THE CORONER & MEDICAL EXAMINER
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When a death occurs someone must be willing to sign a death certificate stating they are sure of its cause. Either a doctor, coroner, or medical examiner has that responsibility. If the death is "attended" meaning the victim was under a doctor's care for the condition that took his life, or at least the doctor knew the cause for sure. If the death is "unattended" then it becomes a coroner's or medical examiner's case.
A medical examiner is a medical doctor. Naturally they have some knowledge of the reasons why people die. The job of the coroner is an elected position. If you meet the election requirements (being 18 or older) and can drum up enough votes you can become a coroner. Most coroners are funeral directors (who else would want the job?), but that does not have to be the case. Some of the counties in New York State have coroners and some have medical examiners.
The coroner or medical examiner (C/ME) are very powerful positions. They have the ability to take complete charge at the scene of a death. They actually have the power to arrest people including members of law enforcement. The basis for this power is rooted in English history. When King Richard (the Lion-hearted) was on one of his Crusades, he was kidnapped by the Austrian king. A huge ransom was demanded if England wanted to get their king back. The local sheriffs in England were in charge of collecting money from the population. They were not the most honest people so a position was established to oversee the sheriffs. That evolved into the present day coroner system.
If a person is involved in an unattended death they become a C/ME case. No one is allowed to touch anything at the scene until the C/ME gives the okay. Whatever the C/ME decides to do to determine the cause of death must be done. If an autopsy is ordered then it is done in the morgue. If a jury is needed to examine the evidence, then a 6-person Coroner's Jury is established. The presentation to the jury is called an inquest. If foul play is indicated the case may be turned back to law enforcement. It is only after the C/ME is satisfied with the findings that a death certificate will be signed.
The morgue is usually located in the bowels of a hospital. There is a refrigerated section consisting or individual drawers or a walk-in room kept at a constant temperature near 40 degrees Fahrenheit. The autopsy room is tiled (for cleaning and disinfection) and has a stainless steel operating table in the center. There is usually a scale for weighing body parts hanging from the ceiling over the table. There are instruments similar to ones found in the other surgical suites, although these do not have to be sterilized. There are Striker saws for ripping bone, suturing materials, saws, knives, scalpels, etc. There is a source of water to wash the body parts free of blood and other fluids. These go down a drain to a special holding tank if the morgue is modern. There may be X-ray machines and a position for a stenographer to take detailed notes of the autopsy. Some have jars filled with various organs for later education or analysis.
The above 2 pictures were taken in the morgue at Benedictine Hospital in Kingston, NY. The tour guide was Ms. Thersa Loundsbury.
The above pictures were also taken in the Benedictine morgue. The tour guide was Ms. Maria Rissio.
The morgue was dismantled after the Death Eduaction class visited for many years.
The autopsy is not done by the C/ME. Usually a forensic pathologist is hired to do it. Although the C/ME may be present during the procedure it is a matter of choice. The pathologist's report is the main document that is sought after. It will be used to determine the actual cause of death.
The autopsy can be grotesque. In large city morgue there may be many operating tables each with a body waiting its turn for dissection. As one passes by the nude corpses various stages of decay can be detected. (In the old days, if the odor of decay was too strong they would set off gun powder in the morgue to mask the smell. Today, some body are frozen prior to the autopsy to reduce the smell.) Trauma deaths due to gunshot wounds, stabbing, automobile accidents, etc. are obvious. After the pathologist does the autopsy the morgue may look like a slaughter house.
These photos of on of the New York City morgues shows autopsies being performed in the background and the refrigeration compartments above.
Initially the exterior of the body is thoroughly examined for evidence. The body then has a block of wood placed under the neck or shoulders causing it to look like it is sitting up while lying down. In this way a head post is easily done. If the skull is to be opened an incision is made from the top of one ear to the top of the other. Then the skin is pulled from the top, middle of the head down over the face. This makes the face inside out. The rear portion is treated similarly. Then the skull is cut with a Striker saw and plucked off with a popping sound. The brain is exposed for tissue sampling and weighing. Rarely is the entire brain removed and most of it not replaced. After the top of the skull is replaced, the two flaps of skin are pulled back over it and crudely sutured together. The hair hides the sutures.
Above (from Scientific American) shows the head post with the top of the face pulled down to the middle of the nose.
If the torso is to be posted an incision is made across the shoulders, down the middle of the chest and abdomen, and then back out to the sides. A Striker saw is used to cut through the ribs. Now the entire flap can be lifted from the body exposing the lungs, heart, liver, stomach, intestines, and other internal organs. Samples of each organ are obtained, Each organ may be removed, weighed and dissected. The contents of the stomach is tested for poison and/or drugs. Other tissues are analyzed for disease, drugs, punctures, bullets, and other abnormalities. Sometimes the organs are replaced and sometimes they are not. In any case, some sort of packing material will be placed in the cavities prior to suturing. The body is then returned to the refrigerator for later identification by next-of-kin or pickup by a local funeral director.
Above (from Scientific American) shows the chest and abdomen post.
If a body is to be identified by someone else it is usually done discretely. Other decedents are shielded from view. In New York City there is a viewing area that opens into a small elevator shaft. The body is brought up the elevator and, when the signal is given, a curtain is raised so the person making the identification is able to quickly see the face. They are asked to make the ID and then the curtain is closed. Some of the emotions displayed at the curtain opening are quite extreme. Some wail, weep, slam their fist on the glass (it's been cracked), scream obscenities, faint, or stand in stoic silence, and some may have to be physically removed.
Over the years the classes were able to visit three morgues in our area. Getting permission to do this was difficult. It usually required several phone calls and considerable explanation as to why a teacher would like high school students to visit such a morbid place.
Students waiting to enter the morgue
During the first year I tried to have the students visit the Ulster County Morgue located in the Kingston Hospital. The person in charge was a Ms. Finger. When she heard my request there was some alarm in her voice as she immediately denied the request. She said something to the effect of, "How can you tramatize high school students that way. Don't you know that just last week we had the body of a man that was partially eaten by his dog. How do you think the students would react to that?" How could I argue?
I turned to a person on the Board of Directors of Benedictine Hospital, also located in Kingston. He was instrumental in getting permission for the class to visit that morgue. We did so for many years, and had a variety of members of the educational staff of the hospital conduct the tours. They all seemed enthusiastic, and were more than willing to to a thorough job.
The Benedictine Morgue consists of two rooms in the basement of the hospital. The first is a walk-in refrigerator kept near 40 degrees Fahrenheit. It is about the size of a normal kitchen. The second is the area where the autopsies are performed. It is about the size of a normal dining room. With the larger classes we had to visit the area in shifts.
Inside the Benedictine Refrigerator
The instruments used for the autopsies are similar to what one would find in one's house. There are regular kitchen knives, hack saws, hammers, etc. The instruments are clean but not the sparkling quality found in the instruments of the operating room. There are stainless steel trays, pans, scales, sinks, and tables making cleanup easy.
Rarely was a body present during a field trip. Either the hospitals wanted to protect the family or because the morgue lacked traffic. Benedictine only used their morgue for their hospital patients that required an autopsy, or for temporary storage of the body while the funeral director was in transit. On one occasion there was a baby wrapped in a shroud that the tour guide held in her arms for the students to see. They were impressed! In the St. Francis Hospital Morgue in Poughkeepsie there was a multi-door refrigerator. There was a body in one of the compartments. There were a few body parts being stored in another (arms and legs). In Vassar Hospital there was a man that was shrouded in a sitting position. He had been burned in his car. Also, on one field trip the pathologist showed the students a simese twin fetus that was stored in formadehyde, and an example of a smoker's lung tissue which was black instead of pink.
Dr. Pushparag, the pathologist at St. Francis Hospital in the morgue
St. Francis pathologist, Phil Lynch, MD, in the morgue May 1993
The most unusual incident we had over the years was a student collapsing in the Benedictine morgue. There were a large number of students in the room and it was quite hot. The kids were motionless as they listened to the lecturer explaining the functions of the instruments. A girl fainted. She fell forward with her hands at her sides and everyone stepped aside. Her head landed on the concrete floor. After she was revived, a lump appeared on her forehead that looked as it someone had placed a golf ball under the skin. She was wisked to the Emergency Room for examination. Fortunately, her mother was one of the class chaperones and was there for the entire episode. This was probably the only time a patient went from the morgue to a hospital room!
Our county is broken up into sections. The head medical examiner has assistants that share the workload. One of those assistants, Frank Mayle, M.D., spent some of his time speaking to the Death Education class. Here is the interview:
Q. What is the purpose of your position?
Dr. Mayle: Basically what we do is investigate the cause of death. This is most important to those that are alive. The best example of that comes from car accidents. If you look at cars today with seat belts, padded dashboards, air bags, etc. All of those came from the study of how and why people die in automobile accidents. The results of those studies and the data gained through the Medical Examiner's Office resulted in the safety features added to the cars.
Q. How do they notify you? Could you be called out right now? Do you have a pager?
Dr. Mayle: I have a pager and the calls originate from Fire Control in Kingston or police departments that have their dispatchers.
Q. Are the majority of cases the result of automobile accidents?
Dr. Mayle: Not any more. At one time the bulk of the cases were due to automobile accidents. Since the crackdown on drunk driving and the awareness people have now, the numbers of deaths on the road are much less.
Q. Please give us a list of what you have seen in the last year as a medical examiner.
Dr. Mayle: By far the old age deaths are the most common. After that, the next most common are accidental deaths. This year I don't think I have had any homicides and just a couple of suicides. I have not had a homicide in about a year and a half.
Q. Have you had a case where it was made to look like an automobile accident but was a covered up murder instead?
Dr. Mayle: A couple of times it's been the other way around. We had a couple of auto-erotic deaths two years ago in the County. In this death people end up strangulating themselves accidently. There's been a number of cases where you go to the scene and it appears that a person has committed suicide. Another case comes to mind where a college student from Boston in New York City was listed as a suicide, and when the case was further reviewed it was found to be an auto-erotic death. What auto-eroticism is that if you partially strangle yourself and decrease the flow of blood to the carotids to your brain during sexual activity. People say it creates a highly sexual response. People that practice that type of activity sometimes slip up and it results in an accidental death. To explain it in more detail, what happens is that the setup involves some form of masturbating activity with something around the neck. Oftentimes men will dress in women's clothes. There will be (pornographic) pictures under them. They are either standing up or on their knees, partially being supported by a bed or a chair, and a rope or cloth tied around the neck and attached to something else. They try to almost pass out just before orgasm. The police first listed that death as a suicide. The family hired a forensic pathologist to take a look at the case because they could not believe their son would commit suicide. They were much more comfortable with the idea it was an accidental death and it was auto-erotic. They were much more comfortable with that because they could understand it.
Q. What reaction do you and the law enforcement personnel have when you come upon a scene such as this?
Dr. Mayle: That depends upon the law enforcement officers present. My first reaction the first time I saw something like that was disbelief. It was something I had read about and knew existed. The first time you don't crack up. The first parachuter I saw where the chute didn't open I didn't crack up. The second time you go in there and start making jokes about how short his legs are and stuff like that. The reason you don't laugh the first time is because the trauma is shocking to you. That is true with any form of death. It's true with the first natural death that you see after medical school. It's true with the first automobile accident you see. It's true with the first person you're working on in the ER that dies. After you do it a number of times, that's when the joking starts. That's when you start to laugh. The reason you start to laugh then is to relieve that stress at the scene. A lot of times you walk into a scene and you can cut it with a knife it's so thick, especially accident scenes that are bloody. You can, literally, feel the tension on everybody. Once a joke is cracked you can feel the tension being relieved.
Q. Have you ever found someone that was offended by what was said at scene?
Dr. Mayle: I have not been caught in that situation yet. One of the biggest things we do is to talk to families, and it's not uncommon for a family member to ask about the personal way the loved one was taken care of at the scene. Everybody that works in those fields or is at the scene is very conscious of the family, so the comments don't occur in front of people.
Q. When you are called that means somebody is dead. How would you react if you were called to deal with a member of your own family?
Dr. Mayle: First of all, I would not take the case. That would not be appropriate for me to be looking at the circumstances of the death of a member of my own family.
Q. Are you on duty 24 hours a day and can you be called out at any hour of the night, and what is the grossest thing you've seen?
Dr. Mayle: Yes, the job probably averages out to about 5 hours per week of actual cases. The grossest thing was the plane crash where the pilot crashed in the apple orchard in the back of the school here. It was very messy. It was a training flight out of Poughkeepsie. It appeared they went into a stall maneuver and the plane came down. The propeller hit an apple tree and the plane flipped over and smashed into the ground about 100 yards down from the tree. It took a long time to clean it up. The best scenario was to get cleaned up and out of there fast. We had to wait for the FAA from Albany to investigate the accident. The longer the time you have to deal with it the harder it becomes. The bodies were partially imbedded in the plane so the extracation was difficult.
Q. What post-reaction do you have? Do you go home and talk to your family about the case?
Dr. Mayle: I only talk to my kids about the accidents that could happen to them. There were 2 high school kids from Wallkill that died in a car accident. I made sure my son and daughter understood what cars can do. Most of the others I talk only to my wife about. It benefits me to talk about it.
Q. Why did you become a medical examiner?
Dr. Mayle: About 6 or 7 years ago Dr. McNamera, the Chief Medical Examiner who has since passed away, came down and told me he was looking for someone to cover this end of the county. I told him I really wasn't interested. He wanted me to take the position for three to six months while he looked for someone else. I stayed on. I keep it because actually it is very satisfying in a lot of ways, mainly by dealing with the families and survivors.
Q. As a medical examiner you have a lot of power. Is it true you are the ultimate authority at the scene of a death?
Dr. Mayle: Yes, by New York State law I have that power.
Q. What would you do if a State Trooper decided to do as he pleased at the scene even though it might go against your wishes?
Dr. Mayle: That happen over some bones that were from an ancient burial ground in Ardonia. One of the head State Troopers in this area was going to have some of these bones shipped elsewhere for analysis and against my wishes. I told him, "No! The bones are from this county and I want them on my desk." That's where they went.
Q. Do people like to talk to you about death?
Dr. Mayle: Some people like to talk about death.
Q. One aspect of your job is the autopsy. If you decided someone has to have an autopsy to satisfy your investigation, is there no stopping it?
Dr. Mayle: A suicide or homicide by law has to have one. If it's a death where it's not a hard case, or if there are religious objections autopsies can be stopped. That really doesn't play a big role because we do not desecrate the body. A number of Rabbis, for example, understand the importance of getting medical evidence. All the body parts have to be put back in the body.
Q. Do you do any part of the autopsy?
Dr. Mayle: No. I attend them depending on the type of death. We have a pathologist that will come down within 24 hours from upstate.
Q. What is it like to deal with kids?
Dr. Mayle: Kids are always harder. It affects everybody involved. There was a 10 or 12 year old from the Bronx visiting here in the county. He got on the family snowmobile and hit a telephone support wire with his skull. It was a very sad death.
Q. What about death by fire?
Dr. Mayle: The bodies are harder to identify. It takes a longer time period. It's not the body so much, it's the smell. It is hard to describe burnt flesh. It has a characteristic smell though. It's like a very bad chicken burning. If you ever smell it you won't forget it.