Medicolegal Documentation Research Articles

Diagnostic Dilemmas: Anatomical Masquerades in Dental Radiographs – A Sri Lankan Perspicacity  

Dental radiographs are an essential component in routine dental practice. They serve multiple purposes such as aiding in the diagnosis, and exclusion of disease monitoring the progression or healing of lesions and observing the natural development of the dentition. Furthermore, they play a considerable role in medico-legal documentation. Dental radiographs are usually taken within the dental clinic and are not routinely reported by the radiologists. Instead, dental surgeons themselves use them for diagnostic purposes.Intra Oral Periapical radiographs, Upper Standard Occlusal radiographs, and Dental Panoramic Tomographs are frequently taken in dental practice despite their inherent limitations. Although there are better imaging techniques propitious in clinical practice, increased radiation exposure and higher cost, make them less utilized as a primary tool in day-to-day practice. Therefore, it is imperative to have a better knowledge of natural structures that are superimposed in dental radiographs. Instituting other investigations with thorough clinical assessment is highly recommended in doubtful cases.This mini review presents a series of radiographs where normal anatomical counterparts simulate pathology in them. All the presented cases were taken in Sri Lanka under the purview of the authors.

Fresh Hemorrhages in Intestinal Resection Margins Are Associated with Unfavorable Clinical Outcomes in Preterm Infants with Necrotizing Enterocolitis with Surgical Intervention.

Necrotizing enterocolitis (NEC) is a common disease in premature infants. If conservative treatment does not respond, surgical removal of the necrotic section of bowel is common practice. This study investigates whether there is a correlation between the histopathological findings and the postoperative clinical course of the children who have undergone surgery. To date, only a few detailed studies on a possible correlation have been published. The surgical specimens of 49 infants diagnosed with NEC in the years 2010-2019 were re-evaluated. The histologic specimens were examined for tissue viability and hemorrhage of the resection margins, peritonitis or perforation of the central resection segment. The groups were divided according to the clinical outcome: death, postoperative complications and patients without complications. 5 of 49 (10.2%) children died, 22 children (44.9%) required reoperation, while 22 (44.9%) had no complications. Univariate and multivariate analyses showed a significant association between fresh hemorrhage in the resection margins and postoperative outcome. In our data, correlation between the vitality of the resection margins or the extent of necrosis and the postoperative course was not seen. This retrospective study shows a significant correlation between a fresh hematoma in the tissue of the resection margin and the clinical prognosis. Fresh bleeding in the resection margins was associated with increased morbidity with stenosis and possibly another surgical intervention. In contrast, no further correlation was found between the vitality of the tunica mucosae, the tunica muscularis or peritonitis in the resection margin or central part of the NEC specimen and the clinical course. In summary, it can be said that the presence of a fresh hematoma at the resection margin is significantly linked to a poorer clinical outcome for the infants with NEC surgery. Other histopathological findings of the surgical specimen with regard to the clinical course show now significant correlation and, therefore, the histological examination mainly serves the medico-legal documentation and quality assurance of the NEC operation.

EHR Documentation and Referrals for Intimate Partner Violence and Sexual Assault.

Hospital settings provide a unique opportunity to screen for interpersonal violence (IPV) and sexual assault (SA) yet often lack health IT solutions for generating reliable and valid medico-legal documentation via forensic reports. The objective of the project was to evaluate a pilot, technology "tool" for documenting cases of IPV and SA that could support forensic nurse examiners and related stakeholders in generating high quality documentation and coordinating victim support services. The tool was a digital health intervention implemented for use among forensic nurse examiners, law enforcement, victim support organizations, and more within four counties of California. We conducted a mixed-methods pilot study that captured data around the adoption, use, and impact of having access to the newly implemented tool. The tool successfully went live in all four pilot counties at different time points with different proportions of use by county and form type: exams, referrals, addenda, risk assessments, and other. Participants were motivated to use the tool out of a perceived need for data handling functionalities that went beyond traditional manual (paper) means. Key functionalities included body mapping, data quality controls within validated forms, attaching addenda to already existing case reports, and the means to distribute data to external recipients. Further study and development are needed on functions to incorporate into body maps and forms, and understanding the information needs of law enforcement and victim support organizations. Our evaluation demonstrated the feasibility and acceptability of a health IT tool to support forensic nurse documentation of IPV and SA, and direct information to multiple legal and support-related stakeholders. Areas of future development include integrating IPV and SA-related data standards for digitized forms, enhancements to the body mapping feature, and understanding the needs of those who receive digital data from forensic nurse examiners within the tool.

Didactic Instruction's Impact on Medicolegal Quality of Radiation Oncology Resident Physician Documentation.

Effective documentation serves as a cornerstone for communication and patient care, especially in radiation oncology (RO). Studies have shown room for improvement in documentation practices, and although documentation guidelines exist, it is uncertain if RO physicians are aware of or adhere to them. We aimed to assess RO resident physicians' medicolegal knowledge and the impact of an educational intervention on documentation practices. Grading rubrics for consultation and progress notes were created using guidelines, comprising of a fundamental score and total score. Residents from two institutions attended a didactic seminar on medicolegal documentation. Pre- and post-seminar, an electronic anonymous survey was used to assess resident knowledge and perspectives and random resident consultation and progress notes were scored. Mean documentation and survey item scores from pre- and post-seminar were compared. Fourteen resident physicians participated and completed surveys, and 48 consultation notes and 40 progress notes were analyzed. No participant had prior education specific to RO documentation, nor were any aware of available resources. Post-seminar, participants' medicolegal documentation knowledge significantly increased (86.61% vs. 95.54%, p = 0.001), as did the fundamental score (83.64% vs 89.29%, p = 0.041) and total scores of consultation notes (69.82% vs. 78.98%, p = 0.001) and total score of progress notes (55% vs. 75.19%, p < 0.001). Our seminar significantly enhanced residents' medicolegal knowledge and quality of documentation, and surveys revealed a lack of speciality specific documentation education. This combined with findings from other studies and participant opinions suggest that resident physicians would benefit from such training during residency.

182 Keyboard Warriors Sparking a Digital Renaissance: The New Frontier in Traumatology Documentation

Abstract Aim To align clinical records with the high-caliber examinations performed, specifically targeting the vague "Neurovascularly Intact" or 'NVI' term. By enhancing record accuracy, the initiative sought to improve patient recovery tracking and provide robust medicolegal documentation, all while easing the workload of on-call doctors. Method Our audit evaluated the initial clerkings by on-call doctors for trauma patients, analyzing 59 records (n=59) against NICE and BOAST standards pre-intervention. To rectify the prevalent use of 'NVI', we introduced an autotext template, activated by 'NVIL' or 'NVIU', which auto-populates with a detailed assessment while allowing clinician customization. Post-intervention, we examined a further 57 records (n=57) to assess the impact on documentation quality. Results Before intervention compliance was poor: Nerve listed (11.86%), motor tested using MRC grading scale (8.47%), sensory tested (22.03%), blood vessel listed (18.64%), CRT tested (18.64%), and limb color recorded (6.78%). After intervention, compliance increased: nerve listed (91.23%), motor function (96.49%), sensory (96.49%), blood vessels (92.98%), CRT (94.74%), and limb color (82.46%). Documentation of 'NVI' reduced from 55.93% to 3.51%. Fisher's Exact Test with post hoc Bonferroni correction shows results were statistically significant (P&amp;lt;0.05). Conclusions This audit heralds an innovative breakthrough by adeptly leveraging system one thinking through technology to enhance documentation in the NHS. By introducing the autotext template, we've elevated documentation precision, strengthened medicolegal safeguards, and shifted the focus from service-dominated tasks to allow time for physician professional growth.This advancement is a significant stride towards balancing the scales, emphasizing the importance of both patient outcomes and physician development in a system under pressure.

Indian Dental Malpractice Claims and Lawsuits: A Medico-Legal Analysis.

The law of the land assumes that a dentist will always use credible skill, care, and caution in the care of patients. Failing to do something that one is supposed to do (act of omission) or doing something that one is not supposed to do (act of commission) falls under the purview of medical jurisprudence. Each patient is legally entitled to get quality medical care from a physician; failure to such trust is an actionable offense and grievances can be challenged in consumer redressal forums. This analytical study was aimed to study the reasons for dental negligence cases that sought judicial assistance in consumer courts in terms of monetary benefits and also to study the delay in settlements. Archival data of final court-pronounced judgment cases on dental negligence between 2018 and 2022 (i.e., 5 years) were gathered from customer forum websites (https://confonet.nic.in, http://indiankanoon.org/doc, and www.casemine.com). A total of 56 proven dental allegation cases were retrieved. In each verdict case, the allegation against dentist by the plaintiff was recorded, and the response to the complaint by the defendant was studied and analyzed. The year of filing the case and date of judgment, basis of compensation awarded, delay in judgment and role of expert evidence appointed by the court assessed. Misdemeanor by serious negligence: 3, slight negligence: 8, negligent injuries: 35, felony of injuries by serious negligence: 10. Because dentistry involves making decisions in unclear scenarios that affect patient care, there is an inherent danger of malpractice litigation. Awareness of medico-legal issues and professional indemnity insurance coverage for the dentist to safeguard himself from negligence, continuous medico-legal training and documentation of records, and adherence to clinical standards for procedures should be emphasized as prior motives to enhance the standard of care, and a basic awareness of how Indian courts resolve disputes would help dentists plan their professional indemnity insurance and operate their profession properly.

Medico-Legal Cases: An Overview

A Medico-Legal Case can be defined as a case of injury or ailment in which investigations by the law-enforcing agencies are essential to fix the responsibility regarding the causation of the injury or ailment. Once the attending doctor decides to treat the case as Medico Legal Case, immediately he is required to inform the jurisdictional police as provided under Section 39 of Criminal Procedure Code, failure to do so, may result in a prosecution under Sections 176 or 202 of Indian Penal Code. Based on the report, police visits the patient to verify details mentioned in Medico-Legal Case. If there is subsequent death of patient or if the relatives wish to take a legal action against the offender, then based on the Medico-Legal Report, a First Information Report is registered under the relevant Indian Penal Code section. Medical practitioners share the responsibility of action against crime by supporting the justice system. The best way for a medical practitioner to achieve this is by proper examination of victims and/or perpetrators, and completing the legal documents meticulously. Medico-legal documentation is more than the compilation of a medico-legal report. Inappropriate completion of medico-legal documentation may necessitate the practitioner having to explain the documentation to make it understandable to the court.

Protocol on medico-legal documentation of threats.

The use of threats remains prev-alent in law enforcement practices in many parts of the world. In studies with torture sur-vivors, credible and immediate threats have been considered a distinctly harmful method of torture. Notwithstanding this prevalence, there is a considerable degree of difficulty in legally substantiating and establishing harms produced by threatening acts. It is also gen-erally difficult to clearly identify the harms that go beyond the fear and stress inherent (therefore not unlawful) in law enforcement practices. We present a Protocol on Medico-Legal Documentation of Threats. The aim of the Protocol is to improve documentation and assessment of harms so that stronger legal claims can be submitted to local and interna-tional complaints mechanisms. The Protocol has been developed based on a methodology initiated by the Public Committee against Torture in Israel (PCATI), REDRESS and the DIGNITY - Danish In-stitute against Torture (DIGNITY) involving: compilation and review of health and legal knowledge on threats; initial drafting by the lead author; discussion among the members of the International Expert Group on Psycholog-ical Torture; pilot-testing in Ukraine by local NGO Forpost; adjustments were made ac-cording to the results of the pilot study. We present the final Protocol and a Quick Interviewing Guide. This Protocol is cognisant of the significance of the specific social, cultural, and political contexts in which threats are made and might be subjected to ad-aptations to specific contexts. We hope that it will improve the documentation of threats as a torture method or as part of a torturing en-vironment, as well as inform efforts on their prevention more broadly.

Medicolegal Aspects during Mass Casualty Due to Road Traffic Accidents in the Era of Covid: A Tertiary Care Institutional Experience

Background: In March 2020, the world health organization declared COVID-19 a world wide pandemic.Countries introduced public health measures to contain and reduce its spread. The effect of mandated societallockdown to reduce the transmission of corona virus disease 2019 (COVID-19) on road traffic accidents is notknown. For this we performed an in-depth analysis singdata of emergency and trauma centre UPUMS, Saifai.As most of the manpower was involved in managing Covid patients directly or indirectly, it was a challenge tomanage these mass casualty patients who require intensive care as well as Medicolegal documentation , recordkeeping , Consent for life saving procedures in absence of Relatives.Materials and Methods: We reviewed data on total 2876 road traffic accident records in UPUMS, Saifai fromJanuary 1, 2020 through September 30, 2020. We treated March 20th as the first day of mandated societal lock downand 1st July as the first day of re-opening.Results: We have found that the reis increase in road traffic accidents resulting in serious or fatal injuries duringlockdown and post-lockdown period. There was increased Medicolegal burden in spite of the decreased medicalresources, manpower as most of manpower and resources were being utilized for covid patients.Conclusion: Road traffic accidents are a prominent contributor to hospitalization and may negatively impact theexisting hospital resources directed towards COVID-19.

An Analytical Study on the Medical Reports of Rape Survivors in Nepal

Case reports of rape is increasing in society. Rape adversely affects physical, mental, and social wellbeing. Clinicians are at the forefront for the medical management as well providing medico-legal documentation as per the guidelines protocol imposed by the State. This is a retrospective rape case law study of cases retrieved from the Nepalese Supreme Court website. The medical reports provided were studied on the rape cases claimed and analyzed. 149 rape cases were analyzed for medical report. Only one third of the rape cases had positive findings of rape. However, only physical evidence of violence was noted, mainly on the state of hymen, signs of struggle and the presence or absence of spermatozoa in female genitalia. Age determinations were requested to mitigate the punishment in perpetrator. The significance of mental, behavioral, and social wellbeing in rape victims were completely overlooked in the medical report documentation.

"Power" ful eye causing postoperative blurring of vision after non-ocular surgery under general anesthesia.

Dear Editor, Ocular complications can occur in patients following non-ocular surgeries under general anesthesia which range from transient blurring of vision to irreversible blindness.[1] We report a case where preexisting hypermetropia was the cause of postoperative blurring of vision. A 38-year-old man with no comorbidities was posted for laparoscopic orchidectomy for right undescended testis. Preoperative evaluation revealed no abnormalities. General anesthesia was induced with fentanyl 100 mg, propofol 120 mg, atracurium 30 mg, and intubated with 8 mm endotracheal tube. Anesthesia was maintained with oxygen, air, sevoflurane and atracurium 5 mg, and fentanyl 50 mg. Opticlude eye patch (3M India) was used to gently close the eyes during surgery. Surgery in supine position lasted for 1 h and was uneventful. After reversal with neostigmine 2.5 mg and glycopyrrolate 0.5 mg, the patient was extubated. Postoperative recovery was uneventful. 24 h later in the ward, the patient complained of blurring of vision in both eyes while viewing a mobile phone. Ophthalmologist’s opinion was taken. Anterior segment examination including cornea was normal in both eyes. Fundus examination and extraocular movements were normal in both eyes. Uncorrected Snellen’s visual acuity for distance was 6/12 right eye and 6/6 left eye and uncorrected near visual acuity was N6 in both eyes. On refraction testing, the patient had simple hypermetropia of + 1.5 diopters in the right eye and no refractive error in the left eye. On questioning, the patient accepted that he had some difficulty while reading small print even before the surgery but never visited an ophthalmologist. The patient was reassured and glasses were prescribed for hypermetropia following which the blurring of vision resolved. The causes of postoperative blurring of vision after non-ocular surgeries can range from simple corneal abrasion to serious retinal vascular occlusions and ischemic optic neuropathy.[2,3] Our patient complained of blurring of vision postoperatively. We ruled out corneal abrasion and other serious ocular causes. To our surprise, he had hypermetropia which was corrected with spectacles. In a study by Warner et al.[4] on 671 patients undergoing non-ocular surgery under anesthesia, 4.2% of patients experienced new-onset blurred vision of at least 3 days duration postoperatively. In most of them, it resolved spontaneously over weeks. 25% of patients with blurred vision required new corrective lens or changes to existing lens over the next 18 months. The authors found no significant risk factors. Our patient had hypermetropia preoperatively itself which got unmasked after surgery. Preexisting refractive errors can get exaggerated following surgical stress due to transient accommodative weakness and can cause blurring of vision postoperatively. Due to limited mobility in the postoperative period, patients commonly watch mobile and read books for a prolonged time. This constant focus on simple visual tasks may cause patients to notice any small change in their vision. Further studies are required to know the incidence and risk factors for the transient postoperative blurring of vision from refractive errors. It is also important to enquire about the difficulty in vision for both near and far during preanesthetic checkup in all patients coming for surgery as medicolegal documentation. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

OA43 Development of a national across specialty multi-disciplinary team for management of hyper-inflammatory conditions during the SARS-CoV-2 pandemic

Abstract Background/Aims Effective multi-specialty team working is extremely beneficial in management of children with hyper-inflammatory conditions. With the recognition of paediatric inflammatory multisystem syndrome (PIMS) it became apparent a standardised process for discussion of patients would be beneficial. This includes urgent discussion, with access to multiple specialties, and sharing knowledge and experience in a novel condition. Delivering equitable healthcare including access to expertise, specific treatments and research is challenging in Scotland due to its geography. This is facilitated by successful clinical networks (Scottish Paediatric &amp; Adolescent Rheumatology Network [SPARN] and Scottish Paediatric&amp; Adolescent Infection &amp; Immunology National Managed Clinical Network [SPAIIN]) and a well-established paediatric transport service (ScotSTAR). Our aim was to develop a multi-specialty multi-disciplinary team (MDT) for management of patients with hyper-inflammatory conditions. Methods Narrative account of MDT and service development Results We identified a core group of individuals with an interest in inflammatory disorders from different centres and specialties across Scotland including Rheumatology, Infectious Diseases, Cardiology, Intensive Care, Academic Paediatrics, Pharmacists and Clinical Nurse Specialists. Three priorities emerged from initial planning stages: urgent discussions around patient management, peer-to-peer learning and information sharing, and effective prioritisation of research. We designed a written framework and referral pathway, including criteria for acute cardiology involvement, ScotSTAR transfer and intensive care. An electronic proforma was designed to guide MDT discussion, medico-legal documentation and audit purposes. Table 1 describes characteristics of the first nine patients discussed. A particular strength was in diagnostics and consideration of differentials; among patients referred we identified those with haematological malignancy, systemic lupus erythematosus and non-accidental injury. Regular peer-review sessions were held, for reflection on cases and their management in both secondary and tertiary care settings. Clinicians throughout Scotland were encouraged to join via SPARN and SPAIIN networks. Conclusion This multi-specialty MDT has been and continues to be beneficial for management of hyper-inflammatory patients. We will review the process but hope the MDT will prove to continue to be beneficial for future patients. The authors would like to acknowledge all members of the MDT. Disclosure K. McLellan: None. L. Reilly: None. L. Pollock: None. O. Swann: None. C. Anderson: None. N. Martin: None. M. Brennan: None. R. Hague: None. J. Walsh: None.

Knowledge, Attitude and Practice (KAP) of medico-legal documentation among the interns of SCB Medical College, Cuttack, Odisha and the effectiveness of training

Knowledge, Attitude and Practice (KAP) of medico-legal documentation among the interns of SCB Medical College, Cuttack, Odisha and the effectiveness of training

The case for digital image capture during procedures.

The case for digital image capture during procedures.

Laterality and severity of nasal obstruction does not correlate between physicians and patients, nor among physicians

BackgroundNasal obstruction is a common patient complaint and has a variety of etiologies, and a specific anatomical abnormality can often be found within the nasal cavity on physical examination. In practice, this observed pathology does not always correlate with the laterality, severity, and exact intranasal site of the patients' perceived obstruction. ObjectivesWe seek to answer the following questions: 1) Does a physician's evaluation of nasal obstruction correlate with subjective patient complaints? 2) Is there reasonable correlation between physicians of similar training in the routine evaluation of nasal obstruction? MethodsFirst, we asked patients presenting to the otolaryngology clinic with a primary complaint of nasal obstruction to fill out a modified NOSE survey. Nasal endoscopy was performed on all subjects to assess all potential sites of obstruction. We then determined whether there is an association between patient complaints and findings on physical examination. Second, we determined if there is correlation between similarly trained physicians in their interpretation of a basic nasal examination. Otolaryngologists were shown a series of standardized videos of an endoscopic nasal examination that were recorded with a primary complaint of nasal obstruction. Findings were reported in an anonymous online survey focusing on laterality, severity, and specific site of perceived obstruction. ResultsA total of 38 patients were included in the first part of the study. The Cohen's kappa coefficient was used to determine the interrater agreement between the patient and physician in the degree of nasal obstruction. The kappa coefficient was 0.03 (p value 0.372) for the comparison of the left-sided scores (fair agreement), and 0.16 (p value 0.014) for the right-sided scores (slight agreement). A comparison was also done between the side of the nose the patient felt was most obstructed to the most obstructed side found on physical exam by the otolaryngologist. Thirteen of the 38 patients (34%) had perceived nasal obstruction on the opposite side of that noted to be most obstructed on physical exam. Despite this, the kappa coefficient in this comparison was 0.43 (p value <0.001) revealing moderate agreement between the two groups. Seventeen otolaryngologists participated in the second part of the study. Data extrapolated revealed very little agreement among the physicians in reporting which side of the nose was most obstructed, what anatomical structure contributed to the obstruction the most, and what percentage obstruction was present. DiscussionBased on our findings, patients can reasonably determine based on their symptoms which side is most obstructed, but symptoms do not correlate with severity of obstruction when compared to physical exam. There is also very little consistency between otolaryngologists in their assessment of the degree of nasal obstruction on exam. The results of this study may have far-reaching implications for patient management, surgical intervention, and medicolegal documentation as it relates to the current surgical treatment of nasal obstruction.

Forensic evaluation of alleged wrist restraint/handcuff injuries in survivors of torture utilizing the Istanbul Protocol.

Despite being a common form of abuse, there is a paucity of literature describing shackling and wrist restraint injuries among survivors of torture. Forensic evaluation of alleged wrist restraint/handcuff injuries in survivors of torture presents challenges to the evaluator, especially if the injuries are remote and do not leave lasting marks nor neurologic deficits. Thorough history-taking and physical examination are critical to effective forensic documentation. Guidance is provided in The Manual on Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (Istanbul Protocol), the gold standard for the medicolegal documentation of torture. This guidance relies primarily on physical findings, with less direction provided on how to interpret historical evidence or when historical evidence provided by the patient can be interpreted as highly consistent with alleged injury in the absence of current physical findings. Through a case-based review, we present diagnostic strategies for the evaluation of alleged abuse involving wrist restraints/handcuffs, focusing on skin, neurologic, and osseous injuries. We highlight key findings from both the history and physical examination that will allow the evaluator to improve the accuracy of their expert medical opinion on the degree to which medical findings correlate with the patient's allegations of wrist restraint injuries.

The potential of epigenetic methods to provide evidence of torture

&#x0D; &#x0D; &#x0D; &#x0D; Introduction: The last five decades have wit- nessed a transition from brutal forms of physi- cal torture to other physical and psychological methods that do not leave marks on the body. Providing evidence of these types of torture is often a challenge. Finding biological markers of torture would potentially contribute to solve this problem.&#x0D; Methods: Scientific literature review.&#x0D; Results: Methods to analyse certain biological marks present in the genetic material (the DNA), called epigenetic marks, have been developed in recent years. These marks can change in response to environmental factors, but these changes do not alter the genetic information contained in the DNA. Changes in epigenetic marks have been correlated with traumatic stress. Given that torture is an extreme form of trauma, this article argues that torture may also be associated with epigenetic changes.&#x0D; &#x0D; &#x0D; Discussion: Epigenetic methods offer a new tool that might be useful for the medico-legal documentation of cases of torture. Given that these methods have not been used for this purpose yet, they should be tested. Whether they have potential to contribute to determine the severity of suffering, establish a severity threshold or design strategies for the rehabilitation of torture survivors is discussed. The advantages and limitations of these methods, as well as ethical implications, must be taken into account.&#x0D; &#x0D; &#x0D; &#x0D;

Gender-based violence experienced by women seeking asylum in the United State: A lifetime of multiple traumas inflicted by multiple perpetrators

Estimates by the World Health Organization indicate that 1 in 3 women—more than one billion people worldwide—have experienced some form of Gender-Based Violence (GBV). Violence Against Women (VAW) is a prominent subset of GBV, defined by the United Nations as any act “that results in, or is likely to result in, physical, sexual, or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.” VAW can include verbal harassment, physical abuse, sexual abuse, honor killing, and femicide and can occur at the hands of individuals, institutions, or states. Whereas numerous studies have documented the multiple forms of physical, sexual, and psychological violence experienced by women, a thorough characterization of the abuses experienced by asylum-seeking women in the United States has not yet been undertaken. Our analysis of the affidavits for 85 cisgender, female asylum seekers who applied for forensic medical evaluations through a student-run asylum clinic, reveals a life-long pattern of multiple types of VAW inflicted by multiple perpetrators. These findings have implications for the focus of the medico-legal documentation submitted in support of female asylum seekers as well as for the design of comprehensive healthcare services for women and girls who are granted relief.

Medicolegal perspectives of interpersonal violence: A review of first-contact clinical notes.

South Africa has one of the highest rates of interpersonal violence (IPV), in all its forms, in the world. Incidents of assault are largely under-reported and place an immense burden on the healthcare, fiscal and judicial systems. The first contact a victim of IPV has with a medical practitioner may be the only opportunity to identify, record and preserve valuable evidence, as evidence not captured on this occasion may be lost forever. The accuracy and quality of clinical notes taken at the time may be of paramount importance in facilitating the administration of justice. (i) To investigate the adequacy of medicolegal note keeping by doctors in cases where subsequent legal proceedings may ensue; and (ii) to apprise clinicians of their shared responsibility in contributing to the administration of justice through both appropriate patient management and objective and contemporaneous recording of findings from a medicolegal perspective. A prospective descriptive study was conducted over a period of 18 months from 2016 to 2018. The investigators reviewed patient files and critically appraised first-contact clinical notes in fatal-outcome cases of IPV admitted to the Pretoria Medico-Legal Laboratory during the study period. The cases were reviewed using rubrics specifically designed by the investigators to critically but consistently assess the adequacy of documentation of the medicolegal aspects applicable to each case. One hundred cases met the defined criteria for inclusion in the study. The victims were predominantly male (98%), and most (79%) were aged &lt;40 years. Blunt-force injuries were the most frequent type of injury (43%), while gunshot wounds accounted for 36% of cases and sharp-force injuries were documented in 11%. Insufficient medicolegal documentation, wound description and evidence collection, by medical practitioners, was identified across all wounding modalities in the study sample. This study showed that medicolegal documentation in cases of IPV is suboptimal, with many important parameters not being routinely recorded, which is likely to impact negatively on criminal investigations and downstream legal proceedings. Greater emphasis on these issues is required during the undergraduate training of healthcare workers in a society as severely afflicted by IPV as SA. Although this study focused on fatal-outcome cases, these conclusions are equally applicable to many more cases where investigators, prosecutors and presiding judicial officers may be dependent on findings contemporaneously and objectively recorded by medical professionals.

Awareness of Medico-Legal Aspects and Documentation amongst Health Professionals in a Tertiary Care Hospital

Awareness of Medico-Legal Aspects and Documentation amongst Health Professionals in a Tertiary Care Hospital