Research Article| Volume 18, ISSUE 1, P1-22, March 1998

Download started.


Death in Custody

  • Donald T. Reay
    Address reprint requests to Donald T. Reay, MD, Chief Medical Examiner, King County Medical Examiner's Office, Harborview Medical Center-359792, 325 Ninth Avenue, Seattle, WA 98104-2499
    From the Seattle-King County Department of Public Health; and the Department of Pathology, University of Washington School of Medicine, Seattle, Washington
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.
      Death in custody is the most demanding investigation that a medical examiner or coroner can perform. The investigation requires attention to detail at the time of scene investigation and autopsy examination, as well as a careful assessment of the toxicologic results and circumstances of the death. Synthesis of the many facts that are developed during the investigation should allow the medical examiner or coroner to establish a reasonable cause of death. It is incumbent on the medical examiner and coroner responsible for investigating deaths of these types to utilize all the information generated during the investigation and to identify an appropriate cause of death.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.


      Subscribe to Clinics in Laboratory Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Adelson L.
        Asphyxial stigmata.
        in: Pathology of Homicide. Charles C Thomas, Springfield, IL1974: 528
        • Adelson L.
        • Huntington III., R.W.
        • Reay D.T.
        A prisoner is dead: A survey of 91 sudden and unexpected deaths which occurred while the decedent was either in police custody or penal detention.
        Police. 1968; 13: 49
      1. American Civil Liberties Union of Southern California. Pepper spray update: More fatalities, more questions. June 1995

        • Arnold R.W.
        • Dyer J.A.
        • Gould A.B.
        • et al.
        Sensitivity to vasovagal maneuvers in normal children and adults.
        Mayo Clin Proc. 1991; 66: 797
        • Betz P.
        • Eisenmenger W.
        Frequency of throat-skeleton fractures in hanging.
        Am J Forensic Med Pathol. 1996; 17: 191-193
      2. Bradlen CE, Lindell JW: Police neck restraints at the crossroads. Police Chief July 1992, p 53

        • Cebelin M.S.
        • Hirsch C.S.
        Human stress cardiomyopathy: Myocardial lesions in victims of homicidal assault without internal injuries.
        Hum Pathol. 1980; 11: 123
        • Cohen F.L.
        • Fruehan C.T.
        • King R.B.
        Carotid sinus syndrome.
        J Neurosurg. 1976; 45: 78
        • Copeland A.R.
        Deaths in custody revisited.
        Am J Forensic Med Pathol. 1984; 5: 121
        • Costillo E.
        • Rubin R.T.
        • Holsboer-Trachsler E.
        Clinical differentiation between lethal catatonia and neuroleptic malignant syndrome.
        Am J Psychiatry. 1989; 146: 324
      3. Daly MD, Angell-James JE, Elmer R: Role of carotid-body chemoreceptors and their reflex interaction in bradycardia and cardiac arrest. Lancet, April 7, 1979, p 764

        • Frost R.F.
        • Hanzlick R.
        Deaths in custody.
        Am J Forensic Med Pathol. 1988; 9: 207
      4. Granfield J, Onnen J, Petty CS: Pepper spray and in-custody deaths. International Association of Chiefs of Police, March 1994

        • Govindarajan V.S.
        • Sathyanarayana M.D.
        Capsicum-production, technology, chemistry, and quality.
        Part V. Impact on physiology, pharmacology, nutrition, and metabolism; structure, pungency, pain, and desensitization sequences. Food Science and Nutrition. 1991; 29: 435
        • Hirsch C.S.
        Restraint asphyxiation [letter].
        Am J Forensic Med Pathol. 1994; 15: 266
        • Jordon F.B.
        • Schmeckpeper K.
        • Strope M.
        Jail suicides by hanging.
        Am J Forensic Med Pathol. 1987; 8: 27
        • Knight B.
        Mechanical asphyxia.
        in: Forensic Pathology. Oxford University Press, New York1991
        • Kosten T.R.
        • Kleber H.D.
        Rapid death during cocaine abuse: A variant of the neuroleptic malignant syndrome?.
        Am J Drug Alcohol Abuse. 1988; 14: 335
        • Laposata E.A.
        • Hale P.
        • Poklis A.
        Evaluation of sudden death in psychiatric patients with special reference to phenothiazine therapy.
        J Forensic Sei. 1988; 33: 433
        • Lifschultz B.D.
        • Donoghue E.R.
        Deaths in custody.
        in: Wecht C. Legal Medicine Annual. Butterworth, Salem, NH1991: 45-70
        • Lown B.
        Mental stress, arrhythmias and sudden death.
        Am J Med. 1982; 72: 177
        • Luke J.L.
        • Reay D.T.
        The perils of investigating death in police custody.
        Am J Forensic Med Pathol. 1992; 13: 98
        • Luke J.L.
        • Reay D.T.
        • Eisele J.W.
        • Bonnell H.J.
        Correlation of circumstances with pathological findings in asphyxial deaths by hanging: A prospective study of 61 cases from Seattle, Washington.
        J Forensic Sei. 1985; 30: 1140
        • Chan T.C.
        • Vilke G.M.
        • Neuman T.
        • et al.
        Restraint position and postional asphyxia.
        Annai of Emer Med. 1997; 30: 578
        • O'Halloran R.L.
        • Lundy J.K.
        Age and ossification of the hyoid bone.
        J Forensic Sei. 1987; 32: 1655
        • O'Halloran R.L.
        • Lewman L.V.
        Restraint asphyxiation in excited delirium.
        Am J Forensic Med Pathol. 1994; 15: 266
        • Pudiak C.M.
        • Bozarth M.A.
        Cocaine fatalities increased by restraint stress.
        Life Sei. 1994; 55: 379
        • Reay D.T.
        • Eisele J.W.
        Death from law enforcement neck holds.
        Am J Forensic Med Pathol. 1982; 3: 253
        • Reay D.T.
        • Hallo way G.A.
        Changes in carotid blood flow produced by neck compression.
        Am J Forensic Med Pathol. 1992; 3: 199
        • Reay D.T.
        • Hazelwood R.
        Deaths in military police custody and confinement.
        Mil Med. 1970; 135: 765
        • Reay D.T.
        • Howard J.D.
        • Fligner C.L.
        • Ward R.J.
        Effects of positional restraint on oxygen saturation and heart rate following exercise.
        Am J Forensic Med Pathol. 1988; 9: 16
        • Safar P.
        Resuscitation from clinical death: Pathophysiological limits and therapeutic potentials.
        Crit Care Med. 1988; 16: 923
        • Smialek J.E.
        • Spitz W.U.
        Death behind bars.
        JAMA. 1978; 240: 2563
        • Stauder K.H.
        Die Tödliche Katatonia.
        Archives Psychiatry Nervenker. 1934; 102: 614
        • Steifer C.H.
        • Lantz P.E.
        • Flannagan L.M.
        • et al.
        Oleoresin capsicum (pepper) spray and in- custody death.
        Am J Forensic Med Pathol. 1995; 16: 185
      5. Stopford W: Pathophysiology of capsicum and risks associated with OC exposure. Division of Occupational and Environmental Medicine, Duke University, July 1996

        • Suzuki T.
        Suffocation and related problems.
        Forensic Sei Int. 1996; 80: 71
        • Wetli C.V.
        • Fishbain D.A.
        Cocaine-induced psychosis and sudden death in recreational cocaine users.
        J Forensic Sei. 1985; 30: 873
        • Wetli C.V.
        • Mash D.
        • Karch S.B.
        Cocaine-associated agitated delirium and the neuroleptic malignant syndrome.
        Am J Emerg Med. 1996; 14: 425
        • Wetli C.V.
        • Mittleman R.E.
        The "body packer syndrome" toxicity following ingestion of illicit drugs packaged for transportation.
        J Forensic Sei. 1981; 26: 492
        • Wetli C.W.
        • Mittleman R.E.
        • Rao V.J.
        Mechanical asphyxia.
        in: Practical Forensic Pathology. Igaku-Shoin, New York1988: 78