1. Forensic Science Death Investigation The Medical Examiner System and the Role of the Forensic Pathologist

2. Lecture Outline Forensic Pathology Forensic Pathology Determining Cause of Death Determining Cause of Death Determining Manner of Death Determining Manner of Death The Medical Examiner System The Medical Examiner System

3. Forensic Pathologists Investigate the sudden and unexpected deaths of persons who are in apparent good health Investigate the sudden and unexpected deaths of persons who are in apparent good health Investigate deaths suspected to be traumatic Investigate deaths suspected to be traumatic

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

5. Cause and Mechanism of Death Cause of death- a disease or injury that initiated the lethal chain of events that led to death of the person Cause of death- a disease or injury that initiated the lethal chain of events that led to death of the person Mechanism of death- a biochemical or physiologic abnormality produced by the cause of death that is incompatible with life Mechanism of death- a biochemical or physiologic abnormality produced by the cause of death that is incompatible with life

6. Manner of Death defined as the fashion in which the cause of death came to be defined as the fashion in which the cause of death came to be Four manners of death: Four manners of death: Natural Natural Accidental Accidental Suicidal Suicidal Homicidal Homicidal

7. Time of Death Three methods used to estimate time of death Three methods used to estimate time of death Rigor Mortis Rigor Mortis Livor Mortis Livor Mortis Algor Mortis Algor Mortis

8. Time of Death Rigor Mortis- stiffening of muscles which occurs following death: Rigor Mortis- stiffening of muscles which occurs following death: Glycogen, normally used to provide energy for contraction muscles, is used up and not reformed Glycogen, normally used to provide energy for contraction muscles, is used up and not reformed Rigor Mortis normally sets in about 4 hours after death Rigor Mortis normally sets in about 4 hours after death Exceptions include instant rigor mortis and death from electric shock - both create shorter onset of rigor mortis from time of death Exceptions include instant rigor mortis and death from electric shock - both create shorter onset of rigor mortis from time of death Rigor Mortis generally disappears 24-48 hours after death due to decomposition Rigor Mortis generally disappears 24-48 hours after death due to decomposition

9. Rigor Mortis and Time of Death Manner of Death is suicide. Manner of Death is suicide. The shotgun has been removed but his arms are locked in place. The shotgun has been removed but his arms are locked in place. How long has he been dead? How long has he been dead?

10. Time of Death Livor Mortis- discoloration of body from settling of red blood cells after blood stops circulating, aka lividity Livor Mortis- discoloration of body from settling of red blood cells after blood stops circulating, aka lividity In light skinned individuals, lividity may be seen within an hour after death In light skinned individuals, lividity may be seen within an hour after death In dark skinned individuals, lividity may not be able to be seen In dark skinned individuals, lividity may not be able to be seen Substantial blood loss may result in little lividity Substantial blood loss may result in little lividity Lividity becomes fixed about 12 hours after death, and slowly disappears with decomposition after 36 hours Lividity becomes fixed about 12 hours after death, and slowly disappears with decomposition after 36 hours

11. Livor mortis or Lividity Post-mortem lividity Post-mortem lividity Shows on the soles of the feet Shows on the soles of the feet Manner of Death: Suicide by hanging Manner of Death: Suicide by hanging Gravity caused red blood cells to accumulate in the feet Gravity caused red blood cells to accumulate in the feet

12. Time of Death Time of Death Algor Mortis- cooling of the body after death, and assumes ambient temperature is lower than body temperature Algor Mortis- cooling of the body after death, and assumes ambient temperature is lower than body temperature General rule of thumb- a nearly nude body exposed to 18-20 degrees Celsius loses 1.5 degrees per hour for the first 8 hours General rule of thumb- a nearly nude body exposed to 18-20 degrees Celsius loses 1.5 degrees per hour for the first 8 hours

13. History of the Coroner System Officer of coroner existed in England before the 10 th century Officer of coroner existed in England before the 10 th century Coroner interpreted as “crowner of the king” and assumed a judicial function Coroner interpreted as “crowner of the king” and assumed a judicial function Acted as an inquisitional judge responsible for investigating, interviewing and making judgments in the cause of death Acted as an inquisitional judge responsible for investigating, interviewing and making judgments in the cause of death

14. Coroners in the United States There is no provision in the US constitution for death investigation There is no provision in the US constitution for death investigation Cities and States often elected coroners to determine cause of death whose backgrounds varied widely Cities and States often elected coroners to determine cause of death whose backgrounds varied widely The first Federal Medical Examiner’s Office was in the Armed Forces Institute of Pathology in the 1990s The first Federal Medical Examiner’s Office was in the Armed Forces Institute of Pathology in the 1990s

15. Medical Examiner System In latter part of 19 th century standards were developed for medical examiners In latter part of 19 th century standards were developed for medical examiners Massachusetts replaced coroners with medical examiners in 1877 Massachusetts replaced coroners with medical examiners in 1877 Required medical examiners to be licensed medical practitioners Required medical examiners to be licensed medical practitioners

16. Medical Examiner System So while there has been a move toward standardization: So while there has been a move toward standardization: Many rural areas are still served by elected coroners Many rural areas are still served by elected coroners Some states still have both coroners and medical examiners Some states still have both coroners and medical examiners Therefore confusion still exists Therefore confusion still exists

17. Education and Training of Forensic Pathologists Pathologists first began appearing in mid 19 th century Pathologists first began appearing in mid 19 th century Police and Coroners relied on Pathologists to perform autopsies and determine cause of death Police and Coroners relied on Pathologists to perform autopsies and determine cause of death Used microscopes to examine tissues for injury or disease Used microscopes to examine tissues for injury or disease

18. The Study of Pathology Pathology is derived from: Pathology is derived from: Pathos- suffering or disease Pathos- suffering or disease Logos- word or writing Logos- word or writing Study of disease, its causes and its diagnosis Study of disease, its causes and its diagnosis

19. Education and Training of Forensic Pathologists Pathologists later began to manage laboratories where blood and urine were tested Pathologists later began to manage laboratories where blood and urine were tested Mid 20 th century pathologists were specialized as a field Mid 20 th century pathologists were specialized as a field End of World War II, forensic pathology was recognized by the American Board of Pathologists End of World War II, forensic pathology was recognized by the American Board of Pathologists

20. Training Requirements for a Forensic Pathologist Bachelor degree or equivalent, 4 years Bachelor degree or equivalent, 4 years Medical school, 4 years in length, and graduation from a recognized allopathic (M.D.) or osteopathic (D.O) granting medical school Medical school, 4 years in length, and graduation from a recognized allopathic (M.D.) or osteopathic (D.O) granting medical school

21. Training Requirements for a Forensic Pathologist Postgraduate training for 4 additional years: combination of anatomic pathology or anatomic and clinical pathology Postgraduate training for 4 additional years: combination of anatomic pathology or anatomic and clinical pathology One additional year of training at a large coroner’s or medical examiner’s office required: Intern normally receives pay One additional year of training at a large coroner’s or medical examiner’s office required: Intern normally receives pay

22. Training Requirements for a Forensic Pathologist After candidate completes 5 years of postgraduate training, it is necessary to pass a 2-4 day examination to become a board certified forensic pathologist After candidate completes 5 years of postgraduate training, it is necessary to pass a 2-4 day examination to become a board certified forensic pathologist There are an estimated 500 forensic pathologists practicing in the United States There are an estimated 500 forensic pathologists practicing in the United States About 25 pathologists have both medical and legal degrees About 25 pathologists have both medical and legal degrees

23. Training Requirements for a Forensic Pathologist Many forensic pathologists also specialize in additional areas: Many forensic pathologists also specialize in additional areas: Toxicology Toxicology Serology Serology Tool mark or Impression evidence Tool mark or Impression evidence Firearms examination Firearms examination Crime scene analysis Crime scene analysis Forensic Anthropology Forensic Anthropology Forensic Odontology Forensic Odontology

24. Duties of Forensic Pathologists Investigate the deaths of persons who die suddenly and unexpectedly or as a result of injury Investigate the deaths of persons who die suddenly and unexpectedly or as a result of injury Normally employed by cities, counties or division of government Normally employed by cities, counties or division of government Some forensic pathologists work as consultants in litigation Some forensic pathologists work as consultants in litigation

25. 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 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 Medical history is the starting point of investigation

26. Reviewing Medical History To certify cause of death, forensic pathologists must: To certify cause of death, forensic pathologists must: Be able to discern injuries from treatment from emergency personnel - needle marks, incised wounds, etc Be able to discern injuries from treatment from emergency personnel - needle marks, incised wounds, etc

27. Autopsy Examination Autopsy means to look at oneself Autopsy means to look at oneself Necropsy means to look at the dead Necropsy means to look at the dead Autopsies have been practiced since the middle ages Autopsies have been practiced since the middle ages Term autopsy generally used in United States Term autopsy generally used in United States

28. Testimony Forensic pathologists either give testimony via subpoena for civil cases, or via their presence in court for criminal case Forensic pathologists either give testimony via subpoena for civil cases, or via their presence in court for criminal case Forensic pathologists also testify as expert witnesses in cases where they did not examine body of deceased Forensic pathologists also testify as expert witnesses in cases where they did not examine body of deceased

29. Problems Autopsy Demonstration: www.hbo.com/autopsy/interactive/index.htm www.hbo.com/autopsy/interactive/index.htm 1. Describe how rigor mortis occurs. 2. Describe how rigor mortis helps determine time of death. 3. Describe lividity and how it is used to determine time of death. 4. A victim dies of a heart attack after being shot in the chest. Describe the cause and manner of death. 5. Get with a partner and construct a scenario in which the others will determine cause and manner of death and time of death.