The Medical Detectives: Cases from the Original CSI Investigators

THE MEDICAL DETECTIVES:

CASES FROM THE ORIGINAL CSI INVESTIGATORS

By PAULETTE COOPER

PUBLISHED BY POLOPUBLISHING

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COPYRIGHT © 2013 BY PAULETTE COOPER

All rights reserved, including the right to reproduce this book, or parts thereof, in any form, except for the inclusion of brief quotations in a review.

Dedicated to

RUCHLA AND CHAIM BUCHOLC

who died in the region of Auschwitz.

ACKNOWLEDGMENTS

I am extremely grateful for the great deal of time given to me by those doctors who have chapters devoted to them. In addition, I particularly want to thank Dr. John Devlin, Dr. Lowell Levine, Dr. Alexander Wiener, attorney Robert Straus, and especially Dr. John Edland, who helped arrange interviews and checked this manuscript prior to publication. Listed alphabetically:

Dr. Lester Adelson

Chief Pathologist, Cuyahoga County

Cleveland, Ohio

Dr. Michael Baden

Deputy Chief Medical Examiner

New York City, New York

Dr. Frank Cleveland

Chief Coroner

Hamilton County, Ohio

Dr. John Devlin

Deputy Chief Medical Examiner

New York City, New York

Dr. John Edland

Chief Medical Examiner

Monroe County, New York

Dr. Harry Gordon

Professor of Pediatrics

Albert Einstein College of Medicine

Bronx, New York

Dr. Elliot Gross

Chief Medical Examiner

Hartford, Connecticut

Dr. Milton Helpern

Chief Medical Examiner

New York City, New York

Dr. M. Dorothea Kerr

Medical Investigator of the Office of the Chief Medical Examiner

New York City, New York

Dr. Judith M. Lehotay

Chief Medical Examiner

Erie County, New York

Dr. Lowell Levine

Consultant in Forensic Dentistry to the Office of the Chief Medical Examiner

New York City, New York

Dr. James Luke

Chief Medical Examiner

Washington, D. C.

Dr. Thomas Noguchi

Medical Examiner-Coroner

Los Angeles, California

Dr. Clara Raven

Interim Chief Medical Examiner

Detroit, Michigan

Dr. Abraham Rosenthal

Assistant Medical Examiner

Office of the Chief Medical Examiner

New York City, New York

Dr. Jane Simon

Assistant Medical Examiner

Office of the Chief Medical Examiner

New York City, New York

Dr. Werner Spitz

Chief Medical Examiner

Wayne County, Michigan

Charles Umberger, Ph.D.

Director of Toxicological

Laboratory Office of the Chief Medical Examiner

New York City, New York

Dr. Cyril Wecht

Chief Forensic Pathologist

Allegheny County Coroner's Office

Pittsburgh, Pennsylvania

Dr. Sidney Weinberg

Chief Medical Examiner

Suffolk County, New York

Dr. Alexander Wiener

Director, Department of Serology and Bacteriological Laboratories

Office of the Chief Medical Examiner

New York City, New York

THE LEGAL DETECTIVES:

Dino Fulgoni

Medical Legal Department

District Attorney's Office

Los Angeles, California

Vincent Nicholosi

Assistant District Attorney

Queens County, New York

Robert Straus

Assistant District Attorney

Brooklyn, New York

Sidney Schatkin

Attorney at Law

New York City, New York

Also:

Narciso Garganta

Medical Librarian

Milton Helpern Library of Legal Medicine

New York City, New York

INTRODUCTION

I am pleased to have been asked to write the introduction to this interesting, instructive book. A book on the work of the medical examiners provides a splendid opportunity to emphasize that all deaths that are sudden, suspicious, medically unattended, obviously violent, unusual, or that occur when a person is in legal custody, should be reported to the official medico-legal agency provided for that purpose. It is equally important that an investigation of the death be carried out automatically and not left to the option of the agency. The agency should not refuse to investigate deaths because of lack of interest or because of lack of time, and the post mortem investigation and certification of sudden, suspicious, and violent deaths should be mandatory in all jurisdictions.

At present, failure to report and investigate many of these deaths is one of the weaknesses in the system of medico-legal investigation in many places throughout the country. But that is only part of the problem. To investigate deaths effectively, agencies must have qualified, experienced medical personnel. This includes official medical investigators, forensic pathologists, and ancillary specialists, such as toxicologists-for the detection of poisons and for determining body substances and serologists-for the examination of blood stains and body fluids such as saliva, sweat, and semen. There should be well-equipped laboratories capable of preparing tissues from an autopsy for microscopic examination, as well as facilities for bacteriological studies of deaths from infection.

It is true that not every death investigated requires all of these disciplines, and not every death requires that the post mortem examination of the body include an autopsy. Yet, it must be recognized that in addition to determining the cause and manner of death, however obvious they may appear, an autopsy is essential to establish, confirm, or provide sound answers rather than surmises to the many questions that may arise later in connection with even the most evident type of violent death.

Physicians as well as lay persons often have visited the autopsy room of the medical examiner, observed the body of a victim of a violent death by gunshot, and then asked why an autopsy was necessary when the cause of death was so apparent. When we look at a victim, apparently dead of multiple bullet wounds, we might assume without an autopsy that the wounds came from a single bullet. But on examination, if we find that they were produced by bullets of different calibers traveling in different directions, we realize that they must have been fired from different weapons, and see why an autopsy can be so vital.

An autopsy also may reveal that the stomach contents and organs of the body contain alcohol, and possibly other drugs and poisons, and while this finding may be unrelated to the cause of death, it can still provide important information which clarifies how and why the death took place. At an autopsy the presence, amount, and nature of the food found in the deceased's stomach are important and may provide a clue as to the time of death. This information may also serve as an important check on the reliability of witnesses reporting when the victim was last seen alive. In some murder cases, such findings provide the clues that point to the perpetrator.

Another determination of the autopsy, and the basis for an important, though often disregarded, principle in legal medicine and forensic pathology, is the age of the injury. A person may be seriously or even fatally injured without being immediately disabled; and death may take place after the victim has been removed from those circumstances that provide some basis for suspicion of murder. The production of symptoms from fatal wounds may be delayed, and if a careful post mortem examination is not done, or the autopsy is improperly performed, the result may be a failure to recognize the traumatic character of the death.

This ability to recognize the age of the original injury is extremely important, especially in connection with deaths caused by child abuse, or by internal or head injuries. For example, a man could meet a woman who apparently had been drinking quite a bit, take her home, and on the way witness her stumble, fall, and suddenly die. The man could be suspected of having pushed or hit her, and if the medical examiner's office reported to the police and district attorney merely that the cause of death was a traumatic subdural hemorrhage,the man could be in considerable trouble. But if it is recognized and reported that the subdural hemorrhage was at least four or five days old, and that the woman apparently had been walking around with this traumatic condition before she met the man, he obviously could be cleared.

There have been many instances in which the most obvious violent deaths, and even apparently natural ones, have been disproved by a carefully performed complete autopsy, done by a qualified, experienced, and sensitive forensic pathologist. The responsibility for detecting the cause of death is great, not only in those cases which are homicidal, but also those which are accidental, suicidal, or natural. Unfortunately, there has been too much emphasis on the work of the medical examiners in deaths which are gruesome or bizarre, and provide good copy for the mass media. Most deaths which the medical examiner clarifies by his investigation are not of this type.

For example, on a number of occasions the bleeding bodies of several victims have been found lying about rooms in which the furniture has been disarranged, so these deaths were first reported to the medical examiner's office as suspected homicides. Yet, careful autopsies have proved the cause of death to be acute carbon monoxide poisoning from an unsuspected source. In the early stages of acute carbon monoxide poisoning, when prolonged exposure to dangerous, but not heavy, concentrations of carbon monoxide in the air of the room occurs, the victim may undergo a progression of symptoms, including headache, nausea, vomiting, mental confusion, and muscular incoordination.

This can cause him to stumble, fall over furniture, and knock over lamps and other objects, the broken edges of which may lacerate the skin and cause bleeding. The scene in such cases, particularly when more than one person is involved, and especially with the presence of blood, usually leads the initial observer to believe that the deaths were violent.

Strangely enough, such unlabeled cases rarely are diagnosed correctly by a physician, and not infrequently are overlooked, unsuspected, and incorrectly diagnosed even at an autopsy. Obviously it is important to recognize the nature of such deaths, for the source of the carbon monoxide may present a continuing hazard to others. The ability of the medical examiner to recognize promptly death caused by acute carbon monoxide poisoning is a good example of the way in which an effective system of medico-legal investigation can benefit the community.

This example also illustrates the fact that a medical examiner's office is as concerned with preventing deaths as with detecting homicide. It should be pointed out that the medical examiner is a guardian of the public health and well-being, responsible for detecting deaths from contagious or epidemic disease, or from poisoning in the household and in industry.

Equally important, however, is his responsibility for establishing cases in which a suspicious-looking death is not homicidal. This is important to protect the innocent person who may fall under suspicion of having committed a violent act when there was none. Clearly, the medical examiner has great responsibility for detecting the cause of death not only in cases of homicide, but ,also in deaths that are natural, accidental, or suicidal. It should be evident that the post mortem investigation and autopsy preformed by qualified, experienced medical examiners is necessary to the proper administration of justice in any community and wherever a death becomes a subject of judicial inquiry.

If anyone doubts, let him read this book.

Dr. Milton Helpern

Chief Medical Examiner

New York City, New York

PART I

WHAT MEDICAL DETECTIVES DO

WHAT DONE IT?

DEAD MEN DO TELL TALES

There may be no such thing as a perfect crime in the sense that it leaves no clues; there may be only imperfect investigators who do not know how to translate them. Something is almost always left at the scene. The evidence may be as small as a strand of hair, a simple spot of saliva, or maybe just a single speck of blood. The clues to be found may not even be at the proverbial scene of the crime but rather in the victim: in the chemical content of his hair and fingernails (for arsenic detection); in the blood chloride level of the chambers of his heart (to determine drowning); in the amount of carbon monoxide in his blood (for burning); etc. It is simply a matter of knowing what to look for, and understanding what is found . For it is not just a proverb but a fact that dead men do tell tales; unfortunately there is not always enough time or people to translate everything they are saying to us.

The men, and sometimes women, who find and translate these corporeal clues specialize in a field called forensic medicine, which has been defined by its first important practitioner, an Englishman named Sir Bernard Spilsbury, as that area where medical matters come into relation with the law. Most of us may think of these experts as medical detectives, but their official titles are usually medical examiner, pathologist, or coroner. Some chemists, biochemists, and serologists also specialize in forensic medicine, but those who are medical examiners or pathologists must be medical doctors. In a few states coroners must be physicians, while in others the coroner can be anyone from the local mortician to the local beautician. Although the job requires an extensive knowledge of medicine and sometimes a smattering of law, it has been and unfortunately still is occasionally awarded to people who don't know a windpipe from a drainpipe.

While most states have gone beyond the old North Carolina law that stated that the only qualifications for becoming a coroner were that the person had not denied the being of Almighty God or participated in a duel, some states still award the job solely for political reasons-although it has been aptly stated that there is no Democratic or Republican way to work on a murder or establish a suicide. The job of coroner is also given to undertakers, and at one time undertaker-coroners used to race to the scene of the crime, not to see justice carried out, but to see if they could carry out the body before the other undertakers got to it. Fortunately, such practices are now on the wane, and hopefully, this trend will continue as the public learns more about the role of the medical detectives in helping to solve crimes and in detection work that helps to prevent them.

Technically, the job of is not to solve crimes or catch criminals, but rather to provide information which ultimately is used by investigative bureaus to help them apprehend and punish the perpetrators. As Vincent Nicholosi, assistant district attorney of Queens County, New York, states, The relationship between the two groups is often a symbiotic one, for the medical examiners may use the other's findings to indicate the area to look for, and the agencies utilize the medical examiner's report to show them who to look for.

Dr. Milton Helpern, Chief Medical Examiner of the City of New York, emphasizes that are not concerned with whodunit, but rather what-done-it, or in other words, what caused the person to die. Unfortunately, establishing this is not always simple, for, as he explains, "It's not like bookkeeping, where you add up a column of figures. Yes, you can always come up with an answer, but it may not be the right one. It's better to come up with no answer than the wrong one, for an unlabeled case is better than a mislabeled one.

The important thing is to know when you don't know. Unfortunately, not all medical detectives agree. There's extremely good money to be made in giving expert court testimony, and some pissologists," as the other pathologists call them, are all too anxious to give an opinion on the cause of death and state it as fact, when perhaps only God may know the real answer to the question.

How do determine the cause of death? Say a man is found dead with a rope around his neck. It would seem obvious that he had been strangled to death, or, more technically, that he had died from asphyxia or lack of oxygen.

But that may not be true. Perhaps the man was poisoned to death; and since the killer knew his purchase of poison could easily be traced, he tried to disguise the cause of death by putting the rope around his victim's neck after he died so that no one would suspect he was poisoned.

Or maybe the deceased had a heart attack as he realized that a noose was going around his neck, and the heart attack got him before his killer did.

It is therefore necessary for to check several things before deciding what really killed the person. The first step might be to see if the rope was pulled tight enough to kill the deceased. Next, the medical detective would check to see if the man had died from asphyxia (which could have been caused by the rope).

This he does by looking for its classic sign: petechial hemorrhages or small, often pinpoint-sized blood spots, caused by the breaking of the capillaries from pressure and lack of oxygen. (Other signs could be cyanosis, or blue, purple, or black lips, ears, and fingertips; a protruding tongue; clenched hands, or froth emanating from the nose and mouth.)

Even if the rope was tight enough to kill and the person had petechial hemorrhages, this still would not prove that the rope around his neck caused asphyxiation and that asphyxiation caused his death. The medical detective still would have to establish whether the asphyxia could have arisen from other causes (such as inhaling illuminating gas, heart or lung trouble, tumors, etc.).

He would have to examine all of the person's internal organs and tissues carefully to determine that none of these other problems could have been responsible . for death. And, finally, he would have to establish from the appearance and size of the bruises on the neck under the rope whether the rope had been tied around the person before he died, or whether the marks on his neck could have occurred after death, perhaps from careless transportation of the body.

All this may seem like a tremendous amount of effort just to establish a seemingly insignificant what-done-it. But determining the cause of death can sometimes cause another death-or save a life-if someone is accused or cleared of putting a fatal rope around the man's neck. Therefore must be certain that they are correct on the what-done-it; and that is often far more difficult to establish than in the above hypothetical example, for murderers commonly try to confuse the cause of death or lie about it outright.

For example, a medical detective once examined a woman with a knife thrust into her chest. Obviously, she had been stabbed to death. Obviously? As he examined the knife wound, he saw that it had not bled, and since dead bodies do not bleed (although they may drain, depending on the position of the person), he concluded that she must have been stabbed after she died. Guessing someone might do that in order to divert attention from the real cause of death, he examined the rest of her body carefully. He discovered that she died from the results of an illegal abortion.

As for lying about the cause of death, a man once had an affair with a young girl who lived in an adjoining state and she subsequently gave birth to his baby. The man told her he was taking the child away to his house to care for it, but instead he took it away and killed it. When he was questioned by the police as to the whereabouts of the child, he admitted to the murder, adding that he put the infant in a sack with a chloroform rag in it, drove across to his own state, and disposed of the body. He was probably conversant with criminal law, and blithely confessed, knowing that the law states that a defendant can only be tried in the state where the murder was actually committed. Who could say in which state the child had died?

And so were asked to help out. It appeared that the father had already given the answer to the what-done-it (chloroform), but the examiner performed a post mortem nonetheless to see if more clues could be gleaned. To their surprise, they found no trace whatsoever of chloroform in the baby's body. Had chloroform really been administered, it would probably have taken days to dissipate and so would most likely still have been found.

The medical detective therefore examined the rest of the child's body to uncover the real cause of death. The severe marks of violence on the baby's face and neck indicated that the what-done-it had been the fatal assault.

When the father was again questioned and confronted with this irrefutable medical evidence, he admitted that he really had beaten the child to death. Most important, perhaps realizing that it was futile to fight further, since getting away with murder requires a knowledge of medicine