Forensic Medical Expertise Research Articles

Mathematical modeling of the kinetics of a single intake of ethanol

The aim of the study is to construct a kinetic equation of zero-order ethanol elimination with first-order absorption, taking into account the presystemic metabolism of ethanol, with the possibility of determining the errors in estimating the parameters of the model, as well as the implementation of the model in the format of a computer program. Analytical mathematical modeling of the kinetics of a single oral intake of ethanol has been performed. A mathematical model of the kinetics of a single intake of ethanol with its zero-order elimination, absorption and first-order presystemic metabolism has been developed. A method is proposed for estimating the limiting absolute errors of the kinetic parameters of the constructed model based on the summation of the partial contributions of the initial physical quantities. The complex of the developed computational procedures is implemented in the format of the «Alcohol Calculator V 1.0» computer program. The conclusion is made about the expediency of using the developed information and computing technology in the forensic medical expert assessment of acute alcohol intoxication.

Mathematical modeling of the kinetics of a single intake of ethanol

The aim of the study is to construct a kinetic equation of zero-order ethanol elimination with first-order absorption, taking into account the presystemic metabolism of ethanol, with the possibility of determining the errors in estimating the parameters of the model, as well as the implementation of the model in the format of a computer program. Analytical mathematical modeling of the kinetics of a single oral intake of ethanol has been performed. A mathematical model of the kinetics of a single intake of ethanol with its zero-order elimination, absorption and first-order presystemic metabolism has been developed. A method is proposed for estimating the limiting absolute errors of the kinetic parameters of the constructed model based on the summation of the partial contributions of the initial physical quantities. The complex of the developed computational procedures is implemented in the format of the «Alcohol Calculator V 1.0» computer program. The conclusion is made about the expediency of using the developed information and computing technology in the forensic medical expert assessment of acute alcohol intoxication.

Current state of the problem of forensic medical determination of the time since death (literature review)

Determining the time since death is a key issue for forensic authorities when working with a corpse at the scene of death. After all, it is precisely the accurate data provided by the forensic medical expert that makes it possible to answer important questions during the investigation of a crime. Despite the enormous amount of fundamental research conducted over many decades and devoted to the exact establishment of the time since death, this problem has not been solved yet. Despite the obtained promising results, most of the proposed methods were characterized as unreliable due to sensitivity to the influence of many external and internal modifying factors. In our opinion, it is promising to combine different methods of postmortem interval diagnostics for the simultaneous analysis of several components, which will allow taking into account various causes of death, pathological conditions and other factors that can influence the obtained result.

CURRENT ISSUES OF FORENSIC MEDICINE IN THE CONDITIONS OF MILITARY ACTIONS

Forensic medicine is a science that uses medical and general biological knowledge to solve issues that arise in the practice of law enforcement agencies. Therefore, the range of issues studied by forensic doctors is quite wide. This includes the study of death and cadaveric changes (forensic thanatology), the study of injuries (forensic traumatology), forensic medical examination of living persons regarding bodily injuries, sexual crimes, etc., forensic medical examination of material evidence, identification of a person, forensic medical examination in cases of medical errors and offenses and many others. The fact of military operations on the territory of Ukraine requires that in the training of medical students and interns in the field of «forensic medical examination», special attention should be paid to the issues that a doctor may encounter both in the combat zone and in rear health care facilities. After all, in the conditions of martial law, not only military personnel, but also medical workers are on the front line in the fight against military aggression. Therefore, it is important to pay great attention to the training of medical personnel at a high level, regardless of the difficulties faced by medical education institutions under martial law. That is why this article highlights the key points and problematic issues that must be paid attention in the course of training students and interns at the Department of Forensic Medicine and Medical Law. Algorithms for solving problematic practical tasks that arise before the forensic medical expert in the conditions of martial law are also proposed to ensure high professionalism and reliability of the performed forensic medical examinations. Thus, focusing the attention of forensic medics on the main principles and algorithms, highlighting and discussing problematic issues related to the actions of forensic medics in wartime, namely those issues related to the order of dissection of corpses, their identification and description of bodily injuries have the priority place and are able to significantly facilitate the work of forensic medical experts in such a difficult time. After all, every forensic medic who competently performs his work before conducting active military operations must be familiar with a clear algorithm of actions, which does not contradict the main provisions of Resolution No. 205 dated 03.05.2022 "On approval of the procedure for ensuring the collection of bodies (remains) of fallen military personnel of the state- of the aggressor (the Russian Federation), as well as illegal armed formations, in particular from the temporarily occupied territories in certain areas of the Donetsk and Luhansk regions", which was approved by the Cabinet of Ministers of Ukraine with the beginning of a full-scale military invasion of the territory of Ukraine by the aggressor state. This resolution regulates the actions of military administrations, the territorial defense forces of the Armed Forces, the National Guard, the National Police, the State Emergency Service, representatives of the relevant expert (medical) services, interested bodies and public organizations (associations), which are aimed at ensuring collection in the territories of military operations (armed confrontation) unburied bodies (remains) of fallen servicemen of the aggressor state (Russian Federation), as well as illegal armed formations, in particular from temporarily occupied territories in certain areas of Donetsk and Luhansk regions (hereinafter - bodies), in order to prevent the deterioration of the sanitary and epidemic situations, the occurrence of dangerous infectious diseases on the territory of Ukraine.

ПРАВОВЕ РЕГУЛЮВАННЯ ТРАНСПЛАНТАЦІЇ В УКРАЇНІ: СУЧАСНИЙ СТАН ТА ПЕРСПЕКТИВИ РОЗВИТКУ

The article is devoted to the characteristics of the current state and existing problems of the legal regulation of transplantation in Ukraine, as well as to the formulation of scientifically based recommendations aimed at its improvement. The works of Ukrainian scientists devoted to certain issues of legal regulation of the transplantation of anatomical materials in Ukraine were analyzed. The latest positive changes in the national legislation in this area are characterized. In particular, it is noted that the identified problems were partially resolved thanks to the adoption of the Law of Ukraine "On Amendments to Certain Laws of Ukraine Regulating the Transplantation of Anatomical Materials to Humans" dated 12/16/2021 No. 1967-IX. The positive provisions of this law were noted. On the basis of the analysis of the current legislation in the field of transplantation of anatomical materials to a person, its shortcomings and gaps were identified and determined. It is about: 1) proper formulation of the principles of transplantation; 2) determination of the legal status of the authorized person of a specialized state institution in the field of transplantation of organs, tissues and cells, 3) the involvement of a forensic medical expert in the extraction of anatomical materials; 4) the issue of legal responsibility for violations of legislation in the field of transplantation of anatomical materials to humans; 5) proper legal regulation of xenotransplantation, etc. It was concluded that despite the positive developments in the field of transplantation, which were caused by the adoption of Law No. 2427-VIII, there are still many issues in Ukraine that require urgent solutions.

Causal Relationship in Cases Related to Compensation for Harm Caused by Improper Provision of Medical Services

The paper studies some peculiarities of establishing by the court of a causal relationship between the unlawful action (inaction) of the tortfeasor and the resulting harm in considering compensation cases for harm caused due to improper provision of medical services. Having analyzed the judicial practice, the author considers the way the court classifies a legally significant causal relationship. The author raises a question about the significance and assessment by the court of a forensic medical expert opinion in establishing a causal relationship between defects in the medical service provided and the resulting harm. The experience of establishing a causal relationship in the litigation of England and Germany has been studied. The use of the doctrines of res ipsa loquitur, сondicio sine qua non, «fully managed risks» in the process of establishing a causal relationship when considering this category of cases, taking into account the specifics of the organization of medical activity, including in complex clinical cases, is considered.

Forensic significance of X-ray data in the definition prescription of diaphyseal fractures: a case from expert practice

BACKGROUND: Determining the prescription of fractures is important when conducting a forensic medical examination of victims, accused persons, etc. This allows the expert to immediately determine the causal relationship of the skeletal injury found in the sub-expert with the events described in the decision on the forensic medical examination, especially in cases when the conducted examination according to medical documents may be concealed or distorted of the incidental circumstances; thus the investigating authorities need to decide on the case and establish the truth. Often, medical documents, especially in cases of a single request for medical help, do not contain enough information about the clinical picture of the fracture, with limited or missing descriptions of the local status. In such cases, one of the most important sources of information for the expert is radiography data (radiographs in electronic form or on X-ray film and computed tomograms), which the study allows the expert to conclude the mechanism of injury and the prescription of fractures. The study of literary sources on this topic did not reveal the exact criteria for determining the prescription of fractures based on the study of the X-ray examination results in the forensic aspect.
 CASE PRESENTATION: The description of a case from practice was provided. In our practice, a case with fractures that did not correspond to the events of the described incident in the resolution as found by the sub-expert, and these fractures were not regarded by the surgeon as old and unrelated to the specified circumstances of the case. The presented radiograph examination allowed the forensic medical expert to determine the time frame of the detected fractures and establish the absence of a causal relationship of this injury with the events specified in the resolution.
 CONCLUSION: The analysis of this expert case allows us to conclude the importance of examining the radiography data by the forensic medical expert to determine the description of fractures.
 SIGNIFICANCE FOR FORENSIC MEDICINE: The presented case from the practice demonstrates the need for a critical approach of the forensic expert, both to the presented medical data and the information contained in the materials of the preliminary examination or criminal case, as well as the importance of an independent study of the X-ray examination results of the subject.

International congress: “Topical issues of forensic medicine and expert practice-2022”

On April 2021, 2022, the International Congress: Topical Issues of Forensic Medicine and Expert Practice-2022 was held in Moscow based on the Moscow Regional Research Clinical Institute named after M.F. Vladimirsky. The International Congress has once again gathered a pool of leading experts in the field of forensic medicine from different countries. The International Congress was attended by leading practitioners and prominent scientists, department heads, and heads of forensic medical expert institutions. Specialists from Germany, Italy, Portugal, Japan, Turkey, the Czech Republic, Slovakia, Belarus, Kazakhstan, Turkmenistan, Kyrgyzstan, and other countries expressed a desire to share their experiences with colleagues and discuss the most pressing problems of forensic medicine. The scientific program of the congress was compiled, emphasizing the latest achievements in various fields of forensic medicine and related disciplines. Program reports on trends and ways of world forensic medicine development in the XXI century were presented at the plenary sessions, and the most promising areas of expert research in the field of thanatology, laboratory diagnostics of pathological processes, experts, and law enforcement practice of harm caused to human health were discussed at specialized sections.

Estimation of the postmortem interval by the method of finite element modeling of postmortem heat transfer in human head

Aim to develop a two-dimensional finite element model (FEM) of postmortem heat transfer in head to determine the postmortem interval (PMI).
 Material and methods. The finite element modeling of the geometry and postmortem heat transfer in an adult's head was carried out using the ELCUT 6.5 Student application. A hemisphere with a radius of 98 mm was used as a geometric model of the cerebral part of the head, consisting of evenly distributed homogeneous layers: the scalp, the bones, the cerebrospinal fluid of the subarachnoid space and the brain. For FEM validation we used the evaluation of the cooling curves convergence obtained by FEM and by the Marshall Hoare and Newton Richman cooling laws under conditions of constant and linearly varying ambient temperature.
 Results. A scalable two-dimensional FEM for finding the postmortem temperature field of the head was developed. The model allows for accounting any changes in the ambient temperature, combined heat exchange conditions and the dependence of thermophysical parameters of biological tissues on the ambient temperature. The FEM check-out under standard cooling conditions showed the maximum convergence of the results of finding the postmortem temperature field with the results of valid phenomenological mathematical models when only convective heat exchange with a heat transfer coefficient equal to 6 W/(м2К) was set on the outer edge. The developed FEM is characterized by the stability of the results of determining the prescription of death coming to deviations of the initial temperature field of the calculated region from its physiological level.
 Conclusion. It is advisable to use the proposed FEM in the forensic medical expert practice when determining the prescription of death coming.

CONCEPT OF PROFESSIONAL TRAINING FORENSIC EXPERTS IN UKRAINE

The authors analyzed foreign experience in the training of forensic experts. This experience is compared with the corresponding training system for forensic doctors that existed in Ukraine until 2022. A comparative analysis of the working curricula of pathologists and forensic doctors was carried out. It is shown that the proposed system of training forensic medical experts based on a three- month specialization of pathologists can potentially lead to a decrease in the qualifi cation level of forensic medical examination in Ukraine, since such a training period is not enough. It is proposed to adjust the training program for pathologists from this year by combining the educational material of pathological anatomy, clinical pathophysiology and certain sections of forensic medicine, with the expansion of the competencies of a pathologist. The authors also propose to change the name of the specialty from «Pathological Anatomy» to «Pathology». The teaching of forensic medical examination during the postgraduate training of pathologists should be carried out by highly qualifi ed teachers in the specialty «Forensic Мedicine».

TO THE FORENSIC MEDICAL SUPPORT OF KIDNEY TRANSPLANTATION IN ST. PETERSBURG

The issues of organ and tissue transplantation are currently one of the urgent tasks of clinical medicine. This also applies to the practice of treating kidney diseases, where one of the effective methods is the transplantation of a donor organ. However, despite extensive practice to date, all the problems of organizing this process have not been solved. The aim of the work was to study the history of development and prospects of interaction between transplant doctors and forensic medical experts during kidney transplants in St. Petersburg. The period of the early 2000s to the present was analyzed. As a result of the study, the main difficulties of such joint work in the implementation of kidney transplants at different stages of the analyzed period were revealed. It is shown that the main condition for successful transplantation activity is adaptation to the requirements of society, detailed awareness of the requirements of laws and other governing documents, as well as strict and strict compliance with them. Only the joint efforts of transplantologists, city health managers, specialists of the city's Forensic Medical Examination Bureau and law enforcement agencies made it possible to create and develop an operating, constantly improving system of post-mortem organ donation. One of the key concepts in such a system was the development of requirements for "forensic medical support of organ transplantation". In cooperation with interested specialists of St. Petersburg, the city Bureau of Forensic Medical Examination organized round-the-clock shifts of forensic medical experts. Clear instructions have been developed for them with legal, medical and forensic contraindications to the collection of organs and tissues from the corpses of donors. This type of activity of the Bureau of Forensic Medical Examination was introduced as a state task.

METHODS OF SEX ESTIMATION FROM THE CLAVICLES IN FORENSIC EXAMINATION OF BONE REMAINS

One of the most complex problems in forensic medical expertise is the process of identification of unknown corpses and their parts, which very often include bone remains. Sometimes it is practically impossible to collect the data needed for police investigation because the most important parts of the skeleton such as skull, pelvic bones and long trabecular bones are absent. The aim of the study was to develop new methods for sex determination from the clavicle of an adult person based on the mathematical and statistical analysis of their osteometric properties. For this purpose bone samples from three skeletal collections were used: collection of the Department of Anthropology of Lomonosov Moscow State University; collection of the Department of Physical Anthropology of the Peter the Great Museum of Anthropology and Ethnography (St. Petersburg), and the The Robert J. Terry Anatomical Skeletal Collection stored at the Department of Physical Anthropology of the Smithsonian’s National Museum of Natural History (Washington). The study demonstrated the possibility of correct sex determination from the clavicle using the five-interval diagnostic table suitable for quick sex assessment and multiple discriminant models with an accuracy of correct sex estimation between 85% and 97.5%. The methods described in the article can be applied not only in forensic context (especially when working with a limited set of isolated skeletal elements or their fragments), but also in the physical and medical anthropology for reconstructing an unidentified individual’s biological profile.

The problems of determining of the age of bruises by modern diagnostic methods. Literature review

Determination of the age of bruises is an important task forensic medicine. The article provide a review of the literature concerning the state of the study of this problem.
 Traumatic hemorrhages, the most frequent injuries encountered in practice by a forensic medical expert, are formed as a result of accumulation of blood in the lesion due to rupture of blood vessels. Traditionally, the leading methods for determining the age of traumatic effects are macroscopy, colorimetry, radiography, impedance measurement, ultrasonography, infrared thermometry, spectrophotometry, etc. The difficulties of using instrumental methods are associated with the operation of devices, the high cost of equipment, and often with the contradictory opinion of the authors, which does not allow choosing a certain method.
 In various publications, the advantage is given to those methods that analyze color as the main characteristic of a bruise. In order to objectify this characteristic, is actively underway on the development of spectroscopy technologies capable of determining the spectrum of substances beyond the control of the human eye. A promising approach to establish the prescription of traumatic hemorrhages can be the method of hyperspectral spectroscopy by simultaneously capturing the image of a bruise and obtaining spectral, including spatial data of the studied skin area. The expediency of using hyperspectral technologies in forensic medical practice lies in the non-invasiveness of the study, harmlessness to living persons, compactness of the device, as well as the prospects of studying the lifetime of bruises in corpses.
 The conducted analysis of the literature creates the need to explore the possibilities of this method.

To the problem of death of children from closure of respiratory tract by foreign object: expert observation

In the special forensic literature, information on the deaths of children from mechanical asphyxiation as a result of closure of the airways by foreign objects is small and fragmentary, a small number of works are devoted to them, despite the fact that the social significance of this problem is great.
 An expert observation of a case of asphyxia developed in a child as a result of closure of the upper respiratory tract by a foreign object is given. The child played for 1.5 years and suddenly began to choke. A forensic examination of the corpse revealed the presence of a foreign body (part of a childs toy) in the area of the vocal cords, completely covering the lumen of the entrance to the larynx; acute pulmonary bloating, hemorrhages in soft tissues from the area of entrance to the larynx, foci of acute pulmonary alveoli emphysema, hemorrhages in pulmonary tissue, signs of rapid death.
 Forensic medical diagnosis: mechanical asphyxia from closing the lumen of the respiratory tract with a foreign body (the presence of a foreign body in the vocal cords, completely blocking the lumen of the entrance to the larynx; acute swelling of the lungs, hemorrhages in the soft tissues from the entrance to the larynx, foci of acute emphysema of the pulmonary alveoli, hemorrhages in the lung tissue, signs of rapid death).
 The work of a forensic medical expert is often hampered by the lack of clinical data and the circumstances of the incident, as well as difficulties in interpreting the results of the study. In cases where adults are present during the aspiration of a foreign body by a child, respiratory failure is recorded with cyanosis of the face, breath holding, followed by paroxysmal unproductive cough, which indicates an existing threat of asphyxia. In this expert observation, the detailed circumstances of the incident provided by law enforcement agencies and the asphyxic alertness of the expert helped to establish the cause of death and formulate a forensic diagnosis and conclusions. However, it is important to understand that cases of death of children from obstructive asphyxia are potentially preventable and require targeted preventive work.

Review of the collective monograph «Forensic medical expert service of the Moscow region: history and modernity» edited by V.A. Klevno, V.Yu. Nazarov

The article analyzes the book Forensic Medical Expert Service of the Moscow region: history and modernity edited by Doctor of Medical Sciences, Professor Vladimir Alexandrovich Klevno and Doctor of Medical Sciences, Associate Professor Viktor Yurievich Nazarov, presents an objective assessment of the published data on the history and current state of the forensic medical expert service of the Moscow region and the development of Russias largest state forensic institution State Budgetary Healthcare Institution of the Moscow region Bureau of Forensic Medical Examination. The purpose of the review is to give an objective assessment of the information contained in the scientific publication and to determine their value for science and practice.
 First of all, the author notes the uniqueness of the publication, in which for the first time the history of forensic medicine of the Moscow region is covered in detail and reliably, the main milestones of the history of the Bureaus development are scrupulously and carefully outlined, an unprecedented number of little-known facts and reliably generalized information are included (archival data, accurate statistical reports, detailed biographies). The conclusion is substantiated that by its 100th anniversary, the state budgetary healthcare institution of the Moscow region Bureau of Forensic Medical Examination, under the leadership of Professor V.A. Klevno, has achieved leading positions in all indicators of forensic expert activity and has become the leading among state forensic expert institutions in the healthcare system of the Russian Federation. It is noted that the book Forensic Medical Expert Service of the Moscow region: history and modernity, written at the highest scientific level, includes an unprecedented amount of little-known and reliably generalized information.
 The author noted that the book was written at the highest scientific level and, undoubtedly, is a significant contribution to the history of the national forensic medical service.
 It can be argued that with the publication of the book Forensic Medical Expert Service of the Moscow Region: History and Modernity, a whole and reliable picture of the true history of the Moscow Regional forensic medicine is being created, covering the main significant time intervals.
 Without a doubt, this work will serve for many years as a source of reliable information for forensic experts, historians and a wide range of people interested in the past, present and future of forensic medicine in Russia.

Обнаружение бромдигидрохлорфенилбензодиазепина (феназепама) и его метаболита в биологическом объекте при сверхнизких концентрациях

In extreme situations, reliable detection of the minimum therapeutic concentrations of psychotropic substances is important, since this allows one to provide adequate resuscitation. The group of benzodiazepine derivatives, which includes bromodihydrochlorophenylbenzodiazepine (phenazepam), is widely used in clinical practice. Along with the positive clinical effect, phenazepam has numerous side effects, capable of causing poisoning, even death. The study was aimed to develop the method for detection of the phenazepam metabolites by high-resolution HPLC–TMS suitable for achieving the aims and objectives of forensic medical expertise in case of the ultra-low urine substance concentrations. Urine of six patients (males and females aged 28–40), who were prescribed phenazepam and took the drug at minimum therapeutic concentrations on an ad hoc basis, was used during the study. Optimum conditions for the analyte chromatography after the urine sample preparation were defined with the phenazepam retention time of 7.05 ± 0.06 min; specific ions (m/z) 179, 183, 206, 242, 271, 285, 320, 348 (main) were defined for identification of phenazepam.

Az orvosi látlelet szerepe a csecsemőgyilkosság miatt indított eljárásokban

The study examines the role of medical records (visum repertum) in three criminal proceedings initiated for infanticides in Békés County. The expert opinions were written in accordance with the provisions of decrees and with the regulations of the medical profession. The prosecution and the defence based their arguments on the expert opinions, and the court accepted, in every instance, the forensic medical expert’s position. In one case, the body of the infant was not found, wherefore the woman was convicted for adultery, on the basis of the medical examination proving childbirth (1823). In the second case, a preterm birth occurred, so the widow was punished for concealing her pregnancy (1847). In the third case, only the infant’s fatal bleeding could be proven, but the intent to cause injury could not; consequently, the girl was found guilty in wrongful death caused by negligence (1834).

Features of a forensic medical expert study to establish age

Today, during war on the territory of our country, quite frequent situations arise when it is necessary to determine the age of a living person or a dead body. The article is devoted to the analysis of the possibilities of a forensic medical examination of a living person and the dead body to determine the age. In the course of the work, an analysis of the special literature on research methods in determining the age was carried out. These are the works of N.N. Tagaev (2003), K. A. Chaplinsky (2007), A. A. Babanin, V. D. Mishalov, A. V. Belovitsky, A. Yu. Skrebkova (2012), B. V. Mikhailichenko (2014), I. I. Smirnova (2021) and others. It has been established that this type of examination is assigned in cases where the documents in which the date of birth is marked (passport, birth certificate) are lost for any reason: war, sudden relocation from the place of residence, natural disaster. And in certain cases, such documents are deliberately hidden in order to avoid the criminal liability of adolescents, service in the armed forces, when identifying a living person. At the same time, it may be necessary to establish the age in civil cases: when replacing children, determining the age of marriage or the age of persons hired, involved in labor service, as well as in cases of establishing the age of majority, assigning and paying state pensions. The term "age" is understood as the period of development of a biological individual (human, animal, etc.), characterized by certain anatomical and physiological changes in the process of evolution and involution (reverse development of the physiological properties of the organism). The author presents various systems of periodization of biological age, which are based on the age-appropriate anatomical and physiological characteristics of the organism, and for childhood, they take into account adaptability to the environment. It has been determined that a forensic medical examination to establish age is carried out in three directions: age is determined by sight, it is determined using clinical and dental examinations, as well as laboratory research methods both in living persons and dead bodies. The features of age-related changes in the anthropometric parameters of the skin, the degree of development of secondary sexual characteristics, the number of teeth and their condition, and the ossification of the zones of epiphyseal bone growth are analyzed. It is highlighted that age-related changes in bones play an important role in determining the age of living persons, but they are even more important in determining the age of a deceased person. Thus, it should be noted that expert age determination refers to complex types of forensic medical examination and requires the use of a complex of clinical, laboratory and instrumental studies. It is carried out on a commission basis consisting of doctors of various specialties: a radiologist, an endocrinologist, a therapist, a psychoneurologist, a geneticist, a pediatrician and other necessary specialists, chaired by a forensic medical expert. As a result of an increase in the growth of the youth population, acceleration of its physical development and puberty (acceleration), ossification of the skeleton and due to this reduction in growth by one or two years in girls and boys at the present stage, for the use in the production of an expert study of tables for determining age, compiled in the last century, it is necessary to be critical. The totality of the number of research methods used determines the degree of authenticity of the conclusions of the forensic medical examination to determine the age.

A CONTRIBUIÇÃO DO ESPECIALISTA EM MEDICINA LEGAL E PERÍCIA MÉDICA NO SERVIÇO DE SAÚDE

Introduction: With the growing demand for judicial medical expertise due to litigations involving allegations of damages associated with health care and the known ignorance of social security issues by health teams, this paper aims to discuss the usefulness of the specialist in Legal Medicine and Medical Expertise in health services as a consultant on these issues. Material and Method: non-systematic literary review on the themes of “medical error”, social security medical expertise, medical law and legal medicine and medical expertise. Results: no studies were found discussing the usefulness of the specialist in question working in health services, having found studies related to the theme and some repercussions of litigation involving health. Conclusion: the specialist in Forensic Medicine and Medical Expertise for being the link between medical knowledge and the law has technical competence to act in an interdisciplinary way in health services with regard to ethical and legal issues in these services.

Statistical analysis of performance indicators of medical forensic departments of the FME bureaux in the Russian Federation

This article presents the results of the study of the quantitative performance indicators of medical forensic departments of state forensic medical expert institutions in Russia as a whole and in individual federal districts from 2009 to 2018. Medical statistics methods were used. We analyzed absolute and intensive indicators, their percentages, and correlation relationships. Trends and patterns were studied to identify causal relationships and assess the effect of various factors. A steady trend of reducing the total number of expert examinations performed in the medical forensic departments was shown. However, their share of the total number of violent death cases is increasing. The labor intensity of medical forensic examinations and the number of examination methods used are increasing. Regional differences in the studied indicators are revealed. The presented metadata can be used to improve the workflow management of forensic medical departments and monitor the effectiveness of improvements. The findings confirm the need to modernize and adapt the regulatory and procedural framework of the expert work.