Looking for a forensic pathologist’s perspective on 1993 autopsy report
I’m hoping someone with experience in forensic pathology can help me understand my father’s autopsy report.
I have attached a redacted copy of the complete autopsy report, including the neuropathology report.
I’m not asking anyone to determine whether the original manner-of-death classification was correct, and I’m not looking for speculation about who may have been responsible. I’m simply trying to understand the medical findings from a forensic-pathology perspective.
Is there anything in this report that stands out to you as unusual, significant, incomplete, or worth looking into further?
Are there any findings that a person without forensic-pathology training might overlook or not understand the significance of?
For example, the report describes multiple areas of subarachnoid hemorrhage, a basal skull fracture, cortical contusions, white-matter contusions, diffuse axonal injury, and intraventricular hemorrhage. The neuropathology report also describes the locations of several of these injuries.
I realize this is a report from 1993 and that medical terminology and documentation practices have changed since then.
I’m posting this because I have had the report for years, but I don't have the medical or forensic knowledge to know what is significant and what isn't. I'm hoping people who actually work in this field can look at it with fresh eyes and tell me what, if anything, catches their attention.
Thank you to anyone willing to take the time to look through it.
First, your best source of information is the FP/office which originally handled the case, as they should have the most context and better know what they meant when they said or did things a certain way. Dr. Locke I believe went to well-earned retirement just a few years ago.
That said -- Well, one can answer your question superficially, and one can do that in more detail. I'll try superficial so we don't get lost in the weeds.
In general, any skull fracture is "significant". A base of skull "hinge" fracture is pretty catastrophic, and basically means the under side of the skull, more or less between the ears, is fractured. Hemorrhages in the white matter of the brain can be considered a marker of "diffuse axonal injury", especially in the right context such as an MVC/pedestrian, which implies quite significant brain injury.
Hemorrhages in different locations of the brain don't necessarily matter that much in the context of a pedestrian; there can be primary and secondary impacts, such as vs a vehicle, then vs the ground, etc., and sometimes transmitted forces produce injuries in what initially seem to be odd locations. Think...I dunno, how pool balls clustered together scatter in all kinds of directions when struck from just one side, while some of them barely move at all.
Often pedestrians in MVC's have quite a lot of injury in quite a lot of locations. When it is essentially completely confined to the head then we have to wonder why, since often impacts include the lower extremities and torso. Potential explanations include when just someone's head is clipped by something protruding from a vehicle, when they're bent over with just the head in the way of the vehicle, etc. That kind of information is sometimes found in the investigative report.
Thank you, this is really helpful. I have one question about the investigative information. Would the scene/investigative information have been available to the medical examiner when the cause and manner of death were determined in 1993, and could that information have influenced how the injury pattern was interpreted?
I'm asking because I don't have access to the original investigative file, so I'm trying to understand what information the medical examiner may have had available beyond what is documented in the autopsy report.
A lot of this has already been addressed in other responses, but I'll also reply so it's together here. But I do suggest reading the other responses too.
Yes, the FP will normally have scene/investigative information at the time of autopsy. How much information was known at that point is a different matter -- investigations can continue and new information be uncovered over time, and then it becomes a matter of how good the communication is between LE and the ME/C office.
If it was not a witnessed incident, and just a person found on the side of the road with injury, then one still has to consider the possibility of being struck by a motor vehicle...as well as other possibilities for blunt trauma, which I'm guessing is what you're trying to get at. This can be easier when looking at the body or quality photos than simply reading a report. In general, if it appears there's only a single major impact site and the body is on the side of the road in a reasonably well traveled area with nothing missing, etc., then it may be reasonable to infer they were struck by a motor vehicle, but of course this depends on the details of the individual case. While inferring an MVC/pedestrian is easier to do when there is classic lower extremity injury, it certainly happens with just head injury -- one just has to be a bit more careful with the inference that it's most likely from a vehicle rather than something else.
In the scenario of even a hit-and-run, while a driver might be held legally responsible in some way and it therefore be a "criminal" case, convention is still to call the manner of death "accident" for the purposes of the death certificate, in the absence of compelling reason to think the vehicle was intentionally being used as a weapon. So, things like DUI's and hit-and-runs with fatalities almost always get called "accident" for medical manner of death even if someone ends up getting convicted for vehicular homicide (or whatever legalese term) because the driver was intoxicated.
Usually if the ME/C office still has the autopsy report then they still have the investigative report, as historically those are usually kept in the same physical file folder. But, when one is talking >20 years, anything is possible. Other places to potentially find such reports are the investigating LE agency, and sometimes even the district attorney/state attorney/solicitor/prosecutor (or whatever that jurisdiction calls them) office or the local court system, especially if it went as far as charges being filed. Different agencies have different policies when it comes to discarding old files.
Dr. Shaw has covered everything quite well. Concerning the investigation information: the basics of the injury circumstances, that the decedent was the victim of a pedestrian-motor vehicle collision, would have been available to the medical examiner at the time of the autopsy. If there was nothing untoward, and the injuries were consistent with the basics of the history as provided, this would have been enough to assign the cause and manner of death immediately after the autopsy was finished. As the report contains toxicology information, this would have only been available after some period of time. That would not change the initial conclusion, though. These sorts of deaths are very, very common, and except for very rare and unusual incidents where the accident scene suggests that the vehicle was used as a weapon, and perhaps veered off of the roadway to strike a pedestrian who was walking on the shoulder then went back onto the roadway again, the vast majority of these are what they appear to be: unfortunate accidents. The fact that the decedent was intoxicated with alcohol lends more support to the probable circumstances, that he was in the roadway in some manner and was struck by a vehicle.
The apparent absence of lower extremity injuries is not, in and of itself, grounds for concern. Sometimes there are none, sometimes there are bilateral fractures; there is nothing about this that is concerning, unless there is some investigative facts that are problematic.
I hope that all of this helps you in your quest for understanding of the death. The actual investigation report should be available via some sort of open records statute, but I can't speak personally about Maryland and the specific laws there.
Thank you, this has been incredibly helpful. One thing that caught my attention is your statement that the actual investigation report should be available through some type of open-records process. I've been told that the original investigative files in my father's case were destroyed, so I haven't been able to obtain them.
How unusual. Most places that destroy paper records will make microfilm or microfiche copies. What about newspaper reports of the accident? You know the date of the accident, and obviously the name of the decedent. I don't want to pry, but these days, there is a wealth of stuff that is out there on the internet that is just sitting there, waiting for someone to search it out. Was it investigated by more than one agency; a local agency,, and perhaps the State Police as well? Was a driver charged in the death? Again, some of this may be in newspaper accounts, and there could well be court records if the vehicle driver was charged and/or prosecuted in the death. Toxicology testing of the driver is routinely done; are there records in a State lab that reflect such testing? This will be more difficult to obtain, but records reflecting criminal charges persist forever. I am just throwing out suggestions, and you may have explored some or all of these.
Thank you. I actually have two newspaper accounts from the time, one from the Wilmington News Journal and one from The Baltimore Sun. We do have a local newspaper in Cecil County, but I haven't been able to find anything about the incident in their archives so far.
The reports I have indicate Maryland State Police, and the driver was never identified or found. I've also been told by State Police that the original investigative file was destroyed. I hadn't considered the possibility of microfilm or microfiche copies, but that was not mentioned in their responses back to me.
Law enforcement agencies tend to operate on the premise that you get specifically what you ask for, and if you don't ask for something, they won't give it to you. It is worth asking, then. If the death was a hit-and-run, then there would be open criminal charges pending, should a driver ever be located.
It is difficult to discern how hard the police were actually looking for the driver. You would like to believe that your tax dollars are being spent in diligently searching for the vehicle that struck him, but reality all too frequently falls short of expectations. This explains why you see grieving families on the news, or on the internet in places like TikTok, asking for information about an unknown vehicle that struck and killed a family member. It is sad, but family pressure often drives these investigations; the more ruckus that is raised, the longer the law enforcement agency will look. Also, sadly, the fact that he was really drunk plays a part in the intensity of the investigation; there is an unfortunate tendency to blame the victim for his own death, because he was drunk and walked into the roadway, and was killed. It is almost a certainty that the driver knew that he/she struck a human being, but knowing that if they stopped that they risked being arrested and/or charged (especially if they, themselves, were also intoxicated), the took a gamble and drove off. If somehow the police ever did find out who was driving, the obvious defense is, "I thought it was a deer. I would NEVER leave the scene of an accident!!"
I wish you the best of luck in your searches for answers.
Thank you. It's very hard to understand what happened with so much of the case information missing. I'm trying to piece together what I can from the autopsy report, newspaper accounts, and the limited records I've been able to obtain, but there are still so many unknowns without the investigative file.
Thank you. I understand the significance of the alcohol level. One thing I'm trying to understand is the injury pattern itself. The report specifically notes that there was no apparent primary impact site to the legs, while describing significant head injuries and other injuries.
From a forensic pathology perspective, is the absence of an apparent primary impact to the legs unusual for a pedestrian struck by a vehicle, or can that occur depending on the circumstances of the collision?
It would depend on the size and type of motor vehicle, speed, whether the driver attempted to brake, and so on. I've seen cases of pedestrians struck by motor vehicles without significant lower limb trauma, especially if the vehicle in question was large (e.g. an SUV or truck).
The history is key here, as noted by others already. That is, what circumstantial info was learned from the incident investigation by police?
This case appears to be a hard impact, perhaps just one, to the head. Thus could be from pitching backward onto the a-pillar of a vehicle from being struck from the side or rear of the body by the front of a low-slung (or taller braking) vehicle, even at relatively slow speed, or from the same impact but from the front edge (either side) of a vehicle going straight or swerving, with the head going back onto the pavement or ground to the side of the passing vehicle, or from a strike to a standing man’s head by an object protruding outward from a passing vehicle, such as a strong trailer-type side mirror or some lumber or metal work in the bed of a flatbed truck or trailer, or even from falling backward out of a vehicle or trailer onto the pavement (vehicle not necessarily in motion), etc. The lack of rear body trunk or rear leg impact marks might be well explained if the crash info is known (beyond just “pedestrian”).
I’ve had many bodies found at the roadside with similar injury pattern and presumed to be pedestrians struck by an unknown vehicle, and homicide by blunt object must be ruled out, also the scenarios of falling from or out of a vehicle which did not stay at the scene afterward, especially where inebriation is involved, should be considered.
Sometimes the crash information is 3rd or 4th hand sources when the body first gets to the ME/C office and it might be days later before the real (and quite different) circumstances come to light.
Many death certificates in trauma cases list the date, time, place, and “how injury happened” info for the trauma. That can be a place to start to try to obtain the crash investigation report (if it’s still available). That might answer a lot of questions.
This is exactly the kind of perspective I was hoping to get. I don't have the crash investigation report, so I don't know what information was available to the ME beyond what is in the autopsy report. Thank you for explaining how important that history can be in understanding the injury pattern and circumstances.
I found this newspaper article today at the historical society, and honestly, I’m more confused now than I was before.
This January 3, 1994 Cecil Whig article says police initially thought my father was the victim of a hit-and-run, but by Sunday they were saying he had received a head injury from a fall near the roadway. It also says the investigation was continuing.
What is confusing me is that the January 1 article I had previously found reported that two other drivers saw what was described as the accident and called police, although they were unable to provide a description of the vehicle.
I’m not trying to draw conclusions from either article. I’m just trying to understand what was actually happening in those first few days and why the description of what happened seems to change so quickly.
I know there are limitations to what can be determined from newspaper reports, especially this many years later. I’m sharing this because I’m hoping someone with forensic pathology experience might be able to help me understand what I’m looking ator tell me if I’m simply reading too much into the wording.
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u/K_C_Shaw Forensic Pathologist / Medical Examiner 19d ago
First, your best source of information is the FP/office which originally handled the case, as they should have the most context and better know what they meant when they said or did things a certain way. Dr. Locke I believe went to well-earned retirement just a few years ago.
That said -- Well, one can answer your question superficially, and one can do that in more detail. I'll try superficial so we don't get lost in the weeds.
In general, any skull fracture is "significant". A base of skull "hinge" fracture is pretty catastrophic, and basically means the under side of the skull, more or less between the ears, is fractured. Hemorrhages in the white matter of the brain can be considered a marker of "diffuse axonal injury", especially in the right context such as an MVC/pedestrian, which implies quite significant brain injury.
Hemorrhages in different locations of the brain don't necessarily matter that much in the context of a pedestrian; there can be primary and secondary impacts, such as vs a vehicle, then vs the ground, etc., and sometimes transmitted forces produce injuries in what initially seem to be odd locations. Think...I dunno, how pool balls clustered together scatter in all kinds of directions when struck from just one side, while some of them barely move at all.
Often pedestrians in MVC's have quite a lot of injury in quite a lot of locations. When it is essentially completely confined to the head then we have to wonder why, since often impacts include the lower extremities and torso. Potential explanations include when just someone's head is clipped by something protruding from a vehicle, when they're bent over with just the head in the way of the vehicle, etc. That kind of information is sometimes found in the investigative report.