Lesson 7: Wield “The Big Stick” for the office.

Being a medical examiner can be compared to being in the middle of vicious fight. As the parties angrily hurl invective and possibly other objects at each other, the hapless medical examiner stands in the middle of it all, hoping to keep him or herself out of as much trouble as possible. For this reason, the term, “forensic,” defined as “of, relating to, or used in debate or argument1,” seems in this sense to fit in front of the word, “pathologist.” There is also a tendency for one or more of these parties to want to kill the messenger, particularly if the message from the medical examiner does not fit an agenda.

One of the things I noticed when I assumed a new job in a previously troubled office was the resistance to positive change. Because the previous medical examiner was weak and his findings were questionable, other agencies—the police, the prosecutor, and the child protective agency—adjusted the way they conducted investigations in order to compensate for that weakness. For example, police agencies in my jurisdiction used to remove all of the evidence from the body before the pathologist viewed the body. This practice was unacceptable, and no fully accredited death investigation agency in this country allows this. Prosecutors and child protective agencies also made it a habit of consulting outside pathologists in critical cases, thereby calling into question their faith in the findings of the one hired by the county. When you, the new chief medical examiner, arrive on the scene, these practices do not go away immediately. You are immediately questioned, and your opinions and decisions are immediately viewed with suspicion.

Consequently, I believe it is essential for the new chief medical examiner to be ready to wield “The Big Stick” for the office.

Shortly after I began work in Kansas City, one of my former investigators complained about how tough it was to work in the office. We occupied a portion of the morgue in the ground floor of the county hospital. He complained that housekeeping never came down to empty the trash, even though trash would overflow from the bins, particularly after a busy weekend. The hospital radiology technologists responded slowly to our requests for radiographs on our cases, both for the taking of the x-ray and for their subsequent development. When the medical examiner investigator would arrive at the death scene, the police officers and other personnel would not show him any respect and would not give him access to the body or to information regarding the death. He further moaned about how none of this would ever change. “We are too small,” he said, “and everyone pushes us around.”

I smiled as I told him that all of this would change for the better. “I carry a big stick,” I told him, “and I am not afraid to use it!”

Jackson County, Missouri, finally decided to spend much more money than before in order to hire a chief medical examiner with excellent credentials and an excellent reputation. The county government finally decided to remedy a neglected agency. I felt I had a mandate to fix the situation, and I was prepared to do so.

In spite of the investigator’s disbelief, the situation with housekeeping and radiology was easily fixed. It was simply a matter of going over their heads and speaking to their supervisors. Further, I employed a technique that I have found to work well over the years. If the x-ray department, for example, said that they could not take the x-ray films immediately because they were taking care of other more urgent situations, I asked them for a specific time that they could respond. If they did not respond at the time they said they would, I would have my investigator telephone them every five minutes until they came. The squeaky wheel does indeed get the grease, so in a nice way I did a lot of squeaking! Soon, housekeeping and radiology learned that it was easier to respond immediately than to have to answer all of the telephone calls that would certainly follow.

The tense situations at death scenes were also easily remedied. I instructed my investigators to avoid arguments at the scene. Simply smile, take down the police officer’s name and badge number, and report the situation to me. After several calls to supervisors, the situation immediately reversed. My investigators had no problems doing what they needed to do at the death scene.

It is important for the new chief medical examiner to set the boundaries for acceptable practice and behavior, not only with his or her office staff but also with other agencies. I have found that if you demand respect, you will get it. I feel no need to bow to any type of political pressure if it will lead me to do something I know is not right.

It is also important to demonstrate to the people who work for you that you are willing to fight for them. Wielding “The Big Stick” immediately improves the morale of the office.

The phrase, “Speak softly and carry a big stick,” comes from former president Theodore Roosevelt. This is the way he described his foreign policy. In the same way, the chief medical examiner should always be professional, polished and polite; nevertheless, people should be able to sense toughness behind the polished front.

1 forensic. (n.d.). The American Heritage® Dictionary of the English Language, Fourth Edition. Retrieved May 14, 2007, from Dictionary.com website: http://dictionary.reference.com/browse/forensic