Stephen Cordner

Comparison of antiepileptic drug levels in sudden unexpected deaths in epilepsy with deaths from other causes

Summary: Purpose: (a) To compare postmortem antiepileptic drug (AED) levels in patients with sudden unexpected death in epilepsy (SUDEP) with those in a control group of subjects with epilepsy. If SUDEP patients more frequently had undetectable or subtherapeutic AED levels, this would suggest that compliance with AED treatment is poorer in this group and that poor compliance is a risk factor for SUDEP. (b) To determine whether a particular AED was detected more commonly in the SUDEP group, suggesting that this AED is associated with a higher risk of SUDEP.

Developing standards in international forensic work to identify missing persons

This article examines the need to develop standards in international forensic work to identify missing persons as well as provide evidence of international crimes. It is argued that a systematised method of selection of forensic scientists based on credentials and competence be established, as well as agreed international principles and technical standards to govern the work of forensic specialists operating in an international context.

Methadone toxicity causing death in 10 subjects starting on a methadone maintenance programme

Methadone maintenance therapy is designed to reduce the need for addicts to use heroin or other illegal opiates. Death in patients starting on such a program has not previously been documented. We report the death of 10 persons who died within days of starting a methadone maintenance program administered by general practitioners. Their bodies were subject to a full autopsy by forensic pathologists, with a full toxicological examination. The mean starting dose had been 53 mg, which had been increased to a mean of 57 mg by the final dose. Death occurred after a mean of 3 days. The mean blood methadone concentration at death was 2.1 µmol/L. Complete toxicological analysis showed that six subjects had additional drugs present including two with alcohol, two with benzodiazepines and morphine, and one with benzodiazepines alone. Pathological examination revealed the presence of chronic persistent hepatitis in all subjects and bronchopneumonia in five. The causes of death were given as methadone toxicity or methadone toxicity in combination with bronchopneumonia. Our observations highlight the dangers of methadone in the first days of starting on a maintenance program, particularly when the starting doses are relatively high and subjects have no demonstrated tolerance to opiates

Histology in forensic practice

• To discover, describe, and record all the pathological processes present in the deceased and, where necessary, the identifying characteristics of the deceased. • With knowledge of the medical history and circumstances of the death, to come to conclusions about the cause of death, factors contributing to death, and, where necessary, the identity of the deceased. • In situations where the circumstances of death are unknown or in question, to apply the autopsy findings and conclusions to the reconstruction of those circumstances. This will, on occasions, involve attendance at the scene of death, preferably with the body in situ. • To record the positive, and relevant negative, observations and findings in such a way as to enable another forensic pathologist at another time to independently come to his or her own conclusions about the case. As forensic pathology is essentially a visual exercise, this involves a dependence on good quality, and preferably colour, photographs.’’

Flaws in Australian Northern Territory euthanasia law

character of the underlying condition, that other conditions of the Act have been complied with, and that the patient is not suffering from treatable clinical depression. The psychiatric qualification referred to was the Diploma of Psychological Medicine or its equivalent. The DPM was once the pathway into psychiatry but is now not available from any : medical faculty in any university in the country. It was clear from Marshall : Perron, the Northern Territory MP who : sponsored the legislation and who was : speaking at the Conference, that the legis: lators were unaware that this was a redun:

Ethics and Research on Bodies in the Jurisdiction of Coroners or Medical Examiners

An autopsy is a significant event and should not be undertaken for simply narrow purposes. Forensic pathology institutions, whether in coronial or medical examiner jurisdictions, should be actively engaged in research, either directly or by facilitating access to bodies, tissues and data. The challenge, assuming that resources are available, is to do this lawfully, ethically, and in accordance with community expectations. Failure in the challenge will be wrong and cause damage to the reputation of the institution. The risks associated with such research therefore need to be managed. An approach which is transparent and based on respect for the deceased and consent for the activity, while no guarantee of success, is likely to engender community confidence in the activity and in those undertaking it.

Outcomes for Society: Forensic Pathology

Its high profile does not mean that there is a good understanding of forensic pathology. I would like to take the opportunity today to share with you the sort of outcomes society can reasonably expect from its forensic pathology institutions, outcomes derived from the performance of autopsies in deaths referred to the Coroner. Where is the starting point? The US Treasury is as good a place as any!

Humanitarian forensic science

ABSTRACT Humanitarian forensic science is the application of the knowledge and skills of forensic medicine and science to humanitarian action, especially following conflicts or disasters. It sprouted from the experience of the Argentine Forensic Anthropology Team and was shaped by International Humanitarian and Human Rights Law. It has been further developed by the International Committee of the Red Cross, especially since 2003. Since then, there have been many lessons learned. Forensic science has a humanitarian application as well as being a tool for justice. Identification of the dead is an essential component of the proper involvement of a forensic professional in dealing with human remains. Managing large numbers of deaths following a disaster or in a post-conflict environment, from the point of view of human identification, is a completely different exercise compared with everyday work. Meaningful forensic action in large-scale post-conflict or post-disaster settings may not be the exclusive preserve of forensic experts. Improving the capacity of a forensic system to identify the dead requires improvement of the forensic system generally.

The West Kingston/Tivoli Gardens Incursion in Kingston, Jamaica:

On May 24, 2010, 800 soldiers and 370 police officers stormed into Tivoli Gardens, an impoverished district in the capital of Jamaica. Their aim was to restore state authority in this part of Kingston and to arrest Christopher “Dudus” Coke, who was wanted for extradition to the United States on drug and arms trafficking charges. The incursion was the culmination of nine months of national political turmoil. The first aim was achieved, but the second was not, and only at great cost. Around 70 civilians and three members of the security forces were killed. The authors constituted a small group of international forensic pathologists who, at the request of the Public Defender and over a four-week period from mid-June, observed the autopsies of the civilians. This paper describes some of the outcomes of this work, set within the evaluation of the incursion by the Commission of Enquiry. The Enquiry concluded there was evidence of at least 15 extrajudicial killings and was highly critical of many other aspects of the operation and its aftermath.

Patterns of injury – an evaluation

The concept of ‘pattern of injury’ is used in a number of different ways in forensic medicine. The Oxford English Dictionary defines a pattern, in the sense being used here, as ‘a typical instance; a signal example’. In forensic pathology, the concept underpins conclusions that the death belongs in a particular category, e.g., accident versus homicide; in the case of a body found by the road side, the pattern of injury we associate with pedestrians killed by motor vehicles differentiates the death from one due to blunt force assault. In some cases, we cannot assign the death to one category or other because the strength of the pattern is insufficient to distinguish between the two. We also use the concept to describe how we believe a subset of injuries in one deceased might have been caused. For example, defence wounds in a case of homicidal stabbing. More specifically, we use the concept to describe in general terms how a single injury might have been caused, for example, a tramline bruise. Finally, and very specifically, we sometimes use the concept of ‘pattern of injury’ to describe the individualisation of a particular injury to a particular object, for example, the pattern from the sole of a trainer shoe on the deceased’s forehead linking the injury to a particular shoe, or brand of shoe. The multiplicity of uses of the one phrase must be confusing for the trainee and we should distinguish between them. Leaving these definitional issues to one side, there is a threshold issue of whether a pattern (in one or other of the above circumstances) actually exists. We have no data base, no evidential framework in forensic medicine to help us here. The knowledge base is simply descriptive, and varies considerably depending on the context and circumstances. How dowe decide that the threshold has been reached; that a pattern actually exists? If we think a pattern exists, what properly follows from that? This is actually a very large topic. For the purposes of this presentation, it is illustrated by reference to a conviction largely based on forensic medical evidence about the ‘pattern of injury’ in three homicides by stabbing in one incident. The prosecution successfully contended that the pattern of injury was similar in all three and that this meant there was one killer; the defence position was that this was not the case, and that there were two people responsible for the deaths.