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MEDS 425: Medical Examiner-Coroner: Investigating Death

FALL 2014

Weekday TBA 1 hour 50 minutes

2 units

INSTRUCTORS:

• Lakshmanan Sathyavagiswaran, M.D., F.R.C.P. (C), F.C.A.P., F.A.C.P.

Chief Medical Examiner –Coroner/Director, County of Los Angeles (retired)

Clinical Professor of Pathology and Medicine, Keck School of Medicine of USC

• Guest Faculty from the Keck School of Medicine

• Office Address: Health Science Campus, Keith Administration Building (KAM) 100F

• Office Phone: 323-442-4300

• Office hours by appointment only.

ADMINISTRATIVE ASSISTANT:

• Erin Yamauchi

o eyamauch@usc.edu

Introduction and Purpose

The chief medical examiner-coroner of Los Angeles County is responsible for determining the cause of all violent, sudden, accidental and traumatic or unusual deaths; unattended deaths; deaths in which a criminal act is suspected and such other deaths as are provided by law, and natural deaths where the decedent has not seen a physician within 20 days prior to death.

This course will emphasize the team-based approach used by qualified forensic scientists, medical examiners and coroner investigators to investigate the circumstances and determine the cause and manner of death of decedents falling under the jurisdiction of the coroner. The need for compassion, integrity, and following of rigorous scientific standards will be emphasized. This will have the greatest impact on the grieving next of kin and families of the decedent by bringing them closure.

Students will be exposed to a myriad of medical and forensic science professionals during the course and career paths in forensic medicine will be explored.

Upon successful completion of this course, the student will have a working knowledge of:

1. Career paths in the forensic sciences following undergraduate studies

2. Role of the Medical Examiner-Coroner in the community and public health /Coroner Law

• Coroner law: mandate including local practices for accepting Coroner cases in Los Angeles County.

• Team approach in medico-legal death investigation.

3. Learn the benefits of autopsies in evaluating natural and unnatural deaths.

4. Role /value of a medico-legal autopsy/forensic toxicology and importance of following procedures as they relate to evidence collection/submission and maintenance of chain of custody.

5. Understand Manner of Death determination and evaluation of deaths under medical care

6. Overview of investigation of traumatic deaths:

• Describe and different types of firearm injuries. Understand range of fire.

• Describe sharp/blunt force injury patterns and help understand class characteristics of possible causative instruments /objects.

• Describe different types of asphyxia deaths.

7. Overview of investigation of pediatric and elder deaths from abuse and neglect.

8. Overview of mass fatality management and handling of high-profile cases.

Course Requirements and Grades

• Recommended textbooks for the course:

a)Spitz and Fishers’s –“MEDICO LEGAL INVESTIGATION OF DEATH” 4TH EDITION,2006

b) College of American Pathologists - CAP Press and Publications-- cappress -Handbook of Forensic Pathology,2003

c) Principles of Forensic Toxicology, Revised and Updated 2nd Edition [Paperback]

Barry Levine (Author)

• Course material will be drawn from a variety of sources and catalogued on-line using the on-line learning management system.

• Course materials include a selection of articles from the peer-reviewed medical literature. These required readings are listed below under Class Sessions.

• The course will consist of one 110 minute meeting each week, which will involve a dynamic combination of lecture, videos, class discussion and special guests.

• Prior to each class meeting, students will receive communication with material to read, listen to, and/or watch in preparation for the session. Students will be expected to be able to discuss the material during class.

• After each meeting, students will receive an email with questions involving material from the session. These questions will not be graded, but will instead act as practice questions for the final examination.

• Grading breakdown: Letter Grade

10% of the grade will be for attendance and participation

35% of the grade will be for the mid-term examination

55% of the grade will be for the final exam

Grading Scale:

A 94-100

A- 90-93

B+ 87-89

B 83-86

B- 80-82

C+ 77-79

C 75-76

C- 74-70

D+ 69-67

D 66-64

D- 63-60

F 59-0

Examinations:

Exams will be multiple choice and/or short answer questions or short essays as appropriate and will cover didactic information provided within the class discussions and readings.

Class Sessions: 1 hour 50 minutes

Week 1: Introduction to the Role of the Coroner /ME in Los Angeles county-Coroner Law/stake holders/career paths

Recommended Reading:

a) website: Select student careers/ “So you want to be forensic scientist”

b) website: coroner.

c) Selecting Forensic Pathology as a Career: A Survey of the Past with an Eye on the Future. Hanzlick, R., Prahlow JA., Denton S., Jentzen J., Quinton R., Sathyavagiswaran L., and Utley S. The American Journal of Forensic Medicine and Pathology, Volume 29 No 2, June 2008.

Week 2: Scene investigation and the role of Coroner/ME investigator

Recommended reading:

a). Guide to Death Scene Investigation: Documenting and Evaluating the Body  · PDF file

Week 3: Identification of Human remains/Next of Kin Notification

Recommended reading:

a) Department of Defense updated policy on recovery of remains and identification- remains_policy.

b) DOJ—Notification procedures/ Guide to Death Scene Investigation: Documenting and Evaluating the Body  

Week 4: Forensic Toxicology and Evidence collection/Preservation

Recommended reading:

a). Guidelines for Obtaining Specimens for Post mortem Toxicological Analysis- guidelines.html

b) Post-mortem drug redistribution — A toxicological nightmare - Original Research Article

Forensic Science International, Volume 45, Issue 3, April 1990, Pages 253-263

Derrick J. Pounder, Graham R. Jones

Week 5: Postmortem change/Time of Death determination

Recommended reading:

a) “The estimation of the Time of Death in the early postmortem period”, Claus Henssge, 1995

b) “Stomach contents and Time of death” Frederick A.Jaffe ,The American Journal of Forensic Medicine and Toxicology10(1)37-41,1989

Week 6: Medicol-egal investigation of Deaths while under Medical care/ME-Coroner and Public health

Recommended reading:

a) “Medical Homicide/Neglect” James Gill MD et all-American Journal of Forensic Medicine and Pathology, March 2009,Volume 30,No.1

Week 7: Mid-Term Examination 1 hour 50 minutes

Week 8: Role of Consultants-Odontology/Neuropathology/Anthropology

Recommended Reading

a)Spitz and Fishers’s –“MEDICO LEGAL INVESTIGATION OF DEATH” 4TH EDITION,2006

b) College of American Pathologists - CAP Press and Publications-- cappress -Handbook of Forensic Pathology,2003

c) Investigation of homicides interred in concrete – the Los Angeles experience. Toms, C., Rogers C., Sathyavagiswaran L. Journal of Forensic Sciences 53(1):203-207, 2008

Week 9: Role of Consultants-Anesthesiology/Surgery/Radiology/Cardiology

Recommended Reading

a)Spitz and Fishers’s –“MEDICO LEGAL INVESTIGATION OF DEATH” 4TH EDITION,2006

b) College of American Pathologists - CAP Press and Publications-- cappress -Handbook of Forensic Pathology,2003

c) Pacemaker defibrillator evaluation of Los Angles County Department of Coroner. Saint-Martin P., Rogers, C., Muto J., Boyle NG, Reiders D., Sathyavagiswaran L., Journal of Forensic Science 53(5):1-6, July 2008.

Week 10: Traumatic deaths-Firearms

a)Spitz and Fishers’s –“MEDICO LEGAL INVESTIGATION OF DEATH” 4TH EDITION,2006

b) College of American Pathologists - CAP Press and Publications-- cappress -Handbook of Forensic Pathology,2003

Week 11: Traumatic deaths Sharp/Blunt force trauma/asphyxia

Recommended Reading

a)Spitz and Fishers’s –“MEDICO LEGAL INVESTIGATION OF DEATH” 4TH EDITION,2006

b) College of American Pathologists - CAP Press and Publications-- cappress -Handbook of Forensic Pathology,2003

Week 12: Psychological autopsies /Death review teams

Recommended Reading:

a)“Evolution of the Psychological autopsy: Fifty years of Experience at the LA county Chief ME-Coroner’s office” Timothy Botello MD et al ,Journal of Forensic sciences, July 2013,Volume 58,No.4

b)“Child Fatality Review” did chapter entitled “Suicide Case Studies”, Textbook edited by Dr. R. Alexander, by G. W. Medical Publishing; L. Sathyavagiswaran, MD, and M. Pines, PhD., 2007.

c) "Child and Adolescent Suicide in a Large, Urban Area: Psychological, Demographic, and Situational Factors", LE. Weinberger, S. Sreenivasan, L. Sathyavagiswaran, E. Markowitz; J. Forensic Science 2001: 46(4) pg 902-907.

Week 13: Pediatric /Elder Death abuse/neglect

Recommended Reading:

a)Spitz and Fishers’s –“MEDICO LEGAL INVESTIGATION OF DEATH” 4TH EDITION,2006

b) College of American Pathologists - CAP Press and Publications-- cappress -Handbook of Forensic Pathology,2003

c) Willoughby V, Heger A, Rogers C, Sathyavagiswaran L. Sexual assault documentation program. Am J Forensic Med Pathol 2012 Mar;33(1):22-5.

d)“Child Fatality review , An Interdisciplinary Guide “by Randall Alexander MD,Phd,FAAP,2007

e)Kirschner RH and Wilson HL “Fatal Child abuse ;the pathologist perspective “In Reece RM(Ed) Child abuse, Medical Diagnosis and Management,Willianm and Wilkins publication 1996

Week 14: Mass fatality management/Bioterrorism -the Los Angeles Experience

Recommended Reading

a)Spitz and Fishers’s –“MEDICO LEGAL INVESTIGATION OF DEATH” 4TH EDITION,2006

b) College of American Pathologists - CAP Press and Publications-- cappress -Handbook of Forensic Pathology,2003

c)“Anthrax” Mark LaForce,Clinical Infectious Diseases,1994;19:1009-14

Week 15: High profile deaths/case management /media relations/court testimony

FINAL EXAM 1 hours 50 minutes

Statement for Students with Disabilities

Any student requesting academic accommodations based on a disability is required to register with Disability Services and Programs (DSP) each semester. A letter of verification for approved accommodations can be obtained from DSP. Please be sure the letter is delivered to me as early in the semester as possible. DSP is located in STU 301 and is open 8:30 a.m.–5:00 p.m., Monday through Friday. The phone number for DSP is (213) 740-0776.

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