HJAR Nov/Dec 2021

HEALTHCARE JOURNAL OF ARKANSAS I  NOV / DEC 2021 11 Brown Arkansas has a hybrid coroner/ medical examiner system. For each of the 75 counties inArkansas, a coroner is elected or appointed. The coroners, alongside other investigative agencies including law enforcement, investigate deaths that occur in the counties they serve. Based on the circumstances of the death, a coroner may request for an autopsy to be performed by one of our six full-time forensic pathologists (medical examiners) at the Medical Examin- er’s Office located within theArkansas State Crime Laboratory in Little Rock, Arkansas. Our medical examiner team is comprised of forensic pathologists, medicolegal death investigators, autopsy technicians, foren- sic photographer, public relations coordina- tor, administrative office teammembers and histotechnologists dedicated to ensuring a thoroughmedicolegal death investigation is completed. Our team performs over 1,400 examinations per year. After an examina- tion is completed at the Medical Examin- er’s Office and based on all of the informa- tion obtained throughout the medicolegal death investigation, the forensic pathologist ultimately completes the death certificate, which includes the cause of death and man- ner of death. Editor What is the most surprising thing or unusual case you have seen? Brown In 2018, I reviewed the investiga- tion of and performed a second autopsy on a female who was killed in the mid-1980s, because additional information about her death, which included new DNA test- ing available to identify the person who killed her, was available. Prior to the sec- ond autopsy, I reviewed the Polaroid photo- graphs of the death scene and autopsy from the mid-1980s, as well as the autopsy report that was completed in the mid-1980s. After her body was exhumed, I performed the second autopsy where I documented multiple injuries, which included findings consistent with blunt force injuries, find- ings suggestive of a bite mark, a patterned injury suggestive of smothering and pat- terned dark discolorations of the skin of the neck consistent with strangulation. In my opinion, the cause of death was mul- tiple injuries, including asphyxia, and the manner of death was homicide. After more than 30 years after her death, I was pleased that while the post-mortem changes in her previously autopsied, embalmed, buried and exhumed body precluded optimal evalua- tion, I was still able to document her injuries and opine on a cause and manner of death. Editor Do you watch forensic-related television shows such as Crime Scene Investigation? Do you think they por- tray forensic pathology accurately? Brown If I amwatching television, it is more likely to be a kids’show (my wife and I have three young children), ESPN (football sea- son is my favorite) or Food Network (Din- ers, Drive-Ins, and Dives is my go-to). While I do not watch much of the forensic-related television shows, not surprisingly, the reali- ties of forensic pathology can be misleading on television to include our ability to deter- mine exactly when someone died. Unless someone has witnessed a death, there is no science available for us to precisely deter- mine when someone died. Rather, we rely on a variety of medicolegal death investigative findings that include circumstantial infor- mation, such as when the person was last known alive, death scene findings, such as markings on a calendar, and post-mortem changes to the body to estimate the time of death. This estimate can be on the order of hours, days, months to years based on the post-mortem interval. Editor Outside of the medicolegal death investigation system, what are some examples of how your services impact our community? Where do you think your services could be used that they are not being applied now? Brown Our team already partners withmany community stakeholders in order to review deaths in the communities we serve and discuss harm reduction efforts to prevent future deaths of similar circumstances. The opportunity for us to partner with profes- sionals dedicated to preventing and sav- ing lives through, for example, child death review teams, elder death review teams and drug death review teams, will only fur- ther help our communities. In addition, the opportunity to continue our work with Arkansas Regional Organ RecoveryAgency (ARORA) without compromising the med- icolegal death investigation is important to our team. ARORA allows family mem- bers to consider organ and tissue recovery at the time of death to save lives of other individuals. Finally, we are very much aware of the critical shortage of forensic patholo- gists in the United States. Our team is opti- mistic that through a partnership with the department of pathology at the University of Arkansas for Medical Sciences (UAMS), we will soon apply to have an Accredita- tion Council for Graduate Medical Educa- tion (ACGME)-approved forensic pathology fellowship program to train future forensic pathologists. n