Death in custody is the most demanding investigation that a medical ex
aminer or coroner can perform. The investigation requires attention to
detail at the time of scene investigation and autopsy examination, as
well as a careful assessment of the toxicologic results and circumsta
nces of the death. Synthesis of the many facts that are developed duri
ng the investigation should allow the medical examiner or coroner to e
stablish a reasonable cause of death. It is incumbent on the medical e
xaminer and coroner responsible for investigating deaths of these type
s to utilize all the information generated during the investigation an
d to identify an appropriate cause of death.