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78 5 Death Certification use involves an attempt to determine the “baseline” health and activity level of the individual prior to the injury. Establishing this baseline involves interviewing health care workers and perhaps others, and reviewing relevant medical records. The forensic pathologist then attempts to determine whether or not the individual improved following the injury such that he/she made it back to his/her baseline status prior to death. If the person returned to baseline status prior to death, then it is reasonable to conclude that the injury did not play a role in the death. On the other hand, if the person never returned to baseline status, but ended up dying before fully recovering from the injury, then it is reasonable to conclude that the injury did, in fact, contribute to death, if not directly, then certainly as an added stressor for someone with underlying significant natural disease. When a person’s baseline status is steadily headed downward prior to the injury, and the person showed definite signs of improvement from the injury prior to death, but not back to the baseline that existed immediately before the injury, then it becomes very difficult to make a definitive ruling, because one cannot be sure of where the person’s baseline would have been if there had not been an injury. In certain jurisdictions, other options are available for MOD rulings. In some regions, a therapeutic complication MOD is available to use for deaths that result from the adverse effects of medical therapy. Readers are referred to Chapter 21 for further discussion of death related to medical therapy. In some jurisdictions, there is an unclassified MOD, which is used for recreational drug abuse deaths, since neither suicide nor accident (an unforeseen event) are very good descriptors of these deaths. In the majority of jurisdictions, these other MOD options are not available for use on death certificates. Another important point regarding MOD rulings deserves reiteration. Manner of death rulings should be considered medical opinion statements used for statistical purposes. No entity (insurance companies, prosecutors, courts, etc.) is legally bound to agree with such rulings, and the terms accident and homicide should not be equated with various legal terminology. For example, a MOD ruling of homicide does not necessarily equate to the legal term murder. Specifically with regard to the example provided above within the “cause of death” section wherein a man was forcibly restrained by police officers, if the restraint is considered contributory to death, even if underlying cocaine-induced excited delirium is considered the major factor in death, it is appropriate to rule such a death a “homicide.” This does not necessarily mean that the police were “out of line,” but only that the police officers’ actions were considered contributory to death. Certainly, in a similar scenario, wherein a person resisting arrest is subsequently shot and killed by police officers, there is no question that such a case represents a homicide. Whether or not it represents a “murder” or whether or not such a shooting is “justified” is not for the medicolegal death investigation community to decide. Such questions and their subsequent answers are best left to the courts. In addition to the fact that no one is required to necessarily agree with or be bound by a MOD ruling, another fact regarding MOD rulings is that a variety of case types do not “fit nicely” into a particular MOD category. As such, there can be considerable debate regarding how to appropriately rule the MOD in certain case types. For
Selected References 79 these reasons, some within the forensic pathology community have suggested that the MOD part of the death certification process be eliminated. Disc Image Legends Disc Image 5.1 Examples of other types of medical questions asked on death certificates. Disc Image 5.2 Funeral homes must provide specific information about the funeral home itself, as well as the disposition of the body. Disc Image 5.3 Examples of other information required to be completed by the funeral home. Selected References Cingolani M, Tsakri D. Planned complex suicides: report of three cases. Am J Forensic Med Pathol 2000;21:255–60. Davis GG. Mind your manners. Part I: history of death certification and manner of death classification. Am J Forensic Med Pathol 1997;18:219–23. Davis JH. Can sudden cardiac death be murder? JForensicSci1978;23(2):384–7. Gill JR, Goldfeder LB, Hirsch CS. Use of “therapeutic complication” as a manner of death. J Forensic Sci 2006;51:1127–33. Goodin J, Hanzlick R. Mind your manners. Part II: general results from the National Association of Medical Examiners manner of death questionnaire, 1995. Am J Forensic Med Pathol 1997;18:224–7. Hanzlick R, Goodin J. Mind your manners. Part III: individual scenario results and discussion of the National Association of Medical Examiners manner of death questionnaire, 1995. Am J Forensic Med Pathol 1997;18:228–45. Hanzlick R, Hunsaker JH, Davis GJ. A guide for manner of death classification. St. Louis, MO: National Association of Medical Examiners, 2001. Hanzlick RL Medical Certification of Death and Cause-of-death Statements. In: Froede RC, editor. Handbook of Forensic Pathology, 2nd Edition. College of American Pathologists, Northfield, IL; 2003. Hanzlick R Death Certification. In: Basic Competencies in Forensic Pathology – A Forensic Pathology Primer. College of American Pathologists; Northfield, IL; 2006. Hirsch CS, Flommenbaum M. Problem-solving in death certification. ASCP Check Sample 1995;FP95-1:1–31. U.S. Standard Death Certificate. http://www.cdc.gov/nchs/data/dvs/DEATH11-03final-acc.pdf. Viewed on 7/23/08.
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Forensic Pathology for Police, Deat
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Joseph Prahlow Indiana University S
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vi Dedication accepted the free gif
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viii Foreword quality photographs i
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x Acknowledgements Counties, as wel
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Contents Part I Introductory Topics
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Contents xv Hepatobiliary System .
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Contents xvii RespiratorySystem....
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Contents xix Mercury ..............
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Contents xxi Strangulation . ......
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Contents xxiii Negligence/Neglect .
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About the Author Joseph A. Prahlow,
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Chapter 1 Introduction to Pathology
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Introduction to Pathology 5 Table 1
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Introduction to Pathology 7 Fig. 1.
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Introduction to Pathology 9 Fig. 1.
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Introduction to Pathology 11 Fig. 1
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Introduction to Pathology 13 Fig. 1
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Selected References 15 Disc Image L
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18 2 Introduction to Forensic Scien
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Page 54 and 55: 28 2 Introduction to Forensic Scien
Page 61 and 62: Chapter 3 Introduction to Forensic
Page 63 and 64: Duties of the Forensic Pathologist
Page 69 and 70: Training and Qualifications of Fore
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Page 73: Selected References 47 Selected Ref
Page 76 and 77: 50 4 Death Investigation Death Inve
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Page 82 and 83: 56 4 Death Investigation Fig. 4.2 A
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Page 107 and 108: Chapter 6 Overview of Anatomy and P
Page 109 and 110: Introduction 83 Table 6.1 (continue
Page 115 and 116: Introduction 89 Term Definition Tab
Page 117 and 118: Introduction 91 “mucous membranes
Page 119 and 120: Specific Organ Systems 93 functions
Page 121 and 122: Specific Organ Systems 95 Fig. 6.2
Page 123 and 124: Specific Organ Systems 97 Microscop
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Part II General Topics in Forensic
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130 7 The Postmortem Forensic Exami
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Chapter 8 Postmortem Changes and Ti
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Early Postmortem Changes 165 Fig. 8
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Early Postmortem Changes 167 can be
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Decomposition 169 exposed to sunlig
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Decomposition 171 Fig. 8.8 As decom
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Decomposition 173 Fig. 8.12 As deco
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Decomposition 175 Fig. 8.16 If flie
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Postmortem Injuries 177 Fig. 8.20 I
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Time of Death Estimation 179 Time o
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Time of Death Estimation 181 Fig. 8
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Disc Image Legends 183 Disc Image 8
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Chapter 9 Identification of Human R
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Introduction 187 Fig. 9.2 Badly dec
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Common, Non-scientific Methods of I
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Scientific Methods of Identificatio
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Scientific Methods of Identificatio
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Identification Based on Other Uniqu
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Identification Based on Other Uniqu
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Unidentified Remains 199 Fig. 9.16
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Selected References 201 Disc Image
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Chapter 10 Natural Deaths One man d
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Infectious Disease 207 to as “hyp
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Cardiovascular System 209 refers to
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Cardiovascular System 211 related t
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Cardiovascular System 213 heart int
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Cardiovascular System 215 Aortic An
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Cardiovascular System 217 Vasculiti
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Cardiovascular System 219 Valve Dis
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Cardiovascular System 221 Fig. 10.1
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Central Nervous System 223 Neoplast
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Central Nervous System 225 Viral en
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Central Nervous System 227 Spontane
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Respiratory System 229 Fig. 10.18 T
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Respiratory System 231 Pulmonary Th
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Respiratory System 233 identificati
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Respiratory System 235 Chronic Lung
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Gastrointestinal and Hepatobiliary
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Gastrointestinal and Hepatobiliary
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Reticuloendothelial and Immune Syst
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Endocrine System 243 infection, dis
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Multisystem and Other Disorders 245
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Selected References 255 Fineschi V,
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258 11 Drug-Related and Toxin-Relat
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Chapter 12 Blunt Force Injury Death
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Classification of Blunt Force Injur
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Blunt Force Head and Neck Trauma 31
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Special Topics Related to Blunt For
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Selected References 335 Toro K, Szl
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338 13 Gunshot Wound Deaths shotgun
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340 13 Gunshot Wound Deaths Fig. 13
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346 13 Gunshot Wound Deaths targets
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348 13 Gunshot Wound Deaths (a) (b)
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350 13 Gunshot Wound Deaths Image 1
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354 13 Gunshot Wound Deaths Miscell
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362 13 Gunshot Wound Deaths may be
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368 13 Gunshot Wound Deaths X-Rays
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370 13 Gunshot Wound Deaths left-ha
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372 13 Gunshot Wound Deaths NYCLAD
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374 13 Gunshot Wound Deaths Disc Im
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376 13 Gunshot Wound Deaths Disc Im
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Chapter 14 Sharp Force Injury Death
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Stab Wounds 381 to describe the sha
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Stab Wounds 383 describing “clust
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Incised Wounds 385 Fig. 14.9 A supe
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Incised Wounds 387 Although knives
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Special Issues 389 Fig. 14.16 A sta
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Special Issues 391 Defensive Wounds
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Special Issues 393 disorders; howev
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Special Issues 395 area of “radio
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Special Issues 397 Artifacts A fina
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Selected References 399 Disc Image
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Chapter 15 Asphyxial Deaths So Juda
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Suffocation 403 Fig. 15.1 Petechiae
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Suffocation 405 Certification of th
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Suffocation 407 usual occluding sub
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Suffocation 409 being able to expan
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Neck Compression (Strangulation) 41
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Chemical Asphyxia 419 the object ha
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Chemical Asphyxia 421 Fig. 15.21 A
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Other Issues 423 to function proper
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Other Issues 425 (a) (b) Fig. 15.24
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Other Issues 427 the arms/hands bou
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Selected References 431 Prahlow JA,
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434 16 Drowning Physiology and Mech
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436 16 Drowning Fig. 16.2 Thedriver
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438 16 Drowning Fig. 16.4 “Cadave
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440 16 Drowning Finding water withi
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442 16 Drowning Fig. 16.10 Marked d
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444 16 Drowning Fig. 16.14 True ant
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446 16 Drowning Manner of Death A l
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448 16 Drowning Pachar JV, Cameron
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450 17 Electrical Deaths Fig. 17.1
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452 17 Electrical Deaths required f
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454 17 Electrical Deaths death (Fig
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466 17 Electrical Deaths Disc Image
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Chapter 18 Temperature-Related Deat
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Hypothermia 471 constrict, thus con
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Hypothermia 473 Fig. 18.3 Prominent
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Hyperthermia 475 Toxicology testing
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Hyperthermia 477 Fig. 18.8 A 24-yea
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Selected References 479 disease. In
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Chapter 19 Burns and Fire-Related D
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Introduction 483 Fig. 19.3 Example
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Burn Types 485 Fig. 19.5 A postmort
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Burn Types 487 Chemical Burns As me
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Fire Deaths 489 Fire burns represen
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Fire Deaths 491 Fig. 19.11 Dense so
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Fire Deaths 493 Fig. 19.13 Multiple
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Fire Deaths 495 a CO test or an ins
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Fire Deaths 497 Fig. 19.20 Atrue an
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Disc Image Legends 499 Disc Image L
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Chapter 20 Deaths in Infancy and Ch
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Discarded Fetuses/Infants and Fetal
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Discarded Fetuses/Infants and Fetal
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Birth-Related Infant Deaths 507 abr
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Infant Deaths 509 Fig. 20.3 A diaph
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Infant Deaths 511 Fig. 20.6 The pre
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Natural Death in Childhood 513 path
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Accidental Childhood Deaths 515 pon
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Homicidal Childhood Deaths 517 occu
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Homicidal Childhood Deaths 519 Fig.
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Homicidal Childhood Deaths 521 in a
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Classification of Childhood Homicid
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Pediatric Autopsy Considerations 53
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Disc Image Legends 535 Disc Image L
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Selected References 537 Selected Re
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540 21 Miscellaneous Topics Aircraf
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542 21 Miscellaneous Topics CAMI to
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544 21 Miscellaneous Topics To summ
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546 21 Miscellaneous Topics typical
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548 21 Miscellaneous Topics quite o
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550 21 Miscellaneous Topics Fig. 21
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552 21 Miscellaneous Topics The emb
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554 21 Miscellaneous Topics various
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556 21 Miscellaneous Topics stress
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560 21 Miscellaneous Topics ampheta
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562 21 Miscellaneous Topics victim
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564 21 Miscellaneous Topics more se
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568 21 Miscellaneous Topics Organ a
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572 21 Miscellaneous Topics region
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574 21 Miscellaneous Topics Regardi
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576 21 Miscellaneous Topics and lar
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578 21 Miscellaneous Topics some wo
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580 21 Miscellaneous Topics Non-ion
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582 21 Miscellaneous Topics Yersini
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584 21 Miscellaneous Topics water (
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586 21 Miscellaneous Topics to gene
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588 21 Miscellaneous Topics Disc Im
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590 21 Miscellaneous Topics Leclair
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Appendix: Additional Resources and
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Index Note: The letters ‘f’ and
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Index 597 Arnold-Chiari malformatio
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Index 599 closed head injuries, 311
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Index 601 immediate, 68 intermediar
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Index 603 liver demonstrating cirrh
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Index 605 Death investigation syste
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Index 607 pressure related processe
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Index 609 bridging veins, 316 dura
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Index 611 brain, serially-sectioned
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Index 613 Gestational DM, 247 Gesta
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Index 615 Homicide(s), 444 by heart
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Index 617 Infant death, 501-502, 50
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Index 619 Material Safety Data Shee
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Index 621 CNS, 223-229 cerebral pal
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Index 623 Over-the-counter (OTC), 2
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Index 625 Pregnancy-related materna
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Index 627 industrial settings, 486
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Index 629 Smoke and soot inhalation
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Index 631 Thrombophlebitis, inflamm
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