Forensic Epidemiology Investigations

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Forensic Epidemiology Investigations
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Goals

• Describe the differences between typical public
  health and law enforcement investigations
• Define and compare covert and overt
  health-related attacks
• Describe methods for conducting a joint forensic
  epidemiology investigation

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What is Forensic Epidemiology?

• Forensic epidemiology uses public health methods
  in the setting of a potential criminal
  investigation
• Will be encountered by most public health workers
  through health-related criminal investigations

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Law Enforcement and Public Health Investigations
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Law Enforcement and Public Health Investigations
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Criminal Intent

• Outbreaks usually occur naturally
• Look for mistakes in food preparation, changes in
  the environment, other unintentional incidents as
  cause
• Recognizing criminal intent will help preserve
  evidence and solve the crime

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Covert Attack

• No group or individual takes responsibility
• Incident may not be initially recognized as an
  attack
• Example
• Salmonella typhimurium outbreak (Oregon, 1984)

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Identifying a Covert Attack

• Public health will recognize signs, symptoms, or
  disease clusters through surveillance
• Hospital emergency room, laboratory staff, health
  care providers may become first responders

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Investigating a Covert Attack

• May be difficult to immediately confirm that a
  bioterrorist incident has occurred
• Local health department should
• Immediately notify state health department
• Conduct joint preliminary epidemiologic
  investigation using rapid-response epidemiologic
  and laboratory team
• Once thought to be a possibility, immediately
  notify FBI and other response partners

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Overt Attack

• Perpetrator announces responsibility for the act
• May be reported to public health official
• More likely to be announced on public web site or
  through media
• Example
• Intentional release of sarin nerve agent (Tokyo
  subway, 1995)

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Identifying an Overt Attack

• Law enforcement will detect event
• Law enforcement and emergency management teams
  will be the first responders

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Investigating an Overt Attack

• Many overt incidents have been hoaxes
• Still a crime the site is a crime scene
• If health officials notified of incident or
  threat
• Required to immediately contact FBI, state/local
  law enforcement
• Overall response coordinated by the FBI
• Then local officials should immediately notify
  state health department

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Laws Governing an Investigation

• Different laws govern investigations by public
  health and law enforcement

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Public Health Laws

• North Carolina statutes give permission to
• Review relevant medical records
• Implement control measures, require submission to
  examinations and tests
• Impose quarantine and isolation
• Enter premises of any place where necessary to
  enforce provisions of these public health laws
• Public health officials can respond quickly to
  health-related threats!

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Law Enforcement Laws

• Law enforcement officers must obtain search
  warrant to conduct a search and make seizures
  unless
• Consent to the search is given
• Serious, credible, immediate threat (exigent
  circumstances)

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Joint Interviewing

• Should work in teams to jointly conduct
  interviews
• If joint interview is not possible, each
  discipline should know the type of information
  their counterpart is seeking
• Law enforcement wants to know personal, travel,
  incident, safety, other information pertinent to
  criminal investigation.
• Public health wants to know personal, exposure,
  travel, medical history

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Evidence

• Law enforcement gathers evidence
• Public health gathers specimens
• Two criteria must be met for public health
  information to be used in criminal
  investigations
• Legitimate public health investigation
• Chain of custody

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Legitimate Public Health Investigation

• Example of legitimate public health
  investigation
• Collecting samples of food from a salad bar when
  an outbreak is suspected
• Samples are collected based on legitimate concern
  for the publics safety
• Samples are admissible as evidence in a criminal
  investigation if one is conducted

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Chain of Custody

• Chain of custody special form to document the
  chronological history of evidence
• Includes name/initials of individual who
  collected evidence, each person or entity having
  custody of it, date the item was collected or
  transferred, agency and case number, victim's or
  suspect's name, brief description of item
• Required in law enforcement investigation
• Officials responsible for creating incident
  report, maintaining chain of custody,
  transporting evidence to laboratory or other
  facility

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Chain of Custody

• Not established in typical public health
  investigation
• Persons documented as custodians of the item
  should be able to
• Testify in court that the item was secure,
  unaltered, and uncontaminated while in their
  custody
• Explain the procedures they used to store,
  examine, test, and otherwise process the item

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Confidentiality

• Public health officials concerned with
  confidentiality of patients and medical records
• According to North Carolina statutes, all records
  containing privileged patient medical information
  are confidential
• May report case or outbreak of an illness,
  condition, or health hazard, but should not
  disclose personally identifiable information
• Can contact, interview, offer testing to cases,
  case contacts, and contact contacts considered
  suspect cases, but confidentiality must be
  maintained

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Confidentiality

• When bioterrorist incident or criminal intent
  suspected, law enforcement may gain access to
  confidential or protected health information
• Then confidentiality concerns for the person as a
  patient and as a witness or informant

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Media

• Public health has more symbiotic relationship
  with media
• Rely on media to get information to consumers
• Use media to elicit public response and assist in
  investigations
• Law enforcement not open with media
• To preserve integrity of the case
• To not hinder investigation of unexplored leads
• Need protocol to avoid accidental disclosure of
  important information
• All parties should coordinate messages through
  joint information center

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Classified/Sensitive Information

• Public health may be required to review
  classified or sensitive information
• Some public health officials should hold
  clearances to communicate with law enforcement
  when necessary
• Secure equipment (phone lines, fax machines)
  should be available

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Challenges of Bioterrorism

• Law enforcement and public health face same
  challenges investigating bioterrorist events
• Likely to be high concentrations of agent
• May be a large primary cohort of people exposed
• Agent may have been distributed in a well
  traveled area
• People may present to many different hospitals
• May be a deliberate second attack
• May be wide-spread panic
• Hospitals may become flooded with both sick and
  non-sick

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Challenges of Bioterrorism

• When all participants prepared to respond and can
  work efficiently and effectively together, they
  can
• Control panic
• Ensure a rapid response
• Treat the sick
• Identify the source
• Successfully identify and prosecute those
  involved in the attack

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References

• Goodman RA. Basics of Public Health/Epidemiologic
  Investigations for Law Enforcement. Presented
  at Forensic Epidemiology Training Course
  November 2-5, 2002 Chapel Hill, NC.
• Centers for Disease Control and Prevention (CDC).
  Available at http//www.bt.cdc.gov/EmContact/Pr
  otocols.asp. Accessed August 31, 2005.
• NC General Statutes. Available from
  http//www.ncleg.net/gascripts/Statutes/Statutes.a
  sp. Accessed August 31, 2005.

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References

• Martinez D. Law Enforcement and Forensic
  Epidemiology. Presented at Forensic
  Epidemiology Training Course November 2-5, 2002
  Chapel Hill, NC.
• Technical Working Group on Crime Scene
  Investigation, National Institute of Justice.
  Crime Scene Investigation A Guide for Law
  Enforcement. January 2000. Available at
  http//www.ncjrs.org/txtfiles1/nij/178280.txt.
  Accessed August 31, 2005.
• Scenario 1 Suspicious letter in DeKalb County.
  Working group exercise. Presented at Forensic
  Epidemiology Training Course November 2-5, 2002
  Chapel Hill, NC.