The clinical legal medicine: a need for quality of care and patient’s safety. A single center five-year experience

Main Article Content

Matteo Bolcato
Marianna Russo
Matteo Sanavio
Daniele Rodriguez
Anna Aprile

Keywords

Clinical legal medicine; medico legal advice; medico-legal evaluation; patient’s safety.

Abstract

Introduction. Clinical legal medicine is a branch of legal medicine that takes place in a clinical setting approaching the patient’s bedside and using a particular attention not only for conceptual or normative references but also for every possible medical and social aspect.


Material and methods. The requests of medico-legal opinions received by the Department of Legal Medicine of a large university hospital were retrospectively collected over a 5-years period. The analysis focused on the recurrence rate of the requests and the most common medico-legal issues to be solved in a clinical context, differentiating between adult and minor patients.


Results. The collected medico-legal advices amounted to 448. The most clearly involved clinical area was Medicine (54%) followed by Gynecology and Obstetrics (15.6%), Pediatrics and Surgery (10.7%). The requests concerning patient’s self-determination in therapeutics choices, including refusal of proposed treatments, covered almost one-half of total casuistry. The designation of support administrator represented also a relevant issue (20.5%). In case of minors, the queries related to reporting crimes were three times higher than in adults, while the appointment of a support administrator was never requested.


Conclusion. Clinical legal medicine, through medico-legal advices, plays a primary role in contributing to the safeguarding of health and to the decision-making process of clinicians.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...
Abstract 78 |

References

[1] Sacchetta A. La Medicina Legale nelle U.S.L. Riv It Med Leg 1981;3:742–56.
[2] Cazzaniga A. Programma di Medicina Legale. Milano: Ed. Arti grafiche Calamandrei; 1937.
[3] Beran RG. What is legal medicine – Are legal and forensic medicine the same? J Forensic Leg Med 2010;17(3):137–9.
[4] Benciolini P. La “Medicina Legale Clinica”. Riv It Med Leg 2005;3:451–9.
[5] Giusti G. Medicina legale. Padova: Cedam; 1985.
[6] Carlini L. Le funzioni medico-legali delle Aziende-Unità Sanitarie Locali. In: Giusti G (Ed). Trattato di Medicina Legale e scienze affini. Padova: Cedam; 1998.
[7] Russo M, Rosa Rizzotto M, Giolito M, Ranzato C, Facchin P, Aprile A. Genital trauma and vaginal bleeding: is it a lapse of time issue? A case report of a prepubertal girl and review of the literature. Int J Legal Med 2017;131(1):1885-9.
[8] Sfriso F, Masiero S, Mardegan V, Bressan S, Aprile A. Reflex anal dilatation: An observational study on non-abused children. Forensic Sci Int 2014; 238:22-5.
[9] Aprile A, Ranzato C, Rizzotto MR, Arseni A, Da Dalt L, Facchin P. "Vaginal" bleeding in prepubertal age: a rare scaring riddle, a case of the urethral prolapse and review of the literature. Forensic Sci Int 2011; 210(1-3):e16-20.
[10] Aprile A, Pomara C, Turillazzi E. Gua Sha a traditional Chinese healing technique that could mimick physical abuse: a potential issue with forensic implications. A case study. Forensic Sci Int 2015;249:e19-20.
[11] Aprile A, Benciolini P. Il ruolo della Medicina Legale clinica nell’amministrazione di sostegno: prime esperienze casistiche. Riv It Med Leg 2005;1:89–103.
[12] Turillazzi E, Di Paolo M. Emergency contraception in adolescents. A grey area in Italian legislation. Eur J Contracept Reprod Health Care. 2018;23(3):237-241.
[13] Bolcato M, Fassina G, Rodriguez D, Russo M, Aprile A. The contribution of legal medicine in clinical risk management. BMC Health Serv Res. 2019;19(1):85.
[14] Di Paolo M, Gori F, Papi L, Turillazzi E. A review and analysis of new Italian law 219/2017: “provisions for informed consent and advance directives treatment”. BMC Med Ethics 2019;20(1):17.
[15] Farmer SL, Trentino K, Hofmann A, Semmens JB, Mukhtar SA, Prosser G et al. A Programmatic Approach to Patient Blood Management – Reducing Transfusions and Improving Patient Outcomes. The Open Anesthesiology Journal 2015;9:6-16.
[16] Vaglio S, Gentili S, Marano G, Pupella S, Rafanelli D, Biancofiore G et al. The Italian Regulatory Guidelines for the implementation of Patient Blood Management. Blood Transfus 2017;15(4):325-8.
[17] Franchini M, Marano G, Veropalumbo E, Masiello F, Pati I, Candura F et al.. Patient Blood Management: a revolutionary approach to transfusion medicine. Blood Transfus 2019;17(3):191-5.
[18] Report ISTAT 2018. Il Futuro Demografico del Paese. Previsioni regionali della popolazione residente al 2065 (https://www.istat.it/it/files/2018/05/previsioni_demografiche.pdf).
[19] Fineschi V, Frati P, Aprile A, Bellandi T, Bolcato M, Cingolani M et al. La lettura medico-legale della legge 24/2017: tra sicurezza delle cure e della persona assistita e nuovi profili di valutazione comportamentale degli esercenti le professioni sanitarie. In Gelli F, Hazan M, Zorzit Daniela (Eds.). “La nuova responsabilità sanitaria e la sua assicurazione”. Milano: Giuffrè Editore; 2017.