Forensic Pathology

A pathologist is a physician trained in the medical specialty of pathology.  Pathology is the branch of medicine that deals with the diagnosis of diseases and causes of death by means of laboratory examination of body fluids (clinical pathology), cell samples (cytology) and tissues (anatomic pathology).

The forensic pathologist is a sub-specialist in pathology whose area of special competence is the examination of persons who die suddenly, unexpectedly or violently.  The forensic pathologist is an expert in determining cause and manner of death and is trained specially to perform autopsies to determine the presence or absence of disease, injury or poisoning; to evaluate historical and law-enforcement investigative information relating to manner of death; to collect medical evidence, such as trace evidence and secretions, to document assault; and to reconstruct how a person received injuries.  Forensic pathologists are trained in both forensic sciences and traditional medicine.  Areas of science that the forensic pathologist must have a working knowledge of include toxicology, firearms and ballistics, trace evidence, forensic serology, and DNA technology, among others. The forensic pathologist acts as the case coordinator for the medical and forensic scientific assessment of a given death, making sure that the appropriate procedures and evidence collection techniques are applied appropriately.  Forensic pathologist medical examiners bring their expertise to bear upon the interpretation of the scene of death, in the assessment of the time of death, of the consistency of witnesses’ statements with injuries, and the interpretation of injury patterns or patterned injuries.
 
As a physician who specializes in the investigation of sudden, unexpected, and violent deaths, the forensic pathologist attempts to determine the identification of the deceased, the time of death, the cause and manner of death, and if the death was by injury, the nature of the instrument used to cause the death.  First, a history is gathered detailing how the death occurred and a medical history of the decedent is often collected as well.  Then, the forensic pathologist examines the body -- both externally and internally -- taking small tissue samples to examine microscopically for abnormal changes not visible to the unaided eye.  This post-mortem examination is known as an autopsy.

During the course of the autopsy, various laboratory tests may be performed, including x-rays, collection of body fluids (e.g., blood, urine, bile, etc.)  and small samples of tissues (e.g., liver, lung, brain, tumors, etc.) for toxicological analysis, and cultures of body fluids and organs for evidence of infection.  When all of the information including the history, the results of the autopsy, and the laboratory tests are completed, the forensic pathologist correlates all the information and draws conclusions as to the cause and manner of death. A report is then prepared summarizing these findings. A forensic pathologist can expect to be subpoenaed to testify before courts and other tribunals about the pathologic findings and conclusions.  Coroners, medical examiners and pathologists provide copies of their official reports to parties, such as insurers or public agencies, having a legitimate interest in the cause and manner of death of citizens.

The history is the beginning of the investigation and is of utmost importance in making the determination of cause of death.  The scene investigation may disclose drugs or toxins which may be related to the cause of death.  Some poisonous agents are not detected on routine drug screens; therefore, the pathologist must have knowledge of medications and toxins in order to request the specific analytical tests needed to detect them.  An example would include the "sniffing" of aerosol propellants, a risky activity frequently involving teenagers.  Sniffing of propellant substances can cause sudden death by precipitating lethal cardiac arrhythmias.  A special analysis (gas chromatography by head space analysis) is required to detect the chemicals in the blood.  In other cases there may be sufficient natural disease to account for death, but the individual may in fact have died of a drug overdose or other subtle cause.  In the case of drowning and suffocation, the autopsy findings may not be specific and forensic death scene investigation is critical to understanding the death.  Data developed by medical examiners is studied by medical epidemiologists as well as health and safety agencies to develop strategies to prevent disease and injury thereby saving lives.  The data developed about vehicular crash injuries and fire deaths led to legislation requiring seat belts in vehicles and smoke detectors in building construction.
 
In the examination of skeletal or severely decomposed remains, the forensic pathologist needs a working knowledge of multiple methods of identification including forensic anthropology in order to establish identity.  If sufficient skeletal parts remain, the pathologist may be able to determine the age, race and gender of the individual and can sometimes estimate the length of time since death.  Occasionally, specific markings on the bones may enable the pathologist to come to a conclusion as to the cause of death.

Examinations by autopsy or other means are important even when cause of death appears obvious.  In the case of shootings or other fatal assaults the forensic pathologist, during the course of the examination, may recover bullets or other important trace evidence.  In the case of motor vehicle occupants, it is important to determine who was driving and to assess driver factors, vehicle factors and environmental factors that might have caused or contributed to the crash.  Forensic autopsies may identify inherited diseases that constitute a risk for next of kin (e.g., certain types of heart disease [premature atherosclerosis, hypertrophic cardiomyopathy] and kidney disease [adult polycystic kidney disease]); notifying the family is an important service to the living.

Forensic pathologists are employed by states, counties or groups of counties, or cities, as well as by medical schools, the military services, and the federal government.

Education and training for a forensic pathologist includes the following:

• After high school the future forensic pathologist attends college
  for four years and receives a bachelor’s degree.
• After undergraduate school the aspiring forensic pathologist spends
  four years in medical school, earning a D.O. or M.D. degree.
• After medical school one may spend three years studying anatomic pathology (hospital pathology) followed by an additional year of training in forensic pathology, or alternatively, one may study anatomic pathology, clinical pathology (laboratory medicine), and forensic pathology for five years.

Fellow training in forensic pathology involves practical (on-the-job) experience supervised by trained forensic pathologists. The forensic pathology fellow performs autopsies and participates in death investigations.  To become certified, one must pass an examination given by the American Board of Pathology certifying competence in forensic pathology.  Forensic pathologists practice medicine in the finest tradition of preventive medicine and public health by using the study of the dead to benefit the living.