Lesson 3: Good death investigation is inexpensive (bad death investigation is costly).

Consider the following from the 2005 budget of the Office of the Jackson County Medical Examiner in Kansas City, Missouri.

TABLE 1: Budget Data, Office of the Jackson County Medical Examiner, 2005
Population served 1,022,194
Total County Budget $282,728,176
Medical Examiner Budget $1,648,657
Percentage of ME Budget to Total Budget 0.6%
Cost per Citizen $1.61

The information from budget data demonstrates how inexpensive it is to operate a medical examiner system. Our budget expenditures formed only 0.6% of all county expenditures! The cost per citizen per year of $1.61 is miniscule!

Good death investigation is inexpensive. It is a high value item and well worth the funds expended.

On the other hand, none of us wants to accept the costs that come from poorly performed death investigation. People in the United States of America for the past several years have demonstrated that they are willing to pay any sum of money and go through any sacrifice in order to insure that the dead are recovered, examined and identified properly. The people of New York City expended much money and many resources to identify the victims of the World Trade Center attack, and the government of the United States spared no expense on the morgue operation following Hurricane Katrina. Hundreds of years of jurisprudence have declared that a person is innocent until proven guilty. We believe sending the wrong person to prison is a moral outrage. How much is it then worth to make sure that such an event would never happen?

Dr. Root’s comments in his article are on point in this regard.

“Of the multitude of problems facing forensic pathology, the overwhelming one still appears to be cost. How cheap? Costs cannot be ignored, but they must be viewed in the full context of the cost of the alternatives. How much of a bargain have we received from cheap forensic pathology services? Ask the taxpayers; ask the courts where credibility has been damaged; ask law enforcement officials whose credibility has been impaired; and ask the victims of the injustices, inadequacies, and ineptitudes of the system. Cost is relative. It must be weighed against the alternatives1.”

What about the county officials who come to you to explain that, in the light of hard economic times, they have to cut your budget? Perhaps they tell you they cannot allow a waiver on the hiring freeze or they cannot allow your office to be staffed adequately at this time. What do you do?

You listen carefully and see if you can reasonably go along with what they want. If you cannot, you tell them that you cannot and why. You tell them that the moral imperatives of your duties demand that the office is adequately funded. It would be better to send fewer funds to the public library or the charities they support than it would be to allow one single injustice to occur on their watch. You have to look them in the eye and very diplomatically state, “Over my dead body!”

And if they do not like that, prepare to leave!

1 Root I: “Forensic Pathology – Catch 22. A No-Win Situation (?). Am J Forensic Med Pathol 7(3): 237-240, 1986.