Medicolegal Aspects Research Articles

Medico Legal Aspects of Sexual Violence: Impact on Court Judgments

Medico Legal Aspects of Sexual Violence: Impact on Court Judgments

STATISTICAL STUDY OF FATAL BLUNT HEAD INJURIES IN GREAT CAIRO GOVERNORATE DURING 2014

Backgrounds: Of all regional injuries, those of the head and neck are the most common and most important in forensic practice. The head is the target of choice in the great majority of assaults involving blunt trauma. When the victim is pushed or knocked to the ground, he often strikes his head. The brain and its coverings are vulnerable to degrees of blunt trauma that would rarely be lethal if applied to other body areas. Objective: Study aimed to find out incidence and medico legal aspects of fatal blunt head injury to identify characters and magnitude of the problem to design a plan for better control of the problem. Subjects and method: Study was carried out retrospectively through collecting data from post-mortem report of all fatal blunt head injuries cases autopsied in Zeinhom mortuary during 2014. The variables considered were age and gender of victim, cause and manner of death, type of weapon, types of skull fractures, and seasonal variation. Results: The studied group represented 129 cases out of total 2,128 cases that had been examined in Zeinhom mortuary during 2014. The highest incidence of head injury was seen in victims of 3rd and 4th decades (79 victims; 60%). The majority were males (99; 76%). Ninety three cases (72%) were victims of homicide, while suicidal cases were 16 (12.4%), and accidental fatal head trauma victims were 20 (15.5%). Conclusion: Blunt trauma to the head is still a relevant challenge for the forensic pathologist who must obtain a complete and accurate history of the crime (including details regarding the crime scene), interpret patterns of injury and other findings at autopsy, and correlate all of the findings to make an accurate ruling of the cause and manner of death.

Violence against Female at Beni Suef Governorate (Egypt) from 2010-2014

Violence has always been part of the human experience. Its impact can be seen, in various forms, in all parts of the world. Overall, violence is among the leading causes of death worldwide for people aged 15-44 years. “Genderbased violence (GBV) is the general term used to capture violence that occurs as a result of the normative role expectations associated with each gender, along with the unequal power relationships between the two genders, within the context of a specific society.” While women, girls, men and boys can be victims of GBV, the main focus of this resource package is on violence against women and girls. The present study was done to demonstrate medico legal aspects of violence against females.

Rape is an Injury Caused in Hostile Environment: Suicidal, Homicidal or Accidental

Rape is an injury. Too much has been discussed and debated about rape in the society, media news rooms, court rooms, seminars, conferences, roads, political speeches, public demonstrations, etc. All these public discussions end with a highly intellectual note with a pseudo sense of fear that it is a “Mind Set ”problem. We found it quite amazing and surprising that it is now classified as ‘penetration, insertion, manipulation and application ’and discussed in these terms among the medical fraternity, police personnel, lawyers and judges; stressing upon the need to have more deterrent laws; worried about what justice shall be delivered. Everybody is shouting and searching for a solution to this problem/injury in the form of law and justice, after the rape has been committed, but nobody is concerned about the cause and manner of rape (injury). Present study is just an attempt to look from the eyes of forensic medicine specialist about the medico-legal aspects of the injury i.e. Rape.

Medicolegal Aspects of Investigation of Burns in Dowry Deaths

In India, the traditional custom of dowry not only encouraged parents to be gender selective and greedy husbands and in-laws to torture brides, it also curtailed women status drastically. This resulted in the increasing trends in dowry deaths. Deciding the nature of death as accidental, suicidal and homicidal mainly holds on the autopsy surgeon and the investigation officer. This paper discusses various medicolegal aspects of the investigation of burns in dowry deaths.

Pediatric Intensive Care Unit Admissions from the Emergency Departments in India - The 2018 Academic College of Emergency Experts Consensus Recommendations

There are global variations in policies that define clear indications for PICU (Pediatric Intensive care unit) admissions. In resource limited countries where PICU service availability is limited, the admission criteria to PICU are urgently needed to optimize the utilization of available intensive care services and to maximize patient benefit. The objective of these consensus recommendations on PICU admission criteria is to provide a framework and reference for future policy development by professional societies and governments. Design: The consensus recommendations were developed by a multidisciplinary consensus task force comprised of international experts in pediatric critical care, emergency medicine, trauma, critical care, and health policy stakeholders during the 2016 annual INDUSEM WORLD CONGRESS in Bengaluru, India. Measurements and main results: A task force steering committee completed a global literature search about PICU admission criteria development; reviewed PICU admission guidelines published by a variety of professional organizations worldwide, and performed a literature review of relevant publications. The objectives of this Task Force is to provide a framework for validated approach to determine appropriateness of ICU admission in India(resource limited setting) based on a) prioritization modeling; b) general clinical criteria; c) clinical and objective parameters and d) other criteria. The expert consensus panel then discussed and ranked proposed criteria according to scientific evidence, current standard of care, and expert opinion in the context of the Indian health system. The general subject was addressed in sections: admission criteria and benefits of different levels of care, following the appraisal of the literature, discussion, and consensus, recommendations were written. Conclusion: Although these are consensus recommendations, the subjects addressed encompass complex ethical and medico-legal aspects of patient care that affect daily clinical practice. The scarcity of high-quality evidence made it difficult to answer all the questions asked related to ICU admission. Despite these limitations, the members of the Task Force believe that these recommendations provide a comprehensive framework to guide practitioners in making informed decisions during the admission process. This publication is designed to assist in future development of health policies to ensure effective resource allocation, maximize healthcare benefits and improve access to quality care for children.

A cross-sectional assessment of knowledge, attitude and practice along-with awareness about medico-legal aspects of HIV among medical undergraduate students

A cross-sectional assessment of knowledge, attitude and practice along-with awareness about medico-legal aspects of HIV among medical undergraduate students

Survival and mortality following TBI

ABSTRACTObjectives. Evaluation of life expectancy (LE) post traumatic brain injury (TBI) is important for planning services for patients and for dealing with medico-legal aspects. We hypothesized that LE for patients who survived 2 years post injury is equal to that of the general population (GP).Methods. A cohort of 279 patients was assembled during a 5-year period and was followed for 22–27 years. During follow-up, 32 patients (11.5%) died, creating a huge censored data (88.5%). Analyses included standard mortality ratio (SMR), Kaplan–Meier method (KM), Cox proportional hazards regression analysis (PH) and calculations of life expectancy.Results. About 77% of the patients were under 35 years of age at injury. This age cut-off point yielded differences for survival longevity by χ2 tests (p < 0.0001), by KM analysis (p < 0.0001) and by Cox PH regression analysis (p < 0.0001, HR = 13.95). SMR for the entire cohort was 1.86. Shortening of LE in comparison with the GP is 3.58 years. Estimated shortening of LE by severity for mild, moderate and severe injury were −0.51, 4.11 and 13.77 years, respectively.Conclusions. Patients with mild TBI have a LE similar to the GP, and a reduction in LE was closely related to moderate and severe brain injury.

A study of medico-legal aspects of death due to burns at a tertiary care centre in Mumbai, India

BackgroundFire is a well-known double edged sword for human beings as it served as well as destroyed mankind. Death due to thermal burns is a burning topic all over the globe.Material and methodA total of 109 cases of death due to fatal burns were brought for autopsy at a tertiary care centre in Mumbai, India during the period January 2014 to July 2015, were studied. A specially prepared proforma containing medico-legal aspects of death due to burns was filled. It was analysed by using Microsoft excel and tabulated for better understanding. Cases were studied with respect to marital status, alleged history of dowry death, manner of death, recording of dying declaration, history of psychiatric illness, chronic diseases, previous suicidal attempts etc., method of infliction of burn injury, inflammable substance, cause of death and survival period after burn injury infliction.ResultsFemales were 92 in number (84.4%) out of the 109 cases. Accidental deaths were 71 in number (65.14%). In 12 cases (11.01%), dying declaration was recorded by the police. Seven (6.42%) suffered from psychitric illness while 6 (5.5%) suffered from chronic systemic diseases. Sixty seven cases (61.47%) died of septicemia while 42 (38.53%) died as a result of shock.

Medico-legal aspects regarding drunk driving: experience and competency in practice of community service doctors

Background: Drunk driving has been reported to increase the risk of road traffic accidents associated with death and severe injury. In South Africa, an increase in blood alcohol concentration of as little as 0.01 g per 100 ml above the legal limit may warrant criminal prosecution or the denial of an insurance claim for damages. However, multiple court cases have been withdrawn because of the incompetence of officials at various stages of the investigation. The scope of the mistakes range from poor scene handling to the incorrect handling of blood samples at the laboratory to eventual laboratory testing of blood samples. Using a group of community service doctors (CSDs) as a cohort study group, this study investigated the competency of medical graduates in relation to the medico-legal aspects of drunk driving. Methods: A self-administered questionnaire-based study was done with 150 CSDs. The questionnaire was administered in Afrikaans and English and was dispatched electronically via e-mail. All potential participants were contacted telephonically to obtain verbal consent. Results are displayed as percentages. Results: A response rate of 59.3% was achieved. The results obtained in this study confirm that some CSDs lack competency in handling medico-legal aspects relating to drunk driving, and are thus unable to serve the communities they have been assigned to adequately. Their lack of skills and knowledge suggests that the present undergraduate Clinical Forensic Medicine curriculum is inadequate. Conclusion: It would be beneficial to revise the curriculum for Clinical Forensic Medicine in undergraduate medical training to address the gap in knowledge and practice of various demands of forensic medicine required from new medical graduates and CSDs. Keywords: blood alcohol concentration, clinical forensic medicine, community service doctors, drunk driving

Malpractice in paediatric minimally invasive surgery - a current concept: Results of an international survey.

This study aimed to assess malpractice in paediatric minimally invasive surgery (MIS), and attitudes, prevention strategies and mechanisms to support surgeons while they are under investigation. An observational, multicentric, questionnaire-based study was conducted. The survey questionnaire was sent via mail, and it comprised four sections. Twenty-four paediatric surgeons (average age 54.6 years), from 13 different countries, participated in this study. The majority had >15 years of experience in MIS. Three (12.5%) surgeons reported a total of five malpractice claims regarding their MIS activity. The reasons for the claims were a postoperative complication in 3/5 (60%) cases, a delayed/failed diagnosis in 1/5 (20%) cases and the death of the patient in 1/5 (20%) cases. The claims concluded with the absolution of the surgeon in all cases, and monetary compensation to the claimant in two (40%) cases. Eleven (45.8%) surgeons were invited as expert counsels in medico-legal actions. Medico-legal aspects have a minimal impact on the MIS activity of paediatric surgeons. In this series, claims concluded with the absolution of the surgeon in all cases, but they had a negative effect on the surgeon's reputation and finances. A key element in supporting surgeons while they are under investigation is always to choose a surgeon who is an expert in paediatric MIS as legal counsel. A constant update on innovations in paediatric MIS and appropriate professional liability insurance may also play a key role in reducing medico-legal consequences.

General practitioners’ preferences with regard to colorectal cancer screening organisation Colon cancer screening medico-legal aspects

ObjectiveFrench health authorities put general practitioners at the heart of the colorectal cancer screening. This position raises organisational issues and poses medico-legal problems for the professionals and institutions involved in these campaigns, related to the key concepts of medical decisions and suitability of standards. The objective of our study is to reveal the preferences of general practitioners related to colorectal cancer screening organisation with regard to the medico-legal risk MethodsA discrete choice questionnaire presenting hypothetical screening scenarios was mailed to 2114 physicians from 20 French different areas. The preferences of 358 general practitioners were analysed using logistic regression models. ResultsThe factors that have significant impact on the preferences of general practitioners are the capacity of the primary care professional in the procedure, the manner in which pre-screening information is given to patients, the manner in which screening results are given to patients, the number of reminders sent to patients who test positive and who do not undergo a colonoscopy and the remuneration of the attending physician. ConclusionsOur results reveals that current colorectal cancer screening organisation is not adapted to general practitioners preferences. This work offers the public authorities avenues for reflection on possible developments in order to optimize the involvement of general practitioners in the promotion of cancer screening programme.

Modern Anesthesia and Its Medico-Legal Aspects

The practice of anesthesia has changed dramatically since the days of John Snow. The modern anaesthesiologist is now both a consultant and a primary care provider. The consultant role is appropriate because the primary goal of the anesthetist- to see the patient and comfortably through surgery- generally takes only a short time. However, because anaesthesiologist manage all "noncutting" aspects of the patient's care in the immediate perioperative period, they are also primary care providers. The "Captain of the ship"doctrin, which held the surgeon responsible for every aspects of the patient's perioperative care is no longer valid. The surgeon and anesthesiologist must function together effectively, but both are ultimately answerable to the patient rather than to each other. Patient can select their own anesthesiologist, as well as the surgeon. On the other hand an anesthesiologists have every rights to choice a surgeon, or refuse giving anesthesia to a certain patients. The practice of anesthesia is no longer limited to the operating room. The anesthesiologist are now routinely asked to monitor, sedate and provide general or regional anesthesia outside the operation room. Anesthesiologist have traditionally been pioneers in cardiopulmonary resuscitation and continue to be integral members of resuscitation team. Preoperative evaluation of patients, perioperative and postoperative monitoring and care is absolutely essential. Surgeon-anesthesiologist, anesthesiologist-patient rapport/ co-ordination should be maintained. Documentation is important for both quality assurance and medico legal purpose. Preoperative and intraoperative anesthetic record must be preserved as it serves many purposes. This record should as pertinent and accurate as possible. The written consent with a witness must be taken. The postoperative notes are also essential as many of the patients files complaint against the anesthesiologist, surgeon, and hospitals. Therefore, there are no alternatives rather to preserve all sorts of written documents for their own safety.KYAMC Journal Vol. 7, No.-2, Jan 2017, Page 806-809

Pattern of firearm injuries managed at rural tertiary centre in Western Uttar Pradesh, North India

Background: Firearm injuries are associated with substantial emotional, physical and financial burden on community and hospital resources leads to profound morbidity. It is a global public health problem and pose therapeutic challenges to surgeons. Proper management of firearm wounds requires a working knowledge of physical factors involved in the creation of such injuries. Regional variations of the parameters of medico legal aspects of firearm injuries are still lacking. Objective is to analyse pattern of firearm injuries managed at rural tertiary hospital.Methods: All firearm injury cases brought to the emergency department of Hospital, from January 2016 to December 2016 were included in the study.Results: In this study 108 (83.7%) victims were males and 21 (16.3%) were female. Most common age group victimized was 20-29 year (33.3%). Most cases occurred in winter season.113 cases (87.3%) victim were unemployed.81 cases (62.8%) had below intermediate education. 110 (85.3%) cases were of homicidal motive. Shotgun/ ‘kattas’ outnumbered the rifled firearm injuries (109) cases (84.5%). Trunk was involved in 45 cases (34.8%) and lower extremity in (32.6%) 42 cases,) Exit wound found in 93(72.2%) cases only. The fatality rate was 3.9% (5 cases). . Wound debridement was performed for 48 cases (37.2%) of patients, while emergency exploration was done for 30 cases (23.3%). The hospital stay of 49 cases (37.9%) of patients was more than one week. 111 cases (86.1%) were discharged.Conclusions: Addressing the root causes of violence such as poverty, unemployment, substance abuse will reduce the incidence of firearm injuries in our environment. Establishment of efficient emergency health care services for pre-hospital care and effective ambulance system for rapid transport of injured victims to hospital will reduce morbidity and mortality. Management requires knowledge ATLS protocols, mode, presentation and ballistic of firearm. Authorities issuing license for possession of firearms need to be more strict and vigilant.

Pregnancy and puerperium criminal law aspects

The authors present a review about some aspects of pregnancy and puerperium, and theis relationship with the criminal law in our country. They focused the main medicolegal aspects related with preterm parturition, with abortion, with neonaticide and with newborn infant abandon. Finally, they explain about the criminal doctrine related with this crimes.

Features of organization of medico-legal expert researches in the cases of the mass injuring of victims in the salon of bus

Features of organization of medico-legal expert researches in the cases of the mass injuring of victims in the salon of bus

Letter to the Editor. Medicolegal aspects of craniocentric dog attacks.

Letter to the Editor. Medicolegal aspects of craniocentric dog attacks.

High-risk behaviours for the fœtus in pregnant women: The medicolegal and judicial aspects

Pregnancy is a period of psychological change which may lead to difficulties of adaptation and psychological suffering and give rise to high-risk behaviours for the fœtus in pregnant women. These risk behaviours, which are defined by certain authors as a form of “maltreatment” of the fœtus, usually spring from the psychological distress of the pregnant woman but are not recognised as a specific medical disorder. We illustrate the difficulties encountered in the identification of, and the specific intervention in, these situations through the clinical case of a pregnant drugs-dependent patient subjected to several stress factors who, in addition to consuming substances, developed high-risk behaviours for herself and her pregnancy: self-endangerment under the influence of substances, falls or refusals of treatment. In our first part, we discuss the medicolegal possibilities afforded by French law to protect the fœtus in the event of the future mother's high-risk behaviours. In our second part, we discuss the successive evolutions of the legal status of the fœtus and pregnancy, and their consequences for medical practice and the clinical situations concerned. The lack of an answer concerning the designation of these behaviours, as either medical, legal or social acts, will prompt perinatal practitioners to a certain medicolegal prudence.

The conscientious objection: debate on emergency contraception.

The authors discuss the emergency contraception (EC) topic, assessing scientific and ethical aspects. The almost totality of the studies carried out tends to report on the use of drugs as an emergency measure to prevent pregnancy. However, it is not yet completely excluded that emergency contraceptives can induce medical abortion. The debate on side effects of EC continues to be a highly emotional and controversial issue both for advocates who believe they will lower considerably the number of unintended pregnancies and abortions, and for opponents who believe that using emergency contraception amounts to an abortion. This latter hypothesis highlights the conflicting aspect of the conscientious objection to abortion of physicians and pharmacists. This research work is aimed at investigating the emergency contraception issue, paying particular attention to the medico-legal and regulatory aspects of this subject. Particularly, the authors focus on the conscientious objection in order to assess, if any, legal protection for physicians and pharmacists who claim a right to conscientious objection. Inappropriate use of EC could be resolved through a registry of user. This registry, of course, would not have the intention of persecution, but would only serve to detect possible cases of subjugation, exploitation and harassment.

Surgery of the hallux valgus in an ambulatory setting: a liability risk?

The primary objective of the study is to make an inventory of malpractice in hallux valgus surgery in an ambulatory setting and to identify the patient characteristics for a higher risk of malpractice. The secondary objective is creating a methodology for analyzing the medicolegal aspects of a surgery in day case comparing with hospitalization. The database of the Branchet insurance company was used. A total of 11,000 claims for a period of 11 years (2002-2013) have been investigated. The files of the patients with hallux valgus surgery were isolated from the insurer's database using CCAM codes. The medical director, a medical officer, the legal expert and finally the judge had already analyzed all these cases. The authors reviewed the various documents with a specific questionnaire. We identified 14 cases of claims in relation with hallux valgus 1-day surgery among a total of 138 claims for hallux valgus including all techniques (10%). All patients were female. The mean age was 42.6 years (19-64) in ambulatory patients (AG group) in comparison with 49.5 years (19-73) in hospitalized patients (HG group). Percutaneous techniques were significantly more represented in the AG group (p=0.002) and scarfs osteotomies in the HG group (p=0.004). The use of tourniquet seemed to be lower in the AG group, but it was a not significant trend (p=0.085). In term of anesthesia procedures, no significant differences were seen between the two groups. The comparison of the complications common to both groups showed no significant difference except for insufficient results which were more frequent in the AG group (p=0.026). The rate of insufficient informed consent seemed to be higher in the AG group, but it was a not significant trend (p=0.084). No specific data regarding claims in relation with hallux valgus 1-day surgery are available to our knowledge in the literature. We did not identify in our study specific complications related to ambulatory procedures except for insufficient results. Hallux valgus 1-day surgery does not seem to expose surgeons to higher medicolegal problems than classical hospitalization. Nevertheless, a specific consent form for ambulatory patients is required to limit claims regarding information.