{"title":"The \"Magnificent Seven Errors\" in Forensic Autopsy Practice: The Italian Context.","authors":"Roberto Scendoni, Piergiorgio Fedeli, Nunzia Cannovo, Mariano Cingolani","doi":"10.1177/19253621211056191","DOIUrl":"https://doi.org/10.1177/19253621211056191","url":null,"abstract":"<p><p>According to the Italian legal system, forensic autopsies are performed by a medical doctor specialized in legal medicine, otherwise known as a medicolegal expert (MLE), who has a range of very complex responsibilities. Indeed, the quality of forensic autopsy activity is always questioned in courts of law; incorrect assessments are dangerous because they can jeopardize the validity of a criminal investigation and thus affect the outcome so that a real culprit may be acquitted or an innocent person convicted. Nonconformities also discredit the professionalism of the specialist who performs the autopsy. The work of a MLE implies a series of assignments and duties that should be given constant consideration, but when certain aspects of this activity are underestimated or overlooked, this can lead the expert to make mistakes with irreparable consequences for the judicial investigation. In this article, for the first time, we present a summary of seven known errors related to autopsy activity following death by unnatural causes, with the purpose of alerting MLEs who work under the Italian judicial system to the potential dangers of such errors. These relate to: oversights in autopsy technique, incorrect collection of photographic and video material, unauthorized attendance at the autopsy, missing/mistaken reporting at any stage of the forensic activity, failure to notify the party forensic consultant, using histological or toxicological nonaccredited laboratories for forensic activities, and lack of observance of the chain of custody.</p>","PeriodicalId":36813,"journal":{"name":"Academic Forensic Pathology","volume":"11 4","pages":"208-214"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8727839/pdf/10.1177_19253621211056191.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39889939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neck Injuries Caused by Delivery Modes? Late Questions to the Matshes et al.","authors":"Niels Lynøe, Anders Eriksson","doi":"10.1177/19253621211062043","DOIUrl":"https://doi.org/10.1177/19253621211062043","url":null,"abstract":"","PeriodicalId":36813,"journal":{"name":"Academic Forensic Pathology","volume":"11 4","pages":"215-216"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8727840/pdf/10.1177_19253621211062043.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39889940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Organ Retention Litigation","authors":"V. Weedn","doi":"10.1177/19253621211032498","DOIUrl":"https://doi.org/10.1177/19253621211032498","url":null,"abstract":"The common practice of retaining organs and tissues after the autopsy dissection is a potential legal liability for forensic pathologists and the offices they work for. In 1988, a coroner and the coroner’s office were successfully sued for corneal procurements without the consent of the next of kin. That led to later lawsuits of forensic pathologists and medical examiner offices over the retention of brains for formalin fixation and neuropathologic examination without consent, although the autopsies were not consent based. National Association of Medical Examiners became involved in this ligation and filed numerous amicus briefs. These later lawsuits were not successful. After caselaw on the subject, such lawsuits have largely abated. Nonetheless, the threat of such lawsuits remains, and statutory language can be promulgated to mitigate the risk.","PeriodicalId":36813,"journal":{"name":"Academic Forensic Pathology","volume":"11 1","pages":"156 - 169"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/19253621211032498","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46606876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Thivaharan, I. Kitulwatte, T. Muthulingam, Maleesha Jayasundara, N. Borukgama, Udaya Prageeth, Dumith Senevirathna, D. Kulathunga, Sandamini Aththanayaka
{"title":"Study on Evaluation of Knowledge, Attitude, and Practice of Sri Lankan Traffic Police Officers Related to Examination of Drunk Drivers, in Two Most Populated Districts of Sri Lanka","authors":"Y. Thivaharan, I. Kitulwatte, T. Muthulingam, Maleesha Jayasundara, N. Borukgama, Udaya Prageeth, Dumith Senevirathna, D. Kulathunga, Sandamini Aththanayaka","doi":"10.1177/19253621211032502","DOIUrl":"https://doi.org/10.1177/19253621211032502","url":null,"abstract":"Introduction: Driving under the influence (DUI) of alcohol is one of the substantial predisposing factors for mishaps among road users. A traffic police officer will be the first authoritative personnel a drunk driver encounters in the legal system. The absence of accurate skills and knowledge of these officers impedes the structuring of legal procedures and may lead to miscarriage of justice. Objective: To assess the knowledge, attitude and practice of Sri Lankan traffic police in handling and managing an alleged case of driving under influence of alcohol. Methods: This was a descriptive cross sectional study carried on a sample of 384 traffic police officers attached to the districts of Colombo and Gampaha, through a questionnaire. Results: Out of 384, only 75 of police officers knew the correct preliminaries to perform before administering a breathalyzer test. 79.7% knew the correct instructions for using a breathalyzer, but only 3.4% knew the colour changes of the breathalyzer. Significantly poor attitude was observed among the police officers, regarding the importance of producing a drunk driver for medico-legal examination (P = 0.001) Only 222 (57.8%) answered correctly that a drunk driver needs to be subjected to a medico-legal examination as early as possible. Significantly poor practice and attitude was observed in officers with longer service duration but no significant association was observed between ranks of officers and attitude and practice (P = 0.199). Conclusions: The results of our study demonstrate that the knowledge attitude and practice on efficiently handling a case of DUI among traffic police officers is poor, even though all of them are engaged in DUI duties irrespective of their service duration. The need for continuous professional development programmes was highlighted.","PeriodicalId":36813,"journal":{"name":"Academic Forensic Pathology","volume":"11 1","pages":"126 - 140"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45724162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kunasilan Subramaniam, Grace Wong Yi-Li, Vomanasri Krishnan, Iyvonne Chuah Sock Yi, Muhammad Aniq bin Mohd Amran
{"title":"Crocodile Attack Injuries: A Failed Attempt to Conceal Homicide","authors":"Kunasilan Subramaniam, Grace Wong Yi-Li, Vomanasri Krishnan, Iyvonne Chuah Sock Yi, Muhammad Aniq bin Mohd Amran","doi":"10.1177/19253621211033472","DOIUrl":"https://doi.org/10.1177/19253621211033472","url":null,"abstract":"Crocodile attacks are not uncommon in this region. There have been 92 cases reported since 2015 and 50 cases alone reported in Sarawak. Every year death has been attributed to a crocodile attack. An estimate of 71% of the total cases of crocodile attack ended up dead. However, there are instances where a crocodile attack happened after the death of a person. This is a case of an adult male who was reported missing. His body was found by two local anglers, being mauled by crocodiles. Only partial trunk and lower limbs were found, and the major organs were absent. The postmortem features of the crocodile attacks have been described.","PeriodicalId":36813,"journal":{"name":"Academic Forensic Pathology","volume":"11 1","pages":"174 - 179"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49249204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fatal Necrotizing Fasciitis as a Consequence of Blunt Trauma: A Case Report","authors":"Chandrakanth Hv, H. Rg, S. Rani","doi":"10.1177/19253621211038108","DOIUrl":"https://doi.org/10.1177/19253621211038108","url":null,"abstract":"Necrotizing fasciitis is an uncommon lethal bacterial infection that involves the subcutaneous tissue and fascia. It can be mono or polymicrobial infection. The diagnosis is mainly dependent on clinical signs and symptoms. Trauma is the commonest cause for it. The early signs and symptoms may mimic cellulitis. We present a case of necrotizing fasciitis following an assault. The patient was received in a state of shock. Despite all measures, the patient could not be saved. Early debridement and antibiotic therapy have a key role in the prognosis of the disease. Medicolegal issues can arise when the disease develops post-assault because of the vague and unpredictable nature of the disease and its challenging prognosis.","PeriodicalId":36813,"journal":{"name":"Academic Forensic Pathology","volume":"11 1","pages":"170 - 173"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47627133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Aortoesophageal Fistula Secondary to Esophageal Diverticulum Resulting in Sudden Unexpected Death","authors":"R. Ndikumana, A. Lal, J. Herath","doi":"10.1177/19253621211038122","DOIUrl":"https://doi.org/10.1177/19253621211038122","url":null,"abstract":"Aortoesophageal fistula (AEF) is a rarely encountered clinical outcome that is often fatal. It is most commonly a postoperative complication of vascular surgery (secondary AEF). Reported primary causes of AEF include aortic aneurysm, atherosclerosis, infection, foreign objects, achalasia with megaesophagus, gastrointestinal malignancy, and radiotherapy. Aortoesophageal fistula is often not a top diagnostic consideration for clinicians or pathologists and has the potential to be overlooked. This report describes a rare case of AEF secondary to an esophageal traction diverticulum and associated abscess that resulted in the sudden unexpected death of a 78-year-old male. Aortoesophageal fistula is an important consideration for pathologists and requires careful consideration in the postmortem setting.","PeriodicalId":36813,"journal":{"name":"Academic Forensic Pathology","volume":"11 1","pages":"141 - 146"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48548513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lauren R. Crowson-Hindman, Keenen Smith, A. Phillips
{"title":"Acute Esophageal Necrosis (Black Esophagus): An Autopsy Case Series","authors":"Lauren R. Crowson-Hindman, Keenen Smith, A. Phillips","doi":"10.1177/19253621211036305","DOIUrl":"https://doi.org/10.1177/19253621211036305","url":null,"abstract":"Introduction: Acute esophageal necrosis (AEN), also known as black esophagus and acute necrotizing esophagitis, is a rare pathologic finding of unknown etiology. It was first characterized as diffuse, circumferential black discoloration of the esophageal mucosa that affects predominantly the distal esophagus with sharp transition to normal-appearing mucosa at the gastroesophageal junction. Case frequency of AEN remains low and mainly found incidentally, with up to 0.2% in autopsy and endoscopy studies. Men are 4 times more commonly affected and overall mortality is approximately 32%. Methods: Black esophagus was incidentally found during ten forensic autopsy cases. Complete autopsies with photographs, histological examination, and toxicological analysis were performed. Case background information was reviewed. A review of literature was done, with research criteria including previous case reports, diagnosis, and autopsy, endoscopic, and microscopic findings of AEN. Results: Nine of ten deceased were male, with an age range of 26 to 67 years old. The most common preexisting pathological condition was chronic alcohol consumption, seen in six of ten cases, and in eight cases, the death occurred suddenly at home. “Classic” black esophagus was only seen in four cases. Upper gastrointestinal hemorrhage due to acute necrotizing esophagitis was established as the immediate cause of death in six of ten cases. Discussion: This case series demonstrates ten cases of AEN with variation in appearance, yet diagnosis supported by histology, ancillary testing, and case information. The case frequency was higher than previously reported, 0.7%, suggesting that the prevalence of AEN may be underestimated, especially in forensic death investigations.","PeriodicalId":36813,"journal":{"name":"Academic Forensic Pathology","volume":"11 1","pages":"115 - 125"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45048408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Confronting Forensic Pathologists","authors":"V. Weedn","doi":"10.1177/19253621211032504","DOIUrl":"https://doi.org/10.1177/19253621211032504","url":null,"abstract":"Background: The Sixth Amendment Confrontation Clause gives defendants a right to confront their accusers. Method: U.S. Supreme Court cases that interpreted this right as applied to forensic scientists were reviewed. Results: Melendez-Diaz, Bullcoming, and Williams examined constitutional rights to confront forensic scientists. Lower courts have specifically examined their application to forensic pathology. Whether autopsy reports are considered “testimonial” varies among jurisdictions and has not been definitively settled. Defendants are generally able to compel testimony of forensic pathologists. Where the forensic pathologist is truly unavailable, the surrogate expert should be in a position to render an independent opinion.","PeriodicalId":36813,"journal":{"name":"Academic Forensic Pathology","volume":"11 1","pages":"147 - 155"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/19253621211032504","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43768406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Melissa C Mercado, Deborah M Stone, Caroline W Kokubun, Aimée-Rika T Trudeau, Elizabeth Gaylor, Kristin M Holland, Brad N Bartholow
{"title":"Inconsistencies in Overdose Suicide Death Investigation Practice and Potential Remedies Using Technology: A Centers for Disease Control and Prevention Consultation Meeting Summary.","authors":"Melissa C Mercado, Deborah M Stone, Caroline W Kokubun, Aimée-Rika T Trudeau, Elizabeth Gaylor, Kristin M Holland, Brad N Bartholow","doi":"10.1177/19253621211022464","DOIUrl":"10.1177/19253621211022464","url":null,"abstract":"<p><strong>Introduction: </strong>It is widely accepted that suicides-which account for more than 47 500 deaths per year in the United States-are undercounted by 10% to 30%, partially due to incomplete death scene investigations (DSI) and varying burden-of-proof standards across jurisdictions. This may result in the misclassification of overdose-related suicides as accidents or undetermined intent.</p><p><strong>Methods: </strong>Virtual and in-person meetings were held with suicidologists and DSI experts from five states (Spring-Summer 2017) to explore how features of a hypothetical electronic DSI tool may help address these challenges.</p><p><strong>Results: </strong>Participants envisioned a mobile DSI application for cell phones, tablets, or laptop computers. Features for systematic information collection, scene description, and guiding key informant interviews were perceived as useful for less-experienced investigators.</p><p><strong>Discussion: </strong>Wide adoption may be challenging due to differences in DSI standards, practices, costs, data privacy and security, and system integration needs. However, technological tools that support consistent and complete DSIs could strengthen the information needed to accurately identify overdose suicides.</p>","PeriodicalId":36813,"journal":{"name":"Academic Forensic Pathology","volume":"11 2","pages":"83-93"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8408809/pdf/10.1177_19253621211022464.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39452222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}