Browsing by Author "Kitulwatte, I.D.G."

Now showing 1 - 20 of 57

Acute hemorrhagic leukoencephalomyelitis in a man with viral myocarditis
(Humana Press, 2015) Kitulwatte, I.D.G.; Kim, P.J.; Pollanen, M.S.
We report a case of acute hemorrhagic leukoencephalomyelitis in a man with viral myocarditis. A 48-year-old previously healthy male was found dead in his locked apartment. At autopsy he was found to be malnourished, and his lungs showed gross evidence of bilateral pneumonia with abscess formation and bullous emphysema. Multiple petechial hemorrhages were observed in the brain and mainly involved white matter in the cerebral hemispheres including the corpus callosum and internal capsule, as well as the cerebellum, brainstem, and spinal cord. Microscopy of the brain and spinal cord revealed perivenular hemorrhages, central microthrombi in venules with fibrin exudation into the subcortical white matter, and early perivenular demyelination associated with scanty mixed cellular infiltrates. Other microscopic features included widespread diffuse viral myocarditis, extensive suppurative bronchopneumonia, and chronic bronchitis. This case illustrates the death of a man with a rare fatal disease associated with two other potentially lethal diseases. The case also illustrates the importance of a holistic approach when determining the cause of death, especially when there are competing causes of death.
Adequacy and relevance of medical records of patients admitted following Medico-legally significant trauma
(College of Forensic Pathologists of Sri Lanka., 2020) Priyanath, D. C.; Dharmadasa, L.S.; de Silva, R.L.S.K.; Gunathilaka, M.M.A.C.C.; Nanayakkara, E.H.H.G.; Shakoor, M.S.; Samarawickrama, S.; Kitulwatte, I.D.G.; Edirisinghe, P.A.S.
INTRODUCTION: Details mentioned in Bed head ticket (BHT) and investigations are taken into consideration when an opinion is made with regards to the medico legally significant trauma. Shortfalls of documents can lead to misdiagnosis or wrongful diagnosis. This study was conducted to find out the adequacy of records on BHTs and availability of investigations on patients who had been admitted following trauma with medico legal significance. METHODS: A prospective descriptive study was carried out on patents who were admitted following medico-legally significant trauma during a period of one year, from Aug 2017 to Aug 2018 by perusing their records. The adequacy of the documentation was assessed according to a pre-prepared scale. RESULTS: Analysis of on admission historical and preliminary details revealed that out of 1102 records, only 26% (n=286) had mentioned the time duration since the incident. Recorded cardiovascular stability on admission was above 86% (n=950) though level of consciousness was not mentioned by 19% (n=211). Nature of the injuries were correctly recorded by 65% (n=720) while the location of them were correctly recorded only by 29% (n=316). Surgical procedures were adequately mentioned only among 39% (n=425). CONCLUSIONS: The study revealed that there are gross inadequacies with regard to the records on BHTs made by the doctors. This can lead to limitations in addressing medico-legal issues and sometimes can result in wrong opinions leading to injustice. Need for continuous professional training with special attention to record keeping is highlighted. Further, the quality of records can be further improved with regular audits, continuous professional developmental activities and introducing a common format for documentation in admission, surgical procedures and investigations. KEYWORDS: Medico-legal issues, Medical record keeping, Adequacy, Investigations, BHT
Analysis of child victims of trauma or violence reported for medico-legal Examination in Three Tertiary Care Hospitals in Sri Lanka
(College of Forensic Pathologists of Sri Lanka, 2013) Kitulwatte, I.D.G.; Edirisinghe, P.A.S.; Appuhamy, P.
INTRODUCTION: Injury is a leading cause of disability among children and young adults. Characteristics of child victims of trauma or violence presenting for medico legal examination may vary considerably by age, sex and developmental level of the child. OBJECTIVE: The primary objective of this study was to find out type, distribution and severity of trauma or violence among children presenting for medico legal examination. The second aim was to propose suggestions to prevent such trauma or violence to children. STUDY DESIGN: Retrospective descriptive study was done based on medico-legal examinations performed on all the children under 12 years by the authors. The information was gathered on a proforma to fulfill the objectives. The data was analyzed using SPSS statistical package. RESULTS: Out of 171 cases studied 54% of cases were alleged road traffic accidents,alleged non-accidental injuries 16% and alleged sexual abuse 12% . Sexual violence was commonly seen among female victims (75%). The age of the sexual abuse victims ranged from 1 year to 12 years. 60% of victims of alleged physical abuse were more than 10 years of age. 56% of accidental injuries and 80% of non-accidental injuries were non grievous. Head injuries amounted to 68% of accidental injuries while commonest non accidental injuries were also found on the head and neck (53%). CONCLUSION: Although road accidents are the commonest trauma among children presenting for medico legal examination, there is a significant proportion of intentional trauma including sexual violence. Thus, the preventive strategies should aim on both accidental and non accidental trauma.
Analysis of medicolegal examination in alleged sexual abuse presented to a tertiary care hospital in Sri Lanka
(Wolters Kluwer - Medknow, 2023) Kitulwatte, I.D.G.; Wijewardena, H.P.; Edirisinghe, P.A.S.; Senarathne, U.D.
Forensic experts are often expected to provide an opinion on alleged physical or sexual contact between individuals following medicolegal examination of a case of sexual abuse (SA). There are many factors influencing the opinion. A retrospective descriptive study was performed to study the factors influencing the medicolegal opinion in SA forensic examination using medical and medicolegal records of alleged SA victims to extract data. Records of 441 victims were studied. A majority, 180 (40%), presented due to the guardian’s concerns – 302 (68%) presented for medicolegal examination 72 h after the incident. Recent injuries were observed in only 15% of the victims. Genital injuries were observed in 74% of the victims brought due to concerns of the guardians, with 12 victims having recent injuries. Of the 172 victims who complained of vaginal intercourse, 21% had recent injuries. A firm positive medicolegal opinion could be given in 63% of all cases. In 124 individuals, a firm positive or negative opinion could not be given. A majority (n = 90, 73%) of these individuals did not have any injuries, while 23% had healed injuries. According to the nature of the complaint, in a significant number of victims (53%), no scientific evidence was present to make a firm opinion. The nature of the sexual act and the absence of injuries influence the medicolegal opinion on SA, making it a challenging task for forensic experts.
An Analysis of medicolegal reporting in workman injuries referred for medicolegal examination in a Tertiary Care Hospital of Sri Lanka
(Wolters Kluwer Medknow Publications, 2020) Kitulwatte, I.D.G.; Edirisinghe, P.A.S.
INTRODUCTION: A reasonable number of workman injuries are reported for medicolegal examination every year. In addition to report on the degree of severity and consistency of the injuries with the historical evidence, the medical officers are expected to opine on degree of disability as well. However, routine Medicolegal Examination Form or Report used in Sri Lanka to report these cases does not carry a section for disability or impairment. Objective: To gain an insight into the pathology of workplace injuries and to evaluate the role of medicolegal examination and reporting among the victims presented with injuries at work. Methods: A retrospective descriptive study was carried out on workmen who were referred for medicolegal examination during a period of 5 years in a Tertiary Care Hospital in the Western Province of Sri Lanka. Results: Out of 172 subjects who got injured at work, none had claimed for a report of compensation. 47% (81) of the injured workers were in the age group of 19–30 years. 81% (139) were males. Factory workers were the most vulnerable workers (34%) followed by drivers (15%). A majority 39% (67) of injuries were located on upper limbs. 52% (90) of the victims had grievous injuries. However, a majority 61% (105) had no permanent disability. Conclusions: Disability is not a direct reflection of the category of hurt. Therefore, testifying on routine medicolegal reports on cases of workman compensation will not serve justice to the patient. KEYWORDS: Category of hurt, disability, injury, medicolegal examination, workman
Autopsy review on ‘suspicious deaths' of Sri Lankans who died abroad: a study from Colombo North Teaching Hospital (CNTH)
(Sri Lanka Medical Association, 2008) Perera, W.N.S.; Edirisinghe, P.A.S.; Kitulwatte, I.D.G.
BACKGROUND: Many Sri Lankans have left as migrant workers for the past three decades. When such a person dies in the host country and the family is in doubt about the death, investigations are initiated in Sri Lanka including an autopsy. OBJECTIVE: To study the epidemiological details of the deceased persons, the difference of the cause and the circumstance of death after being subjected to an autopsy in Sri Lanka. DESIGN, SETTING AND METHODS: A retrospective descriptive analysis was carried out on suspicious deaths that occurred in other countries based on autopsy reports, and the case notes attached to them (including certificates of deaths and autopsy reports sent by host countries) at the Medico-Legal Unit of CNTH from January 2003 to March 2007. RESULTS: Out of 52 deaths examined, 69% died in the Middle East, whereas 17% and 10% died in Asia and Europe. 50% and 44% were skilled and unskilled workers respectively. The mean time interval of receiving a body was 3 weeks from the date of death. Analysis of documents revealed that only 51% deaths had a cause of death (COD) and 18%, 12%, 8% of deaths were suicides, accidents and homicides respectively. 69% of cases revealed a COD after autopsy in Sri Lanka. Majority were related to trauma (40%). Comparison of autopsy reports revealed that our injury detection was much better (p=0.001). CONCLUSIONS: Since many deaths abroad are trauma related, an autopsy examination should be made mandatory in Sri Lanka to resolve problems of insurance and compensation of these migrant workers.
Blood alcohol concentration in motorcycle fatalities reported to a tertiary care hospital in Sri Lanka
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Senarathne, U.D.; Edirisinghe, P.A.S.; Kitulwatte, I.D.G.
BACKGROUND: Motorcycle, the common man’s vehicle in Sri Lanka when crashes is fatal due to its inherent instability and absence of an outside shield to absorb energy during a collision. Managing an unstable vehicle after consuming alcohol, a central nervous system depressant, increases the risk of a fatal collision. Research on motor-cycle fatalities and blood alcohol concentrations has not been reported from Sri Lanka earlier. OBJECTIVES: To describe the contribution of blood alcohol concentrations (BAC) to fatal motorcycle accidents. METHODS: A retrospective descriptive study based on post-mortems of motorcycle fatalities referred to a tertiary care hospital from 2010-2014 was done using a pro-forma. RESULTS: Out of 180 motorcycle accidents reviewed, 166(92%) were riders, 14(8%) were pillion riders. 171(95%) were males and majority (n=142, 79%) were between 20-60 years of age. BAC was requested for 88(49%) and reports were available only for 76(86%) victims. Out of them 34(45%) had BAC >80mg/100ml. The highest BAC reported was 428mg/100ml with the mean value being 104mg/100ml. Cause of death (COD) given for 78(43%) victims was head injury for 69(38%) multiple injuries. Presence of >25 injuries (p=0.028) and COD given as multiple injuries (p=0.029) were significantly associated with BAC >80mg/100ml. CONCLUSIONS: Having BAC >80mg/100ml significantly contributes to the motorcycle rider being subjected to more injuries in a collision. Since less than half the cases were subjected to BAC analysis, actual magnitude of the problem could be greater than illustrated by the study.
A Case of fatal pressure on the neck in a woman with a stab injury
(College of Forensic Pathologists of Sri Lanka, 2011) Kitulwatte, I.D.G.; Pollanen, M.S.
Evidence of pressure on the neck forms a spectrum of degree from minimal to marked. We report a case of fatal pressure on the neck with minimal external signs. A 27 year old woman was found dead in her home. A blood stained knife and a blood stained bathrobe belt with hair entangled in it were discovered at the scene. Autopsy revealed a stab injury to the chest extending to the right lung and multiple contusions to the head, face and extremities. There were petechial haemorrhages on bilateral eyelids and conjunctivae. There were 2 small contusions on the front of the neck. Special neck dissection revealed a small haemorrhage in the sternocleidomastoid muscle and a haemorrhagic fracture of the right superior horn of the thyroid cartilage. Cause of death was given as pressure on the neck in a woman with stab injury to the right chest. Petechial haemorrhages play a major role in confirming the cause of death when there is minimal evidence for application of pressure on the neck.
Case of Sudden Death due to Septic Pulmonary Embolism
(College of Forensic Pathologists of Sri Lanka, 2013) Kitulwatte, I.D.G.; Wijerathne, N.A.S.P.
INTRODUCTION: Sudden deaths in hospital following a short duration of seemingly improving illness arouse suspicion of medical maltreatment. It is mandatory to have a medico-legal investigation in to such deaths. Facts, explanations, and opinions made by the forensic pathologists at the end of an autopsy examination are of crucial importance to eliminate or confirm such doubts. We report how a thorough autopsy examination including ancillary testing can lead to effective administration of justice in such cases. CASE HISTORY: A 42 year woman with diabetes mellitus was admitted to hospital with fever and right knee joint swelling and tenderness of one week’s duration. There was cellulitis over the right knee joint and underlying septic arthritis. Surgical drainage of the joint was done and intra venous antibiotics were given and the condition seemed to be improving. On the 4th day of admission, she developed sudden onset of shortness of breath and central chest pain resulting in death 12 hours later. At autopsy she was pale and icteric. There was evidence of septic arthritis with surrounding necrotizing fasciitis and deep venous thrombosis of the right calf. There was consolidation of the right lung with patchy focal pale yellow areas with surrounding erythema, and evidence of multi-organ sepsis. Microscopy confirmed multi organ involvement and revealed pneumonia of the right lung with early abscess formation and multiple bilateral peripheral septic thrombo emboli. There was septic thrombosis of the calf veins with associated thrombo phlebitis. CONCLUSION: Facts revealed at autopsy explained the sudden death and the possibility of such death was scientifically clarified. The cause of death was concluded as septic pulmonary thrombo embolism due to deep venous septic thrombosis and thrombophlebitis due to septic arthritis and necrotizing fasciitis.
A Case of sudden death following minor intentional trauma; pathologist's contribution to the decision on the manner of death
(Faculty of Medicine,University of Peradeniya, 2012) Kitulwatte, I.D.G.
Sudden death following trauma arouses a huge public interest. This in turn leads the investigators to take stern actions at the outset. Thorough post-mortem examination by a pathologist is an essential part of the medico-legal investigation of such deaths. A seemingly direct violence related death can end up as a natural death at the end of the post-mortem examination1. Similarly there can be limitations to the opinions that can be expressed by the pathologist at the end of the post-mortem examination for forensic pathologists are not Sherlock Holmes. We report a case of a man who died immediately after trauma due to a natural disease.
Child victims in medico-legal autopsy
(College of Forensic Pathologists of Sri Lanka, 2011) Kitulwatte, I.D.G.; Edirisinghe, P.A.S.; Ratnayake, T.
Introduction: Death of a child, particularly a sudden death is an essentially a tragic experience for parents, caregivers and the general public. Medico-legal autopsy is an important solution in many unanswered questions that arises after death. Accurate information about childhood deaths is obligatory to improve child survival. Objective: The aim of the study was to determine the distribution and pattern of various causes of death among the medico-legal autopsy population and to assess the areas where interventional and preventive strategies can be taken place. Study Design: Retrospective descriptive study was done based on reports of post mortems performed on children during past 3 years. The information was gathered on a proforma to fulfill the objectives. The data was analyzed using SPSS statistical package. Results: Majority of children were of the age group of less than 1 year (40%). 49% of the circumstances were unnatural while accidents amount to 39%. Most frequent mechanism of death was asphyxia (31%). Almost 53% of them were caused by mechanical asphyxia due to drowning. There was a significant difference in circumstances of death in infants, children between 1-10 years and those aged over 11 years. Death due to natural conditions was predominant among infants (75%), while 58% of the children aged between 1-10 years died of accidental causes. 56% of children over 11 years died of accidental causes while 16% found to be suicides. 54% incidents of unnatural deaths had taken place at home. Conclusion: Accidental deaths were common among children older than 1year of age while drowning was identified as the leading unnatural cause of death which can be prevented easily. It is high time we consider some precautions and regulations to protect children against accidents, injuries and hazards.
Collective violence
(World Health Organization, 2008) Kitulwatte, I.D.G.; de Silva, S.T.G.R.; Siriwardhane, H.A.
No abstract available
A Comparative study of coronary atherosclerosis in young and old
(Masson Publishing USA, 2015) Kitulwatte, I.D.G.; Pollanen, M.S.
INTRODUCTION: Atherosclerotic coronary artery disease is an important cause of sudden and unexpected deaths in the young people. It is assumed that thrombosis and plaque hemorrhage are commonly associated with sudden deaths from coronary atherosclerosis in the young. In this study, we compared the histological patterns of atherosclerosis in young and old populations to see whether an association exists between the histological pattern of atherosclerosis in the young and thrombosis or plaque hemorrhage. METHODS AND RESULTS: All autopsy cases of coronary atherosclerosis in young people (aged younger than 40 years) in comparison with an equal number of randomly selected older people (older than 65 years) over a period of 4 and a half years in the Provincial Forensic Pathology Unit of the Ontario Forensic Pathology Service in Toronto, Canada, were reviewed to characterize the gross and histologic appearance. There were 28 cases of atherosclerosis in young people ("the young"). Twenty-three (82%) of the young had eccentric atherosclerosis compared with 11 (39%) of the old. An inflammatory response was seen in all 28 (100%) of the young in comparison with 17 (61%) of the old. Thirteen (47%) of the young compared with 3 (11%) of the old had thrombosis, whereas 9 (32%) of the young and 17 (61%) of the old had plaque hemorrhage. Pultaceous debris was the principal component in 11 atherosclerotic plaques (39%) in the young, followed by foam cells in 7 (25%). In the older group, pultaceous debris was the principal component in 18 (64%) followed by dense fibrous tissue in 5 (18%). CONCLUSIONS: The morphology in coronary atherosclerosis of the young is significantly different from the old. Coronary atherosclerosis in the young commonly shows an eccentric distribution with associated inflammation. Thrombosis is commoner among the young, whereas plaque hemorrhage is commoner among the old.
A comparative study of the causes of death given in two forensic institutions (Ragama and Edinburgh) and North Colombo Teaching Hospital: lessons we can learn from others
(Sri Lanka Medical Association, 2007) Edirisinghe, P.A.S.; Perera, B.P.P.; Kitulwatte, I.D.G.
INTRODUCTION: Writing the cause of death (COD) according to the WHO format using the International Classification of Diseases has been the accepted practice in order to create comparable national and international statistics. Objective: To analyse whether the forensic doctors and clinicians in the North Colombo Teaching Hospital (NCTH) and the doctors in the Section of Forensic Medicine, University of Edinburgh adhered to WHO proforma and ICD 10 when formulating COD. And to suggest changes if a need was shown by this study. DESIGN, SETTING AND METHODS: CODs written during a six month period in 2003/2004 were obtained from postmortem reports and counterfoils of declaration of death forms from forensic doctors and clinicians respectively. CODs from the Certificates of COD written by forensic doctors in Edinburgh were obtained during a six months period in 2004/2005. RESULTS: 21% of Edinburgh records (n=252) were found to have one or more errors in the COD, whereas CODs written by forensic doctors in NCTH (n=441) had 45% of errors. The main difference between Edinburgh and NCTH was the use of linking words to imply WHO pro-forma by NCTH forensic doctors. Although the clinicians of NCTH use the format of la, Ib, Ic and 2, 79 %( n=432) of CODs had errors. CONCLUSIONS: High error rate of the Sri Lankan sample was due to many reasons. Medical certification of COD according to WHO pro-forma not being a statutory duty, and the COD given by junior doctors without supervision were major reasons.
Death following ceftazidime-induced Kounis syndrome
(London : Sage, 2017) Kitulwatte, I.D.G.; Gangahawatte, S.; Perera, U.L.M.S.; Edirisinghe, P.A.S.
Kounis syndrome, also known as allergic myocardial infarction or allergic angina syndrome, coincides with chest pain and allergic reactions. It involves the activation of interrelated inflammatory cells following allergic, anaphylactic or anaphylactoid insults. We report a case of Kounis syndrome complicated by an injection of ceftazidime. A 52-year-old man developed shortness of breath and hypotension, leading to immediate unconsciousness, after a ceftazidime injection. Despite intensive care management, he showed no improvement and died approximately 19 h after ceftazidime administration. Autopsy showed massive laryngeal oedema, mucous plugging and collapsed lungs. An ImmunoCAP tryptase assay showed the tryptase level in an autopsy sample to be 118 µg/L (normal < 11.4 µg/L). Microscopy of the myocardium showed cellular infiltration preceding myocardial necrosis. These findings support the pathophysiological theory of Kounis syndrome, with cellular infiltration proposed as the cause of myocardial injury rather than an effect related to the healing process.
Death of a child following a superstitious ritual of exorcism
(Elsevier, 2022) Thivaharan, Y.; Dias, V.; Edirisinghe, A.; Kitulwatte, I.D.G.
Introduction: Diseases, especially those related to the psyche produced by demons, are an accepted belief in many communities. This paper elaborates on the death of a child, a victim of an exorcism ritual, and calls for adequate awareness and preventive measures. Case report: The deceased, a 9-year-old child, was taken by her mother to an exorcist to ’expel a demon from her body. The exorcist caned the child for two days while giving ’water’ to drink. On the second day, the child lost consciousness and was pronounced dead on admission. On direct questioning, it was revealed that the child had been made to consume some medicinal syrups forcefully by the mother and the exorcist. The autopsy revealed multiple abrasions, tram-line contusions and burns on the body. There was mottling and consolidation in the lungs. Blood-stained secretions were found in the trachea, bronchi, and stomach. Musculoskeletal dissection revealed subcutaneous haemorrhages and muscular contusions over the buttocks and limbs. Histology revealed evidence of well-established aspiration pneumonia. There was no other significant pathology, especially no evidence of acute kidney injury due to rhabdomyolysis. Toxicological analysis was negative for common poisons, therapeutic drugs, and heavy metals. The cause of death was concluded as aspiration pneumonia in a child subjected to physical violence. Conclusion: With the forceful feeding of the syrup, the child can have aspiration, resulting in aspiration pneumonia. At the same time, it appears that even after the child became symptomatic, she had not been brought for medical treatment but had continued with the same exorcistic therapy. While the caregivers become responsible for the child’s death, the lessons to be learnt are enormous. Thus, banning such practices against children is a need of the hour.
Death of a man managed for backache following a fall from a height
(Department of Forensic Medicine, Faculty of Medicine at University of Peradeniya, 2018) Kitulwatte, I.D.G.
This case illustrates a death of a man who had fallen from a height and managed for fracture of spine who had ultimately died of an unexpected, under-attended pathology. A 35-year-old previously healthy man had a fall from a height and was admitted to a surgical ward with backache. He was diagnosed to have a fracture of the 12th thoracic and 1st lumbar vertebrae. On the 14th day after the fall he became confused but was not febrile. Condition worsened and he succumbed on the 15th day. Examination of the x-ray spine revealed the “fracture” of the 12th thoracic vertebra. At autopsy a defect in the spine was detected with no associated hemorrhage. There was subcutaneous and muscle contusions of the right sacral area with no associated bony injuries. The kidneys were enlarged, congested, oedematous with multiple abscesses indicating acute pyelonephritis. It may be concluded that other possibilities of back ache unrelated to trauma need to be considered in persons who fall from heights.
Elderly victims dying of unnatural causes: a retrospective descriptive study from Ragama, Sri Lanka
(Department of Forensic Medicine, Faculty of Medicine at University of Peradeniya, 2018) Kitulwatte, I.D.G.; Paranavithana, S.S.; Perera, A.A.B.S.; Edirisinghe, P.A.S.
Even though life expectancy among the elderly has been improving health hazards due to unnatural causes are a significant medical and social issue among this group. The objective was to determine the causes and epidemiological aspects of unnatural deaths in the elderly. A retrospective descriptive study conducted for a period of 3 years, at a tertiary care hospital of Sri Lanka where information was collected from hospital records and post mortem reports of persons above 60 years of age, who died due to unnatural causes revealed that a majority of deaths were due to road traffic accidents of pedestrians.
Ethical dilemmas in forensic medical practice
(Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, 2019) Kitulwatte, I.D.G.; Edirisinghe, P.A.S.
ABSTRACT: Forensic practitioners need to ensure that basic medical obligations towards individual patients, judiciary and the public are met while balancing their responsibilities to these parties. Unlike in clinical practice the patient does not present for treatment but for forensic evaluation. Even so, medical practitioners are expected to ensure that ethical standards like for any other medical discipline are maintained in medicolegal practice. At a forensic medical examination, there is an obligation to act in the best interest of the patient and to attend to his/her critical needs. However, attending to the needs of the patient may be viewed as taking undue interest or being fractional by the judiciary. On the other hand, in medical practice, responsibility to patients should overide the interests of third parties. In examination of the dead for medico-legal purposes, the question that can arise is whether there is actually a doctor patient relationship since the examinee is already dead. While there is a duty towards the judiciary to find out the truth about the cause and manner of death there is a duty towards the relatives of the deceased to reveal the true findings especially after having contact with them at the preliminary inquiry. Many of the conclusions made in forensic practice are matters of opinion, and therefore, disagreement is expected which can lead to personal friction specially in handling cases of medical negligence. If forensic practitioners follow the basic principles of medical ethics, while maintaining the highest standards based on scientific evidence they can overcome the majority of the conflicting issues and can perform their duty in the administration of justice. KEYWORDS: Ethics, Forensic medicine and pathology, Best interest, Doctor patient relationship, Judiciary
An Expert and Expectations: A review on Medico-legal opinions in alleged sexual abuse victims
(College of Forensic Pathologists of Sri Lanka, 2015) Edirisinghe, P.A.S.; Kitulwatte, I.D.G.
INTRODUCTION: An expert’s role is to guide the courts in matters related to a particular speciality. In a case of alleged sexual assault an expert is expected to document the history, examination findings and collect available evidence in order to corroborate accounts of sexual assault for courts of law. However in many instances, the medico-legal evidence has shown its limitations and inconsistencies of expert evidence which are known to result in miscarriage of justice. OBJECTIVE: Find out the strengths and limitations that are encountered by an expert when giving opinions in relation to alleged sexual abuse victims METHODOLOGY: Opinions stated in the Medico-Legal Reports (MLR) sent to courts by the authors during the last decade were analyzed. 20 reports from each age group (0-5, 6-10, 11-16, above 16 years) were randomly selected and the allegations and the opinions were analysed according to a scale developed. RESULTS: Out of 80 reports analyzed majority were females (female to male 10.4: 1). The allegation in all age groups except primary schooling group was penetration of an orifice. In the age group less than 10 (preschool and primary schooling), the medico-legal opinion did not support the allegation in almost half the cases. (support: non support is 1.05:1). In the age group more than 10 years the opinion supported the allegation (4.9:1). There was a statistically significant difference between these two groups. (p:0.001). CONCLUSIONS : when the examinee is less than 10 years of age difficulties arose for the medical expert to express an opinion. The law enforcement authorities and the judiciary should be aware of this limitation and it is important to find other corroborative evidence to support or disprove the given allegations.