FORENSIC PATHOLOGYUnder the Microscope

How Did We get Here

Wrongful convictions Evidence based Medicine Recognition of what we can deliver and

what we cannot National Academy of Science report on

Forensic Science (USA)

History of Forensic Pathology in Canada

Hospital based Routine Autopsy Service

Anyone can do an autopsy Certification in Pathology required a candidate

to be able to perform a medico legal autopsy Group of forensic pathologists recognized

the need for specialty training Goudge Inquiry Royal College grants Specialty status to

Forensic Pathology (specialty training 2008)

Wrongful Convictions

Forensic Pathology under the radar until Goudge inquiry

Notable exceptions – Stephen Truscott 1959 conviction of murder, sentenced to death (appeal

denied but sentence commuted to life) Dr. Penistan (district pathologist) testified to time of death

based on gastric emptying supported by Dr. Brooks (Medical officer)

Appeal to Supreme Court 1966 – Battle of the Forensic Pathologists Milton Helpern, Keith Simpson – Crown Francis Camps, Charles Petty – Defense

It was a well known tenant of Forensic pathology even in 1959 that time of death cannot be accurately assessed (Helpern was one of the authors)

Wrongful Convictions

Others Dalton 1989 Johnson 1993

(Wrongful Acquittals)?????

Evidence-based Medicine

Evolved from clinical epidemiology 1988 The use of best evidence in making decisions

relating to diagnosis, investigation and management Assessing quality of evidence* (multiple

systems) Level A – Randomized controlled Level B – Retrospective case controlled Level C – Case series Level D – Expert opinion, physiology, first principal

• UK National Health Service

Deliverables

Important to recognize what forensic pathology can and cannot deliver 1. Time of Death 2. Age of injuries 3. How much force

Particular issue in infant and child deaths homicide vs Accident

4. How long did it take

National Academy of Science

Strengthening Forensic Science in the United States (2009) 1.Certification and Accreditation should be

mandatory 2. Evidence base often sparse and varies

between disciplines Sparse to non in fingerprints, tool mark (bite

mark) 3. Testimony should be grounded in science,

acknowledge uncertainties 4. Strong independent leadership

Future directions

1. Hot tubbing for expert witness Crown and defense experts meet prior to

court Review issues and confirm

Areas in which they agree In areas of dispute discussion takes place, often

conflicts are understood and at times what at first appears as a conflict may not be such a conflict

Must be in Non adversarial

Future Directions

Forensic medicine Opinion on non fatal trauma by a forensic

pathologist (physcian) Clinicians have a different confidence level to

make a diagnosis (51%) Any charge involving physical injury should

have a mandatory review before proceeding to court Diagnosis vs opinion Medical records (aint what they used to be)