The Autopsy Alibi

Movies and television have substantially defined our conception of the term forensics as scientific tests or techniques used in connection with the detection of crime. The “autopsy,” a postmortem medical examination to ascertain cause of death and whether such death is a homicide, is included in this depiction. We are led to believe that an autopsy is a search for truth. The reality is something quite different.

Autopsies ordered or required under law by the state in many US counties are performed by a coroner, who is not necessarily a doctor. Some are even sheriffs or funeral directors, elected or appointed. A medical examiner who performs an autopsy is a doctor, usually a pathologist. Clinical autopsies are always done by pathologists. At the same time, some medical examiners may not be forensic pathologists trained in death investigation.

Marcella Fierro, who retired as chief medical examiner in Virginia in 2008, says the autopsy is the cornerstone of death investigation. It was her job to decide which cases to autopsy. As a member of the National Academy of Sciences panel that issued a report recommending an overhaul of the country’s death investigation systems, Fierro was quoted saying about autopsy results, “Most errors are buried.” 

However, an investigative report by The New York Times (How Sickle Cell Trait in Black People Can Give the Police Cover – The New York Times (nytimes.com) has raised questions about the veracity and reliability of autopsies. It appears that sudden deaths in police custody are not buried but are boldly asserted to be related to  the sickle cell trait (SCT). SCT is an inherited blood condition that affects 1 million to 3 million Americans and 8 to 10 percent of Blacks (about 1 in 13), according to the American Society of Hematology.

The sickle cell trait, as contrasted with sickle cell disease, exists when only one parent’s gene trait passes to a child. According to the medical literature, sickle cell trait cannot become sickle cell disease but, under rare and extreme conditions, such as severe dehydration and high-intensity physical activity, may lead to other serious health issues, including sudden death. The CDC has reported (September 2020) that in nearly four decades (1979 – 2017), only 25,665 deaths occurred from sickle cell disease (the severe hereditary form); about 1226 per year. For the most part, according to the CDC, deaths from sickle cell disease were more likely to be caused by infection, stroke, heart disease, liver disease, kidney disease, and lung disease.

In none of the deaths examined by the Times did the person have actual sickle cell disease, though there were instances where imprecise language by medical examiners left the false impression the trait and the disease were the same.

Notwithstanding the medical literature evidence, the Times report, examining 46 sudden deaths in police custody, found:

In none of the deaths examined by the Times did the person have actual sickle cell disease, though there were instances where imprecise language by medical examiners left the false impression the trait and the disease were the same.

While age is not a significant factor in assessing sickle cell effects, in 23 (half) of the examined cases, the deceased was under the age of 30, including two teenagers (14 and 19). In virtually every case, physical struggle with police was involved, and often multiple Taser shocks or pepper spray were used to subdue the individual. Seeking an explanation for its findings, the Times spoke with Dr. James Gill, Chief Medical Examiner of Connecticut and recently elected president of the National Association of Medical Examiners (NAME), who offered:

… that pathologists would not be doing a thorough job if they identified sickle cell trait and failed to mention it in their reports. We know that this, in the right situation, can cause death, and you can’t just ignore that.

In 2014, in the case of Lashano Gilbert, Dr. Gill followed his own professional advice, which was referenced in a state attorney general’s report in September 2015 finding that excessive force was not present with respect to Mr. Gilbert’s in-custody death. As quoted by the state’s attorney:

Dr. Gill found the cause of the death to be physical altercation including restraint, electric shock and pepper spray, during acute psychosis complicating sickle cell hemaglobinopathy and the manner of death homicide (physical altercation with the police). . . . 

The acute psychotic episode and the altercation with the police caused Gilbert’s blood to sickle. Once Gilbert’s blood sickled, the blood was not able to carry enough oxygen to his body, ultimately leading to his death.

The final anatomic diagnosis found that Gilbert suffered from Sickle Cell Trait with resultant cardiac hypertrophy. Dr. Gill’s examination found no evidence of internal injuries or internal collection of blood. Dr. Gill stated that his examination failed to reveal any trauma or injury to Gilbert that would have caused his death. Dr. Gill explained that the acute psychotic episode and the altercation with the police caused Gilbert’s blood to sickle. Once Gilbert’s blood sickled, the blood was not able to carry enough oxygen to his body, ultimately leading to his death. 

The legal statement and interpretation of the autopsy findings exemplifies the imprecision noted by the Times but, moreover, by their own terms, Dr. Gill’s words do not conclude that the sickle cell trait was a cause of death, especially in light of the surrounding circumstances and assault to Mr. Gilbert’s physical system.

The autopsy was far removed from a search for truth or causation. The mere presence of the sickle cell trait permitted the state’s attorney to reach the conclusion that the police conduct was not a cause and no liability attached to police behavior.

Thus, at least in this instance, the autopsy was far removed from a search for truth or causation. The mere presence of the sickle cell trait permitted the state’s attorney to reach the conclusion that the police conduct was not a cause and no liability attached to police behavior.

In 2017, accreditation for Dr. Gill’s state office was suspended by NAME due to a serious understaffing of professional personnel. This omission rates at least as significant as the presence of sickle cell trait in an autopsy. In 2019, a settlement was reached in a lawsuit by relatives of Mr. Gilbert. During trial, the presiding judge provided a view of the evidence before the court:

A surveillance video of the incident at the police department headquarters “demonstrates that after being subdued — in part with Taser darts — Mr. Gilbert was held in a prone position with various officers leaning their weight on him for several minutes before the arrival of the emergency medical personnel.” “By 2:45 a.m., Mr. Gilbert is held in place on the floor with legs pointing toward the holding cell door; despite the Police Defendant’s claim that Mr. Gilbert is resisting after this point, he does not appear to move his legs again before being placed on the stretcher.”

. . . “the evidence on the record raises genuine dispute of material fact concerning whether the officers ignored Mr. Gilbert’s protestations that he could not breathe due to his positioning as they carried out these actions.”

The inclusion of sickle cell trait in autopsy reports does not seem to add any concrete or causal information establishing a cause of death. At best, its mention merely buttresses the more impenetrable shield of qualified police immunity while, at the same time, offers some liability protection to government jurisdictions. But the worst outcome is that autopsies have become alibis for illegal conduct, shifting rationale for the cause of death to an inchoate medical anomaly.

The inclusion of sickle cell trait in autopsy reports does not seem to add any concrete or causal information explaining a cause of death. At best, its mention merely buttresses the more impenetrable shield of qualified police immunity while, at the same time, offering some liability protection to government jurisdictions. . . . Such circumlocution, professionally curated, is a public disservice that contributes to racial biases and erroneous views of our common social responsibility. The damage from alibi autopsies will take years to recover from.

Such circumlocution, professionally curated, is a public disservice that contributes to racial biases and erroneous views of our common social responsibility. The damage from alibi autopsies will take years to recover from. In the meantime, the medicolegal establishment will continue to propagate its beliefs. “So let it be written, so let it be done,” Ramses (Yul Brynner) said in the 1956 film, The Ten Commandments.”

 

 



Categories: CIVIL RIGHTS, crime and punishment, Issues, National, police, POLICING, racial symbols, RULE OF LAW, State

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