Research Article

Failure to Autopsy: The Otto Warmbier Case

Steven A Koehler* and Victor W Weedn

Published: 12/27/2017 | Volume 1 - Issue 2 | Pages: 098-105

Abstract

Coroner and medical examiner offices are charged with the medicolegal investigation of deaths to determine the cause and manner of death. We describe the recent high-profile case of Otto Warmbier, who tragically died shortly after his return in a coma from North Korea and in which the coroner failed to conduct a complete autopsy, and failed to satisfy the needs of the local, national, and international communities.

Medico legal death investigation offices, including both medical examiner and coroner offices, have a legal responsibility and duty to investigate deaths in the public interest for public safety and public health purposes. Although, they serve the families of the deceased as they can, their raison d’être and priority is service to the greater public good. Thus, they may conduct investigations and even autopsies over the objections of the next-of-kin. Full investigations include a complete forensic autopsy. The utilitarian public interest should, within the constraints of the office resources, drive the decision of whether to autopsy or not. Failure to autopsy can sometimes constitute a breach of faith that the public entrusts in these offices. Empirically, this seems to be a greater problem in coroner jurisdictions than in medical examiner offices. Specifically, we believe the recent case of Otto Warmbier is such a case.

Read Full Article HTML DOI: 10.29328/journal.jfsr.1001012 Cite this Article

References

  1. Fish IS. Who Killed Otto Warmbier? 2017. Ref.: https://goo.gl/UNCbmJ
  2. Ramzy A. North Korea Says It’s Holding U.S. Student for ‘Hostile Act’. Ref.: https://goo.gl/Yg8aYq
  3. Winsor M. Family of American student who died after release from North Korea objects to autopsy. 2017. Ref.: https://goo.gl/CQNfMs
  4. Tinker B. What an autopsy may (or may not) have revealed about Otto Warmbier's death. CNN. 2017. Ref.: https://goo.gl/cUk2ER
  5. Pikle S. Otto Warmbier: The Death Plot. WTD News. 2017.
  6. Full Press Conference with U.S. Student Otto Frederick Warmbier in North Korea, March 1, 2016. YouTube.
  7. Otto Warmbier sentenced to 15 years hard labor in North Korea. YouTube.
  8. Chan M. Otto Warmbier ‘Fought to Stay Alive’ in North Korean Prison, His Father Says. Times. https://goo.gl/F67NrN
  9. Syrluga S. Otto Warmbier has extensive loss of brain tissue, no obvious signs of trauma, doctors say. Washington Post. 2017. Ref.: https://goo.gl/o2Rqi7
  10. Hamblin J. What Happened to Otto Warm bier? What we know of the medical case of the young American who was imprisoned in North Korea. The Atlantic. https://goo.gl/SmkRZV
  11. Roundtree C. What REALLY killed Otto Warmbier? Neurologists reveal the possibilities after the student's mysterious death. DailyMail.com. 2017. Ref.: https://goo.gl/b2GWds
  12. Syrluga S. What happened to Otto Warmbier? When the unthinkable is unknowable. Washington Post. 2017. Ref.: https://goo.gl/xMaqbW
  13. Miller SG. What Can an Autopsy on Otto Warmbier Reveal?. Live Science. 2017. Ref.: https://goo.gl/SSuzhj
  14. Wang C. North Korea and the death of Otto Warmbier weigh on US-China relations. CNBC News. 2017. Ref.: https://goo.gl/g4n9nC
  15. Berlinger J, Sterling J. North Korea: Otto Warmbier's death 'is a mystery to us'. CNN. 2017. Ref.: https://goo.gl/XNZV6A
  16. Sewell D. Cause of Otto Warmbier's death uncertain; family rejects autopsy. Chicago Tribune/Associated Press. 2017.
  17. Bever L, Cha A. What an autopsy could tell us about Otto Warmbier’s death. Washington Post. 2017. Ref.: https://goo.gl/QRfKFp
  18. Ohio coroner performs external exam of ex-North Korea prisoner Otto Warmbier before funeral service at school. The Japan Times/AP. 2017. Ref.: https://goo.gl/3C3T1o
  19. Grinberg E. Family declines autopsy for former North Korea detainee Otto Warmbier. CNN. 2017. Ref.: https://goo.gl/ZGXt74
  20. McCurry J. How did Otto Warmbier die?. The Guardian. Ref.: https://goo.gl/XKxrX6
  21. Winsor M. American student who died after release from North Korea mourned at funeral. ABC News. 2017. Ref.: https://goo.gl/BCdek3
  22. Otto Warmbier: The Coroner’s Report. NY Times. Ref.: https://goo.gl/nm3vkf
  23. Shim E. Ex-North Korean captive says Otto Warmbier was likely tortured. UPI. 2017. Ref.: https://goo.gl/YzKYSm
  24. Pollanen MS. The Dead Detainee: The Autopsy in Cases of Torture. Acad Forensic Pathol. 2017; 7: 340-352. Ref.: https://goo.gl/8NXVy7
  25. Istanbul Protocol: Manual on the Effective Investigation and Documentation of Torture and Other Curel, Inhuman or Degrading Treatment or Punishment. Professional Training Series No.8/Rev.1. United Nations New York/Geneva. 2004.
  26. The Minnesota Protocol on the Inestigation of Potentially Unlawful Death. (2016), Office of the United Nations High Commissioner for Human Rights, New York/Geneva. 2017.
  27. Thomsen JL, Helweg-Legsen K, Rasmussen OV. Amnesty International and the Forensic Science. Am J. Forensic Med Patholo.1984; 5: 305-311. Ref.: https://goo.gl/24Qx7N
  28. Thomsen JL, Vogt J. Forensic medicine and human rights Forensic Sci Int. 1988; 536: 147-151. Ref.: https://goo.gl/snwQ6W
  29. Thomsen JL. The role of the pathologist in human rights abuse. J Clin Pathol. 2000; 53; 567-572. Ref.: https://goo.gl/A2ZvcZ
  30. Saayma G. South Africa: Vulnerable Persons and Groups in a vulnerable Democracy Can Forensic Medical services help to ensure justice in critical time?. Acad Forensic Pathol. 2017; 7: 433-443. Ref.: https://goo.gl/6vtnRr
  31. Herzog R, Elgort DR, Flanders AE, Moley PJ. Variablity in Diagnostic Error Rates of 10 MRI Centers Performing lumbar spine MRI Examinations on the same patient within a 3-week period. Spine J. 2017; 17: 554-561. Ref.: https://goo.gl/b39rsH
  32. Molina DK, Nichols JJ, Dimaio JJ. The sensitivity of computed tomography (CT) scans in detecting trauma: Are CT scans reliable enough for courtroom testimony. J Trauma. 2007; 63: 625-629. Ref.: https://goo.gl/tszA3f
  33. Roberts ISD, Benamore RE, Benbow EW, Lee SH, Harris JN, et al. Post-mortem Imaging As An Alternative To Autopsy In The Diagnosis Of Adult Deaths: A Validation Study. Lancet. 2012; 379: 136-142. Ref.: https://goo.gl/fBz8cC
  34. Jalalzadeh H, Giannakopoulos GF, Berger FH, Fronczek J, van de Goot FRW, et al. Post-mortem Imaging Compared with Autopsy in Trauma Victims-A Systemic Review, For Sci Int. 2015; 257: 29-48. Ref.: https://goo.gl/u1a8Ye
  35. Underwood J. Post-mortem Imaging and Autopsy: Rivals or Allies? Lancet. 2012; 379: 100-102. Ref.: https://goo.gl/ystbRw
  36. Brown HG. Lay Perceptions of Autopsy. Archiv Pathol Lab Med. 1984; 108: 446-448. Ref.: https://goo.gl/e5B2wq
  37. Hirsch CS. Talking to the Family after an Autopsy. Archiv Pathol Lab Med. 1984; 108: 513-514. Ref.: https://goo.gl/xLSuxH
  38. McPhee SJ, Bottles K, Lo B, Saika G, Crommie D. To Reddem Them from Death: Reactions of Family Members to Autopsy. Am J Med. 1986; 80: 665-671. Ref.: https://goo.gl/GYw3xH
  39. Sinard JH. Factors Affecting Autopsy Rates, Autopsy Request Rates, and Autopsy Findings at a Large Academic Medical Center. Exp Molec Pathol. 2001; 70: 333-343. Ref.: https://goo.gl/ZdkEpn
  40. Rosenbaum GE, Burns J, Johnson J, Mitchell C, Robinson M, et al. Autopsy consent practice at US Teaching Hospitals: Results of a National Survey. Archiv Intern Med. 2000; 160: 374-380. Ref.: https://goo.gl/7v25PG
  41. Jentzen JM. Death Investigation in America. Cambridge, MA, Harvard University Press. 2002; 106-109.
  42. Nelson DF. Chappaquiddick Tragedy: Kennedy’s Second Passenger Revealed.
  43. Damore. L. Gretna, LA, Pelican Publishing. 2016.
  44. Jentzen JM. Op. cit. 2002; 154-155.
  45. Ventura J. The Murder of Antonin Scalia. Amazon Digital Services. 2016.
  46. Moravec ER, Horwitz S, Markon J. The death of Antonin Scalia: Chaos, confusion and Conflicting Reports. Washington Post. 2017. Ref.: https://goo.gl/Esnhr1
  47. Hamilton County Democrats name new coroner. [Fox19]. 2012. Ref.: https://goo.gl/Svot4E
  48. Lakshmi Sammarco Elected Coroner in Hamilton County, Ohio. IndiaWest. Ref.: https://goo.gl/Hy7AVr