Ep. 62: Inside the Autopsy Room: What the Dead Tell Us, Dr, Geoffrey Smith. Chief Medical Examiner GBI

Summary

🎙️ Interesting Humans Podcast: Episode 62 Summary Host: Jeff Hopeck | Guest: Dr. Jeffrey Smith, Chief Medical Examiner, Georgia Bureau of Investigation (GBI) | Release Date: June 25, 2025

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I. Introduction

In Episode 62 of the Interesting Humans Podcast, host Jeff Hopeck engages in an enlightening conversation with Dr. Jeffrey Smith, the Chief Medical Examiner at the Georgia Bureau of Investigation (GBI). Set within the autopsy suite at the GBI, this episode delves deep into the intricate world of forensic pathology, exploring the roles, challenges, and profound experiences that define Dr. Smith's career.

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II. Understanding Forensic Pathology

Dr. Smith begins by clarifying the often-confused roles of a medical examiner versus a coroner. “[00:58] Dr. Jeffrey Smith: ... medical examiner is a medical practitioner who's gone to medical school... after obtaining their medical degree, do another four years of training in the specialty pathology... and then after that, those who dare go on and do a further year of training... in forensic pathology.”

He emphasizes the extensive training required, highlighting that his team comprises 11 fully qualified board-certified forensic pathologists at the GBI. The medical examiner's office, established in 1997, now serves as a pivotal division within the GBI, assisting elected coroners across Georgia's 159 counties.

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III. Challenges in the Field

One significant challenge Dr. Smith addresses is the nationwide shortage of forensic pathologists. “[12:29] Dr. Jeffrey Smith: ... we probably need somewhere in the vicinity of 1500 qualified forensic pathologists. And at the moment, I think we're running it and around about 500 for the entire United States.”

He attributes this shortage to several factors, including the rigorous training required and a lack of exposure to the field during medical education.

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IV. Personal Experiences and Anecdotes

a. Testifying in Murder Trials

Dr. Smith recounts his experiences testifying in murder trials, often facing long waits and unexpected scenarios. “[05:39] Jeff Hopeck: What's the craziest thing you ever saw? ... but this sort of craziness on one level I have to deal with.”

A particularly memorable incident involved the Brian Nichols case, where Dr. Smith found himself interconnected with both the prosecution and the victims, illustrating the small-world nature of death investigations.

b. Ethylene Glycol Poisoning Case

Dr. Smith shares a compelling case where initial autopsy findings suggested heart disease as the cause of death. However, further investigation revealed ethylene glycol poisoning, linking it to a previous unsolved case. “[42:36] Dr. Jeffrey Smith: ... two young men dead from ingestion of antifreeze... justice was served.”

This case underscores the importance of thorough forensic analysis and inter-agency collaboration.

c. Child Abuse Case Testimony

Another poignant story involves a child abuse case where Dr. Smith's testimony was profoundly affected by graphic evidence. “[29:59] Dr. Jeffrey Smith: ... the autopsy was distressing... lost my voice.”

Despite the emotional toll, Dr. Smith's professionalism ensured that justice was upheld, and the perpetrator was convicted.

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V. Coping with the Emotional Toll

The demanding nature of forensic pathology necessitates robust coping mechanisms. Dr. Smith admits to facing moments of doubt but finds solace in his role as a medical detective. “[21:23] Dr. Jeffrey Smith: ... medical school... desensitization to the horrors... constantly on the lookout for signs of stress.”

He emphasizes the importance of peer support and the gradual build-up of psychological resilience developed during medical training and professional practice.

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VI. The Opioid Epidemic and Fentanyl

Dr. Smith delves into the rising prevalence of fentanyl-related deaths, detailing its potency and the ensuing challenges. “[52:24] Dr. Jeffrey Smith: ... fentanyl deaths are going down because of greater recognition... effectiveness of naloxone, as far as we're concerned, is zero.”

He discusses the complexities of prosecuting fentanyl-related homicides, noting the difficulties in establishing intent and direct causation, which often leaves the forensic pathologist in a neutral role focused solely on determining the cause of death.

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VII. Determining Cause and Manner of Death

A significant portion of the episode is dedicated to explaining the intricacies of determining the cause and manner of death. Dr. Smith outlines the five manners of death recognized in Georgia: natural, accidental, suicidal, homicidal, and undetermined. “[82:28] Dr. Jeffrey Smith: ... cause of death is the thing that led to your demise... the manner of death is natural, accident, suicide, homicide, or undetermined.”

He elucidates the challenges in classifying deaths, especially distinguishing between sudden and unexpected deaths, and emphasizes the forensic pathologist's role in providing clear, evidence-based conclusions.

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VIII. High-Profile Cases: Plane Crashes Example

Using the example of a plane crash similar to the infamous Kobe Bryant helicopter incident, Dr. Smith outlines the death investigation process:

• Scene Assessment: Coordinating with agencies like the NTSB.
• Body Identification: Utilizing dental records, DNA samples, and unique identifiers.
• Cause of Death Determination: Differentiating between injuries sustained during the crash and those from subsequent fires.
• Coordination with Investigators: Assisting in establishing factors such as pilot health or mechanical failures without overstepping into investigative roles.

"[66:31] Dr. Jeffrey Smith: ... establish the cause and manner of death... identification is a high priority."

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IX. Interaction with Families and the Court System

Dr. Smith touches upon the delicate interactions with grieving families, ensuring clear communication and providing closure where possible. “[87:49] Dr. Jeffrey Smith: ... often we have to say, no, absolutely not. Literally your husband essentially had a heart attack and lights out in a split second.”

He also discusses the courtroom dynamics, noting that while most cases are straightforward, contentious cases like those involving child abuse can lead to intense cross-examinations and differing expert opinions.

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X. Wrap-up and Reflections

In concluding the episode, Dr. Smith reflects on what constitutes a "good day" versus a "bad day" in his role. A good day involves effective communication and providing closure to families, while bad days often stem from personnel issues or particularly harrowing cases. “[107:34] Dr. Jeffrey Smith: A good day is just knowing that you have applied your expertise... providing some answers to interested individuals.”

He expresses satisfaction in mentoring younger forensic pathologists, ensuring the continuity and integrity of the field despite ongoing challenges.

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Notable Quotes

• On the Role of a Medical Examiner
  “[00:58] Dr. Jeffrey Smith: ... medical examiner is a medical practitioner who's gone to medical school...”

• On the Shortage of Forensic Pathologists
  “[12:29] Dr. Jeffrey Smith: ... we probably need somewhere in the vicinity of 1500 qualified forensic pathologists..."

• On Emotional Challenges
  “[21:23] Dr. Jeffrey Smith: ... part of the coping mechanism begins early on...”

• On the Opioid Epidemic
  “[52:24] Dr. Jeffrey Smith: ... fentanyl deaths are going down because of greater recognition...”

• On Determining Cause and Manner of Death
  “[82:28] Dr. Jeffrey Smith: ... cause of death is the thing that led to your demise...”

• On a Good Day at Work
  “[107:34] Dr. Jeffrey Smith: A good day is just knowing that you have applied your expertise...”

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Conclusion

Episode 62 offers a profound glimpse into the life of a forensic pathologist, emphasizing the blend of medical expertise, detective work, and emotional resilience required in the field. Dr. Jeffrey Smith's candid discussions and compelling anecdotes illuminate the critical role medical examiners play in the justice system and society at large, providing clarity and closure in the face of death's mysteries.

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For those intrigued by the intricate balance of medicine, law, and human stories, this episode is a must-listen, offering both educational insights and moving personal narratives from the front lines of forensic pathology.

Transcript

[Jeff Hopeck]

All right, folks, welcome to another episode of Interesting Humans. I'm Jeff Hopeck, your host. We are at the gbi, the Georgia Bureau of Investigation, today in their autopsy suite and today's interview, I have Dr. Jeffrey Smith, who's a chief medical examiner. And we are in for a treat today. I will say, the last time I personally had this feeling was the, the day in 2003 when I walked into the White House for my first, my first day on the job doing U.S. secret Service. I am nervous for this because this is incredible being here. We're not on video today, obviously, but thank you folks for having us. This is going to be an incredible conversation. And let's get right into it. Medical examiner, what is it? Why do people confuse it with coroner? Doc?

[Dr. Jeffrey Smith]

Oh, hi. I'm happy to be here. And yes, my name's Jeffrey Smith. I'm a duly qualified medical practitioner who has chosen the fascinating, yet little known specialty of forensic pathology. And I'm currently privileged to be the chief medical examiner for the state of Georgia's medical examiner system, which is part of the Georgia Bureau of Investigation. We're actually a division, a branch within the division of Forensic Science Crime lab here. And the medical examiner's office was established here at the GBI in 1997. Prior to that, it's a little bit of the Wild West. They didn't have a formal state medical examiner's office. Obviously, those that know Georgia and the metropolitan Atlanta area, there are a number of counties there that have sufficient population base to have their own medical examiner's office. And that's really just four of the 159 counties in the state of Georgia. So we medical examiners here, and I am happy to say we have 11 fully qualified board certified forensic pathologists working here at the headquarters at the Georgia Bureau of Investigation. We are consultants really for the coroners. And just so the distinction can be made, medical examiner is a medical practitioner who's gone to medical school.

[Jeff Hopeck]

Okay.

[Dr. Jeffrey Smith]

And that individual, after obtaining their medical degree, do another four years of training in the specialty pathology. And if you think of pathology as the doctors who make diagnoses in the lab, they look down the microscope tests, maybe you go to the doctor and have a blood test, go to a pathology lab so the clinical pathologist can interpret results. And that's a four year stretch of training. And then after that, those who dare go on and do a further year of training at a an accredited training program in forensic pathology. And here in Georgia currently have three accredited training programs. First one established at the Fulton County Medical Examiner's Office, where I did my training after I did my residency in pathology at Emory University. And obviously my medical training was not in the United States, was actually at the University of Auckland in New Zealand. And it's a six year training course. It's basically three years of undergraduate and then three years of clinical. We don't have college in New Zealand, so it's based on the British system. So Fulton County Medical Examiner's office has a training program here at the gbi. We have a training program for fledgling forensic pathologists. And I think that DeKalb county has just been approved for a training program. So all of the doctors here are highly qualified in the area of both pathology and forensic pathology. And we receive calls from coroners who are elected officials throughout the state of Georgia. Each county has a. A coroner, okay. And those individuals, men and women, are elected, duly elected, and they are in charge of the death investigation from the local county aspect. And they're also responsible for signing the death certificates for individuals. So bodies of deceased individuals are transported from all over the state to one of our three facilities. There's the headquarters facility here in Decatur. There is a facility in Macon, and we have a facility in Pula, which is all of the Savannah, because 10 minutes outside of 16. And they have a lovely new facility down there. And we have a doctor working down there full time at the moment, looking for other doctors to join the ranks. And perhaps we can get into that sometime later in this discussion, just in terms of the issues that forensic pathology and forensic pathologists face not only in Georgia, but throughout the United States. Okay, so that's by way of introduction.

[Jeff Hopeck]

Great. Very, very helpful. What's the craziest thing you ever saw?

[Dr. Jeffrey Smith]

Sometimes the craziest thing I ever see or experience is my being called down to testify in a murder trial. And it can be just about anywhere throughout the state where I happen to have performed the autopsy on an individual who is died as a result of murder or homicide, as we call it. And very often the attorneys will essentially call me and say, doctor, we need you here at 9 o' clock in the morning. So say, great, I get up at 5 o' clock, hit the road, drive down to the courthouse, and I am told, doc, we're glad to see you. We're just getting underway. We'll hopefully we're going to get you before lunch.

[Jeff Hopeck]

Oh, no.

[Dr. Jeffrey Smith]

So, and then it's a waiting game outside. And I have testified and I. I'm not sure how many counties throughout the state of Georgia, but It's always a little bit of adventure because some of the counties had the old courthouses, you know, some historic buildings, a lot of them are brand new courthouses. But there's always, it's a hive of activity, but usually behind closed doors something's going on. We sort of thinking, well, it's going to be my turn soon to testify in this case and occasionally an investigator will come up. Can I get to you, Doc? Don't you worry. Well, the most recent episode was having done all that, apparently one of the witnesses for the defence didn't turn up. So the judge basically, after two and a half hours, sort of said, well, we won't be proceeding with this today, so everybody go home and have a very nice weekend. So, you know, it was a, a long haul waiting around and then false start, you're gonna have to come back and do it again. But that's, that's not particularly crazy. But this sort of craziness on one level I have to deal with. I think you're probably interested in something and you know, I don't want to get into the details of particular cases necessarily. And I think, you know, like I say, over the last 30 or so years that I've been doing this, at last count, I'm somewhere close to 11,000 autopsies and examinations myself. So it's hard to pick something that is crazy. But I would like to say that the majority of cases that we do not deal with, sorry, we do, we deal with, are not particularly crazy. There are often crazy stories behind things and sometimes they're crazy stories about somebody having a heart attack, which is not something you're going to see in the newspaper or anything like that, the story that we're provided. So. But let me tell you, I, I think one thing comes to mind which was a little bit of an eye opener and this was a good number of years ago and I went out to, I think it was Burke county near Augusta to testify in a homicide case and was an individual who got into a fight or some sort of altercation at a party and ended up deceased and body came here to the GBI and I performed the autopsy, prepared an autopsy report and then good number of months later I was called to testify in the case and I got to the courtroom at Burke county and this was. Actually I've done two stints here out of the GBI as a medical examiner and this was during my first and early aughts turn of the century. And anyway, I turned up and one of the people involved with the Prosecution sort of said, well, you're going to be before our star witness. And I said, oh, okay. I mean, I'm seldom the star witness in these sorts of situations. It's. It's essentially I have to be there to describe what I saw at the time of autopsy. And Seaton died as a result of this particular injury or that particular injury. So I. I wasn't expecting. Certainly, I didn't expect anybody to come out and sort of say, well, Doc, you're the star witness, but you're going to be after our superstar witness or anything like that. But I said, oh, who is the witness? And they said, well, you see that woman over there? And I said, yes, who is it? And she said, that's Ashley Smith, and she was the spouse of the deceased. And the name rang a bell. And I said, Ashley said, yes, Doc, you're familiar with the Brian Nichols case, You know, the Fulton County Courthouse homicides that occurred back in, I think, 2005. And I said, my goodness, yes, because she was the woman who persuaded Brian Nichols, after a night, you know, he was on the lam. Night on the lam to turn himself into law enforcement. And so I think part of her story was that she had been through the grieving process because her husband had died violently and that sort of thing. And I just thought, oh, my goodness. And the circle was closed because I actually performed two of the three autopsies on the victims of the. So, you know, small world. So, I mean. And again, I don't know if that qualifies as crazy, but, you know, just sort of the sorts of coincidences that you can have this very small world of death investigation. And, you know, part and parcel of it is the fact that we as forensic pathologists are a very, you know, small cadre of qualified medical specialists. Sure. And, you know, that's part of the problem that forensic pathology is having in the United States at the moment is that we are unable, as a specialty, to recruit and retain individuals to do the work that's necessary where it's, you know, number. Various numbers are quoted. But I think for the population base in the United States, they say we probably need somewhere in the vicinity of 1500 qualified forensic pathologists. And at the moment, I think we're running it and around about 500 for the entire United States.

[Jeff Hopeck]

Oh, my.

[Dr. Jeffrey Smith]

So, you know, it's. It's. It's. It's a problem. You know, there are various theories about it. I have my own theories as to. To why there was a problem sort of recruiting individuals. What do you Think, well, let me go back into the mists of time and talk about my exposure to forensic pathology as a medical student in New Zeal. First of all, pathology, which is, again, the study of disease, was taken very seriously by my medical school and the training. And it started early, third year, so this is undergraduate, undergraduate time. And we started having lectures. We started having small group sessions where we discuss cases. And I think that's where the light went off in my head as to what I'd like to do as a physician, because up until that point of time, I wouldn't say I was a terrible medical student. I was just a somewhat reluctant and befuddled medical student, sort of thinking, where am I going to fit into this, the scheme of things here? This is a lot of hard work, and I'm not sure that I'm up to it. Yeah, we pathologists were an interesting bunch anyway. They seem to be much more relaxed. Relaxed than the clinicians that we dealt with. And I was fortunate enough to be part of a small group session where the pathology resident in charge of it brought in a basket full of organs that were preserved in formalin in large acrylic containers, and he would hand them out to each one of our group, and I think we had about five people in our group. And he would say, what is it? And what's going on here? And then the light went off. I think my first specimen I had was somebody who died as a result of a heart attack. And I'm looking at this preserved specimen, and you start off by saying, I think it's a heart. Very good. What is wrong with this heart? And suddenly all that stuff you'd be learning about physiology and anatomy fell into place, because I'm dealing with a disordered physiology and anatomy that somebody has died as a result of. And so the gears are starting to turn. I'm sort of thinking, okay, this is starting to get exciting. And that was part of pathology was presented as. Not as something, you know, sort of, oh, the equivalent of medical bean counters sitting in a little office looking down a microscope. It was presented as something sort of dynamic and directly applicable to patient care. As part of my pathology training, we had to attend 50 autopsies before we graduate here in the United States. I'm almost ashamed to say that a good number of medical students can go through medical school without having seen an autopsy at all. And that's because, first of all, the number of autopsies being done in hospitals have dropped dramatically over the last probably 25, 30 years.

[Jeff Hopeck]

Okay.

[Dr. Jeffrey Smith]

Pathology training has Become in the United States has become very contracted. I don't know how many months of pathology exposure they get, but it's sort of shoehorned in with everything else that's being learned with the clothes. Clinical aspect of things. So medical students are not being exposed to pathology. And I had a little bit of this myself. I remember when the professor of medicine, a very distinguished professor, came and spoke to my medical class of 130 students. And I can't remember, I think it was Introduction to Clinical Studies. It was. We just finished our pre clinical part and they brought out the big guns to sort of say, well, now you're on the road to becoming real physicians. And he gave a long, distinguished sort of speech about the, you know, sort of privilege and pleasures and roller coaster ride of being a clinical physician. At the end of it, he said, and if you're not interested in these sorts of things, you might as well go and be a pathologist in this very disdainful sort of voice. And I was thinking, you know, right on, I might take you up on that. But, you know, there was still some sort of, you know, pathologists weren't real physicians, you know, where they, they, they. But anyway, so part of that pathology was being exposed to forensic pathology because the forensic pathologists work in the medical school pathology department. So if you went and watched an autopsy, chances are you were going to see something that one of the forensic pathologists was going to be doing. Not just a hospital autopsy. You'd see somebody that was found in their home. They hadn't been seen for three days, their newspapers hadn't been collected, last seen walking their dog. And suddenly somebody from work sort of said, go and do a welfare check. And this person is found collapsed deceased in their bathroom, on their bed, out in the back shed, something like that. And you know, very often this narrative would be sort of a few sentences. I was immediately transfixed. I thought, man, this is great. I'm given three sentences and a entire individual body to sort out what happened here. So I was hooked. Yeah, yeah. And. And you know, it wasn't something that one goes to medical school thinking, I want to be a Francologist. Now that you will get the occasional person whom I meet, a young person sort of says, the only reason I went to medical school, become a friend. Which is good. But a lot of people, I think are very interested in forensic pathology because greater exposure on tv. Quincy, everybody sort of says, remember Jack Klugman as Quincy throwing back the blanket and all the police officers turning and you know, sort of losing Their cookies and fainting, that sort of thing. So he was, I think he was the, the, the first and Quincy sort of gave forensic pathology a good and a bad name I think because he was out there sort of. Not only did he do the autopsy but he was there also doing a bunch of police work. Sure. Police where they'd screwed up and where they might want to look here. And oh by the way, I went and spoke to this witness and you know it's not really like that in real life but you know there's been more exposure on television, csi, that sort of thing. Yeah, but there's no way around, unfortunately there's no way around the fact that if you want to be a forensic pathologist to have an undergraduate degree, get into medical school, you have to do a pathology residency and do forensic pathology training.

[Jeff Hopeck]

Darn.

[Dr. Jeffrey Smith]

And it's a hall work here.

[Jeff Hopeck]

I just can't do the med school.

[Dr. Jeffrey Smith]

Exactly. So but anyway, so yeah, you know it's, it's, it's, it's a fascinating career. I've, I've enjoyed it. You know like I say, I started this on a part time basis. You know, back in 1992 when my residency at Emory started. I was fortunate enough to have a couple of very good mentors and it's, it's, it's been a roller coaster ride and, but always enjoyable. I think there's a part of me, I think there's a part of every forensic pathologist that the medical detective part solving mystery. We know that there's no happy outcome. The patient is not going to come back to life, they're not going to resume their jobs. I think you probably sort of before we started this recording you wanted to touch on part of that as to how we reconcile what we do with the reality medical and in the context of medical practice and where are the mechanisms for deriving satisfaction and authentication. So coping with the sorts of things that we see on a day to day basis.

[Jeff Hopeck]

Sure. And what does that look like? What's a ride home from work for you?

[Dr. Jeffrey Smith]

Well, I would have to say there have been sort of in the last 30 years, I mean three days at work where I came home, thought, you know what, I just don't really want to do this anymore. And it's usually a, I think most two of the three of them where there were multiple victims and it was a particularly egregious, atrocious sort of circumstance. And part of the coping mechanism I think begins early on. I think we sort of began to touch on this, that medical School, whether you like it or not, is a two warring things. There's a encouraging, a sensitivity towards the human dilemma of illness, but there's also a desensitization to the horrors that you are going to witness. And you know, I don't think that we as medical examiners are necessarily worse off than other busy physicians in hospitals. I think illness across the board has the potential for being damaging to the individuals that are exposed to it on a day in, day out basis. And yes, we see as medical examiners the end product of often vile humanity, human acts and that sort of thing. But I often think that am I any worse off, for example, than physicians tending for children with cancer or individuals in the emergency room, seeing individuals come in near death?

[Jeff Hopeck]

Yeah.

[Dr. Jeffrey Smith]

Trauma surgeons, for example, or you know, even gerontologists or, you know, geriatricians dealing with people at the end of their lives. I think it all weighs on the individuals. And I think part of the medical school training right from the get go, from the exposures to the cadaver labs to, I think there were labs that we did, you know, they start off with small animals and then I remember one particularly unpleasant lab for 50 physiology which I wish I hadn't attended, but sort of made clear that, you know, you have to attend to pass this course, which is essentially doing some sort of physiologic experiment on a group of dogs from anesthetized dogs, but dogs from the pound. So basically the justification is, well, these dogs are due to be euthanized, we might as well put them to use at the medical school. And I remember at the time sort of thinking, you know, what, this, this, this, the juice isn't worth the squeeze for this as far as I'm concerned because. And it goes on. I remember talking to one of the lecturers sort of saying I was not going to do a particular lab anymore because, you know, with all due respect, you know, sort of, I don't like the, you know, I think it was a lab with slab rats. So I think there's a, there's a process where you yourself as a physician are building up sort of resistance to being mortally wounded, if you will, psychologically. And I think you also realize too, you get, obviously there's peer support and that sorts of things, but it's up to you to how you cope with the sort of traumas that you're going to see from day to day. And as a forensic pathologist think, interestingly enough, part of the way that I cope with the fact that here is a deceased individual Goes back to when I was working as a house doctor back in New Zealand at a hospice facility. And you're there as a house officer and you're attending to people at the end of life, end of life care. And you, I think you occasionally, you know, I think on a number of occasions you do have the. I wouldn't call it the privilege, but the experience of seeing somebody pass from life to death there. To pronounce the individual formality, sure. But I was astonished. Even in an individual who is obviously at the end of their life, they may be suffering from cancer or some debilitating disease, that transition from life breath to death, not only can you see it, but you can feel it. And you realize that whoever that person was is no longer there. And you get a little bit of emotional about it. It is, you know, and I think a lot of people experience this obviously when they're, you know, with their loved ones, when they take the last breath. But it impressed me as a physician at the time that whatever or whoever this person was in life, they're gone. And so the body is a shell. Now, as a medical examiner, one of the investigators saying, well, doc, here in front of you is a complex body of evidence, if you will. You have to work with this evidence to work out what happened to the individual. So that helps. And I'm not a particularly religious person at all. You know, I don't think sort of, I don't have necessarily this Christian belief that this individual has either gone to heaven or hell or anything like that at all. But I think there is that moment which, you know, most of the time as forensic pathologists, obviously we don't experience because we're not there at the scene or we're seeing it somewhat taken away from the scene of the death. But I think, you know, sort of, I don't take any consolation myself as a medical examiner and thinking Virgil's gone on to a better or a worse plane or anything. But there are times when you see something particularly egregious, when you do feel like you need to knuckle down and call on your reserves, cope with things. And it's an ongoing process. You know, it's. It's not something where you do this for a number of years and then suddenly you decide, you know, sort of I am accomplished or, you know, I am complete.

[Jeff Hopeck]

Right?

[Dr. Jeffrey Smith]

It's a day to day thing. And, you know, we, we as staff, both the autopsy staff that we have our autopsy assistants and the doctors, you know, we're constantly on the lookout for, you know signs of stress. And. And here at the gbi, there's a lot of peer support and there are buffers. Buffers.

[Jeff Hopeck]

All right, so the next question I want to ask you, something's going to come into mind and however you want to articulate it, however you feel comfortable, just be the word yes or details if you'd like. But is there something you've seen in your career? Ace a body, whatever you refer to it as, is there something that you saw? Discover the Ryan Pyle Podcast. Hosted by acclaimed adventure television personality Ryan.

[Dr. Jeffrey Smith]

Pyle, launched in April 2020, this engaging series blends insightful discussions on current events with exclusive interviews featuring prominent figures in adventure, travel, sports, filmmaking, music and entertainment. Join Ryan bi weekly for compelling stories and profound perspectives that inspire and inform. Available on Apple podcasts, Spotify and YouTube. Subscribe now and embark on a journey of discovery with the Ryan Pyle Podcast. No, but I will tell you another anecdote and please stop me if I'm too full of animals. But. And again, this is, this is, this is interesting because it is an egregious case. It's a child case that I dealt with. And it wasn't at the gbi. It was another medical examiner's office. And it was a young child who had died as the result of true child abuse at the hands of grandmother. And the case occurred here in Georgia. And I did the autopsy and I'm not going to go into the details of the findings at all, graphic description, or anything like that, but the child died as the result of abuse. And I use that word sparingly because a lot of the time when children die at the hands of an adult, we call it child abuse. And it is, I guess, in the strictest sense terms, but very often it's an individual occasion where an adult lashes out at the child with a fatal outcome. I tend to think of abuse as something that is ongoing over a period of time that results in the death of the child. So this was a child abuse case. This child had been one of a number of children that this grandmother was in charge of, and this child had probably been singled out either for whatever reason or abuse. And the reason I will circle around the answer to your question because at the time, for me, it was sort of a distressing case, but business as usual in terms of working out what happened to this child, doing my autopsy, issuing an autopsy report, and then came the prosecution case. And this occurred over a relatively long period of time because the grandmother in the meantime had left Georgia and was living in another State and there was extradition issues and there were some investigational issues that they needed to pull up. But basically the DA's office got a hold of the case. And I think I met with four different assistant district attorneys who were going to prosecute this case over a period of time. And I think it was over a period, about two, two and a half, three years. And I had gone over, you know, you meet with the attorneys, you discuss the photographs, you discuss the autopsy findings. They asked me to tell you which questions you're going to asked trial. I did this, I think three or four times. And it was, it was becoming, you know, just like sort of, oh, we're talking about this case. Oh, I already met with an attorney. Yes, that attorney's sort of left the office or I've been charged with this case. So finally trial actually came around. Basically the defendant came back and I was called to testify. And it was the usual. Testified many hundreds of times now, child cases, adult cases, and it was the usual introduction. Explain to the jury what you do, Dr. Smith, how did you become involved in this particular case? Da, da, da, da. And then that was fine. And you know, you talk to the jury and you explain how you do what you do and qualifications. That part of the idea. And then they got into the case and the ADA said, district attorney said, and as part of your examination, doctor, do you take photographs? Yes, we do. And would the photographs help explain your findings to the jury? I said, yes, I'd seen these photographs, at least half a dozen. They put them up on the first photograph of the child up on the screen and I lost my voice. Yeah, I mean, and I might lose my voice again because it was just suddenly the horror of it was there for everybody to see and it was completely unexpected. You know, I had to say to the judge, excuse me, your honour, do you mind if we just take. And the judge was very good. He immediately sort of said, ladies and gentlemen of the jury, just going to take a few minutes and you know, had a drink of water, took a few deep breaths, start again. But I didn't expect that sort of hammer blow to hit me right in the chest. Having seen these photographs multiple times. So that's something that in retrospect, you know, sort of something from the universe told me that, you know, whoa, here's a signal point. So, you know, it's hard to explain. Like I say, it wasn't the first time I testified in a child case. Something cumulative, I think came back that moment. Anyway, I think the testimony ended up being as effective as it could be, the individual was found guilty and justice was served. But it was quite a moment. Wow.

[Jeff Hopeck]

Yeah. I need that same moment right now. I can't fathom it'd be different during that. Not as a father, but now as.

[Dr. Jeffrey Smith]

A father of four. Six.

[Jeff Hopeck]

Four.

[Dr. Jeffrey Smith]

All right.

[Jeff Hopeck]

So do you follow have you found in your career? You'll follow all the way through the outcome. Like once you come home that day. Do you have to follow anything else about that case?

[Dr. Jeffrey Smith]

Oh, well, very often we do things weigh on the mind simply because the autopsy did not provide the answers at the time. As I said earlier on, you know, an autopsy is a lab test. We basically do an examination. We identify injuries, we identify disease, we do some testing, toxicology, lab testing, that sort of thing. But there may be holes in the story that we're missing far as investigation is concerned. Like I say, the investigators may, at the time of the autopsy, only know the name, age, race and gender of the individual.

[Jeff Hopeck]

Yeah.

[Dr. Jeffrey Smith]

Say, Doc, this person, we know who they are, but we don't know where they've been or what they've been doing between when they're last known alive and where we found them by the side of the road or the bush or in the shed in the back of their property. So in many cases, it's an ongoing collaboration with local investigators, either coroner or local law enforcement, or if the GBI agents become involved, and here in Georgia, the GBI will become involved in a local investigation, such as a homicide, for example, at the request of local. They don't automatically get involved in those investigations. And you know that. That happens a lot because a lot of the smaller jurisdictions, they'll have mayhem occurring. Sure. And it'll be the first murder they've had there in two years. You know, small rural county and law enforcement basically sort of says, whoa, you know, we're going to need a bigger boat. They will call and GBI to assist with the investigation.

[Jeff Hopeck]

Yeah.

[Dr. Jeffrey Smith]

As far as, you know, things playing on the mind, you know, again, very often the cases that you go home and you sort of later in the evening, you think about are not the ones that are going to appear in the news or on the front page of the newspaper. It's going to be one where you received a particular piece of investigational information. The case the individual came is thinking, this is going to be what we think the cause of death is, Doc, based on what we see. You do the autopsy and you find it's not that at all. It's something completely unexpected. And, you know, a Lot of the doctors, including myself, get a great deal of satisfaction of actually reminding ourselves that we are in fact physicians. We recognize a disease process that nobody diagnosed at all. And, you know, I've got a couple of doctors that, you know here that basically they'll be doing cartwheels in the hall if we find something that not only looks, you know, sort of really interesting at the time, but, oh, I can't wait to see what this looks at, like underneath the microscope. And by the way, I'd love to get those medical records from their last hospital visit because obviously nobody recognized that they had this particular disease process. So.

[Jeff Hopeck]

Wow.

[Dr. Jeffrey Smith]

You know, that's. And again, part of this is also reminding ourselves as forensic pathologists that we are physicians. And I tell the trainees that the first day they come here, I sort of say, I want you to remember that you are trained physicians. Don't immediately think that you are autopsy doctors. You are trained physicians that not only use the autopsy, but also all the investigational tools at your.

[Jeff Hopeck]

Yeah, all of them disposal. Okay. What's a time when was something different? Maybe it was the first thing that came to my mind was like it was a poisoning, that they thought it was a gunshot or. When is a time when it's. We think it's one thing, but then it becomes another.

[Dr. Jeffrey Smith]

Well, let me give you an example of that. And it's a very well known case in Georgia since you used the word poisoning. We received a case and again, this is going back in the mists of time. One of the doctors in our office received a case of a young man. And I say young man, he was in his 30s. So there's a young man, as far as I'm concerned, dying suddenly and unexpectedly after feeling vaguely unwell, he went the exact detail. Basically, I think he sought medical attention. Feeling was that he had some sort of viral illness or. And was treated symptomatically. And then he went home, was found deceased. Short time thereafter, he came to the GBI medical examiner's office for autopsy. And the doctor that did the autopsy sort of said, hi, he appears to have some heart disease and that could be the cause of death. But let's just look at the microscopic sections and wait for the toxicology to come back. And you know, that was one of those cases that came through, one of a number and way below the radar until a month or so later when the doctor. The autopsy, hey, you remember that case of the young guy that came in sort of feeling vaguely unwell and a bit of heart disease, but died suddenly and unexpectedly.

[Jeff Hopeck]

Yeah.

[Dr. Jeffrey Smith]

Well, I just looked at the microscopic section of his kidneys, and they're full of crystals. And as soon as we hear the word crystals in the kidneys, it can mean any number of things. But what he meant at this point in time was that he had oxalate crystals in his kidneys. And it wasn't subtle. It was the sort of thing that if you do it sort of look at the slide, and then under a certain light, it literally lights up like the Milky Way. And that's distinctly abnormal. So he's thinking, well, this is unexpected. And the most common reason we see that is ethylene glycol poisoning, antifreeze poisoning. And at about the same. And again, it's amazing how the circle closes at about the same time. Got a call from a law enforcement agency up north of the city and said, hey, let's do an autopsy on a guy named so and so. Yeah, as a matter of fact, we did. Well, his girlfriend had a husband who several years ago, he was in his 30s, who died suddenly and unexpectedly. Okay, yeah, you guys didn't do the autopsy, but if you're interested in reviewing the autopsy findings in the light of what you have down here at the gbi, would you be interested in doing that? And the doctor sort of said, yeah, absolutely. And so he got the autopsy report, and he got the microscopic slides from the case done by another medical examiner's office. And he put the kidney slide from this previous death under the microscope, and boom, lit up like the Milky Way. And so suddenly, we have two young guys separated in time and space, dying apparently suddenly and unexpectedly with what looks like ethylene glycol poisoning. And the only common point is a woman who was married to the guy died several years earlier, and the current guy, who her boyfriend, I believe, at the time, dying suddenly and unexpectedly. So, anyway, to cut a long story short, both the young men at the time had heart disease. One previously was signed out as heart disease, so that diagnosis was missed. At the time. His body had to be exhumed to get organs so that he could test for ethylene glycol, because, of course, he'd been interred for many years, but they were able to breathe organs, do scientific testing to establish that he had ethylene glycol in his system. Toxicology on the current case showed that he had ethylene glycol in his system. So you've got two young men dying suddenly and unexpectedly as a result of ingestion of antifreeze. So everything zeroed back in on this particular individual. And I think, you know, like I say, this is, this isn't secret. This case was adjudicated. It was a very high profile case. The individual was convicted of murder, basically. Malice murder.

[Jeff Hopeck]

Yeah, for sure.

[Dr. Jeffrey Smith]

And so that's a, that's an example, a well known example of things weren't what they seemed initially, but the forensic pathologist did what he needed to do in the, you know, the most recent case.

[Jeff Hopeck]

Yeah.

[Dr. Jeffrey Smith]

And justice was served, I believe, in the case of the individual who died several years earlier.

[Jeff Hopeck]

That's incredible.

[Dr. Jeffrey Smith]

Yeah. So, you know, again, it's consummate sort of medical detection in conjunction with investigation and lab finding. Like, you know, we need to have the lab here to be able to sort of say, well, we think it's antifreeze. Can you test for it? Absolutely, we can.

[Jeff Hopeck]

Wow.

[Dr. Jeffrey Smith]

All that has to come together, you know, for the diagnosis and ultimately, you know, sort of it goes to the courts. You need to be able to present that all that evidence as a nice, tidy package.

[Jeff Hopeck]

Is there, was there ever a time where you couldn't come up with a cause of death?

[Dr. Jeffrey Smith]

Oh, absolutely. First of all, probably the most common time when we can't come up with cause of death is when the post mortem interval, the time from when the person died to when the body is found, has resulted in advanced decomposition of the body. And that happens very quickly here in Georgia in the summer. I mean, we are bracing ourselves here at the office for the influx of individuals who are not found in a timely fashion. And with summer temperatures, humidity and insects in Georgia, a deceased individual will decompose very quickly so that decomposition can range from early stages to near skeletonization.

[Jeff Hopeck]

What do you have to wear? One comes in like that.

[Dr. Jeffrey Smith]

No, you know, it's interesting. I mean, it's not something that people enjoy. Obviously you can't enjoy it, but somehow, I don't know, your brain and your nasal passages somehow sort of just acclimate. I mean, there's no point putting a mask on. I mean, that cuts through everything. Basically. The odor of decomposition is immediate. It penetrates your clothing, hair. It's a fact of light for we forensic pathologists, we adjust to it. Again, it's the business of sort of, here's a problem that we need to solve and we knuckle down and do it. So.

[Jeff Hopeck]

So you acclimate. I can't even believe you used that word, acclimate to the smell of.

[Dr. Jeffrey Smith]

Yeah, it's, it's. I remember one time, wow. I went to a scene with an investigator where there was A decomposed body in a relatively small apartment complex. And, you know, we're at the scene, you know, the. Basically the medical examiner turns up and we're in charge of. We're not in charge of the investigation necessary if this power play or anything like that. But we have to first of all establish that death has occurred and we take jurisdiction over the body once the investigators are satisfied that, you know, and this individual had been deceased for some time and. But it was sort of the usual sort of hurry up and wait at the crime scene. And that were not the crime scene, the scene of death. And the scene was a small apartment, and a lot of time was spent inside in close proximity to the deceased individual. But I remember afterwards, investigator and I had done a bit. This is when I was doing my training back at Bolton County. And the investigator, a fun guy, he basically. He would turn up every day at work, like, not a. He actually had a. A blazer, tie, shirt. He was there in his finery. I was there in my sort of quasi medical student garb type thing. And he looked at me and he used to call me Geoff. He said, well, Geoff, Geoff, I think, Geoff, it's time for lunch. And I said, absolutely, you know, sort of, I'm hungry. And I remember we went straight from that scene to a little diner and, you know, sort of just walked right through it to our table. And I don't really remember anybody sort of looking up and sort of going, you know, sort of, hell's going, well, what is that terrible smell? But it occurred to us afterwards, we sort of like, my God, we. We are not socially acceptable at the moment. From the olfactory point of view, what were we thinking? And it was because we had. When we left that scene, it was sort of like we had again, our senses had essentially dialed things down to the point where we're not noticing this. But I'm sure there were people in that restaurant that wondered, what have they got going on in the kitchen out there? Who opened the back door to where the. But anyway, that was. I just remember. I remember, you know, sort of like the investigator sort of saying, well, gee, off, let's go and grab a bite to eat. Yeah. I didn't sort of think, well, maybe we need to go back to the office and change, maybe have a shower, you know. Right.

[Jeff Hopeck]

What a story. Oh, my gosh. Oh, that's awesome. All right, let's. Let's talk about Fentanyl. So before the interview started, I was talking to Stella, Chris and Reggie and I were talking to Stella Mention, and she mentioned that there was a day, I hope I'm saying this right way, there was a day where almost every body that came in, like 24 out of 30 is fentanyl. Am I saying that right? Is it that popular?

[Dr. Jeffrey Smith]

Well, it's, it's, it. Stella might have exaggerated, she's prone to exaggeration, but she was 23 out of 30. Yeah. There are periods of time, like for example, here at the headquarters, we are busy. We. We do have a backlog of cases and it fluctuates depending on sort of how, you know, like I said, it's the one thing, one of probably a couple of things I can't control, but the one thing I definitely cannot control when I wake up in the morning and come to work is how many deceased individuals have come in for exams. Cannot control. But if you look. So there have been periods of time, look at the list every day. And anywhere from probably 15 to 30% will be POS OD, which means possible overdose. Sent in is a possible POSOD.

[Jeff Hopeck]

Okay, yeah.

[Dr. Jeffrey Smith]

POS OD, that's the abbreviation that we get. And the reason that is because essentially it's a person. They go to the scene, they find drug paraphernalia. The person has no other obvious cause of death. Very often they're a young person with no medical history, found deceased in a residence or wherever the body is found. And there's a high suspicion that drug overdose and you know, the superstar drug, you know, sort of, when I say that disparaging fashions, the superstar drug for the past several years has been fentanyl. And fentanyl, as you probably know, is an opioid drug. It's many times more potent than morphine. And my first experience with fentanyl was back when I was a medical student when I would see little ampoules of what was called sublimase, which I thought was a great name, Sublimase. And that's the stuff that anesthesiologists use when you're going, we all, you know, anybody that has general anesthetic will get powerful painkiller. It's part of the anesthetic cocktail. Then people decided this is a great drug. Maybe we'd use it for chronic pain relief. And then there was the fentanyl used as a transdermal patch, where they put the drug in a patch and the drug is absorbed through the skin over a period of time to provide low level of drug chronic pain. And my first experience with a fentanyl death in the state of Georgia. I Remember it very distinctly was a young man who went out with his buddies. And their story was, we went out and my mate here, we had a beer. That's all he had. And he was legless. We had to basically leave with him draped over our shoulders, get him in the car, drive him home, put him on his bed. That's where we left him. And he died. Young guy, probably. I did the autopsy. He had lot of the signs of having died suddenly and unexpectedly. His friends swore that the only thing he had was beer, which that was unusual because, hey, usually we're bending our elbows most of the evening, right? But he and the autopsy and the toxicology were absolutely unremarkable. I'm not even sure that he had. If he had any alcohol in his system, it was very low. His death wasn't due to an alcohol overdose. He didn't have any heart disease, any disease at all. He was a mystery. Sometime later, coroner, local investigator. Again, I told the coroner, I said, hey, I don't know what's going on here. I'm basically sitting on my hands deciding what to do before we sign this case out. And the coroner said, well, let me go and, you know, sort of just ask a few more questions. And he came back. He said, doc, this young man apparently was in the habit of taking a family member's fentanyl patches, and he would put them on the inside of his mouth and he'd get high. And I said, really? Okay, let's find out if we can test for fentanyl. We asked the lab, because it wasn't part of the normal toxicology testing at that point in time. It was relatively rare anyway, it came back positive for fentanyl. So he died as a result of a fentanyl overdose. And he was one of the first that I saw. And again, that was at a stage where fentanyl was only available as the patch chronic pain use and as little ampoules that anesthesiologists use. And so that was a snapshot in time. Then heroin made a big comeback back in the early aughts and seemed like there was a lot of heroin around. Suddenly people have learned, people, being the ingenious individuals that they are, decided that, hey, maybe we can manufacture a form of fentanyl that comes in powder form. Guess what? What happened? It's the beginning of the epidemic. And I think my experience, probably relatively few chronic fentanyl addicts. There are probably some, because we do get the history of, you know, this person dies, known to use illicit drugs, drugs of choice, Include fentanyl. So there probably are people that use it over a period of time, but they're really playing sort of a form of, you know, sort of chemical Russian roulette, because you never know, you know, the illicit stuff. You never know what you're getting.

[Jeff Hopeck]

Yeah.

[Dr. Jeffrey Smith]

I think part of the problem, too is that individuals that are accustomed to using one particular drug, whether it's cocaine or heroin or methamphetamine, are getting more than they bargain for. And they get fentanyl. We find it all the time. We do presumptive urine drug screening at the time of the autopsy. Just to give us an idea of are we dealing with a drug overdose here with the toxicology and. Yeah, it's been an epidemic. I mean, I don't have the numbers for you for the state of Georgia, but it's high. I think nationwide, it seems that the fentanyl deaths are going down because of greater recognition of the problem and also the availability of narcan or naloxone. Needless to say, we. The GBI here is forensic pathologists. The effectiveness of naloxone, as far as we're concerned, is zero.

[Jeff Hopeck]

Yeah.

[Dr. Jeffrey Smith]

Because we only see fatal hours.

[Jeff Hopeck]

You only see one of ed. Right.

[Dr. Jeffrey Smith]

And a more, I suppose, on the horizon. This is part of what we're going to be having to be doing as forensic pathologists is now we are. Are probably going to have to testify more in cases where individuals have died as a result of fentanyl toxicity and the local jurisdiction is charging the drug dealer. The supplier.

[Jeff Hopeck]

Yes. Right.

[Dr. Jeffrey Smith]

With some version of homicide. And I have to say I think that's a noble cause. I've been involved in a number of these cases already. I think the prosecution had a difficult time persuading the jury that a drug dealer, unless it can be shown that they absolutely, knowingly gave this individual a large dose of fentanyl with malice and forethought. If an individual comes to a drug dealer and says, I have your money, I have the money. You've got the drugs. I want the drugs. I'm taking them of my own volition. You know, again, playing that sort of, you know, Russian roulette, I think juries probably have a hard time sort of saying, well, he paid the money, he took the drug of his own volition, and now you want me to put this guy in prison. It's a tough call.

[Jeff Hopeck]

That's a tough call.

[Dr. Jeffrey Smith]

Yeah. I think they will get. I think they will get conviction, probably. But as medical examiners, we have no dog in the fight there we're just basically there sort of saying this individual died as a result of fentanyl. They may have other drugs on board. And it gets sort of into the weeds about, well, how much did the fentanyl contribute versus the cocaine or the methamphetamine or the ant drug, that sort of thing. But, and we call them accident, you know, we think that it's an inadvertent complication of drugging.

[Jeff Hopeck]

Yeah, makes sense.

[Dr. Jeffrey Smith]

Yeah.

[Jeff Hopeck]

All right, Jeffrey, you've mentioned the phrase signs of dying unexpectedly and suddenly mentioned a few times. And this time I'd like to like to unpack that. What are signs that you see in the deceased?

[Dr. Jeffrey Smith]

Well, I think I used it in reference to a drug related death. And obviously the, the most reliable evidence of sudden and unexpected death would be an eyewitness account. Person A says, I was talking person B when suddenly he clutched his chest, his eyes rolled back, he fell to the ground and was deceased. That is, you know, sort of, that is sudden. It might not necessarily be unexpected. That individual may have known heart disease. He may have, you know, had a coronary artery bypass and on multiple medications for heart. So his death would be sudden but not necessarily unexpected. Okay, so when we talk as medical examiners about sudden unexpected death, those are key words we're listening for. But the two are often sort of, you know, exclusive. Like for example, we may be very interested in, in a sudden death and an unexpected death, but we. In the case that I just mentioned of the person with heart disease, yes, the death is sudden, but it's not unexpected. And so our interest as medical examiners, because of the medical history and the eyewitness account, we would probably not get involved in that, investigating that from the medico legal point of view.

[Jeff Hopeck]

Okay.

[Dr. Jeffrey Smith]

But as far as looking at autopsy findings of individuals who die suddenly and unexpectedly, you know, there's a few anatomic findings that we see, you know, sort of maybe non specific. The buildup of fluid in the lungs, for example, sometimes again, brain swelling, a very non specific thing. But we see it in association with deaths that can be sort of sudden. But they're more often they fall into the unexpected category and something's happened where the brain has had physiologically has swollen and it might clue us into something like perhaps a drug overdose or a death by asphyxia or some other mechanism. But like I said, it's fairly non specific. So most of the time we're talking about sudden and unexpected death. That's, they're really sort of investigational findings from, you know, the locals Say, well, we're not sure that his death was sudden necessarily, but it's certainly unexpected because he's a young individual with no medical history. So.

[Jeff Hopeck]

Yeah.

[Dr. Jeffrey Smith]

So. And again, in relation to the drug death, death may be sudden, but then again, is it drug truly unexpected, the sense that if you sort of are dealing with potent narcotics.

[Jeff Hopeck]

Right.

[Dr. Jeffrey Smith]

You know, sort of sudden death, necessarily unexpected.

[Jeff Hopeck]

So, yeah. Interesting. All right, I want to. I want to understand the entire process from. I'll use the first one that comes to mind. Famous case. Kobe Bryant's helicopter goes down. Right. So you have signs of distress, people saying, oh, there's a helicopter spinning out of the sky. It lands on the ground. I want to understand the whole process from it hit on the ground and burst in flames. I'm guessing all the way through. Getting. Getting to you. And then who. How it gets determined what goes on the actual death certificate. So every step of the way, as you know it.

[Dr. Jeffrey Smith]

Sure. Well, you know, there's. There's a number. A complex death investigation like that involves multiple agencies. Now, obviously with. Again, I don't want to go out outside of my lane here, but something like a helicopter going down, there's going to be the NTSB involved in that and maybe the faa, I'm not sure, but the role of the medical examiner. And I will. I'll basically walk myself through a scene like that because I have been to a small aircraft crash, right. Where there was a fire. The first thing is to give the investigators a wide berth to establish the parameters of the scene. The medical examiner or the medical examiner investigator will be in charge of accounting for and the cataloging and transportation of bodies to the medical examiner facility for where the examination is going to be done.

[Jeff Hopeck]

Okay.

[Dr. Jeffrey Smith]

All right, so let's, let's simplify things and say that there are two individuals or you use the example of Kobe Bryant. I'll use a similar example of a case that I was involved with directly of a small plane that crashed onto 285 several years ago shortly after takeoff from.

[Jeff Hopeck]

Yeah, yeah, I remember a guy named.

[Dr. Jeffrey Smith]

And basically that scene, there was some video. I think it was on a law enforcement camera car, the dash cam, see the plane going up, down, and you know, sort of sort of like that. Similar to that flight, Air India flight, you know, see the plane going down, so made a fireball. I was involved with that because there were four people on that plane and conflagration, four bodies burnt. Medical examiner investigator went to the scene. And at that point in time, you have a very complex scene in the sense that you don't know sort of who was. The chances are you don't know who the pilot was, where the passengers were sitting. But it's a high impact. They may have been thrown about in the claim, maybe separation of bodies. So the, the first thing that the medical examiner, investigator and the medical examiner at the scene has to do is first of all obvious establish, you know, these are human remains, this is a human individual, and we don't know who that individual is. So they will be decedent A, next decedent B, next decedent C, next precedent D. So they are given generic identification. It could be number one, number two, number three, number alpha, beta, gamma, that, that sort of thing. But as long as that individual is received with a designated unidentified individual A, we will usually have an idea of who was on, you know, for example, on the plane. In this case it was father, two sons and one of the sons. So you know that you had three male decedent on female decedent. Depending on how badly burned the bodies are, may be able to distinguish readily, obviously female versus male, you may be able to distinguish sort of an individual in their twenties from an individual fifties. Most of the time in those sorts of incidents, the bodies are what we call burned beyond recognition. Means that I can't, I'm not going to be able to look at this individual and say this appears to be so and so based on the photographic evidence you've given me, a, a picture of the driver's license or whatever. I'm sorry, I can't tell. We're going to have to essentially use more. Sure.

[Jeff Hopeck]

Dental records. That would be like a dental record.

[Dr. Jeffrey Smith]

So the autopsy itself on individuals A, B, C and D will initially be to determine the cause of death.

[Jeff Hopeck]

Okay.

[Dr. Jeffrey Smith]

And the possibilities in situation like we're talking about is that did they die as the result of the crash, means they sustained lethal injuries in the course of the crash or did they die in the fire? And you know, that's, that's obviously important to distinguish that again, there are certain hurdles, little roadblocks that we pathologists, forensic pathologists have to overcome in identifying injuries because the fire itself will inflict injuries as a result of the intense heat on the body. So we have to be able to distinguish. And I'm going to. Here's a plug for forensic pathology. This is why we do what we do and why we're trained like this. Because I don't want to be attributing fractures that were caused by the fire itself to crashes, to fractures sustained on impact, you know, we will get individuals that have fractured skulls, long bones at the upper and lower extremities fractured, and they may be all due to exposure to intense heat, which means that the individual didn't sustain these fractures. As a result, they may, in fact, in the majority of cases, by the time the fire does its worst on the body, the decedent is dead. So, and this gets into things further down the road that lawyers are very interested in from a civil point of view, conscious pain and suffering. So, you know, we, you know, for better and for worse, we will often be deposed on those. But just to break it down broadly, the individuals, you know, most of the time in a light aircraft crash will have sustained lethal blunt force injuries. Means that they will have injuries as a result of the impact of the plane. Very occasionally we'll find autopsy evidence that the person was alive at the time the fire started. And what we look for there is evidence that they were breathing at the time the fire started. And we will find products of combustion, smoke and soot in the airway. That's presumptive evidence that the individual breathing at the time, and they breathed in smoke. Okay, very often, not always, but very often concomitant with those sorts of fires are the generation or is the generation of carbon monoxide. So we will do testing for carbon monoxide in the blood as a result of the smoky fire, complete combustion. So that's the first thing once we have established the cause of death. A is what? Blunt force injuries, the cause of death. B is multiple blunt force injuries of death. C is multiple blunt force injuries, the cause of death. D is some. Multiple, sorry, some injuries, but also evidence of smoke inhalation. And we'll say, well, this individual breathing at the time the fire started. Now, they may not have survived their injuries, but they were breathing at the time. Not everybody necessarily dies instantaneously, like you can see, sustain an injury that will allow you to be not necessarily conscious, but breathing. And again, this is another murky area. Well, yeah, impact. Is this individual conscious? Having sustained these injuries, are they conscious? And that's where the attorneys will go after you saying conscious pain and suffering, which means that, you know, they were. The brain was still working.

[Jeff Hopeck]

Yeah, yeah.

[Dr. Jeffrey Smith]

So the establishment of the cause and manner of death. The manner of death is going to be an accident. You know, majority of time is going to be. And that's where the, you know, the other investigation from the NTSB side is. Was there a malfunction of the plane? The other thing that the FAA is interested in is they want to do their testing, mostly toxicologic testing at their lab. And so we procure specimens and they, they say we would like specimens from the pilot because they're interested in is what's going on with the pilot. The pilot. Was the pilot under the influence of drugs? Was the pilot. Is there any disease that you sort of found at the autopsy? Oh, they said that this individual was on medication for heart disease. Did you find any heart disease? They're going to look for any sort of medications, obviously intoxicating drugs, that sort of thing. So part of the difficulty is sometimes they'll say doc, we don't know who the pilot was, so you need to do this on. Sure. Or they were co pilot, you know, so we don't know who had the controls at the time. So can you. So there's that then comes down the business of identification of these individuals. And very often you can have some ideas at the end of the autopsy that this appears to be an older individual. So I think this was probably in this case, you know, sort of the parent. Okay. We have two young men here and they're both burned beyond recognition. There's no identifying features on the body. The height and weight are of no use whatsoever because, you know, there's been burning of the body. So that's when we go to scientific identification. If it's available, we'll look at dental records. If available, we'll get DNA samples from presumptive relatives.

[Jeff Hopeck]

Okay.

[Dr. Jeffrey Smith]

We'll do X rays of the body to see. Oh yes, so. And so had a knee joint replacement 10 years ago in his right knee. And we'll be able to see that on the X ray. And that very often is, is, is the most pressing and important thing that we have to do with medical examiners is identification. People need some sort of closure from that point. Yeah, I mean, I think there is probably implicit understanding that somebody is involved in a cast, you know, catastrophic plane crash. Death is going to be due to something related to the crash. But it's when there's delays in terms of we don't know who this individual is. So that, that, that becomes very high priority as far as the medical. And we work in conjunction with our lab here, the DNA lab here. And again, it's contingent upon the investigators to approach the family, get the DNA sample, that sort of thing. And then at the end of that, once identification is established scientifically, we have a cause and manner of death. All ancillary testing is done, lab testing, any sort of microscopic examination, anything like that, we will Sign the death certificate.

[Jeff Hopeck]

Okay.

[Dr. Jeffrey Smith]

Now, as far as the actual cause of the crash is concerned, that's of interest. Yeah, but it's not our prerogative, you know, to determine what that is.

[Jeff Hopeck]

Right.

[Dr. Jeffrey Smith]

It helps explain things and we may be able to contribute. Like, for example, they. We may sort of say, look, there doesn't appear to be any problem with the plane at all. We got a distress signal from the pilot, basically sort of saying, I'm going to have to turn back, you're not feeling well, something, and boom. Is there any reason why he might have said that? Well, sure. All we can tell at the time of the autopsy was, is that he does have bad heart disease. Or, you know, we're not going to be able to sort of say, oh, my goodness, yes, he had a heart attack, or anyway, you know, that's something we can't.

[Jeff Hopeck]

Yeah.

[Dr. Jeffrey Smith]

Tell. But can use presumptive autopsy evidence and any other investigations to say, well, this is what may have happened.

[Jeff Hopeck]

Okay, so the coroner's role in that whole thing. What brings the box?

[Dr. Jeffrey Smith]

Well, the coroner, if you're talking about the coroner, like the, the, the incident that I was involved in was the medical examiner's office. I was working. Okay. Which was in another county. If it's the one, for example, in one of the core the coroner counties that we take care of here at the gbi, the coroner will be there essentially to take jurisdiction over body. So essentially, he will basically be the one that says, yes, here is a deceased individual. I'm going to put this identification tag on the body, on the bag, and going to be unidentified individual number one or unidentified individual number A. We think it's going to be so and so. So and so. Heads up, but we're not sure. Okay.

[Jeff Hopeck]

And then they get them and then they're done. Once the body's here, or do they do the death certificate or who does.

[Dr. Jeffrey Smith]

The coroner, at that point in will the investigation, their partner investigation will probably be over. They will probably approach the families or presumptive families of the decedents to DNA samples. But when we finally get to the death certificate, one of our investigators or myself occasionally, but one of our investigators here get on the phone and say the death certificate for the individual A, who is now identified as Mr. Or Mrs. Or so and so. So and is ready to be signed out. Here's the cause of death. Here's the man of death that. That coroner will sign that death. Okay, so that's, that's our role pretty much completed. Unless we get involved in civil deposition. You Know, that sort of thing. Like, I remember a case where several individuals died as a result of a semi trail track truck driving into the back of a minivan and exploded with a bunch of people on board. Did the autopsies found the cause of death in a good number of months later, attorney for the families came to me to discuss my findings and essentially said, thank you very much, Doctor. That's all we need to know. No deposition. They just wanted closure. Individuals died as a result. They didn't die as a result of the collision. They died in the fire.

[Jeff Hopeck]

Closure. They would consider closure.

[Dr. Jeffrey Smith]

Well, the attorneys, basically at that point, I was told by this attorney that their mantra is if you survive the crash, you shouldn't die in the fire. So they're going to go after cause of the fire in the minivan, which was a known problem at the time. I think I was told that the fix for this problem with a $2.50 plastic part, but it involved a recall of an enormous number of vehicle. Oh, and I guess the automobile manufacturers essentially sort of said, we're not going to do a recall. Take the hit when they occur.

[Jeff Hopeck]

Oh, that. Well, that's a big one. That's a big hit right there.

[Dr. Jeffrey Smith]

Yeah.

[Jeff Hopeck]

How many different types of causes of death possibilities are there?

[Dr. Jeffrey Smith]

Hundreds there.

[Jeff Hopeck]

Oh, there are hundreds.

[Dr. Jeffrey Smith]

Hundreds.

[Jeff Hopeck]

So, okay.

[Dr. Jeffrey Smith]

Well, they say that, you know, there's one way to be born and there's many hundreds, if not thousands of ways to die. I mean, when I get asked to explain cause of death to a jury, I say it's the thing that led to your demise. So it's a heart attack, it's a drug overdose, it's a road traffic accident. Fall from a ladder, it's a fall down a flight of stairs, it's a gunshot wound, it's a stab wound, it's a strangulation, it's a strike by lightning. There's all sorts of causes of death. The problematic part for medical examiners is something which we call the manner of death. And that's another part of the death certificate that we are responsible for figuring out. So you will hear the statement, cause and manner of death. I'm not going to go into the weeds with this, but essentially what I say to juries is because the attorneys will ask, they'll sort of say, and doctor, what is the manner of death? And I say, well, the manner of death is much more prescribed. We have five manners of death put on a death, one of five that we put on a death certificate in Georgia. And they are natural, which means that the death is due to natural disease, heart attack.

[Jeff Hopeck]

Okay.

[Dr. Jeffrey Smith]

They are accident. Something that is unforeseen, unpredictable. Like for example, a fall down flight of stairs.

[Jeff Hopeck]

Okay.

[Dr. Jeffrey Smith]

You know, anything that you sort of think of as an accident, A lot of people think road traffic accident.

[Jeff Hopeck]

Sure.

[Dr. Jeffrey Smith]

Suicide.

[Jeff Hopeck]

Okay.

[Dr. Jeffrey Smith]

Means that we are confident that the individual not only had the means, but the intent to take their own life. Homicide. And this is the one where people, you know, get very hung up, particularly in the courtroom. They say, doctor, you called this a homicide. Does that mean that this person was murdered? I say, no, it's not homicide in the strictest sense of the term as far as we medical examiners are concerned. Few little outsider exceptions, which I'm not going to go into, basically means that an individual died as the result of the action or action of another individual.

[Jeff Hopeck]

That's homicide.

[Dr. Jeffrey Smith]

Homicide. So if Jeff, you and I go out hunted in my life, you and I go out hunting one cold morning, we're out there, sitting there in front of me, I'm looking out, suddenly go, ah. You stand up and I stand up and you fire and I fire. And I take off the top of your head with my shotgun blast.

[Jeff Hopeck]

Yeah.

[Dr. Jeffrey Smith]

What's the cause of death there? The cause of death is the shotgun. What's the manner of death?

[Jeff Hopeck]

I don't know. Accident?

[Dr. Jeffrey Smith]

No, it's a homicide. Because I hired the gun that killed you. Now, it doesn't mean I murdered you. It doesn't mean now I may have nefarious sort of intent, that basically you screwed me over sort of about something. Da, da da da da. We're going to go out duck hunting. I'm going to make your murder look like an accident. So as medical examiners, we will call that a homicide and we will leave it to investigators and the judicial system to decide what. What happened. So basically I would probably be charged with some lower form of manslaughter, if at all.

[Jeff Hopeck]

Yeah.

[Dr. Jeffrey Smith]

So say, oh my good. I, I didn't even realize he'd come back and sat in front of me. And when he stood up, you know, I just pulled the gun and pulled the trigger.

[Jeff Hopeck]

Yeah. So homicide versus murder.

[Dr. Jeffrey Smith]

So we have to make it clear to the court that we're not calling things murder. That's up for them to decide.

[Jeff Hopeck]

Yeah.

[Dr. Jeffrey Smith]

Homicide is essentially I've done something which led directly or indirectly the death of an individual.

[Jeff Hopeck]

So one can't be the other, but one. So, so a murder.

[Dr. Jeffrey Smith]

All murders are homicide, Homicides and murders.

[Jeff Hopeck]

Okay.

[Dr. Jeffrey Smith]

And the other category, just before we leave this subject is undetermined which means that I've done an autopsy, I've done the lab work, I've had, got all the investigation, and I still can't decide. I don't know whether this is an accident or a suicide. I don't know whether homicide or an accident, you know, can't decide.

[Jeff Hopeck]

Yeah.

[Dr. Jeffrey Smith]

We're basically sort of saying, look, I can only take this so far. It's, it's, you know, one or two of these things. And these are the cases that, you know, sort of. You asked me, is there some time when you can't determine the cause of death? Sometimes we can't determine the cause of death and the manner of death. Like, for example, the skeletonized remains out in the middle of nowhere. And we don't know what happened.

[Jeff Hopeck]

Oh, right.

[Dr. Jeffrey Smith]

Cause of death. We don't, we don't have enough work material to work with.

[Jeff Hopeck]

Yeah.

[Dr. Jeffrey Smith]

And we don't know the circumstance.

[Jeff Hopeck]

Yeah.

[Dr. Jeffrey Smith]

Most often we can get to a cause of death, but sometimes we have problems with the manner of death because there's just not that little. And again, this is the, you know, I stress to my trainees and my staff that basically the biggest part of what we do investigational and what we do is basically listen. We listen to people telling us about what going on this case.

[Jeff Hopeck]

It is like, for example, you would have one of these interviews when you say you're listening to people. You patch me in here and sit and do it here, or phone families coming in or.

[Dr. Jeffrey Smith]

No, families generally don't come in. Families. Generally we will talk to families, but the coroner is our intermediary there.

[Jeff Hopeck]

Okay.

[Dr. Jeffrey Smith]

Like a coroner might call up and say, look, doc, the family are interested to know why you said this, this, or this. And the auto say, well, here's why I said that. Are you comfortable conveying that information or would you like me to speak to the. And he'll often sort of say, I think I can handle this. I know the family well. Okay. Something like that. Or they'll sort of say, doc, you know, sort of, this is way above my pay grade. I'd really like you to be able to explain to them what, you know, sort of you put on the death certificate. And I'm happy to do that. I mean, that's part and parcel again, you know. So people sort of think, well, you forensic pathologists, all you do deal with is dead people, you know, sort of. What's, what's, what's the doctoring there? Yeah, a lot of time the doctoring is basically talking to, you know, grieving family. Members and loved ones explaining.

[Jeff Hopeck]

Sure.

[Dr. Jeffrey Smith]

And. And that's how a lot of the time we provide closure. They want to know things like, I know you put this on the death certificate and your autopsy report. Do you think they suffered when this happened? And often we have to say, look, I really know. But a lot of the time we can say, no, absolutely not. I mean, basically your husband essentially had a heart attack and literally lights out in a split second.

[Jeff Hopeck]

Quick.

[Dr. Jeffrey Smith]

Yes.

[Jeff Hopeck]

Huh.

[Dr. Jeffrey Smith]

So. And sometimes that is of. That's the most, you know, important piece of PR that I can do for, you know, sort of the. The office and for that family.

[Jeff Hopeck]

Yeah. What's the breakdown of the five different manners, what's the most common and what's the.

[Dr. Jeffrey Smith]

It might surprise you to hear this, but most medical examiners, the most common manner is natural. And that's because a lot of people die suddenly and unexpectedly and unexpectedly. No medical history, no available medical history. They're young and, you know, conceptually people shouldn't, you know, die. It shouldn't happen. Well, this gets to sort of why Another interesting part of forensic pathology. You know, some pathology in the hospital, we're trained for that initially, sort of look down the microscope, do the lab tests, that sort of thing. So that's the stuff that happens in the hospital situation. But forensic pathology is usually what's happening outside of the hospital situation. And there are enormous numbers of individuals who quite justifiably are suspicious of the medical profession. So you're gonna have to drag them kicking and streaming to get to a doctor. Yeah, they don't have access to medical care. They have symptoms like say, yeah, complaining of a stomachache days. I said, go to the doctor. He said, I'm just gonna go down to the pharmacy and get some TUMS or some over the counter thing. They die and say, well, it wasn't a stomachache, he was actually having a heart attack. Or it's a pity he didn't go to the hospital because he's got an appendix essentially he thought was going to get better and it ruptured. So the most common one is natural. For most medical examiner's office, probably here at the gbi, we do fewer natural cases than other medical examiner's offices because the coroner will say, doc, he's got a good medical history. I'm comfortable. The natural death, I don't think he needs to do an autopsy. In the situation, the coroner is the one that we're guided by. If the coroner has a natural death and they're comfortable with it, going to press them and Basically say, well, I think this person needs to come in for an autopsy. Unless there's something sort of a little bit sort of unusual about it or you might sort of say, well I understand that he has this medical history, but what you're telling me is something a little bit different and it might be a good idea to sort that out.

[Jeff Hopeck]

Yeah. Come in and.

[Dr. Jeffrey Smith]

Say, obviously with drug related deaths and the road traffic accidents and on the job sort of incidents, probably accidents are up there fairly high. We deal with a lot of homicides and those, you know, it's mandatory that they come in for autopsy. Yeah.

[Jeff Hopeck]

Okay.

[Dr. Jeffrey Smith]

We're not getting a coroner calling up these days. I can talk about the bad old days. These days a coroner is not going to be calling up and sort of saying, well doc, I've got a guy here that was involved in an altercation with his neighbor who shot him twice with a shotgun. We've got the gun, we know it's a shotgun injury. We're not sending. Hang on a minute. No, that body's coming. Yeah. Autopsy, right? Yeah.

[Jeff Hopeck]

Let's look at some of the plane crash ones.

[Dr. Jeffrey Smith]

Yeah.

[Jeff Hopeck]

So use the example that you gave before would be the cause and the manner. Just so I have it right.

[Dr. Jeffrey Smith]

Okay. The cause of death in the plane crashes be majority of times would be multiple blunt force injuries, manner of death, accident. This was, this was something inadvertent, unexpected and you know, an act of God. Yeah.

[Jeff Hopeck]

Okay, then let's look at the poisoning ones.

[Dr. Jeffrey Smith]

That awesome case where poisoning one is basically poisoning is always homicide and it's always, you know, murder one because somebody. And it's relatively rare. I mean, I think this is the only poisoning case that I can summon from my memory banks. We occasionally get allegations of poisoning and it's a family member and sort of a most common thing is either a mother or a father who has remarried a younger spouse, they die. Families sort of say that stepmother of ours poisoned him or there's allegations of poisoning which are almost always unfounded. Because first of all, question we ask is, well, what sort of poison are we talking about? There are millions of poisons. They say, I don't know, we just think they were poisoned. So we will take that seriously. Bring the body in an examination and we will test pan. We're not going to spend millions of dollars looking for every single poison under the sun. Sun.

[Jeff Hopeck]

Right.

[Dr. Jeffrey Smith]

We will do a relatively comprehensive toxicologic testing and document our other findings. And actually those go away pretty quickly. Cases that don't go away, that are often the most Heart rending the suicide because I think there is a natural sense of disbelief that a loved one would take their own life even when there is sort of evidence there seen for example like they left a note or being sort of in the past sort of taught self destructive policies. Some of the most wrenching discussions have with a family and I usually do those face to face is essentially presenting the evidence that you know, this is individual had the means and had the intent to end their own life. And I don't think I've ever left one of those discussions where everybody's, somebody's looked me in the eye and sort of said you know what Doc, thank you so much. You've got it right. It's usually thank you very much doctor, we appreciate your time. And I might get another phone call, might have to have another meeting but usually, usually after a period of time I think most people make their peace.

[Jeff Hopeck]

The death certificate, almost like a contract word family has to write off on it and say sign it or doesn't go into action.

[Dr. Jeffrey Smith]

It's an interesting question because I think a lot of the times people are objecting to the suicide. There's the personal reason they just the sense of disbelief about it. But the number of times the vigil say well I just don't want to see death suicide on the death certificate or I'm worried that you know, sort of my community is going to see suicide on the death certificate. First thing is in our instance here at the gbi, it's happened call up the coroner. I'm not thinking singling out any coroner. I'm just saying in the past we coroner with a cause of death, whatever it is, manner of death, suicide and the coroner will put something else on the desk which he is or she are perfectly entitled to do. They are yes. Now it doesn't happen very often but the source of situations where it might happen is one where maybe it's not quite so obvious. Well as far as I'm concerned, for example before I tell a coroner that I think it's a suicide I have to be pretty close to 100% if I'm not sure if I, I'm not sure whether this is an accident or a suicide, I will defer to undetermined or accident on the degree of. Yeah, that sort of thing. I will not put suicide if there's sort of, you know, doubts about it just simply because it's such a, an important opinion.

[Jeff Hopeck]

Sure it is.

[Dr. Jeffrey Smith]

But if we call in one which scientifically, investigationally we think is a suicide coroner for Whatever reason feels that they're going to spare the family the stigma or suicide, they may put something else.

[Jeff Hopeck]

Is there any foul play? Did foul play happen in that ever?

[Dr. Jeffrey Smith]

No. Basically, the death certificate is an opinion. There's nothing binding legally. The death certificate, essentially, it's a medical opinion, and everybody has opinion.

[Jeff Hopeck]

Okay, so an outcome in court different than what's stated on the death score.

[Dr. Jeffrey Smith]

Oh, sure. Okay. Like, for example. Well, you know, the most common one would be, well, you know, this is a homicide. You know, subject A shot, subject B, subject A went to trial, cause of death, gunshot, Manner of death, homicide. But the jury sort of say, well, yeah, he died of a gunshot, but I don't think he did it or it was justified or, you know, just, you know, say we. And that's why we don't have a vested interest in what happened court. We have to be there as neutral. I don't know who did this. You know, one of my doctors basically always has a chuckle when after he's testified, sometimes the attorneys will ring him up and sort of say, doc, you know, break out the champagne. We got a conviction. And he says, well, I'm glad you got your conviction. By sure as hell hope you got the right guy, because I. Wow. No idea. You know, good luck, you know, well done. But, you know, sort of. Yeah, so we, you know, I don't get on the phone unless there's. Occasionally I will follow up with attorneys to find out the outcome of the case in terms of, like, if there was. If it was a particularly contentious case or case, for example, where my opinion was being challenged, you know, by an opposing expert. So say, with all due respect, Doctor, I think you did a great job on this autopsy, but you got it wrong. That doesn't happen very often. I mean, usually that's.

[Jeff Hopeck]

There are.

[Dr. Jeffrey Smith]

There are certain. Most of the time, we are there. Just basically, the cause of death is not in dispute. Somebody dies of a gunshot wound.

[Jeff Hopeck]

Got it.

[Dr. Jeffrey Smith]

The defense attorney is basically sort of sitting there looking at these photographs while I'm explaining them to the jury and saying, oh, can we just get this done with? You know, So a lot of defense attorneys don't want the medical examiner there. They're sort of saying, right, he died of gunshot wound. We agree. And the reason that is is not because, you know, out of disrespect, it's just they really don't want the medical examiner up there describing all these injuries that their client allegedly inflicted upon this deceased individual and showing them photographs. So they often sort of say, we're happy to stipulate, prosecution will say, no, we're going to get the doctor here to tell the jury what happened.

[Jeff Hopeck]

Do they ever come straight, like lawyers in court? Do they ever come right out and Doc, you out of frustration, do you think he did it or not? When are they going to.

[Dr. Jeffrey Smith]

The most common thing that defence attorneys will get up and ask, I think more out of a sense of showing their client that they're doing something. Having had my direct examination, the defence attorney will get up, basically say, doctor, you weren't there when this incident occurred. I know I was not. But doctor, you have no idea who shot. No, I do not. Thank you very much. No further question. That's it? That's it.

[Jeff Hopeck]

They don't question like, doc, we found this time when you were wrong. Are they ever doing anything?

[Dr. Jeffrey Smith]

No. You can be, I, I guess, you know, sort of try and avoid having situations where you can be impeached either from previous testimony, where basically, you know, sort of in one case you said this, this is a near identical case and you're saying something else. It's not usually a problem. I mean, I think for the majority of cases that we deal with as medical examiners, cause of death when we go to court is not in question. The ones where it is and become most contentious are the child cases where the allegation is on the side. Prosecution, based on the medical examiner's findings, was that this is an injury caused the death of this child and it was inflicted by another person. So that's a homicide. The defence will say, no, we understand the injuries, we know where you're trying to go with this, but we think the decedent fell off the bed and sustained, therefore it's an accident. So that's where you get the back and forth between experts that everybody finds exciting. You know, sort of like, you know, while the medical examiner said that this child sustained lethal blunt force injuries inflicted by the caretaker, the defence expert is saying, no. The story that the caretaker is telling, that the decedent fell off the couch while they were climbing up trying to open the window, is it? So those are the ones. And I don't think I, as a, as a medical expert myself, I have not been confronted by a defense attorney saying to me, Dr. Smith, you really screwed up that case back in 19 something something, didn't you? You're more likely to get that when, as a medical examiner, if you're one of these hired guns that go around sort of getting large sums of money to testify for one side or the other.

[Jeff Hopeck]

Oh, Geez.

[Dr. Jeffrey Smith]

Create, you know, sort of raising sand.

[Jeff Hopeck]

Yeah.

[Dr. Jeffrey Smith]

They may sort of say, well, how many times, Doctor, have you appeared for the defense in these sorts of cases, you know, where you're alleging that all these cases that are accidental, you know, they may have, you know, isn't it strange, Doctor, that the only time we ever see you in court, there's a hired expert in these sorts of cases where you're saying that, no, this is an accident. There are people, you know, unfortunately, there are individuals out there go around doing that, but get sort of. You're on the blacklist, if you will. Yeah. They say you've gone over to the dark side when that happened.

[Jeff Hopeck]

Oh, my goodness. All right, last. Last discussion point. So a couple episodes ago, I interviewed a guy who was a hunting accident. Doesn't. It was his first time hunting. He didn't want to go hunting. I think it's interesting because you said you're not. I'm not a hunter as well. Never, never have hunted. So he goes out and he's close to a deer. He kneels down, and then from 100 yards away, his cousin takes a shot. But the cousin didn't know that the kid there.

[Dr. Jeffrey Smith]

Yes.

[Jeff Hopeck]

Right. So he gets through the center of his throat a.30 rifle round when he was 18. Now I'm interviewing him last a couple weeks ago, and he's age 55.

[Dr. Jeffrey Smith]

Right.

[Jeff Hopeck]

So he's clearly survived it. He said the surgeon told him it was equivalence of getting struck by lightning five times. I want to hear just, just your opinion on this. How did the. How does a.30 30 round go through the center of the throat? Then instead of going straight out the back, which it should go south 5 inches through his windpipe, blows out his lung, but then comes to rest. I can all I can explain.

[Dr. Jeffrey Smith]

Explain things in terms of the, the. I. I don't know that I would use the analogy. The, the lightning analogy.

[Jeff Hopeck]

Okay.

[Dr. Jeffrey Smith]

Basically, 30 30, it's a bullet, a rifle round, and when it exits the muzzle of the gun, it's going at several thousand feet per second. Now, your average handgun round is going at several hundred feet per second.

[Jeff Hopeck]

Right.

[Dr. Jeffrey Smith]

But because the round has so much more gunpowder propelling the projectile, it's going way faster. And if you cast your mind back to your high school physics, energy is not related to the mass of the bullet. It's related to the velocity squared. So every time you double the velocity, a geometric increase in the energy of that projectile. So its very nature, the. 3030 is first of all, it hits the target, transferring an enormous Amount of energy. As to how this individual survived with the gunshot wound, as you describe it, I'm not sure. The other thing I do know about bullets is that at that rate of speed, a bullet will travel in a straight line until it runs out of energy. So in order to account for that trajectory in the neck and ending up down, what, in the bottom of the lung or.

[Jeff Hopeck]

Yep, here's the lung. The hole in the lung.

[Dr. Jeffrey Smith]

Yes. So he must have. He probably would have to have been the bullets not come straight at him. If he's standing upright, hit the neck and then do a 90 degree right. Doesn't do that. Bullets don't do that. Basically, that bullet is in there the back and dead. You know, the fact that he survived is, you know, sort of miracle. Again, straight line, so.

[Jeff Hopeck]

Makes sense. Yeah.

[Dr. Jeffrey Smith]

That's the only thing I can think of. And like I say, from what you're telling me, it sounds like it was a miracle. I don't know what the surgeon found or that sort of thing. But anyway, lucky.

[Jeff Hopeck]

All right, just tell me, then we'll end. We'll end here. Tell me. A good day driving home and then the exact opposite drop. What's a bad day driving home? What's a good day driving home?

[Dr. Jeffrey Smith]

A good day driving home is when my staff are behaving themselves. I don't have any personnel issues. A bad day driving home is when I've got personnel. Somebody's misbehaving. No, a good day going home would be. I think this is something that's sort of generative within oneself, is, you know, I'm still performing autopsies myself, even though I've, you know, sort of had this, you know, exalted title as Chief Medical Examiner. I enjoy doing cases. I think I'm still effective and useful being in the autopsy suite doing cases. I think a good day is just knowing that you have applied your expertise in a focused fashion to the work that you've done and that you have been able to provide some answers to interested individuals that whilst not necessarily providing consolation at this point in time, then we'll be providing sort of, I suppose, the beginning of working towards some sort of closure. Like I say, there, there are no sort of. I, I can never get on the phone with a coroner and basically sort of say, you know, the autopsy was a success and the patient, you know, ready to resume life again. Yeah, it doesn't, it doesn't exist. It doesn't happen. So I think because a lot of what we do, and again, not in the high profile sensational cases. A lot of what we do is complex medical concepts. If I can get on the phone with a family member and explain to them my findings, language that they can understand and telephone call, they can say to me thank you very much doctor. That really helps in whatever way that it helps. Then I. That's the best I can do for that particular individual. Obviously there's other people. They're basically going to sort of say well thank you very much, doc. You've confirmed our suspicions. An accident, we burned our suspicions. Homicide. You know those cases that. That's satisfying helping law enforcement, you know, interest. And then you know, sort of at this stage in my career I. I derive a lot of satisfaction from seeing the younger doctors starting to really get it. They stride in profession that takes some time. I mean, sure, you know, it's a pressure a year as a forensic pathology trainee to do, you know, the 200 cases. You have to get all your reports finished. You have to read a bunch of material. You have to turn up, you know, put up tyrannical supervisors and then, you know, at the end of that you're expected to go out and get a job. And it's, you know, sort of. It's like I liken it to sort of to driver's license. Driver's license has shown that you have a certain proficiency in operating your vehicle.

[Jeff Hopeck]

Yeah.

[Dr. Jeffrey Smith]

Now you start to learn how to drive.

[Jeff Hopeck]

That that's. I mean I. I could stay here all day. This was so incredible. So thank you to all of you who put it on the interns as well. Thank you to you guys.

[Dr. Jeffrey Smith]

Jeff. I mean I hope I haven't over talk.

[Jeff Hopeck]

I actually felt bad even talking at all. I just want to sit here and just listen to you and I can listen to you all day. So I really mean it. Thank you for taking the time. I know this is going to help many. I know it's helped us. It's just so cool to hear what you guys do.

[Dr. Jeffrey Smith]

Pleasure.

[Jeff Hopeck]

I want to shake your hand.

[Dr. Jeffrey Smith]

Thank you very much.

[Jeff Hopeck]

Thanks so much. Awesome.