Autopsy: medicolegal

1. violent (suicides, homicides, accidents)

2. suspicious

3. unattended

4. death in custody

5. sudden and unexpected deaths (usually natural)

6. deaths associated with public health risk

7. physician unable to sign death certificate

8. other

what are the broad categories of reportable deaths (8)

1. homicide

2. suicide

3. accident/injury

type of violent reportable deaths (3)

1. poisoning

2. occupational disease

3. contagious disease constituting a public health hazard

examples of reportable deaths associated with possible public health risks (3)

1. no physician in attendance

2. not under physician’s care for previous 20 days

3. physician in attendance for less than 24 hours

4. physician unable to state COD

what are examples of reportable deaths when physicians would be unable to sign the death certificates (4)?

1. suspicious for criminal activity

2. OR deaths (even if expected)

3. postanesthesia death where patient does not fully recover from anesthesia

4. solitary deaths

5. patient comatose for entire period of medical evaluation

6. death of an unidentified person 

7. sudden death of an infant

8. death of prisoners

9. death of patients in hospitals for mentally or developmentally disabled

10. deaths where questions of civil liability exists

examples of “other” reportable deaths (10)

cause

injury or disease that produces a physiological derangement in the body that results in death (e.g. gunshot wound, ruptured aorta)

mechanism

physiological derangement produced the results in death (e.g. exsanguination, intracerebral hemorrhage)

manner

how the death came about (accident/natural/homicide/suicide/undetermined)

1. ME (pathologist) owns and operates independent lab, and sends fluids or tissues from autopsies to be tested at his own facility = financial

2. coroner/mortician facilitates using his mortuary services to grieving families = financial

3. coroner/mortician facilitates a death an accident versus a suicide so the family of the deceased receives insurance benefits

   1. family is grateful and in return pays for a more expensive funeral package and coroner makes a bigger profit = financial

4. Sheriff/ERnurse/midwife/paramedic/surgeon acting as a coroner

   1. Potential to cover up cases of malpractice

identify 2 examples of a conflict of interest that may exist in a medicolegal investigative system

1. deceased prior to death

2. attorney-in-fact (POA)

3. spouse (not legally separated; unless custody of all minor children)

4. adult child age 18+

5. adult grandchild

6. parent

7. adult sibling

8. grandparents

9. adult uncles and aunts

10. other adult relative

11. friend accepting responsibility

12. public official

rank those people who are able to give autopsy consent from those having the most authority to those having the least authority (12)

1. in-depth investigation of the scene, environment, terminal circumstances, social/medical history

2. careful exclusion of criminal act suspicion

3. external exam

4. radiographs/imaging studies

5. toxicology on blood, urine, gastric samples, or CSF

6. endoscopic examination

7. in situ or minimal procedure exams

suggest procedures that may be used to alleviate the need to perform a complete autopsy in the presence of religious objections (7)

medical

medical vs. forensic autopsy: permission of next of kin is required and they can restrict the limits

medical

medical vs. forensic autopsy: purpose is to confirm suspected COD, as a teaching tool or assess effectiveness of treatment

medical

medical vs. forensic autopsy: ID of body known

medical

medical vs. forensic autopsy: circumstances/time of death is known

medical

medical vs. forensic autopsy: background info/medical history of deceased is known

medical

medical vs. forensic autopsy: evidence usually not collected

medical

medical vs. forensic autopsy: external exam is less critical than internal

medical

medical vs. forensic autopsy: photos optional

medical

medical vs. forensic autopsy: toxicology usually not taken

medical

medical vs. forensic autopsy: body may be embalmed

medical

medical vs. forensic autopsy: typically performed in hospital

medical

medical vs. forensic autopsy: more focus on microscopic sections

forensic

medical vs. forensic autopsy: permission of next of kin NOT required and they cannot restrict the limits

forensic

medical vs. forensic autopsy: purpose is to determine or document COD or rule out unsuspected COD in criminal case

forensic

medical vs. forensic autopsy: ID of body unknown

forensic

medical vs. forensic autopsy: circumstances of death unknown

forensic

medical vs. forensic autopsy: background info/medical history of deceased unknown

forensic

medical vs. forensic autopsy: evidence usually collected

forensic

medical vs. forensic autopsy: external exam is more important than internal

forensic

medical vs. forensic autopsy: photos required

forensic

medical vs. forensic autopsy: toxicology routinely collected

forensic

medical vs. forensic autopsy: body NEVER embalmed

forensic

medical vs. forensic autopsy: usually performed in ME/coroner’s office