Browsing by Author "Edirisinghe, P.A.S."

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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
Alcohol consumption and tobacco smoking in an urban adult Sri Lankan population
(Sri Lanka Medical Association, 2008) Kasturiratne, A.; Pinidiyapathirage, M.J.; Perera, H.K.K.; Fernando, E.D.P.S.; Ranasinha, C.D.; Edirisinghe, P.A.S.; Makaya, M.; Kato, N.
BACKGROUND: Data on the prevalence and patterns of alcohol consumption and smoking in the general population in Sri Lanka are scarce. Objective: To describe patterns of alcohol use and smoking in an urban adult population in Sri Lanka. DESIGN, SETTING AND METHODS: A random sample of the general population aged between 35-65 years, resident in the Ragama Medical Officer of Health area was interviewed to obtain drinking and smoking habits. RESULTS: Among 2985 subjects [males 45.5%; mean age 52.7 years (SD7.8)], 1156(39.7%) reported ever use of alcohol, and 892(29.7%) reported current use. 58.8% of males and 5.7% of females were current drinkers. 190(14%) males and 12(0.7%) females consumed alcohol above the weekly safe limit (>14 units for males, >7 units for females). The median duration of alcohol use among ever users was 18 years (interquartile range 10-25), and current users was 20 years (interquartile range 1,0-25). The commonest type of alcohol consumed was arrack (n=492), followed by beer (n=217). 60.2% of males and 2.1% of females reported ever smoking, 483(16.2%) were current smokers. 35.1% of males and 0.5% of females were current smokers. The median duration of smoking was 20 years among both ever smokers (interquartile range 10-27.3), and current smokers (interquartile range 15-30). Most (55.3%) smoked cigarettes, only 36(4.2%) smoked beedi. The median pack years of current smokers was 4,5 (interquartile range 2-10). CONCLUSION: Lifetime and current use of alcohol and smoking are high among males. Focused interventions are required to reduce current rates among males and to maintain low rates reported by females.
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 Cafe coronary death due to a banana
(Faculty of Medicine, University of Peradeniya, 2010) Edirisinghe, P.A.S.
Café Coronary syndrome which was first reported as sudden collapse at restaurants while dining was found to be due to fatal occlusion of upper airway by large pieces of food. Many of those individuals had consumed large amounts of alcohol prior to the incident. However, same condition has also been noticed among institutionalized elderly with dementia and psychiatric conditions. This is an un-witnessed death of a café coronary syndrome , where a 70 year old man after having dinner with his children previous night found dead next day morning in his bed. At autopsy a blob of mucoid secretions were found at right nostril and a piece of banana weighing 21g was found impacted within the laryngophrarynx, occluding the air way. He was edentulous. This case highlights the need of being aware of the condition especially in the elderly with mastication problems due to lack of teeth and other deglutition problems.
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.
A comparative descriptive study on adolescents presented to Ragama and Anuradhapura Teaching Hospitals for medico-legal examination with a history of 'sexual activity'
(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Edirisinghe, P.A.S.; Perera, W.N.S.; Paranithran, P.; Perera, B.P.P.; Samarasekera, A.; Waidarathna, M.D.; Jayasena, A.S.
INTRODUCTION: Adolescents engaged in sexual activity are brought for medico-legal examination as they are minors. Though some have consented for sexual activity, it is not legally acceptable. The perpetrators include boyfriends, relatives, known persons and strangers. The 'boyfriend' group is unique as the consent is not obtained by illegal means. OBJECTIVE: To find out potential predisposing factors that contribute to 'consensual' or 'non consensual' sexual activity of adolescents and to find out how 'consensual' and 'non consensual' sexual activity affects sexual health of adolescents. METHODS: A retrospective descriptive study was done using records maintained at the offices of the Judicial Medical Officers of Ragarna and Anuradhapura. The data was analyzed using SPSS statistical package. RESULTS: 202 and 154 victims examined between 2000 to 2006 at Ragama and Anuradhapura were analyzed. Male to female ratio was 1:10 in Ragama and 1:24 in Anuradhapura. The most vulnerable age group for sexual activity was 14-15 years. The majority of cases were from the low socio-economic strata. Vaginal intercourse was the most preferred sexual activity; the likelihood of an adolescent from Anuradhapura to have penetrative sex was 2.47 times more as compared to an adolescent from Ragama. Boyfriend was the assailant in 39% and 37% of cases in Ragama and Anuradhapura respectively. 63 % of victims from Ragama had eloped as compared to 19% from Anuradhapura. In both groups, nearly half of the cases had a relationship less than 6 months. An adolescent having sexual activity with a relative was 2.31 (95% CI 1.36-3.93) times greater in Anuradhapura as compared to Ragama. There were 18 and 16 pregnancies in Ragama and in Anuradapura, respectivly. 61 cases from Ragama had psychological symptoms and signs after the incident. CONCLUSIONS: Adolescents are more susceptible to engage in sexual acts around 14 years. Consented sexual activity with a boy friend resulting in legal action is a significant social problem. The high incidence of sexual activity with relatives and known persons indicate the vulnerability of adolescents to engage in sexual activity in their own environments.
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.
Dengue viral myositis complicated with Rhabdomyolysis and superinfection of Methicillin-resistant Staphylococcus aureus
(Hindawi Pub. Corp, 2013) Sunderalingam, V.; Kanapathipillai, T.; Edirisinghe, P.A.S.; Dassanayake, K.M.M.P.; Premawansa, I.H.G.S.
Dengue is endemic in Sri Lanka and the physician should be aware of different and unusual presentation of the illness. Rhabdomyolysis is a well-known complication following many viral and bacterial infections; however, only a few cases have been reported with dengue viral infections. Further occurrence of coinfection by dengue and bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) has been underestimated, and few reports have been published so far. This case describes a 17-year-old boy who presented with prolonged severe myalgia, dark red urine, and a febrile illness that was diagnosed as having dengue viral myositis, dark red urine, and a febrile illness that was diagnosed as having dengue viral myositis complicated with rhabdomyolysis and super infection of MRSA. Despite intensive care management, he died due to multiorgan failure. Autopsy and serological studies confirmed the diagnosis. This case stresses that red-coloured urine in dengue patients is not always due to haematuria, and if a patient's vital signs do not respond to appropriate fluid management in DHF, sepsis from a secondary pathogen including MRSA should be suspected.
Elder abuse among out patient department attendees in a tertiary hospital
(Sri Lanka Medical Association, 2009) Edirisinghe, P.A.S.; Paranitharan, P.; Perera, W.N.S.; Shehan, W.
BACKGROUND: Abuse of older people is a hidden problem in society. Older people are frightened or embarrassed to report its presence. The extent of the problem is not studied adequately in Sri Lanka. METHODS: A cross sectional descriptive study was conducted at the North Colombo Teaching Hospital, outpatient department on 530 consecutive adults over 60 years of age. The Hwalek-Sengstock Elder abuse screening test which was assessed for face validity and content validity among 50 older persons and modified, was used for data collection along with a brief demographic questionnaire. Those with a mini-mental state examination score of 23 or less were excluded from the study. Data was collected by trained medical officers after informed written consent from the subjects. Confidentiality of the information provided was assured. RESULTS: 348 females (65%) and 182 males (35%) were included in the study. The mean age was 68.5 years. 26 (5.6%) reported physical abuse of whom 14 (2.6%) had been struck, slapped or kicked and five had received medical attention for injuries. Three had made a Police complaint. Up to 136 (25%) had perceived emotional abuse. 53 (10%) had experienced derogatory remarks and 12 (2. 3%) had been threatened with punishment and institutionalisation. 20 (3.7%) claimed neglect and 116 (22%) claimed their caregiver was financially dependent on them. There was no significant difference among the sexes. CONCLUSIONS: Physical, emotional and financial abuse of elders is present in our study population. The numbers although small, may represent only the tip of the iceberg.
Elder abuse among outpatient department attendees in a tertiary care hospital in Sri Lanka.
(Sri Lanka Medical Association, 2014) Edirisinghe, P.A.S.; Paranitharn, P.; Perera, W.N.S.; Williams, S.S.
OBJECTIVES: Abuse of older people is a hidden problem. Some believe that it is less in Asian societies as the extended family is a protective factor. The real extent of the problem however, is not researched adequately in Sri Lanka. METHODS: A cross sectional descriptive study was conducted at the North Colombo Teaching Hospital on 530 consecutive adults above 60 years of age attending the out-patient department. The Hwalek-Sengstock elder abuse screening test with modifications to address socio-cultural differences was administered. A brief demographic questionnaire and questions on past and present abuse were also included. RESULTS: Out of 530 elders studied, 32 (6%) were above 80 years of age and the mean age was 68.5 years. Male to female ratio was 1:2. Abuse, either physical, psychological, verbal or neglect was reported by 239 (45%) elders. Physical abuse was reported by 5.6%. The screening test revealed that the study population was vulnerable to psychological and financial abuse. Total overall rate of abuse was 38.5%. Loneliness was reported by 26%. Of the caregivers, 22% were financially dependent on the elders. Having more than three children was a risk factor for psychological and financial abuse and being single was a risk factor for psychological abuse. CONCLUSIONS: Physical, emotional and financial abuse of elders were reported in our study population. A limitation of this study was that it studied elders who sought treatment at a tertiary care hospital. Community studies will be needed to establish the true prevalence of elder abuse.
Elder abuse--a wake up call
(Sri Lanka Medical Association, 2009) Paranitharan, P.; Edirisinghe, P.A.S.; Williams, S.
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.
Extreme violence-homicide; an analysis of 265 cases from the offices of JMO Colombo and Ragama--a study from Sri Lanka
(Elsevier Science Ireland Ltd, 2009) Edirisinghe, P.A.S.; Kitulwatte, I.D.G.
Violence in a society can be categorized into many areas such as interpersonal violence, domestic violence, violence against children, violence of human rights, violence due to wars etc. The most extreme form of violence is killing of another human. To study whether the underlying reasons (motives) for killing has a relationship to the methods employed for killing. A retrospective descriptive study based on autopsy reports, magistrate orders and case notes attached was carried out on all the cases examined at the office of the JMO Colombo and Ragama from July 2005 to June 2006. The data were analyzed using SPSS statistical package. Out of 265 autopsy examinations alleged to be homicides, 39% of deaths were related to terrorist acts while previous enmity was recorded in 35% of cases. The commonest method of homicide was firearms (31%) while explosives recorded the second highest (28%). Blunt force and sharp force trauma were the reasons for 23% and 14% of homicides respectively. Almost all the deaths related to war was caused by firearms and bombs (96%) where as 47% of previous enmity deaths were caused by firearms. Firearms were never used in homicides of sudden provocation or drunken brawls. The increased use of firearms was not only seen in terrorism related homicides, but also in homicides related to previous enmity. Further research is needed in this area as to why it occurs despite having a tight firearm policy in Sri Lanka.