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Cunningham N.,Victorian Institute of Forensic Medicine
Journal of Forensic and Legal Medicine | Year: 2012

The sexual assault consultation is a high-risk procedure with the potential for errors resulting in harm to both patients and staff. As such, it can be likened to practices in high-risk industries such as aviation and surgery. In contrast to these domains however, the focus on performance safety and Threat and Error Management has not been widely adopted. This is despite a growing recognition of the vulnerabilities of the investigative and prosecutorial stages of alleged sexual assaults.In the context of "high risk" sexual assault consultations, the notion of safety refers not only to the risk of patient morbidity and mortality, but also to physical, psychological and judicial outcomes that affect patients, staff, and the wider community.This article identifies the latent threats present in sexual assault consultations and suggests a conceptual framework for application of Threat and Error Management in this specialised area of medicine. This will enable practitioners to be better equipped to recognise the risks and improve the performance and safety of sexual assault consultation processes.In an era of growing medicolegal concerns regarding issues such as environmental safety and the potential for contamination of cases, focussing on education and safety culture components within the investigative systems will allow sexual assault consultation processes to progress towards a new level of organisational reliability. © 2011 Elsevier Ltd and Faculty of Forensic and Legal Medicine.


Ibrahim J.E.,Monash University | Murphy B.J.,Monash University | Bugeja L.,Monash University | Ranson D.,Monash University | Ranson D.,Victorian Institute of Forensic Medicine
Journal of the American Geriatrics Society | Year: 2015

Objectives To describe the nature and extent of external-cause deaths of residents of nursing homes in Victoria, Australia. Design A retrospective cohort study of all decedents using routinely collected data contained within the National Coronial Information System. Setting Accredited nursing homes in Victoria. Participants Nursing home residents who had died from external causes and whose deaths were reported to the Coroners Court between July 1, 2000, and December 31, 2012. Measurements Basic descriptive analysis was conducted to measure frequencies and proportion of exposures within each outcome group, and rates were calculated using population data. Results One thousand two hundred ninety-six external cause deaths of nursing home residents were identified. Deaths were due to falls (n = 1,155, 89.1%), choking (n = 89, 6.9%), suicide (n = 17, 1.3%), complications of clinical care (n = 8, 0.6%) and resident-on-resident assault (n = 7, 0.5%). Deaths occurred more frequently in women (n = 814, 62.8%), in keeping with the sex distribution in nursing homes, and residents aged 85 and older (n = 923, 71.2%). The number of inquests held to investigate a death as a matter of public interest was small (n = 24, 1.9%). Conclusion A significant proportion of nursing home resident deaths are from external causes and are potentially preventable. A shift in community attitudes is required toward an understanding that premature death of a resident from injury is not a natural part of life. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.


Bassed R.,Victorian Institute of Forensic Medicine
Journal of law and medicine | Year: 2012

This column discusses the issues encountered when courts attempt to determine if an individual who has no reliable age at birth documentation has reached adulthood, or is still a legal minor. This issue has recently received a high level of public interest due to the wrongful imprisonment in Australian adult prisons of Indonesian minors accused of people smuggling following the determination, subsequently shown to be incorrect, that they were adults. The discussion explains current deficits existing in the science of age estimation with reference to the recent Australia Human Rights Commission "Inquiry into the Treatment of Individuals Suspected of People Smuggling Who Say That They are Children". Future research possibilities in the science of age estimation which may help to resolve many of the issues are explored.


Rintoul A.C.,Monash University | Dobbin M.D.H.,Mental Health | Drummer O.H.,Monash University | Drummer O.H.,Victorian Institute of Forensic Medicine | Ozanne-Smith J.,Monash University
Injury Prevention | Year: 2011

Objective In light of an emerging epidemic identified in the United States and Canada, to identify trends in fatal drug toxicity involving oxycodone and the demographic characteristics and indicators of socioeconomic disadvantage of the deceased. Study design Population-based observational study in Victoria, Australia. Population Decedents whose death was reported to the Victorian Coroner between 2000 and 2009 and where oxycodone was detected. Main outcome measures Association between supply of oxycodone and deaths. Demographic characteristics of decedents. Rate ratios of the rural or metropolitan location and socioeconomic indicators of disadvantage of the deceased. Results Supply to Victoria has increased nine-fold from 7.5 mg per capita in 2000 to 67.5 mg per capita in 2009. Detection of oxycodone in deaths reported to the Victorian Coroner has increased from 4 (0.08/100 000 population) in 2000 to 97 (1.78/100 000 population) in 2009da 21-fold increase in deaths. Of the 320 cases described, 53.8% (172) were the result of drug toxicity. Of these, 52.3% were unintentional and 19.8% intentional self-harm; the remaining 27.9% are either still under investigation by the coroner or intent is unknown. Drug toxicity deaths were overrepresented in both rural areas and areas indexed with high levels of disadvantage. Conclusions The substantial increase in the number of deaths involving oxycodone is strongly and significantly associated with the increase in supply. Most drug toxicity deaths involving oxycodone were unintentional. This newly identified trend in fatalities in Victoria supports concerns that a pattern of increasing deaths involving oxycodone is emerging globally.


Pilgrim J.L.,Monash University | Drummer O.H.,Monash University | Drummer O.H.,Victorian Institute of Forensic Medicine
Forensic Science, Medicine, and Pathology | Year: 2013

The use of quetiapine in Australia has increased rapidly in recent years. Anecdotal and post-marketing surveillance reports indicate an increase in quetiapine misuse in prisons as well as an increase in its availability on the black-market. This study examined a cohort of quetiapine-associated deaths occurring in Victoria, Australia, between 2001 and 2009, to determine the prevalence of deaths associated with this drug and to determine whether misuse represents a legitimate concern. Case details were extracted from the National Coronial Information System. There were 224 cases with an average age of 43 years of age (range 15-87 years). The cause of death was mostly drug toxicity (n = 114, 51 %), followed by natural disease (n = 60, 27 %), external injury (n = 31, 14 %) and unascertained causes (n = 19, 8 %). Depression and/or anxiety were common, observed in over a third of the cohort (80 cases, 36 %). About 20 % of cases did not mention a psychiatric diagnosis at all which raises the question of whether quetiapine had been prescribed correctly in these cases. Cardiovascular disease was the most commonly reported illness after mental disease. Quetiapine ranged in concentration from the limit of reporting (0. 01 mg/L) to 110 mg/L. The median concentration of quetiapine was much lower in the natural disease deaths (0. 25 mg/L) compared with drug caused deaths (0. 7 mg/L). The most commonly co-administered drug was diazepam in 81 (36 %) cases. There were a small number of cases where quetiapine contributed to a death where it had not apparently been prescribed, including the death of a 15 year old boy and one of a 34 year old female. Overall, misuse of quetiapine did not appear to be a significant issue in this cohort; use of the drug only occasionally led to fatalities when used in excess or concomitantly with interacting drugs. However, considering that it is a recent social concern, it is possible that analysis of cases post 2009 would reveal more cases of quetiapine abuse. Close monitoring of quetiapine is therefore advised to prevent adverse outcomes, particularly in vulnerable populations such as substance abusers. © 2013 Springer Science+Business Media New York.

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