非法行医政人死亡案例特点及法医学鉴定

非法行医一直是我国卫生行政部门以及公安机关严厉打击的违法犯罪行为,但目前非法行医仍不少见,并时常有致人死亡的案件发生。本文收集我系十多年来经检验鉴定的２０例非法行医致人死亡的案例,总结分析其死因和特点,并探讨这类案件的法医学检验和鉴定。１材料和方法收集我系１９８５～２０００年受委托检验鉴定的非法行医致人死亡的案件２０例。死者尸体经系统的病理解剖和组织学检验,并进行相关的毒物分析和药品检验。将这些材料按性别、年龄、生前疾病、诊治措施、死亡原因及寻求非法行医者诊治的原因进行分类整理,并加以总结分析。…     

关于打击非法行医工作的思考

1武汉某市场非法行医情况概述武汉某市场地处武汉市硚口区与江汉区交界处,主要以小商品、服装、鞋类、皮具箱包等商品为主的批发市场,有个体工商户13000余户,日均人流量20万人次,市场占地面积1．67平方公里;其中,户籍人口10万人。2006年5月中旬,在所辖26个社区,共发现无证非法行医点127个。这些无证非法行医点的面积90％在12平方米左右,而且集诊断、治疗以及行医者吃住为一体。这些无证行医者85％以上来自武汉周边的天门、仙桃、汉川等县市,其中55％为乡村医生,近90％的无证非法行医者,均未取得“中华人民共和国医师执业资格证”,95％以上无证行医者,未采取相应的消毒、隔离等传染病防治措施,所产生的医疗废弃物未经任何无害化处理随意排放。     

非法行医致人死亡案例特点及法医学鉴定

非法行医一直是我国卫生行政部门以及公安机关严厉打击的违法犯罪行为 , 但目前非法行医仍不少见 , 并时常有致人死亡的案件发生 . 本文收集我系十多年来经检验鉴定的 20例非法行医致人死亡的案例 , 总结分析其死因和特点 , 并探讨这类案件的法医学检验和鉴定 .     

14例非法行医所致药物中毒死亡案例分析

中药及其制剂引起的中毒甚至死亡已有不少报道1-3，但因非法行医引起药物中毒死亡的案例尚未见专门的文献报道．本文总结同济医科大学法医学系自1958年以来的14例非法行医所致药物中毒死亡案例，认为认真分析总结非法行医中毒的原因和特点，探讨有关医政管理措施，以及可能的防范措施，对防止类似中毒的发生和提高法医学鉴定水平具有重要意义．1材料与方法从同济医科大学法医学系1958－1995年的尸检资料中选出14例明确因非法行医所致药物中毒死亡的案例，即因应用无行医执照的游医所配药物而中毒死亡的案例．将每份尸检材料包括法医病理学尸…     

瓜蒂牵牛子和大黄致人中毒死亡及动物中毒实验观察

<正> 非法行医者自制瓜蒂散、禹功散和导水丸致人死亡1例,并根据人与动物的药物等效剂量关系[1]进行对比性观察。1案例资料 简要案情 徐某,女,66岁。1999年2月27日,因头晕等症去寻医,从吕某(非法行医)家取其自制的吐药(含瓜蒂、小豆、人参、甘草)、泻药(含牵牛子、茴香),以及50粒胶囊(含大黄、黄芩、滑石、牵牛)。3月4日早7时30分,徐空腹用煮沸的腌咸菜水冲服,30min后腹痛,酱油色便,1h后便呈血性;同时呕吐,内容物为黄色,随之为粘液样血     

从犯罪构成分析追究医疗卫生监督员玩忽职守

近年来因非法行医致人死亡进而追究卫生监督员玩忽职守罪的事件屡屡发生。本文结合案例,从犯罪构成的角度分析此类案件的过失、危害行为、因果关系、主体的认定,从中找寻此类案件的辩护要点,避免在辩护中陷入误区。     

9例个体行医医疗纠纷法医学鉴定

近几年来个体行医引发的医疗纠纷有所增加,笔者搜集了有关这方面的临床法医学鉴定9例进行回顾性研究。案例资料一、被鉴定人一般情况9例中男性5例,女性4例,年龄从5岁至5 1岁不等;骨折治疗2例,臀部注射3例,皮下注射1例,痔疮切除、烫伤、关节炎治疗各1例,均为伤病后首次就医。二、个体行医者一般情况被告均系自然人,案由均为人身损害赔偿,未涉及非法行医刑事诉讼问题。被告人中退休医生2人,个体从医人员7人。取得当地卫生行政主管部门颁发的执业许可证的2人,无执业许可证7人。三、鉴定情况不良后果中死亡1例,余为程度不等的功能障碍。与医疗行…     

非法行医罪疑难问题研究

非法行医罪是我国于1997年新增设的罪名,在2008年最高人民法院又颁布了《关于审理非法行医刑事案件具体应用法律问题的解释》。理论界和司法界对该罪的理解存在着诸如对于非法行医罪中主体的认定、非法行医罪行医行为等问题多种不同观点。同时,伴随我国医疗服务业迅速发展,如何有效对其进行规制,迫切需要学者给予理性回答。本文通过相关案例介绍及对争议焦点分析,探寻非法行医罪主体、"行医行为"、救助行为等疑难问题的解决方案。望能为日后非法行医罪实践难题的解决提供帮助,促进医疗行为有序进行。     

大兴区借助行刑衔接机制治理非法行医情况分析简

目的：了解大兴区非法行医治理现状,为制定整治对策提供依据。方法：对2011-2012年大兴区非法行医整治工作情况进行综合分析。结果：2年间共取缔427户次,立案处罚151起、移送公安机关追究其刑事责任12人、申请法院强制执行93起,与行刑衔接开展前相比差异有统计学意义（P〈0.01、〈0.05）,综合治理使得非法行医初步得到遏制。结论：借助行刑衔接机制,初步解决了在打击非法行医工作中经常遇到的调查取证难、行政处罚与执行难等一系列制约卫生行政执法的难题。应将行政处罚作为目前治理非法行医的有效手段,以提高办案质量与效率和案件移送的成功率为切入点,及时将那些明知故犯、无视病人生命与健康权而再次非法行医者绳之以法。     

1例医疗纠纷检案分析

近几年，医疗纠纷案各地均有报导，无证行医者致人死亡的也时有发生，笔者曾遇无证行医因冠心病摔死而引起的医疗纠纷案例，报告如下：1案例资料1·l临床资料周某，男，54岁，农民。1998年4月17日感头晕、头痛，乏力不适，不思饮食，在本村以“感冒”治疗，不见好转。4月19日晚自觉症状加重，且右肢活动不便，次日晨6时许到邻村卫生室诊治，初诊“脑血栓”，即给予输液治疗。于当日上午10时20分许，在输液过程中突发恶心呕吐，呕吐物为咖啡祥物，急救无效死亡，急救时间约10min左右。死者亲属知其无证行医，怀疑用错药物或用假药，医治死亡…     

Pregnancy-associated deaths: a 15-year retrospective study and overall review of maternal pathophysiology

Pregnancy-related death is defined by the International Classification of Diseases, Tenth Revision (ICD-10) as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death. In the year 2000, a collaborative effort involving World Health Organization (WHO), UNICEF, and UNFPA estimated 660 maternal deaths in the United States. This averages 11 maternal deaths per 100,000 live births reported. Many pregnancy-associated deaths are not easily identified as such since the presence of a recent or current pregnancy may not be listed on the death certificate. Thus, the WHO estimates that in the United States, the maternal mortality is approximately 17/100,000 pregnancies. This is significantly higher than the goal set by the US Department of Health and Human Services in Healthy People 2010, which sets the target for maternal mortality at less than 3.3/100,000 live births. The most common causes of maternal death vary somewhat from region to region in the United States. They include pulmonary thromboembolism, amniotic fluid embolism, primary postpartum uterine hemorrhage, infection, and complications of hypertension including preeclampsia and eclampsia. Pulmonary disease, complications of anesthesia, and cardiomyopathy also are significant contributors to maternal mortality in some populations. The death of a pregnant or recently pregnant individual poses a wide scope of challenges to the forensic pathologist and investigator. The pathologist must have a broad knowledge of the physiologic and biochemical changes that occur during pregnancy, as well as the clinical and pathological manifestation of these changes. Conditions that may be "benign" in the nonpregnant individual may be lethal in the puerperal period. In addition, it should be kept in mind that deaths during pregnancy may be due to unnatural causes. Accident, homicide, and suicide must be ruled out in each case. The authors reviewed all forensic cases referred for autopsy to the Forensic Section of the Medical University of South Carolina from January 1989 through December 2003. All decedents listed as pregnant or postpartum were analyzed as to maternal age, race, past medical history, previous pregnancies and outcome, prenatal care, gestational age, fetal or neonatal outcome, location of delivery, placental findings, maternal autopsy findings, toxicology, cause of death, manner of death, and fetal or neonatal autopsy findings. The authors present this retrospective study to better determine the factors leading to maternal demise and discuss the autopsy/ancillary techniques useful in determining the cause of death in this challenging area.     

Pulmonary embolization by chorionic villi causing maternal death after a car crash

Throughout the last century, there has been a marked decline in obstetric maternal deaths, resulting in an increase in the proportion of nonobstetric deaths among pregnant women. Trauma, in particular, has become a leading cause of maternal death. We report the case of a 20-year-old primigravid woman who was involved in a motor vehicle crash at 36 weeks gestation. The woman developed abruptio placentae, followed by disseminated intravascular coagulation, adult respiratory distress syndrome, and shock, and died the day after the crash. Widespread pulmonary embolization by chorionic villi was identified at autopsy. This report discusses traumatic maternal deaths, with emphasis on the differences in injury pattern observed in pregnant trauma victims in comparison with other adults. It is important that the pathologist be aware of these problems so that an accurate cause of death can be identified in cases of maternal death after trauma. Also discussed is the relationship between trauma and placental abruption and the mechanism of death in the patient. To the authors' knowledge, this is the first reported case of extensive embolism of chorionic villi to the lungs after trauma.     

孕产妇死亡医疗纠纷案法医病理研究

目的探讨孕产妇死亡医疗纠纷案的特点、主要死因及其防范对策。方法采用回顾性研究的方法,对我室1985年至2003年12月的法医尸体解剖案例资料进行统计,并对其中存在医疗纠纷的孕产妇死亡案例进行分析。结果31例存在医疗纠纷的死亡孕产妇法医尸检案例中:(1)围产期死亡26例(83.9%),妊娠早期人工流产后死亡5例(16.1%);(2)产科出血引起的失血性休克死亡22例(71.0%),羊水栓塞死亡5例(16.1%),其它原因死亡4例(12.9%);(3)乡镇医疗机构17例(54.8%),地县级医院占7例(23.6%),市级医院占4例(12.9%),其他占3例(9.7%);(4)纠纷产生的原因中疑为误治14例(45.2%),误诊的9例(29.0%),抢救不及时的7例(22.6%),其他1例(3.2%)。结论孕产妇死亡医疗纠纷案主要发生在围产期,其次是妊娠早期;产科出血是导致孕产妇死亡的最主要因素之一;乡镇及县级医疗机构易引起纠纷;引起纠纷的主要原因是误诊、误治和抢救不及时。     

Fetal death. A 10-year retrospective study

Fetal death has been defined by the World Health Organization as death before complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy. Certain causes of fetal death, including syphilis, Rh isoimmunization, toxemia, and diabetes, have shown significant declines over the past several decades. However, many fetal losses continue to occur from intrauterine infections, lethal malformations, fetal growth retardation, and abruptio placentae. Fetal death with no identifiable specific cause is another consideration when dealing with these cases. Other risk factors can include maternal, sociodemographic, and medical care factors. The authors reviewed all forensic cases referred for autopsy to the Forensic Section of the Medical University of South Carolina, Medical Examiners' Office over the 10-year period 1990-1999. All cases listed as fetal death or stillbirth were included. The 42 cases were analyzed as to fetus' gestational age, sex, race, weight, location of delivery, history of prenatal care, maternal drug use, chromosomal abnormalities, cause and manner of death, and autopsy findings. The black:white ratio was approximately 2:1, and the male:female ratio was virtually 1:1. Most fetuses were older than 20 weeks' gestational age, with one third between 20 and 29 weeks. The majority were externally normal aside from maceration. Only 7.5% had congenital anomalies. Twenty-one of 38 placentas were grossly and microscopically normal. Of cases with toxicologic analysis, 21% were positive for drugs, and 17% were positive for cocaine/benzoylecgonine. The manner of death was classified as natural (28), accident (2), and undetermined (12). Few studies have reported the specific causes of fetal death, and the lack of uniformity in data collection and classification of causes of fetal death has made comparisons difficult. The authors present this retrospective study to better determine the factors leading to fetal demise in the hope of assisting death investigators in this challenging arena.     

Medical negligence in drug associated deaths

According to epidemiological studies adverse drug events are one of the most frequently encountered complications during medical treatment, a leading cause of hospitalisation and frequent cause of death. However, medical malpractice claims due to medication errors seem to be relatively rare. Based on a retrospective multicentre study on medical malpractice cases with lethal outcome (n = 4450), drug related cases (n = 575) were further evaluated. In 50% of cases a causal connection between drug therapy and death could be ruled out already after autopsy. In 232 cases a causal connection between drug therapy and death could be approved (drug allergies, relative overdose, wrong application, mix-up of drugs and sepsis after injection abscess). However, within the legal context only in 70 cases a medication error was approved which was in 42 cases causal for death, in 28 not. Administration of contraindicated drugs, incorrect application and relative overdose in renal insufficiency are the prevalent mistakes. Concerning the frequency of ADE in epidemiological studies medication errors are underreported in all data sources on medical malpractice; this seems to be due to the fact that even doctors and attending physicians rarely recognize an ADE; furthermore approving the connection between drug effect and death is extremely difficult for the expert witness.     

Forensic Pathological Examination on 73 Medical Malpractice Cases of PediatricsCSCD

Objective: To analyse 73 medical malpractice cases of pediatrics for discussing the importance of forensic pathology in solving the issues such as medical malpractice of pediatrics. Methods: From January 2002 to August 2016, 73 medical malpractice cases of pediatrics with age of death between 28 days old and 10 years old were collected from Institute of Judical Expertise of Nanjing Medical University. The relationship between causes of death and related medical institutions was retrospectively analysed. Results: In 73 cases, the male to female ratio was 1.70:1, and ages of 28 days old to 1 year old were common (26 cases, 35.62%), followed by ages between 1 year old and 3 years old (21 cases, 28.77%). In 71 cases which had been determined the cause of death by postmortem examination, the main cause of death was disease, especially respiratory diseases (33 cases, 46.48%), followed by cardiovascular diseases (12 cases, 16.90%). In 75 medical institutes which involved with these medical malpractices, most were tertiary medical institutes (32, 42.67%), followed by the sub-secondary (excluding the secondary)medical institutions (23, 30.67%). The clinical diagnosis of 38 cases (52.05%) completely or mostly corresponded with the pathological findings. There were 35 cases (47.95%) undefined or misdiagnosed cases. Conclusion: Autopsy and forensic pathological examination contribute to determine causes of death, which not only provide scientific evidence for medical malpractice of pediatrics, but also enrich and develop clinical medical knowledge, and thus improve diagnosis and treatment level in a certain extent. © 2018 by the Editorial Department of Journal of Forensic Medicine.     

Amniotic fluid embolism as cause of death in a car accident--a case report

Amniotic fluid embolism (AFE), a relatively rare complication in pregnancy, has a high mortality rate. We describe a case of a 38-week pregnant woman with such an embolism leading to almost immediate death after a blunt abdominal trauma inflicted in a motor vehicle accident and probably associated with improper positioning of a seat belt. It has been assumed that the pathophysiology of amniotic fluid embolism is related to an anaphylactoid reaction and that mast cell degranulation indicates this mechanism. Moreover, immunohistochemical antitryptase staining of pulmonary tissue samples in our case revealed mast cell degranulation.     

医疗事故的原因分析和相关技术鉴定的建议

目的分析医疗事故的发生原因,及医疗纠纷技术鉴定的现状。方法32例医疗纠纷技术鉴定按一般情况(性别、年龄、主要疾病、后果)和鉴定结果(有无失误、因果关系、责任程度等)进行统计分析。结果死亡鉴定17例,活体鉴定15例。32例中医疗事故13例,非医疗事故19例,医疗事故的原因多为医疗责任心不强。结论加强医务人员综合素质培养可以减少医疗事故的发生。为了使医疗纠纷技术鉴定取得积极的效果,建议国家进一步完善有关尸体解剖的立法;事故等级中宜增加医疗差错的鉴定;有必要进一步提高医疗纠纷鉴定的公正性。     

Sudden infant death syndrome: a subject of medicolegal research

During the last decade, much attention has been paid to the risk factors of sudden infant death syndrome (SIDS). Many researchers have demonstrated that infant-care practices are linked to the risk of SIDS. Prone sleeping, bed sharing, maternal substance abuse, and cigarette smoking have been reported to be significant potentially modifiable risk factors for SIDS. Despite the reports that the incidence of SIDS has decreased by 38% in the United States, it remains the leading cause of death in the first year of life. Deaths resulting from child abuse or neglect inflicted or permitted by their caretakers being second only to SIDS in infant mortalities and some recommendations regarding the differentiation of SIDS and child abuse have generated speculation that some cases of infanticide were misdiagnosed as SIDS. To reach a proper conclusion as to the cause and manner of death of an infant who died suddenly and unexpectedly, investigation must be thorough and professional.     

Deaths Due to Child Abuse: A 6‐Year Review of Cases in The Cook County Medical Examiner's Office

Case files from the Cook County Medical Examiner's Office from 2007 to 2012 were reviewed to analyze homicides due to physical child abuse in children <3 years old. Fatal cases mostly involved younger subjects. Intracranial injuries were the leading cause of death, while death due to extracranial injuries was uncommon. Eyes were involved in most of the cases. Spinal cord was involved in about 1/3 of the cases, mostly in the thoracic area. In some cases, previous injuries were present. There were significant differences in the pattern of injuries between age groups. Subjects showing signs of impact to the head and subjects with no evidence of an impact showed no significant difference in internal injuries. The association of multiple injuries is highly suggestive of child abuse. In suspected child abuse, a postmortem examination including neuropathological, ophthalmological, and radiological information should be always evaluated, together with investigative reports and the medical history.