Fighting for Life
Tricks and Traps of the Death Investigation System

A Guide for Families Navigating Through Death Within
Prisons * Hospitals * Nursing Homes * Prisons


Table of Contents


  1. SPEECHLESS WITH SORROW
    + Death is Inevitable + Speechless with Sorrow + Ignorance is Not Bliss
  2. THINK FIRST TALK LATER
    + Thinking is Labor Intensive + Critical Thinking + What Critical Thinking Requires + Words are So Important
  3. THE BUSINESS OF DEATH
    + Layers and Players + Different But the Same + Start with Facts
  4. THE MEDICOLEGAL DEATH INVESTIGATION SYSTEM
    + System Varieties + Importance of Death Investigation Systems +Dr. Doe, You are a Pathologist Correct? + Knowledge is Key + Locating Your Death Investigation System + Different Systems within the System
  5. CORONERS and CORONER SYSTEM
    + Titles are Confusing + Job Requirements + Coroner's Inquest + Training and Credentialing + County Level and Elected + Conflicts of Interest, Arrogance and Abuse + Beware of Ongoing Problems
  6. MEDICAL EXAMINERS
    + Medical Doctor and Doctor of Osteopathic Medicine + General Internist and General Practitioner + Surgeon + Chiropractor + Back to the Medical Examiner + Titles are Confusing + Office of the Medical Examiner and Job Duties + Death Investigators + Nuances and Problems + In a Pinch
  7. PATHOLOGISTS
    + Overview
  8. FORENSIC PATHOLOGY and FORENSIC PATHOLOGISTS
    + Training and Certification + Forensic Autopsy
  9. AUTOPSIES
    + Generally + Good Versus Bad Autopsies + Can't Sue + Hospital and Nursing Home Deaths + Forensic autopsy + Requesting First or Second Autopsies
  10. PRISON DEATH INVESTIGATIONS, PRISON HEALTHCARE AND PRISON AUTOPSIES
    + Overview + Requirements Are Not the Same + Prison Healthcare Delivery- The Basics + Incorrect Records Equals Incorrect Death Certificates
  11. SUICIDE
    + Overview + Suicide Investigations in Society + Prison Death by Suicide--Not So Fast + Investigation 101 + When An Inmate Dies + Performance of Life Saving Measures + Dead But Not Dead + Contracted Medical Examiners + Contracted Forensic Pathologists + Notification of Family Often Delayed + What If + When Notified of an Inmate Death + Demand Hard Answers + The Discipline of Thinking and Writing + Location of Body + Autopsy? Maybe--Maybe Not + Death and Inmate Property + Take the Offensive
  12. DEATH CERTIFICATES
    + Overview + The Death Certificate Form + The Elderly + Inmate Death Certificate Reporting + A Warning and an Example + Ensure Accuracy + Hipaa + Privacy Versus Public Protection + Inmate Cause and Manner of Death + What Is Not Being Said + The Death in Custody Reporting Act of 2000
  13. FUNERAL HOMES AND FUNERAL ARRANGEMENTS
    + Funeral Home Practices + Under the Radar + Don't Rush To Cremate + Do Not Agree to Let DOCs Take Care of Funeral Arrangements + Do Not Agree to Sign Burial or Cremation Orders + Embalming--Maybe, Maybe Not + The Embalming Procedure + Chance of Exhumation Later + Mortician Paint + Unethical Behavior + Unprofessional Conduct
  14. TOXICOLOGY AND TOXICOLOGY LABORATORIES
  15. ACCREDITATION
    + Professional Accreditation + Accreditation Agencies
  16. PROFESSIONAL CODES OF ETHICS
    + Morality and Ethics + Codes of Ethics
  17. GET THE FACTS
    + Be in the Know + Be Careful Where You Get Your Information + Don't Guess and Don't Assume
  18. STATUTE OF LIMITATIONS
    + Overview + Statute Guidelines + Statute of Limitations by State
  19. FINAL THOUGHTS

Excerpts from Chapter 11
Suicide and Death Investigation


When An Inmate Dies


When an inmate dies correctional staffers usually rope off the inmate's cell and place the cellblock, housing unit and ultimately if necessary, the entire prison on lockdown. All inmates are confined to their cells unable to see what correctional and medical staffers may be doing. This keeps inmates in the dark and works to the system's advantage. By confining inmates to their cells they could very well be told by correctional staffers that the deceased inmate is alive, that staff is doing all they can do, and an ambulance has been called. The cellblock and cell area may be deemed a crime scene but only insofar as to ensure that other inmates are unable to witness what is being done to the inmate, overhear any conversations that may be taking place, or witness the removal of any evidence from within the cell area.

If death is by apparent hanging correctional staffers oftentimes either cut the deceased inmate down or they mistakenly move the body-even when death is obvious and rigor mortis has set in. Such a practice is usually the result of either poorly trained staff, panic by inexperienced staff, or staff that truly believes that the inmate may still be alive. The latter is most often the reason given by correctional administrators as to why standard investigative techniques are not followed i.e., the body is moved. Too, in some cases life saving measures can actually be delayed by correctional staffers who assume the inmate is deceased when he is not . . .

Dead But Not Dead


When correctional staffers arrive at an inmate's cell and clearly observe that he is deceased and may have been deceased for hours, many times they will handle the situation as if the inmate was still alive. Why? There are a couple of reasons for doing so. One reason is that they do not want other inmates to know that the inmate is actually dead. They want inmates to assume the deceased inmate is still alive. By treating the inmate as if he were alive even though he is dead provides a way for correctional staffers to avoid conducting a medicolegal death investigation. They don't have to conduct them because they're not deeming the inmate as dead. Treating the inmate as if he is alive shifts the issue to ambulance attendants even though there is no question in the mind of EMTs that he is dead and may have been dead for hours.

Once paramedics arrive, medical staffers may or may not tell the paramedics that the inmate had a DNR. Many times paramedics just by training alone are required to begin life saving measures immediately, even if it's clear the inmate is dead unless a DNR is provided to them. They usually are working fast and furious to get the inmate stabilized, on a stretcher, and to an outside hospital. This works to the prison's advantage. First, other inmates may see the paramedics performing life saving measures. They may witness the inmate being transported out of the prison on a stretcher hooked up to I.V.s. That suggests to them that the inmate actually is alive when in reality he is not.

Second, it releases correctional staffers from implementing and conducting any qualified death investigations because in their mind, the inmate wasn't dead even though he was. And third, the inmate will be pronounced dead en route or on arrival to the hospital, not on-site at the prison facility. Treating the deceased inmate as if he were alive allows the prison to report that death as one occurring off-site from the prison. If the inmate is pronounced dead on the way to the hospital or at the hospital itself, the death is then reported in that way inferring he was alive at the prison when in fact, he was dead. If the area hospital happens to be in another county other than the county where the prison facility is located, that inmate's death is reported in the county where the hospital is located-not the county where the prison facility is located. As such, the death will be included in that county's death statistics not the county where the prison is located and certainly not counted as a prison death on-site. Countless prison deaths are reported as deaths en route to area hospitals or at area hospitals themselves rather than at the prison facility where the death actually occurred. This method of prison death reporting is more common than one might think and just one of many reasons why death reporting surveys, studies and statistics are highly misleading, not completely accurate, and fail to track other key information. They fail to take any of these practices into account.


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