Popular Books on Forensic Science and Forensic Medicine: Anil Aggrawal's Internet Journal of Forensic Medicine, Vol. 8, No. 2, July - December 2007
  home  > Volume 8, Number 2, July - December 2007  > Reviews  > Popular Books  > page 2: Postmortem: How Medical Examiners Explain Suspicious Deaths by Stefan Timmermans   (you are here)
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Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology

Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology

Volume 8, Number 2, July - December 2007

Book Reviews: Popular Books Section

(Page 2)


A GOOD, THOUGHT PROVOKING READ

quote start...As one concludes reading this informative and thought-provoking book, the author leaves you with some final sage advice and philosophical gems. "Forensic investigations constitute the last line of defense in a system of broad-based societal quality control." They are "not only a treasure trove for research, but also a vantage point from which to examine health care, housing, welfare, and other policies." ...And most eloquently, says Timmermans, "To speak for the dead, as forensic specialists do, means to speak up, gently but insistently, with compassion and without obfuscation." ...Therein lies the challenge for modern day forensic pathologists. Do we have the moral courage to succeed in this noble quest?...quote end


 Postmortem: How Medical Examiners Explain Suspicious Deaths  by Stefan Timmermans. softcover, 8.9" x 6" x 0.9". [from the Series: (FED) Fieldwork Encounters and Discoveries edited by Robert Emerson and Jack Katz].
University Of Chicago Press, 1427 East 60th Street, Chicago, IL 60637 U.S.A. General telephone: (773) 702-7700. Marketing/Editorial fax: (773) 702-9756. Publication Date April 15, 2007. 384 pages, ISBN: 978-0-226-80398-2 (ISBN-10: 0-226-80398-8). ISBN: 978-0-226-80399-9 (ISBN-10: 0-226-80399-6). Price Cloth $30.00, Paper $18.00

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Postmortem: How Medical Examiners Explain Suspicious Deaths by Stefan Timmermans
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 It is difficult to conceive how someone with no formal education, post-graduate training, practical experience, and acquired expertise in either medicine or law could possibly write such a perceptive, comprehensive, and erudite book dealing with the rather scientifically complex field of forensic pathology. Is it realistically possible for a sociologist to truly understand and intellectually fathom the multifaceted role of modern day forensic pathologists functioning in a highly litigious society like ours? After all, to be an officially appointed medical examiner in the United States today, one must have attended four years of medical school following four years of pre-medical education, and thereafter spend four or five years in a full-time residency program studying anatomic and clinical pathology before undertaking sub-specialty training in forensic pathology for another year at an accredited medical-legal investigative facility. Moreover, in order to be selected as a chief medical examiner in any sizeable office, several more years of active practice in forensic pathology will be required.

During all these years of work in a medical examiner's or coroner's office, forensic pathologists must frequently interface with both civil and criminal attorneys, as well as law enforcement and other government officials. As a result, even though such medical specialists have no formal legal education (except for a handful who have also acquired a law degree), they do develop a modicum of knowledge about certain areas of law (e.g., torts, evidence, criminal procedure and criminal law, and even an occasional smattering of agency, domestic and juvenile law).

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Considering this entire panorama of formal education and subsequent professional work experience inherent in the field of forensic pathology, the prospective reader of Postmortem has an understandable right to ask how the author, Stefan Timmermans, a professor of sociology at the University of California, Los Angeles, would be so presumptuous as to even attempt to address the subject of "How Medical Examiners Explain Suspicious Deaths." Well, all such skepticism will be quickly dispelled by readers of this fascinating and provocative book, long before completion of the Introduction and six excellent chapter discussions that follow.
Postmortem: How Medical Examiners Explain Suspicious Deaths by Stefan Timmermans
...Professor Timmermans observed medical examiners at work, for approximately 36 months (staggered over a period from 1999 to 2005), during which time he attended more than 225 autopsies, sat in on morning case assignment meetings, reviewed many additional case files, and conducted informal staff interviews repeatedly on an individual basis...

Professor Timmermans observed medical examiners at work, for approximately 36 months (staggered over a period from 1999 to 2005), during which time he attended more than 225 autopsies, sat in on morning case assignment meetings, reviewed many additional case files, and conducted informal staff interviews repeatedly on an individual basis. He did all this at an unidentified medical examiner's office (presumably somewhere on the West Coast), where he was afforded this very special opportunity.

The names of staff members, decedents and families, and all other possible identifying features, are referred to anonymously. The exception is an incisive, highly critical analysis and discussion of the testimony given by several forensic and other medical experts for both the prosecution and defense in the Louise Woodward homicide case (Matthew Eappen, decedent). Chapter three, "Forensic Credibility at the Nanny Trial," of course is a matter of public record, and hence, the author is quite free to reference everyone who testified in that incredibly contentious and highly controversial courtroom drama.

Undoubtedly, for those legally sophisticated and traumatized veterans of the forensic battlefields, i.e., the courtrooms in which much publicized murder trials, notorious sex and drug-related cases, and multi-million dollar medical malpractice and products liability lawsuits are acrimoniously and quite often vituperatively staged, this comprehensive analysis by Timmermans of individual experts will prove to be the most interesting, informative, and provocative part of Postmortem. The author adroitly captures the intellectually significant and pragmatically relevant differences among acknowledged forensic experts regarding their personal philosophies and overall beliefs, which greatly influence their ultimate conclusions and opinions. This dissection of the key forensic witnesses in the 1997 Nanny trial in Cambridge, Massachusetts - fifteen of the thirty-eight witnesses "possessed scientific expertise spanning the fields of emergency medicine, neurosurgery, neurology, neuroradiology, neuropathology, forensic pathology, ophthalmology, pediatrics, child abuse, and biomechanics - is accomplished in an objective, analytical, and meticulous fashion. While the author does not hesitate to express his own personal observations as to how some of these experts were perceived by the judge and jury, he does so in a non-insulting and non-inflammatory manner.
Postmortem: How Medical Examiners Explain Suspicious Deaths by Stefan Timmermans
...Even long-time forensic scientific and medical experts who may have testified in dozens of cases during their active careers, let alone all less experienced newcomers to the adversarial system of criminal and civil justice in the Untied States, would profit immensely by carefully reading and seriously considering the implications of this discussion...

Even long-time forensic scientific and medical experts who may have testified in dozens of cases during their active careers, let alone all less experienced newcomers to the adversarial system of criminal and civil justice in the Untied States, would profit immensely by carefully reading and seriously considering the implications of this discussion.

For those of us who are actively practicing as forensic pathologists, the most difficult, disturbing, and contentious cases are those involving the deaths of infants as a result of craniocerebral injuries. Is there such an entity as a pure "shaken baby syndrome," or does the more valid pathophysiological explanation regarding the etiology of such cases require some evidence of a traumatic impact? Are forensic pathologists (at least those amongst us, including this reviewer, who argue for the impact theory) better able to analyze and evaluate such cases than are emergency room physicians, pediatricians, and ophthalmologists, who (perhaps with rare exceptions) have not examined (or even seen) a brain at autopsy since they were in medical school?
Postmortem: How Medical Examiners Explain Suspicious Deaths by Stefan Timmermans
...There is a great deal of subjective interpretation involved in the practice of this medical specialty. It is, indeed, quite often as much art as it is science. There is reason, room, and need for different opinions in many civil and criminal matters involving the analyses of illnesses, injuries, etiologies, causal relationships, and even the causes and mechanisms of some deaths...

Professor Timmermans, by examining the investigative aspects of various kinds of cases - Chapter 1, Heart Disease; Chapter 2, Suicide; Chapter 4, Homicides; Chapter 5, Sudden Infant Death Syndrome (SIDS) and other kinds of non-traumatic, unexpected, and seemingly inexplicable baby deaths; and Chapter 6, various kinds of cases in which post-mortem organ and tissue donation questions and controversies arise - demonstrates the validity of an extremely important axiom that many people, including some forensic pathologists, either fail to comprehend, ignore, or tend to forget, namely, pathology is not an absolute science. There is a great deal of subjective interpretation involved in the practice of this medical specialty. It is, indeed, quite often as much art as it is science. There is reason, room, and need for different opinions in many civil and criminal matters involving the analyses of illnesses, injuries, etiologies, causal relationships, and even the causes and mechanisms of some deaths. If this be true, why therefore is it not easy to understand that knowledgeable, experienced forensic pathologists may disagree on the determination of the manner of death. Natural, accident, suicide, or homicide - is it always unequivocally clear? Perhaps forensic pathologists should be more willing to opt for the fifth manner of death available for them to check off on the death certificate, as well as in the autopsy report, namely, undetermined. Intellectual obstinacy, official governmental arrogance, and sometimes, conscious or subconscious bias, can result in rigid conclusions that are scientifically assailable and logically indefensible.

The author eloquently summarizes thoughts and opinions following his prolonged journey through the winding, intricate, and frequently controversial pathways that must be followed by forensic pathologists functioning as medical examiners in modern day society in a very provocative, sagacious, and challenging "Conclusion - The Hope of Forensic Authority." Timmermans points out the strengths of these indispensable medical specialists and graciously acknowledges the significance and importance of their work to our society in countless areas of endeavor. Indeed, it is impossible to even conjecture how any advanced, civilized nation could function effectively, productively, safely, and most importantly, justly, without the professional input of forensic pathologists.
Postmortem: How Medical Examiners Explain Suspicious Deaths by Stefan Timmermans
...to the author's great credit, he does not simply end this fine book with effusive praise and academic adulation. He does something that in the final analysis is far more important for forensic pathologists. He points out traditional deficiencies and areas of weakness in medical examiner officers, emphasizing matters that this reviewer has long been interested in and frequently commented upon....

However, to the author's great credit, he does not simply end this fine book with effusive praise and academic adulation. He does something that in the final analysis is far more important for forensic pathologists. He points out traditional deficiencies and areas of weakness in medical examiner officers, emphasizing matters that this reviewer has long been interested in and frequently commented upon. While medical examiners are "the best death investigators for natural deaths;" and in determining cases of suicide and homicide when "signs of trauma, scene evidence, and medical history triangulate to suggest a logical manner of death," when "one or more of the components of the investigation do not fit the case at hand," then they "tend to limit their professional authority and opt for ultraconservative inferences." What is much more disturbing among the criticisms leveled by Timmermans is his observation that "when the parties providing medical examiners with information are involved in the death, the usual working relationship is even more disturbed. When police or health care professionals are suspected of involvement in a death, for example, medical examiners retreat further into pathology, preferring courts to make determinations about intent." The author specifically refers to the investigation of likely medical malpractice cases and police-related deaths as examples of the rather universal hesitation and unwillingness of medical examiners to confront their medical brethren or law enforcement agencies in controversial matters. Regrettably, it is a matter of historical fact that medical examiners rarely pursue these kinds of cases in an aggressive fashion. They will issue their pathological findings regarding the cause of death and then finesse or delay their official ruling vis--vis the manner of death in various ways. [For example, deaths quite obviously due to some kind of professional negligence by physicians are euphemistically characterized by many medical examiner offices as "therapeutic misadventure."]
Postmortem: How Medical Examiners Explain Suspicious Deaths by Stefan Timmermans
...Paradoxically, it is within this outstanding discussion that the strongest substantive criticism of Postmortem is to be found. Timmermans essentially ignores Coroners Offices in his book. Although his historical references and observations about such elective offices are generally correct, the incontrovertible fact is that there are several top-flight, highly regarded Coroner Offices throughout the Untied States that perform their duties in a very admirable fashion...

Paradoxically, it is within this outstanding discussion that the strongest substantive criticism of Postmortem is to be found. Timmermans essentially ignores Coroners Offices in his book. Although his historical references and observations about such elective offices are generally correct, the incontrovertible fact is that there are several top-flight, highly regarded Coroner Offices throughout the Untied States that perform their duties in a very admirable fashion. More importantly, such elected officials, unlike appointed medical examiners, have the necessary autonomy and independence to pursue controversial socio-political controversial cases in a more aggressive manner. Coupled with the traditional inquisitorial powers of the Office of Coroner inherited from the centuries-old British system, the fact is that competent and morally courageous forensic pathologists functioning as coroners have the legal procedural wherewithal to deal more forthrightly and unhesitatingly with troublesome matters like medical malpractice, police-related deaths, and other potential societal "hot potato" cases than do medical examiners. Timmermans, having been exposed only to a medical examiner system, fails to recognize that it is not the title of the medical-legal investigative system that determines the effectiveness of death investigations by forensic pathologists, but rather how any particular office functions.

There are ample Notes and a good, basic Bibliography at the end of this book that will provide the interested readers with numerous references to relevant forensic scientific publications, organizations, and practitioners.

As one concludes reading this informative and thought-provoking book, the author leaves you with some final sage advice and philosophical gems. "Forensic investigations constitute the last line of defense in a system of broad-based societal quality control." They are "not only a treasure trove for research, but also a vantage point from which to examine health care, housing, welfare, and other policies."

And most eloquently, says Timmermans, "To speak for the dead, as forensic specialists do, means to speak up, gently but insistently, with compassion and without obfuscation."

Therein lies the challenge for modern day forensic pathologists. Do we have the moral courage to succeed in this noble quest?

Cyril Wecht
-Review by Cyril Wecht
Dr. Cyril H. Wecht, forensic pathologist and attorney, is a Past-President of both the American Academy of Forensic Sciences and The American College of Legal Medicine. He is an Adjunct Professor, Duquesne University School of Law, and Clinical Professor of Pathology, University of Pittsburgh School of Medicine. Dr. Wecht has been associated with this journal as an academician, advisor and resource person since its inception. He may be contacted via Email by clicking here

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  home  > Volume 8, Number 2, July - December 2007  > Reviews  > Popular Books  > page 2: Postmortem: How Medical Examiners Explain Suspicious Deaths by Stefan Timmermans   (you are here)
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