Anaesthetic-associated mortality and anaesthetic contributory death: the South African medicolegal approach.

The medicolegal approach to cases of anaesthetic-associated mortality and anaesthetic contributory death (ACD) occurring in Johannesburg, South Africa is presented. The approach adopted has been found to be reasonably workable in practice and places heavy emphasis on the surgical and anaesthetic-related reasons for perioperative deaths and, in particular, on their multifactorial aetiology. It is recognised that in view of the multifactorial nature of the anaesthetic environment certain errors in clinical anaesthetic management are neither precisely quantifiable nor assessable. It is further emphasized that perioperative quality control programs as well as Inquest Court proceedings should comprise input by a team of specialists and which include clinical anaesthesiologists, surgeons and forensic pathologists.