[Features of methodology for the formation of standard operational procedure in the practice of bureau of forensic medical expertise]. / Osobennosti metodologii formirovaniya standartnykh operatsionnykh protsedur v prakticheskoi deyatel'nosti byuro sudebno-meditsinskoi ekspertizy.

OBJECTIVE: To analyze and summarize data on formation and implementation in practice of standard operational procedures for developing algorithm to improve the quality management system of bureau of forensic medical expertise. MATERIAL AND METHODS: Normative legal documents regulating principles of standardization in healthcare were studied. Literature was analyzed in PubMed, Google Scholar, eLIBRARY search engines in English and Russian languages on the issues of development and implementation of standard operational procedures in practice. RESULTS: Data on using standard operational procedures as a standardization element in medical practice have been analyzed and generalized. Specific proposals for developing system of standard operational procedures, based on general principles for the creation of such documents, in forensic medical expert institutions have been proposed. CONCLUSION: Suggested recommendations can be used in practice to develop new common standard operational procedures.

Forensic Mass Spectrometry: Scientific and Legal Precedents.

Mass spectrometry has made profound contributions to the criminal justice system by providing an instrumental method of analysis that delivers exquisite analytical figures of merit for a wide variety of samples and analytes. Applications include the characterization of trace metal impurities in hair and glass to the identification of drugs, explosives, polymers, and ignitable liquids. This review describes major historical developments and, where possible, relates the developed capabilities to casework and legal precedents. This review also provides insight into how historical applications have evolved into, and out of, modern consensus standards. Unlike many pattern-based techniques and physical-matching methods, mass spectrometry has strong scientific foundations and a long history of successful applications that have made it one of the most reliable and respected sources of scientific evidence in criminal and civil cases. That said, in several appellate decisions in which mass spectrometric evidence was challenged but admitted, decisions sometimes still went against the mass spectrometric data anyway, which goes to show that mass spectrometric evidence is always just one piece of the larger legal puzzle.

Estudio médico legal de la Ley Orgánica de Regulación de la Eutanasia en España en comparación con el resto de los países que regulan la eutanasia y/o el suicidio asistido / Medico legal study of the organic law of the regulation of euthanasia in Spain compared to the rest of the countries that regulate euthanasia and / or assisted suicide

La regulación de la eutanasia ha sido objeto de debate desde hace años, desde los campos de la medicina, el derecho y la bioética, y por tanto de la medicina legal, en la que estas 3 disciplinas convergen. En los últimos 30 años hemos vivido un proceso de despenalización y regulación en diferentes países del mundo. Actualmente la eutanasia y/o el suicidio asistido están regulados en 7 países: Holanda, Bélgica, Luxemburgo, Canadá, Colombia, Nueva Zelanda y España, así como en 11 estados de EE. UU.: Oregón, Washington, Montana, Vermont, California, Colorado, Hawai, Maine, Nueva Jersey, Nuevo México y el Distrito Federal de Columbia/Washington D.C., y en 2 estados de Australia: Estado de Victoria y Australia Occidental. En este trabajo de revisión realizamos un estudio sobre los aspectos más importantes de la nueva Ley Orgánica de Regulación de la Eutanasia en España comparando con el resto de los países en los que también tienen la regularización de la eutanasia y/o el suicidio asistido. (AU)

The regulation of euthanasia has been the subject of debate for years, from the fields of Medicine, Law and Bioethics, and therefore of Legal Medicine, in which these three disciplines converge. In the last thirty years we have experienced a process of decriminalization and regulation in different countries of the world. Currently euthanasia and/or assisted suicide are regulated in 7 countries: Holland, Belgium, Luxembourg, Canada, Colombia, New Zealand and Spain, as well as in 11 US states: Oregon, Washington, Montana, Vermont, California, Colorado, Hawaii, Maine, New Jersey, New Mexico and the Federal District of Columbia / Washington D.C, and in 2 states of Australia: State of Victoria and Western Australia. In this review work we carry out a study on the most important aspects of the new law of the regulation of euthanasia in Spain compared to the rest of the countries in which they also have the regularization of euthanasia and / or assisted suicide. (AU)

Strategies Employed by Forensic Community Mental Health Nurses to Resolve Difficulties in Supporting Offenders With Mental Disorders Under the Medical Treatment and Supervision Act in Japan.

OBJECTIVE: This study aimed to identify the strategies used by forensic community mental health nurses to resolve difficulties in supporting offenders with mental disorders under the Medical Treatment and Supervision Act in Japan. METHOD: Interviews were conducted with 13 nurses, and the data were analyzed using content analysis. RESULTS: The study identified the strategies for difficulties in (a) assessing and managing risk potential of forensic service patients, (b) addressing offending behavior, (c) managing the transition of patients, (d) supporting patients to understand the impact of justice processes and applying knowledge of legislation to nursing, and (e) promoting the role of forensic community mental health nurses within the multidisciplinary team. CONCLUSIONS: The findings can benefit and support forensic community mental health nurses' practices. The Japanese forensic community mental health nurses experiencing difficulties and providing home visits to patients can utilize the identified strategies.

Aspectos médico-legais do olho / Medicolegal aspects of the eye

RESUMO A oftalmologia fornece um campo vasto de conhecimentos necessários à medicina legal e às perícias médicas. O presente artigo objetivou revisar as informações na perícia criminal e cível, as repercussões da morte e os achados post-mortem que o exame ocular pode fornecer. Demonstrou-se que a perícia ocular é complexa e multifacetada, fornecendo ferramentas importantes para a classificação das lesões corporais, verificação da capacidade laboral, investigação da causa mortis e estimativa do tempo de morte.

ABSTRACT Ophthalmology provides a vast field of knowledge necessary for forensic medicine and medical expertise. The present article aimed to review the information on criminal and civil medical expertise, the repercussions of death, and the postmortem findings that the eye examination can provide. Ocular expertise has been shown to be complex and multifaceted, providing important tools to classify bodily injuries, verify work capacity, investigate the cause of death, and estimate the time of death.

La gestión de las personas fallecidas a causa de la pandemia de COVID-19 y los retos organizativos desde la óptica de los servicios medicolegales / The management of the deceased from the COVID-19 pandemic and its organizational challenges from the medico-legal services perspective

La enfermedad por el nuevo coronavirus (COVID-19), surgida a fínales de 2019 en la ciudad china de Wuhan, fue declarada como pandemia por la Organización Mundial de la Salud el 11 de marzo de 2020. En los países y regiones más afectadas, paralelamente al elevado número de pacientes y a la saturación de los servicios de salud, la cantidad inhabitual de fallecidos supone un importante esfuerzo de gestión para las autoridades. El presente artículo tiene como objetivo identificar los retos particulares de una adecuada gestión y coordinación de las instituciones implicadas y proponer recomendaciones de actuación para el manejo correcto y digno de los fallecidos y la protección del derecho de sus familiares a un trato respetuoso, a conocer la suerte y el paradero de sus seres queridos y a honrarlos de acuerdo con sus creencias. Se destaca el importante papel que los servicios medicolegales deben jugar para ello. (AU)

The new coronavirus disease (COVID-19), which emerged at the end of 2019 in the Chinese city of Wuhan, was declared as a pandemic by the World Health Organization on 11 March 2020. In the most affected countries and regions, in parallel to the high number of patients and the consequent saturation of the health services, the unusually high number of deaths adds a very sensitive burden to authorities regarding the management of corpses. The purpose of this article is to identify the particular challenges of an appropriate management and coordination of the institutions involved and to propose recommendations for action for the proper and dignified management of the deceased and the protection of the rights of their families to a respectful treatment, to know the fate and whereabouts of their loved ones and to honor them according to their beliefs and customs. The important role that medical-legal services may play for this is highlighted. (AU)

A statewide elder mistreatment virtual assessment program: Legal, ethical, and practical issues.

Telecommunication assisted forensic assessments of capacity and mistreatment by geriatricians with expertise in elder abuse and self-neglect are helping to meet the demand for such forensic services for Adult Protective Services (APS) clients in remote and underserved areas of Texas. The use of synchronous audiovisual assisted interviews instead of in-person interviews with clients to provide capacity assessments has become more important with the arrival of the COVID-19 pandemic. There is growing interest in establishing similar programs in other states using geriatrician faculty from medical schools to serve the clients of their state Adult Protective Services agencies. The arrangement between APS and the geriatricians at McGovern Medical School in Houston, Texas is novel. The structure of the arrangement is important for the success of the program. Legal, ethical, and practical considerations are discussed in this article, including approaches to the Health Insurance Portability and Accountability Act, physician liability, state law, and resource limitations. It is hoped that sharing how one such collaboration has addressed these important issues will suggest approaches for the structuring of similar programs.

Sexual assault and abuse committed against family members: An analysis of 1342 legal outcomes and their motivations.

BACKGROUND: Over the past years medical centres specifically addressed in gender-based violence have developed protocols for the collections of evidence useful in the courtroom, including accurate documentation of physical and psychological states of the victim and collection of samples. Previous studies showed an association between documented physical trauma and conviction but unfortunately, few studies in the recent literature analysed the factors that influence the legal outcome and final judgement. The present study focused on the elements that appeared of significance in the legal outcome, including medico-legal evaluation, source of the crime report and circumstance of the assault. METHODS: It was conducted a retrospective analysis of all the judgments issued by the Public Prosecutor's Office at a Court of a Metropolitan Italian city regarding sexual and domestic violence, from January 1st 2011 to 31st December 31st 2015. Examination regarded the demographic information of the victim and of the defendant, information on the crime, the circumstances of the aggression and medical information retrieved. Sentences were subsequently divided into two categories based on the legal outcome (conviction vs acquittal) and the different characteristics of the two sub-populations were compared to verify if there were variables significantly associated to the judge's final judgment. RESULTS: Over the 5 years taken into consideration, there have been 1342 verdicts regarding crimes of sexual violence (374 cases) and regarding abuses against family members or cohabitants (875): other 93 cases regarded both sexual violence and abuse. 66.3% ended in conviction of the offender and 33.7% in acquittal of the accused. Cases of conviction were more frequent when they involved: use of a weapon by the assailant, as well as if the assailant had a criminal record and had a history of drug abuse or other addictions; duration of proceeding less 22 months and a civil party involved; presence of clinical documentation together with other deposition in addition to victim's deposition; also frequent episodes of violence and application of precautionary measures were associated to conviction. CONCLUSIONS: Many factors seem able to influence the judge's judgment, although clearly each case must be singularly evaluated. The mere presence of medical documentation, without the support of other sources of evidence, such as the victim's statement or further declarations, however, is almost always not definitive for the verdict. Despite so, in cases where there are multiple sources of evidence, clinical documentation can provide useful elements and can give clues on the consistency between the history told and injuries observed.

Expert evidence: Frequently asked questions.

This Faculty of Forensic and Legal Medicine guidance on the law of expert evidence is set out in the form of a series of frequently asked questions.

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.

[Deaths that seem natural]. / Sterfgevallen die natuurlijk lijken.

Every dead body is examined by a doctor to establish the manner of death. In the Netherlands, however, both the quality of post-mortem examinations and the number of autopsies carried out in a clinical or forensic setting are low. Not all causes of death can be determined by post mortem examination alone; the law should, therefore, be changed to allow a forensic physician to legally request additional investigations, such as a toxicological or radiological report, to ensure the detection of crimes such as murder. Additional investigation could increase the quality of post-mortem examinations, and might bridge the quality gap between full autopsy and a simple post mortem. The information obtained could, for instance, be informative for relatives in the context of hereditary research. Finally, to improve the quality of post-mortem examination and identify all cases of murder, it is of the utmost importance that there is sufficient focus on post mortem examination of the cadaver during medical specialist training.