Ms. Harvey said that forcing doctors to send letters could have severe legal ramifications, as the physicians would then be more vulnerable to malpractice suits.

Ndadaye's death sparked severe ramifications across the country.

"On the face of it, it's going to have fairly severe political ramifications," said Nic Borain, a writer and political analyst for HSBC, the global finance company.

Additionally, the entrance of heterogenous residents could have severe political ramifications.

"It will no doubt have some pretty severe ramifications for our industry," said Rod Scarlett, executive director of Wild Rose Agricultural Producers, a farm group based in Edmonton.

"I am sure that we can agree that Georgia's abrogation of a binding contract with an American company would have severe ramifications," Mr. Weinberger wrote on Aug. 12.

Due to the loss of a sitting senator, it led to severe political ramifications in Washington.

"Most of the women I hear from have suffered severe ramifications, personally and professionally," Ms. Primack said.

The oil company said a failure by banks to approve a restructuring package for the German conglomerate would have "severe adverse ramifications" and could impair its ability to finance its operations.

Many medical practitioners freely administer gentamicin as an antibiotic without advising patients of the severe and permanent potential ramifications of its use.