Forensic Epidemiology Investigations

Goals Describe the differences between typical public health and law enforcement investigations Define and compare covert and overt health-related attacks Describe methods for conducting a joint forensic epidemiology investigation

What is Forensic Epidemiology? Forensic epidemiology uses public health methods in the setting of a potential criminal investigation Will be encountered by most public health workers through health-related criminal investigations

Law Enforcement and Public Health Investigations DifferenceExplanation Criminal intentPublic health looks for a naturally occurring bug or environmental hazard rather than a responsible person or persons. Interviews with subjects of an investigation Public health officials interview patients to gather information for health purposes rather than criminal purposes. Laws governing investigations Public health authority influences public health investigations and actions; the criminal justice code is the authority behind criminal investigations. Collecting evidence/samples Public health officials are not required to collect samples (which could be needed as evidence) in a way that makes them admissible in court.

Law Enforcement and Public Health Investigations DifferenceExplanation ConfidentialityPublic health officials are concerned about confidentiality for the person possibly involved in an outbreak; law enforcement officials are concerned about confidentiality for an informant or witness. Media interactionPublic health has a relatively open relationship with the media; law enforcement tends not to be open with the media during an ongoing investigation. Using classified or sensitive information Public health officials or offices may not be equipped to handle or process secret or secure information.

Criminal Intent Outbreaks usually occur “naturally” Look for mistakes in food preparation, changes in the environment, other unintentional incidents as cause Recognizing criminal intent will help preserve evidence and solve the crime

Covert Attack No group or individual takes responsibility Incident may not be initially recognized as an attack Example: Salmonella typhimurium outbreak (Oregon, 1984)

Identifying a Covert Attack Public health will recognize signs, symptoms, or disease clusters through surveillance Hospital emergency room, laboratory staff, health care providers may become first responders

Investigating a Covert Attack May be difficult to immediately confirm that a bioterrorist incident has occurred Local health department should: Immediately notify state health department Conduct joint preliminary epidemiologic investigation using rapid-response epidemiologic and laboratory team Once thought to be a possibility, immediately notify FBI and other response partners

Overt Attack Perpetrator announces responsibility for the act May be reported to public health official More likely to be announced on public web site or through media Example: Intentional release of sarin nerve agent (Tokyo subway, 1995)

Identifying an Overt Attack Law enforcement will detect event Law enforcement and emergency management teams will be the first responders

Investigating an Overt Attack Many overt incidents have been hoaxes Still a crime; the site is a crime scene If health officials notified of incident or threat: Required to immediately contact FBI, state/local law enforcement Overall response coordinated by the FBI Then local officials should immediately notify state health department

Laws Governing an Investigation Different laws govern investigations by public health and law enforcement

Public Health Laws North Carolina statutes give permission to: Review relevant medical records Implement control measures, require submission to examinations and tests Impose quarantine and isolation Enter premises of any place where necessary to enforce provisions of these public health laws Public health officials can respond quickly to health-related threats!

Law Enforcement Laws Law enforcement officers must obtain search warrant to conduct a search and make seizures unless: Consent to the search is given Serious, credible, immediate threat (exigent circumstances)

Joint Interviewing Should work in teams to jointly conduct interviews If joint interview is not possible, each discipline should know the type of information their counterpart is seeking Law enforcement wants to know personal, travel, incident, safety, other information pertinent to criminal investigation. Public health wants to know personal, exposure, travel, medical history

Evidence Law enforcement gathers evidence Public health gathers specimens Two criteria must be met for public health information to be used in criminal investigations: Legitimate public health investigation Chain of custody

Legitimate Public Health Investigation Example of legitimate public health investigation: Collecting samples of food from a salad bar when an outbreak is suspected Samples are collected based on legitimate concern for the public’s safety Samples are admissible as evidence in a criminal investigation if one is conducted

Chain of Custody Chain of custody: special form to document the chronological history of evidence Includes name/initials of individual who collected evidence, each person or entity having custody of it, date the item was collected or transferred, agency and case number, victim's or suspect's name, brief description of item Required in law enforcement investigation Officials responsible for creating incident report, maintaining chain of custody, transporting evidence to laboratory or other facility

Chain of Custody Not established in typical public health investigation Persons documented as custodians of the item should be able to: Testify in court that the item was secure, unaltered, and uncontaminated while in their custody Explain the procedures they used to store, examine, test, and otherwise process the item

Confidentiality Public health officials concerned with confidentiality of patients and medical records According to North Carolina statutes, all records containing privileged patient medical information are confidential May report case or outbreak of an illness, condition, or health hazard, but should not disclose personally identifiable information Can contact, interview, offer testing to cases, case contacts, and contact contacts considered suspect cases, but confidentiality must be maintained

Confidentiality When bioterrorist incident or criminal intent suspected, law enforcement may gain access to confidential or protected health information Then confidentiality concerns for the person as a patient and as a witness or informant

Media Public health has more symbiotic relationship with media Rely on media to get information to consumers Use media to elicit public response and assist in investigations Law enforcement not open with media To preserve integrity of the case To not hinder investigation of unexplored leads Need protocol to avoid accidental disclosure of important information All parties should coordinate messages through joint information center

Classified/Sensitive Information Public health may be required to review classified or sensitive information: Some public health officials should hold clearances to communicate with law enforcement when necessary Secure equipment (phone lines, fax machines) should be available

Challenges of Bioterrorism Law enforcement and public health face same challenges investigating bioterrorist events Likely to be high concentrations of agent May be a large primary cohort of people exposed Agent may have been distributed in a well traveled area People may present to many different hospitals May be a deliberate second attack May be wide-spread panic Hospitals may become flooded with both sick and non-sick

Challenges of Bioterrorism When all participants prepared to respond and can work efficiently and effectively together, they can: Control panic Ensure a rapid response Treat the sick Identify the source Successfully identify and prosecute those involved in the attack

References Goodman RA. Basics of Public Health/Epidemiologic Investigations for Law Enforcement. Presented at: Forensic Epidemiology Training Course; November 2-5, 2002; Chapel Hill, NC. Centers for Disease Control and Prevention (CDC). Available at: Accessed August 31, NC General Statutes. Available from: Accessed August 31, 2005.

References Martinez D. Law Enforcement and Forensic Epidemiology. Presented at: Forensic Epidemiology Training Course; November 2-5, 2002; Chapel Hill, NC. Technical Working Group on Crime Scene Investigation, National Institute of Justice. Crime Scene Investigation: A Guide for Law Enforcement. January Available at: Accessed August 31, Scenario 1 – Suspicious letter in DeKalb County. Working group exercise. Presented at: Forensic Epidemiology Training Course; November 2-5, 2002; Chapel Hill, NC.