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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MDPI AG
2023-11-01
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| Online Access: | https://www.mdpi.com/2075-4418/13/21/3361 |
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| author | Nicola Di Fazio Matteo Scopetti Giuseppe Delogu Donato Morena Alessandro Santurro Luigi Cipolloni Gaetano Serviddio Luigi Papi Paola Frati Emanuela Turillazzi Vittorio Fineschi |
| author_facet | Nicola Di Fazio Matteo Scopetti Giuseppe Delogu Donato Morena Alessandro Santurro Luigi Cipolloni Gaetano Serviddio Luigi Papi Paola Frati Emanuela Turillazzi Vittorio Fineschi |
| author_sort | Nicola Di Fazio |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-03-11T11:31:54Z |
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| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-11T11:31:54Z |
| publishDate | 2023-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-9f90bb9944a94b2d9431305b924238d32023-11-10T15:01:05ZengMDPI AGDiagnostics2075-44182023-11-011321336110.3390/diagnostics13213361Fourteen Deaths from Suspected Heparin Overdose in an Italian Primary-Level HospitalNicola Di Fazio0Matteo Scopetti1Giuseppe Delogu2Donato Morena3Alessandro Santurro4Luigi Cipolloni5Gaetano Serviddio6Luigi Papi7Paola Frati8Emanuela Turillazzi9Vittorio Fineschi10Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, ItalyDepartment of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, ItalyDepartment of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, ItalyDepartment of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, ItalyDepartment of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, ItalyDepartment of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, ItalyDepartment of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, ItalyDepartment of Legal Medicine, University of Pisa, 56126 Pisa, ItalyDepartment of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, ItalyDepartment of Legal Medicine, University of Pisa, 56126 Pisa, ItalyDepartment of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, 00161 Rome, ItalyHealthcare-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.https://www.mdpi.com/2075-4418/13/21/3361healthcare settingforensicmurderheparin overdosefatal hemorrhagePMCT |
| spellingShingle | Nicola Di Fazio Matteo Scopetti Giuseppe Delogu Donato Morena Alessandro Santurro Luigi Cipolloni Gaetano Serviddio Luigi Papi Paola Frati Emanuela Turillazzi Vittorio Fineschi Fourteen Deaths from Suspected Heparin Overdose in an Italian Primary-Level Hospital Diagnostics healthcare setting forensic murder heparin overdose fatal hemorrhage PMCT |
| 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 | healthcare setting forensic murder heparin overdose fatal hemorrhage PMCT |
| url | https://www.mdpi.com/2075-4418/13/21/3361 |
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