Forensic Pathology

1. Forensic Pathology “This is the place where death rejoices to teach those who live.”

2. Introduction • A death that is unexpected or is thought to have been caused by injury or trauma is always investigated. • Coroner • Medical Examiner

3. Coroner vs. Medical Examiner • Coroner – a public official, appointed or elected, who makes inquires into deaths and completes death certificates. • Determines cause/manner of death • Decides if foul play • May or may not have medical training

4. Coroner vs. Medical Examiner • Medical Examiner – a physician, evaluates medical history and physical exam of deceased to determine cause and manner of death. • Must receive special training to become a forensic pathologist • Forensic Pathology – unnatural or suspicious disease or injury • In most large US cities, the medical examiner is required to be a forensic pathologist.

5. Forensic Pathologist • Education and Training • Medical school – 4 years • Post – medical training • 3 to 5 year residency in general pathology • Additional year of training • In medical examiners office (forensic pathology) • American Board of Pathology Exam • Training / Knowledge in other areas of Forensics

6. In US 500 Forensic Pathologists • About 25 of the 500 also have LAW DEGREES

7. Deaths Investigated Two Main Categories • 1. Persons who die suddenly when in apparent good health, those who are unexpected to die, or those who are without medical treatment for fatal diseases. • Public Health Threat (bacterial meningitus) • Death in public places (electrocution in public place) • Maternal Death • Death outside of medical facility

8. Deaths Investigated 2. Deaths caused by unnatural causes Examples: • Acts of violence • Drug related • Trauma / Asphyxiation • Weather • Vehicular accident

9. Deaths Investigated • Special Categories: • Under 18 • Death of an individual under legally dependent care. • Death in correctional facility • On aircraft or ship • MURDERS ARE THE SMALLEST NUMBER OF DEATHS INVESTIGATED!

10. Three facets of guilt: • Motive • Means • Opportunity

11. Medical Examiner’s Duties: • Review eyewitness statements • Examine crime scene • Autopsy • Photography • Report • Testimony

12. Duties and Responsibilities • Establish the cause of death • Establish the time of death • Infer the type of weapon used • Determine the manner of death • Identify the deceased • Determine the effects of trauma or pre-existing conditions.

13. Postmortem Lividity(Livor Mortis) • The Settling of blood that causes the skin to change color

14. 30 Minutes: • Changes in skin color first appear on fair-skinned persons

15. 4 to 8 hours: • The blood in capillaries settles PERMANENTLY

16. Between 1 and 8 hours: • (1) Blanching Light-colored marks made by finger pressure

17. (2) • Where a trained investigator will begin..

18. Why livor mortis is important Has the body been moved?

19. Rigor Mortis • The period of time that a body goes through a state of Rigidity • Caused by lactic acid build-up in the body.

20. Rigor Mortis Progression • Shorter muscles – face, fingers, toes

21. Neck

22. Then moves down and out the long muscles of the legs and forearms

23. Legs stiffen last

24. Rigor MortisTime-line • 1-4 hours: Jaw and neck rigid, rest of body limp • Up to 8 hours: everything down to the legs is rigid • For 12 hours: everything remains rigid • 24 hours: Jaw is limp, everything else is rigid • 30-32 hours: everything but the legs are limp • 36 hours: entire body is limp (no rigidity) decomposition has begun

25. Circumstances affecting Rigor Mortis • Starvation

26. Extreme temperatures

27. Physical exertion

28. Effects of fire

29. or water (in the case of drowning)

30. Decomposition • Bacteria: Co2 is produced, abdominal swelling

31. Blood vessels: • discoloration of skin in upper abdomen • marbling effect • Red → darker red → purple → green

32. Putracine – foul- smelling, nauseating odors

33. Algor Mortis • Either Liver temperature (LT) or Rectal Temperature (RT) • Drop of about 2 degrees per hour

34. Factors affecting temperature loss: • Size (mass) of body • Body Temperature at death • Temperature of crime scene

35. The Autopsy Examination “You've got to be the type of person who can emotionally disconnect [from] it. I mean, if you went into a case looking at it as, 'Geez, this is somebody's little girl or somebody's little boy,' you'd never be able to do the case. You can't personalize it in any way... When you walk in, you never forget that this is somebody's loved one. You never forget that, but when you walk in to do the job, you kinda put that information aside. You look at them more as a puzzle, and your job is to sort out this puzzle. I've got to find out what happened. Who, what, why, when, where. I mean, that's what my job is, to sort out and get those answers. And, do it in a respectful way. A lot of people can't do this type of job. A lot of people don't want to do this type of job. There are a lot of jobs I wouldn't want to do either.” Eric Kiesel Atlanta's Fulton County Deputy Chief Medical Examiner

36. HISTORY OF AUTOPSY • EGYPTIONS • 1600 BCE • HIPPOCRATES • – 5TH + 4TH CENTURY BCE

37. AUTOPSIES TO DETERMINE THE CAUSE OF DEATH:

38. The Autopsy Examination • Legality • Permission required – family can request an autopsy be performed (usually free) • Next of kin must sign autopsy permit. • Religious considerations • Mandatory when death is suspicious of foul play or if public health concern (in most states)

39. The Autopsy Examination • Attending Personnel • Diener – autopsy assistant • Prosector - pathologist • Pathologist Assistant • Precautions – protective clothing

40. The Autopsy Examination • The External Exam = done first when body is examined. • Looking for: • Wounds • Contusions (Bruises) • Unusual marks on the body • Overall impression of the body

41. Forensic Autopsy An intensive search for information To locate PHYSICAL EVIDENCE to determine the cause of death

42. The Autopsy Examination • At this point, a general description of the body is made. All identifying features are noted including: • Race • Sex • Hair color and length • Eye color • Approximate age • Any identifying features (scars,tattoos, etc.)

44. The Autopsy Examination • Opening the Body • Y-incision: incision made from left and right shoulders to mid-chest and straight down to pubic region.

45. No bleeding (usually) because there is no blood pressure. • If head is to be opened, an incision is made across the head from one ear to the other. -----------------------------------------

46. The Autopsy Examination • Rib cage is cut at the cartilage that joins the ribs to the breastbone with a scalpel, saw or knife to enter the chest cavity. Soft tissue peeled back to look for abnormalities.

47. Chest plate (ribs and breastbone) are removed and examined. Often fractured during CPR.

48. Skull is cut in front and back for removal.

49. The Autopsy Examination • Removing and Examination of the Organs • Each organ is removed, photographed and weighed. Organs are usually dissected and slides prepared to look for disease or irregularities.

50. THE HEART Checked for TRAUMA