STATE MEDICAL EXAMINERFORENSIC SCIENCE DIVISION

DEPARTMENT OF JUSTICESTATE OF MONTANA

JAIME L. OEBERST, M.D.

Goals

Hire staff

Participate in Coroner training

Written policies and procedures -standardization

Review and make recommendations regarding death investigation practices

Review medical examiner and coroner statutes

Morgue in Billings

Accreditation

So far…

Fully staffed

Two additional forensic pathologists

Dr. Nikki Mourtzinos

Dr. Robert Kurtzman

Two assistants hired – one in Missoula and one in Billings

Initial recommendations regarding statutes submitted – primarily related to restructuring

Next 6 months…

Written policies and procedures

Review death investigation practices

On going review of statutes

Coroner training

AccreditationNational Association of Medical Examiners (NAME)

Accreditation applies to offices and systems, not individual practitioners.

The standards emphasize policies and procedures, not professional work product.

The standards represent minimum standards for an adequate medicolegal system, not guidelines.

NAME accreditation is an endorsement by NAME that the office or system provides an adequate environment for a medical examiner in which to practice his or her profession and provides reasonable assurances that the office or system well serves its jurisdiction.

Long Term Goal: Accreditation for Autopsy Services

PURPOSE OF A MEDICOLEGAL AUTOPSY

IDENTIFICATION

DETERMINE CAUSE AND MANNER OF DEATH

RECOVERY OF EVIDENCE

IDENTIFICATION

Is it human?

Scars, Tattoos

Dental ID

Fingerprints

AND DNA...

Cause of death

The disease or injury, or combination of the two, that results in death

Manner of death

The circumstances in which the death arose Natural

Accident

Suicide

Homicide

Undetermined

Mechanism of death

The physiological derangement that results in the death

Ex/ exsanguination, cardiac arrest, cardiopulmonary arrest, respiratory arrest

Gunshot Wounds

Entrance vs. exit

Range of fire

Recovery of evidence (projectiles/jackets)

Contact GSWs

Contact GSWs

Contact GSWs

Internal beveling of skull

Near Contact GSWs

Intermediate Range GSWs

Intermediate range gunshot wounds = stippling (gunpowder tattooing)

Stippling can begin to appear with soot still present

Intermediate Range GSWs

Intermediate range GSWs

Shotgun wounds

Contact wounds to wounds of about 2 feet have a smooth outline +/- muzzle imprint

Wounds about 3 feet away start to have a scalloped margin

“Petal marks” like photo usually 1-3 feet

4 feet and greater = “fliers”

Shotgun wounds

For every one inch of spread of “fliers” on body = 3 feet from target

00 Buckshot is the same size as a .38 caliber projectile

Sharp force injuries

Stab and incised wounds

Only rarely can weapons be categorized

NATURAL DEATHS

Majority of deaths investigated will be natural deaths

Sudden natural death means different things to different people

Some use death occurring in less than 24 hours when symptoms began

In general, it is a death that occurs over a short period of time and cannot be explained by medical history or recent history of symptoms Can you answer the question – what is the cause of

death? Not mechanism….cause…….. There is no specific age cut off – but most use 55 to 65

years of age without significant history

Coronary artery atherosclerosis

Coronary artery atherosclerosis

When is an apparent natural death not natural?

ACCIDENTAL DEATHS

THE BODY AS EVIDENCE

IDENTITY

SECURITY

CHAIN OF CUSTODY

Postmortem Care for Medical Examiner Cases

Less is more

Leave all therapy in place

Do not perform postmortem procedures

Preserve clothing, personal property

It is preferable to leave EVERYTHING in place

Recovered evidence may be given to law enforcement – use a chain of custody document

Postmortem Care for Medical Examiner Cases

For cases with successful resuscitation, where toxicology may be an issue, request the lab save the specimens

Get the local coroner involved early for cases of brain death

Take photographs documenting injuries

For homicides, suspicious deaths, deaths involving firearms, the hands should be bagged in paper bags

Bodies should be placed in body bags

What is the underlying cause?