Forensic Pathologists

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Forensic Pathologists

• Perform autopsies and diagnose circumstances
  surrounding the cause and manner of death
• Determine whether death was
• Accidental
• Suicidal
• Homicidal

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Coroner vs Medical Examiner

• Coroner An elected official whose duty is to
  investigate the death of a person
• Medical Examiner An appointed medically
  qualified officer whose duty is to investigate
  deaths and bodily injuries that occur under
  unusual or suspicious circumstances, to perform
  post-mortems, and sometimes to initiate inquests.

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Medical Examiner System

• Many rural areas are still served by elected
  coroners some states still have both coroners
  and medical examiners- confusion still exists

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Forensic Pathologists

• Pathologists first began appearing in mid 19th
  century
• Use of microscope to examine tissues propelled
  this study
• Pathology means
• Study of disease, its causes and its diagnosis

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Training Requirements for a Forensic Pathologist

• Bachelor degree or equivalent, 4 years
• Medical school, 4 years, from a recognized
  allopathic (M.D.) or osteopathic (D.O) medical
  school
• Postgraduate training, 4 years anatomic
  pathology or anatomic and clinical pathology
• One year of training at a large coroners or
  medical examiners office required Intern
  normally receives pay

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Training Requirements for a Forensic Pathologist

• After 5 years of postgraduate training, Must pass
  a 2-4 day examn to become a board certified
  forensic pathologist
• There are an estimated 500 forensic pathologists
  practicing in the United States
• About 25 pathologists have both medical and legal
  degrees

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Training Requirements for a Forensic Pathologist

• Many forensic pathologists also specialize in a
  certain area, such as
• Toxicology
• Serology
• Tool mark or Impression evidence
• Firearms examination
• Crime scene analysis
• Forensic Anthropology
• Forensic Odontology

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Duties of Forensic Pathologists

• Investigate the deaths of persons who die
  suddenly and unexpectedly or as a result of
  injury
• Normally employed by cities, counties or division
  of government
• Some forensic pathologists work as consultants in
  litigation

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Reviewing Medical History

• Forensic pathologists deal primarily with
  determining cause of death, but also review past
  medical history to understand issues raised by
  that death
• Medical history is the starting point of
  investigation

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Reviewing Medical History

• When death is reported to coroner or medical
  examiner, a two pronged test takes place
• Is the death sudden?
• Is the death unexpected?

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Reviewing Medical History

• To certify cause of death, forensic pathologists
  must
• Determine cause of death based on delayed effects
  of injury
• Careful study of medical history to determine
  causes and manners of death of persons with
  trauma is required
• Be able to discern injuries from treatment from
  emergency personnel- needle marks, incised
  wounds, etc

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Reviewing Witness Statements

• Forensic pathologists seek to gather witness
  information about activities of deceased prior to
  death, because
• Assists in determining jurisdiction of death
• Assists in recreating circumstances of death
• Allows use of a hypothesis which can be tested
  scientifically based on statement of witness

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Autopsy Examination

• Autopsy means to look at oneself
• Necropsy means to look at the dead
• Autopsies have been practiced since the middle
  ages
• Term autopsy generally used in United States

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Limitations on Autopsies

• Middle Eastern religions forbid autopsies
• Forbidden by Egyptian polytheism (Mummification)
• Judaism, Islam and Christianity vary in their
  prohibitions
• Next of kin may object to autopsy

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Required Autopsy

• A medical examiner has the legal authority to
  order an autopsy without permission from family
  when
• Sudden or unexpected
• Results from an injury
• Under suspicious circumstances
• Other circumstances defined by law

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Autopsy Process

• Incisions created in chest, abdomen and head
• Removal of organs from those areas of the body
• T-shaped incision is typically used, because it
  facilitates examination of tongue and neck

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Autopsy Process

• Brain is removed via incision from behind one ear
  to behind other ear
• Scalp is pulled upward and backward
• Skull is sawed circularly or in a tonsorial
  manner
• Brain may be dissected immediately, or placed in
  formaldehyde to preserve tissue for better
  examination

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Autopsy Process

• Other internal organs are removed and weighed
• Organs are also dissected to determine disease or
  injury
• In certain cases such as child abuse, spinal
  injury, and subtle blunt trauma more extensive
  dissection and removal may be completed

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Obtaining Appropriate Specimens

• Toxicology requires adequate specimens for
  testing
• Blood is usually taken from aorta
• Bile taken from gall bladder

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Obtaining Appropriate Specimens

• Blood, urine, liver, kidney and brain used to
  determine presence of drugs
• Blood- alcohol or Urine- drugs
• Information from medical history, witness
  statements, scene examination, and autopsy may be
  used to search for other drugs or poisons

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Microscopic Examination

• Small portions of organs are put into a solution
  of formaldehyde to preserve them for study
• Diseased or injured sections of tissue are taken,
  as is normal tissue
• Tissue is encased in paraffin and mounted on
  slides with HE dye for examination under light
  microscope

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DNA Analysis

• Most coroners and medical examiners preserve one
  specimen of tissue for DNA analysis
• If tissue sits in formaldehyde for too long, DNA
  becomes hydrolyzed and unsuitable for study
• DNA embedded in paraffin blocks or cut into
  sections and made into slides will not further
  decompose

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DNA Collection

• Methods to accomplish this
• Blood spotted on absorbent paper allowed to dry
  then stored in envelope
• Pull head hairs, including bulbs, and place in
  envelope
• Cut hair has mitochondrial DNA, bulbs include
  nuclear DNA

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Photography

• Resolution of cameras in pixels
• 3 megapixel cameras- 2050 x 1500
• 5 megapixel cameras- 2560 x 1500
• 35mm film- 9000 x 6000
• Polaroid 1100 x 1580

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Report Preparation

• Forensic Pathologists provide a written report of
  each autopsy
• Gross examination- can be seen by unaided eye
• Microscopic examination- requires a microscope
• Forensic Pathologists dissect then dictate,
  normally

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Gross Autopsy Reports

• Should contain information regarding
• Discussion of external examination
• Medical treatment evidence on body
• Evidence of injuries
• Dissection technique
• Diagnoses based on gross autopsy

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Microscopic Examination Reports

• Dictated after gross autopsy report
• Histology laboratory report takes several days to
  prepare
• Additional time required for preparation of
  slides

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Microscopic Examination Reports

• Toxicology report created by toxicologist,
  reviewed by forensic pathologist, and appended to
  autopsy report
• Forensic Pathologist may prepare a final summary
  of external examination, internal dissections,
  microscopic examination and toxicology report

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Testimony

• Forensic pathologists may spend considerable time
  testifying as to their findings
• In criminal court, testimony of a forensic
  pathologist is almost required
• In civil court, forensic pathologists may be
  called upon to testify as a result of torts
  (civil wrongs) alleged to have caused death

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Testimony

• Forensic pathologists either give testimony via
  subpoena for civil cases, or via their presence
  in court for criminal case
• Forensic pathologists also testify as expert
  witnesses in cases where they did not examine
  body of deceased

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Testimony

• Forensic pathologist subject to ad hominem
  attacks by opposing counsel
• Ad hominem- attack on person themselves instead
  of their testimony