Voltaire said ‘To the living we owe respect, but to the dead we owe only the truth.’ This is the definitive task of the medicolegal death investigator and forensic pathologist. The course of the death investigation has multiple phases including:
- scene investigation
- body assessment
- medical records
- and the forensic autopsy
This is finalized in three documents:
- the death certificate
- the investigator’s report
- and the autopsy report
In order to understand the importance of the autopsy report, and how to interpret it, you should understand how all the other factors influence the report and why you cannot rely on the autopsy report alone. ‘Autopsy’ is from the Greek ‘autopsia’, meaning ‘to see with one’s own eyes’. The following discussion will dissect the autopsy report and supporting death investigation in order to allow the professional Legal Investigator to view death and non-death cases ‘with one’s own eyes.’
For simplicity, all references will be to medical examiners and not on the difference between the medical examiner and coroner systems, or a hospital autopsy and forensic autopsy. For our purposes, the focus will be on the forensic autopsy conducted by a board certified forensic pathologist and autopsy technician. In addition, there are exceptions to every protocol, and jurisdictional policies will differ. Two important things to consider are: 1. the medical examiner’s office is an independent, often law enforcement based, agency which is supposed to be neutral as to their findings; they conduct separate investigations; and 2. these investigations are often concurrent and cooperative investigations between the medical examiner’s office and the law enforcement agency.
AN OVERVIEW OF DEATH INVESTIGATION
At all death scenes there are two scenes: location(s) of the incident; and the body itself. If a crime is suspected (and all suspicious death investigations are treated as such) the incident will belong to the investigating law enforcement agency; and the body, together with all items on or about it, will belong to the medical examiner’s office. The agencies will work independently of each other with overlapping goals. The death investigator has certain responsibilities and a duty to pursue those responsibilities. Of course there are legal and cooperative exceptions to these based on the greater good of the needs of all investigating agencies, particularly involving possible homicides. The body is exclusively under the custody and control of the death investigator. Until they arrive on scene no other person can touch, move or remove the body, or those items on or about it. The assessment includes complete photography, documenting wounds and injuries, or lack thereof, rigor and livor mortis, body position and relationship to the scene and condition of the body due to postmortem interval and environment. If the body has been moved, possibly to a remote area, there will be another crime scene at the place the death actually occurred.
Another component of death investigation concerns the confidentiality of medical records [HIPAA – Health Insurance Portability and Accountability Act]. Medical records are a very important component of the investigation and may be referred to in the autopsy report. In addition to medical history, these records may include mental health history, prescription and medication history, family history, and social history. It is important for the medical history to be shared with the forensic pathologist at the time of autopsy or as soon thereafter as possible. What might be seen as a fall and head injury at autopsy may instead be a spontaneous bleed with previous history and consequential falls.
The ‘CSI Effect’ has influenced the perceived value of an autopsy. Autopsies are valuable and are a component of a complete investigation, if one is performed. All violent, suspicious, unnatural and unattended deaths are investigated, which account for a small percentage of reported deaths. A preliminary investigation, statute and protocol will dictate if an autopsy is performed. The authorization of the autopsy depends on the circumstances of the death and the protocol of the medical examiner’s office. The autopsy consists of the gross external examination (detailed examination and documentation of the body), gross internal examination (detailed examination and documentation of the organs and internal body structure), toxicology tests, and microscopic examinations. The external examination is head to toe and includes measurements of all wounds, scars, marks, tattoos, and condition of the body and structure.
The internal examination is what is often thought of when ‘autopsy’ is mentioned. This surgical procedure includes the in situ examination of the organs, removal of them with weights, and complete external/internal examination of the organs. This examination also includes the assessment of bullet trajectory, wound tracts, ligature markings, etc. One area of specific forensic pathologist training is wound (all injuries and trauma) examination. Specimens of each organ are collected for microscopic examination, part of the anatomical and clinical certifications preceding a pathologist’s forensic certification. At the conclusion of the autopsy the functions of the forensic pathologist and death investigator temporarily separate into two different tasks. The death investigator will submit his report, detailing the findings of his scene investigation, evidence review, and medical records review. The forensic pathologist will review the death investigator’s report and case file to finalize his autopsy report and certify the Cause and Manner of Death. This is a very similar role to ours as professional Legal Investigators. We conduct our investigation, complete detailed reports and present our findings and supporting documentation to the attorney. The attorney enjoins our findings into their legal strategy to advocate for our client.
AUTOPSY REPORT FORMAT AND CONTENTS
The autopsy findings will have a Cause of Death, which will include any factors directly contributing to or causing the death (i.e. blunt force trauma or a cardiac event); and Manner of Death, which include Natural, Accident, Suicide, Homicide and Undetermined. The Mechanism of Death, or the instrument or action causing death, is often overlooked. This notation may include stab wounds, gunshot wounds, ligature strangulation, drug overdose, etc. The autopsy may support the pre-autopsy investigation and medical records, or possibly make a determination that seems unrelated to the event. An example of this is a motor vehicle collision caused by the driver having a sudden cardiac event which caused death before the accident. This is a natural death which caused the accident. Often we see deaths caused by blunt force injuries as a result of the accident, which is ruled an ‘Accident’.
The least desirable or used finding, ‘Undetermined’ is used when there has been no definitive finding as to the Manner, and possibly Cause, of death at the conclusion of the complete autopsy protocol and concurrent investigation(s). This is often seen in cases where the preponderance of one Manner does not prevail, but is consistent with or equal to another. One example of this might be a hunting incident where the decedent was alone, had suicidal history and a thorough autopsy and investigation was inconclusive as to the totality of ‘Accident’ versus ‘Suicide’.
Autopsy reports are not casual or interesting reading material. They are very informative when reviewed with all concurrent investigative reports and evidence. All autopsy reports follow a general format as approved by the National Association of Medical Examiners (thename.org). Although they may differ in appearance, the general content format consists of:
- Circumstances of Death
- Identification of the Decedent
- General Description of Clothing and Personal Effects
- Evidence of Medical Intervention
- External Examination
- External Evidence of Injury
- Internal Examination
- Samples Obtained – Evidence, Histology and Toxicology
- and Microscopic Examination
When the autopsy report is reviewed by the lay person their focus is on the first four items, as these are the summary of the remaining medical details of the report. It is important to review the report and all of the information contained therein for the complete picture. It is also important to understand what is in an autopsy report before we can begin to decipher all the latent and patent information it contains.
The above is an excerpt of Dean Beer’s entire article Reviewing and Comprehending Autopsy Reports.
A condensed version of the entire article also appeared in The Legal Investigator, The National Association of Legal Investigator’s official journal. See http://NALIOnline.org for more information about NALI membership.
Dean A. Beers is the owner and Senior Legal Investigator of Forensic Investigators of Colorado, LLC, based in LaPorte, Colorado. He has been a legal investigator since 1987 with extensive experience in skip tracing. He left the private sector from 2005 to 2008 to work as Deputy Coroner / Certified Medicolegal Death Investigator for the Larimer County Medical Examiner’s Office. He returned to the private sector in late 2008 and now focuses primarily on the legal investigations of Personal Injury, Negligence and Death, as well as Criminal Defense. His wife, Karen, handles agency administrative matters and is also an Associate Legal Investigator. Please visit the agency website for detailed information at www.Forensic-Investigators.com.