Forensic Pathology

Coroners, the Process of Post Mortems and Scene Protocol

the coroners system established in

1194

the first birth and deaths register was created in

1846

when was the coroners and justice bill introduced and when did it become an act

January 2009

November 12 2009

a coroner is

a specialist judge who investigates and explains certain types of deaths

a coroner investigates a death when

when the death is:

• violent

• cause of death unknown

• death occurs in detention

the UK is divided into … coroner divisions

81

the questions coroners need to ask in in an investigation are …

• who died

• where they died

• when they died

• how they died

an inquest is ..

the public court hearing where the coroner or jury establish answers about the death and conclude what happened

a medical examiner is

the specialist doctors that are contracted to provide independent evaluations into the cause of death

the purposes of the medical examiner system is ..

• safeguarding

• ensuring the appropriate direction of death to coroner

• providing services to the bereaved and raising concerns with doctors

• improving the quality of death certification

• improve the quality of mortality data

the key responsibilities of the pathologist are

• keep up to date with latest methods

• professional standards

• integrity of evidence

• remain impartial

• have an understanding of the criminal justice system

what needs to be done before entering a scene

• cordons

• scene log

• death confirmation by doctor (or other qualified medical personnel)

• risk assessment (that is constantly changing)

who is present at the scene of a suspicious death

• crime scene manager

• crime scene examiner

• scene photographer

• scene pathologist

• senior investigating officer

• press

how do you photograph a body at the crime scene

• use general scene photos

• photograph the body in situ

• close up on details like injuries and piercing

• photos of front and back during recovery

a body bag is used to …

used to lower contamination risks and for health and safety

to bag the head you must …

• use a bag not too small

• secure the bag

• don’t let any tape touch the skin or clothes of the deceased

to bag the hands you must …

• secure but not too tightly

• don’t let tape touch skin or clothes

to bag the hands and feet you must …

• secure but not too tight

• don’t let tape touch the skin or clothes

when can you run into issues at a scene

• water -- can cause hazards

• tight spaces make it difficult to move, photograph and remove the body

• when the deceased is in an awkward position due to rigor mortis

what is 1:1 tape lifting

• surface taping on the exposed surfaces of the body and clothing

• each piece is catalogued

• taping can be mapped out

• time consuming

zonal taping is

• used in large area

• areas such as left sleeve at the front etc

when can you proceed with tape lifting

• when the body has been undisturbed

• when the body has been left in situ

• when there’s no contamination concerns

how is a body transported from crime scene to mortuary

• body bag sealed, photographed and recovered

• contracted undertaker attends to transport body

• body usually followed by police

who is involved in a forensic post mortem

• forensic pathologist

• anatomical pathology tech (ATP)

• crime scene manager

• photographer

• wet CSI

• dry CSI

what is a pathologists role in a post mortem

• collect samples

• guides photographer and request specific photos

what is the anatomical pathology techs role in a post mortem

• assists pathologist with technical aspects

• hands equipment to the pathologist

• assist with preparation of body and weighing of the organs

• sews and reconstructs the body

what is an exhibits officers role in a post mortem

• responsible for cataloguing exhibits

• ensures exhibits stored correctly

• ensures exhibits are logged

what is a crime scene manager role in the post mortem

• briefs pathologist on the background of the case

• creates the forensic strategy

• provides crime scene photos

• discusses what samples are required from the post mortem

what is the dirty CSI

• provides appropriate items for samples being recovered

• passes items into the bag held by the clean CSI so external packaging is not contaminated

what is a clean CSI

• scribe for the pathologist

• records exhibit list

• writes all evidence bags for pathologist to sign

• prevents contamination

what is looked for in a post mortem

• evidence of injuries

• wounds present

• recovery of foreign bodies

• consider diseases

• histology samples taken

• samples taken for DNA and toxicology

when does a postmortem take place

after death (hence the post)

what are the different methods for taking body temperature

• fall of temperature approximately 1 degree per hour

• 37 degree - rectal temperature + 3 hours

what is the nonogram method

• requires measurement of deep rectal temperature

• need to assume time at death was 37.4 degrees

what is an autopsy

a complete evaluation of an individual deaths and circumstances surrounding the death

what does the examination in an autopsy include

• complete evaluation of medical history

• collection on and documentation of trace evidence on and around the body

what are the two types of autopsy

• clinical/academic/hospital autopsy

• medico-legal or forensic autopsy

what is a clinical autopsy

• requires permission from next of kin

• diagnosis, extent of lesions, academic interest, teaching and research

• effect of drug therapies on course of disease

where does the legal authority lie for forensic autopsy

coroner or procurator fiscal

medical examiner

magistrate

what are the further subdivisions of a forensic autopsy

• non criminal deaths

• suspicious or criminal death

what is a non-criminal death

• accidents

• suicide

• natural causes

• industrial

what is a criminal or suspicious death

• murder

• manslaughter

• infanticide

who conducts an autopsy

pathologist who has experience and training in forensic pathology

what is the pathology delivery board

• oversees the provision of forensic pathology services in england and wales

• recognises the pathologist with sufficient experience and training

• applications reviewed and then if successful they are entered into the home office register

what is the objective to a forensic autopsy

1. what happened - circumstances

2. who - the identity of the deceased

3. when - the time of death

4. where - the location/place of death

5. why - the cause of death

6. how - manner of death

what are other potential objectives to a forensic autopsy

• obtain samples for analysis

• retain relevant organs and tissues for evidence

• written report of the findings

• offer an expert interpretation

• restore body to best possible conditions before it is released to the relatives

what does a pathologist do at the scene of death (if they are asked)

• visit the scene of death before the body is removed

• always have the appropriate equipment ready

• accept instructions of police officers in relation to approach of body

• not leave any objects or debris of own

• observe great deal but do very little

what is the process for scene of death examination

they look at:

• position of body in relation to nearby objects

• draw a sketch, photograph, record the death scene

• warmth and coolness of the hands and face is assessed by touch

• environmental temperature taken

who provides authorisation and consent for post mortems

• coroner

• relatives not consulted for consent

• permission for retention of material usually covered

how can a body be identified

• identified by a relative

• medical records

how can a mutilated body be identified

through personal items such as clothing, jewellery and relative documents

what precautions must be taken for a post mortem

infective corpses pose great risk to pathologists and mortuary staff

what diseases can a body carry

• HIV

• hepatitis

• TB

• Anthrax

• Plauge

what are the two parts of physical examination

external examination and internal examination

what is an external examination

it consists of inspecting the physical outer layer of the body for signs of fould play that would result in injury or death

what is an internal examination

consists of inspecting internal organs of body for evidence of trauma or other indications of the cause of death

what does external examination do

• detailed head to toe examination

  Helps to draw inferences around:

• nature of weapon

• direction of attack

• other vital aspects

what can an external examination show

• population affinity and gender

• age assessment

• body measurement

how can external examination show post mortem signs

the degree of rigor mortis, hypostasis, any post mortem decomposition

what are the eyes examined for

• petechial haemorrhage

• false eye

• lens opacity

what is the mouth examined for

• foreign body

• drugs

• damaged teeth

• injured gums

• dried powder (recent intake of poison)

• bleeding

• bitten tounge

how is evidence of injury documented

• described systematically - anatomical location

• type of injury

• injuries described

• for burns - the rule of nines

what are the incisions for an internal examination

• Standard Midline

• Y-shape incision

• T- shape incision

what is a standard midline incision

• laryngeal prominence to the pubis

• most commonly used

what is a Y shaped incision

preferred in the cases of strangulation and hanging

what is a T-shaped incision

subclavicular incision

what is the process for internal examination

• inspection of the body cavity

• organs are removed en bloc by a modified rokitanksy procedure or divided into four groups and removed by method of Ghon

• all organs removed and are weighed and examined for unusual markings or signs

what is an autopsy report

• integral part of the procedure

• permanent record of the findings so vital for medico-legal purposes

what are the two forms of an autopsy report?

• essay style (criminal deaths)

• printed performa

what is a virtopsy

• non-invasive procedure

• reconstruction of injuries

• also possible in living patients

• bite marks and other injuries

• 3D documentation and comparison of injury causing instruments

what are the essentials of virtopsy

• multi-sliced computed tomography

• MRI and MRS

• CT Scanning

• Optical 3-D surface scanning and 3-D photogrammetry

what are the pros of virtopsy

• reproducible

• non-invasive

• illustrative visualisation

• digital data stored for a second opinion

what are the cons of virtopsy

• interpretive problems in the advanced decomposition

• considerably high costs

• time consuming