The "utility" principle within the scope of forensic determination of blood kinship using serostatistics

A "realistic" prior probability is always based on case experience (Akten-a-priori). In serological opinions pertaining to parentage, the realistic prior probability is only one piece of information in the whole body of evidence before the judge and does not have any special significance per se. There is no such thing as a "neutral" prior probability. It either implies "ignorance," in which case it cannot be "information," or it must be taken in connection with the utility principle, in which case it is not a "probability." The utility principle is defined in law and cannot be expressed in figures. The utility principle takes effect only when the judge reaches a decision (on the basis of all the evidence before him). It determines the relative importance of the participant's objects of legal protection which are at issue in the case. The expert is bound to apply a neutral utility component, i.e., in a two-hypothesis case (the normal situation) the significance of both the null and the counter hypothesis must carry the same weight. A null and/or a counter hypothesis can combine several single hypotheses; the mean value of their frequencies is taken. As a rule, one should avoid using a "prior case probability" ("Akten-a-priori") when calculating a W value. An "expectation of error" should be as realistic as possible and hence be obtained using a "prior case probability."     

The cutaneous ink sign: a tipoff to suicide or suicide notes

The presence of smeared or unsmeared ink on the skin resulting from the writing process has been observed in a number of suicide victims who have left suicide notes. The authors report a case of a palmar "cutaneous ink sign" and discuss its forensic science import.     

Deaths allegedly caused by the use of "choke holds" (shime-waza)

Shime-waza or the "choke hold", when properly applied, should not cause death; therefore, its primary purpose should be to subdue violent suspects. When properly applied, the choke hold causes unconsciousness in 10 to 20 s. No fatalities as a result of shime-waza have been reported in the sport of judo since its inception in 1882. Among the methods of "control holds" taught to law enforcement officers is the choke hold similar or identical to shime-waza used in judo. Using the choke hold, officers may afford themselves maximum safety while subjecting the suspect to a minimum possibility of injury. The author has reviewed 14 fatalities with autopsy findings where death was allegedly caused by the use of choke holds.     

Tumbling abrasions. Injuries from ricocheting bullets

Atypical entrance gunshot wounds may be produced by deflected or ricocheting bullets. One special type of atypical entrance wound involves abrasion of the skin at a site that is remote from the point of dermal penetration. These remote abrasions, termed "tumbling abrasions," are produced by bullets that tumble after impact with an intermediate target. Three cases of tumbling abrasions are presented.     

The impact of health maintenance organizations and competition on hospitals in Minneapolis/St. Paul

The Healthcare Educational and Research Foundation (HERF) in Minneapolis undertook a two-year research project to study the effects of health maintenance organizations (HMOs) and competition on the hospital industry in Minneapolis/St. Paul. This article summarizes HERF's major findings surrounding three key questions: (1) do the HMOs in Minneapolis/St. Paul use fewer hospital resources relative to conventional payers?; (2) do recent overall community trends in inpatient use suggest evidence of hospital utilization-reducing effects attributable to HMOs?; and (3) given the highly visible competitive process among Minneapolis/St. Paul providers, do hospital cost and revenue data suggest any evidence of cost-containment? The findings (based on data through 1982) indicate that for comparable patients, Twin Cities HMOs appear to use fewer medical care resources per hospitalized patient. There was, however, no clear evidence of community-wide, utilization-reducing effects directly attributable to the "competitive effect" of HMO introduction and development in the market. In addition, there was no empirical evidence that HMOs (which had enrolled 25 percent of the consumer market by 1982), or other large buyers of inpatient services, have selected hospitals on the basis of price as hypothesized by competition advocates.     

Repeat autopsies on corpses from abroad. A futile effort?

A large number of corpses transferred to Athens and the Piraeus Morgue from abroad have been examined in second autopsies. Lack of information, mistakes in data, useless effort, and disappointment on the part of the forensic pathologists because of the lack of new information revealed are characteristic of these cases. With some exceptions, the second autopsy provided no news for the anxious relatives, who, for the most part, had been prompted by their attorneys or other "well-meaning friends" to demand a second autopsy on the corpses of their loved one (who generally died on board ship abroad). Nevertheless, in 10 of 59 cases, the cause of death was completely different from the determined in the autopsy performed abroad or assumed from the information available. This fact ensures that any corpse from abroad undergoes a careful and thorough examination on its arrival in Greece.     

Wrongful termination lawsuits: the employers finally win a few

Much attention has been given of late to the erosion of the "employment-at-will" doctrine. Exceptions to this doctrine began to emerge when courts held that at-will employees could sue if their termination violated public policy. The at-will doctrine was further eroded by court rulings that a contract requiring good cause in order to terminate could be inferred from employee handbooks, company personnel policies, and circumstances of employment. As the initial flood of wrongful termination lawsuits now reaches the appellate level, some guidance on the standards employers must observe can be drawn from court decisions. The authors examine these decisions as well as the legislative reform being proposed in response to them.     

Practitioner fraud and abuse in medical benefit programs: government regulation and professional white-collar crime

Physicians who defraud and abuse medical benefit programs provide a unique group of lawbreakers for scientific study. They could be considered to epitomize white collar criminals given their exceedingly high socioeconomic status and power as a professional group. Using official reports and documents, as well as interviews with enforcement and program personnel at both state and federal levels, this study examines the problem of physician fraud and abuse in Medicare and Medicaid. Major areas relevant to understanding this phenomenon and its control are presented and policy implications of present knowledge in the area are discussed.