Forensic Pathology for Police - Brainshare Public Online Library

586 21 Miscellaneous Topics
to general anesthesia; an allergic reaction to a medication. It should be noted that
in some cases where “accident” is used, a true mistake (which theoretically might
have been prevented) has occurred, but in others, a truly unforeseen (and theoretically
unavoidable) event has taken place. The term “accident” as used in a MOD
ruling should not be misinterpreted as suggesting that a mistake or “malpractice”
has occurred.
Unfortunately, even when a pathologist attempts to employ a fairly detailed “protocol”
or methodology when evaluating deaths related to medical intervention, there
will always be cases that are quite problematic. Each case must be evaluated on its
own merits. If a definitive ruling cannot be made, because of various factors or
issues, it is appropriate to rule such cases as “undetermined.”
Depending on the case, a variety of special inquiries and procedures should be
considered when a therapy-related death is suspected. These include: establish a
protocol that asks hospitals to leave all medical devices on/in bodies after death,
obtain copies of medical records, contact and discuss the case with involved persons
(physician, nurse, etc.), document all conversations, consider collecting samples
from the hospital lab for further testing, learn as much as possible about any procedure
or device that is alleged to have been involved in death, anticipate questions,
document (written and photograph) all findings (including pertinent negatives) at
autopsy, consider retaining any medical device thought to be involved in death,
consider collecting and retaining additional tissue/fluid samples in a possible toxicology
case, consider implementing specialized X-rays or dissection procedures as
described above, and avoid making statements regarding “standard of care” issues
that are outside your area of expertise.
If a drug or medical device is implicated in death, it is appropriate to
report the death to the Food and Drug Administration (FDA) or the Consumer
Product Safety Commission (CPSC), depending on which agency has jurisdiction
over the device. The contact information for each follows: US Food and
Drug Administration, www.fda.gov, 1-800-FDA-1088. Consumer Product Safety
Commission, www.cpsc.gov, 1-800-638–8095, or email: info@cpsc.gov.
Disc Image Legends
Disc Image 21.1 A pilot from an airplane crash. This is the same pilot depicted in
Fig. 21.2, prior to clothing removal.
Disc Image 21.2 Pilot control injury hand X-ray.
Disc Image 21.3 Rattlesnake bite on index finger. Note the two fang marks (arrows)
(courtesy of the Dallas County Medical Examiners Office, Jeffrey J. Barnard,
Chief Medical Examiner)
Disc Image 21.4 Hemorrhagic discoloration within the heart and lung of a rattlesnake
bite victim. (courtesy of the Dallas County Medical Examiners Office,
Jeffrey J. Barnard, Chief Medical Examiner)