Consistent Investigation and Reporting of Sudden Unexplained Infant Death

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Consistent Investigation and Reporting of Sudden
Unexplained Infant Death
SOUTH CAROLINA INITIATIVE David Belk,
Lieutenant, SLED Cynthia Schandl, MD, PhD,
Forensic Pathologist, MUSC Bert von Herrmann,
15th Circuit 1st Asst Solicitor Rae Wooten, RN,
Charleston County Coroners Office
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SUID Sudden Unexplained Infant Death

• Definition The sudden and unexpected death of an
  infant due to natural or unnatural causes.
• CDC text Sudden, Unexplained Infant Death
  Investigation, www.cdc.gov (CDC Center for
  Disease Control)

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SIDS

• Definition Sudden death of an infant under one
  year of age, which remains unexplained after a
  thorough case investigation, including
  performance of a complete autopsy, examination of
  the death scene, and review of the clinical
  history.
• Pediatr Pathol 199111(5)677-684.

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State Observations

• Sudden Infant Death Syndrome (SIDS) cases may be
  over-reported
• Infant death cases may be under-investigated

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Current Status

• Investigation protocols inconsistent from county
  to county
• Reporting protocols inconsistent from county to
  county
• Insufficient information provided to pathologist
• Duplication of efforts
• Lack of uniformity in death certification
• Ineffective prosecution of infant homicide cases

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An Ideal Situation

• Uniformity of investigation
• All investigative information is available to
  those who need it in a timely manner
• Uniformity of reporting
• All agencies can accurately report results
• Uniformity in classification
• Public health issues identified early
• Accurate and early identification of criminal
  cases
• Enhancement of successful prosecutions of
  criminal cases

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CDCs SUIDI Program

• Sudden Unexplained Infant Death Investigation
  Reporting Form
• Interviews and Research
• The Scene
• Pathologist

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Interview

• The Interview
• Introduce yourself and your purpose
• Obtain demographic information of infant and
  caregiver(s)
• Ask open ended questions
• What happened include previous 72 hours
• Determine person who placed infant and person who
  found infant
• Determine infants position when placed, last
  seen alive, and found
• Use a checklist to be thorough

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Research

• Child protective services
• Medical and birth history
• Recent events

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Scene Investigation

• May provide vital information for the pathologist
  prior to his/her examination
• Information regarding the sleeping and living
  conditions will remain only BRIEFLY once the
  infant is removed
• Death certification CANNOT be accurate without
  adequate scene investigation

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Doll Re-enactment and Photographic Documentation

• How infant is PLACED by placer
• How infant is FOUND by finder
• How infant was LAST SEEN ALIVE
• Photography as if it is a CRIME SCENE
• Overall sleep situation
• Intermediate view
• Close-up of body/doll position

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PLACED POSITION
FOUND POSITION
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Pathologist

• Case demographics and history
• Scene information and photography
• Doll re-enactment
• Position placed, last seen alive, and found
• Any suspicions after initial investigation
• Investigator availability

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The Top 25

• National forensic pathologist survey has resulted
  in a list of data required prior to autopsy
• These are divided into FIVE groups
• Sleeping environment
• Infant history
• Family information
• Exam
• Investigator insight

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Sleeping Environment

• Asphyxia
• Evidence of overlying, wedging, choking,
  nose/mouth obstruction, rebreathing, neck
  compression, immersion in water, etc
• Sharing sleep surfaces
• Changing sleep condition
• Hypo/hyperthermia
• Environmental hazards
• Unsafe sleeping conditions

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Infant History

• Diet
• Recent hospitalization
• Previous medical diagnoses
• History of acute life-threatening events
• History of medical care without diagnosis
• Recent fall or other injury
• History of religious, cultural or ethnic remedies
• Cause of death due to natural causes other than
  SIDS

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Family Information

• Prior sibling deaths
• Previous encounters with police and/or social
  service agencies
• Request for tissue or organ donation
• Objection to autopsy

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Exam

• Pre-terminal resuscitative treatment
• Death due to trauma, poisoning or intoxication

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Investigator Insight

• Suspicious circumstances
• Other alerts for pathologists attention

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Prosecution

• In-depth interviews with written notes
• Photographs of the scene and autopsy
• Accurate death certification
• Complete research of medical history

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One way to convey scene information

• www.mdilog.net

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Conclusion

• Interview
• Scene Investigation and Re-enactment
• Information Dissemination

WITH KNOWLEDGE, TEAM WORK AND COMMITMENT, WE CAN
MAKE A DIFFERENCE!!!
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