Clinical forensic medicine

At present, qualified expert opinions and testimony by forensic specialists are usually available only in cases of violent death. However, cases of serious assault with a surviving victim can often benefit from the review and interpretation of injuries by a forensic expert, and the expert’s opinion can be useful to the criminal justice system. Forensic pathologists consult by reviewing medical records and digital photographs.

Forensic anthropology

Forensic anthropologists are experts in the study of skeletal remains in the medicolegal context. They make an important contribution to death investigations where the remains are skeletonized, burned, decomposed, mutilated or otherwise unrecognizable. Forensic anthropologists act as part of the death investigation team. They are the experts at determining whether found bones are human or non-human by examining digital photographs or the remains themselves. They help to plan for multiple fatality events and manage identification when they occur. They are also the experts who determine whether found remains are of recent forensic interest or are archaeological or historical in nature.

The OFPS has one full-time forensic anthropologist on staff along with several fee-for-service consultants. During the reporting period, there were 550 anthropology cases managed at PFPU.

The Identification Team works alongside the anthropologists to provide oversight and coordinate activities related to all unidentified cases at the PFPU. The Identification Team is comprised of the Forensic Human Remains Analyst and the Unidentified/Unclaimed Human Remains Coordinator. The Human Remains Analyst provides services for forensic anthropology examinations conducted at the PFPU, in addition to scene examinations across the province, while facilitating scientific identification requests. The Unidentified/Unclaimed Human Remains Coordinator provides oversight and coordination of activities related to Ontario's unidentified and unclaimed human remains. The position holds a joint portfolio with the OCC to provide oversight and coordination of activities related to management of Ontario’s unclaimed bodies.

During 2021–2022, there were 1,234 unidentified bodies managed by the PFPU. Of these, 1,213 were positively identified and the remaining 21 continued to be managed to determine their identity.

Other professional consultants

The OFPS relies on expert contributions of other professionals, including cardiovascular pathologists, neuropathologists, forensic odontologists, radiologists and a forensic entomologist.

At the PFPU, there were 435 consultation cases completed. These included neuropathology, cardiac and dental consultations.

Histology

Histology is the preparation of microscope slides from tissues obtained at autopsy for examination by a pathologist. The number of slides prepared for each case varies with the type of case and the pathologist’s preference.

Histology services are provided by laboratories at community hospitals and FPUs located in hospitals. The PFPU employs three full-time Histotechnologists who processed about 4,047 tissue specimens each month in 2021–2022.

Toxicology

Toxicological analysis of post-mortem samples is performed by scientists (toxicologists) at the CFS. In many cases, pathologists rely on the results and interpretive notes provided by toxicologists to arrive at an opinion about the cause of death.

During 2021–2022, toxicological analysis was requested in 6,635 death investigations. The average time to issue a toxicology report by the CFS was 66.4 days.

Molecular autopsy/cardiovascular pathology

Many natural disease processes are now recognized to have a genetic underpinning. For a number of these conditions, characterization of the genetic mutations involved is becoming the standard of care in hospitals for living patients and is part of the movement towards targeted therapy and personalized medicine. The first significant manifestation of such a disease may be sudden and unexpected death, which may be first recognized and diagnosed following the autopsy. Thus, particularly for young people, the identification of a genetic contribution to sudden death can have huge implications for the surviving family members as well as the health care system.  

A large proportion of cases where genetic disease may have contributed to death involve the heart and blood vessels. The OFPS provides high quality cardiovascular pathology services to investigate sudden cardiac and vascular deaths in Ontario and occasionally by request from across Canada. In cases that may have an underlying genetic predisposition, DNA banking and genetic testing will also be performed (the molecular autopsy). With the results of the autopsy and clinical investigation, DNA analysis can help define the underlying disease that caused death, facilitate screening in surviving family members and sometimes contribute prognostic information for affected relatives.

High-quality pathological diagnoses are essential. Through the OCC, we communicate with families to give them information about a potential genetic condition and their options for care in subspecialty hospital clinics. Next-of-Kin clinics have also been set up between the PFPU and the OCC to improve communication with family members. Families meet with coroners, forensic pathologists and the Family Liaison Coordinator at the FSCC in person, via video or through teleconferencing, to review the findings of a death investigation.

It is also increasingly accepted that unrecognized genetic disease may play a role in deaths following interactions with correctional officers or police, or in the course of a criminal act. In these circumstances, a molecular autopsy can help provide answers and contribute to coroner’s inquests and the criminal justice system.

Child Injury Interpretation Committee(CCEC)

In 2017, the OFPS established a committee to provide enhanced peer review of certain paediatric deaths that may required a higher level of transparency and broader input due to the level of complexity or criminal justice interest. Membership includes a Chair along with forensic pathologists from across Ontario, particularly those with special interest in paediatric deaths, and child abuse paediatricians along with neuropathologists, cardiovascular pathologists, and forensic pathologists from other provinces, as necessary. The peer review takes place before the autopsy report is released to provide a broad spectrum of specialist opinions for each case to ensure the quality of these challenging death investigations. 

During the reporting period, 21 cases were peer reviewed by this committee.

Complex Case Expert Committee (CCEC)

The OFPS introduced a new quality assurance process, the Complex Case Expert Committee (CCEC). This standing committee of the Forensic Pathology Advisory Committee (FPAC) focuses on cases where there is a persistent difference of opinion during peer review and on cases that require a higher level of review due to significant public or criminal justice interest. The CCEC consists of a Chair, a Deputy Chief Forensic Pathologist, senior forensic pathologists, and other experts, as necessary (for example, neuropathologists). This new process replaces and/or expands the usual peer review for certain cases.

During the reporting period, 12 cases were peer reviewed by this committee.

Forensic imaging

Forensic pathologists at the PFPU incorporate advanced post-mortem imaging (CT and MRI) findings into their case management decisions. Incorporation of these non-invasive techniques into forensic pathology practice has resulted in increased numbers of external and targeted examinations leading to efficiencies and benefits for families.

Senior residents from the University of Toronto’s Diagnostic Radiology Residency Program spend one month at the PFPU where they are integrated into daily service work. Through this rotation, radiology residents learn about lethal injury and disease, as well as changes in the body after death. They report post-mortem CT and MRI scans and can see pathologic lesions in the autopsy room in a way that is not possible in the clinical setting. 

Tissue recovery for donation

The OFPS and OCC are committed to facilitating and increasing the availability of tissue for transplantation through the Trillium Gift of Life Network (TGLN). The Provincial Forensic Pathology Unit houses a dedicated Tissue Recovery Suite that is used exclusively for obtaining donor tissues, including corneas, heart valves, skin and bones. After consent by the family, tissues are recovered by trained staff from TGLN.

TGLN performed 257 tissue recoveries using the PFPU Tissue Recovery Suite during the reporting period, including bones, skin and heart valves This accounts for 87 per cent of TGLN’s multi-tissue donor recoveries for the reporting period.