2. Death Investigation

2. Death Investigation *TRIGGER WARNING* Death Investigation TV Myths • Quickly tell time of death • Recreate the “death scene” in their heads • Determine hand dominance • All suicides leave a note • A Medical Examiner can always determine the cause of death Coroner System • Quasi Judicial function • Determined cause of death • No particular education or training • Massachusetts: 1877 Legislated Medical Examiner (licensed to practice medicine) Medical Examiner (ME) • Replaces Coroner as legal and medical authority • Licensed to practice medicine (M.D.) • Training: • 4 years in medical school • 1 year internship • 4 years residency in anatomic/clinical pathology • 1 year in large ME office (fellowship) • 2 to 3 day examination for Board Certification (Some go on to JD (law) degree) Medicolegal Investigator (MLI) Minimum Qualifications • Degree in Criminal Justice or Biological Sciences (preferred - includes anatomy or physiology) • 3 years of full time experience as medical investigator, deputy coroner, law enforcement officer, mortician, energy medical technician, or related field • Paramedic or physician assistant • Pass a background investigation (includes prior driving, work, and criminal history) MLI Knowledge, Skills, Abilities, Competencies • Medical investigative practices and techniques • Proper handling and processing of evidentiary material • Proper grammar and spelling • Office policies and procedures • Medical terminology, anatomy, and physiology • State and local laws regarding deaths and human remains • Still working with human remains • Digital photography • Dealing with distraught, upset, and violent family members • Preparing accurate, complete, and concise reports (including type written narrative section & diagrams) • Exercise mature judgement, react effectively in emergency/stressful situations, exercise persuasive and tactful authority • Assist with autopsies • Establish and maintain an effective working relationship with other agencies and the public Cause & Manner of Death • Cause of Death: A medical determination or finding based on evidence and opinion. • Manner of Death: A legal determination; circumstances by which cause of death came to be. • Natural, Accidental, Homicide, Suicide, Undetermined Time of Death (TOD) • Establish a Postmortem Interval (PMI) (window of death) • Sometime between the last time __ was seen alive and the time __ was found dead Establishing Time of Death Two Methods/Strategies • Rate: Measures changes in the body by process which take place at known rates. • Rigor, Algor, and Livor Mortis • Concurrence: Compares the sequence of events that took place at known times with the time of occurrence of the event under investigation. • A wrist watch stopped by a blow during an assault. • The extent of digestion of the last known meal. Rigor Mortis: Stiffness of Death • Classic marker of death • Rigidity of the body • Produced by metabolic (chemical) changes • More rapid in small muscles • Heat accelerates - Cold decelerates • Full Rigor: 6-24 hours, 12 average • Very subjective (depends on experience) • Scientifically Unreliable Algor Mortis: Temperature of Death • Body temperature is a narrow range (not fixed). • Illness, decomposition, infection, and absorption of heat can raise body temperature. • Many formulas to determine TOD. • Clothing, bodies of water, fatness, ventilation, age, weather conditions. • Rectal or liver temperature needed. Livor Mortis: Color of Death • Setting of blood to dependent parts of the body. • Cardiac activity stops, hydrostatic pressure of the blood no longer keeps the blood vessels open. • Hydrostatic Pressure: The pressure exerted by blood on walls of blood vessels, keeping them open. • Color depends on skin pigment and additional compounds in the blood (e.g. carbon monoxide). • Generally dark blue/purple. • Body areas touching the ground will be blanched (white). • Usually reaches maximum appearance 8-12 hours. Dependent vs Fixed Lividity • Dependent: Just after death, blood flows to the dependent parts of the body and settles. • Lowest parts of the body due to gravity. • Fixed: After a period of time, blood becomes fixed in its location and will not move (even if the body is moved). Patterned Livor Mortis • Can give class evidence where the person died and was laying. Documentation • The lividity is consistent with the position of the body. Stages of Human Decomposition 4 Stages • Fresh: Initial Decay (Autolysis) • Bloated: Putrefaction • Decay: Black Putrefaction • Post Decay: Butyric Fermentation Stages & Times of Decomposition • 12-36 hrs: Blue green discoloration of skin. Right & left lower quadrant & abdomen. • Marbling: Green black discoloration in blood vesicle distribution • Hemolyzed blood reacts with hydrogen sulfide • 36-48 hrs: Bloating (most marked in areas of loose skin - scrotum, penis, eyelids) • 60-72 hrs: Entire body decomposition • 4 to 7 days: Skin Slippage (glove formation on hands/feet) • Several Months: Saponification/Adipocere (prolonged exposure to moisture. White slippery appearance. From subcutaneous fat) • Mummification: Drying interrupts decomposition. Bacterial growth interrupted if moisture content <50% • Weeks/Years: Skeletonization Decomposition Length • Y = 1285/X • Y = Number of days it takes to become skeletonize or mummified • X = Average temperature (Centigrade/Celsius) during decomposition Bacteria • Break down organs (melt them). • Gas bubbles form. • Liquified organs come through the esophagus and mouth. Autopsy - To See For Oneself Purpose • Provide critical information in determination of the true cause and manner of death When is an Autopsy Performed? • Sudden natural and/or violent death • Cause, manner, and TOD may be unexplained at the time How an Autopsy is Performed (The Basics) 1. Take notes (or get a voice recorder and dictate notes aloud) 2. Document height, weight, age, gender, distinguishing characteristics (birthmarks, scars, tattoos) 3. Take fingerprints (may be needed in police investigation) 4. Examine body very closely, meticulously, under magnification • Check clothing and skin for any marks that look out of the ordinary (fibers, blood droplets, organic materials, residues found on clothing, bruises, wounds, marks on skin - trace evidence) • If foul-play is suspected, carefully check under the victim’s fingernails (often find blood/skin from attacker) 5. Check for any dental work (dental records are often used to identify bodies) • Perform x-ray to find any broken/fractured bones or medical devices (e.g. pacemaker) (records can identify subject) 6. Check the genital area for any signs of rape (bruising & tearing common in such cases) 5. Take photographic record of the body, clothed & nude • Take special care when removing clothing (may be needed for police investigation) • Take close-up shots of the marks, bruises, blood patches 8. Take blood sample (used for DNA and toxicology) 6. Open body cavity with thoracoabdominal incision (Y-incision from each shoulder, across the chest, to the diploid process, down to belly button) 7. Split the ribcage, open it up, examine heart and lungs (note abnormalities & take blood sample directly from heart) 8. Examine, weigh, record anything notable, and take tissue sample from each organ in the chest cavity individually 9. Repeat step 11 for all organs in lower body (partially digested food can be used to determine TOD) 10. Take urine sample from bladder with syringe (toxicology) 11. Carefully examine the eyes/petechial hemorrhages (tiny broken blood vessels in eyes, sign of choking/strangulation) 12. Examine the head. Check for any trauma to the skull (e.g. fractures or bruises) 13. Remove the top of the skull, then the brain. Examine, weigh, and take a sample 14. After the autopsy is completed, finish notes. State the cause of death and reasoning. Mention every detail 15. Based on findings (licensed coroner), The Chief Medical Examiner will issue a Death Certificate 16. The body will be returned to surviving family members for funeral Thoracoabdominal Incision arrangement What do MEs Look For • Abrasion and contusions, defensive wounds • Fingernail marks: Crescentic abrasions (vertical & horizontal) • Fingertip bruises • Trauma to the neck (usually bony structures - hyoid) • Blood at fracture site indicated pre-mortem injury • Petechial hemorrhages • Internal examination of all organs • Evidence of sexual assault human- Amount of Pressure to Cause Asphyxiation • Jugular Veins: 4-5 lbs • Carotid Arteries: 11 lbs • Trachea: 33 lbs • Vertebral Arteries: 66 lbs Performing a Forensic Autopsy 1. A complete history of the circumstances surrounding the death (obtained prior to autopsy). 2. The ID of the decedent should be documented. 3. The complete, detailed external exam of the body and clothing (save all clothing). 4. A complete autopsy should be performed and injuries should be documented with diagrams, photos, and x-rays. 5. Pertinent negatives included in report. 6. Toxicologic studies performed when indicated. Internal Exam Mechanical Asphyxia (e.g. Strangulation) • Can be marked by the appearance of petechial hemorrhages on the conjunctiva. • Signs of Strangulation: Bruises, marks on neck, bleeding in throat, fracture of hyoid bone (Ushaped bone at the base of the tongue). Drugs • Sometimes, people will swallow drugs in containers (e.g. condoms) to transport them. • These containers may rupture or leak, inducing a drug overdose. Last Meal • Stomach starts to empty in about 10 minutes • Light Meal: 1.5 - 2 hours in stomach • Medium Meal: 3 - 4 hours in stomach • Heavy Meal: 4 - 6 hours in stomach • Variations: Stomach Issues • Emotional State • Digestion Rate: Liquids < Semi-Solids < Solids Medical Terminology Anatomy • Anterior: Toward the front • Aorta: The large artery connected to the heart which distributed blood to the other arteries • Artery: Thicker walled blood vessels, under pressure, which carry blood from the heart to the body • Cardiac: Relating to the heart • Cerebral: Relating to the brain • Cerebrospinal Fluid (CSF): The fluid around the brain and spinal cord • Coronary Arteries: The blood vessels supplying the heart • Dorsal: Towards the back (of body, hand, foot, etc) • Gastric: Relating to the stomach • Lateral: Toward the side • Medial: Toward the middle • Midline: The center of the head, chest, and abdomen • Peritoneum: The abdominal cavity • Pleural: The chest cavity about the lungs • Posterior: Toward the back • Pulmonary: Relating to the lungs • Vein: Thin walled blood vessels which return blood to the heart Disease • Aneurysm: A weakening of the wall of a blood vessel with dilation of the vessel and often rupture of the vessel causing severe bleeding • Arteriosclerosis: “Hardening of the arteries” - An aging process marked by narrowing of food vessels by build-up of cholesterol and scar tissue • Cerebra-Vascular Attack (CVA): A stroke, severe injury to the brain resulting from spontaneous hemorrhage or thrombosis (blood clot within blood vessel) • Embolus: A thrombus (clot) which breaks away from where it formed and travels to another area of the body • Hemorrhage: Bleeding either outside the body or into one of the body cavities • Infarction: Dead tissue in an organ due to insufficient circulation of blood • Myocardial Infarction: “Heart Attack” - Death of an area of heart muscle Injury • Bruise/Contusion: The bluish swelling of blood beneath the skin • Comminuted Fracture: A break of a bone with separation of the broken ends • Laceration: A tearing of the skin • Incision: Cutting of the skin due to a blade • Subarachnoid Hemorrhage: Bleeding, often spontaneous, sometimes from an injury, between the brain and the arachnoid • Subdural Hemorrhage: Bleeding, almost always from an in jury, between the inside of the skull and the dura. This accumulation of blood produces pressure on the brain Layers of the Head Other • Asphyxia: A condition of severely deficient supply of oxygen to the body that arises from abnormal breathing (e.g. choking) • Inability of an individual to acquire sufficient oxygen through breathing for an extended period of time • Can cause generalized hypoxia, coma or death • Hypoxia: A condition in which the body/region of the body is deprived of adequate oxygen supply • Deficiency in the amount of oxygen reaching the tissues and cells