Medicolegal death investigators (MDIs) are a crucial part of the death investigation process but the profession remains unregulated and lacks a required accreditation or licensing process that many other professions use. Research shows the current medicolegal death investigations system, though a crucial government function, has existing deficits in its functionality that affect service delivery. The current study was based on an educational theory and utilized open ended survey questions. Data from 16 investigators was collected through surveys where relevant information was asked in the context of their situation and questions were specific to the phenomenon being studied. The data was analyzed by identifying individual and group descriptions of the experience to understand the overall meaning of their experience. The investigators interviewed had different experiences and varying beliefs in the importance of their role as an investigator. They were confident in their roles and provided detailed descriptions of their responsibilities. Additionally, investigators do not appear to have any direct issues due to educational differences but did embrace their roles as death investigators with a desire toward ensuring both their personal safety and that of society. Although many have acquired training as a result of their employment, they did not feel that the lack of prior training was a hindrance. This study contributes to the literature by providing data for consideration when developing regulations promoting standards within the system. This includes the health and safety of medicolegal death investigators and filling the gap of recognizing the need for standardized regulations by identifying the need for uniform training and safety practices.

Background: Incidental findings (IFs) are reported in 20% or more of trauma CT scans. In addition to the importance of patient disclosure, there is considerable legal pressure to avoid missed diagnoses. We reported previously that 63.5% of IFs were disclosed before discharge and with 20% were nondisclosed. We initiated a multidisciplinary systemic plan to effect predischarge disclosure by synoptic CT reports with American College of Radiology recommended follow-up, electronic medical records discharge prompts, and provider education. Study Design: Prospective observational series patients from November 2019 to February 2020 were included. Statistical analysis was performed with SPSS, version 21 (IBM Corp). Results: Eight hundred and seventy-seven patients underwent 1 or more CT scans for the evaluation of trauma (507 were male and 370 were female). Mean age of the patients was 57 years (range 14 to 99 years) and 96% had blunt injury. In 315 patients, there were 523 IFs (1.7 per patient); the most common were lung (17.5%), kidney (13%), and liver (11%). Radiology report compliance rate was 84% (210 of 249 patients). There were 66 studies from outside facilities. Sixteen IFs were suspicious for malignancy. A total of 151 patients needed no follow-up and 148 patients needed future follow-up evaluation. Predischarge IF disclosure compliance rate was 90.1% (286 patients); 25 were post discharge. Four patients remained undisclosed. Compared with our previous report, clearer reporting and electronic medical records prompts increased predischarge disclosure from 63.5% to 90.1% (p < 0.01, chi-square test) and decreased days to notification from 29.5 (range 0 to 277) to 5.2 (range 0 to 59) (p < 0.01, Mann-Whitney U test). Conclusions: Timely, complete disclosure of IFs improves patient outcomes and reduces medicolegal risk. Collaboration among trauma, radiology, and information technology promotes improved disclosure in trauma populations.

Iris recognition is a validated and non-invasive human identification technology currently implemented for the purposes of surveillance and security (i.e. border control, schools, military). Similar to deoxyribonucleic acid (DNA), irises are a highly individualizing component of the human body. Based on a lack of genetic penetrance, irises are unique between an individual’s left and right iris and between identical twins, proving to be more individualizing than DNA. At this time, little to no research has been conducted on the use of postmortem iris scanning as a biometric measurement of identification. The purpose of this pilot study is to explore the use of iris recognition as a tool for postmortem identification. Objectives of the study include determining whether current iris recognition technology can locate and detect iris codes in postmortem globes, and if iris scans collected at different postmortem time intervals can be identified as the same iris initially enrolled. Data from 43 decedents involving 148 subsequent iris scans demonstrated a subsequent match rate of approximately 80%, supporting the theory that iris recognition technology is capable of detecting and identifying an individual’s iris code in a postmortem setting. A chi-square test of independence showed no significant difference between match outcomes and the globe scanned (left vs. right), and gender had no bearing on the match outcome. There was a significant relationship between iris color and match outcome, with blue/gray eyes yielding a lower match rate (59%) compared to brown (82%) or green/hazel eyes (88%), however, the sample size of blue/gray eyes in this study was not large enough to draw a meaningful conclusion. An isolated case involving an antemortem initial scan collected from an individual on life support yielded an accurate identification (match) with a subsequent scan captured at approximately 10 hours postmortem. Falsely rejected subsequent iris scans or "no match" results occurred in about 20% of scans; they were observed at each PMI range and varied from 19-30%. The false reject rate is too high to reliably establish non-identity when used alone and ideally would be significantly lower prior to implementation in a forensic setting; however, a "no match" could be confirmed using another method. Importantly, the data showed a false match rate or false accept rate (FAR) of zero, a result consistent with previous iris recognition studies in living individuals. The preliminary results of this pilot study demonstrate a plausible role for iris recognition in postmortem human identification. Implementation of a universal iris recognition database would benefit the medicolegal death investigation and forensic pathology communities, and has potential applications to other situations such as missing persons and human trafficking cases.

Thesis (MMed (Pathology. Forensic Medicine))--University of Stellenbosch, 2010. / Bibliography / ENGLISH ABSTRACT: Background - The workload of the forensic pathologist and Forensic Pathology Services staff is increased by the referral of potentially unnecessary natural cases to the Forensic Pathology Services. The primary aims of the medico-legal autopsy are limited to establishing a cause of death in presumed unnatural cases, and to exclude criminality or negligence. Objective – To determine the final outcomes of forensic post-mortem examinations in “sudden and unexpected” adult deaths over a 5 year period. Methods - An observational, retrospective, descriptive study was conducted. ”Sudden and unexpected” adult deaths referred to Tygerberg Forensic Pathology Services between 1 January 2001 and 31 December 2005 were reviewed. Data was collected from the autopsy reports, contemporaneous notes and hospital records. Findings – A total of 816 adult cases of sudden and unexpected death were referred to Tygerberg Forensic Pathology Services over the 5 year period studied. Complete autopsies had been performed in 74% (601/816) of cases. The presumed manner of death was natural in 79 % of cases, and an increase in the number of natural cases autopsied per year was noted over the 5-year study period. Diseases of the cardiovascular, respiratory and central nervous systems were responsible for the majority of natural deaths. Infectious diseases were responsible for most deaths in the youngest age group studied (18-29 years). Acute alcohol poisoning was responsible for the deaths of 35 (6%) cases, with an average blood alcohol concentration of 0.38g/100mL in these cases. Eight deaths were drug-/substance related. Waiting times for blood alcohol and toxicology results increased over the 5-year study period. No cause of death was found in 10.6% of cases. Conclusions -The questionnaire and interviewing structure could possibly be improved in order to obtain better pre-autopsy information and to reduce the number of “unnecessary” medicolegal autopsies, thereby reducing the burden of cost on the Forensic Pathology Services. / AFRIKAANSE OPSOMMING: Agtergrond – Die werkslading van die forensiese patoloog en ander personeel van die Forensiese Patologie Dienste word vermeerder deur die verwysing van moontlik onnodige natuurlike gevalle na die Forensiese Patologie Dienste. Die primêre doelwitte van die medies-geregtelike nadoodse ondersoek is beperk tot die bepaling van ‘n oorsaak van dood in vermoedelik onnatuurlike gevalle, en om nalatigheid of kriminele aksies uit te skakel. Doelwit – Om die finale uitkomste van medies-geregtelike nadoodse ondersoeke in “skielike en onverwagte” volwasse sterftes oor ‘n 5-jaar tydperk te bepaal. Metodes – ‘n Observasionele, retrospektiewe, beskrywende studie is uitgevoer. “Skielike en onverwagte” volwasse sterftes wat verwys is na Tygerberg Forensiese Patologie Dienste vanaf 1 Januarie 2001 tot 31 Desember 2005 is hersien. Inligting is versamel vanaf die nadoodse ondersoekverslae, kontemporêre notas en hospitaalnotas. Bevindinge – Agthonderd en sestien volwasse gevalle van skielike en onverwagte sterftes is oor die 5-jaar periode verwys na Tygerberg Forensiese Patologie Dienste. Volledige lykskouings is uitgevoer in 74% (601/816) van die gevalle. Die vermoedelike wyse van die sterfte was natuurlik in 79.04% en ‘n toename in die aantal natuurlike gevalle wat lykskouings ondergaan het, is waargeneem oor die 5-jaar studie tydperk. Siektes van die kardiovaskulêre, respiratoriese en sentrale senuweestelsel was verantwoordelik vir die meerderheid natuurlike sterftes. Infektiewe toestande was verantwoordelik vir die meeste sterftes in die jongste ouderdomsgroep (18-29 jaar) wat bestudeer is. Akute alkoholvergiftiging was verantwoordelik vir die sterftes van 35 (6%) gevalle, met ‘n gemiddelde bloed-alkohol-konsentrasie van 0.38g/100mL in hierdie gevalle. Agt sterftes was dwelm-/middelverwant. Die wagtyd vir bloed-alkohol en toksikologie resultate het vermeerder oof die 5-jaar studie tydperk. Die oorsaak van dood was nie gevind in 10.6% van gevalle. Afleidings – Die vraelys en onderhoud-struktuur kan moontlik verbeter word om sodoende beter inligting te verkry voor die uitvoering van ‘n lykskouing, en om die aantal “onnodige” medies-geregtelike nadoodse ondersoeke te verminder, en sodoende die kostedruk te verminder op die Forensiese Patologie Dienste.