Sunday, October 26, 2014

Election Season: Vote for Coroner!


These are a couple of articles pertaining to coroners' races this Election Day that I have come across in the last week, the first from Indiana, and the second from Washington:


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Why is the coroner an elected position? If you read the first article you would think that all a coroner does is go to schools and talk about drug overdoses to kids. In the second you learn that they have to help families with life insurance claims, and prepare evidence for prosecutors. Is this what a coroner's duties actually entail? 
No.

Well then. You may have to vote on November 2nd for your own county coroner. You want to know what coroners actually do, right? I work for one, and have performed more than 2,000 autopsies over the past 13 years as a board-certified forensic pathologist. Here is what I can tell you about elected coroners.
A coroner is a civil service management job, in charge of an office of the local government that oversees death investigation. When someone within the jurisdiction of that local government (usually a county) dies in a sudden, unexpected, or violent way, the coroner's office takes the call. Typically, the person answering the phone has to assess whether the case really should fall under the coroner's jurisdiction, and to decide whether a full death investigation or autopsy is warranted. Some coroners employ independent death investigators who go out to the scene of death and investigate the circumstances, looking for clues about medical history or foul play. Other offices rely on the police to do the on-scene death investigation. If an autopsy is warranted, then the coroner will hire a doctor to perform it. The doctor presents the autopsy results to the coroner, and the coroner decides, based on the autopsy report, what cause and manner of death to put on the death certificate. In order to be successful, a coroner needs—at a minimum—a good understanding of what generally kills people; enough medical training to know when autopsies are necessary; and the empathy and social skills to get along with the bereaved families, law enforcement, district attorneys, public defenders and the press.
How can voters assess whether the candidate for coroner is qualified to perform these duties?
Being a physician does not make you qualified to be a coroner. My ophthalmologist successfully manages a busy office and is a brilliant doctor, but she doesn't know anything about death investigation. I know several board-certified forensic pathologists who are fully qualified to perform autopsies and do death investigations, but have no management experience or training, and shouldn't be put in charge of a large bureaucracy. 

Being a coroner requires both of these skill sets combined: an understanding of death investigation, and office management skills. In many states, however, anyone can become coroner if he or she is over the age of 18, and prevails in an election to the position. 

So if you have to vote this November for a coroner in your county, I would suggest you look for the following characteristics:


  • Someone who understands what death investigation is and how it's conducted. 
  • Someone with medical background or training. 
  • Someone who wants to improve the office and bring in more funding and qualified staff—and does not brag about "doing less with more." 
  • Someone who understands the importance of American Board of Medicolegal Death Investigators (www.abmdi.org) certification for investigators; American Board of Pathology (www.abpath.org) certification for pathologists; and aims to get the office accredited by the National Association of Medical Examiners (www.thename.org) 
  • Someone who is unbiased and has experience working with grieving families and defense attorneys, as well as with law enforcement and the prosecutor's office. This becomes particularly important in high profile criminal cases, cases of officer-involved shootings or in-custody deaths. 
  • Someone who is a proven manager of an office with a staff on a similar budget, either as a small business owner or in government work.
Not all candidates will have these qualifications, and voting decisions can be difficult—but please educate yourself about the candidates, and do not fail to vote. Your vote matters quite a lot on the county level. You never get to know how much you need a competent county coroner until you suffer the unexpected death of a loved one. Few of us have this misfortune, but all of us should worry about who is in charge of the office that is charged with investigating the deaths of our families, friends, and neighbors.

Thursday, October 23, 2014

Forensic Sound Bites & Half-Truths

A reporter from the St. Louis Post-Dispatch called me earlier this week, saying she had Michael Brown's official autopsy report as prepared by the St. Louis County Medical Examiner, and asking me if I would examine and analyze it from the perspective of a forensic pathologist with no official involvement in the Ferguson, Missouri shooting death. I read the report, and spent half an hour on the phone with the reporter explaining Michael Brown's autopsy report line-by-line, and I told her not to quote me - but that I would send her quotes she could use in an e mail. The next morning, I found snippets of phrases from our conversation taken out of context in her article in the Post-Dispatch. These inaccurate and misleading quotes were picked up and disseminated by other journals, blogs, and websites. 
This is the text of my actual email exchange with Post-Dispatch health and medical news reporter Blythe Bernhard:

"From: "Dr. Judy Melinek" 
Date: October 21, 2014 at 5:53:21 PM PDT
To: Blythe Bernhard 
Subject: Re: media request

Great talking to you. Here are the quotes:

"The autopsy report shows that there are a minimum of 6 and maximum of 8 gunshot wounds to the body. The graze wound on the right thumb is oriented upwards, indicating that the tip of the thumb is toward the weapon. The hand wound has gunpowder particles on microscopic examination, which suggests that it is a close-range wound. That means that Mr. Brown's hand would have been close to the barrel of the gun. Given the investigative report which says that the officer's weapon discharged during a struggle in the officer's car, this wound to the right thumb likely occurred at that time. The chest wounds are  going front to back, indicating that Mr. Brown was facing the officer when he was shot in the torso, then collapsed or leaned forward exposing the top of his head. You can't say within reasonable certainty that his hands were up based on the autopsy findings alone. The back to front and upward trajectory of the right forearm wound could occur in multiple orientations and a trajectory reconstruction would need to be done using the witness statements, casings, height of the weapon and other evidence from the scene, which have yet to be released. The tissue fragment on the exterior of the officer's vehicle appears to be skin tissue, but only DNA analysis would confirm if it is from Mr. Brown or the officer. It is 'lightly pigmented' but even African-American skin can appear lightly pigmented on a small microscopic section, depending on what part of the body it came from."

This is how I was quoted in the Post-Dispatch the next day:

Dr. Judy Melinek, a forensic pathologist in San Francisco, said the autopsy “supports the fact that this guy is reaching for the gun, if he has gunpowder particulate material in the wound.” She added, “If he has his hand near the gun when it goes off, he’s going for the officer’s gun.”  Sources told the Post-Dispatch that Brown’s blood had been found on Wilson’s gun. Melinek also said the autopsy did not support witnesses who have claimed Brown was shot while running away from Wilson, or with his hands up.

Notice the difference? There's a big difference between "The hand wound has gunpowder particles on microscopic examination, which suggests that it is a close-range wound. That means that Mr. Brown's hand would have been close to the barrel of the gun" and "he's going for the gun." 
I was very fortunate to have the opportunity to correct this, in my own words last night, when Lawrence O’Donnell invited me to appear as a guest on MSNBC. Mr. O’Donnell allowed me to explain the autopsy findings clearly and in context—if not in full. The show is called “The Last Word,” and Lawrence O'Donnell makes sure he gets it. Despite the guest-badgering and interruptions that are a signature of his television persona, however, Mr. O’Donnell did allow me to correct the record that the St. Louis Post-Dispatch created. I am even more grateful to Trymaine Lee, whose companion article to last night's Last Word segment (linked above) serves as an excellent corrective to the Post-Dispatch article.
In my memoir of forensic training, Working Stiff, I quote my mentor, Dr. Charles Hirsch, as saying that “the best way to respond to a reporter is with your hat. Put it on and walk away.”
I don't agree. I believe the best way to respond to a reporter is to give the reporter accurate, succinct quotes, and set the record straight if they misrepresent what you said. 
Too many forensic pathologists are afraid of speaking out about their expertise, because they believe that all members of the press have a prepared agenda, or that professional reporters will misquote scientific experts to force a point that doesn't comport with the forensic evidence. But if we forensic pathologists all put on our hats and walk away, others who lack our medical training and experience will fill the void we leave. I want to make sure the reading and viewing (and tweeting) public have an opportunity to understand forensic science in the real world—what it can tell us, and what it can not. I'm not going to walk away. 

Monday, September 29, 2014

"Working Stiff" Book Club Discussion Questions

1. Many reviews and press events about Working Stiff list Judy Melinek as the sole author, even though the book is co-authored by T.J. Mitchell. Do you think this is due to his role as a homemaker? Would Judy's appearance in the media standing by her writer-husband detract from her status as a strong female media figure? Is Judy a “character” the press wants to explore in their stories, even outside the confines of her character role in her own book?
2. What role does New York City play in the book? Is the City a character? If Dr. Melinek had pursued her post-residency training in another city, could she have written a book about her experience? How (apart from her work after the World Trade Center disaster) would training in another city have changed the story?
3. Dr. Melinek took notes and kept a journal every day of her training in 2001-2003, yet Working Stiff is not structured chronologically. Why is this? What is gained from the book's case-based structure? What has been been lost—and what have the authors compromised—in choosing to tell a non-linear story?
4. T.J. worried while writing Working Stiff that the book might read like a hagiography of Dr. Charles Hirsch, and the OCME staff as a whole. Was he right—is Dr. Hirsch a saint, or a real character?
5. What role does the theme of parenting play in the book? Does being a parent make Dr. Melinek a better medical examiner? Was T.J.’s role as a full-time stay-at-home dad important to the story? How does being a parent influence how you do or your colleagues do their job, or affect others you work with?
6. Does Working Stiff have a story arc, or is the book just a collection of interesting if disparate death stories? Does it matter? Does a memoir need a structural arc?
7. What was the most interesting forensic fact you learned in the book? Is this what you expected a medical examiner's training to be like? How is the authors’ portrayal of forensic pathology different from its portrayal on television?
8. Did you wish after reading Working Stiff that you had heeded Judy’s advice, “you don’t want to know,” about stories of terrible deaths? If so, did this desire change with time, after you had finished the book?
9. Do you feel that Judy’s opinion of suicide as "a goddamned selfish act” is too harsh? Do you think it reflects the accepted medical opinion of her peers? Did reading the book change your attitude toward suicide?
10. In the United States 50% of all suicides are effectuated by gun and 50% of all gun deaths are suicides. States with highly restrictive gun control laws have far lower rates of suicide than states with lax gun control laws. These numbers include all types of suicide, not just suicide by gun. Do medical examiners have a civic duty to speak up about highly contentious political issues having to do with death, such as statistics on gun deaths and the effectiveness of gun control?
11. Working Stiff has been described as a “brisk” and “a quick read.” Is is too quick? Would you have liked to read more stories about the various manners of death we explore in the book, even if that meant some of them would become repetitive of others you had already read? Would a longer book have caused you to lose interest somewhere in the middle?
12. Judy & T.J.'s youngest daughter Dina, who is currently 9 years old, is extremely miffed at being excluded from the book. "Not being born yet" was not considered a sufficient reason for this oversight. It wasn't even good enough that we put her in the acknowledgements—because, as Dina says, "nobody reads those." Did you read the acknowledgements, and do you agree with Dina? Do you currently appreciate Dina? Should we write a sequel, "Working Stiff II: Revenge of the Stiffs," to placate her?


Please leave your comments or notes of appreciation for Dina below.

Thursday, August 21, 2014

"Partial Autopsies Yield Partial Answers"

"Partial autopsies yield partial answers" Dr. Charles Hirsch taught me as a young doctor during my forensic pathology fellowship training in New York City, in 2001-2003. This was one of scores of aphorisms we called "Hirschisms," which he employed to instruct us about forensic pathology. Another one was, "Don't confuse the autopsy with the death investigation."

Both come to mind this week in the wake of the release of the findings of the second Michael Brown autopsy, conducted by Shawn Parcells and Dr. Michael Baden. The body diagram they released to the press in the New York Times has now been altered into the "Hands up! Don't Shoot!" pose and is trending on Twitter.

The wounds are clustered closer together, so it must be "realistic," right? 

No. 

This is click bait—a picture that you can retweet easily without thinking about it much. This "tweaked" diagram is a grossly inaccurate portrayal of the victim's body position. The horizontal graze wound near the elbow is missing entirely; the top of the head wound doesn't make sense unless the victim is leaning forward; and the diagnonal graze wound on the right thumb would not occur if the right hand were up in this way—the graze wound has to be in line with the gun barrel, which means the hand was possibly extended forward toward the officer. That's assuming you trust the diagram.

And that's where my experience as a forensic pathologist and death investigator makes me ask a few questions:

1. Why was this diagram from the second autopsy—this evidence of the wounds on the body—even released to the public? The original autopsy diagram, the one prepared during the first autopsy by the St. Louis County medical examiner's office, is still sealed. So are the photos, scene data, and other evidence the district attorney will rely on to decide whether to prosecute the police officer. In all homicide cases, evidence such as this diagram is kept sealed so as to not influence potential witnesses who might see it in the press and change their testimony. Why release crucial evidence that could scuttle that prosecution? 

2. How reliable is this diagram? As I wrote in my recent OpEd on CNN.com, gunshot wound interpretation is not always easy. Parcells and Baden have opined that there were "at least 6 gunshots"—but without knowing the number of rounds fired, the number of casings and bullets recovered, the condition and location of those bullets, and the possible witnessed positions the victim was in, how can they say that with any certainty? What if the same bullet grazed the thumb and then re-entered the body, causing another wound? This diagram alone doesn't tell the whole story.



The diagram reproduced in the New York Times and elsewhere has both Parcell and Baden's signatures at the bottom—but which one of them made the diagram? And why are there no other details about the individual wounds on it? Why have they not noted the location from the top of the head/right of midline, wound size and shape? Where are their notes about soot, or stippling, or other trauma besides the gunshot wounds? The body diagrams I prepare during the course of a forensic autopsy are a whole lot more detailed than this; I need those details in order to accurately dictate my report after I finish the autopsy and get out of the morgue.

3. How reliable is the second autopsy?
There have been recent reports in the press that forensic technician Parcells has no credentials or accreditation, and misrepresents his experience.  Following allegations that Parcells did the autopsy alone, a doctor/blogger in PathologyBlawg.com interviewed Parcells. Parcells affirmed that he alone examined the body on 8/15 before it was embalmed; Dr. Baden was not yet in Missouri at that time. Two days later, after the body had been embalmed, Dr. Baden performed the second autopsy.

There is a big difference between the examination of Michael Brown's undisturbed body during the first, legally-mandated autopsy, performed by the St. Louis medical examiner, and the follow-up examination done days later on his washed and embalmed cadaver. In the embalming process, preservative fluids are injected into the arteries and organs using a sharp tool called a trocar. The trocar pokes holes in the organs. The preservative fluid in the blood vessels pushes the blood ahead of it to the site of any injuries. These changes, which we call "embalming artifact," can exaggerate the size and shape of injuries. 

Even if Dr. Baden, a board-certified forensic pathologist, looked at photos of the injuries taken prior to the embalming, the orientation and quality of the photos taken by the technician would influence his interpretation of the findings. Autopsy means "see for yourself"—and there is no substitute for seeing the undisturbed body for yourself if you are going to be offering opinions with legal ramifications.

Monday, August 11, 2014

Expert Mistakes

"An expert is someone who knows some of the worst mistakes which can be made in a very narrow field."
Niels Bohr

When I review others' reports and find mistakes I always try to learn from them because it is always easier to learn from others' mistakes than to make and learn from your own.

No one is immune to mistakes. It is what makes us human. The question is how do we, as scientists and experts, deal with our errors? Do we ignore them? Deny them? Or do we delve into the reasons why they occurred and make a change? And can we accept that by making a change in policy or procedure we will be opening ourselves up to future attacks by attorneys who will use the change as a basis to invalidate our previous opinions?

What are some of the worst mistakes? The worst I've seen are the result of arrogance. As an expert and legal consultant one needs to be confident and project that confidence when testifying. But knowing the facts of your case and showing proficiency in analyzing and conveying those facts is different from insulting or tearing down an opposing expert, criticizing the person instead of their opinion (ad-hominem attacks). I've been on the receiving end of those with opposing counsel making fun of me for having gone to Harvard or for my dress ("fancy"). Generally I know that if they are attacking me personally it is because they don't know how to attack me based on the facts of the case. I also know that the more obnoxious they get the more they will alienate the decision makers - the jury.

I have seen world-renowned experts, confronted with inconsistencies between their previous and current testimony, or between their testimony and a recently published article get defensive and even aggressive. They respond to legitimate questions with bluster and arrogance. Nothing turns off a jury more. The best way to deal with a direct attack is to address the specific issues at hand and simplify it for the jury. Explain to them why the case the attorney is asking about is different from the current case and how interpretations in science can vary based on these crucial differences. By the time the expert is done explaining, the jury will have either forgotten the attorney's challenge or gotten so wrapped up in the explanation of the facts of the current case that they will be right back along agreeing with the expert.

But how does an expert learn to keep her ego in check? The best way is to hang around people who know a lot more than you do. By teaching residents and medical students and working alongside staff in a university setting you are constantly barraged with questions that force you to challenge your assumptions and stay up on the scientific advances that drive the peer-reviewed medical literature. Take challenging consult cases: by sparring with attorneys on high-profile cases you are going to be confronted with sharp criticism and you'll find that you can't just rely on your experience and training - you need to stay current and sharp. And finally, go to professional meetings. Nothing humbles me more than attending an AAFS or NAME meeting, and sitting in lectures about the cutting-edge research others are conducting, or the challenging cases that others have successfully investigated. I can't sit for more than 10 minutes before having that "shoulda coulda woulda" feeling about some of my own cases. Yet at the same time, when I leave the conferences, I feel invigorated. Forensic science can be incredibly isolating, especially if you are the only doctor in a small rural Coroner's office. Lunching and dining with colleagues makes you realize that there is camaraderie and support; that we may not always agree on the best way to interpret an injury, or certify a death, but we can come together, break bread and do what scientists do best: collaborate.

The next NAME meeting is: Sept 19-23, 2014 in Portland, OR
The next AAFS meeting is: Feb 16-21 in Orlando, FL

Monday, July 14, 2014

"Cutting Corners"

Is it common for coroners or forensic pathologists to cut corners in a death investigation if a case does not look like foul play was involved?  Several visitors to this blog have asked me this question recently, as part of their research into forensic science.  Usually those inquiring have had direct contact with a Medical Examiner's or Coroner's Office - and did not find that institution particularly forthcoming. Office policies require death investigators to be careful about divulging information on open cases, and sometimes cases can be "pending" for several months while the pathologist awaits toxicology reports, microscopic slides, scene investigation or incident reports. This can be frustrating and even infuriating to the deceased's family members. They are the ones who have to plan the funeral, and answer inquires while dealing with their own feelings of grief and even guilt about the death while the case is still "pending additional examination." The law allows you to bury a body with a death certificate that says "pending" under "cause of death," but that is cold comfort to the family which has to tackle the inevitable question - "What happened?" - over and over again. A death certificate that says "Hanging" and "Suicide" may not be welcome, but it is an answer.

Coroners and forensic pathologists are two different groups of people. Coroner's deputies are death investigators (often part of a law enforcement agency, like a sheriff's office) while forensic pathologists are the doctors who do the autopsies. Both can "cut corners," yes - but in different ways. A Coroner's deputy might cut corners by not visiting the scene; by not examining the scene thoroughly, either in order to save time or because they are tired (many death investigations are at ungodly hours); by trusting the reports of the people at the scene about what happened without confirming whether those reports are accurate. The death investigation doesn't end when the deputy returns to the office and writes up the case. Frequently they have to complete their investigation, or ask others to, by getting medical records, police reports or questioning other witnesses who were not at the scene when they picked up the body. 

A forensic pathologist might "cut corners" by doing an incomplete or partial autopsy; or by rushing through the case and by not following up with police or Coroner's investigators when the story being given does not match up with the injury on the body or the presumed cause of death. This takes time. Coroner's deputies get paid per shift and FP's in a coroner system get paid per case. There is no financial incentive for the doctor or the deputy to invest extra time in investigating a case. Many offices are understaffed due to budget shortfalls, so there is always plenty of work and not enough people to do it. A deputy has to be efficient with his/her time; so if a case looks like something routine, such as an overdose or a suicide, you might see them cut corners in the interest of working speed.

Yet speculation frequently follows an overdose. Generally, people who use drugs and alcohol are on the margins of society, hang out with unsavory or unreliable "friends," some of whom may have criminal pasts. This fuels funeral-parlor rumors that foul play was involved when the person dies of an overdose. Generally, the only way the police or coroner can confirm that foul play was not involved is with a thorough death investigation. But the investigative and autopsy findings also have to be articulated to the family. Coroner's staff are not necessarily medically trained and may not be effective communicators, so families might seek out other sources for answers. That other source is sometimes me - and I am always glad to serve as a consultant, but only after asking the person calling whether they aired their concerns with the Coroner's office or with the police. I also ask whether the family member had spoken to the original pathologist who did the autopsy. Frequently they have not.  Sometimes if they go back and speak to those people who were directly involved with the death investigation, they will find out that the investigation was actually more thorough than they initially thought, or was not completely documented in the limited materials that were initially released to them.

Frequently I hear about families finding out about other peoples' suspicions at the time of the funeral. Unless the people fueling the speculation have direct knowledge of what happened, I would be cautious about putting too much faith in rumors. Family and friends often invent or exaggerate the importance of certain events in order to make themselves or others feel better about a death. I have investigated cases that were clear-cut suicides, where the deceased even left a suicide note, the family was understanding and seemed at peace, but then speculation at the funeral made them doubt the coroner's findings and suspect murder by an estranged lover or the roommate who found the body. Denial in the face of a death is a powerful (and expected) reaction - but entrenching that denial by piling doubt upon doubt is harmful to the grieving and healing process. I spend many hours counseling these families and I am grateful for my role in helping them find closure, and while I understand why well-meaning people can sometimes unintentionally cause more grief, it still pains me to watch.

What can be done about this? Well, if you are attending a funeral and have no idea why the person died, don't ask the family "what happened?" You'll find out soon enough. I love the Jewish tradition at a shiva (the equivalent of a wake) to bring food and not speak unless you are spoken to. When my father died the sustenance was appreciated and I was glad not to have to talk to anyone. If you feel really sad and want to share that with the bereaved you can always go with "I'm sorry for your loss," though I personally prefer sharing a happy story about something the deceased did that meant a lot to you or made you smile. That will have resonance and truly give comfort. If you are a family member and have been told things that disturb you about the circumstances surrounding the death of a loved one and are starting to have concerns, start by calling the officer who gave you their card at the death scene or informed you of the death. Tell them what others are saying, and ask them to help you have some closure. They may refer you to the forensic pathologist who did the autopsy, or maybe they will just reassure you that a thorough investigation was already done. If you don't get the answers you need, you can always ask to speak to their supervisor or to the pathologist yourself. In most cases, you will eventually be able to find someone to answer your questions, but please understand that death investigations take time. Just because you haven't heard back from the Coroner's office doesn't mean they have forgotten about you or about the case. The doctor may be waiting for the lab results before proceeding further. The Deputy Coroner may have received no replies when calling people to follow up on your concerns. Find out who the lead investigator is on the case, and what their hours are. If you call the office once every two to three weeks during their shift and always ask to speak to the same person, you will be able to get a progress report on what is going on with the case. I hope this helps you find closure. 

Monday, June 2, 2014

You Gets What You Pays For: Forensics Edition

Recently in the news,  North Carolina Medical Examiners were criticized for violating State law for not examining bodies or doing forensic death investigations in sudden or suspicious deaths that fell under their jurisdiction. In a five part series published by the Charlotte Observer, which contains heartbreaking testimonials by family members who were harmed by inadequate or incomplete death rulings, the Chief Medical Examiner for the State, Deborah Radisch MD, pointed out that North Carolina pays 84 cents per capita for its death investigation system, compared to the nationwide average of $1.76. "You get what you pay for" said Dr. Vincent DiMaio, the retired Chief Medical Examiner of Bexar County, TX, where the death investigation system costs a respectable $2.30 per capita.

Meanwhile, in Maine, the backlog has gotten so bad that they won't even take the time to measure it, the Chief is retiring and they are worried they won't find forensic pathologists to do the work. Why? Underfunding again. Yet while some economists recognize that autopsies are a public good and should be funded by the government, like lighthouses, getting adequate funding is difficult. Since death investigation is run on the county level the investment rests on county supervisors and executives, who are more interested in spending on services for living voters. This is source of the "medical examiner cycle," described by Dr. Shapiro in the Maine Press Herald article: offices get neglected until there is an embarrassing screwup; then heads roll and Chief is let go or demoted. Money gets freed up to recruit new staff, get accreditation, but as soon as the office becomes successful, fully staffed, well-run, and out of the news, the cutbacks begin and the cycle starts again.

What about Federal funding? Well a current Federal government report on forensic pathology points out that "under current Federal policies, ME/C are effectively ineligible for direct Federal funding and cannot receive grants from the Department of Health and Human Services (including the National Institutes of Health [NIH]), the Department of Justice, or the Department of Homeland Security." Coverdell grants, which offices are eligible for, are mentioned in this report but they cover equipment, accreditation and certification; they don't cover staffing or autopsies. The more understaffed an office is, the less likely it will have a person on staff who can dedicate the time required for grant application, paperwork and expenditures. So once an office is at the low point in the "medical examiner cycle" it is unlikely to be able to get out using Coverdell grants alone - just wait until the inevitable political embarrassment that will get the office some funding.

What can we do to prevent this and bring stability to the field? We need a Federal effort to help local counties fund and support their death investigation facilities with matching funds. Eligibility must be contingent on a minimum per capita investment by the local agency, with adjustments based on inflation. The matching funds for accreditation are the carrot but there needs to be a stick as well. One suggestion would be ineligibility for federal law enforcement funding support if the office is part of a Coroner and/or ineligibility for public health research funding if it is a public health agency. What I have seen in over 10 years as a public servant is that unfunded mandates do not work. It is not enough to require accreditation and training. There needs to be funding to support it. When there are reliable, well-paying jobs in the forensic sciences, students will enter the field and there will no longer be a lack of forensic pathologists. There is plenty of interest in forensics, but little motivation among physicians to take a high-profile public sector job for less money than they can make with fewer years of training. If you fund it, however, they will come.