The Forensic Landscape in South Africa Flashcards
Prof Ryan Blumenthal (129 cards)
1
Q
Defintion of snapshot
A
The state of a system at a particular point in time
2
Q
Why was discovering the causes of death important in primitive tribal societies?
A
Even in early tribal societies, understanding the cause of death was crucial to identifying potential dangers and ensuring the community’s safety.
3
Q
What kind of deaths would have raised concerns in such societies?
A
Sudden, unexpected, or unwitnessed deaths would have signaled possible threats, either from within the tribe or from external enemies.
4
Q
Why did legal medicine emerge?
A
It was born out of the need for justice, adapting to scientific, technological, sociocultural, and legal changes throughout history.
5
Q
How does legal medicine function as a science?
A
It is constantly evolving as new discoveries and advancements shape its methods
6
Q
Why is legal medicine important?
A
It plays a crucial role in protecting people’s honor and freedom by ensuring justice is served.
7
Q
Major duties of a forensic pathologist
A
- To determine cause and manner of death.
- To identify the deceased if unknown.
- To collect evidence from the body.
- To document injuries or lack of them.
- To deduce how the injuries occurred.
- To document any underlying natural disease.
- To attend scene of crime.
- To determine or exclude other causes of death.
- To provide expert testimony
8
Q
Two types of forencis autopsies
A
Autopsies of documentation
Autopsies of discovery
9
Q
How did colonial occupation influence apartheid and forensic pathology?
A
The Dutch and British colonial rule shaped apartheid’s policy of separate development, which impacted many professions, including the medical field.
10
Q
What was South Africa like by the 1960s?
A
It had become a police state, heavily controlled by state security forces, the police, and military leaders.
11
Q
What led to increased state control from the 1950s onward?
A
Rising resistance and civil unrest among disenfranchised groups.
12
Q
What did the Truth and Reconciliation Commission (TRC) reveal after apartheid?
A
The TRC hearings exposed cases where state police agencies and rogue individuals had been involved in the deaths of political activists and detainees.
Some victims died during interrogations that included electric torture and other methods like tubing.
13
Q
What major legislative change occurred in forensic medicine in 2004?
A
The National Health Act (Act 61 of 2003) came into effect, making provincial health departments responsible for providing Forensic Pathology Services (FPS).
14
Q
What key transition happened in forensic pathology in 2006?
A
In 2006, medicolegal mortuaries were formally transferred from the South African Police Service (SAPS) to provincial health departments
15
Q
Who should provide clinical forensic medical services?
A
These services must be attended to by duly trained and accredited clinicians who work in the field regularly, rather than by specialist forensic pathologists.
16
Q
What is the vision for FPS as an independent agency?
A
The goal is to restructure FPS into an autonomous state agency, free from alignment with any specific government or service department.
17
Q
How should FPS be governed?
A
It should be overseen by a multidisciplinary authoritative structure such as a board of governors or council.
18
Q
who do the possible members of this multidisciplinary authoratative structure include?
A
- Judges
- Senior medical academics
- National prosecuting authority representatives
- Forensic pathologists
- Other forensic scientists
19
Q
Why is the establishment of an autonomous forensic pathology entity important?
A
A national forensic pathology agency, similar to the Office of the Public Protector, Auditor General, or Health Ombudsman, would strengthen justice and serve society’s best interests.
20
Q
What are some notable forensic textbooks written in South Africa?
A
The Forensic ABC in Medical Practice – Schwär, T.G., Loubser, J.D., Olivier, J.D. (1988)
Guide to Forensic Medicine and Medical Law – McQuoid-Mason, D.J.; Dada, M.A. (1999)
21
Q
How does population growth relate to these textbooks?
A
These books were written when South Africa had fewer people, meaning forensic medicine had to adapt to a growing population and evolving societal challenges.
22
Q
What was South Africa’s population in 1988?
A
35.2 million
23
Q
How has the population changed over time?
A
2000: 44.90 million
2010: 49.99 million
2020: 59.31 million
2025 (March 7): 64,747,319
24
Q
How many people have been added in the last 37 years?
A
29 million extra people!
25
What is the prediction for population growth in the next 15 years?
Strong growth is expected, especially in Southern and Eastern Africa.
26
What is the estimated population of South Africa in 2025?
An aproxiamate R64,747,319 people
27
How many deaths occur in South Africa each year?
Natural deaths: ~500,000 per year.
Unnatural deaths: ~70,000 per year.
28
What are the main causes of unnatural deaths?
Homicides: Up to 25,000 per year.
Road traffic accidents: Up to 15,000 per year.
Suicides: Up to 10,000 per year.
29
How many autopsies does a forensic practitioner typically perform annually?
Between 400 – 600 autopsies per year.
30
How many forensic pathologists are currently registered in South Africa?
Approximately 70 – 80 forensic pathologists.
31
How many medical practitioners graduate annually in South Africa?
Eight tertiary institutions with Faculty of Health Sciences produce 1,200 medical practitioners each year.
32
How many medical practitioners currently serve South Africa?
Approximately 28,000 medical practitioners for a population of 64 million.
33
How is South Africa divided geographically?
There are nine provinces, with the largest populations in:
Gauteng: ~12 million people.
KwaZulu-Natal (KZN): ~10 million people.
34
Which metropolitan area has the highest chance of unnatural death?
Cape Town.
35
How many autopsies should a Medical Examiner perform annually according to the National Association of Medical Examiners? (Pathologist workforce in the USA)
Approximately 250 autopsies per year.
36
37
What is the current trend in the number of pathologists in the USA?
The pool of pathologists is gradually declining.
38
What factors contribute to a net deficit in forensic pathologists?
Population growth and an aging population increase demand.
The number of trained pathologists is insufficient to replace retiring professionals.
A shortage of forensic pathologists leads to high workloads.
39
When is a shortage of pathologists predicted?
By 2030.
40
How many Board Certified Forensic Pathologists are in South Africa?
70-80 forensic pathologists.
41
How many autopsies do forensic pathologists perform annually in South Africa?
Between 400 – 600 autopsies per year, significantly more than the USA recommendation.
42
Is South Africa producing enough forensic pathologists to meet future demand?
No, the number of forensic pathologists in training is insufficient to replace those retiring in the next decade.
43
How many specialist forensic pathologists are currently registered with the HPCSA?
There are between 80 and 90 forensic pathologists registered.
44
What is being suggested for forensic pathology moving forward?
A rethink of various aspects, including:
Who forensic professionals are.
What they do.
How they feel and live.
How they work.
How conferences, education, and technology in forensic pathology evolve
45
What is the ideal number of forensic pathologists per million people?
Ideally, there should be 6 forensic pathologists per million population.
46
How many forensic pathologists are needed in South Africa?
At least 150 forensic pathologists just to keep up with the demand.
47
How many Board Certified forensic pathologists were active in South Africa in 2018?
50 forensic pathologists, which was considered inadequate for the country's population of 57.78 million.
48
How many forensic pathologists were estimated to be active in 2024?
80–90 forensic pathologists, serving a population of 64,007,187 (as of August 29, 2024)
49
What is the estimated population of South Africa in 2025?
64,747,319 (as of March 7, 2025, based on Worldometer and UN data).
50
How many forensic pathologists does South Africa need per million people?
Five to six forensic pathologists per million.
51
How many forensic pathologists does South Africa require overall?
380 forensic pathologists to meet national needs.
52
What are potential solutions for addressing the shortage?
Hiring more staff.
Industrializing the autopsy process.
Increasing forensic pathology assistants.
53
How many assistants does each forensic pathologist need?
Two to three assistants per forensic pathologist.
54
How many forensic pathology assistants are needed in South Africa?
Between 760 and 1,140 assistants.
55
Why is South Africa facing an urgent need for more forensic pathologists?
Rapid changes in forensic medicine increasing workload.
Current training programs are insufficient to replace retiring pathologists in the next 15 years.
56
What are the key expectations of people in the Fourth Industrial Revolution?
People expect to be able to work, learn, and study anytime and anywhere.
57
How is technology evolving in this era?
IT support is decentralized, and technologies are increasingly cloud-based.
Workspaces are becoming more collaborative, influencing how students learn and structure projects.
The internet provides abundant resources and relationships, challenging educators to redefine their roles.
58
How are education paradigms shifting?
They are moving toward online learning, hybrid learning, and blended learning models.
59
What are some ideas for improving court efficiency?
Developing a court-related app to manage processes digitally.
Addressing issues like the absence of stenographers or translators using automated solutions.
60
How has progress in recent years impacted the judicial system?
It has become faster and more efficient, with decisions now more scientifically grounded.
61
What emerging technologies pose challenges?
Drones
Facial recognition software
Laboratories on a chip
Homicide by cell phone
Artificial General Intelligence (AGI)
Artificial Super Intelligence (ASI)
62
What are the new developments in medicine?
The debate between curing the sick vs. upgrading the healthy (e.g., prophylactic mastectomy with bilateral oophorectomy and hysterectomy).
63
What are the innovations in forensic pathology?
Mortuaries of the future
Post Mortem Non-Invasive Virtual Autopsies (PNIVA)
MRI and CT scans used for forensic investigations
The distinction between essential and non-essential autopsies
64
What does the study 'Frontier Models are Capable of In-Context Scheming' suggest about AI models?
It reveals that advanced AI models may engage in in-context scheming, deception, sandbagging, and faking alignment, raising concerns about safety and control.
65
What is deception in AI models?
Deception occurs when AI models lie or mislead users to achieve their own goals.
66
What does sandbagging mean in AI behavior?
Sandbagging is when AI models strategically underperform on evaluations to appear less capable than they actually are.
67
How can AI models fake alignment?
Faking alignment means AI models can appear to support user goals while secretly pursuing their own, potentially misaligned objectives.
68
What is sabotage of oversight?
Sabotaging oversight involves AI models attempting to disable or circumvent mechanisms designed to monitor and control their behavior.
69
Why did Professor Leon Snyman express concern about a recent verdict regarding Dr Danie van Der Walt who negligently killed a woman in labour
A: He believes the ruling sends a chilling message to doctors attending labour cases, as medical professionals face high malpractice risks despite human errors.
70
How much is the insurance premium for obstetricians in South Africa?
R1 million per year, requiring doctors to deliver 24 babies per month just to cover insurance fees.
71
What did Minister of Health Dr Zweli Mkhize say about Dr Munshi’s murder?
He described it as a brutal murder and expressed shock and dismay.
72
What was suspected before Dr Munshi’s assassination?
Both Dr Munshi and his colleague, Professor Peter Beale, reportedly received death threats before the attack
73
What was retired doctor Eric van der Veen convicted of?
Two counts of fraud for signing false death certificates, which were used in multimillion-rand insurance claims without examining the bodies.
and was sentenced to eight years’ imprisonment, wholly suspended for five years.
74
How did Thabo Bester escape prison in South Africa?
He faked his death in 2022, making authorities believe he had died by self-immolation in his cell
A new post-mortem investigation revealed the burnt body found in his cell was not his, exposing the escape.
75
What was the Esidimeni debacle?
It was a tragic incident in South Africa involving the mismanagement of mentally handicapped patients after the termination of a state contract with a private healthcare provider.
76
How were Esidimeni patients originally cared for?
They were receiving treatment at a private mental health care hospital under a contract between the state and the private health care provider.
77
What led Esidimeni to the crisis?
In mid-2015, the hospital and the Provincial Department of Health decided—at short notice and against expert advice—to terminate the contract to cut costs.
78
Where were the Esidimeni patients relocated?
They were transferred to multiple smaller centers, many of which were unlicensed, poorly staffed, and inadequately equipped.
79
What were the consequences relocating the esidimeni patience?
Within months, about 150 patients tragically died, often in undignified conditions, due to inadequate care
80
What are examples of notable medical malpractice cases?
Heart-lung bypass machine failure – Patient suffered hypoxic ischaemic encephalopathy post-operation due to air in the machine.
Tonsillectomy incident – Child woke up with fourth-degree burns on the back of the knees due to diathermy.
Orthopedic surgery complication – Patient developed testicular necrosis post-operation.
Incorrect lab result – Misdiagnosed anaemia, leading to an unnecessary bone marrow biopsy.
Missing tumor case – Medical oversight resulted in an undetected tumor.
81
How is medical malpractice defined?
It consists of wrongful acts by doctors or healthcare workers that cause injuries or harm to patients.
82
What are the two types of medical malpractice?
**Intentional malpractice** – When the wrongdoer deliberately intends to commit the wrongful act and knows it is improper.
**Negligent malpractice** – When the wrongdoer fails to act as a reasonable healthcare worker would in similar circumstances.
83
What level of skill and care is expected from a healthcare worker?
A doctor or medical professional must exercise the degree of skill and care expected of a reasonably skilled person in their field.
84
How does the court determine ‘reasonableness’ in malpractice cases?
The court considers the general level of skill and care exercised by members of the medical profession but is not strictly bound by this standard.
85
How does the standard differ between specialists and general practitioners?
Greater skill and care is expected from specialists than from general practitioners.
86
When is a doctor negligent regarding specialized procedures?
A doctor is negligent if they undertake work requiring specialist skills they do not have.
87
How is the standard of care determined in medical practice?
It is based on how a reasonably competent practitioner in that field would have acted in a similar situation.
88
What determines whether a doctor acted negligently?
If a reasonable doctor would have foreseen the likelihood of harm to the patient and failed to take steps to prevent it.
89
Can a doctor be held liable for an unusual complication?
NO, liability exists if the complication is highly unusual (e.g., idiosyncrasy or hypersensitivity), unless testing could have prevented it.
90
When is a higher degree of care required?
When working with inherently dangerous substances (e.g., poison) or when special knowledge increases the risk.
91
Does the same standard of skill and care apply in emergencies?
Not always—except if the doctor caused the emergency.
92
Can failure to obtain consent be considered negligence?
Yes, it may result in an assault charge if a doctor deliberately fails to get patient consent.
93
How do courts typically handle emergency-related malpractice cases?
Courts are often reluctant to infer negligence in emergencies where facts do not speak for themselves (e.g., leaving a swab inside a patient).
94
What does "culpa in eligendo" mean?
It refers to negligence in selecting a contractor or employee—the master is responsible for the servant.
95
How does this principle apply in hiring officials?
Failure to appoint qualified personnel who comply with international law may result in liability.
96
Are hospitals liable for their employees’ malpractice?
Yes, hospital authorities are vicariously liable for the acts of doctors and nurses if malpractice occurs within their scope of employment.
97
Can a hospital be liable even after warning employees against certain procedures?
Yes, if the wrongful act falls within the general duties of employment, liability remains.
98
Can hospitals be expected to meet unrealistic standards?
No—hospital liability depends on its financial resources.
99
Is a doctor liable for the negligence of their own assistants?
Yes, if the assistant is considered a servant under the doctor’s control.
100
What about assistants provided by a hospital or nursing home?
Liability depends on whether they are under the doctor’s control (i.e., taking direct instructions).
101
Can a qualified theatre sister be considered a doctor’s servant?
No, as she has independent duties to fulfill.
102
Are nurses and sisters generally considered under the doctor’s control?
Yes, unless they are performing independent tasks entrusted to them.
103
Can a doctor be held liable even if an assistant acted independently?
Yes, if the doctor could have intervened to prevent harm but failed to do so.
104
Who is liable for malpractice—hospital or healthcare worker?
Both—the hospital is vicariously liable, but the individual doctor or nurse is personally responsible for any harm caused.
105
Is a surgeon liable for an anesthetist’s negligence?
Generally, no—but the surgeon may be personally liable if they failed to prevent harm to the patient.
106
How are mortuary records currently maintained in South Africa?
Mortuary records are primarily paper-based, which is remarkable given modern digital options.
107
Why is capturing forensic data important?
It helps with policy development, strategic planning, resource allocation, and preventative strategies based on epidemiological profiles of death and injury.
108
Should trial records, conviction details, and acquittals be kept indefinitely?
Yes, all records and materials can be stored indefinitely in accessible and usable condition today.
109
Q: What are the challenges of indefinite record storage? A: Space, management, and cost—especially when most trials and appeals are final and never re-opened.
110
Why is anticipating future legal needs difficult?
New compelling evidence could overturn an acquittal, leading to a retrial years later.
111
What issues can arise for wrongly convicted individuals?
They may suffer psychological and psychiatric trauma and seek compensation for wrongful conviction.
112
What legal principles guide compensation for wrongful convictions?
R (Adams) v Secretary of State for Justice [2011] UKSC 18
Criminal Justice Act 1988 S 133
Criminal Evidence Act (UK, 2003) S 75-97
113
Why is record preservation crucial in today's legal landscape?
We live in an increasingly litigious world, making long-term storage valuable for legal protection.
114
What factors must be considered when storing records indefinitely?
Costs vs. benefits
Medico-legal aspects
Virus/prion/infectious agent risks
Genetic aspects
115
What is the general timeframe for keeping medical and legal records?
Most court cases are initiated within 10 years of the incident, making a 10-year retention period advisable for medical records.
116
What does the South African Medical Association recommend?
Medical records should be kept for six to nine years.
117
117
Why must healthcare professionals comply with statutory record-keeping obligations?
To ensure continuity of patient care.
To reduce the risk of adverse incidents caused by misplaced or untraceable records.
118
What are the key standards guiding medical record management?
:
HPCSA Guidelines on the Keeping of Patient Records (2008) – Paragraph 9.
ISO/IEC 27002:2005 – Covers staff responsibilities, training, premises security, business continuity, protocols, e-mail, and remote access (approved as SANS 27002:2008).
ISO 27799:2008 – Focuses on health informatics and information security in the healthcare sector.
Electronic Communications and Transactions Act – Requires obsolete personal information to be deleted or destroyed
119
How long should medical records be retained?
General records: At least six years after becoming dormant.
Records of minors: Until their 21st birthday.
Records of mentally impaired patients: Until the patient’s death.
Occupational illness or accident records: 20 years after treatment ends.
120
Are there special rules for records in provincial hospitals and clinics?
Yes, records can only be destroyed with authorization from the deputy director-general.
121
How long should records for slow-developing diseases like asbestosis be kept?
At least 25 years, as recommended by HPCSA
122
What must be balanced when deciding to store records indefinitely?
The cost and space implications versus the potential usefulness for litigation, academic research, or medico-legal cases.
123
How should medical records be safely disposed of?
Paper records should be shredded or incinerated.
CDs, DVDs, hard disks, and electronic storage should be overwritten with random data or physically destroyed.
124
What does the Electronic Communications and Transactions Act say about electronic records?
It mandates that obsolete personal information be securely deleted or destroyed.
125
Why must second-hand computers be carefully wiped before disposal?
Deleted information can often still be recovered, so data must be safely erased.
126
What risks threaten paper records? A: Moisture, water, fire, and insects can cause damage.
Q
127
What are best practices for protecting paper records?
1. Install smoke and fire alarms.
2. Use chemical fire extinguishers instead of water-based sprinklers.
3. Avoid storing records in basements (prone to flooding).
4. Store records above floor level, ideally on high shelves.
5. Conduct regular inspections and prevent insect/rodent damage
128
How should electronic records be safeguarded?
Perform regular backups and store them in a secure off-site location (e.g., cloud storage).
If sprinklers are installed, protect computers containing medical records with waterproof covers overnigh
