Medico-Legal Investigations HOW ADEQUATE?

Medical Death Investigative Systems

Past and Present Systems

Death investigation of some sort has existed in all countries for centuries, but not always performed by medical professionals (Committee, 2003 as qtd in Moldovan, 2008). The link between law and medicine traces back to the ancient Egyptian culture in 3000 B.C. This was followed by the English coroner system in around the 12th century. The 194 Articles of Eyre first used the term "coroner" by the English until brought by the first colonists to the New World, America as basis for a legal investigative function. A medical examiner replaced the coroner system in 1890 then functioning in Baltimore. A medical examiner is a trained medical specialist in pathology. The field of death investigation became more and more sophisticated in cities and States, like New York. The Office of the Medical Examiner was established in 1918. Its main function was to determine the manner and causes of unnatural and unexplained deaths. This was the original purview of the fundamental British Coroner system, on which was founded the American legal death investigation (Spitz, 2006 as qtd in Moldovan). At present, there are more than 2,000 medical examiners and coroner offices in the U.S. They combine efforts in examining more than half a million such deaths annually (Bureau, 2004 as qtd in Moldovan).

The field of modern medico-legal death investigation is now part of forensic science (Moldovan, 2008). It is performed by forensic medical practitioners and forensic investigators. The basic principles of the field are often accurately portrayed in popular television programs like "CSI" and "Law and Order." Reality-based TV programs like Dr. G., Medical Examiner" and "North Mission Road" reenact some actual cases and present actual investigators, forensic pathologists or anthropologists, who perform without dramatization. TV presentations have raised much public interest and expectations in the field (Moldovan).

Forensic Professionals and Their Practice

They are the elected or appointed county coroner, an appointed medical examiner, a medical doctor without forensic pathology training, a forensic pathologist, a forensic odontologist, forensic botanist, forensic anthropologist, criminalist, police officer or a specialty-trained forensic death investigator (Moldovan, 2008). In small or rural areas, the elected or appointed county coroner responds to these death cases and conducts an investigation. In metropolitan areas, a medico-legal death investigator with appropriate training probes into the manner and cause of death and collects evidence. He is usually college-educated in criminal justice or a physical science. He processes crime scenes, identifies decedents, collects physical and trace evidence as well as provides expert testimony in courts of law. They are the link between law enforcement agencies and medical establishments as well as the general public. There were no standard procedures for death investigation, often left to the employing agency. Training was often low-budgeted and of low-priority. Yet these professionals enter the horrifying crime or accident scene of death on a daily basis. They expose themselves to various diseases, drugs and weapons, dirty settings, emotionally charged situations, handle and protect property damages. At all times, they must maintain a professional attitude, whatever the circumstances. They must be experts in examining decomposed or mangled bodies and interpreting medical records in search of the manner and causes of death. Their unique training and experience, mental and emotional well-being, fortitude, and desire to help victims make them unique players in the investigative process (Moldovan).

2003 Committee Workshop

This highlighted the status and needs of the current medico-legal investigation system and its capability to meet present challenges and issues in American society (National Academy of Sciences, 2003). Participants reported that approximately 20% of the 2.4 million deaths in the U.S. annually are unnatural and unexplained. These are investigated by medical examiners and coroners, who conduct approximately 450,000 investigations annually. Participants observed that significant weaknesses plague the country's present death investigation system. These result in inadequate available information. They agreed that the problem should be studied more deeply and solutions proposed. The strong public need for accurate death information stood out in the workshop discussion. One compelling type of information was about the cause and manner of death for criminal adjudication. The need to protect the interest of the innocent and to convict the guilty was top priority. The participants also noted the neglected but substantial public interest in public health and civil adjudication, particularly civil disputes between private persons. The use of autopsies to document medical errors and to promote quality and trust in medicine was one illustration. Victim identification is another public need among affected families. Those un-affected have a powerful and broad interest in learning from...

Investigation procedure consists of 5 steps. First is the arrival of the investigator at the scene. Second is documenting and evaluating the scene. Third is documenting and evaluating the body. Fourth is establishing and recording decedent profile information. And fifth is completing the scene investigation (National Medical-Legal Review Panel).
In arriving at the scene, the medical examiner or coroner first introduces and identifies himself and his role (National Medical-Legal Review Panel, 1999). Then he secures the place, receives a confirmation or pronouncement of the victim's death. He participates in the scene briefing, conducts a "walk through" into the scene, establishes a chain of custody and follows appropriate laws. He documents and evaluates the scene by photographing it, prepares descriptive documentation, establishes probable location of injury or illness, collects and preserves property and evidence, and interviews witnesses at the scene. The body is also photographed, examined externally, preserved, identified, and documented. The investigator participates in scene debriefing, notifies the victim's next of kin and ensures the security of remains. He then documents the discovery history, the terminal episode history, decedent medical history, decedent's mental health history and social history. He completes the scene investigation by maintaining jurisdiction over the victim's body, releasing jurisdiction over it, performing appropriate exit procedures, and extending assistance to the victim's family (National Medical-Legal Review Panel).

Disparate Treatment of Hawaiian Natives

A study looked into effects of the disparate treatment in the criminal justice system on native Hawaiians and the possible causes of the disparate treatment (Namu'o, 2010). It found that the racial disparity, particularly among Hawaii's prison population, is the composite of actions from the different stages of the State's criminal justice system. The effects of these actions accumulate through the stages directly or indirectly as the prisoner goes through the criminal justice system itself (Namu'o).

Native Hawaiians, correctional officers, treatment providers, and advocates set forth the processes that result in an inequitable representation of the natives in the State's criminal justice system (Namu'o, 2010). Some of these differences proceed from the way the system operates, but other differences appear to derive from a chronic stereotypes and cultural and personal traumatic experiences. Many diligent and sincere public defenders are perceived as unhelpful and disinterests by former Hawaiian prisoners. They feel that these defenders were not really sympathetic towards them because they only take a plea. They do not really listen or care about what the accused or prisoner says (Namu'o).

The State of Hawaii gives the Hawaii Paroling Authority or HPA substantial authority to set minimum sentences (Namu'o, 2010). The judges set the sentences, but the HPA soon conducts hearing to determine the minimum sentence. It also issues guidelines for setting sentences, covering the nature of the offense, the degree of injury or loss, and the accused offense history. It may use criteria it deems necessary to decide the sentence. The HPA thus determines the length of time an accused stays behind bars. A minimum sentence may guarantee a parole hearing but does not guarantee release. The discretionary nature of minimum sentence setting and release decisions outside the courts are problems to native Hawaiians. The HPA, not the judge, clearly determines the sentence according to arbitrary criteria (Namu'o).

Interactions between native Hawaiian prisons and the correctional staff also reflect the disparity (Namu'o, 2010). Poor interactions with the staff contribute to the length of incarceration. In many cases, correctional officers themselves subjectively determine prisoners' violations or infractions. The prisoners are thus prohibited from participating in certain programs or services, which otherwise entitle or make them eligible for release. Some correctional officers also believe they need not perform interpersonal problem solving (Namu'o).

Incarceration is most traumatic to native Hawaiians because of their deep family and community bond (Namu'o, 2010). It also cuts them off from their jobs and increases trauma in those who already experience trauma in their lives. Imprisoning them in their own Continent is most damaging to them, especially because of the disproportionate impact of the justice system on them. Even their separation from or absence of familiar surroundings and familiar weather is a source of trauma to them. Furthermore, there is a lack of programs and services for their re-entry into society when released. Many of them are deprived of participation in specific programs and services, which will make them eligible for…