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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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Medicolegal Death Investigation is an uncommon term used to describe the investigation into the manner and causes of death. The name implies a combination of medicine and law into a common discipline. However, the field is much more complex than this simple concept may indicate. Death investigation is comprised of a multitude of forensic specialists. These include the investigators, scientific and medical personnel, police, paramedics, clergy and other support staff.

The Medicolegal Death Investigator (MDI) can wear many different hats. He/she can be an elected/appointed county coroner, an appointed medical examiner, a forensic pathologist, a forensic odontologist (dealing with the study of teeth), botanist, anthropologist, criminalist or a trained forensic death investigator. All of these, and more, may play an integral part in the process.

This article examines the role of the Medicolegal Death Investigators who respond to death scenes as representatives of either a County Coroner or Medical Examiner, in order to document observations and collect physical and trace evidence necessary to determine the manner and cause of death (Haglund & Ernst, 1997). MDIs respond to death scenes that include murders, suicides, accidents or natural deaths. Their expertise in reading death scenes and documenting their findings in photographs and written reports is often critical to the final determination as to the manner of death.


magnifying glass & chalk marks
The very name - Medicolegal Death Investigation - implies a combination of medicine and law into a common discipline. Dr. Randy Hanzlick, a forensic pathologist, described it as an umbrella term for a patchwork of highly varied state and local systems for investigating deaths. (Committee, 2003) The combined task of collecting and interpreting information about circumstances and causes of death has traditionally been called medicolegal death investigation. This terminology reflects the interface of medical science with law and public policy.

Death investigation has been performed for centuries in all societies, although not always by medical professionals. (Committee, 2003) Dr. Warner Spitz noted that the association of law and medicine dates back to the Egyptian culture as early as 3000 B.C. (Spitz, 2006) The English coroner system was mentioned in documentations around the 12th century B.C. The 1194 Articles of Eyre provided for Custos Placitorum coronae (keeper of the pleas of the crown) and was the first documented orgin of the term "coroner." (Spitz, 2006) The coroner system was brought to the American Colonies by English settlers and established as a legal investigative function. In 1890 Baltimore replaced its coroner system with that of a medical examiner (a trained medical doctor specializing in pathology.) As death investigation became more complex and required a higher degree of sophistication, other cities and states were to follow this example, like New York, which established the office of medical examiner in 1918. (Hanzlick, 1998) While the original intent of the British Coroner system was to ensure that the Crown received its fair share of proceeds from estates of the deceased, investigations into the manner and causes of death evolved as the office's primary function. (Spitz, 2006) Today, there are approximately 2,000 Medical Examiners and Coroner offices throughout the United States, which examine a combined total of over half million cases annually. (Bureau, 2004)

man holding glowing hot iron
A Medieval Coroner tests guilt through ordeal by fire
Source: Britannia History

Modern medicolegal death investigation has evolved into a discipline of forensic science using both forensic medical practitioners and forensic investigators. While the typical portrayal of the medicolegal death investigation in television programs, such as "CSI" and "Law and Order," sometimes over-dramatizes contributions related to time frames and scientific techniques in solving crimes, the basic tenets of the work are more accurately portrayed than not. Some television programs, such as "Dr. G, Medical Examiner" and "North Mission Road," attempt a reality-based presentation of the field of medicolegal death investigation. They create reenactments and present actual investigators, forensic pathologist or anthropologist, who perform investigations in real cases without much dramatization. In either case, television has brought an increased public interest and at the same time, has increased public expectations regarding forensic investigations.

The nature of modern death investigation includes social issues that extend beyond the crime scene and often impact everyone who is involved with the death. Dr. Randy Hanzlick stated that death investigations carry broad societal importance for criminal justice and public health. The investigations provide evidence to convict the guilty and exonerate the innocent. Death investigation has an impact on judicial decisions involving incarceration and financial and professional status. Death investigations aid civil litigation as well, states Hanzlick. (2003) A thorough death investigation can uncover unsafe conditions that potentially could save the lives of other family members. These include sanitary or unhealthy living conditions as well as genetic abnormalities discovered at autopsy.

Death investigation and forensics has expanded into the science of engineering looking into the causes and effects of design flaws, material defect or human error. (Stanczak, 2008) (See the Discovery Guide "From Building Design to Prime Time " for further discussion

A competent death investigation can identify consumer products that expose people to dangerous environments and, as a consequence, save many lives by either removing the dangerous products from sales, or mandating the manufacturers to render them safe for consumer use. Examples of product design changes include child car seats, baby cribs and children's toys. Death investigations into automobile accidental deaths have improved safety standards by adding air bags, seat belts, bumpers and better side-impact construction.

The death investigation is responsible for determining the cause and manner of death. (Hanzlick, 2003) Vernard I. Adams, M.D. defined the cause of death as "the disease or injury that sets in motion the physiologic train of events culminating in cerebral and cardiac electrical silence" and the manner of death as "a pseudo-judicial classification." (Adams, 2002) The manners (classification) listed on death certificates are "Natural, Accident, Suicide, Homicide and Undetermined."

The complexities of death investigation are reflected in the multitude of actions needed for successful case conclusion. Investigation of a homicide, for example, examines the trauma inflicted upon the decedent, establishes that the cause of death resulted from that trauma, and contributes to the apprehension of a possible suspect by identifying and collecting physical and trace evidence. The investigator also provides detailed testimony at trial when a suspect is apprehended. Court testimony is critical to the findings of guilt or innocence of the accused, and the thoroughness of the investigation can often mean the difference in jury determinations. Jeff Dusek, a prosecutor from San Diego County, correctly identified the importance of death investigation to the prosecution of criminal cases. He stated that a prosecutor looks to the medical examiner's office for accuracy, promptness, and the ability to state opinions clearly in court. (Committee, 2003)

The finding of suicide as a manner of death may impact families differently. Suicide carries a stigma on the family name in many cultures. Consequently, objections are often raised by survivors when suicide is documented on the death certificate. Suicide can also leave survivors feeling guilty and unable to cope with the loss of the loved one. (Leash, 1994) Additionally, the finding of suicide can influence the payment of life insurance policies, as most exclude suicide within the first two years after issuance of the policy in order to prevent profit from an individual's death.

The medical contribution is equally important in deaths ruled natural or accidental. According to Dr. Vincent Di Maio, "Medical expertise is criticial in death investigations. It begins with body examination and evidence collection at the scene and proceeds through history, physical examination, laboratory tests, and diagnosis - in short, the broad ingredients of a doctor's treatment of a living patient." (2003)

students e-checking evidence
Students at Radford University analyze evidence at a mock crime scene

The reporting of death statistics is important in many areas of public health and health care. In addition to the manner and causes of death that document trends of homicides, accidents, suicides and certain health trends throughout the U.S., the data provided by medical examiners and coroners are valuable in other areas of documentation. Dan Sosin stated that the data provided by Medical Examiners and coroners holds great potential for public health surveillance and public health intervention. Medical examiner and coroner death data also can contribute to knowledge regarding bioterrorism and terrorism. (Committee, 2003)

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Unless otherwise indicated all photos are by Emil Moldovan

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