From the professional perspective of a forensic pathologist, the manner in which the post-mortem investigation of the tragic deaths of more than 900 people at Jonestown, Guyana in November 1978 was conducted will always be recalled as an incredible debacle. There could have been no doubt that this bizarre and highly controversial event presented a scenario of unnatural death for hundreds of innocent victims. However, the exact cause and mechanism of death, and hence the manner of death, i.e., accident, suicide, or homicide, were not at all clear. In the absence of complete autopsies and toxicological analyses, performed by fully trained, experienced forensic pathologists and toxicologists in timely fashion, the answers to these basic, medico-legal investigative questions could not be ascertained. Is it conceivable that this incontrovertible fact was not known and appreciated by the U.S. governmental agencies that became involved and assumed official control of the overall situation and the deceased victims? What were the most likely reasons that this mass disaster was treated in such a seemingly insensitive, professionally incompetent, and woefully inadequate fashion?
Based upon public and private comments by various federal authorities in the U.S. immediately following the report of this horrific occurrence, it can be logically assumed that these deaths failed to arouse the sensitive interests and pragmatic concerns of the people in charge because the victims were perceived as “cultists.” The unspoken attitude was something along the lines of “What did you expect from such lunatics?” and “They got what they deserved.”
This insensitive, morally unacceptable belief was probably enhanced by the harsh fact that many of the victims had severed their strong, close family ties with next-of-kin in the U.S. at the time of this event. Hence, their relatives did not direct the kinds of individual and collective pressures directed toward U.S Congressmen, Senators, and other state and federal officials that might have resulted in the appropriate and timely disposition of the deceased bodies.
Of course, the fact that this disaster occurred in a third world foreign country did not facilitate the expeditious processing of these cases. Even allowing for all of the aforementioned negative reasons, I am confident this terribly botched-up aftermath of the Jonestown disaster would not have played out the way it did if these deaths had occurred anywhere in the U.S. No matter which of the 50 states might have been the site of such obvious unnatural deaths, the local Coroner or regional/state Medical Examiner would have had the full legal authority, as well as the governmental obligation and responsibility, to assume immediate jurisdiction and control of all the decedents’ bodies (except possibly the congressman, whose body could have been taken over by the federal authorities pursuant to a special law adopted by Congress following the assassination of President John F. Kennedy).
Although some criticism has been leveled against the Delaware Medical Examiner for not having intervened after the bodies were flown to Dover Air Force Base, the hard fact is that he had no authority to assume jurisdiction and perform autopsies on these bodies. Similarly, the military forensic pathologists could only do what they were ordered to do –or not do – by higher military and federal civilian authorities. Indeed, several forensic pathologists around the entire country (including this writer) volunteered to perform autopsies on these victims at no cost to their families or the U.S. government. To my knowledge, all these generous, spontaneous offers were completely ignored.
To the extent that a few autopsies were ultimately performed, they were not done in a timely fashion. Post-mortem decomposition obfuscated many gross and microscopic pathological findings, and either compromised or completely negated the validity of any toxicological analyses of body fluids and tissues.
We as a nation have dealt with one mass tragedy since Jonestown: New York City, September 11, 2001. The contrast between the way in which the Jonestown victims were handled and the procedures that were employed by the governmental agencies responsible for taking care of the 9/11 victims is truly shocking. The New York City Medical Examiner’s Office performed post-mortem examinations on all the recovered bodies in a timely manner, involving approximately three as many decedents as Jonestown. These were more physically complex than the Guyana case, and were even potentially hazardous. And yet it was accomplished, quite significantly, by a city government!
So, what should be done the next time such a mass tragedy occurs? Local, state, and federal authorities should move immediately to seal the site, bring in appropriate forensic scientific experts and law enforcement investigators, make arrangements to identify and process the victims, and then have each body autopsied by certified forensic pathologists as quickly as possible. Appropriate specimens should be obtained immediately for complete toxicological testing.
It should make no difference whatsoever who the victims are, what endeavor they were pursuing, what their race, gender, nationality, ethnic background, or religion may have been; or what their proclaimed sociopolitical views and agendas were. In death, insofar as objective, unbiased, intellectually honest, and non-governmental controlled forensic pathologists and other forensic scientists are concerned, everyone is equal. The determination of cause, manner, mechanism, place, and time of death are to be based upon complete, thorough autopsies, correlated with toxicological data, clinical medical histories, and scene investigative findings. These kinds of post-mortem examinations need to be undertaken in a timely, organized, and skillful fashion. (There is a newly-formed national certifying professional organization, The American Board of Disaster Medicine, and also the American Academy of Disaster Medicine. Detailed information can be obtained from these groups by any individuals, professional entities, or governmental agencies that would like to learn how to be better prepared for the handling of mass disasters.)
Anything less than this approach should be unacceptable to an advanced, democratic country such as the United States. The negligent fiasco and deliberate governmental machinations that followed the Jonestown disaster of 30 years ago must be strongly condemned and strenuously avoided. We can and must do better.
(Cyril H. Wecht, M.D., J.D., is the past president of the American College of Forensic Sciences, the past president of the American College of Legal Medicine, an Adjunct Professor of Law, Duquesne University, and a Distinguished Professor of Anatomy and Pathology, Carlow University. He may be reached at firstname.lastname@example.org.)