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:

"Candidates for Porter County Coroner Both Tout Experience"

&

"Coroner Cites Criminal Probe Background in Re-election Bid" 

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.

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.