Strangulation of pregnant woman leads to one first-degree murder indictment for the death of the mother: a medicolegal reconsideration of maternal/fetal/homicide.

A Hispanic woman, 7 1/4, to 7 1/2 lunar months pregnant, was strangled to death by her common-law husband. After receiving information from an informant, a reporter uncovered the remains of the woman and fetus in a grave in a river bank near Eloy, Arizona. The remains were submitted by local law enforcement officials to the forensic pathologist for medicolegal examination. After this analysis, they were turned over to the consulting forensic anthropologist for positive identification of the mother and for fetal age determination to assess possible viability. During the 1970s and 1980s, viability for a fetus of this age was thought possible, although not probable. Prosecution of the common-law husband on the charge of first-degree murder of his wife was successful, whereas a comparable charge for the fetus was not sought. Many issues are raised, including gestational age estimation in relation to fetal viability. Fetal age is reassessed by means of measurements from diaphyseal lengths. These measurements allowed for comparability of fetal age estimations between published studies, with discussion of changing dates of fetal viability made possible through technologic advances. Because fetal viability changes with these advances, it is necessary to establish and update the guidelines for medicolegal practice.

Practice guideline for forensic pathology. Members of the Forensic Pathology Committee, College of American Pathologists.

The guideline for forensic pathology was prepared by the Forensic Pathology Committee of the College of American Pathologists. The definitional criteria for forensic pathology included in this guideline have been approved both by the House of Delegates and the Board of Governors of the College of American Pathologists. The guideline presents an overview of forensic pathology and an approach to the forensic autopsy and medicolegal death investigation. Emphasis is placed on the role of forensic pathology in maintaining public health, welfare, and safety. The guideline is intended to serve as an educational tool, and its use should be determined by the individual circumstances and settings of specific cases.

Death investigations on military installations.

The authority to conduct a death investigation, including an autopsy examination, on a military installation depends upon the type of jurisdiction on the installation and the decedent's military connection. Exclusive federal jurisdiction gives the military authority to investigate deaths of active duty military members and, under specific conditions, of civilians with a military connection. Concurrent or shared jurisdiction gives the local civilian medical examiner the right of first refusal as to military members. Thus, the civilian medical examiner may waive jurisdiction to the military. This is not the case when a civilian dies under the same circumstances.

Jurisdiction on military installations.

The death of an individual on a military installation often raises the question of who has the authority to investigate that death and perform an autopsy. The answer to this question depends upon whether jurisdiction is exclusively federal or is shared by the state and federal governments. Jurisdiction can be determined by contacting the installation's Directorate of Engineering and Housing or the legal office. When there is exclusive federal jurisdiction, the installation commander or the Armed Forces Medical Examiner may authorize an autopsy on a military member. Under certain conditions, the installation commander may authorize an autopsy on a civilian, especially where a legitimate connection exists between that civilian and the federal government. When jurisdiction is concurrent (that is, shared by the state and federal governments), the civilian medical examiner may waive jurisdiction to the military, but only as to the death of a military member. The authority to investigate the death of a civilian (whether a military dependent or not), to include autopsy examination, is exclusively civilian when jurisdiction is concurrent. Overseas locations are controlled by special agreements that in general, give the U.S. government jurisdiction over military members, their dependents, and U.S. civilian components of the assigned force.

Quality assurance in drug testing laboratories.

Drug testing is currently regulated for Department of Defense and other federal agency programs and many of the QA actions listed in this article are mandated in the regulations cited. This trend will probably continue in an effort to ensure high-quality test results and may expand into private sector testing. Also, more drugs may be added to the list of the five currently mandated for federal agencies. It remains to be seen if the certified DTLs avoid the pitfalls of past programs. A good QA program will undoubtedly be the key to success.

Postmortem forensic toxicology.

After all of the analytic data have been accumulated, the final step in the toxicologic process is to assess the meaning of the results. In suspected drug intoxications, one must determine if the amount of toxicant or toxicants present in the appropriate specimens is consistent with producing lethality. This decision ultimately must be made by the medical examiner or coroner, who must also consider the history, scene investigation, and gross and microscopic autopsy findings in reaching this decision. Once the cause of death has been determined, the manner of death needs to be decided. This can produce another group of questions to be addressed by the toxicologist. Items such as route of administration, acute versus chronic dose, and consistency between drug concentrations and behavioral effects may be critical factors in assessing the manner of death. These questions may arise even if the cause of death is ruled not to be drug related.

Legal aspects of laboratory medicine.

Societal expectations of modern laboratory medicine will engender increasing scrutiny about the accuracy of laboratory data, the timeliness of performing laboratory tests, and the transmission of the results. Laboratorians who understand basic medicolegal principles applicable to laboratory medicine will be comfortable at the interface between law and medicine, and likely will practice acceptable laboratory medicine. Good medicine is good law. The authors divide their discussion into four parts: accountability for laboratory services, quality and risk in laboratory management, forensic evidence in the laboratory, and testimony by clinical laboratory personnel.

An analysis of toxic deaths, 1982 to 1985, Pima County, Arizona.

Toxic deaths in Pima County, Arizona, were studied over a four-year period. The deaths were analyzed according to cause and manner of death, toxic substance, and demographic data. The age group 40 to 49 years had the highest rate of suicide from toxic substances. The accident death rate was highest for ages 20 to 29 years. Carbon monoxide was most often found to be the cause of deaths in this study. The most prevalent drugs were narcotics followed by antidepressants, cocaine, and barbiturates. Comparisons are made with similar studies.

Cocaine-related deaths in Pima County, Arizona, 1982-1984.

A three-year review of toxicology data from medical examiner autopsies in Pima County, Arizona, has demonstrated that cocaine has rapidly become a leading substance of abuse, second only to alcohol in the frequency of drugs detected by toxicologic analysis of all suspicious deaths, motor vehicle accident fatalities, homicides, and suicides. Gastric contents and urine were analyzed by thin-layer chromatography, and nasal swabs, blood, and urine were tested for the combination of cocaine and its metabolite benzoylecgonine by quantitative radioimmunoassay. A total of seventy-two deaths in Pima County from 1982 to 1984 have involved cocaine. Seventy percent of these have occurred in the last fifteen months. Marked variation in the individual response to cocaine compared to the blood concentration of cocaine/metabolite was noted.

Asphyxiation by hanging in two young Hispanic children--homicide, suicide, or accidental deaths? A review of pediatric hangings.

Case reports of asphyxiation by hanging in two young children are presented along with a review of the literature to determine the incidence and manner of death by hanging in the younger pediatric population.

Bone marrow emboli versus fat emboli as the cause of unexpected death.

Thromboemboli were found diffusely throughout the pulmonary vasculature system of a 76-year-old white female who died unexpectedly 3 days following injury and repair of a left hip intracapsular fracture. A diffuse chronic nonspecific myocarditis with marked fat atrophy, an acute myocardial infarct of the posterior left ventricular papillary muscle, and an acute right lower lobe bronchopneumonia are believed to be the cause of death.

Failure of dialysis therapy in potassium dichromate poisoning.

A fatal case of oral ingestion of potassium dichromate is presented. Following an initial presentation of abdominal pain and vomiting, the patient had a rapid progression to coma with the development of methemoglobinemia, coagulopathy, gastrointestinal hemorrhage, and respiratory distress syndrome. A blood concentration of chromium on admission was 5,800 mcg/dL, 80% of which was found to be in the intracellular fraction. Supportive treatment was also initiated as a four-hour period of hemodialysis followed by a one-hour period of charcoal hemoperfusion. Neither of these treatment modalities was found to significantly remove chromium from whole blood and neither seemed to affect the progression or outcome of this intoxication. We conclude that the ingestion of potassium dichromate is highly toxic and may rapidly lead to death. Hemodialysis and charcoal hemoperfusion appear to have little role in the management of chromium intoxication.

Shotgun diagnosis: "it ought to be something else".

The problems encountered by the surgeon, the radiologist, and the pathologist in the interpretation of radiopaque fragments within tissue are illustrated by a case report. Deformation, particularly flattening, of round pellets should be recognized as a gross radiographic pitfall. The potential and actual external and internal tissue damage resulting from a close-range shotgun blast are also discussed. Careful study of the radiographs, examination of the weapon and ammunition, and the information obtained from good investigation by trained law-enforcement officers should prevent possible misinterpretation.

Systems for human identification.

The methods and techniques used in Categories 1, 2, and 3 are the least reliable because of their subjective nature as well as the ever-present potential for human error. These methods are valuable, however, as adjuncts in identification procedures in a total exclusionary and inclusionary comparison. The methods and techniques described in Category 4 have a more scientific basis, but still caution must be used, and, prior to the completion of the death certificate, a complete evaluation should be made of all techniques employed in the identification.

Alcoholism--the second great imitator. An introduction to the problem of alcoholism.

The problem of alcohol abuse and alcoholism pervades our society. The economic losses run into billions of dollars annually. What is more important is the number of fatalities associated with the problem and the effect of alcohol on decision-making processes within all areas of government and nongovernment. The pathologist must understand the fundamental diagnostic processes, recognize the anatomic and clinical findings, and treat alcoholism as a medical problem.

Fibromuscular hamartoma of the esophagus in an infant.

An 11-month-old infant had a history of dysphagia and continuous drooling without evidence for airway obstruction. A biopsy specimen of a neck mass on the left side adherent to the larynx and esophagus demonstrated pathologic features characteristic of a fibromuscular hamartoma. Upper airway obstruction subsequently ensued and the patient was managed for 16 months with a tracheostomy and feeding gastrostomy. Although posing an extremely difficult management problem, this benign tumor was surgically removed without damage to the larynx when the patient was 28 months old. The differential diagnosis of this unusual lesion must consider congenital fibromatosis and fetal rhabdomyoma.

Sudden unexpected death from cardiac concussion (commotio cordis) with unusual legal complications.

Sudden and unexpected death may result from cardiac concussion following blunt force trauma to the thorax. Undiagnosed pathologic disease must be carefully evaluated as a possible contributory element. Legal complications may arise from any autopsy. It is recommended that a photograph be taken upon completion of the autopsy. This photograph and adequate records can be used to refute any charges against the pathologist or assistants for the poor condition of a body after its release.