There are five matters of death: natural, accidental, suicidal, homicidal, and undetermined. Natural deaths are not usually within the domain of the medical examiner and accidental and suicidal deaths are rarely addressed by his office. But if a death is determined to be homicidal, the full force of the medical examiner and police investigators are brought into play.
This is why, along with cause of death and time of death, the manner of death is one of the most important things the medical examiner must determine. His official statement as to the manner of death will determine what happens next. Will the police be involved or not?
An interesting but sad case in Santa Ana, California underscores this point. In 2006, just before his 16th birthday, Robert Flores was shot numerous times in what is believed to be a gang related shooting. Robert survived the shooting but was left quadriplegic.
Quadriplegia is a difficult and complex medical condition and people who suffer from this are plagued with many complications including pneumonia, urinary tract infections, bed sores, muscle wasting, and a host of other problems. Many of these can progress and become deadly. This is what happened with Robert. Four years after his shooting Robert died.
So what was Robert’s manner of death? I don’t know whether he died from pneumonia or a urinary tract infection or one of the other complications of quadriplegia but he did die from some medical problem related to his paralysis. Since his death was due to a medical problem would his manner of death be listed as natural? The answer is no. His manner of death would be homicidal. He was shot five times and this act started the cascade of events that led to his death. In other words, had he not been shot he would not be quadriplegic and would not have been subjected to the medical complications of this condition. It was not an automobile accident or a fall or some other injury that might cause quadriplegia but rather the criminal act of his being shot that began his decline to death and that is what makes his death a homicide rather than some natural or accidental event.
As of right now there are no suspects in Robert’s shooting but if suspects are ever identified they will likely be charged with homicide.
For more on the Cause, Time, and Manner of death take a look at my books Howdunnit: Forensics or Forensics For Dummies.