Wednesday, February 17, 2016

According to the autopsy report for Hae Min Lee,

Lividity was present and fixed on the anterior surface of the body, except in areas exposed to pressure.

I always presumed that the Office of the Chief Medical Examiner for the State of Maryland has a template that medical examiners use for creating autopsy reports. By looking at other Maryland autopsy reports, this indeed appears to be the case. If so, we can see what decisions Dr. Margarita Korell made while writing the above entry.

1. Fixed vs. Unfixed

This language comes from another autopsy report by Dr. Korell:

Lividity was present and unfixed on the posterior surface of the body, except in areas exposed to pressure. (emphasis added).

From this language, it seems clear that medical examiners are given a choice such as [fixed/unfixed]. If fewer than 8-12 hours (or so) have passed since death and lividity has not yet become fully fixed, they will pick "unfixed." Conversely, if more than 8-12 hours (or so) have passed, they will pick "fixed."

2. Prominent vs. Not Prominent

This language comes from an autopsy report by Donald G. Wright, M.D., John E. Smialek, M.D.:

Lividity was present on the posterior surface of the body, but was not prominent. (emphasis added)

My guess is that it is assumed that lividity is prominent unless language about it being "not prominent" is included. There are a few factors that can lead to lividity being "not prominent," including the victim having darker skin. That was the case with this autopsy report because the victim was African-American.

3. Anterior vs. Posterior

This language comes from an autopsy report by Pamela A. Aronica-Pollak, M.D.:

Lividity was present and fixed on the posterior surface of the body, except in areas exposed to pressure. (emphasis added)

From this language, it seems clear that medical examiners are given a choice such as [anterior/posterior]. If there is lividity on the front of the victim's body, the ME states that there was lividity "on the anterior surface of the body." If there is lividity on the back of the victim's body, the ME states that there was lividity "on the posterior surface of the body." I couldn't find any examples of an ME indicating that there was lividity "on the lateral surface of the body," probably because there are few cases where the victim was perfectly perpendicular to the ground for 8-12 hours (or so) after death.

4. Anterior/Posterior vs. Anterior/Posterior Left/Right Lateral

This language comes from an autopsy report by Stephen S. Radentz, M.D., and John E. Smialek, M.D.:

Lividity was present and fixed on the posterior-left lateral aspect of the body, except in areas exposed to pressure. (emphasis added).

Whereas there aren't many cases in which the victim was perfectly perpendicular to the ground for 8-12 hours (or so) after death, there are many cases in which the victim was at an angle. In these cases, the ME can seemingly supplement her [anterior/posterior] conclusion by noting whether the lividity was [left/right lateral]. In the above example, the medical examiners are indicating that the victim's lividity was on the back left of the body, indicating the victim was on his back in the 8-12 hours (or so) after death, with his right side more elevated than his left side. Conversely, when a medical examiner simply states that lividity was on the "anterior aspect" or the "posterior aspect," this means that the lividity was front-center or back-center.

5. Generalized Lividity vs. Localized Lividity

This language comes from an autopsy report by Stephen S. Radentz, M.D., and Marlon O. Aquino, M.D. (who signed off on Hae's autopsy report):

Lividity was present and fixed on the inferior aspect of the back and the lower extremities, except in areas exposed to pressure. (emphasis added).

I didn't find this type of language very often, presumably because lividity is usually generalized (e.g., generally on the front or the back, but not any particular portion of the back). The type of language used in this autopsy report seems to indicate that the victim was on his back in the 8-12 hours (or so) after death, with the top half of his body more elevated than the bottom half, explaining the lividity pattern.

6. The Uniqueness of Hae's Autopsy Report

In addition to the initial description of Hae's lividity in the "External Examination" section of her autopsy report, there was also this further description in the "Evidence of Injury" section:

The body was found in the woods, buried in a shallow grave with the hair, right foot, left knee, and left hip partially exposed. The body was on her right side.... Generalized skin slippage was noted and livor mortis was prominently seen on the anterior-upper chest and face. I'm not quite sure what to make of this language. If I had to guess, I think this language means that the lividity was more prominent on the anterior-upper chest and face and less prominent, but still present, on the rest of the anterior surface of the body. This would make sense given that the medical examiner from the podcast was able to see anterior lividity on the abdomen when looking at the crime scene photos. It would also be consistent with the lower portion of Hae's body being more elevated than the upper portion, helping to explain the double diamond presure marks in the shoulder area. The reason I don't have certainty about this language is that Hae's autopsy report is the only Maryland autopsy report I've seen which included such a further description of lividity in the "Evidence of Injury" section. This includes autopsy reports written in Maryland from 1995 to 2014. The 2014 autopsy report is publicly available and follows the same format as Hae's autopsy report.* As in all of the other autopsy reports, it has initial language about lividity in the "External Examination" section: Lividity was present and fixed on the posterior surface of the body, except in areas exposed to pressure. And, as with all of the other autopsy reports, it contains no further description of lividity in the "Evidence of Injury" section. So, why did Hae's autopsy report have such a further description in the "Evidence of Injury" section? Was it because Hae's burial position didn't match the lividity pattern? Was it because Dr. Rodriguez, who supervised the disinterment, was present for the autopsy? Did Dr. Korell decide to include this further information in Hae's autopsy report for no apparent reason despite such information not being included in any other available autopsy report written over a 20 year period in Maryland? Is there some other explanation? As with so many other questions in this case, I wish I knew. _________________________ *The report is more terse, but that's probably because the case was an obvious suicide as opposed to a homicide. -CM

https://lawprofessors.typepad.com/evidenceprof/2016/02/d-lividity-was-present-and-fixed-on-the-anterior-surface-of-the-body-except-in-areas-exposed-to-pressure.html