Did You Know?
Due to the increase and complexity of the investigations conducted by the Coroner's Office, it was necessary to establish a way to preserve scenes until the arrival of the coroner and law enforcement. A logical place to start seemed to be with the emergency personnel from the fire departments and ambulance services since they are the first to arrive on scene. The idea is that if these personnel know what the Coroner and law enforcement agencies are looking for, they can better preserve these scenes prior to their arrival.
The program begins with a description of the duties of the coroner's office and the various reporting procedures. A form created by the Coroner to be completed by ambulance service personnel while waiting the arrival of the coroner and law enforcement provides crucial information which may be lost during the response. A brief description of a case is given with emphasis placed on what the coroner is looking for when processing the scene and what is done with the evidence that is collected. This has resulted in fewer scenes being disrupted and allowing for the Coroner and police to better process the scene.
Deaths: Natural vs. Unnatural
A natural death is any death which is the direct result of the progression of a natural, medically recognized disease process. Widespread cancer, acute myocardial infarction due to arteriosclerotic coronary artery disease (heart attack), or chronic obstructive pulmonary disease are all examples of progressive, medically recognized natural disease processes which may ultimately result in the death of the individual. The foreseeable and expected complications of these disease processes would also be classified as natural.
A death falls into the unnatural category when there is an outside intervening influence or circumstance not recognized as a medical disease process which either initiates the lethal chain of events or contributes to the individuals demise. Acute renal failure due to hemolytic uremic syndrome would be classified as natural. Acute renal failure due to antifreeze ingestion would be classified as unnatural with the actual manner (homicide, suicide, or accident) pending additional investigation by the coroner. Acute peritonitis due to a ruptured appendix would be classified as natural, while acute peritonitis due to stab wound of the abdomen would be classified as unnatural with the actual manner (homicide, suicide, or accident) pending additional investigation by the coroner.
Factors which may be contributory to a person's death can make that death unnatural as well.
- An individual with terminal cancer who is on pain medication may either intentionally take, accidentally take, or in certain cases be given excessive medication which would hasten their demise.
- An individual with moderate coronary artery disease who dies while using cocaine for recreational purposes, even though the drug levels are not in the lethal range, would still have cocaine ingestion listed as a contributory cause, thus making the cause of death arteriosclerotic coronary artery disease contributed to by cocaine ingestion. The manner of death would be accidental as a result of the contributory cause.
- Hip fractures in the elderly which exacerbate underlying natural disease processes would have as the cause of death the underlying natural disease process contributed to by the hip fracture. The manner of death would be accidental as a result of the contributory cause, in this case, the hip fracture.
Manner of Death
There are five manners of death:
Homicide, Suicide, Accident, Natural, and Undetermined. The manner of death is the circumstance in which the cause of death came about. The cause of death (bronchopneumonia) can still be the same despite different manners. Bronchopneumonia is still bronchopneumonia and would not change as the cause of death if it resulted from homicidal gunshot wound of the chest, suicidal barbiturate overdose with subsequent coma and aspiration of secondary to blunt traumatic chest injuries in a motor vehicle accident. What would change would be the manner.
Any death where there is even the remote possibility that the underlying cause of death is anything but natural must be reported to the Coroner's office, despite the length of time between the initial insult and death. For example, in May of 1991, an individual who in 1954 developed a well-documented seizure disorder as a result of homicidal gunshot wound to the head is witnessed to have a seizure while in the shower, falls and is scalded. In the hospital he develops bronchopneumonia and dies. The cause of death would be bronchopneumonia, due to thermal injury, due to seizure disorder, due to gunshot wound of the head. Despite the 36-year time interval between the head wound and the pneumonia, "but for" the gunshot wound he would not have had the seizure disorder which led to the dependent and related sequence of events ultimately responsible for his demise. Legally, the manner of death in this case was correctly certified as homicide.
As the above case demonstrates, autopsy alone rarely determines the manner of death. The autopsy is only one facet of the entire investigative process involved in determining a manner of death. A complete medical history, police report, scene investigation and the terminal events must be taken into account if one is to correctly certify the manner of death.
Cause of Death
The cause of death is the etiologically specific disease or injury which initiates a dependent and related sequence of events ultimately responsible for the death of that individual. The cause of death is the "but for" without which the individual would not be dead.
The time interval between the initial injury and death can be instantaneous, as in a massive intracranial hemorrhage due to hypertensive cardiovascular disease, or it can be days, weeks or months between the initial event and death. Bronchogenic carcinoma may be present for months before the tumor eventually erodes a major blood vessel resulting in exsanguination or causes sufficient obstruction as to create a favorable environment for a lethal pneumonia.
Sometimes there may be confusion regarding the actual cause of death, especially if a considerable time interval between the initial insult and death has passed and multiple disease processes have come into play. For example, an individual with massive abdominal injuries secondary to a motor vehicle accident develops acute peritonitis, becomes septic with seizures and subsequently expires a result of aspiration pneumonia; the blunt traumatic injuries to the abdomen are still the underlying cause of death. "But for" the abdominal injuries, none of the other disease processes would be likely to occur in and of themselves.
Another consideration is that the sequence must be dependent and related. An independent supervening factor which would not be a reasonable and foreseeable consequence of the initial disease or injury would alter the cause and manner of death. For example, if our motor vehicle accident patient inadvertently receives a wrong or lethal dose of medication which eventually kills him, that would be an independent supervening factor which is certainly not a reasonable and foreseeable consequence of his initial injury and thus falls under the jurisdiction of the Coroner.
By now you must realize that there is much more to the Coroner's Office than once thought. It takes many hours to investigate, autopsy if needed, complete written documentation, make proper notifications, interface with many agencies, and much more to complete a thorough and timely medicolegal death investigation for the families we serve.
According to Section 9525.3. Elected Coroners to Take Course of Instruction and Pass Examination
- Successful examination - After the effective date of this act, no person elected for the first time to the Office of Coroner in this Commonwealth shall be eligible to take the oath of office unless he has attended the course of instruction and successfully passed the examination given at the conclusion thereof unless, for just cause, the board postpones his attendance and examination. In the event the person so elected fails in either of these respects without being excused, there shall be deemed to be a vacancy in the office and it shall be filled in accordance with law. No person having served as Coroner in Pennsylvania prior to the effective date of this act shall be required to attend instructions or pass this examination if reelected or appointed subsequent to the effective date of this act. This provision shall also apply to chief deputies and full-time deputies who have been appointed prior to the effective date of this act. 1988, March 2, P.L. 108, No. 22, Sec. 3.
Here are some facts about not just our office, but any coroner in general:
- A coroner is an official of a municipal corporation whose responsibilities include the performance of designated functions, the most important of which is the investigation of the cause of any violent or suspicious death that takes place within the geographical boundaries of his or her municipality.
- The Office of the Coroner was established at common law and was one of great dignity since coroners dealt primarily with pleas concerning the crown. Today, statutes establish the terms and procedure of the coroner's office, which has been replaced in some states with the office of medical examiner.
- The main function of a coroner is to conduct inquests, but other powers and duties may include the duty of acting as sheriff, in the event of the sheriff's incapacity, as conservator of the peace, or as magistrate. The duties are considered to be either judicial, ministerial, or both.
Coroner comes from Anglo-Norman corouner, a word derived from coroune, “crown.” Corouner was the term used for the royal judicial officer who was called in Latin "custos placitorum coronae," or “guardian of the crown's pleas.”
The person holding the Office of Coroner, a position dating from the 12th century, was charged with keeping local records of legal proceedings in which the crown had jurisdiction. He helped raise money for the crown by funneling the property of executed criminals into the king's treasury. The coroner also investigated any suspicious deaths among the Normans, who as the ruling class wanted to be sure that their deaths were not taken lightly. At one time in England, all criminal proceedings were included in the coroner's responsibilities. Over the years these responsibilities decreased markedly, but coroners have continued to display morbid curiosity. In the United States, where there is no longer the crown, a coroner's main duty is the investigation of any sudden, violent, or unexpected death that may not have had a natural cause.