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From Death comes Clues for the Living

Forensic pathologists translate tragedy into answers and treatments.

Pathology

In addition to heading UND’s pathology program, Mary Ann Sens serves as president of the National Association of Medical Examiners. .

Murder, mystery, and mayhem rule the landscape of television, where talk shows and crime scene investigation dramas use autopsy reports from forensic pathologists as bills of fare to whet our appetites for not only who “dunnit” but also how they did it.

Forensic pathology is a necessary part of our legal system, but how many of us associate forensic pathology with family and public health?  The Department of Pathology at the University of North Dakota School of Medicine and Health Sciences recently added a powerful, extensive new tool that equips UND forensic pathologists with the means to prepare and present evidence to prosecute the guilty as well as exonerate the innocent, and do much, much more.

That new tool is the School’s forensic clinical practice facility, which opened on July 6.

Former U.S. Sen. Byron Dorgan was instrumental in securing a grant for the project through the Health Resources and Services Administration, and Grand Forks County was vital to securing a Paul Coverdell Grant to computerize the facility.

“The new building opens up the possibility of providing more services to the state and the region,” said Dr. Mary Ann Sens, Chester Fritz Distinguished Professor of pathology and department chair.

Sens is the coroner for Grand Forks County and currently president of the National Association of Medical Examiners (NAME).  NAME is the national professional organization of physician medical examiners, medical death investigators, and death investigation system administrators who perform the official duties of the medico-legal investigation of deaths of public interest in the United States.

Recently joining Sens in the Department of Pathology are Dr. Mark Koponen, a forensic pathologist and Minot, N.D., native, and Ed Bina, a forensic investigator who will conduct death investigations under the supervision of Sens.

In addition to handling criminal cases for Grand Forks County, the UND facility covers all of North Dakota when the state’s chief medical examiner is not available.  Sanford Health System in Fargo and Altru Health System in Grand Forks have contracts with the facility to do all of their autopsy cases.  Sens and UND already have contracts with five Minnesota counties — Kittson, Mahnomen, Marshall, Red Lake, and Norman — that report all deaths within their borders to UND, and the Pathology Department has primary jurisdiction to decide which deaths to investigate.  In addition to those five counties, several other Minnesota and South Dakota counties send forensic cases to UND, recognizing the department’s expertise in preparing evidence for trial.  In contrast to North Dakota where the state determines who runs forensic investigations, in Minnesota and South Dakota it is county controlled.

As important as it is to solve crimes, the true value of UND’s facility comes from investigating unexplained deaths, where no foul play is suspected.

“North Dakota averages about eight homicides annually,” Sens said.  “We shouldn’t concentrate on crime full time.  We need to be working for families and for communities in family and public health.”

The new forensic facility provides an expanded ability to investigate sudden, unexplained deaths that occur at home, in the workplace or from public health hazards.

“Hospitals in North Dakota are not big enough to have a forensic pathology facility, and yet they need one,” Sens said.  “Before the new facility, unless there were clear signs of foul play, investigations of unexplained deaths were not getting done.  We now have the opportunity to do medical death investigations in a state that didn’t really have that ability or had limited facilities for them.  From unsuspected electrocution and carbon monoxide poisoning to work- and farm-related deaths, we investigate them all.”

Forensic pathologists at UND can directly and immediately translate findings from autopsies into treatments.  A number of cases demonstrate the great value this holds for families:

  • A man in early middle age who appears to be in good health dies.  No foul play is involved.  The autopsy reveals he suffered from hyperlipidemia, an increase in the amount of fat in the blood, which can lead to heart disease and pancreatitis.  The pathologist advises the rest of the family to have their lipid levels checked, which reveals that they all have hyperlipidemia.  With treatment they should live longer lives.
  • A man dies unexpectedly.  The autopsy uncovers a genetic heart valve defect.  The pathologist --recommends that the family

    see a cardiologist for screening, who finds the same defect in other family members.  With surgical repairs to the defect, they can live longer lives.

  • A supposedly “alcoholic” man dies.  The autopsy shows what would be expected: cirrhosis of the liver.  However, the autopsy also discovers that the man had hemochromatosis, a congenital disease in which the victim’s body cannot metabolize iron properly and which also leads to cirrhosis of the liver.  The man wasn’t an alcoholic after all.  In addition, two of his family members have the same disease.  The pathologist refers them to their physician for treatment, and through treatment, they are able to live knowing they will not succumb to the same fate as their brother.
  • An elderly person dies in a lone car crash.  The autopsy finds that the victim died of natural causes while at the wheel, which led to the accident.  This knowledge provides comfort to the family in knowing that their loved one did not suffer and die from the crash injuries.
  • In another crash, the woman driver is found to have had a brain tumor that caused a visual obstruction, preventing her from seeing the traffic light.
  • For parents of a child who died from sudden infant death syndrome (SIDS), the death can be overwhelming.  Although SIDS remains a mystery, autopsies have helped parents to cope when they learn that it wasn’t their fault.

In public health, UND’s forensic researchers contribute by investigating deaths in the workplace as well as within vulnerable populations, such as the elderly, children, and individuals in group homes or institutions.  As a part of the Prenatal Alcohol and SIDS and Stillbirth (PASS) Network, UND scientists research the role of prenatal alcohol and other exposures in the risk for SIDS and adverse pregnancy outcomes, such as stillbirth and fetal alcohol syndrome, and how they may be interrelated.  The PASS Network is working with Northern Plains American Indian communities to decrease fetal and infant mortality and to improve child health in these communities.

UND’s forensic pathologists also want to protect North Dakotans from a potential danger blowing in the wind: erionite dust.  Erionite is a stone once used in western North Dakota to cover hundreds of miles of roads and that has been found on driveways and playgrounds; it appears to be associated with increased risks of fibrogenic lung disease, lung cancer, and mesothelioma (a cancer usually related to asbestos exposure).  Few studies have been done on erionite in the United States.  Like asbestos exposure, lung disease or cancer from erionite dust exposure may take decades to develop, so Sens and her colleagues plan to study tissue samples from the lungs of deceased North Dakota elderly to determine the exact cause of death.

“Before the new facility, the state lacked the resources to investigate the deaths of elderly North Dakotans who died from what seemed to be pneumonia but may really have been cancer,” Sens said.

In addition to contributing to family and public health, UND’s forensic science clinical practice facility will be the training ground for physicians educated by the School who will be the future coroners in each North Dakota county.  They will be trained by UND’s forensic pathologists to determine more than just final causes, but to work for the cause — the health of North Dakotans.

This article first appeared in the Fall 2011 issue of North Dakota Medicine, the official publication of the UND School of Medicine and Health Sciences.  Denis MacLeod is the assistant director of alumni and community relations for the School.

Denis MacLeod | Staff Writer

Pathology Lab

The new forensic clinical practice facility serves not only the pathology program of UND’s School of Medicine and Health Services but also the death investigation needs of Grand Forks County and jurisdictions in South Dakota, Minnesota and North Dakota as needed. Opened in July 2011,

the facility was made possible by a grant from the Health Resources and Services Administration. Here, from left to right, are Mark Koponen, forensic pathologist and associate professor of pathology; Gwen Halaas, senior associate dean of the School of Medicine and Health Sciences; Mary Ann Sens, Chester Fritz Distinguished Professor of Pathology and department chair; and Ed Bina, forensic investigator in pathology.