1. Forensic Pathology By: Thomas Sozio D.O. 09-18-13

2. Forensic Pathologists –Perform autopsies and diagnose circumstances surrounding the cause and manner of death Determine whether death was Accidental Suicidal Homicidal Natural Undetermined

3. Coroner vs Medical Examiner Coroner: An elected official whose duty is to investigate the death of a person Medical Examiner: An appointed medically qualified officer whose duty is to investigate deaths and bodily injuries that occur under unusual or suspicious circumstances, to perform post-mortems, and sometimes to initiate inquests.

4. Medical Examiner System –Many rural areas are still served by elected coroners: some states still have both coroners and medical examiners- confusion still exists

6. MCCO The Marion County Coroner's Office performs about 1500 death investigations annually in accordance with nationally recognized standards. –Autopsy: An autopsy is performed by a Forensic Pathologist –External: A body is taken into custody, but only an external examination is performed –SOS: Scene Sign-Outs i.e. A body is released at the scene to the next of kin

7. MCCO Coroner: Dr. Frank P. Lloyd Jr., M.D. Chief Deputy Coroner: Alfarena Ballew Deputy coroners Serve as a liaison between law enforcement and the morgue, focusing on examining the remains of a body in order to determine both how and why a death occurred Typical duties include identification of the body, photographing the crime scene, notification of the next of kin and transportation of the body to the morgue.

8. MCCO Post-Mortem Examination: The decedent's body is physically examined by a certified forensic pathologist who may perform a full autopsy on the body as necessary. Body fluids/tissues may also be sent for lab analysis such as toxicology and histology. Following the examination, the body is made available for pick-up by the funeral home. A comprehensive pathology report will be generated by the forensic pathologist identifying the cause and manner of death. Death Certification: The Coroner's office will review the findings and certify the cause and manner of death in the death certificate. The family may then obtain the death certificate from the Marion County Health Department (Vital Records). Most cases that are investigated by the Coroner's office are reviewed and closed within 14-21 days. If a case is pending toxicology or microscopic examination, a cause and manner of death could take up to 8 weeks for final results.

9. Forensic Pathologist Chief Pathologist: Dr. Joye M. Carter, M.D. Forensic Pathologists include the following: Dr. Geller M.D. Dr. T.J. Sozio, D.O. Fellows are pathologists who have completed their pathology residency and received degrees in clinical and/or anatomical pathology and are now completing the one year long Forensic Fellowship in order to obtain their degree and certification for forensic pathology. Fellows include the following: Dr. Ken Obenson, M.D. (July 2011 – July 2012) Dr. Amanda Brewer, M.D. (July 2012 – July 2013)

10. MCCO A coroner’s case falls under one of the following categories:* 1. Sudden death of a healthy child. 2. Death occurring within 24 hours of admission at a hospital or health care facility 3. Physician unable to state cause of death, after careful review of medical chart, or decedent does not have a physician 4. Known or suspected homicide 5. Known or suspected suicide 6. Related to or following known suspected self-induced or criminal abortion

11. MCCO 7. Following an accident or injury primary or contributory, either old or recent 8. Drowning, fire, exposure, acute alcoholism, drug addiction, strangulation, aspiration or malnutrition 9. Accidental poisoning (food, chemical, drug, therapeutic agents) 10. Occupational disease or occupational hazards 11. Known or suspect contagious disease constituting a public hazard, excluding A.I.D.S. 12. All deaths where patient is under anesthetic 13. Incarceration (any prisoner deaths) 14. All deaths of unidentified persons * The Coroner will determine if the death will be investigated or if the death certificate can be routinely signed by the attending physician.

12. Forensic Pathologists Pathologists first began appearing in mid 19 th century Use of microscope to examine tissues propelled this field of medicine Pathology means: –Study of disease, its causes and its diagnosis

13. Forensic Pathologists Working Conditions –Some work full-time for the city, county, or federal government, while others work in hospitals, medical schools or with a private or group practice that contracts autopsy services to government agencies. –A typical workday can last 10-12 hours or longer, particularly if the forensic pathologist must examine a distant death site.

14. Forensic Pathologists Forensic pathologists spend most of their time in the lab, performing autopsies or examining tissue samples under the microscope. This can involve standing for extended periods and working with small tools. The rest of the workday is divided between writing official reports and making court appearances. The physical demands are not great, but over time, the forensic pathologist may become emotionally affected by continual exposure to graphic violence.

15. What does it take to become a forensic pathologist? Long, hard work. It takes a minimum of 13 years of education and training after high school to become a forensic pathologist. Strength in all areas of science. Forensic pathology draws on biology, physics, chemistry, even psychology and anthropology. Very good communication skills. Half the job of being a forensic pathologist is writing reports and giving testimony.

16. What does it take to become a forensic pathologist? Intestinal fortitude. Forensic pathology is probably the most gruesome, smelly, disgusting job in medicine. Confidence in your skills. Forensic pathologists must defend their conclusions in the face of opposition from lawyers, the media and even the victims’ families. In high school take advanced math, science and English courses Develop strong writing skills Practice public speaking in class and by joining the debate team www.explorehealthcareers.org

17. In college You can choose any undergraduate major, including a humanities degree, but you must take all the science and math courses required to get into medical school If you choose to major in forensic science, be sure the program is accredited and includes at least 24 semester hours of chemistry or biology and math, as well as all the prerequisites for medical school Seek out experiences that expose you to different cultures and perspectives Consider learning a foreign language

18. In medical school Focus on patient care Do an autopsy pathology rotation as an elective to make sure this is the right specialty for you Explore opportunities to work or do a rotation at the local medical examiner’s office

19. Training Requirements for a Forensic Pathologist Bachelor degree or equivalent, 4 years Medical school, 4 years, from a recognized allopathic (M.D.) or osteopathic (D.O) medical school Postgraduate training, 4 years: anatomic pathology or anatomic and clinical pathology One year of training at a large coroner’s or medical examiner’s office required: Intern normally receives pay

20. Training Requirements for a Forensic Pathologist –After 5 years of postgraduate training, Must pass a 1 day exam to become a board certified forensic pathologist –There are an estimated 500 forensic pathologists practicing in the United States –Some pathologists have both medical and legal degrees

21. Training Requirements for a Forensic Pathologist –Many forensic pathologists also specialize in a certain area and depend on specialists, such as the following fields: Toxicology Serology Tool mark or Impression evidence Firearms examination Crime scene analysis Forensic Anthropology Forensic Odontology

22. Reviewing Medical History Forensic pathologists deal primarily with determining cause of death, but also review past medical history to understand issues raised by that death Medical history is the starting point of investigation

23. Reviewing Medical History To certify cause of death, forensic pathologists must: –Determine cause of death based on delayed effects of injury –Careful study of medical history to determine causes and manners of death of persons with trauma is required –Be able to discern injuries from treatment from emergency personnel- needle marks, incised wounds, etc

24. Reviewing Witness Statements Forensic pathologists seek to gather witness information about activities of deceased prior to death, because: –Assists in determining jurisdiction of death –Assists in recreating circumstances of death –Allows use of a hypothesis which can be tested scientifically based on statement of witness

25. Limitations on Autopsies Middle Eastern religions forbid autopsies Forbidden by Egyptian polytheism (Mummification) Judaism, Islam and Christianity vary in their prohibitions Next of kin may object to autopsy

26. Required Autopsy A medical examiner has the legal authority to order an autopsy without permission from family when death is –Sudden or unexpected –Results from an injury –Under suspicious circumstances –Other circumstances defined by law

27. Why is a Forensic Autopsy preformed? Forensics autopsies are preformed when the cause of death of a victim may be a criminal case, often involving foul play. A forensic autopsy applies science to legal law.

28. Natural Death Death by natural cause is a term used by coroners to describe the death of someone by occurring disease process, or is not apparent given medical history or circumstances. The majority of natural death is caused by normal aging and is cardiovascular in nature. Other causes of natural death are cancer, diabetes, stroke, genetic disorders, etc.

29. Accidental Death Accidental death is a death that is often caused by mistake or in a freak occurrence. These deaths are not planned yet can be explained by surrounding circumstances.

30. Homicidal Death The term ‘homicide’ refers to the act of killing another person. There are different types of homicide. –Infanticide - Killing of an infantInfanticide –Fratricide - Killing of one's brother; in a military context, killing of a friendly combatantFratricide –Sororicide - Killing of one's sisterSororicide –Parricide - Killing of one's parentsParricide –Patricide - Killing of one's fatherPatricide –Matricide - Killing of one's motherMatricide –Mariticide - Killing of one's spouseMariticide –Uxoricide - Killing of one's wifeUxoricide –Filicide - Killing of one's childFilicide –Regicide - Killing of a monarch.Regicidemonarch –Genocide - Killing of a national, ethnic, racial or religious groupGenocide

31. Suicidal Death The act of ending ones own life. These autopsies often easily identify source, cause, and other factors of the death. Suicide is often identified in the forensic autopsy by way of toxic ingestion, firearms, blunt force trauma, etc.

32. Unknown Death In some jurisdictions, the Undetermined category may include deaths in absentia, such as deaths at sea and missing persons declared dead in a court of law; in others, such deaths are classified under "Other".

33. Protocol for Performing A Forensic Autopsy? The corpse is brought to the medical examiner’s office in a brand new body bag (to avoid transfer of evidence between cases) or in a set of evidence sheets. The body is then placed on the cadaver dissection table.

34. Physical Examination The physical examination of the body is broken up into two parts. –External Examination The external examination consists of inspecting the physical outer layer of the body for signs of foul play that would result in injury or death. –Internal Examination. The internal examination consists of inspecting the internal organs of the body for evidence of trauma or other indications of the cause of death.

35. External Examination Steps of an external examination. 1.Photographed. 2.Physical evidence collected off body. 3.Samples of hair, nails, etc. are collected. 4.Undressed, examined for wounds. 1.Lacerations, abrasions, bruises. 5.Measured, weighed, cleaned.

36. Internal Examination Steps of an internal examination. 1.Incisions –A “Y” shaped cut from behind each ear and running down the neck, meeting at the breastbone, continuing towards the groin. Most often used in cases of suspected strangulation. –A “T” shaped cut from each shoulder,meeting at the breastbone, continuing towards the groin. Used to create a better looking finished product as this cut is not often seen. –Single vertical cut from throat to groin.

37. Internal Examination (cont’d) 2.Cuts 1.The chest cavity is cut open using shears. 2.The ribs are sawed away, letting them be lifted off the body, exposing the heart and lungs. 3.Removal 1.En masse technique of Letulle – All organs removed at once. 2.En bloc method of Ghon – organs divided into four groups and removed in sections. 4.All removed organs are now weighed and examined for unusual markings or signs.

38. 5.Brain examination 1.An incision is made from a point behind one ear, over the top of the head, to a point behind the opposite ear. 2.The scalp is pulled away from the skull, creating tow flaps. The front flap goes over the face, the rear flap over the neck. 3.The skull is then cut with an electric saw to create a cover that can be pulled off to expose the brain. 4.The brain is then cut from the spinal cord and lifted out of the skull for further examination. Internal Examination (cont’d)

39. In addition, –The cardiovascular system, the respiratory system, the central nervous system, and all other “systems” in the body are examined. Internal Examination (cont’d)

40. Vitreous Humor The levels of vitreous humor in the corpses eye can help give an estimate of how long the victim been dead. The more potassium in the eye, the longer the victim has been dead.