Lesson 2: Never underestimate the potential of a troubled office.

Many forensic pathologists have very definite opinions about the best systems for performing death investigations. Some say that all death investigative systems should be medical examiner systems. Some prefer to retain coroners. Some say that the medical examiner should never work directly for a police agency. Some say it doesn’t matter. Some say that forensic pathologists should be independent contractors, while others believe they should be employed by the government.

Over the years, I have tired of discussions like these. For the most part, not one of us has the power to change state laws. Systems have evolved over time into what they are today, and the likelihood of developing the political clout to change them is not high.

After 11 ½ years as a chief, I found that it doesn’t matter what type of system one works for. Success or failure is not determined by the system, the politics or the government.

Success or failure is determined by the guy or gal in charge: the chief.

How can one person determine success or failure? Very simply. If I take a chief position in any system, no matter how troubled the system, it will either become a roaring success or I will leave it. Either way, I will be successful, because I will do what I do on my terms.

Often we think that troubled offices want to remain troubled offices. Otherwise, why do some offices (I will not mention names) seem to chew up and spit out every chief that takes the job?

In reality, the governments behind these offices do not want them to remain troubled. That is because there are very strong incentives for them not to remain in trouble. In a free society, people demand justice and truth. People demand competence in dealing with the dead. When justice is thwarted, when the truth is undiscovered, when dead loved ones are treated incompetently or disrespectfully, there is an outrage once it is discovered. The media essentially gives voice to the people’s outrage and eventually holds politicians to account for ineptitude. The questions to be answered by medical examiners—questions involving justice and truth—must be answered truthfully and competently. Incompetence is never tolerated, no matter how poorly funded the office.

The problem is that we, the professionals, are too willing to tolerate ineptitude. We are too willing to tolerate shoddy death investigation. We essentially aid and abet incompetence by being passive and tolerant, by failing to recognize the shoddy and take measures—even drastic measures—to correct the shoddiness. Politicians are more than willing to spend money in other places unless the medical examiner is willing to cry, “Enough!” Unless the medical examiner is willing to leave!

The office I directed provides an excellent example for why there is always hope for the troubled office. Back in the early 1990’s, the appointed Jackson County Medical Examiner—the only pathologist in a busy office—wanted a $10,000 increase to his annual salary of $89,000. When the county government refused, he gave them four weeks notice prior to accepting a more lucrative community hospital job in Eastern Kansas. The county was unable to find a replacement in four weeks who was willing to accept an annual salary of $89,000, so the bodies accumulated in the morgue when the medical examiner left. The non-physician death investigators for the office released bodies that did not require further examination, but those that required autopsies—homicides, suspicious deaths, unidentified bodies, etc.—remained in the morgue. A crisis emerged. Numerous complaints were directed to the county. The Kansas City Star wrote a series of articles describing the state of the crisis and the county’s inability to respond to it.

Jackson County Government finally persuaded the medical school pathology department in the same building as the medical examiner—Truman Medical Center in Kansas City, Missouri—to provide pathologists to perform autopsies. Two individuals were selected, and they performed autopsies day and night until the accumulating bodies were released.

One of these pathologists accepted a contract to serve as acting medical examiner. About nine months later, Jackson County revoked his contract because of fallout and negative press from incompetently performed autopsies and investigations. The other pathologist who performed the autopsies later left the Truman Medical Center Pathology Department on unpleasant terms and replaced the dismissed pathologist as the acting Jackson County Medical Examiner. He performed his medical examiner duties part time while also providing pathology services to rural hospitals around Kansas City. A few years later, he had his medical license revoked for fabricating autopsy findings in several cases.

The Truman Medical Center Pathology Department performed a search for candidates for medical examiner because they were interested in obtaining a contract from Jackson County. On behalf of the county, this department interviewed candidates for two years but no one would accept the position.

Meanwhile, I was serving as an associate medical examiner in Atlanta, Georgia. My salary at that time was $85,000 per year. The moonlighting work I relied upon to supplement my income had dried up, and I was considering what moonlighting work I could do to replace it.

It dawned on me at that time that I was doing a major disservice to myself and my family. As I looked at the educational and other expenses ahead for my children, I stopped to wonder why I—a board certified pathologist and a licensed medical doctor—was willing to put up with these circumstances. I informed my employer in Atlanta that I was going to interview for other jobs—primarily hospital pathology jobs—and that I was going to leave Atlanta. As much as I loved forensic pathology and working in a busy medical examiner office, the financial concerns made my first love fade.

My employer understood, stating that he had tried for years to remedy the salary situation, but the government refused to respond. He was sorry it had come to this.

Shortly thereafter, I received a notice of two job openings in Kansas City at the Jackson County Medical Examiner’s office. The University of Missouri, Kansas City, Medical School Department of Pathology at Truman Medical Center was looking for a chief and a deputy. I responded to this ad and made an appointment to visit Kansas City. Two weeks before my scheduled visit, the pathology department canceled the visit. The pathology department and Jackson County Government were in disagreement about the arrangement. About two weeks after the time of the cancelled visit, the pathology department contacted me again and I flew out to Kansas City.

The day of the interview was highly unusual. I was not allowed see the autopsy room and the office space used by the medical examiner because the acting Jackson County Medical Examiner was antagonistic toward the pathology department and refused to show me the office. The Truman Medical Center Pathology Department chairman told me later that day that the disagreement with Jackson County Government was never resolved.

By the time I interviewed with an officer from Jackson County Government, I was thoroughly puzzled by what I had seen. I expressed my confusion to this official and asked what was going on. According to him, the main part of the dispute was the arrangement desired by the pathology department. The county executive wanted the medical examiner to be a county employee rather than a member of the Truman Medical Center Pathology Department and under contract.

I told the county official that I would accept either arrangement. I gave him my conditions for accepting the job, including salary and relocation reimbursement proposals. If the county government met these conditions, I would take the job.

Eventually, the government met those conditions, and I began employment as a Jackson County employee in July 1995. My salary at that time was $160,000 per year, nearly double the salary for the Jackson County Medical Examiner from three years earlier! All of this happened because they tried to save $10,000!

More than a decade later—after resolving the fallout from several scandals, updating the office equipment and staff, training and replacing pathologists and lay death investigators, asking for and receiving increases in the annual budget, obtaining national accreditations for the office as a death investigation system and a forensic pathology training program, and providing reliable and accurate death investigations for law enforcement and the community—I occupied a 10,000 square foot facility within the same hospital complex, utilizing state-of-the-art technology. The office became successful beyond all expectations!

Never underestimate the potential of a troubled office!