Medico Legal Research Articles

Epidemiology of Fatal Road Traffic Accidents: A Six Year Retrospective Study in the Medico legal Centre of a Tertiary Care Health Set Up in Western Maharashtra

Road Traffic Accident (RTA) is a public health concern globally. Rapid urbanisation and increase in thenumber of motor vehicles, lack of discipline and violation of traffic regulations has led to a rapid rise inthe deaths in vulnerable road users. A retrospective study was undertaken in the autopsy centre of a tertiarycare hospital to observe the pattern and trends of deaths between 2013-2018 due to RTAs. Out of 248 RTAcases analysed in this study, 75.4% were male and 24.6% were female. The most vulnerable age group was21-40 years in both two-wheeler and four-wheeler accidents while in pedestrians it was 41-50 years. Highrate of accidents was seen during summer in afternoon in cases of pedestrians as well as motor vehicleoccupants and in the evening after 6 PM in two-wheeler motorcyclists. Observation of the pattern of headinjuries showed fracture of the skull was a common occurrence in two and four-wheeler accidents whereasa greater number of pedestrians reported no skull fracture. Non helmet users suffered higher mortality in theage group of 21-30 years. Subdural haemorrhage caused maximum deaths in two-wheeler motorcyclists andpedestrians while sub arachnoid haemorrhage was seen in four-wheeler accidents. Our study agreed with theWHO report of 2018 and various other studies from India and abroad. Increased number of fatalities wasfound to occur at a particular time of the day with seasonal preference. Two-wheeler motorcyclists withouta helmet suffered maximum deaths. Real time analysis of data in various parts of the country would help inensuring safe road user practices.

Profile of Medico Legal Autopsies at Tezpur Medical College & Hospital, Tezpur, Assam: A One Year Retrospective Study

With the progress of human civilization there has been a marked development in every aspect ofmankind which on the other hand has also resulted in increased number of deaths following unnatural causes.Medico legal autopsies thereby portray not only the causes of death but also reflect the socio economic anddemographic profile of that particular region. The present study was conducted at Tezpur Medical College& Hospital, Tezpur, Assam to find out the various patterns of Medico legal autopsies during the period 1stJanuary 2019 to 31st December 2019.

Medico legal perspective in dentistry

Medico legal perspective in dentistry - IDJSR- Print ISSN No: - 2394-708X Online ISSN No:- 2278-3784 Article DOI No:- 10.18231/j.idjsr.2020.018, International Dental Journal of Student's Research-Int Dent J Stud Res

Perioperative Visual Loss Following Transanal Endoscopic Microsurgery in Prone Position: Medico Legal Consideration

A 67-yr-old man developed Perioperative Vision Loss (POVL) after Transanal Endoscopic Microsurgery (TEM) under general anesthesia in prone position with head-down and turned to one side. After surgery, he complained of ocular pain and no light perception in the left eye. The examination revealed lid edema, ptosis, exotropia, proptosis, chemosis and fixed pupil not reactive to direct light. At funduscopy examination a pathognomonic cherry-red spot in the macula and retinal and disk ischemic pallor were appreciable. The right eye was normal. A diagnosis of left central retinal artery occlusion (CRAO) due to intraoperative extrinsic pressure on the eye was suspected. He never regained vision. POVL is frequently involved in malpractice claims. We discuss the legal implication for anesthesia practitioners.

Perfil epidemiológico dos suicídios em um município brasileiro na região Amazônica

Objetivo: Analisar o perfil de suicídios no município de Marabá-PA, entre 2015 e 2019. Metodologia: Estudo quantitativo, transversal, retrospectivo, que utilizou informações dos prontuários e declarações de óbitos do Instituto Médico Legal de Marabá-PA, ocorridos no período de 01 de janeiro de 2015 a 31 dezembro 2019. As estatísticas descritiva e analítica, foram realizadas no software BioEstat® 5.4. Para a tomada de decisão, foi adotado o nível de significância α = 0,05 ou 5%. Resultados: Houve maior incidência de suicídios em 2017, homens solteiros foram às vítimas mais identificadas. A maior frequência de suicídios ocorreu na faixa etária de 30 a 39 anos, na cor/raça parda, em pessoas com ensino médio completo, da zona urbana e na própria residência. O mecanismo principal foi a asfixia mecânica. A maioria dos óbitos envolveram lesão única. Conclusão: Destacou-se a mortalidade em adultos jovens do sexo masculino, evidenciando a relevância dessa investigação, por possibilitar o subsídio de campanhas de prevenção a saúde mental de públicos-alvo na criação de estratégias de enfrentamento dessa população.

MP40: What are the factors contributing to medico-legal risk of procedural interventions performed by physicians practicing emergency medicine?

Introduction: Physicians who practice emergency medicine (EM) often perform procedural interventions, which can occasionally result in unintended patient harm. Our study's objective was to identify and describe the interventions and contributing factors associated with medico-legal (ML) cases involving emergency physicians performing procedural interventions. Methods: The Canadian Medical Protective Association (CMPA) is a not-for-profit, ML organization which represented over 99,000 physicians at the time of this study. We extracted five years (2014-2018) of CMPA data describing closed ML cases involving procedural interventions (e.g. suturing, reducing a dislocated joint) and excluding interventions related to pharmacotherapy (e.g. injection of local anesthetic), diagnosis (electrocardiograms) and physical assessments (e.g. ear exams), performed by physicians practicing EM. We then applied an internal contributing factor framework to identify themes. We analysed the data using descriptive statistics. Results: We identified 145 cases describing 145 patients who had 205 procedures performed in the course of their EM care. The three most common interventions were orthopedic injury management (47/145, 32.4%), wound management (43/145, 29.7%), and Advanced Cardiac Life Support (24/145, 16.6%). Out of 145 patients, 93.8% (136/145) experienced a patient safety event, and 55.9% (76/136) suffered an avoidable harmful incident. One quarter of patients suffered mild harm (34/76, 25.0%), 18.4% of patients died, 14.5% suffered severe harm, and 13.2% moderate harm. Peer experts were critical of 86/145 cases (59.3%) where the following provider contributing factors were found: a lack of situational awareness (20/68, 29.4%), and deficient physician clinical decision-making (54/68, 79.7%). Clinical decision-making issues included a lack of thoroughness of assessment (33/54, 61.1%), failure to perform tests or interventions (21/54, 38.9%), and a delay or failure to seek help from another physician (17/54, 31.2%). Peer experts were also critical of 48.8% of cases containing team factors (42/86) due to deficient medical record keeping (26/42, 61.9%), and communication breakdown with patients or other team members (25/42, 59.5%). Conclusion: Both provider and team factors contributed to ML cases involving EM physicians performing procedural interventions. Addressing these factors may improve patient safety and reduce ML risk for physicians.

Poverty and Access to Medicine: A Medico Legal Study

The right to health as a basic human right- and access to medicine as a part of it- have been a matterof attention for several decades. Also the responsibilities of different parties- particularly pharmaceuticalcompanies- in realization of this right have been emphasized by World Health Organization. This is whilemany companies find no incentive for research and development of medicines related to rare diseases. Alsosome legal structures such as “patent agreements” clearly cause huge difficulties for access to medicinein many countries. High prices of brand medicine and no legal production of generics can increase thecatastrophic costs- as well as morbidity-mortality of medication in lower income countries. Here weevidently review the current challenges in access to medicine and critically assess its legal roots. Howsocieties/governors can make the pharmaceutical companies responsible is also discussed to have a look onpossible future and actions that policy makers- in local or global level- can take.

Análise das Lesões Anatômicas e Estudo Epidemiológico em Mortes Violentas Causadas pelo Trauma Cranioencefálico

Introdução: O Traumatismo Cranioencefálico (TCE) é uma importante causa de morte e incapacidade, gerando grande ônus aosserviços. Apesar do significativo impacto social, estudos epidemiológicos são escassos e limitam-se aos números de acidentes, sequelas,óbitos, gastos com internações e diagnóstico associado ao TCE. Objetivos: Descrever a frequência das lesões anatômicas no crânio eencéfalo, relacionando-as e comparando-as entre os mecanismos causais além de analisar dados epidemiológicos das mortes por causasviolentas associadas ao TCE. Método: Estudo transversal, descritivo e retrospectivo, baseado nos laudos emitidos pelo Instituto MédicoLegal (IML) de sujeitos que conste o TCE como uma das causas de óbito. Resultados: Dos 207 laudos, 15% eram de mulheres e 84%homens. Quanto aos mecanismos causais, acidentes representaram 63,80%, homicídios 32,40% e suicídios e causas indeterminadas1,90% cada. As lesões anatômicas foram quantificadas em relação aos principais mecanismos causais, sendo a mais comum em grandesvasos. Além disso, constatou-se uma diferença significativa entre o conjunto de lesões quando comparadas entre os mecanismos causais.Conclusões: O conhecimento sobre a etiologia do trauma e sua relação com a região anatômica afetada pode auxiliar na definição decondutas e no estabelecimento de ações de prevenção específicas que possam ser planejadas e aplicadas na prática.

Medicolegal Injury Report Writing: Lessons to be Learnt by Doctors: A Case Report

A petition was filed before Punjab and Haryana High Court by a doctor for quashing of the order of suspension dated 18.6.1993 by which the petitioner (Doctor) was dismissed from service on the ground that it has been found that he was guilty of changing the Medico Legal Report and tampering with it and thus having conducted himself irresponsibly, while on Government duty. It was contended that the mistake in the Medico Legal Report was a result of inexperience being his first posting on permanent basis, therefore, the order of the dismissal was not justified and that he was only a Medical Officer whereas the Resident Medical Officer was to prepare the Medico Legal Report but was on leave on that date and, therefore, the petitioner could not be held responsible. This paper deals with issues related to preparation of Medicolegal Injury report, lapses in report, tempering of injury report, not mention of weapon, cutting, over writing etc. and its impact on outcome of case i.e. acquittal of alleged accused. Power of Disciplinary Authority and relevant case laws has been discussed in brief. What are legal consequences of tempering and inadequacies in preparing medico legal reports? Aim of this research paper is to create awareness among young doctors about their role in preparing a legal document /report and to avoid legal action against them by taking all precautions.

Medico Legal Cases in One Stop Crisis Management Center (OCMC) Kaski

Background: The OCMC (One stop crisis management center) has been established in the recognized government hospitals of Nepal. The OCMC has built coalition and create an organizational manage­ment system with other organizations for providing comprehensive health and treatment services, legal aid services, and counseling services and make cer­tain protection to the survivors of GBV (Gender based violence) as well as to manage and control GBV incident. Worldwide more than 119 countries have laws on domestic violence, 125 countries have laws on sexual pestering and 52 coun­tries have laws on marital rape but still women are suffering from different physical, sexual and Psy­chological violence. Rape, hurt/battery, Indecent as­sault, are the main forms of violence.
 Materials and Methods: Study is conducted in Western regional Hospital Pokhara, in OCMC (One stop crisis management center). It is a cross-section­al type of study. Data collected by the observation, interview and case study from the survivors of vi­olence, available published materials related to women Violence and OCMC are also studied. Total 200 cases of GBV survivors came to OCMC center of Kaski from 2073Baisakh to 2074Ashad and included in the study as a primary source of data.
 Conclusion and Result: Out of total 200 cases, sexual offence victims were maximum in number which was 140 and least were forced marriage vic­tim which were only 4 in number. More than 50% of dalit caste people were the survivors of GBV cases. GBV cases were predominant in age group of 20- 30 years. Maximum numbers of victims of GBV in sexual offence cases were alleged Rape cases which accounts 85% of total cases came to OCMC center.

Medico Legal Aspects of Digital Health

The fast growth of digital technologies is currently transforming healthcare services provided worldwide. The technologies can be from digital communication technology to artific ia l intelligence devices. Therefore, current system and practice are encouraged to keep updated with the current trend. In order to ensure safety for both healthcare personnel and patient, Ministry of Health together with other relevant agencies are implementing changes in the current regulation to promote the development of new technology, to embrace in digital healthcare development and transform the current healthcare system from the complexity - to one of high impact, reasonable cost with great outcomes. Guidelines have been prepared and amended to ensure the new invention is safe for patient and compliant with current acceptable health care standard. However, with the development of new technology the doctors are vulnerable to new complaint and litigation as public nowadays more aware of their rights. And the best way to avoid medico legal issues, is by preventing them.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 22

Retrospective analysis of 172 cases of custodial deaths in China between 1999 and 2016: forensic experience in China.

Custodial deaths refer to the death of an individual who is in prison, a detention center, or a police station. The present study aims to retrospectively analyze cases of custodial deaths examined at Tongji Medico Legal Expertise Center in Hubei (TMECH). A total of 172 out of 5853 cases were screened at TMECH from January 1999 to December 2016. Male preponderance was observed in 172 cases (male-female ratio: 5:1). Natural deaths accounted for the majority (70.93%), followed by suicide (16.28%), accidents (3.49%), homicides (4.65%), and undetermined causes (4.65%). The most common natural cause was cardiovascular disease. Custodial deaths occurred more frequently in prisons and detention houses than in police cells (63%, 63%, and 46%, respectively). Among the 172 cases, 105 deaths occurred after resuscitation failure despite the individual being sent to the hospital. The average age across cases was 36.3 years, and 90% of the deceased were aged under 50 years. Since there is no officially reported data regarding the prevalence of causes and manners of custodial deaths in China, our analysis contributes to enhancing the understanding of such deaths in central China and serves as a reference for law enforcement to develop a prevention program to reduce incidents of mortality in custody.

Estimation of height from the lengths of second and fourth digits of hand in Gujarat region

Introduction: Estimation of stature for personal identification forms a very important criteria in cases of incomplete skeletal and decomposed human parts. It is considered to be important in those cases where only fragmentary or mutilated remains of an unknown person are recovered as in murders, accidents, catastrophic events causing mass deaths from natural disasters. In the present study, the attempt has been made to correlate 2nd and 4th digits length with stature and derive a regression equation to calculate stature from 2nd and 4th digits length. Materials and Methods: A cross sectional sample of 500 (230 males & 270 females) asymptomatic healthy students between the age group of 18-24 years belonging to Gujarat were selected to measure height and correlate 2nd and 4th digits length with height ; from which we derive a regression equation to calculate height from 2nd and 4th digit length. Results: In present study the mean height of male and female is 163.48cm. The mean length of 2nd right is 6.99cm and that of 2nd left digit is 7.18cm. The mean length of 4th right digit is 7.15cm and that of 4th left digit is 7.11cm. Coefficient of variation of height is 5.34, of right 2nd digit is 6.90, of right 4th digit is 7.29, left 2nd digit is 7.63 and left 4th digit is 7.46. Conclusion: It is concluded that length of digits can provide good reliability in estimation of stature. From this study we can derive simple linear regression equation for estimation of height. Simple linear regression equation is found to be one of the essential tools in Medico Legal investigations and in anthropometry. Keywords: Height, 2nd and 4th digit, Correlation coefficient, Regression equation.

An Update on Sudden Unexpected Infant Deaths - A Systematic Review on Aetiology, Reporting, Pathology and Medico Legal Aspects

An Update on Sudden Unexpected Infant Deaths - A Systematic Review on Aetiology, Reporting, Pathology and Medico Legal Aspects

MEDICAL RECORD KEEPING; AN UPDATE

Now a day’s Medical Profession not only deals with Medical affairs it involves various aspects of Legal Profession as well. Hence it should be re- coined as Medico Legal Profession. While providing any medical services if any issue arises then Doctors has to face the legal consequences and brought under the court jurisdiction for prosecution like other criminals. 
 The only thing which helps in front of court is the documents produced by the treating doctor, so keeping the Medical Records in meticulous manner, maintaining it & keeping it safe is very important.
 So one should be very particular while recording the details & vitals in OPD Card, Bed Head ticket, Consent Form, Admission & Discharge Ticket of the patients. Doctors should be well aware of the things to be recorded into Medical Records, as well more aware about how to keep the records & to produce them when demanded in a Legitimate manor.
 Keywords: Medical Records, Record Keeping, Medico legal, Guidelines, Legetimate

Position of Knot and Relation With Working Hand in Hanging Cases- A Medico Legal Study

Background: Hanging is the most common form of violent asphyxial death in our country. Typical and atypical variety of hanging depends on position of knot at the victim body.
 Objective: The objective of this study was to find out the position of knot of ligature material and relation of knot with the working hands in hanging cases along with socio demographical status of the study subjects.
 Materials and Methods: This retrospective study was conducted among 574 Autopsy cases of hanging victims at the Dhaka Medical College Morgue during the period January 2013 to December 2015.
 Results: Out of 574 cases, 159 (27.71%) were male and 415 (72.29 %) female. Among them 304(52.96%) were married and 270(47.04%) were unmarried. Most of the victims 269(46.86%) were from the age group 21- 30 years. Considering the knot, most were situated at right side of neck 281 (48.95%), followed by left side 235 (40.94%), at the nape of neck 50(8.71%) and in front of neck below chin 8(1.39%). Most of the study subjects were right handed. Dopatta (orna) was the commonest 237(41.28%) ligature material. 556 (96.86%) cases had some form of ligature mark in neck. Most of the victims 401(69.86%) hanged themselves at night. 545 body (94.95%) were recovered from inside the living rooms. 472 (82.23%) victims had complete suspension and 102 (17.77%) were cases of partial hanging.
 Conclusion: To reduce the number of suicidal hanging cases a well designed and comprehensive programme is needed, which will identify the causative factors and prevent of suicidal behaviors of affected persons.
 KYAMC Journal Vol. 10, No.-1, April 2019, Page 17-20

Socio Demographic Profile of Head Injury among Medico Legal Autopsies Conducted in a Rural Medical College

Socio Demographic Profile of Head Injury among Medico Legal Autopsies Conducted in a Rural Medical College

Comprehensive and Analytical Study of Medico Legal Autopsies at Tertiary Care Center

Comprehensive and Analytical Study of Medico Legal Autopsies at Tertiary Care Center

A Histopathological Analysis of Medico Legal Autopsy in Cases of Sudden Death

A Histopathological Analysis of Medico Legal Autopsy in Cases of Sudden Death

Medico Legal Mediation: Developing an Interdisciplinary Roleplay

Creating opportunities for law students to expand their horizons by working with students from other disciplines offers a unique learning opportunity. Authentic simulation exercises offer students a dynamic and engaging learning experience. A multi-media based interdisciplinary medical negligence ‘case’ developed in partnership between the University of Adelaide Law and Medical schools combines both elements, offering a truly immersive and realistic educational platform for students from both schools. This article outlines the development, implementation and evaluation of this exercise, and provides both philosophical and practical commentary on the challenges and successes experienced in the process. The article arises out of a proof of concept project developed over a three year period at Adelaide Law School that was aimed at exploring the potential for interdisciplinary engagement between medical and law students in a dispute resolution exercise. Three academics were involved – the developer of the initiative, a medico/legal ethicist and law teacher teaching the undergraduate subject Medical Law and Ethics (Associate Professor Bernadette Richards); a medical practitioner and teacher responsible for the management of simulated learning in the Medical School (Dr Adelaide Boylan); and, a mediator and dispute resolver teaching Civil Procedure and Dispute Resolution to mainly final year law students (Margaret Castles). This article explores the rationale behind the initiative and highlights the value of teaching complex practice skills in an interdisciplinary environment. The scope of this model is not limited to the medico-legal environment, it could be expanded to other law subjects and would enrich the learning of students of both law and other disciplines.