Forensic pathology: separating fact from fiction - Clinical Issues

Medical Laboratory Observer, August, 2003 by Deborah G. Johnson

Not since Quincy, M.E. has there been such interest in forensic science and the medico-legal system. A proliferation of television programs and movies, both documentary and fiction, claim to show viewers the behind-the-scenes activities of forensic pathologists and scientists. These "miracle workers" supposedly can find that crucial bit of evidence that ties the perpetrator to the crime, allowing for the perp's discovery, arrest and conviction--all in 60 minutes (50, not counting commercials). Those of us who work in this field, therefore, find that when we are called to court to testify, we must overcome many misconceptions about what can and cannot be attested to. We often disappoint jurors--not to mention the attorneys who subpoena us--who wonder if doctors or criminalists are behind the times; otherwise, we would speak with more decisiveness about the time of death, the time of injury, or even the cause and manner of death, as do those famous fictional pathologists and scientists.

Television depictions of forensic disciplines--whether it is one of the criminalists in CSI or Dr. Jordan Cavanaugh in Crossing Jordan--give the impression that the main character alone does the work that 10 or 20 other people together do in the real world. In reality, many experts are summoned to help on each case. Most forensic pathologists and criminalists do not go around chasing after and interviewing suspects for the simple reasons that, first, they lack the time, but more importantly, they lack the training. Evidence gained through an improper interview, for example, can later be dismissed outright in court if it was not obtained properly. Conducting a proper interview is as much a skill as conducting a proper autopsy, and the specialists, the homicide detectives, do those interviews. Toxicologists examine bodily specimens for drugs. Microbiologists work up blood and tissue cultures. Chemists analyze the vitreous humor for electrolytes and glucose. Blood may be sent to the nearest serology laboratory to rule out hepatitis or HIV. Fire debris analysts identify fuels used to start an arson fire. Trace analysts look at hair and fibers. Firearms and tool-mark examiners scrutinize guns, bullets, footprints, tire tracks and the tiniest scratches made to force a door. No one person is going to have all these skills. These are all specialty areas that take a great deal of training.

In the real world, the body is under the jurisdiction of the coroner or medical examiner (ME) from the moment of death until he chooses to release jurisdiction to somebody else. In the real world, the victim's hands would not be cut off at the crime scene and taken back to the lab for a fingerprint ID, as did Angelina Jolie's beat-cop character depicted in the film The Bone Collector. This might happen in the real world after the autopsy, if the decomposed or mummified fingers need to be soaked or somehow manipulated to get a decent set of prints--but not until the pathologist has examined them first. The detective also would not be found rifling the pockets of the deceased for a driver's license and other possessions, as do TV detectives on Law and Order, unless the coroner or ME gives permission. The general rule is that whatever is on the body is the coroner's, and whatever is lying around the crime scene--even if it once was on the body--belongs to the police.

Defining forensic pathology

What is forensic pathology? This is the first question the prosecutor will ask after the pathologist gets on the stand, after the usual questions about his name and employment. Since the average juror may not really be sure just what a pathologist does, my personal initial response is always that we must define pathology. Pathology is literally the study of disease. Forensic pathology applies what is known about disease, along with all of medical science, to legal problems. In the United States, forensic pathology is a recognized subspecialty of the larger specialty of anatomic pathology. As such, this field has its own board-certification exams given by the American Board of Pathology, which can only be taken by doctors who have already passed the anatomic pathology boards. Many forensic pathologists are also board-certified in clinical pathology, as well. In the past, any board-certified anatomic pathologist with two years of experience in the field could sit for the forensic exam. Today, only pathologists who have successfully completed an accredited forensic pathology fellowship may take the exam. No one seems to know exactly how many pathologists consider themselves forensic pathologists and are doing forensic autopsies, but the results of a survey conducted in 2000 indicated the number of active board-certified forensic pathologists at that time was around 700. Two-thirds were employed in or under contract to ME or coroner systems, while about a fourth were in private practice or consultation. (1)

The primary role of the forensic pathologist is to determine the cause and manner of death. In most jurisdictions, the manner of death is limited to one of five categories: homicide, suicide, accident, natural and undetermined. Another equally important duty of the forensic pathologist is to make sure that the deceased is correctly identified. This can be as simple as visual identification of the deceased by a family member or friend, or comparison with a driver's license photograph. In other cases, if no family or friends are around, fingerprints can be used, as long as there are any that were made antemortem that can be obtained for comparison. This requires the services of the local police crime lab and its fingerprint experts. Burn victims, terribly decomposed bodies and skeletal remains may require the services of a forensic odontologist to compare dental records or, lacking those, a forensic anthropologist to evaluate the bones for determination of sex, age and ethnicity. The anthropologist is also invaluable in determining if there are subtle signs of injury to bones that might suggest a violent death. If there is usable tissue, a DNA lab can make the identification, if comparison DNA can be found. Plainly, the forensic pathologist does not work alone; he needs a whole host of other experts to help.