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Varfolomeyev focuses on the role of international organizations in fighting the novel pandemics The global spread of the novel coronavirus infection has irreversibly transformed world politics Major international organizations cannot ignore these tectonic changes International "inaction" may seem unrealistic, because it is akin to criminal negligence The WHO defines a pandemic as the worldwide spread of a new disease 2 But note that this is a working (political) definition, not an international legal one The main international treaty for cooperation in health care is the International Health Regulations (IHR) This is an agreement between 196 countries, including all WHO Member States, to work together "for global health security " The IHR not only do not define a "pandemic," they do not even contain this term Under the IHR, states are required to notify the WHO of events that, according to certain criteria, may constitute an emergency

Most children who receive sedation outside the operating room have good outcomes and benefit from efforts to reduce pain and anxiety during a procedure. However, administration of sedative and analgesic agents to children in the outpatient setting always carries some risk to the patient. If a child has an adverse outcome after sedation, and there is evidence of substandard care then there is the potential for a professional liability (“malpractice”) claim against the providers and/or the facility. It is difficult to track with any reliability the actual results of all such claims throughout the USA, in part because there is no uniform national system to report jury verdicts and judgments in state courts that are not appealed. Further, if a malpractice case is settled prior to a jury verdict, the details of those settlements are often kept confidential by the agreement of parties, typically at the request of the medical providers or their insurance carriers. A review of publicly available reports has identified several pediatric sedation claims of alleged negligence. In each of these malpractice cases, the allegations were that the care provided by the professionals (and/or institution) was below an established standard of care, that there was a breach of that standard and that the breach caused injury to the patient. Standard of care is defined as that care which a reasonable physician in a particular specialty would have given to a similar patient, under similar circumstances. Because most clinicians have similar access to information and knowledge, they are usually held to a national standard of care regardless of how remotely the individual may practice.

This chapter consists of a brief discussion on some legal aspects concerning scientists’ responsibility in risk prevention processes. After proposing some introductory considerations on scientists’ responsibility as such, the author deals with the L’Aquila earthquake crisis of 2009, when a strong quake destroyed significant parts of L’Aquila (Italy) and surrounding villages, killing more than 300 people. The chapter focuses on the relations between scientific knowledge, normative expectations, decision-making and criminal negligence for ‘failed’ risk assessment and management, paying particular attention to the role of ‘regulatory science’ in constructing the ‘reasonable person’ normative standard of care in the theory of criminal negligence. This allows explaining why the first judgement in the L’Aquila trial (2012) is not convincing, having misunderstood how policy-relevant science should participate in prevention processes and the construction of normative standards. In his conclusions, the author suggests some reasons for the recent tendency to blame experts when natural or technological disasters occur.

In this paper, the authors discuss the legal liabilities of the professional engineer as both the engineer of record of a project and the construction site manager. In particular, this paper analyzes the case of a fire at an end-user MV/LV substation of a shopping center in Italy, occurred a few years after maintenance works on the electrical installation. The professional engineer who had designed and overseen the construction of the substation was accused of criminal negligence. The authors through the examination of applicable technical standards, as well as of safety regulations, demonstrate that the professional engineer had acted diligently and that there was no ground for the negligence charges. The forensic analysis of the substation fire is provided, and the importance of the chain of custody, the chronological documentation, and the secure storing of all the artefacts and fire-damaged evidence are stressed. The authors believe that this paper can be a useful reference for electrical forensics engineers, investigating similar accidents.

Medical profession differentiates itself from other professions, where apart from the knowledge and skill, touch of humanity is also required. Since the inclusion of medical profession under the ambit of Consumer Protection Act there has been a spurt in the number of cases against the doctors. Bolam's test is applied to assess medical negligence of doctor. Cases against the doctors can be brought in a civil or criminal court, and accordingly the negligence may be civil or criminal negligence. In deciding criminal negligence against doctors criminal intent need to be proved. The Medical Law and Ethical Code for medical professional in India are prescribed by Indian Medical Council, under the section 20-A of Indian Medical Council Act of 1956 and Amendment Act No. 24 of 1964.

The issue of medical negligence has been catching attention of many people nowadays. With advancement of technology in medical field, many incurable diseases of past time can now be managed well at the cost of burdening expenditure. This has resulted in obvious expectations to the patient and their families that any ailment can be cured from the medical procedures and therapies. When these expectations are not met in terms of complications or death of the near ones, people get frustrated and tend to allege health care providers against medically negligent.Negligence are of two types; civil negligence where the doctors are alleged to have lost simple degree of care and attention to the patients thereby causing damage whereas in criminal negligence, the doctors grossly deviate from the standard of care and competence or perform activities which are understood prima facie as a crime, for eg: performing criminal abortion, organ transplantation against the law etc.Whatever the type of negligence, there are legal measures to file complaint against the doctors who are alleged to have caused negligence. Gone are the days when people regarded doctors near to gods. Medical service also falls under the consumer protection act where the patients are the consumers and medical personnel, the service providers. The patients have rights to get quality medical service under this act. If the patients or their relatives are dissatisfied with the medical service rendered to them by the health care providers, they have the right to lodge complaint to the compensation committee of the district in which chief district officer (CDO) is the chairman in each district. If there is an issue of criminal negligence, the complaint can also be filed in the concerned court.In some circumstances, when the patient develops complications or dies, the attendants accuse the doctors for the failure in treatment and protest in the hospital premises rather than opting the legal way of charging them against negligence. The health professionals are at times threatened and forced to apologize in public. Most of the times, they demand for compensation and many direct benefits to the relatives of the deceased. The hospitals and the health professionals feel insecure and often they have agreed to the demands put forth to peacefully settle the issue and to get prevented from defamation. The government is also unable to provide security. Similar cases have been reported time and again in Nepal, creating a sense of lawlessness in the country.When deciding whether a doctor is held liable for negligence, the “standard of care” should be analysed. It means the practice should be an accepted one and standard, such that doctor of the similar filed and competence would have also opted the same procedure in given circumstances. Even when a doctor has duly acted opting standard procedure, still there can be chances that a patient can develop complications. Every human body cannot react exactly same to a medical intervention though that may be a scientifically proven one as there can be chances of medical misadventure. The doctors should have possessed reasonable degree of care and skill when he is attending the patient. According to Bolam’s test, a person is said to have inappropriate standard, and becomes negligent, if it is proven that he had failed to do what a reasonable person would do in the circumstances.1 The degree of care and skill should be comparable to an average doctor in similar settings. In order to analyse these issues, expert opinion from reputable and unbiased experts of the similar field of medicine should be taken. In case of death due to alleged medical negligence, the dead body should be autopsied by qualified experts in Forensic Medicine. This can explain so many facts about the deceased which can be helpful to decide whether negligence has factually taken. It highlights the need of taking opinion from the experts of the concerned field by the councils framed to settle the cases of medical negligence, especially the consumer protection council, Nepal Medical Council, etc.It is a high time for the government to play role to address to this sensitive and quai-legal issue. If this trend is not ended, the trust of patients towards the doctors may nullify. The doctors also cannot work effectively when there is no safe working environment and may begin to have tendency to abandon handling critical cases with a fear of vulnerability to defamation if not physical assault in worst case. The situation is ultimately disastrous to the entire health care system. The very sensitive issue of health care delivery cannot be compared to any other commercial issues. The proper mechanism of addressing the issue of medical negligence should be practiced alongside encouragement from governmental urge to come up with better medicolegal systems in this regard. This is highly essential for balancing expectations of the patients and performance of medical professionals.

The Department of Health estimates that 10% of hospital inpatient admissions result in an adverse event, but ,2% of claims for medical negligence handled by the NHS Litigation Authority result in court action. However, both the number of claims for negligence and the sums involved in settlement are increasing and so it is important that anaesthetists understand the factors leading to a possible civil claim for negligence and the potentially considerably more serious charge of criminal negligence, both of which can arise from failures to uphold a suitable standard of care. This article does not consider claims of negligence in relation to consent which has been considered in a separate article in the journal. The principle of ‘duty of care’ was established by Donoghue v Stevenson in 1932 wherein Lord Atkin identified that there was a general duty to take reasonable care to avoid forseeable injury to a ‘neighbour’. In this case, a woman in Paisley drank ginger beer from a bottle until she found a decomposing snail at the bottom. As a result the woman became ill and a case was brought against the ginger beer manufacturers for compensation. Lord Atkin determined that the company producing the ginger beer had been negligent in failing to ensure the woman’s safety during the production process, even though the ginger beer was not bought by the woman but by her friend. It was established that a general duty of care was owed to a neighbour; a neighbour was defined as ‘someone who may be reasonably contemplated as closely and directly affected by an act’. In this case, it did not matter who had bought the ginger beer, since it was reasonable to consider that anyone who drank the beer would have suffered the same consequences and could therefore be considered under the ‘neighbour’ principle.

The doctrine of informed consent forms an integral part of any doctor-patient relationship. It serves two-fold as it develops trust and confidence in the patient for the doctor after being told about the plan of action; conversely the doctor can carry out planned medical interventions in a more composed manner, being confident in the protection of this doctrine if anything untoward occurs. Informed consent gives a blanket shield against compensation and criminal negligence charges filed by patients if the doctor has not deviated from standard practices of treatment or intervention or if no evidence of mal intention is forthcoming. Informed consent is applicable in most of the treatment modalities in which any intervention/invasive procedure is to be done or if any risk of complication is well known or documented. Surprisingly, even when serious life threatening complications are not only reported but on a steady rise due to vaccines, informed consent in vaccination is neither in vogue nor practice. Even in the US, there is no federal requirement for informed consent before vaccination, even though National Childhood Vaccine Injury Act and the Vaccine Compensation Amendments are in place. This paper attempts to present an overall comment on the necessity of informed consent before any vaccination especially in the Indian context in the backdrop of the beginning of vaccine compensation claims and litigation against the complications of vaccination in India.

A mother from Calgary whose son died after she attempted to treat his strep throat at home with dandelion tea and oil of oregano has been sentenced to three years in prison for criminal negligence causing death. Tamara Lovett, 48, a believer in holistic medicine, did not call a doctor when her 7 year old son Ryan developed a throat infection, only calling an ambulance after two weeks of illness when she found him collapsed on the floor. He was pronounced …

Thus criminal justice tells us where the moral boundaries are, where the line lies between good and bad. It patrols those boundary lines, day and night, rain or shine. It shows the rules directly, dramatically, visually through asserting and enforcing them. (There are lessons from non-enforcement, too: from situations where the boundaries are indistinct, or the patrol corrupt or asleep; and society is quick to learn these lessons, too.) Lawrence M. Friedman, Crime and Punishment in American History White Collar Neglect American law provides federal and state prosecutors with powerful authority to charge individuals and corporations with crimes and to win, but they rarely pursue such cases. This paradox is especially poignant with respect to criminality that kills or injures workers or consumers, or that causes irretrievable damage to natural resources. Prosecutors have largely turned a blind eye to such violations, depending instead on a broken regulatory system to deter illegal behavior. To be sure, some of the criminal statutes that apply to health and safety offenses treat them lightly: purveyors of tainted food or grossly negligent employers face misdemeanor charges providing for prison terms of a year or less. Rather than working to develop cases that overcome these weaknesses by, for example, charging multiple violations that add up to significant jail time, prosecutors have largely abandoned those fields. One conundrum running throughout the field of neglected criminal enforcement is whether to charge corporations or their employees. The decision is admittedly complex, but forgoing enforcement altogether should not be a third and favored option. As a matter of principle, corporations should be subject to prosecution when the violations were endemic to the corporate structure, as opposed to the brainchild of isolated, rogue employees. Individuals can and should be charged alongside their corporate employers, providing a different kind of deterrent to future malfeasance.

On 26 December 1978 one arm of a fairground machine known as the `Concorde Flyer' installed at the Kelvin Hall, Glasgow, Scotland, fractured due to fatigue. The car attached to the arm overturned, killing two passengers. A description of the events leading up to the accident, and the cause of the failure, are taken from the report of an official inquiry. After the event the immediate cause of the accident became obvious and it is easy to see how it could have been prevented. There were no prosecutions for criminal negligence, and the question of civil liability for damages appears to have been settled out of court.

The purpose of this paper is to examine issues of regulation of the market for, and use of, blood and blood products. The situation has changed since the discovery of the Human Immune Deficiency Virus (HIV), the presumed cause of AIDS, because it was recognized that some haemophiliacs were infected with HIV from transfused blood and blood products before 1985. When the danger was realized in that year, regulations were introduced internationally to prevent this, but meanwhile some haemophiliacs developed AIDS. In several countries, governments have accepted responsibility, without liability, for possible transmission of infection, and paid compensation to victims. In Prance three health service officials have been convicted of fraud and criminal negligence. In March 1997 a trial began in Japan of three drugs company executives accused of promoting the sale of HIV-contaminated blood products. Since then there has been a class action in the USA resulting in awards. Further issues have arisen with regard to the outcome and treatment of asymptomatic infection with HIV. The implications for public safety, and for medical and legal practice, are far reaching and reveal a need for more effective monitoring of the existing procedures for supply and clinical use of blood and blood products.

LEARNING OBJECTIVES In this chapter, you will: Develop an understanding of the concepts of ‘duty of care’ and ‘standard of care’ Learn how a nurse's ‘scope of practice’ is determined Learn how a nurse's actions or omissions may be determined to be negligent Learn how to avoid acting negligently Gain an understanding of vicarious liability and professional indemnity Two ambulance officers attended a collapsed, unconscious person. Following ambulance protocol, a dose of intravenous adrenaline was administered. The person remained unresponsive. A second dose of adrenaline was administered, as per the ambulance protocol. Consequently, the person suffered a cerebral bleed as a result of high blood pressure induced by the adrenaline. The ambulance officer was initially found to be negligent, but the finding was overturned on appeal. The appeal judge determined that, by following ambulance protocol, the ambulance officer did provide a reasonable standard of care, and that the harm suffered by the person was not the result of a breach of duty of care. (Eburn 2007) DUTY OF CARE Chapter 4 noted that nurses have a duty of care towards their patients. Duty of care refers to the legal obligation on a professional to exercise reasonable care and skill in the provision of professional treatment: a person comes under a duty of care in relation to the provision of advice or information if he carries on a business or profession and in the course of it provides advice or information of a kind which calls for skill and competence or otherwise professes to possess skill and competence and he provides advice or information when he knows or ought to know that the recipient intends to act or rely on it. (Mason J in Shaddock & Associates v Parramatta City Council (1981) 150 CLR 225 at 248–9)

Cases dealing with criminal medical negligence in South Africa are relatively rare, and rarer still are those that are reported. In fact, the last reported case dealing explicitly with criminal negligence (of specifically medical specialists) resulting in the death of a patient is S v Kramer 1987 1 SA 887 (W). It is for this reason that the reported case under discussion, more than two decades after the Kramer decision, is of interest. Of particular interest would be a principled assessment of the judgment, in context of criminal medical negligence with reference to the crime of culpable homicide. In this case, it is specifically some of the elements of criminal liability, namely the actus reus (in the form of an omission), causation and fault that attract academic attention, albeit by way of a deconstruction of the judgment.

Despite repeated warnings, newspaper reports of fatalities and public health and safety campaigns; accidental deaths from carbon monoxide poisoning continue to occur. They can be from accident, ignorance, criminal negligence or foolhardiness; what ever the reason such deaths are tragic and often avoidable. The case presented here was some of these. The physiology and biochemistry is discussed as well as other unusual causes of death by suffocation. This includes the use and abuse of helium from party balloons and nitrous oxide from the misuse of whipped cream dispensers provoking near suffocation and the occasional deaths, though fortunately rare. The request to attend a "sudden death", al though the death may often be many days, if not weeks old, is never pleasant. However, it is always instructive and often the most interesting, challenging and satisfying of all the work that a forensic medical examiner (FME) does. The approach should be methodical and with care and attention to detail. An awareness of the causes of injuries, forms and types of self-harm, presence of knives, drugs or weapons, and the changes after death are all part of the consideration that the experienced FME can bring to bear in assisting the police. Initial assessment if this is a natural death, a death by misadventure, a death by suicide or perhaps murder is all part of the work of the FME. Paramedics are now increasingly allowed to pronounce life extinct without any of the experience or forensic training of the FME and, in the case presented here, it is doubtful if the former would have spotted what had actually caused this death.

The word “negligence” is always damaging to the reputation of doctors, related to some damage to the patient and a challenge before the judges. In recent years, sudden spurt in the cases of “Criminal negligence” and decision of the Supreme Court raises a fresh debate. This paper deals with current scenario of “Criminal Negligence”, applicability of Section 304 & 304-A IPC in cases of death of patient during treatment, remedial measures available to a doctor facing the charge of ‘Criminal Negligence’ and a brief discussion of important cases related to the issue, including recent case. Negligence is a term of art, but has distinct meanings in different jurisdictions. In ‘Tort’, damage is an essential ingredient but that element is not necessary in the law of master and servant. In criminal law, there are series of offences based on negligence in which loss or injury is not material; it is enough if the act is likely to cause injury or endanger life. Operation of patient without consent is an example of negligence (Statutory Damage) even without actual apparent damage. Dictionary meaning of term ‘Negligence’ is ‘Lack of Proper Care’. As defined by Baron Alderson negligence means: “Omission to do something which a reasonable man guided by those consideration which regulate conduct of human affairs would do, or doing something which a reasonable man would not do”. Same definition is quoted in many decisions of the court. ‘Criminal Negligence’ is an offence against the State while ‘Civil Negligence’ is an offence against the individual act, which leads to injury i.e. physical injury, hurt- Section 319, grievous hurt- Section 320 Indian Penal Code (IPC). Loss of property (financial loss) due to some negligent act is always a civil negligence. The decision of the Supreme Court delivered on last years raises a fresh debate on the issue of ‘Criminal Negligence by the Doctors’. In this case the Supreme Court relied on various decisions of the House of Lords.

□ BackgroundPhysicians frequently have to face an investigation of their work from a judicial point of view. Due to these proceedings the number of cases when they are reproached with malpractice is increasing.□ Case ReportWe report the rare case of a 76-year-old female patient who fell from a 68 cm high couch after a sedative was applied during gastroscopical examination. She died 24 hours after the incident. Forensic necropsy revealed a delayed aortic rupture as the cause of death. The preliminary proceedings against the physician involved for culpable homicide by criminal negligence were suspended after he paid a fine. The possible legal consequences under German law for physicians involved in such cases are discussed as well as strategies to avoid them.□ ConclusionPhysicians who are under investigation for malpractice should act carefully. They are advised to seek professional help at an early stage of preliminary proceedings. A public trial should be avoided if possible.

Objective: TO review the practice and legal principles of negligence law. Case Summary: An illustrative, fictional case is presented, based in part on facts gleaned from actual case law. A respected pharmacist, faced with the financial loss of his business, decided to engage in 2 creative but unethical schemes to increase his profit margin. In doing so, he violated federal Medicare law and placed a number of the patients who used his services at significant risk for medical complications. Discussion: Negligence law has evolved over the past 30 years in a manner that significantly increases the liability of the practicing pharmacist for both ordinary negligence actions and criminal negligence actions. In addition, the past decade has seen the expansion of Medicare Fraud and Abuse law such that it now represents an increasingly high risk area for every medical service provider, including the pharmacist. Conclusions: Professional practice in the US is highly regulated, governed by both case law and statutory law. Every practicing pharmacist should be aware of the law that governs his or her behavior to avoid both civil and criminal liability.

The Doctor-Patient Relationship (DPR) is a complex concept in the medical sociology in which patients voluntarily approach a doctor and thus become a part of a contract in which they tends to abide with the doctor’s guidance. Globally, the DPR has changed drastically over the years owing to the commercialization and privatization of the health sector. Furthermore, the dynamics of the DPR has shown a significant change because of the formulation of consumer protection acts; clauses for professional misconduct and criminal negligence; establishment of patient forums and organizations; massive expansion of the mass media sector leading to increase in health awareness among people; and changes in the status of the doctors. Realizing the importance of DPR in the final outcome and quality of life of the patient, multiple measures have been suggested to make a correct diagnosis and enhance healing. To conclude, good DPR is the crucial determinant for a better clinical outcome and satisfaction with the patients, irrespective of the socio-cultural determinants.

Merry states that ‘in practice the distinction between gross negligence and recklessness may be very subtle’.1 I wonder if his discussion of both the law and the relevant medical errors is outdated. Recklessness in English criminal law is advertent, and as Merry states, requires the conscious choice to take an unjustified risk. Criminal negligence is variously defined, but is usually regarded as not requiring advertence. One textbook definition is ‘… the inadvertent taking of an unjustifiable risk’.2 Historically, confusion has arisen from gross negligence manslaughter being sometimes known as reckless manslaughter. This should no longer be the case. The current leading cases, which Merry does not cite, are Adomako3 and Misra.4 Following these cases, a conviction for gross negligence manslaughter requires the existence of a duty of care, breach of that duty resulting in death and a risk of death which would be obvious to a reasonable prudent person. Additionally, the defendant's conduct must have fallen so far below the standard of a reasonable practitioner as to be grossly negligent in the view of the jury, and thereby warranting a criminal conviction for manslaughter. Although there is overlap, reckless manslaughter has a distinctly different meaning. Similarly, Merry's discussion of intrathecal vincristine administration would be enhanced by discussion of the incident at Nottingham in 2001. A junior doctor was prosecuted for gross negligence manslaughter, and pleaded guilty. However, an external inquiry identified over 50 other contributory factors to the fatal event.5 I hope this additional material may prove interesting and informative to JRSM readers.

The changing doctor-patient relationship and commercialization of modern medical practice has affected the practice of medicine. On the one hand, there can be unfavorable results of treatment and on the other hand the patient suspects negligence as a cause of their suffering. There is an increasing trend of medical litigation by unsatisfied patients. The Supreme Court has laid down guidelines for the criminal prosecution of a doctor. This has decreased the unnecessary harassment of doctors. As the medical profession has been brought under the provisions of the Consumer Protection Act, 1986, the patients have an easy method of litigation. There should be legal awareness among the doctors that will help them in the proper recording of medical management details. This will help them in defending their case during any allegation of medical negligence.

The doctor/dentist-patient relationship has transformed over the last two decades. Health professionals are increasingly viewed as providers of service for consideration. The Consumer Protection Act (CPA) was enacted in 1986 for better protection of the interests of consumers as well as to provide a simple and quick mechanism for redressing consumer grievances. Since 1995, health professionals have been included within the ambit of the CPA, empowering the patient to file lawsuits (in case of perceived negligence) in consumer courts. This review explores the definitions of 'consumer', 'services', and 'negligence', discussing their implications with respect to civil and criminal liability of dentists, while providing relevant case examples and court guidelines in landmark judgments. It is concluded that the potential for civil lawsuits against dentists for negligent actions is existent, although the prospect of a dentist being held liable for criminal negligence is low.

Ireland's director of public prosecutions has been asked to investigate whether the country's blood transfusion service board should be prosecuted for criminal negligence over the infection of women with hepatitis C virus. The call came in a letter to the director, Mr Lamonn Barnes, from Positive Action, the pressure group representing 960 Irish women who contracted hepatitis C after being treated with anti-D immunoglobulin from the blood transfusion service. In its letter the group highlights findings by an expert group set up by …

Last week the Delhi High Court during its own suo moto motion against the Municipal Corporation of Delhi and the Central government chastised the government of India and the government of the Delhi state for ignoring warnings concerning dengue. These warnings were given by the World Health Organization (WHO) and experts at the meeting in Pune in 1994. The Court also chastised the governments criminal negligence which caused hundreds of deaths from the disease in 1996. The Court was alerted by mass media reports of the governments failure to deal with the spreading epidemic in the second half of 1996. 10252 patients were admitted to hospitals in Delhi; 423 patients died. Hospitals were ill equipped and blood banks were disorganized. There were no dengue control initiatives until 1997 when they were instituted by court order. The 10 major Delhi hospitals are now required to be fully equipped for any dengue outbreak and the Central and Delhi governments have been ordered to prepare dengue control programs at the national and state levels. Justices Bhandari and Kumar stated that the respondents must adhere to any further suggestions or warnings by WHO and that a similar blunder must not be repeated.

A French association representing people with asbestosis has filed a lawsuit charging “X” with poisoning, involuntary homicide, criminal negligence, and wilful fraud regarding the risk of a product. Although X designates a person …

In November 1906, Richard Pearson Strong, then head of the Philippine Biological Laboratory, inoculated 24 men--inmates of Manila's Bilibid Prison--with a cholera vaccine that somehow had been contaminated with plague organisms; 13 men died. The governor-general of the Philippines appointed a general committee to investigate the affair, and the U.S. Senate demanded information about the episode. Although the Senate, the secretary of war, and even the president were kept informed of developments, no mainland investigations ensued. The general committee concluded that Strong was negligent for not having locks on his incubators and for leaving a visiting physician alone in the laboratory, where he might have mixed up the cholera and plague cultures on the fateful day. The committee's charge was referred to the attorney general, who found Strong innocent of criminal negligence, whereupon the governor-general exonerated Strong. Strong was despondent over Bilibid but recovered and developed a noteworthy career in American tropical medicine. In retrospect, the disaster at Bilibid presents an epitome of the problems surrounding the use of prisoner-subjects without authorization and without their voluntary consent. Far ahead of its time, the general committee recognized and condemned the shortcomings and urged reform, pleas the government ignored. The Bilibid episode remains, however, as a cautionary tale for those engaged in clinical research.

It must be evident from these figures which have been briefly summarized that a considerable number of women in the last three years lost their lives in the counties of Maryland without satisfactory care before or during childbirth. These women are for the most part not the very young or the old in years, but in the majority of instances the lives that were lost were those of married women living in normal homes and frequently mothers of older children. In other words, they comprise a group that cannot be lost without great loss in many ways to their families and to the communities in which they lived. A surprisingly large percentage of the deaths resulted from premature births among women who had not been under medical advice. Careless and ignorant midwives were associated with these maternal deaths in only a small proportion of these cases. The impression we have received from this review of maternal deaths in the counties of Maryland is that they were due directly or indirectly to the ignorance or indifference of the people themselves. Help from physician or midwife was rarely called for until alarming and dangerous complications had arisen and the physician was obliged to take emergency measures under unfavorable conditions. The patients who were reported to have died in hospitals were almost without exception admitted extremely ill when there was but little that could be done to save them. The apparent acceptance on the part of families and the public of the many deaths in childbearing as a matter which cannot be changed, deserves serious consideration. For until this attitude is altered and it is recognized generally that when a woman is in competent hands early in her pregnancy the dangers of childbearing are greatly lessened, we shall continue to lose many lives unnecessarily. Certainly it is most desirable that those undertaking obstetric work should have adequate training and experience. This matter is receiving attention by many medical faculties. However, a review of the maternal deaths here presented shows that but few of them could have been saved by more skilled hands at the critical period in which the physician was first called. Already sepsis or toxemia or other complication was so far developed as to render the best treatment unavailing. We were not able to determine in our series how much of the delay in calling in a doctor was due to the desire to save money. This seems to have been a factor in a considerable number of instances. Certainly the usual fee in the counties for obstetric service is a moderate return for the value of this service. Moreover, it is a charge which can be anticipated and saved for, as is not true of sudden or unexpected illness. We are told, however, that the cost of illness cannot be defrayed out of the available income in the case of about one-third of the American homes and presumably this is true also of the cost of bearing children. When the dangers of procrastination are not understood, the doctor's services are dispensed with as long as possible. Obstetric service is provided free of all charge by private practitioners in many instances, greatly to the credit of the physician; but this is not fair to either doctor or patient who may not want to be a receiver of charity. In the rural sections there is no obstetric service available to the indigent such as is offered to the corresponding group in Baltimore through the Johns Hopkins Hospital and the Hospital of the University of Maryland and other clinics. Hospital beds, free or at moderate cost, are provided in the county hospitals. There is still much unwillingness to make use of them for normal cases. If there were a general demand for such accommodation, the beds would prove far too few. It would seem then that there is need in each county for some organized plan by which obstetric service could be furnished at little or no cost to those families of very moderate means. From such families come most of our maternal deaths at present. It is hardly reasonable to expect a physician whose practice covers a large area to undertake gratis the care of widely separated normal obstetric cases. If the private physician is to continue to do this charity work, he should receive from the county or elsewhere an adequate financial return. It is the custom of a number of doctors in the counties to use midwives whom they know to be capable and clean in their obstetric practice among the poor. The midwife in Europe, as is well known, occupies a more important position than with us. There she delivers nearly all normal cases and calls upon the physician only when difficulties arise. Our midwives in Maryland are far below those in Europe in education and training. However, the older ones are dying out and the newer ones have had some instruction and have passed a qualifying examination. The standard among them would be greatly raised if a carefully selected number could be received in some of our county hospitals and given instruction and practical experience. This could be arranged with but little expense to the hospital. It is conceivable that a physician with an active obstetric practice might make use of three or four midwives resident in different communities covered by his practice for delivering normal cases under his supervision. It would be advisable that he make at least one complete physical examination and be ready to respond if unforeseen difficulties appeared. There are now public health nurses in every county who are willing to visit any indigent expectant mothers at the request of a physician, give them such prenatal instruction as the physician desires and report to him at regular intervals. In two counties prenatal clinics have been organized with the approval of the profession for the examination and advice of indigent expectant women. We have received monthly reports from one of those prenatal clinics. The patients are either referred by local physicians or are indigent women, found by the public health nurses, who had made no arrangement for their care before or during labor. Of some 50 of these cases at least 10 were suffering from conditions which probably would have resulted fatally except for the care received at the clinic. Thus far there have been no maternal deaths. Would it not be possible in each county for the physicians themselves, or if they desire it, with the assistance of an experienced obstetrician, to organize a similar clinic where indigent expectant mothers may be examined early in their pregnancy, receive prenatal advice, and be helped to make suitable arrangements for their labor? To such a clinic the local physician might care to refer certain of his own patients and examine them himself. Probably many midwives could be encouraged to send their patients to such a clinic for examination and prenatal advice. A regular prenatal clinic in a county could readily be made a useful teaching center for physicians and so of mutual advantage both to the patient and to the profession. It has been suggested that a wider use in the counties of maternity insurance would bring improvement to the conditions it is so desirable to remedy. It is to be feared, however, that the group it seems especially necessary to help, would not be willing, perhaps not able, to pay the necessary premiums. It is quite evident that the profession cannot be, and the public ought not to be, satisfied with the present state of affairs. Through some plan, such as the more frequent use of the county hospital, the use and supervision of selected midwives, the prenatal clinic, maternity insurance, or the employment of the public health nurses, the physician might be able to supply at less sacrifice of his own valuable time and at less financial cost to his patient of moderate means, satisfactory prenatal and natal care, both of which seem desirable from the study of the maternal deaths. The fundamental part of any plan, however, for better service, is the necessity of bringing home to each prospective father and mother in the State, and to every community, that not to attempt to furnish every expectant mother with at least a minimum of medical care during her waiting period and at the hour of labor, is little short of criminal negligence. It is recognized that excellent and early care of the expectant mother and skilled obstetric service will not save all women in childbearing, but it is confidently believed it would result each year in the salvage of one-third of the lives of mothers, and one-third of the potential infant lives now being lost before or shortly after birth. This is certainly a goal worth striving for.

In these latter days of widespread knowledge of aseptic measures for shielding the parturient woman from harm, the occurrence of puerperal sepsis is looked upon, even by the laity, as evidence that some one has blundered, and the attendant is fortunate if he escapes the charge of criminal negligence or inexcusable ignorance. If the infection of the lying-in woman happened only during labor, or her subsequent stay in childbed, the charge might be sustained with justice, but we are convinced that it happens more frequently than is apprehended that an infection has antedated childbed by weeks or months, if indeed it has not preceded conception itself and invaded territory absolutely beyond the reach of any possible antiseptic treatment. With a unilateral pyosalpinx, or a tubal infection, existing before pregnancy, or a subsequent gonorrheal infection of vulvo-vaginal glands or urethra, who can be certain, even though forewarned, that he can be

Objective Introduction: Infliction of harm to life and health due to medical errors is common for the whole world and post-Soviet countries, in particular. The problem of these errors is one of the most important in medical law, although there is no unified concept of it. A small number of sentences in cases of criminal negligence of medical professionals indicates a high latency and often unprovability of this crime in a number of post-Soviet countries. The aim: To disclose the objective and subjective prerequisites of a medical error, reasons for its occurrence, to establish the grounds for criminal liability of medical professionals in case they commit an error and to examine the judicial practice in this regard. Also, to define the concept and types of circumstances exempting criminal liability and their impact on criminal liability issues concerning medical professionals. Patients and methods Materials and methods: The study is based on the Belarusian, Kazakh, Moldavian and Ukrainian statutory acts as well as international acts, the European Convention for the Protection of Human Rights and Fundamental Freedoms, case law of the European Court of Human Rights (ECHR), national court judgments. Such methods as dialectical, comparative, analytic, synthetic and comprehensive have been used in the paper. Results Review: On the basis of the study, it has been established that there is no unified concept of a medical error, medical personnel are fairly brought to criminal liability only if they commit an unjustifiable error in the presence of all the mandatory elements of a crime provided for in the relevant article of the Criminal Code. At the same time, it is extremely difficult to prove existence of such an error. Besides, at the state levels, causes and mechanisms of occurring errors have not been revealed, they are not even discussed, which makes it impossible to outline measures to prevent them or reduce their frequency and degree of danger. Conclusion Conclusions: The struggle against medical errors should encompass a number of such activities as standardization of clinical treatment protocols, further education of medical professionals and lawyers in regard to patient safety, thorough investigation of each incident in order to exclude a justifiable error or circumstances exempting criminal liability. Equitable, severe and uncompromising punishments for perpetrators should be an effective means preventing commission of crimes in medicine.

The term puerperal fever embraces a group of essentially diverse affections, some of which are, unquestionably, non-contagious; the septicaemic variety of the disease is that which alone engages us in this discussion. An estimate of its gravity may be deduced from the statement of Barker that since 1740 there have been more than two hundred epidemics of this disease. This fact sufficiently emphasizes its prevalence; and the mortality attending ay of these epidemics stamps the disease as a surge scarcely less terrible than cholera or smallox It is most humiliating, in view of the fact that uerperal fever is largely a preventable disease, caused too often by criminal negligence on the part of physician or nurse. It is frequently urged that our science is not an exact one; but it seems to me the evidence that this fever may be caused by the contagia of erysipelas, scarlet fever and septic

The basic principles of order and efficiency-everybody doing his job and not intruding on others-while devised by Plato for his ideal republic, have been applied in practice to modern systems of industrial production. As this system reached its entelechy in Ford's assembly line, it is not surprising that the United States, where this perfection of the system was accomplished first, has been profoundly impressed by the principles of order and efficiency. It would mean belabouring the obvious to elaborate on the application of these principles to modern factories in the United States-or the rest of the industrialized world, for that matter. It is also well known that American agriculture benefited enormously by mechanization and rationalization, even if the spirit of industrial production had to be modified in its adaptation to this field of economic endeavour. The marketing of products has been dominated by the principles of efficiency and organization as well, as the supermarkets and the mail-order stores testify. Transportation and communication, roads and telephones, and countless other avenues of economic and administrative activity follow the same dictates. Life in America-from Ford's assembly line to the Yellow Pages, a veritable index to gracious living-is dominated by the spirit and letter of efficient organization. And the wages of this creed is affluence: efficiency-combined with natural resources, to be sure-made America into the richest country in the world. Occasionally there are gaps in this system. It is easier to buy tinned food than get rid of the empty tins in some parts of the country where the garbage disposal system is less than perfect. Railway services are not as reliable as in Europe and it is by no means unusual for trains to arrive much later than scheduled. The unprotected railway crossings, to quote a case of accepted criminal negligence, considerably contribute to the slaughter on the roads. Yet, these and such examples do not essentially change the overall picture. They rather stand out as curiosities against the background of an ordered, efficient, extremely wellfunctioning society which makes the life of the individual easy and comfortable, besides providing him with material wealth.

From a point of pertinent interest I deem it somewhat less than an impertinence to consider this subject, which within the last fourteen months has served to create disturbances of varied degree over different sections of Indiana. The fact of some chicken-pox cases being present in this city, the mildness of some cases not requiring a physician until several members of a family were attacked, snap diagnosis from incomplete observation, and last but not least the ignorance and criminal negligence of some of the physicians in denying the existence of the disease as smallpox, has, with the refusal of the authorities to build a pest-house, notwithstanding the demands of the secretary of the Board of Health, W. T. Fairfield, served to keep up a desultory outcropping of cases in different parts of the city, until up to April 15 there had been reported and discovered 149 cases since the beginning