'A big nebulous, multifaceted concept': reflections from Victorian personal injury lawyers on wellbeing, burnout and vicarious trauma.

There is a spotlight on mental health, with government initiatives in Australia highlighting the importance of, and need for, greater focus on psychological wellbeing and on addressing psychosocial hazards at work. The growing body of evidence in Australia and internationally suggests that the mental health and wellbeing of lawyers is adversely affected by their work. This cross-disciplinary evidence highlights the need for mental health concerns to be addressed systemically to prevent psychosocial injury and for tailored, proactive psychological support services in the legal environment. In this article we present evidence derived from qualitative interviews with Victorian personal injury lawyers, which form part of a broader study of lawyers and mediators engaged in emotion-laden work. This study aimed to ascertain to what extent the legal system considers the emotional wellbeing and mental health needs of personal injury disputants, lawyers and mediators, identify ways to reduce stigma associated with help seeking and inform proactive prevention initiatives and tailored support services. Findings from this build on past research and continue to highlight themes around stigma, vicarious trauma and collegial support and call attention to the psychological impact of legal practice on Australian lawyers. From this, preventative measures can be developed and implemented to avoid psychosocial injury and provide much-needed specialised support services.

Widening the net: Use of social media data in personal injury and disability evaluations.

A central tenet of forensic mental health assessment is the use of multiple sources of data. Traditionally, these sources have included clinical interviews with and observations of the examinee, written records review, psychological test data, and interviews with collateral sources. Data from social media and social networking sites (SNS) is now widely used in civil litigation. However, existing professional practice standards and guidelines do not specifically address the use of SNS data. This leaves forensic mental health evaluators with little guidance as to why, when and how to incorporate SNS data into their evaluations. We review the extant literature on the use of SNS and other social media data in personal injury and disability cases, including legal, ethical, and practical considerations, with the goal of providing forensic mental health practitioners with a framework for making decisions about when and how to incorporate these data into their evaluations and opinions. We advocate caution in conducting independent searches of social media and the Internet, and in making inferences about internal states based on SNS postings. To illustrate these points, we include a case study.

A Guide for Physicians Serving as an Expert Witness for Personal Injury Cases and Other Litigations.

PURPOSE OF REVIEW: To provide a guide for physicians serving as an expert witness in all kinds of cases. RECENT FINDINGS: Different societies proposed different guidelines for physicians serving as an expert witness. We wanted to summarize all recommendations in our article to provide a comprehensive guide to all physicians from different specialties. There is some overlap in recommendations, and it is important for physicians from different specialties to be aware of all recommendations proposed. It is very important for any health care provider who serves as an expert witness for personal injury or other cases to understand the guidelines around this process and best practices.

Legal Theories, Disability Models and Principles of Disability Assessment.

In the personal injury compensation system, the protection and relief of the injured people's rights to life, rights to health, and body rights are generally based on the results of disability assessment. Over the years, with the increased number of personal injury compensation cases, the practice of disability assessment have been greatly developed, and the development of disability assessment standards tends to be mature. However, the lack of basic theories for disability assessment has seriously affected the construction and unification of standards. Starting from the tort legal system of personal injury compensation, this article systematically analyzes the legal theories of disability assessment, and holds that the loss of labor ability is the legal basis for disability assessment in China, and the essence of disability assessment should be understood as the quantitative assessment of an individual's permanent loss of labor ability. This article combines the international disability assessment models and the primary concepts of American Medical Association's Guides to the Evaluation of Permanent Impairment to refine the basic concepts of disability assessment in China, such as impairment, disability, handicap, disabled people and self-care ability, etc. At the same time, it sorts out the critical issues of identification time, promotion principles and compound calculation of multiple injuries in disability assessment. It is expected to be beneficial to the theory and practice of disability assessment in personal injury compensation.

What is the potential of compensation funds for addressing COVID-related personal injury?

The COVID-19 pandemic continues to present new challenges at the frontiers of social risk. Its significant societal impact has prompted the consideration of alternative frameworks like compensation funds to better allocate the risks and impacts of COVID-related injury. Although there has been discussion about the potential of alternative liability structures for vaccine-related injury, there has been less analysis of the right way to compensate other types of injury, such as long-term illness, disability and death, associated with the SARS-CoV-2 virus. In France, a universal compensation fund for COVID-19-related injuries, designed similarly to asbestos-related schemes, was considered by the parliament. With an eye on scientific knowledge of the best practice in the development and operation of compensation frameworks, this paper analyses the design of such funds in Europe as applied to COVID-19 injury and considers the position of compensation funds in relation to tort law, private insurance and social security models.

Legal Theories, Disability Models and Principles of Disability Assessment / 法医学杂志

In the personal injury compensation system, the protection and relief of the injured people's rights to life, rights to health, and body rights are generally based on the results of disability assessment. Over the years, with the increased number of personal injury compensation cases, the practice of disability assessment have been greatly developed, and the development of disability assessment standards tends to be mature. However, the lack of basic theories for disability assessment has seriously affected the construction and unification of standards. Starting from the tort legal system of personal injury compensation, this article systematically analyzes the legal theories of disability assessment, and holds that the loss of labor ability is the legal basis for disability assessment in China, and the essence of disability assessment should be understood as the quantitative assessment of an individual's permanent loss of labor ability. This article combines the international disability assessment models and the primary concepts of American Medical Association's Guides to the Evaluation of Permanent Impairment to refine the basic concepts of disability assessment in China, such as impairment, disability, handicap, disabled people and self-care ability, etc. At the same time, it sorts out the critical issues of identification time, promotion principles and compound calculation of multiple injuries in disability assessment. It is expected to be beneficial to the theory and practice of disability assessment in personal injury compensation.

Factors associated with long term work incapacity following a non-catastrophic road traffic injury: analysis of a two-year prospective cohort study.

BACKGROUND: Road traffic injuries (RTIs), primarily musculoskeletal in nature, are the leading cause of unintentional injury worldwide, incurring significant individual and societal burden. Investigation of a large representative cohort is needed to validate early identifiable predictors of long-term work incapacity post-RTI. Therefore, up until two years post-RTI we aimed to: evaluate absolute occurrence of return-to-work (RTW) and occurrence by injury compensation claimant status; evaluate early factors (e.g., biopsychosocial and injury-related) that influence RTW longitudinally; and identify factors potentially modifiable with intervention (e.g., psychological distress and pain). METHODS: Prospective cohort study of 2019 adult participants, recruited within 28 days of a non-catastrophic RTI, predominantly of mild-to-moderate severity, in New South Wales, Australia. Biopsychosocial, injury, and compensation data were collected via telephone interview within one-month of injury (baseline). Work status was self-reported at baseline, 6-, 12-, and 24-months. Analyses were restricted to participants who reported paid work pre-injury (N = 1533). Type-3 global p-values were used to evaluate explanatory factors for returning to 'any' or 'full duties' paid work across factor subcategories. Modified Poisson regression modelling was used to evaluate factors associated with RTW with adjustment for potential covariates. RESULTS: Only ~ 30% of people with RTI returned to full work duties within one-month post-injury, but the majority (76.7%) resumed full duties by 6-months. A significant portion of participants were working with modified duties (~ 10%) or not working at all (~ 10%) at 6-, 12-, and 24-months. Female sex, low education, low income, physically demanding occupations, pre-injury comorbidities, and high injury severity were negatively associated with RTW. Claiming injury compensation in the fault-based scheme operating at the time, and early identified post-injury pain and psychological distress, were key factors negatively associated with RTW up until two years post-injury. CONCLUSIONS: Long-term work incapacity was observed in 20% of people following RTI. Our findings have implications that suggest review of the design of injury compensation schemes and processes, early identification of those at risk of delayed RTW using validated pain and psychological health assessment tools, and improved interventions to address risks, may facilitate sustainable RTW. TRIAL REGISTRATION: This study was registered prospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12613000889752).

The Great Trade-off in Workers' Compensation: Perceptions of Injustice by Those Experiencing Persistent Pain.

INTRODUCTION: Some claimants harbor perceptions of injustice about the way they have been treated. In particular, those with ongoing and disabling pain have been generally dissatisfied by the way they have been managed by the systems designed to offer them financial compensation. AIM: In this paper we aim to explore possible factors that may contribute to their dissatisfaction. METHOD: We review the historical development of the various systems in which monetary compensation was awarded for personal injury. FINDINGS: In the latter years of the 19th century, a significant trade-off occurred in the German workers' compensation systems. On the one hand, employers accepted the principle of no-fault insurance and agreed to provide injured workers with monetary compensation and medical treatment. On the other hand, employees agreed to relinquish the right to sue their employer for negligence. However, awards under this legal system did not include assessments for ongoing pain, humiliation, or loss of social status as were incorporated in previous systems. CONCLUSION: Although the Prussian and German approach provided a utilitarian model for similar systems around the world, its failure to include some long-established benefits of a moral nature may have contributed to the current perceptions of injustice expressed by many injured workers experiencing persistent pain.

Medical Intervention as a Novus Actus Interveniens: Giving Meaning to the Concept of Gross Clinical Negligence.

The focus of this article is the notion that only grossly negligent conduct by a health care provider will constitute a novus actus interveniens and break the chain of causation between a tortious act and the ultimate harm suffered by a plaintiff. More precisely, it explores the question of what it means for a health care provider to be grossly negligent. Its purpose is not to devise an exhaustive list of acts or omissions likely to constitute grossly negligent medical treatment; it is not necessary or even prudent to do so. However, it is argued that more clearly defined parameters are needed to distinguish ordinary, actionable negligence from gross negligence in a clinical context.

Elder abuse in Europe's "most elderly" city: an update of the phenomenon based on the cases reported to the Penal Court of Genoa from 2015 to 2019 and literature review.

BACKGROUND: Elder abuse is currently a worldwide problem. The literature reports that one elderly person out of six is a potential victim. AIMS: To analyse cases reported to the judicial authorities in the territory of Genoa in the period 2010-2019, to investigate the features of elder abuse, to assess the trend of this phenomenon and to propose preventive strategies. METHODS: We analysed the data on reports of abuse passed by the Court of Genoa in the period 2015-2019 concerning physical and mental maltreatment, abandonment and financial exploitation of elderly subjects. These data were compared with those recorded in the previous 5-year period and in the literature. RESULTS: In the period 2015-2019, 156 cases of elder abuse were identified (versus 63 in the previous period): 18 cases of domestic violence, 5 cases of abuse of the means of correction, 18 cases of caregiver neglect, 76 cases of physical injury and 39 cases of financial exploitation. DISCUSSION: Abuse was seen to be perpetrated most frequently in the domestic setting and by the victims' relatives. The main risk factors were female gender and the victim's dependence on others, the maltreating subject's mental illness and substance abuse. CONCLUSIONS: We documented a progressive increase in the number of abuses reported to the judicial authority; this reflects greater awareness of the problem. However, our figures remained well below the incidence estimated in the literature. It is necessary to train healthcare personnel to identify and manage cases of suspected abuse, and to provide adequate support in situations at risk.

["All forms of violence against health professionals are an offence"]. / « Toute forme de violence contre des professionnels de santé est un délit ¼.

The law sanctions all forms of violence when there is an impact on the physical and psychological integrity of the person who is subjected to it. This principle also applies in health care facilities. In the event of violence a legal process is launched in order to both sanction the behaviour and compensate the victim. Interview with Gilles Devers, a lawyer at the Lyon bar.

Ethical and Professional Considerations in the Forensic Assessment of Complex Trauma and Dissociation.

Empirical research spanning the past three decades has consistently upheld that traumatic experiences are prevalent (Gold, Psychological Trauma Theory Research Practice and Policy, S(1), 114-124, 2008; Kilpatrick et al. Journal of Traumatic Stress, 26(5), 537-547, 2013; Resnick, Kilpatrick, Dansky, Saunders, & Best Journal of Clinical and Consulting Psychology, 61(6), 984-991, 1993). Therefore, the likelihood of encountering an individual who has experienced significant trauma within forensic settings is high (Dalenberg, Straus, & Ardill, 2017). Further, forensic psychologists are frequently called upon to assess the impact of such traumatic events and to opine about their connection to a specific psycho-legal issue such as damages in a civil case or the presence of extreme emotional disturbance or mitigating factors in criminal matters. Childhood trauma that has occurred repeatedly and cumulatively, particularly within the context of family relationships, has been referred to as complex trauma. Complex trauma has been shown to result in significant difficulties in a broad range of capabilities such as affect regulation, dissociation, identity development, relational capacities, and somatic distress (Courtois and Ford 2009). The author delineates core ethical principles and challenges encountered in forensic assessment both generally and more specifically in the forensic assessment of complex trauma and dissociation. She also details practical strategies for responding to those challenges. In addition, the author identifies essential skills needed for competency in this arena and outlines professional considerations that arise when working with this population.

Medico-legal assessment of personal damage in older people: report from a multidisciplinary consensus conference.

Ageing of the global population represents a challenge for national healthcare systems and healthcare professionals, including medico-legal experts, who assess personal damage in an increasing number of older people. Personal damage evaluation in older people is complex, and the scarcity of evidence is hindering the development of formal guidelines on the subject. The main objectives of the first multidisciplinary Consensus Conference on Medico-Legal Assessment of Personal Damage in Older People were to increase knowledge on the subject and establish standard procedures in this field. The conference, organized according to the guidelines issued by the Italian National Institute of Health (ISS), was held in Bologna (Italy) on June 8, 2019 with the support of national scientific societies, professional organizations, and stakeholders. The Scientific Technical Committee prepared 16 questions on 4 thematic areas: (1) differences in injury outcomes in older people compared to younger people and their relevance in personal damage assessment; (2) pre-existing status reconstruction and evaluation; (3) medico-legal examination procedures; (4) multidimensional assessment and scales. The Scientific Secretariat reviewed relevant literature and documents, rated their quality, and summarized evidence. During conference plenary public sessions, 4 pairs of experts reported on each thematic area. After the last session, a multidisciplinary Jury Panel (15 members) drafted the consensus statements. The present report describes Conference methods and results, including a summary of evidence supporting each statement, and areas requiring further investigation. The methodological recommendations issued during the Conference may be useful in several contexts of damage assessment, or to other medico-legal evaluation fields.

Crimen y fútbol: caso del fútbol profesional colombiano (2010-2016) / Crime and football: case of Colombian professional football (2010-2016) / Crime e soccer: caso do soccer profissional Colombian (2010-2016)

Resumen Este trabajo investiga mediante la metodología de regresión binomial negativa de ceros inflados con efectos fijos la relación entre los partidos de fútbol de la liga profesional colombiana y el número de lesiones personales, hurtos y homicidios (en un intervalo de ocho horas) presentados en veinte (20) ciudades de Colombia durante los años 2010-2016. Los resultados no evidencian una relación sistemática entre los partidos de fútbol y los delitos mencionados (es decir, aumentos o disminuciones de los delitos en una ciudad por el hecho de ser sede de un partido de fútbol o ser la ciudad del equipo visitante). Lo que sí evidencian es que hay aumentos en las lesiones personales y hurtos a personas a medida que aumenta la asistencia al estadio. La asistencia no parece tener efecto sobre los homicidios. No obstante lo anterior, los aumentos de lesiones personales y hurtos a personas no parecen ser económicamente significativos para el periodo de ocho horas dentro del cual se jugó el partido ni a nivel agregado anual para las veinte ciudades.

Abstract This paper investigates throgh the methodology of negative zero inflated with effects binomial regression relationship between Colombian profesional football games league and the number of personal injury, theft and homicide (in an interval of eight hours) presented in twenty (20) cities in Colombia during the years 2010 - 2016. The results do not show a systematic relationship between football matches and the aforementioned crimes (that means, increase or decrease in crimes in a city due to the fact of hosting a football match or being the city of the visiting team). What they do show, is that there are increases in personal injuries and theft of people as stadium attendane increases. Notwithstanding the foregoing, increases in personal injury and theft form people do not appear to be economically significant for the eigth - hour period within which the game was played nor annual at an aggregate level for the twenty cities.

Resumo Este trabalho investiga mediante a metodologia de regressão binomial negativa de zeros inflacionados com efeitos fixos a relação entre os partidos de futebol da liga profissional colombiana e o número de lesões coporais, furtos e homicídios (num intervalo de oito horas) apresentados em vinte (20) cidades da Colômbia durante os anos 2010- 2016. Los resultados no evidenciam uma relação sistemática entre os partidos de futebol e os delitos mencionados (isto é, aumentos ou diminuições dos delitos numa cidade pelo fato de ser sede de uma partida de futebol ou ser a cidade da equipe visitante). O que sim evidenciam é que há aumentos nas lesões corporais e furtos a pessoas a medida que aumenta a assistência ao estádio. A assistência no pareceter efeito sobre os homicídios. Não obstante o que precede, os aumentos de lesões corporais e furtos a pessoas não parecem ser económicamente significativos para o período de oito horas dentro do qual se jogou a partida nem a nível agregado anual para as vinte cidades.

The medico-legal assessment of aesthetic damage. A correlation analysis between experts and an operative proposal.

Aesthetic damage, defined as any detrimental modification of the individual morpho-functional exterior attributes, is difficult to assess, since the perception of its entity is rather subjective. This study aims to provide a medico-legal contribution to the assessment of this kind of damage. 60 photographic images, representing stabilized aesthetic damage, were collected and showed to 16 expert evaluators, who were required to exclusively quantify the objective component of the aesthetic impairment. The inter-observer agreement for the assessments was calculated using the Intraclass Correlation Coefficient (ICC). Looking into specific characteristics of both the injury and the damaged subject, the assessors were more consistent in quantifying the damage in male subjects (ICC 0.68) and in subjects aged over 50 years (ICC 0.81) as well as in assessing extensive damages (ICC 0.61) than those of mild severity (ICC 0.41). The assessment of impairments located in the facial area resulted in a high level of concordance (ICC 0.73), while damages located the head and neck regions presented the lowest concordance (ICC 0.35). The evaluators were more consistent in assessing the outcomes of burns (ICC 0.70). Regardless the various reasons underlying the different degree of concordance, these results and the high degree of the overall concordance (ICC 0.63) point out the skillfulness of medicolegal professionals to formulate a complex judgment as more objectively as possible. Finally, an operative proposal was outlined to guide medico-legal professionals or interns in evaluating the aesthetic damage as more objectively as possible.

Epidemiology of malpractice claims in the orthopedic and trauma surgery department of a French teaching hospital: A 10-year retrospective study.

INTRODUCTION: Orthopedic and trauma surgery is the specialty for which claims for compensation are most often filed. Little data exists on the subject in France, especially in a teaching hospital. We conducted a retrospective study aimed at (1) identifying the epidemiological characteristics of patients filing claims against the orthopedic surgery and traumatology department of a teaching hospital in France, (2) analyzing the surgical procedures involved, the type of legal proceedings, and the financial consequences. HYPOTHESIS: The epidemiological profile of proceedings seeking damages in France is consistent with the data from European and American studies. MATERIALS AND METHODS: An observational, retrospective, single-center study of all claims for damages between 2007 and 2016 involving the orthopedic and trauma surgery department of a teaching hospital was carried out. Patients' epidemiological data, the surgical procedure, type of legal proceeding, and financial consequences were analyzed. RESULTS: Of the 51,582 surgical procedures performed, 71 claims (0.0014%) were analyzed (i.e., 1/726 procedures). A significant increase in the number of cases (p=0.040) was found over a 10-year period. Of these, 36/71 (53.7%) were submitted to the French regional conciliation and compensation commission (CRCI), 23/71 (32.8%) were filed with the administrative court, and 12/71 (13.4%) were submitted for an amicable settlement. The most common reason for which patients filed claims was hospital-acquired infections, with 36/71 (50.7%) cases. Twenty-nine complaints (40.8%) resulted in monetary damages being awarded to the patient, with an average award of € 28,301 (€ 2,400-299,508). Damage awards were significantly higher (p<0.05) for cases involving surgery on a lower limb than those involving an upper limb. CONCLUSION: Claims against orthopedic surgeons have been increasing significantly over the last 10 years. Although rare, they represent a significant cost to society. Hospital-acquired infections are the main reason for disputes in our specialization. LEVEL OF EVIDENCE: IV, retrospective study.

Risco do uso do formol na estética capilar riesgo del uso del formol en la estética capilar / Risk of the use of formol in hair aesthetics

Resumo:Buscou-se determinar a apresentação nos meios de comunicação dos riscos do uso de formol na estética capilar por meio de notícias de lesões corporais e morte; reconhecer a percepção de profissionais cabeleireiros da cidade de Petrópolis- RJ, Brasil, sobre esses riscos e evidenciar a presença da substância em cosméticos. Para tanto, analisaram-se matérias jornalísticas, divulgadas após 2007, relacionadas a casos reais de exposição ao formol. Realizou-se também inquérito com 12 profissionais cabeleireiros, buscando determinar o conhecimento sobre a presença ou adição de formol em produtos alisantes e dos riscos à saúde ocasionados pelo uso da substância, além da relação que faziam entre o formol e ocorrências clínicas neles próprios ou em seus clientes. Na ocasião, foram solicitadas amostras de produtos para a determinação qualitativa do formol. Das 12 amostras analisadas, 9 (75%) apresentaram teor de formol superior a 0,01%. Reconheceu-se que apesar da regulamentação e de algum conhecimento dos cabeleireiros sobre os riscos, o uso do formol em alisantes continua. Foi possível detectar a substância nos produtos examinados. Entretanto, diminuíram as reportagens sobre casos de intoxicação aguda por formol na estética capilar.

Resumen:Se buscó determinar la presentación en los medios de comunicación de los riesgos del uso de formol en la estética capilar por medio de noticias de lesiones corporales y muerte; Reconocer la percepción de profesionales peluqueros de la ciudad de Petrópolis-RJ, Brasil, sobre esos riesgos y evidenciar la presencia de la sustancia en cosméticos. Para ello, se analizaron materias periodísticas, divulgadas después de 2007, relacionadas a casos reales de exposición al formol. Se realizaron también encuestas con 12 profesionales peluqueros, buscando determinar el conocimiento sobre la presencia o adición de formol en productos alisantes y de los riesgos a la salud ocasionados por el uso de la sustancia, además de la relación que hacían entre el formol y ocurrencias clínicas en ellos mismos o en Sus clientes. En la ocasión, se solicitaron muestras de productos para la determinación cualitativa del formol. De las 12 muestras analizadas, 9 (75%) presentaron un contenido de formol superior al 0,01%. Se reconoció que a pesar de la reglamentación y de algún conocimiento de los peluqueros sobre los riesgos, el uso del formol en alisantes continúa. Es posible detectar la sustancia en los productos examinados. Sin embargo, disminuyeron los reportajes sobre casos de intoxicación aguda por formol en la estética capilar.

Abstract:It was sought to determine the media presentation of risks formaldehyde used in hair aesthetics, by the news about personal injury and death; recognize the perception of hairdressing professionals in Petrópolis-RJ, Brazil, on these risks and highlight the presence of the substance in cosmetics. Therefore, it was analyzed newspaper articles, published after 2007, related to real cases of exposure to formaldehyde. It was also conducted survey of 12 professional hairdressers and to determine the knowledge of the presence or addition of formaldehyde in hair straighteners products and the health risks caused by the use of the substance and the relation that were between formaldehyde and clinical events in themselves or its customers. At the time, product samples were requested for the qualitative determination of formaldehyde. In the 12 samples, 9 (75%) had concentration greater than 0.01% formaldehyde. It was recognized that despite the regulation and some knowledge of hairdressers about the risks, the use of formaldehyde in hair straighteners continues. It was possible to detect the substance in the products examined.However, it were decreased the reports of cases of acute formaldehyde toxication in hair aesthetics.

Forensic clinical anatomy: A new field of study with application to medicolegal issues.

Forensic clinical anatomy is a new practical application of the discipline of Clinical Anatomy for ascertaining and evaluating medicolegal questions. In particular, individual anatomy (normal anatomy, anatomical variations, age-, disease-, or surgery-related modifications) can acquire significant relevance in various fields of legal medicine such as child abuse, sudden death, medical responsibility and/or liability, personal injury and damage. Anatomical data of forensic interest frequently arise from the correct application of methods of ascertainment; anatomical methods may then be required for further comprehensive analysis. The rigorous interpretation of anatomical data, derived from the ascertainment phase and analyzed on the basis of pertinent literature, can be pivotal for the correct application of evaluation criteria in various forensic contexts. Clin. Anat. 30:2-5, 2017. © 2016 Wiley Periodicals, Inc.

Surgical exploration of hand wounds in the emergency room: Preliminary study of 80 personal injury claims.

BACKGROUND: The SHAM Insurance Company in Lyon, France, estimated that inadequate hand wound exploration in the emergency room (ER) accounted for 10% of all ER-related personal injury claims in 2013. The objective of this study was to conduct a critical analysis of 80 claims that were related to hand wound management in the ER and led to compensation by SHAM. MATERIAL AND METHODS: Eighty claims filed between 2007 and 2010 were anonymised then included into the study. To be eligible, claims had to be filed with SHAM, related to the ER management of a hand wound in an adult, and closed at the time of the study. Claims related to surgery were excluded. For each claim, we recorded 104 items (e.g., epidemiology, treatments offered, and impact on social and occupational activities) and analysed. RESULTS: Of the 70 patients, 60% were manual workers. The advice of a surgeon was sought in 16% of cases. The most common wound sites were the thumb (33%) and index finger (17%). Among the missed lesions, most involved tendons (74%) or nerves (29%). Many patients had more than one reason for filing a claim. The main reasons were inadequate wound exploration (97%), stiffness (49%), and dysaesthesia (41%). One third of patients were unable to return to their previous job. Mean sick-leave duration was 148 days and mean time from discharge to best outcome was 4.19%. Most claims (79%) were settled directly with the insurance company, 16% after involvement of a public mediator, and 12% in court. The mean compensatory damages award was 4595Euros. CONCLUSION: Inadequate surgical exploration of hand wounds is common in the ER, carries a risk of lasting and sometimes severe residual impairment, and generates considerable societal costs. LEVEL OF EVIDENCE: IV.

Can we assess risk of psychiatric sequelae from perinatal injuries?

Medical malpractice litigation involving seven to nine figure settlements has been on the rise over the past decade. Given the life-altering scope of these incidents, forensic child psychiatrists may be asked to opine on the effects of a permanent perinatal injury on normal human development. Whether forensic child psychiatrists can assess risk of future psychiatric effects from such incidents is an important question. This paper is spurred by two separate cases, each involving a male infant having a portion of their genitals accidentally amputated by an obstetrician-gynecologist (OB/GYN) during a routine circumcision. In each case, the genitals were repaired, but permanent defects remained. The question arises how such injuries would affect these children as they matured. An analysis of the literature supported that there are risks of psychiatric effects of such birth-related injuries. Such predictions are made with reference to what is already known about human development, and by an exploration of the literature on the psychiatric effects of comparable injuries to children.