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The Medicolegal Death Investigator
An Evolution in Crime Scene Investigations Relating to Unexpected Deaths

(Released October 2008)

  by Emil Moldovan  


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  1. Medical Examiners and Coroners' Offices, 2004

    Matthew J. [Ph D. ]. Hickman, Kristen A. [MPA] Hughes, Kevin J. [Ph D. ]. Strom and Jeri D. [Ph D. ]. Ropero-Miller.

    United States: RTI International, 2007,

    This report presents key findings from the 2004 Census of Medical Examiners and Coroners (ME/C) Offices. This special report describes the medicolegal investigation of death in the United States. It provides an overview of the personnel, budgets, and workload of these offices by type of office and size of jurisdiction. It also includes information on the number of unidentified human decedents handled by ME/C offices. The report examines record keeping practices and use of national databases for unidentified remains. Detailed data tables on topics covered in this report are available on the BJS Web site. Highlights include the following: (1) about 2,000 medical examiners and coroners (ME/C) offices provided death investigation services across the United States in 2004; (2) in a typical year ME/C offices reported that they handled about 4,400 unidentified human decedents of which about 1,000 remained unidentified after 1 year; and (3) nearly 1 million human death cases were referred in 2004; about 500,000 accepted. Tables

  2. Crime Scene, Part 1: Bloodstain Pattern Interpretation (From Medicolegal Investigation of Death: Guidelines for the Application of Pathology to Crime Investigation, Fourth Edition, P 22-45, 2006, Werner U. Spitz and Daniel J. Spitz, eds. -- See NCJ-214126)

    Herbert Leon MacDonell.


    Following a brief history of bloodstain pattern interpretation and a discussion of the characteristics of liquid blood, this paper discusses basic bloodstain pattern types and how they can be produced in the course of a homicide. Bloodstain pattern interpretation involves three areas of analysis: the shape of the individual bloodstains, the size of the individual bloodstains, and the distribution and concentration of a bloodstain pattern. The shape of the individual bloodstain may allow its origin to be determined in three dimensions. The size of the individual bloodstains suggests the nature of any impact energy that may have produced them; and the distribution and concentration of a bloodstain pattern may suggest the distance between the origin of the blood and the surface upon which it was deposited. This can be important in differentiating between impact spatter, blood expelled from the mouth and/or nose, and blood from an open artery. In examining these aspects of bloodstain interpretation in more detail, this paper discusses target surface characteristics and its effects on bloodspatter, bloodstain characteristics (shape, impact angle, and size), and blood deposited by various means and at various speeds. The latter discussion addresses blood spattered from low-, medium-, and high-velocity impacts; bloodstain patterns from projected blood (arterial bleeding); cast-off bloodstain patterns; bloodstain patterns from blood expelled through the mouth and/or nose; and transfer bloodstain patterns. The paper concludes with a discussion of the recovery and documenting of bloodstain pattern evidence (photography and lifting bloodstain pattern evidence). 36 figures and 8 references

  3. Medicolegal Autopsy Report (From Medicolegal Investigation of Death: Guidelines for the Application of Pathology to Crime Investigation, Fourth Edition, P 1230-1242, 2006, Werner U. Spitz and Daniel J. Spitz, eds. -- See NCJ-214126)

    Werner U. Spitz.


    This chapter suggests how to organize and compose a medicolegal autopsy report. Although the basic medicolegal autopsy report follows an established format, there are differences, depending on the type of case. This chapter provides directions for deciding which autopsy findings should be mentioned because of their presence in the decedent's body and which findings are significant due to the absence of some conditions or substance in the body. The autopsy report should feature the examiner's opinion as to the cause, manner, and mechanism of death. The components of an autopsy necessary to provide a comprehensive and thorough report are described. They include a preliminary investigation that consists of obtaining as much information as possible on the circumstances of the death and the medical background of the deceased. The external examination of a body (the body's surface), including the clothing, is probably the most important element of a medicolegal postmortem examination. The manner and mechanism of the death are often determined in this phase of the examination. The author suggests what can be found in the external examination, such as the presence of rigor and livor mortis, postmortem decomposition, various types of injuries, and patterns of injury on the skin. Findings from the external examination should be descriptive. A description of the internal examination focuses on its objectives under various circumstances and the kinds of findings that should be presented in the autopsy report based on the internal examination. The chapter concludes with a discussion of the nature of medicolegal opinion regarding the cause and manner of death. It should be based not only on the results of the postmortem examination and laboratory analyses, but also on all pertinent information collected on the case. 8 photographic exhibits

  4. Sudden Death Due to an Unrecognized Cardiac Hydatid Cyst: Three Medicolegal Autopsy Cases

    Isil Pakis, Ferah Karayel and Melmet Ozbay.

    Journal of forensic sciences, Vol. 51, No. 2, March 2006, pp. 400.

    This paper reports on three cases of sudden and unexpected deaths caused by heart failures related to echinococcosis, also known as hydatid disease. Echinococcosis is a human parasitic infection caused by the larval stage of the tapeworm Echinococcus granulosus, which usually enters the human body through ingestion. The liver and lungs are the most common locations of infection. Cardiac hydatid disease is rare, even in regions where the disease is more common, e.g., Mediterranean countries, the Middle East, South America, and East Africa. Although heart-related echinococcosis is rare, medical examiners should be informed about it because of its ability to cause sudden death and its lack of obvious symptoms. The three cases of heart-related deaths due to hydatid disease presented in this paper involved a 16-year-old girl, a 39-year-old woman, and a 28-year-old woman, all of whom died suddenly and unexpectedly. In all the cases, the autopsy's microscopic examination of cysts found in the heart showed characteristics of hydatid disease, cysts were not found in any other organs of the body, and there were no toxicological findings. Cardiac hydatid cysts are usually asymptomatic; however, they can cause nonspecific symptoms such as chest pain, palpitations, and cough. The cysts typically grow slowly without causing symptoms. Myocardial atrophy may occur due to the gradual expansion of the cyst. The signs and symptoms of cardiac hydatidic cysts are variable and directly related to their location and size. No clinical signs or symptoms were present in the three cases reported in this paper. 4 figures and 13 references

  5. Forensic Pathology Reviews, Volume 3


    United States: Humana Press, 2005,

    This book provides current knowledge on special topics within the field of forensic pathology. Forensic pathology is a subfield of forensic science that is based on a transverse, multiorgan approach including autopsy, histology, immunohistochemistry, bacteriology, DNA techniques, and toxicology. The main goal is the investigation of obscure fatalities. This book offers chapters on death from environmental conditions, forensic neuropathology, forensic pathophysiology, forensic odontology, taphonomy, death from natural causes, vascular conditions, suicide, iatrogenic injury, and imaging techniques. Chapter 1 focuses on issues surrounding the medicolegal investigation of human bodies found in water while chapter 2 provides an overview of the central nervous system changes in humans with HIV-1 infection. Chapter 3 reviews 10 cases of individuals found deceased in a head-down or inverted position and chapter 4 reviews the evidential usefulness of bitemarks. Chapters 5 and 6 deal in the subfield of taphonomy; one chapter reviews the postmortem changes a human body undergoes after death while the other chapter presents findings of a study on the lay times of 1,259 soil-embedded skeletal remains. Chapter 7 discusses the pathological features and medicolegal significance of right and left ventricular arrhythmogenic dysplasia and chapter 8, which also deals with death from natural causes, reviews the morphological, biochemical, and immunological methods for the postmortem diagnosis of suspected anaphylactic deaths. Chapter 9 considers vascular conditions and focuses specifically on the medicolegal evaluation of fatal pulmonary thromboembolism. Chapter 10 reviews trends in suicide in the United States during the 20th century and chapter 11 provides an overview of murder-suicide. Finally, chapter 12 describes iatrogenic injury and discusses aspects of the postmortem examination while chapter 13 reviews the many uses of radiology within the medicolegal realm. The chapters presented here should provide a guide to daily forensic pathology and medicolegal routine. Tables, figures, references, appendixes, index

  6. Iatrogenic Injury: A Forensic Perspective (From Forensic Pathology Reviews, Volume 3, P 351-439, 2005, Michael Tsokos, ed, -- See NCJ-209976)

    Gilbert M. B. B. S. Lau.


    This chapter describes iatrogenic injury and discusses aspects of the postmortem examination. Iatrogenesis is the induction of illness or injury by the activities of health care clinicians. Iatrogenic death encompasses a wide range of perioperative and nonperioperative complications as well as various types of iatrogenic injury that cause or contribute to the death of the victim. The various types of iatrogenic illness or injuries are reviewed, including complications related to surgery and invasive procedures, nonprocedural complications, and complications associated with therapy and health supplements. Aspects of the forensic pathological investigation of suspected iatrogenic deaths are considered. Such forensic examinations are crucial for their contribution to injury prevention, medical audit, continuing improvement in health care, and to the array of clinicopathological and medicolegal issues that accompany iatrogenic deaths. The process of investigating the iatrogenic origins of death is complex and covers practically all fields within medicine. The author discusses the autopsy proper, aspects of the ancillary investigation, and the autopsy report. The appendix presents 10 cases of complex perioperative iatrogenic deaths, including the circumstances surrounding the death and the autopsy findings. Tables, figures, appendix, references

  7. Macroscopical, Microscopical, and Laboratory Findings in Drowning Victims: A Comprehensive Review (From Forensic Pathology Reviews, Volume 3, P 3-77, 2005, Michael Tsokos, ed, -- See NCJ-209976)

    Philippe Lunetta.


    This chapter focuses on issues surrounding the medicolegal investigation of human bodies found in water. The goal of any medicolegal investigation of human victims found in water is the identification of the victim, the evaluation of postmortem (PM) submersion time, and the determination of the cause and manner of death. Many factors must be considered in such an investigation, including environmental factors and the victim s preexisting condition. Since factors other than drowning must be taken into account as the cause of death, the interpretation of autopsy findings requires a sound knowledge of the pathophysiology of drowning. Morphological changes associated with drowning include those related to liquid penetration into the airways, such as frothy liquid present in the airways or the presence of external foam. Laboratory methods for diagnosing drowning are based on the shift of liquid and electrolytes across the pulmonary air-blood barrier, although it should be noted that the usefulness of such methods is hampered by factors such as postmortem biochemical instability. The diatoms method for the diagnosis of drowning is described but the authors warn that until standardized protocols and reliable separation values for diatoms are established, this method cannot be used for the definitively diagnosis of drowning. Figures, references

  8. Abuse and Neglect: A Ten-Year Review of Mortality and Morbidity in Our Elders in a Large Metropolitan Area

    Lisa B. E. [M D. ]. Shields, Donna M. [M D. ]. Hunsaker and John C. [M D. ]. Hunsaker.

    January 2004, Journal of Forensic Sciences, vol. 49, no. 1, p. 122 - 127

    This paper draws lessons for the investigation of cases that involve elderly victims, based on a 10-year (1992-2001) retrospective study of individuals 60 years old and older whose manner of death included homicide and signs of neglect at the completion of background investigation and postmortem examination performed at the Office of the Chief Medical Examiner in Louisville, KY. The neglect cases included those in which either bronchopneumonia, sepsis, or dehydration were the underlying causes of death, or various combinations of findings were diagnosed, such as decubitus ulcers, necrotizing fascitis/gangrene, and cachexia unrelated to carcinoma. A total of 1,099 autopsy cases were classified as homicide over the study period. Medicolegal investigators determined that 52 individuals were victims of homicidal acts, and 22 subjects died as a result of neglect. The various causes of death of the homicide victims included gunshot, beating, stabbing, and asphyxia, or combinations of these. Twenty-two individuals yielded findings at post mortem examination regarded as suspicious for neglect. Two of the 52 homicide victims sustained a sexual battery, as confirmed at autopsy. A total of 2,250 living individuals 60 years old and older were evaluated by the staff of the Clinical Forensic Medicine Program between 1992 and 2001. The staff concluded that 19 of the subjects were the victims of physical and/or sexual assault. Three subjects had experienced neglect. This report summarizes the characteristic features of elder abuse in both postmortem and living cases and emphasizes the necessity of multiagency collaboration in cases of suspected abuse and neglect that involve elderly victims. Policies established by an elderly abuse task force promote the collaborative interaction required to formulate criteria for the prevention and investigation of abuse and death within this vulnerable population. 3 figures, 7 tables, and 18 references

  9. Preliminary Report on America's Medicolegal Offices

    National Assoc of Medical Examiners (NAME), 430 Pryor Street, SW, Atlanta, GA 30312.


    This assessment of America's medicolegal death investigative process by the National Association of Medical Examiners--the primary professional organization for medical examiners and forensic pathologists in the United States--focuses on personnel and equipment, forensic pathology education, accreditation and professionalism, and collaboration between the Federal Government and State and local forensic laboratories. The Federal Government should recognize the value of medicolegal death investigations for criminal justice, public health, and homeland security. Support for uniform, quality medicolegal investigations should come from all Federal agencies with a stake in public safety and public health. Toward this end, the U.S. Congress should fully fund the National Forensic Science Improvement Act, and the U.S. Department of Health and Human Services should establish policies and programs to encourage more physicians to enter the field of forensic pathology while providing incentives necessary to retain currently practicing forensic pathologists. Forensic pathologists deal specifically with the investigation of cause and manner of death; they perform medicolegal autopsies and ancillary studies. As of 2003 there were 989 certified forensic pathologists in the United States; however, only approximately 600 were active practitioners, and less than 400 functioned as full-time forensic pathologists within medicolegal death investigation systems. Current estimates indicate that America needs at least 800 full-time, board-certified forensic pathologists to maintain medicolegal autopsy loads at acceptable levels. The limited availability of forensic pathologists suggests that many current practitioners are exceeding recommended caseloads and/or many medicolegal autopsies are being conducted by practitioners who are not forensic pathologists. The potential hazards of this practice are errors, the failure even to perform required autopsies, personnel burnout, and attrition. Appended cost information and 19 references

  10. Applications of neuropsychology in capital felony (death penalty) defense

    Cecil R. (1) Reynolds, J. Randall (2) Price, John (3) Niland and Denney, Robert L. (Editor,Editeur scientifique) (1,2).

    Journal of forensic neuropsychology, Vol. 3, No. 4, 2003, pp. 89-123.

    Death penalty litigation is qualitatively different from other forms of criminal prosecution, representing the ultimate authority of the state to take life legally. Many death penalty eligible defendants have known or suspected brain injury or other forms of central nervous system compromise. This paper reviews a team approach, involving consulting and testifying neuropsychologists, to death penalty litigation as it relates to the issues of competency, criminal responsibility, and moral culpability. The special case of the death penalty defendant who may have mental retardation is also addressed.