The Changing Role of the Medicolegal Death Investigator Conducting SUID Investigations

After attending this presentation, attendees will realize how a thorough infant death investigation changed the role of the medicolegal investigator at the Miami Dade Medical Examiner department.

GENERAL

This presentation will impact the forensic community by emphasizing the need for all medicolegal investigators to conduct a thorough investigation to ascertain the entirety of the circumstances surrounding infant deaths and create public awareness of the potential risk factors of unsafe sleep environments. The Miami-Dade County Medical Examiner Department implemented the Center of Disease Control’s (CDC) doll reenactment protocol in February 2007 as a routine component of pediatric death investigations. This change in standard operating procedure for the medicolegal investigator states that all possible Sudden Unexplained Infant Deaths (SUID) must include field-based investigative interviews and doll reenactment with parents and/or caregivers. 

The caregiver is asked to demonstrate to the investigator the sleep environment in which the infant was last placed and the position in which the infant was found. The requirement of doll reenactments by the CDC has helped the role of the medicolegal investigator to evolve from that of a basic telephone interviewer to an in-field investigator.

This change in infant death protocol helps to document unsafe environmental factors such as cosleeping with companions. The CDC has found that the decline in Sudden Infant Death Syndrome (SIDS) rates since 1995 has been offset by increasing rates of other types of sudden unexplained infant deaths.  A recent review suggests that asphyxia and co-sleeping continue to be significant risk factors in SUID investigations.  The new investigative protocol provides photographic and written documentation to inform the forensic pathologist of the first responder’s observations, and therefore, provide a more reliable death certification. Sudden Unexpected Infant Death Investigations (SUIDI) are difficult cases for both families and law enforcement.

The doll reenactment is a tool that the investigators can use to depict possible risk factors. Investigators have accepted their new responsibilities to better assist the pathologist with the determination of cause and manner of death.  The majority of cases have shown that caregivers are cooperative with the investigation and perform doll re-enactments to provide the details surrounding the terminal event.  Several area hospitals surveyed verified educational materials regarding possible risk factors are provided to new parents.  However, hospital staff expressed their concerns regarding that many caregivers failed to follow the current recommendations.

The Miami-Dade Medicolegal Investigators are professionals who are also taking proactive measures by attending educational seminars and maintaining interactions with law enforcement and the public.  The strategic plan for the future is to enhance professional standards by providing further education with the use of visual aids as part of the educational information provided to parents/caregivers regarding risk factors and potential causes of injury and death.  This service to the public is an attempt to prevent future incidents and decrease the mortality rates of infants in our community.