9781422273470

Pathology Examining the Body for Clues

Crime Scene Collecting Physical Evidence Digital Forensics

Investigating Data DNA Profiling

Linking the Suspect to the Evidence Forensic Anthropology Identifying Human Remains Forensic Chemistry Detecting Drugs and Poisons Forensic Psychology

Probing the Criminal Mind Impression Evidence Identifying Fingerprints, Bite Marks, and Tire Treads Pathology Examining the Body for Clues

By Amy Sterling Casil Pathology Examining the Body for Clues

MASON CREST PH I L ADELPH I A | MI AMI

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Introduction: Uncovering How and Why a Person Died . ..... 7 Chapter 1: The History of Pathology ................................... 17 Chapter 2: Autopsies and Postmortems . ........................... 33 Chapter 3: Determining Cause and Time of Death . ........... 47 Chapter 4: Analyzing Injuries, Trauma, Poisons, and Evidence . ...................................................... 59 Chapter 5: Emerging Technologies and Future of Pathology ............................................................. 73 Series Glossary of Key Terms ................................................. 86 Further Reading & Internet Resources ................................. 90 Index . ........................................................................................ 92 Author’s Biography ................................................................. 95 Credits . ..................................................................................... 96 K E Y I C O N S T O L O O K F O R

Words to Understand: These words with their easy-to-understand definitions will increase reader’s understanding of the text while building vocabulary skills. Sidebars: This boxed material within the main text allows readers to build knowledge, gain insights, explore possibilities, and broaden their perspectives by weaving together additional information to provide realistic and holistic perspectives. Educational Videos: Readers can view videos by scanning our QR codes, providing them with additional educational content to supplement the text.

Text-Dependent Questions: These questions send the reader back to the text for more careful attention to the evidence presented there.

Research Projects: Readers are pointed toward areas of further inquiry connected to each chapter. Suggestions are provided for projects that encourage deeper research and analysis. Series Glossary of Key Terms: This back-of-the-book glossary contains terminology used throughout this series. Words found here increase the reader’s ability to read and comprehend higher-level books and articles in this field.

Forensic pathologists are also called “medical examiners.”

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Forensic pathology is a specialty of the broader field of pathology, the study of disease. According to the Royal College of Pathologists in Great Britain, “pathology is the bridge between science and medicine.” Forensic pathologists apply their scientific and medical knowledge in service of the law. Their primary duty is to investigate the cause and manner of death as part of the legal process. Forensic pathologists are also called “medical examiners.” They conduct autopsies on people who have died. “Autopsy” is the formal word for the examination of a dead person’s body. The word “autopsy” comes from Greek, meaning “to see for one’s self.” An autopsy involves a formal medical examination of a body and its organs and fluids. It can be conducted for medical purposes as well as legal purposes. When the legal system is involved, the autopsy is called a “forensic autopsy.” Not all autopsies are conducted to find out whether a crime has been committed. Some are conducted to learn the cause and A forensic pathologist is a physician who has been trained in forensics and in pathology. After completing the requirements to be admitted to medical school, they must complete medical school, then perform an internship and residency to become a pathologist. It takes a minimum of eleven years of undergraduate and medical school education and training to become a forensic pathologist. The usual path for medical school is an undergraduate or bachelor’s degree in biology or another pre-med science program, then four years of medical school, an internship, and then three years of residency before a person can become a licensed forensic pathologist. The American Board of Pathology certifies forensic pathologists in the United States. It requires candidates to have completed four years in an accredited medical school or school of osteopathy and to have a manner of death when it’s not known. Education Requirements

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current, valid medical license in a U.S. state or Canadian province. Forensic pathology interns and residents train under qualified forensic pathologists and complete a graduate education program in a pathology subspecialty. A Day in the Life of a Forensic Pathologist Dr. Judy Melinek has been a forensic pathologist for over sixteen years. She is the co-author of a book about her experiences in the New York Medical Examiner’s office, entitled Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner . Dr. Melinek wrote the book together with her husband, T.J. Mitchell, a professional writer. She started her career in medicine as a surgeon but decided to switch to being a medical examiner because of the long and difficult hours required for her surgical internship. Being a medical examiner allowed her to have more flexible hours. On a typical day, Dr. Melinek gets to her office around 8:30 a.m. She meets with her colleagues and reviews reports from crime scene investigators. The reports describe the details surrounding the deaths of people from the previous day. Her office can sometimes certify the cause and manner of death without an autopsy, depending on the report and the situation. Autopsies are performed between 9:00 a.m. and noon, and Melinek and her colleagues prepare reports in the afternoon. A few times a month, the pathologists will leave the morgue to work with police investigators to determine whether a case is a homicide or another manner of death. Dr. Melinek is both a medical examiner working for her local government and the owner and operator of her own company that provides private forensic consulting. She works about three days a week in the coroner’s office and morgue and provides private consulting during the other days. She can work anywhere between twenty and forty hours per week, depending on the demand for her expertise. Dr. Melinek says that curiosity and a desire to learn are at the heart of her career. Forensic pathologists have to stay on top of many different fields of medicine and crime scene investigation. They need to be problem solvers and should be willing to follow up on their investigations, no matter where they lead. Dr. Melinek told aspiring doctors, “One thing I love about forensic pathology is that, compared with other medical specialties, we doctors can ‘have a life’ and still be able to meet the expectations of our job.”

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Forensic pathologists have to stay on top of many different fields of medicine and crime scene investigation.

Pathologists as Celebrities It might be hard to imagine that a medical examiner who performs postmortem exams could become a celebrity, but people are fascinated by death and the people who can explain what caused it—and, sometimes, what could prevent it. The first celebrity pathologist was a British doctor, Sir Bernard Spilsbury, who identified scar tissue from a piece of flesh found in a London cellar. His identification matched the description of Dr. Hawley Harvey Crippen’s missing wife, Cora, resulting in the conviction and execution of the doctor. At the time of his apprehension, Dr. Crippen was on his way to New York on a cruise ship with his lover, Ethel Le Neve, who had disguised herself as a boy. Dr. Crippen became the first murderer to be apprehended by telegraph when he was identified on the ship by a suspicious telegraph operator, who contacted the British authorities. Dr. Crippen was detained

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Introduction: Uncovering How and Why a Person Died

when the ship landed in Canada and returned to England, where he was tried, convicted, and hanged for his wife’s murder. Spilsbury went on to testify in dozens of murder cases and was noted for his domineering demeanor in the courtroom. Another pathologist who gained fame, although for controversial reasons, was Dr. Jack Kevorkian, also called “Dr. Death.” Kevorkian wasn’t famous for his postmortem exams but for performing euthanasia, or assisted suicide, on terminally ill patients who he said requested him to help them die without pain. Dr. Kevorkian was eventually convicted of second-degree murder and served eight years in prison. Dr. Cyril Wecht often appears on television commenting on murder cases. He was the Allegheny County Coroner and Medical Examiner and former president of the American Academy of Forensic Science. He is best known for questioning the autopsy procedures after the death of President John F. Kennedy. Dr. Michael Baden is the host of the HBO show Autopsy and, like Dr. Wecht, often appears on television, including serving as the “Death Correspondent” for Fox News. Dr. Baden has written many articles and books on forensic pathology as well as forensic thrillers. He has provided expert testimony in cases surrounding famous assassinations, including those of Dr. Martin Luther King Jr. and President John F. Kennedy. He observed the 2019 autopsy of accused pedophile billionaire Jeffrey Epstein at the request of Epstein’s brother and disputed the official finding of the New York City chief medical examiner that the manner of Epstein’s death was suicide, concluding instead that it was homicide. Dr. Jan Garavaglia appeared in the Discovery Channel series Dr. G: Medical Examiner between 2004 and 2012, while she served as the chief medical examiner for Orlando, Florida. Dr. G earned a faithful audience for her fact-based, empathetic presentations of autopsies and communication with surviving family members. Her book How Not to Die: Surprising Lessons on Living Longer, Safer, and Healthier was a bestseller, and she has been named “America’s Favorite Medical Examiner.” Ethical and Legal Responsibilities Forensic pathologists and medical examiners work with bodies that were once living people. Even though the bodies are dead, these people and their surviving family members still have rights. Family members

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Pathology

A pathologist who gained fame, although for controversial reasons, was Dr. Jack Kevorkian, also called “Dr. Death,” who was an active proponent of physician-assisted suicide.

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Introduction: Uncovering How and Why a Person Died

Forensic pathologists are responsible for signing death certificates and determining the cause of death.

are understandably traumatized by the death of a loved one, and they naturally desire closure. Often, family members want to know how their loved one died, even if the answer is not the most pleasant one. As a medico-legal specialty, forensic pathology has responsibilities to both the legal system and the healthcare system. The legal responsibilities of medical examiners involve maintaining chain of custody over evidence, performing autopsies to the standards prescribed by their state regulators and working with law enforcement to gather information that can help to solve crimes. They are formally responsible for signing death certificates and determining both the cause and manner of death whenever possible. Medical examiners are also responsible for maintaining the privacy of autopsies and their results. Law enforcement and family members are

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entitled to receive autopsy reports, but when controversial or celebrity deaths are involved, the risk of releasing confidential information to the public rises. As one example, when the famous musician Prince died in Minnesota in 2016, information about his toxicology report was leaked to news media before his family or investigators were notified. Some of the information was incorrect, and the end result was harm to his death investigation and the ultimate conclusions of the medical examiner, as well as pain and suffering caused to his surviving family members. Medical examiners need to maintain confidentiality of medical records under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and must follow their state’s laws regarding how much information may be released to the public from their autopsy reports and when the information may be released. Career Opportunities Most forensic pathologists are government employees. They work for city, county, or state governments, and some medical examiners also may work for branches of the military, which is part of the federal government. For example, the Office of the Armed Forces Medical Examiner is responsible for determining the cause and manner of death for all active duty military members who die while in active service. Medical examiners can also work as part of hospital or clinic systems, usually in teaching hospitals in major cities. In some areas, hospitals may offer forensic pathology services to their local government on a contract basis. Medical examiners can also work as consultants for attorneys or travel to other countries to consult in postmortem exams and criminal cases. Private autopsies are a rapidly growing specialty. If family members are not satisfied with the results of an autopsy conducted by their local coroner’s office, they can contract with a forensic pathologist for a private autopsy to learn additional information about their loved one’s cause and manner of death. Salaries for forensic pathologists can range from $150,000 per year up to $500,000 per year. Their services are in demand. There was a shortage of between 500 and 1,000 forensic pathologists in the United States as of 2020, probably because of the many years of education and training needed to become certified in the medico-legal specialty.

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Introduction: Uncovering How and Why a Person Died

Medical examiners work in the morgue or coroner’s office.

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