Strengthening Forensic Medicine Stefan Timmermans UCLA

Macro-view of field of forensic medicine How do changes in the organizational set-up and professionals affect death investigation? Main points: Good scientists need to be good politicians. Continuous need to innovate. Proactively strengthen professional basis of forensics.

Transition of professional death investigators Coroners of early 20th century Authority of committing magistrates Elected or appointed officials Fee-for-service or salaried Public inquests Problem: fraud and corruption Reorganization: medical examiners

Contemporary set-up Stronger scientific basis Expert became judge But drop in public involvement No more public viewing Lack of legislative action Change in organization and professionals affect all aspects of death investigation.

Contemporary death investigation 3 core-elements of forensic authority: Valuable public good Statutory law Science Professionalization of death investigation: challenges and strengths

1. Valuable public good: hope Explain suspicious deaths Randomness More victims? Death was not in vain. Knowledge Justice Prevention Who benefits in reality?

Organizational ecology Notification Physicians-hospitals Law enforcement Funeral homes Information Physician-hospitals: medical records Law enforcement: police reports Investigation Law enforcement DA Communication Law enforcement Office of vital records Next of kin Other agencies Courts Media

Benefits-vulnerabilities of cultural need Law enforcement-courts Public health Relatives

Further complications Glamorization of forensics in media Organ-tissue donation: Gift of life Transplant games

2. Statutory laws Coroner-medical examiner laws: Property rights Cases that fall under jurisdiction Describes necessary procedures Trumps interests next-of-kin, other parties

Benefits and vulnerabilities of statutory laws Strong protection on a day-to-day basis Problem: Complacency in professional development Compared to clinical medicine: little innovation, need to lobby, address third-parties Paradox of too much sheltering Laws can be changed… Organ and tissue interests Find cheaper labor

3. Science NAME description of coroner: Coroners are called upon to decide if a death was due to foul play. Depending upon the jurisdiction and the law defining the coroner's duties, the coroner may or may not be trained in the medical sciences. The coroner may employ physicians, pathologists, or forensic pathologists to perform autopsies when there appears to be a question or manner of death that autopsy can elucidate. In some jurisdictions, the coroner is a physician, but in may localities, the coroner is not required to be a physician nor be trained in medicine. In the absence of medical expertise, the non-physician coroner may have difficulty in sorting out subtle non-violent and violent causes of death.

Forensic pathologist The forensic pathologist is specially trained: to perform autopsies to determine the presence or absence of disease, injury or poisoning; to evaluate historical and law- enforcement investigative information relating to manner of death; to collect medical evidence, such as trace evidence and secretions, to document sexual assault; and to reconstruct how a person received injuries. Forensic pathologists are trained in multiple non medical sciences as well as traditional medicine. Other areas of science that the forensic pathologist must have a working knowledge of the applicability of are toxicology, firearms examination (wound ballistics), trace evidence, forensic serology and DNA technology.

Benefits and vulnerabilities of science Superior compared to coroners Context of evidence-based medicine Knowledge stratification Problem mismatch science-manners of death: Suicide Forensic homicide

Consequence Tremendous practice variation Questions expertise Encourages competitors Especially problematic for disaster that crosses geographic boundaries serial killers

Harold Shipman Serial killer Several forensic investigations Governmental inquiry US medical examiner

Summary Great job security Amazing scientists doing an undervalued job Still, professional vulnerabilities: Too focused on law enforcement Professional complacency Practice variation Risk of marginalization Risk of external reform

Suggestions Reach out at diverse constituencies Good scientists AND good politicians Stronger ties with public health Including researchers Advocate of bereaved Initiate legislative action: safety Homeland security ?

Suggestions Accelerate professionalization: Forensic pathologists and elected officials? Training programs Certification Quality assurance Research and innovation Not simply reactive but also proactive.

Suggestions Example of interdisciplinary infant fatality review teams Greater standardization of autopsy reports Embrace information technologies More funding