Factual causation in medical negligence

The conventional approach to causation in negligence is the "but for" test, decided on the balance of probabilities. Even when supplemented by the "material contribution" principle, satisfying the onus of proof of causation can be an insuperable obstacle for plaintiffs, particularly in medical cases. Yet, having found a breach of duty, a court's sympathies may gravitate toward the plaintiff at this point in the case. Accordingly, courts have sometimes accepted a relaxation of strict causation principles. The judicial devices are described: a special principle of causation in particular duties of care; a shifting burden of proof; "bridging the evidentiary gap" by drawing a robust inference of causation; treating a material increase in risk as sufficient proof of causation; and permitting causation to be established on the basis of the loss of a material chance of achieving a better outcome and discounting damages. In Accident Compensation Corp v Ambros [2007] NZCA 304 the New Zealand Court of Appeal recognised the need for a legal device to ameliorate the injustice sometimes caused by the strict rules of causation, and preferred the "inferential reasoning" approach favoured by the Canadian common law for use in the context of the accident compensation scheme. It is hoped that the New Zealand Supreme Court approves Ambros if the opportunity arises.     

Testing the relative importance of contemporaneous offenses: The impacts of fear of sexual assault versus fear of physical harm among men and women

Purpose

The current study tests the shadow of sexual assault hypothesis and extends recent research by examining whether the fear of physical harm or the fear of sexual assault has a greater impact on fear of other crimes.

Methods

To determine the unique interaction between gender and fear, we conduct separate analyses among men and women.

Results

While fear of physical harm and fear of sexual intrusion are both predictive of fear of home invasion, robbery, and murder, fear of physical harm has a significantly greater impact across all types of fear (e.g., home invasion, robbery, murder).

Conclusions

Despite previous empirical evidence that suggests fear operates differently among men and women, our findings suggest that fear of physical harm - rather than fear of sexual intrusion - is a more robust predictor of fear of crime among both men and women.     

The Impact of Field Court Attendance Notices on Property Crime in New South Wales,Australia

Objectives

This paper investigates the impact of Field Court Attendance Notices (FCANs) on rates of property crime in New South Wales (NSW), Australia. FCANs are used for relatively minor offenses, are issued ‘on the spot’, and provide an alternative to the time consuming process of arresting an alleged offender and taking them to the police station for processing. Despite their use in NSW for over 20 years, this study is the first to evaluate their impact on crime.

Methods

We use data provided by the NSW Bureau of Crime Statistics and Research, and the Australian Bureau of Statistics. We specify a general dynamic panel data model estimated via the Arellano and Bond (Rev Econ Stud 58:277–297, 1991) estimator, specifically the first-differenced twostep generalised method of moments (GMM) estimator.

Results

For property crime as a whole, in both the short- and long-run, we find no significant relationship between the use of FCANS and levels of offending. However, when offending rates are disaggregated into 11 sub-categories, we find that in the short-run an increase in the use of FCANs leads to statistically significant decreases in the rate of crime for five of the sub-categories offenses considered (break and enter dwelling; motor vehicle theft; steal from motor vehicle; steal from retail store and; steal from dwelling). The long-run results are largely consistent with the short-run results in terms of their signs and statistical significance, suggesting that the effects persist.

Conclusions

The empirical analysis presented in this paper suggests that the use of FCANs is an effective and potentially efficient policing strategy for a subset of property offenses, in that offenders can be processed at lower cost and long-run rates of certain crimes reduced.

     

Gross and histologic postmortem changes of the skin

Many methods have been attempted to accurately and systematically determine the estimated time of death in autopsy cases. Gross changes of the skin which occur during the postmortem interval have occasionally been used to estimate the time of death under different conditions; however, the postmortem gross and histologic changes of the skin have not been systematically analyzed. We sequentially studied the gross and microscopic appearance of skin in 3 individuals during the early postmortem interval (<1 week) in an outdoor, shaded, cool to temperate climate. Photos and skin biopsy specimens were taken from 4 sites (acral skin, scalp, dependent truncal skin, and nondependent truncal skin) every 12-24 hours on each individual. The gross appearance of the skin remarkably did not change significantly in any of the sites after 1 week of decomposition. Three main histologic changes were seen in the skin biopsy specimens: focal dermal-epidermal separation, eccrine duct necrosis, and dermal degeneration. Although bullae were not present in the gross examination of the skin, focal separation of the epidermis from the dermis was appreciated in several skin biopsies; however, the timing of development was unpredictable. Eccrine duct necrosis was another histologic finding and was relatively predictable, occurring in dependent and nondependent truncal skin biopsies from all 3 individuals between days 4 and 7. Dermal degeneration was a uniform histologic finding only in biopsies from nondependent truncal skin, occurring in all individuals on day 2. Although this study is limited by the small number of subjects and uncontrolled extrinsic factors, histologic findings, such as eccrine gland necrosis and dermal degeneration, in select cutaneous biopsies may be useful in estimating the time of death in the early postmortem interval.     

A profile of children with disabilities receiving SSI: highlights from the National Survey of SSI Children and Families

This article provides a nationally representative profile of noninstitutionalized children 0 to 17 years of age who were receiving support from the Supplemental Security Income (SSI) program because of a disability. To assess the role of the SSI program in providing assistance to low-income children with disabilities and their families, it is important to obtain detailed information on demographic characteristics, income and assets, health and disabilities, and health care utilization. Yet administrative records of the Social Security Administration do not contain many of the relevant data items, and the records provide only an incomplete picture of the family relationships affecting the lives of children with disabilities. The National Survey of SSI Children and Families fills this gap. This summary article is based on survey interviews conducted between July 2001 and June 2002 and provides some highlights characterizing children with disabilities who were receiving SSI and their families. Most children receiving SSI (hereafter referred to as "SSI children") lived in a family headed by a single mother, and less than one in three lived with both parents. A very high proportion, about half, were living in a household with at least one other individual reported to have had a disability. About 70 percent of children received some kind of special education. SSI support was the most important source of family income, with earnings a close second. On average, SSI payments accounted for nearly half of the income for the children's families, and earnings accounted for almost 40 percent. When all sources of family income were considered, slightly more than half (54 percent) of SSI children lived in families above the poverty threshold, a notable fact given that the federal SSI program guarantees only a subpoverty level of income. However, beyond these averages there was substantial variation, with some children living in families with income well below the poverty threshold and others having income well over 200 percent of the poverty threshold. About one-third of SSI children lived in families owning a home, two-thirds lived with parents or guardians with at least one car, and about 40 percent lived with parents or guardians with zero liquid assets. Less than 4 percent lived with adults who owned stocks, mutual funds, notes, certificates of deposit, or savings bonds. The Social Security Administration's administrative records contain only a limited amount of information about disability diagnoses. The National Survey of SSI Children and Families supplements those records with data from an array of questions on functional limitations, self-reported health, and the perceived severity of disabilities. The data suggest that a great degree of variation in severity exists within the childhood caseload, as reflected in reports of the presence or absence of six functional limitations, perceived overall health status, and perceived impact of disability on the child's ability to do things. Overall, 36 percent of the children were reported to have had disabilities that affected their abilities to do things "a great deal," and for 21 percent their difficulties had very little or no impact. Physical disabilities were most common among children aged 0 to 5, and mental disabilities dominated the picture for the other two age groups: 6 to 12 and 13 to 17. Virtually all SSI children are covered by some form of health insurance, with Medicaid being by far the most common source of health insurance coverage. Just as in the case of the severity of disabilities, substantial variation was reported in health care utilization among SSI children. Almost 30 percent of children had two or fewer doctor visits during the 12 months preceding the interview, and close to 50 percent had five or more doctor visits. About four-fifths of the children had no reported hospitalizations or surgeries during the previous year. More than 40 percent of the children visited an emergency room during the previous year, most of them more than once. Importantly, no out-of-pocket costs associated with medical care were reported for more than two-thirds of the children, and only about 3 percent had annual expenses exceeding $1,000 for physical and mental health care. This finding suggests that SSI payments are not used to cover medical expenses for the overwhelming majority of children. The use of supportive therapies varied widely among SSI children: more than half reported having used physical, occupational, or speech therapy; only 8 percent used respite care for the parents or other family members. An analysis of the perception of the survey respondents shows that more than one-third of children had unmet needs for mental health counseling services, and about three-quarters of families had unmet needs for respite care. In several service categories, the proportion perceived to have had unmet service needs was around 10 percent or less. In the dominant service category of physical, occupational, and speech therapy, only 11 percent perceived to have had unmet service needs.     

Interpersonal process-oriented group psychotherapy with offender populations

This article discusses the application of interpersonal process-oriented group psychotherapy to offender populations. Group psychotherapy with offenders presents problems not encountered with other populations; thus, applying the group method requires special considerations. The particular focus of this article is on the relevance of therapeutic factors in group work with offenders, group process as it applies to work with offenders, and work with difficult clients.     

Seasonality in suicide: a study of farming suicides in England and Wales

Seasonality in suicide rates has long been reported. Spring peaks in suicide deaths have been positively correlated with the proportion of the workforce engaged in agriculture. Some studies have indicated that suicides using violent methods are more likely to show seasonality. Recent research has suggested that seasonal patterns have diminished. This study examined deaths in male farmers, an occupational group which might be expected to be more vulnerable to seasonal influences because of the nature of their work and the relatively high proportion of farmers using violent methods for suicide. Data on suicides between 1982 and 1999 by males in England and Wales aged 15 years and over were provided by the Office for National Statistics. Seasonal patterns of suicide in farmers and nonfarmers were examined by nonparametric tests and harmonic analysis. No significant seasonal variation was found for farmers. For nonfarmers, although a chi-square test showed significant variation in monthly distribution, this was not found when a harmonic analysis was applied. There was no significant difference in the variation of violent suicides throughout the year. This study reinforces recent findings that seasonal variation in suicide appears to be diminishing, even in an occupational group where this might be expected.     

Exploring a Research Agenda of the Feminization of the Legal Profession: Theories of Gender and Social Change

This essay suggests that recent work in feminist theory should reorient the questions that are asked about the role of gender in the legal profession. Some use gender as a category of analysis to explore differences that reinforce conventional gendered stereotypes, such as the conceptualization of work and family in lawyering as a "women's issue." Others use conventional sociology of the professions analysis, such as stratification, to measure women's "success" and "satisfaction" in the context of the traditional law firm. By focusing on some recent historical and sociological research on women in the legal and medical professions, the author illustrates how we might ask different questions, not to reify gender differences but to more fully examine the role that gender difference, as socially constructed, might play in the transformation of law practice.