As the unfortunate events unfolded in Ferguson, Missouri, over the past 10 days after a police officer shot and killed 18-year-old Michael Brown on August 9, much of the controversy centered on the lack of transparency of the investigation as to the events of the shooting.  The St. Louis County medical examiner had not released the results of the original autopsy as of August 17, which is the date when the Brown family’s privately hired forensic pathologist, Dr. Michael Baden, released details of his examination.  Dr. Baden was the former chief medical examiner for New York City and had examined the autopsy results of President John F. Kennedy and the Reverend Martin Luther King Jr.  Dr. Baden felt that his results showed that the unarmed Michael Brown was shot four times in the right arm and twice in the head.  It was only after these results were released that information from the St. Louis County medical examiner’s office became available, through an anonymous source, that Mr. Brown was shot in the head and chest between six and eight times.  Apparently, the information had been released to the St. Louis County prosecutor’s office on August 15, but was not made public.  In an unusual chain of events, the U.S. Department of Justice requested a third autopsy, which was completed by a U.S. military medical examiner on August 18.

As I followed this story, I wondered about the role of a forensic pathologist and how it may not be exactly as portrayed on television in shows such as “Crime Scene Investigation.”  I also understood that forensic pathologists have different roles and responsibilities than hospital-based pathologists.  Forensic pathologists/medical examiners often have a role as public health officials, when an investigation into a death may lead to the discovery of unexpected health issues that may be of significance to the public at large.  Communication will often occur with primary care physicians as well as family members.  The medical examiner is traditionally a true independent medical opinion as to the issues at hand/cause of death, with no vested interest in any specific outcome.  What is of importance in a case such as Michael Brown’s is that once the initial autopsy is completed, any further autopsies will be looking at tissue that has already been removed from the original anatomic alignment.  The initial imaging studies done at the time of the original autopsy therefore become of utmost importance for any subsequent examiner.

One of the classic articles about the role of the forensic pathologist was written in 1977 by Dr. Lester Adelson, who was at the Cuyahoga County Coroner’s Office (Cleveland, Ohio) and the Department of Pathology at Case Western Reserve University School of Medicine.  As Dr. Adelson eloquently wrote, “Death in all its forms and all its guises is the professional realm of the forensic pathologist.  From this standpoint, it is reasonable to regard him as the last true generalist in medicine.  He is constantly exposed to the age-old truth that tells him that although there is only one way in which to be born, there are many ways in which to die.  The grief-stricken, shocked family needs and deserves accurate information and comprehensible explanations, sympathetically and patiently imparted by a knowledgeable physician.  In many cases, the survivors' sorrow is compounded by an erroneously assumed burden of guilt for the sudden death.  This aspect of the tragedy must constantly be kept in mind by the pathologist during his interviews with the bereaved family.”  Hopefully, the Brown family will receive the accurate information that they deserve.

I would like to acknowledge the assistance of the New Hampshire Office of the Chief Medical Examiner in the writing of this blog.

As an added benefit for this blog, feel free to test your knowledge against the sample examination questions below from the American Board of Pathology:


Stuart J. Glassman, MD

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