Pediatric Forensic Pathology - Case Study Example

Pediatric Forensic Pathology Child abuse is one of the most rampant crimes today; it is also one of the reasons of the increasing child mortality rate. The vulnerability of children makes them prone to abuse and injustice, and throughout time, children had suffered from abuses and injustices from adults, even from their own parents. In fact, in 1999, there were 1,401 reports concerning fatalities due to child abuse; 54% of which were caused by physical abuse, while 43% were derived from neglect (“Child Abuse,” n.d.). Additionally, in 2009, there were 3.3 million confirmed cases and 6 million child abuse allegations in the United States (“National Child Abuse,” n.d.) These data prove that children are the common victims of abuse and maltreatment, which also lead to their early death. Considering that child abuse is one of the most rampant crimes today, medical and legal practitioners try to find scientific and legal procedures to solve child abuse cases. Pediatric forensic pathology, as a medico-legal investigation procedure, proves sufficient enough to solve child death due to abuses. Accordingly, this paper aims to study the historical development of pediatric forensic pathology and analyze the significant events and people that contribute to its development. This paper will also discuss the theories and methods in pediatric forensic pathology; additionally, with case report evidences, this paper will show and analyze the successes and failures of the application of forensic pathology methods. Historical Background of Forensic Pathology in America: 1950 to the Present Medico-legal investigation in America was patterned after England’s Coroner System, which empowers the coroner (equivalent to a sheriff) to perform judicial and ministerial authority over a corpse (Fisher, 1993, pp. 6-12). As an English colony, the American justice and medical system were patterned after the English system; thus, the American and English medical and justice systems are very much alike. During the years 1950 and onwards, American forensic pathology had undergone several changes and innovations; these innovations had contributed to the growth and advancement of forensic sciences in the United States (Rudin & Inman, 2002). Two of the most significant events in the history of forensic pathology in America are the establishments of the American Academy of Forensic Science (AAFS) in Chicago and the printing of the Journal of Forensic Science (JFS) in 1950. These were followed in 1966 by the discovery of the immunoelectrophoretic technique used to identify bloodstains; this technique was developed by Brian J. Culliford and Brian Wraxall. In the following year, the use of gel-based methods in identifying dried bloodstains was also developed, which gave way to the development of methods using isoenzymes in testing proteins and other body fluids. In 1977, the first electronic fingerprint scanning, Automated Fingerprint Identification System (AFIS) was introduced by the FBI, and in 1984, the first DNA profiling test was developed by Sir Alec Jeffreys. DNA profiling was first introduced in US criminal courts in 1987 while in the 1991, the Integrated Ballistics Identification System (IBIS), a computerized imaging system, was launched by the Walsh Automation Inc. In the succeeding years, forensic pathology continued to evolve as a branch of medicine, and throughout the years, forensic pathology methods had helped determine the real causes of deaths. These methods include weapon and fingerprint scanning, DNA identification, and forensic database upgrade. These innovations had also brought police departments together in tracing the culprits of unknown deaths especially those that have traces of abuse. Along with the development of forensic methods, theories, and techniques was the publishing of several research materials and information regarding forensic science. Pediatric Forensic Pathology Overview As the mortality rate of children increases, the need for investigation on the reasons of the increasing mortality rates grows more obvious and necessary. Accordingly, pediatric forensic science emerges as a result of child mortality problems. Pediatric forensic pathology refers to the branch of forensic science concerning the investigation and evaluation of the corpse of children, particularly those whose death is either unexplained, sudden, or traumatic (Caplan & Catanese, 2010, p. 147). Additionally, most pediatric deaths are accidental especially in the toddler stage while there are also situations wherein pediatric deaths are caused by homicide, child abuse, and neglect (Corey & Collins, 2001, p. 247). In all manners of deaths, it is necessary for pediatric forensic pathologists to investigate the type and nature of the injuries as these would determine the real cause of death. Additionally, these information may be derived from investigations on the child’s scalp (for intensity of the impact), skull (for possible fractures affecting the brain), and the brain (the white and gray-matter inside the brain). As pediatric forensic pathology is essential in determining the cause of pediatric deaths, the process and methods involved in Pediatric Forensic Pathology are both necessary and crucial. Throughout the years, forensic pathology experts develop methods and techniques that improve the process of forensic investigation. Methods Pediatric Forensic Autopsy Autopsy performed in Pediatric Forensic Pathology is different from most hospital-based pathology procedures in a way that this process aims to establish the manner and cause of a child’s death as well as answer both medical and legal questions regarding such deaths (Corey & Collins, 2001, p. 247). Moreover, pediatric autopsy also aims to produce trace evidences as well as document and evaluate those evidences especially when the child’s death is initially seen as caused by trauma, accident, and homicide. In situations where the child is unknown, pediatric forensic autopsy also helps in determining the identity of the child. Pediatric autopsy, as a medico-legal procedure, requires proper and thorough documentation of the child’s clothing, trace evidence, physical appearance, and external evidences. External evidences include any expression of abuse, which will be documented in narrative form (with precise words) with pictures and diagrams to illustrate the real situation. Pediatric Odontology Forensic odontology is a procedure in forensic science that involves documentation and analysis of dental records; this medico-legal process involves three areas of proficiency: “identification of human remains; analysis, interpretation, and comparison of bite marks; and personal injury and malpractice (Souviron, 2005, p. 605). This process is helpful in gathering trace evidences even when the corpse has undergone postmortem changes already. The most precise manner in gathering dental records is dental radiography, which involves dental x-ray. As the tooth enamel is the hardest part of the human body, it can exist for long periods enabling pathologists to derive sufficient amount of information using dental records. Additionally, each person has a unique dental formation and structure allowing forensic pathologists to identify a specific person using dental records as well as determine the cause and manner of death. Pediatric Forensic Toxicology Forensic toxicology is the process used if the death case under investigation involves intake of prohibited or prescribed drugs as well as other toxic substances (Dolinak, 2005, p. 487). This process evolves as a response to the increasing death rate related to poison and drug intake; it also aims to document and evaluate the nature of the drug, its specific effects to different types of biological make-up, and the potential complications that the drug had inflicted on the victim. Forensic Toxicology also helps determine whether the victim had been overdosed, taken the drug accidentally, or forced to take the drug. As the process of forensic toxicology includes documentation of data from toxicology specimens (vitreous fluids, gastric contents, internal organ samples, and blood), this process also determines the victim’s level of drug dependency and toxicity. Case Study: Inflicted Versus Accidental Injuries Case Report The case of AB (a 12-month-old boy) puzzles medical and legal practitioners alike as the reports of AB’s father and the physical features of AB show different manifestations on the cause of AB’s death (Cordner, Ehsani, Bugeja, & Ibrahim, 2008, p. 114). Additionally, AB’s case also clarifies the distinction between inflicted and accidental injuries. While AB’s father reports that AB had fallen from his arms causing AB to become unconscious, medical records show that AB’s skull is severely fractured with large bruises on the AB’s scalp, which demonstrates physical abuse. Following the declaration of AB’s death, the father was interviewed and narrated the event: AB was taken to the bathroom in his father’s arms, the father slipped causing AB to fall 3-4 feet and hit the back of his head on the floor, which seems to explain the skull fracture found on AB’s head. After the father’s investigations, the mother arrives, and, having heard that AB had died, was enraged and accused AB’s father of hitting the boy again. The mother’s testimony drives the investigators to evaluate the case in the light of child abuse. However, the investigators, in their interviews with AB’s neighbors, found out that the father had been shouting during the event, and the neighbors confirmed that AB had bruises on the face sometimes. Additionally, a welfare nurse added that there are times when the mother would report the father’s rough handling of AB. These testimonies along with the reports of the forensic pathologist lead to the conclusion that the father is guilty of homicide-related violation. Forensic Odontology and Autopsy in AB’s Case Forensic Autopsy and Odontology are contributive to the solution of AB’s case in a way that those procedures provide evidences regarding the real manner and cause of AB’s death. During the trial, the forensic pathologist, through the evidences gathered from odontology investigations, reports that the fractures in AB’s skull were not due to his fall as AB do not have injuries in his back. In this case, AB had not in fact fallen from his father’s arms, or was never in his father’s arms at all. Instead, the idea that the death of AB is a homicide case is a probable, and the results of forensic pathology findings point out that AB’s case is related to child abuse and homicide. Critical Analysis of Pediatric Forensic Pathology Successes and Failures: 20th-21st Century While pediatric forensic pathology is helpful in solving cases especially those that relate to child abuse, forensic pathology results also have limitations when it comes to the validity of evidences. For instance, as the defendant and complainant both aim to win the case, it is possible that their investigators only aim to support their individual claims to win the case. In AB’s case, the pathologist of the complainant and defendant use the results of forensic investigations mainly to support their claims, even without second-opinions from third-party pathologists (Cordner et al., 2008, p. 131). Thus, the success of pediatric forensic pathology in the 20th and 21st century lies in the reliability of forensic pathology tools and methods, not merely on the ability of pathologist to arrive in conclusive evidences. In the context of reliability, forensic pathology results need to be evaluated by third-party investigators to ensure that the results are truthful and objective. The Importance of Forensics in Police Work and Justice System In the words of Gruspier (1999), forensic science is helpful in police works and in the justice system in a way that this process generates information that could help solve case especially those that involve abuse (p. 1). Additionally, as police and legal practitioners have the responsibility to give justice to the victims, forensic pathology investigation reports produce the necessary information that could help capture the perpetrators of the crime. Accordingly, as the results of forensic pathology investigations have a high level of certainty, cases, especially those involving child abuse, would be solved. This would also prevent child mortality rates from rising even higher. Conclusion Taken together the development of pediatric forensic pathology is driven by the children’s needs for justice and protection against all kinds of abuses. Accordingly, pediatric forensic pathology provides solutions to the increasing number of unresolved child abuse cases. Pediatric forensic procedures such as autopsy, odontology, and toxicology help gather data concerning the true nature, manner, and cause of death. Although these procedures produce objective results, there is also a need to let third-party forensic pathologists to review the results to ensure the reliability of the investigation results. Thus, Pediatric forensic pathology procedures are especially useful in reducing the augmented child abuse-related cases as those would help in arriving at an objective and fair legal verdict. References Caplan, M. J., & Catanese, C. A. (2010). Pediatric forensic pathology. In C. A. Catanese (Ed.), Color atlas of forensic medicine and pathology (pp. 147-188). Boca Raton, FL: CRC Press. Child abuse statistics. (n.d.). Retrieved from http://www.yesican.org/stats.html Cordner, S., Ehsani, J., Bugeja, L., & Ibrahim, J. (2008, February 15). Pediatric forensic pathology: Limits and controversies. Retrieved from http://www.attorneygeneral.jus.gov.on.ca/inquiries/goudge/policy_research/pdf/Limits_and_Controversies-CORDNER.pdf Corey, T. S., & Collins, K. A. (2001). Pediatric forensic pathology. In J. T. Stocker & L. P. Dehner (Eds.), Pediatric pathology (2nd ed. vol. 1) (pp. 247-286). Philadelphia, PA: Lippincott Williams & Wilkins. Dolinak, D. (2005). Toxicology. In D. Dolinak, E. W. Matshes & E. O. Lew (Eds.), Forensic pathology: Principles and practice (pp. 487-502). Burlington, MA: Elsevier Academic Press. Fisher, R. S. (1993). History of forensic pathology and related laboratory sciences. In W. U. Spitz (Ed.), Spitz and Fisher’s medicolegal investigations of death: Guidelines for the application of pathology to crime investigation (3rd ed.) (pp. 3-13). Springfield, IL: Charles C. Thomas. Gruspier, K. L. (n.d.). Pediatric forensic pathology as a forensic science: The role of science and the justice system. Retrieved from http://www.attorneygeneral.jus.gov.on.ca/inquiries/goudge/policy_research/pdf/Gruspier_Role-of-Science-and-Justice-System.pdf National child abuse statistics. (n.d.). Retrieved from http://www.childhelp.org/pages/statistics#gen-stats Rudin, N., & Inman, K. (2002, February 7). Forensic science timeline. Retrieved from http://www.forensicdna.com/Timeline020702.pdf Souviron, R. (2005). Forensic odontology. In D. Dolinak, E. W. Matshes & E. O. Lew (Eds.), Forensic pathology: Principles and practice (pp. 605-630). Burlington, MA: Elsevier Academic Press. Read More