WHERE DO I START? Coroner Evidence

   By: Jennifer Friedman

Modern crime dramas show coroners and medical examiners as

super-humans who perform the role of coroner, doctor and detective all rolled up in one. While this depiction is not completely accurate, there is some truth to it. In order to fully understand the role of the coroner or forensic pathologist, it is important to  understand the history and development of the coroner system.

The coroner system was developed in England and brought to the United States by the colonists in the 1600s.  The coroner was typically an elected official who had many duties one of which was holding inquests.  The coroner was not required to be a medical doctor and more often than not was a member of law enforcement. However, over the years individuals with medical expertise have largely taken over medicolegal investigations and the functions of the coroner have been taken over by medical examiners who are trained forensic pathologists. Nevertheless, there are still counties throughout the country in which the coroner is an elected official with no medical training. In those counties the coroner typically contracts with a private forensic pathology group to perform its autopsies.

It is important to recognize that the coroner /medical examiner is not simply a medical doctor who performs an autopsy and from the autopsy determines the cause of death. In fact, a medical examiner will not give an opinion regarding cause of death without first getting information from the coroner investigator and homicide detective. Very often, the opinion of the medical examiner regarding the manner of death, cause of death and time of death will be based on information obtained directly from the homicide detective as opposed to any particular medical findings observed during the autopsy. For example, forensic pathologist are often asked to estimate the time of death of the decedent. Time of death may be estimated based on a number of changes that take place in the body after death. Without going into detail, the most common physical phenomenon a forensic pathologist will consider are liver or rectal temperature as compared to the ambient temperature (Algor Mortis), postmortem lividity (Livor Mortis), Postmortem rigidity (Rigor Mortis) and stomach contents. However, any medical examiner will tell you that time-of-death estimates depend partly on information provided by detectives, such as the time the decedent was seen alive, when the body was discovered, and possibly other facts that narrow the likely time period. 

So what is the role of the forensic pathologist?  Forensic pathologists perform autopsies. The purpose of the autopsy is to determine the cause of death as well as the manner of death. One of the primary objectives of the forensic pathologist is to try to reconstruct the circumstances and events which led to the death so that the manner of death can be established. The manner of death may be natural cause, accident, suicide, homicide, or undetermined.

This is in stark contrast to the role of a pathologist in a hospital setting. In a hospital setting an autopsy is typically performed to confirm a known or suspected disease and to gain further knowledge of the disease through microscopic examination of the tissue and organs. In an autopsy, the focus is shifted from the internal tissues and organs to an external examination and geared to identifying external and associated internal injuries and their cause or causes. In addition, there is an attempt to discover information relating to identification of the remains, time of death, evidence of drug use, age of injuries as well as other information necessary to a criminal investigation.

In every homicide case there should be an autopsy report. This will be a summary of the findings made during the course of the autopsy. The cause of death as well as a summary of gross findings should appear in the report. It is often useful to consult a medical dictionary when reading the report. In addition, after you have spotted the issues in your case, one of two textbooks should be consulted for further information:Spitz and Fisher's Medicolegal Investigation of Death: Guidelines for the Application of Pathology to Crime Investigation, 3^rd Edition, Werner Spitz, Published by Charles C. Thomas Pub. Ltd. (1993) or Forensic Pathology, 2^nd Edition, Vincent Dimaio, Dominick Dimaio, and Dominick J. DiMaio.

Finally, it is frequently useful to meet with the forensic pathologist who performed the autopsy to discuss with him information he or she has considered and ruled out and why. In addition, frequently a forensic pathologist has opinions regarding issues in your case that are not stated in the autopsy report. This will give you an opportunity to hear these opinions and the ability to evaluate them through the use of your own expert if appropriate.

Preparation

Make an appointment with the resident or DME who conducted the autopsy. Prior to the meeting, jot down a number of questions some of which are important to you others which are not. You need to understand the issues well enough to formulate the questions and understand the answers. Keep in mind that the autopsy report is just that--a report. Seldom will the DME who testifies feel constrained by the report. Take along a colleague to memorialize the conversation.

Finding an Expert in the Appropriate Case with the Appropriate Expertise.

In some cases a forensic pathologist with general pathology training is appropriate. In other case, it will be necessary to obtain an expert with specialized training, for example, a neuro-pathologist or a pediatric pathologist. It may also be necessary to retain a pathologist as well as a medical doctor with a specialty in a particular field, for example, gynecology, or emergency room medicine.