On Tuesday, I made the case for abolishing the elected coroner system that many states still use to investigate suspicious deaths. I argued that they should opt for a medical examiner system instead. But no matter what system a state or city uses, it will fail if it isn’t properly funded, well-staffed, and structured to guard against cognitive bias and perverse incentives.
New Jersey, for example, does use a medical examiner system. And it’s clearly failing:
An 18-month NJ Advance Media investigation for NJ.com found serious failures at nearly every level of New Jersey’s patchwork system of medical examiner offices, the obscure agencies charged with one of the most fundamental tasks: figuring out how somebody died and why.
The probe revealed families left to grieve without answers or closure, innocent people sent to jail and murders still unsolved.
Ask pathologists across the country and they’ll tell you about New Jersey. They’ll tell you it’s so bad that slowly decomposing bodies sometimes clog storage rooms of morgues by the dozens, stacked two to a gurney, awaiting examination or burial for months.
Ask New Jersey’s past two top medical examiners and they’ll tell you they resigned in protest over a lack of money and power to fix things. Governors and lawmakers for nearly four decades have largely ignored the system’s shortcomings and the tragic consequences, and failed to demand answers.
Ask funeral directors and they’ll tell you about body parts gone missing and mangled corpses. Data shows families wait an average of four months to learn from the state’s busiest offices how their loved ones died. That’s twice the national standard. And that’s if the dead get examined at all.
Experts estimate an effective system should be run in New Jersey for about $31.5 million a year. That’s $3.50 per resident, or about the cost of a gallon of milk per person. Right now, taxpayers pony up about $26 million for a system marred by neglect and dysfunction.
For all the “tough on crime” rhetoric we hear from politicians, the situation in New Jersey isn’t uncommon. In March, the state medical examiner in Kentucky resigned because the legislature refused to adequately fund the office. (State officials later persuaded him to stay on.) After dysfunction and poor funding led to a crisis and loss of accreditation at the medical examiner’s office in Cook County, Ill., the county allocated more resources and hired a renowned forensic pathologist to turn the office around. The new medical examiner restored the office’s accreditation, but then resigned last year, citing “a desire for a more peaceful lifestyle.” New Hampshire’s chief medical examiner retired in September, citing a mounting workload and inadequate resources to handle it. The Los Angeles medical examiner resigned in March of last year, stating he “wasn’t supplied the resources I need to perform my job duties.”
If you want convict people of murder, you need a proper death-investigation system. This is even more important if you want to convict the people who actually committed the murders. But while lawmakers are fond of boasting about the funding they’ve procured for police departments and prosecutors’ offices, they’re often reluctant to fund medical examiners’ offices. Good medical examiners then migrate to states that take the position more seriously.
The field of forensic pathology is already unique within the medical profession. Most physicians practice on the living, in order to save the living. Medical examiners also work to save the living, but they do so by practicing on the dead. That takes a peculiar sort of personality. Medical examiners tend to be quirky — a bit off — and they usually possess the requisite morbid sense of humor. But the peculiarity of the field may also explain why forensic pathology seems to regularly be plagued by scandal. My home state of Tennessee, for example, has had a medical examiner who reportedly threatened to kill a police officer, one who resigned after admitting to drugging and molesting minors and young men, one who was charged with faking an attack by strapping a bomb to his chest. A previous state medical examiner was arrested for drug possession and accused of stealing marijuana from dead people. Another previous state medical examiner resigned after multiple allegations of sexual harassment, botched autopsies and other misconduct. That’s all just in Tennessee. But it isn’t only Tennessee. We’ve seen similar scandals all over the country.
Medical examiner is also a job that obviously requires a high level of tolerance for, or even numbness to, some pretty horrific stuff. Medical examiners are typically called in when a death is suspicious, either due to negligence or as possibly the result of a crime. This means that medical examiners are exposed to some of the worst things human beings do to one another, pretty much on a daily basis. Cops see bad things too, but not every day. Morticians see dead bodies on a regular basis, but few of them are murders. Medical examiners not only deal with bodies each day; they deal with bodies that were likely murdered. They have to autopsy children and victims of sexual assault-homicide, dismemberments and all sorts of other grisly crimes. I’ve sat in on two autopsy sessions and was shaken both times. I still recall both pretty vividly. It’s a hell of a thing to see, and it forces an immediate confrontation with your own mortality. All of which is to say, again, that it’s a field that attracts a peculiar sort of personality.
I don’t mean to disparage the field. There are of course lots of professional, ethical and conscientious medical examiners out there. There are also plenty who could have gone into more lucrative fields of medicine but chose forensic pathology out of a commitment to public service. I’ve known and written about medical examiners who not only are great at what they do, but who also have called out the bad actors in the field and who have railed against the aforementioned problems with cognitive bias and bad incentives. These doctors are heroic. (The two medical examiners in California who resigned to protest the pressure they were receiving from a local sheriff whom I wrote about on Tuesday are great examples.)
But that brings up another important difference between forensic pathology and other medical specialties: Nearly all the available jobs in the forensic pathology are in public service. Government jobs of course don’t pay as well as private-sector jobs, particularly in medicine. In other words, most people go to medical school expecting to make great money while saving lives. Most medical examiners make comparatively less money while working with the dead. The nature of the job means you’re already selecting from a winnowed pool of medical students. From that pool, you’re then further selecting those also willing to work for less pay. And that can sometimes mean you’re selecting from a pool of med students who had fewer other options.
When lawmakers like those in New Jersey (and plenty of other states) refuse to adequately fund medical examiners’ offices, yes, they’re making it more difficult to solve murders. They’re making it more likely that innocent people will be convicted and guilty people will go free. But they’re also contributing to the broader problem of making forensic pathology a less desirable profession in the first place. That means fewer people go into the field, and it means even fewer of the best and brightest go into the field. This means that when a state needs to hire a medical examiner, there are fewer candidates to chose from and even fewer top-notch candidates. And indeed, there is currently a critical shortage of medical examiners across the country. Fewer candidates means states can be less discriminating about whom they hire. That inevitably means sometimes making do with less qualified, less motivated and perhaps less scrupulous doctors.
The common refrain here is that lawmakers are beholden to the voters, and the dead don’t vote. It’s a classic example of the conflict between policy effects that are seen versus those that are unseen. When an office is underfunded, some autopsies still get done and some crimes still get solved. This is what is seen. Everything is fine!
Unseen are all the murders that didn’t get solved; the homicides wrongly classified as accidents, suicides or natural deaths; the people wrongly convicted of, say, shaking an infant to death because an overworked or underqualified medical examiner went along with a prosecutor’s hunch; or the innocent people sent to prison who may never get out because their cases don’t involve DNA.
We see the work medical examiners do with the dead. Just as critical — but harder to see — are the benefits their work, when done properly, has on the living.