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Suggested Guidelines for the Management of High-Profile Fatality Cases

Television entertainment programs, such as Quincy M.E. and CSI CSI Crime Scene Investigator
CSI CompuServe, Inc.
CSI Commodity Systems, Inc.
CSI Commodity Systems Inc. (Boca Raton, FL)
CSI Crime Scene Investigation (CBS TV show)
CSI Christian Schools International
: Crime Scene Investigation Crime scene investigation may refer to:
  • Forensic science, science used in determining legal proceedings
  • , a US television series
, have popularized and glamorized forensic pathology and medicolegal death medicolegal death Forensic medicine Any death that requires official–medical examiner or coroner investigation Examples Unexpected or violent death, death of an infant or child, unidentified or prominent person, anyone not under a doctor's care; death  investigation. It is likely such shows have also cultivated the public infatuation with actual forensic cases, particularly those involving high-profile fatalities. The definition of a high-profile fatality is a death that elicits extensive media coverage through television networks, radio, and the Internet at one or more sociogeographic levels (eg, local, regional, national, international). Cases precipitating extensive, and sometimes excessive, media coverage may include police-related shootings; deaths related temporally to arrest by the police, during police restraint or incapacitation in·ca·pac·i·tate  
tr.v. in·ca·pac·i·tat·ed, in·ca·pac·i·tat·ing, in·ca·pac·i·tates
1. To deprive of strength or ability; disable.

2. To make legally ineligible; disqualify.
, or when in police custody; deaths in boot camps; deaths of celebrities or deaths in which celebrities are suspects; serial homicides; deaths in schools and colleges; clusters of fatalities; terror-related fatalities; rape and homicide, particularly of minors; mutilation Mutilation
See also Brutality, Cruelty.

Mutiny (See REBELLION.)

Absyrtus

hacked to death; body pieces strewn about. [Gk. Myth.: Walsh Classical, 3]

Agatha, St.

had breasts cut off. [Christian Hagiog.
 murders; political assassinations; deaths from threatening epidemics; and unusual methods of homicide.

Although medical examiners and coroners (ME/C) can predict that the aforementioned types of cases will be scrutinized in the media, it may not be as easy to predict which "routine" cases will catch the eye of the media and become a high-profile case overnight. A high-profile case may also be created when a forensic pathologist misdiagnoses the cause or manner of death because of failure (1) to satisfactorily investigate the deceased's medical history, (2) to fully evaluate the circumstances of death, or (3) to recognize and correctly interpret pertinent gross, microscopic, or toxicologic findings. Such errors are understandingly magnified when they result in false criminal charges or the conviction of innocent individuals, unjustified exoneration The removal of a burden, charge, responsibility, duty, or blame imposed by law. The right of a party who is secondarily liable for a debt, such as a surety, to be reimbursed by the party with primary liability for payment of an obligation that should have been paid by the first party.  of the guilty, or removal of children from a household because of unfounded allegations of abuse.

A methodical approach to the investigation of high-profile cases, in tandem with high-quality, day-to-day forensic practices, should assist the ME/C in avoiding the pitfalls commonly associated with high-profile cases. A proper and thorough forensic investigation and autopsy is crucial not only in ensuring confidence in the competence and objectivity of the investigative team and its ultimate findings but also in preventing possible outbursts of public violence.

METHODOLOGY

The Broward County Medical Examiners Office (MEO (Medium-Earth Orbit) A communications satellite in orbit from 1,600 to 15,000 miles above the earth. It is higher than a low-earth orbit (LEO) satellite and lower than a geostationary earth orbit (GEO) satellite. ), situated in South Florida (Fort Lauderdale), has been the scene of several high-profile fatalities in recent years. Most recently, the media celebrity Anna Nicole Smith died suddenly and unexpectedly within our jurisdiction. In approaching this fatality, our office developed a plan that was based on a combination of common sense and our collective experience with other high-profile cases, including critical analysis of our previous successes and shortcomings A shortcoming is a character flaw.

Shortcomings may also be:
  • Shortcomings (SATC episode), an episode of the television series Sex and the City
. Our approach to high-profile cases can be illustrated by our response to the death of this international celebrity.

CASE STUDY

The death of Anna Nicole Smith, a well-known American entertainment figure, resulted in unusually wide and intense local, national, and international media coverage. The initial information regarding the circumstances of death was sparse. The victim was found dead in a hotel room with several types of medications present. There was no obvious evidence of trauma. Allegedly, the deceased had been febrile febrile /feb·rile/ (feb´ril) pertaining to or characterized by fever.

feb·rile
adj.
Of, relating to, or characterized by fever; feverish.
 for several days before death and had been feeling "under the weather" since her arrival in Florida. She was under stress related to several lawsuits in which she was involved.

The unusually intense media coverage challenged the resources of the Broward County Medical Examiners Office. The high-profile nature of this case generated numerous organizational and professional issues that had to be carefully addressed. Antenna-laden trucks, parked outside of the office for the entire 6 weeks of the investigation, inhibited traffic to and from the MEO. The influx of numerous radio and newspaper reporters, as well as curious sightseers, caused tension with nearby residents. Because the deceased's home in the Bahamas was burglarized and evidence was stolen and because of the lurid media attention, legitimate concerns were raised about the prospect of an unlawful break-in to the MEO in an attempt to photograph the body and publish the images (a criminal violation under Florida law) or to tamper with the evidence. At our request, the Broward County Sheriff's Office agreed to provide security for the MEO. The deceased's body and related evidence were sequestered se·ques·ter  
v. se·ques·tered, se·ques·ter·ing, se·ques·ters

v.tr.
1. To cause to withdraw into seclusion.

2. To remove or set apart; segregate. See Synonyms at isolate.

3.
 in an especially secure portion of the morgue morgue (morg) a place where dead bodies may be kept for identification or until claimed for burial.

morgue
n.
.

A medical examiner (ME) investigative team was formed, consisting of the chief ME, the deputy chief ME, the principal prosecting ME, the chief toxicologist, the chief investigator, and the medicolegal medicolegal /med·i·co·le·gal/ (med?i-ko-le´g'l) pertaining to medical jurisprudence.

med·i·co·le·gal
adj.
Of, relating to, or concerned with medicine and law.
 investigator of record. It was decided that the chief ME should be involved in this high-profile case and serve as the media point of contact for the office. The primary prosector prosector /pro·sec·tor/ (-sek´tor) [L.] one who dissects anatomical subjects for demonstration.

pro·sec·tor
n.
 was the pathologist scheduled for cases that day. The team members met frequently, often several times a day, to discuss interim results, monitor pending studies, draft reports, and determine whether further testing was warranted. Input from all team members was considered, and a consensus was reached on most issues. We attempted to view the case through the eyes of the most critical observers in the media and to frequently reevaluate our methods and conclusions.

Following as-is photography and shortly after admission to the MEO, a preliminary, external examination of the body was performed, with sampling of fluids for various bacteriologic bac·te·ri·ol·o·gy  
n.
The study of bacteria, especially in relation to medicine and agriculture.



bac·te
, toxicologic, and ancillary tests. This was done to avoid postmortem postmortem /post·mor·tem/ (post-mort´im) performed or occurring after death.

post·mor·tem
adj.
Relating to or occurring during the period after death.

n.
See autopsy.
 artifacts artifacts

see specimen artifacts.
, such as bacterial overgrowth bacterial overgrowth GI disease The multiplication of opportunistic bacteria in the lower GI tract, often due to antibiotic therapy. See Pseudomembranous colitis Lab medicineThe multiplication of contaminating bacteria in a specimen–eg, blood, urine, due to  and redistribution of drugs. The full autopsy was done the next day with extensive photography and documentation.

Because the police investigators found no apparent evidence of violence or foul play and there was no request by any police agency to keep the autopsy findings confidential, it was decided to publicly release the results of the initial investigation and the gross autopsy findings. A press conference was called at which we released the preliminary autopsy results and the chief of police conjointly con·joint  
adj.
1. Joined together; combined: "social order and prosperity, the conjoint aims of government" John K. Fairbank.

2.
 reported his findings. The reported initial results were rather nonspecific nonspecific /non·spe·cif·ic/ (non?spi-sif´ik)
1. not due to any single known cause.

2. not directed against a particular agent, but rather having a general effect.


nonspecific

1.
 and did not elucidate either the cause or manner of death. The autopsy findings revealed a somewhat enlarged liver enlarged liver Hepatomegaly, see there  but no evidence of trauma or significant pathology to explain sudden and unexpected death. At the initial press conference, the ME concluded that the cause of death was not yet determined and that although physical trauma was excluded, other possibilities were under consideration; the resolution of the case was pending further investigation and testing. The ME also stated that no further information regarding the possible cause and manner of death would be publicly released until the final determination of the cause and manner of death, which could take as long as 6 to 8 weeks. Despite this attempt at defusing the media, during the following 6 weeks, the Broward County chief medical examiner became a frequent guest on many local and national, and some international, media programs. Some of the interviews centered on the safety and physical condition of the body because its impending im·pend  
intr.v. im·pend·ed, im·pend·ing, im·pends
1. To be about to occur: Her retirement is impending.

2.
 deterioration became a problem when interim court decisions precluded embalming embalming (ĕmbä`mĭng, ĭm–), practice of preserving the body after death by artificial means. The custom was prevalent among many ancient peoples and still survives in many cultures.  and releasing the body. Forensic pathology experts consulted by the media advanced theories that the toxicology would show a methadone methadone (mĕth`ədōn', –dŏn'), synthetic narcotic similar in effect to morphine. Synthesized in Germany, it came into clinical use after World War II. It is sometimes used as an analgesic and to suppress the cough reflex.  overdose, a medication apparently used by Anna Nicole Smith, which had caused the accidental death of her son in the Bahamas several months earlier. Other popular theories regarding the cause of death included pneumonia, aspiration and, of course, murder. The Broward ME team decided that to avoid public confusion, none of the mentioned speculative diagnoses would be confirmed or denied during the interim investigation.

During the days following the autopsy, a number of witnesses provided essential information that changed the direction of the investigation and testing. A physician friend disclosed that the deceased had recently complained of discomfort in the gluteal gluteal /glu·te·al/ (gloo´te-al) pertaining to the buttocks.

glu·te·al
adj.
Of or relating to the buttocks.



gluteal

pertaining to the buttocks.
 area, the site she used to inject various medications for weight loss and "rejuvenation Rejuvenation
Aeson

in extreme old age, restored to youth by Medea. [Rom. Myth.: LLEI, I: 322]

apples of perpetual youth

by tasting the golden apples kept by Idhunn, the gods preserved their youth. [Scand. Myth.
." The gluteal area was not dissected initially because it showed only mild dimpling dim·pling
n.
A condition marked by the formation of natural or artificial dimples.
 with no significant cutaneous cutaneous /cu·ta·ne·ous/ (ku-ta´ne-us) pertaining to the skin.

cu·ta·ne·ous
adj.
Of, relating to, or affecting the skin.


Cutaneous
Pertaining to the skin.
 pathology. However, subsequent dissection revealed the presence of several deep-seated, relatively large abscesses, extending from hemorrhagic Hemorrhagic
A condition resulting in massive, difficult-to-control bleeding.

Mentioned in: Hantavirus Infections


hemorrhagic

pertaining to or characterized by hemorrhage.
 needle tracks, likely explaining a fever documented several days before death. At that point in the investigation, a natural manner of death was favored, which was supported by initial toxicologic testing that detected low to therapeutic levels of several anxiolytics and antidepressants Antidepressants
Medications prescribed to relieve major depression. Classes of antidepressants include selective serotonin reuptake inhibitors (fluoxetine/Prozac, sertraline/Zoloft), tricyclics (amitriptyline/ Elavil), MAOIs (phenelzine/Nardil), and heterocyclics
 and no other drugs of significance (including methadone).

Shortly thereafter, additional information, gleaned from witness interviews conducted by the MEO, indicated that the deceased had a history of using an antiquated, but effective, uncommonly prescribed sleeping medication-chloral hydrate-which is not routinely detected in the usual drug screens. Tests for this drug, conducted at a referral laboratory, revealed very high, potentially fatal, levels. Although routine histologic samples were evaluated by MEO staff, expert consultation was sought from 2 cardiac pathologists and a neuropathologist, who verified that there were no significant findings to explain death. Although our infectious disease Infectious disease

A pathological condition spread among biological species. Infectious diseases, although varied in their effects, are always associated with viruses, bacteria, fungi, protozoa, multicellular parasites and aberrant proteins known as prions.
 consultants were supportive of our initial sepsis theory to explain death, after all available data had been tabulated, they agreed with our team and several expert pharmacologists that death was primarily due to an overdose of chloral hydrate chloral hydrate (klōr`əl hī`drāt), central nervous system depressant that is widely used as a hypnotic, or sleep-inducing drug.  in conjunction with several benzodiazepines Benzodiazepines Definition

Benzodiazepines are medicines that help relieve nervousness, tension, and other symptoms by slowing the central nervous system.
Purpose

Benzodiazepines are a type of antianxiety drugs.
. The discomfort associated with the gluteal abscesses may have resulted in excessive self-medication, but that cannot be proven with certainty.

The final report, which was publicly released to the media and is available on the MEO Web site, discussed in detail the various diagnostic alternatives for the cause and manner of death. Ultimately, the manner of death was deemed accidental and due to combined drug toxicity, to the exclusion of any other considered manner of death. In a final press conference, the details of the investigation and the cause and manner of death were reported, and media questions were fully answered. Because of the detail presented in the press conference and in the published material supporting our conclusions, we have received little criticism regarding this case from either the media or expert pundits. The success of this rather complex investigation can be further affirmed by there being no requests for an additional autopsy or for additional toxicologic or other tests.

Our approach to the autopsy, investigation, and followup was meticulous. In reviewing the investigation proceedings, however, we felt that the one issue we had not adequately appreciated or addressed was the significant stress experienced by the ME staff. Staff experienced tension and emotions in response to the unusual security measures and blanketing of information imposed to avoid leaks to the media regarding the changing interim findings in the case. Periodic internal briefings might have boosted employee morale, even if no additional information could be released, and would also have allowed employees to vent or verbalize their stressful experience.

COMMENT

Obviously, high-profile fatalities vary in intensity and scope and require early planning, including ensuring the safety of the deceased's body and preserving the evidence, assessing the appropriate allocation of investigative resources, deciding upon the composition of the investigative team, considering special autopsy techniques and toxicologic and other adjunctive procedures, and determining the schedule and frequency of interim reviews of emerging evidence. Although any responsible forensic pathologist gives full attention to any investigated case, regardless of its publicity quotient, high-profile fatalities mandate more careful and extensive preplanning. The following items should be considered when facing these types of cases.

General Considerations

* Assess staff and resources that will need to be allocated

* Increase the security of the facility and of the body

* Increase the security of the case files, photographs, toxicologic reports, various police reports, hospital and medical records, and related items

Investigational Considerations

* Compose the forensic investigation team

* Investigate and carefully document the death scene

* Directly question witnesses and secure full access by the forensic team to medical records, interrogation interrogation

In criminal law, process of formally and systematically questioning a suspect in order to elicit incriminating responses. The process is largely outside the governance of law, though in the U.S.
 records of law enforcement agencies A law enforcement agency (LEA) is a term used to describe any agency which enforces the law. This may be a local or state police, federal agencies such as the Federal Bureau of Investigation (FBI) or the Drug Enforcement Administration (DEA). , and other pertinent documentation

* Coordinate with police agencies

Autopsy Considerations

* Develop a checklist to be used during the procedure so nothing is missed

* Perform a full autopsy with applicable special techniques, including layered anterior neck dissection neck dissection  Surgery The excision of lymph nodes and other tissues grossly (|a|) (macroscopically) involved by CA in the neck for the staging of cancer. See Commando operation, Radical neck dissection. , dissection of the back of neck, shaving of the head in cases of blunt trauma blunt trauma Molecular Any injury sustained from blunt force, which may be related to MVAs, or mishaps, falls or jumps, blows or crush injuries from animals, blunt objects or unarmed assailants. Cf Penetrating trauma. , and other methods

* Collect the body evidence, including head and body hair, fingernail fin·ger·nail
n.
The nail on a finger.
 scrapings, a rape kit rape kit Forensic medicine A collection of receptacles–cups, envelopes, plastic bags, tubes, disposable items–cotton swabs, napkins, pipettes and tools–sterile comb for pubic hairs, sheets–used to obtain evidentiary specimens from a rape  (as indicated, but especially in female fatalities), and so forth

* Perform special microscopic procedures as required, such as histochemistry histochemistry /his·to·chem·is·try/ (his?to-kem´is-tre) that branch of histology dealing with the identification of chemical components in cells and tissues.histochem´ical

his·to·chem·is·try
n.
 

* Perform special toxicologic procedures and expect to have to test for the unexpected

Documentation Considerations

* Produce an extensive photographic record of the body?fs appearance (front, back, and sides), its injuries, and any abnormalities, as well as pertinent negative findings, under the ME?fs thorough and detailed direction and supervision

* Ensure the security of all photographs because tabloids will offer extravagant sums to acquire them (encrypted digital photos are acceptable in many jurisdictions)

* Produce adequate body diagrams of any injuries

* Generate a detailed autopsy report

* Develop comprehensive toxicology reports

* Coordinate and include written reports of outside consultants

* Produce a detailed summary report

Communications With Outside Agencies or Organizations

* Establish a single point of contact for the media

* Maintain close communication and cooperation with various investigative agencies

* Provide adequate contact and fact-based communication with the media

* Explain the MEO procedural approach to civil rights organizations, attorneys, or special interest groups, if required

Assessment of Needed Staff and Resources. Highprofile cases often require, for a variety of reasons, additional staff and resources beyond the usual capabilities of the ME/C office. Law enforcement officers, as a rule, are willing to provide additional security protection, if needed. Outside consultants, including various subspecialty subspecialty,
n a limited portion of a narrowly defined professional discipline. E.g., surgery is a specialty of medicine and pediatric vascular surgery is a subspecialty.
 pathologists and other experts, should be contacted early in the investigation. Ready access to the facilities of specialized referral laboratories may be needed, and their requirements for sampling, analysis, and testing should be determined before needed.

Continuous Open Communication Channels With Law Enforcement Agencies. Day-to-day communication with law enforcement agencies is routine in every ME/C office. However, in high-profile cases, the intense publicity may adversely affect the ongoing cooperation with law enforcement agencies if the nature of the information to be released is not communicated beforehand or if there is a perception that the law enforcement agencies are being excluded from exposure to the media by the ME/C. Therefore, it is strongly recommended that significant findings be communicated to law enforcement agencies before public release and that senior law enforcement officers be invited to participate in all public conferences called by the ME/C, with the exception of cases in which the death has occurred in police custody or in confrontation with police.

The Forensic Team. The determination of the ME/C forensic investigative team is a function of both the nature of the case and the staffing capability of the respective office. At a minimum, the team should include the autopsy prosector, a toxicologist, and an investigator. The input of reputable forensic experts and subspecialists should also be considered. The frequency of the forensic team's meetings may vary according to the needs of the specific case but should take place at least once a day to follow up on recent developments in the case and to consider additional steps, if needed, in a timely fashion.

Investigation of the Scene. The chief ME/C or a staff pathologist should be at the scene promptly to personally investigate all deaths likely to develop into high-profile cases, even when the case would routinely have required only the presence of a police officer or a forensic investigator. The reason is that, in high-profile deaths, questions of foul play are often raised, and the failure of the ME/C to attend the scene of death may prevent a full and adequate assessment of the case. At the least, the absence of a pathologist at the scene can open a door to questions about the validity of subsequent findings.

Questioning of Witnesses. Direct questioning of witnesses by the ME/C can often prove helpful because such questioning provides an independent path for elucidating the background and circumstances of the death and can redirect the focus of forensic investigation. This approach is also more satisfying to the public because it substantiates the thoroughness and objectivity of the ME/C's investigation. Furthermore, many witnesses feel more comfortable talking to the ME/C, who is often a physician, than to the police. However, such interviews must be voluntary and noncoerced because in some states, such as Florida, coerced, subpoenaed interrogations may bar the State from prosecuting the witness. At times, witnesses may request to have their attorneys present during the interview, and such requests should be honored. It may also be useful to have a representative from the ME/C present during interviews conducted by other agencies. Again, cooperation with law enforcement is the key to maximizing the information gathered without jeopardizing any potential criminal prosecution or impeding the investigation of local police agencies.

Special Autopsy and Microscopic Techniques. Specialized autopsy procedures and extensive microscopic sampling, biochemical studies, histochemistry, and immunohistochemistry may be required in high-profile cases, depending on the nature of the findings and the information obtained by the police and the ME/C investigators. Similar studies are used in other cases but less intensively. Special autopsy techniques may be used to more clearly substantiate the presence or absence of certain pathologic findings. Such techniques, although usually required only in the presence of well-defined indications, may be advisable in some high-profile cases to neutralize the possibility of undue criticism. Such procedures may include a posterior dissection of the neck, full x-rays of the body for detection of skeletal injuries, histochemical stains for subtle myocardial myocardial /myo·car·di·al/ (-kahr´de-al) pertaining to the muscular tissue of the heart.

myocardial

pertaining to the muscular tissue of the heart (the myocardium).
 fibrosis, dissection and sampling of the conduction system conduction system systema conducens cordis Anatomy A network of specialized nerve fibers innervated by both the sympathetic–SNS and parasympathetic nervous systems–PNS; PNS stimulation, eg, ↑ vagal stimulation, ↓ sinus node automaticity  of the heart, electrophoresis of blood for sickle cell disease sickle cell disease or sickle cell anemia, inherited disorder of the blood in which the oxygen-carrying hemoglobin pigment in erythrocytes (red blood cells) is abnormal. , and other methods. Adequate and abundant tissue sampling may substantially reinforce the strength and reliability of the pathologic diagnosis. Whole organs may need to be retained in accordance with state and local regulations to facilitate expert consultation.

Special Toxicologic and Other Tests. The toxicologic analysis should be much broader than usual in high-profile cases to avoid the possibility of missing esoteric drugs, toxic substances, or medications that might have contributed to the death. Efficiency of testing is maximized through correlation with the decedent's drug and medication history. In cases of deaths in police custody or deaths during police restraint, the possibility of excited delirium due to cocaine or other stimulants should be considered. Biochemical assays on brain tissue are currently available that may indicate whether there was probable cocaine-related, excited delirium or only acute cocaine intoxication intoxication, condition of body tissue affected by a poisonous substance. Poisonous materials, or toxins, are to be found in heavy metals such as lead and mercury, in drugs, in chemicals such as alcohol and carbon tetrachloride, in gases such as carbon monoxide, and . As a rule, samples of all major organs should be frozen, and a sample of peripheral blood peripheral blood Cardiology Blood circulating in the system/body  and serum should be obtained and be retained in an assortment of preservatives. Multiple specimens suitable for DNA analysis DNA analysis Any technique used to analyze genes and DNA. See Chromosome walking, DNA fingerprinting, Footprinting, In situ hybridization, Jeffries' probe, Jumping libraries, PCR, RFLP analysis, Southern blot hybridization.  should be collected, particularly if there are ongoing, highly publicized paternity The state or condition of a father; the relationship of a father.

English and U.S. Common Law have recognized the importance of establishing the paternity of children.
 issues. In addition, several tubes of blood and serum should be quickly frozen at -57°C, to prevent in vitro in vitro /in vi·tro/ (in ve´tro) [L.] within a glass; observable in a test tube; in an artificial environment.

in vi·tro
adj.
In an artificial environment outside a living organism.
 degradation of drugs, such as cocaine. Several biochemical assays also require similar samples. Completion of a rape kit is also suggested because MEOs cannot predict the allegations that may arise in any given case. As in all cases, strict chain of custody The movement and location of physical evidence from the time it is obtained until the time it is presented in court.

Judges in bench trials and jurors in jury trials are obligated to decide cases on the evidence that is presented to them in court.
 procedures must be documented and maintained.

Outside Consultants. Using the assistance of experts, including subspecialty pathologists and other consultants, as needed as needed prn. See prn order. , is highly recommended in high-profile cases for verifying both affirmative and exclusionary findings and opinions. A sufficient and adequate body of such credible experts not only reinforces the final conclusions of the ME/C regarding the cause and manner of death but also represents a firm barrier against unfounded accusations and questioning of final determinations. The specific selection of such experts is obviously dependent on the nature of the investigated case, but in general, cardiac pathologists and neuropathologists should be included because significant, but subtle, findings in the heart and brain might have caused or contributed to death. An outside expert asked to verify the findings of a primary examiner should be blinded (ie, be unaware of the results of the initial evaluation).

A Final Comprehensive Report. In addition to a standard autopsy report, a final summary report can be useful in select cases. This document should be very detailed, and the cause, mechanism, and manner of death should be clearly presented. The report should not only objectively substantiate, in great detail, the final diagnoses and opinions but also exclude even low-probability diagnostic alternatives that might be raised. Alternative diagnostic possibilities should be discussed frankly, and pros and cons pros and cons
Noun, pl

the advantages and disadvantages of a situation [Latin pro for + con(tra) against]
 should be thoroughly analyzed. Confirmation bias, the human tendency to see what one expects and desires to see, should be avoided, particularly when evaluating ambiguous evidence. If no conclusive opinion can be reasonably formulated regarding the cause, mechanism, or manner of death, the reasons for such failure should be presented in exquisite detail and be adequately supported by outside expert opinion and referenced literature. The forensic pathologist charged with the investigation of a high-profile death will be a target for pundits and the media. To navigate safely through the turbulent, stormy waves of high-profile cases, the ME/C must be fully aware of the potential forensic pathology pitfalls described in the literature1-4 and take great care to avoid them.

Media Relations. It is important to establish an appropriate protocol for communicating with the media and to decide the specific nature and detail of interim evidence that may be released safely, without jeopardizing the integrity of a possible criminal investigation. The protocol must ensure that communication with the media is professional, fair, and equitable, with no favoritism expressed or implicit. Although a public relations officer public relations officer nencargado/a de relaciones públicas

public relations officer nresponsable m/f des relations publiques

 may be useful for the release of ancillary information, complex forensic information and medical opinions should be explained only by the chief ME or another knowledgeable forensic pathologist. Information released to the public should, as much as possible, protect the privacy of the individuals, avoid controversial but irrelevant medical history or behaviors, and be delivered with as much sensitivity as possible. Use of demeaning de·mean 1  
tr.v. de·meaned, de·mean·ing, de·means
To conduct or behave (oneself) in a particular manner: demeaned themselves well in class.
 descriptions or qualifying words, such as "dead drunk" or "burnt-out drug addict," should be avoided. Instead, accurate but neutral descriptions should be used (eg, "intoxicated in·tox·i·cate  
v. in·tox·i·cat·ed, in·tox·i·cat·ing, in·tox·i·cates

v.tr.
1. To stupefy or excite by the action of a chemical substance such as alcohol.

2.
, user of medications"). The federal Health Insurance Portability and Accountability Act The Health Insurance Portability and Accountability Act (HIPAA) was enacted by the U.S. Congress in 1996.

According to the Centers for Medicare and Medicaid Services (CMS) website, Title I of HIPAA protects health insurance coverage for workers and their families when
 of 1996 (Pub L No 104-191, 110 Stat 1998) protects antemortem antemortem /an·te·mor·tem/ (an?te-mor´tem) [L.] occurring before death.

an·te·mor·tem
adj.
Before death.



antemortem

performed or occurring before death.
 medical records or contents thereof from disclosure, and special permission from the next of kin The blood relatives entitled by law to inherit the property of a person who dies without leaving a valid will, although the term is sometimes interpreted to include a relationship existing by reason of marriage. Cross-references

Descent and Distribution.
 may be required before releasing privileged information. In Florida, disclosure of autopsy photographs is forbidden by state law unless permitted by the next of kin or mandated by the courts.

When an investigation is ongoing, police agencies may request that no information be released to the public. In such cases, especially when homicide is evident or suspected, such an information blackout may be justified. However, the requests must be considered on a case-bycase basis and their justification evaluated following discussion with the requesting authority. It is good practice to demand that such requests be done formally in writing and that a time period, possibly renewable, be set for the period of nondisclosure.

In cases of death during police arrests or during police custody, the ME/C may recommend that the investigation be conducted by a law enforcement agency Noun 1. law enforcement agency - an agency responsible for insuring obedience to the laws
FBI, Federal Bureau of Investigation - a federal law enforcement agency that is the principal investigative arm of the Department of Justice
 other than the one involved, if practicable. Whether this advice is taken or not, the ME/C must remain objective. Following completion of the autopsy, there are 2 possible courses of action for the ME/C, which are dictated by the particulars of a given case. It may be in the best interest of the ME/C and the community to release the cause and manner of death, in some cases, as soon as possible, to avoid allegations of collusion with the police agency or a cover-up. Alternatively, cases may be left pending to allow emotions to cool. Regardless of the course chosen, the MEO must remain unbiased in its findings and in its portrayal of the findings.

Intense media coverage in these cases can clearly increase the anguish of the bereaved families and trigger racial, ethnic, religious, or lifestyle-related tension. Furthermore, outside forensic experts called upon by either the media or the family of the deceased may add to the confusion by expressing premature opinions based on statistical probabilities and insufficient specific data, which may, therefore, be completely inaccurate in the specific case.1,2 Regardless of the accuracy of these uninformed opinions, its influence may result in a second autopsy, additional toxicologic testing, or questions about the findings and conclusions of the initial ME/C. If the criticism is well founded, the consequences for the forensic pathologist at fault are magnified by the massive publicity and could include loss of professional credibility, public humiliation, mandated supervision, various penalties, dismissal, or costly litigation An action brought in court to enforce a particular right. The act or process of bringing a lawsuit in and of itself; a judicial contest; any dispute.

When a person begins a civil lawsuit, the person enters into a process called litigation.
.

Communicating with the media may be smoother and much more effective if the demeanor of the interviewed ME/C is professional, calm, and unassuming. The material presented must be entirely factual and avoid speculations or demeaning criticisms of anyone involved in the case. This setting is not the place for humor or nurturing celebrity status.3,4 The media will invariably in·var·i·a·ble  
adj.
Not changing or subject to change; constant.



in·vari·a·bil
 press for additional information, but as a rule, it will accept consistent answers about information that is unknown, unavailable, or unreleasable because of the ongoing investigation. Credibility is the key to interactions with the media. Like virginity, once credibility is lost it can never be regained. Requests for follow-up interviews should be granted, as a general rule, even if there is no new information available because it somewhat quenches the media's thirst for day-to-day information. These interviews may also serve as an opportunity to educate the lay public about forensic pathology, in general, and about medicolegal investigation procedures (which may differ from what it has learned watching television serials).

CONCLUSIONS

The investigation of a high-profile death is a team effort. Preplanning before the autopsy, establishing security for the facility, using special autopsy techniques and ancillary studies, consulting with a variety of experts, and maintaining close communication with law enforcement agencies will enable the ME/C to weather the media storm associated with these fatalities. Communication with the media should be objective, honest, and timely but not overly technical.4 Although the media should have access to appropriate information, "spending a few days in the spotlight" should never become the goal of the ME/C. As Moritz5 said more than 50 years ago, an ME/C can make the "mistake of talking too soon, too much, or to the wrong people." Nowhere is this truer than in high-profile cases.

We acknowledge the assistance of Predrag Bulic, MD, in the autopsy suite; Chief Investigator Edwina Johnson for her participation in the investigation; Julie Stumpf, BSB/M, for her critical review of the manuscript; and the rest of the Broward County Medical Examiners Office staff who maintained day-to-day operations while in the midst Adv. 1. in the midst - the middle or central part or point; "in the midst of the forest"; "could he walk out in the midst of his piece?"
midmost
 of this distracting incident.

© 2008 College of American Pathologists This article or section needs sources or references that appear in reliable, third-party publications. Alone, primary sources and sources affiliated with the subject of this article are not sufficient for an accurate encyclopedia article.  Provided by ProQuest LLC (Logical Link Control) See "LANs" under data link protocol.

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. All Rights Reserved.
Copyright 2008 Archives of Pathology & Laboratory Medicine
No portion of this article can be reproduced without the express written permission from the copyright holder.
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Author:Joshua A Perper and Gertrude M Juste and Harold E Schueler and Reinhard W Motte and Stephen J Cina
Publication:Archives of Pathology & Laboratory Medicine
Date:Oct 1, 2008
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