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

Medico •

Medico • •

 Mummification  Cryogenic freeze  Donate a body 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 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

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