In cases of suspicious death, a forensic pathologist is charged with determining the cause and manner of death. In the United States, each state has its own regulations that govern what constitutes a forensic case, and each has a system to accomplish the tasks of forensic pathology. Many states have a medical examiner system, in which a city or county will have a chief medical examiner, who must be a physician. The chief medical examiner will, in turn, have a number of associate medical examiners who perform the actual duties of the forensic pathologist. Other states have a coroner system, in which the chief officer may not be a physician but employs forensic pathologists to carry out the necessary duties.
Forensic pathologists have three major duties to perform. They are called to crime scenes to make a preliminary examination of the body and perhaps an initial determination of the postmortem interval (the time since death). They will take charge of the body and direct the trained death scene investigators to carefully prepare and remove the body and transport it to the morgue for later analysis.
Forensic pathologists determine the cause and manner of death by use of the postmortem examination, or autopsy. The autopsy entails careful dissection of the body to search for injury patterns, disease, or poisoning that may point to the ultimate cause of death. In that activity, the forensic pathologist will work closely with forensic toxicologists, who take tissue samples and determine what, if any, substances may be in the body that could have caused or contributed to death. Forensic pathologists also work closely with criminal investigators so as to get a complete picture of the circumstances surrounding the death. At times, the forensic pathologist may consult with forensic anthropologists or entomologists in helping to reach relevant conclusions about the cause and manner of death.
When a person dies, a physician must complete and sign a death certificate. In all forensic cases, the certificate must list a manner of death. The possible manners of death are homicide, accident, suicide, and natural causes. In some states, one of those four must be listed. In other states, the pathologist is also permitted to enter “undetermined” or a variant. Although the determination may be straightforward in a normal case, it can be problematic in a death of suspicious origin.
The final duty of the forensic pathologist is to render opinions in court as to the cause and manner of death. Medical examiners and coroners are called to court quite often and must be able to present their testimony without shocking the jury. Many times, judges will limit or not admit gory photos of the deceased for fear of prejudicing the jury.
Forensic pathologists are physicians who specialize in pathology through a residency that may extend three to four years beyond medical school. An additional one-year residency in forensic pathology will enable a pathologist to become certified in forensic pathology. In complicated death cases, it is easy for an untrained pathologist to make a mistake in determining the cause and manner of death, which may lead to a miscarriage of justice. It is therefore important to encourage pathologists to become certified if they are going to be doing forensic work.