Technical and interpretive pitfalls of postmortem CT: Five examples of errors revealed by autopsy

Image acquisition of dead bodies, particularly using postmortem computed tomography (PMCT), has become common in forensic investigations worldwide. Meanwhile, in countries such as Japan which have an extremely low rate of autopsy, PMCT is being increasingly used in the clinical field to certify the cause of death (COD) without performing an autopsy or toxicological tests, even in cases of unnatural death. Additionally, these PMCT images are predominantly interpreted by clinical personnel such as emergency physicians or clinicians who are not trained in PMCT interpretation and who work for the police, that is, the so-called police doctors. Many potential pitfalls associated with the use of PMCT have been previously described in textbooks and published papers, including the pitfalls of not performing a complete forensic pathology investigation, and the use of physicians without appropriate PMCT training to interpret PMCT and direct death investigation and certification. We describe five examples in which apparent misdiagnosis of COD based on PMCT misinterpretation was revealed by autopsy. Here are the five examples of errors: (1) Postmortem changes were misinterpreted as COD, (2) resuscitation effects were misinterpreted as COD, (3) COD was determined after an incomplete examination, (4) fatal findings caused by external origin were wrongly interpreted as ‘of internal origin’ based on PMCT, and (5) non-fatal findings on PMCT were wrongly interpreted as fatal. Interpretation of PMCT by appropriately trained physicians and an accompanying complete forensic investigation, including autopsy when indicated, is necessary to prevent significant errors in COD determination and related potential adverse medicolegal consequences.     

Legal aspects of sexual violence—Does forensic evidence make a difference?

A survey was done of 307 alleged victims of sexual violence reported to the police departments in Greater Aarhus, Denmark, in 1999–2004. The legal disposition was ascertained and related to victim and assault characteristics together with the forensic medical and laboratory findings. The police pressed charges in more than half of the cases and 11% turned out to be false allegations. Nineteen percent of all cases ended with sentencing of the defendant. Sperm was detected in 35% of the examined and analysed cases, and in 46% consumption of alcohol prior to the assault was reported. Information in the forensic report regarding injury documentation, intoxication, and detection of sperm and DNA match between victim and alleged assailant did not aid in the prosecution of the case. Severe coercion used by the assailant increased the likelihood of conviction. Intoxication estimation and sperm detection suffered from low sensitivity compared with laboratory analyses. Results suggest the need for new research and optimising the sexual assault examination protocol to strengthen the legal impact of forensic evidence.     

Performance Evaluation of a Registered Ballistic Database Using the Evofinder® System

Firearms for police in China are registered along with their fired bullets and cartridge cases. A Registered Ballistic Database (RBD) of 1000 Norinco QSZ‐92 pistols with registered ammunition was established and was evaluated through the Evofinder® system. In this research, 1000 bullets and 1000 cartridge cases were randomly selected and correlated against an RBD of 2996 bullets and 2999 cartridge cases. Examiners found that successful identifications all ranked 1st, supported with land (100%), groove (97%) engraved areas, and primary marks (85.6%) for bullets, and firing pin impressions (99.8%), and breech face marks (99.9%) for cartridge cases. Two known matches (KM) for the same pistol rank in the top two (100%). The distribution of similarity scores varies from marks; however, the Evofinder® system could still effectively distinguish known matches from known nonmatches (KNM) for either bullets or cartridge cases. This study demonstrates the efficiency of the RBD.     

Firearm Deaths by Law Enforcement

Abstract:  The use of deadly force during law enforcement is a matter that compels public scrutiny. There were 42 gunshot deaths caused by police over a 4-year period in New York City. The decedents' average age was 31 years and ranged from 17 to 64 years. There were 41 males and one female; and 26 Black, nine Hispanic, and seven White decedents. Ethanol and/or drugs of abuse were detected in 78% (31/40) of the decedents. The vast majority of shootings occurred with the police responding to a crime and 90% of the decedents were armed (26 handguns, six knives, one axe, one metal pipe, and one toy gun). Vehicles were used as weapons in two incidents. A total of 177 bullets struck the 42 decedents. Fourteen decedents sustained single gunshot wounds (GSWs), and the remainder had multiple GSWs ranging from 2 to 21. In the majority of the cases in this study, the number of GSWs of the body was three or fewer. Thirteen decedents had at least one GSW of the back or buttocks, accounting for 25 of the total 177 wounds, and four of the 13 had GSWs of only the back. With the exception of the upper extremities, GSWs of all locations were more likely to penetrate than perforate. Although these deaths may be high profile, the certification is typically straightforward and the cause (i.e., GSW) and manner of death (homicide) are readily apparent. Although police shootings in which the decedent was unarmed and/or sustained numerous GSWs are widely reported by the lay press, these types of shootings were not typical in our study.     

Medical Findings and Legal Outcomes in Sexually Abused Children*

Abstract: A previous study published in 2000 on a small group of children concluded that the medical examination in cases of sexual child abuse seldom provided legal proof of sexual abuse [J Forensic Sci 45(2000):115–7]. The present consecutive study included children referred to the police for a forensic medical examination. A colposcope was used to evaluate the anogenital findings which were classified as normal, nonspecific, and abnormal. Four hundred and eighty‐two children were included. Abnormal anogenital findings were found in 38% of the girls and 20% of the boys, but there was no relation between abnormal anogenital findings and the two legal outcomes: “appearing in court” and “being convicted.” However, the age of the child turned out to be a more important factor in relation to legal outcome than the physical findings. The results of this study suggest that the child’s statement and not the physical findings were important for legal outcome.     

Police discretion and elder mistreatment: A nested model of observation,reporting, and satisfaction

This study examined police reporting behavior in elder mistreatment (abuse, neglect, and exploitation) cases. Relying on a survey of police officers in Alabama, this research investigates a nested model of mandatory reporting using linear regression techniques. Only about half of all elder mistreatment cases are reported to the proper authorities. Job experience, contact with the elderly, understanding of mistreatment laws, and positive attitudes toward reporting should increase detection, reporting, and overall satisfaction with the system. These causal factors, however, increased detection and reporting, but not satisfaction. Improvements in training and knowledge in elder mistreatment can be counterpro-ductive.     

An assessment of the usefulness of routine histological examination in hanging deaths

A retrospective study was carried out on 100 randomly selected medico-legal autopsies of victims who had committed suicide by hanging. All cases had undergone full police and coronial investigation. Complete external and internal examinations had been carried out including routine histological examination of organs. The age range of victims was 15-94 years (average, 41.7 years) with a male-to-female ratio of 7:1. External and internal injuries were consistent with the reported events. Diagnoses based purely on histology included hepatic steatosis (n = 16), asthma (n = 3), lymphocytic thyroiditis (n = 2), and pulmonary and cardiac sarcoidosis (n = 1). A large cell carcinoma of the lung and a rectal adenocarcinoma were confirmed. Histological evaluation was, however, of limited usefulness in contributing to the medico-legal evaluation of cases, with careful scene, external and internal examinations providing the most relevant information. The results of histological examination of tissues were all incidental to the cause, mechanism, and manner of death.     

108例强奸案件的法医学分析

本文通过对108例强奸案件的分析,从法医学角度探讨了与强奸犯罪相关的一些因素,并提出:加害人与被害人自身素质与强奸案件的发生有关;法医学证据在强奸案件中具有不可替代的作用;及时报案能获取更多的法医学物证;研究犯罪动机有助于预防和减少强奸案件。     

Prior Police Contact and Subsequent Victim Reporting: Results from the NCVS

This study investigated the association between victim reporting and the police response to past victimizations with data from the National Crime Victimization Survey from 1998–2000. The findings include: (1) investigatory effort by police when an individual had been victimized in the past increased the likelihood that the individual would report an ensuing victimization to the police; (2) however, this relationship only held when the victim, rather than someone else, reported the prior victimization to the police; (3) whether the police made an arrest after an individual was victimized in the past had no effect on whether the individual reported an ensuing victimization to the police; (4) the probability of victim reporting was unaffected by investigatory effort or whether an arrest was made after a prior victimization of a member of the victim’s household.     

A Survey of Reasons for the Under Reporting of Cheque Fraud: Examples from Australia

Fraud is generally defined as the practice of obtaining credit and property from another by means of deception. When the object of deception used is a valueless cheque, then the conduct is called ‘cheque fraud.’ Cheque fraud is a crime; but unlike other types of crime, such as crimes involving force, cheque fraud is under reported to the police. The reasons for the under reporting are diverse and mean that only about 15% of all offences come to the attention of the police. An Australian study conducted to survey reasons for this under reporting revealed that a major factor affecting victims' reactions to cheque fraud was their ignorance of police functions and an uncertainty whether the passing of valueless cheques could constitute a crime. The results of this study are reported herein.     

Self‐reported Mental Health Issues Among Arrestees in the Paris,France Area

We studied (May–September 2014) all arrestees who reported mental health issues during the medical examination performed by a forensic physician for the assessment of fitness for detention. Among 4814 arrestees, 420 (9%) reported a current mental health issue. The suspected crimes among arrestees reporting a current mental health issue were more often related to violent behaviors (physical assault, 23% vs. 16%, p < 0.001, sexual assault, 3% vs. 1%, p = 0.01) and less often drug offenses (18% vs. 29%, p < 0.001). Among arrestees reporting mental health issues, 80% reported psychiatric or psychological care, of whom 33% reported previous mental health care. Decisions of unfitness for detention were more frequent among arrestees reporting mental health issues than in other detainees (3% vs. 1%, p < 0.001). The high proportion of patients with interrupted mental health care among those reporting mental disorders suggests that the medical examination during custody could be a significant opportunity to restore psychiatric care.     

试析民间借贷纠纷案件中的文书司法鉴定

随着社会经济的发展,特别是在金融危机和诚信缺失等社会因素的影响下,民间借贷纠纷案件中的文书司法鉴定正面临越来越多的难点和挑战。通过大量民间借贷纠纷案件文书司法鉴定的经验积累,分析归纳这类案件文书司法鉴定的特点和检验要点,并提出规范文书制作以避免法律纠纷的若干建议。     

Injuries due to deliberate violence in Chile

An analysis was made over a period of 6 months of the incidents involving deliberate violence as registered in 'Vicaria', the clinic for out-patients within the Cathedral of Santiago de Chile. A total of 236 victims of deliberate violence were observed. Men aged 15-24 years were found to be victims of deliberate violence most frequently. 'Under education' was the most frequently registered occupation for both sexes, and a large group of male victims were 'Unemployed'. 82% of the victims were men and 14% women, 1.5% were boys and 1.5% girls less than or equal to 14 years of age. None of the victims were alcohol intoxicated when arriving in the clinic. The incidents took place in streets for 81% of the male victims and 79% of the female victims, and in the majority of the cases the aggressor(s) was one (or several) police officer(s). Six percent of the female victims had been injured at home. There was no reporting of the aggressor being a relative or acquaintance. The most frequent type of violence was blunt violence from baton(s) (44%), while blunt violence without the use of instruments was reported less frequently (33%). The use of firearms was registered in 18% of the cases, and of sharp instruments, combustion, electro-shock and chain in 1.4%, 1.4%, 1.1% and 0.4% of the cases respectively. A total of 517 primary and secondary diagnoses were applied to the patients. Most of the victims (99%) had moderate or less serious lesions according to the Abbreviated Injury Scale (AIS) (score less than or equal to 2). Twenty-four percent of the victims had more than 4 lesions, and 7% more than 10 lesions. The head/neck region and the trunk were affected with equal frequency, the frequency of injuries of the head/neck region being comparable with that observed among torture victims and in contrast to the pronounced predominance of injuries of the head/neck region observed in a Danish emergency ward study of deliberate violence.     

Police officers who commit suicide by cop: a clinical study with analysis

Suicide by cop has become a familiar topic among members of law enforcement, mental health professionals, and the general public. This paper presents two cases where police officers chose to commit suicide by getting other police officers to kill them. The two police officers studied, by examination of closed case files, were found to be similar to civilians who committed suicide by cop on several demographic (gender, age, history of mental illness, and suicide attempts), and situational (stress factors, trigger) variables. The cases help us to understand possible motives and management for individuals who choose to end their life in this manner.     

司法精神病鉴定基本问题研究

近年来我国刑事司法实践中曝光的若干典型个案凸显精神病鉴定的混乱状况。实证调研发现,精神病鉴定自身的特征——对象的复杂性、过程的回溯性、知识背景的跨学科性、手段的有限性与结论的主观性,影响到其客观性与可信度。目前精神病鉴定存在的问题主要包括启动难、鉴定过程中医学与法学学科错位、诉讼权利保障机制欠缺、强制医疗制度带有行政化特征以及鉴定体制改革引发的问题。应当在坚持职权主义启动模式的基础上,对部分死刑案件增设强制启动机制,增设申请启动鉴定的上诉途径,细化启动考量标准;司法精神病专家与法律职业群体之间应当重新分工;应当增设被鉴定人由于鉴定导致人身自由被剥夺的法定强制措施以及在专家辅助人的帮助下对鉴定意见的质证权;强制医疗程序应当进行司法化改造并通过社会化途径加强执行能力;在鉴定管理体制上,应当取消现有鉴定主体限于医院的规定,恢复等级化的体系设置并建立鉴定人准入与培养机制。     

Evaluation of Computed Tomography as a Screening Test for Death Inquest

Abstract: The Japanese method of inquest, which depends mostly on external examinations, may misdiagnose a considerable number of accidental deaths and suicides as death by disease. We conducted computed tomography (CT) scans of 80 cases for which police concluded death by disease or natural causes based on police investigations into the circumstances and results from external examinations. The cause of death was clearly determined by CT scan in 17 of 80 cases. Ten cases underwent autopsy after the police suspected criminality based on results of the CT examinations. The results suggest CT scan may be a tool for preventing a number of overlooked crimes and accidents in Japan. However, it cannot be a perfect tool for discerning between death by disease and other causes of death without cooperation from the investigative agencies and subsequent forensic examinations such as autopsy and toxicological tests.     

Usefulness of Systematic Histological Examination in Routine Forensic Autopsy*

Abstract: The forensic community does not agree on the need to perform histological examination at forensic autopsy. The aim of our study was to determine the usefulness of systematic standard histology in forensic autopsies. A prospective study was carried out on 428 autopsy cases for which standard histological examination was systematic. Mechanism of death not shown by gross anatomic findings was discovered by histology in about 40% of the cases. Cause of death was established by only histology in 8.4% of the cases. Microscopic findings affected the manner of death in 13% of the cases. Histology provided complementary information about prior medical condition of the deceased in about 49% of the cases. Traumatic lesions were better documented by histology in about 22% of the cases. According to the results of our study, systematic standard histology for the main organs should be used in routine forensic autopsies.     

Sudden death due to an unrecognized cardiac hydatid cyst: three medicolegal autopsy cases

Echinococcosis is a human infection caused by the larval stage of Echinococcocus granulosus. The most common sites of infection are the liver and the lungs. Cardiac hydatid cysts are very rare, even in regions where hydatic cysts are endemic (the Mediterranean, South America, Africa, and Australia). It has been reported that cardiac involvement is seen in about 0.5-3% of human echinococcosis cases. Three cases of cardiac hydatid disease that caused sudden death and which were histopathologically diagnosed are reported. Cardiac echinococcosis is rare, but due to its insidious presentation and affinity to cause sudden death, it is important that it be identified in the histopathological examination.     

Santeria and Palo Mayombe: Skulls, Mercury, and Artifacts

Abstract:  Santeria and Palo Mayombe are syncretic religions created in the New World based upon African religious beliefs combined with Christianity. The main worship of Palo Mayombe involves religious receptacles that may contain earth, sticks, varied artifacts, and animal and human remains. Due to the use of human and nonhuman remains, discovery of these items often leads to involvement by the police due to a concern of homicide. We review in detail the medical examiner records of two of these ritualistic cases including the autopsy, anthropology, police, and investigators' reports. For the human remains, careful consideration of the context in which the remains were recovered, their state of preservation, and the associated artifacts (e.g., beads and mercury) are important in determining the appropriate level of forensic significance. Anthropological examination with particular attention to taphonomic characteristics also may help determine the origin and forensic significance.