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06/07/2018
1
Forensic pathology in the Netherlands
Prof. Bela Kubat
Organization
• Forensic medicine – regional for. physicians• Forensic radiology – MUMC, Gouda• Other forensic medical disciplines and forensic
toxicology – NFI (Netherlands Forensic Institute)
Regional forensic medicine
• Crime scene• External examination – procedure advice to
the prosecutor• Death certificate issue• Medical examination of living victims• Medical care of persons in police custody
Netherlands Forensic Institute
• 36 forensic disciplines • Forensic medical department
- F. pathology- F. anthropology- F. medicine (complex cases)- F. pediatrics- F. medical photography
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Forensic pathology
• 5 pathologists • Clinical pathologists (5-years’ training)• Sub-specialization in forensic pathology (2-
years’ training)• Additional expertise in forensic
pediatric pathology, cardio-pathology, neuropathology & road and aviation accidents
What do we do• POST MORTEMS • Additional questions, cold cases, reconstructions• Expert witness testimony in court• External activities (Tsunami, MH17)
Question: “Doctor were you sure the victim was dead after the post mortem?”Question: “Now doctor, isn’t it true that when a person dies in his sleep, he doesn’t know about it until the next morning?”
Steps in forensic post mortem
• PM radiology• Case information• External examination – sex, body characteristics,
skin lesions
• Internal examination • Preliminary report• Additional tests• Final repport
PM radiology – total body CT-scan
• Documentation prior to post mortem• Visualization of e.g. fractures • Reconstruction – shot trajectory, 3-D crime scene
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What else can we do with X-ray
• A missing person suspected in a trash barrel• The top sealed with
polyurethane foam
Forensic versus clinical PM
• Extensive external examination• More photo’s
Forensic versus clinical PM
• Extensive external examination• More photo’s • Less well assessable or incomplete bodies and
body parts
Additional examinations
• Histology – disease, dating skin lesions• Neuropathology – trauma, dating of trauma,
disease• Anthropology
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Anthropology
• Skeleton examination• Identification – age, sex,
body length• Injuries and
reconstruction of injury mechanism
Radius
Micro trace analysis (MIT)
Causes of death in NFI population
Shooting, stabbing 32%
No COD (16%) & natural
COD(13%) 29%
Intoxications 16%
Beating 12%
Suffocation 8%Other 3% Almost no suicides
and road accidents come to post mortem in the Netherlands
Problematic COD’s
• Metabolic deregulation – hypo-/hyperglycemia, keto-acidosis
• Genetic arrhythmia’s – legal and ethical limitations
• Acute myocardial infarction• Sudden death in epilepsy• Drowning• Smothering
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Problematic COD’s
• Metabolic deregulation• Genetic arrhythmia’s • Acute myocardial infarction• Sudden death in epilepsy
• Drowning• Smothering
Male aged 45
• Mild (subclinical) form of von Willebranddisease (coagulopathy) and chronic alcohol intake
• Vascular risk factors in the family• Falls on the back of his head after a punch in
the face• 2 days after the incident mild neurological
complaints à GP prescribes aspirin and consultation with a neurologist the next day
Further course
• Brain CT: small subdural hematoma à stop aspirin, report if symptoms increase or change
• Next day: deep coma, large SDH à operation à death
• Forensic post mortem examination into the role of the person who punched the victim
Is there a connection between the punch and the death
Reflections
• SDH due to the fall? • The influence of aspirin? • Was the advice in the hospital correct?
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Reflections
• SDH due to the fall? Yes • The influence of aspirin? • Was the advice in the hospital correct?
Reflections
• SDH due to the fall? Yes • The influence of aspirin? None • Was the advice in the hospital correct? ???
Ruling of the court
• There is a causal relationship between the punch and the death
• A possible treatment error is not relevant to the assessment of the quilt
Thank you