Forensic medical evaluation of harm severity inflicted to one's health by slight craniocerebral injuries in the remote period

A pressing problem is discussed: forensic medical evaluation of harm inflicted to health by slight craniocerebral injuries. Analysis of 2150 expert forensic medical and medico-social conclusions revealed serious organization and methodological errors in evaluation of harm inflicted to health by slight craniocerebral injuries. Approaches to improving the quality of such forensic medical expert evaluations are outlined.     

The topical problems pertaining to the performance of forensic medical expertise of the subjects suspected or accused of committing a crime and remaining in custody

The authors consider topical problems pertaining to the performance of forensic medical expertise of the subjects suspected or accused of committing a crime and remaining in custody. The discussion is focused on the organization of expertise and medical examination of such persons with the participation of personnel representing different clinical disciplines. The special emphasis is laid on the absence in the normative-legal basis of the well-specified criteria for the severity of disease, the degree of vital activity limitation, and duration of the treatment in specialized hospitals. The lack of such criteria hampers not only medical certification of the subjects suspected or accused of committing a crime and remaining in custody but also objective forensic medical estimation of their health status. Recommendations for addressing this problem and its resolution are proposed.     

法医精神病鉴定质量控制对策研究

法医精神病鉴定是一种经验型或技能型鉴定类型,大多数鉴定项目只能依靠鉴定人的经验进行判断,质量控制更显重要。遗憾的是,目前该专业并未像其他法医类鉴定那样实行认证认可制度,质量控制手段不多。为有效保障鉴定质量,必须围绕鉴定意见形成过程的各个阶段或环节进行过程控制与监督,重点关注“人、机、料、法、环”等要素。为此,建议在该行业内逐步恢复认证认可制度,完善质量体系建设,运用好各种内外部质量控制方法,严格把关鉴定人准入,实行鉴定人执业分类管理、强化鉴定人执业能力考核,以规范行业鉴定活动,维护行业司法鉴定的公信力。     

Peculiar approaches to the estimation of the severity of harm to health in children with non-fatal injuries

The medico-legal estimation of non-fatal injuries in the children and adolescents is presented. The data obtained have been used to develop and substantiate the algorithm of forensic medical expertise of such injuries. Scientifically sound criteria have been proposed to be used for the purpose of expert estimation of the severity of harm to health associated with non-fatal injuries taking into consideration their clinical manifestations. The procedures of forensic medical expertise for the estimation of the harm to health have been analysed with special reference to non-fatal injuries in children and adolescents. Main attention was given to the accompanying strategic, organizational, and methodological errors. The approaches to their prevention and correction are described.     

Difficulties in forensic medical evaluation of some forms of craniocerebral injury

Conclusions of 41 repeated expert evaluations of craniocerebral injuries within the framework of criminal and civil cases investigation are analyzed. Some aspects of clinical and forensic medical diagnosis of lethal and nonlethal injuries to the head, evaluation of the quality of medical care, and qualification of the severity of harm to health are discussed. Causes of typical expert errors and approaches to their prevention are shown.     

The data on statistical surveillance of recording forensic medical expertises of the harm to human health collected by the Bureau of Forensic Medical Expertise (BFME) in Central Health Department of the Moscow region

This publication deals with the analysis of application of the "Medical criteria for the harm to human health" put into force on September 16, 2008, as exemplified by the work of the Bureau of forensic medical expertise (BFME), Central Health Department of the Moscow region, during the period from 2007 and 2010. The data were borrowed from the materials of departmental statistical reporting (F.42) on forensic medical examinations of the harm to human health carried out during the period between 2007 and 2010. In addition, the statistical report of BFME on the application of the medical criteria in 2010 was used. The number of forensic medical expertises for the estimation of the degree of harm to human health was shown to decrease by 9% but remain 3% higher than the average across the country. The number of expertises of severe harm to the health increased by 15% as in the whole of the country with the concomitant 20% reduction in the number expertises of mild and moderate harm. These trends are unrelated ether to the changes in the frequency of crimes leading to the serious harm to the health or to the number of subjects convicted of such crimes. It was found that p.p. 6.1.1 - 6.1.30 of the "Medical criteria" that list life-threatening injuries are most frequently (in 58% of the cases) used to document facts of severe harm to the health. The same is true of p.p. 6.11. - 6.11.11 listing the injuries responsible for the persistent loss of occupational capacity (by at least one third). The frequency of application of concrete paragraphs of the (Medical criteria, is determined within each group. The largest number of expert errors (3.2%) were committed while estimating serious harm to the health based on the paragraphs listing the injuries responsible for the persistent loss of occupational capacity (by at least one third). The minimal number of such errors (1%) were committed while estimating serious harm to the health from life-threatening injuries.     

Organization and procedure of forensic medical expert evaluation of professional working capacity loss

Sixty-one forensic medical expert conclusions on the loss of professional working capacity are analyzed and typical errors are characterized. The procedure of forensic medical expert evaluation of the degree of loss of professional working capacity in accordance with the Civil Code and Civil Judicial Procedure Code of the Russian Federation and the actual norm-setting documents is described.     

Forensic medical expertise of injuries in the anorectal region and rectum related to the sexual assault

Injuries to the anorectal region and rectum associated with sexual crimes require forensic medical assessment even though this issue remains to be poorly developed. The results of 84 forensic medical expertises are presented based on the materials obtained by examining both women and men who applied with complains of sexual abuse (anogenital penetration) to the Primorskoye territorial Bureau of forensic medical expertise during 5 years, from 2005 to 2009. The study has demonstrated correlation between dynamics of applications of the victims of either sex and the lack of a tendency toward a decrease in their frequency. The signs characteristic of acute injuries and chronic conditions are described. The causes of diagnostic errors during forensic medical expertise of sexual abuse are discussed.     

The medical review officer: a potential role for the medical examiner

Drug use in the workplace is a problem, both in terms of public health and expense. Workplace drug testing programs serve as deterrents to drug use. Model programs, such as that of the Department of Transportation, use urine screening and are federally regulated or follow federal standards. An essential participant in this process is the medical review officer (MRO), a licensed physician who interprets the laboratory results generated from a workplace drug testing program. As a result of their training and experience with toxicology, collection of evidence, testimony, and recognition of the physical signs of drug abuse, medical examiners and forensic pathologists are well suited to serve as MROs. Recent regulations require the completion of training courses and MRO certification as prerequisites for participation in federal drug testing programs. Several courses are available to train physicians to participate as MROs.     

Feedback on Forensic Mental Health Assessments in a Juvenile Court Clinic Certification Program

Public-sector mental health systems have set forth specialized practice competencies for forensic mental health clinicians conducting court-ordered examinations. This study examined a sample of feedback letters to clinicians who submitted mid-training and final reports for review as part of the requirements for certification as a juvenile court clinician. The most common feedback points were insufficient/irrelevant historical data, problems with clarity/organization of the report, problems with interview/mental status examination, and problems with competency to stand trial data/opinions. Clinicians had fewer deficiencies in their final report compared to their mid-training report, supporting the perspective that forensic training and supervision is associated with better quality reports.     

论司法鉴定人资格认证框架的构建

通过对我国司法鉴定人资格管理中存在的问题分析,在借鉴相关行业管理模式的基础上,以国际标准化组织发布的ISO/IEC17024准则为指导.提出将人员认证与鉴定人职业资格相结合,将资格考试和能力验证作为鉴定人认证的主要评价手段,尝试在现有法律制度和管理模式下构建我国司法鉴定人资格认证的基本框架.     

药物不良事件及其法医学鉴定

目的研究药物不良事件的法医学鉴定原则及注意事项,为此类案件的法医学鉴定提供参考并积累基础资料。方法通过对33例药物不良事件法医学鉴定案件的回顾性分析,总结药物不良事件相关案件的法医学鉴定原则及注意事项。结果药物不良事件的法医学鉴定案件有增长趋势,患者以女性多见(20例,60.6%)。33例药物不良事件中,以医疗过错鉴定案件多见(21例,63.6%),21例医疗过错鉴定案件中,只有1例(4.8%)与医院过量使用药物有关,其他均未发现医院存在医疗过错;非法行医案8例(24.2%),均与使用药物不当有关。法医鉴定类型以活体鉴定为主(27例,81.8%),死亡案件6例(18.2%)。结论药物不良事件的法医学鉴定案例在不断增加并具有自身特点和复杂性,应引起鉴定人的重视。     

The notion and classification of expert errors

The author presents the analysis of the legal and forensic medical literature concerning currently accepted concepts and classification of expert malpractice. He proposes a new easy-to-remember definition of the expert error and considers the classification of such mistakes. The analysis of the cases of erroneous application of the medical criteria for estimation of the harm to health made it possible to reveal and systematize the causes accounting for the cases of expert malpractice committed by forensic medical experts and health providers when determining the degree of harm to human health.     

传染病疫情下法医学尸体解剖检验室建设展望

人群对新型冠状病毒肺炎普遍易感,在国内已造成数万人感染。由于现有的尸体解剖检验室不具备传染病患者或疑似传染病患者尸体解剖检验条件,公安机关法医人员在处理感染状态不清、疫情接触时不明的未知名尸体案事件时,面临着严峻的感染风险。为满足传染病患者或疑似传染病患者尸体解剖工作需要,确保法医人员身体健康安全,了解传染病患者的病理生理改变,完善法医学解剖检验室的建设十分必要。     

Teaching forensic psychiatry to medical students

Are separate courses on forensic psychiatry available for medical students? During the 1985 to 1986 academic year, the authors surveyed all U.S. medical schools to identify courses on forensic/legal psychiatry. A minority of schools included separate courses or practicums on forensic psychiatry or mental health law. In a follow-up telephone survey, instructors of each of these courses were interviewed. Information was obtained on format of course, duration, discipline of instructor or instructors, topics covered, reading materials, institutional settings, and the number of students who took the course. The results are discussed and compared with earlier surveys.     

Evaluating expertise in forensic anthropology

The medicolegal system relies on the ability of experts and non-experts alike to make judgments about expertise and use those judgments to reach consequential decisions. Given the lack of standard criteria, mandatory certification, or licensure for establishing expertise required to practice forensic anthropology and testify as an expert witness, we sought to understand how individuals assess and identify expertise in forensic anthropology by using a social science tool called the Imitation Game. This tool assesses immersion in a specific area of study via discourse, with the premise that some individuals lacking expertise themselves imitate or attempt to pass as experts. For this project we recruited volunteers with varying expertise in forensic anthropology to participate in interviews which asked questions about the practice and structure of the discipline. Those interviews were transcribed, anonymized, and evaluated by other recruited individuals with varying expertise in forensic anthropology. Results found that judges who were experts in forensic anthropology performed better than non-expert judges in determining who was not an expert in forensic anthropology based on their anonymized responses; however, nearly half of the non-experts were still able to pass as experts in forensic anthropology. The difficulties in assessing expertise based on discourse interactions demonstrates the value and need for well-defined credentials and mandatory certification to practice forensic anthropology. This study demonstrates that accurately identifying expertise in forensic anthropology may be challenging for both experts and non-experts, especially when relying solely on interactional expertise rather than formal assessments of competency which directly elucidate contributory expertise.     

从法医角度看医疗纠纷及其产生的原因与防范

从医疗纠纷鉴定人角度研究医疗纠纷,为相关机构防范医疗纠纷提供思路。医疗纠纷是多种原因引起的,一般采用诉讼方式解决。法医在医疗纠纷的解决中扮演重要角色。在医疗纠纷鉴定中要判定诊疗行为对患者造成的损害后果,判定诊疗行为是否存在医疗过失,判定医疗过失与损害后果之间的因果关系．正确地进行死因分析和证据的取舍认定。在引起医疗纠纷的原因中,以技术性、责任心、医患交流不足等方面的原因居多。医护人员应提高自身的业务水平、责任心及服务质量;加强医患交流,建立畅通的医患沟通渠道;增强自我法律防护意识,建立健全的医疗规章管理制度。     

Technical and interpretive pitfalls of postmortem CT: Five examples of errors revealed by autopsy

Image acquisition of dead bodies, particularly using postmortem computed tomography (PMCT), has become common in forensic investigations worldwide. Meanwhile, in countries such as Japan which have an extremely low rate of autopsy, PMCT is being increasingly used in the clinical field to certify the cause of death (COD) without performing an autopsy or toxicological tests, even in cases of unnatural death. Additionally, these PMCT images are predominantly interpreted by clinical personnel such as emergency physicians or clinicians who are not trained in PMCT interpretation and who work for the police, that is, the so-called police doctors. Many potential pitfalls associated with the use of PMCT have been previously described in textbooks and published papers, including the pitfalls of not performing a complete forensic pathology investigation, and the use of physicians without appropriate PMCT training to interpret PMCT and direct death investigation and certification. We describe five examples in which apparent misdiagnosis of COD based on PMCT misinterpretation was revealed by autopsy. Here are the five examples of errors: (1) Postmortem changes were misinterpreted as COD, (2) resuscitation effects were misinterpreted as COD, (3) COD was determined after an incomplete examination, (4) fatal findings caused by external origin were wrongly interpreted as ‘of internal origin’ based on PMCT, and (5) non-fatal findings on PMCT were wrongly interpreted as fatal. Interpretation of PMCT by appropriately trained physicians and an accompanying complete forensic investigation, including autopsy when indicated, is necessary to prevent significant errors in COD determination and related potential adverse medicolegal consequences.     

Diagnosing Crime and Diagnosing Disease‐II: Visual Pattern Perception and Diagnostic Accuracy

Previously, we reviewed how general cognitive processes might be susceptible to bias across both forensic and clinical fields, and how interdisciplinary comparisons could reduce error. We discuss several examples of clinical tasks which are heavily dependent on visual processing, comparing them to eyewitness identification (EI). We review the “constructive” nature of visual processing, and how contextual factors influence both medical experts and witnesses in decision making and recall. Overall, studies suggest common cognitive factors uniting these visual tasks, in both their strengths and shortcomings. Recently forensic sciences have advocated reducing errors by identifying and controlling nonrelevant information. Such efforts could effectively assist medical diagnosis. We suggest potential remedies for cognitive bias in these tasks. These can generalize across the clinical and forensic domains, including controlling the sequencing of contextual factors. One solution is an agnostic primary reading before incorporation of a complete history and interpretation.     

新冠疾病对法医精神病鉴定的挑战与思考

新冠疾病(COVID-19)传染性强,潜伏期长,已在全球快速蔓延,给司法鉴定带来新的挑战.本文对COVID-19疫情下法医精神病鉴定的日常工作相关环节如何避免感染,COVID-19导致的器质性与功能性精神损伤特点及其损伤/伤残评定,COVID-19与精神卫生医疗机构医疗纠纷的防范及法医学鉴定思路等方面进行了探讨,并提出...