One Class, One Day: CSI, for Real
Elizabeth Laposata dissects medical forensics
“Today we’ll cover identification, autopsy procedures, and cause and manner of death,” says Elizabeth Laposata at the start of week eight of her class Medicolegal Death Investigation. The class is part of a master’s program in biomedical forensic sciences, also taken by students in the forensic anthropology program, which began this fall at Boston University’s School of Medicine.
The first step at a death scene, says Laposata, a MED adjunct associate professor, is not taking identification for granted.
“Even when the identity seems obvious, like a person who lives alone found in his or her alleged residence, you have to confirm scientifically that person’s identity,” she says. “It allows for notification of next of kin, settlement of estates, resolution of criminal and civil matters, and the proper completion of the death certificate.”
Laposata points to a case three years ago in northern Indiana, where a coroner incorrectly identified a teen killed in an automobile accident as Whitney Cerak. The other girl, identified as Laura VanRyn, was in a coma. The Cerak family buried what they thought was their daughter, while the VanRyn family was keeping vigil at the hospital.
She discusses photographs that should go in an identification file, including close-ups of the hairline, ears, and face. “If you can determine the decedent’s race, sex, age, time of death, and identifiable characteristics, like hair color, style, and length, facial hair patterns, and any scars, tattoos, and piercings,” she says, “that’s all helpful information.”
Then there’s the protocol at the medical examiner’s office, including taking multiple sets of fingerprints for police agencies and the FBI and specimens for DNA analysis and preparing information for the media. If the body’s face is decomposed, she adds, “a forensic artist can take the skull and draw what the person would look like.”
Techniques for making a positive ID in unusual situations can vary. Laposata tells the class about an investigation she led as chief medical examiner for the state of Rhode Island.
“When I was investigating a serial killer who mutilated his victims, my team and I visited a landfill to recover several body fragments. The suspected victim had been hospitalized, so we ordered her medical records. From slides taken of the victim’s pap smears, we were able to extract DNA and compare it with DNA from the body fragments we found to make a positive ID.”
Laposata then focuses on forensic odontology, the study of teeth. “Resistant to fire and decay, teeth last a long time,” she says. “Adults have up to 32 teeth and 160 surfaces, offering unique sources for identification.” She cites the crash of an Egypt Air jet 10 years ago off the coast of Nantucket. “In one case, we made a positive identification using a single tooth.”
She shows a slide of a set of teeth, her red light pen highlighting the damage. “These are the inside surfaces of the upper teeth, and the enamel has been worn away. Does anybody know why that could have happened?”
One student responds, “A tongue ring?”
Laposata agrees tongue rings can cause damage, but not this kind.
Another student posits, “Bulimia?”
“Exactly,” says Laposata. “This person repeatedly induced vomiting, so gastric acid gradually eroded the enamel on the back surfaces of the teeth. If the victim has a known history of an eating disorder, that’s a compelling point for identification.”
Laposata cites methods for identification, including hardware such as pacemakers and metal ball sockets for a hip prosthesis. “Each piece of hardware includes a serial number tracked by the hospital,” she says.
All that said, some victims remain unidentified. In these cases, advertisements may be placed with personal information and drawings rendered by forensic artists. She shows a Florida newspaper ad describing a victim found in a cardboard box, bound with duct tape and rope, floating in a canal. “Sounds suspicious to me,” she says. The class laughs nervously. After listing more details, she adds, “There is a lot of personal information here that could jog someone’s memory, encouraging a witness to come forward.”
Laposata moves on to autopsy procedures. Shining her pen on a sketch from 1910, she says, “Autopsies haven’t changed much. The first incision is still Y-shaped, and many of the tools are the same. But our methods for diagnosis have changed; there are more sophisticated toxicology tests and molecular biology techniques.”
She highlights an autopsy bay in Florida. “It’s a pleasant place to work,” she says, noting the natural lighting and proper materials. “Autopsies don’t have to take place in a dark, dank ghoulish place.” Her morgue humor elicits chuckles.
She covers the tools of the trade: test tubes for blood, urine, and gastric contents, kits for DNA samples. She stresses the importance of employing an autopsy assistant to weigh organs and help with difficult dissections. She notes proper dress: two pairs of gloves, shoe covers, scrub suit. A mask and plastic face shield are important, because “when using a Stryker saw to remove the decedent’s skull cap, small particles of body fluid can be aerosolized, and shouldn’t be inhaled.”
Laposata switches to cause of death, defined as injury or disease that leads to death. Students scribble notes as she parses cause into three categories: “proximate, immediate, and mechanism.” She encourages students to think carefully: “The proximate cause of death is the initial event that started an unbroken chain of events to the death. This can be something that happened years ago.”
For example, “some children who are diagnosed with cerebral palsy actually developed that condition because they were shaken as babies,” she says. “After the initial event that led to their deaths, they can die 20 years later in an institution. Rather than listing the cause of death as natural, it would be classified as homicide.”
The last slide is a sample death certificate. Laposata explains the procedure for filling it out, including who is authorized to do it and why blank certificates should be carefully monitored. “You should not be able to get your hands on one easily,” she says, “because you could fake someone’s death.”
Class wraps up, but two students stick around. “I’ve had nightmares about tooth problems,” says Kenneth DeCota (MED’11). “The worst dental image I’ve seen was from a victim with meth mouth — the combined effect of what crystal meth does to the body along with the sugar cravings it causes. Makes the teeth turn black and crumble.”
“Maybe you should steer clear of forensic odontology,” jokes Laposata.
Robin Berghaus can be reached at firstname.lastname@example.org.