Criterios medicolegales en la valoración de la responsabilidad profesional médica / Medicolegal criteria in the assessment of medical professional liability

Las denuncias contra médicos por presunta mala praxis son relativamente frecuentes en nuestro medio judicial, su abordaje jurídico y medicolegal es complejo, y los informes periciales solicitados constituyen un reto para la medicina legal y forense. En este trabajo se revisan los principales estudios realizados sobre los denominados efectos adversos en el medio hospitalario, se diferencian de los errores y de las imprudencias, y se comenta que las edades extremas de la vida, la asistencia compleja o urgente y la estancia hospitalaria prolongada son algunas de las circunstancias que favorecen su presentación. Se explica la intervención del médico forense en estos casos y se describen los elementos necesarios para la valoración pericial. Finalmente, se ofrecen unos consejos prácticos para la elaboración del informe pericial, haciendo énfasis en la crucial importancia de tener una sólida formación medicolegal para realizar dichos informes, además de tener amplios conocimientos en la materia médica a peritar (AU)

Professional liability claims against physicians for supposed medical malpractice are relatively common in our country, their legal and medicolegal approach is complex and the expert reports requested constitute a challenge for forensic medicine. In this paper we review the main studies carried out about hospitalized patients adverse events, we distinguish between adverse events, errors and negligence and we comment that extremes of age, complex care, urgent care and a prolonged hospital stay are associated with them. We explain what the forensic physician role in these cases is and we describe the necessary requirements for the expert report. Finally we give practical advice for doing the medicolegal report. The expert or consultant in a judicial setting needs a sound medicolegal training to do these reports, besides to have an extensive knowledge in the specific medical specialty concerned (AU)

Fatal manganese intoxication due to an error in the elaboration of Epsom salts for a liver cleansing diet.

We describe the case of a 50-year-old man with a fatal intoxication after accidental massive oral ingestion of manganese. The patient presented with lethargy, diffuse abdominal pain, vomiting, and profuse diarrhea after ingesting Epsom salts (magnesium sulfate heptahydrate) during a liver cleansing diet. Despite intensive care management with intubation, prone position ventilation, continuous venovenous hemofiltration, and multiple transfusions, he progressed to refractory shock with multiple organ dysfunction resulting in death within 72 h. Similar patients arrived at several hospitals with identical epidemiology (all had ingested the same salt obtained in the same place). Clinical and forensic investigations (X-ray diffraction) discovered that the supplier had mistakenly prepared the salts with hydrated manganese sulfate instead of magnesium sulfate heptahydrate. The results enabled the other patients to be successfully treated for hydrated manganese sulfate intoxication with life support in the intensive care unit and chelation therapy (EDTA). We describe the clinical presentation of acute manganese poisoning and alert professionals to the risk of an increasingly popular diet. This case demonstrates the importance of collaboration between clinicians, pathologists, and forensic scientists to resolve a difficult-to-diagnose case.