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

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

THE MEDICAL EXAMINER AND PUBLIC HEALTH

In performing individual death investigations, the Medical Examiner obtains information whose aggregate analysis holds potential for public health and intervention, as listed in Table 5.10

The Rhode Island Medical Examiners office is one of seventeen states funded by the Centers for Disease Control and Prevention (CDC) to participate in the National Violent Death Reporting System, which identifies local and national trends and factors pertaining to non-natural death. The Rhode Island Child Death Review Team studies characteristics of child deaths in Rhode Island to identify potentially preventable factors to keep children safe.

Medical examiners offices can detect unusual clusters of deaths or unusual individual deaths. For example, the Rhode Island Medical Examiners Office diagnosed the first death in New England caused by the Hanta virus, a virus found in the rodent population and usually confined to the Southwest United States." In addition, Medical Examiner protocols have been developed to detect signs and symptoms of deaths from possible bioterrorist agents.12

THE MEDICAL EXAMINER IN COURT

The forensic pathologist can be asked to provide medical information in the legal setting.13 Unlike a fact witness, an expert witness is allowed to give expert opinions in his/her area of expertise to help the judge and jury understand the evidence. The rules of evidence require that a medical examiner show that his/her testimony is based upon sufficient facts, data, and information about the case, that reliable and accepted methods were used to establish the facts in his/her area of expertise, and that the accepted scientific methods and principles were correctly applied to analyze the fact of the case. 14

Medical examiners testifying as expert witnesses must present medical information in the legal arena. This can be a challenge, as the cultural differences between law and medicine are magnified at court, especially in the context of cross-examination. For example, an expert may be asked at court to give a yes-or-no answer to a question that requires a complex answer. Although the medical examiner often presents the conclusions of the death investigation at the request of the prosecution (in criminal matters), the facts presented are the same regardless of "which side" asks the questions. The expert must be objective and complete because the stakes are high. In criminal cases, the defendant faces a potentially long confinement, and in civil cases, important matters are decided such as those pertaining to malpractice, life insurance, workers compensation and equity actions.

CONCLUSION

The medical examiner speaks for the dead - who are you, and what, when and how did your death happen? By providing answers to sudden, unexpected and/or violent death in the community, the medical examiner can bring comfort to families and use information obtained from death investigations to promote safe and healthy communities.

REFERENCES

1. Randall B, et al, Forensic Pathology. In Collins K, Hutchins G (editors). Autopsy Performance O" Reporting, 2nd edition, College of American Pathologists, Northfield, IL, 2003.