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Rosemary West — guilty or not guilty?
Sixth Cross Channel Conference on Forensic Medicine 1998
Acute excited delirium
7
Clinical forensics of gangs in Los Angeles
Dr Steven B. Karch MD
Dr William Mallon MD, FACEP
Assistant Medical Examiner, California, USA
Dept. of Emergency Medicine, University of Southern California Medical Centre, Los Angeles
The incidence of acute excited delirium, a generally lethal disease, has increased markedly in the last few years. The underlying neurochemical abnormalities have been characterized, but most clinicians have had little experience with either the diagnosis or management of these cases, and there are many misconceptions about this disorder. For one thing, blood cocaine concentrations are not high. In 45 cases seen by the Miami-Dade Medical Examiner, mean cocaine concentrations (1.3 mg/L) were not much greater than those seen in recreational users. This situation often leads to confusion in court, because many still incorrectly believe that death is due to excessively high blood levels. In cocaine-related deaths, be they psychotic or otherwise, blood concentrations completely overlap concentrations in trauma deaths where the presence of the drug is unrelated to the cause of death. Within the last few years it has been shown that victims have decreased D2 receptors in the temperature regulatory centres of the hypothalamus. With fewer D2 receptors, D1 mediated temperature increases are unopposed, explaining why decedents are always hyperthermic. In the Miami series, the mean temperature was 40.6°C at the time of first medical encounter. Psychotic symptoms and violent agitation are explained by alterations in the number and distribution of kappa2 receptors within the amygdala, a structure that plays a vital role in the coordination of emotional responses, particularly aggressive ones. These changes can be identified in post-mortem brain, but only if the brain is removed, and slices frozen, within 12 h. Such testing is beyond the means of any medical examiner, but frozen specimens can be easily sent to any number of neurochemistry reference laboratories. Of course, the mere demonstration of these changes does not prove that police misconduct or medical incompetence did not occur. But it will show that the patient was suffering from a generally fatal disease. Pepper spray is often an issue. Opponents of pepper spray are quite vocal, and they will attribute any deaths that occur to capsicum, rather than the underlying psychiatric state. It has been our experience that when police try to spray agitated psychotics, they usually miss the face and end up spraying the victim's back or shoulder, and sometimes the faces of other officers. We use saline swabs to recover capsicum from skin and clothing, and a modification of the assay used by food chemists to quantitate capsicum. These measures are necessary in order to counter claims that death was due to overzealous application of capsicum by the police. Unfortunately, assays for capsicum in biological matrices are yet to be developed. But if capsicum cannot be recovered from the facial area, toxicity is effectively ruled out. Prudent management also includes a meticulous, well photographed, neck dissection to rule out neck compression. Brain drug concentrations should also be determined. In contrast to postmortem blood measurements, which are notoriously unreliable, brain concentrations may provide a very accurate picture of both the pattern of use, and of the situation at the time of death. Protocols must be put in place to ensure that all the appropriate measures are taken. It is in the interest of all parties to have these protocols in place before the next case occurs.
No abstract submitted FRIDAY 15 M A Y - A F T E R N O O N SESSION 'Rosemary West - guilty or not guilty?'
Mr Graham Ritchie
Forensic Odontologist, Stowrnarket, Suffolk, UK Prior to Frederick West's self-suspension in H M P Winson Green on or about 1 January 1995; Rosemary West had been charged with nine of the twelve counts of murder faced by Frederick. After his death, these nine charges against her were confirmed and one fresh one brought - the murder of Charmaine West. The prosecution of Rosemary West had, for the perfectly good reason of the passage of years, to rely heavily on 'similar fact' evidence supported, as to killing, only by one small piece of possibly factual evidence - the time lapse indicated by changes apparent in the development of the teeth of Charmaine West, as evident in a portrait photograph of her of known provenance, and the state of the teeth in her presumed remains which would, if the prosecution's view was correct, incriminate Rosemary West alone because Fred was incarcerated at the relevant time. This paper will present the evidence and put the proposition that the prosecution's opinion of this evidence cannot have been correct and, if not, what then of 'similar fact'? 'Similar' to what? An analysis of the identification methods used on the victims of the world's worst hijacking. Comoros air disaster - November 1996
Philip H. Marsden* BDS(Lond), LDS RCS(Eng), Dip F O d , MSc(Hons), MIEM, Amar S. Naru PhD, BDS, LDS RCS(Eng), Dip F Od, Eric Dykes PhD, BSc, MIEM, Philip Lewis BAFS, A R S H
*Forensic Odontologist, London, UK At l l . 4 5 a m on Saturday, 23 November 1996, Ethiopian Airlines flight 961 was hijacked shortly after leaving Addis Ababa bound for Nairobi and beyond. At 3.20 pm, that afternoon, the Boeing 767 ran out of fuel and crashed in the Indian Ocean just off the coast of the Comoros. Of the 175 people on board, 125 lost their lives in the worst hijacking the world has known. There were victims from 32 different countries, spanning the world. The authors formed part of a 15 strong team from the U K who were solely responsible for the identification, preservation and repatriation of 112 of these victims, which included the three hijackers. All aspects of the disaster will be covered, with particular emphasis on the analysis of the 15 identification methods used. The role of forensic odontology will be assessed in view of the relatively small percentage of passengers that had any dentistry present. It was the primary, secondary or tertiary method of identification in 85% of the 'white' victims, but only 18% of the 'non-white' victims. The majority of the victims
Acute excited delirium
7
Clinical forensics of gangs in Los Angeles
Dr Steven B. Karch MD
Dr William Mallon MD, FACEP
Assistant Medical Examiner, California, USA
Dept. of Emergency Medicine, University of Southern California Medical Centre, Los Angeles
The incidence of acute excited delirium, a generally lethal disease, has increased markedly in the last few years. The underlying neurochemical abnormalities have been characterized, but most clinicians have had little experience with either the diagnosis or management of these cases, and there are many misconceptions about this disorder. For one thing, blood cocaine concentrations are not high. In 45 cases seen by the Miami-Dade Medical Examiner, mean cocaine concentrations (1.3 mg/L) were not much greater than those seen in recreational users. This situation often leads to confusion in court, because many still incorrectly believe that death is due to excessively high blood levels. In cocaine-related deaths, be they psychotic or otherwise, blood concentrations completely overlap concentrations in trauma deaths where the presence of the drug is unrelated to the cause of death. Within the last few years it has been shown that victims have decreased D2 receptors in the temperature regulatory centres of the hypothalamus. With fewer D2 receptors, D1 mediated temperature increases are unopposed, explaining why decedents are always hyperthermic. In the Miami series, the mean temperature was 40.6°C at the time of first medical encounter. Psychotic symptoms and violent agitation are explained by alterations in the number and distribution of kappa2 receptors within the amygdala, a structure that plays a vital role in the coordination of emotional responses, particularly aggressive ones. These changes can be identified in post-mortem brain, but only if the brain is removed, and slices frozen, within 12 h. Such testing is beyond the means of any medical examiner, but frozen specimens can be easily sent to any number of neurochemistry reference laboratories. Of course, the mere demonstration of these changes does not prove that police misconduct or medical incompetence did not occur. But it will show that the patient was suffering from a generally fatal disease. Pepper spray is often an issue. Opponents of pepper spray are quite vocal, and they will attribute any deaths that occur to capsicum, rather than the underlying psychiatric state. It has been our experience that when police try to spray agitated psychotics, they usually miss the face and end up spraying the victim's back or shoulder, and sometimes the faces of other officers. We use saline swabs to recover capsicum from skin and clothing, and a modification of the assay used by food chemists to quantitate capsicum. These measures are necessary in order to counter claims that death was due to overzealous application of capsicum by the police. Unfortunately, assays for capsicum in biological matrices are yet to be developed. But if capsicum cannot be recovered from the facial area, toxicity is effectively ruled out. Prudent management also includes a meticulous, well photographed, neck dissection to rule out neck compression. Brain drug concentrations should also be determined. In contrast to postmortem blood measurements, which are notoriously unreliable, brain concentrations may provide a very accurate picture of both the pattern of use, and of the situation at the time of death. Protocols must be put in place to ensure that all the appropriate measures are taken. It is in the interest of all parties to have these protocols in place before the next case occurs.
No abstract submitted FRIDAY 15 M A Y - A F T E R N O O N SESSION 'Rosemary West - guilty or not guilty?'
Mr Graham Ritchie
Forensic Odontologist, Stowrnarket, Suffolk, UK Prior to Frederick West's self-suspension in H M P Winson Green on or about 1 January 1995; Rosemary West had been charged with nine of the twelve counts of murder faced by Frederick. After his death, these nine charges against her were confirmed and one fresh one brought - the murder of Charmaine West. The prosecution of Rosemary West had, for the perfectly good reason of the passage of years, to rely heavily on 'similar fact' evidence supported, as to killing, only by one small piece of possibly factual evidence - the time lapse indicated by changes apparent in the development of the teeth of Charmaine West, as evident in a portrait photograph of her of known provenance, and the state of the teeth in her presumed remains which would, if the prosecution's view was correct, incriminate Rosemary West alone because Fred was incarcerated at the relevant time. This paper will present the evidence and put the proposition that the prosecution's opinion of this evidence cannot have been correct and, if not, what then of 'similar fact'? 'Similar' to what? An analysis of the identification methods used on the victims of the world's worst hijacking. Comoros air disaster - November 1996
Philip H. Marsden* BDS(Lond), LDS RCS(Eng), Dip F O d , MSc(Hons), MIEM, Amar S. Naru PhD, BDS, LDS RCS(Eng), Dip F Od, Eric Dykes PhD, BSc, MIEM, Philip Lewis BAFS, A R S H
*Forensic Odontologist, London, UK At l l . 4 5 a m on Saturday, 23 November 1996, Ethiopian Airlines flight 961 was hijacked shortly after leaving Addis Ababa bound for Nairobi and beyond. At 3.20 pm, that afternoon, the Boeing 767 ran out of fuel and crashed in the Indian Ocean just off the coast of the Comoros. Of the 175 people on board, 125 lost their lives in the worst hijacking the world has known. There were victims from 32 different countries, spanning the world. The authors formed part of a 15 strong team from the U K who were solely responsible for the identification, preservation and repatriation of 112 of these victims, which included the three hijackers. All aspects of the disaster will be covered, with particular emphasis on the analysis of the 15 identification methods used. The role of forensic odontology will be assessed in view of the relatively small percentage of passengers that had any dentistry present. It was the primary, secondary or tertiary method of identification in 85% of the 'white' victims, but only 18% of the 'non-white' victims. The majority of the victims