Clinical and Medicolegal Evidence Patterns in Granted and Rejected Medical Malpractice Claims in Indonesia: An Explainable Concept-Tagging Study

Fifia Ardinanti, Rizky Ayu, Sudarto — Mon, 31 Aug 2026 00:00:00 +0000

Background. Medical malpractice judgments encode clinical standards, causation, professional evidence, and procedural constraints, but Indonesian decisions have rarely been analysed at the level of independent disputes.

Objective. To identify which judicially accepted or materially discussed clinical–medicolegal evidence patterns most clearly distinguished granted from rejected medical malpractice claims in a purposive corpus of Indonesian court decisions from 2006–2026.

Methods. This exploratory archival study purposively assembled 16 deduplicated medical malpractice disputes decided in Indonesia during 2006–2026. Eight prespecified, auditable concept tags captured judicially accepted or materially discussed clinical–medicolegal evidence. Granted and rejected claims were compared using risk differences, Haldane–Anscombe-corrected odds ratios (ORs), 95% confidence intervals (CIs), and two-sided Fisher exact tests; a sensitivity analysis excluded one low-confidence case.

Results. Six claims were granted and 10 rejected. Articulated breach linked to causation occurred in 6/6 versus 0/10 disputes (corrected OR 273.0, 95% CI 4.80–15515.67); adverse professional findings in 5/6 versus 0/10 (OR 77.0, 95% CI 2.67–2222.91); and organizational failure in 4/6 versus 0/10 (OR 37.8, 95% CI 1.49–956.48). Acceptance of a standard-of-care or medical-risk defence occurred in 0/6 versus 8/10 (OR 0.023, 95% CI 0.001–0.557). Severe harm was nearly universal (6/6 versus 9/10) and did not discriminate outcomes. Directions were unchanged after excluding the low-confidence case.

Conclusion. In this small purposive corpus, litigation outcomes aligned more closely with judicially accepted evidence connecting specific breach, causation, professional findings, and organizational responsibility than with injury severity alone. The findings are exploratory and support larger, independently coded studies rather than case prediction

Human Blood Thanatotranscriptome Dynamics and Cross-Donor Generalisability of Postmortem Interval Prediction: A Longitudinal RNA-seq Reanalysis

Rachmat Hidayat, Khairiel Anwar — Wed, 19 Aug 2026 00:00:00 +0000

Background. Thanatotranscriptomic profiles may encode time-dependent molecular changes after death, but forensic utility requires temporal signals that generalise across individuals.

Objective. To characterise the genes and molecular pathways that change consistently with absolute postmortem interval (PMI) in serial human postmortem blood samples.

Methods. We reanalysed processed counts from 54 serial postmortem blood samples of seven individuals in GSE163207, spanning an absolute PMI of 2.35-37.83 h. After expression filtering and trimmed mean of M-values normalisation, limma-voom models included individual fixed effects and continuous absolute PMI. Eligible genes required a Benjamini-Hochberg false-discovery rate <0.05, an absolute log2 change >=0.10 per 10 h, and concordant direction in at least five individuals. Enrichment used the expressed-gene background. Nested leave-one-individual-out elastic-net validation kept feature selection and tuning within training donors.

Results. Among 12,633 expressed genes, 1,976 were eligible (954 increasing; 1,022 decreasing). Increasing genes were enriched for cytoskeletal, extracellular-matrix, oxidative-stress, and mitochondrial processes; decreasing genes were enriched for adaptive immune and antigen-presentation pathways. Sensitivity analysis produced an effect correlation of 0.987, with 1,645 genes retaining significance and direction. Cross-donor prediction yielded an RMSE of 10.03 h (95% CI 8.12-11.32), MAE of 8.63 h (95% CI 6.33-10.40), and R2 of -0.219, underperforming the training-mean baseline.

Conclusion. Human blood undergoes reproducible early postmortem molecular remodelling, but this seven-individual cohort does not support generalisable individual PMI prediction.

Sriwijaya Journal of Forensic and Medicolegal

Clinical and Medicolegal Evidence Patterns in Granted and Rejected Medical Malpractice Claims in Indonesia: An Explainable Concept-Tagging Study

Human Blood Thanatotranscriptome Dynamics and Cross-Donor Generalisability of Postmortem Interval Prediction: A Longitudinal RNA-seq Reanalysis