Deadly Irregularities

In February, NPR, Pro Publica, and Frontline released the results of a joint investigation into the handling of forensics, death investigation, and related topics in the United States. It got a fair amount of press because I think there’s a growing interest in these matters; people actively want to explore forensic topics instead of forgetting about them, and because I think a lot of people were pretty shocked by the findings, which were rather dire. One of the medical examiners interviewed on the show pointed out that people usually don’t think that much about death investigation until suddenly they have a dead loved one and want to know what happened, and one thing this series did was make people start thinking about this before they need a competent medical investigator.

I used the study as an excuse to write about the CSI effect, but there’s a lot more going on here that’s worth probing. We’ve seen a shift in the way people in the United States deal with death and dying; people love forensics shows and books, they want to learn a lot about death, but primarily in the abstract. When it actually comes to dealing with real dead people, there’s a more hands-off approach. But that approach is tinged with expectations, like ‘of course, if we get an autopsy, the ME will find out what killed her’ and ‘if my friend is murdered, the police will be able to figure out who did it and the person will be taken to trial.’

Those expectations are often not met, and the series highlighted many of the reasons why. Starting with the coroner system used in a large number of states. Coroners are elected officials and they often have no qualifications or training, relying on a staff to perform investigations. But they make the ultimate determination, and they can decide to overlook or overrule things if they want to, and sometimes they do. Frontline’s documentary also pointed out that coroners often don’t exercise very much oversight over their staff; they followed the case of a medical examiner with clear competency issues who was working for several California counties, including Mendocino, while coroners were unaware of the problem because they didn’t bother to do some research to find out more about him.

Even when an office is headed by a medical examiner, a person with specific training in death investigation and pathology, things are not necessarily rosy. Budgets for death investigation in the United States are fairly limited. There doesn’t seem to be a lot of interest in funding these offices, and consequently, they may not be able to do their work. They may not have a lot of really basic equipment and they have to deal with labs that are tremendously backed up due to budget shortfalls. It can take weeks or months to get reports on evidence gathered at a scene, while trails go cold and the crime becomes harder to investigate.

Clearly, the state of death investigation in the United States is appalling when the location of your death can determine the quality of the investigation. Die on the right side of a state or county line and there will be a thorough, thoughtful workup to find out why you died, to make sure that if you died by something other than natural causes, the matter will be pursued. Die on the wrong side, and you may not receive much of an investigation at all; the LA County coroner pointed out that he only sees about one in three deaths in Los Angeles, which means that suspicious deaths are most definitely slipping through the cracks. How could they not?

The documentary highlighted one such case: an old man who died in a nursing home. The home reported it, the man was buried, and everyone thought things were well. This happens all over Los Angeles every day. It is assumed that age is a cause of death, and that no further investigation or consideration of the matter is needed. But, someone who worked for the home called in a tip to the man’s family and said there was more to the case than that. What they uncovered, after an exhumation and investigation at the nursing home, was that he had been beaten to death, and clearly had been abused prior to his death by one of the staff, a man who had been recognised as one of the facility’s ‘best’ caregivers.

The man had limited communication abilities and couldn’t report what happened, but witnesses said they’d seen the ‘caregiver’ doing things like straddling him in his bed and punching him. These kinds of abuses happen in long term facilities all over the United States every day and they often go unreported and unhandled. Indeed, the people who perpetrate them may win commendations for their work, may get raises and promotions, even as they torture and abuse patients. Very rarely are they caught, and when they are, it’s often after the fact in situations like this, where a red flag gets raised and someone decides to do some investigating.

Clearly, we need a better system for handling death investigation in the United States. Setting national standards, something recommended by forensic pathologists in the documentary, would be a good start. Making sure that facilities are up to date, able to handle the numbers of deaths in their regions, and staffed with qualified personnel is obviously a critical need. Our population is growing and we are dying, and we need to be able to investigate the circumstances of deaths to avoid allowing people, living or dead, to fall through the cracks.

The series also, though, highlighted why investigative journalism is so important. People found out about these issues because journalists sought them out and reported them, and got a big platform because they were working for major media outlets. We need to find a way to preserve investigative journalism in the United States and we should not forget that it is under threat, thanks to a changing media landscape. Without investigations like this, things can and will be missed.