Full Professor
of Legal Medicine
Massimo Montisci: forensic medicine services in Padua
When you decide to deal with legal disputes (“judicial”, “healthcare”, “social insurance” and “private insurance”) you must be aware of the risks and problems inherent in the process.
My professional consultancy is carried out precisely in this, preparing the various clients, institutional or private, to respond to the requests for quality and evidentiary evidence specific to the legal system.
The experience acquired during decades of scientific research, teaching and practical care carried out at the University and Hospital of Padua leads me to conclude that there is no better method than this: providing scientific and professional data produced and validated according to the criteria of evidence, quality, competence and biomedical-legal and forensic multidisciplinarity. Forensic medical investigations are an indispensable tool to ensure accurate results.
Consulting in legal medicine and medical liability
The technical-scientific biomedical-legal consultancy service, with judicial and extrajudicial value, is based on the analysis, interpretation and evaluation of scientific and professional data, self and externally produced.
Biomedical-legal laboratory service
The biomedical-legal and forensic laboratory service, with a prevalent morphological and omic focus, is carried out through collaboration with expert "analysts" and latest-generation equipment used in the most accredited laboratories at national and international level.
Thematic areas of interest in forensic medicine by Massimo Montisci
There are areas of Biomedical-legal sciences on which, due to personal sensitivity to certain types of issues, I have concentrated my interest and to which I have dedicated studies and insights with some particularly appreciated scientific research and publications.
I always like to remember that we Forensic Doctors are men of science, but we are also simply men, with personal events and stories that sometimes also determine our professional choices. In any case, in a delicate work sector such as that of legal medicine, what makes the difference is not your specialization but the obstinate pursuit of excellence.
Professional health and medical-legal liability
The term “malpractice”, born from journalistic language, commonly identifies the dysfunctions and errors that occur within the health system. Law 24/2017, the so-called Gelli-Bianco, which regulates the safety of care and health risk, provides that in the case of medical-professional liability, it is the “medical examiner’s assessment” that evaluates the causes and damages related to errors of conduct of health personnel. The methodological rigor in this medical-legal evaluation area is set out in the “Methodological-assessment and criteriological-evaluation Guidelines” [1] and is applied by the national [2] and international medical-legal scientific and professional community.
Civil liability and personal injury
The report of the National Association of Insurance Companies (ANIA) [3] highlights that in 2020, 5.5 billion euros were paid out to compensate victims of car accidents. A huge figure that gives an idea of how much work still needs to be done in terms of prevention and road safety education. In this specific sector, I have applied a systematic methodology in the field of civil liability, demonstrated by constant scientific production, edited in the Guidelines published in the International Journal of Legal Medicine [4-5], the basis for the assessment and evaluation of personal injury.
Crimes and offences of medico-legal relevance
The role of the medical examiner has become increasingly important within the criminal investigation, during which the Judge and the Public Prosecutor can appoint a technical consultant for the understanding of matters that require specific skills, but the parties involved (prosecution and defense) can provide the contribution of their own consultants. The use of scientific evidence is essential if one wants to reach conclusions of high probability or certainty. In this context, autopsy tests are placed, aimed at establishing the cause, the time and the means that caused death, also making use of radiological investigations, through multidisciplinary assessment protocols developed at an international level, useful for achieving the maximum scientific-technological evidence that can be produced in court [6-9].
Fitness to drive: medico-legal assessments
To return to the topic of prevention and road safety education, of great importance is the assessment that the legal doctor has the duty to carry out in the evaluation of the psycho-physical requirements for obtaining a driving license in relation to the possible consumption of alcohol and/or drugs or in the evaluation of specific conditions such as the physically disabled, subjects over 65, newly licensed drivers or holders of a professional license and subjects affected by diabetes. In this area, I have been applying for more than a decade the systematic method illustrated in the Methodological-Assessment, Criteriological-Evaluation Guidelines edited by the University of Padua [10], the accuracy of which has seen exponential growth in recent years, thanks to the use of cutting-edge instruments and methods, recognized in the international scientific panorama.
Alcohol, Drug and Doping Abuse: Forensic Medical Investigations
The increasing use and abuse of alcoholic, psychotropic and narcotic substances has led to a significant increase in the types and varieties of acute/chronic intoxications. A worrying effect of this phenomenon is the consequent increase in risky behaviors such as accidents at work, drunk driving, episodes of violence, risky sexual behaviors, alteration of the state of consciousness. One of the main tasks of the legal doctor is the assessment of disorders resulting from the intake of substances, through the recognition and identification of physical or psychological symptoms that signal dependence on alcohol, drugs, psychoactive substances and doping agents.
Identification and certification of asylum seekers (Asylum seekers)
There are those who flee from war, those who flee from hunger, those who flee from abuse and violence. Migratory flows from the poorest and most disadvantaged regions of the planet are constantly increasing. In 2021, the competent Territorial Commissions received 53,609 applications for International Protection, but only 50% of these applications were examined. A growing humanitarian emergency that makes the intervention of the legal doctor increasingly indispensable, competent to ascertain and define the possible existence of previous torture or injuries suffered, as well as the current clinical conditions and the related therapeutic and/or assistance needs of the asylum seeker. In my activity of identification, diagnosis and certification of conditions of vulnerability and/or psycho-physical fragility, I have adopted the Assessment Protocol published in 2017 by the International Journal of Legal Medicine [11].
Bibliography
[1] Ferrara SD, Baccino E, Bajanowski T, Boscolo-Berto R, Castellano M, De Angel R, Pauliukevičius A, Ricci P, Vanezis P, Vieira DN, Viel G, Villanueva E; EALM Working Group on Medical Malpractice. Malpractice and medical liability. European Guidelines on Methods of Ascertainment and Criteria of Evaluation. Int J Legal Med. 2013 May;127(3):545-57.
[2] Viero A, Montisci M. Prospettive della responsabilità sanitari alla luce della cd legge Gelli Bianco (L.24/2017). L’apporto medico-legale. Responsabilità Medica. Diritto e pratica clinica. 2018; 2: 223-227.
[3]https://www.ania.it/documents/35135/126701/L%27Assicurazione+Italiana+2020-2021.pdf/e4fa652e-dda7-8c9c-96ef-1e4468d4f903?version=1.0&t=1626333153413
[4] Ferrara SD, Baccino E, Boscolo-Berto R, Comandè G, Domenici R, Hernandez-Cueto C, Gulmen MK, Mendelson G, Montisci M et al. Members of the IALM Working Group on Personal Injury and Damage. Padova Charter on personal injury and damage under civil-tort law: Medico-legal guidelines on methods of ascertainment and criteria of evaluation. Int J Legal Med. 2016 Jan;130(1):1-12.
[5] Ferrara SD, Ananian V, Baccino E, Banczerowski P, Bordignon D, Boscolo-Berto R, Domenici R, Gorriz Quevedo J, Graw M, Hell W, Hernandez Cueto C, Knudsen PJ, Masiero S, Montisci M et al. Whiplash-Associated Disorders: Clinical and medico-legal guidelines on the methods of ascertainment. Int J Legal Med. 2016 Jan;130(1):13-22.
[6] Cecchetto G, Bajanowski T, Cecchi R, Favretto D, Grabherr S, Ishikawa T, Kondo T, Montisci M et al. Back to the Future - Part 1. The medico-legal autopsy from ancient civilization to the post-genomic era. Int J Legal Med. 2017 Jul;131(4):1069-1083.
[7] Montisci M, Cecchetto G, Viel G. Post-mortem assessment and evolutionary role of the autopsy. In Dagan KH. Autopsy. What do we learn form corpses). IntechOped Ed, 2022, Cap. 3.
[8] Giorgetti A, Giraudo C, Viero A, Bisceglia M, Lupi A, Fais P, Quaia E, Montisci M et al. Radiological investigation of gunshot wounds: a systematic review of published evidence. Int J Legal Med. 2019 Jul;133(4):1149-1158.
[9] Visentin S, Pelletti G, Dengo C, De Matteis M, Montisci M. Post-autopsy computed tomography. Pros and cons in a firearm death. Forensic Sci Int. 2017 Jul;276:e16-e19.
[10] Ferrara SD, Snenghi R, Boscolo M, Linee guida Metodologico-Accertative Criteriologico-Valutative Idoneità alla guida & sostanze psicoattive, Piccin ed., Padova 2006.
[11] Visentin S, Pelletti G, Bajanowski T, Ferrara SD. Methodology for the identification of vulnerable asylum seekers. Int J Legal Med. 2017 Nov;131(6):1719-1730.