Forensic Toxicology

Extract

Forensic toxicologists investigate suicides, murders, and accidental poisonings and overdoses. In 2009 accidental deaths accounted for over 117,000 deaths in the United States, 4.8% of all the deaths that occurred.¹ Poisonings accounted for 26% of the accidental deaths, second only to deaths from motor vehicle accidents (33%). These “poisonings” are accidental overdoses; this number includes neither intentional, suicidal overdoses nor deaths in which drug intoxication contributed to but did not cause death, which is true for many of the motor vehicle accidents. Medication errors in hospital patients also cause death, both in the United States² and abroad.³ As Madea et al. point out, physicians may not even recognize that an adverse drug event has occurred, and thus the injury is never detected.³

The few reports cited above are sufficient to show that toxicologic analysis is critical in the medical-legal investigation of deaths. The reports also show that toxicologic analysis can play an important role in the investigation of an unexpected, adverse decline in a patient's condition in a hospital, even if the decline does not end in death. This article discusses forensic aspects of toxicologic analysis in the medical-legal autopsy setting and then application of those principles in hospital practice.