Monday, April 25, 2016

Ethics and the Forensic Expert: What Would You Do?

This article was originally published in Forensic Magazine. To read the original article click here (http://www.forensicmag.com/articles/2016/03/ethics-and-forensic-expert-what-would-you-do)

An attorney asks you to change your report by omitting mention of evidence that is in dispute. Omitting the information does not alter your opinion; in fact, it significantly strengthens it, but this makes you vulnerable to cross-examination if it is admitted. Do you change your report to omit the information?

You are asked to review a civil wrongful-death case for an attorney. You come to the opinion that the attorney's client is lying to him, and is likely to blame in the death of the decedent. The death was certified by the original autopsy physician as an accident, and the client was never charged. After reviewing the records you think this case is a homicide, and that the attorney’s client did it. Your contract with the attorney has a confidentiality clause. Do you break confidentiality to report the crime to the police?

A couple of years ago I was part of a panel of forensic pathologists who formulated these questions and others, and then posed them to both forensic experts and attorneys. We got very different answers from each group. 

Nearly half the attorneys expected their expert to revise the report. Over three-quarters of forensic experts surveyed said they would refuse to do so. And the unreported homicide? Over half of the experts said they would violate confidentiality to report it to police—while over 80% of attorneys expected the experts to stay mum. (The full article is available here: http://store.academicfp.com/the-ethics-of-working-as-a-retained-forensic-expert)

Ethical questions in science and medicine become hot topics in the press when they touch on taboos like sex or death, and when they affect public health and safety. Recent examples include the ethics of caring for the terminally ill at great cost ("death panels") or empowering those same terminal patients to alleviate their own suffering by ending their lives of their own volition ("assisted suicide"). Even the ethical ecology of self-driving cars has come under scrutiny. Do the algorithms employed to keep the driver safe consider collateral damage, maybe lethal, to pedestrians? (more at http://www.technologyreview.com/view/542626/why-self-driving-cars-must-be-programmed-to-kill/). 

Forensic science is popular on television, yet we don't often hear about the ethical challenges that vex forensic experts. One of the few that gained attention in the press in the past year was a story out of Boston in which an assistant district attorney allegedly tried to influence the testimony of a forensic pathologist in a child abuse case. The pathologist felt "bullied" by the attorney to stick to his original determination of homicide, even though the scientific literature and new evidence in the case did not support it. He memorialized his impression in a note in the Medical Examiner's chart, which was eventually released to the defense; he amended the manner of death, and the ADA dropped the charges, but in another child death case the same ADA was barred by a judge from contacting and attempting to influence another medical examiner. (Full article here: https://www.bostonglobe.com/metro/2015/10/12/medical-examiner-notes-suggest-was-bullied/vtEQVvFXJSIzugGayyJvUN/story.html)

It’s common for non-scientists to attempt to influence the outcome of a forensic investigation. In a 2011 survey published in Academic Forensic Pathology (see: https://www.afpjournal.com/nosubscribers/journal/3&y=2013), a quarter of forensic pathologists surveyed reported that they are considered prosecution witnesses within their jurisdiction, with the expectation that they not cooperate with defense counsel. More than 10% related that elected or appointed officials had exerted pressure on doctors to change their testimony or withdraw as an expert in a specific case. Sixty-four percent of government-employed pathologists reported that their job contract imposed limitations on private consultation.

When scientists are forced to testify exclusively for the government, and any defense or outside consult work is viewed as a "conflict of interest,” everyone suffers. The public stops seeing forensic pathologists as impartial, unbiased scientists. We become instead part of a prosecution team that puts people in jail, period. When that's the public perception and someone dies in police custody, it's no wonder that the investigating medical examiners and coroner's pathologists are accused of bias, while the media present the retained expert hired by the family as "independent." It's much harder to be ethical when you are not independent. It is the very essence of our job to speak out in the public interest, even when speaking out puts us in direct conflict with the government that writes our paychecks.

Ethical questions, by their nature, seldom have a single defensible answer. The best course of action may change due to subtle differences in the circumstances of an individual case. Sometimes we make decisions based on the nuances of personal interactions and life experience that can't be quantified in a survey or codified by a commission. Cultural shifts happen over time; what is considered ethical in one place or time might be egregiously wrong in another. 

We must speak publicly and openly and often about the difficult choices we make as forensic professionals so that we can alert other scientists to the challenges they will face in their careers, and educate attorneys and others who interact with forensic scientists about the differences in our training and professional cultures that will spur conflict. We need the public to understand that when science and medicine evolve with advances in research, our culture evolves too, and the definition of what is ethical or what constitutes a conflict of interest will also change. Everyone would like to think that scientific findings are absolute, and that the scientists who testify in court are the purest sort of empirically rigorous professionals—but court testimony is not a laboratory experiment. It is an opinion: a professional, expert opinion that might change over time, or might differ from the opinion held by another, equally scrupulous forensic professional. Forensic science can include an unexpectedly changeable human component when it intersects with a court of law or with the press. It's an ethical requirement of our job to explain to people what we can do, what we cannot, and what we can argue over.

It's not an easy task. Nothing worth doing ever is. Or, rather—I should say—that's my opinion.

Saturday, February 6, 2016

Forensic Radiology and the Medical Examiner

This article was originally published in Forensic Magazine. To read the original article click here (http://www.forensicmag.com/articles/2015/12/forensic-radiology-and-medical-examiner)

It was the first time I had to testify in a case without a dead body. The patient was a 30 year-old Hispanic man who got into a fight with another guy on the street. The emergency room physician told me "it looked like someone tap danced on his face." He had severe facial injuries, including a jaw fracture and bruises that had swollen his eyes shut. He lay unconscious in the hospital for a week, and when he came to, he couldn't remember what had happened—not uncommon with brain-injured patients. Witnesses heard shouting and saw the other guy run away, but didn't witness any beating. When the hospital doctors couldn’t tell the DA how many times the victim was struck, the DA called the Office of the Chief Medical Examiner for a forensic assessment.
I got the man’s medical records and started poring through them, seeking out the times that someone had documented an injury, and drawing each of those on a face diagram. Injuries that align when the face impacts a broad, flat surface are all in a single plane, and counting planes of injury allows me to figure out how the minimum number of times a victim was struck. After going through all the medical and nursing notes and some blurry photos the police had taken of the victim at the hospital, I counted three planes of injury: one under the man’s jaw, another at the forehead, and a third on the opposite side of his face, with the road-rash abrasions I typically see as the result of a fall against pavement. His injuries had to have come from at least three separate impacts.
So, the radiology reports in the medical records documented the bony injury to the face and sinuses—and they also commented on some bruising to the brain. Buried in the description of the findings (but notably omitted in the radiologic diagnoses) was a mention of "swelling" over the scalp. I asked the DA to subpoena the actual CT scans. What I found shocked me. The "swelling" was actually bleedingin two distinct areas: one on the right back of the head, and another at the left side of the head. Two more planes of injury! The ER doc’s tap dancing analogy was not far off.
I called the DA and told her my opinion. With five planes of injury, this victim was struck at least four times, plus a fall against the pavement—and if he had been struck multiple times in the same location I probably wouldn't be able to tell that there were additional impacts, since they would have occurred along the same plane. After reviewing the radiology from the hospital as well as the medical records, I could attest with medical certainty that these injuries did not come about after a single punch and fall, as the defendant was claiming. When the case went to court I was the only prosecution witness who could tell the jury what actually happened, using the physical evidence from the injured man’s body. His assailant was convicted.
This experience during my fellowship training taught me several lessons about radiology. One was that hospital radiologists tend to focus on bony injuries, and will often omit soft tissue findings entirely. If I hadn't sought out the CT scans and looked at them myself, I would have missed two additional impacts—compounding evidence, in this case of criminal assault. I also learned that just because I am a pathologist doesn't mean I'm not qualified to interpret radiology. As a forensic pathologist, I interpret X-rays most frequently when I'm called to identify decomposed cadavers or when I need to find bullets and other foreign bodies in trauma cases; I also receive radiology reports and hospital scans with a decedent’s medical records, and I study those as a part of the postmortem investigation. They have proven crucial in identifying the cause of death or in directing my autopsy examination in several important cases.
If the patient went to the hospital prior to dying, I can stack the clinical radiological images to create a three-dimensional reconstruction of the body. In one officer-involved shooting case, I used this method to answer the question of whether the victim was facing toward or away from the police when he was shot in the face. So while many forensic offices (including the agency where I currently work) have purchased full body X-rays to improve the speed and accuracy of their radiologic examinations, I really yearn for a CT or MRI scanner with 3-D imaging capacity. I want to see the soft tissues too—not just the bones.
Some radiologic findings, like air emboli following laparoscopic surgery, might be missed entirely at autopsy if a CT or MRI isn't done prior to the autopsy examination. Colleagues have shared with me cases in which CT scans have alerted them to subtle findings—small pulmonary nodules, vertebral artery injury, healing fractures in abused children—prompting them to do a more extensive or targeted dissection to make the forensic diagnosis. Some have gone so far as to perform post-mortem angiography by obtaining expired contrast material from hospital radiology departments and injecting it into a cadaver in order to assess vascular integrity. These scans make excellent courtroom exhibits and are less likely to be thrown out by a judge who doesn't want to upset the jury with gory photos from the autopsy.
Radiology is an imperfect diagnostic avenue for postmortem examination, however. It’s a shadow play. You aren’t looking at the real thing, but rather at a two-dimensional image of it, the shadow cast by the X-rays onto a capture plate, and separated by 1 centimeter intervals between the slices taken of the body. During an autopsy the pathologist is looking at the real thing—and feeling it, and smelling it, and listening to the sounds it makes when she handles it. In the course of thorough postmortem I have found linear non-displaced skull base fractures that weren't visible on radiology and vascular injury no clinician had detected. I have also seen benign congenital lesions misinterpreted as malignancy or trauma. That's why I'm not worried that radiologists with high-tech "virtual autopsies" are going to replace me and my trusty scalpel. Nothing can match the certainty and validity of a direct, hands-on forensic examination. Autopsy means “see for yourself.” You can’t do that by staring at shadows on a screen.

Monday, January 4, 2016

5 Case Studies In Forensic Toxicology

This article was originally published in Forensic Magazine. To read the original article click here (http://www.forensicmag.com/articles/2015/10/five-case-studies-forensic-toxicology)

As a practicing forensic pathologist in a busy urban office, I am confronted every week with a stack of toxicology reports from my cases. Most are simple to interpret—the multiple GSW with (inconsequential) trace cocaine; the slam-dunk OD with a needle in his arm and sky high 6-MAM from heroin. Then there are the challenges. I might get a case with no apparent anatomic cause of death. I pend it, confident that tox will turn something up. But instead the toxicology report shows only prescription drugs in therapeutic levels, or—worse!—it’s completely negative. Interpreting the laboratory findings, deciding whether to pursue additional testing, and coming to a reasonable conclusion in these cases can be difficult. Though I can always call a toxicologist for advice, ultimately I am the one to make the call on cause and manner of death, and I have to be able to defend my determination in court.

So, now that we’ve established the stakes, let’s take a look at five case studies that illustrate the most common errors forensic pathologists make related to toxicology.

Not even doing toxicology
There’s a dead man in his locked trailer, naked in bed, no drug paraphernalia at the scene and no signs of foul play. The local coroner finds out the decedent’s medical history included an untreated dental abscess, and signs the death certificate without performing an autopsy. When the dentist gets sued, what is the first thing the forensic consultant on that case asks for? Toxicology. Luckily, the coroner’s investigator collected enough blood and vitreous humor to perform toxicological analysis—and it shows a sky-high methamphetamine level. This finding dovetails with his dental pathology (“meth mouth" is a known complication of chronic amphetamine abuse), and helps the dentist’s lawyers defend him in the lawsuit. The lesson? Just because there are no drugs at a death scene doesn't mean you shouldn't perform an autopsy to collect specimens for toxicology, especially if the decedent has a history of chronic abuse.

Not communicating with the toxicology lab
A young schizophrenic woman has a psychotic break, and her roommate calls the cops. Responding officers find her ranting, and brandishing a screwdriver. She comes at one of them, and he shoots her to death. The gunshot wounds makes for a clear enough cause of death, but on the toxicology form, the forensic pathologist neglects to inform the toxicologist about the decedent’s prescribed medications. When the tox screen comes back negative, the pathologist then writes in his report that the decedent hadn’t been taking her medication at the time of her death. He never calls the lab to confirm this assumption—but, weeks later, a local newspaper reporter does. When the tox lab then runs the tests for the prescribed antipsychotics, it turns out the result is positive. The pathologist's reputation is damaged. Always remember that routine enzyme-based screens will not pick up all drugs. It pays to double check that the lab tested for any specific medications the decedent was supposed to be taking, especially in a high-profile case.

Looking only at the numbers
One hot summer evening, a guard outside a chronic pain clinic finds the decomposing body of a middle-aged woman in her parked car. She has the keys and her purse still clutched in her hands. She had been seen at the clinic that morning, hours before. The autopsy pathologist finds high levels of multiple opioid analgesics, and determines that the death was an overdose. The family sues the pain clinic and the drug manufacturer. During document discovery the dead woman’s medical records reveal a past diagnosis of cardiac arrhythmia. The drug levels? They were already high because the decedent was a chronic, tolerant user, appropriately prescribed; but they were also spuriously elevated due to post-mortem redistribution, the passive diffusion of drugs in a decomposing body that can cause higher detected levels than when the person was alive. Why did the pathologist ignore the woman's heart disease and blame the drugs? Because the opioid levels were high. You cannot focus solely on the numbers—you have to look at the whole case. In this one, the facts of the case pointed to a sudden cardiac arrest, and not to a slow death by respiratory depression as in an opioid overdose.

No scene investigation
An elderly woman is declared dead in the emergency room. Her husband says that she was snoring all night. He called 911 in the morning, when she wouldn’t wake up. On autopsy the pathologist finds a diseased heart, and signs out the case as a death by natural disease. Then, while preparing the house for the funeral, the husband finds the woman’s recently-prescribed but empty medication bottles, and brings them to the coroner's office. In the toxicology report, the woman’s drug levels appeared high but within therapeutic range, so the pathologist hadn’t considered poisoning as a cause of death. The distended bladder he pulled out of her body on autopsy should have steered him to take a closer look at the tox, however. Sleeping patients who are not intoxicated will wake up and go to the bathroom. A bladder with 400 or 500 ml of urine in it may be a signal that something is causing central nervous system depression. Turns out this was a suicidal overdose of prescription medication. The decedent was not just asleep in bed—she was in a coma, and had been metabolizing the drugs for hours while unconscious. When a patient dies in the hospital, death investigators might not go to the primary scene to collect evidence—such as, in this case, the medications. If the decedent’s husband had not alerted the coroner, her death would have been misclassified as natural.

A negative toxicology report does not mean the death is not drug-related
A psychotic prisoner is booked into jail, and the medical staff there change his usual anti-psychotic medication to a different one that they have in their dispensary. He develops a high fever with altered mental status, and goes to the hospital, where that medication is discontinued. He dies a week later, with pneumonia and kidney failure from muscle breakdown. The hospital blood specimens come up negative for all drugs, so the pathologist consults a forensic toxicologist. The toxicologist reviews the medical records and concludes that the change in prescribed medications at the jail had likely triggered a fatal drug reaction. Post-mortem drug tests can come up negative for many reasons, and drug-drug interactions and adverse reactions can lead to death days or even weeks after they occur. Sometimes a toxicologic cause of death may not be apparent without a thorough review of the medical record and consultation with a forensic toxicologist.

Whew. Daunting? Yes. But avoid these five pitfalls, and you will find that toxicological avenues of death investigation can lead to some of the most interesting cases we forensic pathologists have the privilege of investigating.

Dr. Judy Melinek is a forensic pathologist and does autopsies for for the Alameda County Sheriff Coroner's office in California. Her New York Times Bestselling memoir Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner, co-authored with her husband, T.J. Mitchell, is now out in paperback. She is the CEO of PathologyExpert Inc.

Friday, December 4, 2015

7 Common Mistakes Regarding Autopsy Reports

This article was originally published in Forensic Magazine. To read the original article click here.

When a breaking news case involves a sudden, unnatural or violent death, journalists will often get a copy of the autopsy report. Autopsy reports can be daunting to read if you have not been trained in medicine. Because of this, reports in the media can be confusing or misleading to the public. Here, then, are some definitions and guidelines for anyone reading or writing about death investigations, and especially members of the media, should hopefully find useful.

Remember that forensics is complicated, and sound bites are few. Always keep in mind that you are exploring a story about a dead human being. You owe it to that person—and to your audience, and to the public record—to get the details of the death investigation rigorously right.

A coroner is not the same thing as a medical examiner
Both a coroner and a medical examiner perform forensic death investigations—examinations into the circumstances of any death that is sudden, unexpected or violent. The crucial difference is this: A coroner is an administrator or law enforcement officer, and a medical examiner is a doctor. A medical examiner is a forensic pathologist, a physician with specialized training in death investigation. In a medical examiner's office, a doctor called the chief medical examiner is in charge of both the death investigation and overseeing the autopsies performed by other doctors. Consider whether the office calls itself a "Coroner" or "Medical Examiner.” The terms aren’t interchangeable.

Do not confuse cause and manner of death
Cause of death is the disease or the injury that killed the person: heart disease, appendicitis, stab wound, etc. Manner of death is a classification of the cause of death that is separated into five categories: natural (for disease), accident, suicide, homicide or undetermined. It is incorrect to say "the cause of death was natural" or "a motor vehicle accident" because that means you are conflating cause and manner. It would be better to write "the manner of death was natural" or that "death was caused by trauma from the motor vehicle accident."

Homicide is not the same thing as murder
Homicide means "death at the hand of another." Intent is not a factor—only a volitional act is required. It’s up to the district attorney to determine whether it is in the state’s interest to charge the defendant with murder or manslaughter, or not press any charge at all. Even if the DA does not press charges, or the defendant is prosecuted but acquitted, that fatal event is still a homicide. But it is not a murder. Calling a homicide a murder does not fall within the purview of the agency performing the forensic death investigation. That’s a job for the DA, judge or jury.

Don't confuse the autopsy with the death investigation
The autopsy pathologist can only tell so much from a dead body. Trying to figure out the cause of death from a dead body alone without knowing anything about the scene, circumstances, or medical history of the decedent would be like a surgeon coming in to perform surgery on an unconscious patient without the benefit of a physical exam, medical records or X-rays. So do not expect the release of any information about an autopsy on a high-profile case—especially if it’s a homicide—as soon as the autopsy is done. The autopsy is just one piece of a long process that results in a cause of death determination.

‘Pending’ is not the same thing as ‘inconclusive’
In many news reports when the autopsy is complete but the medical examiner has sent out specimens for additional testing, or needs more time to review the police reports or medical records, the preliminary determination after the autopsy will be that the case is "pending.”
“Pending" means you have to wait for the results. It does not mean "we don't know.” It does not mean that the autopsy findings were "inconclusive.” Something is inconclusive when you cannot draw conclusions about it after all the information is available. The autopsy itself may be conclusive, but the medical examiner is not going to tell you that—because they are still working to complete the death investigation, and that will take some time.

The autopsy doesn't ‘show’ or ‘tell’ you anything. The expert does.
"The autopsy showed five gunshot wounds to the body, two at close range, and a single stab wound.” No, the autopsy didn't show that. The forensic pathologist determined it. It is his or her professional opinion of the autopsy findings. A different forensic pathologist might look at the same evidence and determine, based on the position of the body, that the five gunshot wounds were created by only three rounds. Two were bullet re-entries. And the stab wound isn’t a stab wound. It’s actually a therapeutic artifact—a hole created by the doctors in the hospital, during their attempt to save the decedent’s life.

So when you get your hands on an autopsy report, call a forensic pathologist and ask for professional guidance in putting it into plain English. There’s a good reason that forensic pathologists go to court to interpret their findings to juries—those findings can be obscure to anyone not trained in our very narrow and specialized field, and the conclusions we come to in forensic death investigations are important.

The first legally-mandated autopsy done by the coroner or ME's pathologist is an independent autopsy. Everything else is not.
“Independent" means not influenced by anything or anyone. During that first autopsy, the forensic pathologist collects trace evidence, has photographs taken, and makes incisions into the body that literally alter the evidence. Even if this pathologist were to face political or bureaucratic pressure to interpret the findings a certain way, the physical evidence of the first forensic autopsy will become public record and will be used in court. Any pathologist hired by attorneys, the decedent's family, or anyone else to perform a second autopsy is not "independent." He or she is a retained expert. That means if his findings are not helpful to the family's attorney, they don't have to disclose them. At all.

Forensic pathologists are doctors, not police officers and are not in the business of covering up for anyone. While they may rely on good relationships with the police department in order to get the information they need to do their job, they are committed to doing that job properly, for very good reasons—if they do not, they will either lose that job, or ruin their relationship with their own boss (the Coroner or medical examiner) in order to please an outside agency (the police).

Thursday, August 6, 2015

Forensic Literature: A Review of Val McDermid's Forensics and Judy Blume's In The Unlikely Event



Forensics by Val McDermid - Nonfiction - Grove Press 2015

Disclosure: Free pre-publication copy received from the publisher in exchange for review/promotion

Val McDermid is a Scottish crime writer, the multiple best-selling author of more than 30 books, including The Wire in the Blood, A Darker Domain, and The Skeleton Road. Now she has written a nonfiction primer about forensics, covering in each chapter a different discipline of the field: crime scene investigation, fire investigation, entomology, forensic pathology, blood spatter, facial reconstruction, fingerprint analysis, digital forensics, anthropology, and forensic psychology. In each chapter McDermid highlights historic events in the founding of the scientific discipline, taking readers through the crimes where the scientific methodology was first used to catch the killers and convict them in court. McDermid introduces readers to the real people who first developed these investigative tools. Some of the scientists, like Dr. Bernard Spilsbury, a British forensic pathologist who was known for his charismatic courtroom testimony, are fascinating characters. In each chapter McDermid also interviews modern forensic experts, characters in their own right: impassioned, dogged and intelligent. They share highlights from their careers, as well as their frustrations—and even their failures—in pursuing criminal cases. 

This, unfortunately, is where McDermid's book falters. Her interviews with modern experts are superficial and uncritical. She quotes from the scientists without challenging them about their opinions, or seeking out other experts who disagree. For example, in a section about the difference between the legal use of experts in the United States and the UK, she explains that the British system occasionally allows opposing experts to come together and reach a consensus. She then goes on to quote an expert who once saw the prosecution case fall apart because such a meeting did not take place. The expert says that this "did no one any good at all," suggesting that the freedom of an innocent person was outside of anyone's concern.  

Val McDermid’s Forensics is not a work of solid scientific journalism, but it does make for an engaging read, offering an overview of the field for those who know little about the science behind the headlines and want a better understanding of the history of forensic crime investigation. 



In the Unlikely Event by Judy Blume - Fiction - Knopf 2015
Reading Judy Blume's prose again is an act of comfort and joy—meeting an old childhood friend as an adult and picking up where you last left off. Her new novel In the Unlikely Event chronicles through fiction the real events in Elizabeth, New Jersey in the 58 days between December 1951 and February 1952, when three planes crashed around Newark Airport. One character, Dr. Osler, is a local dentist who is called to help identify the deceased.

The perspective taken is that of the children, which Blume herself was at the time and in that place. In interviews she has said she remembered some of the events, but that these characters are fictional. Blume uses fictionalized news reports admixed with real newspaper clippings and advertisements to bring us right back to a time period when girls who aspired to a career as a flight attendant answered ads that required they be white, between 5'2 and 5’6," and compatible with “just below Hollywood” standards of beauty.

Blume brilliantly and sensitively captures what it's like to be a witness to disaster when life is supposed to be perfect; a survivor, when the very foundations of what you've been taught to rely on (family, government, technology) fail. In the Unlikely Event tells the story of how a community comes together and individuals fall apart, and evokes the consequences of living for the rest of your life in the aftermath of a communal tragedy. The words at the end of one of the surviving children, "we're still part of a secret club, one we'd never willingly join,” will stay with me forever.

Thursday, July 2, 2015

What I Did This Summer: Forensics Edition

by Brodie Butler, Biology/Humanities major at Azusa Pacific University

“…I was made to do this.” 

That’s what I tried to convince myself as I was slumped over in the library at ungodly hours of the night or fumbling to complete a titration in chemistry lab. I have known since I was a junior in high school that I wanted to become a forensic pathologist. However, there have always been certain doubts lingering in the back of my mind. Am I really cut out for this? Do I even have what it takes to get into medical school? 

Having the opportunity to do a short internship with Dr. Judy Melinek, M.D. reaffirmed my passion for this fascinating field of study. In addition to giving me the courage and confidence to tackle any obstacle I may face during my journey to becoming a forensic pathologist, she gifted me with an invaluable array of knowledge extending from correct autopsy procedure to effective expert witness testimony. These “bullets” of knowledge are as followed: 

The knowledge I gained from my experience with Dr. Judy Melinek, M.D. includes, but is not limited to, these topics. 

Edema. 

Edema is another odd sounding medical term for intracellular swelling due to direct cell injury. Under a microscope, cerebral edema somewhat resembles Swiss cheese. There are distinct spaces surrounding the nuclei resulting from edematous fluid replacing brain tissue. As the brain expands in the limited space exhibited by the skull, it pushes down on the circulatory and respiratory centers of the brain stem leading to brain death. 

Expert vs. Fact Witness Testimony.

Any first year law student or eager aspiring forensic pathologist should know the difference between these two distinct types of witnesses.

An expert witness is a qualified professional who utilizes their experience and training to offer an opinion on the matter being discussed. Unique to a fact witness, they are at liberty to rely on hearsay ie. police reports and medical records. 

A fact witness, by definition, is a individual who testifies to things they have personally observed or witnessed. They cannot offer any form of opinion or rely on hearsay. 

If a forensic pathologist were compelled to testify as a fact witness and asked, “Were any bullets recovered from the body cavity of John Doe?”, her only lawful response would be, “Your Honor, an answer to that question requires an expert opinion that I am not at liberty to offer as a fact witness.” 

Her response is justified because having the ability to recognize something as a bullet and not just merely a scrap of metal requires experience and training. Therefore, simply stating that something is a bullet is a matter of opinion. 

For her to offer a worthwhile response to the attorney’s question, the Judge must proceed to order the attorney to qualify her as an expert witness. This would require a review of her curriculum vitae (CV) and an explantation from the Judge as to why she is qualified to give an opinion. 

Gun Shot Wounds n’ Stuff. 

Tracking bullet trajectories during an autopsy can be considered an art form. 

It begins with marking the gun shot wounds (GSWs) with a Sharpie pen and giving each wound a corresponding letter for identification purposes.  On a sheet of paper (typically the back of the body diagram) these letters (A, B, C, etc.) are accompanied with an appropriate description of the locations in which the wounds are found. 

The presence of exit wounds are noted and metallic probes are used to locate the bullet’s point of lodgment (POL) in wounds that lack an exit wound (penetrating wounds). All bullets must be recovered as they may serve as evidence in trial at a later date. If a gun shot wound has an entrance and an exit wound (perforating wound), the sequence of the structures the bullet passes through must be identified. 

It is essentially like a puzzle that consists of matching entrance wounds to either a point of lodgment (POL) or an exit wound. If you get over its morbid nature, it’s quite fun. 

Advice to other aspiring forensic pathologists. 
Ask yourself… “Is this really something I’m passionate about?”
Be proactive and persistent. 
If you're not having fun, you're not doing it right. 

Friday, June 19, 2015

Interview with Former SFPD Officer Karen Lynch, author of "Good Cop,Bad Daughter"


Q - In your memoir, Good Cop, Bad Daughter, you describe San Francisco in the 60s and 70s, where you grew up and then became a police officer. In your opinion, how did the anti-war movement affect public perceptions of the police, and how have these perceptions changed over time? 

A - We are living through a time that feels remarkably like my childhood years, in the 1960’s. Police are, once again, perceived as the enemy by a large segment of society, and the public focus has been on police misconduct and malfeasance. Acts of heroism, and the millions of daily interactions between police and citizens that are benign and proper, are being dismissed by the news media, and we are being shown the same half dozen awful videos repeatedly, to the point where some believe what we are seeing is happening constantly. 

During the sixties, we saw news video of acts of police brutality during anti-war demonstrations, and the public perception in progressive circles was that cops were part of a larger machine set into play to oppress people. We are seeing a similar reaction to policing today. Because of the ever-growing divide between the haves and have-nots, many perceive police as protecting the interests of the rich. I believe some of these perceptions are faulty. As a child I attended every anti-war demonstration in San Francisco, and honestly, we never saw police misbehaving. I’m not saying those events did not occur, I am saying most protestors were unmolested by police during protests. 

As to the perception that we exist to protect the rich, for the most part, police spend our workdays in housing projects protecting the poor from predators within their own community. Yes, police misconduct happens, but it is not an hourly, or even daily, occurrence. Of course, in an ideal world, police would always make the right choices, but, as long as police officers are human, that is unlikely to ever happen. In some jobs if an employee screws up, a customer gets a Latte, instead of a Mocha. When cops screw up, people get hurt, so of course, we must hold police to a much higher standard of performance.

Q - Writing a memoir as intensely personal as Good Cop, Bad Daughter could have negative repercussions on your professional relationships. Although you are now retired from the San Francisco Police Department, was the reaction from your colleagues what you expected?

A - I had prepared myself for a backlash, thinking my co-workers would dislike my portrayal of some scenes of police misconduct, but my colleagues have been very supportive. My former classmates and patrol partners have no complaints about how they were portrayed, and those characters who are portrayed as villainous probably will never read the book, or will not recognize themselves if they do.

I dedicated this book to all my co-workers, but mostly to the women officers who paved the way before me. The female graduates of the first few academy classes that admitted women experienced much more discrimination than those of us who came a little later. Those women opened the doors for us, and put up with a lot so that we could have the same opportunities men have in law enforcement careers. 
   
Q - You had a parent with mental illness and it both inspired you to work in law enforcement and informed you about how to handle the mentally ill when you encountered them in your professional capacity. Do you have any professional advice for law enforcement officers who encounter emotionally disturbed persons ("EDPs") on the job?

A - The tools I learned from managing my mother’s illness will be familiar and obvious to anyone who has grown up with a difficult parent, whether mentally ill, or a substance abuser. I learned to speak very slowly and calmly, and that any sort of stimulation can set off panic in a disturbed individual. 
    
Realistically, if a mentally ill person is attacking a cop, or a citizen with a weapon, the police are going to react in the way we have been trained, using force as necessary. But during times when we can bring a sense of calm to a scene, we can sometimes diffuse volatile situations.
    
One of the biggest problems I see in our culture is the lack of facilities to treat the mentally ill. There are few hospital beds, and the need is always much greater than the availability. In an ideal world, help would be readily available to anyone who needs it, on demand. Many lives would be saved if we invested in our mental health infrastructure.

Q - You were raised by multiple caregivers during your childhood, some of them caring, and some, like your mother, who could be neglectful - leaving you with a lot of freedom as a child, which also put you in some dangerous situations. How did your upbringing and police work influence how much freedom you give your own children as a parent?

A - As a child, I was, as they say, “free-range,” which sounds like I provided eggs for my family, though I seldom did. From about age 7, on, my best friend and I roamed the streets of San Francisco freely, creating our own adventures. I now feel incredibly lucky to have had that experience. Being free-range gave me a sense of confidence and agency that I doubt I would have had otherwise. By the time I became a cop, I had already patrolled the streets for years with my best friend.
        
As a parent, I am part of the generation that believed our children would be immediately kidnapped if we took our eyes off them for a moment. Though I am not a helicopter parent, my children never had the same sort of freedom I had. Every time I considered a new liberty for them, I would ask myself, “Would a reasonable person let their child do this? Ride a bike alone? Stay at the mall with a friend?”
       
Since my primary care taker during my own childhood was not “reasonable,” I imitated the parenting skills of other parents in my community who seemed to know what they were doing. In the end, though we probably could have given our children more freedom, they are great people, and self-sufficient, which is the goal of good parenting. A good parent should work himself out of a job.

Q - What are you working on now? Have you thought of using your knowledge of police procedures to help other authors in editing their crime novels?
   
A - Reading and editing other people’s work is one of my favorite things to do. For most writers, editing other people’s work is a welcome break from doing our own writing. I just finished editing, and consulting, for a mystery writer, whose work was a great read. If there are any crime or police procedural writers out there who need an editor, I welcome you. 
         
In the fall, I have an essay coming out in an anthology put together by Amy Ferris, and Seal Press, “Shades of Blue.” My chapter is called, “Thorazine.” This book is for anyone who has dealt with depression, suicide, or suicidal ideation. Amy was inspired to collect these stories after we lost Robin Williams to suicide. I know this book will encourage others to seek help.

Thank you so much for having me as a guest on your blog. I really enjoyed chatting with you.