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The Medical Examiner & Coroner systems 14/01/2008

12:45:00
Today’s lecture
• Readings: none required, optional article on e-learning (history of
legal medicine)
• What happens after someone dies?
A brief history of forensic medicine

what happens when someone dies?


• Attended death
o Under physician care when they die. Hospital or such.
• Unattended death
o Unexpected, or sudden. Murder, car accident, suicide. Might
be witnessed, but not by a physician.
o There needs to be an investigation to find out how, why, when
they died. This has to be done before a death certificate can
be signed.
• Once they get to the Funeral home
o Embalmed
 Burial
 Cremation
 Body donation
 Shot into space
o Not embalmed
 Buried
 Cremation
 Mummification
 Cryogenic freeze
 Donate a body
Medico legal Death Investigation
• Medical examiner
o Forensic anthropologist
o Forensic odontologist
o Forensic engineer
 Mass fatalities, structural failures. Airplane crashes,
bridges.
o Forensic nurse
o Medico legal death investigator
o Forensic entomologist
 What is the period since death. Based on insects
o Forensic botanist
 If a plant from another location is found on the body
they could help finding location of the death
o Forensic toxicologist
 If any type of drugs are found in the body
Medico legal Community Coroner vs. Medical Examiner
• Coroners
o Elected officials – may be lay persons
• Medical Examiners
o Physicians who are forensic pathologists
• Both have the legal responsibility to certify deaths of people who
are not under the care of a physician
History of Coroner System: England
• Origins in medieval England
• Comes from the term “Crowner”
• Formal designation in 1194
• Original duties:
o Post-mortem inquest
o Suicide investigation
o Judicial officer
o Tax collector
o Arrest warrants
 This power has been abolished
The Coroner System Today
• Identify the body
• Notify next of kin
• Collect belongings
• Sign death certificate
• Elected official
o Often sheriff, prosecutor, or funeral director
Why maintain the coroner system today?
• Limited resources
o Not a facility to have a full time practicing physician
• Lack of qualified individuals
• Not enough crime
Medical Examiners
• Licensed physicians
• Forensic specialty
• Determine time, cause, and manner of death
• Issue death certificate
• Florida has a medical examiner system
Early use of the medical examiner’s office (MEO)
• 1647 – the general court of Massachusetts Bay
o autopsies for medical student instruction
U.S. Adopted MEO
• Late 19th century
• 1860 – Maryland: code of public General Laws
o a coroner has to have a physician at an autopsy
• 1877 – Massachusetts: Physicians instead of coroners
o medical examiners have to be a licensed doctor
• 1890 – 1915: medical examiner system adopted in large cities
forensic pathologist training
• physician who studies disease and trauma (pathologist) that
leads to death of an individual
• medical school
• postgraduate training in pathology
• additional training in forensic pathology
• board certification
duties of a forensic pathologist
• review medical history
• review witness statements
• scene examination
o medico legal death investigators
• autopsy
samples for analysis
• toxicology
o liver samples, hair, brain, anything to test for drugs
• microscopic
• DNA analysis
Six Critical Questions
• Who are you?
• When were you hurt/ when did you become ill/ when did you die?
• Where did you get hurt/ where did you die?
• Why did you die?
• How did you die?
• If someone killed you, who was it?
Autopsy
• What is an autopsy?
o “To see for yourself”
• Why perform an autopsy?
Clinical vs. Forensic Autopsy
• Clinical
o Determine cause of death (pathology)
o Standard in hospitals
• Forensic
o Unnatural death
o Medico legal purposes
When is an autopsy performed?
• Death not attended by physician
• Ordered by the court
• Suspicious/unnatural/sudden death
o Suicide, homicide, accident
o Collect evidence
• Teaching/medical research
• Prisoners
• Requested by family
Reasons for a forensic autopsy
• Cause and manner of death
• Time of death, or since death
• Identify, collect, preserve evidence
• Factual information to law enforcement, prosecutors, defense
attorneys, families
• Protect the innocent/prosecution of the guilty
Can you request an autopsy?
• Yes!
• When may an autopsy be requested?
o Insurance
o Suspicion of malpractice
o Severity of illness
o Reveal genetic defects
14/01/2008 12:45:00
14/01/2008 12:45:00