Medical homicide and extreme negligence.

Deaths that occur during medical care for the treatment of a disease are rarely certified as homicides. Some "medical" deaths, however, have been criminally prosecuted for manslaughter, reckless endangerment, or reckless homicide. We describe 5 deaths due to medical complications that underwent criminal prosecution. Three of the deaths were certified as homicides. Deaths certified as homicides due to the actions (or inactions) of a caregiver occur in 3 circumstances. The first is when the medical caregiver intentionally causes the death of the patient. The second is a death due to treatment by an unlicensed fraud or quack. The final circumstance is due to extreme medical negligence that involves a gross and wanton disregard for the well-being of the patient and is the most controversial in the medical community. The law defines reckless endangerment as the conscious disregard of a known substantial likelihood of injury to the patient. Criminal neglect typically is defined as the failure to provide timely, safe, adequate, and appropriate services, treatment, and/or care to a patient. In instances of extreme medical negligence, a homicide manner of death is appropriate because the fatality is due to the criminal acts (or inactions) of another. It also furthers one of the major goals of the medicolegal death investigation system, which is to safeguard the public health.