FORENSIC EXAMINATION OF LIVING PERSONS.
Severity of injuries, its juridical and forensic estimation. Forensic investigation of the instruments (medical documents) for estimation OF severity DEGREE.
Conception about an injury. A notion «injury» is not only medical, but juridical too. In Ukrainian legislation an injury means criminal or not criminal infliction of health disorder by one person to other person without intention to bereave life. It can be caused by activity or inactivity of a suspected person.
Medical definition of the injury is the following: An injury signifies a disorder of anatomic structure (continuity) or physiological function of human tissues or organs caused by the action of different environmental factors (mechanical, physical, chemical etc.). It entails health disorder or death.
Lacerations of the face as an example of injury
Medical classification of injuries. From the point of medicine there are such kinds of injuries: scratches, bruises, abrasions, contusions, wounds, burns (thermal or chemical), tears, bone fractures, injuries of internal organs etc. This is a medical classification of injuries.
Medical classification of injuries
•Abrasions
•Bruises
•Wounds
•Scratches
•Burns
•Bone Fractures
•Injuries of Internal Organs etc.
Among all examination cases of living persons examination on the subject of corporal damages takes place more often and composes 90 %, specifically – with view damages properties determination of and its heaviness degree.
A corporal damage is notioot only medical, but juridical. From point of view of criminal right a corporal damage is criminal, intentional whether careless, without intention to bereave a life, infliction of harm to health by one person to other person. It can be called by action (e.g., blowing in blow, infliction of burns) or inactivity of suspected person (e.g., inopportune assignment of medicare by doctor brought to health discord).
From medical point of view the corporal damage is called violation of anatomic bliss or physiological function of cloths whether organs by reason of action on human organism of various factors of external environment (mechanical, physical, chemical, etc.), which bring on health discord or death.
Juridical classification of injuries
(Severity of injuries)
Juridical classification of injuries. According to Criminal Code of Ukraine (further — CC of
Simple injuries are subdivided into two types:
· Simple with temporary loss of working capacity;
· Simple (mild).
In medicine all of corporal damages subdivide on scratches, scratch, bruises, wounds, dislocations, fractures, cracks, slights tear, breaks, grinding, squashing, tearing off, body dale on parts, traumatic toxicosis, burns (thermal, chemical), freezing, stinging by electric current, etc. This is the medical classification of corporal damages.
Methods of forensic-medical examination of living persons on the subject of corporal damages, learning of construction principles and formulation of deductions is task of practical trainings (model and independent ambulatory reception).
A forensic-medical expert or doctor is ought to take into account large responsibility, which they carry attached to determination of heaviness degree of corporal damages, because their deductions serve as base for actions qualification accused and attracting him to responsibility. Without taking of forensic-medical examination in damages infliction cases go on successfully seen out an outcome whether assize of case.
Grievous (Severe) Injuries:
(According to 121 art. of CCU.)
Grievous (Severe) injuries. According to the art. 121 of the Criminal Code of Ukraine grievous injuries are mainly characterized by definite juridical criteria. There are six such criteria: an injury is determined as severe when it is
Dangerous for life at the moment of their infliction;
Associated with loss of any organ or its function;
Combined with steady loss of working capacity more than 33 percent;
Resulted in mental disease;
Associated with interruption of pregnancy;
Resulted in irreparable face disfiguration
Injuries dangerous for life refer to injuries threaten life or result in death usually. They are:
1. Penetrating into cranial, thoracic, abdominal cavities, spine channel etc. even without injuries of inner organs;
2. Open and closed fractures of the skull except facial bones; luxations and subluxations of jugular vertebrae; fractures of one or some pectoral whether lumbal vertebrae with functional disorder of the spinal cord or without it; closed fractures of the sublingual bone; open fractures of the humerus, femur or tibia; fractures of the bone of the pelvis that threaten life;
3. Severe contusions of the brain video and intracranial effusions of blood that threaten life video ; closed damages of the spinal cord in cervical level; closed damages of the pectoral, lumbar and sacral segments of the spinal cord, which are associated with severe spinal shock whether functional disorders of pelvic organs;
4. Damages of large blood vessels (external and internal): aorta, carotis (general, internal, external), subclavia, humeral, axilary, iliac, femoral, poplitea arteries whether veins, that followed them;
5. Damages with destruction of the integrity of the pharynx, larynx, trachea, main bronchi etc.; closed and open damages of the endocrine glands (thyroid, parathyroid, thymus — in children) together with life threatening phenomena;
6. Closed and open damages of the inner organs (abdominal and pectoral), the organs of retroperitoneal space (kidneys, epinephral glands, pancreas) and the pelvis cavity (urinary bladder, uterus, ovaries, prostate gland, upper and middle parts of rectum, membranous part of urethra) with life threatening phenomena;
7. Damages associated with severe shock, massive bleeding, comma, acute renal and hepatic insufficiency, acute respiratory and circulation insufficiency, endocrine pathology, acute discords of regional blood circulation, fatty whether gaseous embolism, pneumothorax. All of them must be confirmed by objective clinical data including the results of laboratory and instrumental researches;
8. All kinds of mechanical asphyxia accompanied with complex disorders of the central nervous system, cardiovascular system and breathing ( in condition of objective clinical data);
9. General action of high temperature (heat or sun strike) with life threatening phenomena; burns of the ІV degree with the burnt area above 15% of the victim’s surface, burns of ІІІ degree above 20% of the skin, ІІ degree burns above 30% of the human surface. Other burns are also combined with severe shock etc.
Damages, dangerous for life. – this is such damages, which ourselves on oneself threaten to victim life in moment of its infliction, or which attached to usual their flowing (without assignment of medicare) expire whether can result in death. Prevention whether distraction of death by timely assignment of skilled medicare does not influence on acknowledgement of such damage dangerous for life.
To dangerous for life also belong such damages, which attached to clinical flowing on the strength of any time interval create a state, impending for life, by reason of what they results in death of victim person. This state is must be found in straight causally-resulted tie with trauma.
A row of damages, dangerous for life, can turn up trumps, however such its end is an exclusion, and usually they bring on death. Sometimes, specially attached to assignment of medicare, the identical damages can have good end and not to omit after oneself the terrible superventions in appearance of steady capacity loss. So, unsafety for life of such damage arises in the moment of its infliction. The danger for life creates exactly damage, and not its possibility. That’s why tactical infliction of corporal damage, dangerous for life, directed on robbing life of man, is qualified as attempt on murder.
According to “Regulations of forensic-medical heaviness degree determination of corporal damages” (Ministry of Health Ukraine, 1995 y.) a danger for life into infliction moment usually create:
damages penetrating into cranial, thoracic, abdominal cavities, into spine channel, cavity of pericardium whether cellulose of mediastinum, in that number without damages of spinal cord or cerebrum and his envelopes, whether internal organs;
Penetrative injury into the thoracic cavity
open and closed fractures of vault and base skull bones,
Fractures of the skull as dangerous injury
barring bone fractures of facial skeleton and incommunicado crack of only external skull vault plate; fracture-dislocations whether subluxation of jugular vertebrae; fractures of one or some pectoral whether lumbar vertebrae with violation or without violation of function of spinal cord; closed fractures of sublinqual bone; open fractures of the bodies of humeral, femoral bone or tibia; fractures of the bone of pelvis in presence of phenomena impending for life;
slaughter of cerebrum of heavy degree both with squeezing and without squeezing of brain tissue; slaughter of cerebrum of middle heaviness in presence of symptoms of truncus cerebri stinging; intracranial effusions of blood with phenomena impending for life;
•
Subarachnoideal Haematoma
closed damages of spinal cord in cervical department; closed damages of pectoral, lumbar and sacral segments of spinal cord, which were attended with heavy spinal shock whether violation of functions of pelvic organs;
damages with full wall safety violation of pharynx, larynx, trachea, main bronchi, gullet, irrespective of that on the part of cutaneus covers whether on the part of organ clear space they are caused; closed and open damages of endocrine glands of neck region (thyroid, parathyroid, thymus – in children) in presence of phenomena impending for life;
closed and open damages of organs of abdominal and pectoral cavity,
Penetrative injury into the heart
organs of retroperitoneal space (kidneys, epinephral glands, pancreas) and pelvis (urinary bladder, uterus, ovaries, prostata, top and middle departments of rectum, membranous part of urethra) cavity attached to presence of phenomena impending for life;
damage of large blood vessels: aorta, carotic (general, internal, external), subclavia, humeral, axillar, ileal, femoral, popliteal arteries whether veins, that followed them;
damages, which brought on shock, massive bleeding, comma, acute renal and hepatic insufficiency, acute respiratory and circulation insufficiency, endocrine pathology, acute discords of regional whether organ blood circulation, fatty whether gaseous embolism, pneumothorax. All of they are ought to be confirmed by objective clinical data, results of laboratory and instrumental researches;
all kinds of mechanical asphyxia, that were attended with complex of central nervous system, cardiac-vascular system and breathing organs discords, which threatened to life, in condition, that it is set by objective clinical data;
general action of high temperature (heat whether sun stroke) in presence of phenomena impending for life; thermal ІІІ-ІV degree burns with stinging area over 15% of body surface, ІІІ degree burns over 20% body surface, ІІ degree burns over 30% body surface, and also burns of lesser area, that were attended with shock of heavy degree; burns of respiratory ways attached to phenomena impending for life;
damage from action of low temperature (cold), radial damages and such, that were got from conditions of high pressure in presence of phenomena impending for life;
poisoning by matters of any origin with superiority as general and local action (and food toxi-infection) in condition, that in clinical flowing had a place the phenomena impending for life.
From maintenance of some points we can see, that some body damages belong to dangerous for life only when they are attended with shock whether phenomena impending for life, danger for life create the exactly heavy trauma superventions, so, it is one of attributive signs of damage dangerous for life.
To Provide for all of kinds whether damages variants, which are by oneself threat for life into infliction moment, practically impossibly and there are not the needs in this. It well be important to learn, why and which as whole damage can be dangerous for life. Damage unsafety for life is an independent juridical criterion of heavy corporal damage, which does not depend from its final supervention. The only damage (its appearance, properties, peculiarities) contain in oneself or threat for life, or nor. In last case it values on final result, for steady capacity loss whether for health discord (long or momentary).
Damage, which entailed a loss of any organ or loss of its functions. This criterion unites as anatomic (tactical) organ loss (hand, trilbies, but not finger; tongue, eye, sexual member, uterus, etc.), so and loss by these organs their functions, driving them into inactive state. Under hand or leg loss should be understood dissociating of them from body whether loss by them functions in view to paralysis or other state excluding their activity. Under this about loss the hands whether trilbies say then, when has a place their amputation on equal not beneath cubital or knee joints. The rest cases are considered as a loss of part of extremities and values for sign of steady capacity loss.
Under tongue loss trace to understand not only its full whether partial anatomic absence, but language loss, loss the ability to give voice to its thoughts legibly, understood for those present. Stammering is not a language loss. Attached to loss of permanent teeth a heavity degree of corporal damages determine in dependence on dimensions of steady loss of general capacity, and attached to loss of milk-teeth – in dependence on tactical health discord duration.
A loss of productive ability consists in insolvency to copulation (inability to face out sexual intercourse, for example, by reason of amputation of cock, scar constriction of entrance into vagina) or in loss of ability to fecundation (for example, attached to damage of both testicles with their moving away), conception and child-bearing.
An eye loss can be considered as a sight organ loss or as damage bringing on steady capacity loss not less as on one third (35 %). In both cases damage heavity is the similar – it is heavy. Under loss of eyesight we should understand full steady blindness on both eye whether such state, when has a sight lowering of possibility to fingers counting on distance
Under hearing loss should be understood full deafness on both ears or such inconvertible state, when a victim does not hear colloquial language on distance 3-
Damage, which brought on heartfelt illness. The psychic illness is the violation of normal psychic man activity, which displays in lowering of mental abilities, in sickly thinking change and so on., irrespective of following heaviness, duration and curability. Sometimes it can arise as supervention of skull and cerebrum (for example, posttraumatic epilepsy, imbecility, encephalopathy with maniacal whether shizophrenic syndrome etc.) trauma, but not psychosis or neurosis. The degree of damage heaviness bringing on reactive state of nervous system, determines for sign of health discord duration.
Establishment of heartfelt (psychic) illness and its tie with received trauma behave to psychiatrist competence, forensic-psychiatrical examination. Estimation of heaviness degree of such corporal damage supervention is realized by forensic-medical expert after conformable psychiatrists deduction. It must be mentioned, that to heavy corporal damages belongs not psychic disease, but cranial-cerebral trauma, that it called.
Damage entailing health discord, combined with steady capacity loss not less than on one third. A capacity is such man state, attached to which he can realize production activity of concrete volume and quality. Notion is complicated and biosocial, because ability to work depends on many factors. A capacity is general (man ability to execute the unskilled work in usual labour conditions, ability to self-service), professional (ability to work in this profession, for this speciality: engineer, teacher, doctor, artist) and special (ability to execute the narrowly special work in that whether other profession). Contradistinguish a temporal (momentary) and (permanent) loss of capacity. Under steady loss of capacity we should understand such inconvertible function loss, which will never restore and in invariable appearance will be kept to the end of life. A steady capacity loss can be established only after trauma superventions, which already defined, after damage cicatrization.
This criterion provides for steady loss of general capacity, dimensions determinations of which realize in percentages for official “Table of percentages of capacity loss as reason of different traumas, foreseen by conditions of personal insurance”, that is contained in Ministry of finances directions for № 110 from 12.05. 1974 y. “About order and organization of taking of medically-insurance examination”. If after trauma steady loss of general capacity is 33,3 % and more (one third from 100 %), then such damages reckon in heavy for criterion “steady capacity loss not less than on one third”.
Because in table steady loss of general capacity foreseen in rotund ciphers 5 and 10 %, and not in percentages units, then tactically for capacity loss not less than on one third sets loss, general capacity from 35 % and more. In children a capacity loss determines the same as in adult, but in deductions is necessary to mark, that a stated dimension of steady capacity loss will come after arriving of child at able to work age. In invalids a steady capacity loss in tie with got damages determine as in practically healthy peoples, irrespective of disablement and its group, but it is not always correct or justly (for example, loss of part of one hand into one-armed).
Damage, bringing on breaking of pregnancy, should be reckoned to heavy corporal damages only in that cases, when breaking of pregnancy, irrespective of its date, iot associated with individual organism peculiarities, and stands in straight causal tie with trauma. This tie is determineed by the specialists (gynecologists-obstetrics). Thats why forensic-medical examination in such cases is taken together with them.
Breaking of pregnancy can only in time coincide with shutting of damage. Sometimes for medical documents of medical founding, womanish consultation one can be set, that the phenomena of impendent abortion are marked before infliction of trauma. It is impossible aforethought to bring on breaking of pregnancy by dint of fright pregnant.
Damage, which entailed an irreparable face disfiguring. Disfiguring (disfigurement) of face isn’t the medical notion, it is aesthetic, common to all mankind. That’s why for establishment of face disfigurement is not need presence of special medical knowledges. In tie with that a forensic-medical expert whether doctor does not evaluate damage of face as disfiguring. The expert establishes only properties and heaviness degree of the corporal damage, going out from usual signs similarly, as they are disposed not on face. But in its deduction he must obligatorily indicate whether this damage is reparable, because disfiguring notion behaves only to face.
Question about reparability or indelibility of damage (and so about disfigurement of face) can be put only after trauma cicatrization, when form the scars, arise deformations (nose, conchas, eyelids, lips), face asymmetry by reason of nerve paresis, etc. Temporal face disfigurement by trauma (eyelids oedemata, lips and so on) can’t be acknowledged as heavy corporal damage.
Under reparability of damage we should understand considerable underestimation of pathologic scars changes (deformations, violation of mimicry and so on) with time following or under influence of unsurgical methods (massage, thermal whether physiotherapy procedures). Like indelible are defered such damages, which call for its removal or underestimation for officient intervention, in that number of plastic (cosmetic) operation.
The fact of face disfiguring is installed by investigator whether law-court, proceeding from accepted conceptions about human appearance. Personality of victim (sex, age, profession, nationality and so on) does not have any relation to settlement of this question. Admitting that damage brought on irreparable face disfiguring, they transfer a light corporal damage with momentary discord of health whether damage of middle heaviness, established by expert, into heavy corporal damage. But “Regulations” allow expert in his deduction to mark, that damage can be considered as heavy, if will be acknowledged such, that disfigured a face.
In case of examination of living person on the subject of indelible damages, disposed on face, to deductions should be enclosed victim’s photoes in front and profile.
Injuries of moderate severity
(juridical criteria according to 122 art. of CCU .)
Moderate injuries. If the injury does not correspond to the criteria characterizing severe degree it can be classified as a moderate injury (under definite condition). Moderate degree of severity is established in forensic medical practice when an injury meets definite juridical criteria. In particular, according to the art. 122 of the Criminal Code of Ukraine concerning moderate injuries, such criteria are the following:
· Not dangerous for life at the moment of their infliction;
· Absence of consequences specified for severe injuries;
· Causing steady loss of working capacity (less than 33 %);
· Causing long (more than 21 days) loss of working capacity.
The notion «steady loss of working capacity» should be understood as a trauma resulting in loss of general working capacity from 10 up to 33%. The term «long loss of working capacity» refers consequences (dysfunctions) immediately following the trauma with duration more than 21 days.
First two signs do not call for interpretation, they are intelligible from afore-cited text. As for third sign, then is necessary to underline, that in it is foreseen violation of organs functions whether health discord. Under functions violations of any organ should be understood loosening, underestimation of hand, leg, sight and hearing organ, tongue functions, productive ability etc., but not permanent them loss. Can have a place although full but temporal violation of function. Health Discord is violation of normal organism activity of any man: labouring and unlabouring, child and grand-dad, healthy and invalid. You should not to addle health discord with temporal disablement. Health discord can forward, and caot to attended with temporal disablement. Man can be accorded damage, for example – fracture of nose bones, that is the health discord, but to work and be treated (not to have a temporal capacity loss ). That’s why a disablement form or term of staying in permanent establishment whether on ambulatory cure ourselves on oneself not yet bear witness to functions violation duration of any organs whether health discord duration. It is ideal when expert whether doctor attached to examination of living person on the subject of heaviness degree determination of corporal damages, adopted to attentioot duration of temporal disablement and cure, and objectively established a health discord duration, proceeding from general victim state and term, necessary for his convalescence.
For maintenance of a. 102 of CC of
Dimension of steady capacity loss less one third, as one of signs of long functions violation of any organ or other long health discord, ensues from acknowledgement of corporal damage heavy, if it brought on steady capacity loss not less than on one third (a. 101 CC). Percentage of steady capacity loss determine for tables stated above to state insurance.
Fractures of the left lower extremity as an example of injury with moderate severity
Simple injury
Simple injuries. As stated above simple injuries are subdivided into two types: simple with temporary loss of working capacity and simple (mild). If the injury needs for it’s healing time period more than 6 days but less 21 days it signifies temporary loss of working capacity video. That’s why the injury should be medicolegally qualified as simple with temporary loss of working capacity. For example, a wound, ordinary burn, concussion of the brain etc. If the injury heals so rapidly (less than 6 days) like contusion of the soft tissues or doesn’t entail loss of capacity to work it must be determined as simple (like an odnary bruise or abrasion).
The juridical criterion and medical index of these damages coincide: momentary health discord or momentary capacity loss and their duration, or their absence. If damage in person was attended with health discord whether temporal capacity loss by duration over 6 days, but no more three weeks (21 day), then it one should to be acknowledged as light corporal damage with momentary discord health or momentary loss of capacity.
Such duration health discord is attached to infliction of wound, spacious numerous bruises, limited burns of ІІ degree, uncomplicated dislocation in humeral whether other jont, shock of cerebrum of light degree and so on, which call for its cicatrization whether convalescention the period to 3 weeks.
If damage in victim did not attended with health discord whether momentary capacity loss, or had the insignificant fast superventions with health discord whether temporal capacity loss with duratioo more 6 days (single small scratch, bruises, scratches), then such damages acknowledge light without health discord whether momentary capacity loss.
It should be mentioned, that in concrete person the corporal damages caot be simply light, because for Law punishment for them is absent. They can be or light corporal damages with momentary health discord whether momentary capacity loss, or light corporal damages without momentary health discord whether momentary capacity loss. If corporal damage brought on insignificant steady capacity loss, independent from its dimensions, then it for maintenance and significance of a. 106 of CC of Ukraine isn’t light of any any sub-group (whether categories), and is only the damage of middle heaviness. Attached to interpretation of this regulation one should use the principle of law leadership over other acts.
Cases, associated with blowing in light corporal damages, disturb in law-courts only for victims complaints, behave to cases of private accusation, when a previous outcome whether inquest do not take.
A Bruise of the upper lip as an example of simple injury.
Order of the performance of forensic medical examination in cases of severity degree determination. Medicolegal examination of alive persons is carried out at the forensic medical bureau. Sometimes it can be performed in hospitals, court, prison. A person that addresses the bureau must have a written official letter of a legal investigating body about the purpose of the examination. If the examination is carried out on medical documents, original papers must be given by the investigator to a forensic medical expert.
Methodology of forensic medical examination for severity degree determination. It includes some consecutive stages: 1. An expert must be acquainted with the purpose of the examination (noted in the investigator’s direction) and any document identifying the patient. 2. Interrogation and examination of the patient and filling in the introductory part of the «Report of Forensic Medical Examination». 3. Drawing up the forensic medical conclusions.
Scheme and content of «Expert’s Conclusion» and «Report of Forensic Medical Examination». These forensic documents consist of the following chapters: introduction, previous information, complaints of the patient, objective data and conclusion (testimony). The introductory part states the following: time of the examination; the reason of the examination (type of the letter of legal investigating bodies — decision or direction); place of examination; information about the expert (his name, education, specialty, experience of work, category, academic degree); full information about the patient (his name, date of birth, address, professional status). Previous information includes circumstances of the cases (stated by an investigator). Complaints of the patient at the moment of the examination are fixed too. The objective data reflect allclinical and morphological features of the injuries found on a victim. Every injury must be consistently described from top to bottom and from the right to the left according to the following order: type of the injury (bruise, contusion, scratch, abrasion, laceration); location; shape; size; color; appearances of the margins and ends; surrounding tissues. Testimony is a final chapter of the document.
Structure of expert conclusion. Forensic medical expert should necessarily give complete answers to the following questions: 1. Types of the injuries, their location and appearances. 2. Kind of the instrument (blunt, sharp or fire weapon) inflicted the injuries and mechanism of traumatic action. 3. Time of the injuries (according to their clinical appearances — color, swelling, inflammatory changes etc.). 4. Degree of severity with indication of the qualifying criteria.
PRACTICAL CLASS № 4
FORENSIC-MEDICAL EXAMINATION OF VICTIMS, SUSPECTED AND OTHER PERSONS. FORENSIC-MEDICAL EXAMINATION OF SEVERITY DEGREE
Тhemes: 1. Injuries, their legal and forensic-medical classification.
2. Medicolegal examination of living persons (suspected, accused and other individuals).
3. Determination of severity degree on the basis of both victim’s examination and medical documents.
Objectives: to know how to determine severity degree in victims and according to medical documentation in cases of different injuries and to draw forensic conclusion.
Introduction. Practical activity of investigator (detective) is actually associated with cases of violence when different injuries can be inflicted in victims. Successful disclosing of such crimes needs in professional forensic medical examination which must decide a lot of specific questions: traumatic instruments used for the crime, time of injuries, mechanism of their infliction etc. Besides of them one of the most important problems for investigator is determination of severity degree. According to Ukrainian legislation (art. 75,76 CPC) an estimation of severity can be performed by forensic pathologist or nearly doctor only. Medicolegal examination for determination of severity degree can be fulfilled not only for victims (living or dead persons) but on medical documents (patient card’s, ambulatory card’s) too. This helps detective and law court in correct qualification of the crime which took place. Forensic conclusion in cases of violence is necessary both for investigation and law procedure because of it establishes also punishment for criminal. Therefore any doctor must know how to determine severity degree and how to draw an expert’s conclusion in cases of crimes against human health and life. That’s why the topic is so actual for medical students.
Basic level of knowledge and skills (before the practical class)
• To know the scheme and contents of patient card or ambulatory card.
• To know medical classification and clinical features of the injuries.
• To know clinical and morphological specialties of traumatic process in bruises, abrasions, wounds, fractures, injures of inner organs, burns etc.
• To be able to examine a patient with trauma.
• To be able to investigate in practice and correctly describe in medical documents any injury.
Visual Aids and Material Tools:
The objects of the investigation are medical documents (origin or copies medical card of stationary patients, individual card of ambulatory patient, and other documents).
Some photos, studying tables and museum specimens are demonstrated too.
Students’ Independent Study Program
Тheme № 1 of the practical class.
5. Notion about the injury and their severity (gravity). Medical and juridical classification of the injuries.
6. Grievous (severe) injuries, their juridical criteria according to art. 121 of CPC.
7. Injuries dangerous for life at the moment of their infliction.
8. Moderate degree of severity, it’s juridical criteria according to art. 122 of CPC and medical data.
9. Simple injuries, their types according to art. 126 of CPC and medical characteristics.
Тheme № 2 of the practical class.
1. Order of the performance of forensic medical examination in cases of severity degree determination.
2. Methodology of the victim’s examination in cases of severity degree determination.
3. Morphological features and clinical diagnostics of the soft tissues injuries, bone fractures.
4. Specialties of severity degree determination in cases of injuries located on victim’s face.
Тheme № 3 of the practical class.
1. Scheme and content «Expert’s Conclusion» and «Report of Forensic Medical Exami¬nation».
2. Specialties of forensic medical anamnesis and medicolegal examination of alive persons in forensic bureau.
3. Structure and content of forensic conclusion in cases of severity degree evaluation.
Block of Information (Terminology)
Conception about an injury. A notion about injury is not only medical, but juridical also. From the point of Ukrainian legislation an injury means criminal or not criminal infliction of health disorder by one person to other person without intention to bereave of life. It can be caused by activity or inactivity of suspected person.
Medical definition of the injury is following: Injury signifies disorder of anatomic structure (continuity) or physiological function of human tissues or organs caused by the action of different environmental factors (mechanical, physical, chemical etc.). It entails health disorder or death.
Juridical classification of injuries. According to Criminal Code of Ukraine (further – CC of Ukraine) all injuries are subdivided into grievous (art. 121), moderate (art. 122) and simple (art. 125).
Simple injuries are subdivided into two types:
• Simple with temporary loss of working capacity;
• Mild.
Medical classification of injuries. From the point of medicine there are such kinds of the injuries: scratches, bruises, abrasions, contusions, wounds, burns (thermal or chemical), tears, bone fractures, injuries of internal organs etc. They compound medical classification of the injutiescorporal damages.
Grievous (Severe) injuries. According to the art. 121 of the Criminal Code of Ukraine grievous injuries are mainly characterized by definite juridical criteria. There are six such criteria: injury is determined as severe when it is
• Dangerous for life at the moment of it’s infliction;
• Associated with loss of any organ or it’s function;
• Combined with steady loss of working capacity more than 33 %;
• Resulted in mental disease;
• Associated with interruption of pregnancy;
• Resulted in irreparable face disfiguration
Injuries dangerous for life. It refers an injury threaten to life and which resulting as usual in death. They are:
1. Penetrating into cranial, thoracic, abdominal cavities, spine channel etc. even without injuries of inner organs;
2. Opened and closed fractures of the skull except facial bones; luxations and subluxations of jugular vertebrae; fractures of one or some pectoral whether lumbal vertebrae with disorder of function of spinal cord or without it ; closed fractures of sublingual bone; opened fractures of humerus, femur or tibia; fractures of the bone of pelvis with threaten to life phenomena;
3. Severe contusions of brain and intracranial effusions of blood with threatening for life phenomena; closed damages of spinal cord in cervical level; closed damages of pectoral, lumbar and sacral segments of spinal cord, which are associated with severe spinal shock whether functional disorders of pelvic organs;
4. Damages of large blood vessels (external and internal) : aorta, carotis (general, internal, external), subclavia, humeral, axilary, iliac, femoral, poplitea arteries whether veins, that followed them;
5. Damages with destruction of the integrity of pharynx, larynx, trachea, main bronchi etc.; closed and opened damages of endocrine glands (thyroid, parathyroid, thymus – in children) together with threatening phenomena;
6. Closed and opened damages of the inner organs (abdominal and pectoral), organs of retroperitoneal space (kidneys, epinephral glands, pancreas) and pelvis cavity (urinary bladder, uterus, ovaries, prostate gland, upper and middle parts of rectum, membranous part of urethra)attached to presence of threatening phenomena;
7. Damages associated with severe shock, massive bleeding, comma, acute renal and hepatic insufficiency, acute respiratory and circulation insufficiency, endocrine pathology, acute discords of regional blood circulation, fatty whether gaseous embolism, pneumothorax. All of them must be confirmed by objective clinical data including the results of laboratory and instrumental researches;
8. All kinds of mechanical asphyxia attended with complex disorders of central nervous system, cardiovascular system and breathing ( in condition of objective clinical data);
9. General action of high temperature (heat whether sun strike) in presence of threatening to life phenomena; burns of the ІV degree with burnt area above 15% of the victim’s surface, burns of ІІІ degree above 20% of the skin, ІІ degree burns above 30% of the human surface. Other burns also combined with severe shock etc.
Moderate injuries. If the injury does not correspond to the criteria characterizing grievous degree it can be classified as moderate injury (under definite condition). Moderate degree of severity is established in forensic medical practice when the injury satisfies definite juridical criteria. In particular, according to the art. 122 of the Criminal Code of Ukraine concerning moderate injuries, such criteria are the follows:
• Not dangerous for life at the moment of their infliction
• Absence of consequences specified for grievous injuries
• Causing steady loss of working capacity (less than 33 %)
• Causing long (more than 21 days) loss of working capacity
The notion «steady loss of working capacity» should be understood as a trauma resulting in loss of general working capacity from 10 up to 33%. The term «long loss of working capacity» refers consequences (dysfunctions) immediately following the trauma with duration more than 21 days.
Simple injuries. As stated above simple injuries are subdivided into two types: simple with temporary loss of working capacity and simple (mild). If the injury needs for it’s healing time period more than 6 days but less 21 days it signifies temporary loss of working capacity. That’s why the injury must be qualified in medicolegal meaning as simple with temporary loss of working capacity. For example wound, ordinary burn, concussion of the brain etc. If the injury heals so rapidly (less than 6 days) like contusion of the soft tissues or doesn’t entail loss of capacity to work it must be determined as simple (like a single scratch).
Order of the performance of forensic medical examination in cases of severity degree determination. Medocolegal examination of alive persons is carried out at the forensic medical bureau. Sometimes it can be performed in hospitals, court, prison. A person addressed the bureau must have a written official letter of legal investigating body about the purpose of the examination. If the examination is carried out on medical documents original papers must be given by the investigator to forensic medical expert.
Methodology of forensic medical examination for severity degree determination. It includes some consecutive stages: 1. An expert must be acquainted with the purpose of examination (noted in the investigator’s direction) and any document identifying the patient. 2. Interrogation and examination of the patient and filling in the introductory part of the «Report of Forensic Medical Exami¬nation». 3. Drawing up of the forensic medical conclusions.
Scheme and content of «Expert’s Conclusion» and «Report of Forensic Medical Examination». These forensic documents consist of the following chapters: introduction, previous information, complaints of the patient, objective data and conclusion (testimony). Introductory part states the follows: time of examination; the reason of the examination (type of the letter of legal investigating bodies – decision or direction); place of examination; information about the expert (his name, education, specialty, experience of work, category, academic degree); full information about the patient (his name, date of birth, address, professional status). Previous information includes circumstances of the cases (stated by an investigator). Complaints of the patient at the moment of examination are fixed also. Objective data reflect all clinical and morphological features about the injuries found on victim. Every injury must be consistently described from top to bottom and from the right to the left according to the following order: type of the injury (bruise, contusion, scratch, abrasion, laceration); localization; shape; size; color; appearances of the margins and ends; surrounding tissues. Testimony is a final chapter of the document.
Structure of expert conclusion. Forensic medical expert should necessary give completed answers to the following questions: 1. Types of the injuries, their location and appearances. 2. Kind of the instrument (blunt, sharp or fire weapon) inflicted the injuries and mechanism of traumatic action. 3. Time of the injuries (according to their clinical appearances – color, swelling, inflammatory changes etc.). 4. Degree of severity with indication of the qualifying criteria.
II. Меthodology of the practical activity (9.00-11.15 a.m.):
Тopic № 1-2.
Рractical activity 1. Medicolegal examination of victims in forensic ambulatory.
Teacher together with the student’s examine a patient (victim) in Bureau of Forensic Medical Examination. Every such person must have a written official letter of legal investigating bodies about the purpose of examination or an identity card. This letter is declared by the student and the patient is invited. Entry part of the report is filled in then and the follow data are stated on the title: time of examination; the reason of the examination (type of the letter of legal investigating bodies – decision or direction); place of examination; information about the expert (his name, education, specialty, experience of work, category, academic degree); full information about the patient (his name, date of birth, address, professional status). After it under the teacher’s supervision students start an interrogation of the patient. They find out the complaints of the patient, in which areas of a body the impacts were put, which traumatic instruments were applied, consequences, to which they have resulted by. Students write down in the report received data.
The objective examination of the patient begins then. This includes: investigation and description of the injuries – their types (bruise, contusion, scratch, abrasion, laceration); localization; shapes; sizes; color; appearances of the margins and ends; surrounding tissues. All those data are stated completely in the part of the report named as «Objective data».
In generally «Report of Forensic Medical Exami¬nation» consists of the following chapters: introduction, previous information, objective data and conclusion (testimony). Thus after finishing of the objective examination the students make an expert’s conclusion which must include complete answers to the following questions:
1. Which injuries were found on the victim?
2. Which instrument inflicted them?
3. Time of the injuries?
4. Degree of severity?
During the examination all students of the group take an active part in the examination. Teacher answers to the probable student’s questions and helps them in formulation of the conclusion.
Тopic № 3.
Рractical activity 2. It is carried out in studying rooms of the forensic medicine course.
Each student gets the case materials – official letter of legal investigating bodies and a copy of medical card of the patient who was injured during different accidents (vehicular trauma, falling from height, battering etc.). They have to fill in their copy-books a protocol part of the «Report of Forensic Medical Exami-nation» (introduction with detective’s questions, previous information, documental data), using all needful informatiooted in the patient cards. An example of such report is shown in «Appendix». Students draw an expert’s conclusion and give completed answers to the investigator’s questions. So, they must decide and explain from the forensic point the followings:
1. Which injuries (bruises, abrasions, wounds, fractures etc.) were inflicted?
2. Which instrument (blunt, sharp or fire weapon) caused them?
3. Time of the injuries (according to the clinical features of the traumatic process)?
4. Degree of severity?
Discussion about theoretical questions and practical activity (11.45a.m.-02.00 p.m.):
At the end of the class all questions mentioned above are discussed with active participation of all the students of the group.
Exit level of knowledge and abilities. (2.15 – 3.00 p.m.)
It is checking by tests.
Tests and real-life situations for self-assessment:
1. Choose the correct definition – an injury is
A. any bruise
B. any wound
C. disorder of anatomical structure or physiological function of human tissues or organs caused by the action of surroundings
D. any anatomical disorder
E. any assault
2. Which kinds of severity do you now?
A. simple (mild), moderate and grievous
B. moderate and grievous
C. only grievous
D. simple (mild) and grievous
E. contusion, scratch, incision
3. Which juridical criteria of grievous injuries do you now?
A. dangerous for life
B. which entailed loss of organ
C. which entailed loss of working capacity more than 3 weeks
D. which entailed irreparable face disfigure
E. all those criteria
4. Find an injury dangerous for life at the moment of its infliction:
A. penetrative wound into the thoracic cavity
B. incised wound of the arm
C. fracture of the nasal bones
D. contusion of the brain
E. firearm injury of the extremity
5. Choose the correct juridical criterion of moderate severity:
A. injuries threaten to victim
B. any firearm wounds
C. any injuries caused by the action of sharp objects
D. injuries which entail temporary loss of working capacity more than 3 weeks
E. all cases of sexual crimes
6. Which injury can we classify as moderate severity?
A. opened fracture of the skull
B. rupture of the spleen
C. great internal bleeding
D. closed fracture of the radii
E. abrasion of the face
7. Simple (mild) severity means such damage which entails:
A. temporary loss of working capacity more than 3 weeks
B. temporary loss of working capacity less than 3 weeks
C. steady loss of working capacity more than 33%
D. steady loss of working capacity less than 33%
E. without loss of working capacity
8. During road accident V. received an opened fracture of right tibia. Which degree of severity must be determined?
A. severe
B. moderate
C. simple
D. its impossible to establish
E. no enough of data
9. Lady S. was beaten by her husband. In result of this incident some bruises and abrasions on her body were formed. Forensic pathologist examined her and considered that injuries were:
A. dangerous for life
B. simple
C. moderate
D. grievous (severe)
E. very moderate
10. A soldier accidentally shot his friend with a carbine. A trauma was lethal. Some hours ago forensic pathologist investigated the body in autopsy room and found a penetrative firearm wound of the head with destruction of the skull and brain. Which severity of the damage did forensic pathologist determine?
A. moderate
B. simple
C. no simple
D. threaten to victim
E. grievous (severe)
Answers to the tests:
1-C; 2 – A; 3 – E; 4 – A; 5 – D; 6 – D; 7 – E ; 8 – A; 9 – B; 10. – E.
After the practical class every student
must know:
1. Specialties of forensic-medical examination both on alive persons and cases materials.
2. Scheme and contents of «Report of Forensic Medical Exami¬nation» in cases of establishment of severity degree.
3. Juridical criteria and medical sings of the grievous, moderate and simple injuries.
must be able to:
1. Carry out interrogation and inspection of the victim.
2. Fill in the «Report of Forensic Medical Exami¬nation» received data.
3. Determine severity degree of any injury.
4. Make medicolegal conclusions in cases of forensic evaluation of severity degree.
