Forensic-medical obstetric-gynecological examinations in cases on professional delinquency of medical personnel

We studied the trend in the number of forensic-medical examinations in trials against obstetricians and gynecologists conducted in Primorsky Region in 1997-2005. Most typical defects in obstetric-gynecological care are characterized. These cases are analysed in terms of forensic-medical practice. Detection and forensic-medical analysis of the above defects contribute to optimization of the diagnosis and treatment both in obstetric-gynecological practice and in wide medical practice.     

Algorhythm of making forensic medical expert examinations by medical documents in obstetric-gynecological practice

Most of the suits brought against medical professionals concern obstetricians-gynecologists. The experienced clinicians take part in commissions of experts to certify validity of diagnosis, treatment, operations, manipulations. Current state of obstetric-gynecological expertise is characterized. Algorithm of making obstetric-gynecological examinations is proposed. Criteria on forensic-medical assessment of medical care conducted in comparison with current standards of this care are formulated.     

Forensic-medical evaluation of the histologic structure of the hymen

Variants of microscopic structure of the hymen are described and its histological classification based on the stromal component structure is offered. Hypotheses on the hymen histogenesis under different conditions are formulated. Histological analysis and histological classification of the hymen are needed for objective solution of questions arising during expert evaluation of virginity and its violation, probability or improbability of coitus without defloration.     

Forensic-medical evaluation of toxic hepatitis associated with surrogate alcohol poisoning

Medical cards of 1,116 inpatient victims of surrogate alcohol poisoning and 242 cases of its fatal outcome associated with jaundice were available for analysis form Irkutsk Region and other regions of the Russian Federation in the second half of 2006 and early 2007. The study revealed differences in hepatic lesions depending on the chemical nature of toxicants. Mixtures containing guanidine derivatives caused highly specific irreversible disturbance of bile transport in hepatocytes and biliary capillaries in the absence of cholestasis at the level of biliary ducts. Changes in hepatocytes of different type and genesis appear to be due to other toxic components and may be of use for the establishment of causal relation between hepatic lesions and concrete toxic mixtures.     

Expert evaluation of medical care quality in otorhinolaryngology

Defects related with rendering medical care (DMC) in the managerial and information-deontological spheres of healthcare are evaluated. Reasons of the above defects and the related peculiarities are elucidated; the necessity in eliminating them is substantiated. The authors put forward their own definition of DMC on the basis of an independent analysis.     

A method of estimating errors in medical treatment during medico-legal expert evaluation

The authors worked out "Informative chart on medical treatment defects" which is recommended for use in cases of revealing the defects in medical treatment by medicolegal expert.     

Forensic-medical assessment of diaphysis fractures in childhood

The authors established that special structure of bones in childhood have a significant influence on the fractures of long tubular bones. The formation of unusual fractures shows it. Under condition of low speed of bending in the area of fracture many microfissures are formed, which leads to structural failure of intraosseous microcirculation and osteocytes.     

Forensic-medical assessment of terroristic chemical attacks

By potential damage, chemical terroristic attacks are much more dangerous than terroristic bombing. To fight chemical terrorism it is necessary to create the system of medical-environmental defense of the population. In line with emergency medicine, forensic medical service is a very important element of the antiterroristic defense. The activity of forensic-medical experts in the field of terroristic chemical attack is analysed.     

The standard of care and expert evidence of accepted practice in medical negligence

The topic of this article is the perennial issue in medical negligence litigation of various kinds of the extent to which it is a defence to a charge of lack of reasonable care that the defendant's conduct complied with accepted professional practice. Recent English interpretations of the controversial Bolam principle are considered, before the current approach of the courts and the Health and Disability Commissioner in New Zealand is described, using case illustrations. In New Zealand expert medical opinion of accepted practice is relevant to, but not conclusive of, the standard of care. There is, however, more freedom than pursuant to the current English approach for a decision-maker to reject expert opinion of accepted practice, because he or she is able to examine not just the logical defensibility of the practice but its overall reasonableness, including where the practice involved a risk assessment on a matter of clinical judgment. A decision to reject expert opinion of accepted practice is more readily made in areas which do not involve assessment, diagnosis and treatment.     

Factors affecting perceptions of medical errors

The purpose of the study was to assess how three factors affect subjects' perceptions of a medical error made in a hypothetical scenario. The factors were (i) type of compensation system, (ii) degree of procedural “voice” present in the physician-patient relationship, and (iii) magnitude of damage sustained by the patient. Perceptions were defined to include subjects' (i) emotional reactions to the incident, (ii) causal attributions about the incident, (iii) evaluations of the faimess of the compensation systems, and (iv) compensation demands. Results indicated that damage magnitude was the only factor that affected subjects' emotional reactions to the described incident and their compensation requests. When damage was severe, subjects reacted more negatively to the event and demanded greater compensation. Subjects rated the no-fault system and greater voice conditions as more fair. In general, subjects causally analyzed the error incident in a manner that was less blameworthy of the physician when procedural justice was high, especially if this was combined with a no-fault compensation system. Results were discussed in terms of Wexler and Winick's (1991) model of therapeutic jurisprudence.     

Forensic medical evaluation of flaws in medical care rendered at public health institutions in the Russian Federation

The authors analyze the flaws in medical care rendered at various public health institutions by the results of 2436 expert committee conclusions, verified at bureaus of forensic medical expert evaluations. The essence and causes of these defects at the hospital and prehospital stages of medical care, rendered by physicians of different specializations and nurses, are analyzed.     

The role of information technology in reducing medical errors

This Article summarizes the discussion at a breakout session held at the American Health Lawyers Association's (Health Lawyers') 2003 Public Interest Colloquium,' Minimizing Medical Errors: Legal Issues in the Debate on Improving Patient Safety, held February 28-March 1, 2003, in Washington, DC. The authors developed a series of core questions identifying relevant legal and policy issues relating to the use of information technology in reducing medical errors, and facilitated the breakout discussion.