Medico-legal Investigation PDF

Medico- legal investigation Forensic medicine is the medical knowledge applied to situations where legal issues arise and which provides assistance to the courts in legal proceedings. Legal medicine has been mainly used in relation to Civil law issues and it also related to legal issues in relation...

Medico- legal investigation Forensic medicine is the medical knowledge applied to situations where legal issues arise and which provides assistance to the courts in legal proceedings. Legal medicine has been mainly used in relation to Civil law issues and it also related to legal issues in relation to provision of health care. Medical jurisprudence is the science of the law as applied to the practice of medicine. Forensic medicine is divided into clinical forensic medicine which is the investigation of trauma to living patients (diagnoses, treatment, management) and pathological forensic medicine (post- mortem to determine cause of death) which is the examination of traumas to the deceased. Forensic odontology is the application of dental science. Forensic science is any science used for the purposes of the law including fingerprints, toxicology, serology, molecular biology/ DNA, trace evidence, ballistics, fire and explosions, marks and scratches, forgeries, cybercrime and photography, forensic anthropology. Investigation of death principles are: 1. Circumstances leading to death 2. Scene of death 3. Examination of body And then there is the death certificate which is intrinsically linked with all the principles. The aims of an investigation of death are: Proper and accurate certifications of death/ bodily harm Full and accurate statistics Criminal justice: discovery / prosecution of crime and protection of innocent from scientific evidence. Civil justice: info for settling estates / resolution of disputes (e.g. insurance conflicts) Public safety: info to relevant bodies (e.g. car safety) Education: related to preventable deaths and dangers to health and safety Information to public, particularly next of kin: explaining the cause and circumstances of death 1 Medico-legal systems for investigating death: If a death is natural and a doctor can sign a death certificate, the relatives can proceed with burial or cremation of the body. If the death is not natural or if no doctor can complete a death certificate then there is a need for death investigation systems. Death investigation systems are arranged to identify and investigate deaths that are (or might be): unnatural, overtly criminal, suspicious, traumatic, caused by poisoning, unexpected, unexplained. These deaths are examined by a variety of legal officers in different countries: coroners, medical examiners, magistrates, judges, police officers, etc. Magistrate system: Many european states (including Malta, Scotland’s Procurator Fiscal) Magistrate system in Malta; Magistrates are appointed by the president of Malta (from the candidates proposed by the judicial Appointments Committee). Qualify to be appointed after practice as a lawyer in Malta for not less than 7 years and shall sit in the inferior courts. Magisterial inquiry; Technically called “Inquiry relating to the in genere”. This is launched after receiving a request from the Police (or, rarely, from a private citizen). The Inquiring Magistrate (on call rota) conducts preliminary inquiry to collect evidence of the crime, in order to determine whether any person should be charged with an offence (whether sufficient evidence to proceed with a criminal trial). In a magisterial inquiry no person will as yet have been charged by the police before the court, although there may be suspects. Magistrate also carries out an inquiry into suspicious deaths (to establish the manner of death). Magistrate may hold an inquest on site (or direct a Police officer not below rank of an inspector). Magistrate appoints experts to assist in the collection of evidence. Maltese Courts (Courts of Justice) Superior courts: - Constitutional Court - Court of appeal - Court of criminal appeal - Civil Court - Criminal Court 2 Inferior courts: - juvenile Court - Court of magistrates i. Civil jurisdiction ii. Criminal jurisdiction a. Court of criminal judicature b. Court of criminal inquiry (magisterial inquiry - compilation of evidence (kumpilazzjoni) Court experts Experts at the scene include: a doctor to examine the scene of death (clinical forensic physician or the pathologist) SOCOs (Scene of Crime Officers, members of the Malta Police Force with specific training) A photographer An architect to document the scene an expert to hear evidence on oath from witnesses on site (can be the medical expert) others as required (ballistics, toxicologist, DNA, etc.) Court experts are independent and funded by the judicial system. They are appointed by the Court following continental inquisitorial system (independent establishment of the truth). They are appointed in an uneven number and their report is submitted only to the Magistrate, is confirmed on oath, and becomes part of the procès-verbal which include photographs, articles, documents relevant to their investigation. Court experts can see each other's reports, once presented to the Magistrate are the only persons entitled to information derived from the results of the investigation are the Magistrate, the AG and the investigating police officers. Medical experts are; The clinical forensic physician attends scene of death/ interviews witnesses/ advises Court pathologists (often 2) carry out autopsy, identification(and occasionally attend scene) toxicologist, if necessary specialist medical experts Police call a doctor from health centre to certify death – not an expert witness 3 Deaths reported to the magistrate Article 551(1) Criminal Code; “In cases of sudden or violent or suspicious death or of death whereof the cause is unknown, a report thereof shall be made by the Executive Police to a magistrate; the magistrate shall hold an inquest on the body for the purpose of ascertaining the cause of death and shall, for that object, take all such evidence as may be possible for him to procure; after taking all the evidence, the magistrate shall draw up and sign a procès-verbal stating his finding as to the cause of death.” Deaths to be investigated; Article 551(2); Whenever a person dies while he is imprisoned or detained in any place of confinement contemplated in the Prisons Act, or while he is in Police custody, an inquest shall be held and a procès- verbal shall be drawn up for the purposes of and in accordance with the provisions of sub- article (1). Article 551(3); The provision of the last preceding sub-article shall also apply whenever a person dies in Mount Carmel Hospital while he is kept there under an order of a court made pursuant to sub-article (3) of article 525 or to article 623(1) or for the purpose of his being examined by experts appointed by the court to report on the plea of insanity. Deaths reported to the magistrate guidelines; uncertified (no medical history, foreigner) due to violent, suspicious or unexplained cause death in legal custody in mental hospital if under custody accident - use of vehicle, car, ship, aircraft accident in public, including hospital, institution, home by drowning in fire or explosion unexplained Unexplained death in a child possible suicide 4  at work, including industrial disease due to poisoning due to fault of another or to neglect following an abortion death under medical care i. possible negligence by medical carers Ii. therapeutic/ diagnostic hazard Iii. under anaesthetic Deaths reported to the magistrate: manner of death; Manner (or Mode) refers to the circumstantial events (legal categorization). In the investigation of a crime, Magistrate must establish the Manner (or Mode) of Death. There are 5 manners of death; 1. Natural 2. Unnatural - accident, suicide, homicide 3. Unascertained or undetermined Manner vs cause vs mechanism: 1. Manner (or mode of death) - Legal categorization (e.g. natural, accident….) 2. Cause of death - Medical condition, listed on the death certificate e.g. stroke, cancer… 3. Mechanism of death - Physiological derangement that results in death e.g. cardiac arrest, respiratory arrest, coma… 5 Identification Case 1: During the investigation of a fire at a derelict factory, a burnt body was discovered. Questions for discussion; 1. Why is it necessary to identify the victim? The identification of the body is necessary for the following reasons; Ethical and humanitarian need to know who has died, especially for the relatives Criminal investigation Civil field- inheritance, remarriage, presumed death after 7 years (death in absentia) o Legal claims and obligations (property and debts) o Death Certificates: Final & Provisional Social- religious, burial (permit, death certificate) Statistical and legal purposes 2. What information should be collected from the scene? Scene information; position of body i. in relation to fire origin / exit collect all human remains, clothing, personal effects i. fingers, teeth may fall off assess if trauma to deceased ascertain how fire started, ascertain use of accelerants document architectural features of site, document weather changes Personal effects; not part of body, therefore not specific direct line of enquiry identification by weight of evidence degree of association with body as in mass disasters in confined spaces 6  keys, papers, personalised effects (ID, letters, credit cards), clothing, jewellery 3. What features should you look for on external examination? These should be general characteristics such as; Height, weight, build Height: errors due to - loss of water and shrinkage of body - body may lengthen up in the first stage of flaccidity - body may shorten when rigor mortis Weight, build: unreliable in decomposition - weight increases in early decomposition - weight decreases in late decomposition Age Babies - examination of fontanelles and measurement of tables. Fontanelles (soft spots) are spaces between the cranial bones, covered by tough membranes. Anterior F closes by 3 months and anterior F closes by 18-24 months. Children - ossification centres & epiphyses till 20-25 years [+teeth], accuracy possible to within 1-2 yrs in foetus and infant, fusion of epiphyses earlier in females and in tropics, teeth eruption till 20-25 yrs but earlier in girls and in tropics, after 25 yrs, there are no dramatic events such as tooth eruption or the appearance of ossification centres. The appearance of ossification centres is complete by around 5 years. After this stage the fusion of epiphyses acts as a calendar up to about 25 years. The medial clavicular epiphysis is usually the last evidence of such fusion Adults - obliteration of cranial sutures (wide range of ages), full ossification of the thin connective tissue ligaments separating the bones at the suture lines begins in the late 20s, and is normally completed in the 5th decade of life 7 Elderly- degenerative bone diseases (especially pubic symphysis, 4th rib, ilium – equally stressed in all individuals regardless of activity, proportional to age only), edentulous, wear and tear of teeth Sex obvious in all but severely burnt bodies, elderly may have ambiguous facial features, uterus, prostate resist decomposition, teeth, combination of morphological and morphometric features. Teeth are the hardest and most resistant tissues in the body and can survive total decomposition and even severe fire Race some differences in facial skeleton and teeth, but this is usually not possible except for colour of skin Hair distinguish from animal hair & fibres (microscopy), distribution. Colour: grey changes to brassy blonde at 120°C, brown changes to slightly reddish at 200°C, black does not change Hair peels in water Eyes Colour difficult after a few days With decomposition: tend to darken to brown Pupil size and shape (?operation) 4. How can you establish if the victim was alive when the fire started? Victim was alive when fire started: Carboxyhaemoglobin saturation I. Carbon monoxide (CO) toxicity → cherry pink discolouration of skin / internal tissues Ii. Carboxyhaemoglobin (HbCO) is the complex formed when haemoglobin is exposed to carbon monoxide Soot below the level of the vocal cords i. indicates the victim was alive and breathing 8 Case 2: Questions for discussion; 1. What information can be obtained from bone(s)? Bone identification General characteristics; Height, weight, build Age exclude archaeological remains carbon dating aspartic amino acid racemization dating ossification centres, closure of epiphyses Sex This can be attested from the skull And also from the pelvis 9 2. What investigations are necessary/ can be done? anatomical examination with measurements examination of teeth X-ray (e.g. ossification centres) DNA archaeological remains – carbon dating, protein studies Dental evidence Sex The male’s teeth are usually larger - mandible large with a square chin and angle of body with ramus is more straight, less than 125° The female’s chin rounded with a point in midline and jaw differences less marked in Indians Measurements compared to published tables for populations DNA from tooth pulp. Race cannot really be determined from teeth though there are certain racial characteristics Whites have canines with long pointed roots Negroid races have large teeth and more cusps on molars Mongoloid races (Chinese, Mongols, Eskimos, Japanese) have shovel shaped upper central incisors – not exclusive Age Criteria for age biochemical tests for acid in dentine special morphological dental and skeletal methods to assess development and/or deterioration Adults; wear and colour deteriorate with age marked occlusal attrition indicates age- unless rough diet has accelerated process 10  edentulous jaws indicate age- beware of skeletons where conservative dentistry not available alveolar margins (mandible) atrophy when teeth are lost Children easiest up to second decade sequence of deciduous teeth well known - modified by sex (earlier in females), race and climate after third molars erupt, age determination more difficult third molar may be congenitally absent Dental evidence- charting: different diagrammatic methods to record teeth- main examination problem is access due to rigor necessary to cut masseters to release jaw in decomposed bodies or in fires, can remove mandible or skull itself Bite marks typically show a mirror-image alignment of upper and lower dental arches. The surface image of a bite mark on the victim’s skin is correlated with a surface image of the detention of the suspected offender. The following should be noted: dentures - pressure marks on gums or palate dental prosthesis - bridgework, braces extractions - recent or old fillings - number, position, composition artificial teeth - composition crowned teeth broken teeth pathology of teeth, gums, jaw congenital defects - pearls, ectopic teeth malpositioned teeth – rotated or tilted hygiene - caries, plaque, tobacco staining, gingivitis racial pointers 11 Neither a living individual nor a body can be identified simply by taking a dental chart – that chart has to be compared with, and found to match, a chart whose origins are known Dental evidence - radiography; X-rays before removal of the skull and for superimposition, frontal sinuses, broken roots, dental work, congenital anomalies and other foreign bodies Case 3: A partly decomposed male body was recovered from a field, 3 days after the report of a person missing from a home for the mentally disabled. The body was found within an hour’s walk of the home Question fro discussion? 1. What information should be available to the pathologist? Medical information: tattoos - dermal pigment, scarred skin, skin lesions amputations - not unique healed fractures - unique plates and pins prostheses - glass eyes, contact lenses, artificial joints surgical scars and sutures occupational scars normal variance - frontal sinuses, sacroiliac joints skeletal disease - degenerative disorders congenital abnormalities - cervical ribs, extra digits pregnancy dental records Investigations PROCEDURES to confirm or exclude identity Document features & general characteristics (full body autopsy) Dental examination of teeth and jaws (forensic odontology) Comparative methods for identification 12  Medical Records Photography Charting Fingerprints Radiography (full body x-ray) DNA Blood grouping Facial Reconstruction Special features; 1. Fingerprints Unique: each person has a particular pattern of finger and thumb prints specific to that person, no two individuals have identical fingerprints, Formed ~12 weeks gestation and remain unchanged during life unless scarred, chances of identical match ~1 in 64 billion, identical twins do not have completely identical fingerprints, a genuine match: 16 different characteristics match, initial computer match but then visual, useful as long as records of prints exist, identification based on the classification of the finger ridge pattern, the overall appearance of the ridges can be described as arches, loops and whorls, oil/debris on ridge and sides of furrow + dead squamous cells, found on touched surfaces, specific nomenclature with numerical values to specific patterns 2. Full body x-rays fractures, deformities, degenerative diseases, prostheses, metal sutures, dental fillings, metallic objects (clothing, jewellery) 3. Blood grouping ABO, Rhesus grouping from blood, ABO secretors: people who secrete blood group antigens in their body fluids (e.g. saliva, sweat, tears, semen…) 4. DNA fingerprinting Any sample with nucleated cells commonly blood and semen in forensic practice: o saliva, hair, bone marrow, tooth pulp, tissue at scene of a crime 13 An individual's DNA pattern is unique Match based on a number of tests and Probability of having the same DNA is remote (approx. 1 in a billion) Specific features; special techniques: Photo superimposition alignment of photo with radiograph of the skull with optical precision superimposed bony facial features, frontal sinuses 3D methods - 3D printing of skull from CT scan, 3D sculpture, facial recognition from CT scans and facial recognition software Facial recognition - Scan features on photo or acquire from video, Compared with a database of facial images Computer enhanced ageing - Aging the images of missing children, Photograph family members 14 Legal implications of wounding and head injuries The criminal Code title VIII crimes against the person. Article 216(1) | Grievous bodily harm; A bodily harm is deemed to be grievous bodily harm and is punishable with 1-7 years prison if; a. It can give rise to danger of Loss of life Permanent debility of health/ organ of the body Permanent defect in any part of the body Permanent mental infirmity b. Causes deformity or disfigurement in face, neck or hands c. Is caused by a wound penetrating body cavities - cranial, thoracic, abdominal, abdominopelvic (without producing permanent debility or defect) d. Causes mental or physical infirmity for 30 days of more or if the injured cannot work for 30 days or more E. Committed on a woman with child, it hastens delivery Article 218; A grievous bodily harm is punishable with imprisonment for 5-10 years if; A. Causes permanent debility of health or permanent functional debility of any organ of the body or permanent defect or permanent mental infirmity B. Causes serious and permanent disfigurement in face, neck or hands C. Being committed on a woman with child, it causes miscarriage. But 4-20 years if explosives are used Article 217; A grievous bodily harm is punishable with imprisonment fro 2-10 years if arms, cutting or pointed instruments, explosives, burning other corrosive substance. Imprisonment min of 4 years if the offence is committed by means of explosives (and no probation) Article 220; After grievous bodily harm 1. Death as a result of the nature or natural consequences of the harm and not of a supervening accidental cause; a. Within 40 days; 6-20 years 15  b. >40 days but