Author

About the Author
Darren is a 30 year veteran of law enforcement and criminal investigations. He currently serves as an investigator for the Crawford County Missouri coroner’s office. He holds credentials as an instructor for the Missouri Sheriff’s Training Academy, has served as president of the Missouri Medical Examiners and Coroners Association, and is certified and credentialed in numerous fields of investigation. He holds the position of lead instructor and facilitator for the Coroner Talk™ community as he speaks and writes in the area of death investigation and scene management.

Forensic Anthropology – Dr Tersigni-Tarrant

Tarrant_MariaForensic anthropology is the analysis of skeletal, badly decomposed, or otherwise unidentified human remains, and  is important in both legal and humanitarian contexts. Forensic anthropologists apply standard scientific techniques developed in physical anthropology to analyze human remains, and to aid in the detection of crime. In addition to assisting in locating and recovering human skeletal remains, forensic anthropologists work to assess the age, sex, ancestry, stature, and unique features of a decedent from the skeleton. Forensic anthropologists frequently work in conjunction with forensic pathologists, odontologists, and homicide investigators to identify a decedent, document trauma to the skeleton, and/or estimate the postmortem interval.

In this episode 

In this episode I talk with Dr.MariaTeresa A. Tersigni-Tarrant about what is forensic anthropology and how it can help you  in solving your case or answering the unanswered. We dive into the how-to’s of scene work and the obstacles that come with recovering and packaging skeletal  remains.

Important Links 

Dr.MariaTeresa A. Tersigni-Tarrant email:  m.tersigni.tarrant@gmail.com 

ABFA – American Board of Forensic Anthropology:

Todays Guest

Skeletal ServicesDr.MariaTeresa A. Tersigni-Tarrant is a practicing, board-certified Forensic Anthropologist, one just over 100 individuals ever certified by the American Board of Forensic Anthropology.  Dr. Tersigni-Tarrant received her Bachelor’s of Science Degrees in Microbiology and Anthropology from Michigan State University in 2000.  She received her M.A. and Ph.D. in Physical Anthropology from the University of Tennessee in Knoxville.  Dr. Tersigni-Tarrant was awarded a post-doctoral fellowship in 2005 at the Joint POW-MIA Accounting Command’s Central Identification Laboratory (JPAC-CIL) on Hickam AFB, Hawaii.  During this fellowship, she was instrumental in establishing standard operating procedures for the histological analysis of human remains for the purpose of identifying missing armed-service members.  From 2006- 2012, Dr. Tersigni-Tarrant held several teaching positions at undergraduate, graduate and medical school institutions.  Most recently, as a course director and instructor, she developed and implemented curriculum for medical gross anatomy (including the laboratory component) and medical embryology for first year medical students.  Dr. Tersigni-Tarrant served as the Forensic Anthropologist for the State of Georgia-At-Large working with the Georgia Bureau of Investigation (GBI) from 2009-2012.  She continues to consult with GBI on various cases.  Dr. Tersigni-Tarrant returned to JPAC-CIL in 2012, where she was employed as a Forensic Anthropologist and managed the histology casework at the CIL.  She currently owns her own consulting firm offering consulting services related to forensic anthropology casework to medicolegal agencies including the Saint Louis City Medical Examiner’s Office, the GBI and the Department of Defense.  Dr. Tersigni-Tarrant s as an Associate Professor in the Department of Surgery’s Center for Anatomical Science and Education where she teaches gross anatomy and embryology to first year medical students, anatomy graduate students and PA, AT, PT and OT students. She also serves as the Director of Forensic Education and an Adjunct Associate Professor in the Department of Pathology at Saint Louis University, where she runs the Medicolegal Death Investigators training Courses and the Masters Medicolegal Death Investigation Course. Her research interests include bone biology; human and non-human histology, child abuse: patterned fractures and timing of healing, human decomposition research, bone pathology, and developmental anatomy.

Ethnographic Research – The Study of Us

Field NotesEthnography is the study of cultures through close observation, reading, and interpretation. Ethnographic researchers work “in the field,” in the culture which they are studying. The activities they conduct are also often called fieldwork. Ethnographers define the word “culture” in broader terms, as a patterned behavior or way of life of a group of people. Some of the elements of culture then are the common habits, customs, traditions, histories, and geographies—everything that connect the members of the culture together and defines them. Ethnographic research allows the researcher  to get “up close and personal” with cultures. It places researchers at the heart of the investigations, often allowing them to participate in the very culture they study. Such an active role gives writers valuable insights into their subject, which usually cannot be achieved simply by studying books, journal articles, and websites.

Death Investigators as a Culture 

Culture is ordinary: that is the first fact. Every human society has its own shape, its own purposes, its own meanings. Every human society expresses these, in institutions, and in arts and learning. The making of a society is the finding of common meanings and directions, and its growth is an active debate and amendment under the pressures of experience, contact, and discovery, writing themselves into the land. The growing society is there, yet it is also made and remade in every individual mind. The making of a mind is, first, the slow learning of shapes, purposes, and meanings, so that work, observation and communication are possible. Then, second, but equal in importance, is the testing of these in experience, the making of new observations, comparisons, and meanings. A culture has two aspects: the known meanings and directions, which its members are trained to; the new observations and meanings, which are offered and tested. These are the ordinary processes of human societies and human minds, and we see through them the nature of a culture: that it is always both traditional and creative; that it is both the most ordinary common meanings and the finest individual meanings. We use the word culture in these two senses: to mean a whole way of life–the common meanings; to mean the arts and learning–the special processes of discovery and creative effort. Some writers reserve the word for one or other of these senses; I insist on both, and on the significance of their conjunction. The questions I ask about our culture are questions about deep personal meanings. Culture is ordinary, in every society and in every mind.

flavia.medeirosToday’s Guest – Flavia Medeiros

Since 2009,Flavia Medeiros has  been conducting ethnographic research about the relation between Medicine, Science, Justice and Police trying to understand how those fields deal with the death and decedents, specifically in homicide cases.

For her  Master Degree in Social Anthropology,  she has  been doing fieldwork in the Rio de Janeiro Medical-Legal Institute, Brazil. Her  goal was understand the proceedings that define a corpse as a dead person. This research is going to be published as a book: “Matar o morto: uma etnografia do Instituto Médico-Legal do Rio de Janeiro (in English: “Kill the decedent: an ethnography of the Rio de Janeiro Medical-Legal Institute.”) Also, she spent three months in Buenos Aires, Argentina where she could observe the Lomas de Zamora Judicial Morgue.

Currently, the title of her  research project is “How are “homicides” negotiated? A comparative ethnography of the construction mechanisms of truths in cases of “intentional crimes against life” in Rio de Janeiro/Brazil and San Francisco/USA.” Her goal is to explore how “homicides” are classified, appreciating the nature of conflicts, the investigation of their facts and the classifications that will produce truths. In this direction, she proposes to observe, identify and analyze what are the practices in Rio de Janeiro (what she did during 2014) and San Francisco (fieldwork she is doing now) for the investigation, prosecution and trial phases. As well as the moralities, senses and representations triggered so that “homicides” may be traded by the institutional agents involved in construction of their truths.

In this episode I talk with Flavia about her research and what has driven her to conduct such an undertaking.  We discuss her current research, the differences seen between America and Brazil and where her future research will take her.  I find it interesting that she is devoting her PhD work to researching what we do.

Contact information for Flavia 

http://www.uff.br/ineac/ – webpage of the “Institute for the Comparative Study of Conflict Administration Processes”
http://www.uff.br/ppga/ – webpage of the Graduate Program in Anthropology where I am a PhD Candidate
https://www.facebook.com/flaviamedeiross – Her  personal profile

tags: coroner,coroner talk podcast,police training, darren dake,sheriff,deputy,coroner association,murder scenes,csi,detective,detective training,auto fatalities,autoerotic fatalities,become a coroner,forensic science,become a csi, fire fighter, fire fighter training,police,paramedic,medicolegal,anita brooks,ptsd,secondary  traumatic stress,flavia medeiros 

Forensic Video Production

Video CameraIn most cases it’s as much, or more, about the technique than the equipment when it comes to crime  scene videography. Forensic video production is valuable for showing an overview of the crime scene and should be considered in major cases. While video cannot replace still photographs due to its lower resolution, video does provide an easily understandable viewing medium that shows the layout of the crime scene and the location of evidence. Videos of crime scenes are not often used in court, but they are valuable illustrations for explaining the scene to other investigators and are often used to refresh the memory of those who were involved in processing the crime scene.

Crime scene videotaping techniques

When videoing  crime scenes, you should start the video with a brief introduction presented by an investigator. The introduction should include the date, time, location, type of crime scene, and any other important introductory information. The introduction should also include a brief description of the rooms and evidence that will be viewed in the video. The investigator may want to display a basic diagram as an illustration during the introduction.

Following the introduction the recording is paused and the microphone is turned off. This will prevent any distracting sounds from recording on the video  during the recording of the scene. Begin videoing the crime scene with a general overview of the scene and surrounding area. Continue throughout the scene using wide angle and close up views to show the layout of the scene, location of evidence, and the relevance of evidence within the crime scene. While videoing, use slow camera movements such as panning, and zooming.

In-camera editing is an ideal way to produce crime scene videos. In this method you start and stop the recording at the angles and areas you want. This prevents  distractions and distortion  of moving  around and fast zooming. Editing software can then seamlessly put these clips together for a complete overall video production.

Equipment 

Many departments and agencies can not afford high-end commercial use cameras for forensic video production.  That’s perfectly fine, smaller cameras and even iPhone / iPads can be used to produce high quality video production of your crime scene.  In most cases it’s as much, or more, about the technique than the equipment when it comes to crime  scene videography.

Training 

It is critical  investigators get some training in proper forensic video production techniques. These classes are not offered as much as still photography courses. However, it is critical you find these courses. If courses in this area of crime scene processing are not found in your area then search out those people who produce video for other fields, such as television camera operators and wedding videographers. Techniques and camera familiarization can be learn from these professionals and you can adapt what you need for your use.

Above all – try.  Your first crime scene video may not be of the standards you wish it be be. However, with each time, and practice on non-crime scene shoots, you will improve with each shoot.

Episode Guest 

On this episode of the Coroner Talk™ podcast I talk with Scott Alan Kuntz of  Scott Alan Video LLC.  Scott is an active law enforcement officer and owns his own company helping other agencies in training and consulting work.  More about Scott and how he can help your agency can be found at:

http://www.scottalanvideo.com

 

Investigating Gun Shot Wounds

Certain routine steps  are taken in investigating fatal injury inflicted by a firearm either as a result of foul play or accident.’ A fatal gunshot case presents many challenging medicolegal problems which involve cooperation among the forensic pathologist, firearms identification expert, laboratory technician and the police. The belief that an “expert” can view the body and without further corroborating evidence testify in court as to the range at which this person was shot and the calibre of the weapon is one of the most common fallacies.’ Since the average person interested in law enforcement is generally not trained in medicine it seems best to discuss the information which can be obtained from an examination of a gunshot victim’s body. Suppose a male corpse is brought to a coroner’s office for the purpose of identification and determination of cause of death. First, it must be established whether or not the individual has been shot and, secondly, whether or not the gunshot was the cause of death. If no projectiles can be found in the body through X-ray or exploration, the question of whether the individual has been shot is by no means resolved. For example, multiple wounds inflicted by an ice pick in the back oftentimes gives the appearance of buckshot wounds. Bullet wounds, from external appearance, are of two types; entrance and exit.

Few injuries resulting from the discharge of a firearm rule out the possibility of foul play. Firearms identification is also known as “forensic ballistics.” However, since the science of ballistics relates to the study of projectiles in flight the term firearms identification seems preferable.  A review of the leading American text, Hatcher, Jerry & Weller, Firearms Identification, Investigation and Evidence, Stackpole Company, Harrisburg (1957), should quickly dispel any doubts on this matter.

For an excellent discussion of the historical role of the coroner in identifying deceased persons see Harvard, The Detection of Secret Homicide, Cambridge (1960).  Smith and Glaister, Recent Advances in Forensic Medicine, Blakeston’s, Philadelphia (1939) ch. 1, contains a variety of material on the mechanics of gunshot injury.  The use of X-ray examination to locate projectiles or fragments of pellets is particularly important where the investigator wishes to weigh the bullet in order to have some approximation of caliber.  Smith and Glaister, op. cit. supra n. 5 at 20. Published by EngagedScholarship@CSU, 1964 1 FATAL GUNSHOT WOUNDS.

On this Episode 

On this show we talk to Dr Judy Melinek about the issues in investigating gun shot wounds.  We talk about types of wounds and what obstacles investigators can encounter in a fatal shooting incident.

Article Reprinting from Section of:   Journal of Criminal Law and Criminology

Panel Discussion – Wrongful Convictions in Shaken Baby Death Cases

Screen Shot 2015-06-06 at 14.41.46Much has been said about the science and medical findings in Shaken Baby Deaths.  Now new, or not so new,  opinions say  the injuries to the brain which is used as fact evidence is not accurate. This panel discusses these issues and the investigation that goes into these deaths.  The panel members are Craig Smith of C.B. Smith Training & Consulting Ltd. in Canada,  Paul Parker of Parker Medicolegal Services in Arizona and Dr. Judy Melinek of the Alameda County Coroners Office in California.  All panelist contact information is located below.

What  started this discussion was a recent article written for CBS News that shed doubt on the medical findings of a Shaken Baby  Cases and whether or not those finding have lead to the wrongful conviction of parents and care givers in these cases.   That article is reposted below again for review.  This panel does not and did not intend to discredit the writer of this article or CBS News.  The intent was to discuss this opposing opinion and bring  light to the need for accurate and complete investigation so that medical findings alone are not disputed.  The panel does an amazing job at bringing out  every aspect of  this discussion.

Resource talked about on the show 

Mr. Craig Smith referenced at report generated by the  National District Attorney Association that outlines defense objections to head trauma injuries.  That publication can be found here and downloaded  for free.

National District Attorney Association

Panelist Contact Information

Craig SmithCraig Smith 

Paul ParkerPaul Parker 

Melinek-Slide_0Dr. Judy Melinek 

 


 

 

Questionable convictions in “shaken baby” cases?

Deborah Tuerkheimer is a Professor of Law at Northwestern University and the author of “Flawed Convictions: ‘Shaken Baby Syndrome’ and the Inertia of Injustice.” She also appears onSaturday’s “48 Hours” investigation into the case of Melissa Calusinski, a former day care provider who says she is wrongfully convicted in a toddler’s death. Here, Tuerkheimer weighs in on questionable convictions in child death cases. Her opinions do not necessarily reflect those of CBS News.

A few months ago, a 55-year-old Florida day care provider became yet another caregiver accused of shaking a toddler to death. The woman, who had worked with children for decades, denied harming the boy. But pediatricians concluded that this was a case of Shaken Baby Syndrome (SBS).

Even before an autopsy was performed, the state charged the woman with murder. She is being held in jail without bond and if convicted, she faces mandatory life in prison without the possibility of parole.

Based on the press reports, this case resembles many that I have written about in my book, Flawed Convictions: “Shaken Baby Syndrome” and the Inertia of Injustice. Without witnesses or external signs of abuse, the classic diagnosis of Shaken Baby Syndrome rests on three neurological symptoms, otherwise known as the “triad”: bleeding beneath the outermost layer of the brain, retinal bleeding, and brain swelling.

These symptoms are said to prove that a baby was violently shaken and, what’s more, to identify the abuser– whoever was present when the child was last lucid. Shaken Baby Syndrome is, in essence, a medical diagnosis of murder. In order to convict, prosecutors must rely entirely on the claims of science.

But the science has shifted. In recent years, there has been a growing consensus among experts that the neurological symptoms once viewed as conclusive evidence of abuse may well have natural causes, and that old brain injuries can re-bleed upon little or no impact.

In short, current science raises significant questions about the guilt of many caregivers convicted of shaking babies.

Reflecting real movement in the direction of doubt, this past spring, a federal judge in Chicago issued a ruling of “actual innocence” in the case of Jennifer Del Prete, a caregiver accused of shaking a baby in her care. (My book describes this trial in detail.) Del Prete was able to show that, based on what doctors now know about alternative causes of the triad, no reasonable jury could possibly find Del Prete guilty of murder. Indeed, according to the reviewing judge, a lack of evidentiary support for the theory of Shaken Baby Syndrome means that the diagnosis is arguably “more an article of faith than a proposition of science.”

Our legal system has been slow to absorb this new reality. As a consequence, innocent parents and caregivers remain incarcerated and, perhaps more inexplicably, prosecutions based solely on the “triad” symptoms continue even to this day. The cautionary tale of Shaken Baby Syndrome shows that our system is too inclined to stay the course, and awful injustices can result.

Questionable convictions in “shaken baby” cases

Shaken BabyThe term “shaken baby syndrome” (SBS) was developed to explain those instances in which severe intracranial trauma occurred in the absence of signs of external head trauma. SBS is the severe intentional application of violent force (shaking) in one or more episodes, resulting in intracranial injuries to the child. Physical abuse of children by shaking usually is not an isolated event. Many shaken infants show evidence of previous trauma.

Frequently, the shaking has been preceded by other types of abuse.

Mechanism of Injury

The mechanism of injury in SBS is thought to result from a combination of physical factors, including the proportionately large cranial size of infants, the laxity of their neck muscles, and the vulnerability of their intracranial bridging veins, which is due to the fact that the subarachnoid space (the space between the arachnoid membrane and the pia mater, which are the inner two of the three membranes that cover the brain) are somewhat larger in infants. However, the primary factor is the proportionately large size of the adult relative to the child. Shaking by admitted assailants has produced remarkably similar injury patterns:

  • The infant is held by the chest, facing the assailant, and is shaken violently back and forth.
  • The shaking causes the infant’s head to whip forward and backward from the chest to the back.
  • The infant’s chest is compressed, and the arms and legs move about with a whiplash action.
  • At the completion of the assault, the infant may be limp and either not breathing or breathing shallowly.
  • During the assault, the infant’s head may strike a solid object.
  • After the shaking, the infant may be dropped, thrown, or slammed onto a solid surface.
  • The last two events likely explain the many cases of blunt injury, including skull fractures, found in shaken infants. However, although blunt injury may be seen at autopsy in shaken infants, research data suggest that shaking in and of itself is often sufficient to cause serious intracranial injury or death.

 

 

Questionable convictions in “shaken baby” cases?

Deborah Tuerkheimer is a Professor of Law at Northwestern University and the author of “Flawed Convictions: ‘Shaken Baby Syndrome’ and the Inertia of Injustice.” She also appears onSaturday’s “48 Hours” investigation into the case of Melissa Calusinski, a former day care provider who says she is wrongfully convicted in a toddler’s death. Here, Tuerkheimer weighs in on questionable convictions in child death cases. Her opinions do not necessarily reflect those of CBS News.

A few months ago, a 55-year-old Florida day care provider became yet another caregiver accused of shaking a toddler to death. The woman, who had worked with children for decades, denied harming the boy. But pediatricians concluded that this was a case of Shaken Baby Syndrome (SBS).

Even before an autopsy was performed, the state charged the woman with murder. She is being held in jail without bond and if convicted, she faces mandatory life in prison without the possibility of parole.

Based on the press reports, this case resembles many that I have written about in my book, Flawed Convictions: “Shaken Baby Syndrome” and the Inertia of Injustice. Without witnesses or external signs of abuse, the classic diagnosis of Shaken Baby Syndrome rests on three neurological symptoms, otherwise known as the “triad”: bleeding beneath the outermost layer of the brain, retinal bleeding, and brain swelling.

These symptoms are said to prove that a baby was violently shaken and, what’s more, to identify the abuser– whoever was present when the child was last lucid. Shaken Baby Syndrome is, in essence, a medical diagnosis of murder. In order to convict, prosecutors must rely entirely on the claims of science.

But the science has shifted. In recent years, there has been a growing consensus among experts that the neurological symptoms once viewed as conclusive evidence of abuse may well have natural causes, and that old brain injuries can re-bleed upon little or no impact.

In short, current science raises significant questions about the guilt of many caregivers convicted of shaking babies.

Reflecting real movement in the direction of doubt, this past spring, a federal judge in Chicago issued a ruling of “actual innocence” in the case of Jennifer Del Prete, a caregiver accused of shaking a baby in her care. (My book describes this trial in detail.) Del Prete was able to show that, based on what doctors now know about alternative causes of the triad, no reasonable jury could possibly find Del Prete guilty of murder. Indeed, according to the reviewing judge, a lack of evidentiary support for the theory of Shaken Baby Syndrome means that the diagnosis is arguably “more an article of faith than a proposition of science.”

Our legal system has been slow to absorb this new reality. As a consequence, innocent parents and caregivers remain incarcerated and, perhaps more inexplicably, prosecutions based solely on the “triad” symptoms continue even to this day. The cautionary tale of Shaken Baby Syndrome shows that our system is too inclined to stay the course, and awful injustices can result.

Pt 2 The Suicide Plan – Investigating Planned Suicides

SuicideThe assisted suicide movement is, if anything, indefatigable. Not only is it undeterred by its failures, but it is now more energized than any other time in recent years. By the end of March of 2015, bills were introduced in twenty-five state legislatures to legalize assisted suicide.

Defining the Subject

Many people remain confused about the exact nature of assisted suicide advocacy, sometimes confusing it with other medical issues involving end-of-life care. Thus, to fully understand the subject, we must distinguish between ethical choices at the end of life that may lead to death and the poison of euthanasia/assisted suicide.

1.      Refusing unwanted medical treatment is not assisted suicide: Fear of being “hooked up to machines” when one wishes to die at home has traditionally been a driving force behind the assisted suicide movement. But we all have the right to refuse medical interventions—even if the choice is likely to lead to death. Thus, a cancer patient can reject chemotherapy and a patient dying of Lou Gehrig’s disease can say no to a respirator.  Indeed, in 1997, the U.S. Supreme Court ruled unanimously that the right to refuse medical treatment is completely different from assisted suicide.[9]

2.      Assisted suicide/euthanasia is not the same as medical treatment for pain control: Because pain control may require strong drugs, which can cause death, assisted suicide advocates often claim that palliation and euthanasia are ethically the same under the “principle of double effect.” But this is all wrong:

  • Any legitimate medical treatment can unintentionally lead to death, including pain alleviation. In assisted suicide death is the intended effect.
  • We would never say that a patient who died during open heart surgery was euthanized. Similarly, a patient who dies from the unintended side effects of pain control has not been assisted in suicide or euthanized.
  • Pain control experts state that aggressive pain control generally does not shorten life.

3.      Assisted suicide/euthanasia is antithetical to hospice: Hospice was founded by the great medical humanitarian Dame Cicely Saunders in the late 1960s as a reform movement to bring the care of the dying out of isolated hospitals and into patients’ homes or non-institutional local care facilities. Its purpose is to provide dying people with proper treatment of pain and other disturbing symptoms as well as to render spiritual, psychological, and social support toward the end that life be lived as fully as possible until natural death.

In contrast, assisted suicide is about rushing death, making it happen sooner rather than later through lethal actions. Or to put it another way: Hospice is about living. Assisted suicide/euthanasia is about dying. As the noted palliative care expert and assisted suicide opponent Dr. Ira Byock has written, “There’s a distinction between alleviating suffering and eliminating the sufferer — between enabling someone to die gently of their disease and ending that person’s life with a lethal pill or injection.”

4.      Assisted suicide/euthanasia are acts that intentionally end life: In contrast to the above, the intended purpose of assisted suicide and euthanasia is to end life, e.g., to kill. In assisted suicide, the last act causing death is taken by the person who dies, for example, ingesting a lethal prescription of barbiturates. In euthanasia, the death is a homicide, an act of killing taken by a third person, such as a doctor injecting a patient with poisonous drugs.

From an Investigators Standpoint 

With the above statements we can see that the topic of assisted suicide is at best conversional.  As a death investigator, our job is simple; to report the facts and the facts only.  However, it is well understood that our own emotions and bias on the topic can and will play a role in how we approached these scenes. The investigators must guard against allowing these personal feelings to interfere with the proper reporting and interpretation of  the scene.

Conversation with Prosecuting Attorney 

It is  a good suggestion to have a conversation with your  prosecuting attorney and a review of your agency policy to see how best to proceed in these cases. You should always report all facts in the case, but having a better understanding of how you are expected to proceed may well help in your overall review of the case.

With Family

No matter what decision  your Prosecuting Attorney goes, some members of the deceased family will invariably not agree with the decision.  This is why it best to do a proper and complete investigation, report all and only, the facts – and let those responsible for making these critical decision do their job. You, as the investigator , can rest in the knowledge that you have done your job and can properly explain to the family exactly what took place and why decision  are made based upon these facts.  Many family members may still not agree with the outcome, but it is much better for them to have the facts than them come up with their own set of “facts’ as they see it.

Anita Brook-corner talk-secondary stressAnita Brooks    anitabrooks.com

The Suicide Plan – Investigating Planned Suicides Pt1

SuicideThe Centers for Disease Control and Prevention (CDC) collects data about mortality in the U.S., including deaths by suicide. In 2013 (the most recent year for which full data are available), 41,149 suicides were reported, making suicide the 10th leading cause of death for Americans. In that year, someone in the country died by suicide every 12.8 minutes.   With those totals, we are all bound to be involved in investigating suicides.  Suicides can be acute, meaning short term or spur of the moment final decision, or a well planned and risk assessed  action.  In this episode of Coroner Talk™ we are going to look at the pros, if there be any, and the cons of planned suicide.

Featured in this weeks show is a PBS production of  Frontline that deals with the topic of a well planned suicide and the legal and moral implication that accompany such a decision.  Regardless of where you stand on the topic, this episode will start you thinking of the other side.

The Assisted Suicide Debate

Since Oregon legalized physician-assisted suicide for the terminally ill in 1997, more than 700 people have taken their lives with prescribed medication — including Brittany Maynard, a 29-year-old with an incurable brain tumor, who ended her life earlier this month.

Advocates of assisted-suicide laws believe that mentally competent people who are suffering and have no chance of long-term survival, should have the right to die if and when they choose. If people are have the right to refuse life-saving treatments, they argue, they should also have the freedom to choose to end their own lives.

Opponents say that such laws devalue human life. Medical prognoses are often inaccurate, they note — meaning people who have been told they will soon die sometimes live for many months or even years longer. They also argue that seriously ill people often suffer from undiagnosed depression or other mental illnesses that can impair their ability to make an informed decision.

At the latest event from Intelligence Squared U.S., two teams addressed these questions while debating the motion, “Legalize Assisted Suicide.”

Before the debate, the audience at the Kaufman Music Center in New York was 65 percent in favor of the motion and 10 percent against, with 25 percent undecided. After the debate, 67 percent favored the motion, with 22 percent against, making the team arguing against the motion the winner of this debate.

http://www.npr.org/2014/11/20/365509889/debate-should-physician-assisted-suicide-be-legal

The Suicide Plan – Investigating Planned Suicide

Investigators are offered a hard road when it comes to investigating a planned suicide when it is found that family or friends may have assisted in some manner, regardless of the extent of the that assistance.  Even providing a cool drink of water to wash down the pills that will end life can be enough in some states to charge a person with assistance.  But where, as investigators, do we stand on the issue.  Some investigators are only providing cause and manner of death determinations, which can be clouded by the assistance issue. While other investigators are charged with the task  of deciding the criminal aspect of the assistance rendered.

In part two of this issue we will take a deep dive into the debate that will most assuredly muddy up the waters a bit.  That is next episode on Coroner Talk™..

suicide-prevention-lifeline-logo

Dr. Judy Melinek – Working Stiff

Melinek-Slide_0A   forensic pathologist can not work in a vacuum, they must have critical information gathered at the scene by qualified investigators. It is only with this information and the results of the autopsy that a ruling can be made.  It is often that a ruling will be delayed, or no determination made at all, without this information and investigation by the medicolegal investigators.

In this episode I talk with Dr. Judy Melinek, and forensic pathologist working with the Alameda County Coroners Office and and private consultant at  Pathology Expert .com.   We discuss what investigators need to provide to a pathologist to help in the determination of cause and manner of death.  We also discuss her role in the 9/11 attacks as she was working in New York City at the time and witnessed the first plane hit.

Dr. Melinek, along with her husband TJ – wrote the book Working Stiff that chronicle her first two years as a forensic pathologist  and her work in New York City Medical Examiners Office during the 9/11 attacks.

 

Working-stiffThe fearless memoir of a young forensic pathologist’s “rookie season” as a NYC medical examiner, and the cases—hair-raising and heartbreaking and impossibly complex—that shaped her as both a physician and a mother.

Just two months before the September 11 terrorist attacks, Dr. Judy Melinek began her training as a New York City forensic pathologist. With her husband T.J. and their toddler Daniel holding down the home front, Judy threw herself into the fascinating world of death investigation—performing autopsies, investigating death scenes, counseling grieving relatives. Working Stiff chronicles Judy’s two years of training, taking readers behind the police tape of some of the most harrowing deaths in the Big Apple, including a firsthand account of the events of September 11, the subsequent anthrax bio-terrorism attack, and the disastrous crash of American Airlines flight 587.

Lively, action-packed, and loaded with mordant wit, Working Stiff offers a firsthand account of daily life in one of America’s most arduous professions, and the unexpected challenges of shuttling between the domains of the living and the dead. The body never lies—and through the murders, accidents, and suicides that land on her table, Dr. Melinek lays bare the truth behind the glamorized depictions of autopsy work on shows like CSI and Law & Order to reveal the secret story of the real morgue.

About the Authors

tj-mitchell-dr-judy-melinekJudy Melinek, M.D. is a graduate of Harvard University. She trained at UCLA in medicine and pathology, graduating in 1996. Her training at the Office of the Chief Medical Examiner in New York is the subject of her memoir, Working Stiff, which she co-wrote with her husband. Currently, Dr. Melinek is an Associate Clinical Professor at UCSF, and works as a forensic pathologist in Oakland. She also travels nationally and internationally to lecture on anatomic and forensic pathology and she has been consulted as a forensic expert in many high-profile legal cases, as well as for the television shows E.R. and Mythbusters.

T.J. Mitchell, her husband, graduated with an English degree from Harvard and has worked as a screenwriter’s assistant and script editor since 1991. He is a writer and stay-at-home Dad raising their three children in San Francisco. Working Stiff is his first book.

Interviewing Children of Homicide

Interviewing Children
GENERALLY ACCEPTED GUIDELINES

1. Avoid bias; explore alternative hypotheses or explanations

The most important thing for a child interviewer to do to obtain a reliable statement from the child is to have no preconceived belief as to what happened. The approach should be one of hypothesis-testing. Unfortunately, many interviewers try to get the child to say things which confirm what they already think happened. The importance of avoiding bias and taking a hypothesis-testing approach is basic and is specifically addressed by most of the articles that discuss interviewing guidelines. For example, Ceci and Bruck (2) note that “Interviewer bias influences the entire architecture of interviews and is revealed through a number of different component features that are highly suggestive” (p. 80). If the interviewer has a preconceived belief about what happened, he or she is likely to ask questions and get answers that confirm this belief. A number of classic studies in social psychology demonstrate the powerful effect of preconceived beliefs on information an interviewer or experimenter gets (30, 31, 32). Several recent studies show the effects of interviewer bias on the accuracy of statements made by children in interviews (2, 33, 34) as well as in other situations
(35).

To avoid biasing the interview, the interviewer must explore alternative hypotheses. One is that the abuse occurred as alleged. But there are other possibilities. In general, alternative hypotheses often include the following (these are not exhaustive, but are offered as examples):

The allegations are basically valid, but the child has substituted a different person for the perpetrator.

Some of the allegations are valid, but the child has invented or been influenced to make additional allegations that are false.

  •  The child misperceived innocuous or inappropriate but non-abusive behaviors as sexual abuse.
  •  The child has been influenced or pressured to make a completely false allegation to serve the needs of someone else.
  •  The child has made a false allegation for personal motives of revenge, gain, to show off to a peer, or to help someone else.
  •  The child has fantasized the allegations, possibly because of psychological problems.
  •  The child initially made up the allegations but has talked to several people about them and they have now become real to the child.
  • The child saw pornographic magazines and pictures, saw a pornographic movie, or observed adults engaged in sexual activities, and this contributed to the allegations she later made.
  •  The child engaged in sex play with peers or siblings, and then accused an adult.
  • The child was questioned repeatedly by adults who believed the child had been abused, and the child began making statements to please the adult, who then reinforced the child with attention or praise.
2. Videotape (or at least audiotape) all investigatory interviews

There is a strong consensus that forensic interviews of child witnesses should be videotaped, or at least audiotaped. Only electronic recording can ensure an accurate record of the interview. Without a tape, there is no way to know just what was said by the interviewer to elicit a response from the child. There is no way to know just what the child said. There is no way to determine whether the child’s statements are the result of a leading, coercive, and contaminating interview rather than the child’s account from his or her own memory and personal knowledge. There are no good reasons for not taping an investigatory interview of a child witness and many compelling reasons for doing so (36-41).

Even experienced interviewers are unable to accurately recall their specific, verbatim questions and the child’s answers that are necessary for evaluating an interview (42). This includes times when they take verbatim notes during the interview (38). Reports based upon the recollections of interviewers are likely to be inaccurate and underestimate the degree to which they used closed and leading questions as opposed to open-ended prompts. When there are no tapes of an interview, there is no way to know the extent to which a child’s statements are in response to leading and suggestive questioning. If it is impossible to videotape the interview (for example. a police officer must take a statement at the child’s house), it can be easily audiotaped.

3. Interview the child alone

The child should be interviewed alone unless he or she is too young to separate from the parent. A parent or other supportive adult sitting in on the interview can either intentionally or inadvertently cue the child and contaminate the interview. The only exception to this is when a very young child refuses to separate from a parent. But this is not desirable and in such cases the parent should be cautioned not to participate in the interview or cue the child in any way. Also, following the rapport phase of the interview, if the child seems comfortable, the interviewer can ask the child if the parent can leave and wait nearby.

There should also be only one interviewer. To the extent that the child perceives pressure to say what she thinks the interviewer expects to hear, more than one interviewer will increase this perceived pressure. Also, children are more likely to go along with what they believe an interviewer expects if the interviewer is identified as an authority figure (2). I have seen tapes of interviews with as many as four or five adults present in the interview, including police officers in uniform wearing guns. If it is considered necessary for a team to be jointly involved in the interview (such as a social worker from child protective services and a police officer), the team can discuss in advance what topics need to be addressed and then only one person interview the child. The other person can observe the interview through a one-way glass mirror and there can be an opportunity to consult before the interview is over.

4. Have a rapport building phase at the beginning

There should be a rapport building phase at the beginning of the interview. One purpose of this part of the interview is to talk about neutral topics and help the child become more comfortable. But it is also to encourage and teach the child to give information to the interviewer. The interviewer should avoid asking a series of closed and forced choice questions during this phase of the interview.

Such questions tell the child that this is like school where there are right and wrong answers and the teacher knows the right answer and is testing the child to see if the child also knows. Adults routinely test children by asking them questions to which the adult already knows the answer and children are not accustomed to being questioned by authoritative adults when only they have the information and the adult does not.

But in investigative interviews, the child is the source of novel information. Therefore the interviewer must let the child know from the beginning that only he or she has the answers. The interviewer must explain the child’s role, motivate the child to give detailed and complete accounts of events they have experienced, emphasize the importance of telling only about true events that actually happened, and encourage the child to correct inaccurate statements made by the interviewers (43). This is best accomplished by beginning the interview with open questions where the interviewer clearly does not have the information.

5. Have a practice interview

During the rapport phase there should be one or more practice interviews where the child is asked open questions about neutral topics, such their last birthday party or the first day of school, and encouraged to give detailed narrative answers. These practice interviews allow the interviewer to gauge the child’s memory and ability to describe past events. They also allow the child to practice giving information in response to open, nonleading questions. Research indicates that interviewers get better information from children when they begin with such practice interviews (43). Children who have the opportunity to practice giving lengthy narrative responses to open-ended questions in the rapport phase continue this behavior in the substantive part of the
interview.

6. Provide ground rules

Young children have a tendency to try to answer any question an adult asks and may provide answers to unanswerable questions such as “Is milk bigger than water?” or “Is red heavier than yellow?” (44). Therefore, child interviews should begin with ground rules that include telling the child the interviewer doesn’t know the answers and that it is all right for the child to say “I don’t know” or “I don’t remember,” and that the child should correct the interviewer if she says something wrong. It helps if the interviewer practices the ground rules by asking an unanswerable question (e.g., “What is the name of my cat?”) and praising the child when he or she says, “I don’t know.” The interviewer can also deliberately get information wrong (e.g., “You said you have a younger sister and an older brother” when the child has two brothers) and then reinforce the child for correcting the interviewer.

Examples of ground rules include:

  • I wasn’t there and I don’t know what happened. Please tell me everything you can remember.
  • It’s all right to say “I don’t know” if you don’t know the answer: Please don’t guess.
  •  If you cannot remember everything, that’s okay. It’s all right to say “I don’t remember.”
  • If I misunderstand something you say, please tell me. I want to understand everything you say.
  •  If I get something wrong, please correct me.
  • It’s important to only talk: about things that really happened. We don’t talk about make believe or pretend.
  • If you don’t understand something I say, please tell me and I will try to say it using different words.
7. Ask open questions and encourage a free narrative from the child

The most reliable and forensically useful information from children is obtained by encouraging the child to give a free narrative of the alleged events and by asking a series of open, nonleading questions (e.g., who?, what?, when?) or asking the child to “tell me everything you remember about …” The research evidence is clear: freely recalled information is more likely to be accurate than information obtained in response to yes/no and forced choice questions. Consequently, all of the articles discussing guidelines for child forensic interviews make this recommendation. Even children as young as four can provide substantial amounts of forensically relevant information in response to free-recall prompts (45). This means that interviewers do not have to rely on forced choice and yes/no questions even with preschoolers.

The substantive portion of the interview should be also introduced in as open a way as possible. The NICDH investigative interview protocol gives detailed examples of how to progressively phrase such beginning questions (16) and how to continue the interview using open-ended prompts. Some examples of how to use open-ended probes to introduce the topic of the interview include:

  • Do you know why you came here to talk to me today?
  • Now that I know you a little better, I want to talk about why you are here today.
  • Tell me why you came to talk to me.
  • I understand some things have been happening in your family. Tell me about them.

Whenever the child gives response that is on track, the interviewer should encourage a narrative response by asking, “Tell me everything you can remember about that.” When the child pauses, the interviewer should follow up with additional open-ended prompts such as, “And then what happened?,” “Tell me more about that.” Such open questions should constitute as much of the questioning as possible. Interviewers can ask the child to repeat something that wasn’t clear or encourage the child to continue the narrative by repeating a phrase, but they should never interrupt the child to redirect the interview or to ask specific questions. Only when it is clear that the child is not going to provide additional information in response to the open-ended prompts should the interviewer turn to specific questions.

8. Pair specific questions with opened-ended prompts

After obtaining as much information as possible with open questions, interviewers may need to ask specific questions to address important areas that have not been mentioned by the child. When this is necessary, it should be later in the interview; such questions should not be asked at the beginning. But it is a common error for interviewers to ask specific questions rather than encouraging narrative responses (23, 46, 47). When a more specific question must later be asked, it should be paired with an open question. For example, if the child is asked if his clothes were on or off and says, “Off,” the interviewer could then say, “Tell me everything about how they got off” If the interviewer asks if anything happened in the bedroom and the child says, “Yes” the interviewer can then say, “Tell me everything that happened there.” The risk of getting inaccurate information from such closed questions can be minimized if they are paired with an open-ended prompt.

9. Avoid pressure, coercion, suggestion through giving the child information, asking leading questions, and repeating questions

Although open-ended questions can be repeated without contaminating the child’s statements, interviewers should avoid repeating specific, closed, and yes-no questions. When children are asked the same question repeatedly, they can change their answers to conform to what they think the interviewer wants to hear (2, 3, 48).

Interviewers should never ask suggestive questions which provide information about allegations. The general principle is that the interviewer shouldn’t ask a question about something unless the child has already brought it up. Obviously, pressure and coercion should never be used. All the guidelines warn against this. But in practice, many interviews are leading and suggestive (see 2 and 49 for transcripts of suggestive interviews). Even with the attention paid to the importance of avoiding contaminating interviewing techniques, this remains a problem (23). I regularly review videotapes that include closed, forced choice, and leading and suggestive questions with few open-ended prompts.

10. Avoid play, fantasy, and imagining

The interviewer should avoid using such terms as “pretend” or “imagine” or engage in imaginative play as part of the interview. False disclosures of abuse can sometimes occur in response to techniques involving fantasy, imagery, visualization and reenactment during play (24). Guided imagery techniques can be particularly suggestive and can lead to the child confusing an imagined event for something that really happened. Techniques such as having puppets talk to each other, as were used in the McMartin preschool case, should be avoided.

11. Avoid reinforcing specific responses

Social reinforcement can have a powerful effect on behavior and interviewers should never selectively reinforce specific responses. Research shows that such reinforcement during interviews can readily elicit false allegations of wrongdoing from children (50, 51). Wood and Garven (25) note that several types of interviewer behavior are forms of selective reinforcement or punishment that can contaminate interviews, including:

  • Praising the child for making allegations
  • Implying that the child is being helpful or showing intelligence by making allegations
  • Criticizing the child’s statements by suggesting they are wrong or inadequate
  • Giving tangible rewards such as food following disclosures

Limiting the child’s mobility (e.g., letting the child go to the bathroom or terminating the interview) until the child has talked about the topic of interest to the interviewer
Although it is important to create a warm and supportive environment, all such selective reinforcement of the child’s responses must be carefully avoided.

CONTROVERSIAL TECHNIQUES

There is no research supporting the use of anatomical drawings where body parts are named, and these are not generally recommended as part of an interview protocol. There is an indication that such drawings may decrease the reliability of the information obtained (52). When used at the beginning of the interview, the anatomical drawings may communicate to the child that what is to be discussed is body parts and touching. They may confuse very young children who don’t understand that a drawing of a naked body has an abstract relationship to an actual person (53). The drawings should not be necessary with older children. I recently reviewed a taped interview in which the interviewer showed anatomical drawings to a 13-year-old girl of normal intelligence and then asked if she were a girl or a boy. Since interviewers should encourage a child to perform at as a mature and effective level as possible, beginning the interview by asking a teenager such a question detracts from the serious purpose of the interview.

There are similar criticisms about discussions of good touch / bad touch. Guidelines on how to conduct forensic interviews of children do not mention beginning the interview with good touch – bad touch discussions. Wood, McClure, and Birch (26) observe that agencies continue to use the good touch / bad touch discussion for no particular reason other than they had been doing it for years. I continue to see good touch / bad touch discussions in tapes I review. I am unaware of any research supporting this procedure. What it risks is telling the child from the beginning that the purpose of the interview is to talk about genital touching.

Most guidelines do not recommend using anatomical dolls. The few that do caution how they are to be used (e.g., 7, 9, 10, 27, 28). Yuille, et al., (28) note that they should be used only as a last resort and Carnes et al. (9) state that they should be used with “caution” and “only when absolutely needed.” But there are often problems with the way the dolls are used by practitioners in the field (54). In addition, very young children cannot use dolls as symbols or representations for themselves, and make more errors when using the dolls (55). Wolfner, Faust, and Dawes (56) critique the dolls and their failure to add incremental validity to the interview. Many professionals oppose their use. The conclusion, therefore, is that the dolls are controversial and not generally accepted in the scientific community (57, 58). There is no evidence that they add to the completeness and accuracy of the information obtained and they are susceptible to increasing the suggestiveness of the interview.

INTERVIEWS IN THE FIELD

There is now a clear consensus in the professional community as to how children should be interviewed. But this hasn’t always translated to workers in the field. For example, estimates of the frequency of the use of leading questions that introduce information to children vary from 13% to 60% with the majority in the 40% to 50% range (59).

In 1990 Underwager and Wakefield (49) reported on an analysis of 36 actual cases involving 150 interviews and 62 interviewers. The interviewers didn’t encourage free recall; instead they relied on closed questions, pressure, and suggestion and they appeared to be trying to substantiate abuse they had already concluded was real.

In 1996 Warren et al. (23) looked at 42 transcripts of sexual abuse interviews conducted by child protective services personnel and found that the interviewers failed to follow practices recommended by researchers on children’s testimony. The interviewers rarely conducted practice interviews, seldom provided ground rules, and failed to begin with open-ended questions, instead relying on specific, yes-no questions throughout. They frequently introduced new material not previously disclosed by the children. That same year Lamb et al. (60) reported on their examination of 22 audiotaped interviews from 12 field interviewers in Israel. Most questions were directive rather than open-ended, and many were leading.

In 2004 Gilstrap (59) examined 80 interviews conducted by 41 field interviewers with 40 children ages 3 to 7 about staged events. She compared the behavior of these real world interviewers to the types of questions studied in research settings. She found that the field interviewers asked a substantial amount of leading questions (42%) and that approximately one-third of the leading questions introduced inaccurate information. The field interviewers repeated questions 12% of the time and introduced novel information 18% of the time.

Saywitz and Geiselman (61) observe that interviewing guidelines designed to maximize the completeness of children’s reports are not always based on the realities of work conditions on the front lines. A problem for workers in the field is that although young children’s spontaneous descriptions of past events are accurate, their descriptions are often too incomplete to be useful. Important legal decisions cannot be made without more information. Although field workers can gather additional information with more questions, their methods risk undermining the accuracy of the children’s statements. Saywitz and Geiselman have therefore developed approaches specifically geared to field workers to elicit more complete and consistent accounts from children. These approaches, narrative elaboration, and cognitive interviewing, are based on research in their laboratories and appear to be a promising way for field interviewers to get more complete but accurate information from young children. Researchers from the National Institute of Child Health and Human Development have also reported on field studies of their interview protocol (NICHD protocol) which demonstrate that with their protocol even young children can provide a substantial amount of forensically relevant and accurate information in response to free-recall prompts (12, 16, 45, 46, 47).

CONCLUSIONS

Research over the last several years dramatically demonstrates the importance of properly interviewing child witnesses. Interviewers with preexisting biases who ask leading, suggestive, questions risk confirming their beliefs and getting false information. There is now a clear consensus in the scientific community about how children must be interviewed in order to get accurate, uncontaminated, forensically useful information. Unfortunately, field interviewers aren’t using these techniques. Instead, they readily slip into undesirable behaviors that risk compromising the integrity of the interview and the reliability of the information the child gives them.

Article Reprint:

Guidelines on Investigatory Interviewing of Children: What is the Consensus in the Scientific Community?

Hollida Wakefield*

American Journal of Forensic Psychology, 24(3), 57-74