Lesson 17: Do not routinely send pathologists to scenes.

Please allow Dr. Young to skewer a sacred cow!

For as long as I can remember—even from before I can remember—forensic pathologists have always stressed the importance of visiting the death scene personally. Back in October 11, 1956, for example, Dr. Alan R. Moritz delivered the Ward Burdick Award Address at the annual meeting of the American Society of Clinical Pathologists, entitled “Classical mistakes in forensic pathology.” An article that transcribes the speech lists each mistake. Under the heading, “The mistake of not examining the body at the scene of the crime,” Dr. Moritz explained:

“Almost without exception, the various experienced forensic pathologists who contributed suggestions for the preparation of this review stressed the mistakes likely to occur if the pathologist does not observe the body at the scene, and prior to disturbance of the body or its immediate environment…In many instances of death by unexplained violence, it is a fact that appreciation of the full significance of the autopsy findings may depend on evidence that may be obtained only at the scene, and before the body has been moved. Not only may the evidence required for evaluation of the postmortem findings exist only at the place where the body was originally found, but its potential significance may be apparent only to a medically trained person. Thus, in view of the pathologist’s knowledge that the fatal injury was immediately incapacitating, it may be apparent to him that someone other than the dead person must have moved the weapon, must have rearranged the bed clothing, or must have left a trail of blood on the floor. A great deal of this type of evidence may be preserved by adequate photography. Frequently, however, the evidence at the scene is of such a nature that it should be examined by the pathologist in its original state if it is to be correctly evaluated1.”

Even a recent textbook in forensic pathology advocates that pathologists visit scenes of death:

“The purpose of having the pathologist attend the death scene is severalfold. By viewing the body in the context of its surroundings, the pathologist is better able to interpret certain findings at the autopsy such as a patterned imprint across the neck from collapsing onto an open vegetable drawer in a refrigerator. The pathologist is also able to advise the investigative agency about the nature of the death, whether to confirm a homicide by a specific means, evaluate the circumstances to be consistent with an apparent natural death, or interpret the blood loss from a deceased person as being more likely due to natural disease than to injury. This preliminary information helps the investigative agency to define its perimeter, structure its approach, organize its manpower, secure potentially important evidence, and streamline its efforts. Last but not least, the opportunity to meet at the scene initiates the collegial working relationship between the pathologist and the detective/investigator, and promotes interagency rapport as both professionals strive to solve the medical mystery of why that particular person died at that particular time, under those particular circumstances2.”

In several jurisdictions, pathologists are required to appear personally at certain death scenes. Much of the time, they attend scenes where a homicide is evident or suspected. In some forensic pathology training programs, the forensic pathology fellow essentially acts as the scene investigator. After responding to a scene at 2 AM, he or she may then be required to perform the autopsy at 8 AM that same day.

Please do not misunderstand me. When it comes to the importance of scene investigation for determining cause and manner of death, I am a “true believer.” I, too, have seen how viewing an autopsy without being aware of findings at the scene can lead to wrong answers. I agree with Dr. Moritz when he says, “In many instances of death by unexplained violence, it is a fact that appreciation of the full significance of the autopsy findings may depend on evidence that may be obtained only at the scene, and before the body has been moved1.” In fact, I believe trainees in forensic pathology should visit numerous scenes during their fellowship year, particularly on cases where they will perform the autopsy.

I just do not believe that in the great majority of the cases the staff pathologist has to witness the scene personally to derive benefit from the information at the scene.

When Dr. Moritz was alive, pathologists did not send trained medical examiner investigators to scenes. They did not exist as they do today, as far as I know. Also, pathologists did not have ready access to digital images that could be sent by email or wireless web. The pathologist can learn what he or she needs to learn by viewing images of the scene and discussing them with the investigator.

In a busy office, it is important to analyze the cost effectiveness of each employee. Investigators do not do autopsies, so it does not make sense for them to sit in the office without going to scenes. Also, higher-paid pathologists can make better use of their time doing pathology and appearing in court without taking up precious time in transit or standing around at a scene.

Also, I believe the pathologist diminishes the authority of the investigator at the scene. The investigator should be able to do his or her job in the usual way without having to re-ask the same questions asked by the pathologist or by having to learn the information second hand. The investigator should command all the attention. After all, the investigator is the one who has the ingrained habits and is less likely than the pathologist to overlook important information.

In fact, the pathologist’s contribution to the death scene investigation is not only negligible if the pathologist has not performed the autopsy but also risky. The pathologist may be tempted to speculate about findings on the dead body that are visualized in poor lighting, only to be embarrassed later when the autopsy performed under better lighting discloses something different. The pathologist does not have the luxury to speculate about evidence at the scene as do the homicide and medical examiner investigators. The pathologists’ presence at the scene only tempts him or her to say too much too soon to the wrong people, and the pathologist may be later embarrassed in court about a declaration or opinion expressed after viewing the body under poor lighting in less-than-ideal circumstances.

Even when the forensic pathology fellow visited a scene, I would instruct the fellow to: 1) put hands in pockets, and 2) keep mouth shut. The fellow is at the scene to learn, not to take over the investigator’s job.

In my office, the investigators did the vast majority of the scene investigations and the pathologists stayed in the office, even on homicides. I even think that homicides are the least useful scenes to visit. Most homicides are straight forward and do not involve much in the way of scene investigation. There are other kinds of cases where the scene is much more important, but these cases are not predicted ahead of time. How do you know in advance that you will be dealing with a positional asphyxia case, for example?

There are some scenes that I believe it is mandatory for the chief medical examiner to appear. They involve scenes that 1) involve an unusually high profile or involve a very important person, or 2) involve a mass casualty incident. Both of these involve issues that need to be directed to the chief medical examiner immediately from the scene. Also, I instructed my investigators to call me if for any reason they thought I should appear at the scene. I trusted them with that, and they never abused my trust.

I have found that a pathologist is useful in scene investigations performed after the autopsy. The pathologist is then better able to compare and explain scene and autopsy findings. Certainly, these situations occur only once in a while and not as a routine.

Allowing the investigator to be the “go to” person at the scene and allowing the pathologist the time and adequate rest to perform an optimal autopsy makes it possible for the office not only to run efficiently but also to guarantee the most accurate results.

1 Moritz AR. Classical mistakes in forensic pathology (American Journal of Clinical Pathology, 1956). Am J Forensic Med Pathol 1981;2:299-308.

2 Lew E, Matshes E. Death scene investigation. In: Dolinak D, Matshes EW, Lew EO, editors. Forensic pathology: principles and practice. Amsterdam: Elsevier Academic Press; 2005.