Forensic Medical Services Research Articles

Professional Responsibilities of Doctors in Making Visum Et Repertum for Cases of Criminal Acts of Obscenity

The complexity in handling cases of sexual assault highlights the crucial role of Visum et Repertum as vital medical evidence in legal proceedings. This document requires both medical expertise and a profound understanding of law to be effectively utilized in court. Primary challenges include the lack of specialized training for doctors in forensic medicine and external pressures that may compromise professional independence. This research underscores the necessity for clear standards and enhanced competencies to support fair and accurate law enforcement for victims of sexual violence. The aim of this study is to explore the professional responsibilities of doctors in the preparation of Visum et Repertum for cases of sexual assault. Findings indicate that doctors must maintain objectivity and integrity in this forensic medical process, navigating challenges such as external pressures and resource limitations. Effective implementation of professional regulations and standards within medical institutions ensures compliance and the quality of Visum et Repertum as robust legal evidence in court. In this context, improving infrastructure, doctor training, and inter-agency coordination are key to enhancing the effectiveness of forensic medical services in supporting judicial fairness.

Forensic medicine in (West-Bank) Palestine visions and obstacles

Forensic medicine in Palestine is a new branch of medicine compared with other medical specialties and is still at a nascent stage. Only 6 medical doctors specializing in forensic medicine are currently practicing in Palestine, including only one female specialist (the author). Palestine has adopted a system that combines clinical forensic medicine and forensic pathology. Forensic doctors can deal with both the living and the dead and deal with cases of physical and sexual assault, gender-based violence, and domestic violence.In different courts, such as civil, military, and shariah, Palestinian judicial decisions depend primarily on forensic medical reports and the testimonies that forensic doctors provide for the court to explain their reports. Forensic medicine has a significant role and crucial impact on achieving justice for victims of all types of abuse, either dead or alive. However, the role of forensic medicine in achieving justice for victims, and hence fighting and eradicating violence, is underestimated and not fully understood by the general population.This paper introduces to the reader the status of forensic medicine in Palestine, focusing on the challenges and obstacles faced by both the victims and forensic doctors. Meeting these challenges and overcoming obstacles is essential for fighting all types of violence, including violence against women in Palestinian society.The current provision of forensic medical services in Palestine is less than satisfactory, being considerably hampered by the lack of legislation and regulations.Palestine is in great need of continued international support for forensic medicine and forensic services. Two projects supported by the United Nations put the country on the road, but there are still many miles to go toward the aim.

Specifics of Organizational and Design Solutions for Buildings of the Bureau of Forensic Medical Examination

Introduction: Nowadays, biosafety of medical personnel and visitors of the Bureau of Forensic Medical Examination (BFME) is of special importance. One of the most significant issues in terms of infection prevention and control is the design solution for premises of the BFME and departments of anatomic pathology. Up-to-date forensic medical examination institutions shall combine functionality, good technical equipment, and engineering design, all ensuring human comfort and safety. Objective: To evaluate sanitary and hygienic measures, especially organizational and design solutions for BFME buildings ensuring occupational safety and health of the personnel and proper infection control, based on the analysis of scientific publications and valid regulatory documents. Materials and methods: We have reviewed recent Russian and English-language scientific papers on current approaches to infection prevention and control in bureaus of forensic medical examination published in 2018–2022. They were selected using a logical search on such platforms as eLIBRARY.ru, PubMed, CyberLeninka, and Google Scholar. The criteria for inclusion of publications in the review were a non-zero Hirsch index (h-index) or the Russian Science Citation Index (RSCI) and the presence of the following phrases in the title, abstract, and/or keywords: autopsy biosafety, infection of medical staff, infection prevention and control, design of forensic medical examination premises, and occupational safety in forensic medical services. Of 143 sources selected, 47 articles contained a proven risk assessment of biosafety of medical personnel and description of preventive measures and were thus found eligible for inclusion in the review. Results: We established problems in the design of construction or reconstruction of BFME premises in terms of creating a safe working environment. We have noted that the workflow, functionality of the premises, and the level of sanitary measures aimed at prevention of infection in staff and visitors is often disregarded. The procedure of instrument sterilization is not regulated by documents of the Russian Federation. Organization of forensic activities in areas remote from large cities and in towns of 25,000 residents or less remains challenging. It is essential to revise and supplement current regulations to ensure biosafety of forensic medical services. Conclusion: The article describes the shortcomings of design solutions that must be taken into account in construction and/or reconstruction of BFME premises. The design of such buildings in terms of infection control shall be specified in regulatory documents.

Self-Assessment of Undergraduate Medical Students Regarding the Clinical Knowledge in Forensic Medicine

Introduction: Clinical forensic medical services play crucial role in emergency department followed by all other specialty.
 Aims: The preliminary survey was undertaken to assess the knowledge about the clinical forensic medicine among the medical students during their clinical posting in forensic medicine, Nepalgunj Medical College.
 Methods: The questionnaire was used in this study to evaluate the student’s knowledge.
 Results: As many as 108 medical students were included in the survey (70 male and 38 female). The maximum participants were 23 years old 38(35.2%) and youngest participant was 21 years old 6(5.6%). Maximum students were able to perform clinical forensic skills except traffic accident cases 27(25%) followed by gunshot wounds cases 46(42.6%). The students stated that they could master forensic pathology skills in asphyxia cases 80(74.07%) followed by dead victims in blunt and sharp violence cases 76(70.4%) and least in sudden death cases 31(28.7%), criminal abortion 43(39.8%), infanticide 45(41.7%) and sexual offences 49(45.3%). The students were able to issue medical certificate 99(91.7%) followed by issue a death certificate 98(90.7%) and provide information to the police 96(88.9%) but least could give expert statement 30(27.8%).
 Conclusion: In this survey, found the validity of student self-assessment in determining the ability of clinical knowledge, it is influenced by several factors of objectivity and subjectivity of assessment in terms of students.

Sexual violence associated with international travel.

We read with great interest the systematic review by Wyler et al., published recently in this journal.1 This comprehensive review of literature pertaining to mortality arising from injuries in travellers highlighted the importance of discussing the hazards of road traffic collisions, drowning and homicide in the pre-travel consultation. While the review by Wyler et al.1 focuses on fatal injuries arising in these three settings, we wish to draw attention to an oft-overlooked category of travel-related traumatic injury. Sexual assault and rape during international travel, which may occur in isolation or in association with homicide, was the subject of an invited symposium presentation by one of the authors (A.H.) at the CISTM16 conference in Washington DC. While research in this area is sparse, a retrospective review of patients cared for at dedicated forensic medical services revealed that 9% of victims had experienced sexual violence while travelling outside the Republic of Ireland.2 A previous letter to this journal discussed the hidden phenomenon of in-flight sexual assaults and suggested ways in which the airline travel industry should prevent and respond to such distressing incidents.3 Kennedy and Flaherty4 pointed to the reluctance of individuals to disclose their experiences of sexual violence and suggested that this may be magnified in the context of international travel.

Screening for Torture, Asylum, and Trauma among Patients Seeking Care in an Urban Student-Run Free Clinic

Introduction: Many immigrants have histories of violence and persecution in their countries of origin that may make them eligible for asylum in the United States. East Harlem Health Outreach Partnership (EHHOP) is a physician-supervised, student-run free clinic (SRFC) of the Icahn School of Medicine at Mount Sinai that serves exclusively uninsured persons, nearly all of whom are immigrants. This study aimed to provide a screening tool to measure the prevalence of self-reported histories of persecution which may be grounds for asylum and connect these patients to appropriate resources such as legal aid and forensic medical services.
 Methods: The Screening for Torture, Asylum, and Trauma (STAT) questionnaire was developed to screen patients for potential asylum-eligible histories. The questionnaire probed if participants were ever victims of violence or abuse in their countries of origin and the contexts of such violence. Patients screening positive for trauma which may constitute grounds for an asylum claim (“STAT-positive”) were assigned a case manager to oversee referrals to appropriate resources. Changes in demographics between STAT-positive and STAT-negative patients were determined using Fisher Exact Tests and binomial exact calculations to generate P-values and 95% Confidence Intervals (CI), respectively.
 Results: Of the 86 patients screened, 27 (31%; 95% CI [0.22-0.42]) were STAT-positive. Nineteen (70%) were interested in applying for asylum and 15 (79%) of these patients were successfully referred to legal assistance programs. Seventeen (63%) were already receiving care at EHHOP’s mental health clinic. 
 Conclusion: There is a high prevalence of patients (31%) within the EHHOP SRFC with histories of violence, abuse, persecution, or discrimination which may be grounds for asylum in the United States. Identifying these patients for targeted interventions may have a significant positive impact for these patients.

Forensic Medicine in South Asia: Comparison to the Developed Countries.

This study attempted to discuss the historical context and current practice of forensic medicine in South Asia. Comparisons within and between countries in South Asia, and between South Asia and the developed countries (represented by Japan and the USA) have been made to provide an insight into their distinct practice of forensic medicine. Though the formal establishment of forensic medicine in South Asia commenced at a comparable period to the developed countries, their pace of development has been considerably slow. Moreover, their ways of practice as well have evolved differently. In effect, South Asian countries follow an 'integrated service' system, whilst Japan and the USA practice 'divided service' systems to provide forensic medical services. Similarly, regarding the death investigations, most South Asian countries follow a Police-led death investigation system, whereas Japan and the USA follow a hybrid model and the Medical examiner's system of death investigation, respectively. Indeed, forensic medicine in South Asia is undeniably underdeveloped. In this paper, by highlighting the issues and challenges confronted in South Asia, key actions for prompt redressal are discussed to improve the standard of forensic medical services in South Asia.

Complaints against health care professionals providing police custodial and forensic medical/health care services in England, Wales and Northern Ireland - what do we know?

Awareness of the nature and frequency of complaints against health care professionals working in police custodial health care services could provide opportunities to improve patient safety. To explore this freedom of information requests were sent to police services in England, Wales and Northern Ireland, to professional regulatory bodies and to the Independent Office for Police Conduct. Eighty-seven percent of police services responded but only a minority provided complete responses, with data not being held, or not being held in an easily retrievable format, being provided as reasons. The nature and frequency of complaints were similar to a previous 2017 study, suggesting a failure to learn lessons from the investigation of complaints and implement change in clinical practice. No evidence of an accessible complaints handling and recording procedure was provided across the police services surveyed. Regulatory bodies provided some information on the nature of complaints made against doctors and nurses working in police custodial settings, but that for paramedics was unable to do so. It is recommended that the communication loop between police services, those bodies providing health care and forensic medical services and regulatory bodies needs to be closed. A common reporting system or the application of established complaints handling procedures and reporting structures, which could be achieved by transferring these services to the National Health Service, may enhance patient safety in police custody.

The PERFORM-P (Principles of Evidence-based Reporting in FORensic Medicine-Pathology version)

IntroductionMost findings of forensic pathology examinations are presented as written reports. There are currently no internationally accepted recommendations for writing forensic pathology reports. Existing recommendations are also varied and reflect the differences in the scope and role of forensic medical services and local settings in which they are to be implemented. The legal fact-finder thus faces wide variation in the quality of forensic pathology reports, which poses a threat to the reliability of legal decision-making. To address this issue, the development of the “PERFORM-P (Principles of Evidence-based Reporting in FORensic Medicine-Pathology version)” was undertaken. The goal of the PERFORM-P is to provide common practice recommendations adaptable to local requirements to promote evidence-based practice (EBP) in forensic pathology. MethodsAn international consensus study was conducted in three phases by (1) developing a long-list of items to be considered in the reporting recommendations, (2) conducting a Delphi process (an iterative survey method to transform individual opinions into group consensus) with international forensic pathologists, and (3) designing the PERFORM-P prototype and its accompanying manual. ResultsWith assistance from 106 forensic pathologists/forensic medical practitioners from 41 countries, the PERFORM-P was developed. The PERFORM-P consists of a list of 61 items to be included in a forensic pathology report, which is accompanied by its Explanation and Elaboration (E&E) document. DiscussionTo prepare forensic pathology (postmortem) reports that incorporate principles of evidence-based practice, internationally accepted recommendations might be helpful. The PERFORM-P identifies recommendations for necessary elements to include in a forensic pathology report. PERFORM-P can be applied to a wide range of matters requiring forensic pathological analysis, acceptable to forensic pathologists from a representative selection of jurisdictions and medico-legal systems.

Children who present to the Victorian forensic paediatric medical services following multiple sexual assaults – a retrospective study

Background: More than 1200 Victorian children were investigated by child protection in relation to sexual assault in 2016/2017,1 with police enquires initiated in approximately 9% of cases.2 VFPMS see a small number of children who present on multiple occasions following episodes of sexual assault by different offenders. A better understanding of these complex children and the circumstances surrounding the alleged assaults might improve the trajectory of their lives.

The history of collaboration between the Bureau of Forensic Medical Expertise of the Moscow Health Department and the Department of Forensic Medicine of the Sechenovsky University

This article presents the materials devoted to the long-term history of collaboration between the Bureau of Forensic Medical Expertise of the Moscow Health Department and the Department of Forensic Medicine of the Sechenovsky University. Special attention is given to the contribution made by the Department of Forensic Medicine to the scientific and practical activities, methodological and staffing support first of the Moscow forensic medical services and thereafter of the Bureau of Forensic Medical Expertise operating under the auspices of the Moscow Health Department. Simultaneously, the influence of the work of the Moscow Bureau of Forensic Medical Expertise on the development and improvement of the scientific, methodological, and pedagogical activities of the Russia's oldest Department of Forensic Medicine is overviewed. The personal contribution of the most prominent forensic medical experts and physicians of Moscow to medical science and practice is illustrated by concrete examples.

Medicolegal Death Investigation: Coroner and Forensic Pathology Functions and Processes in Victoria, Australia.

The medicolegal death investigation in Victoria, Australia is a traditional coroner system based on the model in England and Wales in the early 20th Century. In 1985, the first of a series of legislative amendments were made that proved the vanguard of reform of the coroners' jurisdictions in Australia. The Victorian Institute of Forensic Medicine (the Institute) was established by the Coroners Act 1985 (Vic.), now the Victorian Institute of Forensic Medicine Act 1985 (Vic.), to provide forensic pathology, medical, and related scientific services needed by the justice system. In addition to death investigation, other forensic and scientific services are performed by the Institute including: clinical medical examinations and support services for assault victims and perpetrators, forensic toxicology services and molecular biology, and anthropology and odontology services in relation to human identification. Medical and nursing staff provide medical information and support to families in a therapeutic setting, as well as direct referral to clinical medical specialists. This takes place where a medical death investigation procedure uncovers genetic or familial disease that may place other family members at risk of future illness. A donor tissue bank ensures that a death also provides the opportunity for families to donate organs and tissues from the deceased for transplantation. Today, the traditional autopsy is one of several modalities of death investigation with postmortem radiology and imaging playing a significant role. This paper describes the principles and new processes at the Institute that support the coroner in death investigation and prevention as well as the therapeutic services designed to relieve the burden of disease on the community.

South Africa: Vulnerable Persons and Groups in a Vulnerable Democracy — Can Forensic Medical Services Help to Ensure Justice in Critical Times?

The role and contribution of an objective and professional medicolegal death investigation service should be valued and strengthened, especially in countries and communities where institutional and governmental corruption, incompetence, and abuse of power may exist, and where there are weak civil watchdog agencies such as a free press. South Africa is a fledgling democracy and is now at a critical juncture from a sociopolitical perspective. A number of incidents and historical perspectives are presented, all of which have specific relevance to the forensic medical community and which serve to illustrate the importance of ensuring the protection of the rights of vulnerable groups and persons who may easily suffer from disregard and abuse by state agencies and their representatives and which may ultimately impact very negatively on the broader society. Strengthening the organizational and legislative framework within which forensic pathologists can function is vital to ensure effective investigation in matters such as deaths in custody and of institutionalized persons/patients as well as deaths associated with police action and mob killings, to name but a few.

Prevalence and pattern of domestic violence at the Center for Forensic Medical Services in Pekanbaru, Indonesia

Background: Domestic violence (DV) is still a significant public health problem, especially in women’s health. Few studies have reported the prevalence and domestic violence in Indonesia. The aim of this study was to identify the prevalence, type of violence, and forensic examination on domestic violence victims in emergency departments.Methods: This study was a retrospective analysis of domestic violence victims observed in the Emergency Department at the Bhayangkara Hospital, Pekanbaru, Indonesia, between 2010 and 2014. The determinations of DV cases are based on the medico-legal reports (visum et repertum) and the police’s official inquiry letters.Results: Out of 6,876 medico-legal injury reports of living victims were reviewed, and 755 (10,9%) cases were DV. The majority of victims in DV were women (93.8%) with childbearing age group as the highest frequency (77.9%). Most of the DV victims were housewives (67.0%). Moreover, physical assault was the most common DV types (98.7%). Bruise was the predominant type of wound among the DV victims (76.2%), and almost half of the victims had abrasions (48.1%). Head and limbs were the predominant sites of wound. Blunt injury was found in more than three-quarters of the victims (88.5%).Conclusion: The prevalence of domestic violence was high among living victims in the emergency department, with women as the majority of victims.

FORENSIC MEDICINE: THE STORY, CLINICAL NEXUS AND CHALLENGES OF THE PRACTICE IN NIGERIA

The synonym of forensic medicine is forensic pathology1,2. Also called legal medicine or medical jurisprudence3. Forensic medicine is a field that involves collection and analysis of medical evidence (samples) to produce objective information for use in the legal system2,3. It can therefore be aptly summed as the science that deals with the application of medical knowledge to legal questions. It is also extremely useful in cases where a patient dies without having made a definitive diagnosis2. The primary tool of forensic medicine has always been the autopsy2. Frequently used for identification of the dead, autopsies may also be conducted to determine the cause of death2. In cases of death caused by a weapon, for example, the forensic pathologist - by examining the wound - can often provide detailed information about the type of weapon used as well as important contextual information. In a death by gunshot, for example, he can determine with reasonable accuracy the range and angle of fire. Forensic medicine is a major factor in the identification of victims of disaster, such as landslide or plane crash4. In cause-of- death determinations, forensic pathologists can also significantly affect the outcome of trials dealing with insurance and inheritance5. Though the autopsy is performed by a forensic pathologist or a medical examiner, particularly during the investigation of criminal law cases and civil law cases in some jurisdictions2, Coroners and medical examiners are also frequently asked to confirm the identity of a corpse. The scope of modern day forensic medicine has expanded far beyond autopsies to include exciting subjects of anthropology; forensic odontology; forensic entomology; ballistics, fingerprint, crime scene and blood spatter analysis; toxicology; DNA; arson and fire investigation; evaluation of the sexual assault victim; forensic psychiatry (which is used to determine the mental health of an individual about to stand trial, and thus, his blameworthiness) and more1,2. It is therefore instructive that the forensic medical services cut across all specialities of medicine with the primary areas of medicine that are commonly involved and harnessed in forensic medicine practice being anatomy, pathology, and psychiatry. To render efficient and effective forensic services in any setting, the forensic pathologist works with a number of support staff including: accident scene investigator; autopsy technician; coroner; forensic investigator; legal consultant; trauma, emergency medicine or psychiatric nurse; sexual assault nurse examiner; social services investigator and/or advocate and more2 .

Healthcare and forensic medical aspects of police detainees, suspects and complainants in Europe

Death and harm is well-recognised in detainees in police custody worldwide. Based on the results of previous global surveys and the CPT (European Committee for the Prevention of Torture) recommendations a questionnaire was developed to summarise the current medical aspects of police custody in European countries. The survey was distributed to named contacts in all European countries. Data from 25 European countries was obtained.The results reveal significant differences in the regulations among the different countries, with nothing close to a harmonised European standard in place at present. This study has identified interesting variations in the methods and standards of healthcare and forensic medical services to detainees in police custody (e.g. quantitative mode of monitoring, qualification of the doctors, maximum time allowed for holding a detainee in police custody, body or an organisation that investigates complaints against the police). There are both very detailed legal regulations in some countries while in others there are only generally observed provisions that sometimes are only given in the form of recommendations.A multinational, multiprofessional expert group is required to identify best practices, recommend basic standards of care and identify qualifications which would be appropriate for healthcare professionals working in this field.

On the training of the expert and pedagogical personnel for the forensic medical services of the Republic of Kazakhstan

We undertook the analysis of the legislative acts currently in force in the Republic of Kazakhstan pertinent to the training of the expert and pedagogical personnel for the forensic medical services with special reference to their advantages and disadvantages from the standpoint of legal regulation of the activities in this sphere. The problems of staffing support of expert practice are illustrated on the example of activities of the Almaty branch of the Centre of Forensic Medicine of the Kazakh Ministry of Justice. The approaches to the solution of these problems are proposed.

Physical abuse against elderly persons in institutional settings

IntroductionPeople over 65 years old are expected to be an increasing group exposed to abuse. Despite the well-studied intra-familial abuse, institutional abuse still lacks a proper understanding about its determinants and characteristics. AimThe general objective of this study is to provide a better knowledge about physical abuse against elderly people in institutional settings, in order to contribute to a timely detection, correct forensic diagnosis and prevention of these cases. MethodsA retrospective study was conducted through the analysis of forensic medical exams performed in the North Forensic Medical Services of Portugal, between 2004 and 2013, to elderly persons allegedly victims of physical abuse in an institutional setting by a caregiver (n = 59). ResultsAll the alleged cases occurred in nursing homes and in most of them (93.2%) the charges were against the institution and not focussing on a particular individual. The alleged victims were mainly female (79.7%), 75 years or older (75.9%), presenting a severe disability (55.9%) and 47.2% being unable to communicate. No injuries or post-traumatic pain were found in 55.9% of the cases to support the charge of physical abuse. Only in 6.8% of the cases were the forensic medical findings suggestive of physical abuse and, although this was not the object of the examination, 69.1% were considered suggestive or highly suggestive of neglect. A statistically significant association was found between the alleged victim's degree of disability and the occurrence of neglect (p = 0.003). ConclusionThe sample's size seems to be underestimated, probably due to lack of detection and/or reporting. The condition of these persons, mainly related with their inability to perceive abusive behaviours and/or to disclose them (mostly by physical and/or mental disability), as well as their reluctance to press charges due to fear of reprisal, affects significantly the detection and diagnosis of physical abuse, particularly in whom injuries are not obvious. In anticipation to the rapid ageing of the population, it is urgent to analyse and understand this emerging issue so that social policies and regulation may be developed, in an effort to protect the elderly, as well as to make improvements in the professionals' skills.

Monitoring HIV infection morbidity in Moscow based on the data of forensic medical expertise

The objective of the present study was the retrospective analysis of the cases of rapid diagnostics of the HIV status of the corpses referred to the pathologo-anatomical departments of Moscow. The standard statistical methods were used for this purpose. The structure of H IV infections is described in terms of age and sex of the affected subjects as well as stages of the disease. It was shown that cooperation of forensic medical services with AIDS control and prevention centres is of primary importance for the substantiation of the diagnosis, improvement of the quality of the relevant statistical information about the causes of death, enhancement of the objective value of epldemiological data on the occurrence of HIV infection and HIV-associated diseases in the city of Moscow.

Detainees in Amsterdam, a target population of the Public Mental Health System?

The Forensic Medical Service of the Public Health Service offers health care to detainees in police cells in Amsterdam. This study describes the registered mental health, addiction and social problems and compares them to the self-reported problems among a sample of detainees. Registers of the Forensic Medical Service are related to information from registers of police detention episodes. A general assessment of substance use, mental health and social problems is obtained by interviewing a sample of 264 detainees. The Forensic Medical Service was contacted in 24% of the 17,321 detention episodes. In 14% of the episodes mental or substance related disorders were observed. Within the sample 59% scored positively on indicators of substance abuse or mental health problems, 35% had additional social problems (debts, unemployment, housing). This proportion increased with age. It is concluded that substance abuse and mental health problems combined with social problems are highly prevalent among detainees, especially among the older ones. This urges for a close cooperation between Public Mental Health Care and Forensic Medical Services.