Exhumation and a hypothesis of medical malpractice: a case report

At autopsy a fresh cadaver has normal gross and microscopic examination and the internal organs are distinct in colour and consistency. In buried bodies one of the major factor for reduced decomposition rate is the depth of burial grave, the soil environment and the season of burial. Soil provides an efficient barrier to solar radiation, and therefore both temperature and temperature fluctuations decrease with soil depth. Deep burial of approximately 4 feet or greater by maintenance of cool temperatures and inhibition of depredation provides an extremely reduced rate of decomposition and the body in this conditions can be virtually intact with minimal tissue loss for a period of at least one year. The case that we present is about a 60 y.o. man with a history of kidney failure that in august 2011 (28.8.11) suffered a domestic accident with a fracture of the left femur treated at the beginning with a conservative treatment and after hospital discharge (28.8-1.9.11), because of persistent pains, was readmitted in hospital and the fracture was treated with an ostheosynthesis (12.9-23.9.11) with immediate relief of pain. In December 2011 was programmed (23.12-1.1.12)) a rehabilitation treatment (hydrotherapy, physiotherapy, elettrotherapy, criotherapy) in a private clinic, but after the second day of treatment he felt very exhausted and with short breath and in the morning of 25.12.11 he was found dead inside the hydrotherapy tub. The patient was buried in 12/2011 without any medical examination and in 3/2012 the family asked the State Prosecutor of Kosovo to investigate the manner and cause of death suspecting a medical malpractice case. Exhumation was performed founding the wooden coffin completely submerged in a mud soil and after medical documentation collection the autopsy was performed in 4/2012 at the DFM in Pristina. The body was substantially well preserved and also the main organ characteristics. In the left lung, in the lower lobe distally, we found macroscopically some intravascular clots formation the right lung vessels were free from clots and also the left femoral vein was completely free from clots or endoparietal formation; histological samples were taken for further investigations. We present the autopsy findings and the arguments that exclude the hypothesis of medical malpractice.