The Cause and Manner of Death can have various impacts

From civil and criminal charges to hereditary issues.  It may even have unintended consequences.
(this post is not about the death penalty or defense strategy)

A recent revelation that the coroner's report has now been modified [amended from 'Homicide' to 'Undetermined'] does little immediately to change Montour's conviction for murdering his daughter in 1998, but the former prosecutor told 9Wants to Know he relied "almost exclusively" on medical reports that have now come into question.

In a court filing made public Tuesday afternoon, Edward Montour's attorneys argue Montour - on trial for killing a Colorado corrections officer in 2002 - was wrongly convicted of murdering his 11-week-old daughter Taylor Montour in 1998.

Montour's defense believes Taylor Montour died not as a result of abuse, but due to brittle-bone disease. "Today, there are four pathologists from the largest jurisdictions in the state," read Tuesday's motion, "who all agree the cause of death is undetermined."

Our agency principals were trained and experienced with infant death investigations based on the recommendations of the Centers for Disease Control.  There are specific multi-investigator and multi-jurisdictional protocols that should be followed.  Medical records play a primary and important function in the investigation.  However, all death investigations are empirical - medical records alone are insufficient.

Our agency provides expert consultations - including the investigative protocols - in all types of deaths, including infant deaths.

http://www.9news.com/news/article/379056/188/Death-conclusion-changed-in-murder-case

Our agency recently published a book for the lay person - A Survivors' Guide  to Understanding Death Investigations - at www.UnderstandingDeathInvestigations.com

We have also developed a distance learning course for all investigators - Death Investigation and Injury Causation for Professional Investigators - at www.MedicolegalDeathInvestigations.com

"We speak for the deceased.  To them we owe the truth."  AFI-LLC intro video http://www.youtube.com/watch?v=OgsvtbSk8fg
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Dean A. Beers, CLI, CCDI and Karen S. Beers, BSW, CCDI
Board Certified Legal Investigator / Expert
Board Certified Criminal Defense Investigators
Certified in Medicolegal Death Investigations / former Deputy Coroners

Associates in Forensic Investigations, LLC
Expert Consultants and Legal Investigators
Personal Injury, Negligence & Death in Civil, Criminal and Probate Litigation

www.DeathCaseReview.com ~ beersda@DeathCaseReview.com
(970) 480-7793 Office (Dean x1 / Karen x2) and (970) 480-7794 Fax
'Quaero Indicium' - To Find The Evidence

Death in Ohio – Suicide or Accident?

Dean and Karen will briefly discuss this case on the next 'Facts & Forensics' podcast (a link will be posted here, when available in mid March).

In Sandusky Ohio on March 02, 2012, 19 year-old Jacob Lamberios was reported dead due to a gunshot wound to the head.  The county elected coroner, John Wukie, was called and certified the death based on verbal reports from on scene sheriff deputies.  No scene response from the coroner or medicolegal death investigators.  It was ruled a suicide.  The evidence was later lost and the decedent buried.  No autopsy.


The death was certified by the coroner as “Reason for death: Suicide. Gunshot wound to head. Deceased shot self in head, may not have realized the gun was loaded.”

The press is calling this an 'Accidental Suicide'.  Like 'Suicide by Cop' - 'Accidental Suicide' is a non-existent manner of death and is purely an emotional conclusion.

You can follow the details of this story at http://www.sanduskyregister.com/limberios-shooting-saga

Our agency is not attempting to opine on if this death is 'Suicide' as ruled, or 'Accident' as determined by a grand jury following an investigation by the Ohio Attorney General; or ‘Homicide’.  Cases like this have such an impact on families and society, and such misunderstandings, that we thought it would be useful to share some professional insight into these types of cases.

First, based only on press reports, here is what is wrong:
-- No scene response, no autopsy and no toxicology.  The role and function of the coroner's office is to independently investigate deaths.  Not all deaths require or should be autopsied - this is one that should have been.
Would this change the ruling?  That question may not be answerable – it likely would not, and by some accounts would not; but it would answer questions of the family, and either support and/or refute the law enforcement investigation.  The most important function of the coroner's office is independently determine the cause and manner of death, to provide answers to the family.

-- A grand jury investigates for felony criminal charges, such as if this were a homicide.  They do not determine cause and manner of death.
A coroner's inquest serves that function.  In the event that it is determined to be a homicide, then it may be sent to a grand jury for consideration of criminal charges.  In addition, grand jury proceedings are secret - they provide no answers to the family.

Next, based only on press reports, here is what has been determined:
-- The decedent's parents sued, resulting in the AG investigation, because they did not want the legacy of their son to be suicide to their (then) two-year old granddaughter.
Death investigations cannot be based on emotions and desires of the family.  This does not conform to the death investigator’s creed of 'To the living we owe respect, to the dead we owe the truth.'

-- The decedent's parents were concerned, but not solely, about an insurance payout. 
Many life insurance policies have suicide clauses - from no payout to a payout only after a period of time from activating the policy (often two years).  In addition, it is common for life insurance policies to have a double indemnity clause for accidental deaths (payout of double the policy value), as well as other insurances (i.e. accident policies, firearms policies, etc.).  Finally, a death determined to be an 'Accident' may have civil remedies that 'Suicide' cannot.

Next, based only on press reports, these are the reported facts:
-- The decedent was not suicidal per his family.
-- The handgun was a .357 magnum revolver holding six rounds in the cylinder.
-- (from an independent source) the handgun had been fired five times, those spent shells removed, leaving the sixth live round in the cylinder.
-- (from an independent source) in testing by the AG’s office, the handgun would misfire three times of ten attempts.  This ‘misfire’ is not detailed.
-- Three other persons were present and reported to scene sheriff deputies that the decedent shot himself.
-- The witnesses reported the decedent shot himself in the right temple, scene sheriff deputies reported the left temple, the first post-exhumation autopsy reported a distant gunshot with no stippling (homicide), and the second post-exhumation autopsy report a contact gunshot with stippling (suicide).  In our experience, it is not unheard of for law enforcement or others not specifically training in injury causation to misidentify an entrance from an exit wound.

Next, let's define 'Accident' and 'Suicide' in death investigation:
-- Accident - Deaths other than natural, where there is no evidence of intent: an unintentional event or category of chain of events.
-- Suicide - Death as a purposeful action set in motion (explicit or implicit) to end one’s life.  Suicide is a ruling that is to the exclusion of all other Manners of Death and is presumptive to the decedent having not committed suicide.  This manner is not used as a fallback when the other manners are inconclusive.  For example, if not Accident or Homicide, it must be Suicide is an unfounded conclusion.

Specific to 'Suicide' - the investigation should not try determining the person’s “final thoughts” - only their final actions.  It is difficult to believe a person could be 'suicidal' and there need not be premeditation or history of suicidal ideations or attempts.  The coroner violates this important protocol - and possibly adds to confusion and familial emotional distress by stating, “...may not have realized the gun was loaded.”  Unless there is specific evidence to support this, it is inappropriate to add conjecture to a cause of death statement.

There are four elements to Suicide:
1. Intent to commit the act knowing that it may result in their death;
2. Knowledge of the instrument used and that it may cause death;
3. History of attempts, ideation or documentation of evidence supporting Suicide; and
4. Evidence of contributing factors to the act.

Finally, based only on press reports, each of the elements exist.  However, two private post-exhumation autopsies and review by independent forensic pathologists differ from the official findings.  If the gunshot wound were not consistent with being self-inflicted, elements one and four are removed.  That would leave 'Accident' or 'Homicide' as considerations.  In the complete absence of sufficient evidence or information, especially about intent, to assign another manner - 'Undetermined' may be ruled.

This example is exactly why we support trained medicolegal death investigation, appropriate protocols and scene response to such deaths.  It is why we have published our latest book, “A Survivors' Guide to Death Investigations” - available at (www.UnderstandingDeathInvestigations.com).  It is also why we have developed our distance learning and continuing education “Death Investigation for Investigators” death investigation course (www.MedicolegalDeathInvestigations.com).  Neither of these are intended to enable a lay person to investigate deaths, but only to understand what protocols should and do exist, and what options exist in equivocal deaths.  It is why we do what we do at www.IsItSuicide.com.
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Associates in Forensic Investigations, LLC
Expert Consultants and Legal Investigators
Personal Injury, Negligence & Death in Civil, Criminal and Probate Litigation

Dean A. Beers, CLI, CCDI and Karen S. Beers, BSW, CCDI
Colorado Licensed Private Investigators Nos. PI-503 and PI-502
Board Certified Legal Investigator / Expert
Board Certified Criminal Defense Investigators
Certified Death Investigators / former Deputy Coroners

www.DeathCaseReview.com ~ Associates@DeathCaseReview.com
(970) 480-7793 Office (Dean x1 / Karen x2) and (970) 480-7794 Fax
'Quaero Indicium' - To Find The Evidence

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Prescription Medications - The Danger of Legal and Illicit Drugs
We are frequently contacted by the media for commentary on current events related to legal investigations and death investigations.  Recently we were contacted for commentary on a story, and presented two questions:
1. Marijuana is virtually never implicated the overdose deaths of Larimer County residents, and only twice in suicide deaths in 2012, and those people were also drunk.  What has been our experience?

2. Prescription drugs have the imprimatur of safety because they come from a doctor, what can and should families be doing to protect themselves?

First, we are opposed to the legalization of marijuana.  There are already experiences of unintended consequences, apparently unlearned from legalization of 'medical' marijuana.  We do not dispute legitimate researched uses, but the latter was long abused and the former is already fraught with issues well known to surface.  We have personally and professionally seen the tragedy and trauma attributed to marijuana use and addiction -- it is beyond the individual and marijuana; it is empirical of drug abuse, families and society.

-- Marijuana is virtually never implicated the overdose deaths of Larimer County residents, and only twice in suicide deaths in 2012, and those people were also drunk.  What has been our experience?

No recorded cases of overdose deaths from marijuana have been found. However, marijuana use can cause accidents and medical problems that lead to death.

During our tenure at the MEs office, a decedent testing positive for marijuana – alone or with alcohol and other drugs – was so common as to be almost expected.  We have not seen any recent statistics; however, we are aware that the use of other drugs – illicit and prescription – has increased.  This should be of great concern.

Also during our tenure at the MEs office, as well as some limited civil and criminal cases in the private sector, we have had several cases of marijuana alone in a decedent or living involved person.  This included several suicides, as well as operation of motor vehicles and either being killed or causing the death of another in the consequential collision or accident.

Prescription medications, like all regulated medications, are deemed safe only if used as directed by the prescribing physician.  However, prescription medications can be addictive and have mind-altering side-effects.  Prescription medications are easily taken and concealed, and seen as harmless because they are prescribed.  However, deaths from prescription medication overdoses – in our experience – has never resulted from a patient following the prescription directives.  Deaths have resulted from the illegal use of prescription medications.  Like items we use and tasks we perform every day, safety is in the hands of the user.  There are occasions of a reaction or side effect, and which have resulted in deaths; however, these are rare.  The most common factors surrounding deaths due to prescription drug overdose are (not in any statistical order or relevance):

1.     Taking of prescription medications by self-diagnosis and self-medication – illegal;
2.     Taking of unprescribed medications – illegal;
3.     Taking of prescription medications contrary to directives – illegal;
4.     Taking of multiple unprescribed medications – illegal;
5.     Taking of multiple prescribed medications contrary to of directives – illegal; and
6.     Taking of medications with alcohol is contrary to directives.

Prescription medications are not the only concern – over-the-counter medications can also be fatal if taken contrary to directives, with other medications, unnecessarily or with alcohol.  Being a prescription or over-the-counter medications is not automatically safe, or legal in their use, simply because they can be purchased at a store or pharmacy.  Contrary to the ‘harmless’ campaign to legalize medical and recreational use of marijuana, the ability to purchase marijuana from a licensed seller does not make it any safer than before it was deemed legal.

To obtain a prescription medication requires a consultation with, and diagnosis by, a physician.  Prescription medications are developed to treat specific diagnosis – some may require increasing dosages, which can lead to tolerance or addiction.  A pharmacist will typically be able to check for any potential conflicting medications of the patient, as well as give directives and warnings about use and side effects.  The prescriptions are tightly regulated, but there is no absolute. 

Marijuana for medicinal use also requires a consultation with a physician and diagnosis of a variety of illnesses – from pain and nausea to seizures and glaucoma – for which medical marijuana is approved.  The patient then goes to a licensed medical marijuana dispensary (not a pharmacy) where a person (with no related education, training or experience) will provide the patient the strain and dosage of their choice or by recommendation.  The use is then a matter of legal self-diagnosis and self-medication.  This is similar to homeopathic self-diagnosis and self-medication.  We are not aware of any instance of a death as a result of homeopathic self-diagnosis and self-medication – either by use or consequence of use.  The medicinal properties of marijuana can be extracted, sold and safely used as a homeopathic self-medication.

There are various unregulated strains of marijuana based on the active incredients, collectively called ‘cannabinoids’.  The active ingredient causing the mind-altering high is tetrahydrocannabinol (THC).  The remaining active ingredients do not make a person ‘high’:  Cannabidiol (CBD), Cannabinol (CBN), and Cannabichromene (CBC).   These remaining cannabinoids are not mind-altering and will not make a person high.  It is these cannabinoids that research supports having medicinal properties.

The potency of marijuana is most often based on the level of THC, and .5% is all that is required to make a person high.  The potency has doubled since 1998; an increase from under 5% in the 60s to 80s.  Common marijuana for medical use potency is 15% or less, and can be over 25% for recreational use.  Why the difference between the potency for medical and recreational use of marijuana?  Simply because as THC potency increases, the active ingredients beneficial for medical use (by research) decreases to nil.  However, the medicinal cannabinoids (by research) of marijuana are extracted – eliminating the user becoming high, something that most prescription analgesics do not do.

Like alcohol and many other available medications, marijuana is a depressant.  A person with a mental illness, diagnosed or not, is more susceptible to misuse of alcohol and other depressant drugs.  The use, particularly for an addictive personality, may become chronic and dangerous – even fatal.  It is common for teens and young adults to have pharmacy parties – mixing drugs obtained from taking just a few pills from a relative’s prescriptions or buying from a friend – and consuming alcohol (often illegal by their ages).  This is a very dangerous combination, and has been fatal in Larimer County and nationwide.

-- Prescription drugs have the imprimatur of safety because they come from a doctor, what can and should families be doing to protect themselves?

Like any other potentially dangerous product – from a hand tool to a vehicle or firearm – being properly informed and keeping the items from unintended persons is a personal responsibility.  Parents may keep car keys from children, and firearms are responsibly stored safely and out of reach.  Alcohol may be kept in locked liquor cabinets.  Medications and other drugs are most often kept in easily accessed medicine cabinets, purses, dressers and other areas.  Children are easily taught to keep away from unsafe products.  However, children grow up and become both curious and irresponsible.  Persons with medications and illicit or legal drugs must keep them safe and out of reach.  A lock box is a good idea, and there are special medication lock boxes and cabinets.  If we keep other dangerous items out of reach, and lock our valuables, why are we not doing the same with medications and legal or illicit drugs?

All medications and drugs – from prescription and over-the-counter to illicit – have side-effects and potentially unintended consequences.  Regardless of the type of medication or drug, intended use, or source, there is a personal and societal responsibility.

Please read the newspaper article in the Fort Collins Coloradoan
A deadly habit: Prescription drugs leading cause of overdose deaths in Larimer County - Drugs kill dozens of Larimer County residents every year but not drugs you might think of. http://www.coloradoan.com/article/20140118/NEWS01/301180104/A-deadly-habit-Prescription-drugs-leading-cause-overdose-deaths-Larimer-County

This is a good article that hopefully better informs the public that prescription drugs are abused and potentially fatal.  Look for a cameo quote from our agency.

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January 15, 2014

Dean A. Beers, CLI, CCDI and Karen S. Beers, BSW, CCDI
Colorado Licensed Private Investigators Nos. PI-503 and PI-502
Board Certified Legal Investigator / Expert
Board Certified Criminal Defense Investigators
Certified in Medicolegal Death Investigators / former Deputy Coroners

Associates in Forensic Investigations, LLC
Expert Consultants and Legal Investigators
Personal Injury, Negligence & Death in Civil, Criminal and Probate Litigation

www.DeathCaseReview.com ~ Associates@DeathCaseReview.com
(970) 480-7793 Office (Dean x1 / Karen x2) and (970) 480-7794 Fax
'Quaero Indicium' - To Find The Evidence