Що вивчає судово-медичний експерт у процесах про медичні помилки – стисле інтерв’ю з професором Андрієм Біляковим
A forensic medical expert in medical malpractice cases assesses a doctor’s actions, adherence to clinical protocols, and the causal link between treatment and patient harm. Professor Andriy Bilyakov explained how experts identify defects in medical care and why expertise often becomes key evidence in court.
Cases of alleged medical negligence are among the most complex for investigation and court proceedings. In such cases, forensic medical expertise plays a crucial role, as it allows for the evaluation of a doctor’s actions, compliance with medical standards, and the presence of a causal relationship between treatment and patient harm. More details on whether judges trust expert opinions and whether they can indeed prove causality can be found in a blitz interview with the acting head of the Department of Forensic Medicine and Medical Law at the O.O. Богомолець National Medical University, Professor Andriy Bilyakov.
– What exactly does a forensic medical expert assess in cases of medical malpractice?
– When investigating crimes against life and health committed by medical professionals (particularly under Article 140 of the Criminal Code of Ukraine), forensic medical expertise is always conducted by a commission involving highly qualified specialists (clinicians).
The expert commission thoroughly evaluates the following stages of medical care provision:
Diagnostic stage: timeliness, completeness, and correctness of diagnosis. Whether the full range of mandatory laboratory and instrumental studies was performed.
Treatment and tactical stage: correctness of the chosen treatment method (conservative or surgical), timeliness of surgical intervention, adequacy of dosage, and compatibility of prescribed medications.
Technical stage: quality of direct performance of procedures and surgeries (whether technical defects, damage to vessels, nerves, or retention of foreign objects occurred).
Organizational stage: correctness of patient routing, timeliness of convening a consultation or transferring the patient to a higher level of care facility.
Defects in medical documentation: thoroughness of filling out the medical record, as it is the primary object of investigation.
– Are medical professionals obliged to follow medical protocols?
– Medical standards and clinical protocols (approved by Orders of the Ministry of Health of Ukraine) serve as the basic criterion by which experts assess the “appropriateness” or “inappropriateness” of a doctor’s actions. They represent the benchmark of safe medical practice.
– Are deviations necessarily violations?
– No, they are not. The main requirement is that any deviation from a standard must be scientifically justified and thoroughly documented in the medical records with an explanation of the reasons. If a doctor deviates from a protocol without objective medical grounds, it is qualified by the expert as a defect in medical care provision.
– Can a causal link be established between undocumented deviations from medical protocols and harm to the patient?
– Establishing a causal link is the most critical part of the expertise. The expert must clearly distinguish between the consequences of the illness itself and the consequences of the doctor’s actions or inaction.
In forensic medical practice, two types of links are identified:
Direct (immediate) link: when the doctor’s action or inaction initiated a chain of pathological changes leading to complications, disability, or death (e.g., perforation of a healthy organ during surgery followed by peritonitis; administration of a drug to which the patient has a known allergy, causing anaphylactic shock). Criminal liability of the doctor arises only in the presence of a direct link.
Indirect link: when the doctor’s error merely contributed to an adverse outcome but was not its primary cause (e.g., delayed diagnosis of cancer reduced the patient’s chances of recovery, but the tumor was the cause of death). Such a link more often becomes the subject of civil claims for damages.
To achieve this, experts use a retrospective analysis method, constructing a chronological chain: “patient’s initial condition – doctor’s action/inaction – pathophysiological changes – final outcomes.”
– To what extent do courts trust the conclusions of forensic medical examinations?
– Judges are specialists in law but lack specific medical knowledge. They cannot independently assess whether a medical procedure was performed correctly or whether the dosage of a drug was chosen appropriately.
According to Article 242 of the Criminal Procedure Code of Ukraine, appointing an expert examination is mandatory when it is necessary to establish the cause of death or the severity and nature of bodily injuries.
The expert’s conclusion is an independent source of evidence (Article 101 of the Criminal Procedure Code of Ukraine, Article 102 of the Civil Procedure Code of Ukraine). It does not have a predetermined weight but, de facto, serves as the foundation for a court decision.
In simple terms, an expert conclusion translates complex biological and clinical processes into the language of legal facts. Without forensic medical expertise, a court is legally incapable of establishing the presence of a crime or a civil offense in the actions of a medical professional.