Step into the riveting world of forensic investigation and healthcare with me, Julie Mattson, your host on Pushing Up Lilies. In this eye-opening episode, we unravel the multifaceted roles of a death investigator and sexual assault nurse, shedding light on the crucial procedures and protocols that guide us through the darkest corners of crime scenes. In today's episode, I draw from my experience as a death investigator and Sexual Assault Nurse to demystify the duties that go beyond the crime scene tape. From the comprehensive examinations undertaken by nurses handling crime cases to the critical step of having the doctor sign the death certificate, we'll delve into the intricate world of forensic investigations. This episode serves as an educational journey for nurses, detectives, and anyone curious about the critical collaboration between healthcare and law enforcement. Through personal anecdotes and professional insights, I aim to bridge the gap between these two vital professions, unraveling the tapestry of responsibilities that contribute to the pursuit of justice. * Listener discretion is advised.
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0:06 Welcome to Pushing Up Lilies.
0:08 I'm your host, Julie Mattson.
0:10 Pushing Up Lilies is a weekly True Crime podcast with spine tingling, unusual and terrifyingly true stories from my perspective as a forensic death investigator and a sexual assault nurse examiner.
0:24 Do I have some stories for you!
0:26 Are you ready?
0:30 Happy Wednesday!
0:32 I hope that everyone is having nice weather.
0:36 I know that many of you aren't, but in Texas we're getting some rain.
0:40 It's been pretty mild in the sixties compared to two years ago when we had that big ice storm.
0:45 I do not miss that weather.
0:47 We all know that Texans do not know how to drive in bad weather and this one is included.
0:54 I am very appreciative for that.
0:57 This week, I wanted to talk about a few things that we struggle with in the office.
1:03 This is completely unscripted and not my planned subject for today.
1:09 But yesterday in the office, we ran up against some issues and it just reminded me that there are certain things that happen a lot and I think a big part of it is educating people and I'm probably not necessarily speaking to the people that need to be educated right now.
1:29 But I think you all know that I am in the master's program at the University of Texas in Arlington.
1:36 One of my projects this week that is due is a PowerPoint on a subject that I felt passionate about, which is the importance of forensic nursing.
1:49 And I think I talked a little bit about this last week.
1:51 But when I was working on my PowerPoint, it just kind of made me realize how little people are educated on the reality of forensic nursing.
2:04 A lot of people just know what they see on TV.
2:08 We have a lot of things that happen that can affect the investigation that not a lot of people think about.
2:17 One thing that I mentioned in my paper was the importance of nurses in the emergency room setting realizing that once a person is pronounced dead, that room where the person is, becomes a crime scene until it is reported to the medical examiner's office.
2:40 And we have determined that it's most likely not a suicide, it's not a homicide, it's not an overdose, they haven't been stabbed.
2:50 You know, we don't see any bleeding bullet wounds as soon as we determine that, then we clear the body to be picked up by the funeral home.
3:00 But until that happens, that room is a crime scene, we may still come in and take photos.
3:08 And so hospitals are not supposed to remove any tubes or Avis or anything until the medical examiner has been called and we have cleared the body to be picked up.
3:22 I know that it's sensitive and it's hard for families who want to come in and see them to see the tubes.
3:33 I have to say that in infant situations, I have gotten permission at times from the doctor to allow the nurse to remove a tube so that mom could hold the baby and it didn't have a tube in.
3:47 But typically, until that scene has been cleared, all those medical interventions have to stay in place.
3:55 Many times.
3:56 I've gotten calls from the hospital and the nurse will tell me, well, we already removed the tubes.
4:03 Well, you shouldn't have, and again, I have been a nurse before I know that when you're in a hurry and you feel pressured, you want to get the room emptied.
4:14 Do you want to get the body out of there?
4:15 You want to get the family notified?
4:17 There's a lot of different things that they look at from their perspective as far as getting their job done than we do.
4:26 I know that many times they'll go in and they'll clean the room and they'll have the floor mopped and everything will be picked up, which in my opinion, it doesn't necessarily hurt anything.
4:39 The only problem with that is that if you allow housekeeping in the room and the body has not been cleared yet, there's a very good chance that the person's clothing could be accidentally thrown in the trash, it could be accidentally sent to the laundry and those clothing items are many times important in our investigation.
5:06 Many times we need those.
5:08 If there's any defects, if the person has been shot or stabbed and they had that clothing on, then we want that clothing to match up to the wounds.
5:20 Again, if we allow someone in there who's unaware of the situation and treats it just like any other room, clean up, that clothing might end up getting thrown in the trash or washed.
5:33 If we take the body, the clothing comes with it.
5:35 Even if it's not on the body, we still take it.
5:41 That is one very important thing another is, and this happened to me the other day, we brought a body in very important that if they did draw labs that we send the blood that was drawn with the body to the medical examiner's office and the nurse had thrown it in the sharp’s container.
6:04 Well, at that point, we're not going to go fish it out of the sharp’s container obviously at the hospital.
6:09 Those blood samples weren't sent when they should have been.
6:15 That's why I say the best rule is to just pronounce, close the door, call the medical examiner.
6:23 If we're going to get involved or the police are going to get involved, let us respond.
6:29 Make sure that nothing we need is discarded because that's super, super important.
6:36 And in doing my paper, I realized just how often this happens many, many times it doesn't really affect our investigation.
6:47 The body is going to go to the medical examiner's office, they can draw more fluids.
6:51 But it may be easier to detect what they're looking for in that initial blood draw.
6:57 I just think the education part of it is important.
7:00 It's important that nurses in the are aware of that and I would very much love to go to emergency rooms and talk to nursing staff and maybe even housekeeping about the importance of a death in the and the importance of not touching anything afterwards, the importance of not removing things out of people's pockets because let's say if it's a homicide we leave all property in place.
7:32 There are a lot of things that people don't realize from our perspective, which I totally get, you know nurses are the absolute best.
7:43 And hey, I was what?
7:44 No, but I respect their position completely and I have never tried to make anyone feel uneducated because of doing these things.
7:56 But I just think that it's very important and I know that it is best if everybody works together so that we can, you know, get answers for the family as far as what happened.
8:09 That's just one thing, like I said, when I was writing my paper that I noticed and also, like, with sexual assault patients, I know that many times in the past that they have presented to the,, and the first thing the nurse wants to do is put a hospital gown on them and that's great and that's great for the patient.
8:30 However, as a sexual assault nurse, the clothing is again part of evidence.
8:36 What we always do is put a paper sheet down that comes in the rape kit and they stand on top of that paper sheet when they remove their clothing and anything on the clothing will fall onto that paper sheet.
8:53 Not only is the clothing sent to the crime lab, but the paper sheet is too.
8:59 And because they stand on it, then there's a good chance that the perpetrator's hair could be on it.
9:05 We could have skin cells on it.
9:07 We could have many things on there that can help us actually find who the perpetrator is or prove who we think it is.
9:17 Clothing is super important, and we can miss a lot of trace evidence like hairs in situations where they're just like haphazardly removed and thrown in a patient belonging bag and basically treated like they're not an important part of the investigation.
9:37 I know that many people have showered, and many people have changed, but we do still keep the clothing that they have on.
9:44 And of course, most importantly is the underwear that is something that we're always going to keep in sexual assault cases.
9:51 The chances of evidence being there are relatively high now that they can do touch DNA, we can actually find skin cells on these things that can help us narrow down who the perpetrator may have been.
10:07 I think that in the aspect of evidence collection, that education is very important in our hospitals and law enforcement can also benefit from that too.
10:18 I mean, I know that they specialize in doing these investigations.
10:22 But even when I'm on the scene, I notice that there's a lot of things that law enforcement officers don't know.
10:28 You know what I love to teach.
10:29 And again, I'm not here to make anybody feel ignorant or uneducated because you don't know until someone tells you.
10:37 I think that that is super important.
10:41 Another thing that we have dealt with recently and I love sharing this with y'all because I think it's important for you to know that we don't just go to the death scenes.
10:51 Our day-to-day activities include a lot of different things.
10:55 I think I've discussed with y'all before that it is the job of a primary care doctor or even a specialist to sign the death certificate of a patient.
11:05 If we show that the death appears natural, they have a medical history and they have a doctor who's documented their medical history in prescribing their medications.
11:14 If they're found deceased or die at the hospital, we expect the doctor to sign the death certificate.
11:21 We've done our investigation at the home, the police have been there, they've searched the home, there's no drugs or alcohol, they don't have a bullet in their head.
11:30 There's not enough in their back.
11:32 We have ruled out foul play if a death happens in the and we call a doctor and say, you know, Mr. Smith passed away in the today he was pronounced by the doctor.
11:44 I understand that he has a history of congestive heart failure and heart disease and diabetes.
11:51 And we're reaching out to you because family said that you are his doctor, and we are going to send you the death certificate to sign the first thing that some doctors say.
12:02 And I said some, not all, because a lot of them are very, very good about it, and especially ones in our area are very accustomed to doing this.
12:11 But a lot of doctors will say, “Why doesn't the doctor sign the death certificate?”
12:16 Well, in some s they might, it's going to be rare though.
12:21 And here's why.
12:22 And let me tell you the doctor gets up out of their chair and goes into the room as Ems is coming down the hallway sitting on the stretcher doing CPR on this person who is nonresponsive, they work a code for, let's just say, randomly, 20 minutes, the person's never been to that hospital.
12:43 There's no record of them.
12:45 Sometimes they don't even know their name wants the doctor to sign the death certificate.
12:50 First of all, they have no history on this person.
12:54 They don't have a clue what happened before they came in.
12:58 They don't know if they have a history of suicide attempts.
13:02 They don't know if they were found next to an empty pill bottle.
13:07 They don't know anything about this person's history because obviously the person was not awake and could not share that information with him as they came in the door.
13:18 My question is always, would you as a doctor, in that situation, sign the death certificate?
13:26 Absolutely not.
13:28 I think a lot of that is common sense.
13:31 Doctors do not have time to request medical records from a primary care doctor to investigate what this person's past medical history is and interview the family.
13:45 That's our job and doctors don't have time to do that.
13:49 They may have another code coming in right behind that one.
13:52 We all know s are busy and hospitals are short staffed.
13:56 Doctors are not death investigators and they are not responsible for signing death certificates on patients who die in the, who have a primary care physician and a documented medical history.
14:12 If you've been someone's doctor for 20 years and you've been prescribing them medications for multiple different diseases, then that is part of your responsibility.
14:24 Texas has not done anything about that yet.
14:27 However, our office does turn doctors into the Texas Medical Board who refuse or do not do this.
14:35 I don't know what happened is really not a good excuse.
14:40 We do give them a complete rundown of what happened.
14:43 And again, we do investigate.
14:45 We talk to the family; we talk to people who were present when the person may have collapsed.
14:51 We talk to the police if they're there.
14:54 If it's at a residence, we get that information and we do not do autopsies by request.
15:02 That's another thing they actually have to meet criteria.
15:06 A lot of doctors will say, well, let me call the family and ask if they want an autopsy.
15:11 Well, if they don't meet medical examiner criteria, then we're not going to do it.
15:16 But they are very welcome to find a private pathologist who is willing to charge them and do an autopsy.
15:24 And then again, you know, you may or may not find out exactly what happened if they have a lot of health issues.
15:31 Another one that I experienced this week was the importance of giving a full and truthful report to us when the call is made.
15:45 I know that many times I'll get reports from the police at a residence, and they'll say they're not on any medications.
15:52 Well, do we know that?
15:53 For sure?
15:54 No, I haven't really looked.
15:56 Ok, well, could you run in and take a peek?
15:58 Like, go in the medicine cabinet?
16:00 Look in the kitchen, look in the refrigerator, see if there's any insulin, like scope the place out.
16:07 You're my eyes and ears.
16:08 Then we'll find out the persons on 10 different medications that were found in the top drawer of the nightstand that were all prescribed by the same doctor.
16:17 What happens here is, had, I believed that this 45-year-old, for example, just died at home and was on no medications and did not have a doctor.
16:29 He would have gone into the medical examiner's office and gotten an autopsy.
16:33 But because the officer took the time to find the medications in the drawer, that opened up, you know, a whole different situation.
16:42 Now, you know, he's got medical history, he has a doctor, he's been sick.
16:47 We have issues.
16:49 This is not just a healthy, 45-year-old who dropped dead.
16:53 Those things are important.
16:55 I had an issue a couple of days ago where a nurse called to report a death in the emergency room, and she said to me the guy was 46.
17:08 No, he was 47.
17:10 She said to me, all we know is that he was drinking at home with friends and collapsed.
17:17 Ok, that's not good.
17:20 Any medical history? No.
17:22 No medical history.
17:23 No doctor.
17:24 Of course, family is there, but we haven't talked to him yet.
17:28 Ok, well, let's do this, go talk to the family and find out for sure if he was on any medications and if he had a doctor and if there's anybody there that witnessed his collapse, please ask them exactly what happened because we don't want to guess we don't want to assume and we don't always get a complete and accurate story from EMS because they're trying to save a life.
17:57 They're not really focused on so much the surroundings.
18:01 She goes and asks the family and come to find out he's on several medications and he has a doctor.
18:09 Wow, that changes things.
18:11 Ok, this 47-year-old is diabetic and has a history of high blood pressure.
18:19 That's significant.
18:20 That's a significant history.
18:21 Even at 47 I've seen 30-year-olds drop dead of a heart attack before the people that were with him when he collapsed were also there when they were asked what happened.
18:34 Here's what they said.
18:36 Well, he's been complaining of chest pain all day long.
18:40 He's been nauseated yesterday.
18:43 He vomited coffee ground emesis.
18:45 Today he took one drink of beer because he told me I was thirsty, and I handed him my beer and then he collapsed.
18:54 Well, that's a lot different than he was drinking beer with friends and collapsed.
19:00 All of that information is so, so important.
19:03 Please don't call me until you have it.
19:05 I need to know all those things and I appreciate that it is so difficult to ask family, those difficult questions at such a difficult time, but they are very important.
19:18 The best way to do that is to just say Mrs. Smith, I'm so sorry for your loss.
19:25 But I'm on the phone with the medical examiner because I have to report your husband's death to them.
19:30 And they have a few questions.
19:32 Do you mind if we have a seat?
19:33 And maybe I ask you those questions, it's very accepted.
19:39 They do expect to be asked some form of question.
19:43 And those are things again that we need to know.
19:45 And I understand again, especially sometimes new nurses, very, very uncomfortable asking family, those types of questions.
19:54 And many times I've said, you know what if you'll hand her the phone, I will gladly ask her, I realize you're uncomfortable and let me do this for you.
20:01 Let me take this load off your shoulders.
20:04 I know it's obviously been a long day for you, and I don't mind doing that either, but it does have to be done because in situations like that when, as you can see, the full details are very important that man again would have gone to the medical examiner's office and gotten an autopsy because of his age.
20:24 If we truly believed that he had no medical history and did not have a doctor.
20:29 And you know what, we probably would have done talks on him because we were told he was drinking before he collapsed.
20:36 None of that is necessary if we know the whole story in many, many situations.
20:42 Now, lastly, and this is something that I had a difficult time with yesterday.
20:48 Our doctors have to clear a case before someone can be cremated.
20:55 When the family tells the funeral home, I want to cremate my dad or mom, then they have to send a cremation permit to our office, and they all have to be reviewed.
21:05 And the reason for this is we don't want anything to slip through the cracks.
21:10 We don't want somebody who was in the hospital and died from a car accident to be cremated if we haven't investigated it because the hospital staff failed to call it into us.
21:25 And the hospital has signed the death certificate as a natural death and put respiratory arrest on the costs.
21:33 A lot of those are going to slip through the cracks and it happens.
21:38 This is kind of something that was put in place to allow us to number one, if there is any trauma related, investigate the death, if it wasn't reported yesterday, I got a death certificate with a cremation request and the hospitalist wrote on the death certificate, natural death fall intracranial bleed.
22:02 Ok, let's use our common sense here.
22:06 Is it natural that this guy fell and had a head blade?
22:09 That's not a natural death, right?
22:11 That is definitely an accident.
22:14 He might have been pushed, might be a homicide.
22:17 I mean, this needs to be investigated when we got this death certificate.
22:22 Of course, I reached out to the hospital, and I called the hospitalist.
22:27 Well, first, let me just tell you this when we got this cremation request, I reached out to the hospital and requested the medical records.
22:35 Firstly, the reason for this is I want to see for myself exactly what happened.
22:43 I want to see all the notes and I want to see where this fall took place.
22:49 And if there was indeed a fall, I want to reach out to family and get more information.
22:55 Like what time of day did he fall?
22:58 How long was he on the floor until he was found?
23:01 Did he fall on carpet or tile?
23:03 Did he hit his head, a lot of different questions?
23:07 Before I'm going to call everybody and start alarming them, I'm going to just get the medical records.
23:12 It's easier for me, especially as a nurse to look through those and just kind of evaluate, hey, is this something I need to investigate or not?
23:21 And at this point, it sounds like it is.
23:24 But when I got the records, this guy came in with a blood pressure of 185/102, he was complaining of a severe headache, and he had left sided weakness.
23:36 He could not move his left arm.
23:38 Now, why as I'm looking through the records, no indication at all of trauma.
23:43 He's had a head CT, he's had a chest X ray.
23:46 He's had lower extremity, X rays.
23:50 There's no pelvic fracture, there's no leg fracture, there's no acute signs of a head bleed.
23:59 There's no fractured ribs, there's no external signs of trauma, no indication whatsoever on that medical record anywhere that this guy fell.
24:11 Now, why did that doctor right fall as the primary cause of death?
24:16 Because number one, he's in a hurry.
24:18 Number two, he doesn't know how to sign a death certificate or how to review a medical record, but it was his patient.
24:28 That's not even a good excuse in this case.
24:31 Thank goodness that those are reviewed by us because in a case where that was a fallen intracranial bleed, he would definitely become a medical examiner case.
24:42 He wouldn't have an autopsy.
24:43 In our situation, our doctor would sign the death certificate and review the medical records.
24:49 But by reviewing the medical records first, I was able to determine that this guy didn't fall at all.
24:55 I get to call the hospitalist and tell him that he needs to go in and amend the death certificate because he signed it incorrectly.
25:04And so a lot of these issues are things that we deal with every day in the office.
25:08 When we're not out on a death scene, we are calling doctors and calling law enforcement and calling hospitals and getting information and requesting medical records and reviewing medical records.
25:20 There is a lot, a lot of desk work and paperwork involved as well.
25:26 I just felt the need to educate you a little bit on some of the struggles that we deal with on a daily basis, just like I said, completely off subject.
25:36 I was planning on talking today about electrocutions like executions via the electric chair.
25:44 We're going to save that for next week.
25:46 But I just wanted to cover that again because I'm working on this project for school.
25:52 And I thought, you know, there is a lot of education that needs to be done again to hospital staff.
25:58 Sometimes even law enforcement, not every detective is a seasoned detective.
26:04 Some are new, and some had terrible training.
26:07 Some were trained by bad detectives.
26:10 It's just important for us to educate.
26:13 Forensic nurses are very important in all of these ways.
26:19 Nurses in general are heroes.
26:22 Not everyone in my office is a nurse.
26:25 Actually I'm the only one.
26:27 Most people are retired law enforcement.
26:29 Most of the people that I work with.
26:31 And I think a lot of people in our office came down that law enforcement path first, which is great.
26:38 They have a good knowledge of what we do because they were detectives and they have seen us on scenes before and they know what's important.
26:46 Anyway, I just wanted to share that with y'all.
26:50 Hopefully you learned something.
26:52 And again, I would love to put it out there that there is a place on my website for you to go in and request me to speak.
26:59 And I would love to come to your facility and maybe just go over a few things with staff that just might help them understand exactly what our jobs are and what's important to us as far as evidence and what to do and what not to do and why and just maybe explain it a little bit better so that people aren't quite as intimidated because it's a lot to remember.
27:25 And I don't expect people to know my job and they don't expect me to know their job.
27:31 I think that the education part of it is critical so that we can all always work together as a team and do what's right for the families.
27:43 We don't want to hold up the death certificate because a doctor signed it incorrectly.
27:48 We don't want to hold up a cremation because we can't authorize it because the doctor signed it incorrectly.
27:56 We don't want to cause someone to have an autopsy because a full and accurate report wasn't given to the death investigator when it was called into our office.
28:07 All those things are very, very important.
28:10 Hopefully, like I said, you learn something you saw kind of behind the scenes, a little bit of the frustrations that we deal with on a daily basis.
28:19 Again, reach out if you want your staff to be educated a little on forensics and the importance of evidence and what is evidence, then I would love to do.
28:29 I think that it's very important to pass that information on to hospital staff being very nonjudgmental.
28:39 Just sharing our viewpoint would help a lot.
28:43 I'm sure in many, many cases this week.
28:47 I am hoping that everyone is good to us and good to you, good to us in our office.
28:55 I'm headed in this morning.
28:56 Yesterday was calm except for some of these issues that I dealt with that.
29:01 I just went over with you, but mostly a fairly calm day.
29:05 It was definitely a Monday for sure.
29:07 Phones ring off the wall and I know we all dread Mondays, but it's Tuesday.
29:13 So, today is a new day and I hope everyone enjoys it.
29:17 I hope the weather is amazing and everyone can go home and relax tonight after a easy day at work.
29:25 Next week, we're going to talk about some executions, some botched executions and we're going to go down that track for a little bit and just kind of cover some of those.
29:36 That's something that I don't see here because we don't have a prison.
29:39 I think it would be great.
29:41 I know it's terrible to say, but as a death investigator, when you know, you're not going to get a certain kind of death, you always wish you were.
29:48 That's just the weird in us.
29:50 We always say here there have been a couple of alligators spotted in some of the local lakes and we just know that eventually one day we are going to get a death that was caused by an alligator.
30:02 It's just going to happen.
30:03 We've never seen it.
30:04 It's unusual in this part of the country, but we feel like it's going to happen and we're kind of ready for it if you know what I mean?
30:13 I know, that's sad.
30:14 But I just, that's why I don't get in lakes.
30:17 I don't get in lakes.
30:18 I don't get in the ocean, not going to do it.
30:20 I am not fish food.
30:23 I don't have time to get rolled by an alligator.
30:27 I don't know about y'all.
30:28 But anyway, have an amazing day and I look forward to talking to y'all next week.
30:33 Thank you so much for joining me today on Pushing Up Lilies.
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30:48 Thanks again for spending your time with me and be sure to visit me at PushingUpLilies.com for merchandise and past episodes.