Opinion ID: 552159
Heading Depth: 4
Heading Rank: 1

Heading: Category-One Statements: Descriptive Observations as to the Condition of the Decedent's Corpse

Text: 36 Statements in the autopsy report falling into this category 13 are reliable for all of the reasons that routine business records or public records are deemed reliable. Like the information contained in business records, the reliability of the descriptive observation portion of autopsy reports prepared by state or county medical examiners' offices is enhanced by the routine and repetitive circumstances under which such reports are made. And since the reports are made at the time of the autopsy, their reliability is far greater than a later-recollected description by the preparer of the record. 14 Like information contained in public records, reliability is further enhanced by the existence of statutorily regularized procedures and established medical standards according to which autopsies must be performed and reports prepared, and by the fact that autopsies are carried out in a laboratory environment by trained individuals with specialized qualifications. See R.I.Gen.Laws Sec. 23-4-1 et seq. (1985) set forth in Appendix. 37 Dr. Burns, the Deputy Chief Medical Examiner, who testified at the trial, authenticated the report and established that it was prepared under the auspices of the Medical Examiner's Office in accordance with the statute and the established medical procedures of the Office. He described the statutory mandate of the Office of the Medical Examiner, the way in which this mandate is carried out, and the generalized procedures of the Office regarding conduct of autopsies and preparation of the reports. 38 It happened in this case that Dr. Burns also had personal familiarity with this autopsy, qualifying him to testify to more than just the general procedures for conducting autopsies and preparing autopsy reports. 15 He had taken part in a conference held by the medical examiners with Dr. Mary Ambler, who did the examination of the formalin fixed brain which formed the core of the report; and he had signed the report even though he did not personally perform the autopsy. 39 The objectivity and impartiality of Dr. Zirkin and those associated with him, and of their methods in performing the autopsy and detailing their observations, are not in issue. 16 There is no reason not to believe that Dr. Zirkin and his associates did not discharge their professional and official obligations under the statute. Their descriptive observations of the physical condition of decedent thus possess particularized guaranties of trustworthiness for all the reasons that attach to business and public records. 40 2. Category-Two Statements: Medical Opinions as to the Nature of Injuries or Illnesses including Medical Conclusions as to the Cause of Death Based upon These Opinions 41 Like their descriptive observations, we believe Dr. Zirkin's opinions and conclusions regarding the medical cause of death are admissible: they reflect the pathologist's expert medical judgment, following an autopsy, as to the cause of death, a subject he was both professionally and by law charged with ascertaining and recording. Dr. Zirkin gave as the medical cause of death, multiple injuries including mandibular and maxillary fractures, contusions and abrasions of the face, subgaleal hemorrhage resulted from the injuries although no cranial fractures, brain contusion, or subdural hemorrhage were seen. These conclusions followed upon Dr. Zirkin's detailed physical findings in respect to the nature and appearance of the observed injuries and related medical conditions. See, e.g., n. 13, supra. 42 Petitioner argues that Dr. Zirkin's conclusion that death was caused by the injuries is suspect as it was based not only on examination of the corpse, but upon certain hearsay evidence. Thus, Dr. Zirkin considered the results of the formalin fixed brain analysis performed by Dr. Mary Ambler. He also reviewed the report and photographs from the police department and the emergency room records of the Roger Williams General Hospital to which the decedent had been brought and where he died. We believe, however, that Dr. Zirkin's exposure to these extrinsic materials was appropriate and enhanced rather than undercut the trustworthiness of the autopsy report. In this regard, we distinguish between the pathologist's determination of the medical cause of death, i.e., multiple injuries as described, and his conclusion as to manner of death, namely homicide. The latter raises different issues which we shall discuss later. 43 Fed.R.Evid. 703 allows expert testimony to be based upon otherwise inadmissible evidence [i]f of a type reasonably relied upon by experts in the particular field in forming opinions or inferences upon the subject.... Rule 703 reflects a recognition of the expert's integrity and specialized skill, which will keep him from basing his opinion on questionable matter. J. Weinstein and M. Berger, Weinstein's Evidence p 803(4) at 803-146 (1990). See also United States v. Williams, 447 F.2d 1285, 1290 (5th Cir.1971) (en banc). Medical examiners are physicians, and physicians commonly base their opinions on tests and examinations performed by other physicians: for example, the reading of an x-ray by a radiologist. Thus, it was reasonable for Dr. Zirkin to consider the results of a brain analysis conducted by another physician as well as of laboratory tests and the like. Physicians also like to know how and when a patient was injured in order better to interpret the patient's observed condition. Thus, here Dr. Zirkin mentioned the police report of a beating at 1 a.m., of decedent's being found with shallow respirations and a weak pulse, and of his being taken by Rescue to Roger Williams General Hospital where he died at 1:47 a.m. This is the type of information a physician charged with Dr. Zirkin's responsibility would reasonably want to know, for whatever assistance it might provide in interpreting and verifying the results of the autopsy. The examiner would, of course, also want to see any hospital records pertaining to decedent's condition and treatment up to death. Such records are themselves independently admissible under the business records exception, a firmly rooted exception to the hearsay rule. See Fed.R.Evid. 803(6). 44 There is, moreover, a close analogy between the admission of medical records containing diagnoses, as specifically allowed under Fed.R.Evid. 803(6) and admission of the autopsy report in issue here. A determination of the cause of death following autopsy is, in effect, a medical diagnosis prepared by the pathologist pursuant to law for important societal purposes. Petitioner's objections to admission of the autopsy reports--that expert qualifications and accuracy of opinion cannot be adequately evaluated without cross-examination of the author of the opinion--are identical to those once made opposing the admission of medical records. Weinstein's Evidence, p 803(6) at 803-198 (1989). However, hospital records, including medical opinions, are now admitted under Rule 803(6), which expressly permits opinions and diagnoses. We believe that hospital records containing statements of medical opinions constitute a firmly rooted exception to the hearsay rule, and thus would pass Confrontation Clause scrutiny. 17 The autopsy report opinion as to cause of death was no more or less prone to error than medical opinions found in such hospital records. Medical opinions as to the nature of injuries or illnesses 18 and medical conclusions as to the cause of death, see supra; p. 772, are based upon a common body of medical knowledge applied by physicians who possess relevant medical qualifications. Examiners lack any reason to falsify their reports and are motivated as professionals and public officials to reach their conclusions as conscientiously and accurately as possible. Rule 803(6), which was applicable in Rhode Island at the time in issue, authorizes a trial judge to exclude such records where indicia of reliability are lacking, and there may be situations where an autopsy report should be excluded because of indications of unreliability. See Stevens v. Bordenkircher, 746 F.2d 342 (6th Cir.1984), discussed in note 16, supra. In this case, the trial court, after conducting a voir dire inquiry as to reliability, found specifically that the report was reliable. We believe, in these circumstances, that the report possesses at least the same indicia of reliability as do commonly admitted hospital records. 45 As with diagnoses reflected in medical records, adequate means were available to the defendant to bring to the jury's attention any error or flawed conclusions in the medical examiner's opinions. The bases of Dr. Zirkin's judgments are described in the report in detail. The defendant could have had his own medical experts review the report and give a different opinion as to the cause of death. In fact, defendant tendered no experts to support his claim that death may have been due to drug-induced or spontaneous hemorrhage rather than the observed injuries. 19 46 The actual preparer of the report was not necessarily any better suited than another equally trained medical examiner familiar with the procedures and medical implications to answer questions as to the medical opinions presented in the report. Petitioner argues that his attempts to cross-examine Dr. Burns as to these very issues were rebuffed by the trial judge in response to the prosecutor's objections. But petitioner's interests were adequately protected by the option, which the judge extended to him, to call Dr. Burns or an outside expert of his own choosing, as witnesses in his case. By these means, defendant could have pressed his argument that death was caused not by the injuries received from the beating but from decedent's use of drugs. 47 The Supreme Court suggested in Inadi that the defendant is further protected from prejudicial hearsay when the defense may subpoena an available declarant: 48 [I]f the defense has not chosen to subpoena such a declarant, either as a witness favorable to the defense, or as a hostile witness, ... then it is difficult to see what, if anything, is gained by a rule that requires the prosecution to make that declarant available. 49 Inadi, 475 U.S. at 398, 106 S.Ct. at 1127-28. Reasoning that imposing a burden on the prosecution to call all such witnesses or demonstrate unavailability was unjustifiable, the Court noted that the defendant's option to call the declarant under the Compulsory Process Clause rendered the benefit of an unavailability rule under the Confrontation Clause slight. Here if the preparer of the autopsy report, Dr. Zirkin, were indeed available, as the district court believed, the defendant could have called him as his own witness or deposed him in Israel or before he departed. 20 50 We conclude that the examiner's opinion that death was caused by the multiple injuries and subsidiary medical opinions in the report were properly admitted. 51 3. Category-Three Statements: Statements as to Circumstances Surrounding the Death Taken from Police Reports or Other Sources 52 When the autopsy report went to the jury it contained the statement, that decedent was beaten by assailants in a parking lot on Mineral Spring Avenue, on November 2, 1980, at approximately 1 a.m. See supra, p. 772. Dr. Zirkin presumably took this from the police report. In this regard, the district court said: 53 In this case, the portion of Dr. Zirkin's report relating to the fight in the parking lot cannot be considered medical opinion. It is a factual conclusion. The report could be and apparently was read by the jury as concluding that the decedent died as a result of the beating in the parking lot, rather than as a result of the subarachnoid hemorrhage. In his grand jury testimony Dr. Zirkin testified that the subarachnoid hemorrhage, swelling and bleeding in the tissue lining the brain, caused the death. 54 Manocchio v. Moran, 708 F.Supp. 473, 478 (D.R.I.1989) at 478. The district court found that the inclusion in the report of the factual conclusions as to the circumstances surrounding the death (as well as the opinion as to manner of death, see infra ) was fatal to its admissibility. 55 The district court's criticism would have force if the autopsy report's reference to the beating at the parking lot added materially to the state's case against defendant--as, for example, had the police report identified defendant as one of decedent's assailants or constituted important evidence that a beating had occurred. While the medical examiner was entitled to take into account, for purposes of formulating an overall picture of decedent's medical condition, the police's information that decedent had been beaten shortly before he died, this was inadmissible at trial to prove the state's case against the defendant. Had defendant objected specifically to the report's reference to the parking lot beating, the trial court should have redacted the material, just as it would redact from a medical record any prejudiced hearsay concerning the particulars of a motor vehicle accident that were relayed to the doctor. 56 The fact that the decedent was beaten by assailants in the parking lot, however, was never seriously contested, nor has it been brought to our attention that the defense ever asked the court to redact the particular portion of the autopsy report referring to a beating. The beating of decedent in the parking lot was testified to at trial by a prosecution eye witness, Jayne Leo. The occurrence of a beating was further supported by the testimony of several other state witnesses, who, while they did not witness the beating, had rushed outside afterwards and ministered to the victim who they found bleeding, injured and dishevelled, lying on the ground in the parking lot, in a state that virtually compelled the conclusion that he had been assaulted and beaten. The circumstances surrounding the death portion of the autopsy report did not mention petitioner's name nor did it state implicitly or explicitly that petitioner was in any way involved in the beating. It stated merely that decedent was beaten by assailants at a certain time and place, that he was found with shallow respirations and a weak pulse, and that he was taken to a hospital where he died less than an hour after the beating. Petitioner did not challenge the truth of any of these assertions; he challenged only the state's assertion that the injuries resulting from the beating caused the victim's death, suggesting, instead, that a hemorrhage induced by drug ingestion, or possibly a spontaneous hemorrhage, caused death. 57 In these circumstances, the district court's implication that the autopsy report's reference to the beating misled the jury into believing that the beating, rather than ... the subarachnoid hemorrhage, caused decedent's death is puzzling: the autopsy report did not reject the subarachnoid hemorrhage as contributing to the death but rather attributed the hemorrhage to the multiple injuries. As noted, there was independent and uncontroverted evidence that a beating had occurred. Whether death resulted from the injuries, or from drug use, was strictly a medical question, which reference to the beating did not affect. We thus see no prejudice in the sentence about the beating. 58 Defendant, indeed, makes no argument that this portion of the report was detrimental to his case because it revealed a beating or linked him to the beating in some manner not fully accomplished by the remainder of the evidence. We conclude, beyond a reasonable doubt, that admission, without redaction, of the portion of the autopsy report repeating this information obtained from the police report was not prejudicial. Delaware v. Van Arsdall, 475 U.S. 673, 684, 106 S.Ct. 1431, 1438, 89 L.Ed.2d 674 (1986); Chapman v. California, 386 U.S. 18, 24, 87 S.Ct. 824, 828, 17 L.Ed.2d 705 (1967). Cross-examination of Dr. Zirkin on the particulars of this information, as to which Dr. Zirkin was without personal knowledge, would, moreover, have offered no benefit to the defendant. 59 E. Category-Four Statements: The Medical Examiner's Final Conclusion as to Manner of Death, viz., Homicide 60 The autopsy report concluded with the statement: Manner of Death: Homicide. Homicide is the killing of a human being. Black's Law Dictionary (4th ed. 1968). Homicide may be justifiable, as when done in self defense, or non-justifiable, as when murder or manslaughter. The autopsy homicide conclusion, therefore, implies two things: First, human action, i.e., the beating, injured the victim; and second, the victim died as a result of these injuries. We discussed the latter component under category two, above, and concluded that the medical examiner's opinion that decedent died as a result of multiple injuries described in the report did not violate the Confrontation Clause. We are left, then, to decide whether the admission of the report's statement--implicit in the homicide conclusion--that the beating caused the victim's fatal injuries 21 was constitutional error. 61 In a different case, this question might be a difficult one. If, for example, decedent had fallen from a window, and the question was whether he was pushed out or had fallen accidentally, a medical examiner's finding of homicide would likely be inadmissible. Such a finding could be highly prejudicial, since it would contradict defendant's claim of accident, and would almost certainly have to be based on a police report or similar extrinsic evidence. At very least, the medical examiner's presence might be needed for cross-examination on whether the finding of homicide rested on medical factors rather than police report hearsay. 62 Here, however, there is no such difficulty. There is no dispute that decedent was beaten. Defendant's theory is not that decedent's multiple injuries were caused by some accidental cause, such as a fall, but rather that the multiple injuries the victim sustained were not the true cause of his death. Instead, defendant speculates--although without offering any expert evidence in support--that the victim died as a result of drug ingestion or, possibly, a spontaneous hemorrhage. This is a purely medical argument, and, as we have held, medical opinions as to cause of death may be constitutionally presented in an autopsy report just as they may be presented in a hospital record. Defendant could refute the examiner's opinion as to cause of death by presenting the opinions of his own experts. 63 Thus in the circumstances of this case, we see no Confrontation Clause problem in permitting the medical examiner's finding of homicide to reach the jury. The finding simply reflected the examiner's opinion that injuries received in an unquestioned beating--rather than some other medical cause--had caused death. 22 64 While, therefore, we question the admissibility of an autopsy report's conclusion that a fatal injury was due to homicide, we believe that its admission here was, at worst, harmless error beyond a reasonable doubt.