The medical examiner (ME) is the person in charge of the forensic investigation of a death that has occurred in his or her area of jurisdiction, whether it is a homicide, suicide, accident, or other suspicious death. He or she has a number of tasks to carry out, chief of which is the determination of the cause and manner of the death through performing an autopsy. The medical examiner also takes charge of the analysis of evidence, works with the police investigating the scene of the crime, and presents evidence in court. In short, the ME is involved in both the medical and legal sides of a forensic investigation.
The role of the medical examiner is one that has been evolving since the nineteenth century. There has always been a tradition in investigating unexplained deaths. Initially, the people appointed to take charge of these investigations were known as coroners and they were elected or appointed but did not necessarily have any special legal or medical training. During the nineteenth century, the practice of medicine became more professional in many countries, with an increasing requirement for proper academic training. At the same time, forensic science and pathology were being established as disciplines in their own right. The old office of coroner was out of step with these new trends. Increasingly, regions began to demand that the coroner have medical knowledge so that scientific principles could be brought to bear on the investigation of a death. In 1877 Massachusetts became the first state to pass a law replacing the office of coroner with that of medical examiner and requiring that the ME have a license to practice medicine.
Increasing urbanization in the United States during the early years of the twentieth century led to several cities introducing the ME system. This change was accelerated by various scandals where deaths had allegedly been improperly or inadequately investigated by ill-qualified coroners. Today, there is a mixture of the coroner and the ME system in many counties, with the former still tending to predominate in rural areas.
Many modern medical examiners have training not just in pathology, but in forensic pathology and so are well qualified to carry out all the medical and legal tasks involved in investigating a suspicious death. However, the ME is not actually required to be a forensic pathologist, as there are not enough specialized forensic pathologists to meet the needs of every community. When a death requires investigation and the relevant region does not have an ME who is a forensic specialist, the area will contract out the work to the nearest center which does offer such services.
The medical examiner has many varied duties when investigating a suspicious death. First and foremost is the task of establishing the cause and manner of the death. For instance, the person may have died of asphyxia and this would be the cause of death. However, there are many different manners in which asphyxia can occurrowning, strangulation, or hanging, for example. The time of death also needs to be determined as accurately as possible so it can be put into context with the events unfolding at the crime scene. It is also important for the ME to establish the identity of the victim, if this is not already known. Where the body has wounds, they should be thoroughly investigated and correlated with any weapons that may have been used to inflict them. The presence of body marks and signs of disease may also be significant and must be recorded and interpreted.
The autopsy findings are clearly highly relevant in establishing the cause and manner of death. However,
When a sudden and unexplained death is reported to the medical examiner, he or she takes the usual systematic approach to investigating it, as any good doctor would with a living patient presenting with a medical complaint. The only difference, of course, is that the ME cannot take a direct history from the deceased. Instead, the ME must gather as much information as possible from witnesses, family members, the police, and anyone else who might be able to shed light on the death. The ME may require people to give evidence, such as blood samples or fingerprints, that may help in the investigation.
When it comes to examining the body, there may be no obvious signs of physical trauma. Often this suggests a death from natural causes. Consultation of the medical records of the deceased and discussion with their physician can establish whether this is likely. An autopsy might then be carried out to confirm any tentative conclusions the ME comes to. Tests for drugs, alcohol, and poisons may also be carried out to see if they played a role in the death. When the investigation is complete, the ME prepares a report which covers the essentials of the case and lays out a conclusion of the cause and manner of death.
While the cause of death can often be established by the ME, deciding on the manner is an opinion based upon their reading of the evidence and circumstances. They will record a verdict such as homicide, suicide, accident, or an open verdict. This opinion will not necessarily be accepted in court and may be challenged by the police, lawyers, or the victim's family. Thus, even if a verdict of homicide is returned by the medical examiner, the police will not necessarily bring a prosecution. Families often object to a verdict of suicide, in cases of drug overdose for instance, and will appeal for it to be changed to accidental death. The ME's verdict on the manner of death may also change if new evidence emerges. A death previously thought to be natural may turn out to be a homicide or suicide, for instance. Finally, it is the ME's job to prepare and sign the death certificate.
The medical examiner often works with a forensic investigator, who is the person who deals with the body at the crime scene. It is usually the forensic investigator who makes the first examination of the body and takes its temperature, which is needed to estimate the time of death. The investigator also directs the taking of photographs of the body and the removal of trace or insect evidence from it. Then the forensic investigator wraps and transports the body to the ME's office. Throughout, the body is in the custody of the medical examiner, while the crime scene is under the control of the police. The forensic investigator provides a useful interface between the two entities.
The forensic investigator often assists the medical examiner in the morgue, with the performance of the autopsy and the preparation of the autopsy report. The task of communication with family members, the media, and the police in matters relating to the ME's office might also fall to the forensic investigator. Finally, the forensic investigator may represent the ME by testifying in court.
The range of cases referred to the medical examiner can be very wide. He or she will be called in to look at any traumatic death that is due to injuries that could be homicidal, self-inflicted, or suicidal. The death need not, however, be violent to be referred. Any death that is unusual, unexpected, or in some way suspicious would have to be investigated. For instance, if a fit, healthy teenage girl was found dead in bed, this would be a clear case for the medical examiner. Sudden deaths occurring within hours of the onset of symptoms need to be examined also; this could indicate a poisoning, although such crimes are relatively rare these days. It is also usual for deaths in police custody, in prison, or during medical or surgical procedures to be investigated. Discovered bodies, such as those washed up on a seashore or found in a shallow grave, also clearly require a full investigation.
The medical examiner need not always perform an autopsy. The frequency with which this is done varies from place to place, but usually up to a quarter of reported deaths are followed up with an autopsy. Often, the deceased person's physician will be involved in the autopsy if it is felt that the death occurred from natural causes. Sometimes all that is needed to clarify a death is a cursory external examination. An experienced forensic pathologist will be able to assess the extent of the investigation needed. Some cases are challenging and it is always important for the medical examiner to come to the right conclusion. Often the medical examiner is the only expert witness that a judge and jury can rely on to explain complex medical matters.
SEE ALSO Autopsy; Death, cause of; Death, mechanism of; Pathology; Toxicology.
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