RHODE ISLAND OFFICE OF THE STATE MEDICAL EXAMINER: PATHOLOGY IN THE PUBLIC INTEREST

Medicine and Health Rhode Island, Sep 2005 by Laposata, Elizabeth A

Records received from outside sources are not re-released to any party and must be obtained from die original source. The fornesic pathologist will come to as prompt a decision as the facts and circumstances allow, or readily explain the time required for other testing and study.

THE MEDICO-LEGAL AUTOPSY

For an individual under a physician's care dying of disease in a hospital, hospital pathologists perform an autopsy only when permission is obtained from the next of kin. The hospital pathologist assesses clinicopathologic correlations, supports medical education and contributes to medical research on disease and treatments depending on family wishes. The disease process and cause of death are rarely a mystery.

The goals of the forensic autopsy are different from the hospital autopsy because the law mandates that it be performed in cases where the cause or circumstance of death may be other than natural. Next- of-kin permission is not required. Surgical incisions do not alter the appearance of the deceased and allow for embalming and viewing at the funeral home.6,7

In some cases, the cause of death may be obvious, such as a gunshot wound. But even in these cases, the postmortem examination helps reconstruct the circumstances of death and supports investigation by police. For example, establishing the tract of a gunshot wound through the body can determine whether any purposeful activities occurred after injury, or determine time to incapacitation, unconsciousness, and death. Thus, the victim of a gunshot wound whose autopsy showed that the bullet transected the spinal column would not be expected to run several blocks. Police use this information to assess the veracity of eyewitness reports. Moreover, the rifling marks on a projectile recovered at autopsy can be matched to a particular handgun, thus identifying the murder weapon. In other cases, the study and documentation of injury patterns can place individuals in specific positions as occupants of motor vehicles, fix the positions of pedestrians when struck, or determine how safety devices may have failed or were circumvented in workplace fatalities. When remains are decomposed or skeletonized, determining the cause of death and establishing positive identification can be challenging.

When the medico-legal postmortem examination preserves items of potential evidentiary value, the forensic pathologist initiates a chain of custody to transfer evidence; e.g., cardiac pacemakers, medication pumps, apnea monitors, child safety seats, and scuba diving equipment. Trace evidence collected from the body may include dried secretion, hairs, fibers, body fluids and tissue samples. Sample collection can include the use of an alternative light source or a postmortem sexual assault kit.

THE CAUSE OF DEATH AND MEDICO-LEGAL LOGIC

Death analysis is rarely addressed in medical school curricula. Important components in forensic pathology training include the acquisition of a medico-legal vocabulary and the ability to apply the concepts embodied in the vocabulary to the evaluation of autopsies.8,9