The multi-factorial determinism of forensic expertise regarding sentence interruption on medical grounds and decision

The topic proposed by this research is the complex determinism or requesting forensic expertise for the purpose of postponing or interrupting a sentence in medical ground. Within the topic, it was necessary to perform a complex analysis on several aspects of inmate life, from the point of view of their rights and especially the right to medical assistance. We have included aspects related to the evolution of the legal framework and current regulations, to the status of medical assistance in the penitentiary environment (illustrating realities related to morbidity and mortality) and to the doctor-patient relationship during a forensic expertise. To this end, this paper aims to reveal the realities of how inmates are informed about the framework in which the institution of forensic expertise operates, as well as to analyse the inmates’ perception on the accessibility and usability of this type of expertise. At the same time, we aimed to identify cases which abusively exceed the boundaries of requesting sentence interruption on medical grounds and the causes of these situations. In the first part, a retrospective statistical study was performed in mortality within the penitentiary population in the area included in the study. The characteristics particular to the doctor-inmate patient relationship were also explored.     

Errors in medical care rendered by military treatment and prevention institutions (according to the data of forensic medical expertise

The authors discuss one of the important aspects of military medicolegal laboratory activities connected with the quality control of medical care rendered in the military treatment-and-prophylactic institutions in the nineties of the XX century. The example of medical care defects (MCD) permitted to reveal their nature, causes and sites of origin at pre-hospital (PHS) and hospital (HS) stages. Despite some decrease in the total number of MCD revealed HS defects prevail (more than 75%); the organizational defects at PHS and diagnostic defects at HS are predominant. The main MCD causes are inadequate qualification of medical workers, defects in organization of treatment-and-diagnostic process and inadequate examination of patients.     

Clinical forensic radiology in strangulation victims: forensic expertise based on magnetic resonance imaging (MRI) findings

Based on only one objective and several subjective signs, the forensic classification of strangulation incidents concerning their life-threatening quality can be problematic. Reflecting that it is almost impossible to detect internal injuries of the neck with the standard forensic external examination, we examined 14 persons who have survived manual and ligature strangulation or forearm choke holds using MRI technique (1.5-T scanner). Two clinical radiologists evaluated the neck findings independently. The danger to life was evaluated based on the "classical" external findings alone and in addition to the radiological data. We observed hemorrhaging in the subcutaneous fatty tissue of the neck in ten cases. Other frequent findings were hemorrhages of the neck and larynx muscles, the lymph nodes, the pharynx, and larynx soft tissues. Based on the classical forensic strangulation findings with MRI, eight of the cases were declared as life-endangering incidents, four of them without the presence of petechial hemorrhage but with further signs of impaired brain function due to hypoxia. The accuracy of future forensic classification of the danger to life will probably be increased when it is based not only on one objective and several subjective signs but also on the evidence of inner neck injuries. However, further prospective studies including larger cohorts are necessary to clarify the value of the inner neck injuries in the forensic classification of surviving strangulation victims.     

Balancing the specialist forensic medical witness

This paper examines the role of forensic medical examiners as expert witnesses and advances the argument for them to incorporate more defence perspectives in their work, so that they can give a better balance of responses. Three case studies are presented and these illustrate defence aspects and enable defence-orientated references to be cited. The paper concludes with comment on the strength of the evidence that a forensic medical examiner can give when acting for the defence.     

Scientific investigations conducted in forensic medical examination

The authors discuss the conceptual problems connected with necessity to reform the research activities in the RF MD expert institutions within the "Program of development of RF MD forensic medical examination for the period of 2001-2005", the character of its main directions. The complex of concrete research and experimental works is described.