The Role of Forensic Pathology in Criminal Profiling

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Sexual Homicide: Chapter 10: The Role of Forensic Pathology in Criminal Profiling

Thinking Through the Issues

by James L. Luke, M.D.

Those of us who are privileged to serve as participants in the arena of medical-legal death

investigation, whether as uniformed police officers, homicide detectives, or physicians,are trained to insulate ourselves from emotional involvement in the cases we investigate.In order to maintain perspective and objectivity, it is important to detach oneself from the

pathos of the tragedy of sudden death. However, I doubt that there are many of us who

don't, from time to time, fall into the habit of personalizing the case at hand. This is anatural, expected, and, I believe, positive human attribute. By personalizing, I mean

identifying with the victim, and painful though it may be, imagining yourself or your

spouse or your child in the victim's stead. The positive result of this level of emotional

involvement is that is ensures, to some extent at least, that the case will be investigatedwith caring, with compassion, and with discretion. It guarantees that the humanity of the

victim will not be obscured by the mayhem of the moment. Whether it also ensures that

better investigative decisions will be made is not possible to know.

More to the point of this discussion, personalizing a case also forms the basis for

pondering about the sort of person who could have committed the crime in the first place.

There are few of us who will not have spent many hours over the course of our careerswondering who did it, how long it lasted, how it must have felt to the victim, and to be

acutely aware, in spite of the spectacular advances that have been achieved in some areas

of the forensic sciences, of the woeful lack of meaningful progress in others. Forensicpathology would fall into the latter category. It is all too easy with a difficult case at our

doorstep to become frustrated at our inability to call up a simulated rewitnessing of the

fatal event. Fanciful though that notion may seem to the uninitiated, the work products of

the various disciplines that constitute the forensic sciences are directed toward preciselythat end. Consequently, this is the mind-set that prompted in 1984 the active inclusion of

forensic pathology in the criminal profiling activities of the Behavioral Science Unit at

the FBI Academy in Quantico, Virginia.

The interface between the disciplines of criminal profiling and forensic pathology forms

the basis upon which a substantial portion of the profiling exercise is established. Gaps inavailable knowledge about what happened to the victim are, proportionally, gaps in the

final profiling product. In this context, the forensic pathologist reviews and evaluates the

postmortem pathologic findings contained in the various materials submitted for

profiling. He examines the diagrams, the photographs, and the narrative autopsy report.He familiarizes himself with the police reports pertaining to the particular circumstances

of the case before him and reviews the reports of forensic scientific laboratory analyses

performed.

At this point it might be useful to spend a moment or two describing the sorts of

pathology-related information that should optimally be included in this type of exercise..


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A comprehensive police report, which may or may not include a chronology of

investigative events.

A scene diagram with a description of climatic conditions, body position, signs of death(including body temperature and postmortem rigidity and lividity, and appropriateness of

each of the latter, in terms of the position of the body when found, for example), clothing

worn by the deceased, drug paraphernalia found at the scene, if any, and other pertinentscene descriptors.

Photographs of the scene of death and of the pertinent autopsy findings, and a diagram of

wound pattern distribution. If a picture is worth a thousand words, a diagram is worth atleast five hundred. And, speaking of pictures, the autopsy photographs ideally should be

eight-by-ten inch prints, in focus., and the wounds depicted should have been cleaned of

dried blood and other extraneous material.

Reports of toxicological and other forensic scientific analyses.

The bottom line is that it is not possible to provide too much factual information.

After the review and synthesis of all available and pertinent information, an evaluation ismade regarding both the completeness and the validity of the data provided. If additional

information is necessary to determine the nature and type of postmortem findings (the

size, shape, and extent of the wounds, for example), the submitting pathologist is

contacted by telephone for clarification and/or elaboration. This personal interaction isextremely useful, not only regarding exposition of findings of fact, but also to elicit the

pathologist's own interpretation of the findings relative to the circumstances of the case,

and, depending on the level of his training and experience, on the degree of certainty heplaces on his interpretations. Bearing in mind that autopsy reports are narrative

descriptions of fact and do not normally contain interpretive judgments, this sort of

person-to-person contact is to be encouraged whenever possible and in many cases is a

prerequisite to proper case understanding and analysis.

The relationship between forensic pathology and the criminal justice system is both

subtle and complicated, and varies from one medical-legal jurisdiction to another. Let'sstart at the beginning. What is forensic pathology? It is a recognized medical subspecialty

requiring supervised training and case-handling experience. Prior to being eligible to take

the American Board of Pathology certifying examination, the candidate must have spentat least one year in an approved residency training program.

From the standpoint of forensic pathology, the two major parameters that form the basis

of any case investigation are (1) identification and documentation of the postmortemfindings present, and (2) interpretation of those findings within the context of the

circumstances of death. Postmortem findings can be positive, in the sense of a

demonstrated gunshot wound, or negative, in the sense of absence of an anatomic

evidence of blunt force injury, for example, in a shooting homicide said to have beenpreceded by an altercation in which the victim is alleged to have been beaten with a pipe.

The circumstances of death might usefully be extended to include the past medical

history of the victim and/or review of his or her hospital records, when applicable. Theroot problem here, of course, is that identification of the postmortem findings and


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interpretation of their significance is a subjective, judgmental exercise. In that regard,

there is no facet of the work of a forensic pathologist that does not require the use of

training and experience to generate the subjective conclusions reached. I am reminded ofa remark by the late Dr. Milton Helpern, former chief medical examiner of New York

City, when he was asked to evaluate a case using only the pathologic findings

enumerated at autopsy. "Forensic pathology is not a specialty," he said, "where you canring up an itemized listing of findings on an autopsy room cash register and expect tototal up the conclusion." That statement can be applied to the forensic sciences in general,

and, for that matter, to any aspect of the art of death investigation. Without judgment and

common sense, we all might be well advised to seek some other form of employment.

Training programs in forensic pathology vary widely regarding caseload volume and the

extent of trainee supervision. Although somewhere between one hundred and two

hundred board-certified forensic pathologists in this country practice their specialty on afull-time basis, significant variability exists in the skill level, motivation, time available

per case, and other important factors that are brought to bear on the individual case.

Similar variability exists in budget, equipment, and other administrative resourcesprovided for death investigative efforts within and between medical-legal jurisdictions. In

some jurisdictions, medical-legal postmortem examinations are performed by

pathologists who have received little or no formal training in forensic pathology. Systems

vary. People vary. When these two intangibles are combined and applied to a givenvictim of a major crime in a particular jurisdiction, it is surprising that so many cases are

reasonably well handled. It is also not surprising that a number of cases fall through the

procedural cracks.

It is important, therefore, to realize that the validity and competence of forensic

pathologic information that is provided to the criminal profiler will not be uniform, and

that further inquiry must be made to improve the quality and usefulness of theseimportant data. At one extreme of the performance spectrum, the forensic pathology

findings and conclusions may be inadequate to the extent that they invalidate even the

certified cause and manner of death. At the other end of the spectrum, clarification ofpostmortem findings may provide valuable data pertaining to estimating bullet caliber (in

an in-and-out skull wound, for example), sequence of injury, prior drug involvement, and

a host of similar parameters that, in a given case, may be critically important indiscovering what happened to the victim. And what happened to the victim is, in large

part, determined by the motivation, character, and mind-set of the offender.

Once we have examined and analyzed the information provided and have made a roughdetermination concerning its validity, it is time to begin a sorting process that is part of

the intellectual armamentarium of every medical-legal death investigator, including

forensic pathologists: What credence can we place on the facts we have developed? What

is the degree of certainty of the forensic pathology evidence?

Time of death

Postmortem intervalRange of gunfire


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Type of blunt force weapon

Identification of patterned injury that may reflect a particular weapon or instrument

Findings indicating sexual assaultExtent of force delivered

Drug levels

The listing is open ended and depends to a great extent on the unique circumstances ofdeath and on the proposed fatal scenario in the case being investigated.

The scene and autopsy room photographs provided to the profiler must be examined not

only to confirm information presented as fact, but also to identify findings present thatmay not have been appreciated or described by the pathologist who performed the

postmortem examination. Most forensic pathologists have had the experience of having

completed an autopsy on a difficult homicide where photographs have been taken and

diagrams and a narrative description of findings prepared, only to discover later when thephotographic material is developed and reviewed that there, staring the pathologist in the

face, is a patterned injury or other trauma that had been completely overlooked or

misinterpreted at the autopsy table. We have had similar experiences in reviewingmaterials submitted for FBI criminal profiling. Patterned blunt force injury has, on

occasion, not been previously recognized. Findings of asphyxia have been overlooked or

misidentified. These errors of omission are not viewed as representing incompetence or

inadequacy on the part of the local investigator or pathologist. In a complex, interpretive,interdisciplinary activity like death investigation, we should always reserve the right to be

smarter and wiser today than we were yesterday.

It may sound simplistic to say that establishing the profile is the profiler's responsibility.

Nevertheless, it would appear to be advantageous for the pathologist not to interject

himself into the actual profiling process prior to completing his own analysis of the

pertinent submitted materials. Objectivity can best be approximated in this fashion.However, now that the forensic pathology findings have been evaluated, the time has

come to discuss the case with the person whose responsibility it is to construct the profile.

This activity may be accomplished either singly- that is, person to person or in a groupprofiling session. My strong personal preference is the latter arrangement, even though a

group session may be more time consuming. If it is not yet an axiom of medical-legal

death investigation, it ought to be, and it should be noted that here too two heads areinvariably better than one. A small group of experienced investigators generates ideas of

potential investigative import in geometrically beneficial fashion. By the same token and

for the same reason, it was agency policy at the Washington, D.C., medical examiner's

office to include additional medical examiners in any complicated case investigation,whether at the scene of death or in the autopsy room, for the express purpose of cross

fertilization of ideas, as well as for documentation or endorsement of complicated case

findings.

At the profiling session the case history, victimology, and forensic pathology findings are

presented and discussed relative to their significance in terms of the specific issues of the

case. Regarding forensic scientific input here, it will become obvious that most forensicpathology findings will be noncontributory to developing the profile. The discussion will


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most likely center around one or two parameters of particular forensic import, parameters

that may have a significant bearing on the profile in progress, based not on the findings

themselves but on the circumstances and unresolved issues of the case.

I would like to illustrate this point by posing several hypothetical questions that were

raised in actual profiling sessions, with each question representing a different case (andwith considerations of forensic pathologic or of profiling significance in parentheses):

How long could the victim have lived with the illness of diabetes insipidus following her

abduction and prior to her death, with the medication that she required not beingavailable to her? (Medical history, time of death and postmortem interval).

How much would the victim be expected to bleed with a wound of this

type in this location, and is it more likely, given the relative paucity of blood on her

clothing and at the scene, that she was killed elsewhere and dumped where she wasfound? (Anatomic wound location and extent of injury).

Is the incised wound of the neck in reality a postmortem injury, given the findings ofconjunctival petechiae, as evidence of asphyxia, and the belt buckle mark of the neck,

which may denote use of a ligature as a controlling device? (Was the sexual assault

inflicted first, and the victim killed to avoid identifying her assailant?).

Item: A middle-aged woman, an alleged police informant, was found naked in her

bedroom, jackknifed over the left side of her bed with her knees on the floor. Her throat

had been slashed to the spine. However, considerably less blood was present on thebedclothes than would have been expected with a major incised wound. of this type.

Careful examination of autopsy photographs of the deceased's neck revealed a patterned

contusion or bruise of the right side of her neck just lateral to the right margin of the

incised wound. The pattern was characteristic of a belt buckle, the belt ligaturepresumably having been employed as a controlling device and anteceding the slash

wound of the throat. No mention of the patterned injury had been made in either the

police report of the case or by the pathologist in the autopsy report.

Is the patterned injury present indicative of a particular type or class of weapon or

instrument? (Did the subject bring his own weapon with him, implying forethought andplanning?)

Item: A middle-aged female motel night clerk was found supine on the floor of the office

behind the registration desk. Her clothing had been forcibly removed. A prominent

complex ligature abrasion was present, involving nearly the entire front of her neck.Review of the scene photographs of the injury demonstrated a multiply repeating pattern

of abrasion and contusion across the neck. The longer the injury was examined, the

clearer the pattern became, much like the development in the darkroom of a photographic

print, finally becoming recognizable as a square shaped belt buckle. The pattern wasspecific enough that the buckle width could be estimated and the prong and vertical prong

support areas could be approximated.


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The point I would like to make here is that it is useful to set aside a block of time to

examine all available wound photographs. Experience is of invaluable assistance in this

regard. It is not enough just to say that an abrasion or contusion exists and to let it go atthat. Much can be learned by active pondering, a process that takes time and effort.

Again, the listing of possible profiling issues related to forensic pathology is bounded

only by the dynamics of the circumstances of the case. Let us next turn to a case study,which will illustrate a number of important forensic pathology principles.

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The Role of Forensic Pathology in Criminal Profiling