Saturday, March 22, 2014

7 CSI Fails

The CSI effect is a term coined by attorneys for the unrealistic expectations created by television crime shows on the public. It's a real thing. As an expert witness in forensic pathology I see the CSI effect when I'm faced with questions like, "Why can't you tell us the precise time of death down to the minute, like on TV?" Potential jurors are now being asked if they watch NCIS, CSI, Bones, Law & Order: Criminal Intent, and a plethora of other shows that depict police and other forensic professionals doing their jobs. So how close are these shows to reality? I'm here to tell you. Here are 7 things these shows consistently get wrong:

1. Somebody Turn on the Lights!
The first thing the police do when they secure a crime scene outdoors is set up Klieg lights to illuminate the scene while we do our work there. When I get to an indoor death scene and the lights are off? Well, we turn on the lights. Television shows striving to effect an atmosphere of suspense portray the crime scene investigators looking around a death scene with flashlights. Back at the lab, it's gloomy and dim. The scientist is wearing a headlamp while he pokes at something bloody but indistinct. Seriously? Forensic science is done in a clean and bright lab. My autopsy suite in the morgue has the same overhead lighting as a surgery suite, with good reason: I need to see what I'm cutting. You can't find the evidence if you can't see the evidence, and without evidence there is no forensic case.

2. Where Do You Shop?
Low cut blouses and high-hemmed skirts are not appropriate attire at a crime scene. Neither are stiletto heels, platform heels—any heels. You don't want to wobble or trip when you're negotiating your way around a corpse on the sidewalk, believe me. Police departments and sheriff-coroners have strict dress codes and grooming rules with restrictions on hairstyles and visible tattoos. You can lose your credibility as a forensic professional if you are not wearing business attire. And one more thing: No Louboutins on a government salary.

3. Don't You Have Anything Else to Do?
Most forensic science jobs, whether in an office or the lab, are nine-to-five. As we say in the morgue at quitting time, "They'll still be dead tomorrow." There is no need to come in at two in the morning to run a lab test because you just can't sleep until you do, or to perform an entire autopsy, alone, in the middle of the night. In fact, most offices have restrictions on entering after hours, and any technician or employee who is poking around in the lab without supervision will encounter serious scrutiny. It's true that police officers work unorthodox hours, but they do so on a shift schedule and overtime is monitored. When the shift ends they pass the case to another investigator, go home to their families, or to bed to sleep, or off to do ordinary things like normal human beings. Unlike their television avatars, they do not single-handedly conduct an investigation around the clock.

4. You're Dating Who?
Why are TV forensic scientists always flirting or sleeping with cops and co-workers? Dating someone you met on the job is taboo in most professions, and even more so in a field where your work is subject to legal scrutiny. If you are caught canoodling with a co-worker you could find yourself under investigation from—no pun intended—internal affairs, and if IA finds either of you has been influenced or biased by your fraternization you could both lose your jobs. Yes, television series need steamy subplots, but do they all have to involve intramural romance?

5. Lab Results, Stat!
DNA results in crime shows come back while the body is still warm, and the toxicology report is ready before the bone saw is even fired up. Someone please tell me where these labs with five minute turn-around-times are, because I want to send my specimens there! Tox results take a minimum of two weeks in the best labs, and DNA can take months to come back. Meanwhile, the autopsy paperwork gets filed and we wait for the results to come back before we conclude anything.

6. Where Are Your PPEs?
On the left: Television --  On the right: Real autopsy gear
PPE is personal protective equipment: gloves, face shields, masks and Tyvek suits, gear worn by forensic professionals while performing autopsies to keep themselves safe from blood-borne pathogens and potentially transmissible emerging infectious diseases. But PPE is notably absent on most shows, probably because directors want to see the actors' faces. Showing emotion with your eyes, body language and tone of voice is not sufficient? If I am pissed off at someone in the morgue that's what I do, and it seems to work just fine. OSHA would shut down these imaginary TV labs in a New York minute over these high-risk and needless violations. Nobody eats in the lab anymore either. That was something they did back in the days of Quincy ME, but it can get you fired nowadays.

And, finally...

7. Where Can I Get Me One of These?
Most crime labs and autopsy facilities in the United States are underfunded. We are lucky to be working with basic equipment, like an X-ray machine that works reliably, and we don't have access to the highfalutin gadgets these lucky TV scientists enjoy. Things like 3-D holographic reconstructions exist in digital-simulation labs at academic institutions, and may be used to publish papers on virtual autopsies in foreign countries, but such doodads are not available to the forensic civil servants who are doing the actual, daily work in the real world. In my autopsy suite I handle tools you will recognize from your kitchen. It's the ultimate in hands-on investigation. I love my job. And I'd love to see it portrayed in fiction with more accuracy—because the reality of forensic death investigation is even more riveting than the fantasy as seen on TV.

For more about real death investigation you can read "Working Stiff: Two Years, 262 bodies and the Making of a Medical Examiner" by Judy Melinek, M.D. and T.J. Mitchell. It is available on pre-order and will be in stores August 12, 2014. For updates check in with Facebook/DrWorkingStiff or at Follow @drjudymelinek and @tjmitchellws on Twitter.

Sunday, March 9, 2014

Risks of Being Chief Medical Examiner

Most recently in the news two Chief Medical Examiners have been suspended: one for mismanaging the San Francisco Medical Examiner's Office and creating a backlog of reports and death certificates that has families upset; the other after some drug evidence in the crime lab he oversees went missing and he was accused of not "minding the store" because of his outside private practice work.  The former, Dr. Amy Hart, was my supervisor at the San Francisco Office of the Chief Medical Examiner for nearly 9 years from 2004-2013. The latter, Dr. Richard Callery, I don't know personally, but I have communicated with him via e mail on numerous occasions.

After the news of my former boss' resignation I wrote the following Op-Ed piece for the San Francisco Chronicle and it has not yet been published, so I am publishing it here:
"I read with great interest your recent article about the changes at the San Francisco Office of Chief Medical Examiner. As a former Assistant Medical Examiner who resigned because of the management problems, I am encouraged that the city is finally taking steps to improve the situation for the staff at the office, and - more importantly - for the families of the deceased, who currently have to wait an inexcusably long time for that office to serve them as they deserve.
It's going to take a lot more than replacing the chief medical examiner to repair the problems at our city morgue. Naomi Kelly, head of San Francisco’s Department of Administrative Services, is going to need to hire additional administrative staff, investigators, technicians, and make sure there are four board-certified forensic pathologists (not three, as suggested in your article) under the new chief in order to adequately staff that office at the current workload, let alone tackling the backlog of cases. Any qualified candidate would doubtless have legitimate reservations about placing this staff at the new facility being planned at 1 Newhall Street. That building was chosen to be retrofitted for the new medical examiner’s office. It is on landfill, very close to the Bay, and quite a distance from SFGH, San Francisco's major trauma center. This building may be a major liability in any kind of disaster, natural or otherwise.
In addition to performing autopsies and shepherding the overhaul of the office, Dr. Hart’s replacement will also need to have the courage to speak truth to power about the financial needs of the office. A chief medical examiner who has an open-door policy to the police, District Attorney, Public Defender, City Attorney and any attorney with questions about the operations of the office will go a long way to improve the public's trust. Equally important, Dr. Hart's replacement needs to have the integrity to testify with full authority in high-profile cases, such as officer-involved shooting incidents and jail deaths. 
The taxpayers and citizens of San Francisco deserve this type of leadership. Unless the City & County of San Francisco is willing to fund a major and expensive overhaul of the San Francisco Office of Chief Medical Examiner, our city will find itself saddled with a weakened disaster preparedness plan and a subpar system of independent, scientific death investigation for many years to come."
With regards to the probe into Dr. Callery's work, I find the criticism of his outside private practice work disturbing because of the politicians' total lack of comprehension of what forensic pathologists do: we are scientists, objective arbiters of the evidence on the body. Our opinion is the same regardless of whether we are hired by the prosecution, plaintiff or defense. Does the Department of Public Health force the doctors in its employ to shut down their private practices?  It is no more a conflict of interest for the Chief Medical Examiner to do a private autopsy as it is for a pediatrician to treat a child in his clinic instead of in the county hospital. It is no more a conflict of interest for the Chief Medical Examiner to testify for the defense in another county as in her own, if she is called to testify by the Public Defender. In fact, Chief Medical Examiners have to be able to testify truthfully to their findings even if it is a conflict of interest for their employer. For instance, if a woman falls on the sidewalk, breaks her hip and dies of the complications, the Chief needs to be able to truthfully testify to the cause and manner of death even if the family then sues the City for not maintaining the sidewalk. This becomes even more important when a State or County institution is being sued for wrongful death of an inmate in police custody. You need someone objective and truthful, who reports to the science without political interference or influence.

Which leads me to the one other thing these politicians don't understand: there are only about 450 of us. That's the size of my son's middle school grade. Only 450 board certified forensic pathologists are currently practicing forensic medicine in the United States. We all know each other- either by name, or reputation, or through a mutual colleague. We read the papers and communicate via e mail listserves. Of the 450 currently practicing forensic medicine I estimate only about 10% (45) are qualified to be Chief Medical Examiners. So now we're dealing with an even smaller pool. Do the politicians who demoted Dr. Hart and are investigating Dr. Callery really think they can replace them that easily? Do they realize that if they are going to restrict outside work they are going to need to double Dr. Callery's salary? Invest millions of dollars into Dr. Hart's understaffed and underfunded office? If they don't they will never fill those positions.  In a few months time we'll be seeing articles about how they can't fill the spots because of the "shortage" of forensic pathologists, when the real reason is that they have poisoned the well and made the Chief position so dangerous and poorly compensated that no qualified applicant will take it, and any applicant who does take it is destined to end up like Drs. Callery and Hart, only 3 years down the line.