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.     

Unusual hanging deaths

Four unrelated hanging deaths involving young white males, all in enlisted status in the United States military, are presented. Taken in a military context, one scene served as a suicide note equivalent with the unmistakable message of extreme defiance toward military regulations. In two cases, the elaborate attire of the decedents could have lead to the misclassification of the manner of death if investigative information had not been considered. Extensive background investigation and review of medical records in the fourth case disclosed that the victim had an eight- to ten-year history of compressing his neck to cause unconsciousness. He left an extensive suicide note in which he concluded that "hanging would be good." Each case has certain unique features, as a group, the cases all demonstrate a continuum from obvious suicide to cases where the manner of death is, at first, equivocal.     

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.     

Non-commercial, accidental water transport (boating) fatalities

A study of non-commercial accidental water transport (boating) fatalities was performed on the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Fla., during the years 1980-1984. A total of 23 cases were collected and analyzed as to the age, race, sex, and the cause of death of the victim along with the blood alcohol content and the Urine EMIT drug screen at autopsy. Furthermore, the type of boat involved, the geographic locale, the time of the incident, the reason or risk factor for the incident, and the scene circumstances were also noted. Commonly, one is dealing with a male population below the age of 30 years who die of drowning. In approximately half of the cases alcohol is detected. The scenario involves "small" boats or canoes in the Atlantic Ocean or in canals in the afternoon or evening. Inexperience in boating/or stupidity plays a key role. A discussion ensues concerning recommendations designed to avoid such tragedies.     

Characteristics of adolescent incest sexual perpetrators: Preliminary findings

Adolescent incest sexual perpetrators seen at an out-patient clinic were interviewed regarding demographic characteristics and occurrence of deviant and nondeviant sexual behaviors. Results indicate that subjects (1) committed more sexual crimes than they had been arrested for, (2) reported a very early onset of sexual behavior, (3) had additional DSM-III psychiatric disorders, and (4) reported previous sexual victimization. Recommendations for future research are made.     

Therapists' obligations to report their patients' criminal acts

The law governing the obligation of therapists to report their patients' previous criminal acts was reviewed. Most often, discussions of this subject fall under the general category of "misprison of a felony," that is, the presumed general obligation of all citizens to report felonies that come to their attention. Review of federal law revealed that the courts have consistently interpreted the federal misprision statute as requiring active concealment of a crime, not a mere failure to report, in order to convict for the offense. State law is more diverse. Only one state has a general misprison statute labeled as such, and several states have recently repealed such statutes. The strong trend in states without statutes is to reject misprison as a common law crime, because of its incompatibility with modern notions of justice. Most states, however, have limited reporting statutes, such as for child abuse or gunshot wounds, that impose similar obligations. Therapists' reporting of past crimes may be affected by clinical and ethical concerns, as well as by obligations to protect future victims. In almost all jurisdictions, however, the fear of prosecution for failure to report a past crime should not be a factor in deciding on a course of action.