The ethical and medico-legal challenges of telemedicine in the coronavirus disease 2019 era: A comparison between Egypt and India

Background: In the coronavirus disease 2019 era, doctors have tried to decrease hospital visits and admissions. To this end, telemedicine was implemented in a non-systematic manner according. The objective of this study was to assess the current knowledge and attitudes of physicians in Alexandria, Egypt, and Punjab, India, toward telemedicine and its ethical and medico-legal issues. Method: A cross-sectional study was implemented using an anonymous self-administered questionnaire carried out over two months (July and August 2020). A four-point Likert scale was used to collect data about background knowledge, training in telemedicine and ethical and medico-legal issues in telemedicine practice. Results: The questionnaire was completed by 175 Egyptian and 51 Indian physicians from different specialties. A significantly higher percentage of Indian physicians practiced telemedicine than Egyptian physicians during the coronavirus disease 2019 era. Although most physicians had no specific training or licensing to practice telemedicine, most of them practiced telemedicine through their social media accounts. Ethical violations involving waiving patient consent were detected. Significant ethical violations to doctors, for example, blackmail, defamation, hate speech, accusations in a court and violations of privacy, were observed. Indian physicians (39.2%) and Egyptian physicians (24%) thought the penalties should be lower in telemedicine than in traditional practice. Finally, most participants would like to continue using telemedicine after the coronavirus disease 2019 era but with improvements. Conclusions: Coronavirus disease 2019 changed the acceptance of telemedicine by physicians. Many ethical and legal issues need to be addressed and clarified using formal training before implementation and standardization of telemedicine services. [ FROM AUTHOR] Copyright of Clinical Ethics is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Study of COVID-19 Impact on Medico Legal Cases Registered at Mediciti Hospital, Ghanpur Village, Medchal Mandal, Telangana

Background and Objectives: In every tertiary care hospital, casualty deals with the emergency cases of which the majority are Medico legal cases. The knowledge about the incidence of Medico legal cases is important to recognise the socioeconomic burden. The present study was conducted to scrutinize different Medicolegal cases at the emergency department of Mediciti Hospital, Medchal. The idea of the study was to find out frequency of several types of medico legal cases at casualty of Mediciti Hospital, Medchal. Material(s) and Method(s): It was a record based cross sectional study in which all the MLC cases registered in MLC record book from March 2020-March 2021 were analyzed. The data was collected on age, sex, type of Medico legal cases, road traffic accidents, mode of occurrence, month-wise distribution of medico legal cases and the time of occurrence. Results were expressed in numbers and percentages. Result(s): Out of all 355 registered medico legal cases, of which 258(73.2%) were males and 94(26.76%) were females. Maximum cases were from the age group of 20-29 years i.e., 127(43.09%). Majority of the MLC's registered we are due to road traffic accidents 144(39.7%) followed by Assault 49(13.8%), falls-43(12.7%), poisoning-43(12.1%), and injury at workplace-43(12.1%), accidental-14(3.9%), snake bite-8(2.2%) and others (7.4%). Conclusion(s): The present study shows RTAs account for a major part of MLCs. By proper education and training of safety measures among public decreases the cases. Enforcement of strict laws reduces the incidence of road traffic accidents. And also, strict laws should be amended to reduce the incidence of Assault.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

Focus on Liability of Residences for Elderly and Sick People: A Case Series and Medico-Legal Issues.

Residences for elderly and sick people, self-sufficient or dependent, are varied. To date, the liability profiles of these structures are not clearly delineated, and increasingly often, their operating and organization criteria are entrusted to subnational, regional, or local regulations. Among the various deficits, there is the keeping of a complete and detailed documentation/diary of the patient, the lack of which can generate medico-legal problems. In this paper, we present three cases of guests in residences for a dependent person brought to the attention of the Institute of Forensic Medicine of the University Hospital of Palermo due to criminal proceedings, where the lack of existing documentation in the structure and, in some cases, the behavior of the professionals working there, led the evaluator to deduce the organization's culpability.

Intravitreal Injection Planning during COVID-19 Pandemic: A Retrospective Study of Two Tertiary University Centers in Italy.

The COVID-19 pandemic has hampered the optimum management of retinal diseases. This study examined the impact of the pandemic on the intravitreal-injection practice in two academic centers in Italy along with the related medico-legal implications. A retrospective analysis of electronic medical records from 16 March 2020 to 14 March 2021 at the ophthalmological departments of University of Cagliari (SGD) and University Magna Græcia of Catanzaro (UMG) was conducted. The data collected between 16 March 2020 and 14 June 2020 (lockdown), 15 June 2020 and 13 September 2020 (unlock), and 14 September 2020 and 14 March 2021 (second wave) were compared with those of the same period of the previous year. Weekly data on the administered drug and the number and type of treated disease were collected and analyzed. During the lockdown, a drop of 59% at SGD (p < 0.00001) and 77% at UMG (p < 0.00001) in intravitreal injections was found. In the first year of the pandemic, the reduction in injections was approximately of 27% (p < 0.0008) and 38% (p < 0.0001) at SGD and UMG, respectively. The COVID-19-related containment measures and the health resources redistribution have led to a delay in the treatment of chronic diseases of the retina, prioritizing the undeferrable ones. The lack of management guidelines has conceived relevant ethical and medico-legal issues that need to be considered in future measures planning.

Management of the Medico-Legal Dispute of Healthcare-Related SARS-CoV-2 Infections: Evaluation Criteria and Case Study in a Large University Hospital in Northwest Italy from 2020 to 2021.

Healthcare-related SARS-CoV-2 infection is an issue of particular concern during the pandemic. It has important repercussions on the National Health System, which represents a source of medical-legal health disputes. In the healthcare context, there are reports of negative screening at hospital admission (via nasopharyngeal swabs) and subsequent diagnosis of SARS-CoV-2 infection during hospitalization. Such cases cannot be considered a priori of healthcare-related infections but require extensive in-depth evaluation. In this study, we propose an empirical classification to frame cases of SARS-CoV-2 infection diagnosed in the hospital (first negative admission swab, with subsequent positive test during hospitalization). The classification is based on five categories: nosocomial, probably nosocomial, indeterminate, probably community, and community cases. We analyzed patients who died after testing positive for SARS-CoV-2 during hospitalization (with initial negative screening) in the largest hospital in Northwest Italy from February 2020 to 31 December 2021. A total of 383 cases were tracked and are listed as follows: 41 cases (11%) were classified as nosocomial (i.e., 3.2% of COVID-19 deaths). In contrast, 71 cases (19%) were classified as probably nosocomial, 69 (18%) were indeterminate (i.e., the clinical, radiological, and laboratory characteristics did not provide information on the genesis of the infection), 166 (43%) were classified as probably community cases, and 36 (9%) were defined as community cases. Deceased patients with nosocomial SARS-CoV-2 infection constituted the following: 3.23% (41/1266) with respect to the total number of COVID-19 deaths, 1.1% (41/3789) with respect to those who entered the hospital with a negative swab and 0.82% (41/4672) with respect to the total of deaths from any cause of death. In this paper we discuss the topic and issues of nosocomial COVID-19 in hospitalized patients and address the medicolegal implications.

Suicide hangings during pre-Covid-19 and Covid-19 - Myths debunked for the lower-middle-income group countries.

The psyche about the adverse effects of the Covid-19 pandemic has got fixed to a level of conviction that committing suicide is directly linked to coronavirus infection. The statistics of suicidal hangings for the pre-Covid-19 and the Covid-19 periods were compared in the Indian capital. The data analysis of the autopsy records showed the absence of temporal association between the incidence rates of suicides between these two periods. The study concludes that there was no net increase in suicide rates in the study population of this lower-middle-income group country during the Covid-19 pandemic.

Changing Trends of Medico-legal Cases during period of Lock Down due to Covid-19 in Agra District

Introduction: During global Covid-19 pandemic, India fought against the situation by implementing strict lockdown in whole country starting from 25th March 2020. Looking at severity of situation government decided to extend it in 4 phases till 31st May, 2020 which has been applied strictly in all district belonging to "Red Zone". Agra is the worst hit district in Uttar-Pradesh and it remained in the condition of strict Lockdown. Materials and Methods: Record-based comparative cross-sectional study looking for the impact of lockdown on change in pattern and number of medico-legal cases in Agra was done. Data related to name, age, sex, place of residence, type of medico-legal case was collected from records of medicolegal cases admitted in Emergency department of S.N. Medical College, Agra for the period of 25th March to 31 May 2020 (lockdown period) and compared it with data collected from 25th March to 31st May 2019 i.e. data of same corresponding period in last year. Results: On comparison we found out that during lockdown there was a decrease in no. of total admissions by 37.7%, while no. of medico legal cases is decreased by 54.2%. On further analysis of the data maximum decrease is seen in cases of road traffic accident, burns and firearm injuries while there was an increase in number of MLC cases of hanging. On gender wise comparison it was found that during lockdown period male MLC patients are decreased by 62.9% while female MLC patients decreased by 23.5%, which is lesser than decrease in total no. of admission. Interestingly we found out that there is increase in no. of MLC cases of female poisoning and hanging also increased significantly which might be due to increased domestic unrest or financial crisis emerged due to lockdown. Although on comparison of age groups no significant difference is seen during lockdown period. On area-wise comparison there was a decrease from 33% to 18% in total no. of MLC cases coming from districts other than Agra. This may be due to affected referral service or restrictions in inter-district transport. Conclusions: There is overall decrease in medico-legal cases with increased cases of hanging. Cases of female poisoning is also increased probably due to undue raised burden caused due to lockdown. © 2021, Punjab Academy of Forensic Medicine and Toxicology. All rights reserved.

Effect of first sixty-eight days of lockdown due to COVID-19 on autopsy cases in a tertiary care teaching hospital situated in a rural area of Himachal Pradesh

COVID-19 virus and disease were unknown before the outbreak began in Wuhan, China, and now it is a pandemic affecting many countries globally including India. On 30th of January, 2020 India reported its first case of COVID-19 in Kerala and on 24th of March 2020;the Government of India ordered a nationwide first phase of lockdown for 21 days. Our study is to compare the number and type of cases brought for medico legal autopsies in our institution during the complete lockdown period of first 68 days i.e., 25th of March to 31st of May, 2020 versus the cases brought to the same mortuary during the same period of the years 2018 and 2019. In total, 55 cases (42 were of males and 13 were of females) were brought to the mortuary in this lockdown period constituting 19% of total case of 2020 as compared to 91(21%) cases and 99 cases (21%) in the years 2019 and 2018 respectively. Present study shows drastic fall in motor vehicle accidents and shows increase in natural causes of deaths but the suicidal tendencies in the form of hanging and poisoning remained almost same as compared to previous two years and did not increase © 2021, Journal of Indian Academy of Forensic Medicine.All Rights Reserved.

Applications and Current Medico-Legal Challenges of Telemedicine in Ophthalmology.

BACKGROUND: The digital revolution is redesigning the healthcare model, and telemedicine offers a good example of the best cost-effectiveness ratio. The COVID-19 pandemic has catalysed the use of the telemedicine. The aim of this review is to describe and discuss the role and the main applications of telemedicine in the ophthalmic clinical practice as well as the related medico-legal aspects. METHODS: 45 original articles and 5 reviews focused on this topic and published in English language from 1997 and 2021 were searched on the online databases of Pubmed, Scopus, Web of Sciences and Embase, by using the following key words: "telemedicine", "privacy", "ophthalmology", "COVID-19" and "informed consent". RESULTS: Telemedicine is able to guarantee patient care using information and communication technologies. Technology creates an opportunity to link doctors with the aim of assessing clinical cases and maintaining high standards of care while performing and saving time as well. Ophthalmology is one of the fields in which telemedicine is most commonly used for patient management. CONCLUSIONS: Telemedicine offers benefits to patients in terms of saving time and costs and avoiding physical contact; however, it is necessary to point out significant limitations such as the absence of physical examinations, the possibility of transmission failure and potential violations of privacy and confidentiality.

Covid-19 pandemic: Medico legal aspects in anaesthesia practice

Anesthesiology is a specialty that delivers prompt and positive results in patient care. It is natural for the general population to expect the highest degree of care and services from anesthetist. In the present time, patients are much more aware of their rights and medical procedure-related negligence. If any catastrophe occurs, it grabs news headlines very quickly. Laypeople suspect negligence in such cases, and these cases land up in the court of law. In the courts, decisions are left to the judiciary, which can be potentially influenced by the opinion of the general public. There has been a rising trend in medical negligence cases registered in consumer courts after the decision of the Supreme Court, that the services provided by an anesthesiologist come under the word “service” of Consumer Protection Act (1986). So the apprehension amongst the anesthesiologists regarding the legal issues is rising. And it has more value in the present COVID-19 pandemic to deal with. This article highlights the importance of maintaining the standard of care and protocols by which anesthesiologists can avoid legal consequences. Doctors should have legal awareness so that they can defend their cases in courts properly. There is a need to maintain a healthy doctor-patient relationship, good record keeping, and to provide a reasonable standard of care. © 2021

An unexplained death in the COVID-19 isolation ward: A case report

A 35-year-old male was referred for autopsy from a District Headquarter hospital, where he was admitted to the COVID isolation ward with suspicion of being infected. His clinical history was a day of fever with chills and abdominal pain. He was alone overnight in the isolation ward post collection of his nasal swabs for screening and blood for routine laboratory tests. However, he was found lying dead on the floor within 18 hours of hospitalization © 2021. Journal of Indian Academy of Forensic Medicine. All rights reserved.

Suspension of Care for Patients With Spasticity During COVID-19 Pandemic: Ethical and Medico-Legal Point of View Starting From an Italian Study.

The COVID-19 pandemic has revolutionized the habits of entire communities, having even more profound negative effects on assistance for the chronically ill. The sudden demand for extraordinary resources caught all worldwide countries unprepared, highlighting shortages in provision of care services. This applies to all patients, affected by COVID-19 or not, as many need continuing access to chronic diseases treatments. Almost all of the energy available has been directed toward care of COVID-19 patients, and almost nothing has been done to continue therapy for patients with spasticity. This study builds on a recent article and discusses its results as a basis for highlighting the ethical dilemmas and unintended consequences of health systems changing their priorities during the pandemic. The above mentioned study has shown increased patient-perceived spasticity during lockdown (72.2%) with reductions in perceived quality of life (70.9%). Telemedicine tools have proved insufficient, with access by only 7.3% of these patients. Despite the health emergency, it cannot be denied that this situation is a violation of these patients' rights and dignity. The healthcare system will also have to bear increased costs in the future to recover the loss of previous therapies benefits, because of their interruption. The real challenge will be to exploit the critical issues emerged during the pandemic, and to resolve the measures needed to take the care to the patient, and not vice versa. This applies particularly to fragile patients, to respect their dignity and right to care.

Remote medico-legal assessment by telephone during COVID-19: Monitoring safety and quality when documenting evidence of torture for UK asylum applicants.

INTRODUCTION: Due to the COVID-19 pandemic, Freedom from Torture developed remote telephone assessments to provide interim medico-legal reports, ensuring people could obtain medical evidence to support their asylum claim. METHOD: To audit this new way of working, feedback was collected from the doctors, interpreters, individuals being assessed, and senior medical and legal staff who reviewed the reports. This paper presents findings from the first 20 assessments. RESULTS: Individuals assessed reported that the doctor developed good rapport, but in 35% of assessments reported that there were some experiences they felt unable to disclose. In 70% of assessments, doctors felt that rapport was not as good compared to face-to-face. In the majority of assessments, doctors were unable to gain a full account of the torture or its impact. They reported feeling cautious about pressing for more information on the telephone, mindful of individuals' vulnerability and the difficulty of providing support remotely. Nevertheless, in 85% of assessments doctors felt able to assess the consistency of the account of torture with the psychological findings, in accordance with the Istanbul Protocol (United Nations, 2004). Factors that hindered the assessment included the inability to observe body language, the person's ill health, and confidentiality concerns. CONCLUSION: This research indicates that psychological medico-legal reports can safely be produced by telephone assessment, but are more likely to be incomplete in terms of both full disclosure of torture experiences and psychological assessment. The limitations underline the need for a follow-up face-to-face assessment to expand the psychological assessment as well as undertake a physical assessment.

Coronavirus lockdown: Excessive alcohol consumption and illicit substance use in DUI subjects.

OBJECTIVE: This study investigates the consequences of the SarS-CoV-2 outbreak and of the resulting control measures on alcohol and illicit substance use in a high-risk population for substance-related disorders, utilizing an integrated medico-legal and toxicological approach. METHODS: The research was structured as a retrospective case-control study of subjects found to be driving under the influence (DUI) of alcohol and/or other psychoactive substances who were examined for driver's license regranting. Alcohol and/or drug use was assessed by comparing cases examined in the period from May to August 2020 (immediately after the lockdown in Italy) to control subjects examined in the same period in 2019. DUI subjects were examined by an integrated approach, descriptive analyses were conducted, and significance was determined by chi-square and Mann-Whitney tests. Variables linked to the pandemic outbreak and resulting lockdown were investigated as predictive factors in determining unfitness to drive. RESULTS: Cases (281) were significantly different from controls (261) concerning the judgment of unfitness to drive (p<.001) and had more subjects with chronic excessive alcohol use and/or illicit substance use. The two groups were rather homogeneous concerning the other variables, except for a difference in blood alcohol concentration (BAC) at the time of DUI (p = .027). No statistical association was found between the investigated variables linked to the lockdown and the judgment of unfitness to drive. CONCLUSIONS: Chronic excessive alcohol consumption and illicit substance use were more frequently observed in cases, which suggests a possible correlation between the pandemic/lockdown restrictions and an increase in psychoactive substance misuse. While these potentially correlative factors are discussed in this article, they require further study. If confirmed, the results should be considered in forensic and clinical settings.

COVID-legal study: neurosurgeon experience in Britain during the first phase of the COVID-19 pandemic - medico-legal considerations.

Introduction: The COVID-19 pandemic has resulted in a significant number of changes to elective and emergency neurosurgical practice.Materials and Methods: This paper reports the results of an online survey of Society of British Neurological Surgeons (SBNS) members undertaken between 10th and 24th of June 2020 regarding changes in consent practice in response to COVID-19, as well as the physical challenges experienced while operating under higher levels of personal protective equipment (PPE).Results: Despite the real and substantial risks associated with COVID-19, 23% of surgeons reported they were not made any changes to their usual consent process, and 54% of surgeons indicated that they made reference to COVID-19-associated risks in their written consent documentation. 93% of neurosurgeons reported physical difficulties operating using PPE; 62% reported visors/goggles fogging up, 55% experienced 'overheating', 62% reported fatigue, and 82% of surgeons reported difficulty communicating with the theatre staff.Conclusions: This survey highlights discrepancies in the consent practice between neurosurgeons which needs to be addressed at both local and national levels. The PPE being used in neurosurgical operations is not designed for use with specialist equipment (82% of respondents reported having to remove PPE to use the microscope) and the reported physical difficulties using PPE intraoperatively could significantly impact on both neurosurgeon performance and patient outcomes. This requires urgent attention by NHS procurement and management and should be urgently escalated to trust occupational health authorities as a workplace safety concern.

Take-Home Messages from the COVID-19 Pandemic: Strengths and Pitfalls of the Italian National Health Service from a Medico-Legal Point of View.

The World Health Organization (WHO) declared the outbreak of the Coronavirus disease-2019 (COVID-19) infection a pandemic on 11 March 2020. As of the end of October 2020, there were 50 million cases of infection and over one million deaths recorded worldwide, over 45,000 of which occurred in Italy. In Italy, the demand for intensive care over the course of this pandemic crisis has been exceptionally high, resulting in a severe imbalance between the demand for and availability of the necessary resources. This paper focuses on elements of preventive medicine and medical treatments in emergency and non-emergency situations which, based on the international scientific literature, may prove to be useful to physicians on a behavioral level and avert professional liability problems. In order to achieve this objective, we have performed a search on MEDLINE to find published articles related to the risks associated with the pandemic that contain useful suggestions and strategies for mitigating risks and protecting the safety of the population. The results have been collocated in line with these specific study areas.

COVID-19 and Forensic Medical Practice.

The COVID-19 pandemic has affected the community in multiple ways. These include direct health impacts on those infected and indirect health impacts on others who may, through fear of infection, not avail themselves of available "face-to-face" health care services. The impact of COVID-19 on the legal system and the related medico-legal services it relies upon has received less attention but the ongoing social restrictions put in place because of the pandemic have the capacity to disrupt a range of legal processes. The impact of the pandemic has the capacity to interfere with both forensic medical and legal processes both in the short term and the long term. It may take some time for the potential harms to be realised but as the pandemic gradually comes under control from a public health perspective the interference to criminal and civil justice will start to become more visible.

When a virus (Covid-19) attacks human rights: The situation of asylum seekers in the medico-legal setting.

The Covid-19 pandemic is a global health emergency that requires immediate, effective action by governments to protect the health and basic human rights of everyone's life. Refugees and migrants are potentially at increased risk because they typically live in overcrowded conditions often without access to basic sanitation. Since the beginning of the official lockdown for Covid-19, the medico-legal assessment of physical violence related to obtaining status or other forms of human protection has been frozen.