Wendy M. Gunther, MD
Stephen J. Cina, MD
Recently the mother of a young woman who had died of a drug overdose more than a year before called one of the authors (W. Gunther) to demand angrily why no test had been done to determine what food her daughter had eaten before she died. Toxicologists had tested the stomach contents, and the tests had shown a fatal overdose of ingested cocaine. But her mother didn't want to know that; she wanted to know if her daughter had ingested a hamburger and Coca-Cola before she died. Her theory: The drug dealer persuaded her daughter to unknowingly ingest the cocaine by offering it hidden inside a hamburger and Coke. When asked what test she thought we could do to determine whether a person had drunk a Coca-Cola before death, she went blank. The best we can do, she was told, is look at the contents of the gastric pouch to see if we recognize any food. There is no massive database, no selection of magical tests that will identify hamburger if the food is fully digested, and no Coca-Cola assay. The poor mother was nonplussed. "Well, on 'CSI' they have a test..." she said. She had to be informed that television isn't always reality.
Despite the welcome attention that "CSI," "Bones,"
and other similar shows have brought to forensic pathology, their large
dose of distortions and flat-out mistakes has affected our dealings with
the people who need us most—the families of the decedents. The "CSI
effect" has led to family members' unrealistic expectations of medical
examiners, suspicions where none should exist, and juries vulnerable to
traps set by savvy lawyers willing to meld fact and fiction to benefit
What do characters like Grissom of "CSI" do on television
that real forensic scientists can't do? There are errors of fact and errors
of proportion. The latter are more subtle and damaging because they often
appear credible to the untrained observer.
Perhaps the most distressing error of proportion is
the implication that one man can do it all. All it takes is Grissom and
perhaps Sara (recently his love interest—generally poor office behavior)
to do the scene investigation, collect all the evidence, commandeer the
lab, and perform all of the specialized tests on every piece of evidence
themselves. This requires forensic training such as no investigator in
real practice ever has. They wander in and out of the autopsy suite, inappropriately
attired, to absorb a summary of the entire gross autopsy in a line or
two, and occasionally take over the body without permission of the forensic
pathologist to perform something as ridiculous as a stab wound casting.
They commonly interview witnesses, which is the job of the detectives.
They do their own DNA examinations, handle their own toxicology, do their
own Internet research, and probe infinite numbers of convenient databases.
All this while getting enough sleep and looking great! A parallel in blood
banking would be if a single employee were an intake specialist, phlebotomist,
local area network computer specialist, hematologist, quality control
specialist, and the person who makes the phone calls to physicians to
alert them to critical values.
In real life, forensics, just like any other area of
pathology, can be handled only by a team. No one person does it all. To
suggest that scene investigators have the time and expertise to handle
not only their job duties but also everyone else's minimizes the importance
of teamwork and mutual reliance that is the hallmark of real forensic
A major sore spot for forensic pathologists is the
false notion these shows give that forensic science can accurately determine
the time of death. Time of death is one of the more difficult scientific
assessments to make; many would call it more art than science. Every year
brings new articles in the forensic journals about the most recent attempts
to scientifically determine time of death. However, these experiments
are conducted under carefully controlled lab conditions; no forensic technique
has proved to be a reliable predictor of the time of death in the uncontrolled
conditions of a crime scene. Estimating the postmortem interval is so
heavily dependent on temperature and myriad other variables that the best
one can do is to make an educated guess. Factors that can lead to gross
error in estimating the time of death include the ambient temperature;
the temperature of the body when the victim died; whether the victim was
frail, thin, obese, or muscular; what the victim was wearing or not wearing;
whether blankets were covering the victim; and subtleties such as the
microclimate (for example, when a transient sunbeam enters the room and
lingers over the body for two or three hours but is gone when the body
is discovered). In the absence of a thermostat-controlled room with no
windows, determining the time of death is fraught with peril for even
the most experienced investigator.
A real forensic scientist who is asked to estimate
time of death always responds with one essential question, which is never
asked on TV: What time was the victim last seen alive, and what time was
he found? If you don't know these simple parameters, you risk your "scientific"
guess falling outside the boundaries of the known facts.
Does the time of death really matter? It often matters
to families who have been taught all they know about crime scene investigation
by television shows. Medical examiners routinely field phone calls: "Doctor,
what time did my husband die?" The guilt-ridden widow can be told what
time he was pronounced dead in the ER, but that's not what she wants to
know. She heard him gurgling in his sleep at 1:30 in the morning and found
him blue and unresponsive at 8:30 in the morning. She wants to know whether
she could have called 911 when she got up to go to the bathroom at 3:30
and is, therefore, to blame. Depending on physical findings such as rigor
mortis and lividity, taken in concert with the circumstances, the medical
examiner can provide her with a window when death may have occurred rather
than a specific moment. She is not happy when told that medical science
can't give her a more accurate answer.
Determining the postmortem interval also matters to
police agencies and lawyers who are trying, based on time of death, to
exclude a suspect from or place a suspect at the scene of a homicide.
A miscalculation or scientifically unfounded proclamation by the forensic
pathologist can result in the arrest, and perhaps execution, of an innocent
person or the release of a killer. When the case goes to trial, if the
medical examiner cannot tell a jury that a badly decomposed victim died
between 1:00 and 1:30 in the morning, 13 days before discovery of the
body, his or her credibility and expertise may be called into question.
The jurors may be dubious of the entire autopsy findings if the medical
examiner can't provide them with a simple time of death—because
"CSI" and other similar shows have told them they can.
A point often omitted is that decedents develop not
only rigor mortis but also concurrent livor mortis over the early postmortem
interval. The settling of blood to a supine decedent's back under the
influence of gravity is one of the most obvious signs of death and may
be an actual forensic clue in a case where a scene has been altered by
movement of the body after death in an attempt to conceal a homicide.
It's understandable that living actors can't exhibit livor mortis—though
if they can have pale faces through makeup, they can surely have purple
backs. If a TV show is going to go to great expense to make a realistic
dummy so they can pretend to have it undergo an autopsy, why doesn't it
have livor mortis? The reason dead people are pale is because the blood
has settled to their backs.
A popular myth is that science will always find the
answer. On "CSI" there is a database or a test for everything and all
you have to do is look it up. It's true that AFIS, the automated fingerprint
inventory system, is a wonderful method for getting good matches on full
and clear thumbprints of people whose prints are already in the system
and on file. It may not be as effective for partial fingerprints, and
a match tends to show up within hours to days, not minutes. And it can't
do anything to identify the fingerprint of a person who has never been
fingerprinted before. But just because AFIS works in some cases in the
real world doesn't mean there is an equally rapid and universal database
It is true that forensic toxicology laboratories can
detect and quantify drugs and a vast array of substances and that the
resolution of many cases depends on their results. However, they can't
do it in 30 minutes. Quality control issues, staff and equipment limitations,
accreditation guidelines, suboptimal samples, and a constant stream of
new designer chemicals mean longer turnaround times. On "CSI," the toxicology
results are back before the end of the show. In real life, depending on
the state or county budget, they are back within two and 102 weeks. A
frequent, uncomfortable phone call goes something like this: "Doctor,
you performed the autopsy on my son this morning. What did the drugs show?"
It is sad and difficult to have to explain to that family member that
although a drug overdose is possible or even likely, neither the family
nor the doctors will know for weeks or months. Sometimes the families
object that it's not that way on "CSI."
A colleague who works in a DNA lab recently shared
her pet peeve: When the DNA analysts on TV come back to report the results,
they are wearing the same clothes they wore when they went in to do the
tests. The need for meticulous sample preparation and quality control
measures to avoid performing PCR on the wrong sequence and the time required
for a DNA expert to interpret a multi-specimen case has resulted in a
huge backlog of DNA tests facing qualified laboratories. The minimum wait
for results is days, if not months. The real DNA analyst doesn't have
any set of clothes she wears for months.
The DNA analysts with whom we are familiar are all
highly reliable scientists. They aren't the types of people who mind tedious
work, repeated with care, if that is the way to get verifiable results.
Then why does Greg, the DNA analyst on "CSI," come across as such an undependable
and untrustworthy fellow? Of all the people in the lab to choose for the
character flaw of unreliability, the DNA analyst should have been the
The idea that every medical examiner's office has an
unlimited budget is a damaging error of proportion. No office we know
of has its own police helicopter in which to fly over any area that might
be interesting to look at from above. No office has the budget to turn
out all its results in hours. No office has the budget to do it all and
do it instantly. No police force has the resources to field endless scene
investigation operatives evaluating every possible scenario. In our world,
budgets are real, and necessary funding is won from harried governors
and county commissioners through skillful representation by chief medical
Another myth popularized by television suggests that
every investigator has the leisure to take on a single case at a time,
investigate it as he or she sees fit, and come to a successful conclusion.
And they always clear their cases and have a clean, well-organized desk.
Busy, overworked police personnel in real life never have the luxury of
handling a single case at a time and many cases are never cleared. Multiple
overlapping cases, insufficient police personnel, and endless sacrifice
on the part of real police heroes are the true story. By comparison, the
infinite periods of leisure and implied infinite funds of television sleuths
are almost insulting.
Many of us are also troubled by the notion that ultimately
there will always be an answer and every case will be solved. If the star
of "CSI" or other such shows can't figure out a problem, it isn't because
science isn't good enough to answer the question; it's because he hasn't
figured out how to apply the science to answer it—yet. The fact
is, everyone who works in this field accumulates a mental list of cases
where, despite exhausting all options, we could not figure out how and
why someone died. I never hear operatives on "CSI"-type shows say, "I
don't know" or "I tried the analysis, and it didn't work." But that is
how real science is. Real science is real because it reports negative
results. Much of science and medicine is admitting when you don't know
the answer or when the test doesn't answer the question. In reality, more
homicide cases are solved by confession than by science.
How prevalent are errors of fact? Not very. The science
behind "CSI," for one, is usually sound. But any time science conflicts
with the needs of television, it's science that must give way. For instance,
many of the actresses of "CSI" have long hair, and when they enter a scene
with a dead body in it, they kneel over that dead body and use their hands
to push back those flowing locks, which would scatter random hairs and
DNA across the decedent and the crime scene. Of course, advisors to "CSI"
know real investigators wear hairnets and Tyvex suits at a scene, but
this is one place where theatrics conflict with reality.
Though hairnets may be too much to ask of television,
surely it isn't too much to ask Grissom to follow basic rules of evidence.
If you see an item on the floor in a crime scene, your job is to document
it. You may draw it on a diagram, take measurements, photograph it, or
do all three. Only then do you collect it. You do not kneel and pick up
the evidence so you can examine it intelligently in front of your nose,
then lay it back down into position and take your photograph. Who knows
what errors you might have introduced by handling the evidence before
you documented it? Worse still, Grissom and colleagues have a disturbing
tendency to taste things they find at the scene.
Another health hazard and accreditation violation seen
on television is inadequate lighting of the laboratory. There is no reason
why the autopsy pathologists on these shows all work in the dark. They
track gunshot wounds through the body by following a single bright light
against dramatic shadows. The first thing a real autopsy pathologist does
is to get the decedent into an autopsy suite under as many fluorescent
lights as the budget permits. We like to see lethal injuries, not blindly
feel our way through them in the dark.
Inaccurate depictions of reality are not limited to
the autopsy suite. For example, the crime scene technicians in these shows
often collect blood-soaked evidence in plastic bags. There's no quicker
way to make a bloody garment turn into a bloody, moldy garment than to
enclose it in a plastic bag. The only suitable bag for decedents' hands
and for most evidence is a paper bag. But the audience can't see through
paper, and that would diminish the dramatic effect.
An example of outright nonsense is the idea that you
can pour casting material into a stab wound to determine the size and
shape of the knife. Everyone who works with actual bodies knows that the
viscera change position as the body goes from standing to sitting to supine.
Further, the internal injuries from a stab wound inflicted on a twisting,
arching person who is trying to avoid a knife differ greatly from those
associated with a wound track imparted to a motionless decedent lying
flat on his or her back. In most cases, there isn't going to be a perfectly
straight channel from the skin surface to the deepest point of penetration.
There's more likely a meandering track through viscera that are no longer
in the same position they were in when the knife entered the body. Lungs
collapse, organs shift, hemothoraces compress adjacent structures. Casting
material poured into a stab wound would never follow a well-defined path
that conforms to the shape of the weapon; it would run into the body cavities
and organs in a path of least resistance. You'd end up with a cast of
the pericardial sac, peritoneum, or pleural cavity. And even if the casting
material did follow the knife wound, the dimensions of the wound path
would not necessarily correspond to the knife's shape and size. A person
who is stabbed finds it uncomfortable and will attempt to move while the
weapon is inside. This creates a wound with features of both a cut and
a stab. It is impossible to determine the width of a blade when this occurs.
The length of a blade is also easily over- or underestimated. The force
applied by the assailant has a lot to do with how far a knife penetrates
the body. It's been said that a strong arm can send a three-inch penknife
from the skin of the belly right down to the spinal column (often twice
its length). A cast of a wound caused by a penknife inserted into a twisting
person's belly may suggest a butcher knife based on the length and width
of the hypothetical cast. But we can't let a little reality stand in the
way of a good story, can we?
Real technology is also misused in fictional television.
In one scene, the crime scene technicians decided to use Luminol to detect
occult blood in broad daylight. Luminol fluoresces when it reacts with
blood, which means one must use it in a dark room to see it light up.
There's no point in using it during daylight. It would be like looking
at a black-light poster in the sun.
Perhaps our favorite scene in a television show was
when the medical examiner looked up from a body and said, straight-faced,
"He died of fear." He didn't specify acute or chronic fear, and without
this critical information, how would it be possible for Vital Statistics
to accurately SNOMED code this death?
Forensic pathologists have become the public face
of pathology because of these shows. Though pathology as a specialty has
benefited from the attention, the many myths the shows propagate have
affected the ability of medical examiners to communicate with families
of decedents and have led to miscarriages of justice. And thousands of
young people watching the forensic television shows may be shaping career
plans based on the jobs the shows' characters have. We welcome and need
sincere and enthusiastic people in our field, but we must consider what
they will do when they find out they can't do it all, can't solve only
one case at a time, can't determine the time of death, don't have a database
for everything, don't have a helicopter, can't take charge of a whole
investigation and tell the detectives and doctors what to do, and don't
always solve the case to a satisfying conclusion in a brief time. For
families and juries and for eager young investigators, the myths of such
shows have much to answer for.
Dr. Gunther is a forensic pathologist in the Virginia Office of the Chief Medical Examiner, Norfolk. Dr. Cina is deputy chief medical examiner, Broward County, Fla. Both are members of the CAP Forensic Pathology Committee.