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.