Forensic MedicineIntroduction

Dr. Raid Jastania

Books

• Simpson’s Forensic Medicine, 12th Edition

• Color Atlas of Forensic Pathology by Jay Dix

• Jastania@hotmail.com• http://uqu.edu.sa/staff/ar/4180114

This Course

• Elective

• Appreciation Orientation of Forensic Medicine

• Contents, Syllabus

• Objectives of the the course

• Exam

Well,What is this Course about?

Problem 1

• You are on call in the medical ward. At 3 am the nurse calls you and asks you to come to see a patient. You come to the room and find the patient “Dead”

• What do you do?

Problem 2• You are doing ICU rotation. You see this 24 year

old man who had RTA and is on mechanical ventilation for 2 years.

• The family approach you and ask you: Is the patient “Brain Dead”? Is there a chance of recovery? Can you disconnect the mechanical ventilation?

• Another family member starts telling a story about someone who has been in “coma” for 2 years and then has full recovery!!!

Problem 3

• During your rotation in the Geriatric ward, one of you patient dies. The patient’s daughter comes to you and asks you:– (My father was working in a factory of

construction and isolation material, and I suspects that he has been exposed to a “carcinogenic material, Asbestos”. Is this death related to this?

• What would you do?

Problem 4

• In a fire, a man is found “Dead”!

• The Police is questioning:– Is this Accident?– Or is it murder?

• What do you think?

Problem 5

• During your ER rotation, you see this 5 year old boy with multiple injuries and bruises on the both legs, back and forehead….

• You have suspicion of “Child Abuse”!!

• What would you do?

Problem 6

• A 23 year old boy has epilepsy and does not hold a driving license. However, he is found dead following a car accident. He is the driver!!

• You are asked to fill in the “Death Certificate”

• What is the cause of death? Is this accident? Or is it natural death?

Problem 7

• A friend of yours calls you and ask for “sick leave” for 5 days. He knows that you work in the hospital and you can easily do him a favor!!

• What would you do?

Problem 8

• The police is investigating a case of Medical malpractice. They see your name in the patient’s file. They ask you to write a report about the patient. This report will be considered as “Evidence” in their investigation!

• What would you do?

Forensic Medicine

• Definition:– Branch of “Medical” practice concerns with– Legal issues – In Life and Death– Usually performed by Pathologists

Aspects of Forensic Medicine

• Life and Death

• Medical Malpractice

• Abuse

• Ethics in medical practice

• Legal issues

Forensic Medicine

• Who performs what:– It depends on the legal system of the country– Terms:

• Coroner

• Medical Examiner

• Court

• Death certification

• Police

The Law

• Source of the Law

• Medical Profession Rules

• Legal vs Ethical responsibilities

The Legal System

• The Criminal System• Offences against public interest

• Individual is presumed innocent until found guilty

• Penalties: fines, imprisonment, beating, amputation of parts, execution

• Civil Courts:• Between individuals

• Restoration of position before the event

• Usually financial compensation

Doctors and the Law

• Citizen

• Professional witness

• Expert witness

• Attendance at court

• Written reports

• Giving evidence

• Behavior in court

How do Pathologist Collect the Evidence

Autopsy

• Definition:– Post mortem examination of body– External– Internal organ– Types:

• Clinical “Hospital” Autopsy

• Forensic Autopsy

– Description of Autopsy Suite

http://health.howstuffworks.com/death-pictures.htm

Medical Reporting

Medical Reporting

• Who is requesting the Report– Police, judge, lawyer, government department

• Am I entitled to write such a report?– Confidentiality– Lack of knowledge– Consent of living patient

• “assumed” consent

– Criminal cases

Exercise:

What do we need to write in Autopsy report?

Make a List!

Structure of a Report

• Patient data• Doctor Data• Time, date, place• People attending autopsy• Consent of autopsy

– Next of ken– Extent of autopsy– Special requests

Structure of a Report

• Physical Examination– External– Internal

• Treatment given

• X-rays

• Blood tests, toxicology

• Injuries

• Openion

Tips for Reporting

• Make it Simple

• Relevant information

• ?Abbreviations

• Background of death

• Scene visit of death

• Confidential

• No change or delete