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 Medico-Legal Case Studies


 Medico-Legal Case Studies

Medico-Legal Case Studies



John A. Budny, PhD, CMI Certified Medical Investigator of Forensic Toxicology – Medico-Legal Case Studies Published in the International Journal of Toxicology 2013 32: 317

Forensic toxicology, in the broadest sense, is the application of toxicology to support the implementation of laws. There are certain criminal and civil adjudications that would not be possible or not be remotely or partially correct without the contributions of a sage toxicologist. In fact, some criminal and civil investigations, as a prelude to a trial, would not be productive without contributions from forensic toxicology. It is reasonable, therefore, to collect and report or publish historical legal matters that were resolved, or at least resulted in a more enlightened outcome, with the help of forensic toxicology so that the legal community can understand the contributions that toxicology can and does make to forensics. It is that purpose for which Kalipatnapu N. Rao wrote Forensic Toxicology – Medico-Legal Case Studies.

The 24x16 cm book has 261 pages and is 1.3 cm thick. There are 21 chapters, six pages of Table of Contents, one page each of a Preface, Acknowledgements, Disclaimer, The Author section and an eight page Index. While the chapters are not grouped into sections, there are collections of chapters, not necessarily in sequential order, that are related.

Chapters 4 and 13 – 18, which constitute 40% of the book, address ethyl alcohol toxicity. Chapters 2 and 3 are another grouping that discusses the analytical toxicology laboratory. Two chapters, comprising approximately 12 pages, discuss plant and animal toxins. Chapters 9, 10, 11, 12 and 20 constitute a grouping that, to some extent, justifies the word “legal” in the book’s title by addressing the U. S. Legal System, Toxicology Report, Deposition Testimony, Court Testimony and Toxic Torts. The final chapter grouping addresses five diverse topics: Historical Perspectives in Toxicology, ethylene glycol, Drug Screens, Drug Overdose and Workers’ compensation.

In the Preface, the author stated that his goal with the book was “to bridge the gap between the medical and legal professions”. While bridging the gap between medical and legal professions may be a desirable outcome, such a daunting task is improbable to accomplish with any text, much less so with this book. In short, the book does not meet the author’s desired expectation.

There are many flaws and inadequacies with the book that are likely due to an unfortunate event. Approximately seven months before the publication date of the book, the author passed away. The author’s passing is consistent with a perceived lack of attention to the manuscript that could not be completely remedied by publisher intervention. However, a more aggressive attention to the manuscript by the publisher could have greatly improved the book that was ultimately published.

There are several examples where serious proof reading, in the absence of the author’s involvement, could have corrected flaws and improved the quality of the text. The publisher’s intervention could have elevated the author’s effort from what appears to be his personal notes to a publishable manuscript. The first example occurs in a section, “Marker’s for Liver Regeneration.” Two tables present data on serum biomarkers of liver function for survivors and non-survivors. Aside from the scientific quality issue of not identifying the toxicant, the identical data are presented in graphic form. The tabular form of the data is not a necessary part of the text. Dual presentation of the same information takes up space needlessly and bores the reader.

A second example of demonstrating a failure in proof reading is obvious in the not just similar but word-for-word duplication of sentences in section 20.2.3 and section 20.2.4. Such an egregious error could have been readily eliminated with a simple review that would not have required toxicological expertise.

A third example of inadequate proof reading occurs in the references appearing at the end of the chapters. The same reference in two chapters is cited differently, both in content and structure. In chapter 3, the citation reads as follows: “Baselt, R. C. and Cravey, R. H. Disposition of Toxic Drugs and Chemicals in Man. Chemical Toxicology Institute, Foster City, CA 1995, p. 802.”; in chapter 19, the citation reads: “Basset [sic], R. C. and Cravey, R. H. Disposition of Toxic Drugs and Chemicals in Man. Chemical Toxicology Institute, Foster City, CA, 1994 [sic].” Misspelling, differences in publication years and the lack of consistency in providing page numbers in the citation are small but important matters for publications that wish to claim an authoritative view of the subject matter.

There are many other mechanical and functional shortcomings of the book. The functionality of internet reference links along with the dates they were accessed isdisappointing. The quality of the Index makes the book almost useless as a reference text. The outline structure within the chapters lack depth and consistency resulting in a superficial treatment of the various topics. The inability of the publisher to work with the author to create a useful reference for the forensics community is apparent.

On the scientific side, there are also serious shortcomings. However, in fairness to the author, his passing appears to have occurred at a time before he had a manuscript ready for publication. There are tell-tale signs that the author had not completed his work: explanations of why cases were selected for inclusion were missing; how forensic toxicology contributes to establishing the cause and manner of death was overlooked; how presumptive and confirmatory testing procedures and processes relate to each other and define drug exposure were ignored; assuring that the book’s Index adequately served the reader for a quick and easy focus for locating topics of interest to the reader was avoided.
In summary, the book appears to be a publication of the author’s notes. It is short on detail, explanation and substance with ample errors of omission and commission. The author’s passing was unfortunate; however, the publisher would have served the author, forensic toxicology and its own economic interests better if it had commissioned a co- author for the book to pick up and finish what the author started. Unfortunately, in its present state, the book is not worth the C-note (1,2) price set by the publisher even though a case-study book in forensic toxicology is an attractive potential resource and a publication that would be desired by toxicology investigators and expert witnesses.

1.The free Accessed April 24, 2013.

2.   Accessed April 24, 2013

This article discusses issues of general interest and does not give any specific legal or business advice pertaining to any specific circumstances. Before acting upon any of its information, you should obtain appropriate advice from a lawyer or other qualified professional.