A Census of Medicolegal Death Investigation in the United States: A Need to Determine the State of our Nation's Toxicology Laboratories and Their Preparedness for the Current Drug Overdose Epidemic.

In 2007, the Bureau of Justice Statistics reported on 2004 data collected from the Census of Medical Examiner and Coroner Offices (CMEC). The CMEC was one of the first comprehensive reports on the state of the medicolegal death investigation system in the United States and included information on administration, expenditure, workload, specialized death investigations, records and evidence retention, and resources. However, the report did not include responses on questions that were related to toxicology such as specimen retention and type of testing. The purpose of this publication is to provide the community with toxicology laboratory-specific responses from nearly 2000 medical examiner and coroner (MEC) offices. Data obtained from a BJS CMEC public use dataset for any remaining information that was not reported in the 2007 BJS report were evaluated specific to the operation of toxicology laboratories within a MEC office or specific to toxicology testing. The CMEC includes information on average operating budget for MEC offices with internal or external toxicology services, budget for toxicology/microbiology services, respondents' routine uses of toxicology analysis, toxicology specimen retention time, average turnaround times, use of computerized information management systems, and participation in federal data collections. These historical data begin to address the present state of our nation's toxicology laboratories within the medicolegal death investigation system and their preparedness for the current drug overdose epidemic.

Newspaper reports from the Coroners Court in Ireland are used to reveal the potential complexity and need for reform in forensic toxicology and medicine services.

Newspapers devote regular space to inquests in the public interest. Accuracy in determining the causes of death is important for public health. Expert opinion features prominently in press reports and is an important channel of public education. How expert are the experts and how complex are apparently simple cases? Toxicology cases involving cannabis and stroke, 'junk food' diet, unexplained sudden death, potential drug interactions, allergy during caesarean section, and ecstacy-type drugs are used to illustrate the complexities. A template for reform is suggested to reform the Coroners Laws in Ireland to recognise the complexity of forensic toxicology and medicine.

Case management in a DUI lab: effect on drugs reported.

An evaluation of an internal laboratory decision to implement a protocol for limiting drug testing based on ethanol concentration in laboratory analysis for driving under the influence (DUI) cases is presented. The described case management strategy is supported by known impairment of ethanol at relatively high concentrations, difficulty assigning a level of contributing impairment from drugs in the presence of high ethanol levels and the likelihood that the drug results may be suppressed at trial. Although the results of this study reinforce the assertion that such protocols lead to the under reporting of drugs in DUI cases, for the majority of cases, 95% in this study, the drug analysis results were not significant and did not warrant the time and resources needed for the additional blood drug testing. Furthermore, the study demonstrated that a high drug positivity rate does not necessarily mean that those drug results are legally or pharmacologically meaningful. Additional research should be conducted with quantitative drug results and casework impact of blood drug screen protocols as previous studies only report drug positivity rates and not whether the drug results would be meaningful to the case.

[Toxicological evaluation in the childhood]. / Evaluación toxicológica del menor.

Intoxications in infancy require urgent medical treatment within national health systems. In our country they represent 0.3% of paediatric urgencies. Most of them are accidental intoxications but is not infrequent to find some related to child abuse or to suicidal intentions, especially in adolescence. The objectives of the study are to evaluate both clinical health care and medical legal aspects in intoxications in infancy. Medical assistance is described and it includes clinical diagnosis, typology of the more common toxics, percentages and referral to social work and emergency care equipment units of the Ministry of Social Welfare and the Department of Health or, where appropriate, directly to prosecutors and courts for their intervention. In cases of detection of alcohol, drugs or medication in infants, the importance of the correct interpretation of the results of toxicological findings is discussed. Several studies for the interpretation of results concerning the detection of these toxics are reported. Both legal aspects and the forensic medical opinion are assessed. The findings will be analysed by the judicial authority in order to circumscribe responsibilities or to take appropriate decisions concerning the protection of infants' interests. In conclusion intoxication in infancy can lead to legal proceedings requiring specific actions for their protection. Both physicians and hospitals must comply with the legal requirement of the submission to the court of judicial parties. On the other hand, this information is an interesting step toward reinforcing public health surveillance.

Evaluación toxicológica del menor / Toxicological evaluation in the childhood

Las intoxicaciones en la infancia requieren la atención médica urgente dentro del sistema sanitario. En nuestro país supone el 0,3% de las urgencias pediátricas. La mayoría son intoxicaciones accidentales, pero no son infrecuentes las relacionadas con el maltrato infantil o las intencionales con finalidad autolítica, especialmente en la adolescencia. Los objetivos del estudio son valorar la intoxicación en el menor en los aspectos clínicos asistenciales y medicolegales. Se valora la asistencia médica que comprende el diagnóstico clínico, el tipo de tóxicos más comunes, su frecuencia y la derivación a las unidades de trabajo social y equipos de asistencia urgente, dependientes de la Consejería de Bienestar Social y Consejería de Salud o, en su caso, la intervención directa de fiscalías y juzgados. Se discute la importancia de la correcta interpretación de los resultados toxicológicos en los casos de la detección en los menores de alcohol, drogas o medicamentos y se describen varios estudios de interpretación de resultados relativos a la detección de estos tóxicos Se valoran los aspectos legales y el dictamen médico forense. Las conclusiones se analizarán por la autoridad judicial a fin de delimitar responsabilidades o tomar decisiones que protejan los intereses del menor. En conclusión, la intoxicación de los menores puede derivar en procedimientos legales que requieran actuaciones concretas para su protección. El envío al juzgado de los partes judiciales es un requisito legal que deben cumplir los facultativos y centros sanitarios. Al mismo tiempo, esta información supone una vía de vigilancia epidemiológica de interés en salud pública (AU)

Intoxications in infancy require urgent medical treatment within national health systems. In our country they represent 0.3% of paediatric urgencies. Most of them are accidental intoxications but is not infrequent to find some related to child abuse or to suicidal intentions, especially in adolescence. The objectives of the study are to evaluate both clinical health care and medical legal aspects in intoxications in infancy. Medical assistance is described and it includes clinical diagnosis, typology of the more common toxics, percentages and referral to social work and emergency care equipment units of the Ministry of Social Welfare and the Department of Health or, where appropriate, directly to prosecutors and courts for their intervention. In cases of detection of alcohol, drugs or medication in infants, the importance of the correct interpretation of the results of toxicological findings is discussed. Several studies for the interpretation of results concerning the detection of these toxics are reported. Both legal aspects and the forensic medical opinion are assessed. The findings will be analysed by the judicial authority in order to circumscribe responsibilities or to take appropriate decisions concerning the protection of infants’ interests. In conclusion intoxication in infancy can lead to legal proceedings requiring specific actions for their protection. Both physicians and hospitals must comply with the legal requirement of the submission to the court of judicial parties. On the other hand, this information is an interesting step toward reinforcing public health surveillance (AU)

Consideraciones toxicológicas sobre supuestos casos de sumisión química en delitos de índole sexual en el sur de España entre los años 2010-2012 / Toxicological considerations on alleged cases of drug facilitated sexual assault in southern Spain between 2010-2012

Introducción. La sumisión química consiste en la incapacitación de la víctima de delitos como violación o robo mediante la administración de sustancias químicas. La obtención de evidencias forenses en este tipo de delitos supone un importante reto para el toxicológo forense. Aunque en los últimos años se han publicado diversos protocolos de actuación con el objetivo de armonizar los procedimientos a seguir frente a estos delitos, se carece en general de datos que reflejen la situación real en los distintos países. Material y métodos. Este trabajo presenta los resultados obtenidos en un estudio retrospectivo realizado en los casos de agresión sexual recibidos en el Departamento de Sevilla del Instituto Nacional de Toxicología y Ciencias Forenses entre los años 2010 y 2012 en los que se sospechaba una posible sumisión química. Se realizó una investigación toxicológica encaminada a poner de manifiesto la presencia de alcohol etílico u otras sustancias psicoactivas. Se determinó también la presencia de semen. Resultados. Más de la mitad de los 73 casos estudiados presentaron resultados negativos, pudiendo considerar, a partir de la información sobre la víctima y los hechos y los resultados obtenidos, únicamente 3 como sumisión química. Conclusiones. Los resultados obtenidos están en consonancia con lo previamente publicado, si bien la evaluación de la situación de los casos de sumisión química en delitos de índole sexual depende del desarrollo y cumplimiento de protocolos de actuación adecuados (AU)

Introduction. Drug facilitated crime consists in incapacitating victims of rape or robbery by administering different chemical substances. Forensic evidence of this type of crime implies an important challenge for the forensic toxicologist. Although different guidelines with the objective of harmonizing existing procedures have been published, there is a general lack of data that could reflect the actual situation in different countries. Material and methods We present here the results obtained in cases of alleged sexual assault received at the Department of Seville of the National Institute of Toxicology and Forensic Sciences between 2010 and 2012, in which a possible drug facilitated sexual assault was suspected. A toxicological investigation designed to determine blood alcohol concentration and to establish the presence of psychoactive substances and drugs of abuse was performed. Semen presence was also determined. Results More than half of the 73 studied cases yielded negative results. From the received information and obtained results we could only classify 3 of the cases as a drug facilitated sexual assault. Conclusions. Obtained results are similar to those previously published, although the assessment of the current status of alleged cases of drug facilitated sexual assault depends on the development and implementation of appropriate protocols (AU)

Sumisión química en casos de presuntos delitos contra la libertad sexual analizados en el Instituto Nacional de Toxicología y Ciencias Forenses (Departamento de Madrid) durante los años 2010, 2011 y 2012 / Alleged drug-facilitated sexual assault cases analyzed at the National Institute of Toxicology and Forensic Science (Madrid Department) during the years 2010, 2011 and 2012

Introducción. La sumisión química en relación con los delitos contra la libertad sexual se puede aplicar tanto a los casos de administración subrepticia de determinadas sustancias, como a los casos oportunistas por una mayor vulnerabilidad de la víctima debido al consumo voluntario de las mismas. Material y métodos. Se ha realizado un estudio descriptivo retrospectivo de los casos de agresiones sexuales relacionados con el consumo de sustancias químicas, remitidos durante los años 2010, 2011 y 2012 al Departamento de Madrid del Instituto Nacional de Toxicología y Ciencias Forenses. Se ha recogido información en relación con el perfil de la víctima, el tipo de muestras biológicas remitidas y los resultados toxicológicos. Resultados. De los 306 casos de agresión o abuso sexual remitidos, 107 han cumplido los criterios de inclusión. El perfil de la víctima es el de una mujer española o latinoamericana joven (edad media: 25,9 años), que admite consumo de alcohol previo al episodio, y que sufre de amnesia total o parcial de los hechos. Las muestras remitidas han sido sangre (27,1%), orina (14%) o ambas (57%). El análisis toxicológico ha sido positivo en el 87,9% de los casos, y las sustancias identificadas han sido etanol (61,7%), fármacos (40,2%, fundamentalmente benzodiacepinas) y drogas ilícitas (27,1%, fundamentalmente cocaína), solas o en combinación. Conclusiones. El estudio refleja la necesidad de trabajar en prevención e información de potenciales víctimas y personal sanitario, que una temprana y adecuada toma de muestras son factores claves a la hora de confirmar el diagnóstico, y que las sustancias detectadas, lícitas e ilícitas, pertenecen a un patrón de consumo frecuente en nuestra sociedad (AU)

Introduction. Drug-facilitated sexual assault crimes can be applied in cases of covert administration of certain substances, as well as cases in which the victim voluntarily consumes these same substances. Materials and methods. This study describes retrospectively cases of sexual assault related to the consumption of chemical substances. They were reported to the Madrid Department of the National Institute of Toxicology and Forensic Sciences during 2010, 2011 and 2012. We collected information related to the victim's profile, the type of biological samples given and the results of the toxicological analysis. Results. Out of 306 cases of sexual assault or abuse referred, 107 have met the inclusion criteria. The victim's profile is of a young Spanish or Latin-American woman (mean age: 25.9 years) who admits to consuming alcohol prior to the episode and suffering from total or partial amnesia with regard to the facts. The given samples were blood (27.1%), urine (14%) or both (57%). Toxicological analysis was positive in 87.9% of cases and the substances identified were ethanol (61.7%), pharmaceuticals (40.2%, mainly benzodiazepines), and illicit drugs (27.1%, primarily cocaine) either alone or in combination. Conclusions. This study reflects the requirement to work in prevention and training of potential victims and healthcare personnel, proves that an early and adequate collection of samples are key factors to confirm the diagnosis and identifies that detected licit or illicit substances belong to a frequent consumption pattern (AU)

Criterios cuantitativos en toxicología forense / Quantitative criteria in forensic toxicology

La toxicología forense requiere resultados analíticos científicamente indiscutibles y legalmente defendibles. Disponer de datos analíticos fiables es indispensable para interpretar correctamente los resultados toxicológicos. Los criterios analíticos en toxicología forense, basados en las normativas y recomendaciones vigentes son proporcionados por prestigiosos organismos de ámbito internacional y local, y su cumplimiento es fundamental para obtener resultados toxicológicos científicamente sólidos. Este trabajo supone una continuación en la revisión y evaluación de los criterios analíticos en toxicología forense, iniciada con el anterior trabajo recientemente publicado en esta revista «Criterios cualitativos en toxicología forense». Su objetivo es contribuir a la calidad de la pericia y al avance en la unidad de criterio científico, aspectos cruciales en toxicología forense. Este trabajo revisa, evalúa y recopila los criterios para una correcta cuantificación detallándose los requisitos para validar las metodologías. Además, pretende servir a aquellos profesionales que deban evaluar resultados toxicológicos emitidos por laboratorios forenses (AU)

Forensic toxicology requires indisputable and legally defensible analytical results. Reliable analytical results are essential for the accurate interpretation of toxicological findings. Analytical criteria in forensic toxicology —based on the regulations and recommendations— are provided by prestigious international and local organizations, and their fulfilment is essential to achieve toxicological results based on solid scientific foundations. This work is a continuation of the review and assessment of analytical criteria in forensic toxicology, started with the recently published work in this journal «Qualitative criteria in forensic toxicology». It is aimed at contributing to the quality of the expert witness report and implementing common scientific criteria, both crucial aspects in forensic toxicology. The criteria necessary for an accurate quantification are reviewed, assessed and compiled in this work, detailing the requirements to validate methodologies. Moreover, this work is intended to serve those professionals who need to assess toxicological findings submitted by forensic laboratories (AU)

Estrategias para la disminución y gestión del error humano en Toxicología Forense / Strategies for reduction and management of human error in forensic toxicology

La práctica de la toxicología forense, como cualquier otra actividad humana nunca está libre de errores. Se define al error humano en toxicología forense como cualquier acción o falta de la misma que condujera a un incumplimiento de unas tolerancias previamente definidas para un sistema analítico de medida. En ese sentido, los errores humanos son los responsables de la mayoría de los incidentes y accidentes que ocurren en un laboratorio. Los tipos de errores que se producen en un laboratorio son los relacionados con el operador, los relacionados con la tecnología e instrumentación y los errores relacionados con el método analítico. Los sistemas de calidad están diseñados para lograr una reducción de los eventuales errores que se puedan cometer en un laboratorio. La principal norma de aplicación a los laboratorios forenses es la UNE-EN ISO/IEC 17025:2005. Además, se dispone de las recomendaciones de la ILAC y de distintas organizaciones profesionales. Se discute en el presente trabajo como la implantación de un sistema de calidad y un modelo sistemático de gestión de errores en los laboratorios de toxicología forense puede conducir a una mayor fiabilidad de los resultados y un mejor servicio a la Administración de Justicia. Se propone la implantación en los laboratorios de una cultura de calidad que promueva la aceptación del error humano como algo inherente a nuestra condición sin que por ello desarrolle una indiferencia ante la aparición de los mismos (AU)

As any other human activity, forensic toxicology is never free of errors. A human error in forensic toxicology would be any action or lack of it leading to a breach of predefined tolerances for an analytic measurement system. Moreover, human errors are responsible for the majority of incidents and accidents that occur in a laboratory. The types of errors that occur in a laboratory are operator-related, technology-related and errors associated with the analytical method. Quality systems are designed to achieve a reduction of potential errors that may be committed in a laboratory. The standard applied to forensic laboratories is the UNEEN ISO/IEC 17025:2005. Forensic laboratories have also available ILAC and professional organizations guidelines. This paper presents the implementation of a quality system and model systematic of error management in forensic toxicology laboratories as the best way to obtain reliable results and achieve a better service to Justice Administration. The implementation of a culture of quality in the laboratories is proposed. Such culture must promote the acceptance of human error as inherent to our condition without developing an indifference to them (AU)

Requesting toxicological specimens from tissue procurement organizations.

Opinions based on toxicology results are dependent, in part, upon the quality of the specimen's acquisition, storage, and chain of custody. The responsibility for these factors is often delegated to tissue and eye bank technicians. These technicians are not employees of the medical examiner (ME)'s office and may have no documented training related to the proper acquisition and handling of retained toxicology specimens. Medical examiners and coroners often request tissue recovery technicians to provide them with these toxicology samples when the tissue recovery is performed before autopsy. This practice helps facilitate donation and is convenient for the ME, but there may be unexpected implications for both the technicians and the ME that deserve further consideration. This article highlights the relevant issues in the postmortem recovery of biological samples for toxicology analysis and makes recommendations for the practice.

Criterios cualitativos en toxicología forense / Qualitative criteria in forensic toxicology

La toxicología forense requiere resultados analíticos científicamente indiscutibles y legalmente defendibles. Los criterios cualitativos son proporcionados por prestigiosos organismos de ámbito internacional y local. Este trabajo revisa y evalúa los documentos elaborados por ellos, con el fin de recoger en uno solo las distintas directrices existentes. El objetivo es contribuir a la calidad de la pericia y al avance en la unidad de criterio científico, aspectos cruciales en toxicología forense para obtener resultados toxicológicos científicamente sólidos. Se discuten los criterios necesarios para una correcta detección e identificación, detallándose las estrategias de detección y los requisitos para validar las metodologías. Respecto a la identificación, se reconoce la importancia de la espectrometría de masas, y también se hace referencia a los criterios relativos a las técnicas analíticas y a los tóxicos. Esta revisión y recopilación pretende además, servir a aquellos profesionales que deban evaluar los resultados toxicológicos emitidos por los laboratorios forenses(AU)

Forensic toxicology requires indisputable and legally defensible analytical results. The qualitative criteria are provided by prestigious international and local organizations. This work reviews and evaluates them to gather in one document these different existing guidelines. The aim of this work is to contribute to the quality of the expertise and to implement the common scientific criteria. Both aspects are crucial in forensic toxicology to achieve toxicological results based on solid scientific foundations. The criteria, to be taken into consideration, for a correct detection and identification are discussed. The strategies for detection and the requirements for validation of these methodologies are detailed. The importance of mass spectrometry, as the most reliable technique for identification, is recognized. The criteria for analytical techniques and for toxics are also detailed. Moreover, this review and compendium of criteria try to serve those professionals who need to evaluate the toxicological findings submitted by the forensic laboratories(AU)

[On the problem of informational support of scientific research in the field of forensic (toxicological) chemistry].

The present work was designed for the analysis of informational support of scientific research in the field of forensic (toxicological) chemistry in this country during the period preceding the collapse of the Soviet Union and in present-day Russia. The established channels of transmission of relevant information are characterized. Recommendations for the further development of the work in this sphere and its improvement are proposed.

Panorama educativo Europeo para la formación de los toxicólogos forenses / European educational overview for the training for forensics toxicologists

La singularidad de los Laboratorios Forenses así como la trascendencia de los resultados que emiten, requiere una labor especializada para la que es indispensable que los recursos humanos e instrumentales sean los adecuados y garanticen su continuidad y adecuación en el tiempo. La formación básica en Toxicología, que comparten diferentes licenciaturas, han adaptado los planes docentes a la nueva concepción de la docencia en el Espacio Europeo de Educación Superior con el objetivo en el pregrado de introducir al universitario en los aspectos más importantes de la Toxicología siguiendo en el postgrado las ramas especificas entre las que se encuentra la Toxicología forense (AU)

Educational overview for the training for forensics toxicologists. The uniqueness of Forensic Laboratories and the significance of their results require a specialized task for which it is essential that human and material resources are adequate and also capable of ensuring their continuity and adaptation over time. Basic training in Toxicology, it is shared by different degrees, have adapted teaching plans to the new concept of teaching in the European Higher Education Area with the objective of introducing the under graduate degree in toxicology ́s most important aspects. Postgraduate studies are focused on more specific issues such as forensic Toxicology (AU)