The Jacksons: An American Dream [Television Series - 1992]
Why Did the Jackson Family Ask for a Second Autopsy?
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On Friday morning, before the first autopsy on Michael Jackson had been completed, I wrote an article in these pages to explain just what an autopsy is, why it's done, and what we could expect from it (I'm a former medical examiner and a board-certified forensic pathologist). As I predicted, the initial examination of his body with the naked eye, which is called the "gross" examination, was inconclusive, in part because further tests, which take days to complete under any circumstances, were required. These tests include the microscopic examination of small samples of each of the organs as well as toxicology tests of the stomach contents, blood, bile and urine. The toxicology tests look for the presence or absence any chemicals including prescription drugs, recreational or illegal drugs, toxins such as heavy metals like lead or mercury, or even poisons such as arsenic (these are all simply examples and not meant to imply their presence in this particular case).
The Los Angeles County Coroner's office has announced that the first part of the autopsy was inconclusive, but they did say that no signs of trauma or foul play were found. This is a lot of information, but not the final report. It is still possible that the microscopic examination of the tissues could show some unusual disease process, however, this is unlikely if the organs themselves looked normal to the eye (a fact that I'm not sure we know definitively yet). But the toxicology examination could find any number of chemicals (as mentioned above), which could have caused death - however, there's no evidence yet that this will be the case, and we must all await the test results. If the microscopic exam and the toxicology exam are both negative and don't find anything untoward, the exact cause of death may forever be unknown.
Why then did the family ask for a second autopsy? There are a variety of reasons that a family might want a second, or private, autopsy. In the first place, the body of someone who dies suddenly and unexpectedly actually becomes the property of the medical examiner. The family cannot stop the investigation because its conduct is required by law. Because of this, the report of the medical examiner's autopsy and other investigations is not publically available until after the entire procedure and all its ancillary parts have been completed. Neither the public nor even the family is privy to the results until the final report is released - unless the medical examiner releases pieces of information at his or her discretion. In such a situation, some families may not want to wait for the medical examiner's final report and may want their own pathologist to do an examination and give them the results immediately. Of course, even the private pathologist will be limited by the time constraints required for the microscopic and toxicologic examinations. But the family could, at least, get an immediate and detailed report on the external and internal condition of the body as it would appear to the naked eye.
Second autopsies are more typically requested when the first procedure was done by someone whose competence the family questions or distrusts. Such is probably the case in the death of actor David Carradine, who died and was first autopsied in Bangkok, Thailand. It is likely that the family was unsure of the competence, knowledge, training and/or experience of the Thai pathologists (who probably were top notch, by the way). It is also possible that they just wanted a pathologist who is extremely familiar with the subtleties of death by hanging to take a critical look at just what happened in that faraway hotel room. Since there can be little question as to the competence of the LA County's medical examiners (among the best in the world and well accustomed to examining celebrity deaths), we can only assume the family wanted some immediate information.
Another possible reason to request a second autopsy would be as an attempt either to avoid future allegations of a government cover-up or fundamentally to expose an active initial cover-up. While it is inconceivable to me that a cover-up could be occurring by the LA Coroner, an inconclusive autopsy will forever feed those wanting to engage in conspiracy theories. In that regard, the second autopsy results, assuming they confirm the first, are welcome. Of course, there are doubtless those who would argue that even the second autopsy could be part of the cover-up (i.e., that the family is in on the cover-up for personal reasons). For conspiracy theorists, the questions and allegations, however absurd, never end.
Second autopsies are unusual, in part because the circumstances that would lead to their consideration themselves are rare, in part because they must be paid for out of pocket and in part because of the competence of most pathologists who perform autopsies in the setting of sudden and unexpected death. On occasion, a forensic autopsy will be conducted by a pathologist not specially trained in forensic pathology (such as one who primarily works in a hospital), and the family may want greater expertise brought to bear. There just aren't enough pathologists who have sub-specialized in forensic pathology to cover every jurisdiction in the country (and outside the country too, in situations where someone dies unexpectedly while abroad). Second autopsies are difficult to conduct and fraught with limitations, primarily because the first autopsy, without getting too graphic here, has, shall we say, disrupted the original appearance of the body and its organs.
There is one particular situation in which a second autopsy can be highly informative. This is when the first autopsy did not, for whatever reasons, contain a thorough examination of the neck and yet some subtle trauma had actually occurred. While strangulation typically leaves tell-tale signs in the eyes and/or the skin of the face or neck, which would mandate a full examination of the neck, in some cases these signs can either be subtle or be overlooked and not give the pathologist specific reason to look in detail at the neck. Further, not every autopsy, not even every forensic autopsy contains a full and detailed examination of the internal organs of the neck, especially if there's no obvious external trauma. This is in part because it is difficult and time-consuming to conduct such an exam and in part because the nature of that examination is highly disruptive to internal organs of the neck. The neck requires, for normal appearance, say at a funeral viewing, the Adam's apple to be present, but which by necessity must be removed and examined in detail to determine whether any trauma may have occurred. In situations where the original autopsy omitted a thorough examination of the neck and in which either the family or the police come to suspect foul-play, a second autopsy can be highly revealing in either a positive (they find something) or negative (they find nothing) manner.
In the case of Michael Jackson, we know for certain that the pathologists involved were highly competent. It is highly likely that they did a full and complete autopsy including a detailed examination of the neck. It is most likely then that the family simply wanted certain information to be given to them immediately, by their own pathologist, so that they would not have to wait, as does the rest of the world, for the final report of the LA County medical examiner.
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