I'm a what done it kind of guy, gave up on the who done it stuff a long time ago. Sometimes I testify in homicide trials and realize after I'm finished that I've never even looked over at the defense table to see who was on trial.

How often does it occur that your conclusions don't follow the narrative of law enforcement and how hard is it to resist their pressure?

Its very rare, and when it does occur I'm on the phone very quickly to address the inconsistency. After that it is their problem to work out why I have found what I found, and how that fits in with their narrative. I'm not there to police the police. Sometimes I give them the case on a silver platter, sometimes 90% of the work has to be on their end to explain why someone died. Otherwise, if no major inconsistencies are present I take their information at face value, and use it like the medical history that any other doctor uses, to make medical opinions. My opinions are just that, and carry no judicial weight.

I cannot think of too many instances where LE has brought malignant pressure to bear on my anatomic findings. What I find anatomically should not be modifiable if I have done my job correctly, anymore so than the severity of a cancer that a hospital pathologist diagnoses. The key is to document as completely as possible.

Manners (homicide, suicide, accident or natural) of death are different. I have had pressure to rule obvious suicides as accidents and such, to spare the family. That's a whole different story and gets way out of what I like to think of as just the practice of medicine. In custody deaths are fraught with these kind of conflicts. Individual on major stimulants, struggling, being shocked, being restrained, in excited delirium, with underlying natural disease, or simply not being in shape to undergo any sort of prolonged struggle. If they die I put in all the factors I believe added up in leading to death as the cause, and depending on the circumstances will many times not feel comfortable with homicide or accident, because there are too many combinational factors. So will place those in the undetermined category, stating in the autopsy report that any criminal or civil legal issues need to be addressed by the appropriate jurisdictional agencies. This kind of classification is variable across the country, some places rule these homicides, some offices rule them accidents. Again its important to note, in my office, categorizing the manner of death has no judicial weight, I can't initiate a murder charge. Technically, assigning a manner of death here is just for epidemiological purposes only, to let the health department know how and why people in this state die. But that doesn't matter many times, because perception is reality, and you have to tread very carefully in these cases. I am not covering up anything, but will happily defer the civil liability or criminality issues of these types of cases to the lawyers.

Lawyers do pressure, that's another story, both civil and criminal, prosecution and defense. I guess they are just born that way. It took a few rough years of getting oriented toward them, felt like I was in a used car lot a lot of times, but I pretty much have a handle on it now. The bottom line is, its their show, they run it, and can spin things however they want; just know the answers to the questions you have for me before you ask them in court, and don't ask the questions you don't like the answers to, because I have gotten pretty good at keeping the important parts of the issue in the big picture.

I imagine there are implications for life insurance too. Did you do it?

Insurance agencies are there to make money. If my findings support them not having to pay someone money, they present them as gold. If not, they use their own doctors to refute my findings, if they can get out of paying the money. They are not obligated to honor the official cause/manner of death in any way.

No, by the time all the info came out it turns out the guy had just bought an insurance policy, and the initial police story fell apart. So I told the cops that all the rapidly arriving conflicting information had left me with no confidence to rule it either way, I ended up ruling it undetermined. The family went after the insurance money, the insurance company hired a very good forensic pathologist to say it was a suicide. I went to court, described the wound and told the judge I was still confused, and without confidence in the initial investigation, and left. Don't know what happened.

In all likelihood it was a suicide disguised by the decedent to look like an accident, something we occasionally see. He went to the land fill to kill rats with his .22, and that's where they found him dead. Was a bizarre wound, contact to the palm of his hand, which was against his chest, the bullet going through the hand, in the chest, to hit the heart.

My morgue tech, was Kenny, big beefy ex high school football star, with all the residual swagger and confidence that gives you, plus growing up in a tough part of the state. As he was taking this guys jacket off, a dead rat falls out. Kenny just loses it, starts screaming like a girl and jumping 10 feet in the first bound, then keeps on running out of the room, screaming, one of the funniest things I've ever seen. Guess Kenny didn't like rats. We found out later he didn't like snakes either. Well I go over and look at the rat, than look at the x-ray, sure enough you could just barely see the little rat skeleton. Then I looked at the rat again, it had been shot.

If this was a disguised suicide, this guy shot a rat, put it inside his coat, to make it seem like it crawled up in there I guess, and in the panic to get it out shot himself and the rat. I don't know, maybe it did happen that way.

How straightforward is it to determine the manner of death once you've done the autopsy? Do defense attorneys ever hire their own forensic pathologist to challenge your conclusions?

edit: I see that insurance companies do try to refute your findings. What about in criminal cases?

More stories plz! Good stuff.

I'm pretty sure Quincy could. You need to step up your game.

Do MEs have this authority in other states?

95% of the time in homicides its clearly obvious its a homicide before the body ever gets to our facility, so no brainer as to the manner ruling. Occasionally its a surprise. We had 3 people in a house trailer fire come in late one day for identification. I was taking a look at the X-rays quickly before going home, hoping they had dental work to help with ID, when I see what I think are bullets. But melted metal in these fires can sometimes look like bullets. A quick look at the very charred remains confirmed my suspicions. So I called the detective, to make sure he had the trailer remnant secured. He told me no they weren't securing it, in fact they had it hauled off. I told him he hauled off his homicide scene. There was a silence, then he said please tell me you're ****ing with me doc. I told him I didn't know him well enough to **** with him that bad. Triple murder, with a pretty good attempt to hide the evidence by fire.

And then we get a mix of other cases which autopsy shows are homicide, a few unrecognized child abuses, adult or child neglect cases raising to fit that grey bar, decomposed bodies with bullets, etc.

All the time on the other forensic pathologists. The defense, even if its a public defender, gets to hire his own experts. I have two cases undergoing the slow journey to trial right now in which other forensic pathologists are coming in, with their huge consulting fees that have to be paid, many times by the state. Its pretty standard.

I had a case of a woman not knowing she was pregnant (happens all the time) claiming she had the baby, thought it was dead and put it in a plastic sack. Then tried to bury it, but it was quickly found by passers-by. My opinion was the baby was born alive, and was then placed in the bag. A lot of disputable variables in that opinion. So the defense attorney wanted to talk to me on the phone, and he sounded really lost, over his head, asked for advice, which is ok, I work for both the defense and the prosecution, although the defense doesn't see it that way most of the times. And I told him he would have to strongly dispute my opinion as to the baby being alive, and it would be legal malpractice if he didn't hire another forensic pathologist to refute my opinion. Which he did, a very good one, who I respected greatly. I even told the jury they should listen carefully to what he had to say, though I stuck to my guns, there was nothing wrong with that baby to cause it to be dead at birth. I think the lawyer got her probation with extensive counseling, but not sure, so he did a good job. If you have ever delivered a baby, they come out floppy and can really look dead to a lay person, so I don't know, she may have really thought it was dead.

Perhaps this is inappropriate, but I'd like to ask what your salary is. Disregard is you're not comfortable.

Also, this is one of the first AMAs that I didn't wonder deep down in side if the OP wasn't just some unemployed kid at home, just pretending. Excellent read.

As far as other Manners of death, it is variable. I don't sign out 50 year old men with heart attacks anymore at the table. I always wait for toxicolgy. Meth is everywhere these days, and its shocking how many of these kind of cases have it in their system. Because of the presence of the drug, its ruled an accident instead of natural.

And toxicology does take our lab 6 weeks to three months. We are overwhelmed with Rx drug abuse deaths. A premium referral lab usually can get reports back in two weeks or less. But we don't have the resources, so have to wait on the cause and manner until we see those results. Those cases are listed as 'pending' until then. Which causes the families that much more pain, but it can't be helped.


I always try to rule for the families in possible suicides if there is any doubt, ruling the manner as undetermined. Of course most suicides are clear cut, even though only 25% or so leave notes. Suicide is a technical manner of death, but there are huge social and religious stigmas that go along with it, and most of the albatrosses I've had hanging around my neck in my career have been suicides. It leaves families with a huge amount of baggage and emotional denial, that sometimes is reflected back to me. For example. You put a gun to your head which you know is loaded, and pull the trigger. Suicide right? But what if 5 of the chambers are empty? Was it Russian Roulette or did he put the loaded chamber under the hammer? Is Russian Roulette suicide? You have voluntarily put a loaded gun to your head knowing that there is a significant chance you are going to kill yourself, suicide. I rule for the family, calling them undetermined, explaining in my report there is the possibility the death was the result of horseplay with a gun.

My salary is listed in the "right to know" section of the on-line web site for our main state paper everyday, as well as being listed in the print section once a year. So I'm used to people knowing it. Its a little bit north of 183k. I have options do to private cases if I need an extra boost, but that is a lot of work, and deep down inside me is a pervasive laziness. I'll just have to depend on my sn date to give me my bona fides, which I had to beg Mason to let me sign back onto after the crash. Amazingly he was pretty nice about it.

Great thread, thanks for doing this.

I hadn't heard about Gary Carson dying, but had picked up somewhere along the way that he was having health problems, so not surprised, I suppose.

I'm having a tough time formulating this question, which means that it's probably a dumb question - since your focus is in pathology, how different is it than "caring for the living"? IOW, would you be able to take a turn as a family practitioner or an ER doctor?

My fiance is blond though, and much younger, and I have a canoe, not a sail boat so I do Quincy out every now and then.

Death investigation systems are highly variable around the country. There are Sheriff-Coroners in California who are not doctors, but are responsible for manner of death classification based on the findings of the pathologist they use to do their cases, and I suppose could generate criminal charges, but don't know for sure. But nowhere I know of is the Doctor considered law enforcement. Its best to keep the pathologist as unbiased as possible.

How does it feel knowing you may be a front line combatant defending all of mankind when the zombie apocalypse comes?

I have to know a huge amount of general medical knowledge in my field, and need to be able to understand and interpret what those guys are doing as it relates to the people I examine, and review of the medical records. But that in no way means I could function as one. Its a real art, and it has to be practiced in a regular way to maintain competence. Retired MDs lose their skills very rapidly, although your general medical knowledge stays with you.

I'm good enough that when employees, friends or loved ones need help I can recognize quickly if they need to go to the ER or pcp, or if I can handle it, which amounts to little more than first aid, or an anti-biotic. I do have to answer a lot of general medical questions though, and try not to make a fool out of myself.

Your plane doesn't kill them?

Otherwise this must be a swoosh, over my head, didn't see the movie etc.

Was she hot? Pics?

Interesting answers. I would have thought "suicide" would be used in a specific objective way, such that the russian roulette would be called suicide regardless of intent. Or do you use a different term, like "self-inflicted" to take away the emotional/legal baggage?

Since you were kind enough to divulge your salary, maybe you can share what kind of car you drive?

No I don't try to remove emotional baggage, can't, but I am for just producing an accurate medical report. Many of my colleagues disagree and think classifying manner of death is the epitome of our practice. But I think the present manner of death categorization is out-moded and unhelpful, and should be changed to more sophisticated list scenarios, like medical coding. In my state many many manners of deaths are filled out by elected lay coroners, who don't have to send the bodies for exam or ask our advice. So as far as statistics, junk in equals junk out at that point. I used to say you can't autopsy intent, just actions, so the argument is valid and there is unending debate among us in our field, but its more like legal logic, I just think its not the real practice of medicine. So its really a matter of convenience, and I find that over the years it has caused me less complications as far as questions from the investigating agency to admit the truth in those "gray" cases, that a word like suicide may not be the best way to describe what happened to the decedent, and since they are giving us no other choices, put it in the not determined category.

I have a 2009 Tundra and a 2010 135i

Nice Truck, although not what I expected, but I guess I'm stereotyping.

Thanks for doing this OP. A couple of dumb questions for now...

Have you ever had a "client?" that you know/recognise?

Are you aware of the West Memphis Three trial?

How big of a deal was it for you to adapt to giving evidence in court? Have you had any incidences of a lawyer getting the best of you and causing you to mince your words, give an impression of evidence or opinion you didn't believe, jeopardise your findings in the eyes of the court or whatever else it is lawyers will try to do?

I did computer forensics which has about 0 in common with your practise except for presenting evidence in court as an expert. One of our teachers would give us mock trials and every single student really struggled with his attacks, I thought it'd be easy but he really had me bothered lol.

Grunching a bit,

has your job affected your eating habits - like, do you ever have a "working lunch"? Has your job turned you off from eating any foods for good, such as liver or spaghetti?