CORONER vs' MEDICAL EXAMINER

1
CORONER vs. MEDICAL EXAMINER

• Citizen
• No specified training
• Professional administrator
• Elected or appointed

• Physician
• May be Certified in Forensic
  Pathology
• Usually appointed

2
MEDICAL EXAMINER'S OFFICE FUNCTIONS

• Investigation.
• Certification.
• Autopsy (if needed).
• Identification.
• Notification.
• Property/ Evidence Control.

3
REPORTABLE DEATHSDefined by CA HS Code 10250
and Gov Code 27491

• Violent, sudden, or unusual.
• Unattended by physician in last 20 days.
• Related to accident or injury, either old or
  recent.
• Homicide, suicide, or accidental poisoning.
• Due to criminal acts.

4
Cause of Death

• The injury, disease, or combination of the two
  which initiated the fatal train of physiologic
  disturbances.
• Multiple Blunt Force Injuries
• Chronic Obstructive Pulmonary Disease
• Drowning
• Undetermined

5
Manner of Death

• The fashion in which the cause of death arose.
• Natural
• Accident
• Homicide
• Suicide
• Undetermined

6
Manner Classification Statistics

• Natural (4500/yr).
• Accident (115/ MVAs/yr).
• Suicide (130/yr).
• Homicide (40/yr).
• Undetermined (20/yr).

7
Reasons For Determining Cause and Manner

• Innocent exonerated.
• Murder recognized.
• Compile medical evidence for civil/criminal
  matters.
• Wrongful death suits.
• Suicide exclusion clauses.
• Recognition of hazards to public health.

8
Identification

• Eyewitness most common.
• Dental records very reliable but must have
  antemortem record and be able to find the
  dentist.
• Teeth preserved even with trauma, fires,
  decomposition.
• Fingerprints reliable if prints on record.
• AFIS Automated fingerprint identification
  system.
• Tattoos or other external marks (eg. absent
  fingers).
• Internal autopsy findings.
• DNA
• Circumstances least reliable.

9
POSTMORTEM MANIPULATIONS

• In all trauma deaths, the Medical Examiner has
  jurisdiction over the body after death.
• No manipulation of a body after death is
  permissible unless consent is first obtained from
  the Medical Examiner.
• The only exception is Law Enforcement may search
  the body for ID at the scene of an auto accident.
  (Organ Donor)

10
Who Can Pronounce Death?

• ANYONE As long as the person can recognize
  death.
• Decapitation
• Decomposition
• Rigor
• Lividity
• Massive Blood Loss

11
Livor Mortis

• Gravitational settling of the blood.
• Usually maroon or purplish in color.
• 30 min 2 hours Onset
• 8-12 hours Fixed
• Blanched vs. Non-Blanched

12
Rigor Mortis

• The tightening of the muscles in the body due to
  an increase of lactic acid.
• 0-12 hours Sets
• 12-24 hours Remains Set
• 24-36 hours Resolves
• Starts simultaneously, but is seen first in
  smaller muscles.

13
The Autopsy

• Examine clothing and collect trace evidence.
• Collect toxicology, serology, microbiology, and
  special study specimens.
• External examination and x-rays.
• Internal examination.
• Package evidence and take fingerprints.

14
Ligature Strangulation

• Death can occur without suspension
• Full suspension
• Less likely to see petechiae
• More likely to have fractures
• Rarely see vertebral fractures
• Horizontal ligature furrow more likely in
  homicide
• Pure homicidal ligature hanging very rare

15
Decomposition

• Green discoloration of lower abdomen
• Marbling of skin
• Bloating of body with skin slippage
• Purge from mouth, anus
• Disintegration of body

16
The scene will contain forensic evidence.
Identify it, collect it and preserve it and it
will speak for the dead