When the medical examiner is faced with a violent or unusual death, there are several questions he must answer. He must identify the victim in cases where the identity is not known. After that he must determine, to the best of his ability, the time, cause, and manner of death. Each of these can be difficult and the manner of death can often be very tricky.
There are five manners of death: natural, accidental, suicidal, homicidal, and undetermined or unclassified. This latter category is when the medical examiner cannot determine the manner of death. An example would be a heroin addict found dead in an alleyway. Did he accidentally shoot up too much product? Did he decide to end his existence by giving himself a large dose? Did his dealer, fearing that the user might be a snitch, give him a more pure sample than he is used to taking? In this situation the matter of death could be accidental, suicidal, or homicidal, respectively. The problem is that at autopsy these would all look the same and therefore the medical examiner might not be able to determine by whose hand and for what purpose the death took place. That requires good investigative work.
In addition, the manner of death can change as new evidence is uncovered, which means it is fluid and not written in stone. Let’s say an elderly man dies of a presumed heart attack or stroke and is buried. Later it is determined that there was a large amount of inheritance involved and questions are raised as to whether his spouse might have murdered him. The body is exhumed and a lethal amount of arsenic is found in the tissues. This changes everything. This changes a natural manner of death to a homicidal one and a police investigation will follow.
Another interesting quirk about the manner of death is that it can be delayed for a very long time. Let’s say an individual is shot, paralyzed, and ends up hospitalized and on a respirator for a number of years. He then gets pneumonia and dies. A death from pneumonia is considered a natural death but had the victim not been shot and paralyzed he would not have been on a ventilator and on bed rest, two situations that promote the development of pneumonia. In other words, were it not for the gunshot he would not have died of pneumonia. When he does die the corner can list his manner of death as homicidal and not natural. This can lead to a police investigation, and an arrest and trial of the shooter for murder. The key here is that the cascade of events that led to his death began with the gunshot wound. This is what makes the death homicidal.
Such cases are not all that rare. In fact, murder charges were just filed in a case exactly like this here in Orange County, CA. Scott Sittler was shot and paralyzed in 1996 and had lived on a ventilator in an extended care facility since the shooting. He died this February of pneumonia. Brothers Erwin and Giovanny Sanchez and Daniel Cruz pled guilty to attempted murder in 1996 and now, with Sittler’s death, will face murder charges.