What Is an Autopsy?  
A Forensic Pathologist Explains

An autopsy is a detailed examination of a body for the purpose of determining how an individual died. The procedure may be done as part of a criminal investigation or it may be performed at the request of family members.

According to McDonald, one of the main duties of a forensic pathologist is to testify about autopsy findings in court.

“It sounds cliche, but it’s really true that we are a voice for these victims,” he said.

McDonald recounted the case of a young boy beaten to death. He had to describe in detail what had happened to the boy and how the child had died with the mother sitting in the courtroom listening to his testimony. The mother later approached McDonald.

“She still had the grace and the dignity to come up to me and thank me for being a voice for her child,” he recalled.

According to McDonald, autopsies most often lead to a determination of a natural death. However, there are cases—skeletonized remains for example—that can potentially frustrate even the most experienced forensic pathologists.

“There are times we’ve looked at everything we can look at and at the end of the day, we don’t know what happened,“ he said. “An autopsy can only tell so much.”

An autopsy may take place in a hospital or, if circumstances warrant, it may be conducted at a medical examiner facility or coroner’s office.

The Montgomery County Coroner’s Office (MCCO) where McDonald works will soon be opening a new facility which McDonald says will improve their ability to process cases and serve the public.

“As society expands and the population begins to increase, you need an expansion of the death investigation system,” McDonald said.

The death investigation system, he explained, provides a mechanism by which the cause and manner of death can be determined in cases where the individual passes away in an unnatural, unobserved or unexplained way.

“As it expands, we need more personnel to cover increased cases,” McDonald said. The additional personnel ensure the investigations and notification of next of kin will be handled in a timely manner.

The new MCCO facility will have expanded work space and updated equipment including new tables, new x-ray equipment, better storage facilities and larger conference rooms to better accommodate meetings with families as well as educational events for the public.

According to McDonald, there are no hard and fast requirements. That, he added, is a problem as there is a patchwork of different systems which may vary from state to state or even jurisdiction to jurisdiction.

Even in Pennsylvania, some counties rely upon the local coroner’s office for death investigations while others—Philadelphia, Delaware and Allegheny counties—have medical examiners.

Generally speaking though, an autopsy may be conducted when questions exist regarding how, when, where or why a person died.

A medical examiner is a physician who has been specifically trained in forensic pathology, toxicology and other related areas. In jurisdictions with a medical examiner’s office, the medical examiner and assistant medical examiners are appointed to office and will often be formally trained as forensic pathologists. They are responsible for conducting forensic autopsies in their jurisdictions.

Coroners are elected to office. While they may often be physicians, they may not be trained as forensic pathologists. Oftentimes, coroners will hire a forensic pathologist on a contract basis to handle cases.

“We may also call in consultants to help us—like a forensic dentist or forensic anthropologist,” McDonald said. “However, a forensic pathologist should always determine the cause and manner of death.”

Autopsies fall into two general categories: forensic and hospital-based.

A forensic autopsy is the more common type. When certain criteria are met, a medical examiner or coroner will have jurisdiction, and therefore, the authority to determine that an autopsy should be done. These criteria include deaths resulting from trauma or violence, motor vehicle accidents, drug-related deaths or deaths where people are not identified.

Hospital-based autopsies usually involve a natural death in a hospital or a home setting in which family members request an autopsy be performed and sign a consent form.

An autopsy is performed in two different phases—an external examination and an internal one.

In the first phase, McDonald explained, the forensic pathologist will note any identifying characteristics and any obvious signs of natural disease. The body will be assessed for post-mortem changes including rigor mortis (stiffening of the joints and muscles) or livor mortis (settling of the blood) which may help determine time of death. Other factors including discoloration, bloating, skin slippage or insect activity will also be noted. The external examination is documented with photography and the forensic pathologist’s notes.

The next phase involves examining the internal organs. That process begins with a y-shaped incision in which the chest cavity is opened.

“At that point, we’re going to start to examine the different layers we’re seeing,” McDonald said.

This examination includes looking for abnormal accumulations of fluids and any unusual masses. The forensic pathologist will also inspect the organs while still in place. When a gunshot wound is involved, the forensic pathologist will note the wound path, which organs were struck by the bullet and the amount of blood loss internally. In those cases, recovery of the bullet is critical.

“They are very important pieces of evidence,” McDonald said.

After the in situ examination is completed, the organs will be removed, examined, weighed, dissected and sampled. In some cases, slides may be prepared for microscopic examination.

During the internal examination, the forensic pathologist or autopsy technician will also collect fluid samples including bile, blood, vitreous and gastric fluids.

After everything has been examined, the organs are placed back in the body.

“We do pride ourselves in the ability to do a complete autopsy but still allow the family to have a funeral with an open casket if they opt to do that,” McDonald said.

The time required to complete an autopsy can vary greatly depending upon the case.

”A case that does not involve a lot of injury or does not require a lot of specimens, with the help of my technician, can be done in about an hour,” McDonald said.

More complicated ones, he added, can take up to eight hours.

Once the autopsy is completed and a determination is made regarding cause and manner of death, the forensic pathologist will issue a report.

“Sometimes I know the cause of death and manner of death right after an autopsy,” McDonald said. “Other times, if it is a drug death for instance, I might have to wait until the toxicology results come in.”

The autopsy report is then turned over to the coroner for inclusion in the coroner’s report. The coroner’s file may also include reports from forensic investigators, law enforcement, emergency medical services personnel, medical records, dental records and more.