Response to the National Association of Medical Examiners Position Paper on the Certification of Cocaine-Related Deaths

CITATION:
Wecht CH. Response to the National Association of Medical Examiners
position paper on the certification of cocaine-related deaths.
Am J Forensic Med Pathol (December) 2004;25: 362-363.

Because it is so short, I've COPIED and posted the FULL TEXT of this letter
BELOW its PDF File LINK. Scroll down to read that, NOW.

I've also posted this Am J Forensic Med Pathol article in PDF file format.
If you don't have an Adobe Acrobat PDF file program, you can download a FREE version HERE.

To the Editor:

The members of the special committee appointed by NAME to review cocaine-related deaths and make recommendations for investigative guidelines are to be commended for devoting their time and professional expertise to this important subject.(1)

There is a critical aspect of these deaths that needs to be emphasized and clarified. While the committee mentions "supervening causes" and "a readily identifiable mechanism or disease," these references do not take into account the most important and controversial feature of such cases, namely, physical altercations with multiple police officers.

The committee refers to "cocaineinduced excited delirium," which is almost always the diagnosis and explana- tion rendered by forensic pathologists and other medical experts in rejecting allegations of suffocation, mechanical or positional asphyxiation, and cardiac arrhythmia precipitated by hypoxia as alternative explanations for sudden death. I believe this is a serious and significant omission in the committee's overall discussion and specific recommendations.

Experienced forensic pathologists recognize and appreciate the fact that each and every death case involving cocaine must be reviewed and analyzed on the basis of its own specific set of facts and circumstances, resulting in differences of opinion from one case to another as to etiology. However, the adamant refusal of some of our colleagues to even consider police misconduct and brutality as the underlying feature of such cases is most regrettable and, in my opinion, morally and ethically indefensible.

Sincerely yours,

Cyril H. Wecht, MD, JD
Coroner, Allegheny County
Adjunct Professor of Law, Duquesne University
Clinical Professor of Pathology, University of Pittsburgh School of Medicine
Past President, American Academy of Forensic Sciences
Past President, American College of Legal Medicine
Pittsburgh, Pennsylvania

REFERENCES

1. Stephens BG, Jentzen JM, Karch S, et al. National Association of Medical Examiners position paper on the certification of cocaine-related deaths. Am J Forensic Med Pathol 2004;25:11-13.

SEE ALSO: CHAS' "REVIEW" of this PAPER:
Miller CD. Response to the NAMEposition paper
on the certification of cocaine-related deaths – and –
Criteria for the interpretation of cocaine levels in human
biological samples and their relation to the cause of death.
Sent February 25, 2004: But DISREGARDED by NAME
and the Am J Forensic Med Pathol
Although these authors provided a few GREAT points and directives,
they MISSED a whole LOT of very important considerations.
This letter was originally posted on the March 2004 NAME position paper page,
following that paper's PDF file link, on February 25, 2004. A separate Library page
was posted when Dr. Wecht's letter came to light, in January, 2005.

Email Charly at: c-d-miller@neb.rr.com
(Those are hyphens/dashes between the "c" and "d" and "miller")