Introduction: Attrition is a process by which cases dropout from the criminal justice system failing to reach a guilty verdict. The conviction rates in cases of sexual abuse are reported to be very low despite the rise in the number of reported cases, which indicates a higher rate of attrition. This paper reports a retrospective analysis of attrition in sexual offences by identifying the stages and characteristics associated with the loss of cases from the time of initial complaint to a verdict in court. Methods:The research (retrospective descriptive cross-sectional study) utilized the police reports (n=427) of alleged sexual offences in the major crime registries in three police stations in the Polonnaruwa district from 01st of January 1998 to 31st of December 2007. The entries as of 01st of January 2020 were analyzed retrospectively.Results: Most of the victims were female 94% (n=403) while all the perpetrators were male in this study. The observed types of alleged offences included 57% (n=242) rapes, 23% (n=98) grave sexual abuse, 14% (n=59) unlawful apprehensions, 4% (n=18) incest, and 2% (n=10) unnatural offences. As of 1st of January 2020, 21% (n=88) of cases have ended up in a conviction in a trial while 33% (n=141) of cases are pending at courts, and 46% (n=198) of cases were dropped out of the legal system. The overall rate of attrition was 46% (n=198) while 20% (n=87) at high courts, 16% (n=69) at magistrate courts and 10% (n=42) at police investigation level. There was a significant association demonstrated in attrition with the age of the victim, the age gap between the victim and perpetrator, delay in reporting of the offence, and type of offence. Conclusion:A considerable number of cases are dropping out of the legal system at different attrition points and pending in courts for a long period of time. Further study revealed a significant association in attrition with characteristics of sexual offences.
Aorto-oesophageal fistula is a life threatening condition in which there is an abnormal connection between the aorta and oesophagus, and is a rare complication of foreign body ingestion from which few patients survive. Classic presentation is with Chiari's triad of mid thoracic pain, sentinel arterial haemorrhage and massive exsanguination after a symptom free interval. A 36-year-old male was transferred to a tertiary care hospital with a history of epigastric pain and discomfort in his retro-sternal area. According to the history, he had ingested fish the previous day while consuming alcohol. He was treated for four days in the hospital, and discharged with a diagnosis of alcohol induced gastritis. He was re-admitted later the same day with an episode of haematemesis. However, investigations such as chest radiography and oesophagogastroduodenoscopy were not carried out. He developed massive haematemesis 12 hours later, and despite vigorous resuscitation and emergency surgery, he expired. Autopsy revealed an impacted fish bone at the junction of upper and middle third of the oesophagus creating a fistula tract from oesophagus to thoracic aorta which resulted in exsanguination, haemorrhagic shock and death. Even though mortality is very high, survival is possible with a high index of suspicion, early diagnosis and rapid surgical intervention. Autopsy findings, review of the literature and medico-legal aspects of possible medical negligence are discussed.
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