Fort Worth Star-Telegram investigative reporter Yamil Berard has an outstanding series on one slice of forensics, autopsies. Her five-part series began on Sunday and runs through Saturday. It's a must-read, especially with other forensics-related news. Here are excerpts from the first four parts of the series:
"With little oversight in Texas, autopsies often careless," is the first installment. Here's the introduction:
The man almost took the dirty secret of his death to his grave. The Tarrant County medical examiner’s office said injuries from a pickup wreck killed him. But after a funeral director hundreds of miles away found a bullet in the man’s head, authorities realized a killer was on the loose.
Worse has happened in the autopsy suites of Texas medical examiners.
A child molester faked his own death and almost got away with it after the Travis County medical examiner mistook the burned body of an 81-year-old woman for the 23-year-old man.
A woman was on her way to Death Row in Alabama after a medical examiner now working in Texas said she had suffocated her newborn. The sad truth, other experts said, was that the baby was stillborn.
An Austin baby sitter has spent years on Death Row for a baby’s murder. The medical examiner whose testimony helped put her there now says the baby’s death may have been an accident.
The medical examiner is the doctor-detective who is supposed to extract truth from the hodgepodge of details about a death. By examining body tissues, organs and fluids, gathering data from a crime scene and examining lab results, the medical examiner provides insight into how and why someone has died. Those judgments are of consequence for violent or suspicious deaths, as well as for unexplained deaths and those that might result from negligence or improper care.
County officials say the state’s system works well by unraveling questions surrounding death at a reasonable cost to taxpayers. In the courtroom, much of the work, they say, stands up to scrutiny.
But over the years, Texas medical examiners have misidentified bodies, botched examinations and had to do a double take on cases of individuals later exonerated by law enforcement. That has opened the door for innocent men and women to go to prison and killers to go free. The slapdash work of some medical examiners could also allow public health threats, wrongful deaths and preventable medical errors to go undetected, experts warn.
"The work of the medical examiner’s office is just so slipshod," said Tommy Turner, the former special prosecutor who put a Lubbock medical examiner behind bars for falsifying autopsies.
Critics say the medical examiner’s office is "the last bastion of junk science." The problems, they say, are similar to those that plagued the state’s crime labs for years: lack of performance standards, poor documentation, a shortage of qualified personnel and lax oversight.
"The state does not keep track of MEs in any shape, form or fashion," Bexar County Chief Medical Examiner Randall Frost said. The state doesn’t even know how many certified forensic pathologists work in government offices, he added.
And a medical examiner doesn’t have to be trained in forensics or pass a specialty exam to do an autopsy. All that’s required is a state medical license. That’s akin to having your family doctor do brain surgery, says a growing chorus of medical examiners.
"It’s a travesty for Texas," Frost said. "Most people are horrified that there are no qualifications for this field under the law. They are shocked when I tell them that."
"Autopsy caseloads require stopgap measures," is part 2.
Around the state, some medical examiner offices have relied on the work of medical school interns and unlicensed doctors, as well as physicians who have repeatedly failed certification exams or been disciplined for poor work — even for complex capital murder cases.
Relaxing qualification requirements is one way the offices have tried to keep up with overwhelming caseloads and a shortage of forensic pathologists.
Some pathologists also operate what critics deride as "path mills." That can lead to significant errors, undermining the criminal justice system, some medical examiners themselves worry.
"Justice becomes secondary when too many bodies come into the morgue every day and when too few people are doing the autopsy," Galveston County Chief Medical Examiner Stephen Pustilnik said.
Professionals say medical examiners should have specific certification in anatomic and forensic pathology, even though the state requires only a doctor’s license. Without the certification, says Bexar County Chief Medical Examiner Randall Frost, "that’s like graduating from medical school and immediately going in and doing a heart transplant."
Dallas County Chief Medical Examiner Jeffrey Barnard agrees, adding, "The fact that someone is not alive doesn’t change the quality of the expectations of the medical practice."
Texas doesn’t keep track of how many certified forensic pathologists work in the dozen county medical examiner offices; some put the number at 50. That’s not enough to serve large counties, let alone the 200-plus smaller ones that turn to them for autopsies.
"There’s only a certain number of doctors out there," Lubbock County Medical Examiner Sridhar Natarajan said.
Because of the shortage, even some larger medical examiner offices use noncertified pathologists. Records that the Star-Telegram obtained from the American Board of Pathology show that the head medical examiner in Laredo for Webb County is not board-certified. Neither is the one in El Paso.
"Questions raised about the 'science' of autopsies," is part 3 from Thursday's Star-Telegram.
A particular concern to critics is that some medical examiners may tailor their findings to fit theories developed by prosecutors and law enforcement, compromising the integrity of the criminal justice system.
It can be a sticky relationship. Medical examiners, police and prosecutors work together, but the medical examiner is supposed to be independent, letting the chips fall where they may.
"It needs to be arm’s length because they are forensic experts. By definition, that is somebody who has prepared for court . . . information as the fact-finder with a neutral, nonadvocate opinion of what happened," said Doug Lowe, criminal district attorney in Anderson County.
Galveston County’s chief medical examiner, Dr. Stephen Pustilnik, said that’s how his office works. "The medical examiner is supposed to help convict the guilty as well as exonerate the innocent. Those are two equal mandates for us."
To avoid bias, most medical examiner offices have checks in place. Tarrant is among those that hire death investigators to gather information from crime scenes so they don’t have to rely on law enforcement. However, Peerwani said he has to rely on police reports and photographs for autopsies he is called to do outside the four counties he serves as medical examiner.
A number of cases over the years point to practices in which critics say a boundary between the scientist and law enforcement was crossed.
Eric M. Freedman, a professor at New York’s Hofstra Law School who specializes in criminal procedure and strategy, is among those who say that medical examiner opinions are sometimes twisted and turned to fit the theories of prosecutors and law enforcement. "The medical examiner considers it his job to support whatever series of theories the prosecutors decide to dream up rather than focus on the objective truth," he said.
"That’s what I see happening," said Richard Ellis, an attorney for a Sulphur Springs man on Death Row. "If you start off with a goal in mind, it’s kind of easy to get through only looking at signs that point to that preconceived notion to how death occurred."
Such criticisms were raised in the case of 18-year-old Daniel Rocha, who died after being shot in the back by Austin police in 2005.
An initial autopsy reported that his body had no cuts or bruises, though police said he had fought with officers. Travis County Medical Examiner Roberto Bayardo did a retake and found that Rocha had abrasions on his right knee and chin. On initial tests, the medical examiner reported that Rocha was drug-free. Police suggested otherwise. Tests were rerun, confirming traces of marijuana. Bayardo said the second test was run with more sensitive equipment. The changes angered both community members and police.
The police chief fired the officer, citing questionable judgment in the shooting, and Austin paid a $1 million settlement to Rocha’s family.
Former Harris County Associate Medical Examiner Patricia Moore had opinions changed on several cases of infant homicides and was criticized by both defense attorneys and former Medical Examiner Joye Carter as having a bias in favor of law enforcement and prosecutors.
"If the law enforcement officer said it was a homicide . . . Patricia Moore came back and said it was a homicide," said Charlie Portz, an attorney for a woman who got a 17-year prison sentence based on Moore’s autopsy of her 2-month-old son. Brandy Briggs was released in 2005 after Moore’s conclusions were overturned by Harris County Chief Medical Examiner Luis Sanchez, who classified the cause of death as undetermined.
Portz filed an unsuccessful innocence claim on behalf of baby sitter Cynthia Cash, who is serving an eight-year prison term after Moore said the baby was a homicide victim. Pathologists who reviewed the case for Portz say the baby died of shock triggered by a combination of vaccines. Last year, Sanchez amended the cause of death to undetermined.
"Had this death been ruled undetermined at the time of the trial," Portz said, "Cynthia Cash would not have been indicted and never found guilty."
Moore now works for the Southeast Texas Forensic Center, a private company that does business as the Jefferson County Morgue and handles autopsies for 16 counties. She could not be reached for comment.
Part 4, in the Friday Star-Telegram is titled, "Some medical examiners boost their pay by offering expertise for sale."
Unlike the glitzy offices of CSI: Miami, the typical U.S. medical examiner’s office is an unremarkable place where professionals tend to be underpaid and overworked. The medical examiner’s job, in fact, carries little glamour. It is work that few really want to do and governments are not eager to pay for.
In Texas, though, some medical examiners boost their pay by also performing autopsies for dozens of the state’s smaller counties, consulting for criminal defense attorneys and doing other side jobs.
And counties can get additional revenues to help pay for the medical examiner’s office.
Some see no problem with the arrangements. Small counties can select the medical examiner who does the best work at the best price, they say.
"It’s a marketplace," said Donald Lee, executive director for the Texas Conference of Urban Counties. "If you don’t like the price you’re getting from one, go to the next one."
The integrity of the medical examiners ensures quality, said Doug Lowe, district attorney for Anderson County, southeast of Dallas. "The people who do forensic work by and large are real serious about their ethics and do not accept cases where the money is about, 'I’m paying you to testify a certain way,’ " he said.
Others, though, are troubled by some of the financial arrangements, which they say can chip away at the integrity of the work.
"The incentive is to run as many bodies through your morgue operation as possible," said Dr. Stephen Pustilnik, chief medical examiner in Galveston. "The more you can do, the more money you make."
Side-business associations also can be rife with conflict, critics say. If a medical examiner’s opinions displease repeat customers — counties, police and prosecutors — they can take their business elsewhere. And it may be difficult to verify whether a medical examiner improperly uses county equipment or facilities for private business.
Dallas County Chief Medical Examiner Jeffrey Barnard says he doesn’t do private consulting for ethical reasons. "No way," Barnard says.
T. Gerald Treece, professor of law at the South Texas College of Law in Houston, likened the private work to a district attorney having a part-time private practice. Such work is forbidden by standards that say the prosecutor should devote his primary effort to his office and should have no outside financial interests that could conflict with his duty.
No such ethics code bans medical examiners from moonlighting.
"I guess the real argument is, Can a public entity run a for-profit concern? In my opinion, it violates the fiduciary duty that the public officials have to the citizenry that hires them," Treece said.
Still to come on Saturday, the final installation, "Texas reform efforts torpedoed."
Reforms are being recommended nationwide, but in Texas a measure to strengthen the medical examiner’s office was vetoed.
Related articles are in the forensics category index. Earlier coverage of the Cynthia Cash case is here. Coverage of the NAS report begins here.
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