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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..