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  • 1. Medical and ForensicMedical and Forensic Autopsy: Fact and FictionAutopsy: Fact and Fiction LSUHSC - Shreveport, LALSUHSC - Shreveport, LA Department of PathologyDepartment of Pathology James G. Traylor, Jr., MDJames G. Traylor, Jr., MD Associate Clinical ProfessorAssociate Clinical Professor && Angela Grantham, MBA, BS MT(ASCP)Angela Grantham, MBA, BS MT(ASCP) Pathology Outreach DirectorPathology Outreach Director Editor: Ms. Lisa LaChanceEditor: Ms. Lisa LaChance
  • 2. Why Should I Care?Why Should I Care? 1.1. Final voice of the patient or victimFinal voice of the patient or victim 2.2. Discussing autopsy with the familyDiscussing autopsy with the family 3.3. Eliminating mythsEliminating myths 4.4. Resources availableResources available
  • 3. IntroductionIntroduction To The AutopsyTo The Autopsy
  • 4. ObjectivesObjectives Describe the role of the autopsyDescribe the role of the autopsy (medical, private and forensic)(medical, private and forensic) Discuss the impact and benefits ofDiscuss the impact and benefits of autopsyautopsy List causative factors in the decrease ofList causative factors in the decrease of autopsies nationwideautopsies nationwide
  • 5. What is an Autopsy?What is an Autopsy? Postmortem examination of the organsPostmortem examination of the organs and tissues of a body to determineand tissues of a body to determine cause of death or pathologicalcause of death or pathological conditions.conditions.
  • 6. Type of AutopsiesType of Autopsies MedicalMedical ForensicForensic PrivatePrivate
  • 7. Why do an Autopsy?Why do an Autopsy? Although the primaryAlthough the primary reason to perform anreason to perform an autopsy is toautopsy is to determine cause ofdetermine cause of death, there are otherdeath, there are other benefits to individualbenefits to individual families, the practicefamilies, the practice of medicine, and theof medicine, and the community at large.community at large.
  • 8. Benefits of an AutopsyBenefits of an Autopsy  Allaying a family’s fears about what theyAllaying a family’s fears about what they could have done to prevent the death.could have done to prevent the death.  Providing family members information aboutProviding family members information about potential genetic diseases that may havepotential genetic diseases that may have implications for them.implications for them.  Medical education, training and researchMedical education, training and research leading to improved health care.leading to improved health care.  Providing information about preventableProviding information about preventable causes of disease and accident and othercauses of disease and accident and other public health hazards.public health hazards.
  • 9. Forensic BenefitsForensic Benefits In addition, there are forensic benefits of investigationIn addition, there are forensic benefits of investigation of homicide, suspected homicide, other unexplained orof homicide, suspected homicide, other unexplained or suspicious deaths, and deaths apparently due tosuspicious deaths, and deaths apparently due to accident or injury.accident or injury.
  • 10. Other FindingsOther Findings Studies have shown that in many cases even whenStudies have shown that in many cases even when cause of death seemed clear, the person in fact hadcause of death seemed clear, the person in fact had medical conditions that were not apparent during theirmedical conditions that were not apparent during their life.life.
  • 11. Objectives of the AutopsyObjectives of the Autopsy The autopsy has a different significance for each person,The autopsy has a different significance for each person, depending on their relationship to the patient and theirdepending on their relationship to the patient and their role in medical care.role in medical care.
  • 12. Purpose For FamiliesPurpose For Families To determine why death occurredTo determine why death occurred To learn whether everything medically possible wasTo learn whether everything medically possible was donedone To determine what the likelihood is that other membersTo determine what the likelihood is that other members of the family may be affectedof the family may be affected
  • 13. Purpose For Non-familyPurpose For Non-family MembersMembers Layman unrelated to the deceased:Layman unrelated to the deceased: Establish the cause of death in cases where death isEstablish the cause of death in cases where death is unexplained or is poorly understood by the medicalunexplained or is poorly understood by the medical teamteam Law enforcement officials:Law enforcement officials: Attempts to clarify the circumstances of violent andAttempts to clarify the circumstances of violent and unexplained deathsunexplained deaths Provides documentation of the injuriesProvides documentation of the injuries
  • 14. Primary-care physicians and non-surgicalPrimary-care physicians and non-surgical consultants:consultants: Provides a final determination of the diagnosisProvides a final determination of the diagnosis Provides explanation of doubtful observationsProvides explanation of doubtful observations Provides evaluation of treatmentProvides evaluation of treatment Surgical specialists:Surgical specialists: Provides information on such matters as whyProvides information on such matters as why a postoperative death occurred, the conditiona postoperative death occurred, the condition of the suture lines, and the completeness ofof the suture lines, and the completeness of removal of a lesionremoval of a lesion Medical staff of a hospital, HospitalMedical staff of a hospital, Hospital Administrator and governmental agenciesAdministrator and governmental agencies monitoring health care:monitoring health care: Provides a quality control mechanism, a finalProvides a quality control mechanism, a final yardstick by which the care of a patient can beyardstick by which the care of a patient can be measuredmeasured
  • 15. Researcher:Researcher: A source of new ideas as to cause of diseaseA source of new ideas as to cause of disease May also provide an evaluation of new proceduresMay also provide an evaluation of new procedures and new therapeutic agents, and an explanation ofand new therapeutic agents, and an explanation of adverse reactions, with the hope that they can beadverse reactions, with the hope that they can be prevented in the futureprevented in the future All members of the medical team:All members of the medical team: Provides a learning experience:Provides a learning experience: Medical student - a first understanding of theMedical student - a first understanding of the effects of diseaseeffects of disease Student, house staff and attending physicianStudent, house staff and attending physician alike - the meaning of certain observationsalike - the meaning of certain observations unexplained during life, such as a heart murmur,unexplained during life, such as a heart murmur, a shadow in a chest x-ray, or an abnormala shadow in a chest x-ray, or an abnormal laboratory resultlaboratory result
  • 16. Society in general:Society in general: Benefits if autopsies could be used to compare theBenefits if autopsies could be used to compare the incidence of particular diseases in differentincidence of particular diseases in different geographic areasgeographic areas To survey the changing status of health andTo survey the changing status of health and disease in the populace from year to yeardisease in the populace from year to year To evaluate the impact of environmental hazardsTo evaluate the impact of environmental hazards To determine priorities among various researchTo determine priorities among various research programs and effectiveness of sanitary measuresprograms and effectiveness of sanitary measures in forcein force
  • 17. Limitations of the AutopsyLimitations of the Autopsy Necessity of viewing care inNecessity of viewing care in “retrospect”“retrospect” Lessons learned may not carryLessons learned may not carry over to current patientsover to current patients Cannot answer questions that youCannot answer questions that you may have about your patient’smay have about your patient’s disease process unless youdisease process unless you communicate with the pathologistcommunicate with the pathologist In 1 to 2 percent of cases aIn 1 to 2 percent of cases a definitive cause of death cannotdefinitive cause of death cannot be foundbe found
  • 18. Postulated Causative Factors:Postulated Causative Factors: Decrease of Autopsy RatesDecrease of Autopsy Rates Improvements in diagnostic technologyImprovements in diagnostic technology Fear of litigationFear of litigation Removal of defined minimum autopsy rate standardsRemoval of defined minimum autopsy rate standards Lack of direct reimbursementLack of direct reimbursement Lack of standardization of the autopsy as a medicalLack of standardization of the autopsy as a medical procedure with resultant lack of credibility as a validprocedure with resultant lack of credibility as a valid outcome or performance measureoutcome or performance measure
  • 19. Forensic Pathology:Forensic Pathology: An OverviewAn Overview
  • 20. OutlineOutline Brief historical perspectiveBrief historical perspective Becoming a ForensicBecoming a Forensic PathologistPathologist Introduction to MedicolegalIntroduction to Medicolegal Case WorkCase Work Louisiana Coroner LawLouisiana Coroner Law Closing quoteClosing quote
  • 21. Brief Historical PerspectiveBrief Historical Perspective Earliest application of forensic medicine had toEarliest application of forensic medicine had to do with the interdiction against suicide.do with the interdiction against suicide. 1010thth century suicide became a crime under thecentury suicide became a crime under the common law in England.common law in England. 1184 the Council of Nimes made the1184 the Council of Nimes made the condemnation of suicide part of the canon lawcondemnation of suicide part of the canon law of the Roman Catholic Church.of the Roman Catholic Church. Decisions as to manner of death seem to haveDecisions as to manner of death seem to have been made mostly by an investigation of thebeen made mostly by an investigation of the circumstances without specific examination ofcircumstances without specific examination of the body.the body.
  • 22. Historians reported Antistius, a physician in Rome,Historians reported Antistius, a physician in Rome, examined the body of Julius Caesar and reached theexamined the body of Julius Caesar and reached the opinion that, of the twenty-three stab wounds Caesaropinion that, of the twenty-three stab wounds Caesar sustained, the only mortal wound was one in the chest.sustained, the only mortal wound was one in the chest. In China a handbook entitled Hsi Yuan Lu wasIn China a handbook entitled Hsi Yuan Lu was published in about 1250 and contained limited briefpublished in about 1250 and contained limited brief outlines for the postmortem examination of bodiesoutlines for the postmortem examination of bodies including descriptions of various wounds caused byincluding descriptions of various wounds caused by sharp versus blunt instruments.sharp versus blunt instruments.
  • 23. Written records of the development of forensicWritten records of the development of forensic pathology in Europe begin in 1507, when a volume,pathology in Europe begin in 1507, when a volume, subsequently known as the Bamberg Code, appeared.subsequently known as the Bamberg Code, appeared. Twenty-three years later, a more extensive penal code,Twenty-three years later, a more extensive penal code, known as the Constitutio Criminalis Carolina, wasknown as the Constitutio Criminalis Carolina, was issued by Emperor Charles V for all lands included inissued by Emperor Charles V for all lands included in his empire.his empire. The two documents :The two documents :  Portrayed importance of forensic pathology in requiringPortrayed importance of forensic pathology in requiring medical testimony be integral part of proof and trials involvingmedical testimony be integral part of proof and trials involving decisions about whether the manner of death was infanticide,decisions about whether the manner of death was infanticide, homicide, abortion or poisoninghomicide, abortion or poisoning  Did not specify that complete autopsies were to be performed,Did not specify that complete autopsies were to be performed, but wounds were opened to determine their depth andbut wounds were opened to determine their depth and directiondirection
  • 24. Latter half of the 16Latter half of the 16thth century Ambrose Pare performedcentury Ambrose Pare performed official medicolegal autopsies.official medicolegal autopsies. Fidelis and Zacchia in Italy, in the early 17Fidelis and Zacchia in Italy, in the early 17thth century, werecentury, were likewise engaged in anatomical dissections and reportedlikewise engaged in anatomical dissections and reported analyses of injuries to internal organs.analyses of injuries to internal organs. First formal lectures in forensic pathology were held byFirst formal lectures in forensic pathology were held by Michaelis and Bohn at the University of Leipzig whereMichaelis and Bohn at the University of Leipzig where students were apparently instructed in the subject ofstudents were apparently instructed in the subject of violent death and simulated natural deaths.violent death and simulated natural deaths.
  • 25. As a result of advancements by these pioneers, theAs a result of advancements by these pioneers, the judicial authorities and the police in Europe soon beganjudicial authorities and the police in Europe soon began to call upon physicians to aid in the solution of fatalto call upon physicians to aid in the solution of fatal crimes, and most of the larger jurisdictions developedcrimes, and most of the larger jurisdictions developed centers, commonly known as institutes of forensiccenters, commonly known as institutes of forensic medicine, where experts carried out their investigations.medicine, where experts carried out their investigations. The historical development of medicolegal investigationThe historical development of medicolegal investigation in America can be clearly traced back to the Englishin America can be clearly traced back to the English coroner system, which had developed in that countrycoroner system, which had developed in that country some 600 years before.some 600 years before. The Chart of Privileges mentionedThe Chart of Privileges mentioned in English historical sources includedin English historical sources included a grant of the coroner’s office by Kinga grant of the coroner’s office by King Athelstane to an English noble,Athelstane to an English noble, identified as St. John of Beverly, inidentified as St. John of Beverly, in the year 925.the year 925.
  • 26. Appointment then included coroner’s duties and theAppointment then included coroner’s duties and the term “coroner” is obviously a corruption of “crowner”term “coroner” is obviously a corruption of “crowner” applied to the individual charged under this law.applied to the individual charged under this law. Justices in eyre, apparently comparable to travelingJustices in eyre, apparently comparable to traveling circuit court judges of modern day, could order thecircuit court judges of modern day, could order the coroner to perform duties of administrative orcoroner to perform duties of administrative or inquisitorial nature within the region for which he hadinquisitorial nature within the region for which he had been appointed.been appointed. Over 200 years later, the officeOver 200 years later, the office of the coroner is formallyof the coroner is formally described. When in September,described. When in September, 1194, justices in eyre were1194, justices in eyre were required to provide that threerequired to provide that three knights and one clerk wereknights and one clerk were elected in every county aselected in every county as “keepers of the pleas of the“keepers of the pleas of the crown.”crown.”
  • 27. Among these were the holding of inquests over deadAmong these were the holding of inquests over dead bodies and “appeals”:bodies and “appeals”:  Inspection of an individual’s woundsInspection of an individual’s wounds  Recording the accusation against another individualRecording the accusation against another individual  If wounds appear likely to be fatal, arresting the accusedIf wounds appear likely to be fatal, arresting the accused individual.individual. Coroner was also authorized by county courts to attachCoroner was also authorized by county courts to attach or arrest witnesses or suspects and to appraise andor arrest witnesses or suspects and to appraise and safeguard any lands or goods that might later besafeguard any lands or goods that might later be forfeited by reason of guilt of the accused.forfeited by reason of guilt of the accused. These duties were carried out eitherThese duties were carried out either alone or with the sheriff, but certain ofalone or with the sheriff, but certain of them were earmarked specifically forthem were earmarked specifically for the coroner’s office, and he couldthe coroner’s office, and he could perform them without being ordered toperform them without being ordered to do so.do so.
  • 28. Despite descriptions of duties, it appears that they wereDespite descriptions of duties, it appears that they were loosely drawn, and the coroner became concerned onlyloosely drawn, and the coroner became concerned only with felonies that resulted in homicide or suicide or awith felonies that resulted in homicide or suicide or a felony resulted in a crown plea requiring enforcement.felony resulted in a crown plea requiring enforcement. Interesting example of the latter is “outlawry”, where, ifInteresting example of the latter is “outlawry”, where, if the accused still absented himself after public demandthe accused still absented himself after public demand had been made for him to appear and surrender tohad been made for him to appear and surrender to justice on four occasions, the justices in eyre wouldjustice on four occasions, the justices in eyre would declare him an outlaw. Thereupon his goods anddeclare him an outlaw. Thereupon his goods and chattels were forfeited to the crown and his head couldchattels were forfeited to the crown and his head could be cut off with impunity by anyone.be cut off with impunity by anyone. Other than the relegation of the function of deathOther than the relegation of the function of death investigation to the coroner with loss of essentially allinvestigation to the coroner with loss of essentially all other duties, there was little development of the coronerother duties, there was little development of the coroner system in England until the middle of the 19system in England until the middle of the 19thth century.century.
  • 29. In 1877 a law enacted requiring an inquest beIn 1877 a law enacted requiring an inquest be conducted:conducted:  Whenever coroner had reasonable cause to suspect violent orWhenever coroner had reasonable cause to suspect violent or unnatural deathunnatural death  When cause of death was unknownWhen cause of death was unknown  Result - granted the coroner the widest authority to investigateResult - granted the coroner the widest authority to investigate cases and was indeed in sharp contrast to the continentalcases and was indeed in sharp contrast to the continental system, where investigations were commenced only by thesystem, where investigations were commenced only by the prosecutors or police officialsprosecutors or police officials Early American colonists,Early American colonists, originating in England,originating in England, brought the coroner systembrought the coroner system with them in essentially thewith them in essentially the state of development it hadstate of development it had reached by the early 1600’s.reached by the early 1600’s.
  • 30. 1877 - Boston Commonwealth adopted a statewide1877 - Boston Commonwealth adopted a statewide system requiring coroner be supplanted by a physiciansystem requiring coroner be supplanted by a physician known as a medical examiner. Unfortunately, theknown as a medical examiner. Unfortunately, the jurisdiction of the medical examiner was confined tojurisdiction of the medical examiner was confined to “dead bodies of such persons only as are supposed to“dead bodies of such persons only as are supposed to have come to their death by violence.”have come to their death by violence.” 1915 - New York City adopted a law eliminating the1915 - New York City adopted a law eliminating the coroner’s office and created a medical examiner system,coroner’s office and created a medical examiner system, authorizing investigation of deaths resulting from:authorizing investigation of deaths resulting from:  Criminal violenceCriminal violence  CasualtiesCasualties  SuicideSuicide  Sudden death while in apparent healthSudden death while in apparent health  When not attended by a physicianWhen not attended by a physician  ImprisonedImprisoned  Any suspicious or unusual mannerAny suspicious or unusual manner
  • 31. Becoming a ForensicBecoming a Forensic PathologistPathologist Graduating from medical school (4 years) and passingGraduating from medical school (4 years) and passing the three parts of the United States Medical Licensingthe three parts of the United States Medical Licensing Examination before being granted licensure in a givenExamination before being granted licensure in a given statestate Acceptance into a Pathology Residency Program withAcceptance into a Pathology Residency Program with successful completion (currently 4 years of additionalsuccessful completion (currently 4 years of additional training which was previously 5 years)training which was previously 5 years) Accredited college or university degreeAccredited college or university degree (usually a four year program)(usually a four year program) Passing the Medical Colleges AdmissionsPassing the Medical Colleges Admissions Test, applying to and being accepted to aTest, applying to and being accepted to a medical schoolmedical school
  • 32. Passing the board examination given by the AmericanPassing the board examination given by the American Board of Pathology (ABP) to become a board certifiedBoard of Pathology (ABP) to become a board certified pathologistpathologist Applying to and being accepted into an approvedApplying to and being accepted into an approved Forensic Pathology fellowship program (subspecialty ofForensic Pathology fellowship program (subspecialty of pathology) which requires an additional year of trainingpathology) which requires an additional year of training Successfully completing the fellowship and sitting for theSuccessfully completing the fellowship and sitting for the board examination in Forensic Pathology given by theboard examination in Forensic Pathology given by the ABP to become a board certified Forensic PathologistABP to become a board certified Forensic Pathologist
  • 33. Total Time InvestedTotal Time Invested  College 4 yearsCollege 4 years  Medical School 4 yearsMedical School 4 years  Pathology Residency 4 yearsPathology Residency 4 years  Forensic Fellowship 1 yearForensic Fellowship 1 year ______________ 13 years and $$13 years and $$ $$
  • 34. Introduction:Introduction: Medicolegal Case WorkMedicolegal Case Work I.I. Five categories of medicolegal cases:Five categories of medicolegal cases:  Violent deaths, i.e., non-natural deaths (accidents, suicidesViolent deaths, i.e., non-natural deaths (accidents, suicides and homicides)and homicides)  Suspicious deaths, i.e., those that may be due to violenceSuspicious deaths, i.e., those that may be due to violence  Unattended deaths, i.e., those in which a physician is not inUnattended deaths, i.e., those in which a physician is not in attendanceattendance  Sudden and unexplained deathsSudden and unexplained deaths  Deaths in custodyDeaths in custody Note: Individual jurisdictions may modify these categories,Note: Individual jurisdictions may modify these categories, either expanding them or contracting them.either expanding them or contracting them.
  • 35. A.A. Prevalence of medicolegal casesPrevalence of medicolegal cases 1.1. In most communities, approximately half of allIn most communities, approximately half of all deaths are reportable to a medicolegal officedeaths are reportable to a medicolegal office 2.2. Of these, half (approximately 25% of all deaths)Of these, half (approximately 25% of all deaths) will be accepted as medicolegal caseswill be accepted as medicolegal cases 3.3. Others are generally unattended deaths ofOthers are generally unattended deaths of individuals under the care of a physician who isindividuals under the care of a physician who is willing to sign a death certificate, e.g., deaths inwilling to sign a death certificate, e.g., deaths in Hospices; at home; etc.Hospices; at home; etc. 4.4. Even if a case is not accepted, a written recordEven if a case is not accepted, a written record of the report containing details of the deathof the report containing details of the death should be made and retainedshould be made and retained
  • 36. B.B. Objectives of medicolegal examination:Objectives of medicolegal examination:  To positively identify a bodyTo positively identify a body  Determine the cause of deathDetermine the cause of death  Determine the manner of deathDetermine the manner of death  To document all findingsTo document all findings  To determine or exclude other factors that may haveTo determine or exclude other factors that may have contributed to the death or how the manner of death should becontributed to the death or how the manner of death should be classifiedclassified  To collect trace evidence from the bodies in criminally relatedTo collect trace evidence from the bodies in criminally related casescases
  • 37. C.C. Pathologist may subsequently be calledPathologist may subsequently be called to:to:  Testify in Court to the findingsTestify in Court to the findings  Interpret their significance; how they occurred; the nature ofInterpret their significance; how they occurred; the nature of the weapon used (if any)the weapon used (if any)  Determine time of deathDetermine time of death
  • 38. II.II. Cause, Mechanism And Manner Of DeathCause, Mechanism And Manner Of Death Deaths can be categorized as to cause of death, mechanismDeaths can be categorized as to cause of death, mechanism and manner.and manner. A.A. Cause of deathCause of death is the disease or injury that produces theis the disease or injury that produces the physiological disruption in the body resulting in the death ofphysiological disruption in the body resulting in the death of the individual, e.g., a gunshot wound to the chest.the individual, e.g., a gunshot wound to the chest. B.B. Mechanism of deathMechanism of death is the physiological derangementis the physiological derangement due to the cause that results in the death, e.g., hemorrhage.due to the cause that results in the death, e.g., hemorrhage. C.C. Manner of deathManner of death is how the cause of death came about.is how the cause of death came about.
  • 39. 1.1. Manners of deathManners of death are:are:  NaturalNatural  AccidentAccident  SuicideSuicide  HomicideHomicide  UndeterminedUndetermined  UnclassifiedUnclassified 2.2. AA homicidehomicide classification does not necessarilyclassification does not necessarily indicate that a crime has been committed:indicate that a crime has been committed:  Term of homicide is not synonymous withTerm of homicide is not synonymous with murdermurder  ““Homicide” means that one individual killed anotherHomicide” means that one individual killed another 3.3. Classification of death as murderClassification of death as murder is done by a Courtis done by a Court not a pathologist.not a pathologist.
  • 40. 4.4. Manner of death is classified asManner of death is classified as undeterminedundetermined when after an investigation of circumstanceswhen after an investigation of circumstances surrounding death, a postmortem examinationsurrounding death, a postmortem examination and appropriate laboratory tests, there isand appropriate laboratory tests, there is insufficient information to classify the death asinsufficient information to classify the death as natural, homicide, suicide or accident.natural, homicide, suicide or accident. 5.5. Some forensic pathologists use a classificationSome forensic pathologists use a classification ofof “unclassified”“unclassified” when the death does not fallwhen the death does not fall into any of the aforementioned manners ofinto any of the aforementioned manners of death.death.  Example - psychotic individual who decides they canExample - psychotic individual who decides they can fly and attempts to do so off a 200 foot cliff. Such afly and attempts to do so off a 200 foot cliff. Such a death is obviously not natural or homicide but is itdeath is obviously not natural or homicide but is it suicide or an accident?suicide or an accident?  Deaths formerly termedDeaths formerly termed “therapeutic“therapeutic misadventures”misadventures” may be listed as unclassified.may be listed as unclassified.
  • 41. 6.6. The average caseload, broken down by manner of death,The average caseload, broken down by manner of death, for a large metropolitan medical examiner’s office:for a large metropolitan medical examiner’s office:  Natural 47.6 %Natural 47.6 %  Homicide 11.4 %Homicide 11.4 %  Accident 28.5 %Accident 28.5 %  Suicide 10.7 %Suicide 10.7 %  Other 1.8 %Other 1.8 %
  • 42. III.III. Forensic Autopsy Versus An ExternalForensic Autopsy Versus An External ExaminationExamination A.A. It is not necessary to perform an autopsyIt is not necessary to perform an autopsy in all medicolegal cases.in all medicolegal cases. The reasons forThe reasons for performing an autopsy are varied. The most obvious onesperforming an autopsy are varied. The most obvious ones are:are:  To determine the cause of death when it is not knownTo determine the cause of death when it is not known  To document injuriesTo document injuries  To exclude other causes of deathTo exclude other causes of death  To determine and/or exclude contributory factors to theTo determine and/or exclude contributory factors to the death. Note: Reason why autopsies are performed indeath. Note: Reason why autopsies are performed in most homicides, suicides and accidentsmost homicides, suicides and accidents
  • 43. B.B. InIn some jurisdictions, autopsies are mandatedsome jurisdictions, autopsies are mandated in certain types of death.in certain types of death. C.C. Autopsies should be performed on allAutopsies should be performed on all homicides.homicides. D.D. The extent of the autopsy:The extent of the autopsy: 1.1. Complete autopsy, at a minimum, involves removal andComplete autopsy, at a minimum, involves removal and examination of the brain; the larynx and hyoid; the thoracicexamination of the brain; the larynx and hyoid; the thoracic and abdominal viscera as well as collection of blood, urine,and abdominal viscera as well as collection of blood, urine, bile and vitreous, when available.bile and vitreous, when available. 2.2. In certain cases one may want to make an even moreIn certain cases one may want to make an even more extensive examination, e.g., incise the legs looking for theextensive examination, e.g., incise the legs looking for the source of a pulmonary embolus.source of a pulmonary embolus.
  • 44. 3.3. As a general rule, either no autopsy or a complete autopsyAs a general rule, either no autopsy or a complete autopsy should be performed.should be performed.  Exceptions occur: Generally involve autopsies limited toExceptions occur: Generally involve autopsies limited to the headthe head  Example - In cases where there is a well documented self-Example - In cases where there is a well documented self- inflicted gunshot wound of the head and the bullet has notinflicted gunshot wound of the head and the bullet has not exitedexited  Purpose of this limited autopsy is recovery of the bulletPurpose of this limited autopsy is recovery of the bullet 3.3. All homicides should be completely autopsied.All homicides should be completely autopsied.
  • 45. IV.IV. Three Steps Of Medicolegal DeathThree Steps Of Medicolegal Death InvestigationInvestigation A.A. Step 1 - investigation of circumstancesStep 1 - investigation of circumstances leading up to and surrounding the death.leading up to and surrounding the death.  Obtain as much information as possible prior to examiningObtain as much information as possible prior to examining the body.the body. 1.1. Postmortem examination of a bodyPostmortem examination of a body should nevershould never bebe conducted until one knows the circumstances of the death.conducted until one knows the circumstances of the death. 2.2. Investigation of the circumstances of a death may involve:Investigation of the circumstances of a death may involve: a.a. Investigation of the sceneInvestigation of the scene b.b. Talking to witnesses, next-of-kin and attendingTalking to witnesses, next-of-kin and attending physiciansphysicians c.c. Obtaining past medical records and/or police reportsObtaining past medical records and/or police reports
  • 46. 3.3. Cases where homicide is suspected, talk to the police to findCases where homicide is suspected, talk to the police to find out any special examinations or tests that they may desire.out any special examinations or tests that they may desire. 4.4. Circumstances of death may determine to some degree theCircumstances of death may determine to some degree the extent of the subsequent postmortem examination.extent of the subsequent postmortem examination.  Example - A complete work-up for rape would beExample - A complete work-up for rape would be conducted on the body of a young girl found semi-nude inconducted on the body of a young girl found semi-nude in an isolated area but not if she was fully clothed and shotan isolated area but not if she was fully clothed and shot walking home from school.walking home from school. B.B. Step 2 - examination of body,Step 2 - examination of body, whether it be anwhether it be an autopsy or an external examinationautopsy or an external examination C.C. Step 3 - performance of laboratory testsStep 3 - performance of laboratory tests (including but not limited to toxicology, ballistic test(including but not limited to toxicology, ballistic test firings, etc.)firings, etc.)
  • 47. V.V. Handling Of Bodies At The SceneHandling Of Bodies At The Scene VI.VI. Handling Of Bodies From A HospitalHandling Of Bodies From A Hospital VII.VII. Handling Of Bodies From The MorgueHandling Of Bodies From The Morgue VIII.VIII. Identification Of BodiesIdentification Of Bodies IX.IX. The Autopsy ReportThe Autopsy Report a.a. External examinationExternal examination b.b. Evidence of therapeutic interventionEvidence of therapeutic intervention c.c. Evidence of injuryEvidence of injury d.d. Internal examinationInternal examination e.e. Microscopic examinationMicroscopic examination f.f. ToxicologyToxicology g.g. FindingsFindings h.h. OpinionOpinion
  • 48. Louisiana Coroner LawLouisiana Coroner Law  Louisiana Revised Statute 33: 1563.Louisiana Revised Statute 33: 1563.  Duty to hold autopsies, investigations,Duty to hold autopsies, investigations, etc.etc. A.A. Coroner shall either view the body or make anCoroner shall either view the body or make an investigation in all cases involving the following:investigation in all cases involving the following: 1.1. Suspicious, unexpected, or unusual deathsSuspicious, unexpected, or unusual deaths 2.2. Sudden or violent deathsSudden or violent deaths 3.3. Death due to unknown or obscure causes or in anyDeath due to unknown or obscure causes or in any unusual mannerunusual manner
  • 49. 5.5. Death without attending physician within thirty-six hoursDeath without attending physician within thirty-six hours prior to the hour of deathprior to the hour of death 6.6. Death due to suspected suicide or homicideDeath due to suspected suicide or homicide 7.7. Death in which poison is suspectedDeath in which poison is suspected 8.8. Death from natural causes occurring in a hospital underDeath from natural causes occurring in a hospital under twenty-four hours admission unless seen by a physician intwenty-four hours admission unless seen by a physician in the last thirty-six hoursthe last thirty-six hours 9.9. Death following an injury or accident, either old or recentDeath following an injury or accident, either old or recent 10.10. Death due to drowning, hanging, burns, electrocution,Death due to drowning, hanging, burns, electrocution, gunshot wounds, stabs or cutting, lightning, starvation,gunshot wounds, stabs or cutting, lightning, starvation, radiation, exposure, alcoholism, addiction, tetanus,radiation, exposure, alcoholism, addiction, tetanus, strangulation, suffocation, or smotheringstrangulation, suffocation, or smothering
  • 50. 11.11. Death due to trauma from whatever causeDeath due to trauma from whatever cause 12.12. Death due to criminal means or by casualtyDeath due to criminal means or by casualty 13.13. Death in prison or while serving a sentenceDeath in prison or while serving a sentence 14.14. Death due to virulent contagious disease that might beDeath due to virulent contagious disease that might be caused by or caused a public “hazard”caused by or caused a public “hazard”
  • 51. Organ ProcurementOrgan Procurement 1.1. Chain of communicationChain of communication • Coroner case – must have coroner’s authorization (Note: ACoroner case – must have coroner’s authorization (Note: A coroner may choose to defer to the forensic pathologist tocoroner may choose to defer to the forensic pathologist to determine if harvesting will interfere with evidence or otherdetermine if harvesting will interfere with evidence or other crucial information that the autopsy can provide thecrucial information that the autopsy can provide the investigators.)investigators.) • Non-coroner case – immediate next of kin must authorizeNon-coroner case – immediate next of kin must authorize organ donation to proceed.organ donation to proceed. 2.2. What can be harvested?What can be harvested? – Body condition and length of time since death are factorsBody condition and length of time since death are factors that can restrict type of harvesting performedthat can restrict type of harvesting performed – Communication with the pathologist is critical to promoteCommunication with the pathologist is critical to promote patient safetypatient safety – Harvesting should be performed prior to the body beingHarvesting should be performed prior to the body being sent to the morguesent to the morgue
  • 52. Closing QuoteClosing Quote ““The search for truth is the essence of forensic pathology.The search for truth is the essence of forensic pathology. This truth forms an essential link between the enforcement ofThis truth forms an essential link between the enforcement of law and the protection of the public in the administration oflaw and the protection of the public in the administration of justice.”justice.” Spitz and Fisher’sSpitz and Fisher’s Medicolegal Investigation Of DeathMedicolegal Investigation Of Death Guidelines for the Application of Pathology to Crime InvestigationGuidelines for the Application of Pathology to Crime Investigation