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Old Issues and New Challenges in Forensic and Legal Medicine
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Old Issues and New Challenges in Forensic and Legal Medicine

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Forensic Medicine".

Deadline for manuscript submissions: closed (31 December 2022) | Viewed by 34466

Special Issue Editors

Dr. Alessandro Feola

E-Mail Website
Guest Editor
Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
Interests: forensic pathology; medical liability; insurance medicine; medical ethics
Prof. Dr. Mauro Arcangeli

E-Mail Website
Guest Editor
Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
Interests: medical liability; insurance medicine; medical ethics

Special Issue Information

Dear Colleagues,

The experts in forensic and legal medicine have nowadays expanded their fields of interest, gaining a new professional relevance, particularly in those countries where they work inside.

The aim of this Special Issue is to discuss and offer an update regarding the different issues in forensic and legal medicine (forensic pathology, toxicology, anthropology, entomology, personal damage evaluation, insurance medicine, clinical risk management, medical liability and medical ethics), thus highlighting the most challenging topics.

Papers (original articles, reviews, and case reports) focused on classic topics, such the study of the post-mortem interval, will be welcome since the application of new technologies and tools is an eternal challenge for solving old problems and offers a more accurate answer to the judicial authority. At the same time, we encourage the submission of original articles, reviews, case reports, and case series that deal with improving clinical risk management strategies and malpractice claims deflation strategies.

Finally, papers (also comments) dealing with new issues of medical ethics will be of great interest.

Dr. Alessandro Feola
Prof. Dr. Mauro Arcangeli
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • forensic pathology
  • forensic toxicology
  • forensic anthropology
  • forensic entomology
  • medical liability
  • medical litigation
  • clinical risk management
  • medical ethics

Published Papers (18 papers)

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Research

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11 pages, 1529 KiB  
Article
Medical Professional Liability in Obstetrics and Gynecology: A Pilot Study of Criminal Proceedings in the Public Prosecutor’s Office at the Court of Rome
by Eva Bergamin, Annamaria Fiorillo, Vincenzo M. Grassi, Maria Lodise, Giuseppe Vetrugno and Fabio De-Giorgio
Healthcare 2023, 11(9), 1331; https://doi.org/10.3390/healthcare11091331 - 05 May 2023
Cited by 2 | Viewed by 1098
Abstract
Criminal trials and claims against physicians for malpractice-related damages have increased dramatically in recent years, and, with Obstetrics and Gynecology being one of the medical specialties that is at the highest risk, we carried out a retrospective analysis aimed at examining all Obstetrics- [...] Read more.
Criminal trials and claims against physicians for malpractice-related damages have increased dramatically in recent years, and, with Obstetrics and Gynecology being one of the medical specialties that is at the highest risk, we carried out a retrospective analysis aimed at examining all Obstetrics- and Gynecology-related medical professional liability prosecutions within the General Register of Criminal Records of the Rome Public Prosecutor’s Office between the years 2000 and 2014. The number of prosecutions increased steadily in the years 2000–2005, with varying trends in the following years. A total of 727 healthcare professionals were involved in criminal charges, and most prosecuted crimes were related to Articles 590 and 589 of the Italian Penal Code, followed by violations of Article 17 of Law 194/78. In most cases, filing was requested and granted without opposition. In 95 cases, an expert witness was appointed by the Court, and in 68 cases, the technical consultants of the State Prosecutor found culpable conduct. Public hospitals, private nursing homes and outpatient clinics, or private practices were mostly involved; in 45% of the cases, the physicians were hospital employees. In this setting, Italy is prepared to introduce new measures and regulations to address the issues posed by defensive medicine and charges of professional liability for healthcare providers. Full article
(This article belongs to the Special Issue Old Issues and New Challenges in Forensic and Legal Medicine)
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14 pages, 1453 KiB  
Article
A Fifteen-Year Survey for Orthopedic Malpractice Claims in the Criminal Court of Rome
by Camilla Bernardinangeli, Carolina Giannace, Simone Cerciello, Vincenzo M. Grassi, Maria Lodise, Giuseppe Vetrugno and Fabio De-Giorgio
Healthcare 2023, 11(7), 962; https://doi.org/10.3390/healthcare11070962 - 28 Mar 2023
Cited by 1 | Viewed by 954
Abstract
The number of legal disputes in the field of medical liability has increased exponentially in the last decades. The aim of this study is to investigate the outcomes of criminal cases against healthcare professionals in Italian criminal courts. The hypothesis is that the [...] Read more.
The number of legal disputes in the field of medical liability has increased exponentially in the last decades. The aim of this study is to investigate the outcomes of criminal cases against healthcare professionals in Italian criminal courts. The hypothesis is that the majority of cases are dismissed and/or most professionals in these cases are acquitted. This retrospective analysis considers criminal proceedings related to medical professional liability registered with the general register of crime reports of the Public Prosecutor’s Office of Rome in the time interval between 1 January 2000 and 31 December 2015. A total of 4793 criminal proceedings were ultimately identified. Proceedings related to the field of orthopedic trauma were then examined and identified. A complete analysis of 132 of the identified files (76.7%) was carried out. The field with the highest risk of disputes was determined to be the field of trauma. The most frequent complaint was found to arise from unsatisfactory surgical outcomes following elective surgery. The most affected anatomical district is the lower limb in both elective and trauma cases, followed by the upper limb in traumatology and spine cases. The surgeon is the most frequently quoted role of the professional involved. The number of physicians actually convicted (3.93%) and for whom liability was thus recognized, i.e., the existence of a causal link between their conduct and the event that took place was established, appears to be extremely small when compared with the far more significant values related to dismissals (53%) and acquittals (14.2%). Adequate legal reform aiming to reduce this disproportion is necessary to ensure physicians experience a more relaxed daily profession and to restore the original connotations of the doctor–patient relationship with the abolition of defensive medicine. Full article
(This article belongs to the Special Issue Old Issues and New Challenges in Forensic and Legal Medicine)
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12 pages, 2779 KiB  
Article
Application of Forensic DNA Phenotyping for Prediction of Eye, Hair and Skin Colour in Highly Decomposed Bodies
by Matteo Fabbri, Letizia Alfieri, Leila Mazdai, Paolo Frisoni, Rosa Maria Gaudio and Margherita Neri
Healthcare 2023, 11(5), 647; https://doi.org/10.3390/healthcare11050647 - 23 Feb 2023
Cited by 2 | Viewed by 2465
Abstract
In the last few years, predicting externally visible characteristics (EVCs) by adopting informative DNA molecular markers has become a method in forensic genetics that has increased its value, giving rise to an interesting field called “Forensic DNA Phenotyping” (FDP). The most meaningful forensic [...] Read more.
In the last few years, predicting externally visible characteristics (EVCs) by adopting informative DNA molecular markers has become a method in forensic genetics that has increased its value, giving rise to an interesting field called “Forensic DNA Phenotyping” (FDP). The most meaningful forensic applications of EVCs prediction are those in which, having only a DNA sample isolated from highly decomposed remains, it is essential to reconstruct the physical appearance of a person. Through this approach, we set out to evaluate 20 skeletal remains of Italian provenance in order to associate them with as many cases of missing persons as possible. To achieve the intended goal, in this work we applied the HIrisPlex-S multiplex system through the conventional short tandem repeats (STR) method to confirm the expected identity of subjects by evaluating phenotypic features. To investigate the reliability and accuracy of the DNA-based EVCs prediction, pictures of the cases were compared as they were available to researchers. Results showed an overall prediction accuracy greater than 90% for all three phenotypic features—iris, hair, and skin colour—at a probability threshold of 0.7. The experimental analysis showed inconclusive results in only two cases; this is probably due to the characteristics of subjects who had an intermediate eye and hair colour, for which the DNA-based system needs to improve the prediction accuracy. Full article
(This article belongs to the Special Issue Old Issues and New Challenges in Forensic and Legal Medicine)
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10 pages, 256 KiB  
Article
A COVID Dilemma: How to Manage Pregnancies in Case of Severe Respiratory Failure?
by Pierpaolo Di Lorenzo, Claudia Casella, Mariagrazia Marisei, Laura Sarno, Carmen Imma Aquino, Eduardo Osuna, Maurizio Guida and Massimo Niola
Healthcare 2023, 11(4), 486; https://doi.org/10.3390/healthcare11040486 - 07 Feb 2023
Viewed by 1210
Abstract
To date, the impact of the COVID-19 pandemic on the world’s health, economics and politics is still heavy, and efforts to mitigate virus transmission have caused remarkable disruption. From the early onset of the pandemic, generated by SARS-CoV-2 spread, the scientific community was [...] Read more.
To date, the impact of the COVID-19 pandemic on the world’s health, economics and politics is still heavy, and efforts to mitigate virus transmission have caused remarkable disruption. From the early onset of the pandemic, generated by SARS-CoV-2 spread, the scientific community was aware of its impact on vulnerable individuals, including pregnant women. The purpose of this paper is to highlight scientific pitfalls and ethical dilemmas emerging from management of severe respiratory distress in pregnant women in order to add evidence to this topic through an ethical debate. In the here-presented paper, three cases of severe respiratory syndrome are analyzed. No specific therapeutic protocol was available to guide physicians in a cost–benefit balance, and unequivocal conduct was not a priori suggested from scientific evidence. However, vaccines’ advent, viral variants lurking on the horizon and other possible pandemic challenges make it necessary to maximize the experience gained through these difficult years. Antenatal management of pregnancies complicated by COVID-19 infection with severe respiratory failure is still heterogeneous and ethical concerns must be pointed out. Full article
(This article belongs to the Special Issue Old Issues and New Challenges in Forensic and Legal Medicine)
11 pages, 2825 KiB  
Article
Intravitreal Injection Planning during COVID-19 Pandemic: A Retrospective Study of Two Tertiary University Centers in Italy
by Daniela Mazzuca, Giuseppe Demarinis, Marcello Della Corte, Fiorella Caputo, Antonello Caruso, Margherita Pallocci, Luigi Tonino Marsella, Filippo Tatti, Emanuele Siotto Pintor, Lorenzo Mangoni, Gabriele Piccoli, Adriano Carnevali, Sabrina Vaccaro, Vincenzo Scorcia, Enrico Peiretti, Carmelo Nobile, Nicola Gratteri and Giuseppe Giannaccare
Healthcare 2023, 11(3), 287; https://doi.org/10.3390/healthcare11030287 - 17 Jan 2023
Cited by 2 | Viewed by 1360
Abstract
The COVID-19 pandemic has hampered the optimum management of retinal diseases. This study examined the impact of the pandemic on the intravitreal-injection practice in two academic centers in Italy along with the related medico-legal implications. A retrospective analysis of electronic medical records from [...] Read more.
The COVID-19 pandemic has hampered the optimum management of retinal diseases. This study examined the impact of the pandemic on the intravitreal-injection practice in two academic centers in Italy along with the related medico-legal implications. A retrospective analysis of electronic medical records from 16 March 2020 to 14 March 2021 at the ophthalmological departments of University of Cagliari (SGD) and University Magna Græcia of Catanzaro (UMG) was conducted. The data collected between 16 March 2020 and 14 June 2020 (lockdown), 15 June 2020 and 13 September 2020 (unlock), and 14 September 2020 and 14 March 2021 (second wave) were compared with those of the same period of the previous year. Weekly data on the administered drug and the number and type of treated disease were collected and analyzed. During the lockdown, a drop of 59% at SGD (p < 0.00001) and 77% at UMG (p < 0.00001) in intravitreal injections was found. In the first year of the pandemic, the reduction in injections was approximately of 27% (p < 0.0008) and 38% (p < 0.0001) at SGD and UMG, respectively. The COVID-19-related containment measures and the health resources redistribution have led to a delay in the treatment of chronic diseases of the retina, prioritizing the undeferrable ones. The lack of management guidelines has conceived relevant ethical and medico-legal issues that need to be considered in future measures planning. Full article
(This article belongs to the Special Issue Old Issues and New Challenges in Forensic and Legal Medicine)
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9 pages, 946 KiB  
Article
An Effective Model for Estimating Age in Unaccompanied Minors under the Italian Legal System
by Roberto Cameriere, Roberto Scendoni, Luigi Ferrante, Dora Mirtella, Luigi Oncini and Mariano Cingolani
Healthcare 2023, 11(2), 224; https://doi.org/10.3390/healthcare11020224 - 11 Jan 2023
Cited by 4 | Viewed by 1084
Abstract
This article presents an effective model for estimating the age of subjects without identification documents, in accordance with Italian legislation covering unaccompanied minors, using instrumental methods recognized by the scientific community for age estimation. A decision-making tree has been developed, in which the [...] Read more.
This article presents an effective model for estimating the age of subjects without identification documents, in accordance with Italian legislation covering unaccompanied minors, using instrumental methods recognized by the scientific community for age estimation. A decision-making tree has been developed, in which the first step is a physical examination. If secondary sexual characteristics are fully developed and there are no obvious signs of abnormal growth, dental X-rays are the next step. If the roots of the seven left mandibular teeth between the central incisor and the second molar are completely developed, the focus then moves to the third molar. If the index of the third molar (I3M) value is less than 0.08, or if third molars are not assessable, the following step is to study the clavicle which, if fully formed, indicates that the subject is an adult with 99.9% probability; otherwise, the probability is 96%. In all other cases (where the I3M is over 0.08), the probability that the subject has reached 18 years is less than 60%. The research, carried out initially on x-rays of the wrist, teeth and clavicle, highlighted the uselessness of the x-ray of the wrist for determining the age of majority, because in our sample, all subjects with incomplete maturity of hand/wrist bones were under 16 years of age; thus, OPT was necessary anyway. What we propose is a practical, easily feasible, fast, economical, and extremely reliable method, which can be used on Caucasian populations and beyond for multiple forensic purposes. Full article
(This article belongs to the Special Issue Old Issues and New Challenges in Forensic and Legal Medicine)
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13 pages, 293 KiB  
Article
Medico-Legal Issues in Cremation: Comparative Analysis of International Legislation
by Pierpaolo Di Lorenzo, Gaetano Di Donna, Ludovica Busillo, Maria Pieri, Emanuele Capasso, Fabio Policino, Claudia Casella and Massimo Niola
Healthcare 2022, 10(12), 2428; https://doi.org/10.3390/healthcare10122428 - 01 Dec 2022
Viewed by 1680
Abstract
Cremation has seen a constant increase in popularity all around the world. Because of its extensively destructive nature, however, a series of medico-legal issues arise concerning identification, forensic autopsy, external examination, histological, toxicological and genetic exams to be performed not in the immediacy [...] Read more.
Cremation has seen a constant increase in popularity all around the world. Because of its extensively destructive nature, however, a series of medico-legal issues arise concerning identification, forensic autopsy, external examination, histological, toxicological and genetic exams to be performed not in the immediacy of death. The aim of this study is to compare the international legislation on cremation, seeking the response of various countries to their medico-legal issues. Several affinities but also some differences were found. Similarities include the need for a certificate by a medical examiner excluding any medico-legal issues and non-natural causes of death and the expression of consent to cremation given by the deceased when still alive otherwise by relatives. Significant differences were found in German law, which provides for a second medical examination prior to cremation and in Italian law providing for the medical examiner to collect biological samples from the body and store them for a minimum of ten years for any future purpose of justice. The Italian approach could give a plausible solution to the medico-legal issues raised by cremation with the imperative premise, however, we need to look deeply into its privacy and consent implications, cost–benefits rate, sample collection and storage protocol. Full article
(This article belongs to the Special Issue Old Issues and New Challenges in Forensic and Legal Medicine)
11 pages, 812 KiB  
Article
Profiling Players Involved in Overkill: An Analysis of 71 Cases in Central Italy
by Alessandro Mauro Tavone, Giulia Ceccobelli, Giorgia Piizzi, Raimondo Vella, Gabriele Giuga, Andrea Cammarano, Giulia Petroni and Gian Luca Marella
Healthcare 2022, 10(10), 1873; https://doi.org/10.3390/healthcare10101873 - 26 Sep 2022
Cited by 1 | Viewed by 1472
Abstract
“Overkill” is characterized by the finding of excessive wounds on the victim’s body. Despite the large use of this term, it does not have a definition in the literature yet. Our study aimed to analyze the information related to the dynamics of overkill [...] Read more.
“Overkill” is characterized by the finding of excessive wounds on the victim’s body. Despite the large use of this term, it does not have a definition in the literature yet. Our study aimed to analyze the information related to the dynamics of overkill cases, collecting objective variables, and producing a profile of the players involved in this type of homicides. Data on 71 overkill cases from reports of the autopsies performed in the Section of Legal Medicine of the University of Rome Tor Vergata from 1 January 2000 to 31 December 2020 were collected. The victims and the perpetrators of overkill shared similar characteristics: they were usually male aged between 20 and 50 years, more likely in the 20–35 years range; victims however also showed another age peak in the range 50–55 years. The type of damage can be linked to the sole action of a cold weapon or the simultaneous use of multiple harmful tools with no significant differences. The most common motive proved to be a dispute for futile reasons; however, in the case of a single perpetrator of the crime, the economic and passionate motives are as frequent as the previous one. Implications of the findings and avenues for future research are discussed. Full article
(This article belongs to the Special Issue Old Issues and New Challenges in Forensic and Legal Medicine)
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15 pages, 4512 KiB  
Article
Antigenicity Preservation Is Related to Tissue Characteristics and the Post-Mortem Interval: Immunohistochemical Study and Literature Review
by Silvestro Mauriello, Michele Treglia, Margherita Pallocci, Rita Bonfiglio, Erica Giacobbi, Pierluigi Passalacqua, Andrea Cammarano, Cristian D’Ovidio, Luigi Tonino Marsella and Manuel Scimeca
Healthcare 2022, 10(8), 1495; https://doi.org/10.3390/healthcare10081495 - 08 Aug 2022
Cited by 4 | Viewed by 1697
Abstract
The main aim of this study was to investigate the post-mortem proteolytic degradation process of selected tissue antigens and correlate it to the post-mortem interval. During the autopsy of 12 cadavers (time interval ranging 1 day–2 years after death) samples of skin, liver, [...] Read more.
The main aim of this study was to investigate the post-mortem proteolytic degradation process of selected tissue antigens and correlate it to the post-mortem interval. During the autopsy of 12 cadavers (time interval ranging 1 day–2 years after death) samples of skin, liver, kidney, and spleen were collected. All samples were formalin-fixed and paraffin-embedded. Four µm paraffin sections were used for hematoxylin–eosin staining and immunohistochemical analysis (Ki67, Vimentin, Pan cytokeratin, and CD20). Data reported here show that immunohistochemical reactivity preservation was related to the characteristics of the tissues. In particular, the most resistant tissue was the skin, where the autolysis phenomena were not appreciable before 5 days. On the contrary, the liver and the spleen underwent early autolysis, while the kidney displayed an early autolysis of the tubules and a late one of the glomeruli. As concerns specific antigens, immunoreactivity was lost earliest for nuclear antigens as compared to cytoplasmic ones. In conclusion, our results demonstrate that immunohistochemical detection of specific antigens may be useful in estimating the post-mortem interval, especially when we need to know whether the post-mortem interval is a few days or more than 7–10 days. Full article
(This article belongs to the Special Issue Old Issues and New Challenges in Forensic and Legal Medicine)
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11 pages, 1472 KiB  
Article
Toxicological Analysis of Illicit Drugs Seized in Naples (Italy) and First Detection of Synthetic Cannabinoids during COVID-19 Pandemic
by Anna Carfora, Raffaella Petrella, Giusy Ambrosio, Ilaria Fracassi, Stefano Festinese, Alessandro Feola and Carlo Pietro Campobasso
Healthcare 2022, 10(8), 1488; https://doi.org/10.3390/healthcare10081488 - 08 Aug 2022
Cited by 1 | Viewed by 2163
Abstract
The COVID-19 pandemic has consistently raised the number of drug seizures, in United States as in Europe. The COVID-19 pandemic has also changed the typology of seizures from “more traditional” drugs to New Psychoactive Substances (NPSs), depending on geographical area. In Europe, the [...] Read more.
The COVID-19 pandemic has consistently raised the number of drug seizures, in United States as in Europe. The COVID-19 pandemic has also changed the typology of seizures from “more traditional” drugs to New Psychoactive Substances (NPSs), depending on geographical area. In Europe, the most frequent NPSs are synthetic cannabinoids (SCs) and cathinones, nonetheless synthetic opioids and phenethylamines are widely used. The aim of the study is the detection of NPS and other substances of abuse available in the black market, by quali/quantitative methods in LC-MS/MS and GC-MS. From 2018 to 2021, 268 seizures occurred in total and were analyzed by the Forensic Toxicology Laboratory (FTL) of Naples (Italy). The distribution of analyzed seizures over the years is the following: 53 in 2018, 61 in 2019, 89 in 2020 and 65 during the first semester of 2021. Cannabis was the most detected drug both in hashish and marijuana seizures, followed by cocaine > heroine > prescribed drugs > ketamine–amphetamine MDMA. No NPSs were seized until June 2021, when NPSs were found in two different seizures: Case #1 showed a bar of Cannabis resin containing a low level of Δ9THC = 0.57% associated to SC AB-FUBINACA in 4.5%; Case #2 showed a vegetal resinous substance (Δ9THC = 0.27%) with SC 5F-APINACA (4.1%) associated with methadone (1.0%). The detection of NPSs is alarming evidence that can lead to an increase in the risk of overdose or other negative and unpredictable consequences, such as violent or self-harming behavior in unaware users of cannabis derivatives considered of “natural” origin. Full article
(This article belongs to the Special Issue Old Issues and New Challenges in Forensic and Legal Medicine)
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11 pages, 2076 KiB  
Article
Medico-Legal Aspects of Hospital-Acquired Infections: 5-Years of Judgements of the Civil Court of Rome
by Michele Treglia, Margherita Pallocci, Pierluigi Passalacqua, Giuseppe Sabatelli, Lucilla De Luca, Claudia Zanovello, Agostino Messineo, Giuseppe Quintavalle, Alberto Michele Cisterna and Luigi Tonino Marsella
Healthcare 2022, 10(7), 1336; https://doi.org/10.3390/healthcare10071336 - 18 Jul 2022
Cited by 13 | Viewed by 2018
Abstract
Introduction: Healthcare-associated infections (HAIs) represent a risk to patients’ health, as well as being an issue of worldwide relevance in terms of public health and increased healthcare costs. The occurrence of a complication causally related to the development of an infection contracted during [...] Read more.
Introduction: Healthcare-associated infections (HAIs) represent a risk to patients’ health, as well as being an issue of worldwide relevance in terms of public health and increased healthcare costs. The occurrence of a complication causally related to the development of an infection contracted during a hospital stay, or in any event during a healthcare activity, may represent a source of liability for the healthcare facility itself and, therefore, lead to compensation for the injured patient. The aim of this research is to analyze the phenomenon of professional liability related to HAIs, to emphasize its economic and juridical aspects and, at the same time, highlight the clinical-managerial issues deserving attention, in order to guarantee the safety of care for patients. Methods: The retrospective review concerned all the judgments regarding HAIs drawn up by the Judges of the Civil Court of Rome, published between January 2016 and December 2020. Results: In the five-year period considered, 140 verdicts were issued in which the liability for which compensation was sought was related to the occurrence of healthcare-related infections. Convictions were recognized in 62.8%. The most involved branches were those related to the surgical areas: orthopedics, heart surgery, and general surgery. The three most frequently isolated organisms were Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae. The total amount of compensation paid was EUR 21.243.184,43. Conclusions: The study showed how the analysis of the juridical and medico legal aspects of HAIs may represent not only a helpful tool for healthcare performance assessment, but also a data source usable in clinical risk management and in the implementation of patient safety. Full article
(This article belongs to the Special Issue Old Issues and New Challenges in Forensic and Legal Medicine)
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Review

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11 pages, 638 KiB  
Review
The Chain of Custody in the Era of Modern Forensics: From the Classic Procedures for Gathering Evidence to the New Challenges Related to Digital Data
by Tommaso D’Anna, Maria Puntarello, Giovanni Cannella, Giovanni Scalzo, Roberto Buscemi, Stefania Zerbo and Antonina Argo
Healthcare 2023, 11(5), 634; https://doi.org/10.3390/healthcare11050634 - 21 Feb 2023
Cited by 8 | Viewed by 4809
Abstract
The purpose of this work is to renew the interest and attention for the chain of custody in forensic medicine, its establishment and maintenance, protecting the integrity and validity of evidence as well as to analyze how over time the establishment of the [...] Read more.
The purpose of this work is to renew the interest and attention for the chain of custody in forensic medicine, its establishment and maintenance, protecting the integrity and validity of evidence as well as to analyze how over time the establishment of the chain of custody and the collection of evidence has evolved also in function of the advent of technology and the use of electronic devices connected to the network. The analysis of the various aspects of the chain of custody demonstrates how necessary it is for the professional figures involved in the phases of the investigation (especially those who manage the evidence and who have, therefore, designated the assignment) to know the procedures to follow, trace the movement and the handling of objects subjected to seizure, also for the purposes of toxicological and/or histological investigations. The knowledge of interferences or complications helps to reduce errors and safeguard the validity of the evidence, assuring the proceeding judicial authority that the evidence is authentic and that it is, in other words, the same evidence seized at the scene of the crime. Furthermore, the issue is particularly felt today, with the recent need to guarantee the originality of digital data. Following a careful review and analysis of the literature currently available in this regard, it is worth adding that further efforts are needed to formulate internationally validated guidelines, harmonizing the different reference criteria in forensic science and medical areas, given the current absence of good international practices valid in the field and applicable both in the case of physical evidence and in the case of seizure of digital evidence. Full article
(This article belongs to the Special Issue Old Issues and New Challenges in Forensic and Legal Medicine)
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Other

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10 pages, 2164 KiB  
Case Report
Useful Evidence by Post-Mortem CT and Stereomicroscopy in Bone Injury: A Case Series from Forensic Practice
by Giuseppe Davide Albano, Giovanni Scalzo, Ginevra Malta, Maria Puntarello, Alberto Alongi, Donatella Piscionieri, Giuseppe Francesco Lo Re, Sergio Salerno, Stefania Zerbo and Antonina Argo
Healthcare 2023, 11(4), 540; https://doi.org/10.3390/healthcare11040540 - 11 Feb 2023
Viewed by 1318
Abstract
The investigation of bone injuries is an essential topic in forensics. We sometimes have to deal with charred or dismembered human remains that have lost soft tissue, making it difficult to diagnose the mechanisms of injury that led to death. Our contribution aims [...] Read more.
The investigation of bone injuries is an essential topic in forensics. We sometimes have to deal with charred or dismembered human remains that have lost soft tissue, making it difficult to diagnose the mechanisms of injury that led to death. Our contribution aims to share with the scientific community how we approached two cases of very different bone injuries and the techniques used to differentiate relevant pathology findings of bone fragments. Two cases are analyzed from the case history of the forensic medicine institute of Palermo. PMCT made it possible to differentiate heat bone lesions from traumatic lesions. The stereomicroscope was superior to PMCT in being able to better characterize and evaluate shear injuries, allowing a more accurate measurement of acute lesions. Injury to bone remains can be appropriately investigated with rapid techniques such as PMCT and stereomicroscopy. The presented methodology shows the importance of a multidisciplinary approach when dealing with bone injuries in forensics that could find further applications in other circumstances to answer forensic questions. Full article
(This article belongs to the Special Issue Old Issues and New Challenges in Forensic and Legal Medicine)
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10 pages, 259 KiB  
Case Report
Focus on Liability of Residences for Elderly and Sick People: A Case Series and Medico-Legal Issues
by Tommaso D’Anna, Antonina Argo, Giuseppe Davide Albano, Maria Puntarello, Chiara Rizzo, Daniela Guadagnino and Stefania Zerbo
Healthcare 2023, 11(4), 539; https://doi.org/10.3390/healthcare11040539 - 11 Feb 2023
Cited by 1 | Viewed by 1204
Abstract
Residences for elderly and sick people, self-sufficient or dependent, are varied. To date, the liability profiles of these structures are not clearly delineated, and increasingly often, their operating and organization criteria are entrusted to subnational, regional, or local regulations. Among the various deficits, [...] Read more.
Residences for elderly and sick people, self-sufficient or dependent, are varied. To date, the liability profiles of these structures are not clearly delineated, and increasingly often, their operating and organization criteria are entrusted to subnational, regional, or local regulations. Among the various deficits, there is the keeping of a complete and detailed documentation/diary of the patient, the lack of which can generate medico-legal problems. In this paper, we present three cases of guests in residences for a dependent person brought to the attention of the Institute of Forensic Medicine of the University Hospital of Palermo due to criminal proceedings, where the lack of existing documentation in the structure and, in some cases, the behavior of the professionals working there, led the evaluator to deduce the organization’s culpability. Full article
(This article belongs to the Special Issue Old Issues and New Challenges in Forensic and Legal Medicine)
7 pages, 800 KiB  
Case Report
Assessment of Cervical Skeletal Trauma: The Synergistic Contribution of Forensic and Clinical Medicine to a Case of Corpse Concealment
by Ilaria Tarozzi, Lorenzo Franceschetti and Valentina Bugelli
Healthcare 2023, 11(4), 510; https://doi.org/10.3390/healthcare11040510 - 09 Feb 2023
Cited by 2 | Viewed by 1440
Abstract
Fatal neck injuries represent a major challenge in forensic pathology because the anatomical complexity and high variability of neck structures make it often extremely difficult to differentiate true pathological findings from artifacts at autopsy. This topic becomes even more relevant when the forensic [...] Read more.
Fatal neck injuries represent a major challenge in forensic pathology because the anatomical complexity and high variability of neck structures make it often extremely difficult to differentiate true pathological findings from artifacts at autopsy. This topic becomes even more relevant when the forensic pathologist is required to make a pathophysiological evaluation of bone fractures in the absence of soft tissue to support the diagnosis. We report a case of unidentified, stone-covered, skeletonized human remains found within a pit below an abandoned building with bony lesions of the cervical spine and ribs, including a full-thickness fracture of the right lateral mass of the atlas (C1). After a careful study of the fractures was carried out by screening forensic literature and anthropological studies, clinical neurosurgical expertise was called upon to provide a reliable explanation. A rapid and violent twisting of the neck in the opposite direction from the fracture site by an attacker who pinned the victim’s torso is the scenario that most likely occurred in our case. This case report shows that the diagnosis of cervical spine injuries in skeletal remains should be the result of a multidisciplinary approach that integrates forensic, anthropological, and clinical expertise. Full article
(This article belongs to the Special Issue Old Issues and New Challenges in Forensic and Legal Medicine)
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10 pages, 2342 KiB  
Case Report
Accidental Injury or “Shaken Elderly Syndrome”? Insights from a Case Report
by Valentina Bugelli, Carlo Pietro Campobasso, Alessandro Feola, Ilaria Tarozzi, Arturo Abbruzzese and Marco Di Paolo
Healthcare 2023, 11(2), 228; https://doi.org/10.3390/healthcare11020228 - 12 Jan 2023
Cited by 1 | Viewed by 1734
Abstract
Subdural haemorrhage (SDH) as result of a traumatic brain injury (TBI) is a common cause of death in cases of fatal physical abuse. Since intracranial bleeding is a common finding in elderly due to age-related intracranial changes or increasing prevalence of anticoagulant medication, [...] Read more.
Subdural haemorrhage (SDH) as result of a traumatic brain injury (TBI) is a common cause of death in cases of fatal physical abuse. Since intracranial bleeding is a common finding in elderly due to age-related intracranial changes or increasing prevalence of anticoagulant medication, differential diagnosis between inflicted and non-inflicted head injury is challenging. A case of an elderly woman’s death caused by TBI is reported. Autopsy showed multiple polychromatic bruises and a frontoparietal hematoma with bilateral subacute SDH. History excluded paraphysiological or pathological non-traumatic conditions that could justify SDH, while iatrogenic factors only played a contributory role. Since polychromatic bruises distributed on the face, the upper extremities and the chest were consistent with forceful grasping/gripping or repeated blows and SDH can form in absence of impact or by mild/minor blows, SDH was considered the result of repeated physical abuses. Differential diagnosis between traumatic and non-traumatic SDH is still challenging for forensic pathologists. As largely accepted in the pediatric population and occasionally described also in adults, however, violent shaking should be also considered as a possible mechanism of SDH—especially in elderly who do not have any sign of impact to the head. Full article
(This article belongs to the Special Issue Old Issues and New Challenges in Forensic and Legal Medicine)
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8 pages, 2042 KiB  
Case Report
“Freedom and Dignity Are Worth More than Life”: The Dramatic Suicide of an Anti-Vax Man
by Sara Sablone, Lorenzo Spagnolo, Enrica Macorano, Mauro Claudio Ciavarella, Natascha Pascale, Giuseppe Strisciullo, Francesco Introna and Aldo Di Fazio
Healthcare 2022, 10(11), 2141; https://doi.org/10.3390/healthcare10112141 - 28 Oct 2022
Cited by 1 | Viewed by 2930
Abstract
Since the beginning of the COVID-19 public health emergency, we have witnessed an increase in psychiatric problems and pathologies, such as depression, anxiety, isolation, posttraumatic stress disorder, substance abuse, and burnout. The world’s collective sentiment finally turned toward optimism after authorization was granted [...] Read more.
Since the beginning of the COVID-19 public health emergency, we have witnessed an increase in psychiatric problems and pathologies, such as depression, anxiety, isolation, posttraumatic stress disorder, substance abuse, and burnout. The world’s collective sentiment finally turned toward optimism after authorization was granted for the COVID-19 vaccines’ emergency use by the FDA in December 2020. With the increase in vaccine coverage in Western countries, case counts and deaths gradually plummeted while activity restrictions were progressively lifted. At the same time, however, a new COVID-19-related public health issue has arisen, as a substantial number of eligible individuals refused vaccination. Behaviors assumed by the so-called anti-vax people in manifesting their own opposition towards COVID-19 vaccination are various, and sometimes assume the forms of dramatic gestures with symbolic value, such as suicide. Here, we present the case of a healthy, convinced anti-vax, 58-year-old man, who allowed himself to be run over by a moving train in the presence of eyewitnesses, bringing with him a demonstrative note of his reasons. The present article aims to raise awareness against the social and psychological impact of COVID-19 vaccination refusal and to point out the need of a specific support net to avoid the spread of psychological impairment, social isolation and suicidal behaviors among the “anti-vax community”. Full article
(This article belongs to the Special Issue Old Issues and New Challenges in Forensic and Legal Medicine)
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7 pages, 2706 KiB  
Case Report
Chronic Encapsulated Intracerebral Hematoma as an Occasional Finding in Sudden Cardiac Death
by Alessandro Feola, Mariavictoria De Simone, Paola Ciamarra, Stefania Sica, Carmela Buonomo, Anna Carfora and Carlo Pietro Campobasso
Healthcare 2022, 10(10), 2053; https://doi.org/10.3390/healthcare10102053 - 17 Oct 2022
Cited by 4 | Viewed by 1562
Abstract
Chronic encapsulated intracerebral hematoma (CEIH) is a rare solid mass characterized by the presence of a fibrotic capsule that can present a variety of signs and symptoms due to the mass effect and hydrocephalus. It may be caused by post-traumatic or spontaneous bleeding [...] Read more.
Chronic encapsulated intracerebral hematoma (CEIH) is a rare solid mass characterized by the presence of a fibrotic capsule that can present a variety of signs and symptoms due to the mass effect and hydrocephalus. It may be caused by post-traumatic or spontaneous bleeding as related to an adjacent aneurysm, angiomas or neoplasms. Differential diagnosis must be applied in order for it to mimic neoplasm or a vascular malformation. Several cases of CEIH have been reported but only a few of them have an intraventricular localization. A forensic autopsy of a 50-year-old male who died suddenly while driving is discussed. Gross analysis, histology and toxicology were performed and a CEIH of the right lateral ventricle was found in a case of acute coronary death. Full article
(This article belongs to the Special Issue Old Issues and New Challenges in Forensic and Legal Medicine)
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