Lesson 8: Think ahead. Think way ahead!

I have learned from training and experience that good forensic pathologists find answers to questions before the questions are asked. It is important at the outset of any investigation or autopsy to anticipate the issues likely to emerge in the case so that the proper information is obtained, the proper photographs taken, the proper tissues sampled, and the proper specimens collected. Whenever someone close to the decedent telephones you with questions, whenever an attorney subpoenas for particular items of evidence, whenever a homicide investigator asks for information obtained from your observations, it is always nice to be prepared to give accurate answers. This requires the good forensic pathologist to think ahead. The forensic pathologist who knows what he or she is doing knows the issues that will surface several years after an autopsy.

As important as it is for the forensic pathologist to think ahead, it is even more important for the chief medical examiner to do the same regarding the office. The chief must not have a problem with “the vision thing,” an expression used by the former president of the United States, George Herbert Walker Bush. A good chief medical examiner must be a visionary because in most of our medicolegal death investigative systems, many improvements are needed and much remains to be done.

For example, I knew back in 1995 that I needed to expand the office from the one broken autopsy table and the office space we shared with the hospital pathology department. I needed to do it in a way that would be affordable and readily accepted by the county. If we remained within the medical complex where we were, I knew we could keep our overhead low because many of the amenities we enjoyed, such as security, library and radiologic services, would be provided by the hospital. I believed our continued presence within the complex would enhance a future training program because of ready accessibility to other academic departments.

We also had a financial advantage by staying within the medical complex. Both the medical examiner office and Truman Medical Center—the county hospital and the main teaching hospital within the complex—received money from the same county fund, known as the Health Fund. This served to keep our rent low, because the County told the Medical Center that they would receive a smaller allocation from the Health Fund if the rent was increased. This kept our rent and supply overhead for the office remarkably low.

I knew we needed to stay in the complex rather than to construct an expensive stand-alone facility, but the challenge was to find adequate space to meet the growing demand and workload of the office. Initially in 1997, we identified and renovated about 4,700 square feet of space on the first floor of the Truman Diagnostic and Treatment Center building. We knew that this renovation would allow us about five years of adequate space because of our growing workload.

My chief investigator, a former security officer who used to work for Truman Medical Center, maintained his contacts with the hospital. About five years after our first renovation, he learned that the relocation of the Magnetic Resonance Imaging office—the office immediately adjacent to the medical examiner office—was in the offing. Armed with this information, we were able to negotiate successfully with Truman for the vacated space and persuade the county government to obtain bond financing for a new project, allowing us to begin the plans for another renovation and an expansion in early 2003. With additional construction of a vehicular sally port, we expanded into the 10,000 square foot space that the office currently occupies. After the renovation, expansion and construction, we were charged by Truman Medical Center only $1,900 per month for rent and supplies!

None of this would have happened if I had not thought ahead. With an overall vision and direction for the office, a chief can recognize and take advantage of important opportunities.

Foresight can also allow the chief medical examiner to prevent crises to the office before they occur. During the best of times, a medical examiner office or individual forensic pathologists can find themselves in trouble because of the emotional and sensational nature of the work we do. The ability to anticipate the moves of police, family members, the media and politicians is an important prerequisite for a chief medical examiner because that anticipation will allow the prevention of crises. This ability to anticipate is gained through experience. That is why, I believe, a person should not consider taking a chief position until they have had several years of experience working in a busy medical examiner office.

I do not consider myself adept in the fine details of budgeting and other money matters. Fortunately, my administrator/chief investigator was competent in these areas, and he took care of the day-to-day management issues. Nevertheless, there has to be one person with a vision and with the knowledge and experience to bring that vision to fruition. Others may help with the details, but only one person should have the big picture in mind at all times. That one person must be an individual who is not only properly trained and experienced in forensic pathology and death investigation but also possesses leadership qualities and vision. It is that person who must be the chief.