University of Oulu

Pakanen, L., Keinänen, N. & Kuvaja, P. Presumed adverse events in health care are a frequent indication for medico-legal autopsy in Finland. Forensic Sci Med Pathol 16, 65–70 (2020).

Presumed adverse events in health care are a frequent indication for medico-legal autopsy in Finland

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Author: Pakanen, Lasse1,2; Keinänen, Noora1; Kuvaja, Paula1,3
Organizations: 1Forensic Medicine Unit, National Institute for Health and Welfare (THL), P.O. Box 310, FI-90101, Oulu, Finland
2Department of Forensic Medicine, Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland
3Department of Pathology, Oulu University Hospital, P.O. Box 50, FI-90029 – OYS, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
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Language: English
Published: Springer Nature, 2020
Publish Date: 2020-05-04


The medico-legal autopsy is an essential tool in investigating deaths caused by an adverse event in health care, for both clinical risk management and for professional liability issues. However, there are no statistics available regarding the frequency of autopsies performed due to suspected adverse events. This study aimed to determine the number of medico-legal autopsies done because of presumed adverse events, whether these events were unintentional, medical errors or cases in which malpractice was suspected. Furthermore, differences in treatment types, causes and manner of death were analyzed. The data was obtained from all medico-legal autopsies performed in Northern Finland and Lapland during 2014–2015 (n = 2027). Adverse events were suspected in 181 (8.9%) cases. The suspicions of an adverse event occurring were most often related to medication, gastrointestinal surgery and orthopedic surgery. The manner of death was classified as medical (or surgical) treatment or investigative procedure in 22 (12.2%) cases. The causes of death were completely unrelated to the suspected adverse event in 41 (22.7%) cases. In conclusion, the frequency of presumed adverse events was quite high in this data set, but in the majority of the cases, the suspicion of an adverse event causing death was disproved by an autopsy. Nonetheless, proper investigation of these cases is essential to ensure legal protection of the deceased, next of kin and health care personnel, as well as to support clinical risk management.

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Series: Forensic science, medicine, and pathology
ISSN: 1547-769X
ISSN-E: 1556-2891
ISSN-L: 1547-769X
Volume: 16
Pages: 65 - 70
DOI: 10.1007/s12024-019-00193-4
Type of Publication: A1 Journal article – refereed
Field of Science: 319 Forensic science and other medical sciences
Funding: Open access funding provided by National Institute for Health and Welfare (THL).
Copyright information: © The Author(s) 2019. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.