Forensic Medico-Legal Procedures

FORENSIC PATHOLOGY
MEDICOLEGAL
PROCEDURES
What is “Forensic”?
 The word “forensic” is derived from the Latin
“forensis” meaning “public” or “forum”
 Forensic Pathology
 Subspecialty of pathology
 Examination of the dead to provide an

opinion about the cause, mechanism and
manner of death
 Forensic Pathologist – usually an anatomical
pathologist with specialist training in forensic
pathology
 Performs medico-legal autopsies and engages
in medico-legal investigations and enquiries
Medico-Legal Procedures
 Duties of forensic pathologist may include:
 Verification & certification of death
 Estimation of time of death
 Identification of the deceased
 Performing autopsies to determine cause
and manner of death
 Giving evidence and opinions in court
Medico-Legal Procedures
When called to see a
“dead” person, the
doctor should:
 Verify death
 Make superficial
examination to rule out
foul play
 Estimate time of death
 Issue cause of death
certificate in non-
Coroner’s cases
Who is The Coroner?
 In some countries – lawyer or
doctor, who may be an elected
official
 Enquire into certain types of
death referred to him by public,
police, death registrars etc.
 In Jamaica - coroner is a resident
magistrate
Coroner’s Cases
 Coroners Act of Jamaica states that:
 Coroner may direct any duly qualified
public medical practitioner to do a
Coroner’s (medico-legal) autopsy, BUT,
 If at inquest into a death the majority of
jury not satisfied with the evidence of the
medical practitioner …they may require
of the Coroner to summon a qualified
forensic pathologist to examine, or re-
examine the body
6
Coroner’s Cases
Indications
 Four indications for the performance of a
Coroner’s Autopsy stipulated in Coroner’s
Act of Jamaica:
 Reasonable cause to suspect that death has
been violent or unnatural
 Sudden death, the cause of which is unknown
 Death in which a medical certificate of cause
of death will not be forthcoming
 Such person has died in prison, or in such
place, or under such circumstances, as to
require an inquest in pursuance of any law
7
Coroner’s Cases
Indications
 Indications in Coroners Act relatively vague
 Resulted in administrative guidelines being
used in most hospitals as indications for
Coroners cases
 Some of these guidelines NOT specifically
noted in Coroners Act
 Origin and legality nebulous and
sometimes controversial
8
Coroner’s Cases
Administrative guidelines/Indications
1. All deaths due to violence – i.e. all deaths due to
accidents, suicide, homicide
2. All deaths due to drowning
3. All deaths from known or suspected poisoning
4. All deaths resulting from criminal abortion
5. All deaths from sudden unexpected natural causes
6. All deaths during or soon after (24 hours) surgical
operation or anaesthesia
7. All deaths that occur within 24 hours of admission to
hospital
8. All deaths of inmates in government custodial
institution or place of detention, e.g. prison, mental
Coroner’s Cases
Administrative guidelines/Indications
1. All deaths due to violence – i.e. all deaths due to
accidents, suicide, homicide
2. All deaths due to drowning
3. All deaths from known or suspected poisoning
4. All deaths resulting from criminal abortion
5. All deaths from sudden unexpected natural causes
6. All deaths during or soon after (24 hours) surgical
operation or anaesthesia
7. All deaths that occur within 24 hours of admission to
hospital
8. All deaths of inmates in government custodial
institution or place of detention, e.g. prison, mental 10
Coroner’s (Medico-legal) Vs
Non-Coroner’s (Hospital) Autopsy
 No consent needed from next of kin

 May not have medical history available
 Identity of deceased may not be
known
 Focus often on unnatural death rather
than clinico-pathological correlations
 Focuses on cause and manner of death
Coroner’s Autopsy
Objectives include:
 Establish identity of deceased if in doubt
 Determine time of death
 Determine cause and manner of death
 Recovering, identifying and preserving
evidence obtained during the autopsy
 If injury found, reconstructing how this
injury might have occurred
Coroner’s Autopsy
 Must be performed by a registered
medical practitioner
 Make relevant notes (diagrams and
photographs if relevant and possible) of
crime scene if visited
 Body identified
 to the DOCTOR
 by the NEXT OF KIN
 in presence of the POLICE
 Perform in well-equipped morgue if

available
What is the cause and manner of
death?
 CAUSE of death
 The condition, whether disease or
injury, that was directly responsible
for death
 MANNER of death
 Circumstances of the death, i.e.
homicidal, suicidal, accidental,
natural, undetermined etc.
Examples of cause and manner of death?
Example 1:
 Cause of death: Stab wound to the heart with
massive blood loss

 Manner of death: Homicidal
Example 2:
 Cause of death: Atherosclerotic coronary artery
disease (ischaemic heart disease) with acute

myocardial infarction
 Manner of death: Natural
Example 3:
 Cause of death: Road traffic accident with blunt
force trauma to the head

Attendance at a Coroner’s Autopsy
 Pathologist/doctor performing autopsy
usually determines who may be present
 General aim - few people present as
possible – confidentiality
 Autopsy room attendant, coroner’s
representative(s)/relevant technical staff
 Doctors in training/medical students
discretionary
 Casual observers should be discouraged
 Jamaica - medical practitioner may observe
on behalf of the family of the deceased
Identification of deceased
Usually achieved by viewing by next of
kin, but may depend on some/all of the
following data:
 Documents or  Fingerprints
I.D. found on  X-rays
the body  Blood type
 Physical  Dental records
data/stigmata  DNA testing
 Published
photographs
Timing of Death
 Never precise – estimate only in
terms of hours/days
 Using stomach emptying as estimate
of time since death is controversial
 Varies
 With the constituents of the meal
 With the state – liquids versus solids
 In the same individual eating the same
meal at different times
Bodily changes after death
May be used to time death
 Body temperature
 Postmortem lividity (hypostasis,
lividity, livor mortis)
 Rigor mortis
 Putrefaction
Cooling
 Starts at death - continues for about
18-24 hours after death until temp =
surroundings
 Rate of fall varies with: body temp at
death, ambient temp, clothing, body
fat, immersion in water
 Body temp recorded in rectum
(sometimes liver)
 Formulae exist by which time of death
can be calculated
Postmortem lividity
(hypostasis, lividity, livor mortis)
 Skin discoloration (congestion) due
to passive pooling of blood by
gravity when blood vessels relax
and dilate after death
 Starts about 1-6 hours after death
 Fully established in 6-12 hours
 Becomes “fixed” after this - useful
pointer if body is moved
Postmortem lividity
Postmortem lividity
23
Rigor mortis
 Depletion of ATP  gelling of actin
and myosin  stiffening of muscles
 Tends to progress from head to foot
and reverses in opposite direction
 Begins in about 3-6 hours
 Affects whole body in about 12 hours
 Lasts about 36-48 – disappears with
putrefaction
 Once broken, does not recur
Rigor mortis
25
Putrefaction
 Bacterial action
 Greenish hue to ant.
abdominal wall in about
48 hours
 Subsequent swelling of
body, discoloration and
blistering of skin,
liquefaction of organs etc.
 Maggots hatch in about
24 hours; flies in 4-5 days
 Accelerated in warm,
moist, airy conditions
27
Adipocere
 3 or more months
 Fatty tissue of body hydrolysed to fatty acids and
soaps (saponification)
 White, greasy, waxy, musty-smelling material
 Found in warm, moist, anaerobic conditions
 May affect part or whole of body
Mummification
 Body dry and brittle -
warm, dry conditions
 Occurs over weeks,
months to years
Skeletonization
 Very variable
depending on
environment, insect
activity etc; can take
weeks to years
Time of death
Only rough guides can be given
 Very early: 0-12 hours  body
temperature
 Early: 12-24 hours  rigor mortis,
lividity
 Intermediate: 48 hrs-3 weeks 
putrefaction
 Late: months-years  adipocere
formation & mummification
Time of death
Crude practical guide by the way
the body feels:
 Feels warm & is flaccid: < 3 hours
 Feels warm & is stiff: 3-8 hours
 Feels cold & is stiff: 8-36 hours
 Feels cold & is flaccid: > 36 hours

Forensic Medico-Legal Procedures

Uploaded by

Copyright:

Available Formats

Forensic Medico-Legal Procedures

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Forensic Medico-Legal Procedures

Uploaded by

Copyright:

Available Formats

FORENSIC PATHOLOGY

 Examination of the dead to provide an

 No consent needed from next of kin

 by the NEXT OF KIN

 in presence of the POLICE

 Perform in well-equipped morgue if

massive blood loss

disease (ischaemic heart disease) with acute

force trauma to the head

You might also like