The D.C. Medical Examiner's Office, once regarded as one of the nation's best, is faced with critical shortages in staff because of budget cutbacks and the resignations of its top doctors, according to prosecutors, police and other city officials.
The problem is so bad that officials in the U.S. Attorney's Office in Washington fear that the prosecution of some murder cases could be hampered. Medical examiners and technicians are so overworked that they could mistake a murder for a natural death, or perform sloppy autopsies that could lead to acquittals in some murder cases, officials in the U.S. Attorney's office said.
"That's just unacceptable when you're talking about something as important as homicide," said Steve Gordon, chief of the felony division of the U.S. Attorney's office here. He said the number of staff members at the medical examiner's office is "completely inadequate for the work."
Dr. James Luke, who resigned in May as chief medical examiner after 12 years in the job, said he did so in part because of the office's increasing problems. Luke is credited with building one of the best programs in the nation and assembling a top-notch staff that researched topics in forensic science. He also wrote for scholarly journals, taught at local hospitals and lectured around the country.
"To see the whole thing fall apart was a tragedy," Luke said. "I just couldn't preside over the dismantling of everything we've built. . . . I'm just dismayed."
In the last week, Dr. Douglas Dixon, acting chief medical examiner, has written Dr. Ernest Hardaway, D.C.'s commissioner of public health, several urgent memos on the understaffing.
Last Monday, Dixon sent Hardaway a memo outlining the office's "critical problems," including the lack of technicians.
"It is likely that soon we will be unable to retrieve bodies on a particular shift when an unanticipated absence occurs. . . . The technicians are beginning to rebel, and reasonably so" against restrictions on when they can take vacations, Dixon wrote.
Dixon also said in the letter that his office likely will be forced to forgo performing autopsies that by its previous standards would have been performed.
In addition, Dixon recently wrote a letter to D.C. Medical Society officials warning that cutbacks could make it impossible for the office to retrieve bodies 24 hours a day, as has been its custom.
"I'm confident city officials are aware of the problem and are anxious to resolve it in a timely fashion," Dixon said last week. He said he is "trying to work through the system," and declined to comment further.
"It's a major problem for a city this size," said assistant U.S. Attorney Joseph diGenova of the problems in the office. He said that the staff shortage could be dangerous in the event of a civil disaster or an outbreak of disease. "You cannot cut corners in the area of public health," he said.
D.C. Police Chief Maurice Turner said he told D.C. City Administrator Thomas Downs last week about the "very critical" problems facing the medical examiner's office. He said city officials intend to fill some positions.
The medical examiner's office, which establishes the cause of death in about 2,000 cases each year and performs more than 1,000 autopsies, started this year with six doctors. Because of resignations, it soon will have only three. In addition, the office has lost almost one-third of its technicians, who retrieve bodies at the scene of death and help prepare them for autopsy.
The office had 41 staff positions two years ago and has 35 employes now, but the city budget for the fiscal year starting in October has set its staff at 32, city officials said.
Officials of the Department of Human Services, the parent agency of the medical examiner's office, said they recognize that the office is understaffed and are planning to speed up the hiring of five employes.
Hardaway, who oversees the medical examiner's office, said that some of the understaffing is a result of vacant positions being unfilled, and that Luke failed to fill the jobs because he didn't perform the paperwork necessary for hiring.
"Dr. Luke had problems with the system," Hardaway said.
Luke said Hardaway or city personnel officials found fault with his hiring requests and blocked them. He called the city's hiring process "a difficult, mind-boggling exercise in futility." Luke and his chief assistant, who also resigned recently, said they left the office because of the developing funding problems and the relatively low salaries they received.
Prosecutors said they have not discovered any sloppy autopsies, and wouldn't know of any if they exist. The reason is that problems in the office started only recently, and there is a wait of six months to a year between commission of a crime and trial, prosecutors said.
The biggest changes have come from the departure of the office's top doctors, including Luke and his assistant, Dr. Brian Blackbourne, who left in January. A third doctor also resigned recently, and a fourth is set to leave next month.
"You don't have good, experienced people leaving all at the same time unless there's a real problem," Luke said last week. "What a shame."
One reason the doctors are leaving, all agree, is that D.C.'s salary for medical examiners, $56,500 a year, is low compared with most other major cities. In contrast, Dallas pays $101,000, Chicago pays $85,000, San Jose and St. Louis pay $80,000 and Milwaukee pays $67,000.
Blackbourne left to become Massachusetts' chief medical examiner at $93,000 a year.
Hardaway said that he recognizes the D.C. salary is low and that he will lobby to get it raised.
Gordon said he and other prosecutors are upset by Hardaway's proposal that some of those hired to fill the vacant positions be pathologists, doctors trained in deaths caused by disease, instead of more specialized forensic pathologists, doctors with more training in deaths caused by guns, knives, poisons and other external means. Until the four resignations, five of the doctors in the office were forensic pathologists, and the sixth was training to be one.
Gordon said Hardaway's proposal is "truly frightening" because it would lower the office's quality of work. Hardaway said he has asked the deans of local medical schools to advise him on the question.
Another problem in recruiting replacements, said Luke and Blackbourne, is the District's rule that new employes must live in the city. Coupled with high housing costs in the city, they said, the rule has driven away several potential applicants.
The troubles represent a sharp break from the past for the medical examiner's office, headed by Luke since 1971. Besides recruiting staff members, Luke oversaw construction of a new medical examiner's office in the mid-1970s. He also set up a computerized information system that cross-indexed information about deaths, allowing the medical examiners to spot trends, such as drug overdoses.
"I would have put us up against any program in the U.S.," Blackbourne said. "We couldn't be beat anywhere."
The first budget problems started several years ago, Luke said, when city officials moved the office from semi-independent status to become a branch of the city's public health office.
"It forced us to compete for funds with infant mortality and other causes , and there's no way politically you can do that," Luke said.
Luke said that he first received the news that his staff was to be reduced in ironic circumstances: within days of the Air Florida crash in January 1982, while he and his employes were working almost around the clock to identify the 78 victims.
"The only call I got from city officials was when I was told we were being cut by four positions," Luke said. "I was really outraged." Luke said the caller, Dr. Arthur Hoyte, then commissioner of public health, said that he might be able to get the money restored if he held a fund-raiser for City Council member Polly Shackleton (D-Ward 3).
Hoyte, now an assistant professor at Georgetown University's medical school, said last week that he had been speaking only abstractly, and that Luke, considered unskilled in political infighting, should throw his weight around politically if he wanted to defend his office's budget.
Others familiar with Luke's work echoed the point that Luke, while running an excellent medical examiner's office, was too unfamiliar with playing hardball in the city government to protect his bureaucracy.