death investigation systems 51
or the payment is lumped under a general remuneration to a hospital without
mandating actual autopsy rates, so there is no financial incentive to perform
the examinations. Pathologists also tend to gravitate to other areas of practice
that are not as time-consuming, less messy, and generate greater income.
As such, the autopsy today is practiced primarily in forensic pathology
settings, such as medical examiners’ offices. Yet these offices have strictly
defined limits on the types of cases they may take under jurisdiction, leaving a
host of “medical” cases unexamined each year. These represent a true treasure
trove of diagnostic and research data that go untapped in the United States.
Medical examiners’ offices vary in their organization, but it is possible to
describe the organization and function of a “generic” office. A typical ME’s
office will be divided into some or all of the following sections:
• Investigations
• Autopsy section
• Toxicology laboratory
• Clerical section
• AdministrationInvestigations is in many ways the most important section of the medical
examiner’s office. It is typically an investigator who takes initial reports of a
death, and makes a determination as to whether or not the case falls under
medical examiner jurisdiction. If it is determined that the case will be investi-
gated by the ME, the investigator must then obtain more information about
the circumstances of the case. The investigator will also take a leading role
in helping to establish positive identification of the decedent. Identification
techniques are discussed at length in a subsequent chapter, and are one of the
most critical functions of any medicolegal examination. Just as a physician
must take a medical history before examining or treating a patient, so must
the forensic pathologist obtain background information on a death before
examining a decedent. As the subject of the examination obviously cannot
be interviewed, it is up to the investigator to gather this information from
whatever source is available. This may involve visitation of the scene of death
to photograph and describe findings (Figure 4.1a and b). Often the position
of the decedent may give critical information about the factors that lead to
death. Conditions at the scene may implicate environmental factors in the
death, or the finding of medications or intoxicants may result in suspicion
of a drug-related demise. Indeed, interpretation of drug levels found in the
body on toxicologic testing often relies heavily on scene or historical infor-
mation about the decedent’s prior drug use. Scene findings, correlated with
autopsy findings, often provide information about how a death occurred
(manner of death), in addition to what caused the death. Apart from the scene
investigation, investigators obtain other information regarding the medical