Medico-legal Process Research Articles

Selfie accidents and crimes in Egypt: A comprehensive discussion of the medico-legal implications.

Selfies are self-surveillance images or videos captured by individuals using digital cameras that, in the attempt to obtain content, may lead to selfie-related injuries or deaths. Criminal selfies refer to offenders who take selfies with their victim(s) during crimes. Globally, both phenomena are underestimated due to deficient official data and the social nature of these incidents. This pioneering media-based retrospective study on selfie-related trauma aims to offset the literature deficit on this topic in Egypt, as an Arabic-speaking country, and extend the global understanding beyond the Western context. We utilised the Egyptian newspaper articles published between January 2014 and May 2023. We identified 25 reports of selfie-related accidents that resulted in 29 casualties with an 82.8% fatality rate. Male victims outnumbered female victims and the mean age was 21.8 years, with most victims aged in their twenties. Regarding the causes of selfie-related deaths, drowning in the Nile ranked first (43.4%) followed by falling from a height (26%). Unless suicide was suspected (n = 1), the remaining cases were considered accidental. We also found four reported criminal selfies that were associated with intimate partner violence. Three of these offenders were male, of which two had a history of drug addiction. In contrast to selfie cases, only one offender belonged to the second decade age group. Overall, selfie-related deaths were infrequent, with an average of three incidents per year. In conclusion, audio-visual communication has altered the modus operandi of crimes, so the digital media analysis should supplement the criminological and medicolegal processes.

Body Packer Syndrome - Ethical Issues? A Case Series

Transporting the foreign bodies, goods, outside or inside the body is called body packer or body pusher or body stuffers and also mules. Contraband substances and specially gold are smuggled in this process. If suspected by Custom Agency or the Police, they refer the case for medical examination and further medico-legal process of recovery of these substances from human body. The role of the doctors is very crucial as far as the life of mules, amount of material to be recovered, preservation of the evidence material including documents, radiological evidence, x-rays and the procedural methods followed, till handing over the recovered material to the concerned officer and keeping records. In the present study, we discussed various cases of body packers which smuggled cocaine and gold. NCCT scan of abdomen is more effective technique to identify body packers. The work experience of such cases in tertiary care hospital is presented here with the aim to share with medical professionals and medico-legal experts.

Balancing the law with children's rights to participation and decision-making: Practice guidelines for mandatory reporting processes in child sexual abuse.

In India, legal response to a sexual offence, namely, punishment of the perpetrator,relies nearly entirely on mandatory reporting provisions in child sexual abuse law.Mandatory reporting forms an important first step in the medico-legal processes of CSAwork, because it leads onto other legal interventions in CSA cases. However, social, stigma, perceived harassment, rampant gender stereotypes, the unwillingness of, family, disbelief of the victim, and threats by the perpetrator are a few of the many, barriers to mandatory reporting in the Indian context. One particularly insufficiently, addressed critical barrier in the global and Indian literature on CSA and law stems from the reluctance of children to allow child protection and mental health professionals to report to relevant authorities. There are few guidelines or practical strategies available,on how to engage children in mandatory reporting processes. This article uses a childcentric lens to propose the need to balance children's rights to participation and decision-making with the mandatory reporting law. It proposes a conceptual frameworkthat acknowledges the imperatives and challenges of the mandatory reporting law and its implementation, whilst also recognizing children's barriers to abuse disclosures andtheir rights to make decisions and provide consent on reporting issues. It culminates in a guideline for child mental health and protection service providers, offering step-bystep support on navigating the challenges and dilemmas of mandatory reporting through suggested scripts that engage children to enable more effective reporting ofCSA to child protection systems and relevant legal authorities.

Transvaginal mesh in Australia: An analysis of news media reporting from 1996 to 2021.

Transvaginal mesh (mesh) surgeries have been used to treat stress urinary incontinence (incontinence) and/or pelvic organ prolapse (prolapse). In Australia, as in many other countries, the harms caused by mesh eventually prompted individual and collective attempts to achieve redress. The rise of mesh surgery as a procedure, the experience of mesh-affected womenand the formal inquiries and legal actions that followed all occurred in social, cultural and discursive contexts. One strategy to understand these contexts is to track how the mesh and key actors in the mesh stories have been portrayed in mass media sources. We conducted a media analysis of the most highly read Australian newspapers and online news media platforms, focusing on how mesh and the interaction of stakeholders in mesh stories were presented to the Australian public. We searched systematically in the top 10 most-read print and online media outlets in Australia. We included all articles that mentioned mesh, from the date of first use of mesh in Australia to the date of our final search (1996-2021). After early scant media reporting focusing on the benefits of mesh procedures, major Australian medicolegal processes created a hook to shift reporting about mesh. The news media then played a significant role in redressing women's experienced epistemic injustice, including by amplifying previously ignored evidence of harm. This created an opportunity for previously unreported suffering to be revealed to powerful actors, in settings beyond the immediate control and epistemic authority of healthcare stakeholders, validating women's testimony and creating new hermeneutic resources for understanding mesh. Over time, media reports show healthcare stakeholders responding sympathetically to these new understandings in public discourse, contrasting with their statements in earlier media coverage. We argue that mass media reporting, in synergy with medicolegal actions and the Australian SenateInquiry, appears to have provided women with greater epistemic justice, giving their testimony privileged epistemic status such that it was considered by powerful actors. Although medical reporting is not recognised in the hierarchy of evidence embedded in the medical knowledge system, in this case, media reporting appears to have contributed to shaping medical knowledge in significant ways. We used publicly available data, print and online media outlets, for our analysis. Therefore, this manuscript does not contain the direct contribution of patients, service users, caregivers, people with lived experience or members of the public.

Groin hit death due to femoral vein rupture in a drug abuser

Recreational drug use has become an imminent social and health problem throughout the world. Intravenous injection for drug misuse has been described in both the upper and lower limbs and is a major cause of millions of deaths each year; deaths are primarily due to fatal overdose and the trauma and infection caused by repeated injections. This paper presents an accidental death due to massive blood loss, which resulted from rupture to the right femoral vessel based on autopsy findings. In case of accidental injuries, a thorough medico-legal process, including death scene investigation, autopsy examination and toxicological analyses, are always necessary to determine the manner of death.

Biopsychosocial sequelae of chronically painful injuries sustained in motor vehicle accidents contributing to non-recovery: A retrospective cohort study

BackgroundClaimants with chronically painful injuries sustained in motor vehicle accidents (MVAs) undergo assessment and management influenced by insurance and medico-legal processes defined by a biomedical paradigm which is discordant with best evidence. We aim to demonstrate the impact of biopsychosocial factors on post-MVA sequelae which contribute to non-recovery. MethodsThis was a retrospective cohort study of medico-legal documents and reports on 300 consecutive claimants referred to a pain medicine physician over 7 years (2012-2018) for assessment of painful musculoskeletal injuries post-MVA. One hundred data items were extracted from the medico-legal documents and reports for each claimant and entered into an electronic database. Post-MVA sequelae were analysed using chi-square analysis (OR >2) for significant associations with demographic, pre-MVA and post-MVA variables. Factors with significant associations were entered into a logistic regression model to determine significant statistical predictors of post-MVA sequelae contributing to non-recovery. ResultsThe claimants were aged 17 to 80 years (mean age 42 years), and approximately half (53%, n=159) were female. The time from MVA to interview averaged 2.5 years. Widespread pain was present in 18% (n=54), and widespread somatosensory signs implying central sensitisation (OR=9.85, p<.001) was the most significant multivariate association. Long-term opiate use post-MVA (32%) was predicted by pre-MVA sleep disturbance (OR=5.08, p=.001), post-MVA major depressive disorder (MDD) (OR=3.02, p=.003) and long-term unemployment (OR=2.22. p=.007). Approximately half (47%, n=142) required post-MVA support from a psychologist or psychiatrist. Post-traumatic stress disorder (PTSD) was diagnosed by a psychiatrist or psychologist in 20% (n=59), yet early identification of risk of PTSD was rare. Pre-MVA, 89.4% (n=268) were studying or employed. Permanent unemployability post-MVA occurred in 35% (n=104) and was predicted by MDD (OR=3.59, p=.001) and antidepressant use (OR=2.17, p=.005). Major social change post-MVA (70%) was predicted by older age (OR=.966, p=.003), depressive symptoms (OR=3.71, p<.001) and opiate use (OR=2.00, p=.039). ConclusionsBiomedical factors, including older age, impaired sleep and indicators of widespread central sensitisation, and psychological factors, including stress, anxiety and depression, were the most prominent multivariate associations as statistical predictors of major adverse sequelae contributing to non-recovery for claimants with chronic pain post-MVA.

Sources of bias in death determination: A research note articulating the need to include systemic sources of biases along with cognitive ones as impacting mortality data.

There are structural and organizational factors that impact how and what mortality data are collected. There are individual decision‐making processes and implicit cognitive biases that influence how and what mortality data are collected. Yet there seems to be a disconnect between how and why these two broad sources of bias may collide and how both need to be understood in order to be able to approach solutions aimed at strengthening the accuracy of mortality data. Using results from a mixed‐method, long‐term research project at four medicolegal offices in two countries, France and the United States, this research note proposes that truly understanding the sources of implicit cognitive bias in forensic pathologists and other medicolegal actors requires knowledge of legal, cultural, and organizational structures that shape medicolegal systems and in turn constrain individual actors' decision‐making processes. The goal is to advocate for multilevel and multi‐methods approaches to propose systemic solutions to the issue of implicit cognitive biases in forensic pathologists and other medicolegal actors' decision‐making processes. For this purpose, the author outlines a series of specific issues to be integrated in future research.

Reframing postconcussional syndrome as an interface disorder of neurology, psychiatry and psychology.

Persistent symptoms following a minor head injury can cause significant morbidity, yet the underlying mechanisms for this are poorly understood. The shortcomings of the current terminology that refer to non-specific symptom clusters is discussed. This update considers the need for a multi-dimensional approach for the heterogenous mechanisms driving persistent symptoms after mild traumatic brain injury. Relevant pathophysiology is discussed to make the case for mild traumatic brain injury to be conceptualized as an interface disorder spanning neurology, psychiatry and psychology. The relevance of pre-injury factors, psychological co-morbidities and their interaction with the injury to produce persistent symptoms are reviewed. The interplay with psychiatric diagnoses, functional and somatic symptom disorder presentations and the influence of the medicolegal process is considered. The judicious use and interpretation of investigations given the above complexity is discussed, with suggestions of how the explanation of the diagnostic formulation to the patient can be tailored, including insight into the above processes, to aid recovery. Moving beyond the one-dimensional concept of ‘postconcussional syndrome’ and reframing the cause of persistent symptoms following mild traumatic brain injury in a bio-psycho-socio-ecological model will hopefully improve understanding of the underlying contributory mechanistic interactions and facilitate treatment.

Medicolegal Practice in India

In India, most of the medicolegal records are still kept as paper documents, even though technology has become integral in every other field of the health sector. Digitalization of the medicolegal processes would allow records to be easily stored and accessed. In addition, it would improve security, accuracy, and readability. Despite some steps in the right direction, most Forensic Medicine departments in India seem to be lagging behind. The authors will attempt to highlight the pressing need for the digitalization of medicolegal services in our country.

The psychological effects of forced family separation on asylum-seeking children and parents at the US-Mexico border: A qualitative analysis of medico-legal documents.

The U.S. government forcibly separated more than 5,000 children from their parents between 2017 and 2018 through its “Zero Tolerance” policy. It is unknown how many of the children have since been reunited with their parents. As of August 1, 2021, however, at least 1,841 children are still separated from their parents. This study systematically examined narratives obtained as part of a medico-legal process by trained clinical experts who interviewed and evaluated parents and children who had been forcibly separated. The data analysis demonstrated that 1) parents and children shared similar pre-migration traumas and the event of forced family separation in the U.S.; 2) they reported signs and symptoms of trauma following reunification; 3) almost all individuals met criteria for DSM diagnoses, even after reunification; 4) evaluating clinicians consistently concluded that mental health treatment was indicated for both parents and children; and 5) signs of malingering were absent in all cases.

The Medical Legal Environment in Neurosurgery: An Informative Overview of the Stages of Litigation and Distinct Challenges

Medical malpractice litigation is something that every neurosurgeon encounters in his or her career and causes significant strife to amateur physicians attempting to navigate the medicolegal process. Neurosurgery in particular is one of the highest risk specialties for litigation. This calls to order the importance of a clear understanding of the medicolegal proceedings that may follow after a complaint has been filed. This report describes the steps to be taken by the physician in the instance that litigation is expected or considered a possibility. We describe the elements that comprise a medical malpractice claim, details of the lawsuit process including hospital peer review and expert witness selection, and how to communicate appropriately with the patients and their families in an empathetic way. It is imperative to gain an appropriate understanding of the entirety of the malpractice claim process to ease the anxiety of litigation for the physician and decrease the amount of avoidable complications.

Evaluation of the Medicolegal Process in Neurosurgical Practice with A Scenario.

The main purpose of medicine is to protect humans from diseases and its complications. Patients may be at risk in the course of diseases or during medical and surgical treatments, which can have undesirable consequences, including death. These risks, which are accepted by all medical authorities and medical literature, are called "complications." One of the responsibilities of the physicians is to detect complications on time and to manage them in accordance with the current medical standards. In the last two decades, allegations that any medical practice is "faulty" have been increasing, and these allegations are presented to the press and media regardless of whether they are justified. This situation adversely affects the medical practice, leading to defensive medical practices, affecting the public health. In this article, we presented our medical responsibilities over a neurosurgical scenario and mentioned the legal procedures to be experienced in such a situation. As physicians, we must know all the legal responsibilities of our profession and record all stages of treatments applied, to suffer the least damage from these claims and legal processes that cause pecuniary and non-pecuniary injury.

Clinical Characteristics and Pharmacological Treatment of Individuals With and Without Intellectual Disability in Pre-trial Assessment-A Population-Based Study.

Background: The current lack of knowledge about intellectual disability (ID) in forensic psychiatric contexts can compromise the legal certainty of these individuals during the medico-legal process. To address ambiguous results in previous literature, the aim of the current study was to estimate the prevalence of ID in a pre-trial forensic psychiatric settings. Moreover, as little is known about the characteristics of offenders with ID, we conducted a clinical characterization of individuals with and without ID being subject to forensic psychiatric assessment.Methods: Using data from several Swedish national registers, we conducted a population-based retrospective observational study on 8,442 individuals being subject to pre-trial forensic psychiatric assessments in Sweden in 1997–2013. We performed univariate analyses to compare the characteristics of individuals with (n = 537) and without ID (n = 7,905).Results: The prevalence of ID was 6.4% in the Swedish pre-trial forensic psychiatric context during the observational period. Compared with individuals without ID, individuals with ID were younger at the time of assessment, had a lower educational level, and had less frequently started families. ID was associated with lower frequency of diagnosed psychotic and bipolar disorders. However, a similar prescription rate of antipsychotics, and a comparable rate of previous inpatient care was observed among individuals with and without ID. Individuals with ID had more often been prescribed anti-libidinal treatments often used for treating sexual disorders, although did not present a higher prevalence of sexual disorder.Conclusions: The prevalence of ID among pre-trial individuals being subject to forensic psychiatric assessment was more than twice as high as assumed in the general population. Our results suggest that individuals with ID received pharmacotherapy without clear indication. Remaining challenges in the clinical management of individuals with ID were indicated by the discrepancy between the occurrence of psychiatric diagnoses, pharmacological treatment patterns, and rates of inpatient care.

Management of bed availability in intensive care in the context of hospitalization by court order

Objective:to identify, from the nurse perspective, situations that interfere with the availability of beds in the intensive care unit in the context of hospitalization by court order.Method:qualitative exploratory, analytical research carried out with 42 nurses working in adult intensive care. The selection took place by non-probabilistic snowball sampling. Data collected by interview and analyzed using the Discursive Textual Analysis technique.Results:three categories were analyzed, entitled deficiency of physical structure and human resources; Lack of clear policies and criteria for patient admission and inadequate discharge from the intensive care unit. In situations of hospitalization by court order, there is a change in the criteria for the allocation of intensive care beds, due to the credibility of professionals, threats of medico-legal processes by family members and judicial imposition on institutions and health professionals.Conclusion:nurses defend the needs of the patients, too, with actions that can positively impact the availability of intensive care beds and adequate care infrastructure.

‘Arrow line incision’-A new approach for neck dissection

Police inquest is an integral part of medicolegal autopsy process in india. Autopsy surgeon usually makes dissection plan based on the information about the circumstances of unnatural or suspicious death in police inquest. Conventionally ‘Y ’or Modified ‘Y ’autopsy incision is practiced for examination of neck structures in cases of suspected neck compression. Unknown cases without any history of neck compression autopsies are done with usual midline straight incision or ‘I ’incision but once the autopsy is started with ‘I ’incision, no type of ‘Y ’incision is possible subsequently. I have developed a new incision called ‘Arrow line incision ’which can be practiced for neck exposure even after usual ‘I ’incision. This new dissection technique, ‘Arrow line incision ’can be practiced in all cases as routine autopsy incision for internal examination with or without history of neck compression.

Age estimation based on maturation of the medial clavicular epiphysis in a Japanese population using multidetector computed tomography.

To estimate forensic age, the Study Group of Forensic Age Diagnostics of the German Association of Forensic Medicine (AGFAD) has recommended the radiological investigation of the medial clavicular epiphysis (MCE). This study aimed to investigate the relation between the maturation of the MCE and age in a contemporary Japanese population using a standard five-stage system by Schmeling et al. and Kellinghaus substage system. A total of 207 cadavers (128 males, 79 females) of known age and sex that underwent postmortem computed tomography (CT) and subsequent forensic autopsy were obtained. The earliest appearance for stage 3c was 18.1 years in the male subjects and 18.4 years in the female subjects. Our results were consistent with those in previous studies and indicate that stage 3c is crucial for medico-legal processes in evaluating age in various countries. Similar studies on the staging of the MCE using CT images in other populations, particularly in Asians, are required.

Boundary-making in the medico-legal context: examining doctor-nurse dynamics in post-sexual assault forensic medical intervention.

A key dimension of the institutional response to sexual assault is the forensic medical examination of a victim's body conducted for purpose of documenting, collecting and testifying to corroborative evidence. Drawing upon in-depth interviews with forensic examiners and forensic nurse practitioners in one region of England, this study addresses a gap in the existing research on medico-legal processes, and critically examines the nature and dynamics of the relationship between doctors and nurses involved in this intervention. Using an analytic framework based on Thomas Gieryn's notion of 'boundary-work', we explore how this historically gendered dyadic relationship is experienced and understood in a context influenced by both medicine and law. We demonstrate very clear boundaries demarcating (i) physicians as experts and nurses as non-experts in the collection and representation of medical evidence, and, (ii) physicians as equated with technical competence and nurses with 'caring' duties. We conclude by positing implications that may stem from these professional relations with respect to sexual assault evidence, professionals and victims.

Terrorist explosive belt attacks: specific patterns of bone traumas.

In cases of terrorist bomb attacks, the issue of victim identification is the principal aim. For investigators and justice, terrorists must also be identified in a timely manner. The fragmentation of bodies caused by explosive devices however makes this operation difficult. The cases presented correspond to six autopsies of perpetrators carrying explosives. Their explosive belts produced different body sections on areas correlated with the location on the body of carrying explosive charges. Indeed, cross-sectional areas are the signature of the level of explosive devices on the body, and some fracture features through the damage of certain areas of constitutional weaknesses are specific elements to consider. These elements can allow a quick distinction between victims and terrorists, in order to assist in the medico-legal process of identification.

Toplu Sünnet Etkinliğinde Tıbbi Uygulama Hatası: İki Olgu

Gerek dini ve kültürel sebeplerle gerekse de tıbbi sebeplerle yapılmış olsun erkek dünya nüfusunun yaklaşık 6’da birinin sünnet edildiği tahmin edilmektedir. Sünnetin komplikasyon oranının ise %0,2 ile %5 arasında değiştiği bildirilmektedir. Bu çalışmada, aynı hastanede, aynı gün içerisinde, aynı hekim tarafından yapılan toplu sünnet etkinliği sırasında iki sünnet işlemi sonrası gelişen klinik tablo, tıbbi uygulama hatası yönünden irdelenmiş, adli tıbbi boyutu ortaya konulmuş ve bu olguların özellikleri literatür bilgileri ile karşılaştırılmıştır. Sonuç olarak, toplu sünnet aktivitelerinden mümkün olduğunca kaçınılması, ülkemizde olduğu gibi sosyoekonomik nedenlere bağlı olarak toplu sünnet uygulaması yapılması kaçınılmaz olan durumlarda bile, ailelerin aydınlatılması ile ilgili prosedürlerin göz ardı edilmemesinin, bu konuda yetkin ve yeterli sayıda hekimlerce, asepsi-antisepsi ilkelerine uygun ortamlarda, bilimsel kaidelere ve yürürlükteki mevzuata uygun olarak yapılmasının komplikasyon gelişimini azaltacağı ve bu alandaki tıbbi uygulama hataları iddialarının önüne geçeceği vurgulanmıştır.

Virtopsy: An integration of forensic science and imageology.

In an era where noninvasive and minimally invasive techniques are heralding medical innovations and health science technology, necrological analysis is not bereft of this wave. Virtopsy is virtual autopsy. It is a new-age complimentary documentation approach to identify and analyze the details of demise. Utilizing virtual autopsy for orofacial forensic examination is an emerging specialty which holds a plethora of potential for future trends in forensic science. Being a noninvasive technique, it is a rapid method which facilitates the medicolegal process and aids in the delivery of justice. The present article is an overview of this emerging methodology.