Medico-legal Procedures Research Articles

Oral and maxillo-facial injuries in victims of political repression during the Chilean dictatorship.

Chile was under a civil-military dictatorship from 1973 to 1990. During that time, systematic violations to human rights were perpetrated. Oral and maxillo-facial trauma was not an exception, and such trauma was carried out through different methods of torture or ill treatment by agents of the State. Currently, Chile has laws and programs in the public healthcare system to carry out the re-habilitation and reparation process in victims, and the registration of the suffered injuries is considered an important part of these med-ico-legal procedures. The aim of this study is to describe and classify the type of torture or ill-treatment in the orofacial area of victims of political repression during the Chilean military dictatorship and relate them to the injuries registered in written reports. 14 reports of oral and maxillo-fa-cial injuries of tortured victims from 2016 to 2020 were analyzed, considering the alleged history of the patient, the visible effects on the oral examination, and the type of torture that was inflicted. Historical clinical records and X ray exams were analyzed when available. 6 variations of torture and ill-treat-ment that involve the maxillo-facial area were caused by agents of the State during the dic-tatorship period. According to the patient ́s account and the clinical examination, all of the torture techniques applied caused, directly or indirectly, the loss of teeth. This resulted in not only physical problems, but psychological problems for the victims.

Death due to Hanging: A Retrospective Medico-legal Study at a District level in Bangladesh

Background: After suicidal poisoning, death due to hanging is one of the common modes of suicide encountered in medico-legal procedure in Bangladesh. Objective: To study on demographic and autopsy findings associated with suicide by hanging at Manikganj district, Bangladesh. Methodology: This retrospective cross-sectional study was conducted in the District hospital, Manikganj, Bangladesh during the period of January 2019 to December 2020. Results: A total of 381 medico-legal autopsies were analyzed, out of which 169 were deaths due to hanging. Out of 169 cases, the maximum (69, 40.8%) deaths were due to hanging in the age group of 21-30 years. Majority (101, 59.8%) of the cases were observed in females and among them, maximum were housewives (60, 35.5%). Most of the death bodies (47, 27.81%) were brought from Manikganj police station. Regarding the ligature material used, majority (133, 78.7%) of victims had used soft ligature material, like Dopatta (orhna) (56, 33.1%). Considering the autopsy findings, cyanosis of fingertips and nail bed was the commonest (163, 96.4%), followed by subcutaneous tissue under the ligature mark found pale, white, hard and glistening (159, 94.0%), and dribbling mark of saliva in case of asphyxial death due to hanging (144, 85.2%). Conclusion: Suicidal hanging was commonly encountered in younger age group and in many cases of financial problem, followed by family disputes were commonly observed. J Monno Med Coll June 2022;8(2): 31-35

Age as a Historical Category of Analysis

This work utilises archival methods to examine the processes of identification authorized by the colonial state to establish the certification routine for children employed in the textile mills of Bombay in the late nineteenth and early twentieth century. Specifically, this project will investigate how colonial administrative and bureaucratic policies, along with the legal regulation of the Indian Factory Acts, naturalized ‘age’ as the category of identification for laboring children. This work argues that the colonial obsession with ‘age’ standardization is very much present in the contemporary law governing child labor in India, i.e. the Child Labor (Prohibition and Regulation) Amendment Act. Therefore, the proposed research plans to center on ‘age’ as a historical category of analysis and its institutionalization with related processes of identification through the introduction of medico-legal procedures by the colonial state. The working hypothesis is that the ‘industrial child’ was produced as an age-based category through the interaction between these regulatory processes, a corrupt bureaucracy, and a superficial colonial concern for child protection.

The Anatomy of a Medico-Legal System. Medical Practitioners and the Investigation of Suspicious Deaths in Early Modern Flanders

During the early modern period, medical practitioners came to play an increasingly important role in criminal proceedings throughout continental Europe. Nevertheless, medico-legal procedures in the Southern or Habsburg Netherlands have hardly received any attention from historians of forensic medicine. The present article aims to address this issue by studying how suspicious deaths were investigated in the early modern County of Flanders. More specifically, three major aspects of the Flemish medico-legal death investigation system are analysed: the composition of the corps of medical practitioners on which the judicial authorities relied to conduct post-mortem examinations, the content of post-mortem reports, and arrangements for the remuneration of medical experts. Although surgeons initially constituted the principal group of medical examiners, university-trained physicians were increasingly required to participate in death investigations over the course of the seventeenth and eighteenth centuries. Furthermore, this period also witnessed a gradual increase in the number of internal autopsies. However, arrangements for the payment of medical experts remained largely unchanged throughout the early modern period.

Prélèvement d’organes et traumatisme crânien non accidentel du nourrisson : état des lieux des pratiques en France

INTRODUCTION
 Les décès de nourrissons par traumatisme crânien non accidentel s’inscrivent dans une procédure médico-judicaire pouvant compliquer les démarches de prélèvement multi-organes. L’objectif de cette étude est de décrire les pratiques du prélèvement d’organes chez ces nourrissons en état de mort encéphalique en France.
 METHODES 
 Une enquête nationale rétrospective a été menée d’Avril à Décembre 2018 auprès des 33 coordinations de prélèvement d’organes pédiatriques et des 28 instituts médico-légaux. Le recueil de données a porté sur les cas recensés entre 2013 et 2017.
 RESULTATS
 Seize cas ont été recensés. La prise en charge des traumatismes crâniens non accidentels éligibles au prélèvement d’organes est très hétérogène selon les centres. Les coordinations considèrent que la judiciarisation des dossiers représente le principal obstacle au prélèvement. Seuls 6 des instituts médico-légaux approuvent systématiquement le prélèvement multi-organes dans ce contexte, 11 estimant qu’il pourrait empêcher la mise en évidence de lésions thoraco-abdominales, compromettre l’interprétation de certaines lésions ou encore la détermination des causes de la mort.
 CONCLUSION
 Une uniformisation des pratiques du prélèvement multi-organes incluant une collaboration étroite entre réanimateurs, coordinateurs, légistes et magistrats sont indispensables pour faciliter le prélèvement d’organes pédiatriques dans les situations médico-judiciaires le permettant, afin d’augmenter la disponibilité des greffons compatibles aux nourrissons en attente de greffe en France.

Violence and epilepsy: Descriptive study of 33 cases

Questions are often raised about the relationship between recurrent seizures and the behaviour of the epileptic person. However, some people who have seizures have behavioural problems and are responsible for medico-legal procedures despite the progress of anticomitial chemotherapy. The objective of this work is to develop the sociodemographic and clinical profile found in epileptic patients who committed violent acts.

Awareness of Forensic Cases Among Nurses: A Descriptive, Cross-Sectional Study.

This study reports the knowledge, experience, and attitudes of nurses toward forensic cases in Turkey; critically evaluates the appropriateness of current practices in the collection and preservation of evidence; and assesses nurses' level of awareness on the law enforcement perspective of forensic cases. The study, thereby, seeks to offer solutions to some practical difficulties faced by nurses in clinical practice in Turkey. The study involved 178 nurses of 202 employed in three healthcare centers operated by the same private healthcare group located in Istanbul, Turkey. The primary method of data collection was a questionnaire composed of three sections. The first section recorded data concerning the participants' age, gender, number of years spent in the profession, number of years spent in current workplace, department in which they worked, and their job title. The second section sought to assess the participants' academic background and, specifically, the extent of their educational training on forensic cases at the undergraduate and graduate levels. Finally, the third section aimed to assess the participants' knowledge of and approach toward the management of forensic cases in real-life time setting by collecting data on their previous experience with forensic cases. Of 178 nurses, 139 (78.1%) were female and 39 (21.9%) were male. The mean age was 28.6 years, ranging from 18 to 51 years. The participants expressed that they experienced difficulties in medicolegal procedures (21.9%), evidence collection (14.0%), history taking and preparation of the patient (10.1%), forensic case reporting (10.1%), registry (9.0%), and physical examination (7.9%). The level of knowledge of the collection of forensic evidence and the protection of wet evidence was statistically higher among the participants who previously received training on the collection, preservation, and transfer of forensic evidence versus those who were not previously trained (p < 0.001 for both). Our study results highlight the need for medicolegal regulations and legislation allowing for the creation of specific positions for forensic nurses in Turkey. We also concluded that these nurses should be trained and equipped with necessary knowledge and skills in forensic nursing.

Matricide in psychotic patients: About 3 case reports

IntroductionMatricide is the murder of the mother and it is one the rarest reported homicides with rates varying between 1% and 4% of all murders. In our country, few studies have focused on this issue.ObjectivesTo precise circumstances of matricide in psychotic patients and the offender and victim’s profiles.MethodsWe report three clinical cases who were hospitalized in the department of Psychiatry “A” at the Hedi Chaker university hospital in Sfax, Tunisia, because of non-judicial proceedings for dementia during the year of 2019.ResultsAmong 3 cases, two patients were male and they were aged respectively 26 and 48 years old. The third was female. All of them had very low educational and income levels and they lived with the victim. In 2 cases, the victim-offender relationship was conflictive and there was already exhibited violent behavior towards victim.Two patients had a psychiatric follow-up and many hospitalizations. The diagnoses were schizophrenia and schizoaffective disorder. However, it was a poor compliance and an interruption of treatment. In the third case, the medicolegal procedure was inaugural. His diagnosis was schizophrenia.All the victims were illiterate and unemployed. Their middle age was 64 years.In all cases, the crime was not premeditated, motivated by persecution delusions including the mother. It was committed in the family house while using a blunt object. The post homicide reaction was marked by coldness.ConclusionsMatricide has always been considered one of the most abhorrent crimes. Regular evaluation of psychotic patients’ dangerousness signals is needed to reduce the acting out.Conflict of interestNo significant relationships.

Interpretation of epileptogenic lesions: Its limitations in medico-legal experts’ reports

Focal cortical dysplasia (FCD) is the third leading cause of pharmacoresistant epilepsy diagnosed by epilepsy surgery and is a common malformation of cerebral cortical development. It is marked by abnormalities of cortical lamination, neuronal differentiation, and neuronal maturation. These epileptogenic lesions have proven anatomical and clinical correlations. Only one case of incidental FCD had been described. Incidental findings highlight infrequent lesions that go unnoticed when a person is alive. It can be an important finding for pathologists as well as for the forensic expert. The difficulty of the expertise will be in cases where these incidental lesions are known to cause symptoms that may be the cause of death. We wish to argue if they can be used in a medico-legal procedure. We report two cases demonstrating discrepancies between anatomical and clinical features, which should encourage the medical expert to use caution when interpreting neuropathological reports. La dysplasie corticale focale (DCF) est la troisième cause d’épilepsie pharmacorésistante diagnostiquée par chirurgie de l’épilepsie. Il s’agit d’une malformation courante du développement cortical cérébral. Elle est marquée par des anomalies de la stratification corticale, de la différenciation neuronale et de la maturation neuronale. Ces lésions épileptogènes ont des corrélations anatomiques et cliniques prouvées. Un seul cas de DCF de découverte fortuite à l’imagerie a été décrit dans la littérature. Ces découvertes fortuites mettent en évidence des lésions peu fréquentes qui passent inaperçues lorsqu’une personne est en vie. Or, ces lésions sont une découverte importante pour les pathologistes ainsi que pour l’expert médico-légal. La difficulté de l’expertise se situera dans les cas où ces lésions incidentelles sont connues pour provoquer des symptômes pouvant être la cause du décès. Nous souhaitons discuter s’ils peuvent être utilisés dans une procédure médico-légale. Nous rapportons deux cas démontrant des divergences entre les caractéristiques anatomiques et cliniques, ce qui devrait inciter l’expert médical à faire preuve de prudence dans l’interprétation des rapports neuropathologiques.

Which antidote to the undue injections of hypertonic bicarbonate solution during tumescence for surgery of superficial venous insufficiency?

The generalization of local anesthesia by tumescence during the thermal endovenous treatment of superficial venous insufficiency transferred the management of sedation to the surgeons. The recommended preferential use of a 1.4/100 bicarbonate solution with 1% of adrenalined lidocaine requires the compliance with certain rules, with the risk of side effects and of potentially serious complications, and possible medico-legal issues. Apart from an overdose in lidocaine, the injection by error of a hypertonic solution can induce extensive subcutaneous and cutaneous necroses in the treated zone leading to many weeks of treatment with surgical debridement, directed healing, and skin grafting, with esthetic even functional important sequelae, leading to medico-legal procedures.

Medico-legal assessment of personal damage in older people: report from a multidisciplinary consensus conference

Ageing of the global population represents a challenge for national healthcare systems and healthcare professionals, including medico-legal experts, who assess personal damage in an increasing number of older people. Personal damage evaluation in older people is complex, and the scarcity of evidence is hindering the development of formal guidelines on the subject. The main objectives of the first multidisciplinary Consensus Conference on Medico-Legal Assessment of Personal Damage in Older People were to increase knowledge on the subject and establish standard procedures in this field. The conference, organized according to the guidelines issued by the Italian National Institute of Health (ISS), was held in Bologna (Italy) on June 8, 2019 with the support of national scientific societies, professional organizations, and stakeholders. The Scientific Technical Committee prepared 16 questions on 4 thematic areas: (1) differences in injury outcomes in older people compared to younger people and their relevance in personal damage assessment; (2) pre-existing status reconstruction and evaluation; (3) medico-legal examination procedures; (4) multidimensional assessment and scales. The Scientific Secretariat reviewed relevant literature and documents, rated their quality, and summarized evidence. During conference plenary public sessions, 4 pairs of experts reported on each thematic area. After the last session, a multidisciplinary Jury Panel (15 members) drafted the consensus statements. The present report describes Conference methods and results, including a summary of evidence supporting each statement, and areas requiring further investigation. The methodological recommendations issued during the Conference may be useful in several contexts of damage assessment, or to other medico-legal evaluation fields.

Just the Basic Facts: The Certification of Insanity in the Era of the Form K.

This paper investigates the certification of insanity through a standardized template called Form K which was used in Ontario between 1873 and 1883. My main thesis is that the introduction of the Form K had profound and long-lasting effects on the determination of insanity. In particular, it created a unique case in the history of certification, it grounded civil confinement on a strategy of consensus, and it informed mental health documentation for more than a century. As the result of a transnational mediation from Victorian England, the Form K prescribed an examination setting which involved a high number of participants, including three physicians and several witnesses. By comparing this case with other jurisdictions of the time, this paper shows how Ontario became a distinctive case worldwide. In order to get a closer look at this medico-legal procedure, I consider the archival records of the Toronto asylum and conclude that the certification of insanity relied on a strategy of consensus. While the Form K proved quite successful in preventing legal actions, it produced financial, logistic, and bureaucratic issues. The Form K was thus discontinued after a decade, yet its structure influenced Ontario's mental health documentation throughout the twentieth century. This paper shows the relevance of the certification of insanity for transnational history and for understanding contemporary issues of involuntary confinement and stigma in mental health.

Reconstruction of the asbestos exposure in a textile company producing sewing threads through the use of an unusual information source.

«Reconstruction of the asbestos exposure in a textile company producing sewing threads through the use of an unusual information source».Background:The Tuscan Regional Operating Center (ROC) of Malignant Mesotheliomas has identified a cluster of 11 cases of malignant mesothelioma occurred in a textile plant manufacturing sewing thread. Using the common research method, the ROC had not previously been able to identify the specific sources of asbestos exposure causing such a large cluster.Objectives:The ROC’s objective was to review all cases of the cluster and to better identify their occupational asbestos exposures.Methods:The cases’ occupational histories of asbestos exposure have been reviewed, using information deriving from the annual reports sent to the Tuscany Region since 1988 by all the asbestos removal companies according to the Law no. 257/1992, article 9, and from interviews to former employees of the plant.Results:The work cycle has been reconstructed and enriched with the new information about the asbestos presence and its uses in the plant. The eleven cases were all reclassified as “certainly occupational exposed” given that the new collected information depicted a widespread asbestos pollution of the workplace during the period of employment of all cases.Conclusions:Using different sources of information, in addition to those traditionally collected through questionnaires, to reconstruct past asbestos exposuresallowed us to clarify the existence of the cluster of mesothelioma cases and the highest level of occupational asbestos exposure was attributed to all cases with consequent activation of the medico-legal procedure.

Minimizing aerosol bone dust during autopsies.

When sawing bone for medical or medico-legal procedures, fine, airborne dust is produced (aerosols) that can pose a health hazard when inhaled. The aim of this study was to determine the influence of saw blade frequency and contact load, bone condition, test environment, and saw blade type, on the production of aerosol particles. A custom test setup was designed, manufactured and used in 8 bone sawing experiments, using a particle counter to determine the production of aerosol particles while varying the 5 chosen parameters. The number of counted particles was highest with higher saw blade frequencies, lower saw blade contact loads, in dry completely skeletonized bone compared to fresh bone, and using an electrical oscillating saw compared to hand-sawing. Under all conditions, the high amount of aerosol counted posed potential health risks. The ventilation system that we tested was adequate in removing the produced particles, but these high-tech systems are not always available in developing countries or emergency situations. The production of aerosols can be reduced by optimizing the sawing parameters. However, even the lowest number of aerosol particles counted during the current study was high enough to cause potential health risks to practitioners. Safety precautions should be taken, such as external ventilation, proper breathing gear, and adequate protocols, to truly minimize the risk in all bone sawing scenarios.

AUTOPSY: Knowledge and Perception of undergraduate medical students in current teaching system

Objective: To evaluate their acquaintance about autopsy, appropriate way of teaching and to appraise their views for the procedure of autopsy and recognition of Forensic as profession.&#x0D; Methodology: A cross sectional questionnaire-based study was done in 2015 to 2016, in a public university running modular system. Data were collected by convenient method, from students of 3rd year and ahead. More than 250 forms were distributed and only 193 completed and analyzed by SPSS 17.&#x0D; Results: Out of 193 students, 165 students claimed to recognize the “autopsy” and 28 not understand the procedure. Only 20 students observed more than 4 autopsies. Out of 193, 179 believed that Forensic education should not be scrapped from the medical syllabi. For teaching methodology 123 preferred a live autopsy and 64 students appreciated watching videos and only 6 favoured books. About 167 students stated autopsy as mandatory in all unsuspected deaths, and 172 agreed for usefulness in medical education but 111 found it disrespectful to the dead body. Around 166 students consider forensic not a prospective profession and 93 suggested its limited scope in Pakistan.&#x0D; Conclusion: Students were aware of the value and necessity of autopsy as a medicolegal procedure. Adequate time must be fixed for viewing autopsy procedures to insure their complete competency. There is need for continuing efforts to improve the teaching of autopsy within a modular system.&#x0D; Keywords: Autopsy, Undergraduate Medical Education, Forensic Medicine, Forensic Education

Medical Negligence and Remedies: A Challenge to Medical Profession

Medical negligence litigation has become a common experience for the medical practitioners. It is important to know what constitutes a medical negligence and take preventive steps. The doctor has certain duties to his patient who comes to him for treatment for his illness. If there is any deficiency of duty or service due to commission or omission causing damage to the patient, it amounts to medical negligence. When there is a litigation of medical negligence, a legal procedure is followed to address the complainant The doctor has to be aware of the medico-legal procedures and laws dealing with alleged medical negligence cases. It will help them to take precautions and follow safe medical practice.

Medicolegal study of sexual violence cases in Pekanbaru, Indonesia: prevalence, pattern, and Indonesian legal framework

BackgroundSexual violence is a major public health problem. The role of forensic examination is very important for collecting evidence on sexual violence cases. The principal aim of this study was to identify the prevalence and pattern of injury in sexual violence victims. In this study, sexual violence in terms of the Indonesian legal framework, especially medicolegal procedures and terms of rape, will also be discussed.MethodsData for this retrospective study were retrieved from the medicolegal reports (Visum et Repertum) of sexual violence victims obtained from the Forensic Medical Service Center (FMSC) Bhayangkara Hospital Pekanbaru (BHP) over five years starting from January 1, 2010, until the end of December 2014.ResultThe average prevalence rate of sexual violence was 13.15/100,000 population/year. The total number of cases was 665, and 94.6% were females. Adolescents composed the highest proportion of cases among both genders. Bruises and abrasions were the most frequent injuries found (17.1% and 14.3%, respectively), with the upper extremity being the most common site. Most victims had ano-genital injury (75.2%), but 77.6% had no bodily injury. There was a significant difference between children and adults regarding bodily injury (P = 0.028), and there was a significant difference between males and females regarding ano-genital injury (P = 0.000).ConclusionThe prevalence of sexual violence was high among living victims in Pekanbaru, with the majority of victims being female. The Indonesian legal framework of sexual violence still adheres to traditional terminology but is making improvements.

Screening of Alleged Medical Malpractice in Egypt (Fayoum Governorate)

Background and Objectives: Medical malpractice is a legal cause of action that occurs when a physician deviates from required substandard and causes deterioration, disability, harm or death to a patient. This study documented all the reported malpractice cases according to the forensic medicine authority in Fayoum Governrate in the in the course of regular and proper health service Methods: All cases of medical malpractice claims of several medical specialties referred to the Forensic Medicine Authority, in 2012-2016 were checked (n=55). Results: The present study shows that 87.3% of the study group were adults, and 12.7% of them were children, 50.9% of them were males and 49.1% were females, and as regards to the place of residence, 47.3% of the victims were from urban places. The study has also pointed out that the majority of malpractices occurred in general hospitals (67.3%), more than in clinics and private hospitals. The 40% of malpractice were complications of surgery, then 23.6% of them were due to negligence, then 21.8% of patients had medication errors, and the least percentage of 14.5% had forgotten gauze and the majority of malpractices occurred in obstetrics and gynaecology which represent (36.4%) of the cases. Conclusion: It is extremely essential to analyse the errors properly in order to get the medical malpractice under control to avoid incidence of litigation and to propose professional standards as well as accurate references in connection with medico-legal procedures.

A qualitative study of the background and in-hospital medicolegal response to female burn injuries in India.

BackgroundMost burns happen in low- and middle-income countries. In India, deaths related to burns are more common in women than in men and occur against a complex background in which the cause – accidental or non-accidental, suicidal or homicidal – is often unclear. Our study aimed to understand the antecedents to burns and the problem of ascribing cause, the sequence of medicolegal events after a woman was admitted to hospital, and potential opportunities for improvement.MethodsWe conducted semi-structured interviews with 33 women admitted to two major burns units, their families, and 26 key informant doctors, nurses, and police officers. We used framework analysis to examine the context in which burns occurred and the sequence of medicolegal action after admission to hospital.ResultsInterviewees described accidents, attempted suicide, and attempted homicide. Distinguishing between these was difficult because the underlying combination of poverty and cultural precedent was common to all and action was contingent on potentially conflicting narratives. Space constraint, problems with cooking equipment, and inflammable clothing increased the risk of accidental burns, but coexisted with household conflict, gender-based violence, and alcohol use. Most burns were initially ascribed to accidents. Clinicians adhered to medicolegal procedures, the police carried out their investigative requirements relatively rapidly, but both groups felt vulnerable in the face of the legal process. Women’s understandable reticence to describe burns as non-accidental, the contested nature of statements, their perceived history of changeability, the limited quality and validity of forensic evidence, and the requirement for resilience on the part of clients underlay a general pessimism.ConclusionsThe similarities between accident and intention cluster so tightly as to make them challenging to distinguish, especially given women’s understandable reticence to describe burns as non-accidental. The contested status of forensic evidence and a reliance on testimony means that only a minority of cases lead to conviction. The emphasis should be on improving documentation, communication between service providers, and public understanding of the risks of burns.

Investigation of Sudden Death in Athletes: The Fittest Bodies in the Morgue

Sporting events are generally viewed as regulated activities with fit and healthy participants; therefore, when deaths occur, they draw considerable public interest. Athletic participants can be considered a vulnerable population based on inherent risks within certain sports and the associated physiologic stresses, which may complicate underlying medical conditions. Sudden deaths in young athletes participating in high school and collegiate organized sports occur at an average of four to six deaths per year; however, sudden deaths related to exercise outside of an organized sport setting remain unaccounted for in the overall prevalence of these deaths. A typical forensic pathology practice will see not only these higher-profile deaths occurring during an organized sporting event, but also lower-profile occurrences of individuals dying during more recreational or unstructured exercise. Sport-related deaths can essentially be categorized as those that occur due to dangers inherent in the sport itself, such as forms of heat-related illnesses, blunt force trauma, and water-related deaths, and those that occur due to susceptibilities of a given predisposed participant, including sickle cell trait, hypertrophic cardiomyopathy, and other cardiovascular diseases. This article will address both types of vulnerabilities and provide guidance for appropriate and specific medicolegal death investigation and autopsy procedures in these deaths.