Medical malpractice: a study of case histories by the Forensic Medicine Section of Bari

The learning objectives of this paper are to study the actual extent of medical malpractice, the medical acts at risk, and their impact on mortality. The number of suits filed against physicians for deaths resulting from alleged malpractice and autopsies ordered by the Judicial Authority in cases of possible therapeutic misadventures are rising. A major factor pushing this trend is public mistrust of healthcare providers and public and facilities. This mistrust is partly fueled by the mass media which, often to gain larger audience shares, sensationalizes single cases of real or alleged iatrogenic injury. Further, the potential for astronomic settlements, either from the single doctor or from the healthcare institution, has increased the number of legal proceedings that start on the basis of mere suspicion. In this context, the autopsy becomes an important instrument for shedding light on the situation, and it must be carried out by highly qualified and experienced professionals capable of ascertaining the cause of death, identifying any possible misconduct, and assessing its consequences. We reviewed the data regarding autopsies performed at the Forensic Medicine Section of the Department of Internal and Public Medicine of the University of Bari over 1991 to 2000. We culled the cases alleged malpractice and, from these, identified those in which the death had truly been caused by medical error. This study also allowed us to understand the incidence of lethal therapeutic misadventures and to identify the medical and surgical branches more frequently involved.     

Interpersonal Aspects of Justice in Relationships Between Consumers and Service Providers: A Confirmatory Factor Analysis

There is a controversy in the justice literature as to whether interpersonal aspects of justice are best represented as one construct (interactional justice) or two (interpersonal justice and informational justice). Using confirmatory factor analysis, we tested competing models of these constructs on a sample of healthcare consumers (n = 1919) with respect to their justice judgments of primary care physicians. We found that the single factor model (interactional justice) represented a better fit to the data. Our results do not necessarily contradict those of prior studies that have found a better fit for a bi-dimensional model in organizational settings, however. Instead, we are suggesting a contingency approach: the results may be due in part to the halo effect, which may manifest itself where consumers are unfamiliar with the service provider and with the complexities of that person’s role.     

Prevalence of trauma, PTSD, and dissociation in court-referred adolescents

This study examines the prevalence of trauma, posttraumatic stress disorder (PTSD), and dissociative symptoms in adolescents. The sample consisted of 76 females and 76 males, between the ages of 12 and 18, referred to the Child Guidance Clinic of the Superior Court of the District of Columbia for a psychological evaluation. Two sets of analyses were conducted. One set included the entire sample; the second set excluded those individuals whose listed referral problem included only being a victim of abuse. Results of the study suggest a high prevalence of trauma in both genders; however, females had significantly higher rates than those reported in males. Similarly, female adolescents demonstrated significantly higher prevalence rates of PTSD symptoms compared with their male counterparts in the entire sample and showed a trend toward significance in the analysis of the subsample. There was a low prevalence of dissociative symptoms across both genders.     

Fatality following right atrial perforation by a screw-in pacemaker electrode

This paper describes the first reported fatality from right atrial perforation complicating the insertion of a screw-in right atrial pacemaker electrode. The patient was an 84-year-old woman with the sick sinus syndrome who also had hepatic cirrhosis.     

Scales for perceived risk of student-on-student victimization in grades 7 through 10: A psychometric analysis of the adolescent index on school safety

Although past research has developed scales for the incidence, prevalence, and fear of student-on-student victimization (SSV), little is known about the scaling of perceived risk (i.e., the cognitive appraisal of the chances of experiencing SSV). Hence, this study examined self-report survey data for the perceived risk of SSV as measured in the Adolescent Index for School Safety (AISS). Children in grades 7 through 10 (n=337) in a single Florida public school completed the AISS. Factor analyses using Maximum Likelihood Estimation with Oblimin Rotation identified nine unique factors for perceived risk. Reliability analyses found standardized Cronbach Alphas that ranged from .64 to .91, and seven out of the nine identified scales were above .80, which suggested good to excellent internal consistency. Future research should examine the content validity, construct validity, and predictive validity for the AISS and other self-report surveys of SSV dynamics. This publication was made possible by a grant [#97-MU-FX-KO12 (S-l)] from the Office of Juvenile Justice and Delinquency Prevention (O.J.J.D.P.), United States Department of Justice (U.S.D.O.J.). This grant is administered through the Hamilton Fish National Institute on School and Community Violence at George Washington University. This specific study was developed and implemented by staff at: 1) East Carolina University’s Department of Criminal Justice; and 2) Florida State University’s Center for Educational Research and Policy Studies. All points of view and opinions in this paper are those of the authors and do not necessarily represent the official position or policies of East Carolina University, Florida State University, the Hamilton Fish National Institute on School and Community Violence, the O.J.J.D.P., or the U.S.D.OJ. The authors would also like to thank Dr. Bill Doerner and Jennifer Jolley for their support, editorial feedback, and insightful comments regarding earlier drafts of this paper.     

Hostage-Taking in the Context of Domestic Violence: Some Case Examples

Initial reports of domestic violence are generally made to law enforcement officers who must respond and intervene. A subset of these episodes involves cases in which the victim, and, in many instances her child(ren), have been taken hostage by her husband or partner. Moreover, there are indications that the number of such incidents is growing. The purpose of this project was twofold: (1) to provide one of the first reports on the prevalence and characteristics of these events, and (2) to more closely analyze domestic crisis (hostage) situations using actual case examples. All information was obtained from the Hostage Barricade Database System (HOBAS) of the FBIs Crisis Negotiation Unit. HOBAS is a postincident information collection tool which stores historical data from law enforcement agencies across the nation on hostage/barricade incidents. An examination of this database yielded different types of domestic hostage-taking acts and outcomes (e.g., tactical vs. negotiated resolutions, survival vs. death/injury of perpetrator and/or victim[s]). Implications of the findings, for future crisis negotiation efforts directed toward nonviolent resolution of these high-risk critical incidents, are discussed.