美国马里兰州法医学制度

各国的法医学体制各有所长。随着我国开放政策的实施 ,体制改革的深入 ,借鉴国外的经验 ,吸取其优点 ,将有助于我国法医学体制改革 ,进一步提高法医学鉴定工作质量 ,尽快做到与国际接轨。关于英国、德国、日本及美国等的法医学体制已有数篇报道[1,2 ] 。本文作者介绍美国马里兰州法医局的法医学建制 ,并对照我国现行的法医学管理体制 ,对其特点进行分析。马里兰州法医局始建于 193 9年 ,是美国第一个以州为法医检验中心、实行法医检验人制度的法医局。马里兰州法医局负责全州 1市和 2 3县的法医检案工作 ,在行政上属马里兰州死后医学鉴定委…     

父子枪手的杀人游戏（上）

11年前的2002年。发生在美国华盛顿特区、马里兰州和弗吉尼亚州的一系列人员遇袭身亡案件，使华盛顿及周边地区陷入恐慌。一时间，整个美国都被该事件所困扰，进而引发美国历史上最大规模的追捕行动。     

53例一氧化碳中毒死亡尸检案例探析

正正确判断一氧化碳(CO)中毒死亡,对案件性质的判断有重要的意义。为探讨涉及死亡案件的CO中毒案例的特点,本文通过对53例尸检资料进行回顾性研究,旨在为这类案例的特点及其死因鉴定提供参考借鉴。1案例资料1.1案例来源本文53例CO中毒死亡的案例,均为本法医室1998年至2013年间受理鉴定的尸检案例。所有案例均已经检验确定系CO中毒死亡,或死者原有疾病     

97例杀人后自杀案件法医学特点分析

目的分析97例杀人后自杀案件特点,为同类案件的法医现场勘验及法医学鉴定提供参考和借鉴。方法收集上海市公安局物证鉴定中心参与鉴定的97例杀人后自杀案件,共死亡207人,其中加害人98名,被害人109名。对加害人、被害人双方的性别、年龄、关系及案发场所、死亡方式等方面的资料进行分析。结果上海地区杀人后自杀案件涉及的死者多为18~59岁青壮年,相互之间多熟识,起因多为家庭矛盾及感情纠纷;被害人女性为主,加害人男性居多;案发场所多为同一室内环境或相邻室内外;杀人多选择机械性暴力手段,而自杀则多采用自缢和高坠。结论上述关于此类案件的特点有助于法医在鉴定过程中对杀人后自杀案件做出快速、准确地判断。     

52例心脏性死亡相关医疗损害的法医学分析

目的综合分析涉及医疗损害的心脏性死亡法医学鉴定案例,探讨其死亡原因、医疗过错及参与程度评定的共性与特点。方法收集2015年1月—2018年4月杭州明皓司法鉴定所萧山分所受理的涉及心脏性死亡的医疗损害案例52例,对案件一般情况、医疗机构、住院情况、死亡原因、医疗过错行为及过错参与程度评定进行回顾性分析。结果 52例中,男女性比例为2.25∶1,年龄以50~60岁居多。高血压性心脏病及冠心病所引起的心脏性死亡占首位(67.3%),其次为病毒性心肌炎和心肌病(13.5%)。涉及手术的有24例,术后至死亡时长为1 h~118 d,中位数为7 d。医疗损害涉及医疗机构63所,多数医院存在不同程度的医疗过错行为,参与程度多为20%~30%。结论法医学鉴定有助于确定死亡原因,为医疗损害案件评定提供了科学的依据,有助于医疗部门进一步提高诊疗水平。     

在马里兰州看"两会"

美国马里兰州(Maryland State)每大年的参众两院立法大会(General Assembly)依据州宪法通常为九十天,主要议程包括政府预算、官员任命、提案审议、机构改革和立法修订.前不久,我在读的华盛顿法学院(Washington College of Law)便组织同学现场观摩,亲身体验美国式的"两会",而且能有机会与参议员交流,让人很兴奋.……     

291例涉及死亡的医疗损害案件回顾性分析

目的通过对涉及死亡的医疗损害案件进行分析,探讨医疗损害案件的鉴定思路和方法。方法收集南方医科大学司法鉴定中心2012年1月—2017年12月受理并结案的291例涉及死亡的医疗损害案件,对被鉴定人的年龄、性别、医院等级、临床科室、是否尸检、死亡原因、医疗过错原因、因果关系及原因力大小等方面进行统计分析。结果涉及死亡的医疗损害案件中,男性多于女性,青壮年及儿童居多。涉及三级医院的案件数最多,临床科室以内科最多,其次为外科、妇产科、儿科等。尸检率具有逐年增加的趋势。大多数患者的死亡为自身疾病的自然转归或治疗无效。大部分医院都存在一定的医疗过错行为,与患者的死亡有间接的相关性,以轻微因素为主。结论医疗损害鉴定应遵循多因一果的原则,需综合考虑自身疾病、自身体质、疾病自然转归、目前的医疗技术以及就诊医院的诊疗水平等。     

重复法医鉴定增多的原因及对策

当前在涉及人身损害的案件中 ,重复进行法医鉴定的情况呈明显增多趋势 ,且呈愈演愈烈之势。为此 ,作者对重复法医鉴定的案件进行了系统的调查 ,对将造成重复法医鉴定案件增多的原因进行统计分析 ,并提出相应的对策。案例资料(一 )一般资料选取本地区法院系统 95年以来审理终结的历经 2次以上鉴定的案例 ,共 3 1 8例。案件性质以故意伤害占绝大多数 ,其次为故意或过失杀人。鉴定次数最少为 2次 ,最多七次 ,平均 3 .0 8次。鉴定机构涉及县 (区、县级市 )、市、省、部四级公检法机关法医 (包括相应的法医门诊 ) ,以及大专院校设置的鉴定机构。(…     

澳大利亚和美国的轻微犯罪惩处考察及思考建议

笔者于2009年4月赴澳大利亚新南威尔士州、堪培拉特区和美国马里兰州，就澳大利亚及美国轻微犯罪惩处的基本情况、决定程序、处罚措施、社会救助以及强制戒毒和戒毒康复措施等进行考察。考察情况和思考建议如下：     

县级公安鉴定机构法医病理学鉴定资格探讨

正我国法医病理学鉴定概况法医病理学是研究涉及法律有关的伤、残、病死的变化及发展的规律,目的是为暴力性案件的侦察或审判提供医学证据,运用相关的医学专业知识解决有关暴力性和非暴力性死亡的死亡征象、死亡原因、死亡方式、死亡时间、死亡地点、个人识别,以及致伤物的推断和确定的一门科学。而法医病理学鉴定指的是法医病理学者对上述问题所做出的结论称为法医     

Evaluation of aortic injury in driver fatalities occurring in motor vehicle accidents in the State of Maryland for 2003 and 2004

Incorporating epidemiological and pathologic factors, a retrospective analysis of aortic injury and driving fatalities was conducted. To better understand the mechanism of injury, data were compiled for decedent demographics, autopsy and toxicology findings, and accident circumstances, with emphasis on directional impact. Review of the autopsy files of the Office of the Chief Medical Examiner in the State of Maryland in 2003 and 2004, identified 150 cases of aortic injury recorded in 537 autopsied drivers. Aortic lacerations occurred in 96% of the cases with aortic injury, two thirds of which were complete or near complete transections. A large percentage of cases involved a side impact collision. Consistent with extant research on frontal and lateral impacts, the majority of aortic injuries occurred at the ligamentum arteriosum. Also, the mechanism of aortic injury seems to be similar for side and frontal impact collisions, involving a combination of rapid deceleration forces along with chest and/or upper abdominal compression. This study emphasizes the importance of side impact collisions as a cause of aortic injury. Aortic lacerations have a high mortality rate and better motor vehicle design may prevent this type of injury.     

Examining fatal and nonfatal incidents involving the TASER

Research Summary According to TASER International, nearly 10,000 police departments in the United States have deployed the TASER as a less lethal force alternative in some capacity. Despite the TASER's increasing popularity, serious questions have been raised about the device's physiological side effects; in particular, Amnesty International has reported that more than 300 people have died after being subjected to the TASER. Although a growing body of research has examined the physiological effects of the TASER on animals and healthy human volunteers in laboratory settings, there has been virtually no empirical analysis of “real‐world” fatal and nonfatal TASER cases simultaneously. This article examines all media reports of TASER incidents from 2002 to 2006 through a comprehensive review of LexisNexis and New York Times archives. We compare TASER incidents in which a fatality occurred to TASER incidents in which a fatality did not occur and then employ multivariate analyses to identify the incident and suspect characteristics that are predictive of articles describing TASER‐proximate deaths. Policy Implications Several suspect factors were significantly associated with the reporting of a fatal TASER incident, including drug use (but not alcohol), mental illness, and continued resistance. Multiple deployments of the TASER against a suspect was also associated with the likelihood of the article describing a fatality—especially if the suspect was emotionally disturbed—which raises the possibility that the risk of multiple shocks might not be uniform for all suspects. More research is needed to explore the relationship between mental illness, drug use (illicit or therapeutic), continued resistance, and increased risk of death. In the meantime, police departments should develop specific policies and training governing the use of multiple TASER shocks against individuals who could be in these vulnerable physiological and psychological states.     

The Value of Outsourcing Selected Cases in a Medical Examiner Population: A 10‐Year Experience

Due to increasing caseloads and inadequate staffing, the burden on Coroner/Medical Examiner Offices to comply with recommended autopsy limits for forensic pathologists (FPs) has been difficult. Since 2006, pathologists at the University of Alabama at Birmingham have performed select autopsies for the Alabama Department of Forensic Sciences. Each case was reviewed by a state FP and scene investigator to determine appropriateness for referral. All referred cases received full postmortem examination including microscopic examination and collection of toxicological samples, and toxicology was ordered by the referring FP as appropriate. The final cause and manner of death were determined by the referring state FP after review of all findings. A majority of the 421 cases were ruled accidental deaths (233), most due to drug toxicity. Of the 178 natural deaths, 118 were attributed to cardiovascular disease. Outsourcing select forensic cases can be educational and an effective tool to manage workflow without compromising quality.     

Investigation of sudden infant deaths in the State of Maryland (1990-2000)

The Office of the Chief Medical Examiner (OCME) has recorded a significant decline in the deaths of sudden infant death syndrome (SIDS) in the state of Maryland since 1994. However, infants who died of accidental or non-accidental injuries remained consistent during the same time period. This report focuses on the epidemiological characteristics and scene investigation findings of infant victims who died suddenly and unexpectedly in Maryland between 1990 and 2000. A retrospective study of OCME cases between 1990 and 2000 yielded a total of 1619 infant fatalities. 802 infant deaths were determined to be SIDS, which represented 50% of the total infant deaths in our study population. Five hundred and twenty-three (31.8%) deaths were due to natural diseases, 128 (7.9%) deaths were accidents, and 74 (4.6%) were homicides. The manner of death could not be determined after a thorough scene investigation, review of history and a complete postmortem examination in 92 (5.7%) infants. SIDS deaths most often involved infants who were male and black. The peak incidence of SIDS was between 2 and 4 months of age. The majority of SIDS infants (60%) were found unresponsive on their stomach. Among SIDS infants, 269 (33.4%) were found in bed with another person or persons (bed sharing). Of the bed-sharing SIDS cases, 182 (68%) were African-American. In the past 11 years, 52 infants died of asphyxia due to unsafe sleeping environment, such as defective cribs, ill-fitting mattresses, inappropriate bedding materials. Of the 74 homicide victims, 53 (70%) involved infants less than 6 months of age. Twenty (27%) exhibited the classical abuse syndrome characterized by repeated acts of trauma to the infants.     

Application of ultrasonography to postmortem examination. Diagnosis of pericardial tamponade

In postmortem examination, it is difficult to diagnose pericardial tamponade in a dead body from the findings of conventional external examination alone. However, ultrasonography is a common diagnostic tool for pericardial tamponade in clinical practice. We studied the postmortem diagnosis of pericardial tamponade at external examination level by applying an ultrasonographic device. The ultrasonographic findings were compared with the conventional autopsy findings. Among 455 cases of forensic autopsy in Hamburg and Tokyo conducted within 5 days after death, we successfully diagnosed 11 cases of pericardial tamponade by ultrasound imaging prior to autopsy, and failed to diagnose pericardial tamponade in only two cases. In addition, 79 cases of external examination conducted at the Tokyo Medicinal Examiner's Office were also examined with ultrasonography, and we diagnosed three cases of pericardial tamponade and five cases of pericardial effusion. The differences in ultrasonographic findings between tamponade and effusion were relatively clear. Although autopsy provides definitive evidence for the cause of death, sometimes autopsy cannot be performed due to some social factors. In such cases, conventional external examination alone cannot establish a cause of death by pericardial tamponade, and application of diagnostic imaging technique will be helpful. While CT and/or MRI may provide more detailed information than ultrasound imaging, these techniques require special equipment, room and specialist, and most of all involves high cost, which is perhaps the most important consideration in the present atmosphere of medical cost containment. On the other hand, the ultrasonographic devices we use are compact, and can be used directly at the scene of death. Postmortem application of ultrasonography may be a valuable adjunct in the work of medical examiners and forensic pathologists.     

Forensic aspects of 40 accidental autoerotic deaths in Northern Germany

Between 1983 and 2003, 40 accidental autoerotic fatalities have been investigated. in the Institute of Legal Medicine in Hamburg. Only 50% (n = 20) were autopsied (13 legal autopsies, 6 for scientific purposes and 1 for an insurance company). All the victims were males, aged between 13 and 79 years (among them five children and adolescents, the deceased mainly between 20 and 40 years). The paraphiliacs utilized a great range of devices and props as fetishism, sexual aids or pain-stimulating agents, like intimate feminine garments, ropes, chains, bondages, locks, pornographic magazines, condoms, rubber items, and chemical anaesthetics. The cause of death was strangulation in 20 cases (17× hanging, 3× ligature strangulation), 11× suffocation (8× under plastic bags, 3× with face-masks, 2× thoracic compression, 1× positional asphyxia, and 1× cocaine intoxication). Five cases without autopsy remained unclear because of missing morphological and toxicological findings; it could not be differentiated between asphyxiation/intoxication/natural disease, although the scene characteristics seemed to be typical for autoerotic deaths. It is emphasized that the findings at the scene, the morphological and toxicological examination of the dead body (full autopsy as prerequisite) by experienced investigators and the personal history of the deceased have to be evaluated very carefully and intensely to reconstruct the accidental fatal autoerotic course accurately and undoubtedly (to exclude the possibility of sexual homicide, neglected killing, or suicide).     

Sudden Death Secondary to an Undiagnosed B‐Cell Lymphoma of the Hypopharynx and Infiltration of the Inferior Constrictor Muscle

The aim of this presentation was to share an uncommon form of sudden death, suffered by a 64‐year‐old woman, due to a mechanical obstruction of hypopharynx by an undiagnosed B‐cell lymphoma, infiltrating the inferior pharyngeal constrictor muscle. A forensic approach by means of scene investigation, circumstantial data collection, autopsy, and histological and toxicological investigations led to conclude that the cause of death was asphyxia, correlated with B‐cell lymphoma of the hypopharynx. The autopsy examination highlighted the presence of a wall thickening, infiltrating, and projecting into the hypopharynx lumen. The histological analysis showed the essential finding of a B‐cell lymphoma of the hypopharynx, diffusely infiltrating the inferior pharyngeal constrictor muscle. To conclude, this case demonstrates once more that in the absence of specific data, a thorough forensic investigation including autopsy, histological examination, and circumstantial data collection is mandatory to reach a correct cause of death.     

Fatal descent from height in New York City

All deaths due to descent from height that underwent autopsy at the Manhattan Office of Chief Medical Examiner of New York City over a two year period (1997-1999) were reviewed. The scene and autopsy findings, psychiatric history, and toxicology results were examined. There were 120 deaths: 77 suicides, 36 accidents, 5 undetermined, and 2 homicides. Psychiatric illness was reported in 86% of suicides. The toxicological detection of psychiatric medications supports the high percentage of psychiatric disease in the suicide group. In the accidental group, the detection of ethanol and illicit drugs was higher (36%) than expected from the case investigation and similar to the suicide group (29%). Accidental falls by women made up fewer than 3% of all manners. Due to the variation in the extent of injuries, it is unwise to attempt to conclude how high a person descended based on the autopsy findings. Descents into water commonly have minimal findings on external examination with marked internal injuries. The methods of investigation and criteria for death certification using the study results are discussed.     

Unplanned Complex Suicide—A Consideration of Multiple Methods

Detailed death investigations are mandatory to find out the exact cause and manner in non‐natural deaths. In this reference, use of multiple methods in suicide poses a challenge for the investigators especially when the choice of methods to cause death is unplanned. There is an increased likelihood that doubts of homicide are raised in cases of unplanned complex suicides. A case of complex suicide is reported where the victim resorted to multiple methods to end his life, and what appeared to be an unplanned variant based on the death scene investigations. A meticulous crime scene examination, interviews of the victim's relatives and other witnesses, and a thorough autopsy are warranted to conclude on the cause and manner of death in all such cases.     

Occupational deaths due to penetrating chest injuries from sledgehammer fragments: two case reports and review of the literature

Occupational deaths due to projectiles from hand tools are rare. We report 2 unusual cases of individuals killed by metallic projectiles produced by the fragmentation of the head of a sledgehammer. At initial examination, these wounds appear similar to atypical gunshot or stab wounds. Proper evaluation requires radiographic examination, scene correlation, and, when possible, comparison of metallic fragments retrieved at autopsy and tools from the scene.