health Sciences Authority. Dr Paul Chui was appointed the Divisional Director.
In 2003, CFM carried out autopsies of suspected SARS cases and helped to provide a better understanding of the pathophysiology of SARS to clinicians in support of the effort to combat SARS. At the same time, the mortuary underwent extensive renovations to cater for a larger public waiting area, as well as to upgrade its biosafety systems and practices. The main autopsy suite was raised to Bio-Safety Level 2+, and an isolation autopsy suite was created with stronger biosafety engineering solutions to handle Biorisk Level 3 agents and decomposed cases.
While dealing with the SARS outbreak, CFM and its vendor learned valuable lessons and developed an innovative solution that would meet the requirements for a Bio-Safety Level 4 Containerised Autopsy Facility (below). This innovative design was subsequently patented in 2004. The mobile containerised facility was commissioned in 2005 and an active competency programme for the handling of suspected highly infectious cases has been put in place since. The facility is mobilised in biennial exercises to ensure operational competency. A histopathology laboratory was installed in 2005 to enable a more efficient in-house processing of tissues to slides.
In 2005, CFM became the first facility outside of the North American continent to be accredited under the National Association of Medical Examiners (NAME) accreditation programme. The accreditation programme covers all aspects of death investigation, autopsy work as well as operational practices, and is part of the quality assurance initiatives in enhancing public confidence in the work carried out. The department was successfully re-accredited for the period 2011-2016.
In 2008, CFM was restructured under the new Applied Sciences Group and renamed as the Forensic Medicine Division (FMD).
The Division continues to improve professional standards of practice and enhance its technical and operational capabilities. Pre-autopsy post mortem CT scanning (below) has been implemented since 2010, to provide enhanced forensic radiological imaging support to decision making and documentation of findings in Coroner’s cases. An anthropology laboratory was built to enable detailed examination of bone remains. Autoclaves were installed in 2011. A strong biosafety and workplace health and safety culture is now in place, minimising the risks of injury and biosafety hazards to staff. The Division has also appointed a number of highly qualified visiting consultants to strengthen its capabilities, particularly in the area of forensic dentistry, histopathology, neuropathology, forensic anthropology and radiology.
In strengthening the administration, two iterations of overhauling the information management and support systems have taken place over the last decade, enabling the division to track and manage cases more effectively. Further integration with other key stakeholders is being considered.
The Division has an active ongoing Continuing Medical Education program, with close attention paid to post-graduate training of both forensic pathology trainees as well as anatomical pathology (histopathology) trainees. The training of forensic pathologists includes attachments to anatomical pathology departments as well as to overseas forensic centres. A number of the consultants are actively involved as adjunct teaching staff in institutions of higher learning, and are appointed as visiting consultants to some public sector hospitals. The capabilities of technical support staff are concurrently being enhanced with more training opportunities and greater focus on particular specialisations, such as biosafety practices, radiological imaging and forensic photography.
In addition, the Division provides its forensic medical expertise and consultancy services to law enforcement and regulatory bodies, in support of cases involving living persons, such as in age estimation, non-accidental injuries in children, and cases of suspected assault, both locally and abroad.
Involvement in Mass Disasters
FMD was involved in victim identification and the accident reconstruction of the Spyros incident in 1978 and in 1986, FMD assisted in identifying the bodies of the casualties of the Hotel New World incident.
In 1997, the SilkAir Flight MI 185 crash in Palembang claimed 104 lives. An 11-man forensic team from Singapore, which included the late Prof TC Chao and Dr Wee, assisted in victim identification in Palembang.
A temporary mortuary was converted from a hangar in Palembang Sultan Mahmud Badaruddin airport (1997) where the crash victims' remains were examined.
A forensic team which comprised two forensic pathologists, A/Prof Gilbert Lau and A/Prof Cuthbert Teo along with two other forensic technical officers, were also involved in the victim identification efforts in Phuket, Thailand during the 2004 Indian Ocean Tsunami disaster.
A/Prof Gilbert Lau (centre) providing victim identification support in Phuket, Thailand (2004).
In 2011, following the earthquake in Christchurch, New Zealand, Dr George Paul, a forensic pathologist, also flew to Christchurch as part of Singapore’s Disaster Victim Identification team to assist with identification of the victim’s remains.
Dr George Paul (right) assisting with the identification of earthquake victims in Christchurch, New Zealand (2011).