When medical evidence becomes central to a criminal case, effective collaboration between attorneys and a forensic pathologist can determine whether the jury clearly understands the science or becomes confused by it.
In 2025, Dr. Thomas Andrew spoke at the County Prosecutor’s Association of New Jersey Annual College Conference in Atlantic City on strategies for improving communication between attorneys (both prosecution and defense) and forensic pathology experts. The following summarizes key practical guidance for both prosecutors and defense counsel.
Know Your Death Investigation System
It is critical for attorneys on both sides to understand how the death investigation system works. In this article, we will review the system at a high level.
Who are the players?
If you have never worked with the medical examiner(s) in your jurisdiction, get to know them. Most of them are approachable and don’t bite. Knowing how death investigations are conducted in your jurisdiction is helpful.
- Does the Medical Examiner (ME)/coroner’s office have its own investigators?
- Does the ME/coroner go to homicide scenes?
- How are cases triaged for autopsy?
There are no right or wrong answers, but answers will vary from place to place. If you have never attended an autopsy, consider attending one to learn exactly what goes into such an exam. Lastly, it is advantageous to have one of the basic forensic pathology texts on your shelf or electronic device.
For example:
- Spitz and Fisher’s MEDICOLEGAL INVESTIGATION OF DEATH: Guidelines for the Application of Pathology to Crime Investigation (5th Ed.), 2020, Charles C. Thomas, pub.
- Forensic Pathology: Principles and Practice, 2005, Elsevier Press
- DiMaio’s Forensic Pathology (Practical Aspects of Criminal and Forensic Investigations), 2021, CRC Press
Understanding the Autopsy Report and Death Certificate
Understand the nomenclature used in these documents. Other posts on this site and the textbooks cited above will explain the forensic significance of terms like cause of death, manner of death, postmortem changes relative to time of death, cutting and stabbing injuries, blunt impact injuries, defensive injuries, asphyxia and more. While formats vary from office to office, a quality report will be well-organized and thorough, addressing details of the external and internal examinations with a separate section for injuries. Be wary of reports that are generated from electronic drop-down boxes and the careless use of templates. That said, we are all human and errors will occur. These should be addressed and clarified prior to any legal proceeding.
The external examination should include descriptions of all clothing, wrappings or other physical evidence accompanying the body to the autopsy suite. A detailed description of the unclothed body should include identifying features as well as injuries. The internal examination should be an organized description of the observed features of each organ system. Special, case-specific dissections are expected in certain situations, e.g. eye examinations in infant deaths with head trauma, posterior dissections in custody deaths, layer-wise neck dissections in suspected strangulation deaths and more.
Preparing the Forensic Pathologist for Trial
Meet with the forensic pathologist to discuss the autopsy report, clarify anything you do not understand and to be sure of what opinions will be offered and their basis. Use this time to determine what visual aids will assist the forensic pathologist in educating the jury as to the findings. Be prepared to substitute diagrams if photographic images are not allowed. Make sure the ME has reviewed all material relevant to their opinion. More is usually better than less, but be aware of the issue of cognitive bias. Review of any opposing expert’s opinion is paramount.
Courtroom Credibility and Demeanor
Attitude is important. The forensic pathologist should not be an advocate, but an educator. It helps if he or she presents as an objective physician as opposed to an arrogant gasbag. Stress the need to avoid medical and scientific jargon if it seems they are headed in that direction. Medical evidence should be presented in a way that could be understood in an eighth-grade biology class. This is no knock on or disrespect of juries, but physicians often forget how much more training they have in these areas than the average person. When it is necessary to use technical terms, they should be clearly defined and explained.
Organizing the Presentation of Medical Evidence for the Jury
If time of death is an issue, flesh out the details of any opinion with its basis. Typical issues the forensic pathologist may be able to address in gunshot wounds include range of fire, entrance v. exit, sequence of shots and fatal potential of injuries. In cutting and stabbing cases wound characteristics may (or may not) allow opinions regarding the type of weapon and/or length of a blade. Blunt impact injuries can be assessed for distinctive patterns. Especially contentious are asphyxial deaths such as manual or ligature strangulation or applications of “choke holds.”
These are but a few examples. Other categories of death can present their own unique problems that must be presented in a clear and understandable fashion to the jury; child abuse deaths, drug-related deaths, certification of homicide in absence of identified cause of death, “homicide by heart attack” and deaths due to delayed effects of trauma.
Recommended Additional Research
Effective collaboration between legal counsel and a forensic pathologist requires clarity, preparation, and objectivity. When medical evidence is properly understood and communicated, it strengthens the integrity of the judicial process.
The National Institute of Justice has produced a video that covers a broader range of forensic evidence than will be addressed by the forensic pathologist. The video “Expert Testimony: Presenting Forensic Evidence in the Courtroom” is an excellent resource to deepen your knowledge.
Dr. Andrew is a board-certified forensic pathologist with decades of experience in death investigation and courtroom testimony.
Attorneys preparing for trial or seeking independent forensic pathology case review should consult with an experienced, board-certified forensic pathologist early in the process to ensure clarity and effective presentation of medical evidence.