Manner of Death for In-Custody Fatalities

Abstract

In-custody deaths are typically investigated by a medical examiner or coroner (ME/C) and include those that occur while in the custody of the police or in a government detention facility (e.g., prison). The potential manners of death are natural, homicide, suicide, accident, therapeutic complication, and undetermined. Once the cause of death is determined, the manner of death is certified based upon the cause and the circumstances of death. Deaths in custody may be challenging due to the potential for death at the hand of another (e.g., inmate, corrections officer, or law enforcement agent) or due to neglect. When a government takes a person's liberty, they have a duty to ensure safe and adequate housing, food, and medical care. Failure of a responsible party to exercise proper care of a person in-custody, may affect the manner of death. Since in-custody deaths at the hand of a government agent can be challenging to certify, we will focus on these manners of death including those associated with excited delirium (ED). Although manners are easily and consistently applied in most deaths, there are nuances in some instances which may result in jurisdictional variations in the determination of the manner of death. We will discuss these variations as the determination made by the ME/C is an opinion based upon his/her particular training, experience, and judgment.

Uncommon suicide methods in the detention regime in Milan (1993–2019): Forensic contribution on autopsy cases

“…A complete and detailed forensic approach is essential to clarify the circumstances, 8 the means and cause of death in prison, to verify whether the death was an unusual suicide rather than homicide, accident or natural causes. 11 To this end, in 2017, the National Association of Medical Examiners (NOME) developed recommendations to be followed by the medical examiner investigating a death in prison to ensure consistency and reliability of investigations. 12 They state the most suitable procedures to be performed, underlining all potentially useful investigations in these cases: photographic surveys, radiographic analysis, archiving and collection of evidence, histological, toxicological and microbiological investigations are often indispensable.…”

Hostage Situation Homicide

“…Some additional GSW death scenarios where the MOD may be accidental are child shooters, malfunctioning firearms, dropped weapons, animals stepping on the trigger, and certain hunting cases (2), none of which tend to be involved in hostage situations. In certain cases, there may be pressure exerted on the pathologist from police or others to make a ruling of “accident” instead of “homicide.” This is not as likely in GSW cases as it is in police “restraint-associated deaths,” where there can be considerable debate regarding MOD (7, 8). In the case presented, the MOD was determined to be homicide, as the police officer pulled the trigger intending to cause incapacitation of the hostage-taker.…”

“…In certain cases, there may be pressure exerted on the pathologist from police or others to make a ruling of "accident" instead of "homicide." This is not as likely in GSW cases as it is in police "restraint-associated deaths," where there can be considerable debate regarding MOD (7,8). In the case presented, the MOD was determined to be homicide, as the police officer pulled the trigger intending to cause incapacitation of the hostage-taker.…”

Custodial deaths seen in the Office of the Chief Medical Examiner, Lagos, Nigeria: An 11-year autopsy study

“…They are often referred to as in-custody deaths, legal intervention deaths or apprehension deaths. 4,5 Recent interest in this topic by the media and the public at large has led to an attempt to establish the roles that law enforcement agents play in these deaths, as well as attempting to understand how they have been managed by medical examiners or forensic pathologists. For these reasons, the National Association of Medical Examiner in the USA proposed a definition for deaths in custody.…”