Transcript Slide 1

Forensic Epidemiology
Investigations
Goals
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Describe the differences between
typical public health and law
enforcement investigations
Define and compare covert and overt
health-related attacks
Describe methods for conducting a joint
forensic epidemiology investigation
What is Forensic
Epidemiology?
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Forensic epidemiology uses public
health methods in the setting of a
potential criminal investigation
Will be encountered by most public
health workers through health-related
criminal investigations
Law Enforcement and Public
Health Investigations
Difference
Explanation
Criminal intent
Public health looks for a naturally occurring bug or
environmental hazard rather than a responsible
person or persons.
Interviews with
subjects of an
investigation
Public health officials interview patients to gather
information for health purposes rather than criminal
purposes.
Laws governing
investigations
Public health authority influences public health
investigations and actions; the criminal justice code is
the authority behind criminal investigations.
Collecting
Public health officials are not required to collect
evidence/samples samples (which could be needed as evidence) in a
way that makes them admissible in court.
Law Enforcement and Public
Health Investigations
Difference
Explanation
Confidentiality
Public health officials are concerned about
confidentiality for the person possibly involved in an
outbreak; law enforcement officials are concerned
about confidentiality for an informant or witness.
Media interaction
Public health has a relatively open relationship with
the media; law enforcement tends not to be open
with the media during an ongoing investigation.
Using classified or
sensitive
information
Public health officials or offices may not be equipped
to handle or process secret or secure information.
Criminal Intent
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Outbreaks usually occur “naturally”
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Look for mistakes in food preparation,
changes in the environment, other
unintentional incidents as cause
Recognizing criminal intent will help
preserve evidence and solve the crime
Covert Attack
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No group or individual takes
responsibility
Incident may not be initially recognized
as an attack
Example:
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Salmonella typhimurium outbreak
(Oregon, 1984)
Identifying a Covert Attack
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Public health will recognize signs,
symptoms, or disease clusters through
surveillance
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Hospital emergency room, laboratory staff,
health care providers may become first
responders
Investigating a Covert Attack
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May be difficult to immediately confirm that a
bioterrorist incident has occurred
Local health department should:
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Immediately notify state health department
Conduct joint preliminary epidemiologic
investigation using rapid-response epidemiologic
and laboratory team
Once thought to be a possibility, immediately
notify FBI and other response partners
Overt Attack
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Perpetrator announces responsibility for
the act
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May be reported to public health official
More likely to be announced on public web
site or through media
Example:
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Intentional release of sarin nerve agent
(Tokyo subway, 1995)
Identifying an Overt Attack
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Law enforcement will detect event
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Law enforcement and emergency
management teams will be the first
responders
Investigating an Overt Attack
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Many overt incidents have been hoaxes
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Still a crime; the site is a crime scene
If health officials notified of incident or
threat:
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Required to immediately contact FBI,
state/local law enforcement
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Overall response coordinated by the FBI
Then local officials should immediately
notify state health department
Laws Governing an
Investigation
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Different laws govern investigations by
public health and law enforcement
Public Health Laws
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North Carolina statutes give permission to:
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Review relevant medical records
Implement control measures, require submission
to examinations and tests
Impose quarantine and isolation
Enter premises of any place where necessary to
enforce provisions of these public health laws
Public health officials can respond quickly to
health-related threats!
Law Enforcement Laws
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Law enforcement officers must obtain
search warrant to conduct a search and
make seizures unless:
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Consent to the search is given
Serious, credible, immediate threat
(exigent circumstances)
Joint Interviewing
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Should work in teams to jointly conduct
interviews
If joint interview is not possible, each
discipline should know the type of information
their counterpart is seeking
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Law enforcement wants to know personal, travel,
incident, safety, other information pertinent to
criminal investigation.
Public health wants to know personal, exposure,
travel, medical history
Evidence
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Law enforcement gathers evidence
Public health gathers specimens
Two criteria must be met for public
health information to be used in
criminal investigations:
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Legitimate public health investigation
Chain of custody
Legitimate Public Health
Investigation
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Example of legitimate public health
investigation:
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Collecting samples of food from a salad bar
when an outbreak is suspected
Samples are collected based on legitimate
concern for the public’s safety
Samples are admissible as evidence in a
criminal investigation if one is conducted
Chain of Custody
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Chain of custody: special form to document
the chronological history of evidence
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Includes name/initials of individual who collected
evidence, each person or entity having custody of
it, date the item was collected or transferred,
agency and case number, victim's or suspect's
name, brief description of item
Required in law enforcement investigation
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Officials responsible for creating incident report,
maintaining chain of custody, transporting
evidence to laboratory or other facility
Chain of Custody
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Not established in typical public health
investigation
Persons documented as custodians of the
item should be able to:
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Testify in court that the item was secure,
unaltered, and uncontaminated while in their
custody
Explain the procedures they used to store,
examine, test, and otherwise process the item
Confidentiality
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Public health officials concerned with
confidentiality of patients and medical records
According to North Carolina statutes, all
records containing privileged patient medical
information are confidential
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May report case or outbreak of an illness,
condition, or health hazard, but should not
disclose personally identifiable information
Can contact, interview, offer testing to cases, case
contacts, and contact contacts considered suspect
cases, but confidentiality must be maintained
Confidentiality
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When bioterrorist incident or criminal
intent suspected, law enforcement may
gain access to confidential or protected
health information
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Then confidentiality concerns for the
person as a patient and as a witness or
informant
Media
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Public health has more symbiotic relationship
with media
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Law enforcement not open with media
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Rely on media to get information to consumers
Use media to elicit public response and assist in
investigations
To preserve integrity of the case
To not hinder investigation of unexplored leads
Need protocol to avoid accidental disclosure
of important information
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All parties should coordinate messages through
joint information center
Classified/Sensitive
Information
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Public health may be required to review
classified or sensitive information:
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Some public health officials should hold
clearances to communicate with law
enforcement when necessary
Secure equipment (phone lines, fax
machines) should be available
Challenges of Bioterrorism
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Law enforcement and public health face same
challenges investigating bioterrorist events
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Likely to be high concentrations of agent
May be a large primary cohort of people exposed
Agent may have been distributed in a well traveled
area
People may present to many different hospitals
May be a deliberate second attack
May be wide-spread panic
Hospitals may become flooded with both sick and
non-sick
Challenges of Bioterrorism
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When all participants prepared to
respond and can work efficiently and
effectively together, they can:
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Control panic
Ensure a rapid response
Treat the sick
Identify the source
Successfully identify and prosecute those
involved in the attack
References
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Goodman RA. Basics of Public Health/Epidemiologic
Investigations for Law Enforcement. Presented at:
Forensic Epidemiology Training Course; November 2-5,
2002; Chapel Hill, NC.
Centers for Disease Control and Prevention (CDC).
Available at:
http://www.bt.cdc.gov/EmContact/Protocols.asp.
Accessed August 31, 2005.
NC General Statutes. Available from:
http://www.ncleg.net/gascripts/Statutes/Statutes.asp.
Accessed August 31, 2005.
References
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Martinez D. Law Enforcement and Forensic
Epidemiology. Presented at: Forensic Epidemiology
Training Course; November 2-5, 2002; Chapel Hill,
NC.
Technical Working Group on Crime Scene
Investigation, National Institute of Justice. Crime
Scene Investigation: A Guide for Law Enforcement.
January 2000. Available at:
http://www.ncjrs.org/txtfiles1/nij/178280.txt.
Accessed August 31, 2005.
Scenario 1 – Suspicious letter in DeKalb County.
Working group exercise. Presented at: Forensic
Epidemiology Training Course; November 2-5, 2002;
Chapel Hill, NC.