Suggested Guidelines for the Management of High-Profile Fatality Cases

Archives of Pathology & Laboratory Medicine, Oct 2008 by Perper, Joshua A, Juste, Gertrude M, Schueler, Harold E, Motte, Reinhard W, Cina, Stephen J

Context.-The investigation of high-profile fatalities poses special challenges to medical examiners and coroners. Most high-profile cases can be readily recognized early in the course of the investigation. Commonly encountered examples include police-related fatalities or deaths in custody, deaths of celebrities, and mass fatalities or clustered deaths (eg, serial killers). Medical examiner and coroner offices should have policies and procedures in place for adequately handling such cases. A rational approach to these high-profile cases includes activating medical examiner or coroner investigative teams, preplanning before the autopsy, using special autopsy techniques and toxicology procedures, skillful questioning of key witnesses, preparing detailed and comprehensive reports, and planning effective communication with the media.

Objective.-The investigation of the sudden and unexpected death of Anna Nicole Smith, an entertainment personality, is presented as an example of how to address the challenging issues inherent in high-profile fatalities and how to adequately prepare for the forensic investigation of high-profile cases.

Design.-This article presents a methodical approach to the investigation of high-profile deaths.

Results.-A comprehensive, preplanned forensic investigation and autopsy (including use of adjunctive studies) following the death of Anna Nicole Smith resulted in the accurate determination of the cause and manner of her death while adequately convincing the public of the objectivity and reliability of the Medical Examiners Office with respect to its conclusions.

Conclusion.-The forensic investigation of death in highprofile cases can be much more tedious and demanding than the investigation of routine cases. It requires more stringent safekeeping of the body and its evidence, more extensive and sophisticated dissection techniques on occasion, and exhaustive toxicologic analysis to exclude lowprobability allegations. Procedures for honest, unbiased, and judicious communication with outside agencies and the media must be followed. Failure to follow such procedures might have serious consequences for the medical examiner, the family of the deceased, and the community at large. Adherence to these suggested guidelines may resolve most of the intricate problems involved in the investigation of these types of cases.

(Arch Pathol Lab Med. 2008;132:1630-1634)

Television entertainment programs, such as Quincy M.E. and CSI: Crime Scene Investigation, have popularized and glamorized forensic pathology and medicolegal death investigation. It is likely such shows have also cultivated the public infatuation with actual forensic cases, particularly those involving high-profile fatalities. The definition of a high-profile fatality is a death that elicits extensive media coverage through television networks, radio, and the Internet at one or more sociogeographic levels (eg, local, regional, national, international). Cases precipitating extensive, and sometimes excessive, media coverage may include police-related shootings; deaths related temporally to arrest by the police, during police restraint or incapacitation, or when in police custody; deaths in boot camps; deaths of celebrities or deaths in which celebrities are suspects; serial homicides; deaths in schools and colleges; clusters of fatalities; terror-related fatalities; rape and homicide, particularly of minors; mutilation murders; political assassinations; deaths from threatening epidemics; and unusual methods of homicide.

Although medical examiners and coroners (ME/C) can predict that the aforementioned types of cases will be scrutinized in the media, it may not be as easy to predict which "routine" cases will catch the eye of the media and become a high-profile case overnight. A high-profile case may also be created when a forensic pathologist misdiagnoses the cause or manner of death because of failure (1) to satisfactorily investigate the deceased's medical history, (2) to fully evaluate the circumstances of death, or (3) to recognize and correctly interpret pertinent gross, microscopic, or toxicologic findings. Such errors are understandingly magnified when they result in false criminal charges or the conviction of innocent individuals, unjustified exoneration of the guilty, or removal of children from a household because of unfounded allegations of abuse.

A methodical approach to the investigation of high-profile cases, in tandem with high-quality, day-to-day forensic practices, should assist the ME/C in avoiding the pitfalls commonly associated with high-profile cases. A proper and thorough forensic investigation and autopsy is crucial not only in ensuring confidence in the competence and objectivity of the investigative team and its ultimate findings but also in preventing possible outbursts of public violence.

METHODOLOGY

The Broward County Medical Examiners Office (MEO), situated in South Florida (Fort Lauderdale), has been the scene of several high-profile fatalities in recent years. Most recently, the media celebrity Anna Nicole Smith died suddenly and unexpectedly within our jurisdiction. In approaching this fatality, our office developed a plan that was based on a combination of common sense and our collective experience with other high-profile cases, including critical analysis of our previous successes and shortcomings. Our approach to high-profile cases can be illustrated by our response to the death of this international celebrity.