Investigation of Deaths Temporally Associated with Law Enforcement Apprehension

Abstract

The investigation of a death that occurs in custody requires a careful and methodical approach since concerns of police or institutional misconduct may be raised. The medicolegal official charged with the investigation and ultimate certification of death bears heavy responsibility to the decedent's family, the public, law enforcement and other institutions. A wide variety of causes of death and manners of death are seen in these deaths. This paper reviews causes, mechanisms, manners, findings, and evaluation of persons who have died in temporal relation to legal apprehension.

National Association of Medical Examiners Position Paper: Recommendations for the Definition, Investigation, Postmortem Examination, and Reporting of Deaths in Custody

“…An autopsy must be performed on all deaths in custody where the death may be deemed unnatural, regardless of phase and time since injury. The purpose is to correlate and/or confirm the reported circumstances, establish the cause of death, verify individual identification, identify potential competing causes of death, document other significant pathologic conditions, and assess claims of wrongful death, mistreatment, or neglect (1, 8, 9). Prisoners with known natural disease who are expected to die and are under medical supervision should be investigated as deaths in custody and receive an autopsy if appropriate.…”

“…Comprehensive toxicology, including common illicit and therapeutic drugs, should be performed on all cases unless a period of hospitalization precludes the usefulness of the testing (1). If appropriate, seizure medications and psychiatric medications may be tested to document if the levels are therapeutic or sub-therapeutic.…”

“…If appropriate, seizure medications and psychiatric medications may be tested to document if the levels are therapeutic or sub-therapeutic. Vitreous fluid should also be tested for glucose, urea nitrogen, creatinine, sodium, potassium, chloride, and ketone concentrations to assess for hydration, hyperglycemia, renal function, and electrolyte abnormalities (1, 9). The vitreous fluid can also be used to test for lithium, ethanol, and illicit drugs, (e.g., parent cocaine or 6- monoacetylmorphine).…”

Hostage Situation Homicide

“…In certain cases, there may be pressure exerted on the pathologist from police or others to make a ruling of "accident" instead of "homicide." This is not as likely in GSW cases as it is in police "restraint-associated deaths," where there can be considerable debate regarding MOD (7,8). In the case presented, the MOD was determined to be homicide, as the police officer pulled the trigger intending to cause incapacitation of the hostage-taker.…”

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“…Positional asphyxia can be defined as a form of asphyxia which occurs in individuals who are found in an abnormal body position which prevents adequate gas exchange such as from upper airway obstruction or a limitation in chest wall expansion. [14][15] The term "positional asphyxia" was transferred to "restraint asphyxia," "compressional and/or traumatic asphyxia" and was applied to law enforcement arrest and restraint situations attempting to support the argument that short-term pressure on the back of the arrestee caused on contributed to the person's sudden death. The prone restraint process generally involves one or two officers placing one or both knees on the person's back to assist in the control and restraint of person in handcuffs and/or leg restraints.…”