The Medical Examiner Forensic Pathologist

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					The Medical Examiner/
Forensic Pathologist

                Forensic Biology
                   Mrs. Howard
Medical Examiners
   A doctor who performs
    an autopsy when
    someone dies an
    accidental or violent
   A medical examiner
    can be a coroner,
    however not all
    coroners are medical
   Investigate how, when,
    and where someone
Schooling/Credentials to Become a
Medical Examiner

     Four years of medical school,
     A five year residency in anatomic and clinical
     A one year fellowship in forensic pathology.
     Pass a Medical Boards in Anatomic Pathology
         following the fellowship you need to pass
          Boards in Forensic Pathology
     A medical doctor is also required to take a
      minimum of 20 hours of approved medical
      education every year to maintain their medical
Medical Examiner vs. Coroner
   A medical examiner is always a medical
    doctor whereas it is not necessary for a
    coroner to be a medical doctor.
   A medical examiner is appointed while a
    coroner is usually elected.
   A medical examiner gives objective
    opinions on the circumstances of a
    victim’s death. A coroner must give
    subjective opinions based on evidence
    found surrounding a victim and their
    death. Coroners usually have legal
    powers such as subpoena powers.
Forensic Pathology
   Forensic pathology
    is a subgroup
    under pathology
    which focuses on
    the medical and
    legal investigation
    of sudden or
    unexpected death.
Forensic Pathologists
   A forensic pathologist is a physician who
    has received special training in pathology
    and forensic pathology. Their training
    takes approximately six years after
    graduating from medical school.
   Physicians can take the examinations
    offered by the American Board of
    Pathology. If they pass this examination,
    the pathologist is considered Board
Forensic Pathologist vs. General

   Forensic Pathologist
       A medical doctor who has completed training
        in anatomical pathology and who has then sub-
        specialized in forensic pathology.
       Performs autopsies/post mortem examinations
        to determine the cause of death
   General Pathologist
       Analyzes blood, fluid, and tissue samples
       Looks at tumors and other abnormal growths
        removed from the human body
Determining Cause of Death
   Using the external and
    internal examinations,
    a medical examiner
    can determine the
    cause of death of a
    victim. Usual causes
    of death are
    bleeding, etc.
Determining Location of Death
                    Many factors used to
                     determine location of
                     death. Some examples
                        Fluid in lungs show
                         death by drowning
                         Testing the fluid can
                         lead to a definite
                         conclusion as to where
                         the body had drowned.
                        Insects that are
                         indigenous to an area
                         can show location of
                         death. However, bodies
                         found with insects are
                         usually sent to a
                         forensic entomologist.
Determining Time of Death
   Examining the
    contents in the
    stomach of the victim
    and the amount of
    food digested.
   Examining the amount
    of vitreous humor
    fluid in the eyes.
   Determining the
    stages of death:
       Algor mortis
       Rigor mortis
       Livor mortis
Determining Natural/Unnatural Deaths
   Natural Death- According to pathologists, "A natural death is
    a death that results from a natural disease process, distinct
    from a death that results from accident or violence."
   Unnatural Death- According to pathologists an unnatural
    death is constituted by any of the following events:
        Accident
        Execution
        Homicide
        Misadventure
        Being attacked by insects, reptiles, fishes, lions, tigers, bears,
         stingrays, or other wild animals
        Adverse outcome of surgery
        Suicide
        Terrorism
        War
Work Besides Performing Autopsies
   Review medical records and investigator reports.
   Examine glass slides of tissue samples under a
    microscope to identify diseases.
   Review toxicology reports for evidence of
    chemical abnormalities or drug use or abuse.
   Report findings as to the cause and manner of
   Meet with law enforcement officers, attorneys and
    family members to explain their findings.
   Appear in court to testify as an expert witness.
Objections to Performing Autopsies
   From the moment a death is reported, the
    coroner/medical examiner is in charge of the body
    until it is released for the funeral. The coroner is
    responsible for finding the specific cause of death.
   They decide whether an autopsy is needed. The
    relative’s of the deceased can make a formal
    objection to an autopsy.
   The state coroner will seriously consider any
    objections. Objections can be made on religious,
    cultural, or personal grounds.
Testifying in Court
   A Medical Examiner cannot leave
    doubt in the minds of the jury
    with either their methodology or
   When testifying in court, the
    State Medical Examiner must be
    able to explain scientific and
    medical findings in clear precise
    language understandable to a
   The testimony of the State
    Medical Examiner is crucial in
    establishing the cause and
    manner of death.
        This is most important in
         cases of fatal child abuse,
         where the defense will
         almost always claim that the
         injuries occurred
   The findings and testimony of the
    State Medical Examiner can lead
    to the acquittal of an innocent
What is an Autopsy?

   A surgical procedure after death which
    involves the examination of body tissues,
    often to determine cause of death.
Medical Examiner Autopsy vs. Hospital

   Hospital Autopsy
       Hospital autopsies are different from
        coronial autopsies. Permission is
        needed from the family of the deceased
        prior to performing a hospital autopsy.
        Families have the right to say no and
        hospital staff will always have to
        respect the families wishes. A family
        may request a doctor to arrange for a
        hospital autopsy to help determine why
        the person died.
   After the Medical Examiner is notified of a death, in
    order to conduct an investigation, they are in charge of
    what happens to the body of the deceased.
   The Medical Examiner Investigator determines whether
    to release the body from the crime scene to the
    morgue or whether they will go to the crime scene.
   The investigation to determine cause of death may
    include interviewing witnesses, friends, relatives, and
    health care providers.
       An examination of the crime scene and the surroundings
        may also be included in the investigation to collect and
        preserve evidence. The investigation may also require a
        physical examination of the body or autopsy, and may
        require laboratory tests of tissue or bodily fluids.
Circumstances for an Autopsy
   determine the cause of
    other benefits
       Families
            Reduce the family’s
             fears/concerns about
             what they could have
             done to prevent the
            providing family
             members information
             about potential
             genetic diseases that
             may be problems for
             them in the future
Circumstances for an Autopsy (cont.)
                         Practice of medicine
                              Assist medical
                               education, training,
                               and research leading
                               to improved health
                         Community at large
                              Provides information
                               about preventable
                               diseases and health
                               hazards that can
                               increase the
                               awareness of the
Steps Taken in an Autopsy
   The pathologist records the results of the external
    examination and lists all physical characteristics.
   First cut- 'Y' incision
       The arms of the Y extend from the front of each
        shoulder to the bottom end of the breastbone. The
        tail of the Y extends from the sternum to the pubic
   The ribs are sawn off in order to remove the
    organs so that they can be examined/tested.
   The brain is removed using a transverse incision.
    It is then either cut fresh for examination or is
    placed in a 20% solution of formalin to preserve it
    for future analysis.
Steps Taken in an Autopsy (cont.)
   All removed organs are weighed and
    studied individually. Most organs are cut
    up in sections by a scalpel.
   Intestines are drained in a sink to remove
    undigested food and feces that remains.
   The stomach is cut open and the contents
    are examined.
   Microscopic samples of most organs are
    taken for further analysis.
   Finally, all major blood vessels are cut
    open lengthwise and examined.
Steps Taken in an Autopsy (cont.)
   The organs are placed back in the body, and the
    body will be filled with a filler material. The head
    and body are then sewn up. The brain is returned
    to the body, except in the cases where the brain
    has been retained for further tests.
   Once the Y incision is sewn up, the autopsy
    (without brain and tissue analysis) is complete.
External Examination
                    The body must be measured
                     and weighed and placed on an
                     autopsy table prior to making
                     the Y-cut. A general description
                     of the body is made before any
                     further examinations are done.
                     All identifying features are
                     noted including:
                         Race
                         Sex
                         Hair color and length
                         Eye color
                         Approximate age
                         Any identifying features (scars,
                          tattoos, birthmarks, etc.)
                         Any wounds inflicted on the
                          outside of the body (burns,
                          ligature marks, stab wounds,
                          bullet wounds)
Internal Examination

   The Y-cut is made so that organs can be removed from
    the body.
   All organs are removed and samples are taken in order
    to examine them.
   The brain is removed in order to examine the skull.
   Internal examinations are conducted in order to check
    for internal wounds to determine cause of death.

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