TOPICS > Health

Extended Interview: Dr. Charles J. Stahl, M.D.

September 21, 2001 at 12:00 AM EDT


SUSUSAN DENTZER: Let’s talk about what is happening even as we speak as remains are being recovered at the Pentagon.

DR. CHARLES STAHL: Several things are happening simultaneously. The remains are being recovered. They are being transported to Dover Air Force Base in Delaware by helicopter at this time, and depending upon the extent of the recovery, which I think will proceed rather slowly, this may be the major mode of transportation, but if a large number of remains are recovered at some point in time, they may use other alternative methods such as trucks or other situations.

At the same time, the information about the aircraft that hit the Pentagon will be transmitted to the Armed Forces Institute of Pathology. So they need a list of the passengers, crew members, and other persons who were known to be on that aircraft.

They also need to know who is missing in the Pentagon, and the list of these personnel will be, again, submitted to the Armed Forces DNA Identification Laboratory. And they will then match up those names with special names in the repository and have them available as the remains are recovered.

In the meantime, teams are assembling at Dover Air Force Base, and these include members of the staff of the Armed Forces Medical Examiner.

At the present time, I don’t know exactly how many people are involved, but certainly the Acting Chief Medical Examiner is involved, the forensic anthropologist who is the Deputy Chief Medical Examiner, and other members of the staff will be there to receive the remains. …They will be assisted by members of the FBI Disaster Squad, who will attempt to identify these people through fingerprint identification, if that is possible.

They will have also on hand photographers, radiologic technicians, and personnel from Dover Air Force Base, including most likely reserve personnel who have been brought in to assist to transport of remains from one point to another. So this is generally what is happening.

They will have photographers, medical photographers on hand to photograph the bodies. They will have people to operate fluoroscopic equipment and x-ray machines, including dental x-ray machines. A large number of people will be involved.

SUSAN DENTZER: What is out at Dover?

DR. CHARLES STAHL: Dover is a unique facility. Years ago, it was established as a port mortuary to receive casualties from the European theater.

More recently, during the Gulf War, they found that it would be best to examine remains at that point. In fact, before that, there had been several major disasters where remains from not only American civilians abroad, but also military personnel were brought into Dover and examined there simply because they have adequate space, adequate security, and the ancillary personnel needed to assist the forensic pathologist and others in identification.

But since the Gulf War, the facilities have been greatly improved. They are excellent. They are unique and probably the only facility of its type–of this type which are available in the United States anywhere. Hundreds of people can be evaluated at one time.

To do this, you have to have an orderly progress through the facility in order to understand how this is actually being done.

SUSAN DENTZER: Why is it that hundreds can be accommodated? Is that a function of lack of space or equipment or what?

DR. CHARLES STAHL: Well, it is based–initially, it was based during the Gulf War upon the potential predictions that there may be hundreds of casualties, including people who were killed in action. This didn’t really happen, as you know, and yet, since that time, this facility has been used on multiple occasions for mass disasters involving military aircraft accidents or other types of events in the military services.

And people can assemble very quickly. They are familiar with the spaces. They are familiar with the stations, and they are assisted by well-trained military personnel who are able to get the job done in the least amount of time.

SUSAN DENTZER: Now, as you mentioned, there are several modes of identification. We talked about one, a very common one, [which is visual identification.] Let’s talk about that and why are families not involved in that process.

DR. CHARLES STAHL: Well, there are two situations. One is the civilian situation where a person may be found dead in a home or perhaps in a garage or sometimes out of doors, and the question is who is this person. So one of the questions that has to be answered by the Medical Examiner in any community is first who is the person that we found, and in order to accomplish this, some method of identification has to be used.

Now, in the civilian situation, very often a member of the family will come forward and say my father or wife or child is missing, could this be that person, and in most Medical Examiner’s offices, there are facilities for family member to look the remains in a proper area and to determine whether or not this may be their loved one.

In most military situations, this is not the case. Very often, the remains in aircraft accidents are fragmented. There may have been fire, and there are thermal effects. There may be some delay in recovery or maybe decomposition. So all of these things preclude visual identification of the human remains.

SUSAN DENTZER: And I understand visual identification also can be very unreliable.

DR. CHARLES STAHL: Yes. Sometimes family members are very anxious to say that, yes, they recognize these remains as their loved one when, in fact, they hastily made a decision and it was sometimes wrong. So, consequently, this not always a reliable method of identification.

The same is true for personal effects and clothing. That when people report someone missing, they are trying to remember what was that person wearing, what kind of shoes, what kind of jacket, what was the color of the clothing, and sometimes this information is not reliable simply because they are uncertain of what they saw on the day the person became missing.

As far as personal effects are concerned, very often in civilian life, there may be interchange of personal effects. People loan articles to one another or sometimes there is an attempt at concealment in homicides where people actually remove the personal effects and substitute them with something else. So we have three factors, one of the visual identification, clothing, and personal effects, which may or may not be reliable in all cases, and certainly not in the situations we are describing now.

SUSAN DENTZER: Let’s talk about some other means of making identification of remains.

DR. CHARLES STAHL: For military personnel and certain civilian personnel in the Federal Government , there are DNA records available. So, once we know who is missing, who was on the aircraft, these records can be made available to support the identification, and, of course, you are matching up the records on file which primarily consist of drops of blood on a filter paper to any specimens that are obtained from either an individual or from body parts at the time the remains are examined.

In civilian life, an effort should be made to do the same thing, although you may not have a record of that individual in a repository. So, consequently, you would want to obtain various samples from the family, blood samples from parents, wife, children, and others who may assist in identification by providing a sample that could be compared against that sample from the deceased remains.

And you can also use things like toothbrushes or clippings from shaver, either a man’s shaver or a woman’s shaver, and sometimes even as remotely as we might thing, a licked stamp or an envelope which may help in identification. So all of these things need to be accumulated at the onset as well as dental records, health records, x-rays, dental x-rays, and other things that can be compared against information derived from the examination of the remains.

SUSAN DENTZER: What about fingerprints?

DR. CHARLES STAHL: Fingerprints, of course, are almost always available for military personnel and Federal civilian employees and certain other personnel in the Government, but they are not always available for civilians unless they have had a criminal record or it was required as an item for their employment. So not all civilians have fingerprints on file.

The FBI Disaster Squad will work with the personnel at Dover, for example, and take fingerprints from remains that are available, including fragmented remains, and compare them with fingerprint records on file at the FBI, and if they make a match, that will enable you to make an identification which would then be confirmed by either dental records or DNA.

So, at Dover, there will be several different stations. As the remains arrive, some of them may have flouroscoped or x-rayed in advance, particularly those people that may have had some relationship to the aircraft to determine are there any missiles within that individual, are there any undetonated devices that may pose a hazard to other people. We look at these things particularly in wartime. They are certainly less expected at this time with these cases.

Then the remains are taken to a point where they go through a certain orderly process. One of the first steps is to photograph them, and when I say photograph the remains, I might be talking about photographing whatever was found in that body bag or pouch, which may be a body part or may be fragments. So each of these bags or containers will be numbered, and each one will be examined individually.

And, of course, as they are moved from one point to another, you have to have personnel available to assist in the transport of these remains from one point in this large facility to another.

After photographing, if there are remains available with clothing and personal effects, these items are documented. So every information–that might include wallets, ID tags, ID cards. Anything that would enable you to make an identification will be documented at the onset.

And generally, the remains will then be removed to the next station which would be perhaps fingerprinting, and the FBI Disaster Squad will be involved, sometimes assisted by one of the military investigative agencies. So they will work together as a team.

One of the third steps would be dental examination. At this point, if there are dental records available, they will be compared with whatever is found as a result of a dental examination, which may include not only the charting of any teeth, but also dental radiographs. And, of course, you need to compare them with available dental records, including x-rays.

The next step would be a point where the remains are examined externally and a determination is made whether or not to do an internal examination. Generally, in military situations, the air crew members have a complete post mortem examination, but this doesn’t necessarily apply to all other people. So it depends on the circumstances whether or not you have sufficient information to determine the cause of death and the manner of death and the identification of the individual because at times you need to do a complete examination. At other times, an external examination may be sufficient.

At the same time, evidence is being collected. This evidence will be used to support any DNA examinations to assist with the investigation of the deaths, and in this case, we are talking about a criminal investigation, and also used to perform toxicologic studies [to determine if the individual consumed drugs or alcohol. This would be especially relevant in the case of] assailants. They are part of the remains found in the aircraft perhaps, and we need to determine are these individuals taking any drugs that would enhance their performance of this type of a violent act. And this is where forensic toxicology studies become important. They are also used for air crew members. So, in both civilian and military aircraft accidents, toxicologic studies for drugs and alcohol are also conducted on all air crew members.

The last for military personnel would be preparing the bodies for burial and receipt by the families, and at Dover, they have not only uniforms from every service for every rank with also the appropriate awards that the individual received, so that when the remains, if they are intact, are [inaudible] and transported back to the family, they will be prepared for a military burial.

Civilian remains would be prepared for receipt by a funeral director, and the whole process is dependent upon the rate of recovery. And that’s one of the problems I see in this case.

SUSAN DENTZER: What do you mean by that?

DR. CHARLES STAHL: I think recovery will be rather slow. That all of these people are assembled to receive all the casualties at one time, and yet I think that the actual recovery will be rather slow and proceed slowly simply because they have to be concerned about the safety of rescue personnel.

They have to be concerned about going through all the rubble and debris. They have to be concerned about fires that fired up on occasion, and in order to end up with an appropriate identification, you have to be very careful about the removal of any remains or body parts from debris in order to assure that they are not damaged or destroyed in any way that would preclude identification.

I think the obstacles that we need to consider are the fact that, one, the recovery may be rather slow because of potential collapse of the remaining structures in the building, the possibility there may be fires again, and also that the remains have to be carefully recovered from the rubble. And all of these things may not proceed rapidly.

Consequently, large numbers of people are assembled at Dover to receive these remains, and they may arrive on a staggered basis. So the rapidity of identification and processing of the remains may be delayed. I think people need to realize that. This is not going to be a fast process.

The second obstacle that I see particularly for the civilian personnel aboard the aircraft is the fact that there was a major fire, and some of the traditional methods for identification such as fingerprints and dental identification may not be available, even though records might be found by the family or other agencies. So, consequently, you will have to rely on DNA identification, particularly if there is fragmentation of the remains, and since there is no repository for these individuals, that means that you have to go back to the family again to get samples that would be suitable for comparison with fragmented remains or incinerated remains or other body parts, and, again, this will take time.

SUSAN DENTZER: You mentioned the difficulty that would be involved in identifying remains from the victims of a plane, a plane crash. What is the worst-case scenario you might be dealing with? Attempting to identify a bone fragment, and a burned bone fragment at that?

DR. CHARLES STAHL: You can use almost any fragment, if that is what you are thinking of, whether it is a bone fragment or a fragment of skin or scalp with hair. So any of these things are potential sources for DNA.

Now, however, with decomposition, DNA may degrade and be the best reliable as far as finding on a particular specimen.

With incineration, of course, the outer portion of a specimen or a body may be charred, but the muscle tissue may be well preserved and suitable for DNA analysis.

SUSAN DENTZER: Now, to try to extrapolate from the situation that we are facing now at the Pentagon to the situation in New York where vastly, vastly many more people clearly died, how do you begin to compare the extent of the effort that will be necessary in New York to identifying bodies?

DR. CHARLES STAHL: I don’t think anybody has had any experience of this magnitude in recovery from one or more sites or in the identification of this number of people at one time, and, again, I think this is going to require a long process. I don’t know how long, and it will require eventually many different people as far as multidisciplinary teams and involvement by families because all of this information that I mentioned has to be provided by someone to compare against the remains that are found.

I think that you may expect a lag time between the recovery and the time that identification can be accomplished. … During this time period, I would attempt to obtain all the information possible about the missing persons in a particular building. That would include not only their dental records, health records, any x-rays for a given individual as well as fingerprints if they have them on file or if there is a knowledge that they were ever fingerprinted.

In some cases, if the person is relatively young, there may be records available in the State health department dealing with the test for phenylketonuria (PKU) when they were infants. Remember with infants, after they are born, people test them for PKU, and very often those specimens may have been retained in some repository.

There may be a specimen such as surgical specimens that are embedded in paraffin. A person had a mole removed and examined. That might be available for comparison.

They may have had a cytologic examination if they were a woman and had a Papanicolaou smear at one time. That slide might be available. So all of these things should be assembled at some point and made available then when identification becomes feasible. This will take a long process.

And the other thing is we are talking about large numbers of people. No one has ever encountered anything quite like this at one time, and you need to have some computer program that will collate all of this data so that you will be able to interpret what does this mean, who is this individual, how did they die, when did they die, and all of the questions that you need to answer. So the responsibility of the Medical Examiner will be severalfold: identification of the remains, determination of the cause of death, and determination of the manner of death.

And, of course, since these deaths occurred at the hands of other individuals, the terrorists, they would be considered for the most part as homicides rather than any other manner of death.

The Medical Examiner has the responsibility to make these determinations and complete a death certificate, and that, of course, will be used as the basis for insurance claims, settlement of estates, and other financial endeavors that will impact on the family. This is why the United States families really need to know who died in a particular incident.

I have had questions in the past, why do we bother with all of this, it is very expensive, too many people involved, why don’t we just say they were in that building and forget about it. Well, that’s unacceptable in the United States….The first reason is the family, the loved ones want to have their remains of their loved one returned to them so they can have a proper burial and funeral and have closure, and the other reasons are financial.

SUSAN DENTZER: What you are describing that will have to be accomplished now under the Medical Examiner of New York is an unprecedented effort not only just at the recovery process itself and the cataloging process, but also the gathering of all these samples, the processing, as you said, the computer, the information technology aspects alone. This is mind-boggling.

DR. CHARLES STAHL: That is mind-boggling, and I can’t tell you at this point how this is going to be accomplished or when it will be accomplished. I don’t know.

SUSAN DENTZER: You said in the case of the New York situation, there will have to be an effort to accumulate lots of different means by which identification can be made, that is to say, dental records and even potentially tissue from prior surgeries and so forth. Whose responsibility is it to assemble all of that? Is this up to the families themselves?

DR. CHARLES STAHL: Well, not necessarily. I think that some guidelines will be given to the families by the Office of the Medical Examiner, New York City, or the law enforcement agencies. And in some cases, not only [for] passengers, but air crew members, the airlines will provide some assistance. So the assistance will come from different sources.

Sometimes the companies themselves will be involved. I know we were involved in one military and Federal civilian crash that included some businessmen, and going back to the company and saying this is what we need to help in identification, the company went out and got this information for us. So very often, since there are multiple offices in those buildings, you may get some assistance from the corporate personnel.

Right now, you see people wandering around New York City looking for their loved one in 25 or 30 hospitals, and they really have no central source of information, or if they do, they are unable to reach that information because the telephone lines are all busy or not available to them, and this is one of the problems.