CSI: The Real Deal? VIFM INFORMATION SHEET

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1 VIFM INFORMATION SHEET CSI: The Real Deal? by Stephen Cordner AM FRCPA FRCPath Professor of Forensic Medicine, Monash University Director, Victorian Institute of Forensic Medicine When I was a medical student, one of our professors would remind us to read regularly the medical advice column in the Womens Weekly: so you know where your patients are coming from medically, but also because you ll look pretty dumb if your patients think they know more than you do!! So it is with CSI, CSI Miami, CSI New York as well as numerous others every one is a forensic scientist now. So much so, that in the US it is said that jurors, based on their televisual forensic feast, feel free to substitute their own conclusions for those of the expert. (This is in addition to jurors, having been exposed to LA Law, Ally McBeal et al, expecting cross examinations to last three short questions and closing addresses two minutes max!) What impresses me about the reality forensic shows is how free of doubt and worry the key players are. Not only that, how multi skilled and efficient they are. They never make a mistake, never have to repeat anything, or wait for a result, or actually spend any time doing whatever it is they are doing. They never have children that need picking up from school, or who are sick and need looking after, or have dinners that need to be prepared. We need about twenty people for every one of them. If only we were so good! But we do need to consider CSI. It affects what people, including politicians and bureaucrats, think about our work and their expectations about what we ought to be doing. It also creates a powerful philosophical framework for forensic science which derives from its dramatic aims and not from the discipline s societal purpose. For example, it is a serious issue that CSI demonstrates no appreciation of uncertainty, which as far as I am concerned as a forensic pathologist, is the milieu in which my craft is practised. VIFM INFORMATION SHEET DNA TESTING 1

2 How sure can you be that that baby died as a result of shaking? How many times was that person punched? Was he alive when he sustained those injuries? There is no drama, I suppose, in uncertainty, in shades of difference; but for me, getting those shades of difference clear in my own mind, and then trying to convey them to a court, is one of the challenges and attractions of the work. But for a community brought up with apparently scientifically based black and white answers, uncertainty can be difficult to accommodate. The late, and great, Governor of Victoria, Davis McCaughey, reckoned that living with uncertainty was one of the real challenges of our lives. Weighing, evaluating and making decisions about uncertainty is at the heart of our justice system. CSI is about crime, and the criminal aspect of our work is of course the sharp edge of what we do. Fear of crime is at epidemic levels in our community, and the fight against crime has become a deeply ingrained societal aim. CSI s popularity is in part related to this. Perhaps the community feels a need to be reassured that its fear is rationally based. The VIFM tries to resist the seductive impulse to use this to institutional advantage. On a purely numerical basis, responding to crime is a small, even if highly visible, part of what we forensic pathologists do. Of the 4,000 deceased admitted to the VIFM annually (a figure which rises inexorably in line with the population, and then some more Messrs Hulls and Brumby please take note!) about are homicides, with another 50 or so deaths being regarded as suspicious before being resolved as not being homicides. This 5% of cases probably consumes about 20% of pathologists time. These numbers have remained static during the life of the Institute. The homicide rate in Melbourne in 1906 was several times this. By this measure which of course is not the only measure - our society is really quite safe, especially as compared with parts of the United States. (This is not in any way to minimize the terrible experience of those families and friends whose lives are affected by homicide and its aftermath read Helen Garner s excellent book Joe Cinque s Consolation for a real account of that). Unlike our counterparts in CSI, we do not interview suspects and witnesses (although in other cases we may well talk to families and treating doctors about aspects of the deceased s medical history or the circumstances surrounding the death); Victoria Police s specialized Homicide Squad do that. Like our opposite numbers on CSI we do attend the scene, where our colleagues from Victoria Police s Forensic Services Department at MacLeod will also be in attendance. Digital photography means that information from the scene can be on the screen in the mortuary while the subsequent autopsy is in progress, which is a tremendous aid. VIFM INFORMATION SHEET DNA TESTING 2

3 A recent addition to our armoury, which I have yet to see on CSI, is a CAT scanner, obtained to assist with identification of large numbers of bodies, especially if they should be incinerated or fragmented, in the event of a mass disaster or terrorist attack. As comprehensive an examination as an autopsy is, there are still many parts it does not reach, in particular the vast bulk of the musculo-skeletal system (ie the muscles and bones of the arms, legs, neck, back and pelvis). The CAT scanner will dramatically improve our ability to do many things, including more accurately evaluate and represent the multiplicity of fractures that occur in many of our cases, track wounds and locate projectiles more rapidly. In case you are wondering, it will not replace the autopsy and we will not be using the term virtual autopsy at the VIFM because of the false expectations the term creates. The CAT scanner demonstrates many pathological states (and there are very many it won t demonstrate) but even when it shows you the existence and shape of an abnormality, the pathological diagnosis (the precise nature of what is wrong with the tissue) usually has to be inferred. Where diagnosis is critical, autopsy will remain the ultimate investigation, and a more powerful investigation at that, supported as it will be by the CAT scanner. One of the outcomes of the autopsy is to try and relate the autopsy findings to what happened at the scene: to contribute to the reconstruction of events surrounding the death. That forensic pathology is really the what happened specialty, not necessarily the who dunnit specialty, is a revelation to many. A noted American academic forensic scientist, Professor George Sensabaugh, defined forensic science as the archaeology of recent events. Amen! This definition has greatest resonance, and is literally true, in relation to the unravelling of the events leading to the mass graves in many parts of the world, in the former Yugoslavia for example. It is in recreating the circumstances around a death that courts come to understand the true nature of that death, and hence the culpability of the accused. The big gap in CSI for Victorian viewers is how our system deals with and learns from the remaining 3,850 deceased admitted to the VIFM every year. Occasionally, these cases may exercise the minds of the courts (eg claims for compensation from WorkCover, or other personal injury claims), but for the remainder it is a matter of concluding the cause of death and understanding more about the circumstances of death for the peace of mind of the family and for the community s benefit. So it is that we, unlike any other state Australia or elsewhere in the UK or US, have developed systems to try and use the learning we obtain from these VIFM INFORMATION SHEET DNA TESTING 3

4 deaths for the purposes of prevention. (It is amazing how difficult it is to get people to appreciate how special it is that things like this happen in Victoria!) In particular this has produced tangible benefits in the area of medical adverse events your chances of survival following major trauma are better today than they were ten years ago because of the work of the Consultative Committee on Road Traffic Fatalities, an autopsy centred clinicopathological evaluation of the medical and emergency management of people who die from road trauma following the arrival of the emergency services. The work of the Committee leads directly to substantial investment and new procedures resulting in considerable improvements to the preventable death rate. There are many other examples of using our privileged access to the dead, and the knowledge and understanding we gain, for community benefit. Over 10,000 Victorian patients have benefited from the transplantation of human tissue donated by relatives from the deceased to our Donor Tissue Bank. This includes heart valves, bone, skin, and in association with the Lion s Eye Bank, corneas. The Clinical Liaison Service tries to help hospitals and health care providers learn from adverse events identified during the evaluation of deaths referred following health care. This model has been replicated in relation to deaths at the workplace with a new unit starting on July 1 last year. The National Coroners Information System based at the VIFM facilitates research into all deaths reported to coroners across the country, about 15,000 annually. Recent publicity relating to deaths from failing car jacks was based on information from the NCIS. Conditions identified at autopsy which may have genetic implications for surviving family members (eg death from coronary artery disease at an early age) are brought to the attention of the family so that they can seek appropriate advice. Medical advice to families to help them understand better the results of the autopsy, and the overall investigation generally is provided on request. Research generated from the Institute based on our toxicological and circumstantial understanding of road traffic fatalities lead directly to Victoria s latest tool in the fight against the road toll: the capacity to test drivers randomly for amphetamine and cannabis use at the roadside. This will undoubtedly result in improvements in road safety over time. VIFM INFORMATION SHEET DNA TESTING 4

5 And it was only possible because of an attitude: mortui vivos docent, or, Let the dead teach the living. So if we were to be the subject of a television program, I would call it MVD. Whether it would rate, I don t know. But it would be the real deal for Victoria! PS When I use the term we, I am really referring to the highly productive partnership that exists between the VIFM and the Coroners Court of Victoria. Stephen Cordner AM FRCPA FRCPath Professor of Forensic Medicine, Monash University Director, Victorian Institute of Forensic Medicine VIFM INFORMATION SHEET DNA TESTING 5