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Medical examiners consider range of evidence

A New York state medical examiner certified that Vincent Viafore’s death was a homicide because his “kayak drain plug (was) intentionally removed by (an)other.”

The New York Times reported that Viafore, 46, drowned in the Hudson River last spring while kayaking with his fiancée, Angelika Graswald, 35. When his decomposing body was pulled from the river about a month later, police thought he’d died by accident. They investigated further when Graswald posted to Facebook photos and videos of herself smiling broadly and turning cartwheels.

When Viafore’s kayak was found, the drain plug was missing.

According to police, Graswald said it “felt good knowing he was going to die.” They say Graswald “moved (Viafore’s) paddle out of his reach” after he went into the frigid water, the Times reported in September. The latter statement suggests to me that Graswald confessed. How else would anyone know that? The Times article doesn’t say.

Graswald’s attorney says Dr. Jennifer Roman made a determination of homicide “without a scintilla of medical evidence,” and her determination that the kayak plug was removed intentionally “overstepped (the) bounds.”

An Orange County spokesperson defended the medical examiner, citing state law that permits medical examiners to consider information other than the autopsy in making their determinations.

“Coroners and medical examiners have been doing this for over 100 years,” Justin Rodriguez said.

I don’t know whether or how strongly evidence against Graswald supports a homicide determination and the conclusion that she removed his kayak plug intentionally.

I don’t know if removal of the kayak plug, even if it was intentional, caused Viafore to drown. Viafore’s kayak was found floating, and kayaking experts say a kayak wouldn’t necessarily sink because of a missing plug.

I don’t know if the Times has all the evidence. I’d be astonished if it did. I can’t judge the accuracy or appropriateness of the medical examiner’s certification in this particular case without knowing what she knew.

I do know what the founding fathers of forensic pathology intended when they envisioned the role of the medical examiner. I knew several of those people and did part of my training under one of them.

As originally conceived, a medical examiner was to be a medical doctor, specifically a pathologist, who was also trained in injury interpretation, death investigation and death certification. The medical examiner would do forensic autopsies, assume the roles of the coroner and the inquest jury and use all available information to determine the cause and manner of death – just as a coroner’s jury would.

Dr. Joseph H. Davis, who was one of the first doctors certified in the new field of forensic pathology in 1959, said, “You cannot perform an autopsy, look at some structural abnormality and say ‘this is the anatomic cause of death’ without correlating these findings with the circumstances under which the person died.”

Davis also said it was “stupid” to rely too much on autopsy findings and microscopic examinations. He and other mentors drilled into me that medical science considered in isolation is a highly fallible means of determining both cause and manner of death. Thoughtful evaluation of other evidence, particularly the circumstances in which the death occurred, is critical.

Today, concerns about contextual bias have led some people – many of them defense lawyers – to argue that medical examiners shouldn’t be allowed to rely on “non-scientific” evidence.

If such a limitation were imposed, I think people would be shocked by how little we could determine.

Dr. Carol J. Huser, a forensic pathologist, served as La Plata County coroner from 2003-12. She now lives in Florida and Maryland. Email her at chuser@durangoherald.com.



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