Medicolegal causation investigation of bacterial endocarditis associated with an oral surgery practice using the INFERENCE approach

Putri Dianita Ika Meilia, Maurice P. Zeegers, Herkutanto, Michael D. Freeman

Research output: Contribution to journalArticlepeer-review

Abstract

Investigating causation is a primary goal in forensic/legal medicine, aiming to establish the connection between an unlawful/negligent act and an adverse outcome. In malpractice litigation involving a healthcare-associated infection due to a failure of infection prevention and control prac-tices, the medicolegal causal analysis needs to quantify the individual causal probabilities to meet the evidentiary requirements of the court. In this paper, we present the investigation of the most probable cause of bacterial endocarditis in a patient who underwent an invasive procedure at a dental/oral surgical practice where an outbreak of bacterial endocarditis had already been identified by the state Department of Health. We assessed the probability that the patient’s endocarditis was part of the outbreak versus that it was an unrelated sporadic infection using the INFERENCE (Integration of Forensic Epidemiology and the Rigorous Evaluation of Causation Elements) approach to medicolegal causation analysis. This paper describes the step-by-step application of the INFERENCE approach to demonstrate its utility in quantifying the probability of causation. The use of INFERENCE provides the court with an evidence-based, transparent, and reliable guide to determine liability, causation, and damages.

Original languageEnglish
Article number7530
JournalInternational Journal of Environmental Research and Public Health
Volume18
Issue number14
DOIs
Publication statusPublished - 2 Jul 2021

Keywords

  • Bacterial endocarditis
  • Infection prevention and control practices
  • INFERENCE approach
  • Malpractice litigation
  • Medicolegal causal analysis
  • Quantification of causation

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