Coroner Talk™ | Death Investigation Training | Police and Law Enforcement

Work law enforcement or ME/C  death investigations long enough and you will end up in court. Whether you are testifying in a criminal case or a civil proceeding, there are things you can do to prepare for testimony.  Done correctly, you will leave the stand with your integrity and professional image intact.  Done wrong, it […]

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  A  prevalent concern, but under-recognized, public health problem of distressing and harmful resident-to-resident interactions in dementia in long-term care homes (LTC) (such as nursing homes and assisted living residences), is a major issue facing many countries today.  This increase can, in part, be attributed to the growing population of older adults from the Baby […]

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As we begin 2017 I want to thank you for a great 2016 and look forward to everything possible in 2017.  I plan to expand training options and continue to develop online training through video and podcast.  As a death investigator, or whatever career you are in, goals and action plans are vital if you […]

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What does a medical examiner do? What is the responsibility of the Medicolegal Investigator?  Do you know how to properly answer questions on a death certificate relating to cause of death v. mechanism. Forensic Pathology and Death Investigation This episode is an audio version of a presentation by Dr. Judy Melinek in March 2014. Dr. […]

The post Pt2-Forensic Pathology and Death Investigation appeared first on Coroner Talk™.

What does a medical examiner do? What is the responsibility of the Medicolegal Investigator?  Do you know how to properly answer questions on a death certificate relating to cause of death v. mechanism. Forensic Pathology and Death Investigation This episode is an audio version of a presentation by Dr. Judy Melinek in March 2014. Dr. […]

The post Forensic Pathology and Death Investigation-Part 1 appeared first on Coroner Talk™.

OVERVIEW OF THE MEDICOLEGAL DEATH INVESTIGATION SYSTEM IN THE UNITED STATES

Randy Hanzlick

The medicolegal death investigation system is responsible for conducting death investigations and certifying the cause and manner of unnatural and unexplained deaths. Unnatural and unexplained deaths include homicides, suicides, unintentional injuries, drug-related deaths, and other deaths that are sudden or unexpected. Approximately 20% of the 2.4 million deaths in the US each year are investigated by medical examiners and coroners, accounting for approximately 450,000 medicolegal death investigations annually.

Death investigations carry broad societal importance for criminal justice and public health. Death investigations provide evidence to convict the guilty and protect the innocent, whether they are accused of murder, child maltreatment, neglect, or other crimes. Death investigations aid civil litigation, such as in malpractice, personal injury, or life insurance claims. Death investigations are critical for many aspects of public health practice and research, including surveillance, epidemiology, and prevention programs, most often in injury prevention and control but also in prevention of suicide, violence, or substance abuse. And death investigations are emerging as critically important in evaluating the quality of health care and the nation’s response to bioterrorism.

The term medicolegal death investigation system is something of a misnomer. It is an umbrella term for a patchwork of highly varied state and local systems for investigating deaths. Death investigations are carried out by coroners or medical examiners. Their role is to decide the scope and course of a death investigation.

Qualifications For a Death Investigator – No Consistency

The quality of a death investigation system is difficult to assess, but it can be measured with several indicators. One is accreditation by NAME, the professional organization of physician medical examiners. Only 42 of the nation’s medical examiner offices, serving 23% of the population have been accredited by NAME in recent years. Most of the population (77%) are served by offices lacking accreditation. Another indicator of quality is statutory requirements for training: about 36% of the US population lives where minimal or no special training is required of those responsible for death investigations (Hanzlick, 1996). In Georgia, for example, the typical requirements for serving as a coroner are being a registered voter at least 25 years old, not having any felony convictions, having a high-school diploma or the equivalent, and receiving annual training of 1 week.

Funding levels also vary greatly. County systems range from $0.62 to $5.54 per capita, with a mean of $2.6 per capita. Statewide systems are generally funded at lower levels: $0.32-$3.20 per capita, with a mean of $1.41 per capita. Third-party payers generally do not support the costs of operations, nor are there medical billing systems. Funding is almost exclusively from tax revenues. Because of insufficient funding, salaries of medical examiners are much lower than those of other physicians. Lower salaries lead to difficulty in recruiting and retaining skilled personnel.

Article Credit: Overview of the Medicolegal Death Investigation System in the United States.” Institute of Medicine. Medicolegal Death Investigation System: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/10792.

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Euthanasia, also known as assisted suicide, physician-assisted suicide (dying), doctor-assisted dying (suicide), and more loosely termed mercy killing, means to take a deliberate action with the express intention of ending a life to relieve intractable (persistent, unstoppable) suffering.

Some interpret euthanasia as the practice of ending a life in a painless manner. Many disagree with this interpretation, because it needs to include a reference to intractable suffering.

In the majority of countries euthanasia or assisted suicide is against the law. According to the National Health Service (NHS), UK, it is illegal to help somebody kill themselves, regardless of circumstances. Assisted suicide, or voluntary euthanasia carries a maximum sentence of 14 years in prison in the UK. In the USA the law varies in some states (see further down).

Euthanasia Classifications

There are two main classifications of euthanasia:

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* Voluntary euthanasia – this is euthanasia conducted with consent. Since 2009 voluntary euthanasia has been legal in Belgium, Luxembourg, The Netherlands, Switzerland, and the states of Oregon (USA) and Washington (USA).

* Involuntary euthanasia – euthanasia is conducted without consent. The decision is made by another person because the patient is incapable to doing so himself/herself.

There are two procedural classifications of euthanasia:

* Passive euthanasia – this is when life-sustaining treatments are withheld. The definition of passive euthanasia is often not clear cut. For example, if a doctor prescribes increasing doses of opioid analgesia (strong painkilling medications) which may eventually be toxic for the patient, some may argue whether passive euthanasia is taking place – in most cases, the doctor’s measure is seen as a passive one. Many claim that the term is wrong, because euthanasia has not taken place, because there is no intention to take life.

* Active euthanasia – lethal substances or forces are used to end the patient’s life. Active euthanasia includes life-ending actions conducted by the patient or somebody else.

Active euthanasia is a much more controversial subject than passive euthanasia. Individuals are torn by religious, moral, ethical and compassionate arguments surrounding the issue. Euthanasia has been a very controversial and emotive topic for a long time.

The term assisted suicide has several different interpretations. Perhaps the most widely used and accepted is “the intentional hastening of death by a terminally ill patient with assistance from a doctor, relative, or another person.”

Some people will insist that something along the lines of “in order relieve intractable (persistent, unstoppable) suffering” needs to be added to the meaning, while others insist that “terminally ill patient” already includes that meaning.

Portion of article by

Written by Christian Nordqvist

Fri 8 April 2016

http://www.medicalnewstoday.com/articles/182951.php

 In this episode: Euthanasia in America

In this weeks show at talk with Anita Brooks and Shawn Parcells in a panel discussion around this topic of Euthanasia in America.  We discuss the legal, medical, and ethical issues surrounding the decisions of euthanasia  We also discuss the responsibility of  investigators concerning knowledge of euthanasia in a death.

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The role of the medicolegal death investigator is to investigate any death that falls under the jurisdiction of the medical examiner or coroner, including all suspicious, violent, unexplained and unexpected deaths.

A death investigation is a process whereby a coroner or forensic pathologist seeks to understand how and why a person died. A coroner or forensic pathologist must answer five questions when investigating a death:

Who (identity of the deceased)

When (date of death)

Where (location of death)

How (medical cause of death)

By what means (natural causes, accident, homicide, suicide or undetermined)

Information may be obtained from several sources including, but not limited to family, co-workers, neighbors, doctors, hospital records, police and other emergency service workers. Contact with family is vital as they often have important information that can aid the investigation.

In This Episode – Medicolegal Death Investigations

In this episode I talk with Dr Mary Dudley about the field of Medicolegal Death Investigations and where the field  is progressing.  We discuss  some ‘best practices’ and obstacles faced by medicolegal death investigators  across the country, as well as what new and up coming investigators need to do to have a better chance of entering the field.

Mary H. Dudley, MD, is the chief medical examiner (retired 2015)  for Jackson County in Kansas City, MO. She is board certified in Anatomic and Forensic Pathology by the American Board of Pathology. She completed a two-year fellowship in Forensic Pathology at the University of New Mexico following a four-year Anatomic and Clinical Pathology residency at Penrose Hospital in Colorado Springs. She has a diploma, BS, and MS in nursing and also founded the first forensic nursing certificate program in the United States in 1994. Dr. Dudley originated the first Forensic Medical Investigation course in the United States in 1996.

Dr. Dudley is a Board Member of the National Association of Medical Examiners, Fellow of the American Academy of Forensic Science, co-chair of the Medical Examiner Advisory Board of Musculotissue Foundation, member of the Missouri Child Fatality Review Board, and member of the National Disaster Medical Systems (Disaster Mortuary Operations Response Team). She is also an Associate Professor of Clinical Pathology – University of Missouri-Kansas City and on the teaching faculty at the University of Colorado-Colorado Springs and Metropolitan Community College-Penn Valley Campus in Kansas City, Missouri, USA.

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Features

* Includes an extensive section on injury recognition covering blunt, sharp, and patterned injury, forensic odontology, gunshot wounds, and craniocerebral injury

* Covers all the essential aspects relating to death investigations as well as investigations involving abuse and injury

* Illustrates concepts with graphic images throughout

Summary

Introducing the basic concepts of clinical forensic medicine and death investigation, this book covers the main areas of forensic investigation . It provides an introduction to forensic science and coverage of injury patterns, natural disease, accidental trauma, child injury and fatalities, and domestic violence. Anyone who has direct contact with death, crime, and the medicolegal system, including nurses, physicians, attorneys, death investigators, forensic pathologists, and police detectives, will find this an invaluable reference.