Tag: medicolegal

Medico-Legal Journal, Ahead of Print.
No amount of symposia and clinical meetings and formal management will make a clinical difference unless obstetric units regularly and ruthlessly self-assess to curb medical negligence. Court case, which represent a small portion of substandard outcomes, not infrequently reveal a serious lack of obstetric judgment as well as paucity of knowledge which are compatible with unsupervised responsibility of labour ward duties. One UK court case ACF 32(2): 09/2019 presents a factual picture of obstetric practice which is difficult to reconcile with modern UK practice. This article limits itself to a number of facts as presented to court by the claimant, and the comments are directed purely at the resulting implications. These facts as stated are seriously worrying in themselves as they reflect practice well below the minimum care to be expected in a modern country and are far from what is recommended by the Royal College of Obstetricians and Gynaecologists and indeed every day standards. The article recommends the shifting of focus from individual to collective or unit responsibility to achieve better care. In any case where gross mismanagement is found, there should be a wider check on practices within the whole obstetric unit.

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Medico-Legal Journal, Ahead of Print.
The Covid-19 pandemic has created the opportunity for corruption to flourish in healthcare sectors around the world. Challenges include misuse and mismanagement of resources and corruption, which require scrutiny and attention. This article deals with such corruption during the pandemic, involving public procurement of goods and services for the treatment of diseases, falsification of public contracts and kickbacks, embezzlement of healthcare funds, opacity in governance, misuse of power, nepotism and favouritism in the management, petty corruption in the level of service, fraud and theft or embezzlement of medicines and medical devices.

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Medico-Legal Journal, Ahead of Print.
We report the case of a 28-year-old patient with a history of post-traumatic epilepsy who, following a spinal cord injury and the onset of nosocomial infection, went into a deep coma. A brain MRI revealed non-specific findings, anti-Glutamate Receptor 3 (GluR3) auto-antibodies were detected in the liquor, and the patient’s serum and immunomodulatory therapy proved ineffective. Autopsy and histological investigations led to the diagnosis of autoimmune encephalitis. This case highlights the diagnostic difficulties of a rare and still poorly researched disease and the possible role that traumatic and infectious episodes may play in the progression or acceleration of an immune response. As for patients with unexplained encephalitis, tests for autoantibodies against GluR3 in cerebrospinal fluid and serum should be considered. Forensic pathologists should be aware of encephalitis and epilepsies and that complete post-mortem investigations are required in such cases.

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Medico-Legal Journal, Ahead of Print.
In the period 1 January 2012 to 30 June 2020, 76 doctors whose names/entries had been erased from the UK Medical Register by a disciplinary tribunal applied for restoration, and 23 out of 76 (30.3%) applications granted. In 5 of the 53 of those refused restoration, the tribunal suspended indefinitely the right to make further applications. The most frequent reasons for refusal were failure to demonstrate insight (seen in 96%), failure to demonstrate remediation (seen in 79%), and failure to demonstrate that knowledge and skills were up to date (24.5%). Success was more common in UK graduate applications (14/29 – 48.3%) than non-UK graduate applications (9/37 – 24.3%), and in those legally represented (16/29 – 55.2%) than in those without legal representation (7/29 – 24.1%), but the data does not indicate the reasons for these differences. Disciplinary erasure need not necessarily be for life as doctors who learn from their experience, change their ways, and provide evidence of genuine insight and remediation along with up to date knowledge and skills can successfully be reinstated on the register.

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Medico-Legal Journal, Ahead of Print.
The prevalence of ischaemic heart disease with associated cardiomegaly and other chronic diseases such as diabetes mellitus has increased in Malaysia in recent years. As the contribution to mortality from ischaemic heart disease/cardiomegaly in different ethnic populations is unclear, a three year (January 2013–December 2015) retrospective study of autopsy cases was undertaken at the Department of Forensic Pathology, University Malaya Medical Centre. There were 80 cases with lethal ischaemic heart diseases/cardiomegaly. The age range was 30–69 years (mean 50.19 years) with a male to female ratio of 39:01. The most vulnerable age was 50–59 years accounting for 38.75% of cases. Malays accounted for 15% of cases, Indians for 32.5% and Chinese for 36.25%. Although in 35 cases (43.75%) there was a history suggestive of ischaemic heart disease, the remaining 45 cases (56.25%) were apparently healthy until the terminal collapse. It appears that Indian males in the 50–59 year age range are most at risk for lethal cardiac events in this population, most often with no preceding symptoms or signs. The study demonstrates the value of studying subpopulations for disease risk rather than relying on accrued general population data.

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Medico-Legal Journal, Ahead of Print.
At the early stage of an emerging disease, information is often insufficient for governments to determine what actions are necessary to contain its transmission. Taiwanese society was not prepared when the SARS epidemic hit in 2003. After the SARS epidemic, Taiwan began to overhaul its Communicable Disease Control Act authorising the government to act in a murky situation without the fear of violating due process. In hindsight, the new law has contributed a large part to the effective containment of Covid-19 in Taiwan. However, a new issue emerged concerning the conflict between an individual’s freedom of confidential communication and the government’s use of cell phone positioning to monitor self-quarantine. Although Taiwan’s Council of Grand Justices previously resolved the concern over potential breaching of due-process, the legislature may have to strike a balance between public health emergency and the use of an electronic footprint to trace individual activities.

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