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Fourteen Deaths from Suspected Heparin Overdose in an Italian Primary-Level Hospital

Healthcare-related homicidal cases are not novel within the medical–legal landscape, but investigations are often made difficult with the scarcity of material evidence related to the crime. For this reason, it is necessary to carefully analyze the clinical documentation and employ ancillary forensic...

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Autores principales: Di Fazio, Nicola, Scopetti, Matteo, Delogu, Giuseppe, Morena, Donato, Santurro, Alessandro, Cipolloni, Luigi, Serviddio, Gaetano, Papi, Luigi, Frati, Paola, Turillazzi, Emanuela, Fineschi, Vittorio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10650777/
https://www.ncbi.nlm.nih.gov/pubmed/37958256
http://dx.doi.org/10.3390/diagnostics13213361
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author Di Fazio, Nicola
Scopetti, Matteo
Delogu, Giuseppe
Morena, Donato
Santurro, Alessandro
Cipolloni, Luigi
Serviddio, Gaetano
Papi, Luigi
Frati, Paola
Turillazzi, Emanuela
Fineschi, Vittorio
author_facet Di Fazio, Nicola
Scopetti, Matteo
Delogu, Giuseppe
Morena, Donato
Santurro, Alessandro
Cipolloni, Luigi
Serviddio, Gaetano
Papi, Luigi
Frati, Paola
Turillazzi, Emanuela
Fineschi, Vittorio
author_sort Di Fazio, Nicola
collection PubMed
description Healthcare-related homicidal cases are not novel within the medical–legal landscape, but investigations are often made difficult with the scarcity of material evidence related to the crime. For this reason, it is necessary to carefully analyze the clinical documentation and employ ancillary forensic resources such as radiology, histopathology, and toxicology. In the presented scenario, the observation of 14 deaths from abnormal bleeding in a First-Level Italian Hospital revealed the administration of massive doses of heparin by a nurse. On behalf of the Judicial Authority, a multidisciplinary medical team investigated the case through the following steps: a thorough review of the clinical documentation, exhumation of the bodies belonging to the deceased patients, performing PMCT and autopsy, and collecting tissue samples for histopathological, immunohistochemical, and toxicological investigations. All the analyzed cases have been characterized by the observation of fatal hemorrhagic episodes not explained with the clinical conditions of the patients, confirmed using autopsy observations and the histological demonstration of the vitality of the lesions. However, due to the limited availability of biological material for the toxicological analysis, the indirect evidence from hematological analyses in hospitalized patients was crucial in demonstrating heparin overdose and its link to the recorded deaths. The present scenario demonstrates the fundamental importance of a multidisciplinary approach to cases of judicial interest related to the healthcare context. Therefore, the illustrated methodologies can be interpreted as an operational framework for similar future cases.
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spelling pubmed-106507772023-11-01 Fourteen Deaths from Suspected Heparin Overdose in an Italian Primary-Level Hospital Di Fazio, Nicola Scopetti, Matteo Delogu, Giuseppe Morena, Donato Santurro, Alessandro Cipolloni, Luigi Serviddio, Gaetano Papi, Luigi Frati, Paola Turillazzi, Emanuela Fineschi, Vittorio Diagnostics (Basel) Article Healthcare-related homicidal cases are not novel within the medical–legal landscape, but investigations are often made difficult with the scarcity of material evidence related to the crime. For this reason, it is necessary to carefully analyze the clinical documentation and employ ancillary forensic resources such as radiology, histopathology, and toxicology. In the presented scenario, the observation of 14 deaths from abnormal bleeding in a First-Level Italian Hospital revealed the administration of massive doses of heparin by a nurse. On behalf of the Judicial Authority, a multidisciplinary medical team investigated the case through the following steps: a thorough review of the clinical documentation, exhumation of the bodies belonging to the deceased patients, performing PMCT and autopsy, and collecting tissue samples for histopathological, immunohistochemical, and toxicological investigations. All the analyzed cases have been characterized by the observation of fatal hemorrhagic episodes not explained with the clinical conditions of the patients, confirmed using autopsy observations and the histological demonstration of the vitality of the lesions. However, due to the limited availability of biological material for the toxicological analysis, the indirect evidence from hematological analyses in hospitalized patients was crucial in demonstrating heparin overdose and its link to the recorded deaths. The present scenario demonstrates the fundamental importance of a multidisciplinary approach to cases of judicial interest related to the healthcare context. Therefore, the illustrated methodologies can be interpreted as an operational framework for similar future cases. MDPI 2023-11-01 /pmc/articles/PMC10650777/ /pubmed/37958256 http://dx.doi.org/10.3390/diagnostics13213361 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Di Fazio, Nicola
Scopetti, Matteo
Delogu, Giuseppe
Morena, Donato
Santurro, Alessandro
Cipolloni, Luigi
Serviddio, Gaetano
Papi, Luigi
Frati, Paola
Turillazzi, Emanuela
Fineschi, Vittorio
Fourteen Deaths from Suspected Heparin Overdose in an Italian Primary-Level Hospital
title Fourteen Deaths from Suspected Heparin Overdose in an Italian Primary-Level Hospital
title_full Fourteen Deaths from Suspected Heparin Overdose in an Italian Primary-Level Hospital
title_fullStr Fourteen Deaths from Suspected Heparin Overdose in an Italian Primary-Level Hospital
title_full_unstemmed Fourteen Deaths from Suspected Heparin Overdose in an Italian Primary-Level Hospital
title_short Fourteen Deaths from Suspected Heparin Overdose in an Italian Primary-Level Hospital
title_sort fourteen deaths from suspected heparin overdose in an italian primary-level hospital
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10650777/
https://www.ncbi.nlm.nih.gov/pubmed/37958256
http://dx.doi.org/10.3390/diagnostics13213361
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