Anatomy of An Autopsy

They've handled some of the country's most notable deaths: the suicide of Marilyn Monroe, the assassination of Sen. Robert Kennedy and, more recently, the slayings of Nicole Brown Simpson and Ronald Goldman. Each day, examiners with the Los Angeles County coroner's office receive about 50 new cases, making the office one of the busiest in the nation.

Some bodies are examined at a mortuary by a coroner's official. Other cases need only a phone call to the deceased's doctor. More than a quarter of the cases require a full autopsy.

Deputy medical examiners search for clues to determine the cause of death. Their findings may help exonerate a suspect or help send one to death row.

"In an investigation, the body is the best piece of evidence. It doesn't lie," said Craig Harvey, coroner's chief of investigations.

Following sharp criticism of the coroner's office during the O.J. Simpson murder trial, reforms were instituted including a policy covering high-profile cases, expanded psychological background checks for anyone having direct involvement with coroner's cases, and the hiring of a jury consultant to advise experts on court testimony. Physical remains in high-profile cases are now kept in a locked crypt, and security on the autopsy floor has been tightened.

At the coroner's office, many people are involved in the process: from the investigators who, along with police, gather clues at a murder scene, to those in the toxicology lab who try to identify what drug caused the death, to board-certified forensic pathologists, who do autopsies every day of the year.

How Autopsies are Done

The word autopsy comes from the Greek word autopsia, meaning "to see with one's own eyes." 1. The doctor examines the outside of the body, marking scars, tattoos and injuries on a diagram.

2. The examination begins with a Y-shaped incision beginning at the top of each shoulder, meeting at the top of the breastbone and continuing straight down the midline to the top of the pubic bone.

3. Skin is pulled back to expose the breastbone and rib cage.

4. A pair of cutting shears similar to pruning shears are used to cut away a portion of the rib cage. The breastbone is removed and set aside.

5. Each organ is removed and visually examined for signs of disease, abnormality or injury. Each organ is weighed.

6. Each organ is placed on a cutting board and dissected. A piece of tissue may be taken from each organ for further study.

7. An incision is made along the back of the head, from ear to ear.

8. The scalp is carefully pulled forward to expose the top of the skull.

9. The top of the skull, the calvarium, is removed, exposing the brain.

10. The spinal cord is cut and the brain removed.

11. The brain is examined, weighed and dissected. If necessary, the doctor may send the entire brain or portions of it to be analyzed by a forensic neuropathologist.

12. The top of the skull is replaced, the scalp moved back into place and the incision is sutured.

13. A bag containing the organs is put back inside the chest cavity. The Y-shaped incision is sewn up.

14. The body is washed down, wrapped in plastic, tied with rope and placed in a refrigerated crypt.

Handling the Remains

Routine Cases: Body is weighed, measure, fingerprinted and photographed when it arrives at the coroner's office.

Special cases: These include homicides, officer-involved shootings, in-custody deaths, SIDS (Sudden Infant Death Syndrome) fatalities and suspected child-abuse deaths. The body is transported to a photo area where pictures are taken from various angles. The body is then undressed, wounds are photographed and the clothing is hung up to dry. Once it is dry, each piece of clothing is wrapped individually and placed in a larger bundle to be turned over to the appropriate law enforcement agency. The body is then washed and additional photos may be taken. If necessary, a full body X- ray is taken and the body is moved to a crypt where it will be kept separately. The bodies of children younger than 14 are X-rayed to find any broken bones.

Criteria for an Autopsy

The coroner's office is mandated by law to inquire into and determine the circumstances, manner and cause of all violent, sudden or unusual deaths that occur in Los Angeles County. The autopsy will determine the cause of death: natural, accidental, homicide, suicide or undetermined.

Anyone objecting to an autopsy has 48 hours to obtain a court order to stop the procedure. Families who request an autopsy must pay the price set by the county auditor-controller: $3,170.34.

Types of Autopsies

Full autopsy (A): With witnesses, extensive photography and X-rays. These "special processing cases" include homicides, officer-involved shootings, in-custody deaths, fatalities involving SIDS and suspected child-abuse deaths.

Standard full autopsy (B): Usually with no witnesses, extensive photography or X-rays. This is the type of procedure used when an autopsy is requested by family members.

Localized autopsy performed in specific areas (C): For example, if there is a gunshot wound to the head, the bullet would simply by removed. Other organs would probably not be examined.

Simple physical exam (D): Without any incisions. The body is examined for scars, marks or tattoos. Specimens such as blood or urine may be taken.

Coroner Caseload

Last year, the Los Angeles County coroner's office handled 19,254 deaths including:

13,503 natural deaths.

2,760 accidental deaths.

1,926 homicides.

943 suicides.

122 with undetermined cause of death.

The Coroner's Office:

166 on staff, including 12 forensic-board-certified pathologists.

An additional five forensic pathologist fellows are in training.

$12-million budget.

Forensic Evidence

Did the fatal stab wound come from the single-edged knife found next to the body or, perhaps, another sharp instrument? The answer lies in toolmark analysis, performed in the coroner's laboratory. To come up with a profile of the weapon used in a deadly attack, the wounds on the corpse are compared with the alleged weapon, the murder site may be revisited, bones and skulls examined, stories compared with evidence, and the crime may be reenacted.

An odontologist, an expert in the structure, growth and diseases of the teeth, might be called in to make a mold of either the deceased's or the suspect's mouth so that bite marks may be compared. A consulting forensic archeologist might be asked to excavate a buried body or skeletal remains. Or a forensic anthropologist may be asked to determine the age and gender of the deceased.

A computerized microscope is used in the coroner's lab to determine the presence of gunshot residue in samples taken from a dead person's hands, clothing and face. "We're going after microscopic information," said Steve Dowell, research criminalist. Information uncovered in the coroner's lab is given to the forensic pathologists to help determine the mode and manner of death.

Toxicology Tests:

The coroner's office performs about 50,000 tests annually on the deceased. Qualitative tests are performed to determine the presence of drugs at the time of death, and quantitative tests are done to determine the amount. Results of alcohol, cocaine and carbon-monoxide tests may come back in a day, but others may take weeks.

Tests may show that a preexisting condition or disease was the cause of death. For example, a person's glucose and thyroid levels might be tested for abnormal elevation. Tissue samples may also be tested to denote microscopic changes caused by disease.

Tools Used During an Autopsy

A deputy medical examiner uses a variety of tools to perform an autopsy. Among those commonly used:

1) Stryker saw, used to open the skull, cut bone fragments for DNA analysis or the pubic bone to determine gender and age.

2) Scalpels, used to cut tissue samples.

3) Forceps, a grasping tool used to take tissue samples and move aside body parts.

4) Hemostats, also used as a grasping tool.

5) Mayo dissection scissors, used for cutting.

6) Enterotomy scissors, used to cut the intestines.

7) Knives, used in dissection.

8) T-chisel, used to take the calvarium from the skull.

9) Syringes, used for specimen collection, such as blood or urine.

10) Larger knife, used to dissect larger organs such as the lungs, liver and brain.

11) Needles, used for suturing.

Sources: Los Angeles County coroner's office; National Assn. of Medical Examiners. Researched by STEPHANIE STASSEL/Los Angeles Times syndrome (SIDS), and suspected child-abuse deaths--the coroner's office will order a full autopsy to determine the cause of death: natural, accidental, homicide, suicide or undetermined. An autopsy may also be needed for victims of traffic fatalities, and those who perish in industrial accidents, commit suicide or die for no apparent reason.

Anyone objecting to an autopsy has 48 hours to obtain a court order to stop the procedure. Families who request an autopsy must pay the price set by the county auditor-controller: $3,170.34.

Types of Autopsies

At about 6 a.m., the operations doctor, usually a senior deputy medical examiner, reviews the cases that are ready for examination, decides what type of autopsy is needed and who will handle it. There are three autopsy rooms, allowing 14 autopsies to be performed at once.

"A" is a full autopsy, with witnesses, extensive photography and X-rays. These "special processing cases" include homicides, officer-involved shootings, in-custody deaths, fatalities involving SIDS and suspected child-abuse deaths.

"B" is a standard full autopsy, with usually no witnesses or extensive photography or X-rays. This is the type of procedure used when an autopsy is requested by family members.

"C" is a localized autopsy. For example, if there is a gunshot wound to the head, the bullet would simply by removed. Other organs would probably not be examined.

"D" is a simple physical exam without any incisions. The body is examined for scars, marks or tattoos. Specimens such as blood or urine may be taken.

What Happens to a Body at the Coroner's Office

Handling of the "special processing cases" goes beyond the routine procedure of weighing, measuring, fingerprinting and photographing a body when it arrives at the coroner's office. These bodies--which include homicides, officer-involved shootings, in-custody deaths, SIDS fatalities and suspected child-abuse deaths--are taken to a photo area where pictures are taken from various angles. The body is then undressed, wounds are photographed and the clothing is hung up to dry. Once it is dry, each piece of clothing is wrapped individually and placed in a larger bundle to be turned over to the appropriate law enforcement agency. The body is then washed and additional photos may be taken. If necessary, a full body X-ray is taken and the body is moved to a crypt where it will be kept separate from the other bodies. All children under 14 are X-rayed to find any broken bones.

Statistics

Last year, the Los Angeles County coroner's office handled 19,254 deaths including:

13,503 natural deaths.

2,760 accidental deaths.

1,926 homicides.

943 suicides.

122 with undetermined cause of death.

The Los Angeles County coroner's office annually averages about:

7,500 deaths handled administratively, requiring no examination.

5,000 full autopsies.

2,700 bodies examined by coroner's investigators at mortuaries.

2,300 partial, or Class "C," autopsies.

1,500 inquiries into surgical deaths.

20-25 autopsies performed each day, including holidays.

12 bodies visually examined, no autopsy.

1-3 autopsies performed daily per forensic pathologist.

350 bodies autopsied per forensic pathologist, well above the "reasonable" annual caseload of 250, according to the National Assn. of Medical Examiners.

250-300 bodies in house at any given time.

200 John Does (male), with about 10 remaining unidentified.

75 Jane Does (female), with one or two remaining unidentified.

150,000 photos printed in the coroner's office photo lab.

3,600 subpoenas received.

About the Coroner's Office:

166 on staff, including 12 forensic-board-certified pathologists.

An additional five forensic pathologist fellows are in training.

$12-million budget.

An average of two doctors are in court each day.

Forensic Evidence

Did the fatal stab wound come from the single-edged knife found next to the body or, perhaps, another sharp instrument? The answer lies in toolmark analysis, performed in the coroner's laboratory. To come up with a profile of the weapon used in a deadly attack, the wounds on the corpse are compared with the alleged weapon, the murder site may be revisited, bones and skulls examined, stories compared with evidence, and the crime may be reenacted.

An odontologist, an expert in the structure, growth and diseases of the teeth, might be called in to make a mold of either the deceased's or the suspect's mouth so that bite marks may be compared. A consulting forensic archeologist might be asked to excavate a buried body or skeletal remains. Or a forensic anthropologist may be asked to determine the age and gender of the deceased.

A computerized microscope is used in the coroner's lab to determine the presence of gunshot residue in samples taken from a dead person's hands, clothing and face. "We're going after microscopic information," said Steve Dowell, research criminalist. Information uncovered in the coroner's lab is given to the forensic pathologists to help determine the mode and manner of death.

Toxicology Tests:

The coroner's office performs about 50,000 tests annually on the deceased. Qualitative tests are performed to determine the presence of drugs at the time of death, and quantitative tests are done to determine the amount. Results of alcohol, cocaine and carbon-monoxide tests may come back in a day, but others may take weeks.

Tests may show that a preexisting condition or disease was the cause of death. For example, a person's glucose and thyroid levels might be tested for abnormal elevation. Tissue samples may also be tested to denote microscopic changes caused by disease.

Tools Used During an Autopsy

A deputy medical examiner uses a variety of tools to perform an autopsy. Among those commonly used:

Mayo dissection scissors: Used for cutting.

Enterotomy scissors: Used to cut the intestines.

Stryker saw: Used to open the skull, cut bone fragments for DNA analysis or the pubic bone to determine gender and age.

Needles: Used for suturing.

Scalpel: Used to cut tissue samples.

Hemostats: A clamping and grasping tool.

Forceps: A grasping tool to take tissue samples and move aside body parts.

Knives: Used in dissection.

Syringe: Used for specimen collection, such as blood or urine.

T-chisel: Used to take the calvarium from the skull.

Sources: Los Angeles County coroner's office; National Assn. of Medical Examiners. Researched by STEPHANIE STASSEL/Los Angeles Times

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