Archiwum medycyny sa̧dowej i kryminologii
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Arch Med Sadowej Kryminol · Jan 2007
[Problems in medical certification of posttraumatic neuropsychiatric disorders for the purpose of criminal and civil law proceedings].
In the past several years, in the material of Forensic Medicine Department, Medical University of Silesia in Katowice, a significant increase has been noted in the number of cases associated with CNS dysfunctions, either as isolated conditions or in association with posttraumatic disorders. In the majority of cases, such dysfunctions were causally related to a head trauma. ⋯ In the present publication, the authors have emphasized difficulties in assessing the complaints reported by the claimants and the possibilities of objectivization of such complaints by neuro-psychiatric examinations. They also stress problems in application of obligatory ICD 10 terms denoting dysfunctions of the central nervous system in medico-legal opinions.
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Arch Med Sadowej Kryminol · Jan 2007
[Medico-legal opinions in cases for annulment of testament. Part I. Characteristics of investigative material. Characteristics of testators].
A very important issue in preparing medico-legal opinions is the establishment whether the devisor had the ability to bequeath at the date of preparing a testament. The subsequent loss of the ability of bequeathing does not have any impact on execution of the previously prepared testament. Experts who pass opinions in testament cases evaluate: 1) the testament itself and the circumstances of its preparation, excluding, however, the reliability of records, 2) statements obtained while interrogating witnesses (descriptions of daily life, motivation to bequeath), 3) medical records (files, case histories, discharge records). ⋯ The length of devisors survival following the drawing up of the final testament was generally short. In total, testaments not only in the oral form, but also made before a notary, were prepared by chronically ill individuals presenting with marked clinical symptoms, what was perceived by their family and caregivers as a sign of the imminent death. Hence, the testaments were often drawn up in a hospital room or in a notary office where the patient was taken between consecutive hospitalizations.
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The objective of this work is a preliminary analysis of claims concerning nosocomial infections advanced by patients against public inpatient institutions. ⋯ 646 patient claims against medical institutions resulting from their civil liability were analyzed. All the claims included expert opinions issued by the Medical Department of PZU SA between the year 2003 and 2005. In the analyzed material, the majority of claims (85.3%) involved public hospitals. The value of the presented material is high, as PZU SA is practically the only insurance company that insures public hospitals against civil liability for medical procedures. Therefore, conclusions from the present analysis may be used to formulate certain generalized statements in the case of claims made by patients against public hospitals in Poland. Nosocomial infections constituted 32% of all patient claims against public hospitals. The majority of claims indicated Staphylococcus aureus infections (37%). Other common infections associated with patient claims were HBV and HCV infections, with HBV infections predominating at surgical and internal disease wards, while HCV infection claims were more common among gynecology and obstetrics patients. Staphylococcus aureus infections were dominant in orthopedic and traumatology wards. Some objective reasons may hinder formulation of an expert opinion, such as finding the causal association between the infection and the timing of hospitalization, or between the infection and the culpability of medical personnel. Medical opinions passed by doctors of the Medical Department in most cases remained ambiguous. New legal regulations that require obligatory reporting and registration of nosocomial infections provide a chance that some of these difficulties may be overcome in the near future.