Trauma-Focused Mitigation Testimony in Capital Sentencing Hearings.

When capital trials of convicted defendants reach the sentencing phase, forensic mental health experts often testify as part of mitigation evidence. Three aspects of such testimony hold particular promise. First, developmental traumas in the lives of the defendants are especially well conceptualized in terms of complex posttraumatic stress disorder, as described in the ICD-11. Second, Cunningham's framework, which critically examines the impact of harmful and protective factors over the course of a defendant's development, allows for an examination of moral culpability apart from legal culpability. Third, specific training on trauma and its effects on personality and psychopathology allows forensic mental health professionals to more skillfully complete trauma mitigation evaluations.

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.

Establishing the shadowline: the border between legally acceptable and unacceptable standards of surgical practice.

INTRODUCTION: Our study investigated how the standard of surgical care is assessed within the English and Welsh litigation process. The 'shadowline' represents the dividing line between acceptable and unacceptable standards of care. Our hypothesis was that different assessors risk adopting materially different interpretations regarding the acceptable standard of care. Any variation in the interpretation of where the shadowline falls will create uncertainty and unfairness to surgeons and patients alike. METHODS: We summarised the legal literature and suggested the factors affecting the assessment of surgical standards. We illustrated our findings on distribution curves. RESULTS: There was a risk that the shape of the curve and the location of the shadowline may vary according to the assessor. Importantly, a gap may have developed between the legal and clinical shadowlines in respect of the consenting process. DISCUSSION AND CONCLUSION: We suggested how a gap between the surgical and legal shadow lines could be narrowed. Clinical governance, balanced literature and realistic expert assessments were all part of the solution.

For debate: the short report - legal and ethical implications.

At the outset of an alleged medical negligence case, it is common for medical expert witnesses to be asked to write a brief report, sometimes called a short report or a screening report. Such requests may come from solicitors acting for a claimant or for the defence. Reassurances may be offered that the opinion given will not be disclosed. However, this is very often not the case. Doctors and the instructing solicitors need to be aware of the legal and ethical implications of providing such instructions. The medical expert must be aware that their duty to the court begins from the time of receipt of a letter from a solicitor requesting such a report.

Navigating the Regulatory Landscape to Develop Pediatric Oncology Drugs: Expert Opinion Recommendations.

Regulatory changes have been enacted in the United States (US) and European Union (EU) to encourage the development of new treatments for pediatric cancer. Here, we review some of the factors that have hampered the development of pediatric cancer treatments and provide a comparison of the US and EU regulations implemented to address this clinical need. We then provide some recommendations for each stage of the oncology drug development pathway to help researchers maximize their chance of successful drug development while complying with regulations. A key recommendation is the engagement of key stakeholders such as regulatory authorities, pediatric oncologists, academic researchers, patient advocacy groups, and a Pediatric Expert Group early in the drug development process. During drug target selection, sponsors are encouraged to consult the Food and Drug Administration (FDA), European Medicines Agency (EMA), and the FDA target list, in addition to relevant US and European consortia that have been established to characterize and prioritize oncology drug targets. Sponsors also need to carefully consider the resourcing requirements for preclinical testing, which include ensuring appropriate access to the most relevant databases, clinical samples, and preclinical models (cell lines and animal models). During clinical development, sponsors can account for the pharmacodynamic (PD)/pharmacokinetic (PK) considerations specific to a pediatric population by developing pediatric formulations, selecting suitable PD endpoints, and employing sparse PK sampling or modeling/simulation of drug exposures where appropriate. Additional clinical considerations include the specific design of the clinical trial, the potential inclusion of children in adult trials, and the value of cooperative group trials.

In the last few decades, great progress has been made in developing new treatments for adult cancers. However, development of new treatments for childhood cancers has been much slower. To encourage drug companies (sponsors) to develop effective treatments for childhood cancer, authorities in the United States (US) and Europe have made new rules for drug development. Under these new rules, sponsors developing drugs for specific cancers in adults have to consider whether the target of that drug also causes cancers in children. If this is the case, sponsors have to carry out clinical studies of their drug in children who have cancer that is caused by the same drug target. In this article, we describe some reasons for why drug development for childhood cancers has been slow and the rules created to address this problem in the US and Europe. We share some recommendations to help sponsors maximize their chances of developing an effective drug in children while satisfying the new rules. Specifically, sponsors need to be aware of the differences between studying drugs in adults versus children and how these influence the way the drug is tested. We make several recommendations for each stage of the development process, beginning with what is needed even before human studies begin. Finally, we highlight some issues that sponsors need to think about during drug development, from the preclinical stage (testing drugs in cells and animals) through to clinical testing in adults and pediatric patients with cancer.

The Litigation Complexity of Posttraumatic Headaches.

PURPOSE OF REVIEW: This review explores the workings of the legal process in posttraumatic headache (PTH) claims by discussing representative court cases, the approaches taken by both plaintiff and defense attorneys in evaluating a client with PTH, and the role of the expert witness. This discussion also examines the question of whether or not litigation prolongs the symptoms of PTH and concussion, looking at the issues of malingering and the psychological effect of litigation. RECENT FINDINGS: Litigation prolongs recovery of PTH, primarily not from malingering but rather due to the psychological mindset of the plaintiff as created by the litigation process. Just as the medical community struggles with PTH diagnosis, mechanism, and treatment, the legal system grapples with identifying valid claims for PTH. Psychological support is an important component for PTH recovery to more effectively deal with the psychological impact of litigation and the concept of perceived injustice.

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.

Mock jurors' evaluation of firearm examiner testimony.

OBJECTIVES: Firearms experts traditionally have testified that a weapon leaves "unique" toolmarks, so bullets or cartridge casings can be visually examined and conclusively matched to a particular firearm. Recently, due to scientific critiques, Department of Justice policy, and judges' rulings, firearms experts have tempered their conclusions. In two experiments, we tested whether this ostensibly more cautious language has its intended effect on jurors (Experiment 1), and whether cross-examination impacts jurors' perception of firearm testimony (Experiment 2). HYPOTHESES: Four hypotheses were tested. First, jurors will accord significant weight to firearm testimony that declares a "match" compared to testimony that does not (Experiments 1 and 2). Second, variations to "match" language will not affect guilty verdicts (Experiment 1). Third, only the most cautious language ("cannot exclude the gun") would lower guilty verdicts (Experiment 1). Fourth, cross-examination will reduce guilty verdicts depending on specific language used (Experiment 2). METHOD: In two preregistered, high-powered experiments with 200 mock jurors per cell, participants recruited from Qualtrics Panels were presented with a criminal case containing firearms evidence, which varied the wording of the examiner's conclusion and whether cross-examination was present. These variations include conclusion language used by practitioners, language advised by government organizations, and language required by judges in several cases. Participants gave a verdict, rated the evidence and expert in all conditions. RESULTS: Guilty verdicts significantly increased when a match was declared compared to when a match was not declared. Variation in conclusion language did not affect guilty verdicts nor did it affect jurors' estimates of the likelihood the defendant's gun fired the bullet recovered at the crime scene. In contrast, however, a more cautious conclusion that an examiner "cannot exclude the defendant's gun" did significantly reduce guilty verdicts and likelihood estimates alike. The presence of cross-examination did not affect these findings. CONCLUSION: Apart from the most limited language ("cannot exclude the defendant's gun"), judicial intervention to limit firearms conclusion language is not likely to produce its intended effect. Moreover, cross-examination does not appear to affect perceptions or individual juror verdicts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Implementation of the European Psychiatric Association (EPA) guidance on forensic psychiatry in Poland. Current state and required measures. / Implementacja wytycznych Europejskiego Towarzystwa Psychiatrycznego (EPA) w zakresie psychiatrii sadowej w Polsce. Stan obecny i konieczne dzialania.

The article discusses the key aspects of the guidance of the European Psychiatric Association (EPA) on forensic psychiatry and the required actions to implement guidance into clinical practice. The authors pay attention to the discrepancies between the recommendations resulting from the guidance and clinical practice and current systemic solutions. The basic difficulties were discussed in relation to the implementation of the guidelines in the clinical practice in Poland as regards providing services as an expert by psychiatrists and psychologists, risk assessment and management, psychiatric therapy in detention centers, implementation of protection measures in inpatient and outpatient treatment conditions, efficiency of pharmacological and non-pharmacological interventions. We hope that discussing the content of the guidance will help to deepen the knowledge of clinicians in the field of work as court expert witnesses and persons responsible for the implementation of the preventive measure. Based on the clinical experience measures were proposed that enable implementation of the guidance, and thus improvement of the quality of care exercised over the mentally ill criminal offenders.

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.

Does DNA evidence in the form of a likelihood ratio affect perceivers' sensitivity to the strength of a suspect's alibi?

Forensic expert testimony is beginning to reflect the uncertain nature of forensic science. Many academics and forensic practitioners suggest that forensic disciplines ought to adopt a likelihood ratio approach, but this approach fails to communicate the possibility of false positive errors, such as contamination or mislabeling of samples. In two preregistered experiments (N1 = 591, N2 = 584), we investigated whether participants would be convinced by a strong DNA likelihood ratio (5,500 in Experiment 1 and 5,500,000 in Experiment 2) in the presence of varying alibi strengths. Those who received a likelihood ratio often concluded that the suspect was the source of the DNA evidence and guilty of the crime compared with those who did not receive a likelihood ratio-but they also tended to conclude that an error may have occurred during DNA analysis. Furthermore, as the strength of the suspect's alibi increased, people were less likely to regard the suspect as the source of the evidence or guilty of the crime, and were more likely to conclude that an error may have occurred during DNA analysis. However, people who received a likelihood ratio were actually more sensitive to the strength of the suspect's alibi than those who did not, driven largely by the low ratings in the strongest alibi. Interestingly, the same pattern of results held across both experiments despite the likelihood ratio increasing by two orders of magnitude, revealing that people are not sensitive to the value of the likelihood ratio.

Juror appraisals of forensic evidence: Effects of blind proficiency and cross-examination.

Forensic testimony plays a crucial role in many criminal cases, with requests to crime laboratories steadily increasing. As part of efforts to improve the reliability of forensic evidence, scientific and policy groups increasingly recommend routine and blind proficiency tests of practitioners. What is not known is how doing so affects how lay jurors assess testimony by forensic practitioners in court. In Study 1, we recruited 1398 lay participants, recruited online using Qualtrics to create a sample representative of the U.S. population with respect to age, gender, income, race/ethnicity, and geographic region. Each read a mock criminal trial transcript in which a forensic examiner presented the central evidence. The low-proficiency forensic examiner elicited a lower conviction rate and less favorable impressions than the control, an examiner for which no proficiency information was disclosed. However, the high-proficiency examiner did not correspondingly elicit a higher conviction rate or more favorable impressions than the control. In Study 2, 1420 participants, similarly recruited using Qualtrics, received the same testimony, but for some conditions the examiner was cross-examined by a defense attorney. We find cross-examination significantly reduced guilty votes and examiner ratings for low-proficiency examiners. These results suggest that disclosing results of blind proficiency testing can inform jury decision-making, and further, that defense lawyering can make proficiency information particularly salient at a criminal trial.

Forensic mental telehealth assessment (FMTA) in the context of COVID-19.

Due to the present COVID-19 pandemic, forensic mental telehealth assessment (FMTA) is an increasingly utilized means of conducting court-sanctioned psychiatric and psychological evaluations. FMTA is not a novel development, and studies have been published during the past two decades that opine on the positive and negative implications of conducting testing and interview procedures online, in forensic and traditionally clinical matters alike. The present article examines prospects for eventual legal challenges to FMTA, describes considerations for conducting FMTA in both institutional and residential settings, and concludes that FMTA is now-due to predicted accommodations on the part of courts, attorneys, institutions, and professional guilds-a permanent part of the forensic evaluation landscape, even once the present COVID-19 pandemic has subsided.

In search of a free movement of forensic evidence: Towards minimum standards to determine evidence admissibility?

In coming to a European Forensic Evidence Area, an European Union ambition to be reached by 2020, judicial cooperation in criminal matters should be levelled-up. Grounded on the legal basis provided by the Lisbon Treaty, this research identifies the minimum standards to be developed by looking into the actions taken both from a legal and from a forensic-scientific perspective to standardise the collection, storage and use of forensic expert evidence. In examining the feasibility of such standards, primary sources of legislation, policy documents and case-law on a European level are compared with a comparative study of domestic norms in six jurisdictions. Depending on the phase in the chain of custody and fundamental principle involved, but also on the level of cooperation between the forensic and legal actors, it was noticeable that the comparison led to different conclusions, depending on the refusal grounds provided by the member states and the necessity of intervention at the European level to safeguard the underlying fundamental values.

Mycobacterium Chimaera: Clinical and medico-legal considerations starting from a case of sudden acoustic damage.

Mycobacterium Chimaera is a microorganism that can cause nosocomial infections particularly in patients undergoing cardiac surgery. The specific case presented herein shows an original clinical presentation of the infection: sudden unilateral deafness as a result of septic embolization. Medico-legal experts appointed by the court in a civil liability dispute analyzed the case and submitted their expert opinion. This article analyzes the peculiar and innovative aspect of professional liability that can be attributed to the healthcare facility and the manufacturer of the equipment used in the operating room from a medical-legal point of view.

Psychological impediments to marriage - forensic and psychiatric opinions. Part II. / Psychiczne przeszkody w zawarciu malzenstwa ­ opiniowanie sadowo-psychiatryczne. Czesc II.

Episcopal courts adjudicate in proceedings for declaring a marriage void and in these cases psychiatrists and psychologists are appointed as experts. Expert judgment requires the expert to follow a specific substantive approach when preparing the expertise, as well as knowledge of canon legal provisions. Canon law makes validity of a relationship dependent on fulfilment of premises of a valid marriage at the time of the marriage, thus accepting the possibility of an invalid marriage. The so-called consensual and indirectly mental incapacity to marry is dealt with in canon 1,095, which says that the following are incapable of contracting marriage: (1) those who lack the sufficient use of reason; (2) those who suffer from a grave defect of discretion of judgment concerning the essential matrimonial rights and duties mutually to be handed over and accepted; and (3) those who are not able to assume the essential obligations of marriage for causes of a psychic nature. Episcopal courts use terminology that is not found in psychiatry or clinical psychology. However, specific psychopathological conditions stand behind specific formulations in the Code, and they should be taken into account by experts in their analyzes. In proceedings before common courts, only mental illness and mental retardation are taken into account, and no specific disorders are mentioned in Church legislation, which means that experts must consider a wide range of mental dysfunctions in their assessments.

A balanced opinion? Considering the role of the external clinical advisor in ACC processes.

The role of the external clinical advisor is critical to the adjudication of complex claims in the processes of the Accident Compensation Corporation (ACC). This is particularly true of claims for treatment injury that occur during birth, which are often very complicated. In most cases external clinical advisors are non-treating doctors, whose opinion strongly guides the hand of ACC. This viewpoint considers the impact of the role of the external clinical advisor by using extracts from an external clinical advisor's report to show how a power imbalance can be enacted in ACC decision making processes. Also considered are the way that the normal checks and balances in the system, particularly those provided by the Health & Disability Commissioner, are bypassed in most cases. Finally, a recommendation is made to potential external clinical advisors to precisely following the standards set by the Medical Council in all cases when writing reports for ACC.