Medicolegal Death Investigation System: Workshop Summary

86 Pages·2003·0.59 MB·English

by  Committee for the Workshop on the Medicolegal Death Investigation System

MEDICOLEGAL DEATH
INVESTIGATION SYSTEM
Workshop Summary
Committee for the Workshop on the Medicolegal
Death Investigation System
Board on Health Promotion and Disease Prevention
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the
Governing Board of the National Research Council, whose members are drawn
from the councils of the National Academy of Sciences, the National Academy
of Engineering, and the Institute of Medicine. The members of the committee
responsible for the report were chosen for their special competences and with
regard for appropriate balance.
Support for this project was provided by the Department of Justice. The views
presented in this report are those of the WORKSHOP PARTICIPANTS and are
not necessarily those of the funding agency
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COMMITTEE FOR THE WORKSHOP ON THE
MEDICOLEGAL DEATH INVESTIGATION SYSTEM
RICHARD BONNIE (Chair), John S. Battle Professor of Law and Director
Institute of Law, Psyschiatry, and Public Policy, University of Virginia,
Charlottesville, VA
DAVID KAYE, Regent's Professor, College of Law, Arizona State
University, Tempe, AZ
THOMAS PEARSON, Albert D. Kaiser Professor and Chair and Professor
of Medicine, Department of Community and Preventive Medicine,
University of Rochester, Rochester, NY
KATHLEEN TOOMEY, Director, Division of Public Health, Georgia
Department of Human Resources, Atlanta, GA
ROBERT WALLACE, Irene Ensminger Steecher Professor of
Epidemiology and Internal Medicine, Colleges of Public Health and
Medicine, University of Iowa, Iowa City, IA
Staff
CAROLYN E. FULCO, Senior Program Officer
GINA BATA, Research Assistant (until December 2002)
HOPE R. HARE, Research Assistant
A. WEZI MUNTHALI, Research Assistant
DEEPALI PATEL, Sr. Project Assistant
ROSE MARIE MARTINEZ, Director, Board on Health Promotion and
Disease Prevention
NORMAN GROSSBLATT, Senior Editor
Consultant
MIRIAM DAVIS, Independent Medical Writer, Silver Spring, Maryland
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REVIEWERS
This report has been reviewed in draft form by persons chosen for their
diverse perspectives and technical expertise, in accordance with procedures
approved by the National Research Council Report Review Committee. The
purpose of this independent review is to provide candid and critical comments
that will assist the institution in making its published report as sound as
possible and to ensure that the report meets institutional standards of
objectivity, evidence, and responsiveness to the study charge. The review
comments and draft manuscript remain confidential to protect the integrity of
the deliberative process. We wish to thank the following individuals for their
review of this report:
MARGARET BERGER, Professor, Brooklyn Law School, Brooklyn, NY
RANDY HANZLICK, Associate Professor of Forensic Pathology, Emory
University School of Medicine, Chief Medical Examiner, Atlanta, GA
CHARLES HIRSCH, Chief Medical Examiner, Office of the Chief Medical
Examiner, New York, NY
KURT NOLTE, Assistant Chief Medical Investigator, New Mexico Office
of the Medical Investigator, Professor of Pathology, University of New
Mexico School of Medicine, Albuquerque, NM
VICTOR WEEDN, Principal Research Scientist, Director of Biotechnology
and Health Initiatives, Mellon Institute, Pittsburgh, PA
Although the reviewers listed above have provided many constructive
comments and suggestions, they did not see the final draft of the report before
its release. The review of this report was overseen by LAWRENCE
GOSTIN, J.D., Professor of Law, Georgetown University, Professor of
Public Health, Johns Hopkins University, Center for Law and the Public’s
Health, CDC Collaborating Center Promoting Health Through Law,
Washington, DC, who was appointed by the Institute of Medicine. Mr. Gostin
was responsible for making certain that an independent examination of this
report was carried out in accordance with institutional procedures and that all
review comments were carefully considered. Responsibility for the final
content of this report rests entirely with the author committee and the
institution.
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PREFACE
On first glance, official identification of human remains and
certification of the cause of death appear to be mundane endeavors that
serve mainly private needs of families, insurers, and litigants. In truth,
however, valid and reliable data on the circumstances and causes of
deaths serve a variety of important public needs, including fair and
accurate adjudication in criminal and civil cases, maintenance of
accurate vital statistics, effective public health surveillance and
response, advances in health and safety research, and improvement in
quality of heath care. The combined task of collecting and interpreting
information about circumstances and causes of death has traditionally
been called medicolegal death investigation, terminology that reflects
the interface of medical science with law and public policy. This
"forensic" function has been performed for centuries in all societies,
although not always by medical professionals.
Concerns about the adequacy of medicolegal death
investigation in the United States have been raised for many decades.
The concerns have been voiced by all the constituencies that have a
stake in the accuracy of data related to circumstances of death and in
the official determinations based on them. For the criminal justice
system, concerns about the adequacy of data about deaths merge with
general concerns about all aspects of forensic science. Those concerns
led the National Institute of Justice to ask the Institute of Medicine to
conduct a workshop on the medicolegal death investigation system in
the United States. IOM appointed a committee to plan the workshop
with the advice and assistance of NIJ, staff of the Centers for Disease
Control and Prevention, and other interested constituencies. The
workshop was held on March 24-25, 2003, and this report summarizes
the ideas and observations expressed at the workshop.
Presentations and opinions expressed at the workshop demonstrated
clearly that the current practices of medicolegal death investigation in
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this country are in substantial need of improvement. The workshop
discussions also showed that accurate data on the circumstances and
causes of death (and the identification of human remains) are, in the
language of economists, a valuable public good and that much of their
value accrues to the benefit of the nation as a whole. To rectify the
many deficiencies of the system, it will be necessary to solve many
problems, including fundamental issues of financing. The workshop
was a starting point for further study and, I hope, for eventual reform.
Richard J. Bonnie
Chair
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TABLE OF CONTENTS
1 INTRODUCTION ..................................................................1
2 OPENING REMARKS...........................................................3
3 OVERVIEW OF THE MEDICOLEGAL DEATH
INVESTIGATION SYSTEM IN THE UNITED STATES....7
4 INFRASTRUCTURE AND TRAINING .............................12
5 PROFESSIONALISM, STANDARDS, AND QUALITY...19
6 COMPARING MEDICAL EXAMINER AND CORONER
SYSTEMS.............................................................................23
7 MEDICOLEGAL DEATH INVESTIGATION AND THE
CRIMINAL JUSTICE SYSTEM..........................................29
8 MEDICOLEGAL DEATH INVESTIGATION, PUBLIC
HEALTH, AND HEALTH CARE .......................................38
9 HOMELAND SECURITY AND EMERGENCY
PREPAREDNESS ................................................................49
10 CLOSING REMARKS.........................................................61
REFERENCES...........................................................................65
APPENDIX A WORKSHOP AGENDA...................................67
APPENDIX B PANEL MEMBERS AND INVITED
SPEAKERS...........................................................................71
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