One of the central themes of our new book (which comes out next week) is the utter inadequacy of America’s death investigation systems — and that of Mississippi, in particular. The state has long relied on the antiquated, easily corrupted coroner system. Even after creating a state medical examiner position in the late 1970s, state lawmakers consistently either underfunded it or refused to fund it at all.
As we’ve discussed here before, a “coroner” is an elected position that oversees the investigation of suspicious deaths. The vast majority of coroners are not doctors. A medical examiner, on the other hand, is a doctor, usually (and ideally) a doctor who is certified in forensic pathology. These are the people who perform autopsies. Ideally, the state medical examiner oversees state death investigations. Some states have moved toward that type of system. Some still rely on coroners. And some have some mix of the two. In Mississippi, the state medical examiner was supposed to oversee the coroners. But the coroners were historically a pretty potent and powerful political force. They forced more than a few state medical examiners to resign in frustration. Eventually, the legislature just stopped funding the position. The coroners, in conjunction with prosecutors and police officials, began contracting autopsies out to private doctors. The bad incentives in that sort of ad hoc system should have been pretty obvious — police and prosecutors are going to migrate toward doctors who tell them what they want to hear, not doctors who give them honest assessments.
Consequently, one man came to monopolize the state’s autopsy referrals, doing 1,500 to 2,000 per year by his own admission. Needless to say, this wasn’t ideal for getting objective, science-based assessments about cause of death. If you’ve read this site with any regularly, you know that story. (If not — or even if so — buy the book!)
In the late 2000s, after a couple exonerations, media exposés and a lot of bad publicity, the state hired its first state medical examiner in 15 years. The legislature also created three forensic pathology labs in different parts of the state to handle autopsies. That system seemed to be doing pretty well for several years. But it now looks as if the state legislature has regressed. From WCBI in Starkville, Miss.:
For years, north Mississippi’s coroners have had only one place to send a body for an autopsy, the state crime lab in Pearl.
Now, due to understaffing and an overcrowded lab, those coroners are being asked to hold bodies.
It’s been the universal anthem for state departments, “we need more funding,” and the crime lab in Pearl is another example.
Without the funding to hire a qualified staff of medical examiners, the now one doctor autopsy lab could affect the efficiency of our local law enforcement and court systems . . .
“There is a critical staff shortage at our forensics lab in Pearl,” said Winston County Coroner, Scott Gregory.
“It’s just equipment sitting everywhere and no one’s working,” said Monroe County Coroner, Alan Gurley.
The understaffed lab performs around 10-20 autopsies a day, but it’s not enough to handle the influx of bodies from all over the state.
“Right now, they have a block on putting bodies down there because they can only hold 19 in their storage area,” said Gregory.
“We are being asked by the state medical examiner to only send cases down that are absolutely necessary to be autopsied,” said Gurley.
“The salary for the state medical examiner, set by our legislature… we’re not even competing with other states, so we’re losing our doctors to other states,” said Gregory.
“We’ve had medical examiners who have left Mississippi, I think, and have went and bad-mouthed what’s going on here. They’re going like ‘You don’t want to go there and work,’” added Gurley.
This debate happens every five or six years in Mississippi (although it happens elsewhere, too). For some reason, the state legislature just doesn’t think funding the medical examiner’s office is much of a priority. It’s such a bizarre thing to neglect. Medical examiners testify in homicide cases. Without them, it would be awfully difficult to convict people. They’re also critical for collecting public-health data, such as statistics on outbreaks of disease, drug overdoses, deaths due to industrial pollution, suicides and poisoning. Backups in these labs mean families of the deceased have to endure delays before having funerals, burials and obtaining closure.
And, of course, when you don’t budget enough money to attract competent doctors to perform autopsies, the need for autopsies doesn’t go away. It’s just met by doctors who are less competent. Now you have less-than-competent doctors testifying at murder trials or investigating police shootings and deaths in custody. The disastrous consequences ripple through the criminal justice system, the medical community, and public health.
The problem is that these consequences aren’t as obvious as, say, underfunding police or fire departments. The only people directly affected by a backlog at the morgue are the families of the deceased and the people who work at the morgue. Misclassified deaths or a dearth of public-health statistics can be enormously consequential in the long run, but in the short term, they aren’t the sorts of issues people complain about to their legislators or in a letter to the editor. It isn’t until we see headlines about the wrongly convicted — and the real killer who went on to kill again — that we see the benefits of having a competent, fully funded system of investigating death.