tag:blogger.com,1999:blog-32360684305907952572024-03-14T02:58:43.795-07:00Forensic Pathology ForumDr. Judy Melinek, a board-certified forensic pathologist and author blogs about forensic pathology and science in the news.Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comBlogger41125tag:blogger.com,1999:blog-3236068430590795257.post-88562433320136513452018-08-17T07:50:00.003-07:002018-08-17T07:50:50.635-07:00My Father Killed Himself — Advice from a Physician and Suicide Survivor.<span style="font-family: inherit; font-size: large;">Originally published in <span style="-webkit-font-kerning: none; -webkit-text-stroke-color: rgb(0, 0, 0); -webkit-text-stroke-width: initial; font-style: italic;">MedPage Today</span><span style="-webkit-font-kerning: none; -webkit-text-stroke-color: rgb(0, 0, 0); -webkit-text-stroke-width: initial;"> August 16, 2018 (https://www.medpagetoday.com/psychiatry/depression/74589)</span></span><br />
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<span style="-webkit-font-kerning: none;"><span style="font-size: large;">“My father killed himself when I was 13 years old.” That was the opening line of my medical school admission essay, the one in which I tried to convince an anonymous administrator in another state that, as a suicide survivor, I was specially possessed of both strength and empathy—and that these traits made me specially worthy of becoming a doctor. In the essay I reminisced about the fun times with my dad, like when he would paint and I would sit on the floor poring over his medical textbooks. I described the medical diagrams he sketched on the backs of napkins at the KFC, when he took me out to dinner on our mandated Thursdays and every other weekend. My parents were divorced by then, and these were the only times I got to see my Dad. I treasured them. I didn’t tell the whole story in that essay, though. I didn’t mention how, a week before his death, my dad showed me where his will was located. “Just in case something happens to me,” he said. I also left out the night that he attempted suicide the first time. He called my mom to tell her he’d taken pills. She got the police to trace the call to a hotel. They found him, rushed him to the hospital, and pumped his stomach. He lived two more days, until he hanged himself. I didn’t tell those stories. I was focusing on the positive, you see. I wanted to get in. The real story was too messy and painful for the confines of a university admission essay.</span></span></div>
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<span style="-webkit-font-kerning: none;"><span style="font-size: large;">In my first year of medical school we learned about the warning signs of suicidality, and how to intervene by asking “are you thinking of hurting yourself?” and “do you have a plan?” That was when I realized that his showing me the will and first attempts were our chances to intervene. In medical school I learned about how to contract for safety and, maybe, save a life. I learned that suicide is preventable and that public safety measures—restricted access to guns, the installation of barriers on tall buildings and bridges—has not only thwarted individuals, but has also lowered the overall suicide rate in entire regions after they have been implemented. I learned that when patients survive a suicide attempt they are unlikely to try again and die by suicide. Learning about how to prevent suicide made me feel empowered, but it also made me feel guilty, because I didn’t know these things when I was 13, and I wish I had.</span></span></div>
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<span style="-webkit-font-kerning: none;"><span style="font-size: large;">I see the bodies of the suicidal on my autopsy table every week: the hangings, the incised wounds and gunshot wounds to the head and chest. Family members, survivors, are often in denial. The manner of death “just doesn’t make sense.” Sometimes I will confide that I am a survivor too, and that, even after 35 years, my father’s death still doesn’t make sense to me, either. I’ve been criticized for writing that suicide is a “selfish act”—but I stand by those words. Not out of a sense of abandonment from my dad, but because I too have lived long enough to be suicidal myself. In those moments, when suicide “made sense,” I was so engrossed in my own pain that the tunnel vision of depression made everything else—and everyone else—irrelevant. In that way the suicidal person is selfish; as in “self focused,” unwilling to believe that their pain can fade over time, and that other people rely on their presence in this world. Having coming through those periods myself with the unwavering love and support of my mother and, later, my husband, has made me stronger and more empathetic. I have overcome my father’s suicide, even if the wound it left me has never fully healed.</span></span></div>
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<span style="-webkit-font-kerning: none;"><span style="font-size: large;">I have learned that it helps to talk openly about it. The more I speak out about my father’s death, the more I discover friends who have also been touched by suicide. Silence = death when it comes to suicide, just like with HIV/AIDS. By talking openly about suicide, we can overcome the stigma associated with mental illness, and signal to those who may be suffering and suicidal (even when they aren’t mentally ill, but just going through a difficult time) that it’s okay to reach out for help. Others like me have been through it. We’ve made it to the other side. It may be hard to imagine—but it gets better. </span></span></div>
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<span style="-webkit-font-kerning: none; font-family: Helvetica-Oblique; font-style: italic;"><span style="font-size: large;">If you are thinking of hurting yourself or you know someone who needs help call the National Suicide Prevention Hotline 1-800-273-8255.</span></span></div>
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<span style="font-size: large;"><span style="-webkit-font-kerning: none; font-family: Helvetica-Oblique; font-style: italic;">Bio: <a href="http://www.pathologyexpert.com/drjudymelinek/"><span style="-webkit-font-kerning: none;">Dr. Judy Melinek</span></a> is a forensic pathologist in San Francisco, California, and the CEO of PathologyExpert Inc. She is the co-author with her husband, writer T.J. Mitchell, of the New York Times bestselling memoir <a href="http://www.drworkingstiff.com/"><span style="-webkit-font-kerning: none; font-family: Helvetica-BoldOblique; font-weight: bold;">Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner</span></a>. They are currently writing a forensic fiction series entitled </span><span style="-webkit-font-kerning: none; font-family: Helvetica-BoldOblique; font-style: italic; font-weight: bold; text-decoration: underline;">First Cut</span><span style="-webkit-font-kerning: none; font-family: Helvetica-Oblique; font-style: italic;">. You can follow her on Twitter @drjudymelinek and Facebook/DrJudyMelinekMD. </span></span></div>
Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-4372435849886326452018-05-21T17:38:00.000-07:002018-05-21T17:39:34.947-07:00Reasonable Uncertainty: The Limits and Expectations of an Expert’s Testimony<span style="font-family: "helvetica"; font-size: 10pt;">Reasonable Uncertainty: The Limits and Expectations of an Expert’s Testimony. Originally published in </span><span style="-webkit-font-kerning: none; -webkit-text-stroke-color: rgb(0, 0, 0); -webkit-text-stroke-width: initial; font-family: Helvetica-Oblique; font-size: 10pt; font-style: italic;">Forensic Magazine </span><span style="font-family: "helvetica"; font-size: 10pt;">September</span><span style="-webkit-font-kerning: none; -webkit-text-stroke-color: rgb(0, 0, 0); -webkit-text-stroke-width: initial; font-family: Helvetica-Oblique; font-size: 10pt; font-style: italic;"> </span><span style="font-family: "helvetica"; font-size: 10pt;">2017, 14, 3:18-19</span><span style="font-family: "helvetica"; font-size: 10pt; font-weight: bold;"> </span><span style="font-family: "helvetica"; font-size: 10pt;">(<a href="https://www.forensicmag.com/article/2017/09/reasonable-uncertainty-limits-and-expectations-experts-testimony">https://www.forensicmag.com/article/2017/09/reasonable-uncertainty-limits-and-expectations-experts-testimony</a>)</span><br />
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<span style="font-family: "helvetica"; font-size: 10pt;"><span style="-webkit-font-kerning: none; font-size: 12pt;">“So, doctor, you just said that the article you referenced indicates that only twenty percent of patients with this disease die a sudden cardiac death, correct?”</span></span></div>
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<span style="-webkit-font-kerning: none; font-size: 12pt;">“And your testimony is given under the standard of more likely than not, right?”</span></div>
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<span style="-webkit-font-kerning: none; font-size: 12pt;">“That is correct.”</span></div>
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<span style="-webkit-font-kerning: none; font-size: 12pt;">“That’s the same thing as a balance of the probabilities—more than fifty percent likelihood, correct?”</span></div>
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<span style="-webkit-font-kerning: none; font-size: 12pt;">“Yet </span><span style="-webkit-font-kerning: none; font-size: 12pt; font-style: italic;">less than half</span><span style="-webkit-font-kerning: none; font-size: 12pt;"> of patients with this disease die of the cause you are advocating. How can you possibly testify that it is more likely than not?”</span></div>
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<span style="-webkit-font-kerning: none; font-size: 12pt;">I have faced versions of this question over the years from countless attorneys and I can’t always tell whether they are truly confused by statistics and probability or whether they think I am. They are employing an unsound argument called the ecological fallacy: applying a statistical finding generated by a large population to an individual case. For people who have no understanding of math it “makes sense.” For an expert, these types of questions are an opportunity to educate the judge and jury—and, perhaps, even the questioning attorney—about the science of statistical power and how probability really works.</span></div>
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<span style="-webkit-font-kerning: none; font-size: 12pt;">Courts require experts to testify “within reasonable scientific certainty.” Sounds legit, right? It isn’t—not to scientists. “Reasonable scientific certainty” holds no currency in the scientific community. The National Commission on Forensic Science was a federal body created in 2013 to address conflicts of professional culture between the law and the sciences. Before its charter expired in April 2017, the NCFS released a document that called for the cessation of the use of the term “reasonable scientific certainty” in forensic expert testimony. (<a href="https://www.justice.gov/archives/ncfs/page/file/641331/download"><span style="-webkit-font-kerning: none; font-size: 12pt;">https://www.justice.gov/archives/ncfs/page/file/641331/download</span></a>). There is no agreement among experts of the actual meaning of the phrase. For one thing, nothing in science is based on </span><span style="-webkit-font-kerning: none; font-size: 12pt; font-style: italic;">reason</span><span style="-webkit-font-kerning: none; font-size: 12pt;"> alone; it’s based on evidence and testing. Science is rarely </span><span style="-webkit-font-kerning: none; font-size: 12pt; font-style: italic;">certain</span><span style="-webkit-font-kerning: none; font-size: 12pt;">—it relies on statistical probability, and acknowledges that outliers can and do exist. We forensic scientists operate in a liminal space between science and law. In the past, we have had to accommodate our professional rhetoric to the demands of attorneys by accepting the use of this phrase when we testified. Why have we done so? Because the cost of rejecting this accommodation was to open ourselves to attack. An opposing lawyer would declare that we have no credibility as an expert, and the judge might dismiss our testimony as not adhering to evidentiary standards. If you can’t testify to something with “reasonable scientific certainty” because the evidence was insufficient, the court might throw out all your testimony rather than allowing you to testify to the uncertainty of the science.</span></div>
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<span style="-webkit-font-kerning: none; font-size: 12pt;">Okay, I hear you: This is absurd! Uncertainty is not a sign of poor scientific testimony—it’s the hallmark of the honest scientist! Our paradox rises from the United States Supreme Court’s Daubert decision which limited the bounds of scientific opinion testimony by expert witnesses. Daubert v. Dow (1993) set the federal standard for admissibility of evidence. It never required “reasonable certainty,” but it did set guidelines for testimony to be admissible if the science is reliable. What did the Supreme Court say is reliable? Reliable expert testimony in science and technical fields must be tested and subject to peer review, must have a known error rate, must be maintained by standards, and must be accepted by the scientific community.</span></div>
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<span style="-webkit-font-kerning: none; font-size: 12pt;">As a consequence of Daubert, forensic science disciplines that rely on inference and experience (such as forensic pathology) have been subjected to accusations of unreliability because practitioners have no published error rate and they incorporate ancillary evidence—such as information from witnesses or police—which can be inaccurately perceived as generators of cognitive bias. While testimony about the likelihood of a particular event being within a 95% confidence interval may be appropriate when describing epidemiological research or while performing lab studies on fruit flies, these types of statistics have no bearing on the day to day work of forensic disciplines such as pathology and criminalistics. Our branches of science rely on training, experience, observation, and scientific inference. There is ample inferential literature to support our observations, but not enough statistics to allow us to report on our own error rate. We don’t operate in the zone of experimental science. We can’t run double-blind tests on murdered human beings. We can’t generate fatal industrial accidents to study the mechanical dynamics at play. And so, thanks to the Daubert ruling and the persistent repetition by lawyers of the magical phrase “reasonable scientific certainty,” we have to sit up there on the stand and teach juries about statistics and probability, about inductivism and the scientific method. </span></div>
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<span style="-webkit-font-kerning: none; font-size: 12pt;">Humility is baked into scientific semantics. There are things that are not knowable based on the current state of your field of specialty. But if you are asked to answer a question on the stand and the answer is just “I don’t know” then some lawyer will find an “expert” with no credentials or integrity to follow you and declare “I know!” In my experience, juries and lawyers will prefer the expert who is willing to speak with confidence and certainty. They will defer to the voice who “knows” even if it is not based in good science. It's not good enough to say “I don't know.” If you care about justice prevailing you have to also take the time to explain why you don't know what you don’t know. You have to explain the limits of your science.</span></div>
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<span style="-webkit-font-kerning: none; font-size: 12pt;">The stakes are high. In many states, once a defendant is convicted it is not possible to appeal based on scientific advancement or factual innocence, but only on procedural grounds: that the original trial judge or attorneys erred in some way. Expert testimony that had been deemed reliable by the courts in the past is now being questioned by scientists because the science has advanced, but the new data can’t be used to free those who were incarcerated based on expert witness testimony that is now obsolete or was overstated.</span></div>
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<span style="-webkit-font-kerning: none; font-size: 12pt;">The future of forensic science in the United States is in flux, and scientific literacy is becoming harder to come by in the courtroom and outside it. Nowadays one of the most daunting challenges an expert has to face is to convey uncertainty without appearing unqualified. It is an unfortunate tenet of our nature that we human beings gravitate toward the person who can exude conviction with charisma, no matter his or her actual base of experience. Couple that with the testimonial result of the Dunning-Kruger effect—that the expert with the least experience and qualifications is more likely to testify with absolute certainty—and it becomes even more critical that we forensic professionals train ourselves to express clearly the limits of scientific testimony when the evidence in a case just isn’t there. As individuals with integrity we have to apply rigorous scientific principles in our reports and our testimony, and we have to acknowledge that uncertainty exists. Your training and experience is reliable. Your professional opinion (even when you are uncertain) is reasonable. Be certain that attorneys, judges and juries get that.</span></div>
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<span style="-webkit-font-kerning: none; font-size: 12pt;">Bio: <a href="http://www.pathologyexpert.com/drjudymelinek/"><span style="-webkit-font-kerning: none; font-size: 12pt;">Dr. Judy Melinek</span></a> (link to: <a href="http://www.pathologyexpert.com/drjudymelinek/"><span style="-webkit-font-kerning: none; font-size: 12pt;">http://www.pathologyexpert.com/drjudymelinek/</span></a>)is a forensic pathologist and does autopsies for for the Alameda County Sheriff Coroner's office in California. Her New York Times Bestselling memoir <a href="http://www.drworkingstiff.com/"><span style="-webkit-font-kerning: none; font-size: 12pt;">Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner</span></a>, (link to: http://www.drworkingstiff.com) co-authored with her husband, writer T.J. Mitchell, is now out in paperback. She is the CEO of PathologyExpert Inc.</span></div>
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Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-4305172543406357762018-03-04T09:50:00.001-08:002018-03-04T09:51:06.344-08:00Jury Duty: Inside the Box.Originally published in <i>Forensic Magazine</i> June 2017 14,2:23-24. (https://www.forensicmag.com/article/2017/06/expert-witness-jury-duty-inside-box)<br />
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<span style="-webkit-font-kerning: none; font-size: 11pt;">Last week I was called to jury duty at my local courthouse, where I have testified as an expert witness before. I showed up. I signed in. I watched two videos explaining how our justice system works. Then I was assigned a courtroom—and this time, instead of addressing the people in the jury box, I found I was one of the people in the jury box. A lawyer stepped before us and announced that the legal action for which we’d been selected was a civil matter: asbestos injury litigation.</span></div>
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<span style="-webkit-font-kerning: none; font-size: 11pt;">No way, I said to myself. No way a forensic pathologist can serve as an impartial juror in an asbestos lawsuit. I have got to get excused from this. If this were a lawsuit about larceny, or financial fraud, or building code violations, it would be perfectly appropriate for me to be impaneled. But a case that relies on medical expertise as the evidentiary lynchpin? I felt confident that the attorneys litigating the case would agree that it would be inappropriate to have a medical expert on their jury.</span></div>
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<span style="-webkit-font-kerning: none; font-size: 11pt;">Each of the several attorneys trying the case had a set of questions. They went one by one through the jury candidates. Do you know anyone who died of asbestosis? Do you have any strong feelings against corporations? If a smoker has a smoking-related illness, would you consider it their fault? Every lawyer finished with the same catch-all: Do you have any biases that would influence your judgement in a case like this one?</span></div>
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<span style="-webkit-font-kerning: none; font-size: 11pt;">Each time I was asked this last question, I gave the same answer: Yes. I am a medical doctor and I diagnose asbestosis when it is present in a dead body that comes to my autopsy table. I have my own very definite opinions in the matter, professional opinions founded on years of medical education and practice. To my shock, attorney after attorney then nodded, thanked me—and told me to sit back down in the jury box.</span></div>
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<span style="-webkit-font-kerning: none; font-size: 11pt;">I have a lawyer brother-in-law. That evening, I called him and asked what the heck was going on. Why wouldn’t they excuse me?</span></div>
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<span style="-webkit-font-kerning: none; font-size: 11pt;">“Simple," he replied. "They want someone smart on the jury. They want someone who is going to listen to the facts they present. They don't care about bias as much as they want someone rational."</span></div>
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<span style="-webkit-font-kerning: none; font-size: 11pt;">The next day, when another one of the lawyers asked how I was biased, I had an answer ready. "Let me explain something to you. I am a professional expert witness. I can’t say right now exactly how I am biased, whether it is for the prosecution or for the defense, but I guarantee you that I cannot be impartial when it comes to scientific testimony. If you have medical ‘experts’ get up there and testify? I'm not going to listen to them. I'm going to listen to </span><span style="-webkit-font-kerning: none; font-family: Helvetica-Oblique; font-size: 11pt; font-style: italic;">this”—</span><span style="-webkit-font-kerning: none; font-size: 11pt;"> and here I pointed at my own head—“and then I'm going to convince all </span><span style="-webkit-font-kerning: none; font-family: Helvetica-Oblique; font-size: 11pt; font-style: italic;">these</span><span style="-webkit-font-kerning: none; font-size: 11pt;"> people”—and I pointed at the rest of the members of the jury—“of </span><span style="-webkit-font-kerning: none; font-family: Helvetica-Oblique; font-size: 11pt; font-style: italic;">my</span><span style="-webkit-font-kerning: none; font-size: 11pt;"> opinion. Because that’s what I </span><span style="-webkit-font-kerning: none; font-family: Helvetica-Oblique; font-size: 11pt; font-style: italic;">do."</span></div>
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<span style="-webkit-font-kerning: none; font-size: 11pt;">So that's how I got excused from jury duty. I don't know if my argument finally convinced the attorneys on its merits, or if my hand-waving and air quotes when I sneered </span><span style="-webkit-font-kerning: none; font-family: Helvetica-Oblique; font-size: 11pt; font-style: italic;">medical ‘experts’</span><span style="-webkit-font-kerning: none; font-size: 11pt;"> convinced them I was a lunatic. Whichever the case, they made a wise decision. I would not be capable of accepting what another medical expert told me was the absolute truth. I would question that expert’s opinion. I would challenge it, based on my training and experience, in the jury room; and, in the end, I would come to my own opinion. I can’t do that in a case about insurance fraud, but I can’t avoid it in a case about asbestosis. It is the litigants’ job to convince the entire jury as individuals. You need everyone on the jury to participate in the process of deliberation. If one juror is instead able to sway everyone else to her opinion because she has relevant expertise and professional authority, the trial lawyers have failed.</span></div>
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<span style="-webkit-font-kerning: none; font-size: 11pt;">Attorney friends have confided—and griped—that they don’t get much law school training on jury selection. They learn it on the job; and, unfortunately, that means they apply their own biases when trying to elicit the biases of potential jurors. They might make assumptions based on a combination of factors, including race, gender, religion, educational background, and professed life experience. They might make the assumption that a well-educated person is going to be able to evaluate an expert’s testimony. In fact, the opposite may be the case. A juror with education and experience in the relevant area of expertise may instead dismiss what an expert witness says, even if the expert is correct. This is a flaw in jury selection as it is currently practiced in the United States: It doesn’t succeed at eliciting implicit bias.</span></div>
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<span style="-webkit-font-kerning: none; font-size: 11pt;">Implicit bias has been in the news lately. These are the prejudices and predispositions you don’t even know you have. In the course of jury selection, lawyers rely on jurors to self-report their biases—but there is nothing predictive that will tell a lawyer whether jurors are biased if the jurors aren’t even aware of the preconceptions they carry with them. Lawyers may ask about educational level as a benchmark of a juror’s knowledge base and reasoning ability, but that is a poor way to assess implicit bias. You need to delve deeper, into which sources of information people consume—especially if the case involves a scientific expert witness. In a “post-truth” age of fake news and intentional, sophisticated campaigns of mass-media deception, those who rely on the internet as their primary news portal may be woefully misinformed. And a misinformed juror is worse than an uniformed one. </span></div>
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<span style="-webkit-font-kerning: none; font-size: 11pt;">An expert doesn't win or lose a case: We neutralize other experts. If we’re going to do so effectively, we need to be aware of which false news stories might bias the public. A good expert will address this challenge directly: teach the jury the basic forensic terminology, and explain how misconceptions are spread by television dramas and police procedurals. For instance, bullets do not spin people around. Not everyone who confesses to a crime under police interrogation is telling the truth. Time of death determinations based on postmortem changes are not always accurate or ironclad. </span></div>
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<span style="-webkit-font-kerning: none; font-size: 11pt;">Just because people subscribe to scientific myths doesn’t mean a good forensic expert can’t challenge misinformation and get the jury to understand the science of a case. Unscientific misconceptions might appeal to common sense and might calcify a juror’s biases that have built up over years spent absorbing the zeitgeist’s pseudoscientific claptrap. That doesn’t mean we should surrender to scientific illiteracy. It is our duty as forensic experts to provide the remedy to implicit bias—one jury at a time.</span></div>
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<span style="-webkit-font-kerning: none; font-size: 11pt;">Bio: <a href="http://www.pathologyexpert.com/drjudymelinek/"><span style="-webkit-font-kerning: none; font-size: 11pt;">Dr. Judy Melinek</span></a> (link to: <a href="http://www.pathologyexpert.com/drjudymelinek/"><span style="-webkit-font-kerning: none; font-size: 11pt;">http://www.pathologyexpert.com/drjudymelinek/</span></a>) is a forensic pathologist who does autopsies for the Alameda County Sheriff Coroner's office in California. Her New York Times Bestselling memoir <a href="http://www.drworkingstiff.com/"><span style="-webkit-font-kerning: none; font-size: 11pt;">Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner</span></a>, (link to: http://www.drworkingstiff.com) co-authored with her husband, writer T.J. Mitchell, is now out in paperback. She is the CEO of PathologyExpert Inc.</span></div>
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Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-13881076435269386022017-03-06T11:58:00.000-08:002017-03-06T11:59:21.542-08:00A successful career postmortem — in the flesh: The fun house mannequin that wasn’t<div>
<span style="font-size: large;">By A.J. Chapman</span></div>
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<span style="font-size: large;">In the 1970s, “The Six‐Million‐Dollar Man” was a popular television show. It concerned a man who had met with a disaster that extensively destroyed much of his body that was then replaced with bionic parts that gave him incredible strength, x‐ray vision, and the like. In preparing to shoot one episode of the series, the crew was preparing the set, which was at the “Laff in the Dark” fun house in the Nu‐Pike Amusement Park in Long Beach, California. One member of the crew moved what he thought was a garishly painted mannequin that was designed to glow very bright orange in the dark when illuminated with a black light. The right forearm of the supposed mannequin fell off, having disjointed at the elbow. The crew member picked it up and was astounded to see that this particular mannequin had an actual bone in its arm. Since mannequins do not contain bones, the police were notified. They confirmed that the body was human, and the remains were transported to the office of the Los Angeles County Medical Examiner‐Coroner.</span></div>
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<span style="font-size: large;">An autopsy was performed. The cause of death was a bullet wound, and the body was found to have been preserved with arsenical compounds that were used for embalming only in the period between 1905 and 1930. As an aside, arsenical compounds preserve remains wonderfully. Their use was eventually prohibited because in any case in which arsenic poisoning was the cause of death, that fact could not be proven once the body had been so embalmed.</span></div>
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<span style="font-size: large;">A news release was issued, and a member of a family who had once owned the remains contacted the Los Angeles Police Department. The information provided ultimately led to the identification of the body.</span></div>
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<span style="font-size: large;">Eventually, the facts of the case were established. The “mannequin” was the body of Elmer McCurdy, a less‐than‐successful outlaw, who was killed on 7 October 1911 in Pawhuska, Oklahoma. He and two others held up a “Katie” (MKT—Missouri, Kansas, Texas) train, believing it was carrying a great deal of money for a payroll.</span></div>
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<span style="font-size: large;">The bungling, less‐than‐savvy robbers, however, picked the wrong train and escaped with very little booty. A local newspaper described the fruits of the robbery as “one of the smallest in the history of train robbing . . . . They failed to find as much as a copper cent in the safe in the express car. . . . They also made away with two gallons of whiskey, and during the holdup, they knocked in the head of two kegs of beer and drank part of the contents.”</span></div>
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<span style="font-size: large;">What role the whiskey and beer may have played in Elmer’s killing by lawmen can only be speculated. The robbers were trailed to a ranch where Elmer—after drinking with ranch employees—had gone to sleep in the haymow of the barn. He exchanged gunfire with the posse that had found him for about an hour before being shot dead in the barn. The fatal shot was in the chest.</span></div>
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<span style="font-size: large;">Elmer’s body was taken to Pawhuska, Oklahoma to the Johnson Funeral Home where it was embalmed with arsenical preservatives. No one claimed the body, and after about six months, it was perfectly preserved and could be placed in an upright position. Thus, the “Embalmed Bandit”, as he became known, was dressed in the clothing he wore during his last gunfight, was placed in the corner of a room, and a rifle was placed in his hand. There he stood for five years with curiosity seekers paying a nickel to see him.</span></div>
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<span style="font-size: large;">In 1916, two men appeared, and one of them claimed to be Elmer’s brother. He managed to get the body turned over to him. In reality, however, these con artists were the owner and the manager of Patterson Carnival Shows. Elmer’s body was shipped to Arkansas City, Kansas, and the following morning, the carnival left for Woodward, Oklahoma. Thus, Elmer’s show biz career was launched.</span></div>
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<span style="font-size: large;">Elmer traveled with the show until 1922 when he was sold to Louis Sonney, the owner of a wax figure museum sideshow that was called the “Museum of Crime”. He became an instant “hit” among the other outlaws collected in the show since he was one of the figures who was a very real, even if dead, outlaw.</span></div>
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<span style="font-size: large;">The sideshow did not do well, and in 1971, Elmer went to work for Ed Liersch and D. R. Crydale, partners who set up a wax museum of their own on the Long Beach Pike and purchased Elmer from the show. They displayed him as “The 1,000 Year Old Man”. Five years later, he was “hanging around” in the fun house in the amusement park where the body was subsequently found when the place was leased to Universal Television Studios for filming of the episode of “The Six Million Dollar Man”.</span></div>
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<span style="font-size: large;">All things considered, Elmer’s postmortem career was far better and more successful than his antemortem one.</span></div>
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<span style="font-size: large;">The information concerning the travels and identity of Elmer McCurdy consisted mainly of hearsay, and a more substantial identification was required by Los Angeles County Medical Examiner Coroner, Dr. Thomas T. Noguchi aka “coroner to the stars”, before release of the body. The late Dr. Clyde Snow, the celebrated forensic anthropologist and personal friend of mine from Oklahoma, accomplished this primarily by superimposition of a postmortem x‐ray of the skull onto an existing photograph of Elmer from archives in Oklahoma.</span></div>
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<span style="font-size: large;">Additionally, the positioning of the hands was compared to the postmortem positioning of the hands in a photograph that had been taken when Elmer’s body was in the funeral home in Pawhuska sometime between 1911 and 1916. Elmer McCurdy’s stature, age, gender, and race were known, and a scar had been described on his right wrist—a deep one that had resulted from a drunken knife fight in a bar. The bullet wound was also confirmed. These comparisons provided perfect matches. DNA verification was, of course, not possible since the DNA technology and procedures were relatively far in the future at the time.</span></div>
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<span style="font-size: large;">Dr. Noguchi would release the body only to the Chief Medical Examiner of Oklahoma, who happened to be me, so I met Elmer on the tarmac of Will Rogers World Airport when he returned to Oklahoma on a Boeing 727.</span></div>
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<span style="font-size: large;">For a little perspective: When Elmer was killed, the very first flight of an aircraft by the Wright brothers had taken place only eight years earlier at Kitty Hawk, North Carolina and Oklahoma had only been a state for four years. Arizona and New Mexico had not yet achieved statehood.</span></div>
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<span style="font-size: large;">Hence, his “glorious” return to Oklahoma could never even been in the wildest, drunken imaginings of Elmer.</span></div>
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<span style="font-size: large;">The body was taken to the morgue where it was photographed and placed into a casket that had been handcrafted for the occasion. Steve Lower, my assistant, and I fastened the lid of the casket with corrugated nails to insure it would not be opened prior to burial.</span></div>
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<span style="font-size: large;">Each year in April the ‘89er Celebration is held in Guthrie, Oklahoma, which is located approximately 30 miles north of Oklahoma City and which was the original capitol of Oklahoma until 1910. The celebration commemorates the opening of the Oklahoma Territory to settlement—”The Run of ’89”—22 April 1889. It was during this celebration in 1977 that Elmer was laid to rest in Summit View Cemetery—“Boot Hill”—in Guthrie.</span></div>
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<span style="font-size: large;">Many people dress in period costumes and grow beards for these celebrations, and horses and horse‐drawn vehicles are the preferred modes of transportation. Elmer’s casket was placed into an immaculately preserved horse‐drawn hearse with glass sides that made the casket visible to those along the route of the funeral cortege. The driver of the hearse was formally attired. After the casket was lowered into the ground, a lay preacher intoned a few words for the burial. A romantic girl tossed a single yellow rose onto the casket, which was otherwise bedecked with a spray of white lilies.</span></div>
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<span style="font-size: large;">In order to be certain that Elmer’s postmortem career and traveling about the country was put to an end once and for all, approximately two cubic yards of concrete were poured over the casket before it was covered with the red Oklahoma earth.</span></div>
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Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-75759561594856497172016-10-17T16:37:00.001-07:002017-03-06T11:10:49.188-08:00How Designer Drugs and the Opioid Epidemic Affect Modern Forensic
Practice<i><span style="font-size: large;"><span style="background-color: rgba(255, 255, 255, 0); color: #333333; font-family: "arial" , serif;">This article was originally published in <a href="http://www.forensicmag.com/" style="color: #fc8901; text-decoration: none;" target="_blank">Forensic Magazine</a>. To read the original article click here </span>(<a href="http://digital.forensicmag.com/forensics/september_2016/MobilePagedReplica.action?pg=18#pg18">http://digital.forensicmag.com/forensics/september_2016/MobilePagedReplica.action?pg=18#pg18</a>)</span></i><br>
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<span style="font-size: large;">The decedent was a bright young woman with a promising acting career. She and a friend had spent hours in her apartment memorizing lines for a new play, and wanted to relax. The actress went into the fridge for a pot brownie she had bought at a music festival the day before. A nibble didn’t yield enough of an effect. She took a bigger bite. Then she ate the whole thing. </span><br>
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<span style="font-size: large;">Half an hour later, the woman began to act strangely. Instead of reciting the dialogue she was trying to memorize, she started to describe—and react to—vivid visual and auditory hallucinations. She wanted to go out the window. She needed to, she said. The friend had to restrain her. </span><br>
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<span style="font-size: large;">But this actress was stronger than her friend. She got to the window. She opened it. She made it out. She died of multiple blunt injuries sustained from a three-storey fall to the pavement below. In the course of their investigation, the police located the woman who had baked the brownies. She told them, first of all, that the brownies were vegan, and also that they had been laced with both marijuana and "Spice"—a designer drug that affects the same cellular receptors as THC. She had purchased the Spice online. Based on the police report and the witness statement about the decedent’s behavior immediately before her death, I requested that the blood specimen be tested for synthetic cannabinoids. The toxicology report came back positive for both THC and a synthetic analog.</span><br>
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<span style="font-size: large;">Illicit drugs are consumer products, subject to market forces. As law enforcement agencies have found more effective ways to crack down on supplies of the most common recreational drugs, enterprising producers have responded by trafficking new ones, synthetic analogs that alter the chemical structure of known psychotropics. These analogs may cause a much more pronounced high—and they have deleterious properties that can include fatal side effects. Synthetic cannabinoids like the Spice baked into that pot brownie have been linked to psychosis. Ecstasy and Molly, stimulants derived from methamphetamine, cause hypothermia and cardiac arrhythmia. Street drugs marketed as analgesics like alprazolam, oxycodone, and hydrocodone are being adulterated with fentanyl or fentanyl analogs, synthetic opioids that increase the risk of fatal respiratory depression. </span><br>
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<span style="font-size: large;">These emerging designer drugs are a headache for us forensic pathologists. Routine toxicology may not even detect them, and if there’s enough of the more common drug in the sample then it can camouflage the novel compound. The pathologist will not even realize it’s there, and won't have the blood tested further to isolate it. A pathologist would only think to look for these synthetic analogues if the toxicology came back negative or if the common-drug levels were so low that they shouldn't have caused death.</span><br>
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<span style="font-size: large;">Overdoses have reached crisis levels all over the country. Some jurisdictions, such as Richland County in Ohio (http://www.mansfieldnewsjournal.com/story/news/crime/2016/07/25/autopsies-wont-performed-routine-drug-overdose-cases/87524864/), have decided to stop performing autopsies in cases of apparent drug overdose, because they are overwhelmed with bodies. They're stuck between a rock and a hard place. They are violating standard forensic practice and taking a tremendous risk of missing other causes of death by bypassing autopsies, but they’re doing so because of a lack of funding and staffing. An office that exceeds the annual number of autopsies per pathologist will lose accreditation, but the government agencies funding that same office still view drug overdoses through the lens of law enforcement, not public health. According to the Centers for Disease Control and Prevention, the number of drug overdose deaths in the United States is officially at epidemic levels. The rate of deaths has increased 137% since 2000, including a 200% increase in the rate of opioid deaths (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm). Could street drugs adulterated with synthetic adulterants be to blame? We can't say—not without full autopsies and complete toxicology testing in all overdose cases. </span><br>
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<span style="font-size: large;">Without adequate funding at every level of government, we will not be able to track which specific chemical agents are killing people. Police labs need budgets for synthetic drug testing and screening. Medical examiner and coroner offices need money to track the impact and scope of the epidemic. Every death investigation agency in the country would benefit from a federally-funded national database to correlate overdose deaths with illicit drug seizures across state lines. </span><br>
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<span style="font-size: large;">But money alone won’t fix the problem—we also need legislative and policy changes. Instead of criminalizing the drug based solely on its chemical composition, legality should be defined by toxicity, the accreditation of manufacturing labs, and distribution method. Our federal agencies need to target online distributors. Medical examiners and coroners need to document medications found at overdose death scenes, check those lists against state databases, and report cases of prescription drug diversion. We also need to alert prescribing physicians in these cases so they can re-evaluate their prescription guidelines. Coroners must certify overdose deaths properly—listing all the medications by name instead of just writing "mixed drug intoxication" on the death certificate, for instance. Medical examiners should work with the Drug Enforcement Administration to apply comprehensive testing techniques to pills collected from death scenes, looking for emerging contaminants and designer drugs. This is especially crucial in cases where the drug levels in the OD are low or do not correspond with the reported symptoms of intoxication. Most importantly, forensic pathologists need to perform autopsies in all cases of apparent overdose, and coroners must staff their offices appropriately to manage the caseload. You should be autopsying these cases. If your toxicology report comes back negative in a presumptive OD because the panel is unable to test for a neoteric designer drug, then you'll have buried a body without providing a cause of death. You will have failed at your job's core mission.</span><br>
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<span style="font-size: large;">Bottom line: if we don't have enough money to autopsy all deaths that we are required by statute to investigate, then we damn well better be spending what we can on prevention strategies to keep those bodies from piling up. Prevention is more cost effective than investigation in cases of avoidable lethal intoxication. Surplus mortality should not be ordained by the local supply of recreational drugs.</span>Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-34117640377112500852016-10-17T16:32:00.003-07:002016-10-17T16:35:22.009-07:00Mind Your Manners: Where Death Certification Ends and Prevention Begins<span style="font-size: large;"><i><span style="background-color: rgba(255 , 255 , 255 , 0); color: #333333; font-family: "arial" , serif;">This article was originally published in <a href="http://www.forensicmag.com/" style="color: #fc8901; text-decoration: none;" target="_blank">Forensic Magazine</a>. To read the original article click here (</span></i><a href="http://digital.forensicmag.com/forensics/june_2016/MobilePagedReplica.action?pg=18#pg18?"><i>http://digital.forensicmag.com/forensics/june_2016/MobilePagedReplica.action?pg=18#pg18?</i></a><i><span style="background-color: rgba(255 , 255 , 255 , 0); color: #333333; font-family: "arial" , serif;">)</span></i></span><br />
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<span style="font-size: large;">The police pick up a 45 year old man, a robbery convict, for speeding. The arrest is a parole violation. The man has a history of smoking and substance abuse, and is obese. On his third day back in jail, he refuses to cooperate during a routine search of his cell. The corrections officers address this behavior problem by strapping the man into a restraint chair for several hours until he calms down. After he is released, he immediately starts a fight with another inmate. Once again the guards strap him into the restraint chair, for several more hours, until he is compliant. The man goes back in the chair twice more over the course of the next four days. After the final time, he stands up—and then, without a word, collapses. He's lying on the floor of the jail, unconscious. He is not breathing. The guards initiate CPR immediately, but after a few minutes the man is still not breathing and no longer has a pulse. The guards continue CPR until paramedics arrive ten minutes after the man's collapse. The medics declare him dead.</span><br />
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<span style="font-size: large;">The forensic pathologist conducting the autopsy finds that the man has a large saddle pulmonary embolus and blood clots in both legs associated with the strap marks from the restraint chair. The cause of death is clear—pulmonary embolus. What's the manner, though? A blood clot traveled from the man's legs to his lungs. Obese smokers commonly develop dangerous blood clots, so should this be certified as natural? The man had been immobilized and showed signs of injury on his legs from the restraint straps, so is this death an accident? But, wait—his immobilization was forced. He had been restrained and injured at the hands of the guards. This prisoner's death should be a homicide. How about undetermined? Suicide is the only manner of death we would categorically discount.</span><br />
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<span style="font-size: large;">Medical examiners and coroners agonize over manner of death all the time, and for good reason. The cause of death, the disease or injury leading to the lethal event, may be patently clear, but it's the manner of death that the family hears and that the press pounces on. Call an in-custody death such as this one a homicide, and the media will immediately pronounce that the police killed the inmate, even if the corrections officers were only following their training and jail protocol. Call an in-custody death accident or natural, and you might be accused of a cover up. Call it undetermined (a way of saying the death doesn't fully categorize into one manner or another) and no one is happy: You get branded as either unscientific or indecisive. Or both.</span><br />
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<span style="font-size: large;">What is manner of death? It's a required part of the death certificate, a system of classification most often used for data analysis in the realms of public health and academic research. Every time you read an article that contains information about the ways people die, or compares types of deaths across geographic regions, the researchers likely started their analysis with publicly-available death certificate data, sorted by manner of death.</span><br />
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<span style="font-size: large;">But manner of death has a social function as well, because, like it or not, we attach different moral value to different ways of dying, even when the mechanism is the same. In my experience, families who have lost a loved-one to a drug overdose don't object to the determination that the cause of death was by acute mixed drug intoxication as much as they object to my manner ruling that the overdose was an accident or a suicide, in some cases because of religious prohibitions against suicide. One Pennsylvania coroner has been in the news lately for classifying overdoses of illegal drugs as homicides, so that the drug dealers will be prosecuted for murder, even if the user injected the drugs himself in order to get high. Sounds like a good idea, right? Drugs are illegal and the dealers should be punished. The problem is, such an approach conflates the duties of scientific death classification with those of law enforcement. Our job is statistical and unbiased, and we need a uniform classification system in order to understand how people die in the real world, and to study regional differences. Coroners in jurisdictions surrounding this Pennsylvania county have avoided following suit with this reclassification of manner in drug deaths.</span><br />
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<span style="font-size: large;">We in the forensic sciences must work to communicate with the police, the families of decedents, and with the public at large about the different manners of death, about the national standards used in classifying deaths, and about our decision-making process in arriving at a conclusion in each individual case. We must do so as part of our professional duty to public health in seeking to reduce our national burden of avoidable deaths. We spend a lot of time agonizing about the manner—but the determination of manner doesn't matter if we don't then do something to counsel the decedent's family, to explain what happened to the public, and to prevent this from happening again, if what happened was at all preventable.</span><br />
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<span style="font-size: large;">Some jurisdictions will call our hypothetical case study of the prisoner with the embolus a homicide. Others might call it an accident. A few might even decide this was a natural death. Regardless, they will all be remiss if they stop with cause and manner. We coroners and medical examiners have an ethical duty to do more than just check a box on a death certificate and wait for the inevitable lawsuit. We have a duty to reach out to those in power to change the lethal environment by educating the jail staff and the corrections department managers who write the policies and procedures. If we don't reach out to other professionals in other county agencies, one man's avoidable death will repeat with others under similar circumstances. If we don't publicize it in the press, how will others learn from our experiences and adjust their policies accordingly, before the next death? The next time it happens, what will you do about it? Will you call it another homicide, another accident, another natural death? Whatever your answer, you will have a harder time explaining why another such corpse has come to a slab in the morgue, and why you didn't do anything to stop it getting there. We forensic pathologists are physicians working in the realm of public health. Our job—our duty—does not end with the death certificate.</span><br />
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<br />Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-71495043107853963342016-09-21T07:21:00.001-07:002016-09-21T08:44:10.078-07:00Don't Share a Bed with Your Baby<div>
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<span style="font-size: large;"><span class="Apple-tab-span" style="white-space: pre;"> </span>It was one of the toughest phone conversations I have made in my 15 years as a forensic pathologist. I had just completed the autopsy of a three month-old infant. He had spent the night sharing an adult bed with his mother and six year-old brother. In the morning they found him prone, with his face against the pillow, dead. During the autopsy I found that blood had pooled under the skin of the baby’s face and abdomen after death, and I documented characteristic areas of pallor where the pillow had pressed against his nose and mouth. He had asphyxiated. After leaving the morgue I had to go pick up the phone and tell a mother she had accidentally smothered her son.</span><br />
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<span style="font-size: large;"><span class="Apple-tab-span" style="white-space: pre;"> </span>I investigate sudden infant deaths three or four times a year. Parents who lose a child to a bed-sharing accident inevitably ask me why the cause of death isn't SIDS, sudden infant death syndrome. I have to explain that SIDS is a diagnosis of exclusion: the autopsy and scene investigation rule out injury, and we can't find any fatal natural disease. A child who is found face-down with his nose and mouth covered has been injured. The cause of death in such a case is positional asphyxia, and the manner of death is accident. Accidents are avoidable, which makes that postmortem conversation all the harder. The parents blame themselves. I frequently end up in tears along with them. I have three children who were babies not that long ago, and though I’m a doctor I am not made of stone.</span></div>
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<span style="font-size: large;"><span class="Apple-tab-span" style="white-space: pre;"> </span>My medical colleagues and I were dismayed to read the Los Angeles Times Op-Ed of September 18, 2016 titled "<a href="http://www.latimes.com/opinion/op-ed/la-oe-levine-cosleeping-bedsharing-global-20160916-snap-story.html" target="_blank">It's OK to sleep next to your infant child. In fact, it's beneficial</a>," showing a photo of a smiling mom sharing an adult bed—with soft blankets and pillows—with her three month-old. The authors, two professors of human development, cite anthropological research while dismissing the recommendations for safe sleep promulgated by medical professionals, including those in the CDC and the American Academy of Pediatrics. This article operates under the fallacy that cross-cultural anecdotes trump hard scientific data. It conflates SIDS deaths with all sudden infant deaths, betraying an ignorance about asphyxial death in unsafe sleep environments. It also ignores differences in death investigation and certification between countries. For instance, the authors cite Japan’s low rate of reported infant mortality while ignoring the fact that fewer than 30% of infant deaths in Japan are autopsied. (<a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Taylor+BJ%2C+et+al.+Arch+Dis+Child+2015%3B100%3A1018%E2%80%931023.+doi%3A10.1136%2Farchdischild-2015-308239" target="_blank">Taylor BJ, et al. Arch Dis Child 2015;100:1018–1023. doi:10.1136/archdischild-2015-308239</a>). They press the absurd and dangerous assertion that "the proven benefits of mother-infant co-sleeping far outweigh the largely imaginary risks." These are not imaginary risks. They are real and they are tragic. According to the <a href="http://www.cdc.gov/features/sidsawarenessmonth/" target="_blank">CDC, infant asphyxia is the leading accidental cause of death in infants under one year of age</a>. Parents who lose a child to a preventable death and parents whose children end up in a vegetative state after an anoxic brain injury suffer grievously. They have created support organizations like <a href="http://www.charlieskids.org/" target="_blank">Charlie's Kids</a> and <a href="http://www.firstcandle.org/grieving-families/" target="_blank">First Candle</a> to educate others about safe sleeping, including co-sleeping without bed-sharing.</span></div>
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<span style="font-size: large;"><span class="Apple-tab-span" style="white-space: pre;"> </span>There are safe ways of sleeping next to your child in the same room without sharing the same bed, but most parenting websites and magazines do not distinguish between co-sleeping and bed-sharing. Self-appointed parenting experts who actively advocate for bed-sharing ought to recognize the recklessness of such a position. According to <a href="http://ican.co.la.ca.us/about.htm" target="_blank">ICAN, the Inter-Agency Council on Child Abuse and Neglect</a>, sudden infant deaths in unsafe sleep environments dropped from 69 per year to 35 after a 2013 safe-sleeping campaign in Los Angeles County. Public health outreach saves lives. Misleading parents about published death statistics in the interest of promoting unprovable life-balance benefits is irresponsible, and the endorsement of bed-sharing as a safe approach to co-sleeping is dangerous. Do not share a bed with your infant. It isn't worth the risk of an autopsy.</span></div>
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Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-80984355290071239792016-04-25T10:31:00.002-07:002016-04-25T10:35:42.162-07:00Ethics and the Forensic Expert: What Would You Do?<span style="font-size: large;"><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">This article was originally published in <a href="http://www.forensicmag.com/" target="_blank">Forensic Magazine</a>. To read the original article click here (</span><a href="http://www.forensicmag.com/articles/2016/03/ethics-and-forensic-expert-what-would-you-do">http://www.forensicmag.com/articles/2016/03/ethics-and-forensic-expert-what-would-you-do</a><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">)</span></span><br />
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<i><span style="font-size: large;">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?</span></i></div>
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<i><span style="font-size: large;">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?</span></i></div>
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<span style="font-size: large;">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. </span></div>
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<span style="font-size: large;">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: <a href="http://store.academicfp.com/the-ethics-of-working-as-a-retained-forensic-expert">http://store.academicfp.com/the-ethics-of-working-as-a-retained-forensic-expert</a>)</span></div>
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<span style="font-size: large;">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 <a href="http://www.technologyreview.com/view/542626/why-self-driving-cars-must-be-programmed-to-kill/">http://www.technologyreview.com/view/542626/why-self-driving-cars-must-be-programmed-to-kill/</a>). </span></div>
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<span style="font-size: large;">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: <a href="https://www.bostonglobe.com/metro/2015/10/12/medical-examiner-notes-suggest-was-bullied/vtEQVvFXJSIzugGayyJvUN/story.html">https://www.bostonglobe.com/metro/2015/10/12/medical-examiner-notes-suggest-was-bullied/vtEQVvFXJSIzugGayyJvUN/story.html</a>)</span></div>
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<span style="font-size: large;">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: <a href="https://www.afpjournal.com/nosubscribers/journal/3&y=2013">https://www.afpjournal.com/nosubscribers/journal/3&y=2013</a>), 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.</span></div>
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<span style="font-size: large;">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.</span></div>
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<span style="font-size: large;">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. </span></div>
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<span style="font-size: large;">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.</span></div>
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<span style="font-size: large;">It's not an easy task. Nothing worth doing ever is. Or, rather—I should say—that's my opinion.</span></div>
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Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-53767308916218703662016-02-06T06:42:00.001-08:002016-02-06T06:50:21.232-08:00Forensic Radiology and the Medical Examiner<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">This article was originally published in <a href="http://www.forensicmag.com/" target="_blank">Forensic Magazine</a>. To read the original article <a href="http://www.forensicmag.com/articles/2015/12/forensic-radiology-and-medical-examiner" target="_blank">click here</a> (</span><a href="http://www.forensicmag.com/articles/2015/12/forensic-radiology-and-medical-examiner">http://www.forensicmag.com/articles/2015/12/forensic-radiology-and-medical-examiner</a><span style="background-color: rgba(255 , 255 , 255 , 0); font-family: "helvetica neue light" , , "helvetica" , "arial" , sans-serif;">)</span><br />
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">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.</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-pjtxaGJmBQ92reBX2DkRE847kI4PS-swXaCg9U6IKLjdeZywXvOhaP-wuXwxXNqVReaa30jeHankOsTwL60Cq_-cODhfYvsVeD1mM97wn6QGpG8e-7xAzI1-DPmXsTfvhWTSSAVi9Ikk/s640/blogger-image--66673252.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="" border="0" height="232" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-pjtxaGJmBQ92reBX2DkRE847kI4PS-swXaCg9U6IKLjdeZywXvOhaP-wuXwxXNqVReaa30jeHankOsTwL60Cq_-cODhfYvsVeD1mM97wn6QGpG8e-7xAzI1-DPmXsTfvhWTSSAVi9Ikk/s320/blogger-image--66673252.jpg" title="CT images of a skull reconstruction in a blunt trauma case." width="320" /></a></div>
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.<br />
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">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 bleeding<em>, </em>in 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.</span></div>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">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.</span></div>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">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.</span></div>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">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.</span></div>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">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.</span></div>
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<span style="float: left; height: 412px; margin: 5px; max-width: 100%; width: 275px;"><img alt="" src="http://www.forensicmag.com/sites/forensicmag.com/files/ME%20FIG%202.jpg" style="border: 0px; float: left; height: 412px; margin: 5px; max-width: 100%; width: 275px;" /></span><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">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.</span></div>
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Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-91997550882493035352016-01-04T17:34:00.001-08:002016-02-06T06:50:56.600-08:005 Case Studies In Forensic Toxicology<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">This article was originally published in <a href="http://www.forensicmag.com/" target="_blank">Forensic Magazine</a>. To read the original article click here (</span><a href="http://www.forensicmag.com/articles/2015/10/five-case-studies-forensic-toxicology">http://www.forensicmag.com/articles/2015/10/five-case-studies-forensic-toxicology</a>)<br />
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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.</div>
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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.</div>
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<b>Not even doing toxicology</b></div>
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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.</div>
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<b>Not communicating with the toxicology lab</b></div>
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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.</div>
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<b>Looking only at the numbers</b></div>
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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.</div>
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<b>No scene investigation</b></div>
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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.</div>
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<b>A negative toxicology report does not mean the death is not drug-related</b></div>
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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.</div>
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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.</div>
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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.</div>
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Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-54461661258981380722015-12-04T10:20:00.001-08:002015-12-04T10:25:16.850-08:007 Common Mistakes Regarding Autopsy Reports<span style="font-size: large;">This article was originally published in <a href="http://www.forensicmag.com/" target="_blank">Forensic Magazine</a>. To read the original article <a href="http://www.forensicmag.com/articles/2015/09/7-common-mistakes-regarding-autopsy-reports?et_cid=4803842&et_rid=823626467&location=top" target="_blank">click here.</a></span><br />
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">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.</span><br />
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">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.</span><br />
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<em style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-family: 'Helvetica Neue Light', HelveticaNeue-Light, helvetica, arial, sans-serif;"><span style="font-size: large;">A coroner is not the same thing as a medical examiner</span></em><br />
<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">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.</span><br />
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">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."</span><br />
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">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.</span><br />
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<em style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span style="font-size: large;">Don't confuse the autopsy with the death investigation</span></em><br />
<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">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.</span><br />
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<em style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span style="font-size: large;">‘Pending’ is not the same thing as ‘inconclusive’</span></em><br />
<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">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.”</span><br />
<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">“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.</span><br />
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;"><em>The autopsy doesn't ‘show’ or ‘tell’ you anything. The expert does</em>.</span><br />
<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">"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.</span><br />
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">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.</span><br />
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<em style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span style="font-size: large;">The first legally-mandated autopsy done by the coroner or ME's pathologist is an independent autopsy. Everything else is not.</span></em><br />
<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">“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.</span><br />
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">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).</span></div>
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Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-50579774852051351452015-08-06T07:20:00.001-07:002015-08-06T07:54:50.539-07:00Forensic Literature: A Review of Val McDermid's Forensics and Judy Blume's In The Unlikely Event<div>
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<span style="font-size: large;"><b>Forensics</b> by Val McDermid - Nonfiction - Grove Press 2015</span><br />
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<span style="font-size: large;">Disclosure: Free pre-publication copy received from the publisher in exchange for review/promotion</span></div>
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<span style="font-size: large;">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. </span></div>
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<span style="font-size: large;">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. </span></div>
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<span style="font-size: large;">Val McDermid’s <i>Forensics</i> 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. </span></div>
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<span style="font-size: large;"><b>In the Unlikely Event</b> by Judy Blume - Fiction - Knopf 2015</span></div>
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<span style="font-size: large;">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.</span></div>
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<span style="font-size: large;">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.</span></div>
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<span style="font-size: large;">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.</span></div>
Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-35017078126758382062015-07-02T07:13:00.001-07:002015-07-02T07:15:51.996-07:00What I Did This Summer: Forensics Edition<div>
<span style="font-family: 'Helvetica Neue Light', HelveticaNeue-Light, helvetica, arial, sans-serif; font-size: large;">by Brodie Butler, Biology/Humanities major at Azusa Pacific University</span></div>
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<b><i><span style="font-size: large;">“…I was made to do this.” </span></i></b></div>
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<span style="font-size: large;">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? </span></div>
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<span style="font-size: large;">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: </span></div>
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<span style="font-size: large;">The knowledge I gained from my experience with Dr. Judy Melinek, M.D. includes, but is not limited to, these topics. </span></div>
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<b><span style="font-size: large;">Edema. </span></b></div>
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<span style="font-size: large;">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. </span></div>
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<b><span style="font-size: large;">Expert vs. Fact Witness Testimony.</span></b></div>
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<span style="font-size: large;">Any first year law student or eager aspiring forensic pathologist should know the difference between these two distinct types of witnesses.</span></div>
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<span style="font-size: large;">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. </span></div>
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<span style="font-size: large;">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. </span></div>
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<span style="font-size: large;">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.” </span></div>
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<span style="font-size: large;">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. </span></div>
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<span style="font-size: large;">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. </span></div>
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<b><span style="font-size: large;">Gun Shot Wounds n’ Stuff. </span></b></div>
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<span style="font-size: large;">Tracking bullet trajectories during an autopsy can be considered an art form. </span></div>
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<span style="font-size: large;">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. </span></div>
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<span style="font-size: large;">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. </span></div>
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<span style="font-size: large;">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. </span></div>
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<b><span style="font-size: large;">Advice to other aspiring forensic pathologists. </span></b></div>
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<span style="font-size: large;">Ask yourself… “Is this really something I’m passionate about?”</span></div>
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<span style="font-size: large;">Be proactive and persistent. </span></div>
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<span style="font-size: large;">If you're not having fun, you're not doing it right. </span></div>
Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-17625084419959338402015-06-19T14:31:00.001-07:002015-07-02T07:05:41.287-07:00Interview with Former SFPD Officer Karen Lynch, author of "Good Cop,Bad Daughter"<div>
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<span style="font-size: large;">Q - In your memoir, <i>Good Cop, Bad Daughter,</i> 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? </span></div>
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<span style="font-size: large;">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. </span></div>
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<span style="font-size: large;">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. </span></div>
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<span style="font-size: large;">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. <span style="font-family: 'Helvetica Neue Light', HelveticaNeue-Light, helvetica, arial, sans-serif;">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.</span></span></div>
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<span style="font-size: large;">Q - Writing a memoir as intensely personal as <i>Good Cop, Bad Daughter </i>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?</span></div>
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<span style="font-size: large;">A - <span style="font-family: 'Helvetica Neue Light', HelveticaNeue-Light, helvetica, arial, sans-serif;">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.</span></span></div>
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<span style="font-family: 'Helvetica Neue Light', HelveticaNeue-Light, helvetica, arial, sans-serif; font-size: large;">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. </span></div>
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<span style="font-size: large;">Q - <span style="font-family: 'Helvetica Neue Light', HelveticaNeue-Light, helvetica, arial, sans-serif;">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?</span></span></div>
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<span style="font-size: large;">A - <span style="font-family: 'Helvetica Neue Light', HelveticaNeue-Light, helvetica, arial, sans-serif;">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. </span></span></div>
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<span style="font-size: large;">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.</span></div>
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<span style="font-size: large;">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.</span></div>
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<span style="font-size: large;">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?</span></div>
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<span style="font-size: large;">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.</span></div>
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<span style="font-size: large;">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?”</span></div>
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<span style="font-size: large;">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.</span></div>
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<span style="font-size: large;">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?</span></div>
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<span style="font-size: large;">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. </span></div>
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<span style="font-size: large;">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.</span></div>
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<span style="font-family: 'Helvetica Neue Light', HelveticaNeue-Light, helvetica, arial, sans-serif; font-size: large;">Thank you so much for having me as a guest on your blog. I really enjoyed chatting with you.</span></div>
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Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-50046536493604784342015-06-09T07:23:00.001-07:002015-07-02T07:06:51.602-07:00A High School Student Interviews Dr. Judy Melinek<b style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span style="font-size: large;">What is your definition of a forensic pathologist?</span></b><div>
<span style="font-size: large;">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.</span></div>
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<b><span style="font-size: large;"><br /></span></b><ol class="lst-kix_ek7byxaa8vvb-0" start="2" style="list-style-type: none; margin: 0px; padding: 0px;">
<li style="counter-increment: lst-ctn-kix_ek7byxaa8vvb-0 1; direction: ltr; margin: 0px 0px 0px 36pt; padding: 0px;"><b style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span style="font-size: large;">What specific college courses did you take to prepare you to go into medical school?</span></b></li>
<li style="counter-increment: lst-ctn-kix_ek7byxaa8vvb-0 1; direction: ltr; margin: 0px 0px 0px 36pt; padding: 0px;"><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">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.</span></li>
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<li style="counter-increment: lst-ctn-kix_ek7byxaa8vvb-0 1; direction: ltr; margin: 0px 0px 0px 36pt; padding: 0px;"><b style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span style="font-size: large;">What important things should I expect going into the field of forensic pathology?</span></b></li>
<li style="counter-increment: lst-ctn-kix_ek7byxaa8vvb-0 1; direction: ltr; margin: 0px 0px 0px 36pt; padding: 0px;"><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">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.</span></li>
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<li style="counter-increment: lst-ctn-kix_ek7byxaa8vvb-0 1; direction: ltr; margin: 0px 0px 0px 36pt; padding: 0px;"><b style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span style="font-size: large;">Is a law degree required to become a forensic pathologist?</span></b></li>
<li style="counter-increment: lst-ctn-kix_ek7byxaa8vvb-0 1; direction: ltr; margin: 0px 0px 0px 36pt; padding: 0px;"><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">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.</span></li>
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<li style="counter-increment: lst-ctn-kix_ek7byxaa8vvb-0 1; direction: ltr; margin: 0px 0px 0px 36pt; padding: 0px;"><b style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span style="font-size: large;">Did you study in any kind of forensic pathology specialties (toxicology, serology, odontology, anthropology, taphonomy)?</span></b></li>
<li style="counter-increment: lst-ctn-kix_ek7byxaa8vvb-0 1; direction: ltr; margin: 0px 0px 0px 36pt; padding: 0px;"><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">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.</span></li>
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<li style="counter-increment: lst-ctn-kix_ek7byxaa8vvb-0 1; direction: ltr; margin: 0px 0px 0px 36pt; padding: 0px;"><b style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span style="font-size: large;">What high school courses do you think would help prepare me to be a forensic pathologist?</span></b></li>
<li style="counter-increment: lst-ctn-kix_ek7byxaa8vvb-0 1; direction: ltr; margin: 0px 0px 0px 36pt; padding: 0px;"><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">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.</span></li>
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<li style="counter-increment: lst-ctn-kix_ek7byxaa8vvb-0 1; direction: ltr; margin: 0px 0px 0px 36pt; padding: 0px;"><b style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span style="font-size: large;">What skills would you recommend I should start working on now as a high school student?</span></b></li>
<li style="counter-increment: lst-ctn-kix_ek7byxaa8vvb-0 1; direction: ltr; margin: 0px 0px 0px 36pt; padding: 0px;"><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">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.</span></li>
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<li style="counter-increment: lst-ctn-kix_ek7byxaa8vvb-0 1; direction: ltr; margin: 0px 0px 0px 36pt; padding: 0px;"><b style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span style="font-size: large;">How has being a forensic pathologist rewarded you?</span></b></li>
<li style="counter-increment: lst-ctn-kix_ek7byxaa8vvb-0 1; direction: ltr; margin: 0px 0px 0px 36pt; padding: 0px;"><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">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. </span></li>
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Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-31877288013036398272015-01-09T03:35:00.001-08:002018-05-21T17:55:55.515-07:00A Forensic Primer for Journalists<blockquote type="cite">
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<span style="font-size: large;"><span class="s1">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. </span> </span></div>
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<span style="font-size: large;"><span class="s1">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. </span> </span></div>
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<span class="s1" style="font-size: large;">Here, then, are some definitions and guidelines that journalists or anyone writing about death investigations and autopsies should find useful.</span></div>
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<span class="s1" style="font-size: large;"><b>1. A Coroner is not the same thing as a Medical Examiner</b></span></div>
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<span style="font-size: large;"><span class="s1">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.</span> </span></div>
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<span style="font-size: large;"><span class="s1">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. </span> </span></div>
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<span style="font-size: large;"><span class="s1">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.</span> </span></div>
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<span class="s1" style="font-size: large;">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.</span></div>
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<span class="s1" style="font-size: large;">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.</span></div>
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<span class="s1" style="font-size: large;">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.</span></div>
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<span style="font-size: large;"><span class="s1"><b>2. </b></span><b style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">Do not confuse the cause and manner of death</b></span></div>
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<span style="font-size: large;"><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span class="s1">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" </span></span><span style="background-color: rgba(255 , 255 , 255 , 0); font-family: "helvetica neue light" , , "helvetica" , "arial" , sans-serif;">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 <i>caused by</i> the motor vehicle accident or "death was caused by trauma from the motor vehicle accident."</span></span></div>
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<span class="s1" style="font-size: large;"><b>3. Homicide is not the same thing as murder. </b></span></div>
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<span style="font-size: large;"><span class="s1">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. </span> </span></div>
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<span style="font-size: large;"><span class="s1">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. </span> </span></div>
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<span class="s1" style="font-size: large;">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. </span><span style="font-size: large;">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.</span></div>
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<span class="s1" style="font-size: large;"><b>4. Don't confuse the autopsy with the death investigation</b></span></div>
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<span style="font-size: large;"><span class="s1">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. </span> </span></div>
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<span class="s1" style="font-size: large;">The autopsy pathologist can only tell so much from the dead body. Trying to figure out the cause of death from the dead body <i>alone </i>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. </span></div>
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<span class="s1" style="font-size: large;">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.</span></div>
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<span style="background-color: rgba(255 , 255 , 255 , 0); font-family: inherit; font-size: large;">In many news reports (most recently the ones involving Joan Rivers's death—see <a href="http://www.cnn.com/2014/09/05/showbiz/joan-rivers/">http://www.cnn.com/2014/09/05/showbiz/joan-rivers/</a> ), 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.”</span></div>
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<span style="background-color: rgba(255 , 255 , 255 , 0); font-family: inherit; font-size: large;">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.”</span></div>
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<span style="background-color: rgba(255 , 255 , 255 , 0); font-family: inherit; font-size: large;">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 <i>after</i> 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. </span></div>
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<span style="background-color: rgba(255 , 255 , 255 , 0); font-family: inherit; font-size: large;">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: <a href="http://www.cnn.com/2014/10/16/showbiz/joan-rivers-cause-of-death/">http://www.cnn.com/2014/10/16/showbiz/joan-rivers-cause-of-death/</a></span></div>
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<span style="background-color: rgba(255 , 255 , 255 , 0); font-family: inherit; font-size: large;"><b>6. The autopsy doesn't “show” or “tell" you anything. The expert does.</b></span></div>
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<span style="background-color: rgba(255 , 255 , 255 , 0); font-family: inherit; font-size: large;">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: <a href="http://www.slate.com/articles/news_and_politics/politics/2015/02/laquan_mcdonald_shooting_a_recently_obtained_autopsy_report_on_the_dead.html">http://www.slate.com/articles/news_and_politics/politics/2015/02/laquan_mcdonald_shooting_a_recently_obtained_autopsy_report_on_the_dead.html</a>) No, the autopsy didn't show that. The forensic pathologist <i>determined</i> it. It is his or her professional <i>opinion </i>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. </span></div>
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<span style="background-color: rgba(255 , 255 , 255 , 0); font-family: inherit; font-size: large;">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. </span></div>
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<span style="background-color: rgba(255 , 255 , 255 , 0); font-family: inherit; font-size: large;">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.</span></div>
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<span style="background-color: rgba(255 , 255 , 255 , 0); font-family: inherit; font-size: large;">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. </span></div>
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<span style="background-color: rgba(255 , 255 , 255 , 0); font-family: inherit; font-size: large;">“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. </span></div>
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<span style="background-color: rgba(255 , 255 , 255 , 0); font-family: inherit; font-size: large;">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. <i>At all.</i> </span></div>
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<span style="background-color: rgba(255 , 255 , 255 , 0); font-family: inherit; font-size: large;">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.</span></div>
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<span style="background-color: rgba(255 , 255 , 255 , 0); font-family: inherit; font-size: large;">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 <i>department</i> 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).</span></div>
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<span style="background-color: rgba(255 , 255 , 255 , 0); font-family: inherit; font-size: large;">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. </span></div>
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<span style="font-size: large;"><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">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 <i>original</i> 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 <i>were correct.</i> </span><span style="font-family: inherit;"> </span><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">(See: </span><span style="font-family: "helvetica neue light" , , "helvetica" , "arial" , sans-serif;"><span style="font-family: "times" , "times new roman" , serif;"><a href="http://int.nyt.com/newsgraphics/2014/11/24/ferguson-evidence/assets/gj-testimony/grand-jury-volume-23.pdf">http://int.nyt.com/newsgraphics/2014/11/24/ferguson-evidence/assets/gj-testimony/grand-jury-volume-23.pdf</a> </span><span style="font-family: inherit;">page 38</span></span><span style="background-color: rgba(255 , 255 , 255 , 0); font-family: "helvetica neue light" , , "helvetica" , "arial" , sans-serif;">) </span></span></div>
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<span style="background-color: rgba(255 , 255 , 255 , 0); font-family: inherit; font-size: large;">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.</span></div>
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<span style="background-color: rgba(255 , 255 , 255 , 0); font-family: inherit; font-size: large;">- 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.</span></div>
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<span style="background-color: rgba(255 , 255 , 255 , 0); font-family: inherit; font-size: large;">- 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.</span></div>
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<span style="background-color: rgba(255 , 255 , 255 , 0); font-family: inherit; font-size: large;">- 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. </span></div>
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<span style="background-color: rgba(255 , 255 , 255 , 0); font-family: inherit; font-size: large;">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.</span></div>
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Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-81679034219510770422014-12-04T08:26:00.001-08:002014-12-04T09:01:13.455-08:00Finding a Qualified Forensic Pathology Expert<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><b>1. Is the pathologist certified by the American Board of Pathology?</b><br>This is the most important qualification for an expert witness in the field of pathology. Just because an expert claims to be "board-certified" does not mean he or she is. Not all board certifications are the same. The American Board of Pathology is the only board offering certification in forensic pathology in which the applicant has the following qualifications:<br></span><ul><li><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">Graduated with an M.D. or D.O. Degree from an American College of Graduate Medical Education (ACGME) accredited medical or osteopathic school.</span></li></ul><ul><li><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">Licensed to practice allopathic or osteopathic medicine.</span></li></ul><ul><li><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">Completed a minimum of 3 years training at an ACGME accredited pathology residency program</span></li></ul><ul><li><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">Completed a minimum of 1 year training at an ACGME accredited forensic pathology fellowship program</span></li></ul><ul><li><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">Has passed qualification examinations in Anatomic Pathology and Forensic Pathology.</span></li></ul><span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">Be aware that there are experts who use degrees from on-line "<a href="http://www.elearners.com/resources/diploma-mills.asp">diploma mills</a>" and sham certifications can be purchased. Just because someone has a nice website or has been featured on television in a high-profile case does not make him or her an expert. Titles such as "Forensic Pathologist Assistant" or "Death Investigator" are not qualifications, and if someone is claiming to be a "Professor" it is good idea to check with the institution to make sure they really are on faculty. <br><br><b>2. Where was the pathologist educated and trained?</b><br>Ask for the expert's curriculum vitae or resume. Don't be impressed by the multitude of pages, but look at the content. Have you heard of the universities? Do they have a good reputation? You might want to check with the institutions that the doctor did actually graduate with the degrees listed. If a doctor is not foreign-born but they chose to go to an off-shore medical school, it is sometimes an indication that they couldn't get into medical school in the United States. Foreign medical graduation alone should not concern you if the doctor has subsequently completed residency and fellowship in the United States and passed their Board examinations. It is important to look at where they did their fellowship training: the most prestigious forensic fellowship programs are either in large cities (such as New York, Miami) or part of a centralized State-run Medical Examiner's Office (such as in New Mexico or Virginia). There is also an excellent forensic training program through the Federally-financed Armed Forces Medical Examiner. But even programs with good reputations can undergo seismic changes if there is a scandal or the Chief retires. You can always <a href="https://www.google.com/">Google </a>search the name of the program along with the word "scandal" and see if any news reports come up with the expert's name on in. If you don't do this, opposing counsel definitely will.<br><br><b>3. Do they come recommended?</b><br>Few lawyers take the time to ask for references, but if you are finding an expert witness via the internet, or by using an expert witness referral service, it is a good idea to ask the expert for lawyers they have worked with recently. Only another lawyer can tell you if the expert was readily available, reasonably priced, easy to work with and understandable. The lawyer can also tell you whether jurors understood their testimony, since most pathologists don't get feedback directly from the people they are being hired to educate.<br><br><b>4. Are they currently practicing forensic pathology or are they a "professional expert"?</b><br>Many forensic pathologists who practice forensic pathology full-time at a County Coroner or Medical Examiner's Office still do some consulting as expert witnesses "on the side". A few work part time or do per-diem work at a County facility. However, there are several forensic pathologists who have retired or left practicing medicine completely and work as legal consultants full-time. The latter group can be problematic if they are out-of-touch with the standards and requirements of current medical practice, or are marketing themselves as "hired guns." Some have been forced to leave civil service because of ethical violations or political scandals. Some have a national reputation but only take high-profile cases and don't actually perform autopsies any more. If you are hiring a "professional expert," make sure they are well-qualified, highly recommended, and have their background checked.<br><br><b>5. What is their "bedside manner"?</b><br>Many pathologists enter this field of medicine because they are more comfortable with dead bodies than with living people. Unlike academic medicine, where a pathologist has to have some teaching skills to maintain their appointment, forensic pathology is very attractive to introverted practitioners who like to work in solitude. Although all forensic pathologists are expected to testify in legal cases, and many are quite comfortable with it, that doesn't mean they are any good at communicating complex medical issues. So when you are on the phone with the expert ask yourself if they are understandable. Do they use "Med-speak" or do they explain the medical terminology to you as they talk? Are they personable, even charismatic? While some people are not good communicators over the phone but are very eloquent in person, if your first interaction with the expert is unimpressive you may want to schedule a face-to-face meeting to see if you can understand them better. But if you can't understand what the expert is saying - then neither will the jury.<br><br><b>6. What is their area of expertise?</b><br>Not every forensic pathologist may have the specialized knowledge you need. A land-locked forensic pathologist from the Midwest may not know much about SCUBA related accidents. A suburban forensic pathologist may autopsy a lot of car accidents, but not a lot of multiple gunshot wound homicides. Try to match the needs of your case to the experience of your expert. If it is a rare or unusual type of death, try to find an expert who has published on the subject. One way is to go to the <a href="http://www.ncbi.nlm.nih.gov/pubmed?holding=ucsflib&tool=cdl&otool=cdlotool+">National Library of Medicine (PubMed)</a> and search the database for articles on the topic. Who is the primary author on most of the publications? Depending on the journal, many articles print the author's contact information in fine print at the beginning or the end of the article; and if the primary author doesn't do consulting, you can always ask them to recommend someone in their field of expertise who does.<br><br><b>7. Do they have experience testifying in cases such as yours?</b><br>Most forensic pathologists who practice in a City or County Coroner's office are very good at testifying in criminal cases, since they get a lot of on-the-job experience testifying for the District Attorney's office. But not all of them have frequent contact with Public Defenders or defense attorneys, so if you are a defense attorney, you want to make sure your expert has experience and understands the needs of the defense. Also, few practicing forensic pathologists have experience testifying in civil matters as a routine part of their job. The questions you may need them to answer may be beyond what their experience and training allows, or outside their "comfort zone" as an expert. For example, in an industrial accident, most forensic pathologists will be able to testify to the cause of death and the mechanism of death, but not all have the specialized knowledge regarding interpreting scene investigation to answer complex questions such as: What position was the person in when he was injured? Were the levels of drugs or medications they were taking capable of causing impairment? Make sure the pathologist has experience answering these types of questions before you hire them.<br><br><b>8. What is their expectation of their role?</b><br>Some pathologists see their role as very limited: you send them the material they need (typically medical records, police or incident reports, an autopsy report and microscopic slides) and they tell you what they think and write a report. Others will be more accommodating in offering you additional legal support: looking up references and articles, educating you and your staff about the medical issues as they come up, helping you understand the medicine so that you can formulate good questions for deposition or trial, and writing affidavits. If you ask, the individual expert will usually tell you up front what you can expect from them. You should also ask if they understand the different expectations of opinions written to comply with Frye versus Daubert rules of evidence. If an expert works in a Frye State and has never testified in Federal court, they may not be familiar with what Daubert standards are, and you will need to be more assertive in educating him or her about your jurisdiction's particular needs or legal quirks.<br><br><b>9. Do they teach?</b><br>This is a pretty good litmus test for communication skills. The most successful expert witnesses understand the complexity of their subject matter, but can find a way to simplify their terminology to make the subject accessible to a lay person. The average juror does not have an advanced educational level and is going to get lost unless the expert can speak to their level. Just because an expert has an academic appointment at a medical school or university does not mean they are good teachers. Just about any big-city Medical Examiner or Coroner's Office has academic affiliations because the local pathology residents are required to do a forensic pathology rotation. Does the practitioner have teaching awards? Do they teach groups other than doctors? If they do, then this is a pretty good indicator that they are comfortable with public speaking and can adjust their language appropriately for the audience.<br><br><b>10. How can you balance your needs with the pathologist's expertise, their proximity, availability and your budget?</b><br>Finding the right expert for your needs is a balancing act, and it requires you to be up-front with your expert about costs and expectations. The expert should have plenty of experience with similar cases to give you an estimate of how much time it takes him or her to review materials (for example: an inch of medical records usually takes an hour) or to research and write reports. A local expert with minimal experience may be sufficient if the case is a local one and you are on a tight budget; but you may need an internationally-renowned and published expert from far away if the case is a multi-million dollar class-action lawsuit. Obviously, the more famous or further away an expert is, the larger the expenses will be, and it is best to discuss these issues openly with your expert up-front so that there are no misunderstandings or scheduling complications as deadlines approach.<br><br></span>Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-4097812677545396492014-10-26T08:32:00.001-07:002014-10-26T20:10:27.981-07:00Election Season: Vote for Coroner!<blockquote type="cite">
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<span style="font-family: 'Times New Roman'; font-size: large; letter-spacing: 0px;">These are a couple of articles pertaining to coroners' races this Election Day that I have come across in the last week, the first from Indiana, and the second from Washington:</span><br />
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<span style="letter-spacing: 0.0px;"><span style="font-size: large;">"<a href="http://posttrib.suntimes.com/news/porter/30592186-418/candidates-for-porter-county-coroner-both-tout-experience.html#.VE0Rut1HarW">Candidates for Porter County Coroner Both Tout Experience</a>"</span></span></div>
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<span style="letter-spacing: 0.0px;"><span style="font-size: large;">Why is the coroner an elected position? If you read the first article you would think that all a coroner does is go to schools and talk about drug overdoses to kids. In the second you learn that they have to help families with life insurance claims, and prepare evidence for prosecutors. Is this what a coroner's duties actually entail? </span></span></div>
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<span style="letter-spacing: 0.0px;"><span style="font-size: large;">Well then. You may have to vote on November 2nd for your own county coroner. You want to know what coroners actually do, right? I work for one, and have performed more than 2,000 autopsies over the past 13 years as a board-certified forensic pathologist. Here is what I can tell you about elected coroners.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span style="font-size: large;">A coroner is a civil service management job, in charge of an office of the local government that oversees death investigation. When someone within the jurisdiction of that local government (usually a county) dies in a sudden, unexpected, or violent way, the coroner's office takes the call. Typically, the person answering the phone has to assess whether the case really should fall under the coroner's jurisdiction, and to decide whether a full death investigation or autopsy is warranted. Some coroners employ independent death investigators who go out to the scene of death and investigate the circumstances, looking for clues about medical history or foul play. Other offices rely on the police to do the on-scene death investigation. If an autopsy is warranted, then the coroner will hire a doctor to perform it. The doctor presents the autopsy results to the coroner, and the coroner decides, based on the autopsy report, what cause and manner of death to put on the death certificate. In order to be successful, a coroner needs—at a minimum—a good understanding of what generally kills people; enough medical training to know when autopsies are necessary; and the empathy and social skills to get along with the bereaved families, law enforcement, district attorneys, public defenders and the press.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span style="font-size: large;">How can voters assess whether the candidate for coroner is qualified to perform these duties?</span></span></div>
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<span style="letter-spacing: 0.0px;"><span style="font-size: large;">Being a physician does not make you qualified to be a coroner. My ophthalmologist successfully manages a busy office and is a brilliant doctor, but she doesn't know anything about death investigation. I know several board-certified forensic pathologists who are fully qualified to perform autopsies and do death investigations, but have no management experience or training, and shouldn't be put in charge of a large bureaucracy. </span></span></div>
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<span style="letter-spacing: 0.0px;"><span style="font-size: large;">Being a coroner requires both of these skill sets combined: an understanding of death investigation, and office management skills. In many states, however, anyone can become coroner if he or she is over the age of 18, and prevails in an election to the position. </span></span></div>
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<span style="letter-spacing: 0px;"><span style="font-size: large;">So if you have to vote this November for a coroner in your county, I would suggest you look for the following characteristics:</span></span></div>
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<li><span style="font-size: large;"><span style="background-color: rgba(255, 255, 255, 0); font-family: Times, 'Times New Roman', serif;">Someone who understands the importance of American Board of Medicolegal Death Investigators (</span><span style="font-family: Times, 'Times New Roman', serif;"><a href="http://www.abmdi.org/">www.abmdi.org</a></span><span style="background-color: rgba(255, 255, 255, 0); font-family: Times, 'Times New Roman', serif;">) certification for investigators; American Board of Pathology (<a href="http://www.abpath.org/">www.abpath.org</a>) certification for pathologists; and aims to get the office accredited by the National Association of Medical Examiners (<a href="http://www.thename.org/">www.thename.org</a>)</span></span> </li>
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<li><span style="background-color: rgba(255, 255, 255, 0); font-family: Times, 'Times New Roman', serif; font-size: large;">Someone who is unbiased and has experience working with grieving families and defense attorneys, as well as with law enforcement and the prosecutor's office. This becomes particularly important in high profile criminal cases, cases of officer-involved shootings or in-custody deaths.</span> </li>
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<span style="font-family: Times, 'Times New Roman', serif; font-size: large;">Not all candidates will have these qualifications, and voting decisions can be difficult—but please educate yourself about the candidates, and do not fail to vote. Your vote matters quite a lot on the county level. You never get to know how much you need a competent county coroner until you suffer the unexpected death of a loved one. Few of us have this misfortune, but all of us should worry about who is in charge of the office that is charged with investigating the deaths of our families, friends, and neighbors.</span>Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-4555729542350282692014-10-23T05:43:00.001-07:002014-10-26T19:51:36.763-07:00Forensic Sound Bites & Half-Truths<div>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-family: Times, "Times New Roman", serif; font-size: large;">A reporter from the St. Louis Post-Dispatch called me earlier this week, saying she had Michael Brown's official autopsy report as prepared by the St. Louis County Medical Examiner, and asking me if I would examine and analyze it from the perspective of a forensic pathologist with no official involvement in the Ferguson, Missouri shooting death. I read the report, and spent half an hour on the phone with the reporter explaining Michael Brown's autopsy report line-by-line, and I told her not to quote me - but that I would send her quotes she could use in an e mail. The next morning, I found snippets of phrases from our conversation taken out of context in her article in the Post-Dispatch. These inaccurate and misleading quotes were picked up and disseminated by other journals, blogs, and websites. </span></div>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-family: inherit; font-size: large;">"<b>From:</b> "Dr. Judy Melinek" </span></div>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span style="font-size: large;"><span style="font-family: inherit;"><b>Date:</b> October 21, 2014 at 5:53:21 PM PDT</span></span></span></div>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span style="font-size: large;"><span style="font-family: inherit;"><b>To:</b> Blythe Bernhard </span></span></span></div>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span style="font-size: large;"><span style="font-family: inherit;"><b>Subject:</b> <b>Re: media request</b></span></span></span></div>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-family: inherit; font-size: large;">Great talking to you. Here are the quotes:</span></div>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-family: inherit; font-size: large;">"The autopsy report shows that there are a minimum of 6 and maximum of 8 gunshot wounds to the body. The graze wound on the right thumb is oriented upwards, indicating that the tip of the thumb is toward the weapon. The hand wound has gunpowder particles on microscopic examination, which suggests that it is a close-range wound. That means that Mr. Brown's hand would have been close to the barrel of the gun. Given the investigative report which says that the officer's weapon discharged during a struggle in the officer's car, this wound to the right thumb likely occurred at that time. The chest wounds are going front to back, indicating that Mr. Brown was facing the officer when he was shot in the torso, then collapsed or leaned forward exposing the top of his head. You can't say within reasonable certainty that his hands were up based on the autopsy findings alone. The back to front and upward trajectory of the right forearm wound could occur in multiple orientations and a trajectory reconstruction would need to be done using the witness statements, casings, height of the weapon and other evidence from the scene, which have yet to be released. The tissue fragment on the exterior of the officer's vehicle appears to be skin tissue, but only DNA analysis would confirm if it is from Mr. Brown or the officer. It is 'lightly pigmented' but even African-American skin can appear lightly pigmented on a small microscopic section, depending on what part of the body it came from."</span></div>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span style="font-family: inherit; font-size: large;">This is how I was quoted in the <a href="http://goo.gl/4LM0vN" target="_blank">Post-Dispatch</a> the next day:</span></span></div>
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<i style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span style="font-family: inherit; font-size: large;">Dr. Judy Melinek, a forensic pathologist in San Francisco, said the autopsy “supports the fact that this guy is reaching for the gun, if he has gunpowder particulate material in the wound.” She added, “If he has his hand near the gun when it goes off, he’s going for the officer’s gun.” Sources told the Post-Dispatch that Brown’s blood had been found on Wilson’s gun. Melinek also said the autopsy did not support witnesses who have claimed Brown was shot while running away from Wilson, or with his hands up.</span></i></div>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-family: inherit; font-size: large;">Notice the difference? There's a big difference between "The hand wound has gunpowder particles on microscopic examination, which suggests that it is a close-range wound. That means that Mr. Brown's hand would have been close to the barrel of the gun" and "he's going for the gun." </span></div>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span style="font-family: inherit; font-size: large;">I was very fortunate to have the opportunity to correct this, in my own words last night, when Lawrence O’Donnell invited me to appear as a guest on <a href="http://goo.gl/aw9ktq" target="_blank">MSNBC</a></span><span style="font-family: inherit; font-size: large;">. Mr. O’Donnell allowed me to explain the autopsy findings clearly and in context—if not in full. The show is called “The Last Word,” and Lawrence O'Donnell makes sure he gets it. Despite the guest-badgering and interruptions that are a signature of his television persona, however, Mr. O’Donnell did allow me to correct the record that the St. Louis Post-Dispatch created. I am even more grateful to Trymaine Lee, whose companion article to last night's Last Word segment (linked above) serves as an excellent corrective to the Post-Dispatch article.</span></span></div>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-family: inherit; font-size: large;">In my memoir of forensic training, <em>Working Stiff</em>, I quote my mentor, Dr. Charles Hirsch, as saying that “the best way to respond to a reporter is with your hat. Put it on and walk away.”</span></div>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-family: inherit; font-size: large;">I don't agree. I believe the best way to respond to a reporter is to give the reporter accurate, succinct quotes, and set the record straight if they misrepresent what you said. </span></div>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span style="font-family: inherit; font-size: large;">Too many forensic pathologists are afraid of speaking out about their expertise, because they believe that all members of the press have a prepared agenda, or that professional reporters will misquote scientific experts to force a point that doesn't comport with the forensic evidence. But if we forensic pathologists all put on our hats and walk away, others who lack our medical training and experience will fill the void we leave. I want to make sure the reading and viewing (and tweeting) public have an opportunity to understand forensic science in the real world—what it can tell us, and what it can not. I'm not going to walk away.</span> </span></div>
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Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-26299292512939846012014-09-29T18:42:00.001-07:002014-09-30T08:48:45.965-07:00"Working Stiff" Book Club Discussion Questions<blockquote type="cite">
<span style="background-color: rgba(255, 255, 255, 0); font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;">1. Many reviews and press events about <i>Working Stiff</i> list Judy Melinek as the sole author, even though the book is co-authored by T.J. Mitchell. Do you think this is due to his role as a homemaker? Would Judy's appearance in the media standing by her writer-husband detract from her status as a strong female media figure? Is Judy a “character” the press wants to explore in their stories, even outside the confines of her character role in her own book?</span></blockquote>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;">2. What role does New York City play in the book? Is the City a character? If Dr. Melinek had pursued her post-residency training in another city, could she have written a book about her experience? How (apart from her work after the World Trade Center disaster) would training in another city have changed the story?</span></blockquote>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;">3. Dr. Melinek took notes and kept a journal every day of her training in 2001-2003, yet <i>Working Stiff </i>is not structured chronologically. Why is this? What is gained from the book's case-based structure? What has been been lost—and what have the authors compromised—in choosing to tell a non-linear story?</span></blockquote>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;">4. T.J. worried while writing <i>Working Stiff </i>that the book might read like a hagiography of Dr. Charles Hirsch, and the OCME staff as a whole. Was he right—is Dr. Hirsch a saint, or a real character?</span></blockquote>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;">5. What role does the theme of parenting play in the book? Does being a parent make Dr. Melinek a better medical examiner? Was T.J.’s role as a full-time stay-at-home dad important to the story? How does being a parent influence how you do or your colleagues do their job, or affect others you work with?</span></blockquote>
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<span style="background-color: rgba(255, 255, 255, 0); font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;">6. Does <i>Working Stiff</i> have a story arc, or is the book just a collection of interesting if disparate death stories? Does it matter? Does a memoir need a structural arc?</span></blockquote>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;">7. What was the most interesting forensic fact you learned in the book? Is this what you expected a medical examiner's training to be like? How is the authors’ portrayal of forensic pathology different from its portrayal on television?</span></blockquote>
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<span style="background-color: rgba(255, 255, 255, 0); font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;">8. Did you wish after reading <i>Working Stiff </i>that you had heeded Judy’s advice, “you don’t want to know,” about stories of terrible deaths? If so, did this desire change with time, after you had finished the book?</span></blockquote>
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<span style="background-color: rgba(255, 255, 255, 0); font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;">9. Do you feel that Judy’s opinion of suicide as "a goddamned selfish act” is too harsh? Do you think it reflects the accepted medical opinion of her peers? Did reading the book change your attitude toward suicide?</span></blockquote>
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<span style="background-color: rgba(255, 255, 255, 0); font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;">10. In the United States 50% of all suicides are effectuated by gun and 50% of all gun deaths are suicides. States with highly restrictive gun control laws have far lower rates of suicide than states with lax gun control laws. These numbers include all types of suicide, not just suicide by gun. Do medical examiners have a civic duty to speak up about highly contentious political issues having to do with death, such as statistics on gun deaths and the effectiveness of gun control?</span></blockquote>
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<span style="background-color: rgba(255, 255, 255, 0); font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;">11. <i>Working Stiff</i> has been described as a “brisk” and “a quick read.” Is is too quick? Would you have liked to read more stories about the various manners of death we explore in the book, even if that meant some of them would become repetitive of others you had already read? Would a longer book have caused you to lose interest somewhere in the middle?</span></blockquote>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;">12. Judy & T.J.'s youngest daughter Dina, who is currently 9 years old, is extremely miffed at being excluded from the book. "Not being born yet" was not considered a sufficient reason for this oversight. It wasn't even good enough that we put her in the acknowledgements—because, as Dina says, "nobody reads those." Did you read the acknowledgements, and do you agree with Dina? Do you currently appreciate Dina? Should we write a sequel, "Working Stiff II: Revenge of the Stiffs," to placate her?</span></blockquote>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;"><i>Please leave your comments or notes of appreciation for Dina below</i></span>.</span></blockquote>
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<span style="-webkit-text-size-adjust: auto; font-family: UICTFontTextStyleBody; font-size: 20px;"></span>Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-80223204670786027922014-08-21T02:05:00.001-07:002014-08-21T12:31:59.645-07:00"Partial Autopsies Yield Partial Answers"<span style="font-size: large;">"Partial autopsies yield partial answers" Dr. Charles Hirsch taught me as a young doctor during my forensic pathology fellowship training in New York City, in 2001-2003. This was one of scores of aphorisms we called "Hirschisms," which he employed to instruct us about forensic pathology. Another one was, "Don't confuse the autopsy with the death investigation."</span><br>
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<span style="font-size: large;">Both come to mind this week in the wake of the release of the findings of the second Michael Brown autopsy, conducted by Shawn Parcells and Dr. Michael Baden. The body diagram they released to the press in the New York Times has now been altered into the "Hands up! Don't Shoot!" pose and is trending on Twitter.</span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: large;">The wounds are clustered closer together, so it must be "realistic," right? </span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: large;">No. </span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: large;">This is click bait—a picture that you can retweet easily without thinking about it much. This "tweaked" diagram is a grossly inaccurate portrayal of the victim's body position. The horizontal graze wound near the elbow is missing entirely; the top of the head wound doesn't make sense unless the victim is leaning forward; and the diagnonal graze wound on the right thumb would not occur if the right hand were up in this way—the graze wound has to be in line with the gun barrel, which means the hand was possibly extended forward toward the officer. That's assuming you trust the diagram.</span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: large;">And that's where my experience as a forensic pathologist and death investigator makes me ask a few questions:</span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: large;">1. <i>Why was this diagram from the second autopsy—this evidence of the wounds on the body—even released to the public?</i> The <u>original</u> autopsy diagram, the one prepared during the first autopsy by the St. Louis County medical examiner's office, is still sealed. So are the photos, scene data, and other evidence the district attorney will rely on to decide whether to prosecute the police officer. In all homicide cases, evidence such as this diagram is kept sealed so as to not influence potential witnesses who might see it in the press and change their testimony. Why release crucial evidence that could scuttle that prosecution? </span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: large;">2. <i>How reliable is this diagram? </i>As I wrote in <a href="http://goo.gl/SE7MXz" target="_blank">my recent OpEd on CNN.com</a>, gunshot wound interpretation is not always easy. Parcells and Baden have opined that there were "at least 6 gunshots"—but without knowing the number of rounds fired, the number of casings and bullets recovered, the condition and location of those bullets, and the possible witnessed positions the victim was in, how can they say that with any certainty? What if the same bullet grazed the thumb and then re-entered the body, causing another wound? This diagram alone doesn't tell the whole story.</span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: large;">The diagram reproduced in the New York Times and elsewhere has both Parcell and Baden's signatures at the bottom—but which one of them made the diagram? And why are there no other details about the individual wounds on it? Why have they not noted the location from the top of the head/right of midline, wound size and shape? Where are their notes about soot, or stippling, or other trauma besides the gunshot wounds? The body diagrams I prepare during the course of a forensic autopsy are a whole lot more detailed than this; I need those details in order to accurately dictate my report after I finish the autopsy and get out of the morgue.</span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: large;">3. <i>How reliable is the second autopsy?</i></span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: large;">There have been recent reports in the press that forensic technician Parcells has <a href="http://www.stltoday.com/news/local/metro/missouri-coroners-question-practices-of-forensics-company-operator/article_0662e5b1-dcfa-578f-9487-8ab6a176ea4d.html" target="_blank">no credentials or accreditation</a>, and <a href="http://fox4kc.com/2014/08/19/shawn-parcells-credentials-role-in-michael-brown-autopsy-questioned-by-doctors/" target="_blank">misrepresents his experience</a>. F</span><span style="font-family: Times, Times New Roman, serif; font-size: large;">ollowing allegations that Parcells did the autopsy alone, a doctor/blogger in</span><span style="font-family: Times, 'Times New Roman', serif; font-size: large;"> </span><font color="#000000" style="font-family: UICTFontTextStyleBody; font-size: 20px; -webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);"><a href="http://pathologyblawg.com/pathology-news/pathology-law/forensic-pathology/shawn-parcells-makes-national-news-michael-brown-autopsy/" target="_blank" style="font-family: UICTFontTextStyleBody; font-size: 20px; -webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0);">PathologyBlawg.com</a> </font><span style="font-family: Times, 'Times New Roman', serif; font-size: large;">interviewed Parcells. Parcells affirmed that he alone examined the body on 8/15 before it was embalmed; </span><a href="http://www.nytimes.com/2014/08/18/us/michael-brown-autopsy-shows-he-was-shot-at-least-6-times.html?_r=0" target="_blank" style="font-family: Times, 'Times New Roman', serif; font-size: large;">Dr. Baden was not yet in Missouri at that time.</a><span style="font-family: Times, 'Times New Roman', serif; font-size: large;"> Two days later, after the body had been embalmed, Dr. Baden performed the second autopsy.</span></div>
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<span style="font-family: Times, 'Times New Roman', serif; font-size: large;">There is a big difference between the examination of Michael Brown's undisturbed body during the first, legally-mandated autopsy, performed by the St. Louis medical examiner, and the follow-up examination done days later on his washed and embalmed cadaver. </span><span style="font-family: Times, Times New Roman, serif; font-size: large;">In the embalming process, preservative fluids are injected into the arteries and organs using a sharp tool called a trocar. The trocar pokes holes in the organs. The preservative fluid in the blood vessels pushes the blood ahead of it to the site of any injuries. These changes, which we call "embalming artifact," can exaggerate the size and shape of injuries. </span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: large;">Even if Dr. Baden, a board-certified forensic pathologist, looked at photos of the injuries taken prior to the embalming, the orientation and quality of the photos taken by the technician would influence his interpretation of the findings. Autopsy means "see for yourself"—and there is no substitute for seeing the undisturbed body for yourself if you are going to be offering opinions with legal ramifications.</span></div>
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Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-30555645278511204722014-08-11T06:06:00.002-07:002014-08-11T06:08:46.176-07:00Expert Mistakes<span style="font-size: large;">"An expert is someone who knows some of the worst mistakes which can be made in a very narrow field."</span><br>
<span style="font-size: large;">Niels Bohr </span><br>
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<span style="font-size: large;">When I review others' reports and find mistakes I always try to learn from them because it is always easier to learn from others' mistakes than to make and learn from your own.</span><br>
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<span style="font-size: large;">No one is immune to mistakes. It is what makes us human. The question is how do we, as scientists and experts, deal with our errors? Do we ignore them? Deny them? Or do we delve into the reasons why they occurred and make a change? And can we accept that by making a change in policy or procedure we will be opening ourselves up to future attacks by attorneys who will use the change as a basis to invalidate our previous opinions?</span><br>
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<span style="font-size: large;">What are some of the worst mistakes? The worst I've seen are the result of arrogance. As an expert and legal consultant one needs to be confident and project that confidence when testifying. But knowing the facts of your case and showing proficiency in analyzing and conveying those facts is different from insulting or tearing down an opposing expert, criticizing the person instead of their opinion (ad-hominem attacks). I've been on the receiving end of those with opposing counsel making fun of me for having gone to Harvard or for my dress ("fancy"). Generally I know that if they are attacking me personally it is because they don't know how to attack me based on the facts of the case. I also know that the more obnoxious they get the more they will alienate the decision makers - the jury.</span><br>
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<span style="font-size: large;">I have seen world-renowned experts, confronted with inconsistencies between their previous and current testimony, or between their testimony and a recently published article get defensive and even aggressive. They respond to legitimate questions with bluster and arrogance. Nothing turns off a jury more. The best way to deal with a direct attack is to address the specific issues at hand and simplify it for the jury. Explain to them why the case the attorney is asking about is different from the current case and how interpretations in science can vary based on these crucial differences. By the time the expert is done explaining, the jury will have either forgotten the attorney's challenge or gotten so wrapped up in the explanation of the facts of the current case that they will be right back along agreeing with the expert.</span><br>
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<span style="font-size: large;">But how does an expert learn to keep her ego in check? The best way is to hang around people who know a lot more than you do. By teaching residents and medical students and working alongside staff in a university setting you are constantly barraged with questions that force you to challenge your assumptions and stay up on the scientific advances that drive the peer-reviewed medical literature. Take challenging consult cases: by sparring with attorneys on high-profile cases you are going to be confronted with sharp criticism and you'll find that you can't just rely on your experience and training - you need to stay current and sharp. And finally, go to professional meetings. Nothing humbles me more than attending an AAFS or NAME meeting, and sitting in lectures about the cutting-edge research others are conducting, or the challenging cases that others have successfully investigated. I can't sit for more than 10 minutes before having that "shoulda coulda woulda" feeling about some of my own cases. Yet at the same time, when I leave the conferences, I feel invigorated. Forensic science can be incredibly isolating, especially if you are the only doctor in a small rural Coroner's office. Lunching and dining with colleagues makes you realize that there is camaraderie and support; that we may not always agree on the best way to interpret an injury, or certify a death, but we can come together, break bread and do what scientists do best: collaborate.</span></div>
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<span style="font-size: large;">The next NAME meeting is: <a href="http://www.asip.org/name/2014/" target="_blank">Sept 19-23, 2014 in Portland, OR</a></span></div>
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<span style="font-size: large;">The next AAFS meeting is: <a href="http://www.aafs.org/meetings/2015" target="_blank">Feb 16-21 in Orlando, FL</a></span></div>
Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-2345755765372908912014-07-14T10:19:00.001-07:002014-07-14T10:19:40.270-07:00"Cutting Corners"<span style="font-size: large;">Is it common for coroners or forensic pathologists to cut corners in a death investigation if a case does not look like foul play was involved? Several visitors to this blog have asked me this question recently, as part of their research into forensic science. Usually those inquiring have had direct contact with a Medical Examiner's or Coroner's Office - and did not find that institution particularly forthcoming. Office policies require death investigators to be careful about divulging information on open cases, and sometimes cases can be "pending" for several months while the pathologist awaits toxicology reports, microscopic slides, scene investigation or incident reports. This can be frustrating and even infuriating to the deceased's family members. They are the ones who have to plan the funeral, and answer inquires while dealing with their own feelings of grief and even guilt about the death while the case is still "pending additional examination." The law allows you to bury a body with a death certificate that says "pending" under "cause of death," but that is cold comfort to the family which has to tackle the inevitable question - "What happened?" - over and over again. A death certificate that says "Hanging" and "Suicide" may not be welcome, but it <i>is</i> an answer.</span><br />
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">Coroners and forensic pathologists are two different groups of people. Coroner's deputies are death investigators (often part of a law enforcement agency, like a sheriff's office) while forensic pathologists are the doctors who do the autopsies. Both can "cut corners," yes - but in different ways. A Coroner's deputy might cut corners by not visiting the scene; by not examining the scene thoroughly, either in order to save time or because they are tired (many death investigations are at ungodly hours); by trusting the reports of the people at the scene about what happened without confirming whether those reports are accurate. The death investigation doesn't end when the deputy returns to the office and writes up the case. Frequently they have to complete their investigation, or ask others to, by getting medical records, police reports or questioning other witnesses who were not at the scene when they picked up the body. </span></div>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">A forensic pathologist might "cut corners" by doing an incomplete or partial autopsy; or by rushing through the case and by not following up with police or Coroner's investigators when the story being given does not match up with the injury on the body or the presumed cause of death. This takes time. Coroner's deputies get paid per shift and FP's in a coroner system get paid per case. There is no financial incentive for the doctor or the deputy to invest extra time in investigating a case. Many offices are understaffed due to budget shortfalls, so there is always plenty of work and not enough people to do it. A deputy has to be efficient with his/her time; so if a case looks like something routine, such as an overdose or a suicide, you might see them cut corners in the interest of working speed.</span><br />
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">Yet speculation frequently follows an overdose. Generally, people who use drugs and alcohol are on the margins of society, hang out with unsavory or unreliable "friends," some of whom may have criminal pasts. This fuels funeral-parlor rumors that foul play was involved when the person dies of an overdose. Generally, the only way the police or coroner can confirm that foul play was <i>not</i> involved is with a thorough death investigation. But the investigative and autopsy findings also have to be articulated to the family. Coroner's staff are not necessarily medically trained and may not be effective communicators, so families might seek out other sources for answers. That other source is sometimes me - and I am always glad to serve as a consultant, but only after asking the person calling whether they aired their concerns with the Coroner's office or with the police. I also ask whether the family member had spoken to the original pathologist who did the autopsy. Frequently they have not. Sometimes if they go back and speak to those people who were directly involved with the death investigation, they will find out that the investigation was actually more thorough than they initially thought, or was not completely documented in the limited materials that were initially released to them.</span></div>
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<span style="-webkit-text-size-adjust: auto; background-color: rgba(255, 255, 255, 0); font-size: large;">Frequently I hear about families finding out about other peoples' suspicions at the time of the funeral. Unless the people fueling the speculation have direct knowledge of what happened, I would be cautious about putting too much faith in rumors. Family and friends often invent or exaggerate the importance of certain events in order to make themselves or others feel better about a death. I have investigated cases that were clear-cut suicides, where the deceased even left a suicide note, the family was understanding and seemed at peace, but then speculation at the funeral made them doubt the coroner's findings and suspect murder by an estranged lover or the roommate who found the body. Denial in the face of a death is a powerful (and expected) reaction - but entrenching that denial by piling doubt upon doubt is harmful to the grieving and healing process. I spend many hours counseling these families and I am grateful for my role in helping them find closure, and while I understand why well-meaning people can sometimes unintentionally cause more grief, it still pains me to watch.</span></div>
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<span style="-webkit-text-size-adjust: auto; font-size: large;">What can be done about this? Well, if you are attending a funeral and have no idea why the person died, don't ask the family "what happened?" You'll find out soon enough. I love the Jewish tradition at a shiva (the equivalent of a wake) to bring food and not speak unless you are spoken to. When my father died the sustenance was appreciated and I was glad not to have to talk to anyone. If you feel really sad and want to share that with the bereaved you can always go with "I'm sorry for your loss," though I personally prefer sharing a happy story about something the deceased did that meant a lot to you or made you smile. That will have resonance and truly give comfort. If you are a family member and have been told things that disturb you about the circumstances surrounding the death of a loved one and are starting to have concerns, start by calling the officer who gave you their card at the death scene or informed you of the death. Tell them what others are saying, and ask them to help you have some closure. They may refer you to the forensic pathologist who did the autopsy, or maybe they will just reassure you that a thorough investigation was already done. If you don't get the answers you need, you can always ask to speak to their supervisor or to the pathologist yourself. In most cases, you will eventually be able to find someone to answer your questions, but please understand that death investigations take time. Just because you haven't heard back from the Coroner's office doesn't mean they have forgotten about you or about the case. The doctor may be waiting for the lab results before proceeding further. The Deputy Coroner may have received no replies when calling people to follow up on your concerns. Find out who the lead investigator is on the case, and what their hours are. If you call the office once every two to three weeks during their shift and always ask to speak to the same person, you will be able to get a progress report on what is going on with the case. I hope this helps you find closure. </span><br />
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Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-23135216380038543542014-06-02T06:41:00.000-07:002014-06-02T06:43:42.489-07:00You Gets What You Pays For: Forensics Edition<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><span style="background-color: rgba(255, 255, 255, 0);">Recently in the news, <a href="http://www.charlotteobserver.com/examiners/" target="_blank"> North Carolina Medical Examiners were criticized for violating State law</a> for not examining bodies or doing forensic death investigations in sudden or suspicious deaths that fell under their jurisdiction. In a five part series published by the Charlotte Observer, which contains heartbreaking testimonials by family members who were harmed by inadequate or incomplete death rulings, the Chief Medical Examiner for the State, Deborah Radisch MD, pointed out that North Carolina pays 84 cents per capita for its death investigation system, compared to the nationwide average of $1.76. "You get what you pay for" said Dr. Vincent DiMaio, the retired Chief Medical Examiner of Bexar County, TX, where the death investigation system costs a respectable $2.30 per capita.</span><span style="-webkit-text-size-adjust: auto;"><br /></span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><span style="-webkit-text-size-adjust: auto;">Meanwhile, in Maine, <a href="http://www.pressherald.com/news/Post-mortem_answers_slow_to_surface_in_Maine_s_system_.html" target="_blank">the backlog has gotten so bad that they won't even take the time to measure it</a>, the Chief is retiring and they are worried they won't find forensic pathologists to do the work. Why? Underfunding again. </span><span style="background-color: rgba(255, 255, 255, 0);">Yet while <a href="http://www.npr.org/blogs/money/2010/11/09/131193874/the-tuesday-podcast-lighthouses-autopsies-and-the-federal-budget" target="_blank">some economists recognize that autopsies are a public good and should be funded by the government, like lighthouses</a></span>, getting adequate funding is difficult. Since death investigation is run on the county level the investment rests on county supervisors and executives, who are more interested in spending on services for living voters. This is source of the "medical examiner cycle," described by Dr. Shapiro in the Maine Press Herald article: offices get neglected until there is an embarrassing screwup; then heads roll and Chief is let go or demoted. Money gets freed up to recruit new staff, get accreditation, but as soon as the office becomes successful, fully staffed, well-run, and out of the news, the cutbacks begin and the cycle starts again.<br /></span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">What about Federal funding? Well <a href="http://tinyurl.com/koq729a" target="_blank">a current Federal government report on forensic pathology points out</a> that "under current Federal policies, ME/C are effectively ineligible for direct Federal funding and cannot receive grants from the Department of Health and Human Services (including the National Institutes of Health [NIH]), the Department of Justice, or the Department of Homeland Security." <a href="http://www.nij.gov/topics/forensics/lab-operations/capacity/nfsia/Pages/welcome.aspx" target="_blank">Coverdell grants</a>, which offices are eligible for, are mentioned in this report but they cover equipment, accreditation and certification; they don't cover staffing or autopsies. The more understaffed an office is, the less likely it will have a person on staff who can dedicate the time required for grant application, paperwork and expenditures. So once an office is at the low point in the "medical examiner cycle" it is unlikely to be able to get out using Coverdell grants alone - just wait until the inevitable political embarrassment that will get the office some funding.<br /></span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">What can we do to prevent this and bring stability to the field? We need a Federal effort to help local counties fund and support their death investigation facilities with matching funds. Eligibility must be contingent on a minimum per capita investment by the local agency, with adjustments based on inflation. The matching funds for accreditation are the carrot but there needs to be a stick as well. One suggestion would be ineligibility for federal law enforcement funding support if the office is part of a Coroner and/or ineligibility for public health research funding if it is a public health agency. What I have seen in over 10 years as a public servant is that unfunded mandates do not work. It is not enough to require accreditation and training. There needs to be funding to support it. When there are reliable, well-paying jobs in the forensic sciences, students will enter the field and there will no longer be a lack of forensic pathologists. There is plenty of interest in forensics, but little motivation among physicians to take a high-profile public sector job for less money than they can make with fewer years of training. If you fund it, however, they will come.</span><br />
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Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.comtag:blogger.com,1999:blog-3236068430590795257.post-40721369408126138502014-05-01T06:45:00.001-07:002014-07-14T10:17:50.916-07:00"I Think the Nursing Home Killed Him!"<span style="font-size: large;">I occassionally get calls from families requesting I perform autopsies on a relative because the family was concerned that the care in the long-term care facility or hospice was a contributor to the death. Many of these calls come from out of state because people find my blog on the internet, or were referred by an attorney who may have consulted me in the past. Here is some general advice for those of you who have concerns that the care at a nursing facility was in any way responsible for the death of your loved one.</span><br />
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<span style="font-size: large;">First of all, instead of contacting a forensic pathologist, contact a medical malpractice attorney first. There are attorneys that specialize in medical malpractice litigation against hospitals or care facilities and many of them have in-house nurses, physicians or other specialists who can go through the medical records to see if anything looks amiss. Before meeting with the attorney ask if you should bring a full copy of the patient's chart(s) with you for their review. Sometimes there are several facilities involved: a hospital, nursing facility and hospice. Most attorneys will want a complete set of all the records to get a sense of the complexity of the case. Make sure you write down all your recollections of what the doctors and nurses said or did that concerned you and the dates (if you remember them). When you meet with the attorney, these notes will help you remember what happened, and they may be disclosed to opposing counsel if you ever get deposed, so keep them clear of extraneous notes or unrelated private information.</span></div>
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<span style="font-size: large;">An attorney can guide you in deciding whether you need an autopsy. The attorney will also know local practitioners that are reliable and good at both performing an autopsy and testifying. Performing an autopsy is considered the practice of medicine in most states so it is best if the attorney gets someone who is licensed in your state. The more local the pathologist is, the less the cost will be to you, because of travel fees. If you do not want to sue, but just want to know exactly what the cause of death was, consider having the autopsy done at a hospital where the patient recieved medical care. Many teaching hospitals will do these autopsies for a reduced cost or for free on inpatients because the autopsies are used to teach pathology residents in training. But if you are concerned about trauma or malpractice, it is best you get a forensic pathologist who is board-certified in forensic pathology by the American Board of Pathology. Most importantly, if the death is in any way due to trauma (a subdural, fall from bed, a hip fracture) or there are documented allegations of abuse or neglect, it is required to refer the case to the local Coroner or Medical Examiner and have them perform the autopsy. If you get resistance from the local Coroner because the hospital reported the death as "natural" then you should notify them of the trauma, and you may need to file a police report or call adult protective services to file a complaint about the abuse or neglect in order to encourage the Coroner to do an autopsy. This is important because only the Coroner or Medical Examiner's autopsy has the legal standing to prompt a potential criminal investigation. Also, most hospital autopsies don't collect toxicology so they won't be able to address questions about over-medication. That said, your perception of "over-medication" in a dying hospice patient, may actually be appropriate end-of-life care, so please consult a professional in order to interpret prescriptions, toxicology reports or pharmacy records.</span></div>
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<span style="font-size: large;">Be aware that sometimes an autopsy can't answer all your questions. An autopsy is very good at showing what was happening at the time someone died, and figuring out what caused the death. If a wound has healed or a disease has been treated prior to death, the pathologic findings may have resolved and not be immediately visible at autopsy, but the consequences to the patient should be evident in the medical chart. Therefore, make sure the pathologist who does the autopsy has access to the records ideally prior to the performance of the autopsy, or at the very least prior to completion of the autopsy report. </span></div>
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<span style="font-size: large;">Finally, before you embark on the arduous task of delving into the death of a loved one, be aware that malpractice litigation can take many years and the process of litigation itself can be a stressor on the family that can prolong the grieving process, delaying closure. If there are other members of your family that disagree with your assessment and want you to "let it go" you may want to talk to them and see if litigation is really the best path forward for everyone involved. Make sure you have plenty of emotional support throughout the process either from friends, relatives or spiritual/religious counselors. It will help you heal.</span></div>
Dr. Judy Melinekhttp://www.blogger.com/profile/07515601109320586612noreply@blogger.com