AN EMBLEMATICAL CASE OF FIRST ACCESS IN EPILEPSY WHILE DRIVING ACCORDING TO THE ITALIAN LAW N. 41 OF 23 MARCH 2016 AND A REVIEW OF LITERATURE

Introduction: People with epilepsy, all over the world, have many problems in everyday life because of unpredictable seizures that could hinder every human activity. In particular, they are restricted from driving because of the fear over seizure-related car accidents. The purpose of this work is to raise some questions about risk of traffic accident, driving restriction and personal liability in people with and without diagnosis of epilepsy. Case presentation: We present a case of a 49-year-old woman who accidentally hit a pedestrian with her car, causing him severe personal injury. After many clinical and instrumental examinations, the physicians diagnosed to her generalized epilepsy and she started a daily anti-epileptic therapy. Results: Studies have tried to estimate the real risk of road traffic accident in order to evaluate when a person with epilepsy reaches an acceptable risk of driving, balancing public traffic safety and personal freedom, without a real success. Therefore, we present an overview of laws regarding epilepsy-driving restriction and a recent court case related to a car accident during a first seizure, according to the Italian law n. 41 of 23 march 2016 about personal injuries and murder caused by vehicular accident and a review of Literature about the first seizure while driving. Conclusion: We believe that the driver cannot be held liable for any personal injuries or murder caused by vehicular accident, according to the Italian law n. 41 of 23 march 2016, likewise it happened in the case presented. Indeed, the crisis represent a temporary reduction of liability (incapacity to understand and want), making the person not imputable for own actions during the time of the seizure. Keywords: first seizure, people with epilepsy (PWE), car accident, personal injuries

The new Italian law 219/2017: an extraordinary clinical tool in internal medicine

Abstract On December 2017, Law 219 named Provisions for informed consent and advance treatment directives was approved in Italy, and on one side this law helped the daily medical activity on the other side it enhanced the patient's self-determination. This contribution analyzes the new legislative disposition and the possible medical-legal and practical implications for patients entrusted in hospitals. In particular, it focuses on the usefulness of an early planning of medical care decision in complex pathological situations in order to enhance the patient's self-determination and his eventual impassable refusal. It also safeguards the medical work from disputes and claims, preserving medical autonomy and competence

The Role of DNA Degradation in the Estimation of Post-Mortem Interval: A Systematic Review of the Current Literature

The determination of the post-mortal interval (PMI) is an extremely discussed topic in the literature and of deep forensic interest, for which various types of methods have been proposed. The aim of the manuscript is to provide a review of the studies on the post-mortem DNA degradation used for estimating PMI. This review has been performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the PRISMA Guidelines. Several analytical techniques have been proposed to analyse the post-mortem DNA degradation in order to use it to estimate the PMI. Studies focused mainly on animal models and on particular tissues. The results have been mixed: while on the one hand literature data in this field have confirmed that in the post-mortem several degradation processes involve nucleic acids, on the other hand some fundamental aspects are still little explored: the influence of ante and post-mortem factors on DNA degradation, the feasibility and applicability of a multiparametric mathematical model that takes into account DNA degradation and the definition of one or more target organs in order to standardize the results on human cases under standard conditions

La responsabilit\ue0 professionale medica nei minori. Uno sguardo medico-legale tra le ragioni della dottrina e quelle del cuore

Introduction. Over the past few decades there has been a steady increase in the number of requests for medical professional liability. Objective. A medico-legal observatory on professional liability cases has been set up in an Italian university hospital, with the aim of monitoring and documenting the characteristics of negligence disputes from a medico-legal point of view. Methods. The general analysis includes over 1450 cases, archived between 2004 and 2019. The subpopulation of cases concerning subjects < 18 years and equal to 184 cases (13% of the total) is then examined. Results. In 60% of cases, the claims related to the medical disciplinary area, 20% of the cases to the surgical area and 12% to the emergency area, 8% related to the service area. In the sample of the general population, the percentage of recognition of responsibility by doctors of the facility is 33%, while in the case of minors it is observed equal to 45%. Discussion. Multiple reasons can be highlighted to explain the phenomenon observed such as the frequent absence of comorbidity in young patients, a particular empathy of the evaluator in ascertaining cases relating to minors and probably regarding the presence of elements of organizational deficiencies that may induce to recognize more responsibility. With regard to the latter hypothesis, further studies will need to be carried out in the future. Conclusion. The data collected can be useful from an educational and didactic point of view for professionals dealing with minors and can benefit from useful references to the correct and compilation of the medical record

Mycobacterium Chimaera: Clinical and medico-legal considerations starting from a case of sudden acoustic damage

Mycobacterium Chimaera is a microorganism that can cause nosocomial infections particularly in patients undergoing cardiac surgery. The specific case presented herein shows an original clinical presentation of the infection: sudden unilateral deafness as a result of septic embolization. Medico-legal experts appointed by the court in a civil liability dispute analyzed the case and submitted their expert opinion. This article analyzes the peculiar and innovative aspect of professional liability that can be attributed to the healthcare facility and the manufacturer of the equipment used in the operating room from a medical-legal point of view

Seventeen-Year Medical Professional Liability Experience in a Level III University Hospital

Introduction: In recent decades, the number of medical professional liability disputes has grown exponentially, becoming a well-studied aspect of public healthcare. Legal medicine is an essential tool in managing this phenomenon. Methods: This article reports the results of the analysis of disputes for medical professional liability in a Level III University Hospital in Italy. The study covers the time period from 01.01.2003 to 31.12.2019. Results: About 33% of claims have been compensated. Those claims fall within the following categories: 37% in the surgical field, 17% in the field of internal medicine, and 35% in the emergency care field. As for the types of a medical mistake, compensation was awarded in 30% of diagnostic error cases, 26% of therapeutic error cases, 47% of execution error cases, and 55% of organizational deficiency cases. Discussion: The difference in the rate of compensation between the various medical fields or types of error depends on specific medico-legal characteristics. The aim of advanced healthcare systems is to prevent medical liability disputes by analyzing this phenomenon and improving clinical risk management programs. In particular, according to our study, events related to organizational deficiencies are the most preventable. In addition, through the use of a dedicated reporting procedure, medico-legal analysis of malpractice cases may be the key to risk reduction. Conclusion: Every major hospital should set up a medico-legal watchdog responsible for collecting and analyzing information on professional medical liability disputes in order to prevent and manage such events

The importance of a specific medical-legal training for health care professionals in the management of sexual assault victims

The World International Organization (WHO) defines sexual violence as \u201cany sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed, against a person\u2019s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work\u201d. This definition includes a very wide range of behaviors. According to the Italian National Statistical Institute (ISTAT), the 31.5% of Italian women are estimated to have been victims of physical or sexual violence during their lifetime. Given the acute nature of sexual assault, emergency medicine providers are the first clinicians to take care of the victim, and care of such patients differs from care of those presenting other kind of trauma and injuries. Healthcare professionals treating victims of sexual assault admitted to Emergency Departments (ED) need to deal not only with clinical priorities, but also with the emotional suffering and anguish characterizing the experience of this type of patients. Furthermore, they can effectively assist the victims in their medical-legal proceedings by documenting injuries and by collecting biological evidence for forensic purposes. In order to avoid discrepancies between the medical report and the reconstruction of the event, it is essential to set up strategies which focus on the technical aspect of evidence collection and on the way the victim\u2019s story shall be recorded. Sometimes, indeed, informations collected from the victim in the ED are still inadequate or incomplete to determine how the case event should be reconstructed. Such efforts could lead to a better management of sexual assault victims and to a strengthened legal impact of forensic evidences and of the crime reconstruction. For this reason, it is necessary for health structures: to define specific pathways for the victim\u2019s management; to adopt homogeneous operational protocols which allow a standardization in the methods of collection and preservation of biological material for forensic-genetic analyses; finally, to provide an adequate forensic training for health personnel in order to ensure that they are competent in the medical reporting and in documenting evidences of the sexual assault. From a forensic point of view this could be crucial, as medical documentation may be used in court