Medico-legal Professionals Research Articles

Traffic Accidents in Children and Adolescents: A Complex Orthopedic and Medico-Legal Approach.

Traffic accidents involving children and adolescents present complex challenges from both the medico-legal and orthopedic standpoints. Despite the implementation of road traffic safety laws, pediatric road traffic injuries continue to be a significant contributor to mortality rates, physical harm, and hospitalization on a global scale. For children and young people, automobile accidents are considered to be the primary culprit of mortality in developed nations. Even in highly developed nations, trauma is a significant factor in infant mortality. Each age category, from childhood to young adulthood, has its fracture patterns, as their skeletons are considerably different from those of adults. The consequences of traffic accidents extend beyond the immediate physical trauma. The medico-legal aspects surrounding these incidents add another layer of complexity, as legal repercussions may affect the responsible adult or parent, particularly in cases involving child fatalities. To effectively address traffic accidents in children and adolescents, a comprehensive approach is necessary. This approach should involve not only medical professionals but also legal experts and policymakers. Collaboration between orthopedic specialists, medico-legal professionals, law enforcement agencies, and relevant government bodies can facilitate the development and implementation of strategies aimed at prevention, education, the enforcement of traffic laws, and improved infrastructure. By addressing both the medical and legal aspects, it is possible to enhance road safety for children and adolescents, reducing the incidence of injuries and their associated long-term consequences. In this review, we aimed to summarize traffic accidents in children and adolescents from a complex orthopedic and medico-legal approach.

Adapting forensic case reporting to account for marginalization and vulnerability

Scholarship of forensic sciences has shown politicalization of human remains and potential biases in criminal investigations. Specifically, concerns have been raised regarding how forensic anthropology analysis and documentation may hinder identification processes or obfuscate other data. As part of this scholarship, some have suggested that forensic anthropologists expand their reporting to include broader public health and safety information as well as reconsider who should be included in reports of anthropological findings. In response to these burgeoning discussions, this piece provides examples of ways anthropologists may formulate reports that capture evidence of marginalization or structural vulnerability. Documentation of findings can occur in myriad formats, including, but not limited to, individual case reports, reports on population analyses from cases, collaborative end-of-year reporting conducted with other medicolegal professionals, and collaborative databasing. This piece provides various templates and suggestions for reporting this kind of data while encouraging further discussion on related merits and concerns.

Stature and sex estimation from shoulder breadth, shoulder height, popliteal height, and knee height measurements in a Bangladeshi population

Forensic anthropologists and medico-legal professionals encounter a range of cases in which the body has been severely disintegrated, dismembered, or mutilated beyond recognition. The most critical goal of any medico-legal inquiry is to be able to identify unknown human remains. To establish the biological profile in forensic investigation, estimations of stature and sex from a range of human body dimensions are fundamental issues. This study developed formulae to determine the stature and sex from a range of body measurements in Bangladeshi adult populations based on a sample of 300 healthy young Bangladeshi individuals (150 males and 150 females) aged ranging from 21 to 30 years. Stature and four body measurements (sitting shoulder height, shoulder breadth, sitting popliteal height, and sitting knee height) were measured for each individual. Linear and stepwise multiple regression analyses were utilized in stature estimation and logistics regression analysis was used to determine the sex of the individuals. This study found a good correlation between the stature and all parameters except for shoulder breadth. The left sitting knee height was the significant parameter in stature estimation because of the higher value of R, R2, and a lower SEE value. Moreover, the right-sitting popliteal height revealed a higher sex estimation accuracy rate than other parameters. The sex estimation accuracy varied from 78.000% to 97.000%. The findings of this study have great value in forensic science and research in determination of stature and sex estimation in the adult population of Bangladesh.

Age-related changes in the hyoid bone: An autopsy-based radiological analysis.

Forensic age estimation is a crucial aspect of the biological profile of unidentified cadavers. The utility of age-related changes of hyoid bone fusion in forensic age estimation has not been explored much in the past. These age-related changes can be visualised in both the living and the dead using conventional radiography. These changes can assist medico-legal professionals and forensic anthropologists in the identification of unknown deceased, especially when the cadaver is mutilated or charred or when the other well-established indicators of skeletal and dental maturity are absent. The aims of this study were to evaluate age-related changes in the hyoid bone and to ascertain whether these changes may be utilised for age estimation in forensic examinations. The hyoid bone was carefully dissected using a standard procedure from 75 cadavers during post-mortem examination. The hyoid bone was radiographed, and the bone was replaced in the body cavity before the post-mortem examination was completed. Hyoid bone fusion was studied by using a standard grading method. Spearman's correlation coefficient was calculated between the fusion scores and chronological age to assess their relationship. Box and whisker plots of fusion stage-wise age distribution were constructed to demonstrate the gradual linear relationship between hyoid bone fusion and the chronological age of the study participants. The present study concludes that hyoid bone fusion is an indicator of the chronological age of an individual and can be used in conjunction with other methods of age estimation such as the skeletal and dental age.

Forensic age estimation using conventional radiography of the medial clavicular epiphysis: A systematic review.

Of the many roles that forensic anthropologists and medico-legal professionals need to perform, forensic age estimation is one of the most frequent and important. Scoring medial clavicular epiphyseal (MCE) fusion is a method used to estimate age in young adults. The aim of this systematic review is to assess the reliability and reproducibility of MCE fusion visualised by conventional radiography and scored by Schmeling's grading system to determine whether an individual has attained the age of 18 years. Four articles were acquired after screening 4589 articles across four databases, and these were subjected to qualitative and quantitative synthesis. The risk of bias was calculated in the qualitative synthesis using the QUADAS-2 tool. Horizontal box plots were constructed to see whether MCE fusion as visualised by conventional radiography can be used to ascertain whether an individual has attained the age of maturity (18 years). It was observed that stages 4 and 5 of the Schmeling's method of age estimation from MCE fusion are observed only in individuals aged ≥18 years. This indicates that MCE fusion, when visualised using x-rays, which are associated with less ionisation radiation compared to computed tomography, can be used to verify the attainment of the age majority in individuals.

A multi-perspective exploration of the understanding of patient complaints and their potential for patient safety improvement in general practice

Background Healthcare complaints are an under utilised source of information for safety improvement, particularly in general practice settings. Within general practice in Ireland, complaints management is dependent on individual practice policies, with little standardisation nationally, impeding their use for safety improvement. There is a need to understand factors that contribute to unlocking the potential of complaints for safety improvement in general practice in Ireland and internationally. Objectives To explore perceptions of healthcare complaints of general practitioners, practice nurses and managers, medico-legal professionals, and policymakers. Methods Participants were recruited using convenience sampling. Interviews were conducted from November 2019–May 2020, based on a semi-structured interview guide. Data were then transcribed and analysed using content analysis. An iterative process was applied to identify emerging themes from the interviews. Results A total of 29 participants (19 female, 10 male) were interviewed. Three themes emerged from the analysis, ‘why patients submit complaints’, ‘management of complaints’, and ‘impact of complaints’. Subthemes included ‘barriers and facilitators to complaining’, ‘practice processes’ for complaints management, and ‘impacts on staff’ of complaints, among others. Conclusion There is a lot to be learned about how individuals experience complaints, however, this study adds to existing knowledge. The findings from this study can be used to tackle challenges facing complaints management in general practice, including the barriers to complaining for patients and the negative impacts of complaints on the staff, and can also help to build on positive aspects of complaints such as the desire for systemic change among interested parties.

Competing Ethical Interests Regarding Privacy and Accountability in Psychotherapy.

"Jane" is a mother of two, who was referred for psychotherapy. However, Jane had misgivings about engaging in the offered psychotherapy because of threats made by her domestically violent partner. The therapy sessions are audio recorded for the purpose of professional supervision and clinician reflective practices. Jane's partner had threatened to subpoena the therapy recordings to legally separate Jane from her children. This article focuses on how three different parts of Jane's multidisciplinary care (i.e. clinicians, policy professionals and medico-legal professionals) exhibit different competing ethical priorities. Psychotherapeutic clinicians private use of audio recordings of the therapy enhances patient care and their own professional development but with the risk of concealing possible unethical behaviour by either party. Medico-legal access to the therapy recordings preserves potentially relevant evidence in the pursuit of justice but risks the interpretation of the psychotherapeutic information outside of the therapeutic context. Policies advocating the inclusion of the therapy recordings in the medical record improves clinician (and health service) accountability but risks harming the vulnerable patient due to threats to patient-therapist confidentiality.

The medico-legal assessment of aesthetic damage. A correlation analysis between experts and an operative proposal.

Aesthetic damage, defined as any detrimental modification of the individual morpho-functional exterior attributes, is difficult to assess, since the perception of its entity is rather subjective. This study aims to provide a medico-legal contribution to the assessment of this kind of damage. 60 photographic images, representing stabilized aesthetic damage, were collected and showed to 16 expert evaluators, who were required to exclusively quantify the objective component of the aesthetic impairment. The inter-observer agreement for the assessments was calculated using the Intraclass Correlation Coefficient (ICC). Looking into specific characteristics of both the injury and the damaged subject, the assessors were more consistent in quantifying the damage in male subjects (ICC 0.68) and in subjects aged over 50 years (ICC 0.81) as well as in assessing extensive damages (ICC 0.61) than those of mild severity (ICC 0.41). The assessment of impairments located in the facial area resulted in a high level of concordance (ICC 0.73), while damages located the head and neck regions presented the lowest concordance (ICC 0.35). The evaluators were more consistent in assessing the outcomes of burns (ICC 0.70). Regardless the various reasons underlying the different degree of concordance, these results and the high degree of the overall concordance (ICC 0.63) point out the skillfulness of medicolegal professionals to formulate a complex judgment as more objectively as possible. Finally, an operative proposal was outlined to guide medico-legal professionals or interns in evaluating the aesthetic damage as more objectively as possible.

Connecting forensic odontology among medical practitioners in central Kerala - An original study.

Introduction and Background:The word forensic, defined by Clark, is derived from the Latin word “forensis,” which means “before the forum.” Odontology refers to the study of teeth. Even though the scope of forensic odontology is well established among dental professionals, its practical application lies largely in the hands of medicolegal professionals. The interaction between the above mentioned two communities is highly crucial for the proper application of forensic odontology in medicolegal issues.Aim:The main aim of this study is to analyze the knowledge, attitude, and practice of forensic odontology among medical practitioners in central Kerala since they are the connecting link between victims and the forensic odontologists.Results:A total of 200 medical practitioners had participated in the study, and the response rate was 100%. The study indicated that medical practitioners who are having an experience of above 15 years had more knowledge regarding forensic odontology when compared with those below 15 years of experience. However, the awareness of modern technologies in forensic odontology and latest techniques to register dental markings were found to be more prevalent among doctors with less than 15 years of experience.

Mission impossible? Assessing the veracity of a mental health problem as result of a road traffic accident: a preliminary review of UK experts’ practices

ABSTRACTThe number of people claiming for personal injury after being involved in a road traffic accident (RTA) in the UK continues to soar. In April 2015, the UK Government intervened to implement measures aimed at reducing the prevalence of fraud within such personal injury claims. However, these reforms did not include claims for mental disorder that arise because of a RTA despite being responsible for substantially larger payouts in comparison with claims for whiplash. The present study examines the assessment practice for detecting fraudulent claims of this nature using a mixed methods survey analysing UK medico-legal professionals’ assessment methodologies (N = 37). The findings suggest comprehensively that assessment practices in this field are idiosyncratic. The findings evidence limitations in all aspects of the assessment process from medico-legal assessors being asked to undertake examinations without the presence of medical records to 44% of examiners being unaware of the three types of malingering. The article concludes with recommendations for improving both assessments and the assessment process for assessing RTA claimants in the UK.

The Utility of Advanced Imaging in Forensic Anthropology.

Imaging technologies play an integral role in forensic anthropology cases. Advances in digital photography allow the anthropologist to photo-document the scene and skeletal remains in exceptional detail. Traditionally, radiographs have been used to document remains, potential trauma, and any individualizing characteristics such as healing trauma and frontal sinus morphology. Given technological advances, some forensic anthropologists have begun to incorporate more advanced imaging methods in their case analyses and research, such as computed tomography and three-dimensional (3D) surface scans. These advanced imaging technologies provide a means to document skeletal remains and trauma, and can be used to create 3D replicas of the elements for archival and illustrative purposes. Researchers have begun to develop novel methods for estimating biological parameters from these 3D virtual models, using new variables such as surface areas and volumes, and advanced statistical methods (e.g., geometric morphometric analyses) to quantitatively analyze skeletal variation for sex and ancestry estimation. The use of these technologies in forensic anthropology remains somewhat limited, however, due to required costs, expertise, and the time involved in collecting and processing the data. Newly developed methods require further validation, and some areas of advanced imaging, such as photogrammetry, remain relatively unexplored in the field. Interdisciplinary collaborations between forensic anthropologists and other medicolegal professionals can help alleviate some of these resource constraints and facilitate advancements in forensic case analysis and research.

Implications of sympathy, empathy and apathy in medico-legal practice

The terms sympathy and empathy have subtly different meanings. Sympathy is the caring, concern and understanding for the suffering of others while empathy refers to being-putting oneself in the place of an aggrieved party. A pathy means lack of feeling, emotion, interest or concern which leads the individual to a state of indifference. This article is aimed at creating a dialogue among medico-legal practitioners as to what extent should empathy or sympathy be shown to their clients. Expression of sympathy or empathy by medico-legal professionals in Sri Lanka may be limited because of several reasons. As the prime concern of a medico-legal professional is to gather information for a court of law, this may require him to be more factually oriented without taking emotions into account. Emotional involvement in a case may cloud the professional’s judgement. Furthermore, as medico-legal professionals see many emotionally agonising cases on a daily basis, one might find it traumatising to become emotionally involved in each case. Unless the practicing doctors are appropriately trained in life skills such as the desired method of reacting in front of the patients, bereaved relatives and other concerned parties, the overwhelming reactions to emotions would make the practitioner trespass the professional boundaries. However if one reacts with apathy and indifference, the investigation process may be deficient and incomplete. It is important to strike a balance between ‘caring too much’ and ‘caring too little’. However it is not easy to lay guidelines as to how much to react in a given setting. It should be judged by the practicing doctor using common wisdom and past experience. Therefore it is important to address the matter from the very first stages of post-graduate training in Forensic Medicine. Sri Lanka Journal of Forensic Medicine, Science & Law Vol.6(1): 21-24 (2015)

“Silly Girls” and “Nice Young Lads”

In this article, we explore perceptions and presumptions in relation to rape, raped women, and rapists, among medico-legal professionals who perform forensic medical examinations in rape cases. We draw upon data from in-depth interviews conducted with forensic medical examiners and forensic nurse practitioners in one area of England. Findings reveal that many of these personnel hold particular views centered broadly on the vilification of victims and the vindication of perpetrators. We conclude that these perceptions and presumptions may hold concerning implications for both victim experiences and evidentiary and judicial outcomes.

Estimation of age in the living: in matters civil and criminal.

Estimation of age is one of the main tasks of a forensic practitioner, especially in third world countries, where many births take place in rural settings without the benefit of the expert supervision of a trained obstetrician. Such births are poorly recorded or more often not recorded at all in terms of exact dates. In many other cases, records are fraudulently falsified for some gain, e.g. to get government jobs or pensions. Developed countries, where ordinarily the birth records are meticulously maintained, are not immune to this problem either. Estimation of the age of living individuals may be needed here for refugees or other persons who arrive without acceptable identification papers. A wide variety of methods are used by the forensic clinician to assess the age of the individual in such cases. This paper discusses and evaluates the most common methods used in India, although the methods can be effectively utilized by medico-legal professionals anywhere in the world.

JURISPRUDENCE ISSUES IN FORENSIC ODONTOLOGY

This article exposes the dental profession in the legal environment and the rules that control the acceptance or rejection of expert witness testimony. Written by a practicing dentist and attorney, the author believes that the new forensic dentistry aspirant should develop mentoring relationships with more experienced medico-legal professionals to supplement traditional dental education.

The insanity defence.

The recent A.P.A. Statement on the Insanity Defence is a document important to all psychiatrists and medicolegal professionals in North America. Its contents are reviewed and contrasted with current Canadian practice on the insanity defence, as well as the proposals of the Mental Disorder Project of the Canadian Department of Justice. The American Psychiatric Association's proposal on the definition of mental disorder is contrasted with the current practice. It is also suggested that the proposal of the Mental Disorder Project to change the disposition of insanity acquittees will lead to difficulties similar to those which provoked the current crisis in the United States.

Collection and Preservation of Forensically Important Entomological Materials

Abstract The insects and other invertebrates colonizing corpses as decomposition progresses can provide valuable information concerning the time and manner of death. Accurate determinations are possible, however, only when representative specimens are properly collected and preserved. The protocol developed by the authors describes equipment and techniques for sampling, preserving, packaging, shipping, and rearing forensically important insects. This information should aid medicolegal professionals in data collection, allowing accurate determinations by entomological means.