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

Death InvestigationDeath Investigation

Death Investigation Death Investigation Systems in the United Systems in the United

StatesStates

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

DC

Coroners in every county or district

Mixed ME and Coroners

State ME, coroners in every county or district

State ME, mixed county ME and Coroners

County ME, no coroners

District ME, no coroners

State 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 public or Application of the nursing process to public or legal proceedingslegal proceedings

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

Lynch, (1993)

Roles within Forensic NursingRoles within Forensic Nursing

Clinical Forensic NurseClinical Forensic Nurse Sexual Assault Nurse Sexual Assault Nurse

Examiner (SANE)Examiner (SANE) Pediatric Forensic NursePediatric Forensic Nurse Forensic Psychiatric Forensic Psychiatric

NurseNurse

Nurse Death Nurse Death Investigator/CoronerInvestigator/Coroner

Correctional NurseCorrectional Nurse Legal Nurse ConsultantLegal Nurse Consultant Nurse AttorneyNurse Attorney

Lynch, (1993)

The Forensic Nurse The Forensic Nurse Death InvestigatorDeath Investigator

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

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

across the life spanacross the life span collaborates with interdisciplinary agencies collaborates with interdisciplinary agencies identifies trends identifies trends conducts and/or participates in research conducts and/or participates in research promotes health and safety through community promotes health and safety through community

education.education.

IAFN, FNDI Standards of Practice, 2004, (draft)

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

Apply nursing knowledge which includes Apply nursing knowledge which includes anatomy, physiology, pharmacology and family anatomy, physiology, pharmacology and family interactioninteraction

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

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

Vessier-Batchen, (2003)

Role of the Forensic Role of the Forensic Nurse Death Investigator Nurse Death Investigator

at the Harris County at the Harris County Medical Examiner’s Medical Examiner’s

OfficeOffice

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 infant/child Augment the natural death and infant/child

death investigationdeath investigation Conduct post mortem sexual assault/child abuse Conduct post mortem sexual assault/child abuse

examinationsexaminations Provide case management for pathologistsProvide case management for pathologists Collaborate with organ/tissue procurement Collaborate with organ/tissue procurement

agenciesagencies

Harris County Medical Examiner’s Office, (2004)

Role in the ME OfficeRole in the ME Office

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

Communicate COD and MOD with familiesCommunicate COD and MOD with families Educate the community regarding death Educate the community regarding death

investigation and forensic issuesinvestigation and forensic issues Assist with external examinationsAssist with external examinations

Harris County Medical Examiner’s Office, (2004)

Augmenting the Natural Death Augmenting the Natural Death InvestigationInvestigation

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

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

Conduct a more thorough investigationConduct a more thorough investigation Understand subtle signs of abuse and neglectUnderstand subtle signs of abuse and neglect

Case ManagementCase Management

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

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

External ExaminationsExternal Examinations

Thorough physical examinationThorough physical examination Review of medical recordsReview of medical records Description via diagrams and dictationDescription via diagrams and dictation Document pathological findingsDocument pathological findings

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

Examiner’s OfficeExaminer’s Office

Prior to Forensic NursingPrior to Forensic Nursing

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

Investigators had limited medical knowledgeInvestigators had limited medical knowledge 80% of cases brought in to HCME were 80% of cases brought in to HCME were

autopsiedautopsied Requests/receipt of medical records were Requests/receipt of medical records were

inconsistentinconsistent

Prior to Forensic NursingPrior to Forensic Nursing

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

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

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

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

Forensic Nursing Integrated in Forensic Nursing Integrated in Harris County, TexasHarris County, Texas

After extensive lobbying by Dr. Joye Carter, the Harris After extensive lobbying by Dr. Joye Carter, the Harris County Commissioner’s Court approved 1 Forensic County Commissioner’s Court approved 1 Forensic Nurse positionNurse position

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

examinationexamination Member of Child Fatality Review TeamMember of Child Fatality Review Team

Community FocusCommunity Focus

Improve the natural and infant/child death Improve the natural and infant/child death investigations with better history gathering and investigations with better history gathering and assessmentsassessments

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

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

Provide education regarding the medicolegal Provide education regarding the medicolegal death investigationdeath investigation

Role Begins to ExpandRole Begins to Expand

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

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

Assist with review of organ/tissue procurement Assist with review of organ/tissue procurement recovery requests with the pathologistrecovery requests with the pathologist

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

Expanding RoleExpanding Role

Provide case management for infant/child Provide case management for infant/child deathsdeaths

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

and evidence collectionand evidence collection Community educationCommunity education

Increasing Nursing StaffIncreasing Nursing Staff

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

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

Proposal developed to justify additional Proposal developed to justify additional positionspositions

New Positions Are GrantedNew Positions Are Granted

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

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

ReferencesReferences

Centers for Disease Control. (2004). Medical Centers for Disease Control. (2004). Medical Examiner and Coroner Jurisdictions in the Examiner and Coroner Jurisdictions in the United United States. Found at: States. Found 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. (2004). Harris County Medical Examiner’s Office. (2004). Forensic nurse/ Physician assistant investigator II. Job Job description. Found at description. Found at www.co.harris.tx.uswww.co.harris.tx.us..

ReferencesReferences

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

Lynch, V. (1993). Forensic nursing: Diversity in Lynch, V. (1993). Forensic nursing: Diversity in education and practice. education and practice. Journal of Psychosocial Journal of Psychosocial Nursing, Nursing, 3131(11), p. 7-14.(11), p. 7-14.

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

www.lifeloom.comwww.lifeloom.com..