Analysis of forensic medical opinions issued in criminal cases of alleged medical error in obstetrics at the Department of Forensic Medicine, Jagiellonian University Medical College, in 2010-2016.

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.

Analysis of the nature of injuries in victims of fall from height

AIM OF STUDY: To assess the types and extent of injuries sustained by victims of fall from height depending on the height of fall. MATERIAL AND METHODS: The study included 338 bodies of victims of fatal falls from different heights (from the 1st to 10th floors) who were subjected to medico-legal autopsy at the Department of Forensic Medicine, Jagiellonian University Medical College, between 1995 and 2014. For each individual, selected data were collected including gender, age, body height, injury types and presence of alcohol or other intoxicants in blood. The analysis comprised injuries to the brain, thoracic and abdominal organs, fractures of the skull, extremities, ribs and spine, and fractures of the scapula, clavicle and sternum (considered together). The study focused on determining the frequency of occurrence of different injuries in relation to one another and depending on the height of fall. RESULTS: The number and extent of injuries was found to increase along with the height of fall. Three injury types, including injuries to the mesentery and both kidneys and fractures of upper extremity small bones, were shown to occur from the threshold heights of the 3rd, 4th and 6th floors. Eleven injuries demonstrated a statistically significant correlation with the height of fall. The study also revealed a number of correlations between the frequencies of occurrence of different injuries. CONCLUSIONS: Injuries found from the threshold value may suggest the minimal height of fall. The presence of injuries which correlate with increasing height, and the overall number of injuries observed in victims of fall from height, may be useful for inferring the height of the fall.