The Forensic Examiner (Sample) - Spring 2010

Investigative Differences and Cold Case Profiling:Looking at Typical and Atypical Homicides

Criminal Investigation:The Conclusion to Dr. Greg Vecchi’s Enlightening Four-Part Series

Finding IEDs Before They Find You:

The SMOKE System of Training for Hazardous

Device Detection

Book Reviews

Kate Warne, First Female Detective

Quality ACFEI Products

Member Heidi Bale on Nursing’sFrustrations and Satisfactions

2010 NATIONAL CONFERENCE: ORLANDO, FL • SEPTEMBER 22–24

$7.50 U.S./$9.50 CAN

2 THE FORENSIC EXAMINER® Spring 2010 www.acfei.com

JOIN TODAY!(800) 423-9737

www.acfei.com

The American College of Forensic Examiners InstituteSM (ACFEI) is an independent, scientific, and professional society that serves

as the national center for the continued advancement of forensic examination and consultation across the many professional fields of

forensic science. There are five levels of membership and 11 different specialty boards designed to benefit you in your forensic specialty.

Earn Continuing Education credits, receive The Forensic Examiner® in the mail, network with other members across disciplines, and take advantage of the membership credit card service

and insurance benefits available to members today.

Don’t wait to become a valued member of this growing and nationally recognized professional organization committed to benefiting you.

ACFEI01EX

Spring 2010 THE FORENSIC EXAMINER® 3(800) 592-1399


FORENSICEXAMINER®

THE

The Official Peer-Reviewed Journal of The American College of Forensic Examiners VOLUME 19 • NUMBER 1 • Spring 2010

FEATURES

16

10

16

COVER STORY

Principles and Approaches to Criminal Investigative Analysis: Part 4 of 4By Gregory M. Vecchi, PhD, CFC, CHS-V, DABCIP, DABLEE

Tranquilizer Drug ForensicsBy Jonathan J. Lipman, PhD, FACFEI, DABFE, DABFM, DABPS

TranquilizerDrug Forensics

48

The Commission on Forensic Education

The Detective’s Corner: Doggone TroubleBy Janice Curran

Kate Warne: First Female DetectiveBy Katherine Ramsland, PhD, CMI-V

An Interview with Heidi Bale: Forensic Nurse Discusses Her Diverse, Challenging Work

Falsely Accused: The Truth Sets Only Some Free


FEATURES

CASE STUDIES/OTHER FEATURESALSO IN THIS ISSUE

38

69

73

74

79

08 Letters

2010 National Conference

ACFEI Logo Products

New Members

Book Reviews

Shoebox for Soldiers

3564

70

77

78

40 Typical and Atypical Homicide: Investigative Differences and Cold Case ProfilingBy Gregory Moffatt, PhD, DABPS, LPC; and Nicholas Hersey

Finding IED’s Before They Find You: The SMOKE System of Training for Hazardous Device DetectionBy Matthew J. Sharps, PhD, DABPS, FACFEI, Elaine Newborg, BA, Mallory Glasere, BA, Bill Hayward, BA, and Michael Scholl

48

10 40

35

The American College of Forensic Examiners International (ACFEI) does not endorse, guarantee, or war-rant the credentials, work, or opinions of any individual member. Membership in ACFEI does not constitute the grant of a license or other licensing authority by or on behalf of the organization as to a member’s qualifications, abilities, or expertise. The publications and activities of ACFEI are solely for informative and educational purposes with respect to its members. The opinions and views expressed by the authors, pub-lishers, or presenters are their sole and separate views and opinions and do not necessarily reflect those of ACFEI, nor does ACFEI adopt such opinions or views as its own. The American College of Forensic Examin-ers International disclaims and does not assume any responsibility or liability with respect to the opinions, views, and factual statements of such authors, publishers, or presenters, nor with respect to any actions,

qualifications, or representations of its members or subscriber’s efforts in connection with the application or use of any information, suggestions, or recommendations made by ACFEI or any of its boards, committees, publications, resources, or activities thereof.

The Forensic Examiner® (ISSN 1084-5569) is published quarterly by The American College of Forensic Examiners International, Inc. (ACFEI). Annual membership for a year in the American College of Forensic Examiners International is $165. Abstracts of articles published in The Forensic Examiner® appear in National Criminal Justice Reference Service, Cambridge Scientific Abstracts, Criminal Justice Abstracts, Gale Group Publishing’s InfoTrac Database, e-psyche database, and psycINFO database. Periodicals Postage Paid at Springfield, Missouri, and additional mailing offices. © Copyright 2010 by the American College of Forensic Examiners International. All rights reserved. No part of this work can be distributed or otherwise used without the express written permission of the American College of Forensic Examiners International. The views expressed in The Forensic Examiner® are those of the authors and may not reflect the official policies of the American College of Forensic Examiners International.

CONTACT US:Publication, editorial, and advertising offices of ACFEI, 2750 East Sunshine Street, Springfield, MO 65804. Phone: (800) 592-1399, Fax: (417) 881- 4702, E-mail: [email protected]. Subscription changes should be sent to ACFEI, 2750 East Sunshine, Springfield, MO 65804.

POSTMASTER:Send address changes to American College of Forensic Examiners International, 2750 East Sunshine Street, Springfield, MO 65804.

6 THE FORENSIC EXAMINER® Spring 2010 www.acfei.comwww.acfei.com

Louay Al-Alousi, MB, ChB, PhD, FRCPath, FRCP(Glasg), FACFEI, DMJPath, DABFM, FFFFLMNicholas G. Apostolou, DBA, DABFA, CPA, Cr.FALarry Barksdale, BS, MA E. Robert Bertolli, OD, FACFEI, CHS-V, CMI-VKenneth E. Blackstone, BA, MS, CFC, DABFEDavid T. Boyd, DBA, CPA, CMA, CFM, Cr.FAJules Brayman, CPA, CVA, CFD, DABFA, FACFEIJohn Brick, PhD, MA, DABFE, DABFM, FACFEI Richard C. Brooks, PhD, CGFM, DABFEDennis L. Caputo, MS, DABFET, REM, CEP, CHMM, QEP, FACFEI David F. Ciampi, PhD, FACFEI, DABPSLarry Crumbley, PhD, CPA, DABFE, Cr.FAAndrew N. Dentino, MD, FACFEI, DABFE, DABFM James A. DiGabriele, PhD/DPS, CPA/ABV/CFF, Cr.FA, DABFA, FACFEIJohn Shelby DuPont Jr., DDS, DABFD Scott Fairgrieve, Hons. BSc, MPhil, PhD, FAAFSEdmund D. Fenton, DBA, CPA, CMA, Cr.FA Per Freitag, PhD, MD, FACFEI, DABFE, DABFMNicholas Giardino, ScD, FACFEI, DABFEDavid H. Glusman, CPA, DABFA, CFS, Cr.FA, FACFEIRon Grassi, DC, MS, FACFEI, DABFM, DABFERichard C. W. Hall, MD, FACFEI, DABFM, DABFE, FAPA, FAPM, FACPsychRaymond F. Hanbury, PhD, ABPP, FACFEI, DABFE, DABPS, CHS-IIINelson Hendler, MD, DABFMDavid L. Holmes, EdD, FACFEI, DABFE, DABPSLeo L. Holzenthal Jr., PE, DABFET, FACFEILinda Hopkins, PhD, CFC, DABPS, DABRE Nursine S. Jackson, MSN, RN, DABFNPaul Jerry, MA, DAPA, DABFCPhilip Kaushall, PhD, DABFE, DABPS, FACFEIEric Kreuter, PhD, CPA, CMA, CFM, DABFA, FACFEIRonald G. Lanfranchi, DC, PhD, DABFE, DABFM, DABLEE, CMI-IV, FACFEIRichard Levenson, Jr., PsyD, DABFE, DABPS, FACFEIMonique Levermore, PhD, FACFEI, DABPS Jonathan Lipman, PhD, FACFEI, DABFE, DABPS, DABFMJudith Logue, PhD, FACFEI, DABFSW, DABPS, DABFE, DABFMMike Meacham, PhD, LCSW, DABFSW, FACFEIDavid Miller, DDS, FACFEI, DABFE, DABFM, DABFDJohn V. Nyfeler, CHS-IIIJacques Ama Okonji, PhD, FACFEI, DABFE, DABPS

Norva E. Osborne, OD, CMI-IIITerrence O’Shaughnessy, DDS, FACFEI, DABFD, DABFE, DABFMGeorge Palermo, MD, FACFEI, DABFE, DABFMRonald J. Panunto, PE, CFC, CFEI, DABFETLarry H. Pastor, MD, FACFEI, DABFE, DABFMTheodore G. Phelps, CPA, DABFAMarc Rabinoff, EdD, FACFEI, DABFE, CFCHarold F. Risk, PhD, DABPS, FACFEISusan P. Robbins, PhD, LCSW, DABFSWWalter A. Robbins, CPA, PhDJane R. Rosen-Grandon, PhD, DABFC, FACFEIDouglas Ruben, PhD, FACFEI, DABFE, DABFM, DABPSJ. Bradley Sargent, CPA, CFS, Cr.FA, DABFA, FACFEIWilliam Sawyer, PhD, FACFEI, DABFE, DABFMHoward A. Shaw, MD, DABFM, FACFEIHenry A. Spiller, MS, DABFE, FACFEIMarilyn Stagno, PsyD, DABFE, DABFM, DABPSRichard I. Sternberg, PhD, DABPSJames R. Stone, MD, MBA, CHS-III, CMI-IV, DABFE, DABFM, FACFEIWilliam A. Tobin, MA, DABFET, DABLEE, FACFEIRobert Tovar, BS, MA, DABFE, DABPS, CHS-IIIBrett C. Trowbridge, PhD, JD, DABPS, FACFEIJeff Victoroff, MD, DABFE, DABFMPatricia A. Wallace, PhD, FACFEI, DABFE, DABFM, CFCRaymond Webster, PhD, FACFEI, DABFE, DABFMDean A. Wideman, MSc, MBA, CFC, CMI-III, DABFE

PUBLISHER:Robert L. O’Block, MDiv, PhD, PsyD, DMin([email protected])

EDITOR IN CHIEF:Christopher Powers ([email protected])CHIEF ASSOCIATION OFFICER Katie Wilcox ([email protected])EXECUTIVE ART DIRECTOR:Brandon Alms ([email protected])ASSOCIATE EDITOR:Tanja Kern ([email protected])ASSOCIATE EDITOR:Teresa Hernandez ([email protected])ADVERTISING:Christopher Powers ([email protected])(800) 592-1399, ext. 116

ACFEI EXECUTIVE ADVISORY BOARD

CHAIR: Cyril H. Wecht, MD, JD, CMI-V, CFP, FACFEI, DABFE, DABFM

MEMBERS:Cam Cope, MS, DABFET, DABFE; Chair, American Board of Forensic Engineering and TechnologyDianne Ditmer, MS, RN, SANE, CFN, CMI-III, CHS-III, FACFEI, DABFN; Chair, American Board of Forensic NursingDouglas E. Fountain, PhD, LCSW, DABFE, DABFSW; Chair, American Board of Forensic Social WorkersRaymond F. Hanbury, PhD, FACFEI, DABPS, DABFE, CHS-III, ABPP; Chair, American Board of Psychological SpecialtiesMichael G. Kessler, Cr.FA, CICA, FACFEI, DABFA, DABFE; Chair, American Board of Forensic AccountingMarilyn J. Nolan, MS, FACFEI, DABFC, DABCIP; Chair, American Board of Forensic CounselorsThomas J. Owen, BA, FACFEI, DABRE, DABFE, CHS-V; Chair, American Board of Recorded EvidenceGregory M. Vecchi, PhD, CFC, CHS-V, DABLEE, DABCIP; Chair, American Board of Critical Incident Professionals

FORENSICEXAMINER®

THE

2010 EDITORIAL ADVISORY BOARD

CONTINUING EDUCATION

ACFEI provides continuing education credits for accountants, nurses, physicians, dentists, psychologists, counselors, social workers, and marriage and family therapists.

Approvals for continuing education activities are subject to change. For the most up-to-date status, please check the course catalog on our Web site, www.acfei.com, or by contacting the Continuing Education staff toll-free at (800) 423-9737.

ACFEI is an approved provider of Continuing Education by the following:Accreditation Council for Continuing Medical Education National Association of State Boards of Accountancy National Board for Certified Counselors California Board of Registering Nursing American Psychological Association California Board of Behavioral Sciences Association of Social Work Boards American Dental Association (ADA CERP) The Missouri Sheriff’s Association co-sponsors Police Officer Standards Training (POST) accreditation for the American College of Forensic Examiners Institute’s activities. The American College of Forensic Examiners Institute is a member of the National Certification Commission and the Alliance for Continuing Medical Education. The Ethics Course, Law Course, Evidence Course, Certified Medical Investigator®, Certified Forensic Accountant, Cr.FA®, and the Certified in Homeland Security, CHS® Levels I-V are all approved for the G.I. Bill benefits.

INSIDE THE FORENSIC EXAMINER®

CALL FOR REVIEWERSThe Forensic Examiner® is always seeking members to serve on the Editorial Advisory Board. It is your expertise and dedication that helps all of our authors produce the most accurate and excellent articles for your prestigious journal. Please contact the editor if you wish to become a member of the Board, and thank you for everything you do to make the journal great!


AMERICAN BOARD OF CRITICAL INCIDENT PROFESSIONALSChair of the Executive Board of Critical Incident Professionals: Gregory M. Vecchi, PhD, CFC, CHS-V, DABLEE, DABCIPMonica J. Beer, PhD, DABCIPSam D. Bernard, PhD, DABCIP, CHS-IIIMarie Leeds Geron, PhD, CHS-V, DABCIPRaymond H. Hamden, PhD, FACFEI, DABPS, DABCIP, DABCHS, DAPA, CFC, CMI-V, CHS-VTina Jaeckle, PhD, LCSW, DABCIP, CFCMarilyn J. Nolan, MS, FACFEI, DABFC, DABCIPRev. Roger Rickman, ThD, MBA, ACC, CFC, CHS-V, CMI-III, SSI, CRS, DABCHS, DABCIP, DAPA, FABI, PI, SCS, FAAIMDebra Russell, PhD, CMI-V, CHS-III, CRC, CISM, DABCIPDorriss “Ed” Smith, Col. US Army, CHS-V, DABCIPVincent B. Van Hasselt, PhD, DABCIPAlan E. Williams, MS, CHS-V, DABCIP

AMERICAN BOARD OF FORENSIC ACCOUNTINGChair of the Executive Board of Accounting Advisors: Michael G. Kessler, Cr.FA, CICA, FACFEI, DABFA, DABFEChair Emeritus: J. Bradley Sargent, CPA, CFS, Cr.FA, FACFEI, DABFAStewart L. Appelrouth, CPA, CFLM, CVA, FACFEI, DABFA, Cr.FA, ABVGary Bloome, CPA, Cr.FAAlexander Lamar Casparis, CPA/ABV/CFF/CITP, CVA, MBA,Cr.FAD. Larry Crumbley, PhD, CPA, DABFA, Cr.FA, CFFA, FCPAJune M. Dively, CPA, DABFA, Cr.FAMichael W. Feinberg, CPA, Cr.FADavid Firestone, CPA, Cr.FAMark S. Gottlieb, CPA/ABV/CFF, CVA, CBA, DABFA, MSTDavid H. Glusman, CPA, FACFEI, DABFA, Cr.FAEric A. Kreuter, PhD, CPA, CMA, CFM, FACFEI, DABFA, SPHR, CFD, CFFA, BCFTRobert K. Minniti, CPA, MBA, Cr.FADennis S. Neier, CPA, DABFA, FACFEIKim J. Onisko, CPA, Cr.FAJoseph F. Wheeler, CPA, Cr.FA, CHS-III, CFF, CAMS

AMERICAN BOARD OF FORENSIC COUNSELORSChair of the Executive Board of Forensic Coun-selors: Marilyn J. Nolan, MS, FACFEI, DABFC, DABCIPChair Emeritus: Dow R. Pursley, EdD, FACFEI, DABFCGeorge Bishop, LPC, LAT, LAC, FACFEI, DABFELaura W. Kelley, PhD, LPC, DABFC, FACFEIWilliam M. Sloane, JD, LLM, PhD, FACFEI, DABFC, CHS-III, CMI-I, DACC, DCPC, FAAIM, FACC, MTAPA

AMERICAN BOARD OF FORENSIC DENTISTRYChair Emeritus of the Executive Board of Foren-sic Dentistry: Brian L. Karasic, DMD, MScFin, MOA, MBA, CMI-IV, FACFEI, DABFD, DABFM, DABFE, FAAIMMembers of the Executive Board of Dental Advi-sors: Bill B. Akpinar, DDS, CMI-V, FACFEI, DABFD, DABFE, DABFMStephanie L. Anton-Bettey, DDS, CMI-VJeff D. Aronsohn, DDS, FACFEI, DABFD, CMI-VSusan Bollinger, DDS, CMI-IV, CHS-IVJames H. Hutson, DDS, CMI-V, DABFD, FACFEI

AMERICAN BOARD OF FORENSIC EXAMINERSMembers of the Executive Board of Forensic Examiners: Jess P. Armine, DC, FACFEI, DABFE, DABFMJohn H. Bridges III, CHS-V, CHMM, CSHM, DABCHS, DABCIP, FACFEIRonna F. Dillon, PhD, DABFE, DABPS, CMI-V, CHS-IIIBruce H. Gross, PhD, JD, MBA, FACFEI, DABFE, DABFM, DABPS, DAPADarrell C. Hawkins, MS, JD, FACFEI, DABFE, DABLEE, CMI-V, CHS-III, F-ABMDII, IAI-SCSA, IAAI-CFIMichael W. Homick, PhD, DABCHS, CHS-VJohn L. Laseter, PhD, FACFEI, DABFE, DABFM, CMI-IV, CHS-IIIJonathan J. Lipman, PhD, FACFEI, DABFE, DABFM, DABPSLeonard K. Lucenko, PhD, FACFEI, DABFE, CPSIEdward M. Perreault, PhD, DABFE, FACFEIMarc A. Rabinoff, EdD, FACFEI, DABFE, CFCJanet M. Schwartz, PhD, FACFEI, DABFE, DABFM, DABPS, DABCHS, CHS-V, DAPA, NCC, NCP, CDP-I

AMERICAN BOARD OF FORENSIC ENGINEERING AND TECHNOLOGYChair of the Executive Board of Engineering and Technology Advisors: Cam Cope, BS, DABFET, DABFEVice Chair: George C. Frank, CFC, DABFE, FACFEIChair Emeritus: Ben Venktash, DABFET, DABFE, Peng (UK), FSE, CHSP, REA, FRSH (UK), FIET (UK)David Albert Hoeltzel, PhD, DABFE, DABFETRobert K. Kochan, BS, FACFEI, DABFET, DABFEJ.W. “Bill” Petrelli Jr., AIA, NCARB, TAID, FACFEI, DABFET, CFCMax L. Porter, PhD, DABFET, DABFE, PE, HonMASCE, Parl, Dipl ASFE, FTMS, FACI, CFC, FACFEI

AMERICAN BOARD OF FORENSIC MEDICINEChair of the Executive Board of Medical Advisors:Cyril H. Wecht, MD, JD, CMI-V, CFP, FACFEI, DABFE, DABFMMembers of the Executive Board of Medical Advisors: Douglas Wayne Beal, MD, MSHA, CMI-V, CFP, DABFE, DABFMZhaoming Chen, MD, PhD, MS, FAAIM, CFPJohn A. Consalvo, MD, DABFE, DABFM, FACFEIVijay P. Gupta, PhD, DABFMLouis W. Irmisch III, MD, FACFEI, DABFM, DABFE, CMI-V, CFPE. Rackley Ivey, MD, FACFEI, DABFM, DABFE, DAB-MCM, DAAPM, CMI-V, CFPKenneth A. Levin, MD, FACFEI, DABFM, DABFE, CFPE. Franklin Livingstone, MD, FACFEI, DABFM, DABFE, DAAPM, FAAPM&R, CFPManijeh K. Nikakhtar, MD, MPH, DABFE, DABPS, CMI-V, CHS-V, CFPJohn R. Parker, MD, FACFEI, DABFM, FCAP, CFPJerald H. Ratner, MD, DABFE, DABFM, FACFEIMatthias I. Okoye, MD, MSc, JD, FRCPS. Sandy Sanbar, MD, PhD, JD, FCLM

AMERICAN BOARD OF FORENSIC NURSINGChair of the Executive Board of Nursing Advisors: Dianne T. Ditmer, MS, RN, SANE, CFN, CMI-III, CHS-III, FACFEI, DABFNHeidi H. Bale, RN, CFN, CCHPMarilyn A. Bello, RNC, MS, NYSAFE, CHS-III, CMI-IV, CFC, CFN, SAFE, DABFN, DABFEWanda S. Broner, MSN, RN, FNE, CEN, SANE-ACynthia J. Curtsinger, RN, CFNLinda J. Doyle, RN, CLNC, CFN, CMI-IIIL. Sue Gabriel, EdD, MSN, MFS, RN, CFN, SANE, SANE-A, DABFE, DABFN

Diane L. Reboy, MS, RN, CFN, LNCC, FACFEI, DABFN, CNLCPElizabeth N. Russell, RN, BSN, CCM, BC, DABFN, FACFEI Sharon L. Walker, MPH, PhD, RN, CFNCarol A. Wood, RN, CFN, BS, NHA

AMERICAN BOARD OF FORENSIC SOCIAL WORKERSChair of the Executive Board of Social Work Advisors: Douglas E. Fountain, PhD, LCSW, FACFEI, DABFE, DABFSWChair Emeritus: Karen M. Zimmerman, MSW, DABFSW, DABFESusan L. Burton, MA, MSW, LMSW, DABFSW, DABLEEJudith V. Caprez, MSW, ACS, LCSW, DABFSWPeter W. Choate, PhD, BA, MSW, DABFSW, DABFEJudith Felton Logue, PhD, FACFEI, DABFE, DABFSW, DABPS, DABFMMichael G. Meacham, PhD, LCSW, DCSW, FACFEI, DABFSWKathleen Monahan, DSW, MSW, CFC, DABFESusan P. Robbins, PhD, LCSW, DCSW, BCD, LDC, DABFSWSteven J. Sprengelmeyer, MSW, MA, FACFEI, DAB-FSW, DABFE, LISW

AMERICAN BOARD OF PSYCHOLOGICAL SPECIALTIESChair of the Executive Board of Psychological Advisors: Raymond F. Hanbury, PhD, FACFEI, DABPS, DABFE, CHS-III, ABPPVice Chair: Raymond H. Hamden, PhD, FACFEI, DABPS, DABCIP, DABCHS, DAPA, CFC, CMI-V, CHS-V Chair Emeritus: Carl N. Edwards, PhD, JD, FAAFS, FICPP, FACFEI, DABPS, DABFECarol J. Armstrong, PhD, LPC, DABPSRobert J. Barth, PhD, DABPSMonica J. Beer, PhD, DABCIPJohn Brick III, PhD, MA, FAPA, CMI-V, FACFEI, DABFE, DABPS, DABFMAlan E. Brooker, PhD, FACFEI, DABPS, DABFM, DABFE, CMI-III, ABPP-CnRonna F. Dillon, PhD, DABPS, DABFE, CMI-V, CHS-IIIStephen P. McCary, PhD, JD, FACFEI, DABFE, DABFM, DABPS, FAACP, DAPAHelen D. Pratt, PhD, FACFEI, DABPS Douglas H. Ruben, PhD, FACFEI, DABPS, DABFE, DABFMRichard M. Skaff, PsyD, DABPSCharles R. Stern, PhD, DABPS, DABFE, DABFM, FACFEI, CMI-VJoseph C. Yeager, PhD, DABFE, DABLEE, DABPS, FACFEI Donna M. Zook, PhD, DABPS, CFC

AMERICAN BOARD OF RECORDED EVIDENCEChair of the Executive Board of Recorded Evi-dence Advisors: Thomas J. Owen, BA, FACFEI, DABRE, DABFE, CHS-VErnst F. W. (Rick) Alexanderson, BA, MBA, FACFEI, DABRE, DABFEEddy B. Brixen, DABFET Charles K. Deak, BS, CPC, DABFE, FACFEIRyan O. Johnson, BA, DABFE, DABREMichael C. McDermott, JD, DABRE, DABFE, FACFEIJennifer E. Owen, BA, DABRE, DABFE Lonnie L. Smrkovski, BS, DABRE, DABFE, FACFEI

ACFEI EXECUTIVE ADVISORY BOARDS

INSIDE THE FORENSIC EXAMINER®

LETTERS

Do you have something you would like to say to your fellow Forensic Examiner®

readers? Pleased, angry, or indifferent, share your opinions

on articles, issues, trends, or ideas here! E-mail your

thoughts and comments to [email protected] or write to:

2750 East Sunshine St, Springfield, MO 65804

Please note that submissions may be edited for

length and content.

October 26, 2009 Dear Dr. O’Block, Thank you for your leadership and commitment to excellence. Your continued efforts and dedi-cation make a difference to the members of this outstanding organization. I sincerely appreciate the privilege of being a member of the ACFEI and the opportunity to share information with colleagues at the conference. It is an honor to serve you, your staff, and my nursing colleagues as chairman of the ABFN [American Board of Forensic Nursing]. Your vision has propelled the nursing division into a new area by providing focused on-line cur-riculum. The nurses are energized and have a plan to grow our courses and contribute schol-arly articles to The Examiner. Our new commitment has been supported by Katie, Anna and Samantha, for whom we are most grateful. Thank you for another outstanding conference. I look forward to supporting this organization and your vision for many years to come. Sincerely, Dianne Ditmer, RN, PhD, CFN, DABFN, CMI-III, CHS-III, SANE, FACFEI

Share your expertise—submit an article on a forensic topic for po-tential publication in future issues of The Forensic Examiner®!

No matter what your specialty or interest in the forensic science are-na, we’re sure you have important insight and information to share with fellow forensic professionals. The Forensic Examiner® includes scientific articles, case studies, new research in the area of forensic in-formation, and interviews with forensic professionals. We will accept article submissions on any topic of interest to our diverse membership base. Share your knowledge and experience with our readers!

Submit your articles to The Forensic Examiner® editorial de-partment by e-mailing them to [email protected].

Visit www.theforensicexaminer.com or call (800) 423-9737 for more information. Have any suggestions on how we can improve The Forensic Examiner®? Please let us know—we are always open to suggestions! CA

LL FO

R SU

BMIS

SION

S

For subscriptions call toll free: (800) 423-9737Subscribe online: www.TheForensicExaminer.com

Call now to find out how to receive a free issue!

Leann LongEditor in Chief

Office: (417) 881-3818Direct: (417) 823-2517

Toll Free: (800) 423-9737 Fax: (417) 881-4702Web: www.acfei.com

E-Mail: [email protected]

Association Headquarters:2750 East SunshineSpringfield, MO 65804


CFS01EX


BROUGHT TO YOU BY THE AMERICAN COLLEGE OF FORENSIC EXAMINERSDR. ROBERT O’BLOCK FOUNDED

BY CHIEF ASSOCIATION OFFICERKATIE WILCOX CHRIS GREIG

WWW.REGISTEREDINVESTIGATOR.NET

DESIGN BY

SM

RISM

Registered Investigator

Get Certified Be RecognizedExplore Opportunities

Uncover exciting new career possibilities!

RI01EX

Principles and Approaches to Criminal

Investigation, Part 4

By Gregory M. Vecchi, PhD, CFC, CHS-V, DABCIP, DABLEE

For the purposes of this series of articles, the term investigative processes will be used to de-scribe both criminal investigation and crime scene processing. Any distinctions between crim-inal investigation and crime scene processing will be designated as such. Although crime scene processing is part of criminal investigation, it is distinct; crime scene processing requires rigorous scientific methodologies (i.e., collection proce-dures, testing protocols, etc.), while criminal in-vestigation has less of a “hard science” character and relies more on the experience and skills of the investigator rather than rigid scientific pro-tocols and procedures. In this light, crime scene processing can be viewed as the “science” of in-vestigative processes, whereas criminal investi-gation can be viewed as the “art.” The format of this article series is to provide information on the entire spectrum of investigative processes that is useful for all individuals involved in investiga-tions: the responding officer, detectives/investi-gators, police supervisors, lawyers, judges, and other criminal justice professionals. This article examines special investigations such as white collar crime, drug trafficking, high-tech crime, and terrorism using the Enterprise Theory of Investigation; trial and testimony; and conflict and perspective.

Special InvestigationsSpecial investigations include white-collar crime, drug trafficking, organized crime, high tech-nology or cyber crime, cults, and terrorism (Criminology Today, 1995-2002a, 1995-2002b; Dyson, 2005). These crimes require special in-vestigative techniques, such as undercover op-erations and the use of the Enterprise Theory of Investigation. White-collar crime is often related to corporate crime, such as the Enron and WorldCom scandals; however, it is also as-sociated with health care, telemarketing, bank and securities, contract, and residential mov-ing. Organized crime is usually associated with centrally controlled organized criminal organi-zations, such as Italian, Italian-American, and Colombian criminal groups; however, lesser known decentralized criminal organizations are making inroads. For example, Russian and Israeli criminal groups are threatening to take control of rackets like drugs, money launder-ing, and many extortion-related schemes, which were once the exclusive realm of the centralized organized criminal groups.

The views expressed in

this article do not necessarily represent the

views of the FBI.


CASE STUDY

Drug trafficking still remains a very lucrative and corrupting influence in the United States (Criminology Today, 1995-2002a). Although there has been some success in curbing the influx of illegal drugs through enforcement and educa-tional programs, the amazing amount of wealth, resources, and cunning of drug traffickers is sometimes beyond the capability of the govern-ment to control. As a result, the government has begun to cut into the profits of the illegal drug trade through the aggressive application of assets forfeiture. For example, many law enforcement agencies assign officers to Drug Enforcement Administration (DEA) task forces for the pur-pose of obtaining forfeited assets and currency through drug investigations, which are used to supplement their operating budgets. High-technology crime affects significant as-sets and has the potential to be extremely costly and dangerous, especially with regards to infra-structural components such as air traffic con-trol, nuclear facilities, power grids, satellites, and banking systems (Criminology Today, 1995-2002b). Over the past decade, computer hackers have become very sophisticated and many are being paid by other organized crime and terrorist groups to manipulate these assets for profit and control. Because these types of high-tech crime are fairly anonymous, they are very difficult and expensive to solve. Terrorism has eclipsed nearly all other in-vestigative priorities since the September 11, 2001, terrorist attacks in New York City and Washington, DC. These investigations are very complex, due in part to the secret nature of terror-ist activities, the fluidity of their operations, their ability to embed themselves among us, the lack of centralized control and stated national affilia-tions, their willingness to die for their “cause,” and their uncooperative nature when caught (Dyson, 2005).

Enterprise Theory of InvestigationSpecial investigations such as drugs, organized crime, cyber-crime, and terrorism require a dif-ferent approach than more traditional crimes such as murder, robbery, and arson. Traditional investigations are focused on individuals, who, for the most part, are principally responsible for the crime (Criminology Today, 1995-2002a, 1995-2002b; Dyson, 2005). Once they are caught, prosecuted, and incarcerated, the crime stops. Shoplifting and assault are examples of

less complex individual-focused cases, whereas serial rapes and murders and the Washington, DC sniper case are examples of more complex individual-focused investigations. With special investigations, the focus needs to shift from be-ing solely on individuals to their collective “en-terprise” as a whole (the “enterprise” representing a specific racket—drugs, extortion, data acqui-sition or destruction, terrorism, etc.) because removing any one person will not stop further crimes from being committed by the remain-ing network. Therefore, the goal is to disrupt, dismantle, and incapacitate the entire network. Drug trafficking is the most common example of this, where continually arresting street dealers and raiding crack houses only result in someone else taking their places. Terrorism has similar characteristics with the additional disturbing trait of individuals lining up to die in service to their organizations’ ideologies and objectives. Most criminal organizations are in business to make money, whether it is accomplished through selling illegal drugs or stolen property, launder-ing other people’s money, extortion, or a myriad of other schemes. Even terrorist organizations are in the business of making money in order to fi-nance their ideological or political ambitions and objectives, as well as pocket some along the way (Dyson, 2005). The command and control of these organizations are efficient and resistant to traditional law enforcement techniques because they have learned to delegate the authority to multiple people and the highest leaders of the organization provide direction but rarely do any of the “dirty work.” Due to these characteristics, the Enterprise Theory of Investigation focuses on targeting the communication apparatus of the organization and following the money. In other words, the focus is on developing human intelligence and conducting covert operations in order to capture communications between members of the organization and identifying

Gregory M. Vecchi, PhD, CFC, CHS-V, DABCIP, DABLEE is the Unit Chief of the Behavioral Science Unit (BSU), Federal Bureau of Investigation (FBI). Dr. Vecchi conducts research, training, and consultation activities in behavior-based conflict analysis and resolution, crisis management, conflict and crisis communication, and global hostage-taking.


and seizing its assets. As previously mentioned, the goal is to dis-rupt, dismantle, and incapacitate the entire crim-inal organization. Therefore, the investigator should penetrate the organization at the highest level possible and use techniques that identify and expose its leadership to prosecution and its assets to forfeiture. The investigator should also strive to move up and down all echelons of the organization in order to ensure maximization of prosecution and assets forfeiture. Prosecuting these types of criminal organi-zations require the use of conspiracy laws and special laws such as the Racketeer Influenced and Corrupt Organizations (RICO) Act, the Continuing Criminal Enterprise (CCE) Act, and the Patriot Act. These laws allow the prosecu-tion of individuals who are culpable in criminal behavior based only on their conversations with others who actually commit the crimes, which allows prosecution of those who only give the orders. For example, if Robert ordered Bill to murder Ted and Bill carried it out, both Robert and Bill could be charged with Ted’s murder. Without special laws like conspiracy, Robert could never be charged. The conduct of these investigations is al-most always covert in nature because the sus-pects know they are committing crimes and they try to avoid contact with law enforce-ment. As such, it is necessary to use covert and undercover techniques, as well as overt techniques (Department of the Army, 1985; Fisher, 2004; Lyman, 2008; Osterburg & Ward, 2007). Covert techniques involve the gathering of criminal intelligence and evidence by using

special techniques such as pen registers and wiretaps. Undercover techniques involve col-lecting criminal intelligence through the use of undercover informants, agents and officers, consensual monitoring, and surveillance. Overt techniques are usually the last methods used for collecting criminal intelligence and evidence through the use of grand juries, interviews, in-terrogations, and search warrants. Special investigations concerning violations such as drugs, organized crime, cyber crime, and terrorism require the investigator to focus on the entire network of individuals who make up the organization, rather than focusing on individual criminal behavior (Department of the Army, 1985; Fisher, 2004; Lyman, 2008; Osterburg & Ward, 2007). Through the use of conspiracy-based statutes and covert/undercov-er techniques, the investigator targets the com-munication apparatus of the organization and its assets in order to disrupt, dismantle, and ul-timately incapacitate the organization. This al-lows multiple prosecutions of the organization’s members as well as forfeiture of its assets.

TrialThe investigator must be very cognizant of the importance of legal processes and con-siderations while conducting an investiga-tion if he or she expects the results to be ad-missible in court (Department of the Army, 1985; Fisher, 2004; Lyman, 2008; Osterburg & Ward, 2007). Among some of the most ob-vious aspects of these legal processes and con-siderations are criminal law, constitutional law, and Miranda rights waivers; however, the importance of trial and courtroom testimony considerations is oftentimes overlooked. It is important to remember that winning at trial is often more about who presents the better argument than it is about fairness or justice. This may seem disappointing; however, it is a reality that the investigator must acknowledge and live with if he or she is to be effective in the courtroom. Before a trial begins, hearings will have oc-curred during which the defense will attempt to obtain rulings from the judge that will be favor-able to their side. Through discovery, the defense

“these investigations are very complex, due in part,

to the secret nature of ter-rorist activities, the flu-idity of their operations,

their ability to embed them-selves among us, the lack

of centralized control and stated national “Cause,” and their uncooperative

nature when caught.”


will have been given access to the evidence that the prosecution plans to present, which is often challenged as being unfair, especially with highly damaging evidence (Department of the Army, 1985; Fisher, 2004; Lyman, 2008; Osterburg & Ward, 2007). Once the trial is set, it will usually be held in front of a jury in complex cases. A jury will be selected and both the prosecution and defense will have opportunities to challenge prospec-tive jurors. As the trial begins, the prosecutor will outline his or her case during opening ar-guments and the defense will outline his or her case, each one postulating the weaknesses of the other’s case. Following the opening arguments, the pros-ecutor will present his or her case, usually be-ginning with calling witnesses whom were ini-tially interviewed by investigators. It is also likely that the prosecutor will have crime labo-ratory experts testify concerning the physical evidence that was recovered by investigators. Additionally, other law enforcement officers will testify about information they developed during the case. The defense will then present its case, usu-ally challenging the physical and testimonial evidence presented by the prosecutor. Most of the challenges occur during cross-examination of the investigators where the defense will at-tempt to call into question the conduct of the investigation and the credibility of the investiga-tors. Technical issues concerning improper col-lection efforts, chain of custody, and method of analyses of the physical evidence are commonly raised. Questions concerning the accuracy of observations, interviews, affidavits, and rights waivers are examples of challenges to testimo-nial evidence. Following the presentation of evidence, both sides will deliver their closing arguments. The prosecution will summarize the evidence they pre-sented and explain how it proves the defendant’s guilt. Thereafter, the defense will review the evi-dence and argue how the evidence presented does not prove their client’s guilt. Ultimately, the jury will render a verdict of guilty, not guilty, or hung (meaning that they couldn’t come to a consensus on the defendant’s guilt or innocence).

Courtroom TestimonyUltimately, a critical factor in bringing a case to fruition is the investigator’s testimony in court. As a result, it is critical that the investigator thoroughly prepares before being called to the stand (Department of the Army, 1985; Fisher, 2004; Lyman, 2008; Osterburg & Ward, 2007). When preparing for trial, the investigator should coordinate closely with the prosecutor to avoid surprises in court. This coordination involves spending enough time with the prosecutor to determine what questions will be asked by the prosecutor and what responses to expect from the investigator based on the evidence and facts of the investigation. In addition, the investigator should query the prosecutor on possible ques-tions and alternative interpretation of the facts of the investigation that may be brought up by the defense. The following actions should be considered before testifying (Department of the Army, 1985; Fisher, 2004; Lyman, 2008; Osterburg & Ward, 2007):

Review investigative actions and coordi-•nate with the prosecutor before attending the hearing.Review all statements for clarity.•Review all waivers, affidavits, and search war-•rants for investigative and legal sufficiency.Review times, dates, and places of primary •importance to the investigation.Review investigative notes and prepare •miscellaneous notes for use as quick refer-ence material.Avoid trying to memorize notes.•Coordinate with the evidence custodian •and physically review all evidence acquired during the investigation.Verify that the evidence is properly marked •for identificationReview the chain of custody.•Coordinate with the prosecutor on specific •items of evidence required for court.Refresh memory by visiting the scene of •the crime.

During court, it is important for investigators to establish themselves as credible witnesses (Department of the Army, 1985; Fisher, 2004; Lyman, 2008; Osterburg & Ward, 2007). To


accomplish this, the investigator should present an appearance marked by clean-liness, neatness, and concern for the de-tails. Additionally, the investigator should refrain from distracting mannerisms or actions, such as shaking, fidgeting, or ex-cessive arm motions. Investigators should also avoid using police jargon or technical language, as it tends to confuse the jury. For example, instead of saying “I then ob-served the suspect exit the vehicle,” the in-vestigator could say, “I then saw Mr. Jones get out of his car.” If an objection is raised by either the pros-ecution or defense, the investigator should stop his or her testimony until the judge rules on the objection. In addition, the in-vestigator should never blurt out answers to a question that is asked by the defense un-til he or she is sure that the prosecution will not object. Likewise, the investigator should never volunteer any information while testi-fying that was not called for in a question. If the investigator does not know the answer to a question, he or she should respond, “I do not know,” rather than trying to guess, which can cause a loss of credibility (Department of the Army, 1985; Fisher, 2004; Lyman, 2008; Osterburg & Ward, 2007). Finally, the investigator should keep in mind that during cross-examination, the defense counsel will use a variety of ques-tioning techniques in attempts to establish inconsistencies and prejudices regardless of the strength of the case (Department of the Army, 1985; Fisher, 2004; Lyman, 2008; Osterburg & Ward, 2007). This should be expected, so it is in the investi-gator’s best interest to remain calm, polite, and professional. The best any investigator can do is to bring into court a well-prepared case. The investigator should not expect the defense to plea bargain or stipulate to anything. In fact, the investigator should expect rigorous cross-examination. The in-vestigator must be prepared to provide the best testimony possible, which is grounded in good preparation and coordination with the prosecutor.

Conflict and PerspectiveThe job of investigators is rife with conflict, both within and outside their agencies. Investigators are constantly trying to meet the needs of the investigation, and when someone or something blocks those needs, conflict ensues; therefore, it is important to understand the importance of perspec-tive as it relates to dealing with conflict between entities (inter-conflict) and with-in entities (intra-conflict) (Vecchi, 2006). Many of the most noticeable investigative conflicts occur inter-organizationally with entities outside of the investigator’s parent agency. For example, an investigator who needs a certain witnesses’ testimony would experience conflict if that witness was not allowed to testify. Likewise, conflict would occur if, at the last minute, a prosecutor unilaterally decides to plea a defendant to a lesser charge against the wishes of the investigator, causing the investigator to lose credibility with his or her agency be-cause the bigger crime was not charged as promised. Intra-organizational conflict occurs when an investigator’s needs are blocked by someone within his or her agency (Vecchi, 2006). For example, an investigator who believes that an undercover buy-walk pur-chase of drugs from a suspect would be the best way to prove the case is prevent-ed from doing so from the supervisor who believes that a buy-bust scenario would be better. In this example, differences in perspective are at the root of the conflict. The investigator is focused on the buy-walk scenario because he or she perceives that this will lead to a better case, as this will allow multiple drug purchases from the suspect (thus more charges) and better the odds of the undercover officer being able to penetrate deeper into the crimi-nal organization and eventually arresting more people. Contrarily, the supervisor is focused on the buy-bust scenario because this will ensure an arrest and likely con-viction, productive statistics, and allow for the recovery of the buy money for other operations.

Waco: An Example of Perceptual ConflictOne of the most enduring and vivid exam-ples of how differences in perspective can underpin deadly conflict occurred in 1993 during the siege at Waco, Texas (Boyer & Kirk, 1995; Dennis, 1993; Vecchi, 2002). On February 28, 1993, Bureau of Alcohol, Tobacco, and Firearms (ATF) agents raided the Mount Carmel Center with a search warrant for illegal weapons. Upon attempt-ing to serve the warrant, four ATF agents were killed and 16 others were wound-ed. Additionally, an undetermined num-ber of Branch Davidians were killed or injured. Among the Branch Davidians in-jured was David Koresh, who was their leader. Following the botched raid, the ATF agents withdrew and the FBI deployed their elite tactical and negotiation teams from Quantico, Virginia: the Hostage Rescue Team (HRT) and the Critical Incident Negotiation Team (CINT). Negotiators began negotiating with Koresh and some of his followers, while the HRT set up a perimeter around the compound and de-ployed armored vehicles. The CINT advised against using ha-rassment and favored establishing rap-port and trust with Koresh and his follow-ers (Boyer & Kirk, 1995; Dennis, 1993; Vecchi, 2002). Nevertheless, the electricity to the Mount Carmel Center was cut off, and the compound was illuminated with bright lights at night to increase the pres-sure on the Branch Davidians to surrender. These actions by the HRT occurred despite objections from the CINT, which caused Koresh and his followers to perceive this ac-tion as a “huge setback.” The HRT wanted to show force, but the CINT believed that force would break the fragile trust between Koresh and the negotiators. Negotiations continued and Koresh al-lowed several of his followers to leave the compound (Boyer & Kirk, 1995; Dennis, 1993; Vecchi, 2002). Despite this success, the HRT responded by playing loud music causing Koresh to respond by saying that no others would come out. The conflict between the HRT and the CINT intensi-


fied, as the CINT tried to influence the FBI commanders to use negotiation techniques to persuade the Branch Davidians to sur-render while the HRT continued to increase their tactical posturing. A tear gas plan was ultimately decided upon. The HRT subse-quently cleared away Koresh’s cars and other vehicles. In response, some Davidians held children up in tower windows and a sign reading “Flames Await” was posted. On April 19, 1993, an FBI negotiator telephoned the Branch Davidians and an-nounced the siege. The HRT then began inserting tear gas into the compound us-ing armored vehicles and the Davidians opened fire on them. The HRT contin-ued the application of tear gas, breach-ing several areas of the building, causing a portion of the roof and the right-rear wall to collapse. Thereafter, fires started in at least three locations within the compound. The CINT telephoned Koresh and im-plored him to lead his followers out safely; however, only nine Davidians fled Mount Carmel and were subsequently arrested. Several FBI agents then heard “systematic gunfire,” which convinced them that the Davidians were killing themselves. After the fire was squelched, more than 80 Branch Davidians, including 22 children, were found dead (Boyer & Kirk, 1995; Dennis, 1993; Vecchi, 2002).

Differences of PerspectiveBy instinct and training, the HRT was inclined to action (Boyer & Kirk, 1995; Dennis, 1993; Vecchi, 2002; Vecchi, 2006). One member of the HRT stated: “A crime’s been committed. I’m talking the murder charges and you’ve got to do something about it. You CAN NOT [emphasis add-ed] just let these people sit” (Boyer & Kirk, 1993). An HRT sniper stated: “The more uncomfortable we make them inside, the more apt they are to try and negotiate bet-ter” (Boyer & Kirk, 1995). The negotia-tions coordinator at Waco, exhibited a dif-ferent perspective: “You can’t deal with a cohesive group like it’s a group of bank robbers because the things you can do to

bank robbers to make them come out sim-ply drives the Davidians together. If you look at the core of a nuclear bomb, it’s this tightly packed ball of uranium, and what makes that so powerful is it’s so tightly packed. The Davidians were tightly packed and all we did was compress it even more and make it more volatile” (Boyer & Kirk, 1995). The conflict between the HRT and the CINT was more than just a difference of perspectives; it was also played out physical-ly (Boyer & Kirk, 1995; Dennis, 1993). For example, during a negotiation between the FBI chief negotiator and Steve Schneider (an assistant to Koresh), Schneider informed the negotiator that the HRT was running over their [Davidians’] guard shacks. The negotiator, surprised and upset about not knowing about this, tells Schneider: “You’re kidding, I know they’ve [HRT] been or-dered NOT [emphasis added] to go in there!” (Boyer & Kirk, 1995). During Waco, conflict developed over the perceived differences in perspectives and world views between the tactical and nego-tiation teams. This conflict occurred as a re-sult of the individual organizational culture of each team, which separated them from each other based on their differing perspec-tives, world views, beliefs and philosophies. Likewise, but from an individual perspec-tive, investigators also experience conflict as a result of differences of opinions and per-spectives on how best to handle investiga-tions (Boyer & Kirk, 1995; Dennis, 1993; Vecchi, 2002). To reduce this conflict, the investigator must be aware of these other opinions and perspectives and take them into account when presenting alternatives that strive to meet the needs of all stakehold-ers of the investigation (Vecchi, 2006).

ReferencesBoyer, P. J., & Kirk, M. (1995). Waco: The inside

story (M. Kirk, Director). In M. Kirk, M. McLeod, & K. Levis (Producers), Frontline. Bos-

ton: WGBH Educational Foundation.Criminology Today. (1995-2002a). Drug abuse and

crime. (chap. 13). Retrieved from http://cwx.pren-hall.com/crim2day/chapter13/

Criminology Today. (1995-2002b). Technology and crime. (chap. 14). Retrievedfrom http://cwx.pren-hall.com/crim2day/chapter14/

Dennis, E.S.G., Jr. (1993). Evaluation of the handling of the Branch Davidian stand-off in Waco, Texas: February 28 to April 19, 1993. Washington, DC: U.S. Government Printing Office.

Department of the Army. (1985). Law enforcement investigations. Washington, DC: Author.

Dyson, W. E. (2005). Terrorism: An investigator’s handbook (2nd ed.). Cincinnati, OH:

Anderson Publishing.Fisher, B. A. J. (2004). Techniques of crime scene

investigation (7th ed.). Boca Raton, FL: CRC Press.

Lyman, M. D. (2008). Criminal investigation: The art and science (5th ed.). Upper Saddle River, NJ: Prentice Hall.

Osterburg, J. W., & Ward, R. H. (2007). Criminal investigation: A method for reconstructing the past (5th ed.). Newark, NJ: Lexis-Nexis.

Vecchi, G. M. (2006). Assessing organizational group conflict in law enforcement hostage/barricade man-agement. Ann Arbor, MI: Proquest.

Vecchi, G. M. (2002). Hostage/barricade management: A hidden conflict within law enforcement. FBI Law Enforcement Bulletin, 71(5), 1-7. n


This article is approved by the following for continuing education credit:(ACFEI) The American College of Forensic Examiners International provides this continuing education credit for Diplomates. and certified members.

After studying this article, participants should be better able to do the following:1. Understand the common pharmacological mechanisms and effects of tranquilizing drugs acting at the brain’s GABA-A receptors.2. Understand how drug adverse effects of different tranquillizer classes can be involved in forensically-relevant behavior.3. Appreciate the growth of illicit drug abuse that parallels the ethical, licit, market.

KEY WORDS: sedative, anxiety, tranquillizer, benzodiazepene, barbiturate, zolpidem (Ambien), gamma aminobutyric acid (GABA) receptor, automatism, amnesia, disinhibition, hostility, rageTARGET AUDIENCE: Behavioral scientists, forensic examiners, pharmacologistsPROGRAM LEVEL: BasicDISCLOSURE: The authors have nothing to disclose.PREREQUISITES: None

The recent death of singer Michael Jackson has focused popular attention on the drug propofol (Diprivan) that is relatively un-known outside of hospital anesthesiology. This drug shares many pharmacological similarities with a number of tranquilizing drugs that are widespread and common in use and abuse and form the bulk of the pharmaceutical money train. The relative

availability and prevalence of illicit (non-prescribed) or non-medical use of tranquil-izing drugs has paralleled their emergence into medical markets and constitutes a ma-jor problem in drug abuse. This review ad-dresses a common mechanism, and certain common effects, shared by the majority of currently-available tranquilizing drugs of widely different chemical families’ action

TRANQUILIZERAddiction, dependence, withdrawal syndromes, memory disturbances, amnesia, dis-inhibited behavior, violence, impulsivity, automatistic and somnambulistic states, and cognitive and neuropsychological impairments result at least in part from activation of receptors in the brain for the neurotransmitter Gama Aminobutyric Acid (GABA) This mechanism is responsible for many of the common, shared, and similar actions of various tranquillizing drugs used for relief of anxiety, for night-time sedation, as anticonvulsants, as a muscle-relaxant, and for surgical anesthetic purposes. These tranquillizing drugs of superficially very different chemical classes share this GABA

mechanism, and they produce effects similar to beverage alcohol, ethanol. These drug effects, alone and in interaction with other drugs, combine with idiosyn-cratic neurobiological vulnerabilities to bring the user’s behavior to forensic notice in a wide variety of criminal and civil cases.

www.acfei.com

CE ARTICLE: 3 CE CREDITS

By Jonathan J. Lipman, PhD, FACFEI, DABFE, DABFM, DABPS

at the brain’s GABAA receptors (described

more fully below). Notwithstanding these mechanistic similarities or commonalities, however, different members of the class also exert actions at non-GABA

A sites and

mechanisms in addition. The purpose of this article is to provide an understanding and appreciation of the shared and common GABA

A mechanisms

and effects that tranquilizing drugs medi-ate on brain, mind, and behavior in cir-cumstances of forensic relevance. Although the incidence rate of disabling psychotox-ic effects caused by GABA

A stimulation is

relatively rare in the general population of therapeutically-prescribed users, it is higher in the drug abuser population, and in both populations of users and abusers, the crimi-nal and civil justice systems act as a sieve to select and concentrate these cases of forensic interest. Tranquilizing drugs are used for a vari-ety of medical purposes: relief of muscle spasm (spasmolytics), anxiety relief, treat-ment of panic attacks (anxiolytics), epi-

lepsy treatment (anticonvulsants), night-time insomnia relief (hypnotics), conscious surgical sedation (sedation and amnesia), and complete surgical anesthesia (uncon-sciousness, insensibility). Given in deliber-ate overdose, they are used for pest control and animal euthanasia and—in the United States—for prisoner execution, either as a component of a serial drug mixture, or, as recently adopted by the state of Ohio and perhaps in other states to come, as a sin-gle drug injection (thiopentone). In many cases, the same drug is used for more than one such intended purpose and most of these tranquilizing drugs—at least in a portion of their pharmacological spec-trum—have in common a shared or closely related mechanism of action at the recep-tors on nerve cells in the brain and spi-nal cord for the neurotransmitter GABA. Therefore, regardless of the tranquilizing drugs’ structural class (barbiturate or car-bamate or benzodiazepine or imidazopyri-dine etc.), they all, to some extent and in part, act in the brain to facilitate the ac-

tion of GABA at the “Type A” GABA re-ceptor (the GABA

A receptor). They share

this mechanism with ethanol, also known as beverage alcohol. Like beverage alcohol, the acute effects of tranquilizing drugs may be forensical-ly relevant in criminal and civil law cases involving driving or operating machin-ery or other intoxicated, dis-coordinated or disinhibited or impulsive behavior or misbehavior or in poisoning, homicide or suicide issues. When chronically used (repeatedly taken over time) other com-plex forensic neuropharmacological is-sues emerge, including dependence and withdrawal states resulting from changes in brain biochemistry caused by repeated use of the tranquilizer. In addition, the adaptive changes wrought by these drugs in the brain over time and their interac-tions with other drugs taken or co-admin-istered typically need to be accounted for and understood in neuro-behavioral terms (see below) in order to evaluate their fo-rensic relevance.

DRUG FORENSICS


Tranquilizing drug effects on cognitive function can influence alleged cognitive disability as relevant to brain injury claims or compensation issues, or employment disability claims, and can interfere with performance in the neuropsychological tests used to evaluate such brain function. Under certain circumstances and in certain individuals—described more fully below —tranquilizer intoxication can influence “competence at the time of the crime” or “competence to be tried” and drug-influ-enced memory or the absence of this (am-nesia) may enter into insanity and legal competence considerations. Where guilt is not at issue in a criminal case, the effects of these drugs may nevertheless bear upon a defendant’s culpability and at sentenc-ing may be relevant to mitigation of pun-ishment. The issue of voluntary versus in-voluntary intoxication is frequently raised in forensic cases involving the intended or unintended consequences of tranquilizing drug use, either through lack of notice giv-en to the user by the prescriber (if medical, or the perpetrator, if criminal) or because the illicit user had no understanding or an-

ticipation of the likely drug effects, and in either case drug interactions may be para-mount in an interpretation and understand-ing of consequences on the mind, brain and behavior of the consumer. Shared mechanisms of different tranquilizer types: the GABAA receptor complexGamma Aminobutyric Acid (GABA) is the most abundant neurotransmitter in the central nervous system, and GABA recep-tors are widely distributed throughout the brain, with high concentrations in the cor-tex and limbic system. There are two types of GABA receptor (“A” and “B”) of which the B-type is a metabotropic G-protein cou-pled complex and the “A” type (GABA

A) is

a ligand-gated chloride ionophore, a chlo-ride ion channel spanning the thickness of the nerve membrane, which channel pumps chloride ion into the nerve-cell upon stimu-lation by GABA. The chloride ionophores on which GABA

A receptors occur are a family of re-

lated complexes composed of several types of subunits (called alpha, beta, gamma, del-

ta and rho, α, β, γ, δ and ρ subunits) sur-rounding a central pore or channel in the nerve membrane through which chloride ions pass (Levitan et al 1988, cited in Crews (2004)1. In different parts of the brain, and on different nerves, different assemblies of these subunits allow a wide variety of dif-ferent types of GABA

A receptor-linked

ionophores to be formed by varying the type and number of subunits. The receptor complex spans the postsynaptic membrane as illustrated schematically in Fig 1, and receptors—neurotransmitter recognition patches for various chemicals or ligands—are formed either on the subunits, or where subunits meet or within the chloride pore itself. In this article, the chloride pore as-sembly responsive to GABA or drug stimu-lation is referred to as the “GABA

A receptor

complex.” In contrast to the barbiturates, benzodi-azepines cannot directly open the chloride channel, but they facilitate GABA’s ability to do so. Chloride influx at the GABA

A

receptor complex hyperpolarizes the cell membrane, making it more negatively charged on the interior relative to the ex-terior, which renders it less likely to conduct an action potential, and thus the effect of any ligand binding (GABA or ethanol or drug) is inhibitory on the nerve.

Common mechanisms, cross-toleranceThe different types of sedative tranquilizers discussed here each exert a similar facilitato-ry effect on the GABA

A receptor complex,

but when the tranquilizers are used in com-bination, their interaction is multiplicative (either additive or potentiated, synergistic, see below for discussion). It follows, too, from their shared and common site of ac-tion that there is functional cross-tolerance between these different drugs. Thus a with-drawal syndrome resulting from discon-tinuation of ethanol (beverage alcohol) in a dependent alcoholic (“delirium tremens”) can be arrested by administering a benzo-diazepine such as diazepam or alprazolam or lorazepam. Although not recommended, the reverse is probably true as well: alcohol suppressing the withdrawal syndrome re-sulting from chronic benzodiazepine dis-continuation.

Problems of use and abuseThe different families of sedative drugs that act as agonist facilitators, or stimulators, of GABA transmission at the GABA

A receptor

Figure 1Schematic representation of the GABAA receptor complex comprised of α, β and γ, subunits forming the chloride ion pore, spanning the nerve cell membrane. Flow of chloride ion (Cl¯) is from outside to inside the cell when GABA binds to its receptor. Receptors are schematically shown for steroid, barbiturate, benzodiazepine, ω = omega, ethanol (alcohol), picrotoxin and GABA (Gamma Aminobutyric Acid) ligands.


complex include barbiturates, carbamates, some anesthetics and steroids, all benzodiaz-epines, and the now proliferating ‘Z’ drugs such as zolpidem (Ambien) and its relatives, including zopiclone. GABA

A stimulating

drugs have been both used and abused for many years, and the intended and unin-tended effects often produce disinhibited and impulsive behavior that exceeds so-cially acceptable bounds, such as memory impairment; outright amnestic states that confound criminal investigation, prosecu-tion and defense; automatisms and som-nambulistic (“sleepwalking”) states; chemi-cal submission; discoordinated movement

and ataxic gait; and neuropsychological and cognitive impairment. Cognitive impair-ment produced by these drugs, or with-drawal from a dependent state on these drugs, may affect a person’s competence and ability to testify, which becomes relevent in civil and criminal cases. In certain people and under certain circumstances, violent rage is provoked by these drugs. Forensic cases involving sedative tranquilizer drug effects may involve any one or more of these drug-induced dysfunctions in perpe-trators, victims, or witnesses to crime or in law enforcement, judges, counsel, or court personnel. In civil cases, traquilizer drug ef-

fects may relate to competence, disability, or injury evaluation. In the majority of forensic cases involving sedative tranquilizers, including death due to overdose, the drug is combined and interact-ing with another drug. Popular illicit combi-nations include beverage alcohol, stimulants (called “speedballing”), and opiates (called “boosting”, see below for discussion). Forensic cases involving sedative tran-quilizer use (licit) and abuse (illicit) are found throughout the entire spectrum of drug interactions and criminal misbehav-iors. Though their acute use is behaviorally and psychoactively intoxicating, a host of different problems confound their chronic use including sustained memory dysfunc-tion and other cognitive impairments, ex-acerbation of depressed mood, tolerance, dependence, and withdrawal states on dis-continuation of the drug.

History and prevalence of the GABAA agonist drugs:Current problems of forensic concern caused by tranquilizing drug action are merely the leading edge of an historical wave. In seeking to understand the pres-ent context and future direction of this wave it helps to have an historical under-standing of the evolution, use, and abuse of these drugs. The 1966 novel Valley of the Dolls by Jacqueline Susanne, later made into a film, depicts the recreational, and later compul-sive, use of tranquilizing drugs (the “dolls”) by three young women, who combined these drugs with stimulants . The “dolls” of the story were barbiturates, Seconal and Nembutal, and notwithstand-ing their calming, euphoric, and subjec-tively delicious effect on the anxious user, their therapeutic index (the ratio, derived in laboratory animals, of therapeutic dose to toxic dose, see Fig 2) is quite low. The dif-ference between effective and lethal dose is small, and their potential for causing death on overdose is very high. Given the demonstrated market potential of tranquilization and the public thirst for anxiolytic drugs, the lethal disadvantages of the barbiturates led the pharmaceutical industry into a driven search for less-lethal alternatives and in the mid-twentieth cen-tury several functional analogues of the barbiturates were introduced: methylpyry-lon (Noludar) in 1948 2, followed by glu-tethimide (Doriden) in 1954, then ethyl-chlorvynol (Placidyl 3, to which the late

Figure 2Schematic illustrating the concept of “therapeutic index” for sedative drugs. Upper graph shows the dose-effect curves for a drug whose death or lethality curve overlaps with the dose-range of the drug’s sedative effect range. ED50 = Effective (sedative) Dose for 50% of the population treated, LD50 = Lethal Dose for 50% of the population treated. The therapeutic index is small. Lower graph illustrates the case for a drug where sedative and lethal dose effect ranges do not overlap. The therapeutic index is larger.


U.S. Supreme Court Justice Rehnquist was famously addicted) and meprobamate (Miltown) in 1955. Meprobamate was the first of the carbamates, having been dis-covered serendipitously in 1946 4. Though these drugs differ chemically and structur-ally, all are agonists at the GABA

A receptor,

like alcohol and barbiturates. By 1957 more than 36 million prescrip-tions had been filled for meprobamate in the United States alone, a billion doses had been manufactured, and the drug account-ed for fully one-third of all prescriptions written in that year 5. It did not take long, however, before the realization dawned that addiction and dependence, with a with-drawal syndrome resembling the barbitu-rate on discontinuation, had followed the carbamate family into the marketplace 6. Other than being technically describable for marketing purposes as “nonbarbiturate in structure” (a marketing ploy that which would later be used with the non-benzodi-azepine, imidazopyridine z-drugs such as zolpidem, zaleplon and zopiclone, see be-low), the carbamate drugs and their suc-cessors acted pharmacologically in a simi-lar way to the barbiturates at the GABA

A

chloride ionophore and, while markedly

less lethal than the barbiturates they quali-tatively presented the same spectrum of dis-advantages. Pharmaceutical innovation rap-idly led to the introduction of carisoprodol (Soma, which is still very popular), which is in fact both a drug and a pro-drug: active itself, the body metabolizes it, transforms it, to meprobamate, the barbiturate-like carbamate described above. Carisoprodol and meprobamate are advertised as muscle relaxants, yet they have no direct effect on muscles. Their relaxant effect, like that of barbiturates, is mediated at the brain and spinal cord. Competing with these agents for the nighttime hypnotic (sleeping pill) market was methaqualone, another GABA

A ago-

nist drug (synthesized in 1951 and called Quaalude or Sopor in the United States and Mandrax in Britain). Its specific binding site on the GABA

A receptor complex was

not well defined, but the drug enhanced benzodiazepine binding, which revealed its allosteric action at the GABA

A com-

plex. Methaqualone was introduced in the United Kingdom in 1956 and to the United States market in 1965. It was described as a “safe non-addictive barbiturate substitute.” Drug users and abusers appreciated its “sen-

sual euphoric state and relaxed intimate mood,” and by 1965, it was the best selling sedative in the U.K. market. By 1972 it was the sixth most popular in the U.S. market and its abuse had reached “almost epidem-ic” proportions (Foltz, Fentiman & Foltz, 1980)7. It has since been withdrawn from the US market, being placed in “Schedule 1” in 1984. Although barbiturates continue as a mainstay of general anesthesia and for use as anticonvulsants and anti-epileptics, they and their relatives were largely supplanted for daytime tranquilizer and hypnotic use by the benzodiazepines following intro-duction of the first of this class, chlordi-azepoxide (Librium) in 1960, which dis-covery emerged serendipitously from work on dyestuffs by Hoffman-LaRoche (now known as Roche) scientists in the mid-1950s. Subsequent work on the metabo-lite of Librium, demoxepam, led to the development of diazepam (Valium) about four years later. Valium was wildly popu-lar, and by the mid 1970s about 8,000 tons of benzodiazepines were sold every year. Valium maintained the lead for a decade until Upjohn’s 1981 introduction of alpra-zolam (Xanax) displaced the Roche product as the most popular. Balkrishnan and his colleagues gath-ered six years of outpatient office visit da-ta—between 1996 and 2001—from the National Ambulatory Medical Care Survey (NAMCS) and analyzed the treatment pat-terns of patients 18 and older who report-ed sleep problems. They found that nearly two-thirds of those doctor visits resulted in medication prescriptions for a person’s sleep difficulties, and three-quarters of those pre-scriptions were for a benzodiazepine. (Five of the 13 kinds of benzodiazepines on the market in the United States are indicated for treating insomnia) 8. According to the BioVenturist database, a pharmaceutical industry research tool, worldwide sales of alprazolam, a drug which went generic in 1993, were US$409 mil-lion in 2005, US$316 million in 2006 and US$325 million in 2007. According to IMS Health Data, a pharmaceutical marketing intelligence agency, annual sales of alpra-zolam ER tablets (the “extended release” form) in the United States were approxi-mately $53.9 million for the 12 months ending December 2006 9. As with earlier generations of sedative tranquilizers, illicit use has paralleled licit use: In this same year, 2006, as reported by the National Forensic


Laboratory Information System 10, state and local drug laboratories analyzed 24,057 al-prazolam, 6,360 clonazepam, 5,886 diaz-epam, 1,444 lorazepam, and 333 temaze-pam exhibits. These exhibits, of course, are but a very small fraction of the number of doses actually seized by law enforcement. Z-drugs such as zolpidem (the tartrate salt of which is trade-named Ambien in the United States and Stilnox or Stilnoct elsewhere) is one of several structurally imidazopyridine GABA

A agonist drugs to

be recently introduced. The development of this ‘non-benzodiazepine’ imidazopyri-dine family of drugs, added greatly to our understanding of the GABA

A receptor com-

plex and led to the discovery that there were three subtypes of what had been hitherto called benzodiazepine receptors on the GABA

A complex, at one of which zolpi-

dem shared agonist (stimulating) properties. Flumazenil (then known as Ro-151788), the ‘specific antagonist’ of benzodiazepine binding to its GABA

A receptor, also antago-

nizes the action of z-drugs, such that they are pharmacologically, to all intents and purposes “non-benzodiazepine benzodiaz-epines.” This nomenclatural dilemma was resolved by renaming the benzodiazepine receptors to which z-drugs bind “omega” (ω) receptors, of which z-drugs are now said to have activity at the brain’s ω

1 sub-

type. Z-drugs such as zolpidem differ from the benzodiazepines in exerting a sedative effect at a dose much lower than their an-ticonvulsant effect (Depoortere 1986)11. Zolpidem has a very short half-life and is marketed as a hypnotic (a sleeping pill). It was the second z-drug to be introduced, debuting in 1992 after zopiclone (1989) which was not introduced to the U.S. mar-ket but was popular elsewhere. The third was zaleplon (Sonata, a pyrazolopyrimi-dine) and the fourth to be introduced was the S-isomer of zopiclone, called ‘eszopi-clone’ and sold in the United States under the trade name Lunesta. A fifth, indiplon, has 10 to 15 times the binding capacity of zolpidem or zaleplon, and has not yet been commercially released at time of writing. All of these z-drugs seem to act in the same way pharmacologically at the GABA

A receptor,

ω subtype.

The various forensic aspects of tranquilizer intoxicationIn actual practice the different concepts explained below, the range of forensically-relevant effects that GABA

A drugs exert, do

not occur in isolation. Thus ‘automatism’ invariably involves ‘amnesia’ and amnesia may involve confabulation and the organ-ic brain disorder that is the intoxication itself impairs neuropsychological and cog-nitive function. Any or all of these may be present when the drugged individual dis-plays disinhibited behavior, which may be violent. In this article these different facets of drug effect are addressed as separate yet related entities in order to more clearly de-fine them, but the reader is cautioned that this distinction is artificial.

Neuropsychological impairment and kineticsAt higher doses than typically employed therapeutically in the ambulant patient, the barbiturates and benzodiazepines pres-ent a similar alcohol-like clinical picture of intoxication with sluggish movement, in-coordination, difficulty in thinking, slow-ness of speech, faulty judgment, drowsiness, staggering gait, and shallow breathing, with unconsciousness and coma occurring at the largest doses. Death at these higher doses occurs due to respiratory depression of the brain’s medullary respiratory centers or po-sitional asphyxia or inhalation of vomitus while unconscious, or some combination of these. At lower doses the acute neuro-be-havioral intoxication resulting from sedative tranquilizer drug effects can be measured by tests of neurocognitive performance, similar to the tests used by neuropsycholo-gists to assess brain dysfunction resulting from trauma. Benzodiazepines adversely affects mem-ory, a fact first reported by Greenblatt & Shader (1974)12 and later confirmed in clinical trials. The intensity of this amnestic effect varies according to route of adminis-tration, dose and pharmacokinetics (Roth et al 1984)13. In general, the benzodiazepines with the longest mean duration of effect have long-lasting parent molecules, active and persistent metabolites, or both. Thus chlordiazepoxide (Librium) has a half-life (t ½ ) of 6-27 h (average 20 hours) and diaz-epam (Valium) has a t ½ of 21-37 h (aver-age 24 hours), and clorazepate (Tranxene) has a t ½ of only 2 hours, yet each of these drugs are converted, metabolized, in the liv-er to active GABA

A stimulating compounds

including nordiazepam, which has an ex-tremely variable and protracted half-life of 31-96 hours (average about 60 hours) [see Table 1]. Likewise, flurazepam (Dalmane) has a half-life in blood of only 1-3 hours,

but the active metabolite desalkylfluraze-pam has a half-life of 47-100h (average 89 hours). In contrast to these, the short acting ben-zodiazepines such as alprazolam (t ½ 6-27 hours, average 12 hours), oxazepam (t ½ 4-11 hours, average 8 hours) and triazo-lam (t ½ 1.8-3.9 hours, average 2.5 hours) do not generate active metabolites. Of the z-drugs currently available, eszopiclone, sold as the hypnotic Lunesta, has the lon-gest half-life of 4-9 hours. Nightly dosing of long-lived drugs inevitably leads to an accumulation of drug in the body during daytime hours and unintentional carry-over of daytime effects and drug interac-tions may occur, for instance with alcohol consumed the day following a long-acting drug’s nighttime use. This likelihood in-creases, of course, the earlier in the day that alcohol is consumed, and early drinking is not uncommon in alcohol abusers. An appreciation of pharmacokinetic dura-tion is vital to an assessment of drug influ-ence on the neuropsychological evaluation (Stein & Strickland 1998)14. For patients taking chronic doses steady state concentra-tions in blood are reached after about four half-lives. Depending on dose schedule this can be a period as long as several weeks for a healthy young adult. Recently discontinued use also introduces considerations of neu-ropsychological relevance because complete drug elimination takes approximately six half-lives. Further, since discontinuation of short-acting agents produces a more precipi-tous drop in serum level than long-acting agents, the withdrawal syndrome and men-tal and cognitive disequilibrium caused by the former is more intense than the latter. Least affected by benzodiazepine action is short-term memory storage capacity, as required for digit recall, and procedural memory (recollection of previously-learned actions, such as how to drive a car). While information learned prior to drug use is retrievable, recollection of information learned under drug influence is impaired (see amnesia below). Most importantly: sed-ative effects do not predict amnestic effects, which occur with or without sedation. Midazolam (Versed), in many ways a typical GABA

A agonist benzodiazepine, is

used for intravenous sedation prior to sur-gery. Anesthesiologists, surgeons and den-tists are well aware that perioperative recall of information is reduced or obliterated in patients who have undergone midazolam sedation. The amnestic effect also occurs



Table 1Drugs referred to in this article (in alphabetic order) showing their chemical class, their GABAA activity and their marketed purposes. Note that all benzodiazepines (=Benzo) exert muscle relaxant, anxiolytic, sedative and anticonvulsant effects regardless of marketed purpose. Abbreviations used: Barb = barbiturate, Metab = metabolite, Dep = dependant, Half-lives taken from Baselt (2008)69

GenericName

TradeName

GABAA

activity

t ½ Half-life(hours)

CLASS

Marketed Purpose

Mus

cle

rela

xant

hypn

otic

anxi

olyt

ic

Ant

i-co

nvul

sant

Surg

ical

Alprazolam Xanax Yes 6-27 Benzo • •

Alphaxolone Althesin(mixture)

Yes 6-8 min Neurosteroid • •

Alphadolone Yes 30min Neurosteroid • •

Amylobarbitone Amobarbitone Yes 15-40 (dose dep) Barb • •

Buprenorphine Subutex No 18-49 (sublingual) Opiate

Carisoprodol Soma Yes 0.9-2.4 Carbamate •

Chloral hydrate alphachlor Yes 4min (10h trichloroethanol))

•

Chlordiazepoxide Librium Yes 6-27 Benzo •

Clonazepam Klonopin Yes 19-60 Benzo • •

Clorazepate Tranxene Yes 2h( metab 31-97h)

Dexamphetamine amphetamine No 7-34 (urine pH) stimulant

Diazepam Valium Yes 21-37 Benzo • • • •

Eszopiclone Lunesta Yes (ω) 4 - 9 z-drug •

Ethchlorvynol Placidyl Yes 16-32 Carbinol •

Fentanyl Duragesic No 3-12 Opiate

Flumazenil Anexate Yes 0.7-1.3 Benzo Antagonist Overdose rescue

Flunitrazepam Rohypnol Yes 9-25 Benzo •

Flurazepam Dalmane Yes 1-3 (47-100 metabolite)

Benzo•

Indiplon (not yet named) Yes (ω) 1.5-2.0 z-drug •

Lorazepam Ativan Yes 9-16 Benzo • •

Meprobamate Miltown Yes 6-17 Carbamate • •

Methadone Methadose No 15-55 Opiate

Methaqualone Quaalude Yes 20-60 Quinazolinone •

Methylprylon Noludar Yes 7-11 Piperinedione •

Midazolam Versed Yes 1-4 Benzo • • •

Oxazepam Serax Yes 4-11 Benzo •

Pentobarbital Nembutal Yes 15-48 Barb •

Propofol Diprivan Yes 1.5-2.5 diisopropylphenol • •

Ramelteon Rozerem No 0.5-2.4 Melatonin-mimetic •

Secobarbital Seconal Yes 22-29 Barb • • • •

Temazepam Restoril Yes 3-13 Benzo •

Thiopentone Pentothal Yes 6-46 Barb •

Triazolam Halcyon Yes 1.8-3.9 Benzo • • •

Zolpidem Ambien Yes (ω) 1.4-4.5 z-drug •

Zopiclone Imovane Yes (ω) 3.6 - 6.5 z-drug •

with lower-than-surgical doses. Thompson et al (1999)15 employed a computerized neuropsychological test battery to assess the effect of midazolam on normal volun-teers administered 3mg of the drug intra-venously, contrasting this with the effect of nitrous oxide (“laughing gas”). They found that both simple reaction time and choice reaction time are significantly ex-tended by midazolam. The drug signifi-cantly impairs decision time and signifi-cantly degrades digit vigilance and impairs the ability of subjects to retain spatial infor-mation as measured by the spatial working memory test, although they found that it does not affect spatial recognition accuracy. Immediate word recall performance was se-verely affected by midazolam, and subjects committed significantly more word recall errors (“remembering” words that had not been presented) compared with controls. Delayed word recall performance was sig-nificantly impaired, was actually abolished by midazolam—because subjects could recall no words at all—and delayed word recognition performance was markedly im-paired, as were response latencies in tests of picture recognition. They found a signifi-cant degradation of the ability of subjects to discriminate between original and newly presented stimuli. The z-drugs of the Ambien (zolpidem) family of hypnotics – including zopiclone, eszopiclone, zolpidem etc. (see above)—

cause similar neuropsychological impair-ments. Wilkinson (1995)16 investigated the effect of a 10mg dose of zolpidem (the typi-cal hypnotic dose) and a 15mg dose on 24 normal volunteers subjected to a cognitive test battery, comparing responses to place-bo. Subjects were assessed at peak time (45 minutes) and again at 130 and 230 minutes post-dose. At 45 minutes the drug degraded divided attention performance, impaired in-formation processing rate (measured with a visual backward masking task), impaired immediate memory (measured with the Sternberg task) and degraded sustained at-tention measured with a vigilance task. Clearly, a person—either perpetrator or victim or witness—under the influence of a drug acting as an agonist at the GABA

A

receptor could suffer memory and recall impairments that could interfere with their ability to function as a as a witness. Although likely of little practical conse-quence in the day-to-day life of the general population, who might forget where they parked their car, or placed their keys, such deficits may have major importance in a criminal forensic context.

Drug interactionsAlcohols: Abusers of sedative tranquiliz-ers very commonly intentionally consume them with alcohol which markedly increases the subjective “high” of both drugs. The ef-fect was first noted with the barbiturates in

the 1950s, and there is evidence for larger doses producing additivism of effect while the lower doses produce a potentiation or more-than-additive synergism. The dis-tinction is illustrated schematically in Fig 3. Thus: while an ethanol dose of 3 mg/kg in rats has no effect on sleeping time in this species, and 30 mg/kg thiopentone (Pentothal) produces an average 24 min-ute sleeping time, the combination of these doses causes an average sleeping time of 217 minutes (Wiberg et al 1969, cited in Calabrese 1991)17. Likewise Seconal (seco-barbital) at a 50 mg/kg dose in mice pro-duces sleep lasting 11 minutes on average, and a 1.95 mg/Kg dose of ethanol produces no sleep in this species, yet the combina-tion results in 137 minutes of sleep (Gruber 1955)18. Otherwise non-lethal doses of al-cohol when combined with a GABA

A tran-

quilizer can readily cause death, as separate-ly befell musicians Janice Joplin and Jimi Hendrix, with alcohol plus barbiturate, in 1970; and the persistent vegetative state into which Karen Ann Quinlan slipped in 1976 followed a diazepam-alcohol interac-tion. She died of pneumonia nine years later without regaining consciousness. At sub-lethal doses the interactive ef-fect of GABA

A tranquilizers and alcohol

is largely additive in man when measured using performance tests at post-peak blood concentrations. Linnoila et al (1990)19 test-ed the acute effects of alprazolam (Xanax,

Figure 3Multiplicative effect of drug combinations: schematic illustration of additive (left) and potentiated or synergistic (right) drug interaction. In the case of additivism; combining drugs “A” and “B” gives an effect that is the additive sum of the component drug effects. In the case of potentiation the effect of combining drugs C and D is to give a more-than-additive effect. The case is illustrated where an entirely sub-effective dose of drug C is combined with an effective dose of drug D to produce an effect vastly greater than either drug combined (dotted line).


2mg) in the presence and absence of alcohol in normal volunteers, measuring psychomo-tor and cognitive performance. Ethanol was administered three hours after drug, thus avoiding the initial period of synergism or potentiation sought by abusers who typi-cally consume the drugs together. These authors employed a continuous tracking task resembling a driving simulator, test-ed verbal information processing with a word-choice reaction time task and provid-ed a verbal memory task using a list of 12 words, six of which were presented twice. The subject was to indicate their recogni-tion of the repeated word and the word list served also to assess recognition memory and delayed recall. Blood ethanol concen-tration was assessed by Breathalyzer, and the study began with a blood concentration of 65 mg/dl. Measured 4 hours after drug ad-ministration (1h after ethanol) alprazolam produced a severe deficit in performance on the word tests (memory) and the effect of ethanol on this performance was to de-grade it further. Immediate verbal memory was unimpaired, but at 2 hours there was a significant reduction of related word recall (free recall) and a significant reduction of

the number of words correctly recognized (recognition memory). The effect of etha-nol, in this paradigm, appeared to be addi-tive with that of the benzodiazepines. A similar additive effect has been found when alcohol is co-administered with zolpi-dem (Ambien). Wilkinson (1995)20 admin-istered to normal volunteers a dose of etha-nol calculated to produce a blood alcohol concentration of 0.08g% (80 mg/dl, the legal level of presumptive intoxication for fitness-to-drive purposes in the USA for non-commercial drivers) over 30 minutes of consumption, following this with either 10mg or 15mg of zolpidem (Ambien) or placebo. Subjects were then subjected to a neurocognitive performance battery at 45, 130, and 230 minutes post-dose. The de-sign was fully blocked, so that the effect of drug or alcohol alone could be compared with the combination, and a placebo bev-erage drunk from a glass externally scented with vodka served as the alcohol control. Measured at peak zolpidem time (45 min-utes) both zolpidem and alcohol degraded divided attention, and the combination was additive. On the visual backward masking task, testing for information processing

speed, both drugs impaired performance and the combination was again additive. Likewise with the vigilance task; alcohol and zolpidem produced additive impair-ment. Interestingly, at the final evaluation four hours after zolpidem administration, performance on all tasks was within the normal range, except for the divided atten-tion task: thus, although the zolpidem effect had dissipated and the alcohol effect had dissipated, the combination still impaired divided attention even though sedation or drowsiness (measured by the backward masking test) was no longer present.

Stimulants: Among abusers of stimulant drugs (cocaine, amphetamines, meth-ylphenidate) sedative tranquilizers blunt the agitation and anxiety which occurs as a side effect of stimulant action, allays to some extent the paranoia attendant on chronic use and adds a dimension of tran-quility to their jaw-grinding state of hyper-excitability and tension. In this they follow the designs of the pharmaceutical compa-nies such as SmithKline, developer of the Dexamyl (or Drinamyl) formulation that combined amylobarbitone with dexam-phetamine until this was withdrawn from the market in 1981 (see below). The illicitly co-administered combination is generically called “speedballing,” although that term can also be used to refer to opiate-stimu-lant combinations. Stimulant abusers also employ GABA

A agonists to self-medicate

the psychically painful ‘crash’ of withdraw-al when their stimulant supply has dried up or they otherwise need to end a speed run, having been continuously sleepless for many days. Although tranquilizer abuse, unlike stim-ulant abuse, does not as a rule itself provoke outright psychosis, the ameliorative effect of combining tranquilizers with stimulants can enable the combined user to take more of the stimulant for a longer time and to suffer more severely from chronic stimulant psychotoxicity. Such psychotoxicity can in-volve many of the features usually associated with the acute psychotic break of a chronic schizophreniform psychosis, with paranoia, hallucinations (auditory, visual and tactile), delusions, grandiosity and hostility born of irrational fear.

Opiates: The combined use of tranquil-izers and opiate drugs is not strictly con-traindicated in medical treatment and the combination of midazolam (Versed) with


an opiate such as fentanyl is common in surgery where the effect is carefully super-vised and controlled. Likewise chronic pain patients are often prescribed both opiates and GABA

A drugs (benzodiazepines, car-

bamates, barbiturates or “muscle relaxants”) for an extended time without experiencing too many problems in performing activi-ties of daily living although they do suffer neuropsychological impairments as a result (see below). The same is true of patients in opiate substitution programs equipped and staffed to handle “multiple drug” abusers. The combination is not without hazards, however, as epitomized by the 2007 death of Anna Nicole Smith, who expired under the influence of prescribed methadone and benzodiazepines. The greatest problems of forensic concern arise when tranquilizers are used intermittently or abusively in the opiate-consuming population. The com-bination acutely enhances the euphorically subjective “high” of the opiate experience and is particularly attractive to opiate ad-dicts or poorly-controlled chronic pain pa-tients. Illicit combined use is considered a major problem by opiate treatment provid-ers in single-modality opiate (methadone or buprenorphine) substitution programs, where users may illicitly self-medicate with tranquilizers before reporting for their dai-ly supervised opiate dose, a practice called “boosting” (Kleber, 1994) 21. Although substitution programs perform urine testing on patients, they typically do not test blood and unrinalysis results do not indicate current intoxication. Thus behavioral intoxication involving over-se-dation resulting from “boosting” can lead to traffic accidents, and overdose death due to combined respiratory depression is not uncommon. Backmund et al (2005)22 stud-ied the records of 1,685 patients admitted for opiate detoxification, finding that dai-ly intake of benzodiazepines was reported in 44.4% of the patients. Patients treated with methadone or codeine medications reported daily intake of benzodiazepines significantly more often than the heroin-dependent patients. Forensic consequences of combined use may relate to malpractice claims when the drugs are prescribed unsupervised or in er-ror and to civil liability issues when a traf-fic accident or death or injury occurs, and third-party claims may be involved. In neuropsychological terms, the memory deficits caused by the GABA

A stimulating

drugs are magnified by opiate co-admin-

istration. Rapeli et al (2009)23 followed a group of anxiolytic-prescribed patients who were also enrolled in an opiate substitution program. Thirteen took daily methadone and 15 daily buprenorphine as opiate sub-stitution. The GABA

A drugs used by the

group included alprazolam, clonazepam, diazepam, oxazepam, midazolam, temaze-pam, zopiclone and zolpidem. The authors studied these patients initially upon enroll-ment into the opioid substitution program and again between 6-9 months after admis-sion. Patient groups were compared with a parallel group of non-drugged normal subjects tested at the same time intervals. Rapeli et al found that Working Memory (the short-term store that maintains infor-mation that is lost without repetition), test-ed with the Letter-Number Sequencing task from the Wechsler Memory Scale III, was markedly impaired in patients compared with normal controls. This deficit was per-sistent across 6-9 months of constant drug dosing, and no tolerance was shown to the effect. List-learning was more impaired in the buprenorphine-treated group, and this confirmed an earlier finding by Lintzeris et al: that buprenorphine combined with diaz-epam impairs delayed verbal memory more than buprenorphine given alone (Lintzeris, Mitchell, Bond et al, 2006)24.

Addiction and dependenceDependence: The tranquil relief of anxiety that GABA

A drugs induce is dependence-

forming, in the sense that tolerance devel-ops to their effects when used chronically, and changes in the brain which underlie this tolerance reflect a readjustment of the homeostatic balance of brain chemistry counter to the action of the drug. Once adapted to the drug’s effect, the brain of the user undergoes a withdrawal syndrome in the absence of the drug, and it is this con-dition from which the withdrawal state is precipitated that is called “dependence.” The withdrawal syndrome takes the form of symptoms opposite to the drug effect. Whereas GABA

A stimulation is tranquiliz-

ing, peaceful and soporific the withdrawal syndrome is anxious, agitated and insom-niac. The development of early-morning awakening that occurs after triazolam (a benzodiazepine) is used for two weeks as a bed-time hypnotic is an example of the effect of tolerance. Once this change has occurred and the brain has adapted to the drug’s presence, abstinence from use causes insomnia. As barbiturates, benzodiazepines

and alcohol are also anticonvulsant (anti-epileptic) in their effects, withdrawal from a dependence on these drugs can precipi-tate a seizure state, and this can be provoked even in individuals who did not suffer from epilepsy before tranquilizer use. The withdrawal symptoms that occur on discontinuation have “rebound” intensity, greater than existed before tolerance to the drug had developed. Thus anxiety treated with benzodiazepines is more intense after drug withdrawal than it was before treat-ment began, and panic attacks (discrete periods of intense fear and discomfort) can be precipitated by abstinence (Bashir & Schwartz, 2002)14.

Addiction: The word “addiction” has un-dergone some linguistic contortions in re-cent years. Current medical policy in the pain management field is to avoid using the word to describe the craving a patient feels for a legally prescribed drug and to use the term “pseudo-addiction” instead (Weissman and Haddox 199326, Fishbain 200327), re-serving the word “addiction” to characterize the dependence state and resulting behav-iors of the illicit (non-medical, non-pre-scribed) drug user. Pharmacologically this is probably a distinction without a differ-ence. Behaviorally, however, addiction (as opposed to dependence) is usually mani-fest as a lack of self-control over dose esca-lation despite adverse consequences. The term “pseudoaddiction” as applied to opi-oid-treated pain patients taking more drug than prescribed in pursuit of adequate pain relief is now the preferred term adopted by the International Association for the Study of Pain (IASP 1993)28. Since there is rarely any medical need to prescribe beverage al-cohol, the term is unlikely to gain currency in the alcohol addiction field. In a protocol for which it would be im-possible to get Institutional Review Board approval nowadays; a study performed in normal volunteers in 1958 gave the GABA

A

drug meprobamate several times daily for 40 days before the drug was then abruptly withdrawn. The subjects suffered insomnia, vomiting, tremor, muscle twitching, overt anxiety and some of these subjects suffered convulsions 36 to 48 hours after discontin-uation (Hazilip & Ewing 1958)29. These signs and symptoms are facets of, and com-mon to, the alcohol withdrawal syndrome or “delirium tremens” and the commonality lies mechanistically at the GABA

A receptor

complex.


The anxiety, craving, panic, and despera-tion that the dependent sedative/tranquil-izer abuser suffers can drive them to breach laws and conventions to maintain their sup-ply, either by theft or deception. Such in-dividuals can easily find themselves outside the law and subject to forensic evaluation.

Amnesia and automatismGenerally speaking, amnesia is never a defense to a crime, yet automatism may be a complete defense, and the forensic challenges presented by investigation of a case in which the defendant or victim has no memory of the offense can be quite formidable. Resulting from an action on the hip-pocampus, where short-term memory is consolidated into long-term storage, GABA

A agonist drugs prevent this consoli-

dation. Memories are not later retrievable, because they were never transferred from short-term to long-term storage. The am-nesia is anterograde, proceeding forward in time from the intoxication, and in this it differs from the retrograde amnesia of brain concussion. The “alcoholic blackout” phe-nomenon is an example of GABA

A agonist

anterograde amnesia. Amnesia can either be an unfortunate and problematic side ef-fect of treatment or drug use or abuse, or it can be intentional, as for instance when the benzodiazepine midazolam (Versed, men-tioned above) is medically used to produce tranquility and amnesia in patients under-going surgery. The last thing the patient recalls on awakening in the recovery room is having received their midazolam injec-tion in the preoperative suite. Under the drug’s influence the patient does not en-

tirely lose consciousness, appears tranquil, intoxicated, often talkative prior to receiv-ing their later anesthesia, yet none of this is later recalled as a result of anterograde am-nesia. To proceed with surgery actual loss of consciousness is required, often induced by intravenous propofol, a non-benzodi-azepine anesthetic agent also acting at the GABA

A receptor. This is a white-colored,

milky, oil emulsion that is sometimes jok-ingly described by anesthesia staff as “milk of amnesia” which, as earlier mentioned, recently achieved notoriety in the death of singer Michael Jackson (Mundy 2009)30. Flunitrazepam (Rohypnol), the aforemen-tioned benzodiazepine often abused by youth for its drunken alcohol-like intoxicat-ing effect, is likewise known on the street as “mind eraser” and “forget pills’”(Daderman & Lidberg 1999)31. Although the 10mg dose of zolpidem is typically used for night-time sedation, larger doses have been em-ployed as pre-operative tranquilization. In one such study comparing 20mg of oral zolpidem with 15 mg of IV midazolam, zolpidem produced significant anterograde amnesia from 30-60 minutes after adminis-tration in 45% of patients, nearly the same percentage as those given 15mg of midazo-lam (Pahud et al 1988)32. The anterograde amnesia phenomenon has been well studied in the laboratory, and in regular users of the drug is most well associated with rising blood levels in the period following dose administra-tion. An early reported study (Kumar et al 1987)33 gave either alprazolam 0.5mg or lorazepam 1 mg to normal volunteers three times daily. On the sixth day they were tested using a 16-word-list in an immedi-ate and a delayed recall paradigm before and 2 hours after dosing. On this repeat-ed dosing schedule no deficit was found in immediate recall pre-drug (when blood levels were lowest) but there was impair-ment of delayed recall for the list learned 2 hours after dosing (when blood levels were highest). No deficit was found in the recall of already-learned material. Amnesia resulting from GABA

A agonism

leaves the subject with a memory blank that is discovered after the drug intoxication, yet during the course of the intoxication im-mediate (short-term) memory is intact, and the subject may function in an automatistic state, able to walk, talk, respond and engage in often apparently complex tasks although these cannot later be recalled. The subject does not appear to be sleepwalking to an


observer (but see below) and can respond to conversation in an apparently superfi-cially meaningful way. Numerous examples of such automatisms with residual amnesia have been published in the scientific liter-ature, often self-reports of a scientist trav-eling to a professional meeting and taking the drug on their outbound international air travel to assist with jet lag: they arrive at their destination, clear customs and pass-port control, taxi to their hotel, attend a re-ception, and on awakening the next morn-ing their last recollection was of being in the aircraft (Morris & Estes 1987)34. It is only through eye-witness reports that the amnestic, automatistic, episode can be re-constructed. Although apparently genuine cases of “sleepwalking” have been reported to have been induced by z-drugs, particularly zolpi-dem, the majority of such nocturnal ambu-latory episodes are most probably autom-atisms. The distinction between the two can be subtle, but in sleepwalking speech is usually incoherent and the subject is largely unresponsive to their environment, their behavior incongruous to circumstances (Harazin & Berigan 1999)35 and this is not the case in automatisms. Automatisms with residual amnesia usu-ally occur when the subject has taken more of the drug than prescribed or is prudent, often inadvertently, and the interaction of the GABA

A drug with alcohol has a similar

effect to drug overdose through an addi-tive or synergistic process described pre-viously (supra). The phenomenon may or may not be characterized by behavioral dyscontrol (which, when it occurs, can be violent). More commonly the subject simply walks, talks and acts in an unchar-acteristic manner and has no memory for the events after waking from the sleep that follows. Adverse experience reports (AERs) of the more behaviorally deranged cases abound in the scientific literature, how-ever. An early report was of the case of “Ms. A,” who while treated with alprazo-lam (Xanax), drank approximately three ounces of 80-proof whisky, broke into her neighbors’ house an hour later, and “smashed everything in sight,” destroying approximately $50,000 worth of property and inadvertently sustaining lacerations to both wrists from broken glass. Returning then to her house she fell asleep and upon wakening had no memory of the offense—only vague recollections of the sounds of breaking glass (Terrell 1988)36. Other pub-

lished examples of GABAA stimulated au-

tomatisms include:“taking a bath with a raincoat on…

…going to the dentist at night, having con-fused 11 AM and 11 PM…

… pruning rosebushes in the middle of the night… cutting up furniture with a chain-saw” (Pompidou 2001, infra41) …

…crawling in the hallway at night, the pa-tient told the nurse he was going to mass (Yang et al 2005)37

When the subject is well-known and the event occurs in public, the popular press is involved. This was the case in March 2003 when Peter Buck, the then-45-year-old gui-tarist for the musical band REM, went on trial after being charged in April 2003 with a string of bizarre and out-of-character inci-dents attributed to him while flying the 10-hour trip from Seattle to London, Heathrow (BBC 2003)38. He pled not guilty to one charge of being drunk on the aircraft, two counts of common assault involving head steward Mario Agius and steward Holly Ward (covering them in yogurt), and one charge of damaging British Airways crock-ery. The trial took place at west London’s Isleworth Crown Court. Cabin staff aboard the British Airways 747 spoke of him try-ing to load a CD into a hostess trolley, up-ending it and sending a cascade of crockery and food across the floor, and then attempt-ing to slip a knife up his sleeve as he helped clear up the mess. At another stage, it was claimed, Mr. Buck had to be pulled away from an exit door after announcing he wanted to “go home,” before swearing at Captain Tom Payne when presented with a “yellow card” warning him to change his behavior or face arrest. Mr. Buck had been flying to London to perform at the Nelson Mandela concert in Trafalgar Square. He said that he “blacked out” until he woke up in a police cell. The court was told that he did not remember allegedly upending a hostess trolley, did not remember swearing at the captain, and did not remember ripping up a “yellow card” warning him to behave or face arrest. Mr. Buck asserted that he had taken a tablet of Ambien with a glass of wine at the beginning of the trip, and through his attor-ney claimed that what followed constituted a state of “non-insane automatism,” which under English law is an absolute defense to

criminal culpability. He was described by friends and family at the trial as otherwise the “politest, gentlest person imaginable.” Dr. Ian Hindmarch of the University of Surrey, professor of human psychophar-macology, testified for the defense regard-ing ‘non-insane automatism’ induced by Ambien (BBC 2003) 38.

DisinhibitionThe frontal lobes of the brain exert inhibi-tory influence on lower brain areas, and serve executive functions in decision-mak-ing, planning, prioritizing, and execution. GABA

A agonist drugs, in common with

beverage alcohol, reduce this inhibition. The effect can be intentionally produced, as in the prescription of GABA

A agonists

to reduce the anxiety component of path-ological ‘shyness,’ or the use of alcohol as a social lubricant. Persons acting under the influence of GABA

A agonism are more im-

pulsive, more spontaneous and more likely to act without regard to consequences (see below). This was earlier noted in regard to the barbiturates (Baraclough 1976)39 and has continued through the evolutionary and sequential introduction of other, new-er, GABA

A agonists. This disinhibition can

be particularly problematic in individuals with pre-existing frontal lobe impairment such as frontal dementia or an attention deficit disorder, but even in persons not so afflicted the effect of GABA

A agonism is of-

ten a component in impulsive crimes. The subject usually describes their behavior as being “out of character.” Perpetrators un-der the influence of GABA

A agonists may

impulsively steal and victims of involuntary intoxication acting under GABA

A agonist

influence may impulsively and disinhib-itedly have sex with relative strangers or persons they normally would not choose as sex partners. If the dose is high enough they may not later recall their “voluntary” participation (amnesia, see above) 40. Other examples of disinhibition reported in the scientific literature include:

“very high-society Mrs. Z defecated in her bed with great satisfaction while being examined by [an eminent doctor]

… a 36-year-old man engaged, in front of a witness and without restraint, in a sexual act normally practiced alone

… after receiving a 30mg dose of diazepam a 30-year-old woman removed her clothes and


made lewd and direct propositions, in front of a witness…… a doctor uncharacteristically swearing during a [morning] vaccination session—at midday he was under the impression he had not gone to work that morning” (Pompidou 2001)41.

Very rarely the form of disinhibitory be-havior may have qualities of mania; a par-oxysmal excitement, with insomnia, racing thoughts and increased energy, and this has been reported in patients both with and without pre-existing bipolar disorder. Reported initially as a rare manic reaction to benzodiazepines (Strahan, Rosenthal, Kaswan & Winston 1985)42, the same has occasionally been reported in persons who have taken zolpidem (Hill, Oberstar & Dunn 2004)43.

Violent dyscontrol, hostilityand rageRage and violent dyscontrol are a special case of GABA

A agonist-induced disinhi-

bition. The production of violent rage re-quires both a lack of self-restraint and the presence of a motivating anger. In certain persons and under certain circumstances GABA

A agonism evokes both. Ingram and

Timbury (1960)44 first reported danger-ously aggressive dyscontrol and rage under benzodiazepine influence resulting from chlordiazepoxide (Librium) use. DiMascio & Shader (1970)45 reported the same result-ing from diazepam (Valium) use and Bladin (1973)46 reported on clorazepate provoking such hostile dyscontrol, and the phenom-enon came to be recognized as a rare “rage reaction” (Gardos 1968 47, 1980 48). The phenomenon was originally thought to be—and was called—“paradoxical” rage, since these drugs typically reduce, or were expected to reduce, the emotional condi-tions from which hostility might emerge. It early became apparent, however, that albeit rare in the general population, the reaction is not in fact “paradoxical” but is reliably produced in certain persons under certain circumstances (Hall & Zisook 1981)49. Pre-existing hostility level is a determinant (Covi & Lipman 1977)50, as is a past his-tory of poor impulse control, yet the setting of drug use is also relevant. Subjects suffer-ing a predisposing borderline syndrome, in-cluding borderline personality disorder, are particularly vulnerable and in a study of the effectiveness of alprazolam as a treatment in borderline personality disorder, fully 58%

randomized to alprazolam experienced “paradoxical’”rage reactions, compared with none given placebo (Gardner & Cowdry 1985)51. A Swedish study of juvenile offend-ers who abuse flunitrazepam (Rohypnol, or “roofies”), usually in combination with alco-hol, found that impulsive violence was asso-ciated with high scores on verbal aggression and boredom susceptibility in personality tests (Daderman & Lidberg 1999)52. Even in individuals not psychiatrically diagnosed, however, extreme interpersonal frustration is a recognized trigger of GABA

A agonist-

associated hostile outbursts (Karch 1979)53. Neuropsychological dysfunction may also provide a constitutional vulnerability to GABA

A agonist induced rage: in a study of

38 patients given clonazepam (Klonopin), eight subjects who experienced aggres-sive outbursts were found to have mean differences of 17.5 points between verbal IQ (VIQ) and performance IQ (PIQ) as measured by the (adult or child) Weschler Intelligence Scales. The 30 patients who did not react with rage had mean VIQ-PIQ differences of only 6.5 points (Rosenfeld et al 1987)54. Such a VIQ-PIQ difference is often associated with antisocial person-ality traits. A history of anger management prob-lems and of alcohol abuse may predispose the individual to belligerence under GABA

A

drug influence. A recovered female alcoholic given midazolam preoperatively for dental surgery became so abusive and aggressive after receiving an 18mg dose that surgery had to be aborted (Fiset et al 1992)55. Her belligerence continued for 24 hours and the woman afterward claimed no recollection of the events. Yet no such predisposing history was reported in the case of a similar surgi-cal misadventure, with amnesia following, of a woman under conscious sedation with midazolam undergoing breast implant in-sertion. Surgeons reported that force was required to control her (Rodrigo 1991)56. Hostility has also been reported in con-trol subjects and in normals under labora-tory conditions. Although such laboratory studies are a far cry from the circumstances in which hostility is provoked in the “real world,” they may be useful for purposes of modeling the phenomenon and for study of predispositional correlates and drug in-teractions relevant to the effect. Alprazolam is the benzodiazepine most often implicat-ed in this adverse reaction (Cole & Kando 1993)57, and certainly it is the best studied in the laboratory. The phenomenon was

early investigated using diazepam (Valium) by Cherek et al (1987)58 who used a finan-cial game paradigm in which subjects sat before a console having two response but-tons labeled A and B. They were told that they were randomly paired with another, unseen, person in a situation described to them as one in which they could earn money (“points”) by pushing button A and could influence the amount of money (“points”) earned by the other individual they were paired with by subtracting mon-ey from them (punishing them) by pushing button B. They were told the other person could do the same to them. Pressing but-ton A was in fact maintained by a fixed ra-tio (FR) 100 schedule of point presentation. Each point delivery (“earned”) was indicat-ed on a counter mounted next to Button A and each point was given a value of ten cents. Pressing button B ostensibly delivered point subtraction (punishment) to the oth-er person and was defined as “aggressive”—completion of each 10 presses on button B ostensibly subtracted one point (ten cents) from the paired opponent participant and started a provocation-free interval of 125 or 500 seconds. Unknown to the participants was that there was no “other” opponent, and point subtractions (provocations) were automati-cally scheduled to occur at random times throughout the session. In the absence of any aggressive action (pressing button B) on their part, subjects were scheduled to receive 40 point subtractions per session. Thirty minutes prior to each session sub-jects received a gelatin capsule containing either placebo or diazepam at a dose of 2.5 mg, 5 mg, or 10 mg per 70Kg of their body weight. Subjects completed two questionnaires: a self-inventory (Profile of Mood States, POMS) and the Buss-Durkee Hostility Questionnaire at the end of the study. Five of the seven subjects tested had re-duced aggressive responding under diaz-epam influence at the highest dose, one subject demonstrated no change in aggres-sive responding, and one subject expressed increased aggressive responding in the ab-sence of provocation that did not occur in this subject, under placebo conditions and which was not seen in the other subjects. The Buss-Durkee Hostility score of this in-dividual was much higher than any other subject. Bond et al (1995)59 investigated the phe-nomenon of alprazolam hostility in 23 pa-


tients with a diagnosis of panic disorder that had been treated with alprazolam or placebo for eight weeks. Using question-naires and self-ratings, alprazolam-treated patients reported at baseline feeling less hos-tility after eight weeks of drug treatment. The subjects were then subjected to what they were told was a reaction-time competi-tion against an unseen opponent in another room. The subjects wore headphones and were told to select, at the beginning of each trial, one of eight intensities of sound that would be administered to their opponent if the subject’s reaction time was faster than their opponent’s. They were told their op-ponent had similar privileges. In fact, there was no opponent: noise level was increased throughout the experiment over six trial blocks and the subject heard the noise 50% of the time within each block, regardless of reaction time, and whenever their reaction time was 20% slower than their own aver-age. The paradigm was thus provocative of aggression using noise as a punishment that the subject could inflict on their nonexis-tent opponent. As measured by loudness selection patients on alprazolam behaved more aggressively in response to perceived provocation than did placebo-treated con-trol subjects. Provocation, or perceived provocation, is thus an essential element of alprazolam-induced hostility, even in subjects who report less baseline hostility under drug influence when not provoked. Although the proportion of individu-als vulnerable to experiencing ‘paradoxical rage’ is likely very small in the general pa-tient population, the criminal justice system tends to select and concentrate these indi-viduals with attributes of set that include personality disorder, hostile traits, neurop-sychological impairments, impulse control disorders and other neurobiological vulner-abilities to GABA

A agonism-induced rage

and disinhibition of its control. The tense and punitive circumstances in which such people often find themselves, confined by demographic, institutional and legal con-straints outside of their locus of control, also adds an additional environmental con-tributing factor of setting. A disastrous ear-ly experience in the 1970s with using the GABA

A agonist tranquilizing drugs oxaze-

pam (Serax) and diazepam (Valium) in an attempt to control prisoners in the Utah state prison system found that:

“the benefits derived from the administra-tion of these drugs in prisoner control were

[…] outweighed by the frequent appearance of paradoxical rage reactions and increase in hostility and aggressive tendencies in these in-dividuals.” (Brown 1978)60

Chemical submissionDrugging an unwilling victim into a state of unconsciousness for the purpose of rob-bery or rape has a long literary and folk-loric history, popularized by the ‘Mickey Finn” of the 1918 Chicago restaurant poi-sonings, and in novels such as the 1930’s The Maltese Falcon and the 1941 film of the same name. This, however, is not what is meant by “chemical submission,” which is the name given to a state of willing compli-ance, usually against the user’s best interest, that GABA

A agonist drugs can induce in a

person, the victim or subject of this intoxi-cation. Recent reports of chemical submis-sion have been most particularly associated with the above-mentioned benzodiazepine flunitrazepam (Rohypnol or “Roofies”) in connection with its use as a “date rape” drug when combined with alcohol, but his-torically the state has been associated with barbiturates or chloral hydrate, and more recently, zolpidem (Ambien). Hoffmann LaRoche, the manufacturer of Rohypnol, reformulated their tablet in 1997 with a bright blue dye (cloudy in dark colored drinks), which together with its bitter taste is said to render it detectable in most alco-holic drinks. Since the subject/victim under GABA

A

agonist influence is in an altered state of consciousness their consent to sex or other intrusions on their liberty cannot be said to be entirely voluntary, yet the subject is not unconscious or asleep at the time and the purpose of the assault, if it is assualt, is to induce a state of loss of self-control. Submission entails making a person act as one wishes; it is not a matter of exploiting an individual who falls into a deep sleep and remains passive and incapable of action. It follows, too, that where the state is deliber-ately induced in another unknowingly the subject victim is in a state of involuntary intoxication. The victim in submission can be manipu-lated into revealing their credit card number, can be induced to walk around with their aggressor without drawing attention in pub-lic and can be convinced to sign checks, all without later recollection or only fragmen-tary memory for these events (Pompidou 2001, supra). The below-mentioned 2005 case of USA v Matthew O’Connor, wherein

O’Connor waived his Miranda rights and made statements to police while he was un-der influence of the GABA

A agonist drug

propofol, was most likely a case of chemi-cal submission: in a state of organic deliri-um he acceded readily to police request that he incriminate himself in a crime. A similar situation pertained in the 2009 case of State (Georgia) v John David Clay, where the de-fendant was under the influence of a self-administered benzodiazepine overdose when interviewed by police. Neither O’Connor nor Clay later recalled being interviewed, they were amnestic. The picture of a chemical submission most publicized in the popular press, that of a perpetrator surreptitiously drugging an un-willing victim, probably happens less often than is claimed or believed, since in practice drug abusers, particularly youths and young adults, intentionally abuse GABA

A agonist

drugs socially, often willingly consuming them with alcohol. They may have no later recollection, or understanding, of what they did under its influence.

ConfabulationIn chronic abusers of GABA

A drugs, as

with chronic alcoholics, the user’s history is often a patchwork of half-remembered facts, memory gaps and confabulations. Confabulations are not “real” memories, although to the user they feel real. They are more properly thought of as unconsciously manufactured or imagined memories that “make sense” to them, that fill the amnes-tic voids left by drug eradication of mem-ory. These recollections may not comport with the evidence of consensus reality, are not true in an objective sense, yet the user relating them is not consciously lying. In the recent Alaska case of U.S. v Lusk & O’Connor referred to above; the defen-dant O’Connor made statements to law enforcement following medical treatment, and while he was still under the influence of the GABA

A agonist drug propofol in

the hospital. His admissions in this state of organic delirium were bizarre; his speech slipped tangentially from one thought to another, and was delivered in a poetically rhyming cadence. Some of his admissions could be—and were —interpreted by police as incriminating, but considering the en-tirety of his performance, which was audio-taped, it seemed clear to this examiner, and to the U.S. magistrate judge presiding, that O’Connor was delirious, that much of his speech content was confabulatory in con-


tent, and none of it was reliable. His “con-fession,” for which he was later amnestic, was properly suppressed.

Persistent effects beyondwithdrawalChronic use of sedative tranquilizing drugs is the norm: an estimated past-year preva-lence of use in the USA was reported in 1982 from a cross-national survey con-ducted in over 2,000 households as being 12.9% of the population, with 14.2% of this group taking the drug for 12 or more months. Prevalence has increased since then. In the 1982 statistics prevalence of use in the United States fell in the middle of the international distribution surveyed: rates for past-year prevalence of use varied from 17.6% in Belgium to 7.4% in the Netherlands. (Balter et al 1984)61. Even at normal anxiolytic or hypnotic doses, chron-ic users of these drugs develop tolerance and dependence, and a withdrawal syndrome similar to the alcohol/barbiturate type en-sues on abrupt discontinuation, as earlier reported for meprobamate (supra). Prospective studies on chronic sedative/tranquilizer drug users are complicated by the patient’s unavailability to research meth-ods before they start using the drugs. Barker et al (2005)62 employed in the alternative a case-matching design in studying a co-hort of twenty participants evaluated after withdrawal from benzodiazepines, compar-ing each participants’ neuropsychological test performance to that of two (one “anx-ious” and one “non-anxious”, both psycho-metrically defined) age, sex, and education matched control subjects who had never used sedative tranquilizer drugs. Mean du-ration of drug use in the patient group was 108 months, and the battery of neuropsy-chological tests was administered at a mean of 42 months after drug withdrawal. Their results indicated that long-term benzodiaz-epine use may lead to impairments in the areas of verbal memory, motor control/per-formance, and nonverbal memory but not visuospatial skills and attention/concentration. This finding contrasts with the acute mea-sured effect of sedative tranquilizer use on performance testing (see above, Thompson et al 1999), under which both attention/concentration and visuospatial memory was found to be impaired. In view of the length of abstinence, their findings indicate that these impairments persist well beyond cessation of benzodiazepine use. However, observed impairments in the area of non-

verbal memory were not solely attributable to benzodiazepine use and may have been influenced by the elevated anxiety levels present in both the case group and the anx-ious control group. Other studies that compared neuropsy-chological performance during treatment and after graded withdrawal have found dif-ferent results. Some found improvements in task performance measuring attention, vigi-lance, and speed of information processing, as in the report of Sokol & Power (1988)63 who studied 12 long-term benzodiazepine users (mean 9 years). Such studies have been criticized however on grounds of poor ex-ecution and design. Sokol and Power, for instance, tested only 7 of the patients at 4 weeks of withdrawal, when not all subjects were drug-free. Rickels et al (1999)64 compared two groups of chronic (8 year) benzodiazepine users: one group who had successfully with-drawn and one who had not. They report-ed that successful taper patients (drug-free) performed better on a digit-symbol substi-tution task and a symbol copy task, and, furthermore, were observed to be more alert, more relaxed, and less anxious than those still taking the drug. Salzman et al (1992)65 reported recovery of impaired cognitive function in 13 nurs-ing home residents withdrawn from their benzodiazepine medication, compared with a control group of 12 who did not with-draw. The authors also reported a signifi-cant improvement in short-term memory as measured by the digit span and vigilance test methods, which improvement was read-ily apparent to staff and family members: withdrawn patients appearing brighter, less dysphoric, more energetic and more intel-lectually alert. More definitively, however, Barker et al (2004)66 performed a meta-analysis of published research on the subject of seda-tive tranquilizer effects, surveying 34 arti-cles published between 1980 and 2000, of which 15 met all inclusion eligibility cri-teria. They found that previous long-term benzodiazepine users appeared to improve in tested cognitive function in all domains examined, with indications that as age in-creases post-withdrawal the patient’s recov-ery decreases on tasks of attention/concen-tration. As to the degree of improvement: where studies employed a within-subject design it was possible to ask the question: “are previous long-term benzodiazepine us-ers still impaired at follow-up compared to

controls or normative data?” Mean dura-tion of drug use in this data set was 8.9 years and the median drug-free period was 3 months. They concluded that compared to normals or controls, patients who had withdrawn from long-term benzodiazepine use continued to perform more poorly in most areas of cognition than did controls or normative data except for sensory pro-cessing. The residual cognitive impairment resulting from chronic benzodiazepine use is therefore measurable after three months of drug-free living.

Involuntary intoxicationInvoluntary intoxication occurs when an individual becomes inebriated or intoxi-cated on a drug that they consumed un-knowingly or, if knowingly, without knowl-edge or warning of the drug’s likely effect. Involuntary intoxication can occur, for in-stance, if a pharmacist inadvertently dis-penses the wrong drug in error to a patient, or if the physician negligently prescribes the wrong drug in error. The intoxication resulting from surreptitious drugging of an unknowing victim is of course also ‘invol-untary.’ The victim of involuntary intoxi-cation may claim to have been assaulted, and misbehavior they engage in as a result of such victimization is not their fault but resides, rather, with the administrator or provider of the drug causing the intoxica-tion that resulted in the misbehavior. The rare phenomenon of “pathological intoxi-cation” can be considered a special case of involuntary intoxication. In pathological intoxication the subject has a heightened sensitivity to inebriation on a drug, usu-ally alcohol, and becomes excessively in-toxicated after voluntary consumption of a small amount, sometimes as little as a single drink. The essence of the diagnosis of pathological intoxication lies in the id-iosyncratic state of heightened vulnerabil-ity to the drug. For this to be intoxication to be considered involuntary, however, the subject would need to have been unaware of their idiosyncratic vulnerability. Common claims of involuntary intoxica-tion involving tranquilizing drugs are rarely clear-cut, however, particularly when am-nesia is involved, and often result from a patient knowingly consuming alcohol with a properly prescribed GABA

A tranquilizer

or hypnotic, with disastrous consequences resulting from the combination. If the pa-tient was truly given no warning of an ad-verse interaction then a claim of involun-


tary intoxication may be validly made, yet this can be difficult to prove or disprove and the situation contrasts markedly from that where both of the interacting drugs are medically prescribed (an opiate and a ben-zodiazepine, for instance, taken for the first time) and responsibility for giving notice is well defined at the physician and pharma-cist level. Involuntary intoxication also occurs where an inappropriate drug is improperly mandated by law or compulsory process to be taken by a patient against their will. In the Texas death penalty trial of Ernest Ray Willis the defendant’s drugged and unre-sponsive demeanor in the court room was cited by the prosecutor to illustrate to the jury that Willis was cold, calculating and disdainful of the court and the jury. There was no medical reason for this prescription and Willis, who was innocent (the offense was committed by another, who confessed), was too obtunded by the drug to offer any assistance in his defense. Willis’ conviction was overturned, and he was released, 17 years later. Tranquilizing drugs are also used to in-voluntarily pacify agitated patients and nursing-home residents, often more for staff convenience than the patient’s medi-cal need. Since benzodiazepines exacerbate the cognitive confusion of the dementias, forensic questions may be raised regarding the patient’s competence to sign wills and other instruments under tranquilizing drug influence.

The future of tranquilizing drugsAccording to a 2006 pharmaceutical indus-try business report (Business Wire 2006)67 addressing the hypnotics market and the future drug pipeline: “the insomnia market has been dominated by Ambien (zolpidem), Sonata (zaleplon) and Imovane (zopiclone), and the older hypnotics such as benzodiaz-epines. However, the global insomnia market is set to grow from $3.7 billion in 2005 to $5.5 billion by 2014 driven primarily by the launch and adoption of Lunesta (eszopiclone), Rozerem (ramelteon) and Ambien CR as well as pipeline drugs from 2006 onwards” Ambien had U.S. revenues of $2 bil-lion in 2004 but faced competition from recently launched hypnotics, and the drug became generic in 2006, its revenue evaporating. In an attempt to hold onto the residue of the market Sanofi-Aventis launched a sustained-release form (Ambien CR) in the USA in October 2005 yet the

Ambien franchise was predicted to de-cline from 2006 onwards to approxi-mately half the value it is today by 2014. The industry’s “prospective players” [phar-maceutical manufacturers] were warned that by 2014 stiff competition is to be expect-ed from numerous generics, worth nearly US$800 million, as well as a number of non-GABA

A, non-scheduled hypnotics with

revenues topping US$700 million. In such a crowded market, “innovation is key and product differentiation, demonstration of cost-effectiveness and niche strategies are essential.” The report identified such a niche, a new sub-market within the user population, the “transient insomniac” which population, they reported: “…is severely under served, and presents an ideal niche for manufacturers. If manufactur-ers can increase the proportion of individu-als using prescription hypnotics at least a few nights a month, to the level of those who use them at least a few times a week, usage of pre-scription hypnotics could increase by 50%.” Of the hypnotic drugs currently at the forefront of the market only Rozerem (ra-melton) does not stimulate the GABA

A

receptor, but relies on the melatonin sys-tem. A novel and under-explored target for tranquilizer drug action at the GABA

A

complex is the neurosteroid receptor (see Fig 1). The industry has previously mar-keted drugs which act directly at this locus, such as Althesin, a mixture of two neuros-teroids: alphaxolone and alphadolone, sold as a surgical sedative. It was withdrawn from human use in 1984 due to toxic re-actions and has now been‘re-branded’ for veterinary use under the name “Saffan”. Current research is directed however not at direct stimulation of the GABA

A recep-

tor complex’ neurosteroid receptor but at stimulating production of the brain’s own enurosteroid neurotransmitter(s), in the hope that endogenous regulatory process-es will prevent tolerance and dependence from developing. One such compound, currently known as “XBD173” is in the pipeline and shows antipanic effects in animals – apparently without sedation and tolerance (Ruprecht et al 2009)68. Similar safety claims, of course, were previously made for the barbiturates, carbamates, benzodiazepines and z-drugs. Only time will tell, yet the history of the field sug-gests that if the drug gets to market, hu-mans will find some way to abuse it, and forensic examiners will be dealing with its adverse effects.

References1. Levitan ES (1988) cited in Crews FT (2004) Ef-

fects of alcohol abuse on the brain. Chapter 4 in Brick J (editor), Handbook of the Medical Con-sequences of Alcohol and Drug Abuse, Taylor & Francis (pubs)

2. Ellmont B, Struder RA, & Jurgens R (1955) Nolu-dar, a New Sedative-Hypnotic: A Piperidine De-rivative. Schweiz med. Wchnschr. 85. 350

3. Justice William Rehnquist was addicted to Placi-dyl, and suffered several hospitalizations as a re-sult.[ see: http://abovethelaw.com/2007/01/break-ing_was_chief_justice_reh.php?show=comments retrieved 28 May 2009]

4. Carey, B (2008) “Frank Berger, 94, Miltown Cre-ator, Dies” 21 Mar 2008, New York Times, re-trieved 5 May 2009 online at: http://www.nytimes.com/2008/03/21/health/research/21berger.html?_r=1&partner=permalink&exprod=permalink

5. Dokoupil, Tony (2009-01-22). “How Mother Found Her Helper”. Newsweek. http://www.newsweek.com/id/180998. Retrieved on 2009-05-01.

6. Dobkin AB (1958) Efficacy of ataractic drugs in clinical anesthesia: A review, Can Anaes. Soc. J., vol. 5, no. 2, April, 1958

7. Foltz RL, Fentiman AF, Folts RB (1980), Meth-aqualone, Chapter 4 in NIDA Drug Research Monograph #32, GC/MS assays for abused drugs, US Public Health Service (pubs)

8. http://www.medicalnewstoday.com/articles/25416.php, retrieved 6 Aug 09

9. http://www.medicalnewstoday.com/articles/63064.php, retrieved 6 Aug 09

10. http://www.deadiversion.usdoj.gov/drugs_con-cern/benzo_1.htm\ retrieved 6 Aug 09

11. Depoortere H, Zivkovic B, Lloyd KG, Sanger DJ, Perrault G, Langer SZ, Bartholini G. (1986) Zolpidem, a novel nonbenzodiazepine hypnotic. I. Neuropharmacological and behavioral effects. J Pharmacol Exp Ther. 1986 May;237(2):649-58.

12. Greenblatt DJ & Shader RI (1974) Benzodiazepines in clinical practice, New York, Raven Press.

13. Roth T, Roehrs T, Wittig R & Zorig F (1984), Benzodiazepines and memory. Brit. J. Clin Phar-macol. 18 45S-94S

14. Stein RA & Strickland TL (1998) A review of the neuropsychological effects of commonly used pre-scription medications. Arch. Clin. Neuropsychol-ogy 13(3):259-284

15. Thompson JM, Neave N, Moss MC et al (1999) Cog-nitive properties of sedation agents: comparison of the effects of nitrous oxide and midazolam on memo-ry and mood, Brit. Dental J. 187(10):557-562

16. Wilkinson CJ (1995), The acute effects of zolpi-dem administered alone and with alcohol on cog-nitive and psychomotor function, J. Clin. Psychi-atry 56: 309-318

17. Calabrese EJ (1991) Alcohol interactions with drugs and chemicals, Lewis (Pubs) p11

18. Gruber CM Jr (1955) A theoretical consideration of additive and potentiated effects between drugs with a practical example using alcohol and barbi-turates. Arch Int Pharmacodyn Ther. Jun 1;102(1-2):17-32.

19. Linnoila M, Stapleton JM, Lister R, Moss H, Lane E, Granger A, Eckardt MJ (1990) Effects of single doses of alprazolam and diazepam, alone and in combination with ethanol, on psychomotor and cognitive performance and on autonomic nervous system reactivity in healthy volunteers. Eur J Clin Pharmacol. 1990;39(1):21-8.

20. Wilkinson CJ (1995) The acute effects of zolpi-dem, administered alone and with alcohol, on


cognitive and psychomotor function.. J Clin Psy-chiatry. 1995 Jul;56(7):309-18.

21. Kleber H (1994) Assessment and Treatment Plan-ning for Cocaine-Abusing Methadone-Main-tained Patients: Treatment Improvement Proto-col (TIP) Series 10 » Appendix E - Multidrug Abuse Patterns

22. Backmund M, Meyer K, Henkel C, Soyka M, Reimer J, Schütz CG. (2005) Co-consumption of benzodiazepines in heroin users, methadone-substituted and codeine-substituted patients. J Addict Dis. 2005;24(4):17-29.

23. Rapeli P, Fabritius C, Kalska H and Alho H (2009) Memory function in ioiod dependent patients treated with methadone or buprenorphine along with benzodiazepines: longitudinal change in com-parison to normal individuals. Substance Abuse Treatment, Prevention and Policy, 4(6):1-15 DOI: 1186/1747-597X-4-6

24. Lintzeris N, Mitchell TB, Bond A, Nestor L, Strang J (2006) Interactions on mixing diazepam with methadone or buprenorphine in maintenance pa-tients. J. Clin. Psychopharmacol. 26:274-283

25. Bashir A & Swartz C (2002), Alprazolam-induced pan-ic disorder., J. Am Board Fam. Prac. 15(1):69-72

26. Weissman DE and Haddox JD. Opioid pseudo-addiction. Pain 1989 36:363-366. Sees KL and Clark HW. Opioid use in the treatment of chron-ic pain: assessment of addiction. J Pain Symptom Manage 1993; 8:257-264.

27. Fishbain DA (2003) Chronic Opioid Treatment, Addiction and Pseudo-Addiction in Patients With Chronic Pain , Psychiatric Times. Vol. 20 No. 2; 1-5

28. IASP (1993) Nursing Curriculum http://w w w. i a s p - p a i n . o r g / A M / Te m p l a t e .cfm?Section=Nursing&Template=/CM/HTMLD-isplay.cfm&ContentID=2320

29. Hazilip TM & Ewing JA (1958) Meprobamate ha-bituation. N. Eng. J. Med 258:1181-1186

30. Mundy A (2009) Alert of MD abuse of Jackson drug, Wall Street Journal 6 August 2009, page A1

31. Daderman AM & Lidberg L (1999)Flunitraze-pam (Rohypnol) abuse in combination with al-cohol causes premeditated grievous violence in male juvenile offenders, J. Am. Acad. Psychiatry Law 27(1):83-99

32. Pahud J, Forrester A, Gamulin Z et al (1988) Post-operative sedation with zolpidem, midazolam and placebo: a randomized double-blind comparison, Anesthesiology 69:555

33. Kumar R, Mac DS, Gabrielli WF & Goodwin DW (1987), Anxiolytics and memory: a comparison of lorazepam and alprazolam, J. Clin. Psychiatry 48(4):158-160

34. Morris HH 3rd, Estes ML. (1987) Traveler’s am-nesia. Transient global amnesia secondary to tri-azolam. JAMA. 1987 Aug 21;258(7):945-6. and see also: Editorial (1988) You don’t have to be a neuroscientist to forget everything with triazolam--but it helps. JAMA. 1988 Jan 15;259(3):350-2.

35. Harazin J & Berigan TR (1999) Case Report: Zolpidem tartrate in somnambulism, Military Medicine 164:669-670

36. Terrell HB (1988) Behavioral dyscontrol associat-ed with combined use of alprazolam and ethanol.. Am J Psychiatry. Oct;145(10):1313.

37. Yang W, Dollear M, Muthukrishnan SR (2005), One rare side effect of zolpidem- sleepwalking: a case re-port, Arch Phys. Med. Rehabil. 86:1265-1266

38. BBC (2003) http://news.bbc.co.uk/1/hi/health/1913066.stm and see also: http://news.bbc.co.uk/1/hi/uk/1885684.stm retrieved online 15 May 09

39. Baraclough BM (1976) Barbiturate prescribing: psychiatrist’s views, Br. Med. J. 2:928-929

40. Ingram IM, Timbury GC (1960): Side effects of librium (letter). Lancet 2:766, and see also: Hall RCW, Joffe JR (1972), Aberrant response to diaz-epam: a new syndrome. Am J Psychiatry 129:738-742, and see also: Ryan HF, Merrill FB, Scott GE, et al (1968): Increase in suicidal thoughts and tendencies, association with diazepam therapy. JAMA 203:1137-1139,

41. Pompidou Group (2001) Proceedings of the Con-tribution to the Sensible Use of Benzodiazepines: Meeting Organised by the Co-operation Group to Combat Drug Abuse and Illicit Trafficking in Drugs (Pompidou Group), Strasbourg (France), 29-30 January 2001, council of Europe (Pubs)

42. Strahan A, Rosenthal J, Kaswan M & Winston A (1985) Three case reports of acute paroxysmal excitement associated with alprazolam treatment, Am. J. Psychiatry 142:859-861

43. Hill KP, Oberstar JV Dunn ER (2004) Zolpi-dem-induced delirium with mania in an elderly woman, Psychosomatics 45(1):88-89

44. Ingram JM & Timbury GC (1960) Side effects of Librium, Lancet 2:766

45. DiMascio A & Shader RI (1970) Behavioral Toxic-ity in: Psychotropic Drug Side Effects, Shader RI & DiMascio A (eds) Williams & Wilkins (pubs), Baltimore, pp124-131

46. Bladin PF (1973) The use of clonazepam as an an-ticonvulsant, Med. J. Aust. 1:683-688

47. Gardos G, DiMascio A, Salzman C & Shrader RI (1968) Differential actions of chlordiazepox-ide and oxazepam on hostility. Arch. Gen. Psy-chiat., 18:757-760

48. Gardos G (1980) Disinhibition of behavior by anti-anxiety drugs, Psychosomatics 21(12):1025-1026

49. Hall RC, Zisook S. (1981) Paradoxical reactions to benzodiazepines. , Br J Clin Pharmacol. 1981;11 Suppl 1:99S-104S

50. Covi I & Lipman RS (1977) Diazepam induced hostility in depression, Presentation at: American Psychiatric Association Scientific Meeting, May 1977, Toronto.

51. Gardner DL & Cowdry RW (1985) Alprazolam-Induced Dyscontrol in Borderline Personality Dis-order, Am J Psychiatry 1985; 142: 98-100

52. Dåderman AM, Lidberg L.(1999) Flunitrazepam (Rohypnol) abuse in combination with alcohol causes premeditated, grievous violence in male juvenile offenders. J Am Acad Psychiatry Law. 1999;27(1):83-99.

53. Karch FE (1979) Rage reactions associated with clo-razepate dipotassium, Ann. Int. Med. 91:61-62

54. Rosenfeld WE, Beniac TE, Lippmann SM, Loe-wenson RB (1987), Adverse behavioral response to clonazepam as a function of Verbal IQ- Perfor-mance IQ discrepancy, Epilepsy Res. 1:347-356

55. Fiset L, Milgrom P, Beirne R, Roy-Berne P (1992) Disinhibition of behaviors with midazolam: report of a case. J. Oral. Maxilofacial Surg. 50:645-649

56. Rodrigo CR (1991) Flumazenil reverses paradoxical reaction with midazolam, Anesth. Prog. 38:65-68

57. Cole JO, Kando JC. (1993) Adverse behavioral

events reported in patients taking alprazolam and other benzodiazepines. J Clin Psychiatry. 1993 Oct;54 Suppl:49-61; discussion 62-3.

58. Cherek DR, Steinberg JL, Kelly TH. Effects of di-azepam on human laboratory aggression: correla-tions with alcohol effects and hostility measures. NIDA Res Monogr. 1987;76:95-101.

59. Bond AJ, Curran HV, Bruce MS, Sullivan GO and Shine P (1995) Behavioral aggression in panic dis-order after eight weeks’ treatment with alprazolam, J. Affective Disorders 35:117-123

60. Brown CR. (1978) The use of benzodiazepines in prison populations. J Clin Psychiatry. 1978 Mar;39(3):219-22.

61. Balter MB, Manheimer DI, Mellinger GD, Uhlen-huth EH (1984) A cross-national comparison of anti-anxiety/sedative drug use. Curr Med Res Opin. 8 Suppl 4:5-20

62. Barker MJ, Greenwood KM, Jackson M, Crowe SF. (2005) An evaluation of persisting cognitive effects after withdrawal from long-term benzodiazepine use. J Int Neuropsychol Soc. May;11(3):281-9.

63. Sakol MS, Power KG. (1988) The effects of long-term benzodiazepine treatment and graded with-drawal on psychometric performance. Psychop-harmacology (Berl). 1988;95(1):135-8.

64. Rickels K, Lucki I, Schweizer E, García-España F, Case WG(1999) Psychomotor performance of long-term benzodiazepine users before, during, and after benzodiazepine discontinuation. , J Clin Psychopharmacol. 1999 Apr;19(2):107-13.

65. Salzman C, Fisher J, Nobel K & Glassman R(1992), Cognitive improvement following ben-zodiazepine discontinuation in elderly nursing home residents. Int. J. Geriatric Psychiatry

66. Barker MJ, Grenwood KM, Jacxkson M and Crowe SF (2004), Persistence of cognitive effects after withdrawal from long-term benzodiazepine use: a meta-analysis, Arch. Gen. Neuropsychol-ogy 19:437-454

67. Business Wire (2006) Assessment of Current and Future Opportunities and Threats in the Insomnia Market in the US, EU and Japanese Pharmaceuti-cal Markets, Business Wire, 2 March 2006

68. Rupprecht, R, Rammes G, Eser D et al (2009) Translocator Protein (18 kD) as Target for Anxi-olytics Without Benzodiazepine-Like Side Effects, Science 326; 490-493

69. Baselt R (2008) Disposition of Toxic Drugs and Chemicals in Man, 8th Edition, Biomedical Pub-lications (pub), Foster City CA

Acknowledgment:The helpful editorial assistance and con-structive advice of forensic psychologist Tom Schacht PsyD is gratefully acknowledged.n

ABOUT THE AUTHOR

Jonathan J. Lipman, PhD, is a neuropharmacologist and president of Neuroscience Consulting Inc., a forensic, industrial, and research agency providing pharmacological consultation services. Dr. Lipman also serves as associate clinical professor of psychiatry and behavioral science at the Quillen College of Medicine at East Tennessee State University.


Earn CE CreditTo earn CE credit, complete the exam for this article on page 60 or complete the exam on-line at www.acfei.com (select “Online CE”).

Find the crime they’re trying to hide.Forensic Accountants track the money and solve the crimes. The best of the best belong to an elite organization that has rigorous standards and works constantly to advance the important profession of forensic accounting. Becoming a Certified Forensic Accountant, Cr.FA® puts you in good com-pany, helps you to hone your skills, and recognizes your training, experience, and dedication.

Log on to www.acfei.com/crfa for details.Call (800) 423-9737 to talk to member services.Act now to start enjoying the benefits of certification.


CRFA01EX

SM

Protect Your Homeland.Become Certified in Homeland Security, CHS® today.

The CHSSM program has earned its reputation as the premier group dedicated to providing certification, training, and continuing education to professionals across the nation who are committed to improving homeland security. We boast a total commitment to our country’s safety, an extraordinary knowledge base, and an in-place organizational structure that delivers the highest-quality certification and continuing education opportunities in homeland security.

Join us today as we work together to protect what matters most—our families, communities, country, and way of life.

CHS01EX

OOO GI BILL APPROVED! OOO

The American Board for Certification in Homeland Security, CHS®

2750 E. Sunshine St. | Springfield, MO 65804 | www.abchs.com | (877) 219-2519 | [email protected]

Suporting patients while protecting their rights

Forensic nurses are often the bridge that spans medicine and justice. They tend to the needs of victims and help gather and protect the evidence that can lead to a conviction and ultimate justice.

The Certified Forensic Nurse, CFN® program helps forensic nurses get the respect they deserve and unites them in a supportive community of fellow professionals who are dedicated to their field.

“Forensic Nursing is a newly recognized specialty in the fields of Nursing and Forensic Sciences. The ACFEI Forensic Nursing Certification is an important credential that indi-cates advanced expertise and distinguishes those nurses who possess the special skills and knowledge base required in Forensic Nursing”

–Mary K. Sullivan, RN, BSN, Phoenix, AZ

Call (800) 423-9737 or visit www.acfei.com/cfn for more information.

The Certified Forensic Nurse,CFN® Program


CFN01EX

The Commission on Forensic Education (COFE) promotes the growth and em-phasizes the importance of forensic sci-ence programs in secondary education. The Commission offers guidance on in-struction, provides help to those who teach or study forensic science, and reviews pro-fessional certification programs. COFE is an effective and essential network that helps educators and students stay informed of the latest innovations, breakthroughs, and important research in the field. The Commission helps educators ad-vance the field and inspire future forensic professionals by:

Helping educators network with fel-•low teaching professionals and top experts in the field.Convincing potential students of the •importance and the benefits of study-ing forensic science.Helping members stay current in a •constantly evolving field by providing quality continuing education.Providing certification programs that •recognize achievement.

Membership in COFE is open to foren-sic professionals and law educators at both the secondary and post-secondary levels. Members of the Commission may be em-ployed by either public or private educa-tional institutions as full-time, part-time, or adjunct instructors. Members are dedi-cated to advancing the field of forensic sci-ence and providing quality education to future professionals in the field. The Commission has its own interactive, member-centered Web site. This Web site makes it easy for members, teachers, and students to interact with one another while learning and expanding their knowledge in the forensic science fields.

The Commission on Forensic Education had an exceptional year during 2009, in-cluding a successful and mutually beneficial partnership with LeadAmerica, who repre-sented COFE at their forensic science camps at the University of California, Berkeley; Bentley University; Fordham University; and Johns Hopkins University. The Forensic Commissioner of COFE, Anna Pry, was able to represent the orga-nization in person twice this year. The first was at the Florida Institute of Technology’s forensic summer camp, a day camp for high school students that is designed to explore forensic psychology and forensic science through hands on activities, mov-ies, lectures, and guest speakers. It even goes through the steps of an actual crime scene investigation and its subsequent court procedures. Ms. Pry’s second visit was to the American College of Forensic Examiners National Conference at the Rio hotel in Las Vegas.

It was here where she met with members of the Board as well as some outstanding members of COFE to discuss upcoming events and plans for the 2010 year. 2009 also gifted the Commission on Forensic Education with its 200th member, as well as the Commission’s first free online course, a forensic science class syllabus for teachers starting a new program at their schools, dozens of free lesson plans, free forensic science PowerPoint presentations, a study guide template, and a forensic psy-chology overview. All of these are free and currently available on the Commission’s Web site for all of our dedicated members and also for any new members who are in-terested in joining.

Free Forensic SyllabusCOFE now has a forensic science sylla-bus to cover a full semester of forensic sci-ence classes. Created by Jeremy D. McCoy of Kickapoo High School in Springfield,

COMMISSION ON FORENSIC EDUCATION


s JPA Cadets practice traffic stop procedures

Missouri, this syllabus includes various el-ements, including:

Course description•Goals•Outline•Grading scale•Classroom policy and management•

Twenty Lesson PlansMade possible by a generous donation from Chaplain David J. Fair, PhD, D.Min., CHS- IV, ACMC-III, BCETS, FAAETS, BCCC, we now have a full program of 20 lesson plans from the Junior Police Academy! Since 1992, The Junior Police Academy has been dedicated to helping today’s youth grow up to be exceptional citizens of tomorrow. This is accomplished through a series of law enforcement educa-tion, mentorship, and encouragement; with the goal of safer communities and schools for the students they guide. The lesson plans donated to the Commission on Forensic Education give children an inside look at law enforcement in the United States and cover the follow-ing topics:

Introduction to the Junior Police •AcademyGuide to being a law enforcemnt •officerStreet patrol•Traffic enforcement•Crime fighting•Conflict resolution•School resource officer•Bomb squad•

K-9 unit•Swat•Sheriff ’s department•Gangs•The Federal Bureau of Investigation•The Secret Service•Scene of the crime•Crime prevention•School violence•Teens and drug use•Terrorism•Do you have what it takes?•

Free PowerPoint LessonSome students’ minds go straight to popu-lar, compelling shows like CSI when they hear the word “forensics.” With a new PowerPoint presentation submitted by COFE’s partner LeadAmerica, you will be able to show your students the real nature of crime scene investigation. This introduc-tion not only has notes for students but also for the teachers themselves; the presentation covers such topics as suspect and substance identification, crime scene processing and documentation, evidence searching and col-lection, and crime scene reconstruction. LeadAmerica and the COFE have part-nered with a common goal of improving forensic science and crime scene inves-tigation curricula in secondary schools. LeadAmerica and COFE have come to-gether in order to empower children to re-alize their own possibilities and to help give them a sense of reason, honesty, self-belief and accountability. LeadAmerica puts on four camps during the summer in which junior high and high school students come for one week to dis-cover and process a crime scene, examine the evidence, develop hypotheses, and go to trial. COFE provided the camp with differ-ent types of documentation (forensic arti-cles, interviews, cases and brochures) as well as present each student with a “Certificate of Completion” upon successful achieve-ment of the camp’s agenda.


s Sample slide from a free COFE lesson plan; this presentation can be viewed at www.forensiccommission.com.

s LeadAmerica CSI camp: students learn forensic lab techniques, including blood sample analysis.

The Commission on Forensic Education and LeadAmerica plan to extend their part-nership into 2010. To learn more about LeadAmerica, please visit their Web site at Lead-America.org or follow them on Twitter at http://twitter.com/LeadAmerica.

WantedThe Commission on Forensic Education is always looking for new online courses and lesson plans to provide free to our members and help promote the study of forensic sci-ence in high schools. Desired topics include (but are not limited to) the following:

Crime scene analysis •Computer forensics•Medical investigation•Sensitive information security•

If you wish to submit a course or lesson plan for review to the Commission on Forensic Education, please include the fol-lowing information along with the materi-als you wish to have reviewed:

Title•Learning objective(s)•Target audience (grade level)•Short author bio• n

To join the commission, applyonline at www.forensiccommission.com or call Anna Pry at (800) 592-1399

Attention Forensic Educators

THE COMMISSION ON FORENSIC EDUCATIONSM

The Commission on Forensic Education, developed by The American College of Forensic Examiners, emphasizes the importance of forensic science programs in education and is com-mitted to their expansion. The Commission offers guidance on instruction, provides help to those who teach or study forensic science, and reviews professional certification programs. The Commission is an effective and essential network that helps educators and students stay informed of the latest innovations, breakthroughs, and important research in the field. Commissioner membership is open to college and university administrators and full-time, part-time, and ad-junct professors; Associate Commissioner membership is open to high school science teach-ers. The Commission helps educators advance the field and inspire future forensic profession-als through providing supportive services:

Helping educators network with fellow teaching professionals and top experts in the •field.Teaching potential students about the importance and the benefits of studying forensic •science.Giving members a highly visible forum to publish and distribute their research.•Helping members stay current in a constantly evolving field by providing quality con-•tinuing education.Providing certification programs that recognize achievement.•

SM

Questions, comments, submissions, or ideas?We want to hear from you!

Toll Free: (800) 423-9737 Phone: (417) 881-3818, ext. 172 Online: www.forensiccommission.comAnna Pry, Commission Coordinator, at [email protected]


s LeadAmerica CSI camp: a high school student learns about fingerprint dusting and analysis.

COFE01EX

The 2010 National ConferencePreparations are in full swing for the 2010 National Conference to be held September 22–24 at the Renaissance Orlando Resort at SeaWorld® in sunny Orlando, Florida. Again this year, the ACFEI National Conference will run concurrently with its sister associations, the American Board for Certification in Homeland Security (ABCHS), the American Psychotherapy Association (APA), the American Association of Integrative Medicine (AAIM), and the American College of Counselors (ACC). This unique setting provides exposure to and opportunities to learn from other professional disciplines. The schedule is filling up with numerous presentations on exciting and relevant topics in the forensic field. Presentation topics in-clude: Is the Confession Admissible?: Assessing a Defendant’s Competency to Waive Miranda Rights; Application of the Seven-Step Methodology of Criminal Investigations in Forensic Accounting; Evidence Collection, Preservation, and Presentation: Making Sure Your Evidence Withstands the Litigation Challenges; Agitated-Excited Delirium Syndrome and Sudden Deaths; and many more. You can view the schedule online at www.acfei.com, and the complete schedule will be printed in the summer issue of The Forensic Examiner®. In addition, we are proud to announce that ACFEI Chair Dr. Cyril Wecht, Dr. Henry C. Lee, as well as Dr. Greg Vecchi from the FBI’s Behavioral Sciences Unit, will be giving keynote addresses during the conference. To help you stay abreast of all the latest conference news we are beginning a monthly e-newsletter that will highlight various presen-tations, provide conference status updates, and offer other helpful conference information. Make plans today to attend—and be sure to register by February 28th to save $200 by registering with the early-early bird registration rate of $399. See you in Orlando!

Wednesday, September 22

Registration and Exhibitors..........................................................................................12:00pm–8:00pm

ABCHS Pre-Conference Session..................................................................................3:00pm–5:00pm

Welcome Reception.........................................................................................................5:00pm–7:00pm

Thursday, September 23

Exhibit Hall Opens/Continental Breakfast..................................................................................7:00am

Tai Chi..................................................................................................................................7:00am–7:30am

General Session.................................................................................................................8:00am–9:00am

Morning Break....................................................................................................................9:00am–9:30am

Breakout Sessions...........................................................................................................9:30am–11:00am

ACFEI/AAIM Working Luncheons (Additional Registration Required)............11:00am–12:30pm

Breakout Sessions...........................................................................................................12:30pm–5:30pm

Annual Banquet.................................................................................................................7:00pm–9:00pm

Friday, September 24


Tai Chi..................................................................................................................................7:00am–7:30am




ABCHS/APA Working Luncheons (Additional Registration Required)............11:00am–12:30pm

Breakout Sessions..........................................................................................................12:30pm–5:30pm

Schedule-at-a-GlanceVisit www.acfei.com to view the complete presentation schedule!

Be sure to look for additional information on the National Conference in the Summer 2010 issue.


2010 NATIONAL CONFERENCE

Conference TravelWe are proud to announce that we have partnered with Great Southern Travel to assist with travel arrangements to Orlando. Great Southern Travel, a division of Great Southern Financial Corporation, was founded in 1977 with the purpose to make travel as simple, convenient, and worry-free as possible for both business and leisure travelers. Today, Great Southern Travel is one of the largest travel agencies in the state of Missouri and also ranked in the Top 100 in the nation, with 12 offices throughout Missouri, Kansas, and Arkansas. Great Southern agents don’t just find you the lowest published fares and the most convenient itinerary—they negotiate for your best travel options, because you have more important things to do. Great Southern will:

Ensure you get you priority wait listing on flights. •Monitor your flights and fare and tell you if better itineraries or prices come along.•Act as your advocate in disputes and problem resolution. •Work with you in handling emergency problems and flight changes.•

In addition, Great Southern has negotiated special discounts on fare for members traveling on American, Delta, and Southwest Airlines. For more information on Great Southern or to book your travel, contact either Kelly Christian or Lesley Palmer at 800-749-7116 or visit them online at www.greatsoutherntravel.com.

Exhibiting at the 2010 National Conference will get your company noticed so you can introduce your product or service to a wide variety of top professionals. Sponsorships are also available and are a great way to direct attendees to your exhibit booth. Exhibitor space is limited, so reserve your spot today. For additional information or to register, contact the Conference Department at 1-800-423-9737, ext. 168.

Conference Exhibitor: $650• 10’ x 10’ Exhibit Booth• Company name in the conference program• Opportunity to showcase your product on the vendor stage

Conference Bag Insert: $675• Distribution of one promotional piece to all attendees • Company name in the conference program• 50% discount with the purchase of Exhibit Booth Literature Table: $100If you are unable to exhibit, take advantage of our literature table.We will place your brochures on the literature table in the exhibit hall.This is a great way to introduce attendees to your product or service.

Member Book Sales: $25A special booth will be designated for the sale of member books and will be staffed by an association staff member. This is a great opportunity to introduce your book to fellow ACFEI members.Books will need to be shipped to Association Headquarters prior to the conference.

Exhibitor OpportunitiesWednesday, September 22

Registration and Exhibitors..........................................................................................12:00pm–8:00pm

ABCHS Pre-Conference Session..................................................................................3:00pm–5:00pm

Welcome Reception.........................................................................................................5:00pm–7:00pm

Thursday, September 23


Tai Chi..................................................................................................................................7:00am–7:30am




ACFEI/AAIM Working Luncheons (Additional Registration Required)............11:00am–12:30pm

Breakout Sessions...........................................................................................................12:30pm–5:30pm

Annual Banquet.................................................................................................................7:00pm–9:00pm

Friday, September 24


Tai Chi..................................................................................................................................7:00am–7:30am




ABCHS/APA Working Luncheons (Additional Registration Required)............11:00am–12:30pm

Breakout Sessions..........................................................................................................12:30pm–5:30pmSpring 2010 THE FORENSIC EXAMINER® 39(800) 592-1399

www.acfei.com

Typical andAtypical Homicide:Investigative Differences and Cold Case Profiling

his article addresses the difference between typical homicides and atypical homicides. Homicide investigators, even those in large agencies that handle dozens of homicides each year, spend the majority of their careers investigating typical homicides. These include homicides where the per-petrator has a relationship with the victim; the victim is engaged in drug activity; or the victim

is a target, bystander, or participant in another illegal activity. Atypical homicides are those that do not fall into one of these areas; they include serial crimes. This article addresses how the recognition of these two types of homicide, as well as how investigative differences between the two, can assist the cold case profiler and what profilers need for a cold case profiling.

CE ARTICLE: 1.5 CE CREDITS

By Gregory K. Moffatt, PhD, DABPS, LPC; and Nicholas W. Hersey

This article is approved by the following for continuing education credit:(ACFEI) The American College of Forensic Examiners International provides this continuing education credit for Diplomates and certified members.

After studying this article, participants should be better able to do the following:1. Identify the distinction between typical and atypi-cal homicide.2. Identify the different methods of homicide in-vestigation between typical and atypical homicide.3. Identfiy the needs of a profiler for cold case investigation.

KEY WORDS: profiling, atypical homicide, typi-cal homicide, investigation, cold caseTARGET AUDIENCE: InvestigatorsPROGRAM LEVEL: BasicDISCLOSURE: The author has nothing to disclose.PREREQUISITES: None


IntroductionVeteran investigators spend their careers in agencies like Detroit, Baltimore, New Orleans, and other departments that in-vestigate literally hundreds of homicides each year. For example, Detroit had more than 340 homicides in 2008 (Smith, 2008), Baltimore had 234 in 2008 (Unger, 2009), and New Orleans had just over 200 in 2007 (New Orleans Has Highest U.S. City Crime Rate, 2009). These are highly experienced officers in the field. Routine homicides are to po-lice work what diagnosing and treating the flu is to a physician. General practice physicians can diagnose the flu efficiently and quickly, but most physicians rarely see exotic diseases. For atypical diagno-

ses, doctors often refer to a specialist. Homicides are similar. Most of the

homicides these investigators see are the equivalent of the flu. The typical homicide often involves people with a his-tory of violence and when

detectives arrive on the scene, it isn’t un-common for them to know the victim as well as the perpetrator. As an Atlanta homicide detective once told me, “The difference between the dead guy and the perpetrator is that the dead guy was a bad guy who was slower on the draw.” The difference between the homi-cides investigators are accustomed to seeing and the ones that stump them is the difference between typical and atypi-cal homicides. The methods by which homicides are routinely investigated are missing something that cold case profilers need. Many investigators take shortcuts when investigating typical homicides. These shortcuts help expedite the process and can save money and time. To thor-oughly investigate every homicide would be a waste of resources for a seasoned in-vestigator, but shortcuts leave cases lack-ing when they reach the desk of the cold case profiler. Typical and atypical homicide. Most homicides are committed primarily by

one of three types of perpetrators: (1) the victim has a relationship with the perpetra-tor—lovers, spouses, children, neighbors, or coworkers; (2) the victim is engaged in the use, purchase, sale, storage, or distribu-tion of illegal drugs; or (3) the victim is ei-ther an innocent target (i.e. a convenience store clerk) or is engaged in socially mar-ginal activities (i.e. prostitution, gang be-havior). For example, the FBI reports that of 14,000 homicides in 2007, over 6,000 of the murder victims were family members, friends, co-workers, or acquaintances of the killer (Crime in the United States, 2007) and another study reported that between 1976 and 2005, of the 594,276 homicides, over 50% of the victims where killed by someone they knew (U.S. Department of Justice, 2007). These are typical homicides. The cases that faze investigators are those that don’t fit into the investigative model by which they have been trained. Once they run out of suspects and follow all leads to their logical ends, they don’t know what else to do—their training and experience have not prepared them for investigating homi-cides that don’t fit into a typical category. Homicides committed by serial killers, psychotic killers, or perpetrators who do not fit into one of the three major types listed above are considered atypical homicides. These homicides make up a minority of the homicides that are committed, but when investigators approach atypical homicides as they would typical homicides, they run into a dead end. By this point their cases have grown cold and it is difficult or impos-sible to acquire needed evidence—evidence that could have been easily collected from the start. Why cases grow cold. Cases grow cold for several reasons, but the major reasons are:

Inability to identify the victim•Lack of manpower, funding, or moti-•vation to close the casePerpetrators who are known, but in-•sufficient evidence makes conviction unlikelyErrors by investigators•Poorly investigated cases make clos-•ing the case difficult or impossible

These cases will remain inactive until new evidence comes to light; they might never be closed. But cases also grow cold when in-vestigators simply run out of leads. In typi-cal homicides, investigations are more like the movies. There is a finite set of suspects and the perpetrator is likely to be one of

them. Unfortunately, those rules don’t work with atypical homicides. There is an infi-nite number of possible suspects as well as an infinite number of motives. If investiga-tors don’t recognize this difference at the be-ginning of the investigation, they will soon find themselves spinning their wheels. With typical homicides it would be a waste of manpower and effort to pursue extensive interviews with tangential wit-nesses or relatives, establish string trajecto-ries, or perform other time-consuming and expensive processes. The pursuit of the case can be focused much more efficiently on a specific, likely suspect. Most investigators don’t have the luxuries of time, money, or manpower. They are most likely balancing several homicides or other cases simultane-ously. Therefore, shortcuts and heuristics work fairly well and often lead to success-ful convictions. However, when an atypical homicide is investigated in this manner, by the time investigators realize they have been following the wrong trail, the witnesses have vanished and valuable, irreplaceable evidence is gone. Likewise, neighbors have forgotten what they might have seen or heard and their memories are tainted by media coverage. These are the cases that end up in cold case storage and eventually on the desk of the cold case profiler. The 48-hour rule. For years there has been a popular belief that the first 48 hours following the discovery of a homicide are critical. It was said that if a homicide wasn’t solved within 48 hours, the chances of solv-ing it diminish quickly (Walton, 2006, p. 21). While it is true that witnesses disap-pear and memories distort and fade as time goes on, I don’t believe the rule. For one thing, most homicides are not solved within 48 hours. However, I know how this myth evolved. In typical homicides, the direction the homicide needs to proceed is often clear. Sometimes the perpetrator is even still on the scene. In other cases, there is so much available evidence that the direction the investigator needs to pursue is clear. For example, in one homicide a man was mur-dered by his ex-wife and her accomplices. The victim had actually recorded his own murder. The estranged couple was in the midst of a custody dispute involving their five-year-old daughter. The man’s lawyer had advised him to secretly tape his con-versations with his ex-wife. One day when he went to pick up his daughter, his ex-wife was waiting with three cohorts who brutally killed him in her living room with

a baseball bat—in front of their daughter. All of it was recorded and the perpetrators could clearly be heard on the tape using each other’s names. Months later when his body was found in the trunk of his car, the audiotape was discovered and all four of the killers went to jail. This audiotape also demonstrated their ineptitude. It took them over an hour to actually kill the man and they could be heard arguing with each other as to why he wasn’t dead yet. Most killers aren’t very good at murder. They make stupid mistakes that leave a trail of bread crumbs to their homes, offices, or hiding places, as the au-diotape in this homicide demonstrated. In another homicide, for example, the perpe-trator shot himself while trying to kill the victim. A trail of blood led out of the house and ended where he had parked his vehicle. He was discovered within hours at a local emergency room and arrested. Blood was found in his car and his DNA matched the blood on the scene. He was eventually con-victed. In homicides like this, the case may not literally be wrapped up in 48 hours, but it may be clear who the perpetrator is within that period. Another problem with the 48-hour rule is that it is simply a statistic that gives the wrong impression. By far, typical homicide investigations are usually moving within 48 hours; atypical ones are not. Statistically, more typical homicide cases are solved than atypical cases. Therefore, it appears that the issue is time when in fact the issue is the type of homicide. Likewise, shortcuts in investigations like the cases mentioned helped quickly send these perpetrators to prison. Mistakes that might have been made in processing the crime scene didn’t mat-ter because the evidence against them was overwhelming. However, when atypical ho-micides are investigated poorly, by the time the investigator realizes his or her error, it is too late to fix it. This leads to the impres-sion that the issue was the first 48 hours of the investigation when in fact the problem was the method of the investigation.

Cold Case ProfilingNearly every department of any size has cold cases. These are robberies, rapes, mur-ders, and other cases that haven’t had any movement in months or years and/or for which investigators have exhausted all their options. They don’t know what else to do, and cases that are easier to solve take prior-ity. Even though some large agencies have


squads that specialize in cold cases, small departments stow their cold cases and once they go cold, most never see the light of day again. Sometimes a new chief will direct detectives to drag out cold cases and see if any new developments exist, but other-wise it isn’t in the detective’s best interest to pursue them. Detectives prove their value by closing cases. Time spent on lost causes may make the victims’ families feel better, but it doesn’t help the detective’s career and, honestly, most of us probably would prefer that they spend their time on cases they can close. If they invested all of their time and resources on long shots they would be ne-glecting those cases they could close. Cold-case profilers get cases that every-one in the department has already tried to solve. These cases have often gone through the hands of a half-dozen different inves-tigators over the years. During that time, material gets lost or important information gets overlooked. For example, I was doing a profile on a cold case involving several ho-micides that appeared to be the work of a serial killer. In the process of studying the file I found out we had DNA on the perpe-trator in one of the homicides and nobody, including the DA and the lead detective, knew about it. Material gets lost because not everything fits nicely into a single box, such as carpet samples, axes, baseball bats, and other irregular objects. These pieces of evidence may literally be placed in a corner somewhere. The investigator knows where they are, but when he or she leaves, is trans-ferred, or the case is reassigned, sometimes those items get misplaced. Even when all the information is there, sometimes it is in-adequate. It is nearly impossible to profile a crime 10 years after the fact with only a handful of crime scene photos and poorly written reports.

What Profilers Need For Cold Cases To profile a cold case, one needs at least cursory skills in several areas of investiga-tion—blood spatter patterns, basic detective work, anatomy, ballistics, psychology, soci-ology, and even culture. These are the tools that help piece the chain of events togeth-er. Each piece of data I have is like a piece of a jigsaw puzzle; the more pieces I have, the better I am at constructing a coherent story. Like a puzzle, each piece of evidence not only has to make sense, but it also has to fit with the other pieces of evidence. A well-prepared case file provides the profiler

with the data needed to do the job. A good investigation for a cold-case profiler is thor-ough. It should include photographs, dia-grams, measurements, reports, interviews, and all other information from the medi-cal examiner. When I work a cold case, I want everything available. While many of the following sections are important for both typical and atypical homicides, they are critical for profiling atypical homicides and cold cases. On the scene. Nothing in the crime scene should be moved before the crime scene has been thoroughly photographed and measured. I want to know what was on the ground around the victim. Little things might mean nothing, but I won’t know that until I recreate the scene. I want to know the time of day the victim died, the weath-er conditions the day of and the day before the homicide, and how long the victim lay in place before being found. If emergency responders moved the body, don’t try to move the body back to where you think it was. The case record should note anything that was moved or altered. My rule is MLR —Move it, Leave it, Report it. It is important to also include in the case file a list of everyone working the scene, such as EMTs, law enforcement, firefight-ers, and other relevant personnel (Geberth, 1997, p. 6). I might have to find them if I need help sometime down the road. In his homicide investigator’s field guide, Geberth also recommends secretly photographing and/or videotaping bystanders at the scene (1997, p. 19). In atypical homicides, perpe-trators are known to stand by and watch the chaos they have caused. Identify as many bystanders as possible and include their names and information in the case file. Digital and photographic record. The first thing I look at when I profile a cold case is the photographs of the crime scene including the body and surrounding area. If the crime scene is inside, photographs of every room as well as a floor plan are need-ed. The photos need to show the room(s) from every angle as well as include close-up shots of windows and doors. I want to be able to see if there is dust on the windowsill or scrapes on the door casing. If the crime scene is outside, I need photographs com-ing to and from the scene and views away from the body. I want to know what the victim would have seen. Close-ups of footprints and impressions are imperative. Castings get lost and I of-ten have to make my best judgment from

a photograph. I want close-ups of blood, weapons, clothing, wounds, broken fur-niture, shell casings, or anything else that might be related to the crime but hard to see in wide-angle photographs. Evidence can get lost from evidence lockers and if it does, I want to at least have pictures of it. Photograph the outside of the structure from every angle as well as the surround-ing neighborhood. Again, I may get the case 10 or 15 years after it happens. Trees grow taller, new houses are built, sidewalks are added, and streets are widened. Even if I visit the crime scene it may not look as it did when the homicide occurred. I need the crime scene photographs to help me see how it appeared. Seeing the street and the neighborhood is an important part of my profile. Photographs should be taken before any crime scene processing begins. It doesn’t help me create a profile if a body has evi-dence bags over its hands. Bagging the hands is an important part of standard procedure, but the scene needs to be pho-tographed before the hands are bagged. It is also a problem if evidence bags, investi-gators, or other unrelated things are in the crime scene photos. One homicide I pro-filed showed a table full of evidence bags the responding agency had collected—sev-eral pieces of key evidence had been moved. Ten years later, how am I supposed to dis-tinguish between items the perpetrator moved or left and items that were moved by investigators? Not everything at a crime scene mat-ters, but everything might matter. In an earlier age when crime scene photographs were shot with 35mm film, developed, and blown up into 8x10s, it was expen-sive to take photographs you didn’t need. However, with digital photography, tak-ing 100 or more photographs of a crime scene costs next to nothing. With digital imaging, a homicide case file should easily have 100 photographs. Storing 10 photos costs exactly the same as storing 100 photo-graphs. You have to walk the scene anyway. It doesn’t take much more time to shoot, shoot, shoot. Geberth suggests taking “two full-body shots” (1997, p. 20) and in their death in-vestigation guide, The U.S. Department of Justice suggests taking multiple shots “if pos-sible.” (1999). Why wouldn’t it be possible? I want a dozen shots of the body. Duplicates cost nothing so I’ll ignore the ones I don’t need. The photographer should shoot pic-


tures of everything on the way in and every-thing on the way out. These photographs should be copied onto a CD or DVD and labeled. In that form, they will last forever and even if I get the case 20 years later, the photographs will look like they were taken yesterday. Videotape the crime scene when pos-sible. Having video available in my homi-cides been exceedingly helpful to me as I created my profiles. As digital technology improves, it is easier and cheaper to take video of a scene and it is also easier and cheaper to store that video. What you can-not photograph or video, describe in detail in the case file. Anything that isn’t obvious in the photographs or video should also be explained in the case file. I want to hear au-diotapes of anything that might have been taped and if the case has been profiled on TV shows, I look at those, too. Include a printed record of all digital and cyber com-munications of the victim. This includes Twitter, Facebook, answering machines, text messages, voice mail, and e-mail. When a homicide is suspected to be atyp-ical, investigate it like you know it will be 10 years before someone sees the material. Ten years later when I have to put it all to-gether for my profile, digital records are one of my best tools. Diagrams. I need diagrams of the crime scene including distances and location of shell casings and juxtaposition of the body. While this is also a part of typical homicide investigation, many details that are impor-tant to me as a profiler are often left out of diagrams. One homicide I profiled con-tained more than 50 excellent photographs including great close-up shots of the shell casings. However, in no place in the pho-tographs or the reports was there any indi-cation as to where the casings were found. The murder was in a wooded area and small objects like shell casings were invisible un-less photographed up close. The location of these casings was an exceedingly important piece of information when I tried to deter-mine handedness of the perpetrator. This is something I was unable to do because of this one missing detail. Include general distances to neighbor-ing structures, public areas (i.e. shopping centers or parks), or traffic areas (inter-states or busy highways). Online resources like Google Earth are also useful. I often use such tools when I profile a case in or-der to obtain an aerial view of the mur-der’s location. With an aerial view, I can

see the accessibility of the neighborhood. What might look like a remote area from the ground might actually abut an apart-ment complex, shopping center, or indus-trial area. Someone with knowledge of the location could easily walk a path through the woods. Aerial photographs make that kind of option obvious to me. Likewise, neighborhoods change; buildings disappear. An entire subdivision, shopping center, or school complex might have been construct-ed in the time between the crime and when I get the case. I need to know that the area around the crime was distressed, wooded, or developed. If the case notes don’t tell me that, all I have to go on is what I see when I walk the neighborhood. A concrete visual of how the area looked at the time of the crime is very helpful. When a case is deter-mined to be atypical, include something like a Google Earth aerial view in the case record. Reports and interviews. As discussed earlier, with typical homicides, incom-plete interviews and poorly written reports are not always critical in closing the case. For profiling atypical homicides, incom-plete interviews are a major problem. Many times I’ve discovered notes in cold case files about witnesses who claimed to have seen or heard something, but no follow-up was ever made. Likewise, I have regularly found suspects who fell through the cracks and even though their names and information existed in the case file, investigators never knew of them or failed to follow through with the leads. I suspect this happens most often when atypical homicides are investi-gated as typical homicides. The investiga-tor thinks he knows who committed the crime and in his eagerness to close the case, he doesn’t want to be distracted by leads he sees as red herrings. By the time the case grows cold, it may have been passed on to other investigators and incomplete inter-views get overlooked—an easy mistake to make in a case file that may contain 1,000 pages. I want to see every scrap of paper that goes with the case—I read everything. This includes every note written on a nap-kin or post-it note. I never know when something was overlooked as the case passed from one hand to the next. This is how I found the DNA link in the homi-cide mentioned earlier. Reading police reports, interview tran-scriptions, and the like helps me not only to profile the perpetrator, but also to get an

accurate picture of the victim. My profiles all include a profile of the victim as well as the perpetrator. I need as much information as is available on the victim—their friends, lovers, former lovers, work habits, hobbies, hopes, and dreams. Knowing something about the victim helps me form an idea of what the person was like and who could have had access to him or her, how he or she would have responded to various situa-tions, and so forth. The more thorough the case record with regard to the victim, the better it is for a profiler. I can’t easily acquire this information 20 years later. In typical homicides it is not necessary to invest any energy in creating a profile of the victim, but in atypical homicides it is critical. Ballistics and trajectories. Profilers need any information available on ballistics and trajectories in cold cases. I use this infor-mation to determine the order in which any shots or other injuries occurred. This helps me figure out exactly what happened, who was standing where; it sometimes helps me reconstruct the murder. I need to know how every drop of blood fell where it did and how the victim’s body acquired every wound. I develop this information from the crime scene reports, photographs, and from the medical examiner’s reports. String trajectories are very helpful, but very time consuming. String trajectories are not often necessary in typical homicides, but they can be very helpful to me as a cold case profiler of atypical homicides. Type of weapon. Women almost never kill with ligatures. Men use knives, their bare hands, guns, ligatures, and blunt ob-jects. Sometimes they bring their weapon with them and sometimes they use a weap-on found at the scene. Sometimes they take their weapon when they leave and some-times they don’t. The selection of weapon tells me something about the person and what he or she was thinking. I need this information in a report. In typical homi-cides, something obvious like “weapon was acquired at the scene” might easily be omitted from a report. Everyone knows the perpetrator will be arrested before the day is over and that detail won’t be forgotten. However, in atypical homicides, that detail will be very important to me as a cold case profiler, but I won’t have the luxury of ex-ploring the original investigator’s memory. All information regarding weapons needs to be in the report. Medical Examiner’s report. When I pro-file a cold case, I look very carefully at each


of the victim’s wounds. Therefore, I need all of the autopsy photographs. ME reports are fairly uniform and for most cases I’ve worked, the reports have been thorough, but these reports often omit information that would be helpful. I need to know what injuries would be fatal by themselves and which injuries would not. I need to know if an injury would have incapacitated the victim, but not killed him or her. It would also be helpful to know how long the vic-tim would have lived from the onset of the attack. Medical examiners are reluctant to speculate in formal reports about these things and they rarely note the order of in-jury. Even when they think they know they don’t put it in a report because they have to defend their statements in court. Therefore, informal conversations with the ME about such things could help me later as a cold case profiler. These conversations and any speculations need to be in the case file. I want to know if the victim was sexually assaulted and I definitely want to know if sperm and/or seminal fluid are present. A sexual assault with no ejaculation is different than one where the perpetrator ejaculates into the victim’s vagina, anus, or mouth. It is very common in a sexual assault/homi-cide for the victim to be penetrated, but no seminal fluid to be found inside the body. For this reason I need to know if there is evidence of penetration even when seminal fluid is absent. Also, in atypical homicides, perpetrators may masturbate on the victim’s clothing, on the ground, or on the victim’s body after the murder. Any such evidence needs to be in the case notes.

CODIS and ViCAPCODIS is the Combined DNA Database Index System. It is basically a large national DNA database. Any criminal from approxi-mately 1985 and onward who was arrested for certain crimes (i.e. rape, murder) or who was convicted and sentenced to prison (al-most any crime) is in the database. Even if a case is 50 years old, if there is blood or other viable DNA material available, it can be scanned today and run through CODIS. A CODIS hit results in an almost certain conviction. The Atlanta Cold Case Squad has a 100% conviction rate and many of those cases hinge on CODIS hits. If a per-petrator gets arrested and convicted of al-most any crime (forgery, prostitution, or minor possession of a controlled substance), once he goes to prison he is swabbed and his DNA goes into the CODIS database.

It was through CODIS that investigators were able to finally catch Gary Ridgway, also known as the Green River Killer. This was once thought to be a crime that would never be solved and that the 48 homicide cases attributed to him would never be closed. After running samples through CODIS, Ridgway was arrested and charged for the Green River murders. He has since been convicted. Buccal swabs of every possible suspect are imperative. Technologies that don’t ex-ist today may be available by the time your case becomes a cold case. In fact, in 1987 Ridgway had been a suspect in the Green River Killings, but there was insufficient evidence to convict him. Fifteen years later, improved DNA testing methods led to his arrest and conviction. The Violent Crime Apprehension Program (ViCAP) is also a powerful tool available to Cold Case Squads. Serial of-fenders (rapists, sexual killers, arsonists, etc.) can increase their probability of es-caping detection simply by staying on the move. A single homicide or rape in one ju-risdiction is far more difficult to identify as a serial crime (although it is by no means impossible) than several crimes with a simi-lar signature. When agencies do not com-municate, as they often do not, a serial killer could commit a homicide in one city and then move 60 miles away and do the same thing again using the same M.O. and sig-nature. Without communication between agencies, it would be next to impossible to connect the crimes. ViCAP provides that needed communication. Completing the ViCAP Crime Analysis Report is tedious and time consuming, but it is invaluable. While it may not help a given agency solve the majority of its ho-micides or rapes, the most prolific offenders run the highest risk of being caught when their crimes are in the ViCAP database. Nearly everything that I want to know for a profile is contained in the 90-plus questions on the ViCAP Report. Atypical homicides should always be submitted to ViCAP and that report should be in the case record. Other databases such as the Integrated Automated Fingerprint Identification System (IAFIS), the National Integrated Ballistics Information Network (NIBIN), and RUVIS can also be helpful.

Collecting The Cold Case RecordThe homicide record should include all of the previous in a single file if possible, and

it should use dividers and folder tabs for organization. Separate witness statements from initial crime scene reports. Section tabs are also needed for M.E. reports, pho-tographs, investigative leads, suspects in-terviewed, and CODIS reports. Include a section for ongoing leads and new infor-mation. Keep everything. For evidence items that are too large to put in a file, ei-ther include a description of the item or a photograph. If a case goes cold, put ev-erything in a digital format and put it on a CD/DVD. This is an inexpensive and easy way to keep track of cases. It helps me a great deal when I can pick up an en-tire cold case and put it in my coat pocket as opposed to carrying boxes of paper and photographs out of the office.

Summary One case I profiled included a single file folder with only about 40 pages. In the file were five or six 5x7 photographs, the M.E. report, and the attending officer’s hand-written report. The photographs were in horrible condition, out of focus, and not one close-up existed in the entire file. There was a photograph of a substantial amount of blood in a bathroom on the wall and sink. But from no place in the report could I determine where the bathroom was in relationship to the body or whose blood it was. It almost certainly was the perpe-trator’s. However, if the perpetrator were injured and bleeding as profusely as it ap-peared from the bathroom scene, he or she almost certainly would have bled on the floor, carpet, and walls. Yet no such photo-graphs existed and no mention was made of any such blood trail. The case file was use-less to me in my profile. The M.E. report was complete, but the dates and times in it didn’t match the dates and time on the of-ficer’s reports. Some of the information in this case had been lost over time and con-sequently there was very little I could do. In my profile I noted that it was unlikely the case would ever be solved with so much crucial information missing from the file; much of my profile was mere speculation. I wasn’t any help because I wasn’t given any-thing to work with. Investigators should determine if the ho-micide is typical or atypical at the scene. The beginning of recognizing the possibility of an atypical homicide is asking the ques-tions, “Are there obvious suspects or not?” “Does the staging of the scene indicate the potential for a serial crime?” and “Is there


anything about the type of weapon, loca-tion, time of day, access, or potential con-nection to similar crimes that make it pos-sible that the homicide is atypical?” If so, process the case as if it is atypical.

ConclusionProfiling a cold case is difficult work, but it can be made easier if the case file is com-plete and if it has been thoroughly investi-gated. Early profilers often said they could tell everything they needed to know from the crime scene photographs. I disagree with this. That is like trying to talk with someone via video phone with the sound off, trying to guess what they are saying in-stead of simply turning the sound up and listening. I see no reason to speculate when there is other information to confirm or re-fute one’s hypotheses. A complete case file helps create a complete picture for the cold case profiler. Investigators can sometimes get away with sloppy or incomplete work on typi-cal homicides. Convictions are sometimes handed to you on a silver platter. For ex-ample, one of my first homicides involved a man who walked into a trucking com-pany and shot his former boss and three other people as frightened employees fled the building and frantically dialed 911 for help. When the police arrived, the perpe-trator was sitting on the curb outside the building waiting to be arrested. After being Mirandized, he readily confessed to the ar-resting officers and later talked to investi-gators for several hours without an attor-ney. Needless to say, this perpetrator went to prison. But atypical homicides never are this easy to close. This article has provided suggestions re-garding the differences between typical and atypical homicide and what profilers need to better work a cold case. When possible, investigators should investigate every crime scene so someone could recreate the case a decade after their retirement. However, the use of heuristics and shortcuts can be an ef-fective approach with typical homicides, es-pecially when both manpower and budget are limited. Regardless, thorough investiga-tion in atypical cases is crucial.

ReferencesCrime In The United States, (2007). U.S. Depart-

ment of Justice. Federal Bureau of Investigation, Criminal Justice Information Services Division. Retrieved September 3, 2009, from: http://www.fbi.gov/ucr/cius2007/offenses/expanded_informa-tion/data/shrtable_09.html.

Geberth, V.J., (1997). Practical homicide investigation checklist and field Guide. New York: CRC Press, p. 6.

New Orleans Has Highest U.S. City Crime Rate: Report, (2008). Reuters. Retrieved September 5, 2009 from: http://www.reuters.com/article/domesticNews/idUSTRE4AN7LF20081124.

Schmitt, B. (2008). Detroit police say homicides dropped in 2008, Detroit Free Press. Retrieved September 5, 2009 from: http://www.usatoday.com/news/nation/2008-12-31-detroit-homicides_N.htm.

Unger, M. (2009). Baltimore’s homicide rate: positive trend or continuing tragedy? About.com, Retrieved September 5, 2009 from: http://baltimore.about.com/od/government/p/Homicide.htm.

U.S. Department of Justice: Office of Justice Programs, National Institute of Justice (1999). Death Inves-

tigation: A Guide for the Scene Investigator. Re-trieved September 5, 2009, from: http://www.ncjrs.org/pdffiles/167568.pdf.

U.S. Department of Justice (2007). U.S. Department of Justice, Office of Justice Programs, Bureau of Jus-tice Statistics - www.ojp.usdoj.gove/bjs/ Retrieved September 3, 2009, from: http://www.ojp.gov/bjs/homicide/relationship.htm.

Walton, R. (2006). Cold case homicides: Practical investi-gative techniques. New York: CRC Press, p. 21.n

ABOUT THE AUTHOR

Gregory K. Moffatt, PhD, is a college professor, author of numerous books and articles on violent behavior, newspaper columnist, and pub-lic speaker. He has been a licensed counselor for more than 20 years, specializing in children, abuse, and neglect. He is also nationally board certified in child sexual abuse. Dr. Moffatt has served as a regular lec-turer at the FBI Academy, a profiler with the Atlanta Cold Case Squad, and a consultant to numerous airlines, businesses, and schools. He has appeared on ABC, NBC, CBS, and FOX news, as well as America’s Most Wanted, and he has lectured in countries on four continents.

Nicholas W. Hersey, a dedicated husband and father, has devoted his greatest effort to discovering ways to better the lives of children. His passion is to give children who have endured traumatizing experiences a sense of healing by equipping them with tools they can utilize in their days to come. Over the past several years, Mr. Hersey has focused his research and experience working within various refugee populations to find common themes amongst children that are universally applicable.

Earn CE CreditTo earn CE credit, complete the exam for this article on page 61 or complete the exam on-line at www.acfei.com (select “Online CE”).


CE ARTICLE: 2 CE CREDITS

AbstractSearching for and detection of improvised explosive devices (IEDs) and similar haz-ards has become increasingly important in law enforcement and military applica-tions. Training for IED detection can be significantly enhanced through the use of cognitively based training to augment field training methods. The present research ad-dressed cognitive issues in IED detection and training. Five major types of errors in search and detection were identified and characterized. A cognitively based train-ing program was developed and provided

to eliminate these errors. Two experiments were conducted. The results demonstrated that this training, termed the “SMOKE” system (after the acronym for the five er-ror types—errors of Search, Movement, Observation, failures to Keep Searching, and errors of Evaluation), significantly im-proved IED search and detection. Trainees were substantially more successful in detect-ing a spectrum of mock hazardous devic-es, were faster at detecting less well hidden hazards, and were less prone to specific er-ror types than were respondents in control comparison groups. These findings demon-

strated the utility of cognitively based IED search training, to be conducted in tandem with comprehensive field training methods for the development of effective IED search and detection skills.

IntroductionThe detection and neutralization of im-provised explosive devices (IEDs) has be-come increasingly important to American and allied forces in the Persian Gulf and Afghanistan conflicts. IEDs have similarly become more important to domestic law enforcement at all levels and are expected


Finding IEDs Before They Find You:

By Matthew J. Sharps, PhD, DABPS, FACFEI; Elaine Newborg, BA; Mallory Glasere, BA; Bill Hayward, BA; and Michael Scholl, Master Instructor

The SMOKE System of Training for Hazardous Device Detection

to have ongoing and increased importance in the future (e.g., Cameron, 2008). This is certainly the case for police and sher-iff ’s departments. Others involved in such work include the Transportation Security Administration, the U.S. Coast Guard, and additional agencies concerned with Homeland Security. Such search and detec-tion activities may also ultimately involve civilians, such as security guards or volun-teers in police auxiliary programs. It is critically important to improve cur-rent training methods for IED search and detection. Presently, such methods may in-volve training in the recognition of various

(800) 592-1399

This article is approved by the following for continuing education credit:(ACFEI) The American College of Forensic Examiners International provides this continuing education credit for Diplomates and certified members.

After studying this article, participants should be better able to do the following:1. Demonstrate understanding of the issues involved in IED identification and of the difficulties involved in successful IED search and detection.2. Demonstrate understanding of the importance of front-loaded, explicit, feature-intensive, cognitively based train-ing as a foundation for successful IED search and detection.3. Understand that in controlled experiments, the ability of the respondents to detect IEDs was significantly and substantially enhanced by such training.4. Disucss the five types of errors typical of less successful IED search and detection.5. Understand the importance of further research into the the cognitive and individual-differences bases of success in IED search and detection.

KEY WORDS: Improvised Explosive Device Detection, Explosive Ordinance Disposal, SMOKE System, Law Enforcement Training, Military TrainingTARGET AUDIENCE: Commanders, Law Enforcement and Military Trainers, Security Personnel, EOD Personnel, InvestigatorsPROGRAM LEVEL: BasicDISCLOSURE: The authors have nothing to disclose.PREREQUISITES: None

types of explosive devices, and field evo-lutions in which trainees are exposed to practice environments containing mock IEDs. These types of training are laudable and important in the development of haz-ard detection skills. However, they gener-ally lack important cognitive components. Specifically, these are prior frameworks for search methods; explicit connections be-tween the skills employed and their ratio-nales; and the use of specific, feature-inten-sive training to form smooth coordinated search methods in the field (Sharps, 2010; also see Bransford and Johnson 1972, 1973; Haviland & Clark, 1974). Recent research in our laboratory is con-cerned with eyewitness memory for weap-ons, vehicles, people, and crime-scene fea-tures and has demonstrated a number of principles important for visual search in relevant environments (e.g., Sharps, Barber, Stahl, & Villegas, 2003; Villegas, Sharps, Satterthwaite, & Chisholm, 2005; Sharps, Hess, Casner, Ranes, & Jones, 2007; Sharps & Hess, 2008; Sharps, Janigian, Hess, & Hayward, 2009). In these studies, many respondents looked directly at an explicit source of hazard, such as a hand grenade, or at an implicit (potential) source of hazard, such as a military ammunition box situat-ed among street clutter—without noticing the hazard (Hess & Sharps, 2006, April; Sharps et al, 2007). These considerations informed the development of the present research, which was concerned specifically with the improvement of IED search and detection in realistic contexts. The present article reports the development of a cognitively based training program for IED detection, to be used in tandem with current field-based methods. This program presents specific techniques for the provision of the front-loaded, explicit, feature-intensive skills essential for successful IED search and detection (the term “front-loaded” is fre-quently applied in law enforcement to specific training which is provided prior to training exercises, or to field experience, as opposed to training which is acquired during the process of training exercises themselves). Additionally, this research enabled us to explore and iden-tify the major types of errors typically made in IED search activities and to provide spe-cific training to defeat these errors.

Initial ConsiderationsA successful IED search requires specific perceptual and cognitive activities that do not come to one naturally. There is a ten-

dency to focus on the core of any given situation, rather than on peripheral con-siderations; this tendency reaches its height in the “tunnel vision” (e.g., Grossman & Christensen, 2004) characteristic of the stressful or violent environments which may contain IEDs. At its most intense, this “core” focus of attention may be an armed assailant, who may be operating in an IED-rich environment. Any such assail-ant must, of course, be the center of focus for responding law enforcement officers. The immediate threat must typically be eliminated first. However, if that assailant has prepared his or her position with explo-sive devices on the periphery of the action, the IEDs may go unobserved, as occurred in our previous empirical work (Hess & Sharps, 2006, April; Sharps et al., 2007). The potential consequences of this phe-nomenon in the field are obvious. This effect may readily be observed in training situations, as well as in the labora-tory. In realistic field training evolutions, it is not uncommon to observe even seasoned officers so focused on a potential assailant, or on a developing violent situation, that they completely ignore mock IEDs. This will frequently be observed even when those IEDs are placed in plain sight. The core of a given environment may not be something as drastically attention-grabbing as an armed assailant or a firefight. The core for a person hustling through an airport may be internal, such as the indi-vidual’s thoughts about making the flight on schedule, or external yet irrelevant, such as the recalcitrant luggage with which the person is coping at the time. The core for any of us on the street may be another per-son with whom we are speaking, or a vi-sually compelling but innocuous display such as a flashy advertisement or a group of people behaving atypically on the sidewalk. Anything which grabs our attention—and our central perceptual and processing capacities—may be the core that distracts us from the peripheral search necessary for successful hazard detection. Additionally, IEDs may be disguised, or they may be placed or constructed in such a way that they present an innocuous or ambiguous visual picture to the observer. In other words, an IED may present itself in such a way that the major clue to its ex-istence is its inappropriateness to the lo-cal environment. This may be true of the length of pipe that should not be where it is, the metal container which becomes in-

visible among other clutter but is definitely out of place, or of a host of other disguises for hidden sources of hazard. This prob-lem assumes special significance when a disguised or innocuous object is placed on the periphery of a given action. Even when such an object is directly observed, it may be completely misinterpreted. Such errors of observation, even regard-ing important objects such as identifiable weapons, can be quite outlandish. In a re-cent study (Sharps & Hess, 2008; also see Force Science News, 2009), we provided civilian respondents with a street scene depicting a potentially violent situation, in which a man or woman was seen aim-ing a handgun at a female “victim.” This situation, according to the police experts we consulted, absolutely required a shoot-ing response on the part of any officer en-countering it in the field. Our civilian re-spondents agreed—88% indicated that they would fire on the assailant. However, in another condition, we armed our “as-sailant” with a harmless power screwdriver which he might simply have been holding or with which he might have been gestur-ing in a non-violent argument with the “victim.” Eighty-five percent of our respon-dents indicated their decision to kill him, too; the difference was not significant. In other words, our respondents could not tell a power tool from a Beretta. They fired on people holding either object indiscrimi-nately, based on expectation. Incidentally, although our respondents proved equally likely to kill the criminal perpetrator and the unarmed workman, only 11% thought a law enforcement officer was justified in doing so to either individual under any circumstances. This finding may prove to be of substantial importance in the trial of officer-involved shootings before juries. In short, people frequently mistake an object for something else based on their expectations of what should be there. Such errors occur even with a clearly identifiable object in the hands of a core assailant; and such errors of observation will assume le-thal significance if that object is an IED. When an IED is actually located, it may, unsurprisingly, form the core to which our attention is directed. Once we find a po-tentially lethal device, we tend to focus our attention on it and we stop searching. This makes perfect sense; unless, of course, there is more than one IED in the environ-ment. It is critically important to continue searching until all potential hazards have


been identified, with obvious attention to neutralizing the hazard already observed. It’s crucially important to keep searching. Finally, when an individual observes an object that may be an IED, it is important to evaluate it properly. The errors which may be produced in evaluation take two forms. Either the object may be dismissed as innocuous, or it may be incorrectly iden-tified as an IED. This type of error is there-fore not as simple as those previously con-sidered. Although the identification of an innocuous object as an IED may be expen-sive in terms of police resources, the identi-fication of the IED as an innocuous ob-ject is likely to kill people. Therefore, it is important that training evolutions in this area do not reduce the tendency of trainees to identify plausible objects as IEDs. To de-cide that every given object which happens to be in the wrong place at the wrong time is an IED is nonsensical. However, to de-cide that a given ambiguous object might be an explosive device, especially when it is observed in a potentially IED-rich envi-ronment, may be the key to survival. In view of all of these initial consider-ations, we developed an experimental train-ing program to address each of the major factors discussed. The focus of this pro-gram was to provide front-loaded, explic-it, feature-intensive training which would improve the probability and effectiveness of IED search and detection in a realistic field environment.

Experiment 1The intent of Experiment 1 was to pro-vide and evaluate training with the follow-ing goals:

To expand searches to the periphery of 1. a given scene. To enable trainees to make better ob-2. servations of a variety of IED types, of different levels of visual salience, in dif-ferent central and peripheral locations. To enable trainees to evaluate the pros-3. pect that an object might be an IED based on the relative probability of that type of object’s presence in the given scene.

This training was to be front-loaded and explicit. It was intended to form a prior framework for understanding. Finally, it was to be based in feature-intensive un-

derstanding of both the training protocol and of the types of scenes to which it was to be applied. This first experiment was a preliminary pilot study designed to determine the de-gree to which this type of training might result in better IED search and detection. The techniques employed for both training and assessment were based on consultation with law enforcement experts and on ob-servation of police and SWAT training.

MethodParticipants. Twenty-four college-aged par-ticipants (reported age mean 25.5 years, SD 4.47 years) were recruited for course credit from University psychology classes. Twenty-one women and three men partici-pated, reflecting the makeup of the classes. Twelve respondents participated in a train-ing group and the other twelve in a con-trol group that received no training. These participants were of similar age to law en-forcement cadets; additional research is

needed to ascertain the degree to which the observed effects generalize to older or more experienced populations.

Materials. A PowerPoint presentation was prepared, composed of thirty-two slides (the total number of slides was actually fifty-six, including blank grey slides used to separate the slides with training con-tent). Each content slide depicted a po-tentially violent street situation that took place in a gravel driveway with garbage cans and street clutter. In each scene, a male or female assailant aimed a handgun at a female victim. This type of scene has been extensively used in our earlier work on memory, cognition, and eyewitness identification (e.g., Sharps, Hess, Casner, Ranes, & Jones, 2007; Sharps & Hess, 2008; Sharps, Janigian, Hess, & Hayward, 2009; also see Sharps, 2010). In the pres-ent study, however, the scenes were aug-mented by the presence of mock IEDs. The scenes varied in terms of the size and


Sgt. Ralph Scott, of Rochester, New

York, from the 4th Brigade of the

10th Mountain Division, based in

Fort Polk, Louisiana, uses a metal

detector to probe for hidden IED’s

(improvised explosive devices) near

Malek Din in Ghazni province of

Afghanistan, September 2006. Five

years after being overthrown, the

Taliban are back in force, plunging

Afghanistan into its worst violence

and political turmoil since the open-

ing shots of President Bush’s war on

terror. (Tom Pennington/Fort Worth

Star-Telegram/MCT)

color of the IEDs (and hence, the visual salience of the given devices); the place-ment of those IEDs at different periph-eral and central locations; and the degree to which a potential IED was disguised or not (e.g., an unadorned grenade versus a new backpack which, while placed in an odd location, did not give other visual evi-dence of being an IED). Finally, three of the scenes incorporated multiple IEDs to demonstrate the need to keep searching in a given environment even after an initial IED is detected and identified. The types of IEDs employed included a grenade, a single-pipe bomb, a gasoline can rigged with a mock detonator, military ammo cans, a battered briefcase, and a new backpack. Both male and female “assailants” were employed because subjects in previous experiments on eyewitness identification (e.g., Sharps et al., 2007, 2009) have evinced surprise at seeing a female assailant. During the initial phases of this study, a law enforcement expert suggested that the use of an armed assailant in the training materials might prove problematic for law enforcement trainees. Their training hones their responsiveness to a given armed perpe-trator, and this trained allocation of core at-tentional assets to the assailant might reduce the ability of law enforcement personnel to benefit from training in the peripheral ob-

servation skills needed for successful IED search and detection. A contrasting view was suggested by a reviewer of an earlier version of this article, who proposed that although an armed assailant would divert attention from a given response to an IED, the combined threat would place a priority on faster response; thus, according to this hypothesis, the benefit of the SMOKE sys-tem should operate similarly across armed and unarmed assailant conditions. Further experiments are needed to ad-dress these specific issues. However, al-though the experiments reported here were concerned with civilian trainees rather than with law enforcement personnel, the pros-pect of distracting weapon focus was noted (e.g., Steblay, 1992) even for this popula-tion, so an additional set of slides was cre-ated for increased relatability to law enforce-ment training. In these slides, the assailant stood in a threatening posture but was un-armed. Otherwise, these “unarmed” materi-als were identical to the materials in which the assailant was armed.

Procedures. The materials were presented to members of the training group along with an accompanying script read by a male ex-perimenter. This script first introduced the importance of IED issues. Then, as each slide was presented, the lesson of that par-

ticular slide was explicitly discussed. These lessons included the following:

The fact that IEDs may be obvious 1. or difficult to see, either because they are hidden or because they form good contours with their immediate envi-ronment.The need to search peripheral as well as 2. central locations in any given scene.The need to conduct and continue 3. such search even if surprised by a fac-tor such as a female assailant.The need to continue search even after 4. a given IED is discovered.

Again, this initial series of slides was created as preliminary pilot effort rather than as a finished product. The goal of Experiment 1 was to gauge the degree to which front-loaded, explicit, feature-intensive instruc-tion of this type would enhance respon-dents abilities to search for and detect IEDs. The control group, in contrast, was given only the initial information on the impor-tance of IED issues. To evaluate the results of this training, a field search situation was created in a mod-erately cluttered, 8x12-foot laboratory room. This room contained a large rolling tool chest; several computers and a printer; some electronic instrumentation; and a scatter-ing of books, papers, and notebooks across


s Iraqi Police discovered this improvised explosive device Nov. 7 (2005) in eastern Baghdad and disarmed it before it could be detonated in a terrorist attack. Army photo. The IED comprises four large artillery shells plus an anti-tank mine, all connected together via detonating cord. This would cause the five devices to detonate simultaneously.

a counter and two desks. A mock IED was placed between two computer monitors in plain sight on one of the counters. This IED was a pipe bomb, composed of three plain metal pipes bundled together with a timer, power pack, and appropriate wiring. The device was approximately 14 inches long and 5 inches in diameter. Participants in both the control and training conditions were told to enter the room and search for hazardous devices. On seeing such a device, if any, they were told to point directly at it and say “bomb.” Their responses were clocked on a Lafayette Instruments precision timer.

Results and Discussion Weapons, gender, and the potential impor-tance of individual differences. For these ci-vilian respondents, there was no difference in performance between the “gun” and “no gun” conditions. Law enforcement partici-pants, of course, might very well exhibit the effects anticipated for the “gun” condition. This prospect prompted the creation of new elements in the protocol for Experiment 2, reported below. Men’s performance (mean detection time 12.47 seconds, SD = 9.23 seconds), was, on average, 33.8% better than that of women (mean detection time 18.85 seconds, SD = 16.01 seconds). The large gender disparity in this sample precluded formal analysis, but the standard deviations were obviously rela-tively large; the gender difference, when sub-jected to an exploratory uneven-N’s analysis of variance, was not significant. Therefore, it was impossible to say anything substan-tive about male and female performance in this experiment. However, the relatively large standard deviations suggested that individual differences for both sexes might prove to be important for the benefit to be realized for this training. Therefore, individual differences were addressed in Experiment 2 below.

Identified Error Types. Respondents in this study were observed during the field search evolution in which they searched a room containing a mock IED. The errors they made were classified into five types:

Errors of SEARCH. For this error type, 1. respondents focused on only one part of the room, or on only one plane, fail-ing to look up or down. An interesting finding was that some respondents fo-cused on only one side of the room and failed to notice anything on the other side. In short, respondents frequently

took part of the room as their core search area and failed to examine items on the periphery of the given area.Errors of MOVEMENT. There was 2. a tendency on the part of some sub-jects to remain in one place in the room, frequently at the door. From such a perspective, many areas of the room—behind objects and under tables—were completely invisible to them. There was frequently no ten-dency to move about the room in an effort to take different necessary visual perspectives.Errors of OBSERVATION. In these 3. errors, respondents looked directly at the IED but did not report it and moved on to look at other objects. In some cases, the same error was made repeatedly with the IED. Whether these respondents mistook the IED for something else, or simply did not see it, is unknown at this time. However, just as a person can look at a power screwdriver and see a handgun, respon-dents who made these errors looked at a large, silvery pipe bomb with a timer and a battery pack and saw nothing dangerous.Failures to KEEP SEARCHING. In 4. these instances, respondents decided they had found everything there was to find. An innocuous object would be identified as an IED, and the individ-ual would report to the experimenter that he or she was finished. Errors of EVALUATION. These oc-5. curred when respondents identified innocuous objects as IEDs. Such ob-jects included a briefcase, a laptop computer, an electronic amplifier for physiological experiments (the room used for the field exercise was a labo-ratory chamber), a small pillow, and a wooden box. Some of these objects were plausible disguises for IEDs. Oth-

ers were not, ranging from the implau-sible to the absurd. What is important about these errors, however, is that they occurred with the actual mock IED in plain sight.

All errors observed fell within one of these categories and formed the readily memo-rable anagram SMOKE. The five letters of this anagram form a group at the lowest identified capacity for “chunks,”organized units of information, for human short-term memory (see Miller, 1956). They also con-tain only one element more than an optimal “rehearsal group” as identified by Mandler (1967). Thus, this anagram forms an excel-lent mnemonic device on which a front-loaded framework for training in IED de-tection may be based.

Effectiveness of Training. The major question for this experiment was the effect of the training. This effect was clear and signifi-cant—F (1, 22) = 5.06, p = .035. On aver-age, control respondents required a mean of 24.54 seconds (SD = 5.42 seconds) to detect the device. Training group respon-dents required only 11.56 seconds (SD = 6.85 seconds), an average improvement of 53%. The standard deviations were large and clearly indicated the importance of in-dividual differences in the ability to benefit from this training. This issue was addressed in Experiment 2. However, this result represented more than an incremental increase in effective-ness; the average time required to de-tect the IED was halved by the train-ing employed. The strong utility of this front-loaded, explicit, feature-intensive training for IED detection, even in a popu-lation with no prior training or exposure in the area, was clearly demonstrated. Based on this initial result, a revised, modified training method was refined and tested in Experiment 2.

Table 1Mean Numbers of Errors by Type, Experiment 2 Control Group Training Group Search 0.78 0.26 Movement 0.39 0.35 Observation 0.78 0.00 “Keep Searching” 0.78 0.00 Evaluation 1.04 1.04


Experiment 2

MethodParticipants. Forty-six college-aged partici-pants (reported ages mean 19.44 years, SD = 1.9 years) were recruited for course credit from university psychology classes. Twenty-nine women and seventeen men partici-pated, again reflecting the makeup of these different college courses. As in Experiment 1, these participants were of similar age to law enforcement cadets; additional research is needed to ascertain the degree to which the observed effects generalize to older or more experienced populations. Twenty-three respondents participated in a training group, and twenty-three in a control group which did not receive the training. These forty-six respondents were culled at random from an initial sample of fifty-five respondents. The reason for this procedure was to provide for equal-N’s analysis. As a precaution, results from the original sample of fifty-five were sub-jected to unequal-Ns analyses. The effects reported below in the Results section did not differ between the randomly-selected final sample and the unequal N’s of the initial sample.

Materials. A new PowerPoint presenta-tion was prepared, composed of 40 slides. Law enforcement input in the wake of Experiment 1 and the lessons learned from the experiment itself were used to refine this new presentation. The layout of the presen-tation slides was specifically as follows:

The first slide was blank, during which 1. the importance of IED issues was dis-cussed by an experimenter, so that re-spondent attention would be directed solely to the content of the experi-menter’s introduction. The second slide summarized the five 2. types of errors identified by SMOKE. This early introduction was used to maximize the primacy effect, the ben-eficial effect of initial learning (e.g., Crowder, 1976; see also Sharps, Price, & Bence, 1996) on respondent memo-ry for an understanding of the SMOKE errors so they could be avoided.Slides 3–10 followed. These depicted 3. a scene in which several individuals who may have been the victims of an IED attack were lying on the ground in front of a garage. These slides also depicted IEDs of different levels of sa-lience, either alone or in the presence of

a potential assailant. The assailant was armed with a handgun in one slide and unarmed in another; one specific intent of these slides was to give participants initial practice in scanning for IEDs even in the presence of an assailant, armed or unarmed. This is an issue of potentially critical importance for law enforcement trainees, as noted above. The other major intent of these specific slides was to foster the depth of pro-cessing (e.g., Craik & Lockhart, 1972; also see Sharps, 2003, 2010) necessary for training in the search and detection of IEDs in complex contexts. It was felt that dealing with a limited 4. range of IEDs in training might reduce trainees’ ability to recognize other types of IEDs in the field. Therefore, slides 11–18 were used to familiarize partici-pants with a range of different types of IEDs in order to reduce this type of mind-set. It was important for re-spondents to see these IEDs in a real-istic context rather than in isolation; they were therefore depicted as being held or in the act of being deployed by a tactically experienced police officer dressed in typical gang fashion and be-having in a proper field-valid manner. The experimenter’s narrative for these slides encouraged trainees to focus on the IED as well as on the perpetrator and the context and to engage in a fea-ture-intensive analysis of the nature of the given IED observed.With slides 1–18 providing the nec-5. essary cognitive background, slides 19–33 were non-redundant slides that were originally used in Experiment 1. As in the first experiment, these slides gave trainees practice and instruction in detecting IEDs. The IEDs varied in their level of visual salience and dis-guise. They were placed in different peripheral and central locations, under different conditions of potential sur-prise, and in different numbers.Slide 34 reintroduced the SMOKE er-6. ror classification. This was followed by five slides, one devoted to each error type, in order to facilitate maximum trainee focus on each error type for better learning retention. Finally, the last slide summarized the SMOKE errors together. The purpose of these final slides was to reinforce memo-rization of the error types at the end of the training session, making use of

the recency effect, the well established principle in which learning at the end of a given learning session tends to be the most powerful and retained (e.g., Baddeley & Hitch, 1993). In view of the memorability of the SMOKE acronym, in the terms of short-term memory (Miller, 1956) and rehearsal group (Mandler, 1967) mentioned above, the arrangement of these forty slides was intended to provide the best front-loaded, explicit, feature-intensive cognitively based training available at this time (see Sharps, 2010).

Procedures. As in Experiment 1, this regi-men was administered to the “training” group, composed of twenty-three respon-dents chosen at random. The control group, also composed of twenty-three randomly chosen participants, received only the information about the impor-tance of IED issues prior to entering the test environment. The procedure and test environment for this experiment, with a single excep-tion, were exactly the same as those of Experiment 1. Digital photographs of the room layout, made before each experimen-tal session, were used to ensure identical contexts among experiments and cells. The exception was that three devices were used instead of the single-device scenario employed in Experiment 1. That device—a large three-pipe pipe bomb—was used again and in the same relatively visible loca-tion in order to constitute the “simple” (eas-iest to find) device for this experiment. A smaller single-pipe device was also con-structed for this experiment. This IED was placed between a computer and its printer on a desk in an orientation readily visible from the proper angle, but not in plain sight as was the simple device. This partially hidden single-pipe IED was designated the “moderate” (moderately difficult to find) device. Finally, a darkly colored pineapple gre-nade shell was fitted with a mock “stick” timer and battery pack. This device was placed in shadow beneath an office chair, beneath and parallel to one of the horizon-tal supports of the chair. This device, while still visible, was relatively difficult to see or find, and was therefore designated the “dif-ficult” IED for this experiment. As respondents searched this environ-ment, their behavior was observed for in-stances of the five error types discussed


above. An error of Search was recorded if the respondent examined the same area twice or failed to search across a horizontal or vertical plane. An error of Movement was recorded if the respondent did not move from place to place in the room to maximize visual perspectives. An error of Observation was recorded if the respon-dent’s eyes were directed toward a given device but the device was still not reported. A failure to Keep Searching was reported if a respondent stated that he or she was fin-ished without finding all three objects (the search was terminated after three minutes whether or not all three items had been found). Errors of Evaluation were recorded if objects other than the three mock devices were identified as IEDs. This experiment was also used to address the issue of individual differences raised by the large standard deviations observed in Experiment 1. Specifically, this involved the degree to which individual differenc-es in various abilities might have an im-pact on IED search and detection per se, or on the degree to which a given trainee might benefit from the training provided. Accordingly, after the respondents had participated in either the control or train-

ing condition, and had been subjected to the field test environment, a selected bat-tery of individual-difference measurements was administered. These instruments were as follows:

The Shipley Institute of Living Scale 1. (e.g., Shipley, 1940, 1953; also see Shipley, Gruber, Martin, & Klein, 2009). This venerable instrument pro-vides a broad assessment of cognitive functioning in verbal and abstraction format.Portions of the Digit Span Test of the 2. Wechsler Adult Intelligence Scales.(e.g, Wechsler 2008). Items 5, 6, and 7 of each of the Backward and For-ward scales were used to explore pos-sible relationships between respondent attention, short-term memory, and potential success in IED search and detection as examined in this research. The items employed were selected for their approximate correspondence in number of items to average hu-man short-term memory capacity (see Miller, 1956. For most theoretical purposes, the construct of short-term memory has been largely superseded by more current concepts of working

memory [e.g., Baddeley, 1990]. How-ever, for some practical purposes such as those developed here, the original parametric concepts of general limita-tions on “chunking” in short-term hu-man memory remain useful). Finally, we adapted the Rey-Ostereith 3. Complex Figure Drawing test for our purposes. This is a complex figure which respondents are asked to mem-orize and draw. On a face-valid level, the ability to observe and process this abstract visual configuration accurate-ly might relate strongly to the ability to observe and process a potentially IED-rich environment. Therefore, we adapted the figure for group adminis-tration. The figure was projected on a screen for 30 seconds for respondents. This was followed by participation in three minutes of interpolated arith-metic problems to prevent and con-trol for idiosyncrasies in potential re-hearsal. Respondents were then asked to reproduce the figure. Scoring of the resultant reproductions was standard-ized and conducted according to the scoring format of Meyers & Meyers (1995).


s Responders to a crime scene must be aware both of aggressors—whether armed or unarmed—as well as observant of any potential IEDs at the site. Either can distract an officer or soldier from the other. Caution and acute observation are required. MCT photo

Thus, in Experiment 2, the effect of front-loaded, explicit, feature-intensive training for IED detection was tested. The degree to which errors of the five identified types would be made under training and control conditions was assessed. Finally, specific, face-valid individual differences in general cognitive functioning, short-term mem-ory, and complex visual processing were examined in relation to their roles in IED search and detection both generally and in the ability to benefit from training of the type offered here specifically.

Results and Discussion Speed and accuracy of detection. For this ex-periment, with its three devices which were either simple, moderate, or difficult to de-tect, two factors were important. The first, as in Experiment 1, was detection time. The second was whether detection was ac-complished at all. The effect of training on detection was significant. Participants in the training condition were significantly more likely to detect all three devices than

were those in the control condition, χ2 (1) = 4.57, p = .032. Twelve of twenty-three training respondents (52%) successfully de-tected all three devices; only five of twenty-three control respondents (22%) did so. As in Experiment 1, the effect of partici-pant gender was not significant. However, in terms of simple-device detection time, male performance was 40.10% superior to that of females. The fact that this rela-tively large difference was non-significant again reflects very large standard deviations. This large disparity in the performance of females and males may reflect the influ-ence of social expectations. We have previ-ously provided evidence that gender-based expectations can reduce women’s visual/spatial cognitive performance relative to that of men in task contexts in which no sex difference is observed when those ex-pectations are removed (Sharps, Welton, & Price, 1993; Sharps, Price, & Williams, 1994). Regardless, this result underscores the importance of understanding individual differences in this area.

Again as in Experiment 1, trained re-spondents (mean detection time 18.28 seconds, SD = 13.21 seconds) found the “simple” device significantly faster than did control respondents (mean 34.14 sec-onds, SD = 22.13 seconds), F (1, 44) = 8.72, p = .005. This reflected a 47% ad-vantage in time to detection as a result of training, similar to the 53% observed in Experiment 1. Training did not result in enhanced de-tection speed for the moderately difficult device, nor, interestingly, did it enhance the likelihood of finding this device significant-ly. This will be further discussed below in the “Error Analysis” section with reference to errors of movement. Perhaps the most important results involve the detection of the difficult device. Real devices are most likely to be concealed and the best-concealed of the mock IEDs used here was the stick-timer grenade, which was concealed in the shadows beneath an office chair and placed parallel to one of the chair’s horizontal supports. Training did not en-


s This photo shows the careful removal of an IED by a bomb squad member. It is important to remember that even after an IED is found, others may be present—vigilance at the scene must be high at all times. MCT photo

hance the speed of detection of this device, but it did dramatically enhance the ability of trainees to find it at all. Only five of the con-trol-group respondents found the difficult device. However, twelve of the respondents in the training group did so. The difference was significant, χ2 (1) = 4.57, p = .032. Not only were respondents in the training con-dition faster at detecting the simple device, they were more likely to detect all three de-vices, including the complex device—the IED which was most difficult to find.

Error analysis. These results are presented in Table 1. The training provided in this ex-periment significantly reduced the average number of errors across three of the five error types. Errors of SEARCH were significantly reduced, F (1,44) = 6.77, p = .013, as were er-rors of OBSERVATION, F (1, 44) = 19.48, p < .001, and failures to KEEP SEARCHING, F (1, 44) = 31.26, p < .001. Trainees, as opposed to respondents in the control group, were more likely to engage in a comprehensive search of the room, ex-amining all quadrants and searching above, below, and at their line of sight for IEDs. They were also more likely to identify and report an IED when they saw one. Finally, trainees were more likely to continue their search for additional IEDs even when they had already identified one. Thus, the train-ing provided in Experiment 2 resulted in a significant advantage in IED search and detection beyond the levels observed with the control group. Errors of Evaluation were not reduced by the training. Those who received training were just as likely to identify an innocuous object as a potential IED as those who did not. This result may in fact be construed as salutary. In a potentially IED-rich envi-ronment, it is far more dangerous to mis-take an IED for an innocuous object than it is to mistake an innocuous object for an IED. The degree to which this may prove important in the field should be the subject of further research. Errors of Movement also were not sig-nificantly reduced by the training provid-ed. This speaks directly to the finding cited above with reference to the “moderate” de-vice—the fact that our training did noth-ing to improve the detection of this device. Although the device, a single-pipe bomb, was situated in plain sight, it was only in plain sight from a specific perspective within the field test chamber. The moderate IED was placed between a computer and its printer.

It was not directly visible unless the partici-pant moved to a position in which there was a direct line of sight to its location. The training provided was presented in a PowerPoint presentation. Trainees did not move during the training; they were seat-ed before a screen on which the presenta-tion was made. Therefore, although they were informed of the need to move about any given environment to enhance their perspective, they received no direct motor training in this crucial aspect of search. Was this the reason for the absence of a training effect for the moderate device? An additional analysis was conducted to address this question. We correlated the presence of errors of Movement with the amount of time needed to detect each de-vice. Errors of Movement were significantly correlated with the amount of time need-ed to detect the moderate device, r (22) = 0.59, p < .001. No such correlation was ob-served with the simple or complex device. Thus, errors of Movement, which were not reduced by SMOKE training in isolation, were the most probable explanation for the anomalous results observed with the mod-erate device. This result strongly underscores a point made above: SMOKE training, the front-loaded, explicit, feature-intensive training system presented here, cannot replace field training. Rather, it is presented as a pow-erful adjunct to field training. The present findings indicate that the SMOKE system must be accompanied by rigorous field training, in realistic environments, for the detection of IEDs. Trainees in possession of the cognitive skills engendered by SMOKE must search realistic mock environments as well, in order to foster the movement skills needed for successful searches and also to fine-tune the skills acquired in the SMOKE training for real-world environments. From the perspective of cognitive science, the SMOKE system should be presented, fol-lowed by realistic training provided by field training experts, and then presented again; this will optimize both the primacy and re-cency effects (see Baddeley, 1990; Crowder, 1976; also see Sharps et al., 1996) for opti-mal memory and retention of the training, as discussed above. Cognitively based training such as SMOKE cannot, and is not intended to, replace solid field training. However, the present experiments have demonstrated that such training provides a powerful cog-nitive framework for successful field train-

ing, and for ultimate success at IED search and detection.

Individual differences. Interestingly, neither of the scales of the Shipley instrument, which deals with general cognitive func-tioning, was related to successful searches across conditions of detection difficulty. Neither were the scales of the Digit Span, which deals with attentional and short-term memory capabilities, nor our adaptation of the Rey-Ostereith figure, which deals with the ability to perceive and remember a com-plex visual pattern. However, a more interesting pattern was observed with reference to the “dif-ficult” IED condition alone, which pre-sented the most realistic of the three mock IEDs presented in the field test evolution. In the control condition, none of the indi-vidual-difference measures manifested sig-nificance. However, across the control and training conditions, performance on the Rey-Ostereith figure was in fact significantly related to the ability to detect the difficult device, F (1, 30) = 4.39, p = .045. In the training condition, this significance was maintained, F (1, 12) = 11.70, p = .005. The Shipley Abstractions scale also proved to be related to performance in the train-ing condition, F (1, 12) = 4.90, p = .047. The most parsimonious explanation of this pattern of results follows. Neither in-tellect, short-term memory, attention, nor even the ability to remember a com-plex visual pattern predicted the abil-ity to search for and detect IEDs in the absence of cognitively based training. However, what was predicted by our adap-tation of the Rey-Ostereith figure and by the Shipley Abstractions elements, was the ability to benefit from the training provid-ed within the SMOKE framework, at least with reference to more difficult and there-fore more realistic IEDs. Those with better abstraction powers benefited more from the training than did those without. Perhaps more importantly, the ability to remember and process a complex visual figure (the Rey-Ostereith) was also directly related to the ability to benefit from SMOKE train-ing. These are preliminary results, of course, and further research will be absolutely nec-essary to verify and, if appropriate, to extend them; but these findings strongly indicate the potential for an empirically-based path-way to predict those who are more likely to benefit from cognitively based IED search and detection training.


General DiscussionTaken together, these experiments have demonstrated the following:

Five specific types of errors characterize 1. unsuccessful search and detection of IEDs. These are described in detail above.Cognitively based, front-loaded, ex-2. plicit, feature-intensive training can be used to reduce many of these errors sig-nificantly, and to provide superior per-formance in the detection of IEDs, as suggested by earlier work (e.g, Sharps, 2003, 2010). The effects of such training are strong 3. in isolation; however, it is highly prob-able that far stronger and more salutary effects will be achieved in combination with a comprehensive program of real-istic field training.It may be possible to predict the prob-4. ability that a given trainee will benefit substantially from this type of training, based on his or her capabilities with reference to abstraction and to the re-call and processing of complex visual stimuli. However, further research is absolutely essential on this issue.

Effective search and detection of IEDs is of substantial importance now, and is likely to assume even greater importance in the future (e.g., Cameron, 2008). The present results have demonstrated the importance of front-loaded, explicit, feature-intensive training (see Sharps, 2003, 2010) as a powerful adjunct to field training methods already in use.

It is of paramount importance to con-duct additional research to determine the most important components of this train-ing and the degree to which individual differences may be used to predict train-ee success. It is also important to deter-mine the generality of these results across populations, especially with reference to age and experience. Additional research should also address the degree to which the SMOKE method is used consciously by trainees in their approach to field evo-lutions. Ultimately, however, the present findings serve to underscore the importance of a cognitive approach to IED search and detection and the degree to which this ap-proach has immediate practical benefits for the training of law enforcement, military, and appropriate civilian constituencies in an increasingly risky world. It is hoped that the inclusion of the type of training elucidated in the present experiments will reap substantial benefits, especially for law enforcement and for those charged with homeland security, in terms of enhanced officer survivability, professional effective-ness, and enhanced abilities to protect the civilian population.

ReferencesBaddeley, A.D. (1990). Human memory: Theory and

practice. Boston: Allyn & Bacon.Baddeley, A.D., & Hitch, G.J. (1993). The recen-

cy effect: Implicit learning with explicit retrieval? Memory and Cognition, 21, 146-155.

Bransford, J.D., & Johnson, M.K. (1972). Contextual prerequisites for understanding: Some investiga-

tions of comprehension and recall. Journal of Verbal Learning and Verbal Behavior, 11, 717-726.

Bransford, J. D., & Johnson, M. K. (1973). Consid-erations of some problems of comprehension. In W. G. Chase (Ed.), Visual information processing. Orlando, FL: Academic Press.

Cameron, S. (2008). Securing the cities: Agencies work-ing together to detect dangerous radiological materi-als. The Police Chief, reprinted offprint of article ap-pearing in the October, 2008 edition, pgs. 1-5

Craik, F.I.M., & Lockhart, R.S. (1972). Levels of pro-cessing: A framework for memory research. Journal of Verbal Learning and Verbal Behavior, 11, 671-684.

Crowder, R.G. (1976). Principles of learning and mem-ory. Hillsdale, NJ: Erlbaum.

Force Science News (2009, February 13). I. New study: When civilians would shoot…and when they think you should. Force Science Research Center, Transmis-sion #117, www.ForceScienceNews.com

Grossman, D., & Christensen, L.W. (2004). On com-bat. PPCT Research Publications.

Haviland, S.E., & Clark, H.H. (1974). What’s new? Acquiring new information as a process of com-prehension. Journal of Verbal Learning and Verbal Behavior, 13, 512-521.

Hess, A.B., & Sharps, M.J. (2006, April). Identifi-cation and interpretation of peripheral sources of hazard in complex crime situations. Western Psy-chological Association, Palm Springs, CA..

Mandler, G. (1967). Organization and memory. IN K.W. Spence & J.T. Spence (Eds.), The psychology of learning and motivation (Vol. 1). Orlando, FL: Academic Press.

Meyers, J.E., & Meyers, K.R. (1995). Rey complex fig-ure test and recognition trial. Lutz, FL: Psychological Assessment Resources, Inc.

Miller, G.A. (1956). The magical number seven, plus or minus two: Some limits on our capacity for processing information. Psychological Review, 63, 81-97.

Sharps, M.J. (2003). Aging, representation, and thought: Gestalt and feature-intensive processing. New Bruns-wick, NJ: Transaction.

Sharps, M.J. (2010). Processing under pressure: Stress,


sIn this file photo, a Stryker lies on its side after surviving a buried IED blast in 2007.

memory, and decision-making in law enforcement. Flushing, NY: Looseleaf Law Publications, Inc.

Sharps, M.J., Barber, T.L., Stahl, H., & Villegas, A.B. (2003). Eyewitness memory for weapons. Forensic Examiner, 12, 34-37.

Sharps, M.J., & Hess, A.B. (2008). To shoot or not to shoot: Response and interpretation of response to armed assailants. Forensic Examiner,17, 53-64.

Sharps, M.J., Hess, A.B., Casner, H., Ranes, B., & Jones, J. (2007). Eyewitness memory in context: Toward a systematic understanding of eyewitness evidence. Forensic Examiner, 16, 20-27.

Sharps, M.J., Janigian, J., Hess, A.B., & Hayward, B. (2009). Eyewitness Memory in Context: Toward a Taxonomy of Eyewitness Error. Journal of Police and Criminal Psychology, 24, 36-44.

Sharps, M.J., Price, J.L., & Bence, V.M. (1996). Vi-sual and auditory information as determinants of primacy effects. Journal of General Psychology, 123, 123-136.

Sharps, M.J., Price, J.L., & Williams, J. (1994). Spa-tial cognition and gender: Instructional influences on mental image rotation performance. Psychology of Women Quarterly, 18, 413-425.

Sharps, M.J., Welton, A., & Price, J.L. (1993). Gender and task in the determination of spatial cognitive per-formance. Psychology of Women Quarterly, 17, 71-83.

Shipley, W.C. (1940). A self-administering scale for measuring intellectual impairment and deteriora-tion. Journal of Psychology, 9, 371-377.

Shipley, W.C. (1953). The Shipley Institute of Living Scale for measuring intellectual impairment. In A. Weider (Ed.), Contributions toward medical psychol-ogy (Vol..2): Theory and diagnostic methods (pp. 751-756). New York: Ronald.

Shipley, W.C., Gruber, C.P., Martin, T.A., & Klein, A.M. (2009). Shipley-2 manual. Los Angeles: West-ern Psychological Services.

Steblay, N.M. (1992). A meta-analytic review of the weapon focus effect. Law and Human Behavior, 16, 413-424.

Villegas, A.B., Sharps, M.J., Satterthwaite, B., & Ch-isholm, S. (2005). Eyewitness memory for vehicles. Forensic Examiner, 14, 24-28.

Wechsler, D. (2008). WAIS-IV. New York: Pearson/Psychological Corporation.

AcknowledgementsThe authors wish to thank Chief of Police Jerry Dyer and the staff and officers of the Fresno Police Department for their unstint-ing expert advice, generosity, and support of this research. Thanks also to Sergeant Michael Manfredi of the Fresno Police Department, and to Lisa Giuliani, Amy Balmanno, and Morgan Goodwin for their help in the preparation of the materials for this research. The research, views, and opin-ions presented in this paper are entirely and solely those of the authors, and do not nec-essarily reflect the views or opinions of the Fresno Police Department or of its Chief of Police, staff, officers, or employees. n

ABOUT THE AUTHORS

Matthew J. Sharps, PhD, DABPS, FACFEI, is professor of psychology at California State

University, Fresno, and adjunct faculty member in forensic clinical psychology at Alliant

International University. He received his MA in clinical psychology from UCLA, and MA

and PhD (psychology) from the University of Colorado. He is a Diplomate of the American

Board of Psychological Specialties and a Fellow of the American College of Forensic Examiner

Institute. He is the author of numerous articles and papers on cognition, forensic cognitive

science, and related topics, as well as the books Aging, Representation, and Thought: Gestalt

and Feature-Intensive Processing (2003, Transaction Publishers), and Processing Under Pressure:

Stress, Memory, and Decision Making in Law Enforcement (2010, Looseleaf Law Publications,

Inc.). He has consulted on issues of eyewitness identification and related cognitive issues in

over 160 criminal cases.

Officer Michael Scholl is a 13-year law enforcement veteran and has served his entire

career with the Fresno Police Department. Assignments have included patrol, neighbor-

hood police officer, Citizens on Patrol coordinator and the Homeland Security Bureau. He

has spent the last four years as the Department’s terrorism liaison officer and is responsi-

ble for the field collection of terrorism-related Intelligence, the sharing of information with

regional Fusion Centers, and Critical Infrastructure Vulnerability Assessments. Duties also

include the design and delivery of terrorism training for police officers, police cadets, acad-

emy cadets and civilians. In addition, Scholl wrote a 40-hour curriculum for California POST

entitled, “Homeland Security with Law Enforcement Volunteers,” where he also achieved the

designation of POST Master Instructor. He has also been certified by the Louisiana State

University as an instructor for the Prevention and Deterrence of Terrorist Acts and Response

to WMD Response for Law Enforcement. Publication credits include The International Journal

of Counter-Terrorism. Officer Scholl teaches terrorism intelligence awareness for the Federal

Law Enforcement Training Center and is also an instructor for the International Association

for Chiefs of Police. Lastly, Officer Scholl is adjunct instructor for the California State

Regional Training Center, Fresno Police Academy where he teaches counter-terrorism and

emergency management.

Mallory Glasere, BA, is a graduate of California State University, Fresno, and a doctoral

candidate in forensic clincial psychology at Alliant International University, Fresno.

Bill Hayward, BA, is a graduate of California State University, Fresno, and a doctoral can-

didate in forensic clincial psychology at Alliant International University, Fresno.

Elaine Newborg, BA, is a graduate of California State University, Fresno, and a doctoral

candidate in forensic clincial psychology at Alliant International University, Fresno. Earn CE CreditTo earn CE credit, complete the exam for this article on page 62 or complete the exam on-line at www.acfei.com (select “Online CE”).


Law Enforcement

If you require special accommodations to participate in accordance with the Americans with Disabilities Act, please contact the CE Department at (800) 592-1399.

Information was relevant and applicable.Learning objective 1 was met.Learning objective 2 was met.Learning objective 3 was met.You were satisfied with the article.ADA instructions were adequate.The author’s knowledge, expertise, and clarity were appropriate.Article was fair, balanced, and free of commercial bias. The article was appropriate to your education, experience, and licensure level. Instructional materials were useful.

1 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 5

1 2 3 4 5

EVALUATION: Circle one (1=Poor 2=Below Average 3=Average 4=Above Average 5=Excellent)

Name: State License #:

Phone Number: Member ID #:

Address: City:

State: Zip: E-mail:

Credit Card #

Circle one: check enclosed MasterCard Visa American Express

Name on card: Exp. Date:

Signature Date

PAYMENT INFORMATION: $15 per test (FREE ONLINE)

Statement of completion: I attest to having completed the CE activity. Please send the completed form, along with your payment of $15 for each test taken. Fax: (417) 881-4702, or mail the forms to ACFEI Continuing Education, 2750 E. Sunshine, Springfield, MO 65804. If you have questions, please call (417) 881-3818 or toll free at (800) 592-1399.

KEYWORDS: Sedative, Tranquilizer, Benzodiazepene, Barbiturate, Zolpidem (Ambien), Gamma Amniobutyric Acid (GABA) Receptor, Automatism, Disinhibition, Hostility, Rage

TARGET AUDIENCE: Behavioral scientists, pharmacologists, forensic examiners

PROGRAM LEVEL: Basic

DISCLOSURE: The authors have nothing to disclose.

PREREQUISITES: None

Which of the following drug classes exhbit cross-tolerance:1. opiates and benzodiazepenesa. ethanol and benzodiazepinesb. opiates and stimulantsc. ethanol and stimulantsd.

The amnesia caused by GABA-A drugs proceeds: 2. forward in time (anterograde)a. backward in time (retrograde)b.

When a subject of interview is confabulating, the are:3. relating an untrue memory for purposes of deceptiona. consciously misleading the interviewerb. relating an untrue memory that they believe is realc.

GABA-A drugs can be safely abused with which of the 4. following:

alcohola. opiatesb. sedativesc. a and bd. b and ce. none of the abovef.

“Boosting” is a drug abuse strategy of:5. potentiating stimulant drug effect by coadministering a a. tranquilizerpotentiating opiate drug effect by coadministering a tranquilizer b. both a and bc.

Answer true or false: A drug with a therapeutic index of 6. 2.0 is safer than a drug with a therapeutic index of 4.0.

truea. falseb.

“Chemical submission” is associated with which of the 7. following drug receptors in the brain:

opiate receptor stimulationa. dopamine receptor stimulationb. GABA receptor stimulationc. a and b onlyd. b and c onlye.

“Involuntary intoxication” can result from which of the 8. following:

Prescription errora. Dispensing errorb.

Idiosyncratic vulnerability of the patient/subjectc. all of the aboved.

The term “potentiation” describes which of the following:9. one drug that neutralizes the effect of another drug con-a. sumeda drug whose effect is additive with that of a second drug b. consumeda quantitatively greater than additive effect resulting from the c. consumption of two drugs having qualitatively similar effects

The plasma half-life of a hypothetical drug is 5 hours. For 10. how long will it be detectable in plasma after a single dose?

a) 10 hoursa. b) 15 hoursb. c) more than 20 hoursc.

POST CE TEST QUESTIONS (Answer the following questions after reading the article)

ATTENTION ACFEI MEMBERS: Journal-Learning CEs are now FREE when taken online. Visit www.acfei.com.

CE ARTICLE 1: (Pages 16–32)Tranquilizer Drug Forensics

ABSTRACT

After studying this article, participants should be better able to do the following:Understand the common pharmacological mechanism and effects of tranquilizing drugs acting at the brain’s 1. GABA-A receptors.Understand how drug adverse effects of different tranquilizer classes can be involved in forensically-rele-2. vant behavior.Appreciate how the growth of illicit drug abuse parallels the ethical, licit market.3.

LEARNING OBJECTIVES

In order to receive 3 CE credits, each participant is required to1. Read the continuing education article.2. Complete the exam by circling the chosen answer for each question. Complete the evaluation form. 3. Mail or fax the completed form, along with the $15 payment for each CE exam taken to: ACFEI, 2750 East Sunshine, Springfield, MO 65804. Or Fax to: 417-881-4702. Or go online to www.acfei.com and take the test for FREE.

For each exam passed with a grade of 70% or above, a certificate of completion for 1.0 continuing educa-tion credit will be mailed. Please allow at least 2 weeks to receive your certificate. The participants who do not pass the exam are notified and will have a second opportunity to complete the exam. Any questions, grievances or comments can be directed to the CE Department at (800) 592-1399, fax (417) 881-4702, or e-mail: [email protected]. Continuing education credits for participation in this activity may not apply toward license renewal in all states. It is the responsibility of each participant to verify the requirements of his/her state licensing board(s). Continuing education activities printed in the journals will not be issued any refund.

TO RECEIVE CE CREDIT FOR THIS ARTICLE

This article is approved by the following for 3 continuing education credits:

(ACFEI) The American College of Forensic Examiners International provides this continuing education credit for Diplomates and certified members, whom we recommend obtain 15 credits per year to maintain their status.

CE ACCREDITATIONS FOR THIS ARTICLE

Addiction, dependence, withdrawal syndromes, memory disturbances, amnesia, disinhibited behavior, violence, impulsivity, automatistic and somnambulistic states, and cognitive and neuropsychological impairments result at least in part from activation of receptors in the brain for the Gama Aminobutyric Acid (GABA) neurotransmitter.

This mechanism is responsible for many of the common, shared, and similar actions of various tranquillizing drugs used for relief of anxiety, nighttime sedation, anticonvulsant, muscle-relaxant, and surgi-cal anesthetic purposes. These tranquillizing drugs, of superficially very different chemical classes, share this GABA mechanism and the effects produced with beverage alcohol (ethanol).

These drug effects, alone and in interaction with other drugs, combine with idiosyncratic neurobiological vulnerabilities to bring the user’s behavior to forensic notice in a wide variety of criminal and civil cases.


TARGET AUDIENCE: Behavioral scientists, pharmacologists, forensic examiners


Law Enforcement



1 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 5

1 2 3 4 5




Address: City:

State: Zip: E-mail:

Credit Card #



Signature Date



KEYWORDS: Profiling, Atypical Homicide, Typical Homicide, Investigation, Cold Case

TARGET AUDIENCE: Investigators, cold case profilers



PREREQUISITES: None

The three major groups of homicides victims include all of the following except:1. Mafia/organized crime professional “hits.”a. Drug related homicides.b. Homicides where the victim has a relationship (work, family, lover) with the perpetrator.c. All of the above were discussed by the authors.d.

The importance of the difference between atypical and typical homicide is:2. Typical homicides involve crimes of passion while atypical crimes do not. a. Atypical homicides should be investigated differently than typical homicides.b. ViCAP requires this distinction.c. All of the above were important distinctions mentioned by the authors.d.

According to the authors, cases grow cold for all of the following reasons except:3. Lack of motivation, funding, or manpower to close the case.a. Poorly investigated cases.b. Political involvement where investigators are pulled from the case.c. The perpetrator is known, but there is a lack of enough evidence for a conviction.d.

When photographing a scene, investigators should:4. Take numerous photographs of the scene, body, and environment from many angles.a. Wait until the crime scene has been processed and then photograph what you can.b. Move a body back into its original position before EMT’s worked on before photographing it.c. Take only a few pictures of the scene. Too many pictures can be confusing.d.

The authors suggest that a profiler needs all of the following except:5. An aerial view of the scene, such as is available on Google maps.a. Facebook, Twitter, and other electronic records of the victim.b. String trajectories.c. All of the above.d.

A good case file for a cold case profiler should include:6. Photographs of the victim, scene, surrounding area, and numerous close-ups of evidence.a. Detailed information on the victims so that the victim can be profiled as well as the perpetrator.b. ViCap data and the Medical Examiners reports/photographs.c. All of the above should be included.d.

The authors suggest that atypical homicides should be investigated:7. In a way that the scene can be recreated ten years after the investigator retires.a. In complete detail regardless of typical or atypical homicide.b. Without regard to type (atypical or typical homicide).c. None of the above are reasonable summaries.d.



CE ARTICLE 2: (Pages 40–46)Typical and Atypical Homicide: Investigative Differences and Cold Case Profiling

ABSTRACT

After studying this article, participants should be better able to do the following:To identify the distinction between typical and atypical homicide.1. To identify the different methods of homicide investigation between typical and atypical homicide.2. To identify the needs of a profiler for cold case investigation.3.

LEARNING OBJECTIVES

In order to receive 1.5 CE credits, each participant is required to1. Read the continuing education article.2. Complete the exam by circling the chosen answer for each question. Complete the evaluation form. 3. Mail or fax the completed form, along with the $15 payment for each CE exam taken to: ACFEI, 2750 East Sunshine, Springfield, MO 65804. Or Fax to: 417-881-4702. Or go online to www.acfei.com and take the test for FREE.



This article is approved by the following for 1.5 continuing education credits:



This article addresses the difference between typical homicides and atypical homicides. Homicide investigators, even those in large agencies with dozens of homicides each year, spend the majority of their career investigating typical homicides. These include homicides where the perpetrator has a relationship with the victim, the victim is engaged in drug activity, or the victim is a target, bystander, or participant in other illegal activity. Atypical homicides are those that do not fall into one of these areas and they include serial crimes. This article addresses how the recognition of these two types of homicide, as well as how investigative differences between the two, can assist the cold case profiler and what profilers need for a cold case profiling.


Law Enforcement



1 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 5

1 2 3 4 5




Address: City:

State: Zip: E-mail:

Credit Card #



Signature Date



KEYWORDS: Improvised Explosive Device Detection, Explosive Ordinance Disposal, SMOKE System, Law Enforcement Training

TARGET AUDIENCE: Investigators



PREREQUISITES: None

THE SMOKE system:1. improved speed of detection for relatively visible devicesa. improved probability of detection for relatively well hidden devicesb. reduced all forms of errors in IED detectionc. a and bd.

Important for cognitively-based training of the SMOKE type:2. Feature-intensive processinga. Explicit relationshipsb. “Front-loading,” or prior frameworks for understandingc. All of thesed.

The SMOKE system does not reduce the following type of errors:3. Errors of SEARCHa. Errors of MOVEMENTb. Errors of OBSERVATIONc. Failure to KEEP LOOKINGd.

The result dicussed in Question 3 indicates:4. the importance of providing SMOKE-type training in isolation from other training methodsa. the importance of combining SMOKE-type training with appropriate field training in a comprehen-b. sive training programthe importance of verbal instruction in IED detectionc. the importance of Gestalt information in IED detectiond.

Predicted by performance on our adaptation of the Rey-Ostereith figure, and on the Shipley 5. Abstractions elements:

Expertise and experience in all IED detectiona. General intelligenceb. The ability to benefit from the training provided within the SMOKE framework, at least with ref-c. erence to more difficult and therefore more realistic IEDs.The ability to benefit from the training provided within the SMOKE framework, wiht reference to d. all forms of IEDs and hazardous devices.

Not an error type within the SMOKE framework:6. Errors of SEARCHa. Errors of SAFETYb. Errors of EVALUATIONc. Failures to KEEP LOOKINGd.



CE ARTICLE 3: (Pages 48–59)The Finding IEDs Before They Find You: The SMOKE System of Training for Hazardous Device Detection

ABSTRACT

After studying this article, participants should be better able to do the following:Demonstrate understanding of the issues involved in IED identification and of the difficuluties involved in 1. successful IED search and detection.Demonstrate understanding of the importance of front-loaded, explicit, feature-intensive, cognitively-based 2. training as a foundation for successful IED search and detection.Understand that in controlled experiments, the ability of respondents to detect IEDs was significantly and 3. substantially enhanced by such training.Discuss the five types of errors typical of less-successful IED search and detection.4. Understand the importance of further research into the cognitive and individual-differences bases of suc-5. cess in IED search and detection.

LEARNING OBJECTIVES

In order to receive 2 CE credits, each participant is required to1. Read the continuing education article.2. Complete the exam by circling the chosen answer for each question. Complete the evaluation form. 3. Mail or fax the completed form, along with the $15 payment for each CE exam taken to: ACFEI, 2750 East Sunshine, Springfield, MO 65804. Or Fax to: 417-881-4702. Or go online to www.acfei.com and take the test for FREE.



This article is approved by the following for 2 continuing education credits:



Search for and detection of improvised explosive devices (IEDs) and similar hazards has become increasingly important in law enforcement, as well as in military applications. IED-detection training can be significantly enhanced through the augmentation of cognitive training into field training methods. The present research addressed cognitive issues in IED detection and training. Five major types of errors in search and detection were identified and characterized. A cognitive training program was developed and provided to eliminate these errors. Two experiments were conducted. Their results demonstrated that this training, termed the “SMOKE” system after the five error types (errors in Search, Movement, Observation, failures to Keep searching, and errors of Evaluation) signifi-cantly improved IED search and detection. Trainees were substantially more successful in detecting a spectrum of mock hazardous devices, were faster at detecting less well-hidden hazards, and were less prone to specific error types than were respondents in control comparison groups. These findings demonstrated the use of cognitive IED search training when conducted in tandem with compre-hensive field training methods for the development of effective IED search and detection skills.


You entered the field to help people. When was the last time an organization provided any real help to you?

BECOME A BOArd CErtifiEd PrOfEssiOnAl COunsElOr, BCPC

www.americanpsychotherapy.com • 800.592.1125

The American Association of Integrative Medicine (AAIM) recognizes that a multi-disciplinary approach to medicine provides the maximum therapeutic benefit. AAIM’s advocacy for broader treatment options facilitates a bond between integrative and Western medicine, and the end result is a gathering place for healers, educators and researchers from all specialties to compare notes and combine forces, benefiting both the patient and the health care provider.

Join AAIM today asBoard Certified in Integrative Medicine, BCIMSM



BCPC01EX

AAIM01EX

THE DETECTIVE’S CORNER—A FICTION MYSTERY

The Forensic Examiner® is proud to continue its fiction

mystery feature, The Detective’s Corner, made possible by

the efforts of talented free-lance writers. Read the mystery

and make your predictions. Visit us on the Web at

www.acfei.com to see if you figured it out!

Doggone Trouble

By Janice Curran

Sheriff Meg Paterson watched as the last spade of dirt fell on the tiny grave outside the Greene farmhouse. The niece who’d phoned about the death laid the tool aside and sniffed back tears. “At least he’ll be with Aunt Tilly again. He has seemed so lost since her death last month.” The sheriff ’s deputy-in-training, Freddie Hinkle, offered her his handkerchief. “Please don’t cry, Ms. Greene.” Dabbing at her eyes, she gave Freddie a shy smile. “The name is JoBeth, Deputy. And you’re too kind. This murder, coming so soon after Aunt Tilly’s passing, well…it’s all very upsetting.” “Murder!” Harold Greene, Tilly’s brother, ex-claimed. “How do you murder a mutt? I can’t believe you called the sheriff for this, JoBeth. What a waste of taxpayer money.” JoBeth cast her uncle a disapproving look. “Sheriff, there were two things my aunt loved in this world—her dog Cupcake and her prize choc-olate meringue pie. Uncle Harold hated both.” “You’re forgetting to include yourself among Tilly’s favorites,” Harold corrected her. “Your

aunt fussed over you as much as she fussed over that dog. What did I get? Scraps.” JoBeth pursed her lips. “Do you call eight thousand dollars ‘scraps’? You were named sole beneficiary on her life insurance policy.” Sheriff Paterson tilted back her hat. “Is that so?” Harold scowled. “What of it? Almost every penny went to the funeral director. Tilly left the whole danged farm to JoBeth.” JoBeth laid her hand on Freddie’s arm. “You have to understand I helped Aunt Tilly care for the place since she took Prince and me in.” To Harold, she said, “There’s no reason you can’t continue to live here. Although, you’ll have to pitch in more now.” Harold glared. “Do you suppose I’ve been on Easy Street? Your aunt kept me on a shorter leash than her nasty pooch. You’d think she owned stock in that fancy dog food company.”“Cupcake was a pedigree,” JoBeth said. “He needed a special diet. You should be ashamed—jealous of that little bit of a thing. Why, he could jump no higher than my knee!”


“That’s what I would’ve thought,” Harold said. Then he shrugged. “All I know is that fleabag cost Tilly more a year than what she paid in taxes.” Sheriff Paterson cut in to head off another round of griping. “JoBeth, you mentioned in your call that Cupcake was poisoned.” JoBeth nodded. “I believe he was. A week ago, Cupcake was healthy—snapping and snarling, as usual—and now he’s dead.” “Maybe he died of a broken heart,” Harold said with a snicker. “Or maybe you killed him so Prince could win that stupid competition. As long as Cupcake was alive, the best Prince could do was second place.” JoBeth turned up her nose. “Pshaw. Why would I call the sheriff if I poisoned Cupcake?” Harold folded his arms across his chest. “Easy—to keep suspicious minds from inquiring. You wouldn’t want to hurt ol’ Prince’s chances in the next competition.”“I wasn’t even home when Cupcake took ill,” JoBeth said. “Don’t you think I know you and Prince hightailed it out the kitchen door the min-ute our neighbor rang the bell in the front?” Harold snorted. “Sheriff, that biddy has been bringing us casseroles every Saturday for a month. And every Saturday, JoBeth and her also-ran take off.” JoBeth inclined her head toward Freddie and said in a confiding tone, “Don’t let Uncle Harold fool you. He’s taken a fan-cy to ‘that biddy.’ That’s why he had a pie thawed and waiting.”

While Harold blushed and spluttered, the sheriff took the opportunity to ask, “Was Cupcake examined by a veterinarian?” JoBeth raised an eyebrow. “Uncle Harold said he was.” Harold collected himself. “I was getting to that. With all the business Tilly gave Doc Wood, he owed us a free house call—and I made sure I told him so. He didn’t say noth-ing about poison.” Before the uncle and niece could find something else to squabble about, Sheriff Paterson quickly said to Freddie, “Let’s go talk with Doc.” The veterinarian seemed surprised to find the law at his door. “Cupcake’s death was an unfortunate accident, Sheriff. He got into something he shouldn’t have.” “What was that?” the sheriff asked. “Chocolate. It contains theobromine, a substance that, if consumed in a high enough quantity, is toxic to dogs. The amount of the type chocolate Cupcake ate was deadly for a canine his size.”

Freddie looked relieved. “Neither of the Greenes killed him.” Sheriff Paterson wasn’t so sure. “I often see accidental ingestions around the holidays, when people bake more than usual,” Doc Wood said. “But Tilly kept her freezer stocked with chocolate meringues. When Harold left one on the counter un-attended …” “Cupcake scarfed it down,” Freddie fin-ished for him. “A dog enthusiast would’ve known bet-ter,” Doc Wood said. “As soon as I saw the remains of the pie on the floor, I knew what had happened. No need to waste Harold’s money on a necropsy.” “Should we swing back to the farm, Sheriff?” Freddie asked eagerly. “JoBeth will feel better once we tell her Cupcake wasn’t poisoned.” Sheriff Paterson shook her head. “Cupcake wasn’t poisoned in the usual way, Freddie. I suspect that, in this case, death by chocolate is a crime.” n

ABOUT THE AUTHOR

Janice Curran is a freelance writer, short story author, and aspiring novel-ist who makes her home in the northeastern U.S. along with her husband, a social worker, and their two kittens. She’s been a reporter for a weekly regional newspaper, staff writer for a resort and leisure corporation, and senior writer for the creative services department of a children’s mental health organization, where she received numerous awards for her work. Her stories appear in several publications. Writers and other industry profes-sionals are welcome to connect her at www.facebook.com/janice.curran.


Certified Forensic Consultant, CFC®

Combine your expertise with knowledge of the judicial system by becoming a Certified Forensic Consultant, CFC®.

You are most comfortable and efficient in familiar surroundings: your primary field of expertise. Yet, it can be difficult to put your expertise to work if you are unfamiliar with and uncomfortable in a courtroom setting. The Certified Forensic Consultant, CFC®, program will educate you in the complexity of the American judicial system. (800) 423-9737 • www.acfei.com

AVAILABLE ONLINE

CFC01EX



CONF01EX


ACFEI Logo ProductsA. ACFEI wooden laser carved wall plaque—$100*B. ACFEI fleece blanket (available in black and pink)—$25C. ACFEI luggage tag—$5D. ACFEI pocket bouillon—$60*E. ACFEI pen & letter opener set—$12F. ACFEI men’s camp shirt (dark navy, sizes: S to XXXL)—$55G.ACFEI men’s all-weather jacket (Navy, sizes: S to XXXL)—$60H. The Forensic Examiner T-shirt men’s or women’s (black, sizes: men’s—S to XXXL; women’s—S to XXL)—$24I. ACFEI men’s T-shirt (navy, sizes: M to XXL)—$24J. ACFEI men’s fleece jacket (black, or lt. blue/gray, sizes: S to XXXL)—$60K. ACFEI men’s or women’s polo shirt (navy, sizes: men’s S to XXXL; women’s—S to XXL)—$48L. ACFEI men’s polo shirt (tan, sizes: S to XXXL)—$48M. ACFEI women’s dress shirt (blue, sizes: S to XXL)—$55N. ACFEI men’s dress shirt (gray, sizes: S to XXXL; XLT & XXLT)—$55O. ACFEI lapel pin—$5P. ACFEI jotterpad—$5Q. ACFEI padfolio—$20R. ACFEI labcoat (sizes: 32-50)—$40S. ACFEI track suit (sizes: men’s S to XXXL; women’s—S to XXL)—$99

* A & D are special orders requiring 12-16 weeks for delivery.

A B C D E

F G H I J

K L M N O

P Q R S

Name I.D. Number

Deliver To (Street Address Only)

Address

City/State/Zip

Credit Card Number Exp. Date

Signature

Payment Method (Please do not send cash.) rCheck/Money Order rMastercard/Visa rAm.Express rDiscover(please make checks payable to ACFEI)

Item Size Quantity Total

Sub-Total Shipping & Handling (See chart below) Rush Delivery Total

Arrive in style to the 2010 National Conference. Order your ACFEI logo products today!

2750 E. Sunshine, Springfield, MO 65804 • Phone: (800) 423-9737 • Fax: (417) 881-4702 • www.acfei.com

Shipping Costs:1 item: $8.00, 2 items: $9.50, 3 items: $10.75, 4 items: $12.50, 5 items: $13.75, 6 items: $15.25, 7 items: $17.00, 8 items: $19.00, 9 items: $21.00, 10 items: $21.75, Add $1.75 for each additional item. Overnight: additional $25.00. International orders: additional $35.00

LOGO01EX

Many people credit Allan Pinkerton with developing America’s first detective agen-cy, but few realize he also trained the first female detective. However, it wasn’t ex-actly his idea. He wasn’t even sure it was a good idea, but Kate Warne insisted that she could go places and do things that no male agent could. When François Eugene Vidocq started the Suretè in Paris in 1811, he’d employed female undercover operatives, but none had made it a career. Pinkerton broke entirely new ground, but once he hired Kate, she became indispensable. He even entrusted her with one of the riskiest and most responsible jobs ever to land on his desk. Because Kate Warne died young and her records were lost, her legacy is dif-ficult to establish, but her bold spirit makes her one of the most valuable women in fo-rensic history.

A Mind of Her OwnAllan Pinkerton arrived in the U. S. from Scotland in 1842. He became Chicago’s

first police detective before he partnered with an attorney to found the organiza-tion that would evolve into the Pinkerton National Detective Agency. “The Eye,” as Pinkerton came to be known, developed a reputation for reliability and expertise. “We never sleep,” was his company motto and he trained agents for undercover operations, railroad security, government espionage, and the pursuit of the West’s most noto-rious bandits. His early efforts during the Civil War gave rise to the Secret Service. In 1856, a delicate young woman came into Pinkerton’s office. He assumed she was looking for clerical work, but she said she was there in response to an ad he’d just placed for a new agent. Once an aspiring ac-tress and recently widowed, Kate Warne was ready for any assignment. As unseemly as it was in those days for a woman to be bold, she’d made up her mind. Pinkerton studied her, and he would later record his impres-sion: “[she was] a slender, brown-haired woman, graceful in her movements and self-

possessed. Her features, although not what could be called handsome, were decidedly of an intellectual cast… her face was honest, which would cause one in distress instinctly [sic] to select her as a confidante.” Pinkerton asked her why she thought she could do this kind of work. She told him she “could worm out secrets in many plac-es to which it was impossible for male de-tectives to gain access.” Warne might have described methods available exclusively to women that could elicit knowledge from even the most careful suspect. Men often told women things they kept secret from other men, whether to brag or unburden their conscience, or simply because women made them feel safe. Pinkerton advised Mrs. Warne that he would consider her proposal. After she left, he talked it over with his brother, who thought it would be a mistake to train a woman as a detective. But Pinkerton had been impressed by the fire he’d seen in Mrs. Warne’s eye. The next morning, he offered her a posi-tion as an operative-in-training. It was his opinion that, male or female, detectives with “considerable intellectual power and knowledge of human nature as will give him a quick insight into character” would do an effective job. Apparently Kate had these qualities, as Pinkerton would one day write in his memoir that she had never dis-appointed him. Kate was a natural for the job, able to play both a female from any walk of life as well as a young male. By some reports, she once even dressed as a Union soldier. She could adopt a Southern drawl, a false name, and the hoop skirts of a lady of means to create whatever impression she might need. She could exploit the way men viewed her as a fragile member of the weaker sex to de-flect their attention from her methods and goals. She was quick to assess a situation, savvy about people, and had a flair for ad-venture. No matter where her boss sent her, she strove to do her best, but she was also pleased with the opportunities to exercise her penchant for drama.


FORENSICS IN HISTORY

By Katherine Ramsland, PhD, CMI-V

KATE WARNE: First Female Detective

s This photo comes from the Library of Congress. The photo is taken of Allan Pinkerton (sitting on the right) during the Civil War at Antietam. Standing behind Pinkerton is believed to be Kate Warne, the first female detective in America. Both are believed to be in the same area during this photo. There are no other known pictures of Warne.

Faux FriendAs various express mail companies formed to compete with the U.S. Postal Service, some hired Pinkerton to investigate finan-cial crimes. One client was Adams Express, out of Chicago. Company executives were faced with the theft of a pouch contain-ing $40,000. Pinkerton studied the details and identified a likely culprit in Nathan Maroney, the manager of a company office in Alabama. On slight evidence, Maroney was arrested. Since he was a popular figure in the area, he’d easily posted the minor bail imposed. It seemed likely that the com-pany would lose its case, so Pinkerton was hired to strengthen it. To Kate’s delight, she would get to dress up in fine clothing. Pinkerton traveled to Montgomery, Alabama, with Kate and three male opera-tives. One detective surreptitiously shad-owed Maroney’s young wife, while Kate posed as the wife of a wealthy businessman to get an introduction. Soon, she’d become Mrs. Maroney’s confidant, learning that the Maroneys’ “good fortune” came from forg-ing bank bills. Another agent turned up the address in New York of a locksmith who’d copied a key for Maroney that was the property of Adams Express. Pinkerton advised Adams Express to get Maroney re-arrested for con-spiracy, which would require a stiff bail and thereby keep him in jail for a while. Once Maroney was ensconced in a cell, Pinkerton sent in an agent to pose as a recently-ar-rested forger. Pinkerton also sent anony-mous letters to Maroney that described another man (an agent) moving in on his wife. When she came to visit Maroney in jail, he confronted her. Flustered, she ad-mitted it. He was so rattled that he needed to talk (just as Pinkerton had hoped). He confided in his cellmate, who offered him the name of a bribable lawyer (another Pinkerton agent). Maroney sent word to his wife to get the stolen money ready to pay the attorney. Mrs. Maroney discussed this with her new friend. Kate considered the situation and agreed that paying the attorney was probably the best course of action. In short order, Mrs. Maroney handed over the sto-len Adams Express pouch with the stolen money. It was incriminating evidence in the theft and Maroney was placed under arrest. At his trial, he was stunned when his former

cellmate, the forger, testified against him, so he quickly pled guilty. The case in which Kate’s contribution is most renowned is the infamous Baltimore Plot.

Saving Lincoln It was the end of winter in 1861. A num-ber of southern states had seceded once it was clear that Abraham Lincoln would be-come the sixteenth U.S. president. He had recently stated in a speech that “a house di-vided against itself cannot stand,” a veiled intimation that for America, slavery was finished. He had attracted many power-ful enemies.

As Lincoln prepared to enter Washington, D.C., for his inauguration, he planned sev-eral stops along the way. Since railroad com-panies offered executive cars for his use, his route was no secret. Any crank could take a shot at him. To make matters worse, there was not yet Secret Service for presidential protection. Pinkerton’s security firm had been hired to scout around, and they were quick to spot trouble. Pinkerton developed the first lead at Baltimore’s Barnum Hotel. He knew this place was a hotbed of anti-Lincoln con-spiracy, so, with an alias, he opened an of-fice, hung out in the bar, and got his hair trimmed in the hotel’s barber shop. The bar-ber, a member of a secessionist group, knew quite a lot about the meetings held there. He liked to express his dark opinion that Lincoln would not live to serve as president.

Pinkerton sent operatives into the city to gather the details of a possible assassi-nation plot. Kate was among them, dress-ing as a wealthy Southern woman visiting Baltimore. She infiltrated the hotel’s social gatherings, moving easily from one circle to another as she listened for details or confirmed what she’d already heard. Soon she was able to report that a plot was in-deed afoot: she even knew how and where it would likely occur. Pinkerton believed that a group of assas-sins would attack the president-elect where he’d be most vulnerable, either at a crowded reception, or somewhere along the stretch that required carriage transport for chang-ing trains. To make matters worse, Lincoln could expect no extra protection from the local police force, as the chief sympathized with the South. Pinkerton informed Mr. Lincoln of the dangers involved in a public appearance. Lincoln asked many questions until he was satisfied that the risk to his life out-weighed the disappointment he would cause by not showing up. He placed him-self in Pinkerton’s hands. Pinkerton’s secu-rity preparation included severing the tele-graph lines out of Harrisburg to prevent messages about Lincoln’s secret departure to Philadelphia from passing to his enemies. Kate Warne coordinated the operatives’ reports and devised a scheme to get Lincoln safely from Philadelphia to Washington. She reserved four sleeping berths close to-gether in the last car of a night train, under the pretext that she and her relatives were escorting her invalid brother. She also made a disguise for Lincoln, wrapping him in a traveling shawl with an upturned collar, giving him a Scottish cap, and urging him to stoop as if burdened with illness. This would hide his signature height. Carrying a worn bag, he boarded through a rear door left unlocked for his convenience, with no one the wiser about his presence on this train save a close friend, his wife, and the Pinkerton operatives. Pinkerton and two of his agents were on board. Kate, in the berth next to Lincoln, remained vigilant throughout the night, armed and ready to act. Pinkerton stood all night on the rear platform, despite the frigid air. His agents were posted at every crossroad and bridge along the way, using lanterns to signal their presence and to offer

“She could adopt a southern drawl,

a false name, and the hoop skirts of a

lady of means to create whatever im-

pression she might need. She could

exploit the way men viewed her as a

fragile member of the opposite sex

to deflect their attention from her

methods and goals. She was quick to

assess a situation, savvy about peo-

ple, and had a flair for adventure.”


a code that all was well… or otherwise.Lincoln’s entourage traveled on the original train so that no one would suspect the co-vert operation. Only when he failed to dis-embark in Baltimore as expected did peo-ple realize he was not going to show. He’d passed through the city that night without incident. By the time the would-be assas-sins, mingling with the crowds, were aware that he had foiled their plan, Lincoln was preparing to accept his new office. Journalists later revealed that the assassi-nation plot had consisted of a plan to derail the train, with a back-up strategy involv-ing a lone shooter. In any event, thanks to Pinkerton and Warne, Lincoln gained time in which to make a number of pivotal de-cisions for the country before John Wilkes Booth succeeded in ending his life.

War EffortThe Civil War during the 1860s brought new opportunities to Pinkerton’s agency to assist with intelligence gathering and security. General McClellan had requested Pinkerton’s service for his own security, set-ting up an office in Cincinnati, Ohio. Kate was one of the operatives assigned. Not long afterward in Washington, Pinkerton discovered a spy operation run by a female - “Wild Rose” O’Neal Greenhow. She was the aunt by marriage of Stephen Douglas, Lincoln’s opponent for his party’s choice for the presidency. Secretly, she worked for the South. A popular and pretty widow with plenty of charisma, Rose moved easily in and out of the city’s elite social circles. Among her friends and acquaintances were senators, diplomats, legislators, and military officers; she’d even been a close friend of President James Buchanan. Thanks to her smuggled information, General Beauregard defeated the Union army at the first battle of Bull Run, and Rose then organized a network of spies to ensure more such victories. But a Pinkerton operative planted in the Confederate army notified his boss. Pinkerton put Rose under surveillance, and when she realized this, she and her ladies devised some clever games of deflection. It was difficult to catch them in the act of es-pionage, but after Pinkerton peered through Rose’s window one night and watched a man provide her with key maps of military defenses, he had the information he needed

to stop her. By August 1861, Wild Rose was under house arrest. Still, she found ways to maintain her network, naively providing Pinkerton with more names. He decided to take his success a step further, so he called in Kate. With a code book discovered during a search of Rose’s home, he composed messages full of false information to a Confederate col-onel. To make these letters more convinc-ing, he had Kate copy them in an imitation of Rose’s handwriting. Unfortunately, the Confederates had learned of Rose’s arrest, so they’d changed the code, foiling Pinkerton’s plan.

Kate Moves OnAs Kate proved herself over and over, she became the supervisor of Pinkerton’s Female Detective Bureau. More female agents were hired and she passed along her expertise. However, her expenses became a sore spot between Pinkerton and his brother, who be-lieved she was actually Pinkerton’s mistress. But Pinkerton was the boss and he made the decisions. He adored Kate, personally and professionally, although he never ad-mitted to a romantic relationship with her. Still, his grief was overwhelming when she fell ill at the age of 35. Pinkerton stayed by her side through her lengthy and painful illness (there no record of what she had), nursing her through it. Finally, Kate Warne could hold out no lon-ger, and on New Year’s Day 1868, she passed away. It was a sore loss for Allan Pinkerton. She’d been one of his key operatives for a dozen years and he’d grown to count on her as his right arm. Whether he wrote more about his time with her or about the cas-es she managed shall never be known, be-cause in 1871, the infamous Chicago fire destroyed his archive.

Having no family of her own, Kate Warne was buried in Pinkerton’s family plot in Chicago’s Graceland Cemetery, in a spot that would be next to Pinkerton’s when he was buried. (There’s no record of what his wife thought of this arrangement.) In Pinkerton’s will, made decades later, he would dictate that Kate Warne’s plot was never to be sold. In later years, when Pinkerton’s son Robert conspired with two other lead agents in 1876 to cease hiring female detectives, Pinkerton sent him a blazing telegram, in-sisting on maintaining his long-held views. “It has been my principle to use females for the detection of crime where it has been useful and necessary,” he wrote. “With re-gard to the employment of such females, I can trace it back to the time I first hired Kate Warne, up to the present time. And I intend to still use females whenever it can be done judiciously. I must do it or falsify my theory, practice and truth.” The agency today carries on Pinkerton’s far-sighted legacy.

Sources:Horan, James D. (1967) The Pinkertons: The Detective

Agency that Made History. New York: Crown.Levy, Lynn H (2005) “Kate Warne: The First Female

Private Investigator had a Baltimore Connection,” PI Magazine, January/February.

Mackay, James. (1996). Allan Pinkerton: The First Pri-vate Eye. Edison, NJ: Castle Books.

Pinkerton, Allan. (2002) A Double Life and the Detec-tives. Fredonia Books.

----- (1884) Thirty Years a Detective, 1500 Books, 2007.

Rowan, Richard W. “Lincoln’s Sister,” The American Weekly, Feb 11, 1951, sameshield.com. n

ABOUT THE AUTHOR

Katherine Ramsland, Ph.D., CMI-V has published over 900 articles and 36 books, including The Devil’s Dozen: How Cutting Edge Forensics Took down 12 Notorious Serial Killers and Beating the Devil’s Game: A History of Forensic Science and Criminal Investigation. Dr. Ramsland is an associate professor of forensic psychology and the department chair at DeSales University in Pennsylvania. She has been a member of the American College of Forensic Examiners since 1998.


Welcome New ACFEI Members!

NEW MEMBERS

New Members Chadwick N. BordeauxDavid J. ClaytonReginald T. CookRobert D. EgbertDaisy GarciaMark K. GoldsteinRyan CW HallJackie HarperEdward C. KimAndy L. MartinezMichael J. MillerThomas J. NigraKathryn M. PeoplesTheresa SardellaJeffrey D. SavianoRita G. UmbergerNejat BocnakCindy Y F ChauThewage D.S. PereraFerhad ThottoliFahmi Alubbad

Stanley G. BellEvan BenjaminAndrea S. BladesLindsey M. BroussardAllan E. BrownRon CarrollJane E. CoxLuis Cruz LopezJames V. DebrowChristopher L. EmoryJoshua M. EudoweRobert L. GeversRod GreggJohn T. GriebelValdee Harmon-SheffieldDenise D. KilburnBeth LanningDominic J. MagaKevin MerrittLee A. MillerDavid MillsapMatthias I. Okoye

Norman M. OsumiAmna ParyaniJanet L. PhillipsJames V. ProvenzanoMelinda J. RockwellJeremiah A. RootMartin A. RothbardS. Sandy SanbarMeredith B. SmithNikki StapakisBarbara A. StephensonMadeleine VescovacciDennis M. YoungArmindo E. ComarTina M. LloydAnna W. Olearnik

New FellowsMarvin E. BullingtonAndrew C. Santora

CERTIFICATION PAYS!

The American College of Forensic Examiners InstituteSM offers certifications that show the world your expertise!

• NEW! Registered InvestigatorSM,RISM

• Certified Forensic Accountant, Cr.FA®

• Certified Medical Investigator®, CMI• Certified Forensic Nurse, CFN®

• Certified Forensic Consultant, CFC®

• Sensitive Security Information, Certified®

• Certified in Disaster Preparedness, CDP-ISM

• Certified Forensic Physician®, CFP• Certification in Forensic Social WorkSM

• Accredited Forensic Counselor, AFCSM

Call (800) 592-1399 or log on to www.acfei.com for more information.


CERT01EX

BOOK REVIEWS

Shocking Cases from Dr. Henry Lee’s Forensic Files Dr. Henry C. LeeJerry Labrioloa, MD

Dr Henry C Lee is highly regard-ed throughout the law-enforcement community as one of the most tal-ented and experienced forensic sci-entists in the world. He has also re-ceived widespread public recognition and media attention through his as-sociation with sensational criminal investigations, including the the JFK assassination, the suicide of White House counsel Vincent Foster, the Chandra Levy homicide, OJ Simpson, Jeri Ramsey, and, most recently, the

Caylee Anthony cases. In this book, Dr Lee and critically acclaimed mystery writer Jerry Labriola, MD, team up again to present another true-crime page-turner on five notorious incidents:

The Phil Spector case: Legendary music mogul Phil Spector •was charged with murder in the death of actress Lana Clark-son, found slain in his mansion. But has Dr Lee produced forensic evidence suggesting her death was a suicide? The Brown’s Chicken Massacre: The savage murder of help-•less employees of a restaurant in Palatine, Illinois, was left unsolved for over a decade until the painstaking forensic skills of Task Force and Dr Lee eventually identified the killers; and, Genocide in Bosnia-Herzegovina: Dr Lee discusses his role in the excavation and, in some cases, the identification of hundreds of bodies in the former Yugoslavia. The evidence he uncovered was later used to build a case against suspects indicted by the International War Crimes Tribunal.Murder in the Sacristy: The brutal murder of a nun in a •Toledo, Ohio, church had bizarre ritualistic overtones and remained unsolved until a priest was prosecuted twenty-six years later - the same priest who had conducted the nun’s fu-neral service! Dr Lee testified at the trial of the priest and here he demonstrates how the perseverance of law enforcement officials and forensic scientists eventually solved the crime; The shooting of a Connecticut state trooper and the uninten-•tional shooting death of a fourteen-year-old young man: Dr Lee discusses the dual hazards of police world - being killed or injured in the line of duty and the accidental killing of in-nocent victims or suspects. In Hartford, while racial tensions threatened to spin out of control, Dr. Lee reconstructed the shooting of an young African American by a police officer. His diligent work defused hostilities that nearly led to a riot.Genocide in Bsnia-Herzegovina: Dr. Lee discusses his role in •the excavation and, in some cases, the identification of hun-dreds of bodies in the former Yugoslavia. The evidence he un-covered was later used to build a case against suspects indicted by the International War Crimes Tribunal.

Combining fascinating details of forensic science with a vivid narrative, this is must reading for true-crime readers and forensic science lovers. n

Ends of the Earth (A Bugman Novel)Tim Downs

Nick Polchak must stop a terrorist from causing a global ecological night-mare.

Two beautiful women from Nick’s past are competing for his heart.

For the first time in his life, Nickis finding it hard to concentrate.

When forensic entomologist Nick Polchak is called to the scene of a murder on a small organic farm in

North Carolina he is astonished to find that the victim’s estranged wife is an old friend, a woman he once worked with—a woman he once had feelings for. When she asks Nick to investigate her husband’s drug-related murder Nick seeks the assistance of Alena Savard, the reclusive dog trainer known to the people of northern Virginia as the Witch of Endor.

Alena jumps at the chance to renew her relationship with Nick—but when she arrives in North Carolina she discovers that she’s not the only woman who has her eye on the Bug Man.

Soon Nick finds his usually analytical mind clouded by thoughts of a strangely human nature. These two women have stirred feel-ings that he can’t quite fathom, feelings of lost opportunities and future possibilities…

Now Nick must navigate the unexplored territory of his own heart while he solves an agroterrorist’s plot to ignite an environmental holocaust that could spread to the ends of the earth. n

Forensic Cardiovascular MedicineBasil RuDusky, M.D.Private Practice, Wilkes-Barre, Pennsylvania

A unique resource for medical exam-ines and forensic specialists, Forensic Cardiovascular Medicine draws upon Dr. Basil RuDusky’s vast experience to provide coverage of the clinical aspects lf cardiac disease in a forensic context. The book emphasizes some of the most frequently encountered cardiovascular medical problems facing the medical examiner or forensic medical special-ist, while also placing special emphasis on those conditions and disease states that are apt to be overlooked, misdi-

agnosed, or tardily considered.


WANT YOUR BOOK REVIEWED?

Mail it!Editor; The Forensic Examiner® 2750 E. Sunshine St.Springfield, MO 65804

Please remember to include a press release.

It covers death certificates, autopsies, and the role of the medical examiner and presents 25 case studies from the author’s experience to illustrate concepts, including cardiac trauma, vascular abnormali-ties, specific cardiopathic disorders, and toxic, physical, technical, epidemiological, and social influences. The book contains the first complete classification of myocardial contusion and blunt cardiac trauma. Includes a special section on the cardiovascular effects of breast cancer therapy Dr. RuDusky has served as a consultant for the federal govern-ment, corporations, insurance companies, and independent medical service agencies. He sits on the manuscript review board for sever-al medical journals and is associate editor of Angiology, the official international journal of the American Society of Angiology and the International Academy of Clinical and Applied Thrombosis/Hemostasis. In this volume, he brings his considerable expertise to this survey of the topic.

Dr. RuDusky’s book was recently published by CRC Press, a di-vision of the prestigious Taylor and Francis Group. It is the world’s first textbook on that particularly important subject, and has been hailed as a must-read for all practicing physicians and those indi-viduals involved in the legal and judicial aspects of cardiovascular medicine. n

certified forensic physician®, Cfp

DIAGNOSIS—JUSTICE

Sometimes the only deciding factor between an innocent person being wrongly convicted or the guilty walking free to victimize again is your expert testimony. You know medicine. This online course will provide you the tools you need to accurately present the facts and stand your ground in court.

Minimum Requirements: ACFEI membership; MD or DO license (or foreign equivalent); and five years of medical experience.

YOU MAKE THE DIFFERENCE. APPLY FOR CFP TODAY!

Track 1: Online Course & ExaminationStep 1: Complete the application and submit:

Online at www.acfei.com•By phone at (800) 423-9737•By fax at (417) 881-4702•By mail at 2750 E. Sunshine St., •Springfield, MO 65804

Step 2: Review the online study guide.Step 3: Pass the exam authored by Dr. Cyril Wecht, MD, JD, CMI-V, CFP Step 4: Submit necessary documentation such as résumé and professional license

Track 2: Portfolio Review Step 1: Complete the application and submit:

Online at www.acfei.com•By phone at (800) 423-9737•By fax at (417) 881-4702•By mail at 2750 E. Sunshine St., Springfield, •MO 65804

Step 2: Submit necessary documentation such as:Current résumé/curriculum vitae•Photocopies of your degree(s), diploma(s), •certificate(s), and license(s)Sample work products•


American College of Forensic Examiners Institute

Application for the

Certified Forensic Physician®, CFP Program

First Name________________________________ M.I.______ Last Name_______________________________________ DOB_________________

Address_________________________________________________ City____________________________________ State_______ ZIP____________

Office Phone________________________________ Home Phone __________________________________ Fax Number________________________

E-Mail_________________________________________ Cell Phone ______________________________Designation__________________________

License Number/State (If Applicable) _______________________________Primary Specialty Area____________________________________________

How did you hear about the CFP Program? _______________________________________________________________________________________

List two Professional References:

Name ________________________________________________________________ Phone ______________________________________________

Name ________________________________________________________________ Phone ______________________________________________ I certify that the information I have provided to American College of Forensic Examiners Institute (ACFEI) is true, correct, and complete. I may be asked to provide additional documentation. I understand that ACFEI reserves the right to verify any and all information that I provide. If I misrepresent my credentials, refuse to provide documentation at a later time if asked, or allow my

membership with ACFEI to lapse, I understand and agree that my membership and/or certification status will be revoked and my membership terminated. I agree that I will notify ACFEI in writing of any civil, criminal, or complaint that is made against me. I agree to hold harmless and indemnify ACFEI and its officers, directors, employees, and agents for any misrepresentation of my credentials

and for all claims, loss, judgment, or expense. ACFEI does not endorse, guarantee, or warrant the work or opinions of any individual members. Membership does not imply licensing or registration by

the organization of a member’s qualifications, abilities, or expertise. The objective of ACFEI’s publications and the activities that it sponsors are for informative and educational purposes. The views expressed by the authors, publishers, or presenters are their own views and do not necessarily reflect those of ACFEI. ACFEI does not assume any responsibility or liability for its members or

subscribers’ efforts to apply or utilize the information, suggestions, or recommendations made by the organization, publication resources, or activities.

YES NO

Have you ever been convicted of a felony? If yes, please provide an explanation on a separate sheet of paper. Have you ever been disciplined, or are you currently under investigation, by any legal or licensing board? If yes, please provide an explanation on a

separate sheet of paper.

_________________________________________________________________________________________________________________________ Signature Type or print your name exactly as it should appear on your certificate. Date

Membership and Certification Pricing

Step #1: Membership

Current Member: (Member #) _________________ Become a Member: $165 (for one year’s annual dues) Life Member: $2,500 lifetime membership fee (never pay dues again)

Step #2: Please select your preferred option

Certified Forensic Physician®

, CFP Program Certification Fee: $995

CFP Online Course and Exam Portfolio Review Step#3: Please submit the following documentation with your application:

Current Resume/Curriculum Vitae

Copy of your professional license(s) If applying by portfolio, please submit degree(s), certificate(s), and work products Total Amount Due:_________________

Payment Information

Payment must accompany application. You may choose the payment method that is most convenient (personal/company check or credit card). Payment plans are available.

For the payment plan, a minimum of $250 down payment must be made, and the balance can be paid in monthly installments ($200 minimum) by check or automatically charged to your credit card. Certificate(s) will be issued upon full payment. Annual membership dues for the year are $165 for Members or $190 for Certified Members. Please note annual membership renewal is required in order to maintain your certification. International mailing addresses please add $25 to annual dues to cover

additional postage. There is a $50 administrative fee for all canceled or rejected applications.

Check here for automatic dues renewal, if paying by credit card.

Visa MasterCard American Express Check Enclosed (Payable to ACFEI)

Paid in full $______ Please accept $______ (min. $250) as down payment and charge $_____ (min. $200) per month until balance is paid in full.

Card Number____________________________________________ Expiration Date Signature____________________________________

Fax: (417) 881-4702 or Mail: ACFEI, 2750 E. Sunshine, Springfield MO, 65804

Phone: (800) 423-9737 Email: [email protected] Online: www.acfei.com

Heidi Bale graduated from an Associate Degree program in 1984, and has nearly finished her bachelor’s studies in nursing. The majority of her nursing career has been spent in rural hospitals practicing in a vari-ety of areas—surgery, obstetrics, intensive care, and pediatrics. For 18 years she prac-ticed in emergency nursing, pre-hospital care, and trauma. Her impressive educa-tional background includes certifications in emergency nursing, advanced cardiac life support, pediatric advanced life sup-port, and the trauma nursing core course. In addition she serves on ACFEI’s American Board of Forensic Nursing. During that 18-year period, she taught injury prevention to children and teenagers in many schools as well as to service organizations; she even assisted in the founding of a neighborhood injury prevention program in Jerusalem. For the last eight years of her extensive career she has practiced correctional health care both in a major facility and at headquar-ters, managing out-of-state and jail inmates for the Washington State Department of Corrections. During this time, she earned certification in correctional health care. She also developed a study curriculum for prac-titioners who wished to take the certification exam; it is still used today by the National Commission for Correctional Health Care. Since September 2008, the focus of her practice has been home health and hospice care. However, she has plans for the near future to become a legal nurse consultant and open her own practice.

Heidi enjoys speaking at conferences and has presented at numerous corrections and health care conferences across the United States, including ACFEI. Her work has been published in both CorrectCare and The Forensic Examiner®.

Could you discuss your involvement with the CFN program and how it has helped you in your work?I had been a member for about three years and heard about it [the CFN] from reading The Forensic Examiner®. I feel strongly that the certification “raises the bar” and adds useful education to any nursing curricu-lum. It connects you to other high-caliber members of the nursing community. The certification has benefited my work through its improvement of the quality of my doc-umentation—it is much clearer, and I can communicate better and more observantly to others. I refer to the program frequently and enjoy its updates. In my current career I work with adult protective services; it is a team effort that requires excellent com-munication and documentation between all involved.

What does your typical workday entail?As of right now, my patient load is light. I fill in for people who are off-duty or oth-erwise unable to be at work. Because of my up-front, blunt, honest nature, many of my patients fire me. They don’t like being told what they need to do, but it’s pretty sim-ple—they either fire me, ignore my medi-cal advice, and die; or, they listen to me, get better, and can go back to living an active, unassisted life in their community. Today I worked with two elderly pa-tients. One of them is over 90 and has both diabetes and pneumonia, and the other is bedbound and suffers from dementia. A portion of my time with patients is spent monitoring their vitals and staying on top of their conditions. I also frequently check on patients’ mental and emotional statuses. Patient and family education support is im-portant because it gives patients the tools

they need to live comfortably and with dig-nity, and have their symptoms managed well. I can drive anywhere from 20 to 100 miles daily; sometimes I have up to five or six patients across the county. Because it is a very rural area, I have learned to look at a map once, then gauge and plan the day, driving distances, and durations of visits (based on type of care being provided).

Is there anything that you particularly dislike or wish you could change about your work?It’s very challenging. My personality is ba-sically, “put it out there and say it as it is.” This is not always therapeutic for some peo-ple. Regardless, I am not going to change and some people inevitably do not like that. I want to open a legal nurse consul-tant business. I’m pursuing my bachelor’s in nursing and, in April, will complete a certification in legal nursing. Because of my work as a forensic nurse, I’m very good at looking through medical records, find-ing the answers I need, and putting pieces together that others don’t see. This career would allow me to be home more as well as step back from working directly with patients. With regard to patients, a major issue for me is that attitudes and atmospheres are changing. No one cares any longer if people want to get better on their own. I hate that patients have this attitude of not caring about getting better. Because of Medicaid and Medicare, people have a sense of entitlement, an outlook that they have to make no effort to get better, but that someone else will just hand everything to them. Legal nursing will remove me from interacting with people like that.

Do you feel that your work is rewarding?Yes. I realize that hospice work is emotion-ally charged, both negatively and positively. There is a lot of personal satisfaction in giv-ing high-quality end-of-life care to a patient in his or her home, not in a sterile, miser-able hospital. n


INTERVIEW By Heidi Bale, RN, CFN

TAKING THE GOOD WITH THE BAD:An Interview with Heidi Bale, RN, CFN, CCHP

s Heidi Bale, RN, CFN

FALSELY ACCUSED

Wrongfully convicted inmates are often exonerated by DNA evidence and testing; at least, this is what one would typically expect to hear. Sometimes, however, these individuals are freed by an even more compelling argument—that of the “victim.” Allegedly, Biurny Peguero Gonzalez (then only Peguero) and McCaffrey met one night in September 2005 at the intersection of Broadway and Dyckam Street in Inwood (Barish, 2009). Both of them were report-edly drinking heavily that evening. Peguero was parked in front of an eatery where her friends were meeting; McCaffrey met her there and picked her up for a party. She left her friends at the restaurant. Peguero told the jury that because both she and McCaffrey were too drunk to safe-ly drive (while McCaffrey is on the record as saying that after meeting, she initially drove, then after he ascertained that she was far too drunk to drive, at which point he took over for her), they parked in a nearby garage and waited for some of McCaffrey’s friends to pick them up in their van. After arriving at the party, which had ended, she and McCaffrey returned to the garage. According to McCaffrey’s statement, they returned because Peguero received multiple calls from her friends. The attendant of the garage where the vehicle was left is reported to have said that after returning, several of Peguero’s friends arrived and got in her car, where they began “yelling and hitting each other” (Moynihan, 2009). After McCaffrey left, Peguero returned to her friends—still inside the restaurant—and told them McCaffrey had raped her. She admitted herself to Christ Hospital in Jersey City early the next day, displaying bites across her arm and shoulder. Sources claim Peguero recently renewed her Catholic faith as a result of being re-cently married and becoming pregnant—and in March of this year she subsequently admitted to her priest (Reverend Zelijko Guverovic) at St. Anthony’s that the claims of rape she made to her friends and family,

the police, and the jury at McCaffrey’s trial were all lies. As per the reverend’s counsel, Peguero brought the matter to the attention of her lawyer, Paul Callen. From there, they went to the Manhattan District Attorney’s Office, where Peguero recanted her original testimony (Barish, 2009). Incredulously, Peguero made up the sto-ry because after McCaffrey dropped her off and she returned to the restaurant, one of her friends, upset at having been left at the restaurant without a ride, assaulted her. Her friends harassed and fought one another—and were responsible for the bite marks on her arm. One of the women even went so far as to kick in a car window. DNA test-ing in 2008 confirmed that the material in the bite mark lacked male chromo-somes—yet McCaffrey was still convicted in 2006. He was sentenced to 20 years in prison (Eligon, 2009). Chief district attorney Mark Dwyer con-firmed that the results of the DNA test combined with Ms. Gonzalez’s withdrawal of her original testimony led to skepticism about the situation. “We are committed to completing a full, thorough investigation of the matter and have been conducting one,” he said (Barron, 2009). Regardless of her admission of guilt, Gonzalez now faces perjury charges for ly-ing at McCaffrey’s trial. She has reportedly also been difficult to work with, accord-ing to the defense team. She wants to use her Fifth-Amendment right and refuses to testify again. She is expected to receive her sentence on February 9, 2010—and was informed that while she is a United States citizen, she might find herself deported to her birthplace, the Dominican Republic (Moynihan, 2009). While she did go to Christ Hospital after the night of her assault, there was never any report of physical evidence of a rape having occurred. There was no DNA evidence to support her sympathy-garnering claims. Perhaps here lies evinced a double stan-dard with regard to sexual crimes—they seem often to overturn the “innocent until

proven guilty” standard. Living in our mod-ern society while also clinging to the nostal-gic, antiquated notion that everyone who cries rape must be telling the truth is out-dated and naive. Playing the “frail victim” card, this despicable trend can drive the lives of innocent people into the ground. False rape allegations are nothing new. According to statistics released in a 1996 study conducted by the U.S. Department of Justice revealed the following:

Every year since 1989, in about 25 percent of the sexual assault cases re-ferred to the FBI where results could be obtained, the primary suspect has been excluded by forensic DNA test-ing. Specifically, FBI officials report that out of roughly 10,000 sexual as-sault cases since 1989, about 2,000 tests have been inconclusive, about 2,000 tests have excluded the pri-mary suspect, and about 6,000 have “matched” or included the primary suspect (McElroy, 2006).

Sadly, cases like these are not atypical.

ReferencesBarish, S. (2009, August 13). Woman admits to lying

about being raped. WPIX. Retreived December 15, 2009, from http://www.wpix.com

Barron, J. (2009, August 11). Prisoner says DNA test exonerates him of rape. New York Times. Re-trieved December 15, 2009, from http://www.ny-times.com

Eligon, J. (2009, December 10). Formal exoneration for man wrongly convicted for rape. City Room. Re-trieved December 14, 2009, from http://cityroom.blogs.nytimes.com/2009/12/10/rape-conviction-overturned-in-manhattan/#more-111481

Eligon, J. (2009, November 23). Judge sees vindi-cation for a man jailed in rape. New York Times. Retrieved December 14, 2009, from http://www.nytimes.com

McElroy, (2006, May 2). False rape accusations may be more common than thought. Retrieved Janu-ary 2, 2009, from http://www.foxnews.com/sto-ry/0,2933,194032,00.html

Moynihan, C. (2009, December 7). Woman who made false rape charge is guilty of perjury. Re-trieved December 15, 2009, from http://www.ny-times.com n

WRONGFULLY ACCUSED AND CONVICTED:

The Truth About a Lie Sets Imprisoned Man Free



Trail mix, AA batteries, and army green socks might not make the

top of your wish list this holiday season, but for soldiers stationed

abroad over the holidays, it’s the little things that feel like home. The

employees of Management Executives Inc., which operates the American

Psychotherapy Association®, the American College of Forensic Examiners

Institute SM, the American Board for Certification in Homeland Security,

and the American Association of Integrative Medicine, opted to send goody boxes to soldiers this

year instead of exchanging gifts with one another. The donations were part of the Shoebox for Soldiers

program, started by Army mom Rhonda Luttrull in 2008.

Luttrull’s son Dustin Hudson always dreamed of joining the Army, so after high school he enlisted and

was stationed at Fort Campbell, Kentucky. His unit deployed to Afghanistan, and Luttrull

asked family members to help her send packages to Dustin. During a phone con-

versation with Dustin, he mentioned that, sadly, some of the men in his unit had

not heard from home. Luttrull asked her church family to adopt a soldier. They

agreed to pray for their soldiers, send them cards, letters, and packages when-

ever possible. Andy Taylor, morning radio show host at KTTS in Springfield,

Missouri, heard about Luttrull’s ministry and decided they would help sponsor

a drive. Employees at ACFEI contributed 33 boxes to the drive,

and the company paid for postage. In total,

Shoebox for Soldiers collected 430 Priority

Mail boxes stuffed with morale and supply

items for local soldiers serving overseas this

holiday season.

For some, the charitable drive took on personal signifi-

cance. The Forensic Examiner® editor Chris Powers gath-

ered items for a friend who is a Marine based in Afghanistan.

“It was a lot of fun snack foods, Scattergories, lip balms, and lo-

tions—the little things that we don’t think a lot about over here,

but over there it’s a big deal.”

Shoebox for

Soldiers

(Top Right) ACFEI employees hard at work packing boxes for

soldiers serving overseas.

(Left) Conference Coordinator Samantha Cloud carries some of

the 33 boxes Management Executives sent abroad.

ACFEI staff m

embers at work.


American College of Forensic Examiners InternationalSM

2750 E. SunshineSpringfield, MO 65804

American College of Forensic Examiners InternationalSM

2750 E. SunshineSpringfield, MO 65804

www.acfei.com(800) 592-1399

The Forensic Examiner (Sample) - Spring 2010

Documents

Transcript of The Forensic Examiner (Sample) - Spring 2010