“The Allegheny County Medical Examiner’s office did not conduct a full autopsy, or surgical procedure, to determine Pastorek’s cause and manner of death.”

[Note: In a jail death, is a full autopsy necessary? Or is an external examination sufficient?

Throughout the USA, consent from family members are required for a full autopsy, but if a coroner or ME wants to perform an autopsy, this person can without anyone’s consent.

Still, it may not be the best decision to perform an autopsy, particularly in a well-documented natural death. The decedent’s loved ones may not want incisions, so the coroner/ME may have to explain why he made them to an angry family. Also, limited resources already straining the system work against taking the time and expense to perform numerous autopsies.

What about “deaths in custody”? Was an internal examination of Daniel Pastorek necessary? Forensic pathologist Roger Mitchell, according to this news reporter, believes Pastorek should have had a full autopsy and not just examined externally. Why? Because Pastorek’s case “‘is one of the rare cases’ in which a pathologist can determine when the heart attack happened and how long it took for emergency services to respond.”

What?!

I am willing to give Dr. Mitchell the benefit of the doubt: perhaps the reporter misunderstood him. Dr. Mitchell’s comments are strange if he actually said them. “We could find out if someone responded and when. I can tell you from six hours to three days—under the microscope.” No, you can’t.

First, Dr. Mitchell doesn’t believe that Pastorek’s death was from violence or foul play. The investigation did not disclose anything other than a natural death from well-documented disease, and Dr. Mitchell’s comments imply this. Rather, Dr. Mitchell wonders if the medical response to the natural disease was timely.

According to pathology textbooks, the earliest changes of a myocardial infarction—where heart muscle dies from a lack of blood flow—appear in six hours or so. In reality, the situation is more complicated than that. A myocardial infarction may be asymptomatic or variably symptomatic, so changes under a light microscope will not determine if rescue personnel responded to the victim’s symptoms in a timely manner. An autopsy can’t do what multiple witnesses who saw what happened can.

Also, most of the time, there will be no microscopic changes from a myocardial infarction in someone who dies from one. The microscopic changes Dr. Mitchell describes are rarely seen at forensic autopsy.

Should the Allegheny County Medical Examiner have performed an autopsy on the body of Daniel Pastorek? They could have, but I don’t believe it was necessary—unless there were external injuries leading to reasonable suspicion or their investigation disclosed possible foul play.]