Forensic Pathology Pathology 1

The Science of Pathology Branch of medicine associated with the study of structural changes caused by disease or injury Two branches Anatomic Deals with structural alterations of the human body Includes autopsies Clinical Deals with laboratory examination of samples removed from the body Includes toxicology screens, blood tests, microbiology, hematology

The Coroner/M.E. Systems Usually elected Need not even be a medical doctor, although they should have had at least some medical training Not exempt from civil liability for acts of negligence

The Coroner/M.E. Systems Medical examiner Operates out of centralized county to state level offices Frequently possess both law enforcement and limited judicial powers Can initiate homicide investigations Can take sworn testimony Exempt from civil liability for acts of negligence

Forensic Pathology Adds the word "unnatural" or "suspicious" to pathology Most forensic pathologists are experts in both branches of pathology All are medical doctors certified by American Board of Pathology Can be called as “expert witnesses” and must understand court systems and legal proceedings

The Autopsy Pathology 2

The Autopsy A post mortem examination of a body to document anything that may have contributed to death Purpose is to render an opinion regarding the cause and manner of death Results are included on a death certificate

When is an Autopsy Required? Criminal violence Infant/child Result of police action In custody of local/state/federal institution Workplace injury Electrocution Alcohol, drugs, poisons Drowning Unidentified persons Skeletonized remains Charred remains As deemed necessary

The Autopsy Usually consists of external and an internal exam External Assists mainly in body I.D. Internal Assists in determining cause of death

The Autopsy Most autopsies are “uneventful” Not always necessary if a natural cause of death is known May be required for insurance purposes Generally range from 30 minutes to several hours to complete Usually performed in the medical examiner's or coroner's office Sometimes in a funeral home or hospital

The 4 Stage Model 1. Contributing Cause of Death 2. Mechanism of Death 3. Immediate Cause of Death 4. Manner of Death

1. Contributing Cause of Death Usually pre-existing illness or condition Could ultimately be actual cause of death Examples: Pneumonia, asthma, HIV

2. Mechanism of Death What events happened to lead to death Usually in medical language Example: ”…lungs became obstructed by fluid and could no longer transport oxygen”

3. Immediate Cause of Death The actual cause of death Example: Asphyxia, “GSW to the head”

4. Manner of Death By law, a fatality must be identified as one of the following categories Suicide Homicide Accidental Natural Unknown

“Rules of the Road” Mechanism + Immediate Cause = Manner If Mechanism is undetermined… Manner must be ruled “Unknown” Example: Poisoning, strange phenomena If Immediate Cause aggravates pre-existing condition… Manner must be ruled “Natural” Example:

“Rules of the Road” Most traffic fatalities are ruled “Accidental” If a suicide involves additional individuals in the Immediate Cause… Manner must be ruled “Homicide”

Reporting Deaths Necessary for legal and financial reasons Report is required in order to issue Death Certificate Considered public record May not list certain information due to confidentiality laws

The External Exam Procedures Review known information Think before you examine Measure body length and weight Examine external details Take photographs Warning: Graphic Image follows…

Case Study 1

The External Exam Preliminary Procedures Link clothing with injuries Search/collect trace evidence on clothing for criminal cases Remove clothing Photograph/list clothing and personal effects

The External Exam Record physical characteristics Apparent age Sex Race/ethnic characteristics Hair Eyes Abnormal body conditions/parts Scars, tattoos, amputations Presence/absence of dentition

The External Exam Record physical characteristics Inspect/describe head, neck, thorax, abdomen, extremities, hands Inspect/describe posterior body surface Prior medical or surgical procedures

The External Exam Describe livor mortis Describe rigor mortis Most pronounced ~10 hours after death Describe rigor mortis Begins ~6 hours after death Disappears after ~24 hours Post mortem changes Evidence of embalming Decompositional changes Warning: Graphic Image follows…

Case Study 2

The External Exam Specific Procedures for Sexual Assault Swab oral, vaginal and rectal cavities for fluids, DNA Pubic hair combings or tape lifts for hair/fiber Fingernail scrapings or clippings

The External Exam Specific Procedures for Injuries Describe injuries Type, location, size, shape, pattern Correlate to internal injury Document track/direction of wound Recover foreign body(ies) Document object(s) Warning: Graphic Image follows…

Case Study 3

Patterned Injuries

The External Exam Specific Procedures for Firearms Wound size and location (be specific) Soot/stippling (residue) Abrasion ring, searing, muzzle imprint, lacerations Warning: Graphic Image follows…

Case Study 4

The External Exam Specific Procedures for Burns Appearance of burns Distribution of burns with special emphasis on degree of burn/chars Warning: Graphic Image follows…

Case Study 4

The Internal Exam Position of abnormal medical devices Exam all internal organs in place Be methodical Position of abnormal medical devices Evidence of surgery

The Internal Exam Internal Organs (after removal) Record weight of brain, heart, lungs, liver, spleen, kidneys Dissect and describe organs

Postmortem Exam Report Prepare postmortem exam report for each case All relevant forensic information (date, time, investigator, etc.) Summary of external and internal exam findings Separate section for injuries Describe findings in enough detail to support opinions and conclusions Identify cause and manner of death