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).

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.

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. 

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.

A High School Student Interviews Dr. Judy Melinek

What is your definition of a forensic pathologist?

A forensic pathologist is a doctor who is trained to perform autopsies to figure out the cause of death and is also trained in death investigations to figure out the manner of death. The cause of death is the disease or injury that starts the lethal sequence of events without sufficient intervening causes. The manner of death is a system that classifies the cause of death as either natural, accident, suicide, homicide or undetermined. Forensic pathologists work for county or state medical examiners or coroners and under the law do autopsies in cases of sudden, unnatural or violent deaths.

2. What specific college courses did you take to prepare you to go into medical school?
3. I was a biology major so I mostly took the courses I need to meet my major and pre-med requirements (luckily there was sufficient overlap to allow me to take some electives in topics I would never study again, like the history of Iran and an overview of the psychology in the bible). I would recommend that students take courses in biostatistics to help them understand the medical literature better and also take courses in business management and marketing. These are not taught in medical school but will help with your career in the long run.

3. What important things should I expect going into the field of forensic pathology?
4. You should expect that even though the field appears exciting on television (and it is) the excitement is with the daily discovery of things you don't know, not with helping the police catch the "bad guys." A lot of our job involves grief counseling and explaining how people have died to their loved ones. This can be emotionally exhausting, but also rewarding.

4. Is a law degree required to become a forensic pathologist?
5. No, but you do learn quite a bit about the laws that pertain to criminal and civil litigation on-the-job. I actually teach as an invited speaker at several law schools because I know a lot about the laws that pertain to what I do and how to best work with medical experts.

5. Did you study in any kind of forensic pathology specialties (toxicology, serology, odontology, anthropology, taphonomy)?
6. Yes. In my memoir, "Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner" I detail my training at the New York City Office of the Chief Medical Examiner. There, I did rotations at the toxicology lab and also worked alongside the anthropologist. I didn't learn as much as I would need to replace them - that would require years of education and training - but I learned enough about what they do that I would understand when I need to consult them.

6. What high school courses do you think would help prepare me to be a forensic pathologist?
7. The most important things in high school is to take the courses that challenge you but that still allow you to get an "A." Getting into college is a numbers game and you want the highest grades possible to get into the college of your choice and be able to afford to go with academic scholarships. If you love biology, take it, but don't take AP bio and get a C - work hard for that A because college interview decisions are based on your GPA and SAT or ACT scores.

7. What skills would you recommend I should start working on now as a high school student?
8. Reading and critical thinking skills are essential. So are having the self-motivation for independent study. Start by reading journal articles in Scientific American, Popular Science or Forensics Magazine. Look up terms you don't understand on line and spend some time on Khan Academy teaching yourself something new. These skills will help you in any field, not just forensics.

8. How has being a forensic pathologist rewarded you?
9. In so many ways! It is both intellectually and emotionally rewarding.  Working for a coroner every day that I go in to work I know that anywhere from two to half a dozen families have lost their loved ones in the past 24 hours and are waiting for an answer. Sometimes I can give them an answer right away, like if I find a heart attack or aneurysm; but in most cases I have to wait until the lab results come back including toxicology and histology. During that time I can develop a relationship with those family members, gets more information about the decedent's medical history and spend time researching what I found, especially if it is a rare disease. As a medical specialist that works for myself or for a government entity, I also don't ave to deal as much with the difficulties my colleagues in primary care face with getting paid by insurance companies. I am very satisfied with my choice and I encourage more students to pursue forensic pathology as a career path. 

A Forensic Primer for Journalists

Since the publication last year of my New York Times bestselling book Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner, I have found myself in the public eye as an expert in my field of forensic pathology. When a high-profile death investigation hits the news, journalists from all over the U.S., and occasionally other countries, call and ask me to "explain the autopsy"  to them.  

Autopsy reports can be daunting to read if you have not been trained in medicine, so when I have the time I will make an effort to put things into plain English for these reporters, just as I do for a jury when I work as an expert witness. In many cases, however, I find that professional writers and news analysts lack even the most basic knowledge about forensics.  

Here, then, are some definitions and guidelines that journalists or anyone writing about death investigations and autopsies should find useful.

1. A Coroner is not the same thing as a Medical Examiner

Both a coroner and a medical examiner perform forensic death investigation—that is, examinations on behalf of the public 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 coroner position is a political one. Coroners are either appointed by an elected official, or are themselves elected. In some counties, the coroner’s office may be a division of the sheriff's department. In some, the coroner may be a prosecutor or justice of the peace. In some states, it's a branch of the state police.  The coroner is not a physician and does not perform the autopsy; he or she hires contract forensic pathologists for that job. The coroner is responsible for supervising the administrative aspects of the death investigation. The contracting forensic pathologist determines the cause of death (the disease or injury that killed the person), and the coroner determines the manner. Manner of death is a system of classification of the causes of death into categories. The usual list is natural, accident, suicide, homicide, and undetermined, though these may vary slightly by individual jurisdiction.  

Sometimes—historically rarely—the coroner will perform a coroner's inquest, a special court proceeding in which the coroner acts as judge. The coroner has subpoena power and can call witnesses to testify, to answer the coroner's questions, and also to present findings to a jury. Either the coroner or the jury decides the manner of death after a coroner’s inquest. 

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 performance of autopsies by other doctors, usually known as assistant medical examiners or deputy medical examiners. The decision of cause and manner of death determination falls on the deputy medical examiners, who receive guidance and supervision from the chief. Generally, medical examiners do not hold inquests.

To confuse things, some offices (like Los Angeles County and Santa Clara County in California) use the term "Medical Examiner-Coroner," and in some counties they refer to the death scene investigators as "Medical Examiners" even though they are not physicians. And, to complicate the term even further, in some areas "Medical Examiner" is also used to refer to doctors in general practice who do insurance physicals in disability claims, and who have nothing at all to do with death investigation.

Bottom line: Find out whether the office you are reporting on calls itself a "Coroner" or "Medical Examiner," and use that term. Stick to it. Don’t use the terms interchangably. It is a mistake to mix them up.

2. Do not confuse the cause and manner of death

Cause of death is the disease or the injury that killed the person: heart disease, appendicitis, stab wound, drowning, etc... Manner of death is a classification of the cause into 5 categories: natural (for disease), accident, suicide, homicide (for injuries) or undetermined (if it can't be categorized easily or there is insuffucient information). So it is incorrect to say "the cause of death was natural" or "the cause of death was the 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 he died of "natural causes." For the motor vehicle accident, the cause of death is from blunt force trauma caused by the motor vehicle accident or "death was caused by trauma from the motor vehicle accident."

3. 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 to call a death a homicide. So if someone is playing with a loaded gun and accidentally shoots another person, the medical examiner or coroner will classify that death as a homicide. 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.  

In some jurisdictions all motor vehicle fatalities are classified as "accidents" regardless of the driver's intoxication status, while in others, DUI offense deaths are mannered "homicide." The district attorney can still charge them as "vehicular manslaughter" or as "criminally negligent homicide" but those are legal determinations and don't change what the coroner will call it.  

Whenever a member of a law enforcement agency kills someone, whether it is an officer-involved shooting, a choke hold, or any other means of causing a fatal incident, the death is generally classified as a "homicide" because it is a death at the hand of another. Typically there is a review by the district attorney to decide whether the officer will be charged with a criminal offense. If the district attorney decides to charges the officer, a prosecutor will take the evidence either to a grand jury or to a preliminary hearing in front of a judge. The forensic pathologist who performed the autopsy will be called to testify as an expert witness in this legal hearing. The judge or jury will decide whether there is sufficient evidence that a crime was committed. If the judge or jury decides the officer was using deadly force within the guidelines of his professional judgement and training, then they will probably find that no crime has occurred. That fatal event is still a homicide. That’s what it says on the death certificate as manner of death, as determined by the coroner or medical examiner. But it is not a murder. Murder is a criminal charge, and 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.

4. Don't confuse the autopsy with the death investigation

Deaths are only reported to the medical examiner or coroner if they are sudden, unexpected, or violent. Each state has laws that delineate what cases fall under the jurisdiction of the Coroner/ME, and each jurisdiction decides which cases get investigated, and to what extent. If the death is violent and suspicious, typically the police handle the primary investigation, and the medical examiner will incorporate their findings into the overarching forensic death investigation. The medical examiner will request the police reports and witness statements, and will even review the video of the incident (if there is one) if it helps in the determination of cause and manner of death. But not all agencies are willing to cooperate with the medical examiner's office, and it is not unusual that in high-profile cases, attorneys get involved, and the exchange of information slows even further.  

The autopsy pathologist can only tell so much from the dead body. Trying to figure out the cause of death from the dead body alone without knowing anything about the scene, circumstances, or medical history of the decedent is medical malpractice for a doctor like me. It 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 coroner or medical examiner to release any information about the 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. That process may, and in many cases must, take many months to complete.

5. "Pending" is not the same thing as “Inconclusive"

In many news reports (most recently the ones involving Joan Rivers's death—see http://www.cnn.com/2014/09/05/showbiz/joan-rivers/ ), 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.”

Please, please understand this, members of the professional news media: “Pending" means you have to wait for the results. It does not mean "we don't know.”

A pending cause or manner of death also 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. In a pending case, we are all still waiting for that information before we can come to any conclusion. The autopsy itself may be very, very 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. 

If at the end of the investigation the medical examiner or coroner says the cause of death is “undetermined”… Well, then and only then are you correct in writing that their investigation was "inconclusive." In Joan River's case, several months after the autopsy and the inaccurate early news stories calling the autopsy “inconclusive," the investigating medical examiner’s office reached a determination of both cause and manner of death. These were not inconclusive in the least: http://www.cnn.com/2014/10/16/showbiz/joan-rivers-cause-of-death/

6. The autopsy doesn't “show” or “tell" you anything. The expert does.

It always riles me when I read in the news that "the autopsy showed five gunshot wounds to the body, two at close range, and a single stab wound.” (For instance: http://www.slate.com/articles/news_and_politics/politics/2015/02/laquan_mcdonald_shooting_a_recently_obtained_autopsy_report_on_the_dead.html) No, the autopsy didn't show that. The forensic pathologist determined it. It is his or her professional opinion of the findings. A different forensic pathologist might look at the same body, or at the photos and scene investigation, and determine that, based on the position of the body, the five gunshot wounds were created by three gunshots. Two were bullet re-entry wounds. Oh, and that stab wound? It isn’t a stab wound. It’s actually a therapeutic artifact—a hole put in the body by the doctors in the hospital, during their attempt to save the decedent’s life. 

It is confusing to the public if you divorce the autopsy from the opinion of the practitioner, especially when there is a subsequent review of the findings, and they are found to be mistaken or misinterpreted. It also undermines the public trust in forensic scientists who do their best to interpret the injuries, but may not always be given all the information they need to do a thorough job. 

It is also confusing to the public if you get your hands on an autopsy report and regurgitate its findings without at least calling the pathologist who authored it, to request help in comprehending what exactly you are reading. If he or she won’t speak to you, please try another forensic pathologist. The lay public, whether journalists or their audience, do not have the experience or expertise to interpret most autopsy reports without professional guidance. That may sound paternalistic, but it’s the truth. There’s a good reason that forensic pathologists go to court to interpret their findings in person to juries, and even to judges—their 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.

In most cases the coroner or medical examiner will release autopsy reports under Freedom of Information Act requests, but they may not have a public information officer who will be able to take the time to explain it all to you. Or the investigating pathologist may not want to go on the record interpreting the findings, and then get cross-examined on what some journalist wrote in the paper about that interpretation—especially if that reportage turns out to be inflammatory or erroneous. Your best bet as a journalist is to find another expert who will take the time to explain it to you so you get it right. 

7. 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, where it is open to unblinking scrutiny. So the Coroner's or Medical Examiner's autopsy is always an “independent” autopsy—even if their conclusions turn out to be wrong. It is the documentation and collection of the evidence from the whole body, the first time, that matters, and it is this process of collection that makes the forensic autopsy the only independent one. 

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. 

The Coroner or Medical Examiner's pathologist doesn't have that option. They represent an agency which is legally charged with independently ascertaining the cause of death. They will be called to trial. Their report will be disclosed and argued over. That is the ultimate in quality control—legal transparency and cross-examination. If another public agency, like the Armed Forces Medical Examiner, reviews the original findings at the request of the family or because there is public outcry, that is a secondary review, and it is also no more "independent" than the autopsy performed by the coroner’s or medical examiner pathologist. When journalists refer to a second autopsy by a retained pathologist or a secondary review by an outside agency as  “independent” it makes it appear that the initial coroner’s or medical examiner’s autopsy was not independent and undermines public trust in our civic institutions.

Forensic pathologists are doctors, not police officers. Autopsies are not "ordered by the police," or “done for the police," as was written repeatedly during the Michael Brown case in Ferguson, Missouri. Forensic pathologists are not in the business of covering up for anyone, even the police. 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).

8. "Consistent with" does not mean "it's the only explanation”, and “appears" is not the same thing as “is.”

When an expert says that something is "consistent with" or that it "appears to be” something, that does not mean this is the only explanation of the forensic findings. Other explanations or interpretations may be plausible, or equally consistent with the physical findings. Sometimes the expert's preference for a particular scenario is contingent on the information that is available at the time, or on that expert’s own experience and training. 

Shawn Parcells, the forensic technician who autopsied Michael Brown under the hire of the Brown family and their attorneys, found this out when the final autopsy report showed that there was particulate material consistent with gunpowder in the wound on Michael Brown's hand. He and retained forensic pathologist Dr. Michael Baden had stated in public that all the wounds "appeared to be" distant range, but Parcells had not taken microscopic sections during the second autopsy he conducted. After Dr. Baden looked at the microscopic slides collected by the original forensic pathologist in the normal course of the first autopsy, he testified to the grand jury that the St. Louis County Medical Examiner's findings were correct.  (See: http://int.nyt.com/newsgraphics/2014/11/24/ferguson-evidence/assets/gj-testimony/grand-jury-volume-23.pdf page 38) 

The news reports surrounding this case made it seem that the forensic experts disagreed with one another. They didn't. It's just that they were asked different questions at different points in time. And when one of those experts used the word “appeared” about a finding that was not yet final, he was quoted and interpreted by many media outlets as speaking definitively instead.

Conclusion: So what should a journalist do?

- Consult a forensic expert. When you have a breaking news case and an autopsy report in hand that makes no sense, first contact the medical examiner or coroner's office that released the report. Ask if someone there will explain it to you. If they can't or won't, find a forensic pathologist who will.

- Read about forensic topics, and look up information in forensic journals so that you can become more fluent with the language the scientists use, and so that you will be able to challenge them with intelligent questions.

- Be careful how you quote the forensic pathologist. If the expert says "don't quote me" or "off the record," respect that. Scientists are protective of their professional credentials, and will be a lot more comfortable speaking with you on the record if they can see their quotes in context in the substance of the article before it gets out. Have them check what you wrote to make sure it wasn't taken out of context or misunderstood prior to publication. It is much better to get it right than to issue a retraction or correction—or to watch while the source you relied upon comes out in public and points out that you took the time to do your research, and then got the story completely wrong. 

It happens. Forensics is complicated, and sound bites are few. But 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.