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 www.drworkingstiff.com. Follow @drjudymelinek and @tjmitchellws on Twitter.

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.

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.