Brain infarction in botulism (Clinical case)

Professional activity of intensivists consistently ranks high among the most «risky» areas of medicine. In 6 out of 89 criminal «iatrogenic» cases initiated by investigative authorities in the Moscow region in 2016–2018 anesthesiological or intensive care in the ICU was the subject of investigation. In 4 of these 6 cases, iatrogenic complications were detected during the forensic examination. Intensivist is considered an attending doctor and therefore holds responsibility for defects in the provision of medical care and its adverse outcome. The purpose of the study is to outline the professional risks in the work of an intensivist and identify ways to reduce them by using a case study with a fatal outcome, which led to criminal proceedings. Materials and methods. We studied and analyzed the criminal case files which included the complaint of the patient’s relatives with the prosecutor’s office, the explanations and interrogation records of the patient’s relatives (4) and healthcare workers (6), the minutes of the Morbidity and Mortality conference, the expert report on patient care quality issued by health insurance company, the final report of sanitary and epidemio-logical examination, autopsy protocol, emergency call files (3), the inpatient medical records, outpatient records and the final report of Commission of forensic medical examination. Results. Defects in the provision of medical care were not identified. The differential diagnosis was performed correctly. The severity of the patient's condition was due to brain infarction and associated abnormal-ities. Underdiagnosis of botulism did not affect the outcome of the disease and was not the cause of death of the patient. Conclusion. The reasons for filing a complaint with the Prosecutor's office and initiating a criminal case were organizational shortcomings and ethical and deontological aspects. © 2020, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved.