FS AGENDA 10/17/17

1. FS AGENDA 10/17/17 • YOU NEED • ½ sheet of paper • White board • Calculator • handout

2. Forensic Science Death Investigation The Medical Examiner System and the Role of the Forensic Pathologist

3. Lecture Outline • Forensic Pathology • Determining Cause of Death • Determining Manner of Death • Determining Time Since Death (PMI) • The Medical Examiner System

4. Forensic Pathologists • Investigate the sudden and unexpected deaths of persons who are in apparent good health • Investigate deaths suspected to be traumatic

5. Forensic Pathologists • Perform autopsies and diagnose circumstances surrounding the cause and manner of death • Determine whether death was • Accidental • Suicidal • Homicidal • Natural

6. Cause of Death • Cause of death • a disease or injury that initiated the lethal chain of events that led to death of the person

7. Manner of Death • defined as the fashion in which the cause of death came to be • Four manners of death: • Natural • Accidental • Suicidal • Homicidal

8. Time of Death • Four methods used to estimate time of death • Rigor Mortis • Livor Mortis • Algor Mortis • Entomology

9. Time of Death • Rigor Mortis- stiffening of muscles which occurs following death: • Glycogen, normally used to provide energy for contraction muscles, is used up and not reformed • Rigor Mortis normally sets in about 4 hours after death • Exceptions include instant rigor mortis and death from electric shock - both create shorter onset of rigor mortis from time of death • Rigor Mortis generally disappears 24-48 hours after death due to decomposition

10. Rigor Mortis and Time of Death • Manner of Death is suicide. • The shotgun has been removed but his arms are locked in place. • How long has he been dead?

11. Time of Death • Livor Mortis- discoloration of body from settling of red blood cells after blood stops circulating, aka lividity • In light skinned individuals, lividity may be seen within an hour after death • In dark skinned individuals, lividity may not be able to be seen • Substantial blood loss may result in little lividity • Lividity becomes fixed about 12 hours after death, and slowly disappears with decomposition after 36 hours

12. Livor mortis or Lividity • Post-mortem lividity • Shows on the soles of the feet • Manner of Death: Suicide by hanging • Gravity caused red blood cells to accumulate in the feet

13. Time of Death • Algor Mortis- cooling of the body after death, and assumes ambient temperature is lower than body temperature • General rule of thumb- a nearly nude body exposed to 18-20 degrees Celsius loses 1.5 degrees per hour for the first 8 hours

14. History of the Coroner System • Officer of coroner existed in England before the 10th century • Coroner interpreted as “crowner of the king” and assumed a judicial function • Acted as an inquisitional judge responsible for investigating, interviewing and making judgments in the cause of death

15. Coroners in the United States • There is no provision in the US constitution for death investigation • Cities and States often elected coroners to determine cause of death whose backgrounds varied widely • The first Federal Medical Examiner’s Office was in the Armed Forces Institute of Pathology in the 1990s

16. Medical Examiner System • In latter part of 19th century standards were developed for medical examiners • Massachusetts replaced coroners with medical examiners in 1877 • Required medical examiners to be licensed medical practitioners

17. Medical Examiner System • So while there has been a move toward standardization: • Many rural areas are still served by elected coroners • Some states still have both coroners and medical examiners • Therefore confusion still exists

18. Education and Training of Forensic Pathologists • Pathologists first began appearing in mid 19th century • Police and Coroners relied on Pathologists to perform autopsies and determine cause of death • Used microscopes to examine tissues for injury or disease

19. The Study of Pathology • Pathology is derived from: • Pathos- suffering or disease • Logos- word or writing • Study of disease, its causes and its diagnosis

20. Education and Training of Forensic Pathologists • Pathologists later began to manage laboratories where blood and urine were tested • Mid 20th century pathologists were specialized as a field • End of World War II, forensic pathology was recognized by the American Board of Pathologists

21. Training Requirements for a Forensic Pathologist • Bachelor degree or equivalent, 4 years • Medical school, 4 years in length, and graduation from a recognized allopathic (M.D.) or osteopathic (D.O) granting medical school

22. Training Requirements for a Forensic Pathologist • Postgraduate training for 4 additional years: combination of anatomic pathology or anatomic and clinical pathology • One additional year of training at a large coroner’s or medical examiner’s office required: Intern normally receives pay

23. Training Requirements for a Forensic Pathologist • After candidate completes 5 years of postgraduate training, it is necessary to pass a 2-4 day examination 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

24. Training Requirements for a Forensic Pathologist • Many forensic pathologists also specialize in additional areas: • Toxicology • Serology • Tool mark or Impression evidence • Firearms examination • Crime scene analysis • Forensic Anthropology • Forensic Odontology

25. 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

26. 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

27. Reviewing Medical History • To certify cause of death, forensic pathologists must: • Be able to discern injuries from treatment from emergency personnel - needle marks, incised wounds, etc

28. 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

29. 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

30. The Medical Examiner System in Virginia How much does a ME earn per case? If a visit to a CS is required?

31. http://www.vdh.state.va.us/medExam/becomemedicalexaminer.htm • https://www.vdh.virginia.gov/medExam/evms.htm

32. Problems Autopsy Demonstration: www.hbo.com/autopsy/interactive/index.htm • Describe how rigor mortis occurs. • Describe how rigor mortis helps determine time of death. • Describe lividity and how it is used to determine time of death. • A victim dies of a heart attack after being shot in the chest. Describe the cause and manner of death. • Get with a partner and construct a scenario in which the others will determine cause and manner of death and time of death.