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.     

Here comes the judge: the influence of judge personal characteristics on federal sexual harassment case outcomes

This study explored the effects of judges' personal characteristics (gender, race, age, and political affiliation) and case characteristics on the outcomes of federal cases of hostile environment sexual harassment. Results revealed that even after controlling for the effects of relevant case characteristics (e.g., severity of the harassment), judges' personal characteristics influenced case outcomes. Specifically, younger judges and Democrat judges were more likely to find for the plaintiff (the alleged victim of harassment). The probability that the decision would favor the plaintiff was only 16% when the case was heard by an older judge but 45% when heard by a younger judge. The probability that the decision would favor the plaintiff was only 18% when the case was heard by a judge who had been appointed by a Republican president but 46% when the judge had been appointed by a Democrat president.     

The medical review officer: a potential role for the medical examiner

Drug use in the workplace is a problem, both in terms of public health and expense. Workplace drug testing programs serve as deterrents to drug use. Model programs, such as that of the Department of Transportation, use urine screening and are federally regulated or follow federal standards. An essential participant in this process is the medical review officer (MRO), a licensed physician who interprets the laboratory results generated from a workplace drug testing program. As a result of their training and experience with toxicology, collection of evidence, testimony, and recognition of the physical signs of drug abuse, medical examiners and forensic pathologists are well suited to serve as MROs. Recent regulations require the completion of training courses and MRO certification as prerequisites for participation in federal drug testing programs. Several courses are available to train physicians to participate as MROs.     

Building bridges between the parole officer and the families of serious juvenile offenders: a preliminary report on a family-based parole program

Responding to a model of juvenile offender case supervision that called for a new intervention paradigm to guide the work of probation and parole officers, the present article reports on the use of a family-based parole initiative known as the Growing Up FAST program. Developed in part as a tool for use within this new intervention paradigm, the Growing Up FAST parole program targets serious youthful offenders who have been released from juvenile correctional facilities and their families. Based on elements contained within the "what works" literature and the Balanced and Restorative Justice model, this program recognizes the central role that field staff can play in rehabilitation efforts. Demographic information and formative data regarding the first set of families to participate in this program are presented, then program limitations and lessons learned as part of the initial offering of this parole initiative are discussed.     

The inpatient evaluation and treatment of a self-professed budding serial killer

The authors present the case of a man who was hospitalized after claiming that he was about to become a serial killer. The patient presented with extensive written homicidal fantasies and homicidal intentions without evidence of actual homicidal acts. In addition to routine assessments, hospital staff members used case conferences, psychological testing, outside forensic consultation, and a forensic review process to make decisions regarding diagnosis, treatment planning, and discharge. The patient was discharged after 8 months of inpatient treatment and was apparently free of homicidal impulses or symptoms of severe mental illness. A 2-year court commitment allowed for the enactment and potential enforcement of a discharge plan that was endorsed by the patient, the hospital, and community care providers. The authors review diagnostic and risk management issues. Comparisons with known features of typical serial killers are made.     

Ontario: pressure from stakeholders leads to improved access to selected drugs

A campaign spearheaded by the Canadian Treatment Action Council, and involving other disease groups, has convinced the Ontario government to cover the costs of vaccines for HIV-positive children and to speed up access to other subsidized drugs.     

Measures of aggression and mood changes in male weightlifters with and without androgenic anabolic steroid use

Supraphysiologic doses of testosterone are associated with increased aggression that is hypothesized to be a function of testosterone serum concentrations, mood, and personality. The study attempted to characterize this relationship among weightlifters who were users (n = 10) and nonusers (n = 18) of anabolic steroids. Participants were interviewed using the Modified Mania Rating Scale and Hamilton Rating Scale for Depression to assess mood, the Buss-Durkee Hostility Inventory (BDHI) and Point Subtraction Aggression Paradigm (PSAP) to assess aggression, and the Personality Disorder Questionnaire (PDQ-R) to assess personality. Blood samples were obtained for the determination of total, free, and weakly bound testosterone. Comparisons of continuous variables between testosterone users and non-users were performed with a parametric (unpaired t-test) or non-parametric (Mann-Whitney) test where appropriate. Correlations with testosterone were examined separately for testosterone users and non-users, using Spearman rank correlation. The subjective (BDHI) and objective (PSAP) assessments of aggression found that supranormal testosterone concentrations were associated with increased aggression. However, the PDQ-R results suggest that this finding was confounded by the personality disorder profile of the steroid users, because steroid users demonstrated Cluster B personality disorder traits for antisocial, borderline, and histrionic personality disorder.