Atlas of Forensic Pathology

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ATLAS OF FORENSIC PATHOLOGY

NEAR MISSES Near Miss #1: Natural disease presenting as motor vehicle accident. When a motor vehicle accident occurs, the first thought is that the decedent sustained injuries in the accident; however, it is very possible for an accident to occur after the decedent sustains a natural death. In Figure 3.4A, the decedent’s car was found impacted against a tree; however, at autopsy, no lethal injuries are identified. The decedent had hyper inflated lungs (Figure 3.4B) and was determined to have had status asthmaticus, and died as a result. PEARLS & PITFALLS Death investigations frequently involve the interactions of two separate agen cies: the coroner or medical examiner (depending upon what type of system the death occurs in) and law enforcement, with each agency having a different focus. Law enforcement identifies and documents crimes and coroners and medical examiners identify and document the cause and manner of death. In the case of a suspected homicide, law enforcement most likely will not let the coroner or medical examiner move the body until they have completed their investigation of the scene, and often will not even allow death investigators onto the scene itself. Unfortunately, such circumstances lend themselves to conflict between agencies, which serves no useful purpose. If the death investigators can develop a rapport with the law enforcement agencies and promote understanding and coopera tion, such as by teaching law enforcement officers how the death investigator’s examination of the body can assist the scene investigation through interpretation of postmortem changes, both parties will benefit. PEARLS & PITFALLS A large component of any death investigation is not actually performed at the scene, but in the form of the acquisition of appropriate records related to the death (eg, medical records, both medical and psychiatric, police reports, 9-1-1 recordings) and interviews with medical providers, law enforcement, family mem bers, friends of the decedent, and witnesses to the terminal event. Depending upon the nature of the death, any one of these forms of records or interviews can be vital to the investigation. For example, a good social history can provide very useful information to confirm a manner of death as suicide.

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A B Figure 3.4. Natural disease presenting as potential accident. While the scene investigation suggested injuries sustained in a motor vehicle accident as the cause of death ( A ), autopsy identified asthma as the cause of death ( B ).