Medicolegal Death Investigation Research Articles

Medicolegal Death Investigation of Railroad-Related Fatalities.

Railroad-related fatalities in the United States are increasing. A paucity of literature exists regarding the medicolegal death investigation of railroad-related deaths. We report on a subset of deaths in western Michigan, propose protocols for investigating train-related deaths, and propose a stepwise approach for the medicolegal investigation of railroad-related fatalities. Fourteen railroad-related fatalities from 2015 to 2019 were reviewed. Each case was analyzed for demographics, investigative components, train variables, and death certification. The average age was 32 years. Nine decedents involved pedestrians versus trains, and 5 involved motor vehicles versus trains. Male victims were more common, and 50% of the cases were associated with mental illness or recent stressors. Accident was the most common manner of death. With the exception of basic weather conditions, the remaining investigative variables were rarely reported. Image and audio recordings were taken in 3 cases, but railroad companies refused to allow the recordings to be viewed by the medical examiner. We conclude that in addition to a thorough medicolegal death scene investigation and postmortem examination, audio/video recordings are crucial components of death certification in railroad-related fatalities and advocate that medical examiners/coroners be given the legal right to view and retain them.

Medical examiner response to the drug overdose epidemic in King County Washington: "Real-time" surveillance, data science, and applied forensic epidemiology.

As the overdose epidemic overwhelmed medicolegal death investigation offices and toxicology laboratories, the King County Medical Examiner's Office responded with "real-time" fatal overdose surveillance to expedite death certification and information dissemination through assembling a team including a dedicated medicolegal death investigator, an information coordinator, and student interns. In-house testing of blood, urine, and drug evidence from scenes was performed using equipment and supplies purchased for surveillance. Collaboration with state laboratories allowed validation. Applied forensic epidemiology accelerated data dissemination. From 2010 to 2022, the epidemic claimed 5815 lives in King County; the last 4 years accounted for 47% of those deaths. After initiating the surveillance project, in-house testing was performed on blood from 2836 decedents, urine from 2807, and 4238 drug evidence items from 1775 death scenes. Time to complete death certificates decreased from weeks to months to hours to days. Overdose-specific information was distributed weekly to a network of law enforcement and public health agencies. As the surveillance project tracked the epidemic, fentanyl and methamphetamine became dominant and were associated with other indicators of social deterioration. In 2022, fentanyl was involved in 68% of 1021 overdose deaths. Homeless deaths increased sixfold; in 2022, 67% of 311 homeless deaths were due to overdose; fentanyl was involved in 49% and methamphetamine in 44%. Homicides increased 250%; in 2021, methamphetamine was positive in 35% of 149 homicides. The results are relevant to the value of rapid surveillance, its impact on standard operations, selection of cases requiring autopsy, and collaboration with other agencies in overdose prevention.

Role of Checklists in Medicolegal Death Investigation

Role of Checklists in Medicolegal Death Investigation

Transnational comparison of the impact of COVID-19 on medicolegal death investigations and the administration of justice: Early stages of the pandemic

COVID-19 has had an unprecedented impact on arguably every sector of our criminal justice system. To assess the impact that this global health crisis has had on our medicolegal investigations and administration of justice during the early stages of the pandemic, this research aims to give voice to the lived experiences of medicolegal death investigators (coroners, medical examiners and pathologists). This research involved in-depth interviews and follow-ups with experienced personnel from Canada (3), Italy (1), the United Kingdom (1) and the United States (4). Results suggest that despite facing similar challenges, each individual office has had to develop their own strategies to overcome obstacles during the early stages of the pandemic. These results help identify overlapping areas for constructive policy and procedural changes, including recommendations for workflow adaptations, strategic partnerships and other approaches to best prepare for subsequent health crises.

Five-year review (2014-2019) of paediatric accidental deaths in Cook County, Illinois (USA).

In the USA, intentional and accidental injuries are the most frequent causes of death in children. Many of these deaths could be avoided through preventive measures, and aetiological studies are needed to reduce fatalities. The leading causes of accidental death vary by age. We analysed all paediatric accidental deaths recorded by a busy urban Medical Examiner"s Office in Chicago, Illinois (USA). We searched the electronic database for accidental deaths in children aged under 10 between 1 August 2014 and 31 July 2019. 131 deaths were identified with a preponderance of males and African Americans. This is consistent with ratios of other deaths recorded for this age group (during the same period and area). The leading causes of death were asphyxia due to an unsafe sleeping environment (in subjects <1-year-old), and road traffic accidents/drowning (in subjects >1-year-old). Behaviours, risk factors and environments most likely to contribute to fatal injuries are discussed. Our study highlights the role of forensic pathologists and medico-legal death investigators who identify the causes and circumstances surrounding these deaths. The research results may help from an epidemiological perspective to implement age-specific preventive strategies.

The medico-legal death investigation system in Nepal.

In Nepal, police inquests have several limitations. When they receive information about a death, the police visit the crime scene and write an inquest report. Then, they arrange for the body to be autopsied. However, most autopsies are performed by medical officers in government hospitals who lack specialised training in conducting autopsies. Although all Nepalese medical schools teach forensic medicine to undergraduate students and require them to witness some autopsies, most private institutions are not authorised to perform them. Autopsies performed without expertise can be subpar and, even when trained personnel are available, these facilities are inadequately equipped. In addition, there is a lack of sufficient manpower to provide expert medico-legal services. The Honourable Judges and District Attorneys of all district courts believe that the medico-legal reports prepared by the doctors are inappropriate, incomplete and inadequate for use as evidence in court. Moreover, the police are more concerned with establishing criminality than other aspects of medico-legal death investigation, such as autopsies. Therefore, the quality of medico-legal investigations, including death investigations, will not improve until government stakeholders recognise the importance of forensic medicine in the judiciary and for the resolution of crimes.

The effects of the (fentanyl-fueled) drug overdose epidemic on medicolegal death investigation in the United States.

The evolving opioid epidemic in the United States, fueled by illicit fentanyl, has greatly increased deaths from illicit drug use. These nonnatural deaths require formal death investigation. The National Association of Medical Examiners states in its Forensic Autopsy Performance Standards that autopsy remains a necessary component for proper investigation of suspected acute overdose deaths. If a death investigation office lacks adequate resources to investigate all deaths under its jurisdiction while meeting expected standards, then that office may be forced to consider altering its protocols for investigation by changing the types of deaths investigated or the extent of its investigations. Drug death investigations take longer to complete because novel illicit drugs and mixtures of drugs complicate toxicological analyses, prolonging a family's wait for completion of a death certificate and autopsy report. Public health agencies must also wait for results, but some agencies have developed mechanisms for rapid notification of preliminary results to allow timely deployment of public health resources. The increased deaths have strained the resources of medicolegal death investigation systems throughout the United States. Given the significant workforce shortage of forensic pathologists, newly trained forensic pathologists are too few to meet the demand. Nevertheless, forensic pathologists (and all pathologists) must make time to present their work and themselves to medical students and pathology trainees to encourage an understanding of the importance of quality medicolegal death investigation and autopsy pathology and to provide a model that can encourage interest in a career in forensic pathology.

Simplified COI barcoding of blow, flesh, and scuttle flies encountered in medicolegal investigations.

Accurate insect identification is critical to the estimation of time of colonization (TOC) and post-mortem interval (PMI) in medicolegal death investigations. DNA testing is advantageous because it enables the identification of immature specimens that may not be identified based on morphology alone. We describe here a simplified DNA barcoding method for identifying relevant species that may be implemented by forensic genetics laboratories. A cytochrome oxidase (COI) fragment is analyzed after PCR amplification with a single primer set. The method is effective for many species commonly encountered in death investigations in the USA: members of blowfly genera Calliphora, Chrysomya, Cochliomyia, Lucilia, and Phormia; members of the flesh fly genera Blaesoxipha, Oxysarcodexia, Ravinia, and Sarcophaga; and the scuttle fly Megaselia scalaris. We tested the method on specimens with verified identifications and used it to build a collection of reference sequences from specimens collected in Harris County, Texas. We show here the correct identification of larvae, pupae, and pupal exuviae from the medicolegal casework.

Necropolitics and Trans Identities: Language Use as Structural Violence

Despite the increasing visibility of transgender and gender diverse (TGD) people in U.S. society, current linguistic practices within forensic anthropology and death investigation in general are not TGD-inclusive. This lack of consideration for TGD decedents can cause unnecessary delays in the identification and disposition of their remains; moreover, failing to recognize their true identities is a form of forced post-mortem detransition. Using De León’s concept of necroviolence as a framework, we argue that language can also harm the dead and that the (mis)use of language within medicolegal death investigation reflects and reinforces structural violence against TGD people. Examples drawn from a qualitative review of public details for 87 cases are used to demonstrate how language and language-enforced bureaucratic structures can harm TGD decedents, their loved ones, the broader TGD community, and the process of medicolegal death resolution itself. We then suggest steps that anthropologists, death investigators, and their affiliated partners can take to reduce the systemic necropolitical violence faced by the TGD community. While TGD-inclusive methods will take time to implement at the institutional level, individual practitioners can enact significant change within the system by upholding core standards that recognize and respect the personhood and lived experiences of TGD decedents.

An interdisciplinary forensic approach for human remains identification and missing persons investigations

AbstractThe resolution of unidentified human remains (UHR) and long‐term missing persons (LTMP) cases is paramount for administrative, legal, and humanitarian reasons. There are various forensic profiling methods for human identification; however, their utility is dependent on several factors. First, UHR can be found in different stages of decomposition, so the availability and diversity of post‐mortem (PM) information will differ. Second, the availability and totality of the LTMP's ante‐mortem (AM) information will differ. Therefore, the suitability of existing methods will be dependent on the quality and quantity of PM and/or AM data available for comparison. Visual recognition is the simplest and quickest method, but typically not practiced or possible, owing to the altered, fragmented, or skeletonized state of UHR. Primary forensic profiling methods involve the comparison of fingerprint, dental, DNA, and medical data. Secondary forensic profiling methods from anthropology, radiology, geochemistry, and anatomy disciplines can provide supplementary evidence to support comparative identification approaches. Emerging forensic molecular technologies such as genomics, microbiomics, epigenetics, and proteomics, together with individual digital footprints from personal devices, offer new investigative leads for establishing identity. However, despite the success of these individual methods, their limitations must be considered when used in isolation. Through the development of a guiding forensic examination framework, this review endorses an interdisciplinary response to unidentified and missing persons investigations, where various forensic specialists collaboratively examine UHR using a suite of contemporary forensic profiling methods to produce multiple and/or different lines of evidence to link them effectively, efficiently, comprehensively, and systematically to LTMP.This article is categorized under:Forensic Science in Action/Crime Scene Investigation &gt; Special Situations and InvestigationsForensic Biology &gt; DNA Testing in Disaster Victim and Missing Persons IdentificationForensic Medicine &gt; Medicolegal Death Investigation SystemsJurisprudence and Regulatory Oversight &gt; Interdisciplinary Collaboration

Problem areas in postmortem imaging of the brain

Postmortem imaging notably CT, has been embraced in medicolegal death investigation. It allows for non-invasive interrogation of the skull and cranial contents prior to autopsy, forewarning likely findings and excluding overt pathology such as fractures, haemorrhage, and mass lesions. There are, however, deficiencies in postmortem CT in part due to changes to the brain at or after death, and inherent insensitivity to subtle changes in the parenchyma such as early infarction, encephalitis, and low-grade neoplasm. This can in part be rectified by use of postmortem MRI. As in clinical evaluation, postmortem CT and MRI can assist pathologists in understanding cause and mechanism of injury and disease that may not be initially apparent. Examples that will be discussed include: impact of cerebral amyloid angiopathy in traumatic brain haemorrhage; rupture of vessels other than vertebral artery in traumatic basal subarachnoid haemorrhage; venous extradural haematoma; relative contribution of natural disease and trauma in fatal cerebral haemorrhage (so-called chicken v egg); underlying pathology in cases of prolonged hospital stay, hypoxic ischaemic brain injury and status post neurosurgery, by way of forensic interpretation of clinical (antemortem) imaging.

Operationalizing the structural vulnerability profile within the medical examiner context

The medicolegal death investigation process in the United States, historically focused on personal identification and determination of cause and manner of death, has evolved in recent decades to include space for advocacy centered around public health. Particularly, in the domain of forensic anthropology, practitioners have begun to incorporate a structural vulnerability perspective on human anatomical variation, with the goals of articulating the social determinants of ill health and early death and ultimately influencing public policy. This perspective has explanatory power far beyond the anthropological sphere. In this piece, we argue that biological and contextual indicators of structural vulnerability can be incorporated into medicolegal reporting with potentially powerful impacts on policy. We apply theoretical frameworks from medical anthropology, public health, and social epidemiology to the context of medical examiner casework, highlighting the recently proposed Structural Vulnerability Profile developed and explored in other articles in this special issue. We argue that: 1. Medicolegal case reporting provides a valuable opportunity to record a faithful accounting of structural inequities in the annals of death investigation, and 2. Existing reporting infrastructure could, with limited modifications, provide a powerful opportunity to inform State and Federal policy with medicolegal data, presented within a structural vulnerability framework.

The Impact of COVID-19 on Adolescent Suicide Deaths in the State of Maryland

Abstract On March 11, 2020, the World Health Organization officially declared the SARS-CoV-2 virus (COVID-19) a worldwide pandemic. As of December 2021, there have been over 278 million cases and 5.4 million deaths reported. One area of concern regarding the pandemic was its potential impact on mental health, and it was feared that the onset of such a devastating pandemic would lead to increased suicide risks among the general population. With suicide being a leading cause of death in adolescents, it is important to assess the potential mental health consequences that the COVID-19 pandemic may impose. Aim The aim of the study was to analyze the impact of COVID-19 on suicide deaths among adolescents in the state of Maryland from 2019 to 2021. Subjects and Methods This was a retrospective study of adolescent suicide victims, aged 10–19 years, from January 2019 to December 2021 in the state of Maryland. De-identified data were collected from the statewide medical examiner’s office which is responsible for the medicolegal death investigation in Maryland. Results A total of 102 adolescent suicide deaths were investigated statewide by the Maryland Office of the Chief Medical Examiner during these 3 years. The number of adolescent suicide cases stayed relatively stable during the COVID-19 pandemic, with slightly more cases during the pre-COVID-19 pandemic period (2019: n = 37; 2020: n = 31; and 2022: n = 34). Looking at months of incidence, less cases were reported in March–May 2020 (n = 5), which marks the beginning of the pandemic when compared to the same period in 2019 (n = 13). The number was higher for August–November 2020 (n = 15) than for that of 2019 (n = 8) and 2021 (n = 8). The male-to-female suicide ratio was 3.7:1 (n = 80/22). However, the data exhibited a significant increase in the number of female adolescent suicides, from 8.11% in 2019 (n = 3) to 25.81% in 2020 (n = 8) and 32.35% in 2021 (n = 11). Of the cases examined, more than 50% were white and approximately 27% were African-Americans. The two leading causes of death were hanging (47%) and firearm injuries (29%). Maryland consists of 23 countries and Baltimore City. The majority of adolescent suicides occurred in county residents with only 8.8% of cases in Baltimore City.

Undergraduate Education in Forensic Medicine in Germany, Japan, and Korea

Germany, Japan, and Korea have a similar medicolegal death investigation system, the so-called European style, governed by prosecutors for crime investigation and brought into Korea through Japan from Germany. In this system, all physicians must be engaged in postmortem external examination and issue a death certificate for unnatural death. Therefore, education in forensic medicine should be provided to medical students to ensure the ability to determine the cause of death and the manner of death after graduation. However, the quality of undergraduate education in forensic medicine is known to be unsatisfactory in Korea because there is no well-organized nation-based education policy. This study aims to review significant features of the education system for forensic medicine in Germany, Japan, and Korea. Related laws and regulations, standard curriculum, and incorporation of forensic medicine in medical license examination are comparatively analyzed. In conclusion, the Korean education system in forensic medicine has a weak structure for achieving competency in postmortem external examination, while Germany and Japan have sustained relatively concrete frameworks. Practical approaches are proposed for improving education quality, including incorporating forensic medicine into compulsory assessment in the medical licensing examination.

The Role of Medical Evidence in Determining the Cause of Death in Murder Cases in Zambia

Purpose: This paper seeks to demonstrate the necessity of medical evidence in determining the cause of death in Murder cases. Further, to show that the use of ocular observations to determine the cause of death is not always sufficient or accurate. It is important for medical evidence to be adduced to determine the cause of death in murder cases because a conviction for murder carries the ultimate punishment of death. Secondly, determining the cause of death in a murder case is not only a legal question but also a medical question. Combining both approaches is likely to lead to a more just determination of the matter.&#x0D; Methodology: The research was conducted by analysing statutes, judicial precedents, journal articles and other legal authorities that address the legal principles and issues underpinning this subject matter.&#x0D; Findings: Firstly, the use of expert medical evidence in determining the cause of death in murder cases is not mandatory in Zambia. Secondly, relying solely on ocular observations to determine the cause of death will not always lead to a just and or accurate determination of the cause of death. Thirdly, there is a lack of trained experts in the field of Medico legal Death Investigations. Fourthly, the use of a combination of both eye witness testimony and expert medical evidence will lead to a just conclusion of murder cases. Lastly, determining the cause of death is both a legal and medical question&#x0D; Unique contribution to theory, practice and policy: The study highlights the importance that must be attached to the use of medical evidence in murder cases in view of the fact that determining the cause of death is not just a legal question premised on eye witness accounts but a medical question requiring expert opinion. It further advocates a mandatory requirement for the state to adduce medical evidence in prosecuting murder cases. Lastly it calls for investment in training experts in the field of medicolegal death investigations to provide the much-needed expert opinion in these cases

Decomposition and insect succession on human cadavers in a humid, continental (Dfb) climate (Quebec, Canada).

Forensic entomology has been developing globally for decades. Despite this discipline being used in criminal investigations around the world, only a few controlled studies have been performed on human cadavers in human decomposition facilities, with the majority of these being conducted in warm and often dry climates. Therefore, the purpose of our research was to catalogue the first published data on insects associated with decomposed human bodies in a humid, continental (Dfb) climate. Specifically, our objective was to document the diversity and succession of the entomofauna associated with human cadavers throughout the decomposition process, in the Quebec province of Canada, during the summer season. Two human cadavers were studied in 2020 at the site for Research in Experimental and Social Thanatology, REST, located in Bécancour (Quebec, Canada). Insects (and other arthropods) were regularly sampled by visual observations, collection from the cadavers, and by using an entomological net and pitfall traps. Our results highlight that the decomposition process is a heterogeneous and complex process in Quebec, with cadavers showing signs of precocious desiccation/mummification. In addition, our observations confirm that the presence of superficial skin lesions accelerates the colonization of blow flies (Diptera: Calliphoridae) and, consequently, the process of decomposition. Finally, we were able to discriminate between "early colonizers" (e.g., Calliphoridae Lucilia sp. or Calliphora livida), "late colonizers" (e.g., larvae of Piophilidae or Heleomyzidae), and "non-specific colonizers." We also officially report the first observation of Cochliomyia macellaria (Diptera: Calliphoridae) in Quebec. These findings will provide new information to help medico-legal death investigations by determining the minimum time elapsed since death and the circumstances surrounding death.

Addendum to previously published article titled "Medico-Legal Death Investigation Systems – Sri Lanka" Sri Lanka Journal of Forensic Medicine, Science &amp; Law, Vol. 13 (Special Issue) 2022 :53-56 DOI: http://doi.org/10.4038/sljfmsl.v13i0.7923 Published on 30th September 2022.

The Sri Lanka Journal of Forensic Medicine, Science &amp; Law (SLJFMSL) is a peer-reviewed, open-access journal published biannually in June and December each year by the Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka.The mission of the SLJFMSL is to stimulate, encourage and empower researchers to publish high quality research in order to promote evidence based practice and provide a platform for researchers to share experiences and knowledge in the fields of forensic medicine, forensic sciences, medical ethics and relevant law. This journal publishes original research papers, reviews, points of view, case reports, technical notes and letters to the editor. The SLJFMSL is committed to maintaining and conforming to the editorial and ethical standards recommended by the International Committee of Medical Journal Editors.SLJFMSL was assessed by the Journal Publishing Practices and Standards framework and was placed at level five (of six) and is currently listed in SLJOL, DOAJ, IMSEAR, NLM Catalogue.

The added value of molecular-based diagnostics in the African forensic medical setting.

Sudden unexpected infant death (SUDI) is reported to be an extraordinarily high burden in sub-Saharan Africa, with the incidence rate in South Africa among the highest in the world. It is common for the cause of many such infant deaths to remain unexplained even after a full medico-legal death investigation, and then to be categorised as a sudden unexplained infant death (SUID). Fortunately, advances in molecular-based diagnostics allow researchers to identify numerous underlying inherited cardiac arrhythmogenic disorders in many SUDI cases, with a predominance of variants identified in the SCN5A gene. Such cardiac arrhythmogenic-related sudden deaths generally present with no structural alterations of the heart that are macroscopically identifiable at autopsy, therefore highlighting the importance of post mortem genetic testing. We report on a significant genetic finding that was made on a SUDI case in which the cause was ascribed to an acute bacterial pneumonia but it was still subjected to post mortem genetic testing of the SCN5A gene. The literature shows that many SUDI cases diagnosed with inherited cardiac arrhythmogenic disorders have demonstrated a viral prodrome within days of their death. It is therefore not uncommon for these cardiac disorders in infants to be mistaken for flu, viral upper respiratory tract infection or pneumonia, and without the incorporation of post mortem genetic testing, any other contributory causes of these deaths are often disregarded. This study highlights the need for research reporting on the genetics of inherited cardiac disorders in Africa.

Medico-legal death investigation – multiple methods to achieve the same objective

The Sri Lanka Journal of Forensic Medicine, Science &amp; Law (SLJFMSL) is a peer-reviewed, open-access journal published biannually in June and December each year by the Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka.The mission of the SLJFMSL is to stimulate, encourage and empower researchers to publish high quality research in order to promote evidence based practice and provide a platform for researchers to share experiences and knowledge in the fields of forensic medicine, forensic sciences, medical ethics and relevant law. This journal publishes original research papers, reviews, points of view, case reports, technical notes and letters to the editor. The SLJFMSL is committed to maintaining and conforming to the editorial and ethical standards recommended by the International Committee of Medical Journal Editors.SLJFMSL was assessed by the Journal Publishing Practices and Standards framework and was placed at level five (of six) and is currently listed in SLJOL, DOAJ, IMSEAR, NLM Catalogue.

Medico-Legal Death Investigation Systems – Poland

The Sri Lanka Journal of Forensic Medicine, Science &amp; Law (SLJFMSL) is a peer-reviewed, open-access journal published biannually in June and December each year by the Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka.The mission of the SLJFMSL is to stimulate, encourage and empower researchers to publish high quality research in order to promote evidence based practice and provide a platform for researchers to share experiences and knowledge in the fields of forensic medicine, forensic sciences, medical ethics and relevant law. This journal publishes original research papers, reviews, points of view, case reports, technical notes and letters to the editor. The SLJFMSL is committed to maintaining and conforming to the editorial and ethical standards recommended by the International Committee of Medical Journal Editors.SLJFMSL was assessed by the Journal Publishing Practices and Standards framework and was placed at level five (of six) and is currently listed in SLJOL, DOAJ, IMSEAR, NLM Catalogue.