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W.Va. medical examiner tackles death's hows, whys

Oct. 28, 2012 @ 09:13 AM

CHARLESTON, W.Va. (AP) — While some doctors devote their lives to keeping people alive for as long as possible, there are others who spend their days with the dead, wondering how they got that way.

Dr. James Kaplan has served as West Virginia's chief medical examiner since 1997. Though he originally planned to become a doctor of the living, a brush with death investigations in medical school changed his career path forever.

"It was love at first sight," he said.

Kaplan was working at a hospital in Charleston, S.C., and decided to take an autopsy rotation. The hospital didn't have any autopsies scheduled, however, so Kaplan got to work under the local forensic pathologist.

He found the combination of science and crime investigation "intoxicating."

"You're helping to solve these mysteries. It was a wonderful mix of helping out policemen and solving problems."

As chief medical examiner, Kaplan is the state's main problem solver when someone dies under mysterious circumstances.

He has eight forensic pathologists under his employ, six who work in the chief medical examiner's Charleston headquarters and two who work at the West Virginia University Department of Pathology.

But Kaplan also manages an army of death investigators who operate as liaisons to municipalities.

There are about 120 death investigators in the state, and though all of them have medical backgrounds, they have a wide variety of specialties. State law allows anyone from a physician to an emergency medical technician to become an investigator.

One county medical investigator is a professor at the West Virginia School of Osteopathic Medicine. Others are registered nurses and physicians' assistants.

Kaplan said when investigators arrive on the scene of a death, they look for a few specific pieces of information. They want to identify the victim and find the time, location, manner and cause of his or her death.

There are a few basic ways to determine the victim's approximate time of death. Investigators first look for activities at the scene. Has the victim placed any calls on a cellphone recently? Did he or she open today's mail?

The human body also goes through noticeable changes once a person dies. Muscles stiffen and temperature drops. Both factors can give investigators a general idea of when the victim breathed his or her last.

"That's not an exact answer, but there are times it is enough to contradict the story of a witness," Kaplan said.

When trying to find out how someone died, investigators are on the lookout for inconsistencies at the scene. If an 85-year-old man is found dead in his bed, his family might suggest he suffered a heart attack based on previous health problems.

But if the man is found with bruising around his neck . . . well, that raises some questions about the family's hypothesis.


It's important to note the difference between the "manner" of a person's death and the cause. Kaplan said it's not difficult to figure out how someone died if he or she fell from a fifth-story window. The better question is "why?"

If the person was despondent and jumped, it might be a suicide. If he or she was pushed out the window, it's a homicide.

The death could be ruled an accident if investigators learn the victim, in the moments immediately preceding his or her demise, was painting a windowsill when a stepladder slipped. But if he or she had a seizure while on the stepladder, the death would be blamed on a "natural event."

That's another big piece of the medical examiner's job. Kaplan's office operates as a watchdog for local health departments, monitoring deaths caused by disease outbreaks.

If several residents of a nursing home all die from similar ailments, for instance, Kaplan's office will investigate to see if there is a common cause. In those cases, investigators can access medical records, examine the bodies, order lab tests and inspect the victims' living environments.

"The most important thing we do here is provide a clear picture of how well public safety and public health are doing," he said.

Kaplan's office trains death investigators in all aspects of the job, including how to recognize natural disease, how to identify accidents and how to work with local emergency personnel.

Each investigator is required to take 20 hours of classes taught by forensic specialists. They take a competency test at the end of those classes. If they pass, they are appointed as official death investigators for three years.

Sometimes, however, death investigators cannot get all the answers to their questions. That's when the forensic pathologists get involved.

If a simple inspection of the scene or an external inspection of the body isn't sufficient, death investigators can draw fluids from the victim for toxicology tests at the chief medical examiner's office.

Autopsies are the last resort when questions about a person's death cannot be answered through any other means.

Kaplan's office investigates about a quarter of the 20,000 deaths in West Virginia each year. Around 1,500 involve autopsies.

If someone dies in a car crash, it is usually evident how he or she died. In those cases, medical examiners just run toxicology tests to make sure no drugs or alcohol were involved.

But remember the example of the old man who might have had a heart attack but was probably strangled to death? Death investigators would likely turn that case over to a forensic pathologist.

"It might be necessary to perform a more intensive inquiry," Kaplan said.