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Forensic pathologist’s opinion

In this video, watch Dr Stephen Cordner explain the errors which may arise while reporting cause of death.
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The need for reliable background information . From the outset, the forensic pathologists needs to be armed with as much reliable information as possible. There are many sources of information the pathologist can and should access.
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After receiving information about the death, the deceased should be examined at the place of death or where the body has been found and should be examined by the forensic pathologist. Paragraph 149 of the Minnesota Protocol states that, if possible, the doctor should attend the scene of death, preferably with the body in situ. Other forensic experts, such as crime scene specialists, might also be present to assist. There will be legitimate reasons why the doctor should not visit the scene with the body in situ on occasions. For example, if the deceased is not moved as soon as possible, the hot sun will cause it to decompose rapidly, swell and discolor, making subsequent examination so ineffective as to be almost useless.
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Often, perhaps even usually, the pathologist will not visit the scene and the body will come into the forensic pathology facility, a mortuary. Often accompanied by a brief history of what is known of the death gathered by the police. As more details of the circumstances of the death become known to police, the forensic pathologist should be informed. Although this is becoming controversial to some extent because of the ability of information to sometimes bias the pathologists.
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For example, if the police say doctor, we spoke to the boyfriend and he confessed to strangling her before the doctor has even looked at the body, this could bias the doctor, the forensic pathologist’s approach from one of impartiality to an approach which is more designed to support the police. The police may have come to an incorrect conclusion that the deceased had been strangled and verballed the boyfriend for all that the pathologist knows.
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The deceased may have a medical record with a doctor or with multiple doctors or with the hospital or all of them. The family or friends, may know who and where these are and the records can be sought.
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Some forensic pathology centers around the world now have access to CT scanners, and this is a non-invasive way of obtaining information about the deceased prior to taking a decision about the need for autopsy. But CT scanners are a long way from being common. But it would be unusual for there not to be an autopsy in a death where homicide was known or suspected. In such cases, if there was no autopsy, the Minnesota protocol, which is, as I’ve mentioned, the international standard for death investigation and potentially unlawful deaths, expect that there will be a documented reason for the decision not to have an autopsy and that that decision is judicially reviewable, for example, by the family.
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What are the common mistakes in reporting the cause of death? First, much of what we’ve been discussing here in these talks is not written about in the forensic literature and is not, in my view, terribly well understood. It is certainly not dealt with uniformly in forensic pathology. Conclusions about the cause of death can be based on insufficient information. Information that’s wrong or because inferences drawn from the post-mortem findings are incorrect. As an example of insufficient information being available to inform the cause of death, let me ask you how often do you think clinical doctors get the cause of death on a death certificate wrong?
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Well, the answer to that is somewhere between 20 and 50 percent, depending on the sort of deaths and where they occur in the community or in hospitals for examples. Much larger numbers than you might expect. But when you think about it, not unexpected at all. The clinical doctor can’t get a history from the patient, and the relevant investigation in an autopsy has not been conducted. The cause of death is been given simply and solely based on the medical history alone. What about information that is wrong? Pathologists need to be very transparent in their reports about the information they’re relying on in coming to their conclusions.
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Very often, reports actually have no conclusions at all beyond the boldly stated cause of death at the end of a list of descriptions and findings. The link between the findings and the cause of death and other conclusions made, if there were any, need to be included in the report and maybe the difference between an inaccurate understanding of the death and an accurate one. Without this link, it’s more or less impossible for anyone to engage with the report and work out whether it’s reliable or not. I would go further and say that if that reasoning is not included, the starting point could reasonably be that the report may not be reliable.
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Now that begins to overlap with the third common mistake in reporting causes of death and that is drawing the wrong conclusions from the information provided, including from the autopsy information.
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The finding of a bruise on the scalp of a toddler or even an infant does not equal child abuse. There may be accidental explanations. The forensic pathologist must be careful. More often than the forensic pathologist might like, he or she might have to be noncommittal, even if the injury or injuries are severe. Of course, there will be many cases where the forensic pathologist can properly conclude child abuse, and there will be some where there can be reasonable disagreement by competent, well-intentioned forensic pathologists. This goes to the fact that the conclusions in forensic pathology are not facts. Most often they are opinions, and better opinions are usually well explained in report with reviewable material to back them up.

What information does a forensic pathologist have access to from a criminal investigation? What are the common mistakes in reporting cause of death? Are conclusions in post mortem reports ‘facts’? Let us explore these questions with Dr Cordner in this video.

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Decoding Forensics for Legal Professionals

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