Harris County Institute of Forensic Sciences Document Type ...

Harris County Institute of Forensic Sciences Section: Toxicology Approved by: Chief Toxicologist Document Type: QA/QC Procedure No.: TOX07.1009 Title: Medical legal evidence receiving, processing, storage, disposal, and chain-of-custody Rev: 23

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1.0 Purpose 1.1 This document describes receiving, processing, sealing, storage, disposal and

the internal chain-of-custody procedures of the Forensic Toxicology Laboratory for medical legal (ML) and out-of-county (OC) cases.

2.0 Scope

2.1 This laboratory uses chain-of-custody procedures to maintain control and

accountability of medical legal evidence, from receipt through completion of testing, storage, and final disposal. The chain-of custody procedure ensures the integrity of evidence. Cases are processed one at a time.

3.0 Definitions and Abbreviations

3.1 Grossing Analyst (A) - opens, handles evidence for source and volume

determination, and applies evidence labels. 3.2 Grossing Analyst (B) - enters information into JusticeTrax and prepares case

folders 3.3 Case owner - Toxicologist responsible for attending pathologist meetings,

reviewing case folders, assigning testing on ante mortem specimens and following up on case progress.

3.4 NTR - Not Toxicology Related 3.5 ROT - Rule Out Toxicology 3.6 TR - Toxicology Related 3.7 SST - Serum Separator Tube 3.8 OD - Overdose

4.0 Materials

4.1 Instruments and Equipment

4.1.1 15 & 50 mL polypropylene centrifuge tubes with caps 4.1.2 1 mL disposable transfer pipettes 4.1.3 12 x 75 mm glass culture tubes 4.1.4 Test tube caps 4.1.5 Red top vacutainer tubes 4.1.6 7/8” x 7/8” Nalgene Labels 4.1.7 ¾” diameter color coding labels 4.1.8 22” x 15” x 3” cardboard storage boxes 4.1.9 Evidence tape 4.1.10 Security tape 4.1.11 Scalpel and/or scissors

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4.1.12 Kimwipes

4.2 Reagents 4.2.1 DI water 4.2.2 10% Bleach solution

4.3 Stock Standards

4.3.1 Not Applicable

4.4 Working Standards and Controls 4.4.1 Not Applicable

5.0 Evidence Receiving Procedure

5.1 Evidence Receiving

5.1.1 Morgue personnel will place the sealed autopsy specimen bags in a

refrigerator in Room 147 for temporary storage. Authorized Evidence Technicians will pick up evidence daily Sunday through Friday and designated holidays. Refer to QAE07.0001. Specimens for culture are also picked up daily Monday through Friday. A. All cultures will be logged on Culture Form TOXF08.016. The

pathologist will enter the ML/OC case number, initials, date/time, and check off cultures collected for send out. The Evidence Technician or Toxicology staff member will verify all specimens collected and initial with date and time. (LA06.1008)

5.2 Evidence Entry and Transfer 5.2.1 After the Evidence and the proper documentation is retrieved from the

secured refrigerator located in Room 147 by Evidence Technician, the evidence is logged into LIMS, using the JusticeTraX® LIMS-plus-Case Submission Login Procedure (QAE08.0005). The evidence is delivered to a Toxicology refrigerator in Room 300. For ease of transfers, all autopsy cases may be entered into a container (example: Tox autopsy samples 2, Tox autopsy samples 3) and transferred from the Evidence Technician to the refrigerator.

5.2.2 The evidence barcodes generated by the Evidence Technician will be delivered to the grossing room.

5.2.3 All chain-of-custody transfers must be scanned in JusticeTrax LIMS

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(QAE07.0003). 6.0 Evidence Processing Procedure

6.1 Start-up

6.1.1 Evidence is removed from the Toxicology refrigerator. The cases are put in sequential order and given priority. See TOX07.1008 DUI/DWI and DFSA Submissions and Testing for DWI/DUID and DFSA cases and TOX07.0006 General Protocol Proficiency Test Specimens for proficiency cases.

6.1.2 Grossing Analyst (B) will open the current TOX08.033 Toxicology Laboratory Summary Worksheet and TOX08.023 Data Review Tracking Chart for Quantitations forms.

6.1.3 Grossing Analyst (B) will log on Justice Trax by double clicking on the desktop icon and enter the login username “GROSSING” and designated password.

6.1.4 Index investigator reports. Refer to procedure TOX.QC.1045 Indexing Investigator’s Reports into JusticeTrax.

6.1.5 If an ML or OC case is processed, uncheck the “Use Case Number Mask” button.

6.1.6 Evidence is transferred and placed into a Grossing Analyst (A)’s custody in Justice Trax. For ease of transfers, all autopsy cases may be placed into a container (i.e. Tox autopsy samples 2). This container is emptied into the Grossing Analyst (A)’s custody.

6.2 Request of Toxicology Examination form and verification

6.2.1 Grossing Analyst (A) will open the evidence bag and will verify with Grossing Analyst (B) that all of the case information in Justice Trax is correct with the Toxicology Request Form. Compare the case number on the specimens to the case number on the Toxicology Request Form.

6.2.2 Grossing Analyst (A) will print their name, sign, and write the date on the bottom on the Request for Toxicology Examination form. The time may also be documented, but is not required.

6.2.3 JusticeTrax verification and entry A. Case Info Tab: The Synopsis contains anything pertinent to

Toxicology. Grossing Analyst (B) will enter the pathologist initials, whether the case is an autopsy or external, type of case (NTR, ROT, TR) and any additional information from the Pathologist Daily Case Summaries

B. Individual Tab: Verify that the name, age, race, sex are correct. C. Local Data Tab: Grossing Analyst (A) will provide information for

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Grossing Analyst (B) to enter in drop down menus in the For Toxicology only area: a. Manner b. Cause c. Processing Type (ie. ML, DWI/DUID, DFSA, PT, No-Tox,

Other) d. Number of items -Entry e. Number of submissions-Entry. The number of sub-items will be

entered by the case technical reviewer. f. “No Toxicology Analyses Performed” in Results field for No

Toxicology cases g. Analyst 1 Grossing Analyst (A) h. Analyst 2 Grossing Analyst (B) i. Case Ownership

6.2.4 Testing ordered on Toxicology Laboratory Summary Worksheet A. Grossing Analyst (A) determines the appropriate testing from the

“Request for Toxicology Examination” form original white copy. Refer to the duplicate yellow copy from the case owner for testing additions or deletions during the pathologist’s meeting. Refer to attachment Table 1 for Panel Definitions.

B. Grossing Analyst (B) will designate the testing on TOX08.033 Toxicology Laboratory Summary Worksheet. All Toxicological Test Requests are marked on the summary sheet with the following format:

a. Mark “ ” on the Summary Worksheet “Yes” or “No” if the evidence container is sealed.

b. Mark “ ” in the box on the upper right corner if the case specimens are decomposed. a. Verify the pathologist has checked “Decomposed” in the

Circumstances area of the request form. If not, mark the request form appropriately and initial and date.

c. For NO TOX cases, mark “ ” in the box on the upper right corner.

d. Enter the letter “Y” or specimen type (i.e. BL, LVBL, UR, SC, LV) in the test boxes for required testing

e. All HIV, HEP A/B/C, or Metabolic screen send outs and specialty/confirmation testing for OTHER TESTS are marked

“ ” . Other test names are typed next to entry box. f. Circle the appropriate type of case on the bottom of the summary

sheet.

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C. Print the Toxicology Laboratory Summary Worksheet and affix JusticeTrax case labels to the upper left hand corner of the worksheets.

6.2.5 Data Review Tracking Chart for Quantitations A. Print TOXF08.023 Data Review Tracking Chart for Quantitation

with the case number. No Toxicology cases do not require this form.

6.3 Evidence processing 6.3.1 Grossing Analyst (A) will process the specimens in the evidence bag.

The barcode labels are printed in the following order (if available): blood gray tops (1, 2, 3, etc.), blood red top(s), blood lavender top(s), vitreous humor, urine, bile, stomach contents, liver, brain, and other tissues. A. Specimens may be wiped with a Kimwipe to remove moisture,

spills, etc. This ensures barcode labels will adhere. B. Verify the case number on the pre-printed evidence barcode label

matches the case number printed on the original barcode label from the pathologist.

6.3.2 Ensure that evidence is in the custody of Grossing Analyst (A) under Evidence, Location.

6.3.3 Under the EVIDENCE Tab, the Grossing Analyst (B) will enter the following information from the Grossing Analyst (A) by selecting edit to access the evidence fields: A. In the DESCRIPTION field, the specimen entered by the Evidence

Technician will be shown. The source is added [i.e. Blood (femoral)] by entering the appropriate source abbreviation and typing F3. Refer to TOXF.084 Abbreviations. If no source is available, leave the description as “Blood” only.

B. For all other bloods, enter the date and time of collection. Use handwritten date and time over printed label date and time. Verify labels with no name with medical record number from the investigator report.

a. Antemortem: Blood (date@time)--for whole blood tubes b. Serum (date@time)--for SST gold blood tubes c. Plasma (date@time)--for SST mint blood tubes d. Blood (date) -for tubes with no time e. Blood (hospital) --for tubes with no date or time

C. Procurement Agency specimens: Blood (LifeGift), Vitreous (Lions Eye Bank), Blood (Biograft), etc.

D. Samples submitted for Volatiles/Helium testing: Headspace vial (specimen) – i.e., Headspace vial (Blood). Ensure specimens submitted are in a large headspace vial (labeled with marker) and

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inside a plastic bag with the evidence label on the exterior of the bag. Make corrections if needed.

E. In the NOTES field, enter the volume of the specimen. a. Post mortem blood (gray, red, lavender) - color of blood tube

top and volume (mL). Volume determinations are made using the graduations on the hood light or by using the labeled tubes in the hood. Use lowest volume determination when between graduations

b. Body fluids (vitreous humor, bile, urine) - volume (mL). Volume determinations are made with pre-printed graduations. Use lowest volume determination when between graduations

c. Stomach contents and tissues (liver, brain, spleen, muscle, etc.) - volume estimation (i.e., <1/8, 1/4, 1/2, 3/4, full)

d. Antemortem blood (i.e., gold, red, etc.) - color of blood tube top or cap and volume (mL).

e. Blood (LifeGift)—(date and time of collection if available), color of blood tube top, and volume (mL)

f. Document any specimen discrepancies or conditions of the specimens (i.e. clotted, decomposed specimens that are yellow and oily, specimen labeled “Blank”, specimen leaked). See section 6.4 for further instruction.

F. EVIDENCE TYPE should be verified with the Grossing Analyst (B). This information is pre-entered by the Evidence Technicians for all autopsy specimens. If it needs to be changed, choose the evidence type from the drop down menu. a. Antemortem Specimens

1. Blood, antemortem 2. Serum, antemortem 3. Plasma, antemortem 4. Urine, antemortem

G. Handwrite the specimen volume and source (if available) on the pre-printed barcode labels and affix to the evidence. Do not cover the original Path Assist bar code label which contains pathologist initials and source information. a. Trim the blank edges of the JusticeTrax barcode labels before

affixing to small hospital blood tubes, lavender blood tubes, and specimen cups.

H. Write the last two digits of the case number on the top of the blood tubes and last four digits of case number on tops of stomach contents, tissues and other specimen cups for easy identification. Grossing Analyst (A) may also write on the vitreous humor, urine and bile containers for ease in identification.

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I. See 6.8 for No Tox specimens. 6.3.4 Creating Aliquots

A. Aliquots for Toxicology testing are to be itemized under the original evidence submission (i.e. vitreous humor for chemistries, etc.)

B. Highlight the piece of evidence to itemize and right click. C. Select itemize evidence. D. In the description field, use the following format for the aliquots:

a. Liver → aliquot LV= b. Muscle → aliquot MUS= c. Brain → aliquot BR= d. Vitreous Humor → aliquot VIT= e. Clot → aliquot CLOT= f. Stomach Contents → aliquot SC= g. Liver Blood → aliquot LVBL= h. IFS urines → aliquot UR= i. Spleen → aliquot SPL= j. Spleen Blood → aliquot SPL BL= k. Subdural Clot → aliquot subdural clot= l. Aliquots for outside testing use the following format:

Bloods: aliquot BL=(amount) mL Example: aliquot BL=0.1mL for metabolic screening aliquot BL=3mL for HIV testing m. Subdural clots

a. An aliquot of the clot must be stored with the gray blood tubes for screening testing (exception: if specimen cup is <1/4 full, do not aliquot).

F. Type in the Notes field what the aliquot is for (i.e., Screening,HIV, metabolic screen, chemistries, etc.) Justice Trax prints a label as each item is itemized. Apply the barcode label to the relevant container.

G. Transfer aliquot to container and cap. Refer to TOX07.1026 Aliquotting Case Samples from Original Container.

H. Filter any solids from stomach contents and mark aliquots of stomach contents with a dot sticker. This signifies screening use only.

6.3.5 Items in plastic bags A. All submitted plastic bags (typically containing antemortem and

LifeGift specimens) require the contents to be itemized. A. Highlight the plastic bag and right click. B. Select itemize evidence. C. Check the boxes “Lock Via” and “Lock Apply” at the bottom

of the screen. This will allow for editing the previously entered itemized specimen after clicking on APPLY.

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D. Follow steps under section 6.3.3 B for processing the specimens E. JusticeTrax prints a label as each item is itemized within the plastic

bag. F. Complete a Case Owner form TOXF.124 for antemortem specimen

assignments in testing requests.

6.4 Discrepancies 6.4.1 Toxicology submission administrative corrections (i.e. no pathologist

signature, no testing marked, incorrect date, specimens not received, etc.) A. Complete the TOXF.124 Case Owner Form and include in case

folder. B. The Case Owner will contact the pathologist until the problem is

resolved. 6.4.2 Toxicology specimen corrections (no label, mislabeled, etc.)

A. Photograph the submission form and all of the specimens together in one picture.

B. Photograph the affected specimen(s) individually. C. Upload the pictures into the Justice Trax. Refer to the

TOX.EQ.5040 Toxicology Case Photos for instructions. D. Place all specimen corrections in the “Pathologist Correction Bin”

located in R1-2. All transfers must be done through Justice Trax. E. Complete TOXF.124 Case Owner Form and include in case folder. F. The Case Owner will contact the pathologist. G. The pathologist will make the necessary corrections and the

specimen(s) will be placed into the appropriate storage location(s).

6.5 Evidence List and Sealing 6.5.1 When all evidence items are edited with source and volume, added or

itemized aliquots, under the EVIDENCE tab, print the case physical evidence list by right clicking the mouse and select Print Physical Evidence List. Select printer of choice.

6.5.2 Seal all containers of solid tissues or stomach contents with initialed and dated evidence tape. Seal all other evidence with initialed and dated security tape by Grossing Analyst (A). Do not place any evidence tape over the Justice Trax labels. The labels are used for transfer of evidence.

6.6 Case Folder Preparation by Grossing Analyst (B)

6.6.1 As case processing proceeds, the case folders are prepared. Ensure

proper color designation (ML/OC or IFS). Three case labels will be

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attached to each folder. Ensure the labels on folder tabs can be visualized when case folders are stored horizontally and vertically. Each case folder will contain the following documents: A. TOX0F08.033 Toxicology Summary Worksheet B. Physical Evidence List (from Justice Trax) C. Request for Toxicology Examination Form (original) D. Request for Toxicology Examination Form (yellow copy from

morning pathologist meeting with case owner’s initials, if available) E. TOXF08.023 Data Review Tracking Sheet (exception: for No Tox

casework) stapled inside of the folder. 6.6.2 To generate case file evidence barcode label:

A. Open the case number by clicking on the folder icon. B. Select the AGENCY tab C. Right click on the blank screen D. Select Add Agency E. Select HCIFS Laboratory from the drop down menu. F. On the second line, type in the case number G. Select EVIDENCE tab H. Right click on the blank screen I. Select Add Evidence J. Change agency to HCIFS Laboratory K. Select analyst’s name for Representative L. Change evidence number to “000” for ML/ OC cases and evidence

number to “0000” for IFS cases. M. In the Description field, type “Tox Case File”. N. Select Case Folder for Evidence Type. O. Under initial Transfer, scan analyst’s barcode in the From with PIN

entry and To—scan barcode for Grossing Room. P. Select Apply and a barcode label will automatically print. Q. Place the barcode label below the stamped image on the front of the

folder.

6.7 Ordering Test Requests 6.7.1 Grossing Analyst (B) will add the “Tox Laboratory Report” as the first

request (request #0001). Do not add this request on No Toxicology cases. A. Click on the Request tab at the top. B. Right Click in the white space and select Add request.

a. Select Harris County Institute of Forensic Sciences as Agency b. Select pathologist for ML and OC. c. Select Toxicology as Department under Request Information d. Select Tox Laboratory Report as Service

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e. Select Grossing as Analyst C. Click OK. D. Evidence, individual, and offense do not have to be related to this

request. Click OK on each of windows requesting for something to be related.

E. Do not print request labels, uncheck request label in lower left hand corner.

F. Click Apply, then Close. 6.7.2 Ordering Test Requests from Toxicology Laboratory Summary Sheet

A. Click in the white space and select Add Request. a. Select Agency-Harris County Institute of Forensic Sciences or

submitting agency b. Select Representative-pathologist for ML and OC cases. c. Select HCIFS Laboratory for Request Information Lab d. Select Toxicology for Department e. Select testing as Service, i.e. alcohol screen, standard basic

screen, ELISA (full) etc. according to testing on the Toxicology Laboratory Summary Sheet. a. Select ELISA (IFS) for DFSA, while-at-work (WAW) and in-

custody deaths. f. Select Analyst-assign to section performing the test.

SCREENING, GCMS, LC/MS/MS g. Uncheck the Print Request Barcode. Click OK to complete

request. B. The next screen will ask to “relate the evidence.”

a. Highlight the specimen(s) to be tested. Refer to Table 1- Tests and Specimen Sources. Cases with antemortem specimens will be assigned by the Case Owner.

b. Click on the drop down arrow. Click OK. C. The next screen will ask to “relate the individual.”

a. Highlight the individual. b. Click on the drop down arrow. Click OK

D. For specialty testing or send outs, refer to “Grossing Drug Test Requests” under F:\Toxicology\Grossing for specific specimen requirements and section (SCREENING, GCMS, LCMS, etc.) performing the test.

6.8 No Toxicology Reporting 6.8.1 In some instances, cases and specimens are submitted but analyses are

not requested at the time of grossing. A. Select No Tox in the processing type field in the Local Data tab. B. Select No Toxicology Analysis Performed in the results field in the

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Local Data tab. C. Mark all blood (grey) specimens on hold with an “X” across the

caps. Additionally, mark red top and vitreous humor with an “X”. 6.8.2 Process “No Tox” request per the TOX08.1035 JusticeTrax LIMS-plus-

No Toxicology Reporting.

6.9 Infant Panel 6.9.1 Process all metabolic screens, a test in the infant panel, per TOX07.2007

procedure.

6.10 Case Statistics 6.10.1 After all of the cases have been processed, the grossing analyst will

create the daily Toxicology Examination Case Statistics for grossing. A. Click on the Crystal Report Icon on the top of the JusticeTrax screen

(or select Crystal Report under the Administrative drop down menu Generate)

B. Select “TOX Stats-Cases Processing Started” C. Click on PRINT (Print destination: default printer) D. Enter Start and End range with today’s date OK E. Analysts will initial the bottom of the printed sheet as the Grossing

Analysts (A & B). Document if any analysts are in training.

6.11 Transfer and Storage 6.11.1 Grossing Analyst (A) or designee will then transfer all specimens into

appropriate storage locations using JusticeTrax. Any aliquots, including send-outs, MUST be transferred first, before the original specimens are transferred. A. Stomach contents, liver, spleen, clots, and ante-mortem urine

containers are placed in numerical order in 22”x15”x3” cardboard boxes stored in a Toxicology refrigerator.

B. All other solid tissue specimens (e.g. muscle, brain, etc) are placed in 22”x 15”x 3” card board boxes and stored in the walk-in freezer.

C. Specimen numbers are on the outside of the storage box for easy identification.

D. Purple top blood tubes and/or pieces of rib or other tissue are transferred to a Toxicology refrigerator until an evidence technician from Forensic Genetics laboratory picks up the specimens. See 6.13.2 for proper transfer of Forensic Genetics evidence.

E. All other specimens are stored in the temporary refrigerated storage areas:

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a. Biles/Urines (labeled test tube racks) b. Red top blood tubes/Antemortem blood (labeled test tube racks) c. Grey top blood tubes (labeled test tube racks) d. Vitreous humor (labeled test tube racks)

F. All plastic bag JusticeTrax labels (antemortem and LifeGift specimens) and urine drug tests from ML/OC casework will be transferred in to “Biohazard Disposal” after all specimens are transferred to their storage units.

G. Volatile headspace vials are stored separately in the walk-in freezer. H. Hair specimens are stored indefinitely in the walk-in freezer.

6.12 Outsource Testing

6.12.1 The send out forms (TOXF.043 General Send Out Form and TOXF.044

Ben Taub Send Out Form) must contain the following information: A. ML/OC case number B. Date sent C. Test requested (example: Valproic acid) D. Type of specimen (blood, tissue, etc) E. Outside testing facility (BTGH, etc) F. Pathologist name and date requested

6.12.2 Evidence Transfers A. All transfers are documented in the JusticeTrax system under the

Evidence Transfer. B. For temporary storage, all send outs will be transferred to a

Toxicology refrigerator until actual date and time of transfer to testing facility.

C. For Ben Taub send outs, the sealed evidence package will be placed in “Ben Taub Send Out” container in a Toxicology refrigerator and transferred by Toxicology personnel.

D. All other send outs (NMS, FAA, court orders) will be transferred from a Toxicology refrigerator on the actual date and time via (Fed EX, agency, person, etc.) by Toxicology personnel.

E. The written request, external release form, external request form and/or shipping information will be stored in the case folder.

6.12.3 The following criteria is adhered to for outsourcing: A. The Toxicology laboratory will comply with the client’s request to

which laboratory the specimen is sent for analysis. B. These requests may include testing for

a. Microbiological b. Genetic c. Independent re-testing

C. If no prior laboratory selection has been made by the client, the

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Toxicology laboratory can recommend a testing laboratory. This laboratory, at minimum, is to be certified by College of American Pathologists (CAP) Laboratory Accreditation Board.

D. Drug assays that are not conducted by the Toxicology laboratory may be outsourced to testing laboratories accredited by any of the following: a. American Society of Crime Laboratory Directors/Laboratory

Accreditation Board (ASCLD/LAB) ISO 17025 Standards b. American Board of Forensic Toxicology (ABFT)

E. The Toxicology laboratory sends outsource specimens to NMS laboratory. Accreditation certificates are available on the NMS website: http://www.nmslabs.com/about-accreditations/

6.13 Transfer of Evidence (In-house)

6.13.1 All transfers are documented in the JusticeTrax under Evidence Transfer

to an evidence technician. Evidence technicians are responsible for transferring the evidence to another in-house laboratory.

6.13.2 Forensic Genetics A. All lavender top tubes, bones and tissues for Forensic Genetics are

placed in a Toxicology refrigerator until the evidence technician picks up the specimens.

B. For ease of transfer all specimens are placed in a JusticeTrax container “dna refrig bin” so the technician can pick up all specimens at earliest convenience. The container must be transferred in the Grossing Analyst’s possession before adding more specimens.

C. Forensic Genetics container protocol: a. Transfer the container into analyst’s possession

1. Click on Transfer or icon for Evidence Transfer. 2. Select Evidence Transfer from the drop down menu 3. Scan analyst’s barcode in To field. Pin Entry. 4. Click on the “No Barcode” icon next to the “Evidence to

Transfer” field. 5. Select Container from the drop down menu. 6. Select dna refrig bin from the drop down menu

and click Select. 7. A message will pop up that says “Do you want to empty

the container?” Click on NO. Click Close. b. Transfer the new specimens into the container

1. Both the specimens and container must be in the analyst’s possession before continuing.

2. Click on Transfer

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3. Select Containers from the drop down menu. 4. Select dna refrig bin and double click 5. Scan new specimen barcodes into the container 6. Click OK. 7. Close the window

c. Transfer the container back into the refrigerator 1. Click on Transfer 2. Select Evidence Transfer from the drop down menu 3. Click on the “No barcode” icon next to the “To” field. 4. Select Storage location from the drop down menu. 5. Click on the “No barcode” icon next to the “Evidence

to Transfer” field. 6. Select Container from the drop down menu. 7. Select dna refrig bin and click Select. 8. A message will pop up that says “Do you want to empty

the container?” Click NO. Click Close. D. Whenever Forensic Genetics testing is requested on specimens at a

later date, the sealed specimens (livers, muscles, blood, etc.) must be handled by Forensic Genetics personnel. The specimen will be transferred (and a copy of the submission form for DWI cases) after all Toxicology testing is complete. Forensic Genetics personnel will cut the tissue(s) or aliquot the blood for the required request. After the cutting or aliquotting is complete, the specimens are transferred back to the Toxicology Lab. All transfers are recorded in Justice Trax.

6.13.3 Drug Chemistry A. Loose tablets, controlled substances, or other items found outside of

the body are transferred to the Drug Chemistry laboratory. B. Loose tablets or controlled substances found inside the body are

considered biohazardous and may be analyzed by the Toxicology laboratory if testing has been requested. Contact the Chief Toxicologist for guidance if the testing is not available.

C. All transfers are completed through the Justice Trax system. Documentation for the reason of transfer can be typed in the notes section under the Evidence tab for the piece of evidence of interest.

6.13.4 Histology A. Histology decals are released to Histology.

6.14 Evidence Releasing to External Agencies

6.14.1 Release of specimens require filling out an HCIFS Evidence Release form with date, time, ML/OC#, type and amount of specimen released, releasing personnel’s signature, and signature and ID of individual

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accepting the evidence. The original release form is attached to the case file, and a copy is given to the agency for their records. These transfers should be from the Toxicology Laboratory to Evidence when appropriate.

6.14.2 All transfers are completed through the JusticeTrax (applicable for cases 2007 and above). Documentation for the reason of transfer can be typed in the notes section under the Evidence tab for the piece of evidence of interest.

6.14.3 Individuals such as family members, lawyers, etc., requiring autopsy specimens for other analyses must make a written request to Laboratory Administration.

6.15 Long Term Storage of Sealed Evidence

6.15.1 While specimens are being analyzed, autopsy specimens are stored in

secured temporary storage refrigerators. After each analytical test is completed, the evidence will be re-sealed with initialed and dated evidence or security tape.

6.15.2 The stomach contents and liver tissues are sealed and stored in boxes in a Toxicology refrigerator. When full, the boxes are transferred to long term freezer storage.

6.15.3 As refrigerators are filled, the sealed blood, vitreous humor, urine, bile and IFS specimens are transferred to long-term refrigerators at the off-site Cryogene Laboratory storage facility (9300 Kirby Drive, Suite 200, Houston, Texas, 77054). Refer to TOX09.1042.

6.15.4 All ML/OC specimens are stored for a minimum of one year. 6.15.5 Any ML/OC specimens saved for court orders or by written letters will

be handled by Evidence. Refer to procedure QAE08.0007 “Processing Toxicology Save Specimens”.

6.16 Disposal of Evidence

6.16.1 Disposal of Autopsy Specimens

A. All autopsy specimens will be disposed into contracted licensed biological waste containers after a minimum of one year.

B. All specimens will be transferred to Biohazardous Disposal under Storage Location in the JusticeTrax system

7.0 Test Request Order Actions 7.1 Screening requests

7.1.1 Refer to TOX07.1019 Preferred sources used for screening and

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confirmation. 7.1.2 All standard acidic requests require an ELISA Acetaminophen. 7.1.3 All single ELISA requests (Salicylate-(S) and Acetaminophen-(A)) will

require an abbreviation of the request in the requestor notes of the original ELISA request.

7.1.4 When ELISA is requested on a decomposed decedent, request the “ELISA (decomp)” panel or “ELISA (decomp stimulant)” panel.

7.1.5 If the pathologist requests synthetic cannabinoids, bath salts, or designer amphetamines, request a TOF screen in addition to the confirmation request.

7.1.6 If the pathologist requests stomach content quantitation, create a case message in JusticeTrax. A. While in the Case Info tab, select “Case” then “Case message”.

Type in “SC quantitation requested” in the text box.

7.2 Decomposed specimens

7.2.1 For alcohol requests, enter decomposed in the requester notes of the alcohol request. Specimen preference for alcohol requests: vitreous humor, decomposition fluid, urine, bile, spleen blood, spleen. Avoid liver if possible.

7.2.2 For drug screening requests in decomposed cases without blood, the order of preferences of specimens to be related are: decomposition fluid, urine, spleen blood, spleen, and liver.

7.3 Carboxyhemoglobin requests 7.3.1 Enter the age of the decedent in the requestor notes of the test request.

Request Carboxyhemoglobin (Co-Ox) for blood specimens. If available, heart blood (gray) is preferred. Request Carboxyhemoglobin (Headspace GC) for tissues. If available, spleen is preferred.

7.4 Alcohol requests 7.4.1 Enter Driver on Tox Summary Sheet if indicated as driver. Also enter

Driver in requester notes under the request. 7.4.2 Enter decomposed in the requestor notes of the alcohol request for

decomposed cases. 7.4.3 Alcohol testing on an isolated source (heart, femoral etc) is preferred

over cavity blood (ie chest, abdominal). 7.4.4 Due to the additives found in yellow and blue top blood tubes, they are

not preferred for alcohol analysis.

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8.0 Acceptance Criteria 8.1 Not Applicable

9.0 References

9.1 Not Applicable

10.0 Revision History

Revision Description of Change Reviewed By Date

14

Updated section 6.8 with evidence sealing, added request labels memo, grossing decomposed cases, signing request form, and change requests

F. Guale/ A. Beard 1013

15

Added information on documenting decomposed decedents on the Request for Toxicology Examination and adding either ELISA (decomp) or ELISA (decomp stimulant) requests, updated description of volatile and helium headspace vials, and added “minimum of” wording to specimen retention intervals A. Beard 0314

16

Clarified the retention statement was for IFS specimens, added where the send out paperwork is stored, removed specific refrigerator identifications, incorporated change request A. Beard

0514/0714

17 Added selecting the processing type on No Toxicology cases A. Beard 0814

18 Added steps to add “Tox Laboratory Report” request and addressed raised changes A. Beard 1014

19

Changed the retention policy to 1 year for grey top bloods, deleted aliquots of tissue in decomposed cases without blood and clots for long term storage. Update

A. Beard/ L.Nickell 1114

20

Added spleen blood and subdural clot aliquot commands, removed specimen volumes from aliquot commands because any volume can be aliquotted, updated Forensic Genetics requests section to indicate the sample will be transferred once all Toxicology testing is complete, added comparison of case number between pre-printed labels and labels printed by the pathologist. A. Beard 0215

21 Added Table 3 attachment for panel definitions; reorganize, address raised changes, update table 1.

A. Beard/L. Nickell

0615/0715

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22

Update tables, formatting changes, address raised changes, update to chief toxicologist, remove stomach content testing on TR cases, added typing color of blood tube to notes field

L. Nickell/T. Gray/A. Beard

0716/1016

23 OC cases will be designated with ML processing type in the local data tab; typo in metabolic screen corrected

T. Gray/A. Beard/L. Nickell 1116

11.0 Attachment(s) or Appendices

11.1 Table 1: Panel Definitions 11.2 Table 2: Tests and Specimen sources

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Table 1: Panel Definitions

Driver Panel Infant panel In-Custody Panel DFSA Panel Alcohol Screen Alcohol Screen Alcohol Screen Alcohol Screen

Chemistries ELISA (IFS) ELISA (IFS)

ELISA (Full) TOF Screen IFS Standard Basic Drug Screen GHB Screen ELISA (Acetaminophen)

ELISA (Salicylate) Metabolic Screen

Homicide Panel W-A-W Panel Alcohol Screen Alcohol Screen

ELISA (Stimulant) ELISA (IFS)

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Table 2: Tests and Specimen Sources

Specimen Submitted

Alcohol (100 µL)

ELISA (100 µL)

Standard Basic/Acidic (2 mL/1 mL)

GHB/TOF screen

(1 mL/0.2 mL)

Drug Confirmation

PM Gray-same source

Tube #1 or tube w/ least

specimen

Tube #2 or tube w/ least

specimen

Tube #3 Tube #3 Tube different from screen

PM Gray-different source

Tube #1 or isolated source

Heart/related great vessels or

tube w/ least specimen

Heart/related great vessels (other than

ELISA) unless only 1 received

Heart/related great vessels (other than

ELISA) unless only 1 received

Peripheral source

Gray-one tube

1. gray 2. body fluids 3. tissue

bloods 4. tissue

1. red 2. tissue

blood 3. tissue

1. red 2. tissue

blood 3. tissue

1. red 2. tissue

blood 3. tissue

1. gray 2. stomach

content 3. liver

No blood 1. body fluids 2. tissue

blood 3. tissue

1. tissue blood

2. tissue

1. tissue blood

2. tissue

1. tissue blood

2. tissue

1. stomach content

2. liver

Embalmed Vitreous humor Vitreous humor Liver Liver Liver AM Blood Tube

assignment by Case Owner

Tube assignment by Case Owner




Clot Clot Clot Clot Clot Clot

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