Archiwum Medycyny Sadowej i Kryminologii最新文献

Aim of the study: Analysis of forensic medical opinions in the field of obstetrics prepared at the Department of Forensic Medicine, Jagiellonian University Medical College in Krakow, in 2010-2016, in order to evaluate changes in the number of filed cases involving an alleged medical error over the years, and determine the most common situations where medical errors are suspected by patients, and the most prevalent types of medical errors in obstetrics.

Material and methods: The opinions were divided into two groups. In the first group, the medical management was appropriate, while in the second group medical errors were identified. The medical errors were categorised as diagnostic/therapeutic, technical, and organisational. The effects of medical errors were classified as death, impairment to health, exposure to death, and exposure to impairment to health, by considering them separately for post-natal women, and for foetuses and neonates (during the first days of life).

Results: A total of 73 forensic medical opinions were analysed. In 25 cases, a medical error was identified. The most common situations in which a medical error was committed, and in which the suspicion of medical error proved to be unfounded, were listed. Overall, there were 17 diagnostic/therapeutic errors, 7 organisational errors, and 4 technical errors. In cases where a medical error was identified, there were 15 deaths, and in cases without a medical error - 31 deaths.

Conclusions: It was found that 66% of the analysed forensic medical opinions involved no medical errors. In most of these cases, a therapeutic failure occurred, including perinatal haemorrhage, tight wrapping of the umbilical cord around the foetal neck (nuchal cord), premature birth, and septic complications. A few cases involved uncooperative patients. The most prevalent medical error was failure to perform or delaying a caesarean section when it was needed (because of emergency or urgent indications). The second most common medical error was related to incorrect CTG interpretation.

Whiplash injury (distortion of the cervical spine) is the most commonly diagnosed type of injury sustained in car accidents, and it ranks first in the structure of compensation claims for personal injury resulting from traffic incidents. The verification of whiplash-associated disorders (WADs) continues to be a great problem in the formulation of medico- legal expert opinions, as injuries of this type, cannot, by definition, be captured using available imaging methods ("radiologically negative effects of acceleration/deceleration mechanism with a wide variety of clinical manifestations"). The present study aims to define a set of criteria that might represent threshold conditions for WAD verification, enabling preliminary cohorting (preselection) of evaluated cases and facilitating the adoption of legal decisions. The available scientific literature addressing problems relating to WAD verification was reviewed to identify factors that differentiate an extremely broad spectrum and varying severity of symptoms depending on the circumstances of incidents, the results of physical evaluation of patients and additional instrumental examinations, as well as technical indicators. Based on the literature search, a range of criteria with the highest potential significance for application in routine medical and forensic expert practice were selected (with a focus on aspects related to verification, quantification and outcomes). The primary prerequisite for recognising the presence of moderate impairment to health (according to the Polish penal code) due to distortion of the cervical spine should involve confirmation of grade 3 WAD according to the Quebec Task Force (QTF) classification, and exceeding the threshold values of Δv (> 15 km/h), acceleration of the victim's vehicle centre of gravity (> 4 g), and NIC criterion (> 15 m2/s2). Additional criteria used by experts should include the verification of the correct head restraint position as well as results of biomechanical examinations evaluating the level of safety of a given vehicle, and epidemiological data retrieved from databases including the statistics for claims filed by victims of real-life accidents.

Aim of the study: 1) evaluation of the frequency of occurrence of traces and injuries on hands of persons firing firearms, 2) detailed description of types of traces and injuries as mentioned above, 3) detailed evaluation of the mechanism of their arising in respect to types of firearms and ammunition, and the way of holding firearms during shooting.

Material and methods: The material consisted of 8 cases in which traces or injuries were found on the upper limbs of the person firing the shot. A total of 217 firearms, including 68 pneumatic firearms, were tested during the period under investigation, with approximately 1100 sample test shots.

Results: Traces and injuries were only revealed in about 5% of all shots fired from a particular type of firearm. They were not found in the case of pneumatic firearms. The lesions took the form of singeing, gunpowder tattooing, and various shapes of epidermal abrasions and superficial wounds caused by moving elements of firearms (lock, hammer). Some of them reflected the design of the moving parts of the firearms.

Conclusions: In criminal and forensic medical practice, detailed knowledge of the type and mechanism of traces and injuries on the shooter's hands may have significant evidential value in cases concerning the use of firearms. The results of this analysis confirm the need for further study and observation in this area.

A fatal case of drowning under the influence of multiple psychotropic drugs, such as quetiapine, escitalopram, aripiprazole and flunitrazepam, is presented. Quantitative toxicological analysis of a femoral blood sample revealed concentrations of quetiapine, escitalopram, aripiprazole and 7-aminoflunitrazepam (a metabolite of flunitrazepam) of 1.266 µg/ml, 0.609 µg/ml, 0.124 µg/ml and 0.055 µg/ml, respectively. From the autopsy findings, results of toxicological examination and investigation by the authorities, we concluded that the cause of death was drowning under the influence of mainly quetiapine and escitalopram.