The Forth Worth Star-Telegram investigative reporter's series concluded with Saturday's report, "Tighter requirements on medical examiners are blocked in Texas." Here's an extended excerpt:
An onslaught of news reports about mistakes in medical examiner offices is rattling the foundations of the U.S. criminal justice system.
Critics are having a field day pointing out blunders — children’s eyes misplaced, bodies mismatched, skeletal remains missing. "Abuses are going on all over the country," said Barry Scheck, co-founder of the Innocence Project.
Pick a state, find a scandal:
The Boston medical examiner’s office sent the wrong bodies to funeral homes and had a body cremated before police could determine whether a murder had taken place.
A Mississippi forensic pathologist is being sued over his testimony that was key in convicting two men later exonerated by DNA testing. The pathologist was conducting about 1,500 autopsies a year.
The Oklahoma City medical examiner’s office had its accreditation yanked this summer because of dozens of deficiencies, and a grand jury reported that the office mishandled items that could have been used as evidence in criminal cases.
The Tennessee Medical Board found a state medical examiner guilty of 18 counts of misconduct, potentially compromising hundreds of convictions. The violations included botched work, tampering with evidence and sloppy records, with a heap of callousness added to the mix.
A report by the National Academy of Sciences, presented to Congress this spring, found pervasive deficiencies nationwide. It recommends modernizing the medical examiner’s office by establishing performance standards and quality-control measures and testing the scientific validity of forensic methods. It also calls for creating a national watchdog agency that could set education standards, require certification of facilities, and develop and implement new technologies.
A group of medical examiners themselves recommended minimum national standards, calling for such changes as requiring that autopsies be conducted by those who have been trained in anatomic and forensic pathology.
But so far, the resources have not been available to implement major reforms identified by the scientific community. And in Texas, a lack of political will and divisions among pathologists have torpedoed efforts to make more basic changes.
As errors have come to light, some states are bringing more scrutiny to pathologists’ work. A new Tennessee law requires that autopsies be performed in medical examiner offices that conform to standards of the National Association of Medical Examiners. Washington state is looking at a proposal requiring such standards for autopsies of infants and other young children. Florida has a commission tasked with scrutinizing any abnormalities in the work of its medical examiners.
"It . . . is just a matter of having the political will and proper use of resources," said Dr. John Howard, NAME’s president.
Texas hasn’t budged, though. Accreditation is voluntary, and only six medical examiner offices in Texas have the nod.
This past session, the Legislature approved a bill that would have required that medical examiners and their deputies be board-certified in anatomic and forensic pathology. It also would have given medical examiners the say-so on who can attend autopsies and the power to subpoena law enforcement and medical records.
Sen. Jeff Wentworth, R-San Antonio, who introduced the legislation, cited a need for "more accurate, precise and reliable autopsies and evidence" in courts.
But even though the changes had support from the Texas Conference of Urban Counties, which had criticized past legislation affecting medical examiners, Gov. Rick Perry vetoed the bill containing the measure. His office did not respond to requests for comment.
"It’s back to square one," said Bexar County Chief Medical Examiner Randall Frost, who urged Wentworth to introduce the legislation.
In 2005, the state created the Texas Forensic Science Commission to hear complaints about shoddy work. But medical examiners do not fall under its jurisdiction, said Edwin Colfax at The Justice Project. Only crime labs do.
Medical examiners have "been given a pass because we’re dealing with doctors," Colfax said.
Berard also has this sidebar on accreditation results:
Harris County The county attorney said it didn’t have the inspection report on file and wouldn’t request it from the National Association of Medical Examiners, though the Star-Telegram made repeated inquiries over several months. "Based on your last transmission, I believe you did not understand my email (below)," Barbara Callistien, general counsel to the Harris County medical examiner’s office, wrote in an e-mail. The office "is not obligated under the law and is not going to request a report from another agency that is not in the HCMEO’s possession."
Dallas County The report shows that before Dallas was fully accredited, it was given provisional accreditation because it exceeded the maximum number of allowable autopsies and had one medical examiner who was not certified in anatomic pathology. Its chief toxicologist also was not certified by the American Board of Forensic Toxicology. And the office also had "substantially substandard" completion rates on homicide autopsy reports, wrote Dr. Randy Hanzlick, who performed the inspection. Those reports took 60 days to complete, the report shows. The morgue received full accreditation when it hired additional staff and improved the turnaround time on reports.
Tarrant County The district attorney’s office said the county didn’t keep a copy of its 2004 inspection report. After the Star-Telegram made a plea to Dr. Nizam Peerwani, he personally sought it from NAME and released it. The review described the office as an outstanding resource for the counties, but warned that the number of autopsies being performed exceeded the standard. The office’s accreditation was up in May; it has applied for renewal and is awaiting to be assigned an inspector.
Nueces County County officials did not respond to repeated requests by the Star-Telegram under the Texas Public Information Act. Its accreditation expires in November, said Chief Medical Examiner Ray Fernandez. The renewal is up in the air, he said. He performed 387 autopsies in 2008, in excess of the cap.
Bexar County The county did not have a copy of its assessment and was unable to obtain it from NAME, said Chief Medical Examiner Randall Frost. He was not the chief medical examiner when the inspection was conducted. The office is seeking renewal of its accreditation, which expired Aug. 29.
Travis County The medical examiner received provisional accreditation in November 2008 and received full accreditation in July after it hired additional staff. The report described the investigations staff as superior. "The chief investigator and the forensic nurse investigator are board certified. . . . This office is to be highly commended for this dedication to investigative excellence," it says.
Sunday's Star-Telegram carried the related report, "Most deaths still being reported using paperwork despite existence of electronic registry," by Bill Bowen.
Two years after Texas lawmakers mandated that doctors, funeral directors, medical examiners and others file death reports electronically through an Internet-based system, it is being used for fewer than half of the approximately 35,000 death reports filed each month.
Instead, many of the medical experts are falling back on the paperwork that doctors say takes a small fraction of the time consumed by the clunky, arcane and nonintuitive software adopted by the state.
The two-year struggle to get the Texas Electronic Registry up and running has prompted the state to spend $720,000 to hire a firm to manually enter the paper records into the database — more than twice what Texas paid for the software to begin with — and to catch up with its vital-statistics reporting to the federal government and to beef up training.
But as problems linger, families are complaining about delays in getting death certificates, which are needed to settle life insurance claims, gain access to bank accounts, and initiate inheritance and other probate proceedings.
And a rift has developed between funeral homes and doctors.
Parts 1-4 of Berard's Star-Telegram Series is noted here.
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