Forensic psychiatry and malpractice

This paper concerning the last 87 malpractice cases referred to the Department of Psychiatry and Law, Menninger Clinic, includes 57 suits against mental health practitioners and/or institutions, and 30 nonpsychiatric suits against general hospitals, surgeons, obstetricians, etc. A patient was available for interview in only 12 percent of the psychiatric cases; in 88 percent we reviewed medical records and consulted with attorneys. In the psychiatric cases the crucial question was whether a generally accepted standard of care was breached. The inherent problems of applying appropriate criteria to standards of care by practitioners and institutions are discussed. In half the psychiatric cases we found no significant deviation from acceptable clinical performance; in half we concluded that negligent practice had occurred. We did see a litigant for evaluation in 90 percent of the nonpsychiatric cases. The main issue involving them concerned harm or disability related to presumed negligence by medical personnel. How we evaluate such cases and apply disability criteria is discussed.     

Fatalities in west Austrian prisons

The purpose of this study is to review 23 causes of death that have occurred in Western-Austrian prisons from 1974 to 1989. The majority of them (11 cases) were due to suicides. Among 9 cases of natural death there was a 25 years old man, who died of an unknown purulent meningoencephalitis. Two drunken prisoners had not been supervised and therefore died of alcohol poisoning. In one case the police jail physician did not recognize an epidural hematoma.     

Social justice as a Holy Grail: The endless quest

This paper gives the author's impressions on the following aspects of justice: desert, equity, equality, need, and intergenerational equity. The author concludes that these different aspects cannot be reconciled but instead must be compromised. An example of such a compromise is provided by a discussion of welfare reform. The author claims that rights are correlative with duties, and that asserting the former has little meaning without specifying the latter. He then discusses justice toward groups rather than individuals. He proposes that maintaining cultural variety in the presence of a homogeneous superculture is a major problem of the contemporary world. The paper concludes with a discussion of various forms of power, particularly the integrative power that people acquire over each other by virtue of ties of loyalty and identity.     

Effects of positional restraint on oxygen saturation and heart rate following exercise

This report assesses the effects on peripheral oxygen saturation and heart rate that positional restraint induces when a person is prone, handcuffed, and "hog-tied." Peripheral oxygen saturation and heart rate were monitored at rest, during exercise, and during recovery from exercise for 10 adult subjects. The effects of positional restraint produced a mean recovery time that was significantly prolonged. Consequently, the physiological effects produced by positional restraint should be recognized in deaths where such measures are used.     

Bicommunalism in Northern Ireland

Northern Ireland is a bicommunal society in which Protestantsare numerically dominant; Roman Catholics constitute virtuallyall of the remaining population. On the island as a whole, Protestantsare heavily outnumbered; the Republic of Ireland (the "South")has a population that is about 96 percent Catholic. Social segregationof the two northern communities is relatively distinct, andthere is little crosscutting between groups that might lessenbicommunal conflict. A reciprocal relationship exists betweenthe social system and political structures. Northern Irish politicalinstitutions followed the Westminster model, which facilitatedthe political exclusion of Catholics and impeded social as wellas political integration. The bicommunal social structure hasimpeded the development of more accommodating political structures.Geographic issues and external linkages compound the politicalproblem. Northern Irish politics can be viewed as a "dual dyad"in which the United Kingdom and the Republic of Ireland arecritical components. Psychological dimensions of Northern Irishbicommunalism further exacerbate the conflict.