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.