Serial Killer Quiz
Want to test your knowledge of serial killers? Attendees at the 2013 IACME Fall Meeting and Education Expo took this quiz at the Friday, November 14 Annual Banquet. The quiz contains 20 multiple choice questions and the answers appear on page 3.
Training Opportunities for Death Investigators
John C. Kraemer, PA-F-ABMDI
The Iowa Office of the State Medical Examiner would like to make you aware of some great training opportunities in the field of death investigation.
The National Institute of Justice, through the National Forensic Science Technology Center, is pleased to offer the online course “Forensic Sciences: An Overview for Medicolegal Death Investigators.” This course will provide medicolegal death investigators with general knowledge of the scope and application of the forensic sciences within the criminal justice system, including crime scene processing and photography, latent fingerprint processing, controlled substances analysis, toxicology, forensic anthropology, forensic entomology, forensic odontology, firearm and tool mark collection and preservation, trace evidence analysis, fire debris analysis, explosives and explosive device identification, and forensic biology (serology/DNA).
American Board of Medicolegal Death Investigators offers continuing education credits for this program. Trainees who complete the online coursework and score 80 percent or higher on final assessment are eligible to apply for up to 16 credit hours.
To apply, go to www.nfstc.org/meetings, register and complete the online application. Qualified applicants will be notified of acceptance status within five business days of completed application submittal.
New End-of-life Care Preferences Tool May Affect Death Investigators
by Michael Hensch, MA, F-ABMDI
There is a new tool for expressing end-of-life care preferences and, in the near future, medical examiners and medical examiner investigators may be expected to address its use during the course of death investigations.
While it is preferable that seriously ill people determine the course of their health care, this is not always possible. If the seriously ill person is a minor or has diminished mental capacity, lack of knowledge or preparation can complicate an already stressful situation. Various types of advanced care directives, e.g., living wills and durable power of attorney for health care decisions, have been developed over the past few decades to facilitate preparation.
In Iowa, as in most other states, advanced directives were legally recognized only for people 18 years and older. Despite the progress that has been made toward a more nuanced and comprehensive end of life care model, a question has persisted: what about seriously ill children? A recent national movement, POLST (Physician Orders for Life Sustaining Treatment), has aimed to help seriously ill individuals of all ages clearly express their care preferences to the most important individuals and institutions in their lives.
Linn and Jones Counties participated in a four-year pilot program to develop an implementation of the POLST model, Iowa Physician Orders for Scope of Treatment (IPOST). IPOST has now been state law (Code of Iowa §144A; Iowa Administrative Code §641—142) since July 1, 2012, though awareness and usage are still spreading across the state.
Some important goals of IPOST: 1. Establish a standardized document expressing end of life treatment preferences. 2. Encourage document portability across organizations. 3. Allow people to express a wider range of treatment preferences beyond those addressed in current DNR orders.
Why is IPOST important to medical examiners and medical examiner investigators? As use of the IPOST document becomes more widespread, it is important that medical examiners be aware of its existence and possibly be ready to account for it during the course of a death investigation. Since IPOST is presenting the first opportunity for children to establish an out-of-hospital DNR order, it is possible that your offices will be contacted by a family wanting to file an IPOST with you or otherwise seeking guidance on the topic of planning an out-of-hospital death.
Recently, the mother of a terminally ill child came to the Johnson County Medical Examiner Department with questions regarding autopsy procedure. During the course of the conversation, she noted that the family wanted the child to die at home. IPOST was mentioned by our staff as a safeguard that could ensure that their preferences were honored. Following the meeting she consulted with her child’s health care provider, completed an IPOST, and sent a letter to our office informing us of its existence along with a copy of the actual IPOST. When the child later died at home, having this information on file allowed for minimal intrusion upon the family at the time of death.
It should be noted that the presence of an IPOST does not ensure that a child’s death will not fall under medical examiner jurisdiction, as his or her death could still be caused by something other than a natural disease process.
How should medical examiners and medical examiner investigators prepare? We recommend four courses of action. Create a file in advance where you will store IPOST documents: completed forms, related communication records, etc. Know how to facilitate access to an IPOST form, if you are consulted by a family or health care provider. If you investigate the death of any terminally ill individual, always check to see if the individual had completed an IPOST. Ensure that your entire department is made aware when you have corresponded with an individual about IPOST.
POLST National Website http://www.polst.org
IPOST Form and Instructions from IDPH http://www.idph.state.ia.us/ipost/Form.aspx Iowa
Healthcare Collaborative IPOST Training http://www.ihconline.org/aspx/general/page.aspx?pid=82
IACME Board statement on service recommendations from medical examiners, medical examiner investigators
The Iowa Association of County Medical Examiners Board of Directors has advice for first responders who are asked for recommendations on biohazard companies—Proceed with Extreme Caution.
The Board discussed the issue at its May 17 meeting after the Des Moines Register reported that a biohazard company was accused of overcharging customers in Iowa and is the target of consumer complaints in 11 states. The company was a paid vendor at the IACME Fall Meeting two years ago, and has engaged in aggressive marketing to Iowa’s county medical examiners and investigators.
County medical examiners are frequently asked for biohazard company recommendations by family members of deceased Iowans.
“It’s fine to let family members know that there are companies that provide biohazard clean-up and other services, but we advise our members not to recommend specific companies to anyone,” says Dan Cole, MD, IACME president-elect. “Instead, we recommend referring them to the Internet or to their homeowner’s insurance carrier.”
John Kraemer, PA, Director of Forensic Operations for the Iowa Office of the State Medical Examiner, recently sent an email on this topic to county medical examiners in Iowa.
“This is a friendly reminder to be careful of any resource recommendations you make to families or other constituents,” Kraemer said. “As county employees/contractors you cannot favor one entity over another. For instance, you should not be recommending one funeral home, crime scene clean-up business, or any types of other resources over another.”