与医疗保健相关的凶杀案件在医学法律领域并不新鲜,但是,由于与犯罪有关的物证匮乏,调查通常很困难。出于这个原因,有必要仔细分析临床文件,并利用辅助法医资源,如放射学,组织病理学,和毒理学。在所呈现的场景中,在意大利一级医院对14例异常出血死亡的观察显示,一名护士服用了大剂量肝素.我代表司法机关,一个多学科医疗小组通过以下步骤调查了该病例:全面审查临床文件,挖掘死者的尸体,进行PMCT和尸检,收集组织样本进行组织病理学检查,免疫组织化学,和毒理学调查。所有分析病例的特点是观察到的致命性出血性发作没有用患者的临床状况解释。通过尸检观察和组织学证明证实了病变的活力。然而,由于用于毒理学分析的生物材料的可用性有限,来自住院患者血液学分析的间接证据对于证明肝素过量及其与记录的死亡之间的联系至关重要.目前的情况表明了多学科方法对与医疗保健背景相关的司法利益案件的根本重要性。因此,所说明的方法可以解释为类似未来案例的操作框架。
Healthcare-related homicidal cases are not novel within the medical-legal landscape, but investigations are often made difficult with the scarcity of material evidence related to the crime. For this reason, it is necessary to carefully analyze the clinical documentation and employ ancillary forensic resources such as radiology, histopathology, and toxicology. In the presented scenario, the observation of 14 deaths from abnormal bleeding in a First-Level Italian Hospital revealed the administration of massive doses of heparin by a nurse. On behalf of the Judicial Authority, a multidisciplinary medical team investigated the case through the following steps: a thorough review of the clinical documentation, exhumation of the bodies belonging to the deceased patients, performing PMCT and autopsy, and collecting tissue samples for histopathological, immunohistochemical, and toxicological investigations. All the analyzed cases have been characterized by the observation of fatal hemorrhagic episodes not explained with the clinical conditions of the patients, confirmed using autopsy observations and the histological demonstration of the vitality of the lesions. However, due to the limited availability of biological material for the toxicological analysis, the indirect evidence from hematological analyses in hospitalized patients was crucial in demonstrating heparin overdose and its link to the recorded deaths. The present scenario demonstrates the fundamental importance of a multidisciplinary approach to cases of judicial interest related to the healthcare context. Therefore, the illustrated methodologies can be interpreted as an operational framework for similar future cases.