Medicolegal Death Investigation Research Articles

Machetes: Sharpening materials and methods– producing different striation patterns on bone

As forensic anthropologists play a larger role in post-mortem examinations, the examination and interpretation of skeletal trauma resulting from sharp, blunt, projectile, and thermal injuries have become of critical importance and may assist in medicolegal death investigations. Although there is a plethora of research on sharp force trauma on bone, at present, there is little research regarding the striations produced by large bladed weapons on bone, whether those striations are weapon-specific, or whether they are the result of sharpening materials and methods. To test whether striations are weapon type specific, this study aimed to examine if different sharpening materials and methods produced different striations on the kerf walls of cut marks on bone produced by machetes. Or, if they do produce the previously identified ‘rolling hill’ striation pattern. Four factory machetes sharpened by the same manufacturer were re-sharpened using a wet stone, a bastard file, and a coarse and medium-grained machine grinder. The bones and casts were subjected to both macro and micro analyses, and the results identified clear differences in the shape of striation ridges and troughs, indicating that striation patterns are not weapon type-specific. The study's findings have opened up a new area of research into weapon types and the analysis of associated striation patterns and may aid in the identification of weapon types and the materials used for maintenance or sharpening, potentially offering additional evidentiary evidence.

The role of coroner in natural deaths in the elderly in New South Wales, Australia – can this change for the better?

ABSTRACT In 2015, the combined average life expectancy for males and females in Australia was ranked 6th in the world at 82.5 years. The exact age at which a person can be classified as being elderly will differ amongst countries but is generally between 60–65 years. The increase in life expectancy and increased recognition of the elderly as a vulnerable group will most likely lead to an increased workload in the medico-legal death investigation system.

The surge of bromazolam-related fatalities replacing other novel designer benzodiazepines-related fatalities in San Francisco.

Bromazolam, a novel designer benzodiazepine (NBD), exhibits potent sedative, hypnotic and anxiolytic effects, raising concerns regarding its potential for misuse and fatal outcomes, particularly when combined with opioids such as fentanyl. Despite limited documented fatalities globally, its use poses a significant threat, exacerbated by under-reporting and a lack of routine testing. This study analysed NBD-related deaths in a major US city over a 4-year period. Analysis of accidental overdose deaths involving NBDs in San Francisco, CA, USA from 2020 to 2023, was performed utilizing medico-legal death investigations including comprehensive forensic toxicology, pathology and demographic information. San Francisco conducts thorough investigations into all non-natural and sudden unexpected deaths, including routine alcohol and drug testing of decedents under its jurisdiction, including etizolam, flualprazolam, flubromazolam and bromazolam analysis. There was a sudden surge in bromazolam-related deaths, with 44 fatalities documented in 2023, contrasting with relatively fewer deaths related to other NBDs. Bromazolam fatalities frequently involved co-ingestion with opioids, primarily fentanyl, and stimulants such as methamphetamine and cocaine. Demographic characteristics indicated a predominance of males, with a significant proportion lacking fixed addresses. Blood concentrations of bromazolam increased during the study period, suggesting heightened availability and/or purity in the community. There was a surge in bromazolam-related deaths during 2023 in San Francisco, CA, USA, contrasting with relatively stable numbers of deaths associated with other NBDs over the preceding years. The findings underscore the urgency for enhanced death investigation, testing and reporting to facilitate targeted harm reduction strategies for individuals at risk of bromazolam-related morbidity and mortality.

Improving state medicolegal death investigation: Does system level reform improve public health data concerning drug-related mortality?

In the United States, the governance of unnatural death certification varies greatly by state. Although cross-sectional research has linked mortality data quality with variation in medicolegal death investigation systems across states-especially with regards to drug-related deaths-this relationship has not be sufficiently tested using longitudinal data. This research assesses the impact of system governance reform on the quality of drug mortality data by assessing the impact of transitioning from a coroner system to a medical examiner system on data quality. The research finds no evidence that system-level reform is associated with improved drug-related mortality data quality. These findings suggest that alternative methods should be examined for improving public health data concerning drug-related mortality. These likely include focusing on individual-level characteristics and practices of officials and offices, rather than system-level variables.

Dental Anthropology and Its Role in Forensic Anthropology

Dental anthropology is a subdiscipline of biological anthropology that is concerned with the nonclinical study of teeth. As such, the discipline is distinct from that of forensic odontology, yet still of relevance within forensic anthropology and a medicolegal context. This review of dental anthropology differentiates it as a distinct field of study and highlights its role within medicolegal death investigations, particularly the role of the dentition in estimating parameters of the biological profile. The development and history of dental anthropology in relation to forensic anthropology are outlined. The differentiation of the roles of the dental/forensic anthropologist and the forensic odontologist is discussed. The potential role of the dentition in estimating parameters of the biological profile is discussed, as are the relevant biological processes. Finally, the need for advanced training in dental anthropology is emphasized, as is the potential for future research within this emerging field of study.

Plagues in Our Criminal Justice System

This study compared the causes of wrongful convictions in Canada, the United States, the United Kingdom, Australia, and New Zealand to a) determine the main causes of wrongful convictions in different countries, b) determine if the cause(s) of wrongful convictions significantly differ between each country, c) determine what, if any, recommendations arose from these cases, and d) if any of these recommendations could be implemented in a Canadian setting. The main causes were witness perjury, forensic error, and procedural error (Canada), witness perjury (US), witness perjury and police misconduct (UK), police misconduct (Australia), and procedural error (New Zealand). Kruskal-Wallis tests indicated significant differences in distribution between these countries for medicolegal death investigations, bitemark analysis, procedural error, police misconduct, inadequate legal defence, eyewitness misidentification, and witness perjury. Objectives c and d were addressed through a content analysis resulting in the following five themes emerging: lack of accountability, education, accessibility, discrimination, and post exoneration.

GeoFOR: A collaborative forensic taphonomy database for estimating the postmortem interval

Accurately assessing the postmortem interval (PMI), or the time since death, remains elusive within forensic science research and application. This paper introduces geoFOR, a web-based collaborative application that utilizes ArcGIS and machine learning to deliver improved PMI predictions. The geoFOR application provides a standardized, collaborative forensic taphonomy database that gives practitioners a readily available tool to enter case information that automates the collection of environmental data and delivers a PMI prediction using statistically robust methods. After case submission, the cross-validating machine learning PMI predictive model results in a R² value of 0.82. Contributors receive a predicted PMI with an 80% confidence interval. The geoFOR database currently contains 2529 entries from across the U.S. and includes cases from medicolegal investigations and longitudinal studies from human decomposition facilities. We present the overall findings of the data collected so far and compare results from medicolegal cases and longitudinal studies to highlight previously poorly understood limitations involved in the difficult task of PMI estimation. This novel approach for building a reference dataset of human decomposition is forensically and geographically representative of the realities in which human remains are discovered which allows for continual improvement of PMI estimations as more data is captured. It is our goal that the geoFOR data repository follow the principles of Open Science and be made available to forensic researchers to test, refine, and improve PMI models. Mass collaboration and data sharing can ultimately address enduring issues associated with accurately estimating the PMI within medicolegal death investigations.

Analysis of Medico-legal Death Investigation on Allegations of Elder Abuse in Seattle, Washington

Introduction: Elder abuse is reported in one in six elderly people worldwide, thus, identifying its characteristics is very much crucial. Therefore, this study aimed to describe the characteristics of the decedents, and their complainants and alleged perpetrators in the elderly population in Seattle, Washington over ten years from 2010.Methods: A total of 8,739 medico-legal death investigations in elderly people aged 65 years or older were perused retrospectively at the King County Medical Examiner’s Office in Seattle, Washington. The records (n=161, 002%) contained allegations of elder abuse or neglect and were selected for analysis to describe the characteristics of the decedents, complainants and alleged perpetrators. The data were presented in frequency distributions. The complainants were categorized into five (families, hospice, care facilities, law enforcement and health providers) and alleged perpetrators were categorized into four (families, hospice, care facilities and health providers) and these categories were compared to each other. The presence of pressure ulcers and dementia were described according to the manner of death.Results: Out of 161 cases, the majority (n=97, 60%) were females and the age ranges from 65 to 99 years with a mean of 80 years (standard deviation=6). Most of the deaths were certified as ‘natural’ (n=110, 63%), while, 22 cases (14%) were certified as ‘undetermined’. Most of the complainants were health providers (n=69, 43%). Entities identified as alleged perpetrators were primarily long-term care facilities (n=77, 48%) or families (n=71, 44%). Further, families were less likely to be complainants (n=3, 12%) and more likely to be the alleged perpetrator (n=13, 52%) in deaths certified as ‘undetermined’ (n=25). Long-term care facilities were more likely to be identified as alleged perpetrators in deaths associated with dementia (n=24, 60%). The presence of pressure ulcers was more common (n=14, 56%) than dementia (n=6, 24%) in the ‘undetermined’ manner of death certification.Conclusion: This study demonstrates the importance of a medico-legal death surveillance system. The long-term care facilities and families were identified as alleged perpetrators; therefore, further studies are needed to identify their associated factors. Dementia was under-represented as a potential impetus behind many allegations, thus, conducting prospective studies and neuropathological assessments are recommended. To identify the correlation of racial/socioeconomic disparity, legal consequences on allegations of elder abuse or neglect are required to better understand the context.

Impact of Post-mortem PCR Testing on Lead Time of the Medico-legal Death Investigation. A Retrospective Study During the COVID-19 Pandemic in a Tertiary Care Hospital in Sri Lanka

Introduction: The lead time is defined as the time between the beginning of a process or project and the appearance of its results. A post-mortem nasopharyngeal swab is the preferred specimen and Real-time reverse transcriptase-polymerase chain reaction-based assays remain the “gold standard” for the detection of severe acute respiratory syndrome coronavirus 2. Although the RT-PCR provides a relatively rapid result (average 6 hours) the process of post-mortem specimen collection, transportation, and real-time polymerase chain reaction testing lead to the increased time duration of releasing the deceased to the next of kin. This study aims to assess the effectiveness of the institutional policies governing autopsies adopted during the COVID-19 pandemic at the medico-legal unit of Matale in decreasing the lead time of medico-legal death notification.Methods: This study was conducted at the medico-legal unit of District General Hospital Matale, Sri Lanka. All data was collected from the post-mortem reports and records maintained at MLU of Matale from May 2021 to December 2021. All the post-mortems conducted by the author (442 autopsies) were included.Results: The study population comprised of 283 (64%) males. The majority (30%, n=134) of the decedents were more than 80 years. The mean age of the deceased was 69.20 years and the standard deviation was 17.881. The majority (66%, n=291) of the descendants were Sinhala. The majority of inquests (n= 423, 96%) were conducted by inquire into deaths. In the months of August and October number of autopsies performed had increased 4 times and 3 times respectively to that of the same period in previous years and the following year. Out of the autopsies, 23% (n= 101) of the lead time of autopsy was on the same day of death. In the majority (64 %, 85) of the deaths lead time of autopsy was the next day of the death.Conclusion: During the COVID-19 pandemic, excess mortality was detected, lead time of autopsy was reduced due to the policies adopted by the medico-legal unit. Lessons learned during the pandemic may help improve resource utilization without negatively influencing outcomes in a low-resource setting.

Pathology and forensic science: Dignity, respect, and the dead body

AbstractThis perspective considers the forensic examination of deceased bodies via the medico‐legal autopsy. It is argued that the decisions we make about what we do with, and to, deceased bodies and body parts is, and should be, limited by the need to treat bodies with dignity and respect. The treatment of parts of bodies has been explored in bioethics, substantially due to organ retention scandals bringing this to the public and political attention. But these cases—although important—represent extremes. This perspective therefore focuses on routine death investigations and the extent to which scientific method should be limited because of the competing interests in the deceased body and its treatment. It is argued that how we treat bodies/body parts matters because they represent once‐living people with contexts, histories, and relationships. They had, and perhaps still have, value as human persons. As humans, we share complex relationships and have different views and interpretations of what our duties are to each other. Dignity and respect aid by providing baseline standards, and are reflected as such in professional codes and regulations. However, the system is imbued with sufficient discretion that it is impossible to achieve consistency of standards or practice. This means that the treatment of deceased bodies in forensic science will differ substantially depending on both context and the practitioners involved.This article is categorized under: Forensic Medicine > Medicolegal Death Investigation Systems

Umbilical Cord Tissue: From Antemortem Monitoring to Postmortem Possibilities.

Umbilical cord tissue (UCT) traditionally has been used as an antemortem matrix for identifying and monitoring fetal exposure to drugs suspected to have been used during pregnancy. The specimen offers several advantages as a testable tissue, including accessibility and ease of collection, ample sample volume, a long window of detection, and ability to detect for a wide range of drugs. Despite these advantages, little to no research exists on the use of UCT as a postmortem forensic toxicology specimen. This article aims to provide insights into UCT toxicological testing and infer potential applications for postmortem use, such as investigations into stillbirths and infant abandonment. Umbilical cord tissue offers several benefits as a postmortem toxicological specimen. Importantly, it can be collected with or without an autopsy being performed and may help explain factors that contribute to the underdevelopment and death of the neonate. With the limited sample volumes present in infant investigations, toxicological analysis of UCT could become a valuable tool for neonatal medicolegal death investigations.

Time- and Temperature-Dependent Postmortem ?9-Tetrahydrocannabinol Concentration Changes in Rabbits following Controlled Inhaled Cannabis Administration.

Postmortem redistribution (PMR), a well-known phenomenon in forensic toxicology, can result in substantial changes in drug concentrations after death, depending on the chemical characteristics of the drug, blood collection site, storage conditions of the body and postmortem interval (PMI). Limited PMR data are available for Δ9-tetrahydrocannabinol (THC), the primary psychoactive component in Cannabis sativa. PMR was evaluated after controlled cannabis inhalation via a smoking machine and exposure chamber in New Zealand white rabbits. Necropsies were performed on five control rabbits immediately after euthanasia, whereas 27 others were stored at room temperature (21°C) or refrigerated conditions (4°C) until necropsy at 2, 6, 16, 24 or 36 h after death. THC and its phase I and glucuronidated phase II metabolites were quantified in blood, vitreous humor, urine, bile and tissues by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Under refrigerated temperature, heart blood THC concentrations significantly increased at PMI 2 h in rabbits, whereas peripheral blood THC concentrations showed a significant increase at PMI 16 h. Central:peripheral blood and liver:peripheral blood ratios for THC ranged from 0.13 to 4.1 and 0.28 to 8.9, respectively. Lung revealed the highest THC concentrations, while brain and liver exhibited the most stable THC concentrations over time. This report contributes much needed data to our understanding of postmortem THC behavior and can aid toxicologists in the interpretation of THC concentrations in medicolegal death investigations.

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.