Episode 23: Dr. Gregory McDonald, Forensic Pathologist
Dr. Gregory McDonald, Dean of the School of Health Sciences and the chair of the Department of Forensic Medicine and Pathology at the Philadelphia College of Osteopathic Medicine, and chief deputy coroner for Montgomery County, Pennsylvania, speaks about his experience, career trajectory, and passion for forensic pathology.
Dr. Gregory McDonald
Gregory McDonald, DO, graduated from the Philadelphia College of Osteopathic Medicine in 1989. He went on to complete a residency in anatomic pathology at the Lankenau Hospital followed by a forensic pathology fellowship at the University of Pennsylvania and the Medical Examiner's office in Philadelphia, Pennsylvania. After completion of this fellowship, he served for 14 years as an assistant medical examiner in Philadelphia, Pennsylvania.
Dr. McDonald currently serves as Dean of the School of Health Sciences and is a professor and chairman of the Department of Forensic Medicine and Pathology at the Philadelphia College of Osteopathic Medicine. His work at PCOM also includes serving as the program director of the Master of Science (MS) in Forensic Medicine program. Dr. McDonald lectures extensively to DO, physician assistant and forensic medicine students as well as providing residents and attending physicians with continuing education programs. He has been the recipient of multiple awards for outstanding teaching.
In addition to his teaching duties at PCOM he has lectured regionally and nationally in subjects including post mortem changes, determination of cause and manner of death, blunt and sharp force injury, asphyxiation and child abuse. Dr. McDonald is also the chief deputy coroner of Montgomery County Pennsylvania.
He has served as the Vice Chairman and Chairman of the American Osteopathic Board of Pathology where he also is the Chairman of the subcommittee on Forensic Pathology. Certified in both anatomic pathology and forensic pathology, he has completed more than 8,000 autopsies and has testified in more than 800 court cases.
Intro Voices [00:00:05] Where do I go? It only happened once. I think I was singled out. The phone calls began about one month ago. What is hazing? Something happened to me when I was younger. I'm worried about my safety. He said he was sorry. Can someone help me? Where can I get help? Can someone help me?
Intro Voices [00:00:31] This is “You Matter”, a podcast for the NYU community developed by the Department of Public Safety.
Karen Ortman [00:00:37] Hi, everyone, and welcome back to “You Matter”, a podcast created to teach, inspire and motivate members of the NYU community who have been victimized in some form or fashion and to identify resources both on and off campus that can help. I am your co-host, Karen Ortman, Assistant Vice President of Field Operations at the Department of Public Safety and a retired law enforcement professional.
Sabah Fatima [00:00:59] And I am Sabah Fatima, a pre-med graduate student here at NYU College of Global Public Health.
Karen Ortman [00:01:05] Today we introduce Dr. Gregg McDonald, chief deputy coroner for Montgomery County, Pennsylvania, and the Dean of the School of Health Sciences and the chair of the Department of Forensic Medicine and Pathology at the Philadelphia College of Osteopathic Medicine. Welcome, Dr. McDonald. Thanks for being here.
Gregg McDonald [00:01:24] Thank you. Thank you. It's a real honor.
Karen Ortman [00:01:26] So, Dr. McDonald, can you explain to our listeners the difference between a variety of terms: pathologist, coroner and medical examiner?
Gregg McDonald [00:01:37] A pathologist is a physician who has gone through medical school residency and usually a fellowship. And they specialize in diseases or in evaluating diseases, diagnosing tumors and what have you. The term forensic pathologist is a little bit different. Those are also physicians who go through residency and fellowship, but they specialize in examining deceased individuals, mostly unnatural deaths, homicide, suicides, evaluating trauma and time of death, manner of death, etc. Now, a medical examiner is an appointed position. It's not a degree. It's a title, essentially. And a medical examiner is almost always a board certified forensic pathologist. And they tend to be in large urban areas and it's appointed by the governor, the health commissioner or someone in that kind of capacity.
Karen Ortman [00:02:37] So of all the titles that we just spoke of which apply to you?
Gregg McDonald [00:02:43] I'm a forensic pathologist. I am a deputy coroner and a coroner, at least in Pennsylvania, is an elected position. The chief coroner in the various counties in Pennsylvania are elected. So they could be - they don’t have to be a physician. They could be anyone who has a high school diploma, who does work in the general forensic field and they get elected, they can serve.
Karen Ortman [00:03:16] Wow. It's interesting. So for your position and your sort of path of travel to arrive where you are today, what is your educational background?
Gregg McDonald [00:03:34] I was a biology major at Villanova University, pre-med. I then went to the Philadelphia College of Osteopathic Medicine, where I received my Doctor of Osteopathy degree. And I went on to do a residency in pathology. And then I did a fellowship in forensic pathology at the Philadelphia Medical Examiner's Office. And following that, I was offered a job as an assistant medical examiner for Philadelphia, where I served for 14 years. And then I decided to transition to teaching full-time. And that's what brought me to where I am today.
Sabah Fatima [00:04:15] Well, what made you want to go into forensic pathology?
Gregg McDonald [00:04:18] People ask me that a lot, and I'll be honest with you. My bedside manner wasn't always the best, maybe. And I found that I really liked to look at tissue. I really don't like dealing with the abstract. I want to look at tumors either grossly with my naked eyes or microscopically. And that's what I wanted to do and actually get in there and see the things that would kill people or contribute to their death, anyway. And I found the second day of my fellowship that was what I wanted to do the rest of my life. I knew I had a definite calling for it. And term forensic relates to the field of law. You know, like for- comes from “forum” where there's a debate. So in forensic pathology, we have to testify quite frequently in mostly homicide cases. And I found that at least initially, it was very intimidating. And the first couple times were pretty scary for me. But then I found my way and I became pretty good at it. And I really enjoyed it actually.
Sabah Fatima [00:05:30] Good for you.
Karen Ortman [00:05:30] So you spoke about testifying in homicide cases and other probably legal matters. And I'm sure that much of which you testified about were the autopsies that you performed or the postmortem investigations.
Gregg McDonald [00:05:49] Yes, that's correct.
Karen Ortman [00:05:51] So let's talk about that a little bit. What is an autopsy as compared to a postmortem examination or is it the same thing?
Gregg McDonald [00:06:02] It's generally the same thing. Most people use those terms interchangeably. An autopsy is the examination of a dead body. It's conducted in a couple of different phases. The first phase is what we call the external examination, where we're looking at the outside of the body. We look for hair color, eye color, height, weight, anything that may identify the person; scars, tattoos and obviously any type of injury. And we're going to note that, we're going to take photographs of that before we do any incisions on the body. And after that's done, then we go to the internal or an inside examination of the body.
Karen Ortman [00:06:47] So before we get to the inside, can you speak to some of the interesting observations that maybe people aren't aware of that can be found in the external examination of the body?
Gregg McDonald [00:07:05] Good question. One of the things that we do is determine how much rigor mortis is there, stiffening of the muscles after death, and also livor mortis, which is settling of blood in the body after death.
Karen Ortman [00:07:16] And why are those two things significant?
Gregg McDonald [00:07:19] That can tell us a couple things. It can maybe narrow down the time of death. It may be able to tell us what position the person was found when they died, was a body moved? Because if we find a body and their position, the rigor mortis is inconsistent with how you found it. Maybe they were moved previously. And so those are two pretty important things that we look for.
Karen Ortman [00:07:44] Now, the second examination that you do beyond the observation of the body is?
Gregg McDonald [00:07:51] The internal examination.
Karen Ortman [00:07:54] And can you speak a little bit about that?
Gregg McDonald [00:07:57] Yes, that is conducted, and there's a few different methods to use. But usually it starts with a Y-shaped incision in the body. And then we remove the organs. And every pathologist has his or her own way of doing that. But generally there are two ways: we take out all the organs in one big section of tissue and then dissect them individually or we take the organs out individually and examine them one by one.
Karen Ortman [00:08:24] So what are you looking for when you examine the organs?
Gregg McDonald [08:29] In general, we’re looking for any documentation of natural disease processes. Did they have a heart attack? Did they have hardening of the arteries? Was there a stroke? Was there pneumonia, cirrhosis of the liver? Any types of tumors? Obviously, signs of heart failure. Those are things that we look for for every case. Now, if the person had injuries, and externally, if we see a gunshot wound, then we certainly want to track that wound path throughout the internal organs and note the path of it. And a very important part in a gunshot wound case, if there is a bullet still in the body, we need to recover that, because that is very important as far as ballistic evidence. We give that to the police department and then they would evaluate that.
Karen Ortman [00:09:21] So during the process of the external examination as well as the internal examination, is the process itself recorded or documented in any way?
Gregg McDonald [00:09:32] It's recorded on photographs.
Karen Ortman [00:09:35] And who would be taking those photographs?
Gregg McDonald [00:09:37] I may take some of them, but I always work with an autopsy technician and he or she would take the majority of them.
Karen Ortman [00:09:47] When is an autopsy legally required?
Gregg McDonald [00:09:52] In a medical examiner or coroner's jurisdiction, there are certain cases that they take jurisdiction in. They don't get everyone who dies. This weekend I'm working in Montgomery County, Pennsylvania, and I will not get everyone who dies there.
Karen Ortman [00:10:08] Why not?
Gregg McDonald [00:10:09] Well, we're pretty selective about the cases, because once we take jurisdiction in - when I say we, it's the royal “we”, coroner and medical examiners - once we take that jurisdiction, we’ll decide whether an autopsy is done or not, even though the family wishes autopsy is not done. We still could override them. And we take jurisdiction typically in cases of unnatural death. Homicide, suicides, accidents, or something that may fall in between those categories. We called an undetermined case. So anything that may be maybe somewhat suspicious, we would do the autopsy.
Karen Ortman [00:10:44] How about just an unattended death?
Gregg McDonald [00:10:48] It depends with the unattended death on the age of the person, do they have pre existing medical conditions? Are there signs of breaking and entering in their home? Those are the things. And if it's a really elderly person and they were found maybe by their family members, we generally would not bring that kind of case in for a jury for examination.
Karen Ortman [00:11:12] They're probably under the care of the physician in any instances?
Gregg McDonald [00:11:16] Yeah. We would contact their physician and they would tell us what kind of medical history they had. And most times we would let that go.
Karen Ortman [00:11:26] Now, you mentioned that sometimes a family might object to an autopsy being conducted. Under what circumstances would that happen? And under what circumstances do you sort of overrule that objection?
Gregg McDonald [00:11:46] Many objections are on a religious basis, the family may, whatever their religion may be, have a prohibition against autopsies. Now, generally, in almost every case I've had or that if I work with the family, speak to the family, maybe speak to their clergymen or clergy person, and we can usually work out some kind of understanding. I've been doing this almost 30 years and I think there's one time where we could not reach that understanding.
Karen Ortman [00:12:17] So what happened in that one instance?
Gregg McDonald [00:12:20] That went to court.
Karen Ortman [00:12:21] And was the autopsy performed?
Gregg McDonald [00:12:23] No, no, actually, it was not. The court gave us a court order not to perform the autopsy.
Karen Ortman [00:12:34] Can you explain to our listeners the stages or steps of the autopsy and what you're trying to determine at each stage or step
Gregg McDonald [00:12:45] Of the external examination? I'm looking for the things I described previously because one of our goals is to identify the person or confirm their identity. Sometimes we have people, we don't know who they are. We get fingerprints and what have you. So we also look for trauma. We look for signs of gunshot wounds, stab wounds, strangulation, you know, any neck injury that there may be. And then as we proceed through the internal examination, I typically start dissecting the heart first and looking for coronary artery disease, hardening of the arteries. Any valve problems that may be present in the heart? I look at the heart muscle to see if there's any infection there or any signs of an old or new heart attack. We call it a myocardial infarction. Then I move on to the lungs. I dissect the lungs out, looking for tumors, any type of fluid that may be in the lungs; mucus, pus, anything that may be indicative of pneumonia or some other infections. And I move through the gastrointestinal tract from esophagus, stomach, etc., looking for tumors, injuries. The stomach can be important when we examine the stomach contents. That can be important for toxicology, if the person swallowed, took a lot of pills, maybe it was a suicide attempt. It can also help us sometimes determine the time of death. If we know the time the person ate and depending on how well digested the food was, we may be able to extrapolate to when we think they may have been killed or died.
Karen Ortman [00:14:25] Now what about the brain? Is the brain dissected?
Gregg McDonald [00:14:29] Yes. Yes. And that's one of the most important parts. And in most cases, oftentimes that's a target of injury. Gunshot wounds, beatings, what have you. So we look at the scalp. We look at the skull. Make sure there's no fractures in the skull. Make sure there's no bony tumors. And then we remove the brain and dissect the brain, again, looking for signs of a blood clot that may have been produced by trauma or strokes or tumors or something in between.
Karen Ortman [00:15:01] So all of these tissue samples, you know, the contents of the stomach, brain, brain tissue. Where are these specimens sent to for analysis? Or do you conduct the analysis?
Gregg McDonald [00:15:20] I will take representative sections and I will hold on to them in the formal - we have a formal chart that we hold onto for five years or so. But I also take different sections, smaller sections and make microscopic slides out of them. Cause that's, I can oftentimes tell if an organ is diseased by looking at it with my naked eye. But sometimes I need a microscope either to confirm that or to find something I couldn't see. So I'll take different sections, heart, lung, etc. and then make microscopic slides and view those.
Karen Ortman [00:15:55] So how long does it take from the moment you begin the exam, from the external view of the body through to the internal examination and then preparing the slides and analyzing them. Like what is this process in terms of time look like per case?
Gregg McDonald [00:16:04] A relatively uncomplicated case where there's not any injury, there's not a lot of natural disease to document, I can do it in a little bit over an hour.
Karen Ortman [00:16:24] Well, that's surprising.
Gregg McDonald [00:16:26] Yeah. Yeah. In those cases I can. Now, there are complicated cases, if someone had sustained 30 gunshot wounds, that can take hours and hours. If there's a sexual assault, we have to obtain a lot more evidence there. And so that could take eight hours. So it really varies from case to case.
Karen Ortman [00:16:47] Understood. OK. When are the results of the toxicology tests known?
Gregg McDonald [00:16:58] Generally in our office, and most offices, within six weeks, unless it becomes a complicated case where we're looking for something specific that may not be easily found, and then it may take a little bit longer.
Karen Ortman [00:17:12] Can you share with our listeners the types of specimens collected for the purposes of a toxicology examination?
Gregg McDonald [00:17:19] Typically, we get blood from a couple different areas in the body, usually around the heart, and then down in the veins or, excuse me, arteries up the leg.
Karen Ortman [00:17:28] What would be the difference between the two?
Gregg McDonald [00:17:31] Good question. There is a concept for certain drugs and medications that we call postmortem redistribution. So if it's present say in the stomach, if you take certain medications and they’re sitting in the stomach, that's pretty close to the heart. So you may have a falsely elevated blood level around the heart. If this, during the postmortem interval, you have transfusion of some of the medication or drugs from the stomach into the blood around the heart. But if you go to, let's say, the femoral artery or femoral vein, which is down the legs, that postmortem redistribution typically does not get to that point.
Sabah Fatima [00:18:14] Wow, I was unaware of that.
Gregg McDonald [00:18:17] Yeah, a lot of people aren’t. And not all medications will have that redistribution, but many do. So we, in an abundance of caution, we would get both specimens. We also get stomach contents if there’s stomach contents, urine, bile. And in certain cases, we'll get vitreous humor, which is the fluid in your eye. We'll remove that as well. So those are some of the typical specimens that you would get on almost every case.
Karen Ortman [00:18:44] Thank you.
Sabah Fatima [00:18:45] Because of your profession, how do you approach the loss of your own loved ones who might have to undergo an autopsy?
Gregg McDonald [00:18:53] Well, if it has to be done, it has to be done. And I know that we need to do that. And I certainly would not object to that in any way. And many people don't quite understand the whole role of the autopsy. I'm glad that we're being able to discuss it. In many cultures, it's taboo. And a lot of people just don't like discussing death in general, let alone the autopsy process. But it really is a great tool for learning, documenting diseases. But in my field, what we do it for is for analysis for a legal case. And that may result in someone being prosecuted. It may result in someone being set free. And so that's what I think is so important. And so if it ever were to occur where a family member would have to have a examination, I certainly would support that.
Sabah Fatima [00:19:53] Yeah. It also gives them a peace of mind, I would suppose.
Gregg McDonald [00:19:56] Yes. In many cases it does. If you have a young person who died and you don't know why, if we can provide the answers to the family, that gives them a little bit of comfort.
Sabah Fatima [00:20:08] So I know you said that if it's a normal autopsy it usually takes an hour. But who pays for the cost of this, if it takes more than that.
Gregg McDonald [00:20:18] Well, it's built into the cost of whatever government agency is heading the medical examiner's office or coroner's office. So in Philadelphia, it was the Philadelphia Health Commissioner, the health department. So it's really tax based. It's not - the families don't have to pay for it. Insurance doesn't have to pay for it. It's like, you know, you wouldn't have to pay for police services or 911 services. So it's built in. If it comes under a coroner's office jurisdiction or medical examiner's office jurisdiction, then there's no fee passed on to the family.
Sabah Fatima [00:21:00] What is the most difficult case that you have handled?
Gregg McDonald [00:21:04] Well, I've had a bunch. There's many, and they're difficult in many other ways. In general, some of the most difficult ones I have are children who have been abused or neglected. One of the very first cases I testified in was a very young child who was six months old. And the mother just refused to feed or give him water. And there was like, no fat left on the child, the child was completely emaciated. And to understand how a young child would go through that. It wasn't a quick death. It was slow and lingering. And I had to describe that when I testified. And so that certainly, you know, that type of thing sticks with you. Any type of person who's in a vulnerable position, the elderly, you feel bad for as well. I've had a case where elderly were beaten to death, maybe sexually assaulted, children who were sexually assaulted and sustained multiple injuries. Those are certain ones that really kind of stick with you. And you know, especially when, I have two boys, and especially if the age of the decedent kind of matched the age of one of my sons, it kind of hit home a little bit.
Sabah Fatima [00:22:26] Do autopsies ever interfere with open casket funeral services?
Gregg McDonald [00:22:30] That's an excellent question, and they should not. We go beyond - we do our best to make our incisions in places where it could be covered up by clothing or in certain makeup, sometimes by the funeral director. And we pride ourselves in doing autopsies where the person can be viewed with an open casket if the family wishes so.
Sabah Fatima [00:22:58] If you could go back in time to when you first entered this field, what advice would you give yourself?
Gregg McDonald [00:23:05] You're doing the right thing.
Karen Ortman [00:23:08] Wow.
Gregg McDonald [00:23:09] Yeah, I mean, I really think that if any one was made for a job, this was made for me and vice versa. Yeah. And once I got over my fear of testifying and public speaking, you know. I really was terrible, really afraid of public speaking. And I took a small course, like a community college course, and that changed everything. For 50 bucks, it was, and it was probably the best 50 bucks I ever spent. And now I like to think I'm a pretty good expert witness and I'm respected by both the defense and the prosecutors.
Sabah Fatima [00:23:49] Amazing. Good for you. At least you're really passionate about it.
Gregg McDonald [00:23:52] I am. I love it. Thank you.
Karen Ortman [00:23:56] Thank you so much for coming here today and talking to us.
Gregg McDonald [00:24:01] Well, my pleasure. My pleasure. Thank you.
Karen Ortman [00:24:03] Is there anything else that you would like to share with our listeners?
Gregg McDonald [00:24:06] Just that, you know, the field of pathology is pretty interesting, forensic pathology, and we have other people besides forensic pathologists who help us out. We have autopsy technicians. We have forensic investigators, they're typically the people who go to the scenes. I will go to a scene once in a while if it's really needed. But they're the ones who are going out, those cold scenes at 3:00 in the morning and documenting things. And I’ve been at my work at PCOM, I've been happy that I was able to develop a Masters degree program to help train forensic investigators.
Karen Ortman [00:24:42] Oh, that’s great.
Sabah Fatima [00:24:42] Incredible.
Gregg McDonald [00:24:44] Yeah, because we started this in 2002. Prior to that, there was really a paucity of training programs for forensic investigators. Many of them just had high school diplomas and they really wanted more. But then on the other end, the pathologists who have, you know, tons of training and a board certification. But there wasn't the same thing, though, for investigators. And I wanted to develop a program that would narrow that gap. And I think we've been pretty successful at PCOM
Karen Ortman [00:25:16] It’s probably pretty popular, too.
Gregg McDonald [00:25:17] It is, it's popular among a variety of different people. We have law enforcement people coming in, we have physicians coming in. Actually, we've got retired physicians, teachers, nurses are being a part as well and wanting to look to make a career change, perhaps. And people who want to go to medical school, they may use that as a stepping stone.
Karen Ortman [00:25:42] I'm sorry, tell our listeners again what PCOM is.
Gregg McDonald [00:25:44] PCOM stands for, the Philadelphia College of Osteopathic Medicine. And I'm the Dean of the School of Health Sciences there. And I've received the forensic medicine program, the physician assistant program, the physical therapy program and various biomedical science master's degree programs.
Karen Ortman [00:26:02] And I'm sure you have a Website if any of our listeners are interested in checking out your school.
Gregg McDonald [00:26:07] Sure. PCOM.edu. Very simple. And go there and you’ll see my autobiography, so to speak, and something about the programs, we offer other programs, the medical School where I graduated from, we have a series of psychology programs, pharmacy programs. And so we're expanding and we're very proud of that.
Karen Ortman [00:26:33] Great work, Dr. McDonald.
Gregg McDonald [00:26:36] Thank you, thank you very much. Thanks for having me.
Karen Ortman [00:26:37] Thank you so much for being here.
Sabah Fatima [00:26:40] Thank you to our guest, Dr. McDonald and to all of our listeners for joining us for today's episode of “You Matter”.
Karen Ortman [00:26:45] If any information presented today was triggering or disturbing, please feel free to contact the wellness exchange at 212-443-9999. You can also get in touch with NYU’s Department of Public Safety and their Victim Services Unit by calling 212-998-2222.
Sabah Fatima [00:27:06] Make sure to rate, review, and subscribe to more podcasts like these on Apple Podcasts, Google Play and Spotify.