Medical and Forensic Medical and Forensic Autopsy: Fact and FictionAutopsy: Fact and Fiction

LSUHSC - Shreveport, LALSUHSC - Shreveport, LADepartment of PathologyDepartment of Pathology

James G. Traylor, Jr., MDJames G. Traylor, Jr., MDAssociate 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

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 availablea.a. PathologistPathologistb.b. Pathology Outreach DirectorPathology Outreach Directorc.c. CoronerCoroner

Introduction Introduction To The AutopsyTo The Autopsy

ObjectivesObjectives

Describe the role of the autopsy (medical, Describe the role of the autopsy (medical, private and forensic)private and forensic)

Discuss the impact and benefits of autopsyDiscuss the impact and benefits of autopsy

List causative factors in the decrease of List causative factors in the decrease of autopsies nationwideautopsies nationwide

What is an Autopsy?What is an Autopsy?

Postmortem examination of the organs Postmortem examination of the organs and tissues of a body to determine cause and tissues of a body to determine cause of death or pathological conditions.of death or pathological conditions.

Type of AutopsiesType of Autopsies

MedicalMedical

ForensicForensic

PrivatePrivate

Why do an Autopsy?Why do an Autopsy?

Although the Although the primary reason to primary reason to perform an autopsy perform an autopsy is to determine is to determine cause of death, there cause of death, there are other benefits to are other benefits to individual families, individual families, the practice of the practice of medicine, and the medicine, and the community at large. community at large.

Benefits of an AutopsyBenefits of an Autopsy Allaying a family’s fears about what Allaying a family’s fears about what

they could have done to prevent the they could have done to prevent the death.death.

Providing family members information Providing family members information about potential genetic diseases that about potential genetic diseases that may have implications for them.may have implications for them.

Medical education, training and Medical education, training and research leading to improved health research leading to improved health care.care.

Providing information about Providing information about preventable causes of disease and preventable causes of disease and accident and other public health accident and other public health hazards.hazards.

Forensic BenefitsForensic Benefits

In addition, there are forensic benefits of In addition, there are forensic benefits of investigation of homicide, suspected homicide, investigation of homicide, suspected homicide, other unexplained or suspicious deaths, and other unexplained or suspicious deaths, and deaths apparently due to accident or injury.deaths apparently due to accident or injury.

Other FindingsOther Findings

Studies have shown that in many cases even Studies have shown that in many cases even when cause of death seemed clear, the person in when cause of death seemed clear, the person in fact had medical conditions that were not fact had medical conditions that were not apparent during their life.apparent during their life.

Objectives of the Objectives of the AutopsyAutopsy

The autopsy has a different significance for each The autopsy has a different significance for each person, depending on their relationship to the person, depending on their relationship to the patient and their role in medical care.patient and their role in medical care.

Purpose For FamiliesPurpose For FamiliesTo determine why death occurredTo determine why death occurredTo learn whether everything medically possible To learn whether everything medically possible

was donewas doneTo determine what the likelihood is that other To determine what the likelihood is that other

members of the family may be affectedmembers of the family may be affected

Purpose For Non-family Purpose For Non-family MembersMembers

Layman unrelated to the deceased:Layman unrelated to the deceased:Establish the cause of death in cases where Establish the cause of death in cases where

death is unexplained or is poorly understood by death is unexplained or is poorly understood by the medical teamthe medical team

Law enforcement officials: Law enforcement officials: Attempts to clarify the circumstances of violent Attempts to clarify the circumstances of violent

and unexplained deathsand unexplained deathsProvides documentation of the injuriesProvides documentation of the injuries

Primary-care physicians and non-Primary-care physicians and non-surgical consultants: surgical consultants: Provides a final determination of the Provides a final determination of the

diagnosisdiagnosisProvides explanation of doubtful Provides explanation of doubtful

observationsobservationsProvides evaluation of treatmentProvides evaluation of treatment

Surgical specialists:Surgical specialists:Provides information on such matters as Provides information on such matters as

why a postoperative death occurred, the why a postoperative death occurred, the condition of the suture lines, and the condition of the suture lines, and the completeness of removal of a lesioncompleteness of removal of a lesion

Medical staff of a hospital, Hospital Medical staff of a hospital, Hospital Administrator and governmental Administrator and governmental agencies monitoring health care:agencies monitoring health care:Provides a quality control mechanism, a Provides a quality control mechanism, a

final yardstick by which the care of a final yardstick by which the care of a patient can be measuredpatient can be measured

Researcher:Researcher:A source of new ideas as to cause of disease A source of new ideas as to cause of disease May also provide an evaluation of new May also provide an evaluation of new

procedures and new therapeutic agents, and procedures and new therapeutic agents, and an explanation of adverse reactions, with the an explanation of adverse reactions, with the hope that they can be prevented in the futurehope that they can be prevented 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 Medical student - a first understanding of the effects of diseasethe effects of disease

Student, house staff and attending Student, house staff and attending physician alike - the meaning of certain physician alike - the meaning of certain observations unexplained during life, such observations unexplained during life, such as a heart murmur, a shadow in a chest x-as a heart murmur, a shadow in a chest x-ray, or an abnormal laboratory resultray, or an abnormal laboratory result

Society in general:Society in general:Benefits if autopsies could be used to Benefits if autopsies could be used to

compare the incidence of particular diseases compare the incidence of particular diseases in different geographic areasin different geographic areas

To survey the changing status of health and To 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 To evaluate the impact of environmental hazardshazards

To determine priorities among various To determine priorities among various research programs and effectiveness of research programs and effectiveness of sanitary measures in forcesanitary measures in force

Limitations of the AutopsyLimitations of the AutopsyNecessity of viewing care in Necessity of viewing care in

“retrospect”“retrospect”

Lessons learned may not carry Lessons learned may not carry over to current patientsover to current patients

Cannot answer questions that Cannot answer questions that you may have about your you may have about your patient’s disease process patient’s disease process unless you communicate with unless you communicate with the pathologistthe pathologist

In 1 to 2 percent of cases a In 1 to 2 percent of cases a definitive cause of death definitive cause of death cannot be foundcannot be found

Postulated Causative Postulated Causative Factors: Factors:

Decrease of Autopsy RatesDecrease of Autopsy RatesImprovements in diagnostic technologyImprovements in diagnostic technology

Fear of litigationFear of litigation

Removal of defined minimum autopsy rate Removal of defined minimum autopsy rate standardsstandards

Lack of direct reimbursementLack of direct reimbursement

Lack of standardization of the autopsy as a medical Lack of standardization of the autopsy as a medical procedure with resultant lack of credibility as a valid procedure with resultant lack of credibility as a valid outcome or performance measureoutcome or performance measure

Forensic Pathology:Forensic Pathology:

An OverviewAn Overview

OutlineOutline

Brief historical perspectiveBrief historical perspective

Becoming a Forensic Becoming a Forensic PathologistPathologist

Introduction to Medicolegal Introduction to Medicolegal Case WorkCase Work

Louisiana Coroner LawLouisiana Coroner Law

Closing quoteClosing quote

Brief Historical PerspectiveBrief Historical PerspectiveEarliest application of forensic medicine Earliest application of forensic medicine

had to do with the interdiction against had to do with the interdiction against suicide.suicide.

1010thth century suicide became a crime under century suicide became a crime under the common law in England.the common law in England.

1184 the Council of Nimes made the 1184 the Council of Nimes made the condemnation of suicide part of the canon condemnation of suicide part of the canon law of the Roman Catholic Church.law of the Roman Catholic Church.

Decisions as to manner of death seem to Decisions as to manner of death seem to have been made mostly by an have been made mostly by an investigation of the circumstances without investigation of the circumstances without specific examination of the body. specific examination of the body.

Historians reported Antistius, a physician in Historians reported Antistius, a physician in Rome, examined the body of Julius Caesar and Rome, examined the body of Julius Caesar and reached the opinion that, of the twenty-three reached the opinion that, of the twenty-three stab wounds Caesar sustained, the only mortal stab wounds Caesar sustained, the only mortal wound was one in the chest.wound was one in the chest.

In China a handbook entitled Hsi Yuan Lu was In China a handbook entitled Hsi Yuan Lu was published in about 1250 and contained limited published in about 1250 and contained limited brief outlines for the postmortem examination of brief outlines for the postmortem examination of bodies including descriptions of various wounds bodies including descriptions of various wounds caused by sharp versus blunt instruments. caused by sharp versus blunt instruments.

Written records of the development of forensic Written records of the development of forensic pathology in Europe begin in 1507, when a pathology in Europe begin in 1507, when a volume, subsequently known as the Bamberg volume, subsequently known as the Bamberg Code, appeared.Code, appeared.

Twenty-three years later, a more extensive penal Twenty-three years later, a more extensive penal code, known as the Constitutio Criminalis Carolina, code, known as the Constitutio Criminalis Carolina, was issued by Emperor Charles V for all lands was issued by Emperor Charles V for all lands included in his empire.included in his empire.

The two documents :The two documents : Portrayed importance of forensic pathology in requiring Portrayed importance of forensic pathology in requiring

medical testimony be integral part of proof and trials medical testimony be integral part of proof and trials involving decisions about whether the manner of death involving decisions about whether the manner of death was infanticide, homicide, abortion or poisoning was infanticide, homicide, abortion or poisoning

Did not specify that complete autopsies were to be Did not specify that complete autopsies were to be performed, but wounds were opened to determine their performed, but wounds were opened to determine their depth and directiondepth and direction

Latter half of the 16Latter half of the 16thth century Ambrose Pare century Ambrose Pare performed official medicolegal autopsies.performed official medicolegal autopsies.

Fidelis and Zacchia in Italy, in the early 17Fidelis and Zacchia in Italy, in the early 17thth century, were likewise engaged in anatomical century, were likewise engaged in anatomical dissections and reported analyses of injuries to dissections and reported analyses of injuries to internal organs.internal organs.

First formal lectures in forensic pathology were First formal lectures in forensic pathology were held by Michaelis and Bohn at the University of held by Michaelis and Bohn at the University of Leipzig where students were apparently Leipzig where students were apparently instructed in the subject of violent death and instructed in the subject of violent death and simulated natural deaths.simulated natural deaths.

As a result of advancements by these pioneers, As a result of advancements by these pioneers, the judicial authorities and the police in Europe the judicial authorities and the police in Europe soon began to call upon physicians to aid in the soon began to call upon physicians to aid in the solution of fatal crimes, and most of the larger solution of fatal crimes, and most of the larger jurisdictions developed centers, commonly known jurisdictions developed centers, commonly known as institutes of forensic medicine, where experts as institutes of forensic medicine, where experts carried out their investigations.carried out their investigations.

The historical development of medicolegal The historical development of medicolegal investigation in America can be clearly traced investigation in America can be clearly traced back to the English coroner system, which had back to the English coroner system, which had developed in that country some 600 years before.developed in that country some 600 years before.The Chart of Privileges The Chart of Privileges

mentioned in English historical mentioned in English historical sources included a grant of the sources included a grant of the coroner’s office by King coroner’s office by King Athelstane to an English noble, Athelstane to an English noble, identified as St. John of Beverly, identified as St. John of Beverly, in the year 925.in the year 925.

Appointment then included coroner’s duties and the Appointment then included coroner’s duties and the term “coroner” is obviously a corruption of term “coroner” is obviously a corruption of “crowner” applied to the individual charged under “crowner” applied to the individual charged under this law.this law.

Justices in eyre, apparently comparable to traveling Justices in eyre, apparently comparable to traveling circuit court judges of modern day, could order the circuit court judges of modern day, could order the coroner to perform duties of administrative or coroner to perform duties of administrative or inquisitorial nature within the region for which he inquisitorial nature within the region for which he had been appointed.had been appointed.

Over 200 years later, the Over 200 years later, the office of the coroner is office of the coroner is formally described. When in formally described. When in September, 1194, justices in September, 1194, justices in eyre were required to eyre were required to provide that three knights provide that three knights and one clerk were elected in and one clerk were elected in every county as “keepers of every county as “keepers of the pleas of the crown.”the pleas of the crown.”

Among these were the holding of inquests over Among these were the holding of inquests over dead bodies and “appeals”:dead 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 accused If wounds appear likely to be fatal, arresting the accused

individual.individual.

Coroner was also authorized by county courts to Coroner was also authorized by county courts to attach or arrest witnesses or suspects and to attach or arrest witnesses or suspects and to appraise and safeguard any lands or goods that appraise and safeguard any lands or goods that might later be forfeited by reason of guilt of the might later be forfeited by reason of guilt of the accused.accused.

These duties were carried out These duties were carried out either alone or with the sheriff, either alone or with the sheriff, but certain of them were but certain of them were earmarked specifically for the earmarked specifically for the coroner’s office, and he could coroner’s office, and he could perform them without being perform them without being ordered to do so.ordered to do so.

Despite descriptions of duties, it appears that they Despite descriptions of duties, it appears that they were loosely drawn, and the coroner became were loosely drawn, and the coroner became concerned only with felonies that resulted in concerned only with felonies that resulted in homicide or suicide or a felony resulted in a crown homicide or suicide or a felony resulted in a crown plea requiring enforcement.plea requiring enforcement.

Interesting example of the latter is “outlawry”, Interesting example of the latter is “outlawry”, where, if the accused still absented himself after where, if the accused still absented himself after public demand had been made for him to appear and public demand had been made for him to appear and surrender to justice on four occasions, the justices in surrender to justice on four occasions, the justices in eyre would declare him an outlaw. Thereupon his eyre would declare him an outlaw. Thereupon his goods and chattels were forfeited to the crown and goods and chattels were forfeited to the crown and his head could be cut off with impunity by anyone.his head could be cut off with impunity by anyone.

Other than the relegation of the function of death Other than the relegation of the function of death investigation to the coroner with loss of essentially investigation to the coroner with loss of essentially all other duties, there was little development of the all other duties, there was little development of the coroner system in England until the middle of the coroner system in England until the middle of the 1919thth century. century.

In 1877 a law enacted requiring an inquest be In 1877 a law enacted requiring an inquest be conducted:conducted: Whenever coroner had reasonable cause to suspect Whenever coroner had reasonable cause to suspect

violent or unnatural deathviolent or unnatural death When cause of death was unknown When cause of death was unknown Result - granted the coroner the widest authority to Result - granted the coroner the widest authority to

investigate cases and was indeed in sharp contrast to investigate cases and was indeed in sharp contrast to the continental system, where investigations were the continental system, where investigations were commenced only by the prosecutors or police officialscommenced only by the prosecutors or police officials

Early American Early American colonists, originating in colonists, originating in England, brought the England, brought the coroner system with coroner system with them in essentially the them in essentially the state of development it state of development it had reached by the early had reached by the early 1600’s.1600’s.

1877 - Boston Commonwealth adopted a statewide 1877 - Boston Commonwealth adopted a statewide system requiring coroner be supplanted by a system requiring coroner be supplanted by a physician known as a medical examiner. physician known as a medical examiner. Unfortunately, the jurisdiction of the medical Unfortunately, the jurisdiction of the medical examiner was confined to “dead bodies of such examiner was confined to “dead bodies of such persons only as are supposed to have come to their persons only as are supposed to have come to their death by violence.”death by violence.”

1915 - New York City adopted a law eliminating the 1915 - New York City adopted a law eliminating the coroner’s office and created a medical examiner coroner’s office and created a medical examiner system, authorizing investigation of deaths system, authorizing investigation of deaths resulting from:resulting from: Criminal violenceCriminal violence CasualtiesCasualties SuicideSuicide Sudden death while in apparent healthSudden death while in apparent health When not attended by a physician When not attended by a physician ImprisonedImprisoned Any suspicious or unusual mannerAny suspicious or unusual manner

Becoming a Forensic Becoming a Forensic PathologistPathologist

Graduating from medical school (4 years) and Graduating from medical school (4 years) and passing the three parts of the United States passing the three parts of the United States Medical Licensing Examination before being Medical Licensing Examination before being granted licensure in a given stategranted licensure in a given state

Acceptance into a Pathology Residency Program Acceptance into a Pathology Residency Program with successful completion (currently 4 years of with successful completion (currently 4 years of additional training which was previously 5 additional training which was previously 5 years)years)

Accredited college or university Accredited college or university degree (usually a four year program)degree (usually a four year program)

Passing the Medical Colleges Passing the Medical Colleges Admissions Test, applying to and being Admissions Test, applying to and being accepted to a medical schoolaccepted to a medical school

Passing the board examination given by the American Passing the board examination given by the American Board of Pathology (ABP) to become a board certified Board of Pathology (ABP) to become a board certified pathologistpathologist

Applying to and being accepted into an approved Applying to and being accepted into an approved Forensic Pathology fellowship program (subspecialty of Forensic 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 Successfully completing the fellowship and sitting for the board examination in Forensic Pathology given by the board examination in Forensic Pathology given by the ABP to become a board certified Forensic the ABP to become a board certified Forensic PathologistPathologist

Total Time InvestedTotal Time Invested College 4 years College 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 $$$13 years and $$$

Introduction:Introduction:Medicolegal Case Medicolegal Case

WorkWorkI.I. Five categories of medicolegal cases:Five categories of medicolegal cases:

Violent deaths, i.e., non-natural deaths (accidents, Violent deaths, i.e., non-natural deaths (accidents, suicides and homicides)suicides and homicides)

Suspicious deaths, i.e., those that may be due to Suspicious deaths, i.e., those that may be due to violenceviolence

Unattended deaths, i.e., those in which a physician is Unattended deaths, i.e., those in which a physician is not in attendancenot in attendance

Sudden and unexplained deathsSudden and unexplained deaths Deaths in custodyDeaths in custody

Note: Individual jurisdictions may modify these Note: Individual jurisdictions may modify these categories, either expanding them or categories, either expanding them or contracting them.contracting them.

A.A. Prevalence of medicolegal casesPrevalence of medicolegal cases1.1. In most communities, approximately half of In most communities, approximately half of

all deaths are reportable to a medicolegal all deaths are reportable to a medicolegal officeoffice

2.2. Of these, half (approximately 25% of all Of these, half (approximately 25% of all deaths) will be accepted as medicolegal deaths) will be accepted as medicolegal casescases

3.3. Others are generally unattended deaths of Others are generally unattended deaths of individuals under the care of a physician individuals under the care of a physician who is willing to sign a death certificate, who is willing to sign a death certificate, e.g., deaths in Hospices; at home; etc.e.g., deaths in Hospices; at home; etc.

4.4. Even if a case is not accepted, a written Even if a case is not accepted, a written record of the report containing details of record of the report containing details of the death should be made and retainedthe death should be made and retained

B.B. Objectives of medicolegal examination:Objectives of medicolegal examination: To positively identify a body To 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 have To determine or exclude other factors that may have contributed to the death or how the manner of death contributed to the death or how the manner of death should be classifiedshould be classified

To collect trace evidence from the bodies in criminally To collect trace evidence from the bodies in criminally related casesrelated cases

C.C. Pathologist may subsequently be called Pathologist may subsequently be called to:to:

Testify in Court to the findingsTestify in Court to the findings

Interpret their significance; how they occurred; the Interpret their significance; how they occurred; the nature of the weapon used (if any)nature of the weapon used (if any)

Determine time of deathDetermine time of death

II.II. Cause, Mechanism And Manner Of DeathCause, Mechanism And Manner Of Death

Deaths can be categorized as to cause of death, Deaths can be categorized as to cause of death, mechanism and manner.mechanism and manner.

A.A. Cause of deathCause of death is the disease or injury that is the disease or injury that produces the physiological disruption in the body produces the physiological disruption in the body resulting in the death of the individual, e.g., a resulting in the death of the individual, e.g., a gunshot wound to the chest.gunshot wound to the chest.

B.B. Mechanism of deathMechanism of death is the physiological is the physiological derangement due to the cause that results in the derangement due to the cause that results in the death, e.g., hemorrhage.death, e.g., hemorrhage.

C.C. Manner of deathManner of death is how the cause of death came is how the cause of death came about.about.

1.1. Manners of deathManners of death are: are: NaturalNatural AccidentAccident SuicideSuicide HomicideHomicide UndeterminedUndetermined UnclassifiedUnclassified

2.2. A A homicidehomicide classification does not necessarily classification does not necessarily indicate that a crime has been committed:indicate that a crime has been committed:

Term of homicide is not synonymous with Term 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 is done by a Court not a pathologist.Court not a pathologist.

4.4. Manner of death is classified as Manner of death is classified as undeterminedundetermined when after an investigation when after an investigation of circumstances surrounding death, a of circumstances surrounding death, a postmortem examination and appropriate postmortem examination and appropriate laboratory tests, there is insufficient laboratory tests, there is insufficient information to classify the death as natural, information to classify the death as natural, homicide, suicide or accident.homicide, suicide or accident.

5.5. Some forensic pathologists use a Some forensic pathologists use a classification of classification of “unclassified”“unclassified” when the when the death does not fall into any of the death does not fall into any of the aforementioned manners of death. aforementioned manners of death.

Example - psychotic individual who decides they Example - psychotic individual who decides they can fly and attempts to do so off a 200 foot cliff. can fly and attempts to do so off a 200 foot cliff. Such a death is obviously not natural or homicide Such a death is obviously not natural or homicide but is it suicide or an accident?but is it suicide or an accident?

Deaths formerly termed Deaths formerly termed “therapeutic “therapeutic misadventures” misadventures” may be listed as unclassified.may be listed as unclassified.

6.6. The average caseload, broken down by manner of The average caseload, broken down by manner of death, for a large metropolitan medical examiner’s death, for a large metropolitan medical examiner’s office: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 %

III.III. Forensic Autopsy Versus An External Forensic Autopsy Versus An External ExaminationExamination

A.A. It is not necessary to perform an It is not necessary to perform an autopsy in all medicolegal cases. autopsy in all medicolegal cases. The The reasons for performing an autopsy are varied. The reasons for performing an autopsy are varied. The most obvious ones are:most obvious ones are:

To determine the cause of death when it is not To determine the cause of death when it is not knownknown

To document injuriesTo document injuries To exclude other causes of deathTo exclude other causes of death To determine and/or exclude contributory factors To determine and/or exclude contributory factors

to the death. Note: Reason why autopsies are to the death. Note: Reason why autopsies are performed in most homicides, suicides and performed in most homicides, suicides and accidentsaccidents

B.B. In In some jurisdictions, autopsies are some jurisdictions, autopsies are mandatedmandated in certain types of death. in certain types of death.

C.C. Autopsies should be performed on all Autopsies 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 Complete autopsy, at a minimum, involves removal

and examination of the brain; the larynx and hyoid; and examination of the brain; the larynx and hyoid; the thoracic and abdominal viscera as well as the thoracic and abdominal viscera as well as collection of blood, urine, bile and vitreous, when collection of blood, urine, bile and vitreous, when available.available.

2.2. In certain cases one may want to make an even more In certain cases one may want to make an even more extensive examination, e.g., incise the legs looking for extensive examination, e.g., incise the legs looking for the source of a pulmonary embolus.the source of a pulmonary embolus.

3.3. As a general rule, either no autopsy or a complete As a general rule, either no autopsy or a complete autopsy should be performed. autopsy should be performed. Exceptions occur: Generally involve autopsies limited Exceptions occur: Generally involve autopsies limited

to the headto the head Example - In cases where there is a well documented Example - In cases where there is a well documented

self-inflicted gunshot wound of the head and the self-inflicted gunshot wound of the head and the bullet has not exitedbullet has not exited

Purpose of this limited autopsy is recovery of the Purpose of this limited autopsy is recovery of the bulletbullet

4.4. All homicides should be completely autopsied.All homicides should be completely autopsied.

IV.IV. Three Steps Of Medicolegal Death Three Steps Of Medicolegal Death InvestigationInvestigation

A.A. Step 1 - investigation of circumstances Step 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 Obtain as much information as possible prior to examining the body.examining the body.

1.1. Postmortem examination of a body Postmortem examination of a body should nevershould never be be conducted until one knows the circumstances of the conducted until one knows the circumstances of the death.death.

2.2. Investigation of the circumstances of a death may Investigation of the circumstances of a death may involve:involve:

a.a. Investigation of the sceneInvestigation of the scene

b.b. Talking to witnesses, next-of-kin and attending Talking to witnesses, next-of-kin and attending physiciansphysicians

c.c. Obtaining past medical records and/or police Obtaining past medical records and/or police reportsreports

3.3. Cases where homicide is suspected, talk to the police Cases where homicide is suspected, talk to the police to find out any special examinations or tests that they to find out any special examinations or tests that they may desire.may desire.

4.4. Circumstances of death may determine to some Circumstances of death may determine to some degree the extent of the subsequent postmortem degree the extent of the subsequent postmortem examination. examination. Example - A complete work-up for rape would be Example - A complete work-up for rape would be

conducted on the body of a young girl found semi-conducted on the body of a young girl found semi-nude in an isolated area but not if she was fully nude in an isolated area but not if she was fully clothed and shot walking home from school.clothed and shot walking home from school.

B.B. Step 2 - examination of body, Step 2 - examination of body, whether it be whether it be an autopsy or an external examinationan autopsy or an external examination

C.C. Step 3 - performance of laboratory tests Step 3 - performance of laboratory tests (including but not limited to toxicology, ballistic (including but not limited to toxicology, ballistic test firings, etc.)test firings, etc.)

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 Reporta.a. External examinationExternal examinationb.b. Evidence of therapeutic interventionEvidence of therapeutic interventionc.c. Evidence of injuryEvidence of injuryd.d. Internal examinationInternal examinatione.e. Microscopic examinationMicroscopic examinationf.f. Toxicology Toxicology g.g. FindingsFindingsh.h. OpinionOpinion

Louisiana Coroner Louisiana Coroner LawLaw

Louisiana Revised Statute 33: 1563. Louisiana Revised Statute 33: 1563. Duty to hold autopsies, investigations, etc.Duty to hold autopsies, investigations, etc.

A.A. Coroner shall either view the body or make an Coroner 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 any Death due to unknown or obscure causes or in any unusual mannerunusual manner

4.4. Bodies found deadBodies found dead

5.5. Death without attending physician within thirty-six Death without attending physician within thirty-six hours prior to the hour of deathhours prior 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 Death from natural causes occurring in a hospital under twenty-four hours admission unless seen by a under twenty-four hours admission unless seen by a physician in the last thirty-six hoursphysician in the last thirty-six hours

9.9. Death following an injury or accident, either old or Death following an injury or accident, either old or recentrecent

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

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 Death due to virulent contagious disease that might be caused by or caused a public “hazard”might be caused by or caused a public “hazard”

Organ ProcurementOrgan Procurement1.1. Chain of communicationChain of communication

• Coroner case – must have coroner’s authorization Coroner case – must have coroner’s authorization (Note: A coroner may choose to defer to the forensic (Note: A coroner may choose to defer to the forensic pathologist to determine if harvesting will interfere pathologist to determine if harvesting will interfere with evidence or other crucial information that the with evidence or other crucial information that the autopsy can provide the investigators.)autopsy can provide the investigators.)

• Non-coroner case – immediate next of kin must Non-coroner case – immediate next of kin must authorize organ donation to proceed. authorize organ donation to proceed.

2.2. What can be harvested?What can be harvested?– Body condition and length of time since death are Body condition and length of time since death are

factors that can restrict type of harvesting factors that can restrict type of harvesting performedperformed

– Communication with the pathologist is critical to Communication with the pathologist is critical to promote patient safetypromote patient safety

– Harvesting should be performed prior to the body Harvesting should be performed prior to the body being sent to the morguebeing sent to the morgue

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 This truth forms an essential link between the enforcement of law and the protection of the public in enforcement of law and the protection of the public in

the administration of justice.”the administration of 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