Death in Custody

When a person dies in police custody, forensic pathologists are responsible for performing an autopsy and determining cause and manner of death. While many people think “in custody” specifically means “in jail”, custody technically begins whenever the individual perceives that their freedom is being restricted. This leads to a broader timeline which can be divided into two main sections – the “pre-custody” and “custody” phases.

The “pre-custody” phase begins with the first interaction with law enforcement when the individual can no longer leave at will. Note that this does not necessarily mean they are under arrest, and it doesn’t necessarily involve physical contact. A wide variety of situations are therefore encompassed in this definition – it can mean a patrol office stopping (or “detaining”) someone on the street to ask questions, a police car putting on lights and sirens to pull someone over, or law enforcement arriving at a home with a lone person in crisis barricaded inside. This may seem like an excessively broad definition, but including this phase is necessary to capture deaths that occur during police pursuit and/or before apprehension. These are myriad and include deaths from blunt force injuries sustained in motor vehicle accidents, self-inflicted or other-inflicted gunshot wounds during a stand-off, or even a myocardial infarct (heart attack) while fleeing on foot. It isn’t hard to believe that amongst these many scenarios, some of these deaths could be preventable by policy changes or education. Without categorizing these deaths as in custody, we have no way of being able to review them and identify areas for potential improvement.

Once the individual is under physical control by law enforcement, the custody phase begins. This phase continues throughout incarceration until release (or, less commonly, judicial execution). Again, the types of deaths during this phase are widely variable and include natural diseases, accidental overdoses, suicidal hangings, and homicidal deaths from inflicted injuries. Because prisoners are a vulnerable population, unable to independently access medical care or report mistreatment, complete investigation and autopsy are needed. Even if prisoners are transported to the hospital for care and may be considered “discharged” from prison, they must be considered a custody death and reported to our office. After all, if the injury was sustained (or the disease began) while they were incarcerated, we need to make sure that foul play or neglect did not play a role.

During the autopsy, additional procedures are done to rule out occult trauma. The subcutaneous soft tissues of the wrists and ankles are examined, to identify injuries that may be associated with restraints. In situ examination of the muscles and cartilage of the neck can clarify whether pressure was placed on the neck (i.e. a chokehold). Given the degree of public interest, full transparency is of the utmost importance. Therefore, additional photographs (of both positive and negative findings) are performed to ensure reproducibility of the findings.

The public discourse around these deaths can be emotionally and politically heated, which is why it is so important that forensic pathologists and medical examiners are empowered to render scientific, unbiased opinions. In many areas of the United States, the death investigation system is run by a Coroner (an elected official). In some regions, the medical examiner is under the authority of the Sheriff. This problem was highlighted in 2017 in San Joaquin County, CA, when both the forensic pathologists resigned. Their resignation announcement informed the public that the Sheriff-Coroner was overruling their findings on death in custody. Subsequent legal changes were made to hopefully remedy the problem, but similar conflicts of interest exist in many other jurisdictions. If there is pressure from a politician or law enforcement, then forensic pathologists may not be able to fulfill their role of providing an impartial and scientific assessment of the facts.

It’s important to remember that our manner of death determination does not necessarily imply criminal actions. Most often, a ruling of homicide for an in-custody death doesn’t result in legal prosecution (think of the example of a person shot while pointing a gun at police). The autopsy can even help dispel concerns over excessive force or medical neglect. But without transparency and freedom from influence, the results will be viewed with suspicion. Deaths in custody therefore provide a crucial example of why forensic pathologist independence is a foundational element of death investigation.

References:

Prados MJ, Baker T, Beck AN, Burghart DB, Johnson RR, Klinger D, Thomas K, Finch BK. Do Sheriff-Coroners Underreport Officer-Involved Homicides? Acad Forensic Pathol. 2022 Dec;12(4):140-148. doi: 10.1177/19253621221142473.

Mitchell RA Jr, Diaz F, Goldfogel GA, Fajardo M, Fiore SE, Henson TV, Jorden MA, Kelly S, Luzi S, Quinn M, Wolf DA. National Association of Medical Examiners Position Paper: Recommendations for the Definition, Investigation, Postmortem Examination, and Reporting of Deaths in Custody. Acad Forensic Pathol. 2017 Dec;7(4):604-618. doi: 10.23907/2017.051.