Medico-Legal Journal最新文献

Informed consent is a fundamental component of ethical and legal medical practice in the United Kingdom (UK). As COVID-19 transitions to an endemic phase, this study explores how consistently its ongoing risk is communicated during the surgical consent process. We prospectively reviewed 147 surgical consent forms collected over 2 months in 2024 at a UK tertiary centre. The primary aim was to assess how often COVID-19 risk was documented; secondary outcomes included postoperative infection rates and 30-day mortality. COVID-19 was explicitly mentioned in only 5.4% of consent forms. No significant variation was found across clinician grades (p = 0.840). Three patients developed postoperative COVID-19, and one died within 30 days. This mortality association was statistically significant (p = 0.020). Despite existing guidance, COVID-19 risk is rarely discussed when obtaining consent, raising ethical and legal concerns. These findings highlight the need for institutional safeguards to ensure transparent, patient-centred consent that aligns with medico-legal standards in post-pandemic care.

Umbilical granuloma (UG) is a benign and common umbilical anomaly in neonates and infants, typically managed conservatively with salt application or silver nitrate. While rarely requiring surgical intervention, complications arising from invasive treatments are significantly underreported. We present a rare, but fatal case, of bowel perforation following electrocautery excision of a UG in an 11-month-old male infant. The child had a persistent pinkish umbilical lesion unresponsive to conservative treatment. Ultrasonography ruled out underlying vitellointestinal anomalies, and surgical excision was performed under short general anesthaesia. The procedure was uneventful, and the infant was discharged within a few hours postoperatively. Within 24 hours, the child exhibited signs of abdominal distress and was declared dead upon arrival at the emergency department. A medico-legal autopsy revealed haemoperitoneum and a perforation on the antimesenteric border of the ileum. Histopathology demonstrated transmural necrosis at the perforation margins. No other organ pathology or toxicologic cause was identified. The cause of death was certified as haemorrhagic shock secondary to bowel perforation. This case emphasises the need for caution even with routine paediatric procedures, particularly when involving thermal instruments. It underscores the anatomical vulnerability of infants, the critical need for intraoperative precision, extended postoperative observation and protocol-based care. From a legal standpoint, this case raises questions about informed consent, standard of care and institutional liability. The findings highlight the need for national paediatric surgical safety guidelines, especially regarding electrocautery use in superficial procedures and demonstrate the vital role of forensic pathology in uncovering preventable iatrogenic deaths.

National guidelines and the legal standard of care for the management of cauda equina syndrome (CES) patients in primary care have recently changed. Any patient with a history of symptoms of CES must be referred to secondary care for urgent MR imaging (MRI) even in the absence of any objective signs of CES. This article reviews the prevalence and clinical diagnosis of CES, the new national guidelines and management in primary care. The standard of care for doctors, the legal basis of national guidelines and an illustrative judgement are discussed. This new standard of care for GPs will make it easier for claimants to demonstrate a breach of duty of care and, because patients should be referred earlier (on the basis of symptoms not signs of CES), causation and quantum will be higher than for cases where MR imaging and surgery are delayed until the onset of objective signs.

Section 164 statements can be taken at any time during investigation of alleged abductions in Pakistan. The independence of such statements is open to question when they are taken in the presence of the alleged abductor. To assess the processes adopted for investigation and prosecution of alleged abductors of girls and women in a defined community, data were collected on abductees in 2022 and 2023 in the four districts of Dera Ghazi Khan, Punjab. Police reports were analysed for abducted girls: under 16, 16-18 and over 18. The number of cases almost doubled during the period. Girls under 16 were significantly more likely to be abducted than those aged 16-18 (p < 0.005), who were significantly more likely to be abducted than those over 18 (p < 0.02). In all three groups the abductor was significantly more likely to be physically present in court when a statement was taken from the abductee as to the events of the alleged abduction than her parents (p < 0.001). Abductions were twice as common in rural districts and abductors significantly more likely to be in court than parents (p < 0.01). The paper proposes an educational and research strategy to address these issues with formal training programmes for police, magistrates and judges to clarify their understanding of the relationship between statutory law and sharia and the need not to base their decisions on traditional cultural views.

Acute subdural haemorrhage in sudden infant death (SID) presents a forensic challenge, particularly in resource-limited settings, where distinguishing true injury from resuscitation or post-mortem artefacts is difficult. We report a case of a previously healthy 2-month-old male infant found unresponsive shortly after being placed prone following breastfeeding. Despite prolonged resuscitation, the infant died. Autopsy revealed faint anterior chest contusions consistent with resuscitation and bilateral acute subdural haemorrhages without skull fractures, retinal haemorrhages or cerebral oedema. Histology confirmed acute subdural and subarachnoid haemorrhages without chronic changes, and toxicology was negative. Scene investigation identified no risk factors for trauma or accidental suffocation. The findings suggest the haemorrhages probably resulted from peri-mortem hypoxic vascular injury or resuscitation artefacts, emphasising the importance of integrating clinical history, autopsy, histology and scene information to avoid misinterpretation of subdural haemorrhages in cases of SID.

Thirty years ago, a 24-year-old teacher attended hospital, suffering from persistent stomach pains, more pronounced around the navel, along with nausea; she vomited several times with several diarrhoeal stools. When admitted to the emergency room, she had normal vital normal laboratory findings, and the basic X-ray image of the abdomen did not indicate intra-abdominal perforation and ileus. On palpation, her abdomen was continuously diffusely painful, and the elastic wall had no defence musculature; there was no back pain. Given the clinical picture of a "pseudoacute abdomen", the patient was examined by an internist, surgeon and gynaecologist. Three hours after admission, during examination, the patient suffered a fatal cardiorespiratory arrest which did not respond to resuscitation procedures which were applied immediately and for one hour. At autopsy, an infraceliac complete asymmetrical ruptured abdominal aortal aneurysm of the posterolateral wall, 9 cm in length, was found with massive coagulum and fresh blood filling the entire retroperitoneum. Pathohistologically, a typical lesion of abdominal aortal aneurysm dissection into media with intimal fragmentation, intramural haematoma and mild atherosclerotic plaques was proven. The cause of sudden death was declared to be unknown, spontaneous, non-traumatic ruptured abdominal aortal aneurysm with massive retroperitoneal bleeding and ireversible haemorrhagic shock.

This analysis is based on the published outcomes of the Shipman and Mid-Staffordshire Inquiries, Parliamentary discussions recorded in Hansard and the resulting Acts. The Analysis assesses whether the present structure of the ME programme can deliver the roles which various Inquiries called for so as to improve patient safety in England and Wales.