Police custody deaths in Maryland, USA: an examination of 45 cases

Previous published research suggests there are a diverse, yet relatively consistent, set of factors present in sudden, unexpected, and initially inexplicable deaths in police custody. This retrospective analysis examines police custodial deaths in Maryland, USA. Police custody death is operationalized to include deaths which occurred suddenly and unexpectedly during police/citizen encounters. Only deaths for which the cause was initially undeterminable are included. Suicidal hanging, police shootings and fatal pursuits are not included. Review of the records at Maryland’s Office of the Chief Medical Examiner indicates that 45 persons died suddenly and unexpectedly in the custody of the police, between 1990 and 2004. Commensurate with existing research, our analysis identifies multiple factors generally present in this type of police custody death. Although individual-specific, these factors include a relatively static constellation of behavioral (e.g., erratic and/or violent behavior, and physical struggle) and physical (e.g., stimulant abuse, natural disease, and obesity) dimensions. While the presence of these factors has been well-documented, their empirical significance, interactions and causal sequence have yet to be established. To increase the methodological rigor of subsequent research, we have developed a comprehensive, national custody death database by which multivariate models may be analyzed.     

A study of methadone in fatalities in the Strathclyde Region, 1991-1996.

There was a substantial increase in the percent of drug screens testing positive for methadone between 1991 and 1996 in the Strathclyde region of Scotland. Seventy-nine per cent (n = 136) of these deaths were drug-related, involving methadone either alone or in combination with other drugs such as diazepam, temazepam, alcohol and morphine. The involvement of methadone in the majority of these fatalities was due to diversion of legitimate supply. This paper highlights the dangers of resuming methadone consumption following a period of abstinence or when taken in combination with other drugs.     

Profile of unnatural deaths in Manipal, Southern India 1994-2004

Pattern of unnatural deaths is a reflection of the prevailing social set up and mental health status of the region. In an attempt to understand the magnitude and pattern of unnatural deaths in Manipal, Southern India, a 11-year retrospective study was carried out in the Department of Forensic Medicine, Kasturba Medical College, Manipal. The study revealed a rise in road traffic fatalities (37%) that constituted the majority of autopsies carried out followed by death due to poisoning and burns. Male preponderance was quite evident (2.5:1) except for death due to burns where ratio was reversed (1:2.9). People in 3rd decade were most prone to such fatalities. Of the total medicolegal autopsies conducted in this period, the manner of death was unnatural in 98% of the cases and 71% of them were accidental in nature.     

Prevalence of chlorpheniramine in aviation accident pilot fatalities, 1991-1996.

BACKGROUND: Chlorpheniramine is known to cause drowsiness, and this side effect has a potential to impair performance and could be a factor in accidents. METHODS: Therefore, to establish the prevalence of this drug in pilot fatalities of aviation accidents, a postmortem toxicology database--maintained at the Civil Aeromedical Institute--was examined for the presence of chlorpheniramine in the fatalities, occurred during 1991-1996. RESULTS: There were 47 (2.2%) accidents involving chlorpheniramine. Of these, 16 had only chlorpheniramine at 109 ng.ml-1 (n = 4) in blood and 1412 ng.g-1 (n = 12) in liver. Other drugs were also present in the remaining 31 cases, wherein chlorpheniramine concentrations were 93 ng.ml-1 (n = 18) in blood and 747 ng.g-1 (n = 12) in liver. Ninety-five percent of all quantitated blood values were at or above the therapeutic level (10 ng.ml-1), giving a 100 ng.ml-1 (n = 21) mean blood value. The drug's mean liver concentration from all cases was 1080 ng.g-1 (n = 24). The average blood value was approximately 10 times higher than the therapeutic value. CONCLUSIONS: The presence of other drugs did not appear to significantly alter the blood chlorpheniramine level, but no such correlation could be established with the hepatic value. The approximate 10-fold increase in the liver concentration was consistent with the general trend of drug distribution in the hepatic compartment. However, the contribution of postmortem redistribution of the drug to alter its concentration cannot be entirely ruled out. This study suggests that chlorpheniramine was present in some aviation fatalities at levels higher than therapeutic levels.     

Healthcare issues of detainees in police custody in London,UK

Little is known about the general healthcare needs of detainees in police custody. The aims of this study were to: determine the level of general health issues, diseases and/or pathology for detainees in police custody, and to determine how well those general health issues, diseases and/or pathology are being managed. This was done by a detailed analysis of healthcare issues of a cohort of detainees and reviewing intended and prescribed medication needs with current medication availability. In August 2007, a prospective detailed, anonymised, structured questionnaire survey was undertaken of 201 detainees in police custody in London, UK. Of these 83.6% consented to participate in the study. 85.1% of subjects were male; mean age was 33.9 years; 70.8% had English as a first language; 13.7% were of no fixed abode; 70.2% were registered with a general practitioner (primary care physician); 25% were already in contact with other healthcare teams; 7.1% had previously been sectioned under the Mental Health Act 1983; 16.7% had previously intentionally self-injured; 33.9% were dependent on heroin, 33.9% on crack cocaine; 25% on alcohol, 16.6% on benzodiazepines and 63.1% on cigarettes. 56% of subjects had active medical conditions; of those with active medical conditions 74% were prescribed medication for those medical conditions; only 3/70 had their medication available. 28/70 were not taking medication regularly, and many were not taking it at all. Three subjects who had deep vein thromboses were not taking their prescribed anticoagulants and six subjects with severe mental health issues were not taking their anti-psychotic medication. Mental health issues and depression predominated, but there was a very large range of mixed diseases and pathology. Asthma, epilepsy, diabetes, deep vein thrombosis, pulmonary embolism, hepatitis, and hypertension were all represented. The study has achieved its aims and has also shown that – in part because of the chaotic lifestyle of many detainees – appropriate care was not being rendered, thereby, putting both detainee, and potentially others coming into contact with them, at risk.     

The Canadian Forces Airsickness Rehabilitation Program, 1981-1991.

Airsickness is a significant obstacle in the training of some student pilots. When conventional therapy fails, desensitization therapy may be indicated. Using experience gained by the RAF and USAF, the Canadian Forces (CF) began such a program in 1981. This paper reports program results from 1981-1991. Following subject identification, treatment consists of three phases: biofeedback relaxation therapy, ground-based desensitization training and in-flight desensitization therapy with a pilot-flight surgeon. Employing a definition of cure used by the RAF, success was compared with that of the RAF and USAF programs. A total of 22 student pilots have undergone rehabilitation, 17 of whom have been successfully treated for a success rate of 77%. This is comparable to success rates of other programs. It is reaffirmed that desensitization is a valid clinical tool in treatment of airsickness.     

Nontraumatic exercise-related deaths in the U.S. military, 1996-1999

We identified 215 exercise-related deaths in U.S. military personnel on active duty during 1996-1999. The most complete case information was for active duty Army personnel during 1998-1999, providing an exercise-related death rate of 4.3 per 100,000 person-years (41/963,000) and accounting for 6% of Army deaths (14 during physical fitness testing). The cause of death was confirmed by autopsy or clinical data for 85% of the cases. Arteriosclerotic coronary artery disease was the predominant cause of death for those 30 to 58 years of age. For age 17 to 34 years, 50% of deaths were attributable to preexisting heart disease (16% from coronary anomalies), 20% attributable to nontraumatic drowning, and 12% attributable to exertional heat illness, also a potential contributory factor in cardiac deaths. Most exercise-related deaths were related to running (60%), sports (14%), and swimming (13%). Improvements in health promotion, medical management, and stricter exclusion from inappropriate exercise (especially fitness test runs) could reduce these deaths.     

Gunshot suicides in Victoria, Australia, 1988

A study of the 96 gunshot suicides in Victoria, Australia, in 1988 is presented. Only three of the cases were women, all of whom had a psychiatric history. The suicides were commonly associated with physical or mental ill health, the break up of relationships or contact with police. There was often a history of alcohol related problems and 31% showed evidence of drinking before suicide. The suicides tended to occur without witnesses (90%), at home (73%), often in the bedroom (32%). Handguns were used much less commonly than in other countries, although the distribution of entry wounds was similar. The change of gun ownership laws which occurred in 1988 may be expected to alter the incidence of gunshot suicide in future years.     

A review of the British Journal of Sports Medicine 1991-5.

OBJECTIVE: To review 5 years of the British Journal of Sports Medicine (BJSM) to assess the nature of articles published, look at which specialities and nationalities were contributing most frequently, and analyse the numbers of subjects involved in the studies. METHODS: Data were collated from all original papers, review articles, and case reports from March 1991 to December 1995. RESULTS: Authors from 35 different countries contributed a total of 282 papers in the 5 year period, with medical authors (118) predominating. They covered a wide range of subjects in all aspects of sports medicine. There were few randomised controlled studies (9). CONCLUSIONS: The BJSM has wide international input which covers all aspects of sports medicine. A greater number of large randomised controlled studies would, however, provide a firmer statistical basis for future research and injury management. There is also scope for development of the BJSM especially in the areas of education, innovations, and the practical applications of research.     

Homeless deaths in Istanbul, Turkey

We retrospectively analyzed the autopsy records of the Council of Forensic Medicine during the 5-year period between the years 2000 and 2004 to contribute to the efforts targeted at lowering death rate in the milieu of homelessness by documenting the current status of this group particularly in terms of mode of death. Two hundred and nine of the 229 cases (91.27%) were males and remaining 20 were females. The preponderance of male cases in our autopsy population was also detected in homeless population. Most of the cases were in the age group of 40-49 years (64 cases, 27.95%). One hundred and ninety two corpses (83.85%) were found outdoors and only 37 of the cases (16.15%) indoors. Natural events constituted the cause of death in 138 of the cases (60.26%) and in remainder 91 cases the cause of death was related to an unnatural event (39.74%). In approximately 1/3 of the cases of natural death cases, autopsy revealed the evidence of pulmonary tuberculosis but only in 32 of these cases the tuberculosis was the primary cause of death. The presence of alcohol was found to be significantly associated with the manner of death. Blood alcohol level over 50mg/100ml was determined only in 9.42% of natural death cases, whereas it was positive in 61.53% of unnatural death cases. We concluded that immediate precautions targeted at lowering death rate in this population must include health care for preventable natural diseases.     

A study of homicidal deaths in Delhi

A meticulous post-mortem review was undertaken in the department of forensic medicine at the Maulana Azad Medical College (MAMC) to find out trends in homicides during the period 1992-1996. Standard procedures for autopsies and a review of the inquest papers were carried out. Out of 3,886 medico-legal autopsies performed in the department during the said period, only 232 cases (5.9%) were homicidal deaths. The commonest age group of the victims was 21-30 years (38%). Males were victimized three times more often than females. The incidence of crime was slightly more at night than in the daytime, though evenly distributed during the winter and summer seasons. In our series, sharp weapon injuries were the most common type (34.9%) followed by blunt force injuries (15.9%). Defence wounds were present in 35 cases (15%). Violent rage/quarrel was the motive in 61 cases (29%).     

A survey of radiation synovectomy in Europe, 1991–1993

The prevalence of radiation synovectomy practice is unknown. As new particulate radiopharmaceuticals offering many potential advantages are being developed, it seems prudent to appraise the extent, frequency and variation in radiation synovectomy practice. We have evaluated radiation synovectomy practice in Europe over the period 1991–1993 by means of a postal questionnaire. More than 2300 European members of the European Association of Nuclear Medicine were questioned about the number of treated patients and joints, disease prevalence in their patients and the use of radio-pharmaceuticals. Overall, 119/490 (24%) of centres replying to the survey practised radiation synovectomy during the 3 years. There were 13 450 different joint injections in 8578 patients. Rheumatoid arthritis was the most prevalent disease in patients treated (71%) and the most frequently treated joints were knee (46%) and finger joints (20%). Eight different radiopharmaceuticals were employed. Yttrium-90 colloids were most frequently and widely (100/119 centres) used, mainly employed for knee synovectomy but were also used to treat most appendicular joints. Erbium-169 colloid was almost exclusively used to treat finger joints (31/33 centres). Corticosteroid was routinely co-injected in 36/60 (60%) centres. Radiation synovectomy was widely practised throughout Europe during 1991–1993. There are variations in practice illustrated by the diversity of treated arthritides and injected joints and by the use and application of different radiopharmaceuticals.     

Victims of homicidal deaths - an analysis of variables

In the 11-year period from January 1993 to December 2003, 61 homicide victims were autopsied in the Department of Forensic Medicine, Kasturba Medical College, Manipal. Documents concerning the age and sex of the victims, time of assault, method used for assault, location of fatal injuries and number of offenders involved were analyzed. Of the 61 victims of homicide, majority were males and most of them were between 21 and 30 years. Most of the crimes occurred during the evening and night hours (52.4%) and winter was the commonest season for homicide. There were significantly more homicides over the weekends (Saturday and Sunday). 37.7% of the victims exhibited evidence of injuries due to sharp force trauma. Head injuries were more common. Multiple offenders were involved in 47.5% of cases whereas single offender was involved in 40.9%.