1.) The 15-year-old son of a police officer arrives home from school on a Thursday afternoon. He barely talks with his father, with whom he has been having relationship problems, quickly curtailing the conversation as to “how he was doing,” saying that he had not taken a shower after PE, and needed to do so. His dad heard the shower water running, and left to go to get Lottery tickets and pick up some dry cleaning. While out, he happened on the scene of a minor traffic collision, stopping to check on injuries, call his department, and to tell the people involved to move their vehicles from the middle of the street to the curb. Upon his return home, some 90 minutes after leaving, he heard the shower still on. He knocked on the bathroom door, telling his son he was wasting water, and to “get out of there NOW!” Two minutes later, the water was still on, and the dad pounded on the door, ordering his son to unlock it, however there was no response.
The father then forced the door open, finding his son hanging from a towel that was draped over the top pipe of the shower head, and was wrapped around the boy’s neck. The father took down the towel, and removed his son from the shower. Rapid assessment revealed the son to be non-breathing and pulseless. The dad called 911, and initiated CPR. Paramedics and multiple police units responded to the house. There was a brief effort to apply Advanced Cardiovascular Life Support, but the patient was pronounced dead when he failed to respond to treatment for Asystole.
The dad is horribly distraught, insists there is no way his son would commit suicide, and makes the homicide lieutenant present at the scene promise that the person responsible for his son’s murder will be brought to justice.
a) Describe your approach to the medicolegal investigation of this young man’s death (including assessment of the scene, the autopsy, laboratory studies, and any other approaches to forensic death investigation you would employ).
b) What possible causes of death may be found at autopsy?
c) What are the possibilities as to “Manner of Death,” given the circumstances?
d) Based on your education and experience, which Manner of Death do you believe is most probable (appreciating that a definitive decision will be made only after a complete investigation).
2.) A 31-year-old female, married, mother of 3, has been depressed since the birth of her last child, some 3 months previously. On multiple occasions her husband has encouraged her to seek mental health counseling and/or pharmacotherapy for her depression, as well as spiritual counseling, however she has been resistant to doing any of these things. One afternoon, when her husband is away at a business conference, she calls her mother and asks that she take her grandchildren for the day, as their mom needs “a break.” Her mother picks up the children, taking them to her home. The female then ingests the remaining contents in her valium prescription bottle, and begins drinking alcohol. After a few hours, she is still awake and disgusted at her inability to kill herself. She gets into her vehicle, and drives out into the forest that surrounds the community in which she lives.
A truck driver, going home down a small mountain road at approximately 2230 hours, comes upon her vehicle, which has struck a tree. Sitting in his truck and shining his spotlight on the scene, he notes that the female is half-in and half-out of the vehicle, not moving. The truck driver proceeds home, and goes to bed.
A Sheriff’s Deputy, on routine patrol, comes upon the scene at approximately 0530 the next morning. Assessing the patient, he finds her to be non-responsive, non-breathing, pulseless, cold to the touch, and somewhat stiff. Going to work at 0630 the next morning, the truck driver again comes upon the crash scene, however there are now multiple official vehicles present, including the Sheriff’s Department, California Highway Patrol, and County Coroner. The truck driver rolls down his window, and says to the CHP officer “I see you found her.” The CHP officer inquires as to what, exactly, the truck driver means, to which he replies “That’s exactly the way she was when I came by here 8-hours ago.” At this point the CHP officer invites the truck driver to carefully park his truck in an area of road that would not obstruct other traffic, and offers to provide further transportation for the truck driver.
The body is removed to the County Morgue. The Forensic Pathologist completes his initial inspection of the clothed body, following which an external inspection of the unclothed body is conducted, revealing no findings of note. To accomplish his internal autopsy examination, the Forensic Pathologist punctures the skin in the Left Acromioclavicular region to begin the classic Y-incision, upon which he thinks he hears a very faint moan.
a) What are possible explanations for the observation of the Forensic Pathologist?
b) What factors did or could cause this?
c) What actions should the Forensic Pathologist take to address this situation?
3.) Firefighters respond to a report of a house completely engulfed in flames. It takes them some time to successfully suppress the flames. When going through the house to conduct his investigation, the fire inspector discovers a body. Upon external examination in the morgue, it is thought that the remains are those of a male, because of the body size and apparent musculature, although the body is badly charred, and the genitalia are not in evidence. Further external examination reveals obvious skin splitting in multiple sites, instability of the right lower extremity, and open fractures of the skull. Further inspection reveals a collection of blood between the fractured skull and the dura matter, although its appearance is not that classically seen with an epidural Hematoma.
a) What are the possible causes that would account for these pathological findings?
b) How would you approach the medicolegal investigation of this death?
4.) The body of a 41-year-old male is found caught on the rocks of a slow-flowing river. The body is lying on its right side. The decedent is fully clothed, including shoes. There is obvious evidence of external trauma to the body, consisting of facial lacerations. No evidence of blood is found on the rocks. The portion of the face and head in the water do not demonstrate any evidence of bleeding, however a minimal amount of blood is found in the right external ear canal. Upon examination in the morgue, obvious facial fractures are found on x-ray and grossly. A faint fern-like discoloration is also noted over the superior aspects of the anterior chest.
a) What possibilities exist that would account for this patients death?
b) What further findings do you believe might be found at autopsy?
5.) The Medical Examiner’s Office is called by the police to a studio apartment. The occupant of the apartment is a retired lady in her late 70s. When her family could not reach her for several days, they called law enforcement, asking officers to “check on the welfare” of their mother. Upon their arrival, officers found the drapes open, and looking in could see the body of the resident lying on the floor. Upon making entry, the officers found the heat on, and the decedent fully dressed in a blouse, pants, two pair of socks, a sweater, and coat. This they found very suspicious, since the atmospheric temperatures had been in the hundreds, with high humidity, for several days. Examination of the body at the scene revealed no external evidence of trauma. The body was transported to the Morgue for autopsy.
a) What possible scenarios may account for this presentation?
b) What factors might be operative that would cause the scenarios you cite in your response to Question a?
c) What findings from your medicolegal death investigation would support or diminish the likelihood of the above scenarios having occurred?
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