death investigation systems 55the decedent. They may also assist in evaluating traumatic or other changes
in the skeleton that may show acute or remote injury. Neuropathologists,
pediatric pathologists, radiologists, and other medical specialists may provide
valuable input into the investigation of specialized medical aspects of a case,
and nonmedical specialists, such as engineers, electricians, entomologists,
meteorologists, and geologists, may assist in the evaluation of the external or
environmental factors in a death.
The toxicology section is integral to the function of any modern medical
examiner’s office. Proper analysis of the blood and other body fluids is not
only required to confirm cause of death in cases of apparent drug overdose,
but is routinely performed in cases of deaths due to unknown causes, deaths
due to trauma, and some deaths due to apparent natural disease. Information
on intoxication is critical to adjudication of many traumatic deaths, and
often drug intoxication is found in deaths initially thought to be solely due
to natural disease. Though many large medical examiners’ offices will have
an on-site dedicated toxicology laboratory (Figure 4.4), other, smaller offices
may find that it is more cost-effective to utilize the services of a large off-site
commercial laboratory. In either case, it is imperative that the laboratory be
appropriately accredited and supervised, and that protocols for specimen
collection, retention, and analysis be well established and meet the require-
ments of the chief medical examiner or supervising forensic pathologist. It is
also necessary that the forensic toxicologist be available for ready consulta-
tion in difficult or problematic cases.
Figure 4.4 a view of one of the many types of analytical instruments (liquid
chromatography–mass spectrometry analyzer) in the toxicology laboratory.