Tuesday, October 02, 2007

Coroner Death Investigation

Why does your office do its own investigation of an individual’s death?

There are a number of reasons. First, since we are the agency that must make a decision as to the cause and manner of death, it just seems to make sense. We certainly work in tandem with and parallel to other law enforcement agencies. We use the information they gather and they use the information we gather. It is a synergy that just plain works. But our medicolegal investigations may take a bit of a different tack or have a slightly different focus so we can arrive at the conclusions that we must to make our ultimate decisions.

In addition, if an autopsy is done the forensic pathologist needs answers to a number of questions as she proceeds through the autopsy. If we have done our own investigation we get answers to those questions and have them available as we assist with the autopsy. Such things as exactly how was the decedent lying when found, whether they were lying against something that might have left a certain mark, all can make a difference to know as the post-mortem progresses.

Another reason is that often two sets of eyes are better than one. We may pick up a detail that another investigator glossed over inadvertently. Or we might think to document something that the other investigators don’t. Recently, for example, among the agencies investigating a death, ours was the only one that took photos of the crash scene in daylight and those photos became an important element in subsequent legal proceedings.

My deputies are all trained in death investigation, evidence tech work, and all the skills needed to do a “class” investigation. The number of cases we investigate is certainly sufficient to keep up their proficiency as well. We are proud to use our skills and talents to do the job necessary to arrive at the cause and manner of death in our cases. And as I said we use the investigations of others as part of our “tool set” in these investigations. Death investigation is a cooperative effort, with each of us doing our part. As is often the case, here too the whole is often more than just the sum of the parts.


Anonymous said...

Interesting! Amazing how much can be deduced. Glad to hear that the different branches work in synergy.

Laura said...

Can you comment on what circumstances allow the coroner's office to determine cause of death? Obviously in homocides, foul play, etc. Do you have any input on hospital deaths? Does it depend on if the patient had been there >24 hours? If a patient has lung cancer, but dies from sepsis r/t neutropenia, is it you or the doctor who says what a person died from? If no autopsy is ordered, does your office have to be involved in a hospital death? What about deaths at home under hospice? (if all this info is available publicly, you can just direct me to that info)

Dr. Richard Keller said...

All unnatural deaths fall under the jurisdiction of the Coroner’s office: homicide, suicide, accidents, and questionable deaths. As do deaths in children, and all deaths in a hospital occurring in folks admitted for less than 24 hours, deaths related to surgery, trauma/injury related (no matter the time interval between death and injury or how trivial the injury might seem).

Deaths in pre-registered hospice patients are reported to us and reviewed to be certain that there was nothing unexpected (like too much medication consumed) and for the possibility of new trauma.

A new category for us is nursing home residents who die with 10 days of being hospitalized.

Doctors assign the cause of death for patients that they are attending and sign the death certificate, but we do have an opportunity to review these as well as they cycle through our office.

If any of our reviews of deaths not strictly in our purview by statute raises questions best answered by further investigation, we will take jurisdiction.

Jeanne said...

When testing post-mortem for cocaine death, is 2mg per liter 24-48 hrs post-mortem lethal? What does this usually mean...Per liter of blood? Urine? Body fluids? I am a lay person and 2 mg. doesn't seem like much, but of course, I have never done cocaine and don't know how much 2 mg. of it looks like much less acts on one's body. Thank you for Dr. for your thoughts in advance :)

Dr. Richard Keller said...

2 mg per L would be well above a lethal level if found in any body fluid. While we measure the amount of drug in a small volume of body fluid, it is multiplied out to get consistent units for comparison with published studies so that conclusions can be drawn. It really doesn't take all that much cocaine getting into the blood (and subsequently into the other body fluids)to cause death. There is more than 2mg (in this case) consumed, but it distributes throughout the body and the concentration is measured after that distribution.

asalberg said...

does an inquest need to be performed on a death(suicide,accidental,homicide).Also what is the proper procedure in this inquest-how many days after death,who is notified,findings
I would appreciate any answers to these questions i have
thank you

Dr. Richard Keller said...

Inquests are no longer required in Illinois. In the past and in other states with Coroner systems, inquests are done on all unnatural deaths (suicides, accidents, homicides). Family is usually notified 10-14 days prior to the inquest. Testimony is given for consideration by investigators (Coroner’s deputies, law enforcement, and others as are pertinent) involved in the case. Jurors have access to investigative reports and other documents for consideration as well.