Cobb County Medical Cobb County Medical Examiner’s OfficeExaminer’s Office

Presented by Presented by Michael GerhardMichael Gerhard

Operations ManagerOperations Manager

What is a Medical What is a Medical Examiner?Examiner?

A medical doctorA medical doctor Board Certified Forensic PathologistBoard Certified Forensic Pathologist 13 years of school…after high school!13 years of school…after high school! Appointed position by county Appointed position by county

CommissionCommission 4 Counties in Georgia have Medical 4 Counties in Georgia have Medical

Examiners - Cobb, Gwinnett, Dekalb, Examiners - Cobb, Gwinnett, Dekalb, FultonFulton

What is a Coroner?What is a Coroner? No specific training requiredNo specific training required Must be at least 25 years oldMust be at least 25 years old Live in the same countyLive in the same county Elected positionElected position Never convicted of a felonyNever convicted of a felony There are 159 counties in Georgia – There are 159 counties in Georgia –

The GBI Medical Examiners handle The GBI Medical Examiners handle 153 counties153 counties

Georgia Death Georgia Death Investigation Act Investigation Act

(O.C.G.A. 45-16-20)(O.C.G.A. 45-16-20)

When are Deaths reported?When are Deaths reported? Caused by violenceCaused by violence Suddenly when in Suddenly when in

good healthgood health Unattended by a Unattended by a

doctordoctor Suspicious or Suspicious or

unusual, particularly unusual, particularly to those 16 years to those 16 years old and youngerold and younger

After birth but After birth but before age of 7before age of 7

In custody of state, In custody of state, county, or city penal county, or city penal institution / Policeinstitution / Police

When unconscious When unconscious upon arriving to the upon arriving to the hospital or dying hospital or dying within 24 hours of within 24 hours of admissionadmission

As a result State As a result State execution / death execution / death penalty (Butts penalty (Butts County)County)

Who works at the Who works at the Medical Examiner’s Medical Examiner’s

Office?Office?

The current Chief Medical The current Chief Medical Examiner isExaminer is

Dr. Brian Frist.Dr. Brian Frist.

He was an associate M.E. with He was an associate M.E. with Dr. Burton for Cobb, Dekalb, and Dr. Burton for Cobb, Dekalb, and Gwinnett Co. from 1989 to 1999.Gwinnett Co. from 1989 to 1999.

Forensic InvestigatorsForensic Investigators Currently 4 on staffCurrently 4 on staff Representative of the Medical ExaminerRepresentative of the Medical Examiner Trained in death investigation, previous Trained in death investigation, previous

law enforcement backgroundlaw enforcement background Liaise with police, hospitals, families, Liaise with police, hospitals, families,

media, etc.media, etc. Can provide official time of deathCan provide official time of death Testify in court proceedingsTestify in court proceedings

Forensic TechniciansForensic Technicians Currently 2 on staffCurrently 2 on staff Background in funeral or health servicesBackground in funeral or health services Assistant to the Medical Examiner in the Assistant to the Medical Examiner in the

lablab Removes organsRemoves organs Documents all findings (ie: photos, Documents all findings (ie: photos,

drawings)drawings) Collects evidenceCollects evidence Takes x-raysTakes x-rays

Manners of DeathManners of Death NaturalNatural – death by natural physiological – death by natural physiological

changes (i.e. cancer, diabetes, hypertension)changes (i.e. cancer, diabetes, hypertension) AccidentAccident – death due to negligence, – death due to negligence,

disaster, or the elements (i.e.: traffic disaster, or the elements (i.e.: traffic accidents, overdoses, falls, exposure, accidents, overdoses, falls, exposure, storms,)storms,)

SuicideSuicide – death caused by self – death caused by self HomicideHomicide – death caused by another– death caused by another UndeterminedUndetermined – death when a manner is – death when a manner is

not readily apparent even after a thorough not readily apparent even after a thorough examination and investigationexamination and investigation

Manner, Cause, MechanismManner, Cause, Mechanism Person accidently shoots a man Person accidently shoots a man

during hunting.during hunting. Hiker dies from hypothermia.Hiker dies from hypothermia. Person overdoses on heroin.Person overdoses on heroin. Person overdoses on prescription Person overdoses on prescription

under doctor care.under doctor care. Person drowns.Person drowns. Person dies of meningitis. Person dies of meningitis.

Cause of DeathCause of Death The The process that produced process that produced the the

mechanism of death mechanism of death Ex:StabbingEx:Stabbing

Mechanism-Mechanism- actual physiological actual physiological change that causes death change that causes death

Ex: Exsanguination (bleeding out)Ex: Exsanguination (bleeding out)

Common MechanismsCommon Mechanisms Asphyxia (changes due to lack of Asphyxia (changes due to lack of

oxygen)oxygen)

Leading Causes of death Leading Causes of death U.S.U.S.1. Heart disease 1. Heart disease

2. Cancer 2. Cancer 3. Cerebrovascular diseases (stroke) 3. Cerebrovascular diseases (stroke) 4. Chronic Obstructive Pulmonary Disease (COPD; Bronchitis, 4. Chronic Obstructive Pulmonary Disease (COPD; Bronchitis,

Emphysema)Emphysema)5. Accidents (unintentional injuries) 5. Accidents (unintentional injuries) 6. Diabetes mellitus 6. Diabetes mellitus 7. Alzheimer’s disease 7. Alzheimer’s disease 8. Influenza and pneumonia 8. Influenza and pneumonia 9. Kidney disease 9. Kidney disease 10. Septicemia (Blood Infection)10. Septicemia (Blood Infection)11. Suicide 11. Suicide 12. Chronic liver disease (Cirrhosis) 12. Chronic liver disease (Cirrhosis) 13. Hypertension (High Blood Pressure)13. Hypertension (High Blood Pressure)14. Parkinson’s disease (Affects Motor skills) 14. Parkinson’s disease (Affects Motor skills) 15. Homicide 15. Homicide National Vital Statistics Reports Volume 58, Number 19 May 20, 2010: Data for 2007National Vital Statistics Reports Volume 58, Number 19 May 20, 2010: Data for 2007

Leading Causes of Death for Leading Causes of Death for U.S. Youth 15-19U.S. Youth 15-19

1. Unintentional Injury (Accidents)1. Unintentional Injury (Accidents)2. Homicide2. Homicide3. Suicide3. Suicide4. Cancer4. Cancer5. Heart Disease5. Heart DiseaseNational Center for Health Statistics National Vital Statistics Reports March 7, 2005National Center for Health Statistics National Vital Statistics Reports March 7, 2005

The Autopsy

External Exam Photographs Clothing Valuables X-rays Evidence Drawings Documents the external findings

Autopsy Forms

Autopsy

Surgical Dissection Remove and weigh each organ Dissect and examine each organ Documents the internal findings

ORGANS Heart Lungs Liver Spleen Kidneys Pancreas Gastrointestinal tract Brain

Heart

Heart

Lungs

Liver

Spleen

Kidneys

Pancreas

Brain

Post Post MortemMortem

ChangesChanges

LividityLividity Settling of blood due to gravity.Settling of blood due to gravity. Most cases becomes visible within 30 Most cases becomes visible within 30

minutes to two hours.minutes to two hours. If the body’s position is changed, two If the body’s position is changed, two

patterns of lividity could develop.patterns of lividity could develop. Helpful in determining if body has Helpful in determining if body has

been moved.been moved. Cherry red coloration in Carbon Cherry red coloration in Carbon

Monoxide (CO) deaths.Monoxide (CO) deaths.

Lividity

Rigor MortisRigor Mortis Stiffening of the muscles caused by Stiffening of the muscles caused by

chemical changes.chemical changes. Starts in smallest muscles (eyelids, face, Starts in smallest muscles (eyelids, face,

neck, fingers) neck, fingers) Peaks at 12 to 24 hoursPeaks at 12 to 24 hours Leaves after 36 hoursLeaves after 36 hours Little usefulness in determining time of Little usefulness in determining time of

death but helpful in determining position death but helpful in determining position at deathat death

DecompositionDecomposition First external signFirst external sign - Green discoloration over the - Green discoloration over the

right lower abdomen (24hrs to 2 days)right lower abdomen (24hrs to 2 days) BloatingBloating – Expansion of body cavities caused by gases – Expansion of body cavities caused by gases

and chemical release of - ammonia, hydrogen sulfide, and chemical release of - ammonia, hydrogen sulfide, mercaptans, methane, phosphoric and sulfuric acids.mercaptans, methane, phosphoric and sulfuric acids.

PurgePurge - Contents of the respiratory and GI tract exiting - Contents of the respiratory and GI tract exiting orifices as a result pressure. orifices as a result pressure.

Skin slippageSkin slippage – Epidermis separates from the dermis. – Epidermis separates from the dermis. MarblingMarbling - Pattern resulting from bacterial gases - Pattern resulting from bacterial gases

mixing with blood in the superficial blood vessels.mixing with blood in the superficial blood vessels. MummificationMummification - Extreme dehydration, occurring in a - Extreme dehydration, occurring in a

dry environment which can be warm or cold.dry environment which can be warm or cold. SaponificationSaponification - transformation of fatty tissues into - transformation of fatty tissues into

adipocere or graves wax. Not common. Seen in adipocere or graves wax. Not common. Seen in bodies immersed in water or buried. bodies immersed in water or buried.

Early Decomposition

Marbling

eMedicine

Advancing Decomposition

eMedcine

Skin Slip

Traffic AccidentsTraffic Accidents

Don’t be in a hurryDon’t be in a hurry

ALWAYSALWAYS wear your seatbelt wear your seatbelt

Driving and alcohol do not Driving and alcohol do not mixmix

Determining time of death:Determining time of death: Ocular fluid- potassium level in Ocular fluid- potassium level in

vitreous humor in eyes rises after vitreous humor in eyes rises after deathdeath

Gastrointestinal tract:Gastrointestinal tract: Stomach- contents digested and Stomach- contents digested and

emptied within 2-4 hoursemptied within 2-4 hours Small intestine- food further digested Small intestine- food further digested

and absorbed, 2-3 hours (4-8 hours and absorbed, 2-3 hours (4-8 hours total time)total time)

Large intestine-waste 12-24 hours (20-Large intestine-waste 12-24 hours (20-30+ hours total time)30+ hours total time)