History of the Forensic Pathology Service of Hong Kong

In 1949, a Forensic Laboratory, the precursor to the Forensic Pathology Service, was established at the Police Headquarters by Dr PANG Teng-cheung (彭定祥), the founder of the Service, who was appointed the first Police Surgeon in Hong Kong. His post title was changed to Forensic Pathologist in 1956. He was promoted to Senior Forensic Pathologist in 1957 and later appointed as Specialist (Forensic Pathology) in 1961. In its early days, the Service dealt with medico-legal autopsies that were likely to be followed by court proceedings, clinical examination of victims and suspects of crime, crime scene investigation as well as blood stain examination. Its work falling into the arena of forensic science was gradually taken over by the Forensic Science Division of the Government Laboratory in the 1970s. In 1981, the Service took over the management and operation of all public mortuaries under the purview of the then Medical and Health Department, namely Kowloon Public Mortuary located at Hung Hom and Victoria Public Mortuary located at Kennedy Town. The third public mortuary, named Fu Shan Public Mortuary, commenced operation in March 1989 at Tai Wai, Shatin. In September 2005, the new Kwai Chung Public Mortuary commenced operation, while Kowloon Public Mortuary ceased operation and was reserved for contingency use. To cope with the increasing service demand and enhance quality of operation and hygiene standards in mortuaries, approval was obtained for the reprovisioning of Fu Shan Public Mortuary in 2018, and the re-provisioned Fu Shan Public Mortuary started operation in December 2022.

At present, the Forensic Pathology Service runs three public mortuaries, which are specialised forensic pathology facilities for conducting medico-legal investigation of deaths that are reportable to the Coroner in accordance with the Coroners Ordinance (Cap.504). The core functions of public mortuary are receiving deceased bodies round the clock, conducting necessary Coroner’s procedures including interviews with families, external examination of bodies, formal identification of bodies, performance of medico-legal autopsies and associated investigations, and releasing deceased bodies to families afterwards. The three public mortuaries conducted 13,728 post-mortem examinations of dead bodies, 2,430 full autopsies and 33,378 histological examinations in calendar year 2022. In 2011, the Service acquired ISO 9001 certification on the quality management of the operation of all three public mortuaries.

The Service also runs three Forensic Pathologists’ Offices equipped with clinical forensic examination suites located within Police premises, in which hundreds of clinical forensic examinations on victims and suspects of criminal cases such as sexual offences are carried out each year. The Service also conducted physical examination for claimants of non-refoulement protection to assist the Immigration Department in its assessment of these cases. Other areas of forensic medical practice in Hong Kong includes provision of expert opinions to government departments on medicolegal matters including death reports and complaint against police cases, attending scenes of suspicious deaths and giving expert testimonies in Courts of Law.

While the customary impression of a forensic pathologist is that he relies on his keen pair of eyes and dissection skill to find out the cause of death and help solving crimes, in practice he also utilizes other pathology expertise to perform in-depth death investigation in different scenarios. Histopathology is routinely employed to look for disease processes invisible to the naked eye or to further clarify the nature of macroscopic pathologies, while post-mortem toxicological and microbiological examinations are useful for the identification of poisoning and infectious diseases that may cause or contribute to the death. Immunology also played an important role in the post-mortem diagnosis of severe allergic reaction including anaphylaxis.

Advances in Genetic and Genomic Pathology also found application in forensic practice in the form of “molecular autopsy”, whereby inherited arrhythmogenic diseases with negative autopsy findings such as Brugada syndrome, Long QT syndrome and catecholaminergic polymorphic ventricular tachycardia (CPVT) can be diagnosed with post-mortem samples by molecular genetic analysis. A molecular autopsy service was started in 2017 in collaboration with Clinical Genetics Unit of the Department of Health (transferred to Hong Kong Children’s Hospital since 2023).

The use of post-mortem radiology to complement or even to replace the conventional autopsy was growing since the turn of the millennium. A computed tomography (CT) system was installed in the re-provisioned Fu Shan Public Mortuary. The system allowed a preliminary view of the interior of the body before the commencement of the autopsy, providing guidance to the forensic pathologist on where to focus his attention before dissection of the body. In some cases, it would obviate the need for an autopsy by identifying the pathology causing death without opening up the body, relieving the distress of family members who objects to autopsy due to personal or religious reasons.

Forensic pathologists play a pivotal role in the handling of incidents of mass fatalities including natural and man-made disasters as well as epidemics. Apart from determining the cause of death of victims, forensic pathologists contribute significantly to the establishment of the identities of deceased persons and the reconstruction of incidents, as well as ensuring the proper storage and disposal of bodies. In the Garley Building Fire in 1996, forensic pathologists completed the autopsies of all 41 victims expeditiously and confirmed their identities in collaboration with the police and forensic odontologist.

In the aftermath of the Manila Hostage Crisis in 2010, in which 8 Hong Kong tourists were shot dead after being held hostage by a gunman inside a coach, a forensic pathologist from Hong Kong was sent to Manila to observe autopsies of some of the deceased bodies at Philippine National Police Crime Laboratory and to document the findings. Detailed autopsies were then carried out on the bodies back in Hong Kong to enable the reconstruction of bullet trajectories, to allow the retrieval of bullet fragments inside the bodies and to rule out the presence of injuries caused by glass fragments. The autopsy findings, together with reconstruction and simulation carried out by forensic scientists and police firearm expert, firmly established the fact that all deceased were killed by bullets fired from the gunman’s weapon.

During the 5th wave of the COVID-19 pandemic in early 2022, there was a sudden surge in the number of patients who passed away at Accident and Emergency Departments (A&EDs) in public hospitals that had to be handled by public mortuaries, and the body storage capacity of public mortuaries was overwhelmed.

In response to the emergency, the Service set up a new body storage facility near Fu Shan Public Mortuary in Shatin which could store more than 2 700 deceased bodies in about 60 refrigerated containers in early March 2022. In collaboration with the Police and the Food and Environmental Hygiene Department, a special operation was undertaken to transfer over 1800 deceased bodies from A&EDs of public hospitals to the new body storage facility in about 2 weeks.

As all cases transferred from A&EDs were reported to the Coroner, a thorough death investigation procedure including body identification interview had to be carried out in each case. The Service deliberated with the Police and the Coroner’s Court to devise measures to facilitate the next-of-kin to identify body and handle after-death arrangements at the new storage facility expeditiously. With support by the Police and the Coroner’s Court, the Service managed to complete body identification and case submission to the Coroner’s Court for more than 1800 deceased persons within a two weeks’ period during end-March to early-April 2022, allowing next-of-kin to collect documents for after-death arrangement and to claim the bodies for funeral arrangements in a timely manner.