The Real “CSI”: How America’s Patchwork System of Death Investigations Puts the Living at Risk (excerpts)

Watch Frontline's documentary [1] produced in conjunction with this story tonight. (Check local listings. [2]) And listen to NPR's All Things Considered for more on this story. (Check local listings. [3])

by A.C. Thompson, Mosi Secret, Lowell Bergman and Sandra Bartlett ProPublica (excerpted)

In detective novels and television crime dramas like "CSI," the nation's morgues are staffed by highly trained medical professionals equipped with the most sophisticated tools of 21st-century science. Operating at the nexus of medicine and criminal justice, these death detectives thoroughly investigate each and every suspicious fatality.

The reality, though, is far different. In a joint reporting effort, ProPublica, PBS "Frontline" and NPR spent a year looking at the nation's 2,300 coroner and medical examiner offices and found a deeply dysfunctional system that quite literally buries its mistakes.

Blunders by doctors in America's morgues have put innocent people in prison cells, allowed the guilty to go free, and left some cases so muddled that prosecutors could do nothing….

The qualifications of those who oversee death investigations vary widely from state to state -- and, in some areas, from county to county. But the main divide is between medical examiner systems, run by doctors specially trained in forensic pathology, and coroner systems, run by elected or appointed officials who often do not have to be doctors….

The 2009 report by the National Academy of Sciences, a comprehensive overview of defects in the nation's death investigation system authored by more than 50 luminaries in the field, recommended phasing out coroners and replacing them with medical examiners. (For a detailed, state-by-state breakdown, see our app [10].)…

another concern raised by the academy is that coroners often are closely aligned with law enforcement agencies. In 48 California counties, the local sheriff serves as coroner. In Nebraska, county prosecutors perform the coroner's duties. "Sensitive cases, such as police shootings and police encounter deaths ... require an unbiased death investigation that is clearly independent of law enforcement," the NAS report stated….

Despite the ubiquity of forensic pathologists in pop culture, the field has little appeal to most medical school graduates.

To become certified by the American Board of Pathology [15], doctors must receive an extra year of training in autopsies at a coroner's or medical examiner's office and pass a one-day exam. In addition, forensic pathologists are typically paid less than doctors in other specialties.

By most estimates the United States has only 400 to 500 full-time forensic pathologists. It's a tiny cadre of professionals for a country where roughly 2.5 million people die every year.

Partially because of the shortage of qualified practitioners, many of the nation's busiest coroner and medical examiner offices employ physicians who are not certified.

A survey of more than 60 of the nation's largest medical examiner and coroner offices by ProPublica, PBS "Frontline" and NPR found 105 doctors who have not passed the exam -- or more than 1 in 5 doctors on their full-time and part-time staffs.

Some have recently completed their training and have not had a chance to take the test, which is offered once a year. Others are long-time practitioners who have no plans to become certified.

But in numerous cases, the doctors are not certified because they have failed their exams….

'I Think We Miss Murders'

Lack of resources [16] has forced Oklahoma to engage in a risky brand of triage.

The state's Office of the Chief Medical Examiner has been without its top doctor for nearly a year. Three of its nine slots for forensic pathologists are empty.

Its remaining six doctors handle overwhelming caseloads. Most did between 300 and 400 autopsies last year, said Timothy Dwyer, the state's chief investigator. One did more than 500 -- double the maximum number recommended by the National Association of Medical Examiners.

Because of the grueling pace, the state has had to impose limits on the types of cases it investigates: Oklahoma typically does not autopsy possible suicides or alleged murder-suicides. In most instances, it does not autopsy people age 40 or older who die of unexplained causes.

"If we did an autopsy on every suicide, it would be all consuming, as with drug overdoses," said Cherokee Ballard, the office's chief administrator. "With suicides, we don't autopsy most them because it's an obvious cause of death."

But experts called Oklahoma's practices alarming. A savvy criminal can make a murder look like a suicide, said Dr. Robert Bux, a forensic pathologist who serves as coroner for El Paso County, Colo.

"The only way you're going to be able to sort it out, from my standpoint, is to do a complete autopsy," Bux said.

"I've had a lot of suicide cases they didn't autopsy," added Kyle Eastridge, a former homicide detective with the Oklahoma City Police Department and the Oklahoma State Police. "I don't think that every suicide is a murder, but I think we miss murders."…

In 2009, N.A.M.E. yanked Oklahoma's accreditation, in part because of its failure to autopsy suspected suicide and homicide cases….

Even at some of the nation's more robust death investigation units, staffers worry that they do too few autopsies to fulfill their watchdog role.

The Los Angeles County Department of Coroner looks into a comparatively large portion of deaths, roughly one in three each year, said Craig Harvey, the chief death investigator. Yet he would like to do more.

"I would love to have the staff to respond to every nursing home death. They're fraught with potential misses," Harvey said. "But if anything was to go wrong in those facilities, unless somebody says something, there's a good chance the case will pass through the system without ever being seen by the coroner."

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