Medical examiner's unique technique helps ID desert dead

The Pima County Office of the Medical Examiner has earned national recognition for breakthrough work with fingerprinting unidentified bodies of people, including border crossers, who have died in the desert.

“I can’t think of another jurisdiction has the number of unidentified we have and a lot of that comes back to that to the environment and the migration issue,” said Dr. Gregory Hess, PCOME’s chief medical examiner.

That experience led Hess and medicolegal death investigator Gene Hernandez to collaborate on a presentation detailing how they've refined a process their office performs again and again and again, steadily producing fingerprint that triggered 34 identifications in 2011-2012 alone.

Hess and Hernandez presented their paper to the National Association of Medical Examiners at the organization's annual conference in Milwaukee, Wisc., last October, where it received a Best Affiliate Presentation Award.

Sharing the results of their work fits in well with the goals of the sssociation, said Dr. Greg Schmunk, chairman of the group's board. Schmunk, who is also chief medical examiner at Des Moines Polk County (Iowa) Medical Examiner's Office, was the organization's president during the paper's presentation.

“Our primary purpose is to provide educational resources for our members,” Schmunk said.

In arid conditions such as Southern Arizona’s desert, it doesn't take long to run out of water. This, as well as sickness, injuries and other accidents, can lead to fatalities and the dehydration process doesn’t stop after death. Many of the bodies brought to the PCOME’s well lit, tiled hallways have begun to mummify.

When nobody knows who the person was, mummification makes identification an even greater challenge.

“If a person is out of doors in the heat and dryness frequently they're not identifiable and even to someone that may know them fairly well,” Schmunk said.

It also makes one of the first steps of the identification process, getting fingerprints, difficult.

That’s why, when starting from scratch, readable fingerprints that can be matched to databases from law enforcement or state registries are so important.

“You just can't take a mummified finger and grab a fingerprint,” Hess said. “It won't work, it won't get enough ridge detail on the skin to make a usable, comparable fingerprint.”

It's possible to rehydrate the tissue using sodium hydroxide. The process can take up to 72 hours and requires a mixture of attention and patience.

If printing is attempted too soon, the prints are still distorted — but waiting too long can mean permanently losing the fingerprints.

“The risk again is always you can dissolve the tissue if your solution's the wrong concentration or you leave the tissue in the solution for too long and that kind of thing,” Hess said. “So we have a fairly rigid process.”

It was a process that Hernandez began helping to develop after he started working at the PCOME in 2000.

“We were still getting a lot of smudged prints and a lot of prints that were either just not really readable or not usable for any kind of identification,” Hernandez said. “We just hadn't perfected it.”

When construction of border fences in California and Texas pushed border crosser traffic into Arizona’s more dangerous and rural terrain, death rates skyrocketed.

“The challenges that we hear in the media quite often are the challenges we face daily here,” Hernandez said. From 2002 on the PCOME has handled over 100 bodies believed to be border crossers each year, peaking at 225 in 2010.

That year Dr. Bruce Park’s, PCOME’s chief medical examiner at the time, discussed the rising death toll, saying: “It’s been going on now for over 10 years and there are offices like this which are involved in finding out who the people are and there’re offices doing other aspects of the work to try to locate these people and save them and take care of them and render medical care, if they’re lucky enough to survive.”

So many bodies were unidentified that the case records filled multiple shelves and some years extra storage space was needed for bodies waiting on names.

“So in Southern Arizona, and a few other places along the border, it’s a big deal and it’s a sad situation,” Parks said.

The numbers stayed over 150 the next year as Parks retired from a two-decade career and Hess took charge of the PCOME.

The PCOME’s annual report for 2012 noted that that year on December 31 there were 734 bodies waiting for identification.

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“We've made this kind of a people issue,” Hernandez said. ”We treat these individuals as any individuals who would die in our county so we treat them with lots of respect and a lot of hard work and it takes a lot of time to kind of get through each one of these cases.”

It’s an attitude and an approach that’s always come from the top.

Starting in 2001, pathologists, forensic anthropologists and medico legal investigators at the PCOME looked for ways to improve their identification for anyone who had died in the desert.

They worked on process for tracing names and phone numbers carried in pockets or stored in cell phones. They developed partnerships with universities, law enforcement, community groups, consulates and embassies. They perfected techniques like searching for identifying marks on skin - tattoos, scars, birthmarks - with infrared cameras. They shared their results with other offices.

“It’s a field where a lot of sharing of information goes back and forth,” said Hernandez.

While searching for ways to improve their fingerprinting, Hernandez spent time studying his colleagues work and consulting with law enforcement who regularly took prints or used fingerprint databases.

Yet handling a case that requires rehydration is rare for most medical examiners and coroners.

Before coming to Tucson in 2007, Hess spent a year working in Milwaukee, which has a similarly sized jurisdiction. He encountered just one case of an unidentified body during that year — and that body was already suspected to be a specific person, a local man who had earlier gone missing so fingerprints weren’t a necessary part of confirming his identity.

“If you're starting with a presumptive ID it's just a process of elimination to see if the remains that you have are consistent with the suspected person you believe it to be,” Hess said. “Which is a lot different not knowing where to start to begin with.”

That’s why, when starting from scratch, readable fingerprints that can be matched to databases from law enforcement or state registries are so important.

“Other offices may have one case where it would be helpful for them to rehydrate mummified tissues once every two years,” Hess said. “so as people turnover is sort of like reinventing the wheel for those offices and learning it from scratch and people are kind of afraid to do it.”

That’s because if the process goes wrong fingerprints can be permanently erased.

“The risk again is always you can dissolve the tissue if your solution's the wrong concentration or you leave the tissue in the solution for too long and that kind of thing,” Hess said.

The PCOME started adding extra steps, carefully rinsing hands of debris and pausing the soaking process regularly to check pliability — sometimes even drying the hands again slightly. 

They kept scanning the prints for comparison to fingerprint databases where matches would be the first step in the process of tracking down family members who can confirm the identification through medical records or DNA.

“We started getting a lot of compliments from the identification folks that some of our prints were coming out fantastic,” Hernandez said. “Then I knew we were on to something.”
When Parks retired in 2011, Hess became supervisor of an office that's used the rehydration technique to obtain fingerprints more than 500 times since 2001.

“What kind of makes us unique about it is we just do so much more of it than other offices,” Hess said. “So we had the opportunity to practice using this technique and perfecting it.”

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At the beginning of 2013 Hess asked Hernandez if he was interested in working on a paper about the rehydration process.

“It had never crossed my mind so when he asked I took it on as a challenge,” Hernandez said.

Being asked to present at the NAME conference was also new to Hernandez, who attended for the first time last fall.

“It was a pretty big honor for me to go in front of this particular group of folks who were obviously very knowledgeable about these types of things, a little intimidating.”

The paper is now scheduled for publication later this year in the Academic Forensic Pathology Journal.

“I'm a little shocked by it but it's wonderful,” Hernandez said. “I'm just proud of the work that was put into it.”

“We've been lucky enough to be able to share a lot of this information,” Hernandez said.

Now the PCOME has also directly consulted other offices about the rehydration process including cases in Texas and Colorado.

“Since I've been back we've had at least four other counties contact us from around the country asking us about the process, asking us about you know steps and those types of things so the information is out there and folks are using it ,” Hernandez said. “It's practical.”

And there’s one more thing about the process: costing less than $100, it’s affordable for most local governments.

The Arizona climate and the PCOME's quantity of cases is unique but the work has national applications, Schmunk said. 

“It was not something that most of us I would say were very familiar,” Schmunk said. “It was a fairly new process that they came up with.”

Unidentified bodies may be a results of all kinds of situations where someone in the wrong place at the wrong time dies without their identification whether they left it behind intentionally, as people frequently do while going out to exercise, or their identification was lost, stolen or destroyed.

“If you would go missing this afternoon and you don't have any identification on you, we could identify you if we had your dental records,” Schmunk said. “But we need to know who your dentist is in order to get your dental records — so we have to have some kind of a clue.”

And then there are national disasters.

“Fingerprints in those circumstances can be very difficult if there's been decomposition or damage or trauma,” Schmunk said.

During Hurricane Katrina, Schmunk and other medical examiners trying to get fingerprints from victims faced a challenge from the flooding that was equal but opposite to the effects of the desert.

“We had a lot of people that came in there,” Schmunk said. “They were waterlogged, and that can do the same type of damage to your fingerprints and make them unidentifiable.”

While the techniques being used vary, the goals are the same: obtaining a name association. 

A name leads to family and friends who will recognize clothing or other objects found with the body, to medical and dental records that can confirm a positive identification.

“If you locate the family then essentially they have information,” Hess said. “You can go through basically what amounts to a missing persons report with them and compare that information to the remains that you found to see if it's possible that this could be the person.”

This part of the process can be tough for everyone — especially when the identification needs to be verified by dental records or DNA because the body, changed by time in the desert’s harsh environment, doesn’t look like the person friends and family remember.

“You have a family who has to take your word that this is in fact their loved one who they've been searching for for quite some time,” Hernandez said. “The double-edged sword comes into play where now you've found out that yes we've found them however they're deceased.”

However bittersweet the answers are, it means a family can end their search.

“That is an important part of our goal for serving our communities,” Schmunk said. “To make sure that people are reunited with their loved ones and this is one of the ways that we do it.”
Each step towards identification - each print, each process, each paper and conference — is made with these reunions in mind.

“Most of the time people are very relieved,” Schmunk said. “They can put it to rest, they can get some closure.”