It's OK to Forget

I made the mistake of going on Facebook today. Someone had tagged me in a post and I wanted to see the photo and it was just that sort of thing that brings you automatically to check the news feed. "Never Forget" said my cousin's post and I immediately had to shut it off. Every anniversary it's the same thing: radio silence. And TV and social media silence too. You see, I don't want to remember. Remembering triggers the nightmares and starts me crying . For some in grief, remembering is bad. Memorials and monuments and ceremonies do not help - they serve as triggers. 

I should have known better. It's usually me who counsels grieving families to start moving on with their lives after months pass and they are still calling. When someone dies from a sudden or violent death and their body comes to the Medical Examiner it is often my job to tell their family members what happened. Sometimes we form a bond, because I was the last person who communed with their loved one, and so they call me to talk. They'll call after the funeral when well-meaning friends and family have said inappropriate things or made upsetting remarks. They call me on the deceased's birthdays and on the anniversary of their death.

"Do you have a shrine in the house?" I ask them

"What do you mean?" they respond, perplexed.

"You know, a memorial. A photo, some keepsakes - something that makes you think of him every time you walk by?"

"Yeah - it's in the hallway" or "It's on the piano" or "No - but there's this photo in my bedroom..."

"Put it away." I say. "You are not dishonoring them by putting the photo in a drawer, but you can't be remembering every day, every time you see it. It's OK to put it away. It's also OK to turn off the radio when that song they love comes on. You have to function. It's OK to shut it off." I give them permission to forget and when they stop calling I know they've taken my advice.

There is ample research supporting the notion that repressive coping mechanisms can prevent post-traumatic stress (see links below), but I learned this lesson not from reading books or journals, but from my own experiences after my father died - and then again after 9/11. When my father died, I ignored everyone who said to shut off music, cover the mirrors and sit shiva (stay indoors and do no work). The more I worked and listened to the music I loved, the better I felt. Getting back to normal was the best thing I could have done. I turned in my index card report to Ms. Liebman on time and got an A. I listened to Howard Jones' "Things can only get better." And after 9/11 I also got to work. While others felt helpless, I had a job to do, and no time to ruminate or grieve. We kept the television off because my then 2-year old son loved airplanes and could not be allowed to even glimpse the events that unfolded repeatedly on the tube. Yes, it was repression, and I didn't talk about it for a long time. Writing the 9/11 chapter in "Working Stiff" last year was probably the hardest thing for me and TJ to do, but it was over a decade behind us and we focus in the book on how we coped, which was therapeutic.

So for my friends, I am sorry if I don't respond to your posts today, or "like" your photos on Facebook for the next few days. And for those of you at the New York City OCME who were with me on 9/11, we will forever share a bond that nobody but us understands. Thank you for helping me get through it. That I will never forget.

Interesting Links on PTSD:

http://www.npr.org/2012/08/13/158584243/dreamland-uncovers-science-of-odd-sleeping-habits

http://mbldownloads.com/0109CNS_Suppl1Zohar.pdf

http://www.psychosomaticmedicine.org/content/64/5/748.short

Forensic Science Foundation Student Travel Grant

The Forensic Sciences Foundation (FSF) is pleased to offer Travel Grants for students to assist with travel expenses in attending the American Academy of Forensic Sciences (AAFS) Annual Meeting in Seattle, WA. The FSF Board of Trustees has allocated $7,500, not to exceed $1,500 per student, including complimentary meeting registration. This is a wonderful opportunity, and members are encouraged to promote it.

Travel Grant Eligibility Requirements:

1.    The applicant must either be an AAFS member/affiliate or an AAFS applicant for membership.

2.    The applicant must have submitted an abstract either as a presenter or co-author for the annual meeting he/she will be attending.

3.    The applicant must be a fourth year undergraduate or a graduate student at an accredited four-year college, university, or professional school whose accreditation is acceptable to the FSF Board of Trustees.

4.    The applicant must have a letter of recommendation from his/her advisor or professor.

5.    The applicant must submit a 400-600 word essay explaining how attendance at an AAFS meeting will impact his/her career decision.

6.    The applicant must submit a curriculum vitae to include specifics regarding their involvement in forensic science.

 

All submissions must be completed and received by October 15. The deadline is firm with no extensions.  Incomplete submissions will not be reviewed.  Please submit the aforementioned Student Travel Grant Requirements electronically to Kimberly Wrasse atkwrasse@aafs.org, or by mail to: Kimberly Wrasse, FSF, 410 North 21st Street, Colorado Springs, CO 80904.

Kimberly Wrasse
Executive Assistant
Continuing Education Coordinator
American Academy of Forensic Sciences
410 North 21st Street
Colorado Springs, CO 80904
719.636.1100, x115
719.636.1993 fax

 

Lead in: Why "Leaning In" is not Enough

"I was at a start-up incubator meeting the other day and I was the only woman in the room!" lamented Virginia.

"Would the guys even talk to you?" I asked. "Not that it matters – I find that when I meet male entrepreneurs they usually have pretty useless advice, like 'read this book' as if all the help they ever needed they got out of a book."

This was the brunt of the conversation between two women CEOs. Virginia is 40, working crazy hours at a start-up while I, 44, have just incorporated my medico-legal consulting practice. We ended the conversation by pledging to help each other, and I said I'd introduce her to a corporate coach I met through a legal client - another woman entrepreneur. That's the mentoring Virginia really needs: another CEO who knows how to communicate with and guide other women. 

Reading books is fine. I read "Lean in." I read "You're Hired" by Bill Rancic.  I just finished "The E Myth Revisited: Why Most Small Business Don't Work and What to Do about It."  But the best business advice I ever got wasn't from a book. It was from other small-businesswomen who referred me to clients, suggested book-keepers and accountants, and told me how to avoid costly mistakes. Genuine mentorship. These are women who had an idea, figured out how to fund it, made the connections to promote it.  They created businesses which weren’t there before – and now they employ people. These are women who are willing to take a risk.

That is the biggest hurdle for entrepreneurs in general, and for female entrepreneurs in particular: risk. Most of my successful female friends and colleagues are risk-averse. They are the "good girls" who did well in school and listened to their parents and teachers. It starts with the admonitions yelled to us on the playground to "be careful" every time a we climb too high on a play structure, after watching the boys do the same damn thing moments earlier to no reaction. But it also comes from life experience and social pressure. As Sheryl Sandburg discusses in "Lean in," there is a social pressure on women to defer to men and stand back; we are criticized for being too aggressive or pushy if we assert ourselves at work. It gets worse as we age and enter our child-bearing years. Becoming a parent is in itself a professional risk for women, who often have a hard time re-entering the workforce after maternity leave, or who find that time taken for being a stay-at-home mom is not considered valuable experience on a resume despite the long hours and multi-tasking the job requires. When you have kids there is little incentive to leave a cushy corporate or government job with benefits and health insurance to join a start-up and work nights, no matter how promising the venture. Most new business ventures fail. 

Why are there no women in higher management? It isn't because we aren't in the workforce in sufficient numbers. It isn't because we aren't leaning in – successful women are leaning in and they still can't seem to climb the corporate ladder to CEO. But that's the problem: it isn't a ladder. Not all CEOs are promoted from within the ranks. Many don't climb the corporate ladder. They start their own companies and declare themselves CEOs. 

It comes down to risk. If we are serious about increasing the numbers of women entrepreneurs we have to do something to offset the risk involved, personal and professional. It's not enough to "lean in." We have to encourage women to lead. We have to tackle the issues of child care and health insurance. In general, starting your own business actually increases your flexibility with child care. That's why many women-owned businesses start from home (where the kids are) on the internet, on e-Bay and etsy. As CEO I can make my own hours.  I don’t need the approval of my boss or co-workers.  But this flexibility has its costs in salary and health insurance. I no longer get paid vacations or "comp time," and I am paying for a high-deductible health plan with a health savings account to cover my entire family while we wait for my state to create a small business exchange this October.  If and when it does, I can pool with other small businesses and make a better health plan more affordable for myself and any future employees. Until then, in the absence of single-payer health care like parent-entrepreneurs in other countries enjoy, I am on my own.

So as a small business owner this is my recipe for entrepreneurship that will help women (CEOs and their employees) thrive:

- Subsidized child care with extended hours for small business owners

- Small business insurance risk pools so that one and two-person companies can pool together to get reasonable health insurance rates

- Women-owned business collaboratives, where women can learn from and be introduced to other women entrepreneurs

- Women CEOs who mentor other women publicly and vocally. Who has Sheryl Sandburg mentored? I want to know!

- A venture capital firm that will invest in women-owned businesses with family-friendly business policies that promote work from home, flex-time and outreach

If you are a small-business owner please feel free to comment below and add to the list. I am partnering with other women entrepreneurs to help mentor others and I want your input.

Finding a Qualified Forensic Pathologist Expert Witness

1. Is the pathologist certified by the American Board of Pathology?
This is the most important qualification for an expert witness in the field of pathology. Just because an expert claims to be "board-certified" does not mean he or she is. Not all board certifications are the same. The American Board of Pathology is the only board offering certification in forensic pathology in which the applicant has the following qualifications:

• Graduated with an M.D. Or D.O. Degree from an American College of Graduate Medical Education (ACGME) accredited medical or osteopathic school.

• Licensed to practice allopathic or osteopathic medicine.

• Completed a minimum of 3 years training at an ACGME accredited pathology residency program

• Completed a minimum of 1 year training at an ACGME accredited forensic pathology fellowship program

• Has passed qualification examinations in Anatomic Pathology and Forensic Pathology.

Be aware that there are experts who use degrees from on-line "diploma mills" and sham certifications can be purchased.

2. Where was the pathologist educated and trained?
Ask for the expert's curriculum vitae or resume. Don't be impressed by the multitude of pages, but look at the content. Have you heard of the universities? Do they have a good reputation? If a doctor is not foreign-born but they chose to go to an off-shore medical school, it is sometimes an indication that they couldn't get into medical school in the United States. Foreign medical graduation alone should not concern you if the doctor has subsequently completed residency and fellowship in the United States and passed their Board examinations. It is important to look at where they did their fellowship training: the most prestigious forensic fellowship programs are either in large cities (such as New York, Miami) or part of a centralized State-run Medical Examiner's Office (such as in New Mexico or Virginia). There is also an excellent forensic training program through the Federally-financed Armed Forced Medical Examiner. But even programs with good reputations can undergo seismic changes if there is a scandal or the Chief retires. You can always Google search the name of the program along with the word "scandal" and see if any news reports come up with the expert's name on in. If you don't do this, opposing counsel definitely will.

3. Do they come recommended?
Few lawyers take the time to ask for references, but if you are finding an expert witness via the internet, or by using an expert witness referral service, it is a good idea to ask the expert for lawyers they have worked with recently. Only another lawyer can tell you if the expert was readily available, reasonably priced, easy to work with and understandable. The lawyer can also tell you whether jurors understood their testimony, since most pathologists don't get feedback directly from the people they are being hired to educate.

4. Are they currently practicing forensic pathology or are they a "professional expert"?
Many forensic pathologists who practice forensic pathology full-time at a County Coroner or Medical Examiner's Office still do some consulting as expert witnesses "on the side". A few work part time or do per-diem work at a County facility. However, there are several forensic pathologists who have retired or left practicing medicine completely and work as legal consultants full-time. The latter group can be problematic if they are out-of-touch with the standards and requirements of current medical practice, or are marketing themselves as "hired guns". Some have been forced to leave civil service because of ethical violations or political scandals. If you are hiring a "professional expert", make sure they are well-qualified, highly recommended, and have their background checked.

5. What is their "bedside manner"?
Many pathologists enter this field of medicine because they are more comfortable with dead bodies than with living people. Unlike academic medicine, where a pathologist has to have some teaching skills to maintain their appointment, forensic pathology is very attractive to introverted practitioners who like to work in solitude. Although all forensic pathologists are expected to testify in legal cases, and many are quite comfortable with it, that doesn't mean they are any good at communicating complex medical issues. So when you are on the phone with the expert ask yourself if they are understandable. Do they use "Med-speak" or do they explain the medical terminology to you as they talk? Are they personable, even charismatic? While some people are not good communicators over the phone but are very eloquent in person, if your first interaction with the expert is unimpressive you may want to schedule a face-to-face meeting to see if you can understand them better. But if you can't understand what the expert is saying - then neither will the jury.

6. What is their area of expertise?
Not every forensic pathologist may have the specialized knowledge you need. A land-locked forensic pathologist from the Midwest may not know much about SCUBA related accidents. A suburban forensic pathologist may autopsy a lot of car accidents, but not a lot of multiple gunshot wound homicides. Try to match the needs of your case to the experience of your expert. If it is a rare or unusual type of death, try to find an expert who has published on the subject. One way is to go to the National Library of Medicine (PubMed) and search the database for articles on the topic. Who is the primary author on most of the publications? Depending on the journal, many articles print the author's contact information in fine print at the beginning or the end of the article; and if the primary author doesn't do consulting, you can always ask them to recommend someone in their field of expertise who does.

7. Do they have experience testifying in cases such as yours?
Most forensic pathologists who practice in a City or County Coroner's office are very good at testifying in criminal cases, since they get a lot of on-the-job experience testifying for the District Attorney's office. But not all of them have frequent contact with Public Defenders or defense attorneys, so if you are a defense attorney, you want to make sure your expert has experience and understands the needs of the defense. Also, few practicing forensic pathologists have experience testifying in civil matters as a routine part of their job. The questions you may need them to answer may be beyond what their experience and training allows, or outside their "comfort zone" as an expert. For example, in an industrial accident, most forensic pathologists will be able to testify to the cause of death and the mechanism of death, but not all have the specialized knowledge regarding interpreting scene investigation to answer complex questions such as: What position was the person in when he was injured? Were the levels of drugs or medications they were taking capable of causing impairment? Make sure the pathologist has experience answering these types of questions before you hire them.

8. What is their expectation of their role?
Some pathologists see their role as very limited: you send them the material they need (typically medical records, police or incident reports, an autopsy report and microscopic slides) and they tell you what they think and write a report. Others will be more accommodating in offering you additional legal support: looking up references and articles, educating you and your staff about the medical issues as they come up, helping you understand the medicine so that you can formulate good questions for deposition or trial, and writing affidavits. If you ask, the individual expert will usually tell you up front what you can expect from them. You should also ask if they understand the different expectations of opinions written to comply with Frye versus Daubert rules of evidence. If an expert works in a Frye State and has never testified in Federal court, they may not be familiar with what Daubert standards are, and you will need to be more assertive in educating him or her about your jurisdiction's particular needs or legal quirks.

9. Do they teach?
This is a pretty good litmus test for communication skills. The most successful expert witnesses understand the complexity of their subject matter, but can find a way to simplify their terminology to make the subject accessible to a lay person. The average juror does not have an advanced educational level and is going to get lost unless the expert can speak to their level. Just because an expert has an academic appointment at a medical school or university does not mean they are good teachers. Just about any big-city Medical Examiner or Coroner's Office has academic affiliations because the local pathology residents are required to do a forensic pathology rotation. Does the practitioner have teaching awards? Do they teach groups other than doctors? If they do, then this is a pretty good indicator that they are comfortable with public speaking and can adjust their language appropriately for the audience.

10. How can you balance your needs with the pathologist's expertise, their proximity, availability and your budget?
Finding the right expert for your needs is a balancing act, and it requires you to be up-front with your expert about costs and expectations. The expert should have plenty of experience with similar cases to give you an estimate of how much time it takes him or her to review materials (for example: an inch of medical records usually takes an hour) or to research and write reports. A local expert with minimal experience may be sufficient if the case is a local one and you are on a tight budget; but you may need an internationally-renowned and published expert from far away if the case is a multi-million dollar class-action lawsuit. Obviously, the more famous or further away an expert is, the larger the expenses will be, and it is best to discuss these issues openly with your expert up-front so that there are no misunderstandings or scheduling complications as deadlines approach.

This list was originally published on www.PathologyExpert.com

Transparency and Ethics

At my last job, I was asked to fill out a 22 page financial disclosure form. I have filled them out before. It is an onerous task that takes several hours and involves quite a bit of paperwork, and it was due before April 15, making it more likely that any errors would be the result of one's paperwork being with a tax accountant rather than intentional perjury. Yes, it is signed under penalty of perjury. In doing this annual exercise, which in most places is relegated to people with actual financial decision making capacity (elected officials and top City managers) but now has been expanded recently to include lowly City employees such as myself I wondered: is this really adding to transparency and improving ethics or is it just a pointless exercise to create the appearance of ethics?

I favor the latter. First of all, the form doesn't actually list financial amounts but allows you to check a box with a ballpark, and it would be easy to obscure actual large contributions to an elected official by spreading them out over multiple entities or better yet, doing it the legal and completely undisclosable way: contributing to their election campaign via groups now proliferating since the Supreme Court Citizen's United Decision. Contributions to groups that keep an elected official in power and allow him or her to continue collecting a large salary and control large government contracts are legal and not included on Form 700. Interesting.

But what about the lowly forensic pathologist? If a forensic pathologist actually had a financial interest in the determination of someone's death, for example if their rich uncle died and they were inclined to sign the death certificate as, say an accident, in order to collect on a large accidental death policy. Technically, a large inheritance would be disclosable on Form 700 but nowhere do you have to identify that you signed the death certificate. It would require some digging on the part of the press or public and it would most definitely be picked up by the insurance company. Insurance companies have their own review process for releasing any awards. A pathologist inheriting on a policy where he signed the death certificate would most run into trouble collecting.

Finally, what are the real ethical decisions that challenge forensic pathologists on a daily basis? Are these financial decisions or something much more complex, that cannot be uncovered by any financial disclosure form? Things like: do I tell the grieving family that their infant died from being smothered on the blanket they got as a gift from their great aunt or do I just tell them it's SIDS? Do I tell the DA what the public defender told me when they met with me about their trial strategy or do I keep that to myself? What should I do if the DA demands me I tell her? Or threatens me? What do I do if I am told by my boss or his boss not to testify in a politically-charged, high-profile case?

These are not theoretical questions. These are actual ethical questions that have confronted forensic pathologists I know. So while commissions and government bodies have us filling out financial paperwork we forensic pathologists actually got together and wrote on this subject. You can find it in the NAME Position Paper on Medical Examiner Independence and it is available on line, published in the peer-reviewed journal, Academic Forensic Pathology. A companion paper, published in the same journal, documents several high-profile cases that were a challenge to pathologists' ethics and that prompted the response. In surveying members of the National Association of Medical Examiners, our survey uncovered that nearly a quarter (24%) of those surveyed reported that they are considered prosecution witnesses within their jurisdiction with the expectation that they not cooperate with defense counsel and 42% of the respondents reported that they were expected to divulge details of their conversations with the defense with the prosecution. Approximately a quarter of pathologists (22%) had pressure applied by elected officials or appointees to change cause and manner of death and 11% experienced pressure to change their testimony or withdraw as an expert in a specific case. While pathologists working in Coroner systems were more likely to have the cause of death on the death certificate changed from what was on the autopsy report (43% versus 14% for Medical Examiners), Medical Examiners were more likely to restrict forensic pathologists from private consultation than Coroners (64% versus 0%). The position paper outlines real ways that government can improve on this situation, for example by recommending that forensic pathologists be independent of law enforcement and be available for consultation for both prosecuting and defense attorneys. It also recommends that given the scarcity of forensic pathologists in the United States, they should be free to review, offer opinions on and testify on cases from outside their own jurisdiction.

This paper goes part way in addressing ethical concerns, but it doesn't address issues of respect and professional regard. Most recently a colleague of mine from Oklahoma has been forced to come back under Federal subpoena to testify in a case he did many years ago and the Federal attorneys will not compensate him for his time or work as an expert, insisting that since he did the autopsy years ago under contract he must take vacation time from his current job and miss work in order to do his "civic duty" to testify. If forensic pathologists are not compensated for their work and are treated by the courts in such a way, it is no wonder we are having problems attracting professionals to our ranks.

If those of us that work within the justice system as experts are stymied by breaches of ethics and frustrated by lack of regard and compensation, then what does it say about the quality of the justice system in our country? Comments welcome below.