Colorado has had its recent share of media stories of child deaths that some feel may have been prevented.  This story comes out of Snohomish County, WA.  We are not familiar with the medical examiner's office, protocol or policies of that office and make no opinion of them.  Information has been shared among forensic professionals and media stories.  Before reading this blog further, please read the stories for some background.  In order, they are:
-- http://heraldnet.com/article/20120307/NEWS01/703079869#No-autopsy-of-Monroe-child-despite-police-requests%0A
-- http://www.komonews.com/news/local/Premature-cremation-of-boy-leaves-questions-into-suspicious-death-141689403.html
-- http://heraldnet.com/article/20120308/OPINION01/703089979#Suspicion-is-part-of-the-job

This is a disturbing story, and we agree in the basic premise of the latter editorial opinion regarding the necessity of autopsies; but we disagree that an outside agency should dictate when autopsies are or are not done -- that should be in protocol and policy with specific assessment training.  Colorado has empaneled a child fatality review team at the state level, but many at the county level have not historically participated; some chastised their medicolegal death investigators for being 'too involved' in their cases (that criticism coming from the chief and husband).  That being said, our county -- from which we received education, training and experience that exceeded any expectations and content  available -- was very instrumental in setting guidelines for child death investigations and the investigative process that CDC has recommended and we use in our private expert consultations.  The policy was that one investigator would go to the scene and one to the decedent (usually at the hospital), also where the family was -- there are many investigative reasons for this.  Only if there were an underlying  significant terminal medical history (and verified by consultation with the treating physician and independent review of the medical records) and no suspicious circumstances (and a higher standard than adult deaths) would the case not be autopsied.  This component alone could have the responding medicolegal death investigators, and law enforcement active for 12-24 uninterrupted hours.  There were two concerns:  1) a proper initial investigation to determine the necessity of an autopsy; and 2) to not further traumatize the family while trying to follow Voltaire's famous quote, "To the living we owe respect, to the dead we owe the truth."  This was not the end of the investigation, it was only the component that would answer the question:  autopsy or not.  The investigative process often took several days to weeks and only concluded after toxicology and all other medical, physical and circumstantial information, facts and evidence were reviewed.  I know of one story of a devoted medicolegal death investigator as the primary investigator on a suspicious infant death.  Although he believes one death went unanswered, his attentiveness to a second death in the same jurisdiction was instrumental in preventing a third.  A sad story to be sure, that thankfully did not continue ... and he was one later chastised for being 'too involved' by his superior and her co-worker spouse, who did not participate in child fatality reviews of their own child death cases.

What I would like to know from this story is who makes the decision to autopsy or not.  As investigators we had the first decision, but if there were some gray area we called the on-call doc.  Our training was extensive enough that having a doc on scene or calling to run cases by was minimal.  I enjoyed the work and experience, but not the office politics, and would like to expand the child death investigations model for other jurisdictions.

At some point the responsible jurisdictions have to treat and compensate medicolegal death investigators, the offices of the medical examiner and/or coroner offices, and their forensic pathology staff for the often uncommended work as stewards of both public health and public safety.  ME/Coroner investigators, and forensic pathologists, are often the first to experience budget restrictions and first to be criticized.

Any time we teach a death investigation course, child deaths are a large part of it.

With kindest regards, Dean
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Dean A. Beers, CLI, CCDI and Karen S. Beers, BSW, CCDI
Board Certified Legal Investigator / Expert
Board Certified Criminal Defense Investigators
Certified Death Investigators / former Deputy Coroners

Associates in Forensic Investigations, LLC
www.Forensic-Investigators.com ~ beersda@Forensic-Investigators.com
(970) 480-7793 Office (Dean x1 / Karen x2) and (970) 480-7794 Fax
'Quaero Indicium' - To Find The Evidence

_Dr. Cina underscores the importance of a proper medicolegal death investigation, as well as forensic autopsy and procedures.

This reminds me of a case in Pueblo, CO (January 2007) used in my book, "Practical Methods for Legal Investigations", in which a person exited the interstate and then shot herself in the head with a small caliber pistol, which was ejected from her rolled vehicle. This appeared to be an accident, but was easily determined at autopsy to be a suicide.

< Click Here > for the full story

Our consulting Forensic Pathologist, Stephen Cina MD, was interviewed for this article.

WORCESTER —  Reversing an earlier determination, police say the man who died in a melee at City Hall Wednesday suffered a fatal gunshot wound. In the hours after the man's death, police said the man appeared to have suffered from a pre-existing medical condition.

Javier A. Santiago “died as the result of a single gunshot wound to the upper torso,” police said in a brief statement yesterday afternoon.

< Continue to the full story >

This reminds me of a case in Pueblo, CO (January 2007) used in my book, "Practical Methods for Legal Investigations", in which a person exited the interstate and then shot herself in the head with a small caliber pistol, which was ejected from her rolled vehicle.  This appeared to be an accident, but was easily determined at autopsy to be a suicide.