Forensic Pathology: An Overview
Guest: Dr. Nick Batalis - Pathology & Laboratory Medicine, MUSC
Host: Dr. Linda Austin – Psychiatrist, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Nick Batalis, who is a pathologist here at the Medical University of South Carolina, specializing in forensic pathology. Dr. Batalis, let’s talk about what, exactly, forensic pathology is. How would you describe your field?
Dr. Nick Batalis: Forensic pathology is a subdivision of pathology as a whole. I guess it’s easiest to start by explaining that. Pathology, essentially, is the study of disease. So, general pathologists may interpret whether a biopsy is a tumor, or whether it’s a benign tissue. We help in laboratory diagnoses. If you’re getting a blood draw, we can help interpret those values. Forensic pathology, then, is a specialty in which our specific aim in the field is death certification, that is, to determine the cause and manner of death, or how and why individuals have died.
Dr. Linda Austin: Typically, when one thinks of forensic pathology, there’s an association with crime. Is that necessarily so, or do you get involved, let’s say, just a regular unexplained death?
Dr. Nick Batalis: Actually, there are a lot of misconceptions about forensic pathology. One of them is that we just go in, and gunshot wounds, and stab wounds, and that’s all we do. But, actually, half the cases are going to be due to natural disease, not necessarily long-progressing natural disease for which they’ve been under the care of a physician. They tend to be more kind of ordinary folks who didn’t realize that they had, maybe, bad hypertensive disease, bad high blood pressure, or bad coronary arteries, and then they experience a sudden demise. So, those types of cases, more natural-type of cases, with natural disease, really, comprises at least half of our work.
Dr. Linda Austin: So, really, you start with any unexplained death? Would that be correct?
Dr. Nick Batalis: Yeah. The types of death that are referred to a forensic pathologist kind of vary by state and jurisdiction, but, generally, sudden, unexpected deaths in individuals; even folks who are in hospitals. If they’ve only been in the hospital for less than 24 hours, that will follow under our jurisdiction. Generally, the thought is that maybe they didn’t have enough time in the hospital to be fully worked up to determine what was wrong with them. In those cases, generally, forensic autopsy is warranted. Also, deaths that occur in a hospital, maybe after a surgery; within 24 hours of surgery, are generally referred to the forensic pathologist, just to kind of sort out what may have gone wrong, or didn’t go wrong, in the surgery. Beyond that, any “non-natural” deaths, whether an accident, a suicide, homicide, all those types of cases would come to the forensic pathologist.
Dr. Linda Austin: Now, it’s pretty easy to understand why it would be important to find the cause of death if there was suspicious circumstance, if it were part of, potentially, a criminal investigation. But, let’s take the other situation. Let’s imagine you have somebody, an older person, maybe late 70s or 80s, or there’s no particular reason to think that there might be criminal misconduct in some way. Why, in those situations, would it be important to get an autopsy to uncover the cause of death?
Dr. Nick Batalis: Some of those cases are actually some of the most important. Like you said, even if we’re not going to solve a crime, actually, a lot of times, those cases give the most comfort to the families. I had a case, recently, where an older gentleman experienced a rather sudden death. He’d some sorts of medical illnesses, but it was unclear why he died. And it happened so rapidly that the family wasn’t really sure of what happened to him. But through the autopsy, we were able to go through and let the family know what happened. We found significant medical disease that caused his death. And it actually helped the family, I think, cope, and grieve, knowing what he died from, and knowing that the doctors didn’t do anything wrong that may have injured him, and that there wasn’t anything that they’d missed: if only I’d taken him to the hospital sooner. A lot of times people put that on themselves.
Those types of cases can actually help families the most, which is, I think, again, another misconception; that all we deal with is the dead. A lot of times, we deal with the families. So, I think, with some of those older folks, and natural causes of death, it actually helps the families the most.
Dr. Linda Austin: As well as, I would imagine, to understand what genetic illnesses there may be that, perhaps, the family members could take some preventive health measures, such as heart disease, or tumors, or that sort of thing.
Dr. Nick Batalis: Yeah. Every year, we find out that more and more diseases are related to genetics; hereditary diseases and tumors, and such. They may have nothing to do with why the person died. But, maybe, if we can diagnose the tumor, we can let the other generations know. And if it has to do with small children, maybe those kids could get some genetic screening to see if they’re going to be at risk for something that their relative died from.
Dr. Linda Austin: In what circumstances does a family have a choice about whether or not to ask for an autopsy? And, in what circumstances do they have no choice; it’s a state order that there will be an autopsy?
Dr. Nick Batalis: Here in South Carolina, it’s a coroner-based system. The coroner is an elected official. The coroner will take jurisdiction in the cases that I’ve talked about. If there’s an accident involved, a suicide, or homicide, essentially, any non-natural cause of death, the coroner can take jurisdiction.
We really like to encourage open communication between the family and the coroner. I think a lot of folks don’t understand exactly what an autopsy entails, and there are a lot of myths about it. I think if we can talk with the families, and we can talk with the coroners, we can help explain which cases do need autopsies; some cases don’t. Maybe there’s a car accident and a family has a strong religious objection, or otherwise. Maybe we can come to an understanding, take a look at the body from just outside and not conduct a full autopsy. Maybe we can make both sides happy.
Dr. Linda Austin: So, in other words, the autopsy can be guided in part by what is necessary to determine a cause of death? You don’t necessarily have to do the entire autopsy if the family does not wish for that to happen?
Dr. Nick Batalis: Right. In general, we do one or the other. We either do an external examination, where we will examine the outer surfaces of the body, look for any evidence of natural disease or trauma. Otherwise, generally, we do a full autopsy, which involves the dissection of the internal organs.
We try to have open communication with the families as to whether or not they would like an autopsy to be performed. Sometimes the coroner does have to take jurisdiction. For example, a homicide case, if there’s, let’s say, a bullet left inside somebody, we do need to do that autopsy so we can collect the bullet, and collect the evidence. So, that case would go to trial, and we preserve that evidence; preserved the chain of custody. In those cases, we respect the body. We try to respect the family’s wishes as far as time frames, and try to work around their wishes as much as possible. But sometimes there are cases when an autopsy is needed, against the family’s wishes.
Dr. Linda Austin: Now, I think anybody who has ever watched a crime show on TV knows about the pathologist’s report. Are there circumstances where the pathologist talks to the family? Is that possible, if the family wishes that?
Dr. Nick Batalis: Oh, definitely. Depending on the case, we’ll either talk to the families directly, or we’ll talk to the coroner, and the coroner will relay that information to the families. Again, I think that helps to comfort the families quite a bit. They may have some misconceptions about our examination and what an autopsy entails. So, if we can talk to them for even five or ten minutes after we get finished with a case and explain to them what we found, and that their loved one is ready to go; their going to have their funeral just as planned, it helps them grieve, and to move on, knowing that their loved one is intact, and they can still have their funeral, and, at the same time, a better understanding of why they passed.
Dr. Linda Austin: I see. How long does it take to perform an autopsy?
Dr. Nick Batalis: It varies by the case. A fairly straight forward “natural” case, where somebody does not have a lot of trauma, the actual physical exam itself and the autopsy may take approximately two hours, after which we generate a report, which may involve microscopic slides; and maybe a couple more hours, so maybe, in total, approximately four hours.
Dr. Linda Austin: In situations of crime, does the pathologist ever go to the scene of the crime?
Dr. Nick Batalis: Again, this varies by jurisdiction. Here in South Carolina, we don’t often do that. In other systems that are set up as medical examiner systems, pathologists will go to the crime scenes to help correlate findings they may see on the body, to help figure out how those may have come about.
Dr. Linda Austin: Dr. Batalis, thank you so much for talking with us today.
Dr. Nick Batalis: Thank you.
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