1. The Role of the Forensic Nurse in the Medicolegal Death Investigation

2. Death Investigation Systems in the United States

3. Three Types Medical Examiner Medical Examiner Coroner Coroner Mixed Mixed DiMaio, (2001), p. 9-18

4. Medical Examiner vs. Coroner Medical Examiner –A licensed physician in the state in which she/he practices forensic pathology and has been hired by the jurisdiction to investigate sudden and unexpected deaths Coroner –An elected official in the jurisdiction who investigates sudden and unexpected deaths. May or may not be a physician DiMaio, (2001), p. 9-18

5. MEDICAL EXAMINER AND CORONER JURISDICTIONS IN THE UNITED STATES - 2002 DC State ME, mixed county ME and Coroners State ME, coroners in every county or district Mixed ME and Coroners Coroners in every county or district State ME, no coroners District ME, no coroners County ME, no coroners Source: Centers for Disease Control. (2004).

6. What is Forensic Nursing?

7. Forensic Nursing Application of the nursing process to public or legal proceedings Application of the nursing process to public or legal proceedings Application of the forensic aspects of health care to the scientific investigation of trauma and/or death related to medicolegal issues Application of the forensic aspects of health care to the scientific investigation of trauma and/or death related to medicolegal issues Lynch, (1993)

8. Roles within Forensic Nursing Clinical Forensic Nurse Clinical Forensic Nurse Sexual Assault Nurse Examiner (SANE) Sexual Assault Nurse Examiner (SANE) Pediatric Forensic Nurse Pediatric Forensic Nurse Forensic Psychiatric Nurse Forensic Psychiatric Nurse Nurse Death Investigator/Coroner Correctional Nurse Legal Nurse Consultant Nurse Attorney Lynch, (1993)

9. The Forensic Nurse Death Investigator

10. What is a Forensic Nurse Death Investigator? A Registered Nurse who: A Registered Nurse who: applies the nursing process to death investigation across the life span applies the nursing process to death investigation across the life span collaborates with interdisciplinary agencies collaborates with interdisciplinary agencies identifies trends identifies trends conducts and/or participates in research conducts and/or participates in research promotes health and safety through community education. promotes health and safety through community education. IAFN, FNDI Standards of Practice, 2004, (draft)

11. What can a nurse add to the death investigation? Apply nursing knowledge which includes anatomy, physiology, pharmacology and family interaction Apply nursing knowledge which includes anatomy, physiology, pharmacology and family interaction Questions are formulated based on a medical knowledge base Questions are formulated based on a medical knowledge base Aid families and survivors in terms of the grieving process Aid families and survivors in terms of the grieving process Vessier-Batchen, (2003)

12. Role of the Forensic Nurse Death Investigator at the Harris County Medical Examiner’s Office

13. Role in the ME Office Obtain death reports per state code Obtain death reports per state code Augment the natural death and infant/child death investigation Augment the natural death and infant/child death investigation Conduct post mortem sexual assault/child abuse examinations Conduct post mortem sexual assault/child abuse examinations Provide case management for pathologists Provide case management for pathologists Collaborate with organ/tissue procurement agencies Collaborate with organ/tissue procurement agencies Harris County Medical Examiner’s Office, (2004)

14. Role in the ME Office Provide link between pathologists and lay investigative staff Provide link between pathologists and lay investigative staff Communicate COD and MOD with families Communicate COD and MOD with families Educate the community regarding death investigation and forensic issues Educate the community regarding death investigation and forensic issues Assist with external examinations Assist with external examinations Harris County Medical Examiner’s Office, (2004)

15. Augmenting the Natural Death Investigation Normally, only uniformed officers attend the natural death scene Normally, only uniformed officers attend the natural death scene Other types of death may present as a natural death Other types of death may present as a natural death Conduct a more thorough investigation Conduct a more thorough investigation Understand subtle signs of abuse and neglect Understand subtle signs of abuse and neglect

16. Case Management Collaborate with pathologist to determine the appropriate medical records Collaborate with pathologist to determine the appropriate medical records Review medical records once received Review medical records once received Obtain follow-up information Obtain follow-up information Organize interagency meetings as necessary Organize interagency meetings as necessary

17. External Examinations Thorough physical examination Thorough physical examination Review of medical records Review of medical records Description via diagrams and dictation Description via diagrams and dictation Document pathological findings Document pathological findings

18. Evolution of the Forensic Nursing Program at the Harris County Medical Examiner’s Office

19. Prior to Forensic Nursing In 2002, 80% of deaths that were reported were natural deaths In 2002, 80% of deaths that were reported were natural deaths Investigators had limited medical knowledge Investigators had limited medical knowledge 80% of cases brought in to HCME were autopsied 80% of cases brought in to HCME were autopsied Requests/receipt of medical records were inconsistent Requests/receipt of medical records were inconsistent

20. Prior to Forensic Nursing Incomplete records were received and multiple requests had to be made Incomplete records were received and multiple requests had to be made Medication lists often did not correlate with the medical history Medication lists often did not correlate with the medical history Few inquiries into circumstances that lead up to the death Few inquiries into circumstances that lead up to the death Information between pathologists and investigators was fragmented at times Information between pathologists and investigators was fragmented at times

21. Forensic Nursing Integrated in Harris County, Texas After extensive lobbying by Dr. Joye Carter, the Harris County Commissioner’s Court approved 1 Forensic Nurse position After extensive lobbying by Dr. Joye Carter, the Harris County Commissioner’s Court approved 1 Forensic Nurse position Job description: Job description: Adjunct to pathologists and investigative staff Adjunct to pathologists and investigative staff Oversee medical record aspect of the medicolegal examination Oversee medical record aspect of the medicolegal examination Member of Child Fatality Review Team Member of Child Fatality Review Team

22. Community Focus Improve the natural and infant/child death investigations with better history gathering and assessments Improve the natural and infant/child death investigations with better history gathering and assessments Contact family members in order to provide information on cause and manner of death Contact family members in order to provide information on cause and manner of death Discuss medical and familial implications of cause of death, if applicable Discuss medical and familial implications of cause of death, if applicable Provide education regarding the medicolegal death investigation Provide education regarding the medicolegal death investigation

23. Role Begins to Expand Three positions approved by Commissioner’s Court at the end of 2002 Three positions approved by Commissioner’s Court at the end of 2002 Expand coverage of nursing services to evening and night shift Expand coverage of nursing services to evening and night shift Assist with review of organ/tissue procurement recovery requests with the pathologist Assist with review of organ/tissue procurement recovery requests with the pathologist Assist with natural death and infant/child death scene investigation Assist with natural death and infant/child death scene investigation

24. Expanding Role Provide case management for infant/child deaths Provide case management for infant/child deaths Respond to scenes and take reports Respond to scenes and take reports Conduct the forensic gynecological examination and evidence collection Conduct the forensic gynecological examination and evidence collection Community education Community education

25. Increasing Nursing Staff By end of 2003, identified that additional positions were necessary By end of 2003, identified that additional positions were necessary Conducted survey of selected medical examiner/ coroner offices throughout the United States regarding use of nurses in this setting Conducted survey of selected medical examiner/ coroner offices throughout the United States regarding use of nurses in this setting Proposal developed to justify additional positions Proposal developed to justify additional positions

26. New Positions Are Granted In September 2003, Commissioner’s Court authorized nine (9) new nursing positions! In September 2003, Commissioner’s Court authorized nine (9) new nursing positions! Once all positions are filled, there will be twelve (12) nurses! Once all positions are filled, there will be twelve (12) nurses!

27. References Centers for Disease Control. (2004). Medical Examiner and Coroner Jurisdictions in the United States. Found at: http://www.cdc.gov. Centers for Disease Control. (2004). Medical Examiner and Coroner Jurisdictions in the United States. Found at: http://www.cdc.gov.http://www.cdc.gov DiMaio, V.M. (2001). DiMaio, V.M. (2001). Forensic Pathology. (2 nd ed). Boca Raton: CRC Press. Harris County Medical Examiner’s Office. (2004). Job description. Found at www.co.harris.tx.us. Harris County Medical Examiner’s Office. (2004). Forensic nurse/ Physician assistant investigator II. Job description. Found at www.co.harris.tx.us.www.co.harris.tx.us

28. References International Association of Forensic Nurses. (2004). Forensic Nurse Death Investigator Standards of Practice. Draft copy. International Association of Forensic Nurses. (2004). Forensic Nurse Death Investigator Standards of Practice. Draft copy. Lynch, V. (1993). Forensic nursing: Diversity in education and practice. Journal of Psychosocial Nursing, 31(11), p. 7-14. Lynch, V. (1993). Forensic nursing: Diversity in education and practice. Journal of Psychosocial Nursing, 31(11), p. 7-14. Vessier-Batchen, M. (2003). Forensic nurse death investigators. The Web Mystery Magazine. Found at: www.lifeloom.com. Vessier-Batchen, M. (2003). Forensic nurse death investigators. The Web Mystery Magazine. Found at: www.lifeloom.com. www.lifeloom.com