Computer support for medicolegal investigative systems.
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Biomedical subjects
Publications and source records attributed to J T Weston.
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The association of alcohol with unnatural death, especially automobile accidents, is widely accepted. Unfortunately, national statistics often do not include information from medical examiners, which can be a significant contribution. This report summarizes the experience of the New Mexico Office of the Medical Investigator during the period 1974-76. Thirty-nine per cent of automobile drivers involved in fatal motor vehicle accidents and 40% of pedestrians killed by motor vehicles had some blood alcohol present. The relationship of alcohol and other violent crimes is summarized, indicating the involvement of alcohol in 39% to 74% of the several types of crimes presented. The expense of alcohol-related accidents is presented. The psychological autopsy was used to prepare profiles of drivers involved in a variety of vehicular accidents. Drivers were grouped into five categories according to behavioral characteristics that were likely to have contributed to their accidents. Twenty-eight per cent of drivers involved in serious and fatal accidents in this study were judged to have had behavioral disorders in which alcohol often played a role.
The autopsy appears to be on the way to assuming an increasingly important role in patient care, continuing education, education of medical students and house staff, research in environmental pathology, and more fundamental aspects of disease. This trend needs to be nurtured. Not only pathologists but all physicians need to plan carefully to utilize autopsies to the fullest possible extent. Interest will continue to grow only if autopsies are performed or are closely supervised by highly motivated and experienced pathologists asking critical questions of current medical, scientific, and social concern. New, imaginative approaches are needed to develop the data necessary to address these questions.
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A 5-year study of a busy ski population in Utah revealed a total at-risk period of approximately 3.5 million skier-days. While the morbidity (fractures, strains, sprains, and occasionally more severe injuries) associated with skiing is well recognized and considered by most physicians concerned to be distributed somewhat unevenly within the various skills of skiing, the authors have identified an exceedingly low mortality among the same population. Six individuals died as a result of injuries directly attributable to skiing. Three of these were considered to be advanced skiers and three were of intermediate skill. In three instances the environment was considered to play a role in the accident. Two of these victims were skiing out of control, one as a result of ice-covered snow and one as a result of speed in combination with a small jump. The third victim was crushed in an avalanche. One accident was completely unexplained, the skier having skied without apparent attempt at checking or change of course into a nonrecreational area. The two remaining skiers of intermediate skill both suffered injuries incident to falling forward with considerable force onto a relatively flat, hard snow surface. Notwithstanding the intense and sometimes prolonged exertion at relatively high altitudes (9,400 to 11,000 ft or 2.9 to 3.3 km), only one skier with a previous history of atherosclerotic heart disease died while skiing. One additional middle-aged skier with similar history died at the conclusion of the day.(ABSTRACT TRUNCATED AT 250 WORDS)
For those medicolegal investigative systems charged by statute with the responsibility of investigating and examining known or suspected iatrogenic deaths--whether in a perioperative or operative situation, or in some other relationship to medical intervention--there is usually little doubt that these types of investigations constitute the most difficult, often perplexing, and far-reaching investigation, examination, and reporting problems of any of the types of cases referred. Much of this difficulty derives from the changing attitude of the public at large, including the medical and the legal community. In the United States, as recently as 15 years ago, the loss of life or injury subsequent to a therapeutic or operative procedure, with rare exception, was accepted virtually as an act of God.
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All childhood deaths which occurred in New Mexico during 1974 and 1975 were reviewed. Nine fatal instances of abuse were identified representing the entire spectrum of physical abuse: neglect, abuse in a single episode of injury, repetitive abuse, or sexual abuse. Several cases are summarized. These are unusual either in the distribution of pathologic findings or in the problems encountered in court presentation.
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