“Oh dear, oh dear ... our Dad is dead
Yesterday, the will was read.
Stepmother Jane got all the dough
None of us liked her much, you know.
Even though Dad was awfully sick
We know she gave him arsenic.”
One of my colleagues composed this ditty and posted it on the National Association of Medical Examiners’ Internet forum during a discussion about family allegations of poisoning.
The discussion was initiated when a member asked if anyone had seen a case in which an aggrieved relative accused the primary caregiver of poisoning, and the allegation was found to be true.
Most responders said while they’d certainly dealt with such accusations, they’d found none to be true. Only one – a medical examiner in his 60s – said he thought perhaps he’d seen or heard of “a case of two” during his career.
So, in light of what almost everyone perceived as the futility of investigating poisoning allegations made against caregivers, should medical examiners accept jurisdiction and spend taxpayer dollars to investigate? Or should jurisdiction be declined?
Does any office, one participant asked, accept jurisdiction and bill the accuser(s) for toxicology tests in the way that some jurisdictions bill for search-and-rescue operations?
Often, accusers who are “very keen to leave no stone unturned” if public funds are to be used for the investigation have “no interest” if they have to pay for testing themselves. Perhaps the threat of a huge bill would dissuade troublemakers.
Another participant suggested steps designed to differentiate between serious suspicions and family vendettas:
Ask why the accuser suspects poisoning, and whom he thinks is responsible. Warn that anything said will become part of the investigative record.
Tell the accuser he must report his suspicions to police. Anybody with knowledge of a crime is obligated to report it.
Ask what specific poison is suspected. Explain that you can’t test for every poison in the world, so without reasonable direction, you can test only for “common” poisons.
Follow these steps, my colleague said, and at least half the accusers will back off.
Half seems an underestimate. This is pretty much the technique I’ve used, and in my experience, a significant majority of complainants will withdraw their accusation if required to file a formal report with the police.
If the accuser does make a police report, an autopsy is needed. If the autopsy documents a disease that’s a reasonable cause of death, and routine toxicology screening tests are negative, almost all accusers will be satisfied.
One participant suggested anyone who insists on further testing could be offered the option of paying for any additional tests. That takes the taxpayer off the hook, but it would be risky to release autopsy specimens for testing by a third party without permission from the next of kin – who is probably the person the accuser suspects.
Accusations of caregiver poisoning require the medical examiner to balance fiscal realities against the ideal – an all-out investigation of every allegation of foul play.
firstname.lastname@example.org. Dr. Carol J. Huser, a forensic pathologist, served as La Plata County coroner from 2003-12. She now lives in Florida and Maryland.