It Can (and Does) Happen Here!: One Physician's Four Decades-Long Journey as Coroner in Rural North Idaho

by MD Facs Robert S. West

Overview

When a loved one dies in a mysterious manner, we rely on coroners and medical examiners to tell us what happened. The stakes are high: Coroners seek justice for the dead, exoneration for the wrongfully accused, and closure for the families of victims. They are always on call and work closely with law enforcement.

Author Robert S. West, who served as a physician-coroner in rural Kootenai County, Idaho, from 1970 to 2011, delves into the challenges he faced on the job. While he often lacked resources, he always did the best he could to serve his community, solving numerous mysteries using the tactics of forensic medicine.

Dr. West also explores the shortcomings of the coroner/medical examiner system and how it can be improved. Widely varying educational requirements and unrealistic expectations need to be balanced in order to fill the shortage of forensic pathologists while enhancing the training of current coroners.

Join a coroner from rural northern Idaho as he looks back at his career?s most challenging cases and explains how to reform the system in It Can (and Does) Happen Here!

Product Details

ISBN-13:	9781458215444
Publisher:	Abbott Press
Publication date:	04/29/2014
Pages:	170
Product dimensions:	5.90(w) x 8.80(h) x 0.60(d)

Read an Excerpt

It Can (And Does) Happen Here!

One Physician's Four Decades-Long Journey As Coroner in Rural North Idaho

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By Robert S. West

Abbott Press

Copyright © 2014 Robert S. West, MD, FACS
All rights reserved.
ISBN: 978-1-4582-1544-4

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CHAPTER 1

System or Non-System

The strobe lights of multiple squad cars flashed over the neighborhood on a February night in 1986. Dr. Bob West, a general surgeon and the Kootenai County Coroner—stopped at the mobile command post on Fourteenth Street in Coeur d'Alene, Idaho. He contacted the Special Weapons and Tactics (SWAT) team commander to get a briefing on the incident.

"We have a twenty-eight-year-old 'psycho' holed up in this house, threatening to kill anyone who tries to enter. The windows and doors are barricaded, the phone lines have been cut, and several shots have been fired. There has been no sign of activity in the house for the past thirty minutes and the chief of police requested the coroner and paramedics to be on scene.

"We do not know much else about him. The family reports a marked change in his personality over the past six months. He has become moody, withdrawn, and very paranoid and has complained of severe headaches. Kootenai County Sheriff deputies have responded to the home several times for domestic violence issues. They say he was an electrician for a local contracting firm and always been a safety-conscious worker. "

SWAT team members had the house surrounded and hailed the occupant to come out. Hearing no response, they forced the lock on the front door, entered the house, and found the victim with a gunshot wound to the head. A revolver lay next to the victim with a single spent cartridge in the chamber. The paramedics on scene confirmed the death and returned to quarters. The lead detective from the sheriff's office began a systematic scene investigation, taking photos of the victim, the weapon, and the interior of the house.

After the investigators completed their initial investigation, Dr. West and the on-call funeral home personnel entered the home to remove the victim. The detective asked whether there would be an autopsy. It seemed clear the victim had committed suicide. Even though the case seemed straightforward, Dr. West explained that there would be a full autopsy, including toxicology, conducted by the Spokane County Medical Examiner's (SCME) office.

Further investigation revealed that six months previously, while working as an electrician at the Coeur d'Alene Resort Golf Course's signature floating fourteenth green, the victim was working in the mechanical equipment room. Mercury switches in that room operate pumps to ensure the green stays level. As the green shifts side to side, or fore and aft, the switches activate pumps, which force water into ballast tanks, keeping the green's surface level.

As the victim was working on the electrical system, one of the mercury switches exploded, vaporizing the mercury and the victim inhaled the poisonous mercuric oxide fumes. The room was subsequently ventilated. The electricians were not evaluated by physicians.

The victim's toxicology from the autopsy results came back showing marked elevation of serum mercury levels. Further testing showed the effects of chronic mercury poisoning as the likely cause of deterioration in mental status of the victim.

This would explain the "mad hatter syndrome" symptoms in the victim. Long before Louis Carroll penned Alice in Wonderland, workers in hat factories used mercury compounds while working felt for hats. They experienced headaches, anemia, and personality changes and eventually became demented, hence, the name "mad hatter."

This case was an industrial accident, not a suicide. The subsequent wrongful death lawsuit did not make the coroner any friends in the resort's management. However, it did illustrate the type of investigation necessary, even in rural Idaho.

It also demonstrates the need for coroners to make their own investigation in each case and gather the information from both the autopsy and toxicology. The elevated blood mercury levels were not expected in this case. Coroners must educate themselves of the effects of various toxins, mercury in this case, but also a variety of substances seen in other cases.

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The term coroner dates back to medieval England. The Magna Carta, signed at Runnymede in 1215, states: "... No sheriff, constable, coroners, or others of our bailiffs shall hold pleas of our crown." At that time, one of the duties of the coroner was to collect fees owed to the crown from the estate or family of deceased persons.

In the United States, as the persons responsible for creating and signing death certificates and burial permits evolved into the present system, there have been wide-ranging abuses and less-than-professional practices. In New York City in 1866, burial permits were sold to murderers to bury their victims. Twelve percent of physicians responsible for completing and signing death certificates have no training in correctly listing the cause and manner of death. The error rates on death certificates range up to 29 percent. There continues to be reluctance to list socially unacceptable causes and/or manner of death (e.g., syphilis, alcoholism, alcoholic cirrhosis, HIV/AIDs, suicide, homicide, or accidental deaths). When law enforcement shoots a person in the process of apprehension, the manner of death is homicide. The review panel and prosecutor make the determination as to justification or not. It is not uncommon for the coroner's office to receive inquiries as to why these cases are considered a homicide.

The National Academy of Science report, "Strengthening Forensic Science in the United States: A Path Forward," gives a detailed overview of the problem and suggested paths for resolving the deficiencies.

The general public frequently misunderstands several of the terms listed below:

1. Medical examiner: A licensed physician (MD or DO) who has completed a pathology residency, a fellowship in forensic pathology and is certified in both pathology and forensic pathology by the American Board of Pathology.

2. Physician coroner: A physician (MD or DO) who has graduated from medical school and is licensed to practice medicine. He/ she may or may not have had post-graduate training in death investigation.

3. Death investigator: A person who has completed one or more courses in death investigation. These may be sponsored by universities, hospitals, and/or state coroner organizations. Many national and state organizations offer certification as a death investigator.

4. Nurse coroner: A nurse (RN or LPN) who graduated from a nursing program and is licensed to practice as a nurse. He/she may or may not have trained in death investigation.

5. Mortician or funeral home technician coroner: A funeral home employee trained in the procedures involved in the removal, embalming, and care of deceased persons. He/she may or may not have trained in death investigation.

6. Coroner: Any of the above persons elected, appointed, or otherwise qualified for the position as specified in the state code. Recent changes in the Idaho code have added periodic coroner continuing education requirements for coroners.

This list, while not exhaustive, illustrates the wide range of persons who comprise the coroner/medical examiner system in the United States.

My Background

This was the status of the coroner/medical examiner system when Dr. William T. Wood, Kootenai County Coroner, called me in July 1970 to ask if I would cover coroner calls while he was at the Idaho Medical Association meeting in Sun Valley. Since statehood in 1890, local physicians had acted as coroner in Kootenai County as a part of their responsibility to the public. The Idaho code states, "The coroner shall be twenty-one years of age and a resident of the county for one year."

I asked him what my duties were. His response: "Raise your right hand." With a few words, I became a deputy coroner for Kootenai County, with the duty and legal responsibility to investigate all deaths by "other than natural causes" within the 1,441 square miles of Kootenai County.

He also failed to inform me, "The coroner shall act as sheriff in the event of the death, arrest, or other incapacitation of the sheriff."4

While this was daunting to a young surgeon recently arrived to Coeur d'Alene, I did have some background in death investigation.

As a freshman at the University of North Dakota Medical School Gross Anatomy Lab, my partner and I found an impacted piece of steak in the posterior pharynx of our cadaver. Our "patient" had died of a "cafe coronary" long before Dr. Heimlich described his eponymic maneuver.

Later, at Harvard Medical School, students attended a weekly death conference where the Suffolk County (Boston) Medical Examiner would detail the many complex cases presented to his office.

Boston was still reeling from the disastrous Cocoanut Grove fire of November 28, 1942, which resulted in 492 deaths. Most of these deaths were caused by smoke inhalation. One good result from that tragedy: public buildings afterward were required to have self-contained emergency lighting and unlocked exits.

We were required to attend all autopsies while on the surgical service of the Massachusetts General and Beth Israel Hospitals.

After a rotating internship at Chelsea Naval Hospital in the United States Navy Medical Corps, I served at the US Naval Station Hospital, Argentia, Newfoundland. We had no pathologist on staff. We transported our autopsy cases eighty miles to and from St. Johns, Newfoundland. Occasionally US Coast Guard Cutters would dock at Argentia with the body of a crewman who had succumbed to the frigid waters of the North Atlantic during their thirty-day patrols at Ocean Station Charlie. These cases were airlifted stateside to appropriate facilities.

An Irish physician assigned to a British submarine which docked at Argentia over St. Patrick's Day managed to drive a borrowed car off the harbor dock at two o'clock in the morning. We found his body clinging to a piling less than three feet below the surface. The Royal Navy arranged for his removal to England.

Noncombat military death statistics reflect alcohol's impact on more than 50 percent of motor vehicle deaths. Infrequently, flight crews would break the "five hours from bottle to throttle" rule. An F-4 Phantom Jet pilot drowned in an Officer's Club swimming pool after flying from Virginia to the Jacksonville Naval Air Station with less that two hours sleep in the previous forty-eight hours.

I witnessed the effects of alcohol in many deaths while serving as a surgical resident at the University of Vermont Medical Center Hospitals. I also performed several autopsies under supervision while on a pathology rotation to determine the cause of death. This included reviewing the medical records, laboratory and X-ray results, the microscopic slides, and then writing the final report detailing the cause of death.

I attended a mass-casualty management course at Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas, where mock-up casualties were triaged under battlefield conditions. I spent a week at the Armed Forces Institute of Pathology reviewing various cases from its vast collection and attending clinico-pathological conferences.

Nevertheless, I never considered myself a pathologist (or a forensic pathologist.) Rather, these experiences contributed to my basic fund of knowledge.

Kootenai County Coroner History

The lake city of Coeur d'Alene, where I have resided since 1969, is thirty miles across the border from Spokane, Washington. The Idaho Panhandle is bisected by Interstate 90 and U.S. 95 and surrounded by a million acres of the Panhandle National Forest. The area's five lumber mills, the Silver Valley Mines, and the Kaiser Aluminum Rolling Mill in the Spokane Valley resulted in a steady stream of industrial accidents.

Tourists have flocked to the lakes and streams of North Idaho since the 1920s. During World War II, the Farragut Naval Training facility on Lake Pend Oreille provided sailors on liberty a good time in the bars and dance halls of the Lake City. Canadians with lake homes vacationed here in large numbers.

Kootenai County has had many physician-coroners since statehood. It was considered a part of a physician's civic duty. In Idaho, the Coroner is an elected, partisan position with a four-year term. Most Idaho Coroners are not physicians. There were only three physician-coroners in the State of Idaho between 1984 and 2010.

As of this writing, the non-physician coroners of Ada, Canyon, Twin Falls, and Bannock counties employ forensic pathologists who also provide forensic services to adjacent counties. The Spokane County Medical Examiner's (SCME) office also provides forensic services for the five northern Idaho counties. These positions are presently held by: two nurse-coroners, and three mortician-coroners.

Contract forensic pathologists provide forensic services to other counties on rare occasions such as a private request for an autopsy or for a "second opinion" autopsy. These cases are paid for by the requester.

Nationally, there is great misunderstanding of the dichotomy between the public's perception and the realities of this hodge-podge Coroner/Medical Examiner "non-system." The public assumes all coroners are board-certified Medical Examiners with the training, facilities and expertise to produce uniformly accurate results in one hour or less, as seen on the TV program CSI Miami. The 2011 NOVA public television documentary Post-Mortem chronicled a dismal picture of some of the worst deficiencies of the current coroner-medical examiner system. State and local funding entities do not come close to supporting the type of forensic systems necessary to provide even basic functions. Many coroners are not prepared to investigate coroner cases personally and on-scene regardless of the circumstances, distance, or time of day.

Professionally, there are few incentives to attract physicians or other persons to the field. Careers in forensic medicine are not encouraged by college pre-medical counselors. Medical students and pathology residents are seldom encouraged to enter this field of medicine. The financial rewards pale in comparison to the more lucrative specialties. A forensic pathologist typically spends thirteen to fifteen years of postsecondary education and may acquire $150,000–200,000 of student loan debt before reaching his/her first position as a medical examiner.

Much of this will have to change before we begin to address the current shortfall of some 1,500 qualified medical examiners in the United States Many current medical examiners are approaching retirement age. The lack of new physicians entering the training pipeline ensures that the problem will persist or worsen in the future.

One of the frequent comments heard from those who prefer to maintain the status quo of this system is: "Why do you need such an expensive, complex system? Nothing ever happens here like it does in New York or Los Angeles." or "We just need an Idaho coroner to complete the death certificates and authorize cremations." My answer to that is: "It can and does happen here!" Coupled with the above is the public's aversion to the whole subject of death and dying. Even physicians attending inpatients at Kootenai Medical Center (KMC) occasionally decline to sign death certificates, even though they were the attending on the case for several days in the intensive care unit. When death certificates default to the coroner for signature, families question as to why the coroner was involved.

I hope the following chapters will document my experiences and recognize the efforts of coroners in Idaho and other jurisdictions who carry out their duties in the face of apathy, ignorance and false conservatism.

We seldom address the issue of death in an open manner. The public and even my medical colleagues would occasionally comment to patients "… do you really want the coroner to be your surgeon?" My fellow elected county officers trailed my vote tally in several successive election cycles. However, the coroner's budget still comprises less than 1 percent of the total county budget.

(Continues...)

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Excerpted from It Can (And Does) Happen Here! by Robert S. West. Copyright © 2014 Robert S. West, MD, FACS. Excerpted by permission of Abbott Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

Contents

Preface, vii,
Foreword, ix,
Chapter 1 System or Non-System, 1,
Chapter 2 Spokane Establishes a Medical Examiner Office, 11,
Chapter 3 Baptism by Fire, 13,
Chapter 4 Planes, Trains, and Automobiles, 15,
Chapter 5 Missing Persons, Unidentified Bodies and Missing "Perps", 27,
Chapter 6 Marine Issues, 30,
Chapter 7 Indigenous and Exotic Species Hazards, 39,
Chapter 8 Hunters and the Hunted, 42,
Chapter 9 Nothing like a Walk in the Woods, 46,
Chapter 10 The Suicide "Epidemic", 55,
Chapter 11 Pimps, Prostitutes and Johns, 72,
Chapter 12 The Environment is Always around Us, 78,
Chapter 13 "Dumpster Diving for Dummies", 87,
Chapter 14 Domestic Violence and Homicide, 90,
Chapter 15 Sudden Unexpected Infant Deaths (SUID) (Including SIDS), 94,
Chapter 16 Trees, Logs and Loggers, 97,
Chapter 17 Homicide in Kootenai County and Idaho, 102,
Chapter 18 Joseph E. Duncan, III and the Groene-Mackensie Murders, 110,
Chapter 19 Mass Fatality Management, and Planning,
Chapter 20 Guns, Ammo and the, Second Amendment,
Chapter 21 Drugs, Meth Labs and Other Haz-Mat Situations, 133,
Chapter 22 Unique Aspects of Teenagers, 137,
Chapter 23 Deaths in Custody, 140,
Chapter 24 International Relations - Coeur d'Alene Indian Tribal Matters, 143,
Chapter 25 Organ and Tissue Donation, 146,
Afterword: Where Do We Go From Here?, 149,
Abbreviations, 151,
Bibliography, 153,
Acknowledgements, 155,
About the Author, 157,