Death Investigation System Research Articles

Coroners recommendations and the prevention of fatal injury

IntroductionA purported strength of the medico legal death investigation system (coroner or medical examiner) is the provision for formal recommendations to be made about the prevention of fatal injury. Recent...

Medical Homicide and Extreme Negligence

Deaths that occur during medical care for the treatment of a disease are rarely certified as homicides. Some "medical" deaths, however, have been criminally prosecuted for manslaughter, reckless endangerment, or reckless homicide. We describe 5 deaths due to medical complications that underwent criminal prosecution. Three of the deaths were certified as homicides. Deaths certified as homicides due to the actions (or inactions) of a caregiver occur in 3 circumstances. The first is when the medical caregiver intentionally causes the death of the patient. The second is a death due to treatment by an unlicensed fraud or quack. The final circumstance is due to extreme medical negligence that involves a gross and wanton disregard for the well-being of the patient and is the most controversial in the medical community. The law defines reckless endangerment as the conscious disregard of a known substantial likelihood of injury to the patient. Criminal neglect typically is defined as the failure to provide timely, safe, adequate, and appropriate services, treatment, and/or care to a patient. In instances of extreme medical negligence, a homicide manner of death is appropriate because the fatality is due to the criminal acts (or inactions) of another. It also furthers one of the major goals of the medicolegal death investigation system, which is to safeguard the public health.

Death Investigation System and Expert Witness on Forensic Pathology

Death Investigation System and Expert Witness on Forensic Pathology

The Conversion of Coroner Systems to Medical Examiner Systems in the United States

Coroner and medical examiner systems in the United States conduct death investigations for most deaths that are sudden and unexplained, or which involve external causes such as injury and poisoning. They play a very important role in the criminal justice, public health, public safety, and medical communities, and they also contribute a substantial portion of autopsy-based mortality data to the state and federal mortality statistics systems. Death investigations often involve complex medical issues and necessarily require the involvement of appropriately trained physicians. Over the years, there has been a trend to replace the elected lay coroner systems with systems run by appointed, physician medical examiners. Presently, about 31% of counties in the United States are served by a medical examiners at the county, district, or state level. Between 1960 and 1989, there was considerable conversion to medical examiner systems, but this trend slowed in the 1990s. Since 2000, only 6 counties in the United States have converted to a medical examiner system, no states have converted since 1996, and 1 county has reverted to a sheriff-coroner system. Possible reasons for this decline are discussed, including legislative, political, geographical, financial, population-based, and physician manpower distribution factors. It is important to ensure that all death investigation systems have appropriate access to medically educated and trained physicians such as forensic pathologists.

Investigating Asthma Deaths among Children and Young Adults: Michigan Asthma Mortality Review

We developed a surveillance system to investigate asthma deaths in children and young adults. A rapid asthma death notification and investigation system for Michigan was developed to identify interventions to prevent future deaths among people aged 2-34 years. Multidisciplinary panels to determine causal factors and recommend preventative actions reviewed information from death certificates, autopsies, next-of-kin interviews, and medical records. An annual report was disseminated to public health workers, health-care providers, insurers, and others. Eighty-six asthma deaths in Michigan residents, aged 2-34, occurred from 2002-2004. Sixty-one next of kin were interviewed and medical records were obtained for 84 of the deceased. Summaries were prepared on each of the deceased and were reviewed by expert panels, which reached consensus on causal factors and potential preventive action for each death. Each year an annual report, which summarized the causal factors and potential preventive activity, was prepared. This review has informed and catalyzed interventions to improve asthma care and management in Michigan. Factors leading to the review's success and future activities are discussed.

Medical Examiners, Coroners, and Public Health: A Review and Update

Abstract Context.—Traditionally, the emphasis of work done by medical examiners, coroners, and the death investigation community has been viewed as serving the criminal justice system. During the last several decades, however, an important role for these 3 groups has emerged within public health. Objective.—To provide important background information on death investigation systems, the evolution and framework of public health entities that rely on information gathered by medical examiners and coroners, and the role of medical examiners and coroners in epidemiologic research, surveillance, and existing public health programs and activities. Data Sources.—Previous articles on epidemiologic aspects of forensic pathology and the role of medical examiners and coroners in epidemiologic research and surveillance; a review of the Web sites of public health and safety agencies, organizations, and programs that rely on medical examiner and coroner data collected during medicolegal investigations; and a review of re...

Medical Examiners, Coroners, and Public Health: A Review and Update

Traditionally, the emphasis of work done by medical examiners, coroners, and the death investigation community has been viewed as serving the criminal justice system. During the last several decades, however, an important role for these 3 groups has emerged within public health. To provide important background information on death investigation systems, the evolution and framework of public health entities that rely on information gathered by medical examiners and coroners, and the role of medical examiners and coroners in epidemiologic research, surveillance, and existing public health programs and activities. Previous articles on epidemiologic aspects of forensic pathology and the role of medical examiners and coroners in epidemiologic research and surveillance; a review of the Web sites of public health and safety agencies, organizations, and programs that rely on medical examiner and coroner data collected during medicolegal investigations; and a review of recent public health reports and other publications of relevance to medical examiner and coroner activities. The role of medical examiners and coroners has evolved from a criminal justice service focus to a broader involvement that now significantly benefits the public safety, medical, and public health communities. It is foreseeable that the public health role of medical examiners and coroners may continue to grow and that, perhaps in the not-too-distant future, public health impact will surpass criminal justice as the major focus of medicolegal death investigation in the United States.

A Case-by-Case Comparison of the Classification of Law Enforcement and Vital Statistics Data on Homicide

This study uses data from the California Linked Homicide File as a basis for evaluating the validity and reliability of homicide data. Case-by-case comparisons of variables reported by both agencies indicate that agreement between law enforcement and vital statistics data is highest with classifying homicides and victim gender and race and lowest with classifying victim age, manslaughters, and police justifiable homicides. The findings from a multilevel analysis examining what types of cases are unable to be linked over the two data-collection systems reveal that homicides involving Hispanic victims, weapons other than handguns, and family members other than intimate partners and homicides involving felonies, other nonfelonies, and negligent manslaughters have a greater likelihood of not being matched across the agencies. Death investigation systems that use medical examiners also decrease matching. The need for qualitative research examining how classification decisions are made by police and medical examiners or coroners is discussed.

Investigation of suspicious deaths and deaths related to violence, a Malaysian perspective

Investigation of suspicious and violent deaths forms an important aspect of the administration of justice. In a routine medico-legal practice the need often arises to investigate various types of deaths. In some deaths the cause and manner of death are obvious and therefore an elaborate investigation may not be necessary. However, for some deaths owing to the nature and because of apparent suspicious circumstances surrounding the death a detailed investigation becomes important. Legal, law enforcement and medical personnel who are involved in the investigation of sudden, unnatural, violent and suspicious deaths, in addition to various knowledge should ideally have some background information regarding the historical evolution of the death investigation system. This paper explores the Malaysian perspective of routine death investigation.

Continuous Quality Improvement as a Management Concept for Death Investigation Systems

Continuous quality improvement (CQI) represents a management technique where the basic approach to managing quality consists of setting a standard for a work process, measuring variation in the work process in relation to the standard, and then implementing programs to decrease variation and improve end results. Everyone providing a service becomes involved both in understanding how quality is measured and in discussing how to improve quality. A team approach is adopted and instead of focusing on poor quality outcomes and how to avoid them, the team becomes involved in setting continuously improving standards for better performance and in finding ways to meet those standards. The objective is to meet or exceed consumer or user expectations. Relevant related concepts such as survey research, needs determination and outcomes analysis, and the importance of a mission statement are discussed using a medical examiner system as an example.

Medical examiner and coroner systems: history and trends.

Medical legal investigations in the United States (primarily unnatural or suspected unnatural deaths) are carried out by medical examiner or coroner systems. Medical examiners-usually physicians and generally with training in pathology, medicolegal death investigation, and performance of forensic autopsies-generally have greater expertise in unnatural death investigations than do coroners. To document the locations and implementation year for states and counties that have medical examiner systems that have replaced coroner systems or that are defined in statute and assist coroners in their investigations. Review of published information and national survey in 1997. United States. County medical examiners and state medical examiners or their administrators. The location of states and counties with medical examiner systems, the implementation year for each system, and the proportion of counties and population served by medical examiner systems. A total of 79 of 91 county medical examiners responded. A total of 36 states have at least 1 medical examiner system at the county, district, or state level in which there is no coroner involved in the death investigation process. Only 22 states have medical examiner death investigation systems in place and have no coroners in the state. Among 13 states in which some counties have coroner systems and some have medical examiner systems, medical examiner systems exist in 8% of counties and serve 43% of the population. Medical examiner systems that operate without coroner involvement serve about 48% of the population nationwide. Few state or county medical examiner systems have been implemented since 1990. In this century, medical examiner systems have gradually replaced coroner systems, but such change has slowed in recent years, with medical examiner systems now serving about 48% of the national population.

Death Investigation in Canada

A survey of death investigation systems in Canada was conducted by questionnaire and included questions on the type of system used (coroner or medical examiner), budget, method of appointment and qualifications of coroners and medical examiners, responsible department of government, training requirements, laboratory facilities, and the utilization of investigators and pathologists by each jurisdiction. Of the population of Canada 81.5% reside in coroner jurisdictions, the primary death investigator in 81% of the population is a licensed physician. The majority of jurisdictions either require or provide training in death investigation. All death investigation systems are under the respective provincial or territorial department of Justice or Attorney General with the chief coroner or chief medical examiner appointed by their respective provincial cabinet. The qualifications of the chief coroner vary with jurisdiction, while in 75% of medical examiner jurisdictions the chief medical examiner must be a pathologist. On a per capita basis medical examiner systems are less expensive to operate than coroner systems.

The Abstractability and Consistency of Medical Examiner/Coroner Reports: Results from the 1993 National Mortality Followback Survey Pilot

The 1993 National Mortality Followback Survey (NMFS) is designed to provide national estimates of important characteristics of the 2,218,940 people aged 15 years and older who died in 1993. One topic of special interest in the survey is injury-related deaths. Previous followback surveys have not obtained data from medical examiner and coroner offices (ME/Cs), who investigate most injury-related deaths. In this study, we sought to determine the feasibility of collecting data from various ME/C offices for the NMFS and the usefulness and limitations of data derived from their records. We 1) developed a pilot survey instrument, the Medical Examiner/Coroner Abstract (MECA); 2) attempted to collect ME/C records on 159 deaths from 55 ME/C offices in four states with a variety of death investigation systems; and 3) assessed the feasibility of abstracting data from these records using the MECA. We received records on 105 deaths from 39 ME/C offices in three states. We identified items that could be abstracted from the records of most deaths and found that different abstractors could reproducibly and reliably identify information on these core items. Using the results of this study, we revised the MECA for use in the NMFS.

More Expertise Needed in Death Investigations

THE SCIENCE of death investigation is hardly for amateurs. Yet in one Georgia county, the coroner is a bus driver. South Carolina has had two blind coroners. Higher qualifications are needed since errors too frequently are made by coroners, said Kim Collins, MD, a forensic fellow at the Medical University of South Carolina, Charleston. Throughout the country, Collins told an audience during the annual meeting of the American Academy of Forensic Sciences (AAFS), the structure and quality of death investigation systems remains uneven. But she focused on South Carolina, one of 17 states with a dual coroner-medical examiner system. Each of the state's 46 counties has a coroner, but the two largest—Charleston and Greenville—also have medical examiners. Elsewhere, 11 states use only coroners while 22 states and the District of Columbia rely strictly on medical examiners. Medical examiners are physicians while coroners often are not. Last year, Collins said South

Medical Examiner/Death Investigator Training Requirements in State Medical Examiner Systems

Comprehensive and properly performed investigation of suspicious, unusual, unnatural, and various natural deaths is necessary to maintain the health, safety, and well-being of society as a whole. Adequate investigation requires the combined efforts and cooperation of law-enforcement and other public-service agencies, medical professionals, and those within the forensic community. As such, the "death investigator" plays a crucial role in the investigation process. These front-line investigators, whether they be coroners, medical examiners, physicians, other medical professionals, or lay-people, are required to make important decisions which have far-reaching consequences on how death investigation cases proceed. Death investigation practices vary greatly among medico-legal jurisdictions. A recent publication has categorized state death investigation systems by type of system. In an attempt to better delineate death investigation practices with specific regard to investigators' training and continuing education requirements, we surveyed the 20 systems categorized as state medical examiner systems and the five states with combined state medical examiner and county coroner/medical examiner systems. We present our findings and make recommendations which address the attributes and deficiencies of current death investigation practices.

Justice in the Forensic Sciences

Abstract Many historical references to the origins of forensic science, even to ancient times, exist in the vast literature of humanity. It was not, however, until Sir Arthur Conan Doyle with intriguing foreshadowing suggested the use of scientific crime detection methods, through his fictional character Sherlock Holmes, that modern forensic science began its development. Holmes applied principles of serology, fingerprinting, firearm identification, and questioned document examination long before these techniques and their utilization were to be recognized and accepted in modern investigation. Marsh in 1832 isolated arsenic to demonstrate the actual presence of a toxic substance, and displayed this before a jury. Bertillon initiated a system of anthropometric measurements for personal identification which was adopted by the Paris police in 1882. The English coroner, originally established to insure that the King received his share, later extended his duties to the investigation of death, and in America, the first medical death investigation system was established in New York in 1918. These and many other developments continued to merge and move forward until R. B. H. Gradwohl in 1948 called a meeting in St. Louis of forensic medicine and sciences which led to the first meeting of the American Academy of Forensic Sciences, 26–29 Jan. 1950. Among the stated purposes of this pioneering group of approximately 150 members was to raise the standards of investigation techniques and the quality of testimony in the courts and engender the confidence and respect of the judiciary, specifically to create and foster confidence by the courts in scientific and legal proof, and to raise the standard of reliability in investigation and testimony of men who do this work. At that time, sections existed in forensic pathology, forensic psychiatry, forensic toxicology, forensic immunology, jurisprudence, police science, and questioned documents. The Academy has subsequently grown and with it the struggle to recognize the expertise provided by the increasing number of forensic science disciplines. Overcoming much turmoil and controversy, the Academy today is supported by 2700 members representing an expansion of sections including Criminalistics, Engineering, General, Jurisprudence, Odontology, Pathology and Biology, Physical Anthropology, Psychiatry, Questioned Documents, and Toxicology. The image of the forensic scientist was recently boosted by the media when the television show “Quincy” removed the dull fog of night and replaced it with a symbol of service and dedication. In recent years, we have come together, replaced divisiveness with unity, and put our best foot forward. Some recent events threaten to compromise these gains. We read of forensic scientists challenging one another even in areas where the issues do not appear substantial or timely. If one of us loses, we all lose. This is a time, I believe, for forensic scientists to rethink the lessons of the past, to remember the purposes of the original 150, for it is in doing so that our future will be preserved and that justice in the forensic sciences will be insured.