PBS "Frontline" program on death investigation

[KCShaw]

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A couple of people might be interested in this:

http://www.pbs.org/wgbh/pages/frontline/post-mortem/

It's a recently aired program on death investigation (by way of ME's/coroners) in the U.S., highlighting some of the common big issues by way of a few specific stories.

Part of the problem with the "system" of death investigation as it applies to medical examiners/coroners is that there -is- no system nationally. The terms "coroner" and even "medical examiner" are without standard meaning -- every jurisdiction/county/state defines them separately and has different statutory requirements attached to them. Sometimes the coroner has to not only be a physician but a certified forensic pathologist, while sometimes a medical examiner does not have to be a pathologist (much less a forensic pathologist) at all. The attempts by organizations such as the National Association of Medical Examiners to create and apply national standards, while admirable, carry no weight in many jurisdictions as there is little to no legal or financial incentive to attain or maintain accreditation. Forensic pathologist jobs go unfilled in some areas because they are poorly advertised, poorly funded, clearly politically charged, and/or poorly supported. Forensic pathologists are fewer than they could be because the jobs pay more poorly, on average, than any other pathology subspecialty while jobs are scattered (one is essentially guaranteed to have to move to take a new job, rather than finding another job in the same large city, unlike almost any other medical subspecialty) and more frought with sometimes unpredictable politics.

There -must- be more standardization applied to the "system" as a whole, as well as a layer of insulation from oversight/control by law enforcement or prosecutors, for forensic science in general and forensic pathology specifically to mature and improve for the good of the local community, the state, and ultimately the nation. Without a strong foundation there can be little stability, and nothing to build on.

 

[TMZ2007]

Not to mention that there is often not a whole lot of science in "forensic science."

I recently had to drop an anonymous letter and facebook posting to one of our fine television news organizations reminding them that we did not have a Coroner's Office but an OCME staffed by forensic pathologists. To their credit, recent reports on death investigations have referred to the body going for autopsy by "forensic pathologists from the medical examiner's office".

An eye-opening documentary on death investigation when no next-of-kin are available is on Netflix streaming also.

 

[KCShaw]

Not to mention that there is often not a whole lot of science in "forensic science."

That's something addressed in the NAS report, though courts are variable in how they address/accept/challenge the existing science, studies, and things accepted as "true". It's also worth repeating, as Dr. Fierro did in the Frontline program, that there have been previous national reports addressing death investigation and at least some of their recommendations have been ignored (specifically addressing coroners, at the least). Until people demand and are willing to pay for a system, with enforceable standards, competency and consistency are going to remain patchy.

I've meandered around and seen enough reports that even in jurisdictions which have never had a coroner system, media and even law enforcement occasionally talk about the fictitious "coroner". There are a tremendous number of largely false assumptions floating around with regard to this topic, though that's at least partly bred from the inconsistencies across the country.

I'll have to check out the documentary you linked -- thanks.

 

[redapple123]

A couple of people might be interested in this:

http://www.pbs.org/wgbh/pages/frontline/post-mortem/

It's a recently aired program on death investigation (by way of ME's/coroners) in the U.S., highlighting some of the common big issues by way of a few specific stories.

Part of the problem with the "system" of death investigation as it applies to medical examiners/coroners is that there -is- no system nationally. The terms "coroner" and even "medical examiner" are without standard meaning -- every jurisdiction/county/state defines them separately and has different statutory requirements attached to them. Sometimes the coroner has to not only be a physician but a certified forensic pathologist, while sometimes a medical examiner does not have to be a pathologist (much less a forensic pathologist) at all. The attempts by organizations such as the National Association of Medical Examiners to create and apply national standards, while admirable, carry no weight in many jurisdictions as there is little to no legal or financial incentive to attain or maintain accreditation. Forensic pathologist jobs go unfilled in some areas because they are poorly advertised, poorly funded, clearly politically charged, and/or poorly supported. Forensic pathologists are fewer than they could be because the jobs pay more poorly, on average, than any other pathology subspecialty while jobs are scattered (one is essentially guaranteed to have to move to take a new job, rather than finding another job in the same large city, unlike almost any other medical subspecialty) and more frought with sometimes unpredictable politics.

There -must- be more standardization applied to the "system" as a whole, as well as a layer of insulation from oversight/control by law enforcement or prosecutors, for forensic science in general and forensic pathology specifically to mature and improve for the good of the local community, the state, and ultimately the nation. Without a strong foundation there can be little stability, and nothing to build on.

What about the pay? moolah ?

 

[KCShaw]

Pay for a forensic pathologist seems to be in the range of roughly $110-$200k (more or less in the range of academics), but without a lot of room for improvement without adding a consulting component. Chief salaries may be a little higher (up to around $250k, give or take), but still quite variable depending on location. Very few people will have a purely private consulting practice, something which is fading anyway as defense attorneys are pointing out that X hasn't actually done an autopsy in 15 years but merely reviews reports and makes comments/draws conclusions. The up side is that many will get government benefits.. if they stay in one location long enough. When a pathology resident is finishing up and looking at >$100k debt, some closer to $300k, to pay back, while paying for a move, new house or nice apartment, etc., and they have to choose between a $150k job with a low ceiling and a $220k job with theoretical partnership in the future, it's easy to see how bright and capable individuals might choose something other than forensic pathology (general pathology job market issues notwithstanding).

So yeah, one of the major problems nationwide is funding for board certified forensic pathologists.. as well as facilities, morgue technicians, morgue photographers, certified investigators, toxicology, histology, occasional consultants such as forensic odontologists or forensic anthropologists, etc.

 

[HbyHA]

. When a pathology resident is finishing up and looking at >$100k debt, some closer to $300k, to pay back, while paying for a move, new house or nice apartment, etc., and they have to choose between a $150k job with a low ceiling and a $220k job with theoretical partnership in the future, it's easy to see how bright and capable individuals might choose something other than forensic pathology (general pathology job market issues notwithstanding).

So yeah, one of the major problems nationwide is funding for board certified forensic pathologists.. as well as facilities, morgue technicians, morgue photographers, certified investigators, toxicology, histology, occasional consultants such as forensic odontologists or forensic anthropologists, etc.

pretty much. but i just can't put a monetary value on finally loving what i do. i remember sitting at the bar after the boards and talking about our impending fellowships. SP, cyto, etc represented. I was the ONLY one who was positively giddy with excitement. the others, not so much. just a means to an end.

even my worst day in forensics is better than my best day in hospital path. but that's just me😀

 

[KCShaw]

👍

 

[gschl1234]

A couple of people might be interested in this:

http://www.pbs.org/wgbh/pages/frontline/post-mortem/

Thanks for posting this! It was a really great, informative report. I am pretty surprised that the New Orleans coroner was willing to go on camera given all the controversial cases related to his office. I'm also pretty shocked about Dr. Gill, who was able to move from state to state messing things up everywhere. Oh, at it was very cool to see Dr. Weedn on camera! He's a really great teacher. 🙂

 

[KCShaw]

I'm a little surprised that some people were willing to face what they -probably- knew would be some tough questions and criticism. And while I certainly think the program raised some very good issues, I keep in mind that the point isn't the individuals being razed but the system, or lack thereof, perpetuating or at least not effectively addressing some broad fundamental underlying concerns. I generally have little faith in reporting on specific individuals or cases, as it is almost invariably biased and ignores big parts of the specific individual story -- but sometimes the broader underlying issues raised are worth properly looking into independently. Such as.. individuals practicing medicine (signing death certificates) with not only no medical license, but no medical training, and often little to no training in death investigation at all. To be momentarily alarmist, it's akin to having your high school English teacher sign out a medical renal biopsy. Possibly without a microscope or clinician input.

As much as there will always be some level of disagreement among doctors, scientists, and people, there is a tremendous amount we can do to standardize and build simple but consistent foundations of practice and conduct, so we can academically argue over salient points rather than drown in an ocean of inconsistencies.