MEDS 425: Medical Examiner-Coroner: Investigating Death
FALL 2014
Weekday TBA 1 hour 50 minutes
2 units
INSTRUCTORS:
 Lakshmanan Sathyavagiswaran, M.D., F.R.C.P. (C), F.C.A.P., F.A.C.P.
Chief Medical Examiner –Coroner/Director, County of Los Angeles (retired)
Clinical Professor of Pathology and Medicine, Keck School of Medicine of USC
 Guest Faculty from the Keck School of Medicine
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Office Address: Health Science Campus, Keith Administration Building (KAM) 100F
Office Phone: 323-442-4300
Office hours by appointment only.
ADMINISTRATIVE ASSISTANT:
 Erin Yamauchi
o eyamauch@usc.edu
Introduction and Purpose
The chief medical examiner-coroner of Los Angeles County is responsible for determining the cause
of all violent, sudden, accidental and traumatic or unusual deaths; unattended deaths; deaths in which a
criminal act is suspected and such other deaths as are provided by law, and natural deaths where the
decedent has not seen a physician within 20 days prior to death.
This course will emphasize the team-based approach used by qualified forensic scientists, medical
examiners and coroner investigators to investigate the circumstances and determine the cause and
manner of death of decedents falling under the jurisdiction of the coroner. The need for compassion,
integrity, and following of rigorous scientific standards will be emphasized. This will have the greatest
impact on the grieving next of kin and families of the decedent by bringing them closure.
Students will be exposed to a myriad of medical and forensic science professionals during the course
and career paths in forensic medicine will be explored.
Upon successful completion of this course, the student will have a working knowledge of:
1. Career paths in the forensic sciences following undergraduate studies
2. Role of the Medical Examiner-Coroner in the community and public health /Coroner Law
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Coroner law: mandate including local practices for accepting Coroner cases in Los Angeles
County.
Team approach in medico-legal death investigation.
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3. Learn the benefits of autopsies in evaluating natural and unnatural deaths.
4. Role /value of a medico-legal autopsy/forensic toxicology and importance of following procedures
as they relate to evidence collection/submission and maintenance of chain of custody.
5. Understand Manner of Death determination and evaluation of deaths under medical care
6. Overview of investigation of traumatic deaths:
 Describe and different types of firearm injuries. Understand range of fire.
 Describe sharp/blunt force injury patterns and help understand class characteristics of possible
causative instruments /objects.
 Describe different types of asphyxia deaths.
7. Overview of investigation of pediatric and elder deaths from abuse and neglect.
8. Overview of mass fatality management and handling of high-profile cases.
Course Requirements and Grades
 Recommended textbooks for the course:
a)Spitz and Fishers’s –“MEDICO LEGAL INVESTIGATION OF DEATH” 4TH EDITION,2006
b) College of American Pathologists - CAP Press and Publications-- www.cap.org/cappress Handbook of Forensic Pathology,2003
c) Principles of Forensic Toxicology, Revised and Updated 2nd Edition [Paperback]
Barry Levine (Author)
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Course material will be drawn from a variety of sources and catalogued on-line using the on-line
learning management system.
Course materials include a selection of articles from the peer-reviewed medical literature. These
required readings are listed below under Class Sessions.
The course will consist of one 110 minute meeting each week, which will involve a dynamic
combination of lecture, videos, class discussion and special guests.
Prior to each class meeting, students will receive communication with material to read, listen to,
and/or watch in preparation for the session. Students will be expected to be able to discuss the
material during class.
After each meeting, students will receive an email with questions involving material from the
session. These questions will not be graded, but will instead act as practice questions for the final
examination.
Grading breakdown: Letter Grade
10% of the grade will be for attendance and participation
35% of the grade will be for the mid-term examination
55% of the grade will be for the final exam
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Grading Scale:
A 94-100
A- 90-93
B+ 87-89
B 83-86
B- 80-82
C+ 77-79
C 75-76
C- 74-70
D+ 69-67
D 66-64
D- 63-60
F 59-0
Examinations:
Exams will be multiple choice and/or short answer questions or short essays as appropriate and
will cover didactic information provided within the class discussions and readings.
Class Sessions: 1 hour 50 minutes
Week 1: Introduction to the Role of the Coroner /ME in Los Angeles county-Coroner Law/stake
holders/career paths
Recommended Reading:
a) website: AAFS.org Select student careers/ “So you want to be forensic scientist”
b) website: coroner.lacounty.gov
c) Selecting Forensic Pathology as a Career: A Survey of the Past with an Eye on the Future. Hanzlick,
R., Prahlow JA., Denton S., Jentzen J., Quinton R., Sathyavagiswaran L., and Utley S. The American
Journal of Forensic Medicine and Pathology, Volume 29 No 2, June 2008.
Week 2: Scene investigation and the role of Coroner/ME investigator
Recommended reading:
a). Guide to Death Scene Investigation: Documenting and Evaluating the Body
https://ncjrs.gov/pdffiles1/nij/234457.pdf · PDF file
Week 3: Identification of Human remains/Next of Kin Notification
Recommended reading:
a) Department of Defense updated policy on recovery of remains and identificationwww.miafacts.org/remains_policy.
b) DOJ—Notification procedures/ Guide to Death Scene Investigation: Documenting and Evaluating
the Body https://ncjrs.gov/pdffiles1/nij/234457.pdf
Week 4: Forensic Toxicology and Evidence collection/Preservation
Recommended reading:
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a). Guidelines for Obtaining Specimens for Post mortem Toxicological Analysis- www.forensictoxicology.org/guidelines.html
b) Post-mortem drug redistribution — A toxicological nightmare - Original Research Article
Forensic Science International, Volume 45, Issue 3, April 1990, Pages 253-263
Derrick J. Pounder, Graham R. Jones
Week 5: Postmortem change/Time of Death determination
Recommended reading:
a) “The estimation of the Time of Death in the early postmortem period”, Claus Henssge, 1995
b) “Stomach contents and Time of death” Frederick A.Jaffe ,The American Journal of Forensic
Medicine and Toxicology10(1)37-41,1989
Week 6: Medicol-egal investigation of Deaths while under Medical care/ME-Coroner and
Public health
Recommended reading:
a) “Medical Homicide/Neglect” James Gill MD et all-American Journal of Forensic Medicine and
Pathology, March 2009,Volume 30,No.1
Week 7: Mid-Term Examination 1 hour 50 minutes
Week 8: Role of Consultants-Odontology/Neuropathology/Anthropology
Recommended Reading
a)Spitz and Fishers’s –“MEDICO LEGAL INVESTIGATION OF DEATH” 4TH EDITION,2006
b) College of American Pathologists - CAP Press and Publications-- www.cap.org/cappress Handbook of Forensic Pathology,2003
c) Investigation of homicides interred in concrete – the Los Angeles experience. Toms, C., Rogers C.,
Sathyavagiswaran L. Journal of Forensic Sciences 53(1):203-207, 2008
Week 9: Role of Consultants-Anesthesiology/Surgery/Radiology/Cardiology
Recommended Reading
a)Spitz and Fishers’s –“MEDICO LEGAL INVESTIGATION OF DEATH” 4TH EDITION,2006
b) College of American Pathologists - CAP Press and Publications-- www.cap.org/cappress Handbook of Forensic Pathology,2003
c) Pacemaker defibrillator evaluation of Los Angles County Department of Coroner. Saint-Martin P.,
Rogers, C., Muto J., Boyle NG, Reiders D., Sathyavagiswaran L., Journal of Forensic Science 53(5):1-6,
July 2008.
Week 10: Traumatic deaths-Firearms
a)Spitz and Fishers’s –“MEDICO LEGAL INVESTIGATION OF DEATH” 4TH EDITION,2006
b) College of American Pathologists - CAP Press and Publications-- www.cap.org/cappress Handbook of Forensic Pathology,2003
Week 11: Traumatic deaths Sharp/Blunt force trauma/asphyxia
Recommended Reading
a)Spitz and Fishers’s –“MEDICO LEGAL INVESTIGATION OF DEATH” 4TH EDITION,2006
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b) College of American Pathologists - CAP Press and Publications-- www.cap.org/cappress Handbook of Forensic Pathology,2003
Week 12: Psychological autopsies /Death review teams
Recommended Reading:
a)“Evolution of the Psychological autopsy: Fifty years of Experience at the LA county Chief MECoroner’s office” Timothy Botello MD et al ,Journal of Forensic sciences, July 2013,Volume 58,No.4
b)“Child Fatality Review” did chapter entitled “Suicide Case Studies”, Textbook edited by Dr. R.
Alexander, by G. W. Medical Publishing; L. Sathyavagiswaran, MD, and M. Pines, PhD., 2007.
c) "Child and Adolescent Suicide in a Large, Urban Area: Psychological, Demographic, and Situational
Factors", LE. Weinberger, S. Sreenivasan, L. Sathyavagiswaran, E. Markowitz; J. Forensic Science 2001:
46(4) pg 902-907.
Week 13: Pediatric /Elder Death abuse/neglect
Recommended Reading:
a)Spitz and Fishers’s –“MEDICO LEGAL INVESTIGATION OF DEATH” 4TH EDITION,2006
b) College of American Pathologists - CAP Press and Publications-- www.cap.org/cappress Handbook of Forensic Pathology,2003
c) Willoughby V, Heger A, Rogers C, Sathyavagiswaran L. Sexual assault documentation program.
Am J Forensic Med Pathol 2012 Mar;33(1):22-5.
d)“Child Fatality review , An Interdisciplinary Guide “by Randall Alexander MD,Phd,FAAP,2007
e)Kirschner RH and Wilson HL “Fatal Child abuse ;the pathologist perspective “In Reece RM(Ed)
Child abuse, Medical Diagnosis and Management,Willianm and Wilkins publication 1996
Week 14: Mass fatality management/Bioterrorism -the Los Angeles Experience
Recommended Reading
a)Spitz and Fishers’s –“MEDICO LEGAL INVESTIGATION OF DEATH” 4TH EDITION,2006
b) College of American Pathologists - CAP Press and Publications-- www.cap.org/cappress Handbook of Forensic Pathology,2003
c)“Anthrax” Mark LaForce,Clinical Infectious Diseases,1994;19:1009-14
Week 15: High profile deaths/case management /media relations/court testimony
FINAL EXAM 1 hours 50 minutes
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there be any suspicion of academic dishonesty. The Review process can be found at:
http://www.usc.edu/student-affairs/SJACS/..
Emergency Preparedness/Course Continuity:
In case of emergency, and travel to campus is difficult, USC executive leadership will announce an
electronic way for instructors to teach students in their residence halls or homes using a combination
of Blackboard, teleconferencing, and other technologies. Instructors should be prepared to assign
students a "Plan B" project that can be completed at a distance. For additional information about
maintaining your classes in an emergency please access:
http://cst.usc.edu/services/emergencyprep.html
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