During autopsy, dr. young discovered no visible reason

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Reference no: EM13146993

Case Study: Internal Final Case Briefing Report

Assignment:

As a medico-legal death investigator, you will be expected to complete reports regarding the cases that you have been assigned. These reports may be sent to a prosecuting agency, the law enforcement agency, special investigators, or governmental oversight boards. If you are an investigator in a small office, you may be able to get by with informal briefings given person-to-person or during meetings; however, if you work in a large metropolitan office with many cases, you will need to present your reports in written form.

For this assignment, you will be given a case study to review. You will write an internal final case briefing to be attached to the case report and the autopsy report. This briefing will go to the chief medical examiner (ME). Include the following:

all case notes and pertinent information regarding the case
all information collected from family members, witnesses, and/or other agencies regarding the death
all testing results, evidence results, and information leading to the identification of the deceased and the identification of any evidentiary items; and the final results of any testing performed or used by the assistant ME to determine cause and manner of death
In writing this report, be mindful of your audience. What information will the chief ME need in order to sign off on the case? How should you present this information? Do any aspects of the case pose concerns or cause uncertainty? Be mindful of ethical disclosure, legal implications, and level of discretion when writing your report.

The report should be organized in a logical manner and written with professional language. This is a final case report that will be sent to the head of the agency. It need not be over 6 pages in length.



Case Notes:

Victim has been identified as Sharon Jane Miller, DOB 10/07/1987. Per police report, victim discovered June 17, 2011 by her sister, Valerie Edith Anderson, DOB 08/22/1985. The 911 call was recorded at 11:38am (1138). Victim was discovered in her apartment, located at 16B East Locust Street, Virtual, MD. Per Anderson, the sisters were going out to lunch and Anderson had gone to Miller's apartment to pick up Miller for lunch. This was confirmed by police via an examination of the cell phones of each sister (Anderson gave consent) and a review of the text messages on each cell phone. Per Anderson, Miller had recently broken up with her boyfriend of four (4) years. The family was happy the relationship was done, as boyfriend was abusive. Per police, boyfriend is Todd Nathan Hughes, DOB 02/14/1980. Per police, Hughes has an extensive criminal record, including multiple arrests for domestic violence and drug abuse. Miller also has a criminal record, for domestic violence and drug abuse, which start about same time she started dating Hughes.

Per police, Miller has an ex-parte against Hughes, which Hughes had been arrested for violating. Hughes was released from jail the day before Miller was discovered dead (06/16/11). Police interviewed Hughes, who stated that he had learned his lesson and did not go anywhere near Miller after being released from jail. Hughes's mother backed up his story. However, according to police, Hughes's mother looked scared and Hughes had bruises and lacerations on his hands, which Hughes stated he got in jail. The Virtual Jail did not have a record of Hughes being involved in any fights while at the jail. Hughes's alibi for the time after he was released from jail is his mother.

Miller's mother (Dorothy Edith Miller, DOB 04/30/1962), interviewed at home, stated that the family and that Miller did not know that Hughes had been released from jail. They are sure he had something to do with her death. Anderson also feels that Hughes had something to do with Miller's death, as he threatened to kill her and get away with it when he was arrested the last time for violating the ex-parte. Miller's father (Jeffrey Mark Miller, DOB 06/01/1960), interviewed at work, also felt that Hughes was responsible.

Victim was wearing a floral print summer type "sun" dress when discovered. No injuries or discernible cause of death was visible on victim. After being turned over, blood was discovered on the back of victim's dress. Victim was not wearing any underwear and blood was discovered to emanate from vaginal area of victim. However, the amount of blood lost is not enough to cause death. In addition to the injuries surrounding the vaginal area discovered at the scene (lacerations and contusions) there were contusions on the facial and breast area of the victim. Palpitation of those areas did not produce any bone movement which would indicate breaking of the bones or any injury which lead to death.

One witness: resident of 16A East Locust Street, Edith Margaret Williams, DOB 09/16/1934. Said she heard loud voices from 16B at about midnight, but since this had been a common occurrence, she didn't think anything of it. She took out her hearing aid and went to sleep. Williams was not sure if the voices she heard were of Hughes, but she was sure Miller was the female voice. She didn't see anyone the night of June 16 and did not see Miller at all on June 17. Without her hearing aid, Williams is practically deaf.

Police had arrived at apartment at 11:45am. Detectives arrived at 11:55am. CSI's arrived at 12:01pm. Forensic Investigator (FI) from ME's Office arrived at 12:21pm. Victim transported to Virtual Hospital by the Foot Livery Company on June 17 at 1:34pm. Autopsy ordered by FI. Victim transported to ME's Office by Office personal at 5:11pm June 17. Autopsy performed on June 18 by Dr. W. Young. FI performed time of death analysis at scene. Livor mortis was along back (victim discovered on back) and was fixed. Rigor mortis was fully involved in all muscles. Liver temperature was 81.3°F. Based on information provided by FI, Dr. Young determined TOD to be 11:30pm June 16 to 2:30am June 17.

Formal identification provided during autopsy using police file fingerprints. Victim positively ID'ed as Miller. During autopsy, Dr. Young discovered evidence of forceful sexual encounter. There were lacerations and contusions both of the thigh and outer vaginal area of victim as well as inside the vaginal cavity of victim. Ejaculate material was also discovered in the vaginal cavity of victim. Ejaculate was collected by Dr. Young and signed over to police detectives who attended autopsy. Detectives also collected dress victim was wearing. Victim was not wearing any additional clothing or jewelry when discovered. Dr. Young also collected a known blood specimen from victim, which was signed over to police.

During autopsy, Dr. Young discovered no visible reason for death. Although there were lacerations and contusions to the face and chest area of victim, none were deep or serious enough to cause death. None of the lacerations were deep: all were superficial. There was no breakage of bone under any of the lacerations or contusions. All organs were examined. Excepting the damage to the vaginal cavity, all organs were the correct size and shape for a 23/24 year-old female. There were no remarkable findings during the autopsy. Samples were removed from the body for toxicology, including blood from the heart, urine and vitreous humor. Also, multiple slices were taken from the heart, lungs and brain for further microscopic studies. Dr. Young has filed this case as undetermined pending the results of the microscopic studies and the toxicology studies.

The body was released to Smith Family Funeral Home on June 19, 2011 for burial.

Reference no: EM13146993

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