Internship in the Investigations Division of Travis County Medical Examiner
During the fall of 2016 and spring of 2017 I conducted an internship with the Travis County Medical Examiner’s office in the investigations division. This report will outline my activities and duties there and explain how a background in anthropology is beneficial to this position in the medicolegal setting. My internship took place in Austin, Texas at the Travis County Medical Examiner’s office. The forensic center is the building that the medical examiners use and is located behind one of the hospitals in Austin. The investigations offices and autopsy suites are located next to each other on the first floor to allow easy communication between the pathologists, autopsy technicians, and death investigators. The second floor houses the toxicology laboratory and the third floor is where the administrative offices are. Almost every door in the facility is locked and only accessible with a valid Travis County Medical Examiner (TCME) identification card, for the safety of any forensic evidence and the employees. The investigations office is staffed by at least one investigator 24 hours a day, 7 days a week. The death investigator is similar to a nurse at a doctor’s office. The investigator gets information and circumstances surrounding a death from the law enforcement agency that is investigating and passes it on to the medical examiners. The investigator gives the examiner an idea of the cause of death based on the context in which the body was found by performing either a scene response, which is the act of going out to the location of the body and conducting a walk-through and search for any clues regarding how the death occurred, or by interviewing witnesses, family members, and law enforcement officers that are at the scene. Almost all unattended deaths, which are those that occur without a medical professional present, in Travis County result in a scene response and investigation. Deaths that occur outside of the county can be reported to us if the investigating county wishes to have an autopsy performed. These types of deaths do not result in the TCME death investigators responding to the location of the body. Funeral homes transport these decedents from their respective locations of death and their examinations are performed for a fee, paid for by the requesting county. When scene examinations are not required, we work in the investigations office. For example, some of my duties as a medicolegal death investigator intern included updating a case log with the previous day’s decedents, locating Legal Next of Kin (LNOK) of positively identified decedents, and taking reports of expected deaths from hospice nurses in the area. When there is a death reported, the investigator must determine if the body falls under the medical examiner’s jurisdiction or if the jurisdiction can be deferred to the decedent’s primary care physician. Usually the hospice cases are deferred to the hospice doctor, unless there is a history of falling, seizure disorder, or other injury in the medical history.
Death Scene Investigation
Almost every time that the TCME is contacted by police or sheriff dispatch operators, there is a scene response. I was allowed to go on natural deaths, overdoses, suicides, and accidental deaths. If there was any suspicion of foul play at a death scene, I had to stay behind. Due to privacy policies and laws, I cannot describe any actual death scenes that I attended. I can, however, provide a hypothetical death and describe a typical scene investigation from the beginning of TCME’s involvement to the end of the scene response. For my hypothetical death, I will use a 22 year old Caucasian male as the decedent. When the investigations division gets a call from a dispatch operator, there is usually limited information available. Sometimes the dispatch operator does not know any information other than the address of the deceased person and the officer that is currently at the location of the body. The investigator is then given the contact information for the responding officer present at the scene and the homicide detective that will be involved in the investigation. Depending on the type of death, a homicide detective may or may not be present at the scene.
In my hypothetical case, the police officer that responded to the scene reports to us on the telephone that the 22 year old decedent had been found suspended from a ceiling beam by a rope. The decedent was found by his mother, at his residence at about 9:00 in the morning. The mother called 9-1-1 and EMS responded. The decedent was pronounced with obvious death at 9:25 am and police responded. Because there were obvious signs of decomposition including bloating, skin marbling, and sloughing of the skin the decedent was left in his found position. After getting the available preliminary information from the officer, the investigator and I are given the green light to head out to the scene. Before leaving the office, we create a case in the computer database and take a picture of an ME card to keep the pictures in the digital camera organized with the correct case number. Investigators have a backpack or bag that they take with them to scenes that is stocked with latex gloves, shoe covers, evidence collection equipment, ankle tags, and body bag seals. Most investigators also carry a clipboard with a storage compartment filled with pens, markers, and extra TCME forms in case there are any calls while out in the field. After loading the “go bag,” clipboard, and camera into the vehicle, we head out to the address of the death.
When we arrive we are waved through law enforcement barricades and provide our names to the scene’s recording officer. At every death scene, there is a recording officer posted outside to document any individuals present. Once we are allowed to pass the barriers, we begin to take a few exterior pictures of the residence. We take photographs of any building numbers visible and of the front door and any damage present on the door frame. An officer or homicide detective greets and informs us that the body is in the living room directly adjacent to the front hallway by the door. We take some more pictures of the short path into the living room, and then we take some overview shots of the room containing the decedent. If any alcohol, drug paraphernalia, or prescription medications are present, it is important to photograph and collect those materials. After photographing the decedent in the context of the room, we begin to photograph the decedent in his found position-hanging from the ceiling beam. The rope that the decedent used as his implement to commit suicide is measured while suspended, along with the height from the ceiling beam down to the floor of the living room. After gathering all required measurements, the decedent is lowered to the floor, taking care to keep the rope in place. The body is placed into a body bag, and the rest of the external examination is conducted. While conducting the external exam, certain aspects of the decedent must be photographed. The upper portion and the lower portion of the front and back of the body are documented. Close up photographs of the face, hands, neck, and genitalia are taken, along with any apparent trauma or healing wounds. We palpate the decedent’s head to look for any trauma that is not apparent and the entire body is looked over for visible trauma. Once the anterior aspect of the body is examined, it is turned and the same process is conducted for the posterior. If there is any livor or rigor mortis, that is noted and included in the investigator’s report of death. After the scene examination of the body and getting all required photographs, an ankle tag with the name, race, and sex of the decedent, and the signature of the death investigator present at the scene is secured to the decedent’s right ankle. A photograph is taken of the tag fastened onto the ankle and the body bag is zipped up. After being zipped, the bag must be sealed with another type of tag. This tag has the signature of the investigating law enforcement officer, the medicolegal death investigator’s signature, and the date of the scene investigation in order to ensure there is no tampering or mishandling of the body from the scene to the medical examiner’s office. The final picture that is taken at the scene is a shot of the place the body was in to show that we took custody of the decedent.
After conducting this portion of the scene investigation, we talk to any family that is present at a scene. If there are no family members at the scene, then we usually head back to the office. At my hypothetical scene, there are family members present, including the decedent’s parents, sister, and a family friend. We get some medical history from the family and ask some detailed questions regarding the decedent. Required questions include whether or not the decedent had a history of drug or alcohol use or abuse and any history of suicidal thoughts, ideations or attempts. After interviewing the family, we give them information on what will happen to the body in the time period that we have custody of it. If they have any questions or concerns about the policies of the ME office, we try to alleviate the worry as best we can without compromising the procedures in place. We then give our condolences and leave the scene.
After arriving back at the office, a scenario report must be written. A scenario report gives the medical examiners context for where and how the body was found to help them in their cause of death rulings. It is basically a report of what information was given to us on scene and what we directly observed while investigating at the scene. There are general guidelines for information that must be included in the scenario report, such as last known responsive time, position found in, and whether the decedent had any complaints or voiced anything concerning during the hours or days leading up to their death. This context report is the main job for the death investigator. It is what assists the pathologists in determining the manner and cause of death. It is written in narrative form, with extensive use of medical and forensic terminology, and includes a probable cause of death as a starting point for the medical examiner to use.. If an identification of the decedent was not made on the scene by a family member via visual ID or the investigator via a government issued identification card, the person will be brought into the office as unidentified and fingerprints will be made and sent off to various law enforcement agencies in an attempt to identify the individual. If there were no family members present at a scene and no information was available on a Legal Next of Kin (LNOK) for the deceased person, the investigator must find family members of the decedent. This involves computer searches most of the time. After the LNOK is found and notified of the death of their family member, they are interviewed and told the procedures just like they would have if they had been present at the scene over the phone. Once the LNOK is found, the autopsy and examination is finished, and we have gathered all relevant medical records and information, the body can be released to the mortuary that the family has selected. After the body is released and the death investigator calls to give the family the doctor’s final ruling on cause of death, the investigator’s job is done for that case.
Valuable Assets to an Investigator
There are many attributes that a good death investigator possesses. The death scene can be a highly emotional environment if there are family members of the decedent present, so professionalism and patience are very important characteristics of a death investigator. For example, a decedent’s family is usually interested in knowing how their loved one’s remains will be treated. If the investigator is seen acting unprofessional, such as joking or laughing during the scene response, the family loses confidence in the investigator’s ability to treat their loved one with respect while the body is at the medical facility.
Observational skills are also an important asset to the investigator so that any items that could have contributed to the cause of death or could aid in identification of the decedent or the LNOK for them are not overlooked while at the death scene. The ability to spot an item like alcohol, drugs, or paraphernalia, even when hidden, is important because the forensic pathologists need to know if there was any recent usage of anything that could have contributed to or caused the death of the person.
Strong communication skills are also very important because the investigator is constantly communicating with people including nurses, doctors, law enforcement officers, and family members of the deceased. An investigator must be comfortable speaking with many different types of people in many different methods, including face-to-face and on the telephone. An investigator must be able to extract information that is required from others and also must be able to convey information effectively to the individuals that need it.
Some days there are no scenes on the shift and there are few phone calls, so we take care of follow up tasks on previous cases. Depending on the day and the types of deaths that occur during the investigator’s shift, death scene responses may or may not happen. Even though there are occasional scene visits, the death investigator job is actually an office job for the most part. Many tasks that must be completed by the investigator involve the computer, so being technologically knowledgeable is important. Being able to think liberally and anthropologically helps in this field because you have to be able to keep up with a very dynamic and changing field. Since a death investigator deals with deaths of people from all ages and ethnicities, being knowledgeable on various cultural practices and popular technologies becomes very useful (Hookano, et al. 2013). An anthropological background also comes in handy when dealing with a death that is more complicated because being a liberal thinker, one can come up with multiple perspectives and break something down layer by layer. The investigators I worked with were all well versed in the different areas and residents of the county. The investigators’ concepts of these different cultures and subcultures are based on statistics and past incidences. A death investigator must be up to date on the many different demographical factors that come into play in an area such as Travis County to effectively do their job.
A background in forensic anthropology can particularly help in this job. Knowledge of human decomposition and taphonomy, which are both studies of the processes of what takes place biologically after death, can be used to help give a rough timeline of when the individual died and what has happened to the body postmortem, or after death. While most of the death scenes that are investigated are not skeletal remains, a level of understanding of osteology can help when there are skeletal remains that need to be collected or a bone is broken on a more recently dead decedent. If skeletal remains are found, knowledge of osteology and anatomy can also help to determine if the bones are human or nonhuman (White and Folkens 2000). Osteology training can also help because of the anatomical terms used in the case reports that are sent to the doctor. Knowledge of skeletal variation, pathological conditions, and traumatic manifestations can aid in estimating cause of death (Christensen, et al. 2014).
I particularly enjoyed being able to see results of my work quickly, as opposed to working and researching for months on one project. Being able to take in all of the information available at the scene and making an educated guess as to the cause of death is one example of quick results. While confronting death constantly can be difficult, it is also fascinating. I always have a surge of adrenaline when we find out we have a scene to attend, even the seemingly uninteresting deaths. The investigator also helps to bring the family members of the deceased closer to having closure regarding the death. I like being able to help in bringing closure through finding cause of death indicators and giving them some piece of mind regarding the way their loved one will be handled at TCME. I have really enjoyed the internship and feel like I would enjoy a career in death investigation. I hope to make my way back into medicolegal investigation soon.
Christensen AM, Passalacqua NV, Bartelink EJ. 2014. Forensic anthropology: current methods and practice. San Diego, CA: Academic Press.
Hookano R, Knight LD, Brunelli RA, Stoppacher R. 2013. Applications of social network media in medicolegal death investigation. Journal of Forensic Sciences, 58(6), 1628-1632.
White TD, Folkens PA. 2000. Human osteology. San Diego: Academic Press.