Transcript Less Than Lethal Force: A Medical Examiner`s View

Less than lethal force:
A Medical Examiner's View
J.C. Upshaw Downs, M.D.
Regional Medical Examiner
Savannah, GA
912-921-5903
[email protected]
It’s all about customer service.
Autopsy
• Injuries
• Disease(s)
• Drug(s)
• Other(s)
• Evidence
Medicolegal Autopsy
aka Forensic Autopsy
• Mandated
• Complete examination
external
clothes
evidence
wounds
internal
gross
microscopic
fluids (tox, chemistry, etc.)
Medicolegal Autopsy
aka Forensic Autopsy
• Mandated
• Complete examination
external
clothes
evidence
wounds
internal
gross
microscopic
fluids (tox, chemistry, etc.)
The
Scene!
Cause of Death
• Proximate or underlying triggering event
• Determined by medical examination > other
• Multiple medical diagnoses
heart attack (ASCVD)
pulmonary embolus (PE)
cancer
• Trauma
GSW, blunt/sharp force, MVC, etc.
“It is a capital mistake to theorize
before one has data.
Insensibly one begins to twist facts
to suit theories,
instead of theories to suit facts.”
A Scandal in Bohemia - Arthur Conan Doyle
History
Autopsy
clothing
trauma
toxicology
odors
personal effects
foreign materials
specialized testing
microscopics
heart
lungs
liver
spleen
kidneys
genitals
endocrine
GI tract
CNS
M/S
Autopsy
History
heart
clothing
lungs
trauma
medications medical liver
toxicology
social spleen
symptoms
odors
drug
activities
kidneys
personal effects
changes
terminal
foreign materials
genitals
scene
witnesses
specialized
testing
endocrine
EMTs
family
GI tract
microscopics
CNS
M/S history!
History, history,
Autopsy
History
heart
clothing
lungs
trauma
medical liver
medications
Questions
toxicology
social spleen
symptoms
other(s)?
who?
odors
drug
activities
what?
kidneys
why?
personal effects
changes
terminal
when?
how?
foreign materials
genitals
scene where?
witnesses
specialized
testing
endocrine
EMTs
family
GI tract
microscopics
CNS
There’s no such thingM/S
as a silly question.
History
Clinical
Physical
Autopsy
History
heart
clothing
lungs
trauma
medical liver
medications
Questions
toxicology
social spleen
symptoms
other(s)?
who?
odors
drug
activities COD what?
kidneys
why?
personal effects
changes
terminal
when?
how?
foreign materials
genitals
scene where?
witnesses
specialized
testing
endocrine
EMTs
family
GI tract
microscopics
CNS
Cause and manner
are opinions.
M/S
Autopsy
History
heart
clothing
lungs
trauma
medical liver
medications
Questions
toxicology
social spleen
symptoms
other(s)?
who?
COD
odors
drug
activities
what?
kidneys
why? MOD
personal effects
changes
terminal
when?
how?
foreign materials
genitals
scene where?
witnesses
specialized
testing
endocrine
EMTs
family
GI tract
microscopics
CNS
M/S
The Daily Poop Nov 4, 2006
Police gun down unarmed man
Choke
hold!
EMI!
Batons!
Pepper
spray!
Lawyers!
COD: He needed killin’
MOD: Natural (he had it comin’)
What is the relationship of events?
• Description of circumstances
• Is use of “sub-lethal” means not involved
• Relative import
primary or underlying cause
contributory/other significant condition
disease
toxicology
environment
Levels of Certainty
•
•
•
•
•
•
Certain
Probable
Equivocal
Possible
Coincidental
Uncertain
• 25 WM
• Partying downtown
• Bizarre behavior
Ofc.
Cpl.
Ofc.
Area of arrest
Government St. & George St.
Ofc.
Physical Combat
• 02:59:10
“We’ve got him surrounded Sarge,
we’re waiting for you.”
• 03:01:27
“3S1, I’m out with 35.”
• Duration: 2 minutes 17 seconds.
• Witness: 1 minute 32 seconds
Right Costal Margin
Right Elbow
Six oblique
purple
contusions
Guide
Slot
Orange discoloration (OC)
OC DEATHS
Risk Indicators
•
•
•
•
Bizarre/Violent Behavior
Obesity -- especially “big bellies”
Drug and/or alcohol involvement
Apparent ineffectiveness of Spray
R
L
larynx
R
SCM
trachea
SCM
What happened?
Who killed him?
Why did they do it?
How much will this cost?
Time up front is cheap,
time on the back end is expensive.
How’s that investigation coming?
• Police –
depends on ME investigation
• ME –
pending for police investigation
Cause of Death
strangulation
with
multiple blunt force injuries
during
arrest procedure
(including prone restraint)
while in an
excited state
Manner of Death?
Toxicology
• LSD: 1.5 ng/ml
• Alcohol: 0.235%
Good police work solves cases.
9. Cases start and end at the scene.
ALL the evidence is important.
Status post law enforcement subdual
•
•
•
•
Multiple BFI (contusions & abrasions)
TASER burns, left breast
Left occipital brain contusion
Right occipital subarachnoid hemorrhage
Diagnoses
•
•
•
•
•
•
Temperaturecore = 1070F
Methamphetamineblood = 1100 ng/mL
Amphetamineblood = 220 ng/mL
Rhabdomyolysis
Coagulopathy
Centrilobular hepatic necrosis
COD:
Sympathomimetic poisoning syndrome
(malignant hyperthermia)
Due to:
Methamphetamine toxicity
MOD:
Accident
What happened?
• Excited delerium
illicit drug use
noncompliance
perceived threat
• Restraint process…
EMI
handcuffing
MBFI
 coagulopathy (DIC)
 hepatic necrosis
 rhabdomyolysis
Excited State
• Excited delirium:
acute mental disorder
impaired thinking
disorientation
visual hallucinations
• Behavior
consistent, purposeless
often violent
• Potentially lethal medical emergency
Custody Deaths Catecholamine Rush
• Fight-or-flight
• Sensitizes heart to dysrhythmia
• Psychological stress
• Sudden death without anatomic cause
must exclude restraint/expgenous
Manner of Death
• Circumstances of cause
• Determined by investigation > other
•
•
•
•
•
Natural
Accident
Suicide
Homicide
Undetermined
Homicide = Murder
The ME must remain impartial.
“Living is easy with eyes closed,
Misunderstanding all you see.”
- Winston O’Boogie