the role of the forensic nurse in the medicolegal death investigation

The Role of the The Role of the Forensic Nurse in Forensic Nurse in the Medicolegal the Medicolegal

Death InvestigationDeath Investigation

Death Investigation Death Investigation Systems in the Systems in the United StatesUnited States

Three TypesThree Types

Medical ExaminerMedical Examiner CoronerCoroner MixedMixed

DiMaio, (2001), p. 9-18

Medical Examiner vs. Coroner

• Medical Examiner – A licensed physician in

the state in which she/he practices forensic pathology and has been hired by the jurisdiction to investigate sudden and unexpected deaths

• Coroner – An elected official in

the jurisdiction who investigates sudden and unexpected deaths. May or may not be a physician

DiMaio, (2001), p. 9-18

MEDICAL EXAMINER AND CORONER JURISDICTIONS IN THE UNITED STATES - 2002 MEDICAL EXAMINER AND CORONER JURISDICTIONS IN THE UNITED STATES - 2002

DC

State ME, mixed county ME and CoronersState ME, mixed county ME and Coroners

State ME, coroners in every county or State ME, coroners in every county or districtdistrict

Mixed ME and Coroners Mixed ME and Coroners

Coroners in every county or districtCoroners in every county or district

State ME, no coronersState ME, no coroners

District ME, no coronersDistrict ME, no coroners

County ME, no coronersCounty ME, no coroners

Source: Centers for Disease Control. (2004).

What is Forensic What is Forensic Nursing?Nursing?

Forensic NursingForensic Nursing

Application of the nursing process to Application of the nursing process to public or legal proceedingspublic or legal proceedings

Application of the forensic aspects of Application of the forensic aspects of health care to the scientific health care to the scientific investigation of trauma and/or death investigation of trauma and/or death related to medicolegal issuesrelated to medicolegal issues

Lynch, (1993)

Roles within Forensic Roles within Forensic NursingNursing

Clinical Forensic Clinical Forensic NurseNurse

Sexual Assault Sexual Assault Nurse Examiner Nurse Examiner (SANE)(SANE)

Pediatric Forensic Pediatric Forensic NurseNurse

Forensic Forensic Psychiatric NursePsychiatric Nurse

Nurse Death Nurse Death Investigator/CoronInvestigator/Coronerer

Correctional NurseCorrectional Nurse Legal Nurse Legal Nurse

ConsultantConsultant Nurse AttorneyNurse Attorney

Lynch, (1993)

The Forensic The Forensic Nurse Death Nurse Death InvestigatorInvestigator

What is a Forensic Nurse What is a Forensic Nurse Death Investigator?Death Investigator?

A Registered Nurse who:A Registered Nurse who: applies the nursing process to death applies the nursing process to death

investigation across the life spaninvestigation across the life span collaborates with interdisciplinary collaborates with interdisciplinary

agencies agencies identifies trends identifies trends conducts and/or participates in research conducts and/or participates in research promotes health and safety through promotes health and safety through

community education.community education.IAFN, FNDI Standards of Practice, 2004, (draft)

What can a nurse add to What can a nurse add to the death investigation?the death investigation?

Apply nursing knowledge which Apply nursing knowledge which includes anatomy, physiology, includes anatomy, physiology, pharmacology and family interactionpharmacology and family interaction

Questions are formulated based on a Questions are formulated based on a medical knowledge basemedical knowledge base

Aid families and survivors in terms Aid families and survivors in terms of the grieving processof the grieving process

Vessier-Batchen, (2003)

Role of the Role of the Forensic Nurse Forensic Nurse

Death Investigator Death Investigator at the Harris at the Harris

County Medical County Medical Examiner’s OfficeExaminer’s Office

Role in the ME OfficeRole in the ME Office

Obtain death reports per state codeObtain death reports per state code Augment the natural death and Augment the natural death and

infant/child death investigationinfant/child death investigation Conduct post mortem sexual Conduct post mortem sexual

assault/child abuse examinationsassault/child abuse examinations Provide case management for Provide case management for

pathologistspathologists Collaborate with organ/tissue Collaborate with organ/tissue

procurement agenciesprocurement agencies

Harris County Medical Examiner’s Office, (2004)

Role in the ME OfficeRole in the ME Office

Provide link between pathologists Provide link between pathologists and lay investigative staffand lay investigative staff

Communicate COD and MOD with Communicate COD and MOD with familiesfamilies

Educate the community regarding Educate the community regarding death investigation and forensic death investigation and forensic issuesissues

Assist with external examinationsAssist with external examinations

Harris County Medical Examiner’s Office, (2004)

Augmenting the Natural Augmenting the Natural Death InvestigationDeath Investigation

Normally, only uniformed officers Normally, only uniformed officers attend the natural death sceneattend the natural death scene

Other types of death may present as Other types of death may present as a natural deatha natural death

Conduct a more thorough Conduct a more thorough investigationinvestigation

Understand subtle signs of abuse Understand subtle signs of abuse and neglectand neglect

Case ManagementCase Management

Collaborate with pathologist to determine Collaborate with pathologist to determine the appropriate medical recordsthe appropriate medical records

Review medical records once receivedReview medical records once received Obtain follow-up information Obtain follow-up information Organize interagency meetings as Organize interagency meetings as

necessarynecessary

External ExaminationsExternal Examinations

Thorough physical examinationThorough physical examination Review of medical recordsReview of medical records Description via diagrams and Description via diagrams and

dictationdictation Document pathological findingsDocument pathological findings

Evolution of the Evolution of the Forensic Nursing Forensic Nursing Program at the Program at the Harris County Harris County

Medical Medical Examiner’s OfficeExaminer’s Office

Prior to Forensic NursingPrior to Forensic Nursing

In 2002, 80% of deaths that were In 2002, 80% of deaths that were reported were natural deathsreported were natural deaths

Investigators had limited medical Investigators had limited medical knowledgeknowledge

80% of cases brought in to HCME 80% of cases brought in to HCME were autopsiedwere autopsied

Requests/receipt of medical records Requests/receipt of medical records were inconsistentwere inconsistent

Prior to Forensic NursingPrior to Forensic Nursing

Incomplete records were received Incomplete records were received and multiple requests had to be madeand multiple requests had to be made

Medication lists often did not Medication lists often did not correlate with the medical historycorrelate with the medical history

Few inquiries into circumstances that Few inquiries into circumstances that lead up to the deathlead up to the death

Information between pathologists and Information between pathologists and investigators was fragmented at timesinvestigators was fragmented at times

Forensic Nursing Forensic Nursing Integrated in Harris Integrated in Harris

County, TexasCounty, Texas After extensive lobbying by Dr. Joye After extensive lobbying by Dr. Joye

Carter, the Harris County Commissioner’s Carter, the Harris County Commissioner’s Court approved 1 Forensic Nurse positionCourt approved 1 Forensic Nurse position

Job description:Job description: Adjunct to pathologists and investigative staffAdjunct to pathologists and investigative staff Oversee medical record aspect of the Oversee medical record aspect of the

medicolegal examinationmedicolegal examination Member of Child Fatality Review TeamMember of Child Fatality Review Team

Community FocusCommunity Focus Improve the natural and infant/child Improve the natural and infant/child

death investigations with better history death investigations with better history gathering and assessmentsgathering and assessments

Contact family members in order to Contact family members in order to provide information on cause and provide information on cause and manner of deathmanner of death

Discuss medical and familial implications Discuss medical and familial implications of cause of death, if applicableof cause of death, if applicable

Provide education regarding the Provide education regarding the medicolegal death investigationmedicolegal death investigation

Role Begins to ExpandRole Begins to Expand

Three positions approved by Three positions approved by Commissioner’s Court at the end of 2002Commissioner’s Court at the end of 2002

Expand coverage of nursing services to Expand coverage of nursing services to evening and night shiftevening and night shift

Assist with review of organ/tissue Assist with review of organ/tissue procurement recovery requests with the procurement recovery requests with the pathologistpathologist

Assist with natural death and infant/child Assist with natural death and infant/child death scene investigationdeath scene investigation

Expanding RoleExpanding Role

Provide case management for Provide case management for infant/child deathsinfant/child deaths

Respond to scenes and take reportsRespond to scenes and take reports Conduct the forensic gynecological Conduct the forensic gynecological

examination and evidence collectionexamination and evidence collection Community educationCommunity education

Increasing Nursing StaffIncreasing Nursing Staff

By end of 2003, identified that By end of 2003, identified that additional positions were necessaryadditional positions were necessary

Conducted survey of selected Conducted survey of selected medical examiner/ coroner offices medical examiner/ coroner offices throughout the United States throughout the United States regarding use of nurses in this regarding use of nurses in this settingsetting

Proposal developed to justify Proposal developed to justify additional positionsadditional positions

New Positions Are New Positions Are GrantedGranted

In September 2003, Commissioner’s In September 2003, Commissioner’s Court authorized nine (9) new Court authorized nine (9) new nursing positions!nursing positions!

Once all positions are filled, there Once all positions are filled, there will be twelve (12) nurses!will be twelve (12) nurses!

ReferencesReferences

Centers for Disease Control. (2004). Centers for Disease Control. (2004). Medical Medical Examiner and Coroner Examiner and Coroner Jurisdictions in the Jurisdictions in the United States. Found United States. Found at: at: http://www.cdc.govhttp://www.cdc.gov..

DiMaio, V.M. (2001). DiMaio, V.M. (2001). Forensic Pathology. (2nd ed). Boca Raton: CRC Press.

Harris County Medical Examiner’s Office. Harris County Medical Examiner’s Office. (2004). (2004). Forensic nurse/ Physician assistant investigator II. Job Job description. description. Found at Found at www.co.harris.tx.uswww.co.harris.tx.us..

ReferencesReferences International Association of Forensic International Association of Forensic

Nurses. Nurses. (2004). Forensic Nurse Death (2004). Forensic Nurse Death Investigator Investigator Standards of Practice. Draft Standards of Practice. Draft copy.copy.

Lynch, V. (1993). Forensic nursing: Lynch, V. (1993). Forensic nursing: Diversity in Diversity in education and practice. education and practice. Journal of Psychosocial Journal of Psychosocial Nursing, 31Nursing, 31(11), p. (11), p. 7-14.7-14.

Vessier-Batchen, M. (2003). Forensic nurse Vessier-Batchen, M. (2003). Forensic nurse death death investigators. investigators. The Web Mystery The Web Mystery Magazine. Magazine. Found at: Found at: www.lifeloom.comwww.lifeloom.com..