法医视角下“三类犯罪”保外就医审查存在的问题及对策

The problems and countermeasures for the "three kinds of crimes"-related medical parole review from the perspective of forensic medicine

目的 回顾性分析检察机关法医办理的“三类犯罪”(职务犯罪、金融犯罪、黑社会犯罪)申请保外就医案件的特点,为预防非法保外就医建言献策。方法 以近3年笔者受理的监狱、法院、看守所委托的保外就医审查案件为研究对象,统计分析其中“三类犯罪”保外就医案件存在的问题,包括申请保外就医的疾病种类,临床资料特点,疾病鉴定医院分布,《暂予监外执行规定》中疾病标准运用情况等。结果 (1)在受理的256件保外就医审查案件中,涉及“三类犯罪”的共197件,占比77%;(2)“三类犯罪”常以“高血压”“糖尿病”“肿瘤”“精神疾病”“心脏疾病”“艾滋病”等疾病条款作为保外就医的依据。审查发现,在不符合保外就医的案例中,上述疾病的诊断结论均存在依据不充分或无依据的情况;(3)197例“三类犯罪”不符合保外就医案件大部分存在病历资料不完整,鉴定医院混乱等情况。结论 法医在参与保外就医审查时,对“三类犯罪”的保外就医材料应严格把控,应对待审资料的完整性进行全面审查,在确保医学材料真实、完整、合法的前提下,优先审查临床资料,重视与保外就医疾病有关联的各项辅助材料的审查;重点关注高血压、糖尿病、心脏疾病、精神病、艾滋病、肿瘤等在保外就医疾病范围中表述较为笼统,运用不方便的疾病标准,并充分结合临床诊疗规范,深度研判各项疾病的诊断依据、严重程度等;必要时协助侦查部门到所在医院调阅完整病历,甚至对被审查人重新体检;建立医学专门知识人才库,为保外就医审查工作助力。

Objective To retrospectively analyze the characteristics of the "three types of crimes"(duty crimes,financial crimes,and underworld crimes)-related medical parole review handled by the forensic doctors of procuratorates,and to provide some suggestions for the prevention of illegal medical parole.Methods The author-handled medical parole review cases commissioned by the prison,court and detention house in the past three years were analyzed.The characteristics of the "three kinds of crimes"-related medical parole review were explored,including the types of diseases applying for medical parole,the characteristics of clinical data,the distribution of the disease identification hospitals,and the application of disease standards in the "Provisions on the Implementation of Temporary Prison".Results(1) Of the 256cases under review for medical treatment on bail,197 cases were involved in the "three types of crimes",accounting for 77%;(2) In the "three types of crimes"-related cases,"hypertension","diabetes","tumor","mental illness","heart disease","AIDS" and other diseases were often used to apply for medical parole.It was found that in the cases that did not meet the requirements of medical treatment on parole,the diagnosis evidences of the above diseases were insufficient or missing;(3) Incomplete medical records and disorder of the identification hospitals were involved in most of the 197 cases of "threetypes of crimes" that did not meet the requirements of medical parole.Conclusion When participating in the review of the "three types of crimes"-related medical parole,forensic doctors should strictly review the application materials,focusing on the integrity of the materials,the clinical materials and to the supporting documents relevant to the medical parole diseases.More attention should be paid to the generally described diagnostic criteria of hypertension,diabetes,heart disease,psychosis,AIDS,tumor,etc.,and the clinical diagnosis and treatment norms should be considered to assess the diagnosis evidences and the severity of diseases.If necessary,the complete medical record should be examined,and even the physical examination should be performed again.A medical talent pool can be established to assist the review of medical parole.