Forensic Pathology for Police - Brainshare Public Online Library

556 21 Miscellaneous Topics
stress associated with the criminal activity of another individual. Physical contact
and/or injury does not have to occur in such cases, and the victim does not necessarily
have to be specifically threatened by the perpetrator. The action of the perpetrator
should be of such severity and have sufficient intent to frighten, injure, or kill, so
as to lead to a charge of homicide if the event had led to lethal injury. Additionally,
the victim should have realized that the threat to personal safety was present, either
to themselves or a loved one or friend. The circumstances of the event should be
of a highly emotional nature. The collapse, and often the subsequent death, must
occur during the emotional response period, even if the criminal act had already
ended. Autopsy should demonstrate heart disease of a type that is commonly associated
with a predisposition to a lethal arrhythmia (irregular heart rhythm) (Disc
Image 21.22). In the absence of such a disease, the case may involve a functional
cardiac disorder, such as a conduction system disorder.
Certain other natural disease processes may contribute to the mechanism of death
in a homicide; ruptured cerebral artery aneurysms or arteriovenous malformations
secondary to head trauma are the most common examples.
In-Custody Deaths
An “in-custody death” refers to any death occurring while a person is in the custody
of a police agency, jail, detention center, or other penal institution. Some expand
the definition to include psychiatric patients (and others) who have been placed in
an institution or hospital against their will. By their very nature, in-custody deaths
should be considered high-profile cases, and as such, those involved in the official
investigation of such deaths should consider implementing the suggestions as
described above in the section entitled “High-Profile Cases.”
In persons who are in police custody or incarcerated, it is generally a good idea to
photographically document the presence or absence of injuries. This should include
overall external photographs of the entire body, as well as some close-ups and some
special shots. Many pathologists take close-up photographs of the wrists and soles
of the feet, both before and after cutting very superficially into the skin and subcutaneous
tissues (Figs. 21.16 and 21.17). If injuries are present (from ligatures or
handcuffs on the wrists or from baton strikes to the soles of the feet), they should
be evident, especially after skin incision. Another photograph that is commonly
taken is a shot of the external genitalia, including one with the scrotum raised (to
view the back and underside) (Disc Image 21.23), again for the purpose of showing
presence or absence of injury. Internally, photographs of the subscalpular area after
scalp reflection, the brain after skull cap removal, and anterior and posterior neck
dissections, will likewise document the presence or absence of injuries.
Occasionally, a person in police custody or a recently-jailed individual will die
of a massive drug overdose, because they have attempted to “hide the evidence” by
swallowing a large quantity of an illegal drug. On internal examination at autopsy,
it is important to inspect and possibly save the gastric (stomach) and/or duodenum