Thesis (MMed)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Background: An increase in autopsied cases of community assault fatalities has been observed at the Tygerberg Forensic Pathology Services Facility. A paucity of information exists as to the incidence and prevalence of these cases in a South African context. Objectives: To determine the patterns and trends of injuries sustained in so-called community assault fatalities. Methods: A retrospective and descriptive study was conducted. Fatal community assault cases admitted to the Tygerberg Forensic Pathology Facility over a ten year period, from 1 January 2003 to 31 December 2012 were reviewed. Data was collected from autopsy/post mortem examination reports, contemporaneous notes, attached hospital records, SAPS- 180 form (completed by South African Police Services representative) and other Forensic Pathology Services (FPS) documentation. Results: A total of 424 cases of fatal community assault were admitted during the study period with an annual increase between 2004 and 2008 and a second peak from 2010 to 2012. The cause of death in majority of cases was due to multiple injuries (42%) with blunt force trauma forming the basis of most of the injuries sustained. The most prevalent areas where these assaults occurred was Khayelitsha (166 cases) and Harare (84 cases) - one of the sub-sections in Khayelitsha. Male subjects were predominantly assaulted with only one female fatality recorded. Conclusion: Adequate policing in prevalent areas is essential, to address the unnecessary loss of life and additional burden on the criminal justice system and health care services. / AFRIKAANSE OPSOMMING: Agtergrond: „n Toename in die aantal sterftes na beweerde gemeenskapsaanranding is waargeneem by die Tygerberg Forensiese Patologie Dienste Fasiliteit. Min inligting in verband met die insidensie en prevalensie van sulke gevalle in „n Suid-Afrikaanse konteks is beskikbaar. Doelwit: Om die patrone en neigings van beserings geassosieer met beweerde gemeenskapsaanranding-sterftes te bepaal. Metodes: „n Retrospektiewe en beskrywende studie is uitgevoer. Gevalle van sterftes na beweerde gemeenskapsaanranding wat opgeneem is by die Tygerberg Forensiese Patologie Dienste Fasiliteit oor „n tien-jaar tydperk, vanaf 1 Januarie 2003 tot 31 Desember 2012, is hersien. Data is versamel van outopsie/post-mortem verslae, kontemporêre notas, aangehegde hospitaal-rekords, SAPD-180 vorm (wat deur „n verteenwoordiger van die Suid-Afrikaanse Polisiediens ingevul word) en ander Forensiese Patologie Dienste (FPS) dokumentasie. Bevindinge: Oor die tien-jaar studietydperk is 424 gevalle van sterftes na beweerde gemeenskapsaanranding gesien, met „n jaarlike toename in gevalle tussen 2004 en 2008 en ‟n tweede piek in die aantal gevalle gedurende 2010 en 2012. Die oorsaak van dood in die meerderheid gevalle was as gevolg van veelvuldige beserings, met stomp geweld, die mees algemene tipe oorsaak van beserings. Die areas waar hierdie tipe gevalle mees algemeen voorgekom het, was Khayelitsha (166 gevalle) en Harare (84 gevalle) – een van die sub-seksies in Khayelitsha. In die meerderheid van gevalle is mans aangerand, en slegs een vroulike sterfte-geval is gevind. Afleidings: Voldoende polisiëring is nodig in prevalente areas om die onnodige lewensverlies en die addisionele lading op die kriminele regsisteem en gesondheidsorgdienste aan te spreek.

Study project (M.Med.) -- University of Stellenbosch, 2001. / ENGLISH ABSTRACT: The main purpose in doing forensic post mortems is to supply information to the judicial system. Medical personnel involved in doing post mortems seldom get feedback regarding efficiency. Numerous allegations have been made regarding the work of district surgeons in terms of forensic post mortems, often suggesting that the work is substandard. In South Africa district surgeons do post mortems mostly in the rural areas, and training centre personnel do forensic post mortems in urban areas. Training centre personnel include specialized forensic pathologists, registrars and medical officers working in the Departments of Forensic Medicine, affiliated to universities. The South African Police Service mostly manages government mortuaries. The South African forensic medico-legal system is unique, and does not correspond in with the four main systems used worldwide. Research was done by sending 200 questionnaires to a representative group from the legal fraternity of the Western Cape (including judges / magistrates, state prosecutors, private lawyers) and also the South African Police Service investigating officers. The judiciary, as the users of the information generated through forensic post mortems, are therefore in a suitable position to determine the efficacy of forensic post mortem. The questionnaire was structured to determine the general perception, as well as comments, regarding 9 different aspects involved with doing forensic post mortems. These include the thoroughness and completeness of reports, standard of academic knowledge, efficacy of verbal testimony in court, length of time in releasing the report, general attitude, efficacy of sketches and diagrams, efficacy of photography, sufficient taking of toxicology samples and sufficient utilization of special laboratory investigations. The last question was an open question to allow for general comments and anecdotes. For each aspect it was also determined whether there was a difference in efficacy noted between the two groups. The effect of this, if any, on the judicial criminal justice system was also assessed. A different questionnaire was sent out to all forensic pathologists in the Western Cape. The standard of work of the district surgeons was hereby assessed. General comment regarding academic knowledge, and findings at post mortem made by district surgeons was assessed. The pathologists were also questioned regarding the general attitude of district surgeons, and imput were asked regarding continued medical education programs. An area for general comment was also supplied. The main findings were as follows: a. The legal fraternity in the Western Cape is generally satisfied with the efficiency of forensic post mortems, except the use of laboratory investigations and also the length of time to release reports. b. The legal fraternity could determine a difference in the efficiency of post mortems done by district surgeons and training centre personnel. Training centre personnel were generally regarded as more effective. c. The difference between the two groups, due to ineffective district surgeon post mortems, had a negative effect on the criminal justice system. The following recommendations were made: a. Training centre personnel: Serious consideration should be given to appointing qualified forensic pathologists in the rural areas. Training centre personnel should also be more involved in training the district surgeons. b. District surgeons: The training, re-training and continued medical education of district surgeons in the Western Cape should be prioritized. The service conditions should also be reviewed. c. Administrative: Audit of post mortem reports. The efficiency regarding court appearances should be audited through the Department of Justice. Administrative power will be necessary to oversee the above-mentioned recommendations. / AFRIKAANSE OPSOMMING: Die hoofdoel met die doen van geregtelike post mortems is om inligting te verskaf aan die regsproses. Medici gemoeid met geregtelike post mortems kry baie seide terugvoer oor die effektiwiteit van werk gelewer in die hof. Daar is ook herhaaldelik suggesties gemaak dat die werk van die distriksgeneeshere met betrekking tot geregtelike post mortems soms suboptimaal is. Regsmediese post mortemdienste in Suid Afrika word verskaf deur distriksgeneeshere in die platteland, en deur personeel verbonde aan opleidingshospitale in die stede. Die opleidingssentra-personeel sluit in gespesialiseerde forensiese patoloe, kliniese assistente en mediese beamptes werksaam in 'n Departement van Geregtelike Geneeskunde verbonde aan 'n universiteit. Staats- Iykshuise word bestuur en beheer deur die Suid-Afrikaanse Polisiediens. Daar bestaan geen soortgelyke model vir die voorsiening van regsmediese dienste in die res van die wereld nie. Navorsing is gedoen deur vraelyste uit te stuur aan 200 verteenwoordigende regslui (wat insluit regters/landdroste, staatsaanklaers, privaat regslui) en aan Suid-Afrikaanse Polisiediens-ondersoekbeamptes in die Wes Kaap. Die reg, as verbruikers van regsmediese dienste is gekies om 'n opinie uit te spreek oor die doeltreffendheid van forensiese post mortems. Die vraelyste is gestruktureer om die algemene tevredenheid en opinies en kommentaar te bekom oor nege verskillende aangeleenthede rakend die forensiese post mortem, nl. deeglikheid en volledigheid van verslae, standaard van akademiese kennis, effektiwiteit van verbale getuienisaflegging in die hof, tydsverloop vir lewering van verslae, houding en gesindheid van medici, doeltreffendheid van sketse en diagram me, effektiewe gebruik van fotografie, effektiewe gebruik van toksikologiese ondersoeke, effektiewe gebruik van spesiale ondersoeke, asook 'n algemene oop vraag vir kommentaar oor probleemareas. Daar word vervolgens vir elke aangeleentheid bepaal of daar 'n verskil in effektiwiteit opgelet word tussen twee mediese subgroepe, en indien wei watter groep meer effektief funksioneer. Verder sal nagegaan word of die regsproses geaffekteer word deur enige van bogenoemde bevindinge. 'n Verskillende vraelys is uitgestuur aan aile geregtelike patoloe in die Wes-Kaap. Hiermee word die standaard van die werk van distriksgeneeshere beoordeel. Kommentaar is gevra oor akademiese kennis met betrekking tot geregtelike post mortems en oor bevindinge gemaak deur distriksgeneeshere by post mortems. Daar word ook gevra oor die algemene houding van distriksgeneeshere, asook vir voorstelle vir voortgesette onderrigsprogramme. 'n Oop vraag is gestel vir kommentaar oor probleemareas. Uit die response is die volgende gevolgtrekkings gemaak: a. Die regslui in die Wes-Kaap is oor die algemeen tevrede met die diens gelewer met betrekking tot geregtelike post mortems, met uitsondering van die effektiwiteit van laboratoriumondersoeke, en ook oor die tydsverloop tussen die doen van post mortem en die vrystel van die verslae. b. Die regslui kon 'n verskil bepaal in die graad van effektiwiteit van post mortems gedoen deur distriksgeneeshere en opleidingssentra-personeel. Opleidingssentra-personeel is deur die meerderheid van respondente identifiseer as meer effektief. c. Die verskil tussen die twee groepe, a.g.v. oneffektiewe distriksgeneesheer post mortems, het 'n negatiewe effek op die regsproses. Aanbevelings is gemaak om die sisteem te verbeter: a. Opleidingssentra-personeel: Die uitplasing van gekwalifiseerde forensiese patoloe in die platteland moet oorweeg word. Opleidingssentrapersoneel kan ook meer betrokke wees by opleiding van distriksgeneeshere. b. Distriksgeneeshere: Aandag moet gegee word aan die opleiding, heropleiding en voortgesette geneeskundige onderrig van distriksgeneeshere in die Wes-Kaap. Die werksomstandighede waaronder hulle diens lewer moet ook aangespreek word. C. Administratief: Ouditering van post mortem verslae. Ouditering van effektiwiteit van hofverskynings, in assosiasie met die Departement van Justisie. Admininistratiewe wilskrag sal ook essensieel wees by implementering van bogenoemde voorstelle.