Forensic Medicine

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Forensic Medicine

• Dr. Jeff Ricken, C.S.I.

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Our Judicial branch of government is based on an
adversarial form of justice

• Attorneys represent both the plaintiff (one
  suing someone) and the defendant (doctor, nurse,
  hospital, manufacturer, drug company)
• Damages can be awarded for financial losses,
  mental anguish/suffering, loss of wages,
  disability, etc.

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Judges are either elected or selected
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The jury

• A panel of 10-12 people who are mutually
  agreeable to both plaintiffs and defendants
  attorneys after a brief questionaire and
  interview.
• Everyone must do jury duty if it is agreed to be
  a jury trial
• Some trials are agreed to by both parties to be
  judge trials without a jury.

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Judges

• Judges decide what evidence is admissible in the
  trial
• They only rule on questions of law if its a jury
  trial
• They dont decide innocence or guilt verdicts
  unless it is a judge trial.
• They do decide on punishments, compensations,
  fines, imprisonment, etc.

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Attorney for the plaintiff

• They state their case
• They call witnesses to testify
• They interrogate witnesses to elicit the
  testimony of the witness for the record.
• They present their facts accusing the defendant
• They present their findings first
• The defense attorney can cross examine each
  witness after the plaintiffs attorney is done
• Expert witnesses are hired to present the facts
  for each side

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Defense attorneys

• They are hired by the hospital, doctor or
  manufacturer to show why they are innocent of the
  plaintiffs accusations.
• They are paid for either by the defendants or
  their insurance companies
• They can present evidence in their clients
  defense as well

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Forensics from forum

• Where the senators in ancient Rome discussed
  citizens with aberrant behavior and criminal
  behavior and what to do with them ergo
  Forensics
• Crime a violation of the criminal code or law
• A perpetrator commits a crime

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Kings no longer judge us, a court of law decides
civil and criminal cases
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Presumption of Innocence

• Youre innocent until proven otherwise
• Burden of proof It is up to the prosecution to
  prove its case beyond all reasonable doubt.
• The accused has a right to a judge or jury trial.
• Prosecutor works for or is the District Attorney
• District Attorney a public, elected official,
  also an attorney who prosecutes criminal cases in
  the name of the government and represents the
  interests of its citizenry.
• Public defender provided free if you are accused
  of a crime and cant afford an attorney.

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The bill of rights limits the power of the courts
and prosecution
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Suspects are Arraigned

• The formal charging of a suspect with specific
  violations of the law in court
• Prosecution must convince a judge with evidence
  and testimony that there is reasonable suspicion
  that this person committed a crime.
• Certain capital crimes (like murder) require a
  grand jury (a panel of 10 citizens who must be
  convinced the accused committed a crime

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Grand jury evaluates evidence to decide if a case
goes to trial or not
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If the judge or grand jury is convinced at the
arraignment of a possible crime by the accused

• A hearing for bail may or may not be set
• The prosecutor and the defense attorney argue the
  flight risk of the accused
• Bail is set if the judge sees that the amount of
  funds/property set for bail offsets flight risk
• If insufficient funds/bond money available, the
  accused may remain in custody until trial if
  crime is of a capital nature or the accused poses
  a risk to society before trial

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The body talks to us

• Victims remains tell tales

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Coroner vs. Medical Examiner

• Both are charged with investigating deaths not
  the result of natural causes i.e. suspicious
  deaths or deaths from unusual or suspicious
  circumstances
• Medical examiner always a doctor Coroner
  investigates but may not be a physician

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Expert witnesses

• When the knowledge and expertise of the court
  cannot be expected to render opinions beyond its
  scope of training, it relies on the use of
  experts.
• Doctors, engineers, nurses, psychologists,
  medical examiners and coroners are all trained in
  their fields and often testify on behalf of
  plaintiffs and defendants. They can be paid for
  their services and research into the case
  ethically.

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Expert witnesses testimony for sale?
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You call it black and blue doctors call is
ecchymosis or purpura

• Blunt
• force trauma

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Petichiae broken blood vessels either from
trauma or disease (clots) choking? Squeezing?
Noose?

• Asphyxiation?

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Corpus delecti (body of the crime)

• It means the plaintiff or prosecutor must first
  prove a crime has been committed.
• Prove something was stolen, show a dead body for
  a murder, etc.

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Modus operandi

• The M.O. is a criminals pattern of committing a
  crime
• How did he kill his victims can be ones M.O.

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Autopsy, necropsy, post mortems

• Performed on victims who died under suspicious
  circumstances
• Can ordered by a hospital at their chosing
• Medical examiners are M.D.s while coroners dont
  have to be. Coroners are either elected or
  selected by a county commissioner, mayor or
  governor.

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The burden of proof is always on the prosecutor
or the plaintiffs attorney (if its a civil
case).

• In a criminal case, the prosecution must prove
  their case beyond a reasonable doubt.
• The verdict by a jury must be UNANIMOUS. If one
  juror votes Not guilty the jury is hung. No
  verdict but whole case can then be tried again.
• If the defendant is found innocent then double
  jeopardy prevents them from ever being tried
  again for the same charges. (Bill of Rights no
  double jeopardy permitted).

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Lawsuit both sides present their case jury
listens and decides verdict judge decides
question of law only and punishment after jury is
done.
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Asphyxia signs

• Asphyxia due to loss of oxygen to the brain
  causing death.
• May be due to smoke, drowning, strangulation,
  collapsed trachea, chest crushes, etc.
• Signs include petechiae around the organs
  involved including the eyes, water in the lungs
  (drowning), smoke in the lungs (smoke
  asphyxiation), rope marks around the neck,
  vertebral fractures, blood clots in the brain,
  emboli in the heart, brain, lungs,etc.

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asphyxia
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Hearsay

• Information in court that the witness has no
  direct proof of or can attest to is NOT
  ADMISSABLE.
• Tom says Susan told me she saw Jim near the
  crime scene.
• Objection, your honor this is hearsay.
• Judge says objection either sustained or
  overruled.

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Poisons

• Arsenic common in pesticides and herbicides.
  Some water supplies contaminated with it
  (Bangladesh)
• In low doses, was an early treatment for
  syphillis
• causes massive organ failure by blocking
  metabolism in all organs
• Bloody mucous from organ hemorrhaging

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arsenic
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Cyanide

• Binds with hemoglobin to prevent it from carrying
  any oxygen
• Victim dies by asphyxiation
• Suicide pill works fast, choking, death
• Cyanide used in mining and jewelry industry

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cyanide
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Carbon monoxide

• The result of combustion when there is a limited
  amount of Oxygen available to make CO2 (as in the
  gas engine).
• Binds irrevocably with hemoglobin, red victims,
  pass out, asphyxiate,
• It is a gas that is odorless, tasteless and
  lighter than air (keep the garage door open when
  the engine runs or youll fall asleep and ?)

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Carbon monoxide
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Deposition

• A sworn testimony in preparation for a trial
• Lets both partyies know what each witness is
  going to say and what evidence each will have for
  each side
• Either/both sides call for depositions from a
  witness list each provides the opposing counsel.
• If you lie in court or depositon, it is perjury
  and a crime. There is a chance for cross
  examination by both attorneys.

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deposition
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DNA evidence

• Nuclear DNA can be obtained from any tissue in a
  living persons body buccal DNA swab usually
  used, needs a court order if not voluntary. This
  gets a refence specimen of the accused.
• Then DNA from a crime scene or weapon is obtained
  for a comparison. 99.99 accurate. Hair, nails,
  teeth, semen, sperm in a bank, or any tissue will
  given DNA
• Dead bodies can be exhumed and mitochondrial
  DNA is still left in many deep tissues and hair,
  etc. This is acceptable for matching a reference
  specimne.
• Surreptitious specimens are allowed in the U.S.
  (without the suspects knowledge)

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Death by overdose

• Certain medications like barbiturates and
  sedatives depress respiration and heart rate to
  the point of coma followed by death
• Xanax, percodan, morphine, heroine,valium,
  codeine, Ambiens, ethanol, etc.
• Often it is accidental, sometimes not.
• Coma is common with these and may result in
  vegetative state afterwards if they dont die.