Antonin Scalia, United States Supreme Court Justice, passed away early February at a resort in Texas. His death was, based on all credible accounts, from natural causes — specifically myocardial infarction, a heart attack. That said, countless pundits, mostly not credible, have asked questions and raised conspiracy theories.
Dean and Karen Beers, two of our regular contributors and authors of our course, “Medico-legal Death Investigations,” approached us with an analysis of Justice Scalia’s death. We think it’s appropriate and timely and are thrilled to provide you with this brief look into a typical death investigation.
Death investigations are not limited to suspected homicides, and are best conducted by trained medico-legal death investigators and overseen by a forensic pathologist.
In the following analysis, please keep in mind that information is based solely on available media reports. At this time there are no official reports, only reported statements.
Death Investigation in America
Let’s start with an overview of death investigations in the U.S., and more specifically, in Texas.
When someone dies suddenly or of unknown causes, it’s the job of a coroner or medical examiner to investigate the death. Some municipalities use a coroner system; others use a medical examiner system or a hybrid of both. And there’s a big difference between coroners and medical examiners: Coroners are politicians; medical examiners are doctors. Either may be elected or appointed, and some coroners may even have medical training. But medical examiners are usually MDs, although they may or may not be trained forensic pathologists. Hybrid systems generally have an elected coroner but are supported by a forensic pathologist.
See this explanation of how death investigation works in America, reported by NPR, PBS, and ProPublica.
The Texas System
In Texas, a justice of the peace (JP) makes the decision to order an autopsy, if necessary, and also certifies death. The JP is not required to have any training or experience in law, medicine or death investigations. Autopsies are contracted to forensic pathology groups. In Presidio County, Texas, where Justice Scalia died, there are two JPs. At the time of the Justice Scalia’s death, they were both absent, and their duties were left to the county judge, an elected official with no medical training.
Justice Scalia’s Death
Justice Antonin Scalia was 79 years old and overweight. It is the rare 79-year-old who is in perfect health. Heart disease is common in this demographic, including atherosclerotic cardiovascular disease (ASCVD).
According to news reports, the certifying county judge appropriately consulted with Rear Admiral Brian P. Monahan, MD, the attending physician for members of Congress and the U.S. Supreme Court. Justice Scalia received an examination just before his trip to Texas. Justice Scalia also had a history of heart trouble and high blood pressure; he was considered “too weak to undergo surgery for a recent left shoulder injury,” said one AP report. This injury is unspecified; however, it should be noted that left shoulder pain is often associated with heart disease.
Anyone with this history would not be considered in perfect health. They may be physically strong and mentally alert, but the onset of heart disease would not be unexpected.
Media reports are the only source information available at this time. By report, Scalia was found alone in his bedroom, door closed, lying peacefully and undisturbed. There is no mention of his body position – prone, supine, left or right side, etc. A later report quoted the ranch owner who discovered Justice Scalia:
“We discovered the judge in bed,” the ranch owner said, “a pillow over his head. His bedclothes were unwrinkled. It looked like he had not quite awakened from a nap,” and “His hands were sort of almost folded on top of the sheets. The sheets weren’t rumpled up at all.”
- Lying peacefully and undisturbed — this is important; it describes that the witness saw, nothing to cause him alarm.
- Bedclothes were unwrinkled — at first this seems like a red flag. However, more disturbing would be a report of torn clothes, or unusually wrinkled.
Specifically, the ranch owner who found Scalia reported that the Justice was “peaceful and undisturbed.” He did not use words like, “clenched fists” or “scratches on his face” or “torn or bunched pajamas;” nor did he use any other words of alarm such as, “something didn’t look right.”
As professional investigators, we know there are nuances to what a person sees, how they describe it, and how it is later translated by others. Specifically, the ranch owner that found Scalia described “a pillow over his head” — “over” and “head” being the two key words. He did not say, “on his face,” “over his face,” or “covering his face.” Nor did he say, “it looked like he was suffocated.”
Our first impression was exactly as described: Perhaps the pillow really was “over his head” and possibly against the headboard or wall. This position is not at all unusual. Furthermore, the ranch owner said in an interview on February 17, 2016, “[Justice Scalia] had a pillow over his head, not over his face as some have been saying. The pillow was against the headboard.”
As medico-legal death investigators, we look for signs of injury or foul play. When we take an initial phone call notifying us of a death, the routine questions are: Any falls, injuries, altercations, unusual behavior, alcohol or other drug use, stab wounds, bullet holes, weapons or other unusual circumstances? We hope for an informed and honest answer. We usually get one, but not always.
It is simply false to say that no investigation was conducted into the death of Justice Scalia.
It is simply false to say that no investigation was conducted into the death of Justice Scalia. An investigation is “the action of investigating something or someone; formal or systematic examination or research” and “a formal inquiry or systematic study.” Like all investigations, death investigations have protocols, as well as statutes, and they differ state by state. There are common minimal protocols. These minimum protocols do not include any requirement of a scene response or autopsy.
Based on news reports, there was a law enforcement response. Also, U.S. Supreme Court Justices have their own security, typically U.S. Supreme Court Police or another federal agency. As this private ranch, situated on 30,000 acres, was rural, one would not expect a full protective detail. Finally, all of the people at the ranch at the time of Justice Scalia’s death were accounted for, and can be contacted, at any time.
Death Investigations: Perception and Reality
The “CSI Effect” has influenced the perceived value of an autopsy. Autopsies are valuable and may be a component of a death investigation. All violent, suspicious, unnatural and unattended deaths should be investigated. But these account for a small percentage of reported deaths. A preliminary investigation, statute, and protocol will dictate whether an autopsy should be performed. The authorization of the autopsy depends on the circumstances of the death and the protocol of the medical examiner’s office.
In Texas, an autopsy is not required by statute. In most states, the role or stature of a person does not dictate whether an autopsy is required. In North Carolina, the guidelines include, “Should there be reported to you as a medical examiner the death of any person likely to generate widespread public interest or arousal, please inform the OCME promptly by telephone” and “deaths of travelers, vacationers, convention attendees, workers, students, and other strangers from afar should be carefully evaluated before a decision NOT to autopsy is made.” This does not recommend or require an in-person investigation at the scene or an autopsy, only that the ME office be notified by phone.
Toxicology, absent autopsy, can be collected and retained for extended periods. In the case of diseases afflicting elderly people, indications and confirmations of diabetes, heart disease, hypertension, high cholesterol and other diseases would be documented. In the case of an acute cardiac event, such as a myocardial infarction, specific toxicology tests may confirm the event. (It should be noted, however, that the absence of markers in the toxicology is not an indication of no cardiac event).
In most jurisdictions, the legal pronouncement of death must be by a medical doctor (MD) or Doctor of Osteopathy (DO), or by an appointed deputy coroner/medical examiner. In Texas, using a JP, it is permitted to pronounce death by phone.
The only thing that prevents an autopsy from being performed is cremation; however, Scalia was not immediately cremated. He was embalmed and then transported by private plane from Texas to Virginia, where he lay in repose until cremation or burial. According to news reports, Justice Scalia specified in his will that he wanted to be cremated. Were an autopsy requested, there was ample time to conduct it.
The fact that the judge changed the cause of death has caused quite a stir, and it perplexed many in the death investigations profession. Deaths are certified as to cause and manner: “natural” is a manner, and “natural causes” alone is insufficient for a cause. We generally dismiss this as either a misquote or the judge not having the proper medico-legal death investigative training.
In the end, Justice Scalia passed away in his sleep. Based on news reports, there were no signs of foul play and no indications that anything was amiss in any way. Anytime a high-profile person dies unexpectedly, there will be conspiracy theories and ill-informed questions. Justice Scalia’s death is no exception.
About the Authors:
Dean and Karen Beers of Associates in Forensic Investigations have over 30 years of combined legal investigative experience and over nine years of death investigation experience at a coroner/medical examiner’s office. Dean is one of less than 80 Certified Legal Investigators (CLI) internationally and the only in northern Colorado. With his wife, Karen, he is also a Certified Criminal Defense Investigator (CCDI); they are one of three husband & wife CCDIs and were among the first to be licensed private investigators in Colorado. Dean and Karen are also certified Medico-legal Death Investigators and have authored numerous books and articles on death and legal investigations.