What makes a death suspicious? Besides the obvious, like a knife in the back – some deaths can be quite questionable and not what they seem! Suicides for instance… Is there more than one mark on the neck in a hanging – what is the angle of the mark, does it match the ligature – how was the ligature tied or fastened? Does lividity and rigor mortis match the found position of the remains? When was the person last seen alive? Was there a recent altercation – physical or verbal? Are there scratch marks on the neck showing hesitation or resistance? Any defensive wounds? Any notes or recent verbal threats of suicide?
Did you know it takes much less pressure than suspected to “hang” or “suspend” in the terms of a ligature death. It can be as simple as tying a scarf or belt from a bathrobe to a door knob something similar, then put your head in the loop and lean forward so that your neck is on the loop. The weight of your head and torso leaning forward can create enough pressure to suppress your ability to breath, causing asphyxiation. Often accidental hanging deaths happen during experimentation with autoerotic asphyxia.
Each case starts with a phone call to my office of someone reporting a death. The call starts with basic questions, where is the body, were they on hospice care, any recent surgeries, falls, injuries, suspicious circumstances, unusual amounts of body fluid – vomit, diarrhea, blood and is it near the body or through-out the scene? Is family present? Any drugs, alcohol, open or empty prescription pill bottles? Was anybody home? Was their death witnessed? Did paramedics respond to the scene? Did they do any treatment? If no one was home, was the residence locked? Why did police/fire respond if no one else was home – who called and why?
These are just SOME of the questions we ask when we receive the initial phone call in order to determine what else needs to be done and where to take the investigation next. If the person has a significant medical history, no recent injuries, is at least 65 years old, has been seen by a doctor on a regular basis, no signs of medication abuse, no blood, no contacts for APS (adult protective services), no recent falls, etc… that it appears to be a natural death and the primary care physician is willing to sign the death certificate, then in those cases the person can go to the mortuary and we do NOT need to go out there. Usually in these cases I will send an email or fax to the primary care physician and advise them of the circumstances of the death and why we did not respond. Sometimes they need a little direction in how to word the death certificate so I assist with that too.
If someone is on hospice care it pretty much goes the same. However even a hospice case can warrant further investigation if there are signs of abuse or neglect such as bedsores that are not being cleaned and bandaged, unusual bruises or cuts, dirty bedding, lack of food, apparent dehydration, clogged feeding tube, missing medications, and odd incriminating spontaneous statements by family or caregivers. Then it goes from a medical-natural to something else.
As for the “something else” types of cases, I will get into those on a more individual format. Stay tuned!!!!