www.ForensicOnline.com
Joseph I. Cohen, M.D., Forensic Pathologist
Anatomic, Clinical and Forensic Pathology
10 West Street
New York, NY  10004
(Toll Free 1-877-DRCOHEN, 24 Hour Voice)

Board Certified, American Board of Pathology

GENERAL INFORMATION for INDIVIDUALS
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DO YOU HAVE GENERAL QUESTIONS ABOUT THE:
Death or injury of a family member, friend, acquaintance or individual(s)?
Events or circumstances leading to death or injury?
Pain and suffering after injury or before death?
Investigation or photographs of a scene of death or injury?
Time of death?
Identification of an individual?
Changes in the appearance of the face and body after death?
Alleged injury, abuse, neglect or death of a child?
Alleged injury, abuse, neglect or death of a prisoner or individual in custody?
Alleged injury, abuse, neglect or death in an institution?
Possibility of a first or second, professional, confidential, unbiased forensic opinion?
Review of a medical record or autopsy report?
Possibility of litigation or utilization of a forensic pathologist as an expert witness?
Answer to a quick question?  One or more considerations?

THE FORENSIC PATHOLOGIST
What is a pathologist?
What is a forensic pathologist?
What training is required to become a forensic pathologist?
What personal traits are necessary to work as a forensic pathologist?
Where does the forensic pathologist work?
What are the hours of a forensic pathologist?
What is the salary of a forensic pathologist?
What does "board certified" mean?
Is the forensic pathologist an expert witness?
Why contact a forensic pathologist?
How much does it cost for a forensic consultation?

THE AUTOPSY
What is an autopsy?
Is an autopsy necessary?  A second autopsy?  An exhumation?
Do you need assistance with the decision to have an autopsy or exhumation performed?
How long does it take to perform an autopsy?
Where is the autopsy performed?
When is the autopsy performed?
Does an autopsy affect the appearance of the body?  Is it disfiguring?
How much does an autopsy cost?

THE DEATH CERTIFICATE
What is a death certificate?
What is the CAUSE and MANNER of death on the death certificate?
What is the MECHANISM of death?
Was the death 100% NATURAL?
Did an injury contribute to the death?
Did an old, remote injury contribute to the death?
Did a medical procedure or therapy contribute to the death?
Did an act of omission by a person or institution contribute to the death?
Did medications or illicit drugs contribute to the death?
How does the wording on the death certificate influence insurance disbursements?
Do you need a second opinion with regard to an insurance claim?
Do you agree with the medical examiner/coroner decision NOT to perform an autopsy?
Do you contest how a medical examiner/coroner certified the death certificate?

[About Dr. Cohen] [Quick & Easy Email] [Consultation Form]
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DO YOU HAVE GENERAL QUESTIONS ABOUT THE:
Death or injury of a family member, friend, acquaintance or individual(s)?
Events or circumstances leading to death or injury?
Pain and suffering after injury or before death?
Often, an individual or family member has questions relating to the death or injury of a loved one.  The questions pertain to the circumstances leading up to or surrounding death or injury, or pertain to the possibility of emotional or physical pain suffered by the individual.  The forensic pathologist is capable of offering an expert opinion when considering the severity and duration of pain.  If the death was not witnessed, the opinion should be in the form of a "range of time" unless it is clear that the death occurred suddenly.  The range is narrow or broad depending on the specific circumstances.  The nature and extent of the injury or injuries will obviously impact the degree and duration of pain and suffering.
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Investigation or photographs of a scene of death or injury?
Whenever pertinent records or photographs are available, they should be carefully evaluated as they offer crucial information relating to circumstances surrounding death or injury.
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Time of death?
Time of death estimations are based on eye witness accounts and changes in the appearance and characteristics of the body after death.  There are many different means by which the forensic pathologist estimates the time of death.  They include livor mortis (discoloration of the body due to settling of blood in the dependent portions of the body), rigor mortis (stiffening of the body after death), and algor mortis (change in body temperature after death).  Other useful indicators include changes in the chemical composition of various body liquids after death, and other decompositional changes.  In general, the longer the postmortem interval, the less accurate the time of death determination.
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Identification of an individual?
Occasionally, the identification of an individual is difficult due to the extent of injury or degree of decomposition of the body after death.  Accurate identification is a responsibility of the medical examiner or coroner and is made prior to release of the decedent to the funeral home.  Normally, identification is straight forward and is accomplished when a family member views a photograph (often a Polaroid photo) of the decedent taken by the medical examiner or coroner.  When the need arises, identification is based on a comparison of radiographs (x-rays) from an earlier hospital admission and those taken by the medical examiner.   Comparisons of dental films and fingerprints are commonly used for identification.  When necessary, DNA analysis is performed by the laboratory to make the identification and is accomplished by comparing samples of hair, blood or other tissues.  Less certain means of identification include clothing or personal effects worn by the decedent, tattoos, scars, and the location of the individual (place of death).
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Changes in the appearance of the face and body after death?
The body does change in appearance with time following death.  Although this is alarming for those persons not prepared for such changes, it is a normal transition and can be explained by the forensic pathologist.  The degree of change depends on the time elapsed since death and several environmental conditions such as temperature, humidity, wind and many additional factors.
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Alleged injury, abuse, neglect or death of a child?
Alleged injury, abuse, neglect or death of a prisoner or individual in custody?
Alleged injury, abuse, neglect or death in an institution?
Investigations of death or injury in children, prisoners, individuals in custody, and individuals in the care of an institution constitute special types of investigations which require special expertise.  Many questions are raised, and the sensitivity and nature of these cases requires input by an experienced forensic pathologist.
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Possibility of a first or second, professional, confidential, unbiased forensic opinion?
Review of a medical record or autopsy report?
Possibility of litigation or utilization of a forensic pathologist as an expert witness?
Answer to a quick question?  One or more considerations?
[About Dr. Cohen] [Quick & Easy Email] [Consultation Form]
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THE FORENSIC PATHOLOGIST
What is a pathologist?
A pathologist is a specialized type of physician who studies a vast variety of natural diseases and works in a hospital, a laboratory or a private setting.  There are two main types of pathology - anatomic and clinical.  Anatomic pathology encompasses surgical pathology, autopsy pathology, and diagnostic cytology.  The surgical pathologist examines organs and tissues for the purpose of making a diagnosis to assist the primary physician caring for the patient.  The autopsy pathologist performs autopsy examinations on individuals, usually in the hospital setting.  The purpose is to determine the cause of death and to answer questions raised by the treating physicians and family members.  Most hospital deaths are from natural causes.  A forensic pathologist is often called to investigate the possibility of an "unnatural" death, one not caused exclusively by natural disease.  The cytologist examines individual cells and groups of cells under the microscope to diagnose various benign and malignant conditions.  Forensic pathology is branch of anatomic pathology.  Clinical pathology includes the various laboratory departments such as hematology, microbiology, immunology, clinical chemistry, toxicology and transfusion medicine (the blood bank).  A clinical pathologist is commonly the director of the hospital laboratory.  Pathologists tend to specialize in one or a few areas because there is simply too much to know for one person to be an expert at everything.
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What is a forensic pathologist?
Forensic pathology is a specialized area of pathology.  The forensic pathologist performs autopsies to determine the cause and manner of death in situations falling under the jurisdiction of the local medical examiner or coroner.  These situations include, however, are not limited to violent deaths such as homicides, accidents, and suicides.  Other categories are suspicious deaths, sudden and expected deaths, deaths in children and infants, prisoners, persons under the care of an institution, situations where illicit drugs or alcohol may have contributed to the death, deaths occurring during or in close proximity to a surgical procedure, deaths in individuals not under the care of a physician or when the private physician is unable or unwilling to certify the death certificate, and deaths when there is suspicion of a public health threat.  Many persons fail to realize that approximately half of the deaths examined by the forensic pathologist are natural deaths occurring in the absence of injury.  The forensic pathologist is also an expert witness in the court of law, testifying in a variety of civil and criminal cases involving death or injury.
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What training is required to become a forensic pathologist?
It takes many years of schooling to prepare oneself for a career in forensic pathology.  It begins with a four year college degree, followed by four years of medical school.  After medical school, the young physician begins a three to five year residency training program in general pathology.  The exact duration depends on whether the program is in anatomic pathology, or both anatomic and clinical pathology.   In any event, to become a forensic pathologist, the prerequisite training program must include at least anatomic pathology.  After completion of the residency program, the pathologist embarks on a one year specialty training program in forensic pathology at a medical examiner's or coroner's office, usually in a large city or metropolitan area.
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What personal traits are necessary to work as a forensic pathologist?
There are no specific traits necessary to work as a forensic pathologist.   It sure helps to have decent communication skills as it is necessary to discuss a wide variety of topics with many types of individuals and organizations.  There is a common misconception that the pathologist only deals with the deceased.  An outgoing, energetic personality makes it easier to speak to large groups such as juries during expert witness testimony in a court of law.
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Where does the forensic pathologist work?
The forensic pathologist usually works in a local, county or state medical examiner or coroner system.
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What are the hours of a forensic pathologist?
The hours depend on the office's workload and the numbers of pathologists, and is quite variable from jurisdiction to jurisdiction.
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What is the salary of a forensic pathologist?
The salary is variable; a rough estimate is 75,000 to 200,000 dollars per year and probably averages 80,000 to 120,000 per year.  Private forensic work may yield a higher paycheck but requires more work and more responsibility.
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What does "board certified" mean?
Board certified simply means that the forensic pathologist has successfully completed the required years of pathology and forensic pathology training at an accredited institution, and has passed the appropriate exams as set forth by The American Board of Pathology.  The American Board of Pathology is based in Tampa and issues certificates to those individuals who have met the necessary requirements.
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Is the forensic pathologist an expert witness?
The forensic pathologist is an expert witness, and is frequently called to testify in a court of law.  The frequency of courtroom testimony depends on the population of the jurisdiction and may correlate with the number of homicide cases in the jurisdiction.  Cases include both civil and criminal, and death and injury investigations.
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Why contact a forensic pathologist?
Forensic pathologists have a diverse work experience; hence there are many potential situations whereby individuals could benefit by having a discussion with one.
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How much does it cost for a forensic consultation?
The fees vary widely for the different types of consultations, and depend on the specific nature of the inquiry and the pathologist's level of expertise and experience.
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THE AUTOPSY
What is an autopsy?
An autopsy is an examination of the body after death.  It usually consists of an external and an internal examination of the body.  The purpose is to document any natural disease processes and/or injuries which may have contributed to the death of the individual.  The external examination also documents identifying features such as scars, tattoos or other markings which may assist in the identification of the body.   The internal examination looks at the internal organs to document any natural disease processes and/or injury.  The overall purpose is to render an opinion regarding the cause and manner of death which is specified on the death certificate.
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Is an autopsy necessary?  A second autopsy?  An exhumation?
Do you need assistance with the decision to have an autopsy or exhumation performed?
An autopsy may answer certain questions which may not be answered without the examination.  It often times is better to perform an autopsy though the findings may be entirely uneventful.  At least the forensic pathologist is able to exclude the possibility of internal injury and the presence and extent of natural disease processes can be documented.
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How long does it take to perform an autopsy?
The time it takes to perform an autopsy depends on the presence and nature of natural disease and/or injury.  They generally range from 30 minutes to several hours or more, and probably average a couple of hours.
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Where is the autopsy performed?
Forensic autopsies are performed in the medical examiner's or coroner's office.   Sometimes they are performed in a funeral home or hospital setting.
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When is the autopsy performed?
The autopsies are generally performed in the morning and afternoon hours each day, 7 days a week, 365 days a year in most offices.  They are done on the off hours in the event of a mass disaster or high profile case with media attention.
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Does an autopsy affect the appearance of the body?  Is it disfiguring?
The basic autopsy involves making incisions across the midline of the chest and abdomen, and along the top and sides of the head.  Although the process sounds disfiguring, autopsy incisions are rarely noticeable after completion of the autopsy.   The individual is viewable at the funeral home in most instances.
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How much does an autopsy cost?
The cost of an autopsy is variable and ranges from several hundred dollars to several thousand or more depending on the purpose of the examination and the types of tests required to complete the investigation.
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THE DEATH CERTIFICATE
What is a death certificate?
The death certificate is a legal document which lists the particulars of an individual's death.  It is required by the funeral home prior to burial and is filed with the government's vital records department.  It contains identifying information such as the decedent's name, age, and sex as well as the date and time of death (or when the person was found), place of death, and the CAUSE and MANNER of death.  In addition, if an injury contributed to the death, the specifics of date, time, place, location and mechanism of injury also appear on the death certificate.  If an operation was performed prior to death, those specifics including the surgical procedure and findings appear as well.  The death certificate indicates whether or not an autopsy was performed and contains the signature of the certifying physician (private physician, hospital physician or medical examiner/coroner).
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What is the CAUSE and MANNER of death on the death certificate?
The cause of death is the specific reason that a person dies, for example a stab wound to the abdomen, gunshot wound to the head, asthma, atherosclerotic heart disease, blunt impacts to the head and torso, hanging, drug intoxication or AIDS.  These are only several examples.  The manner of death falls under one of several categories:  homicide, accident, suicide, natural or undetermined.  Some jurisdictions utilize another category, therapeutic complication.  The cause and manner of death are always listed on the death certificate.
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What is the MECHANISM of death?
The mechanism of death is the physiologic reason for a person's death.   Etiologically, it is nonspecific, and does not specify the underlying or proximate cause of death.  It is generally not placed on the death certificate.  Examples are sepsis, shock, electrical irritability of the heart or brain, seizures, exsanguination, cardiac tamponade, pulmonary thromboemboli, and asphyxia.
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Was the death 100% NATURAL?
Did an injury contribute to the death?
Did an old, remote injury contribute to the death?
If the death was 100% natural, that is, caused solely by one or more natural disease processes, it follows that the manner of death is NATURAL.  If any type of injury clearly contributed to the death, then the manner of death is not NATURAL, and by definition must be unnatural or violent.  If the injury played only a small role in the death, then the manner of death must be classified as either homicide, accident, suicide or undetermined.  The medical examiner/coroner must weigh the factors and render an opinion for the cause and manner of death on the death certificate.  If both natural disease and injury contributed to the death, then both are placed on the certificate.  Occasionally, the injury contributing to death happened long before the death actually occurred.  These deaths are "unnatural."
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Did a medical procedure or therapy contribute to the death?
The medical examiner/coroner investigates deaths which occur during or in close proximity to surgery, therapeutic or interventional procedures, and medical therapy.   These deaths are "unnatural" when the procedure or therapy contributes to death.
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Did an act of omission by a person or institution contribute to the death?
When an individual's death occurs because of neglect or failure of a care provider to intervene when necessary, the possibility arises that the death is "unnatural."  These investigations require an unbiased, systematic approach for the purpose of certifying the cause and manner of death on the death certificate.
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Did medications or illicit drugs contribute to the death?
Medications and drugs contribute to death quite often.  Persons who die from the acute or recent effects of drugs or alcohol are classified as accidents, suicides, homicides or undetermined.  Most commonly they are accidental unless the circumstances point to another classification.
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How does the wording on the death certificate influence insurance disbursements?
Do you need a second opinion with regard to an insurance claim?
Insurance companies rely on proper cause and manner of death determinations for the purpose of disbursing monies after the death of an individual.  Frequently, they contact the medical examiner/coroner to verify and discuss the specifics of a person's death.
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Do you agree with the medical examiner/coroner decision NOT to perform an autopsy?
Do you contest how a medical examiner/coroner certified the death certificate?
Most medical examiners and coroners decide each morning which persons require an autopsy and who gets by with only a thorough examination of the outside of the body (the "external" examination).  There is quite a bit of individual variation in this decision making process.  In any case, there is a decent chance with certain situations that two pathologists will come to different conclusions.  Furthermore, when it comes to the wording on the death certificate and the final cause and manner of death interpretations, there are occasionally differing opinions amongst pathologists.
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