Forensic pathology

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The heart of a murder victim.

Forensic pathology is a branch of pathology concerned with determining the cause of death by examination of a corpse. The autopsy is performed by the pathologist at the request of a coroner or medical examiner usually during the investigation of criminal law cases and civil law cases in some jurisdictions. Forensic pathologists are also frequently asked to confirm the identity of a corpse.

The word forensics is derived from the Latin forēnsis meaning forum.^[1]

Scope of forensic pathology

The forensic pathologist:

• Is a medical doctor who has completed training in anatomical pathology and who has subsequently sub-specialized in forensic pathology. The requirements for becoming a 'fully qualified' forensic pathologist varies from country to country. Some of the different requirements are discussed below.
• Performs autopsies/post mortem examinations to determine the cause of death. The autopsy report contains an opinion about :
  • The pathologic process, injury, or disease that directly results in or initiates a series of events which lead to a person's death (also called mechanism of death), such as a bullet wound to the head, exsanguination due to a stab wound, manual or ligature strangulation, myocardial infarction due to coronary artery disease, etc.), and
  • The 'manner of death', the circumstances surrounding the cause of death, which in most jurisdictions include:
    • Homicide
    • Accidental
    • Natural
    • Suicide
    • Undetermined

• The autopsy also provides an opportunity for other issues raised by the death to be addressed, such as the collection of trace evidence or determining the identity of the deceased.
• Examines and documents wounds and injuries, both at autopsy and occasionally in a clinical setting.
• Collects and examines tissue specimens under the microscope (histology) in order to identify the presence or absence of natural disease and other microscopic findings such as asbestos bodies in the lungs or gunpowder particles around a gunshot wound.
• Collects and interprets toxicological analyses on bodily tissues and fluids to determine the chemical cause of accidental overdoses or deliberate poisonings.
• Forensic pathologists also work closely with the medico-legal authority for the area concerned with the investigation of sudden and unexpected deaths i.e. the coroner (England and Wales), procurator fiscal (Scotland) or coroner or medical examiner (United States).
• Serves as an expert witness in courts of law testifying in civil or criminal law cases.

In an autopsy, he/she is often assisted by an autopsy/mortuary technician (sometimes called a diener in the USA).

Forensic physicians (sometimes referred to as 'forensic medical examiners' or 'police surgeons' (in the UK until recently) are medical doctors trained in the examination of, and provision of medical treatment to, living victims of assault (including sexual assault) and those individuals who find themselves in police custody. Many forensic physicians in the UK practice clinical forensic medicine on a part-time basis, whilst they also practice family medicine, or another medical specialty.

In the United Kingdom, Membership of the Royal College of Pathologists is not a prerequisite of appointment as a Coroner's Medical Expert, i.e. doctors in the UK who are not forensic pathologists or pathologists are allowed to perform medicolegal autopsies, simply because of the vague wording of 'The Coroners' Act', which merely stipulates a 'suitably qualified medical practitioner' ie anyone on the GMC Register.

Investigation of death

Deaths where the known cause and those considered unnatural are investigated. In most jurisdictions this is done by a "forensic pathologist", coroner, medical examiner, or hybrid medical examiner-coroner offices.

Terminology is not consistent across jurisdictions

In some jurisdictions, the title of "Medical Examiner" is used by a non-physician, elected official involved in medicolegal death investigation. In others, the law requires the medical examiner to be a physician, pathologist, or forensic pathologist.

Similarly, the title "Coroner" is applied to both physicians and non-physicians. Historically, coroners were not all physicians (most often serving primarily as the town mortician). However, in some jurisdictions the title of "Coroner" is exclusively used by physicians.

Canadian coroners

In Canada, there is a mix of coroner and medical examiner systems, depending on the province or territory. In Ontario, coroners are licensed physicians, usually but not exclusively family physicians. In Quebec, there is a mix of medical and non-medical coroners, whereas in British Columbia, there is predominantly a non-physican coroner system. Alberta and Nova Scotia are examples of ME systems ^[2][3]

Coroners and medical examiner in the US

In the United States, a coroner is typically an elected public official in a particular geographic jurisdiction who investigates and certifies deaths. The vast majority of coroners lack a Doctor of Medicine degree and the amount of medical training that they have received is highly variable, depending on their profession (e.g. law enforcement, judges, funeral directors, firefighters, nurses).

In contrast, a medical examiner is typically a physician who holds the degree of Doctor of Medicine. Ideally, a medical examiner has completed both a pathology residency and a fellowship in forensic pathology. In some jurisdictions, a medical examiner must be both a doctor and a lawyer, with additional training in forensic pathology.

History

Forensic pathology was first recognized in the USA by the American Board of Pathology in 1959.^[4]

In Canada, it was formally recognized in 2003,^[5][6] and a formal training program (a fellowship) is currently being established under the auspices of the Royal College of Physicians and Surgeons of Canada.^[7]

Becoming a forensic pathologist

Forensic pathology is a subspecialty of anatomical pathology. Training requirements differ from country to country.

Australia

There are currently three paths to qualify as a forensic pathologist in Australia. The first is to train solely in forensic pathology (although a significant amount of anatomical pathology knowledge is still required) and pass two examinations for forensic pathology only. The second is to commence training in anatomical pathology, and complete an initial anatomical pathology examination, which takes a minimum of three years; then go on to train solely in forensic pathology and complete a forensic pathology examination, which takes a minimum of two years. The third is to complete a minimum 5 years' training in anatomical pathology to qualify as a fellow in anatomical pathology, then complete a post-fellowship year in forensic pathology (a minimum twelve months further training plus successful completion of an examination).^[8]

Canada

In Canada^[9], anatomical pathology is a five year residency; Then residents who wish to become forensic pathologists must complete a one year fellowship in forensic pathology. Traditionally this fellowship is completed at a centre in the United States, but with the recognition of forensic pathology as a subspecialty by the Royal College of Physicians and Surgeons, this training can now be done in Canada. Currently, the only training program in Canada is in Toronto, with British Columbia, Manitoba, and Alberta possibly offering fellowships in the near future.

United Kingdom

In the UK, anatomical pathology is a five year residency. Successful candidates are eligible for inclusion on the specialist register of the General Medical Council (GMC) having obtained Membership of the Royal College of Pathologists (United Kingdom).

A specialist training (ST) post is applied for post foundation year to enter a training program in Histopathology. Imminent changes as a result of the Tooke report may require two years or more to be fulfilled on general rotational placements before the option of histopathology arises, however the Royal College have not issued their response to this matter as of yet. It is then necessary to obtain the MRCPath Part I examination in the Histopathology after which it is then possible to apply to one of few training posts in Forensic Pathology in the UK. Current approved centres include Belfast, Liverpool, Leicester, Cardiff, London, Sheffield, Glasgow and Dundee. Not all the posts are currently actively training. Following 3 years training in Forensic Pathology and completion of the FRCPath Part II slanted to Forensic Pathology you may then obtain CCT (certificate of completion of training) and work as a Consultant Forensic Pathologist. Another option is to obtain the full FRCPath in general histopathology, followed by another 18-24 months of training in forensic pathology, which will qualify the candidates with either the Diploma of the Royal College of Patholoists in Forensic Pathology (DipRCPath (forensic)), or the Diploma in Medical Jurisprudence (DMJ). In England & Wales you will also need to be Home Office Accredited which will require checks of your training portfolio and completion of a security check and the Expert Witness Training Course run by the Forensic Science Service.

International graduates and specialists will need to apply to the GMC and the RCPath directly to practice Forensic Pathology in the United Kingdom.

United States of America

In the United States of America, forensic pathologists typically complete at least one year of additional training (a fellowship) after completing an anatomical pathology residency and having passed the "board" examination administered by The American Board of Pathology ("board-certified"). Becoming an anatomical pathologist in the United States requires completing a three to five year residency in anatomical pathology, which is something one does on completing medical school. Anatomic pathology (as it is called) by itself is a three-year residency. Most US pathologists complete a combined residency in both anatomic and clinical pathology, which requires a total of four years.

In the US, all told, the education after high school is typically 13 years in duration (4 years undergraduate training + 4 years medical school + 4 years residency (in anatomic and clinical pathology) + 1 year forensic pathology fellowship). Generally, the biggest hurdle is gaining admission to medical school, although the failure rate for anatomic and forensic pathology board examinations (in the U.S.) is approximately 30-40 and 40-50 percent, respectively.

References

External links

• National Association of Medical Examiners (NAME)
• American Academy of Forensic Sciences
• Forensic Science Society
• British Association in Forensic Medicine
• British Association for Human Identification
• British Academy of Forensic Science
• Forensic Medicine for Medical Students - a website providing educational resources in forensic medicine
• Faculty of Forensic & Legal Medicine of the Royal College of Physicians
• Royal College of Pathologists of Australasia
• Forensic Oral Pathology Journal - FOPJ

Becoming a pathologist

• A career in forensic pathology - educational website on career pathways for forensic pathology in the UK and USA
• So, you want to be a forensic scientist? - Simon Fraser University.
• When I grow up: becoming a pathologist by G. William Moore, MD, PhD. - netautopsy.org.
• What is a Pathologist? - a perspective from UK pathologist Fraser Charlton.
• Royal College of Pathologists of Australasia - Follow the "Careers and Training" Link, & go to "Disciplines and Career Brochures", or go to this page directly
• Royal College of Pathologists UK
• Forensic Pathology by David Webb, University of Huddersfield

See also

• Forensic science
• Coroner
• Forensics

Further reading

• Spitz and Fisher’s Medicolegal Investigation of Death – Guidelines for the application of pathology to crime investigation’, 4th Edition, Spitz WU (Editor), 2006 Charles C Thomas Publisher Ltd, Springfield Illinois ISBN 0-398-07544-1
• ‘The Hospital Autopsy’, Burton J and Rutty G (Ed)(2nd Ed), 2001 ISBN 0 340 764201 Arnold Publishers
• 'Knight's Forensic Pathology',(3rd Ed) Saukko P. and B. Knight (2004) ISBN 0-340-76044-3
• 'Forensic Medicine: Clinical & Pathological Aspects'. 2003 Payne-James JJ, Busuttil A, Smock W (Ed) Greenwich Medical Media ISBN 1-84110-026-9
• 'Encyclopedia of Forensic & Legal Medicine'. 2006 Payne-James JJ, Byard R, Corey T, Henderson C. Elsevier (Academic Press). ISBN 0-12-547870-0