A shortage of forensic pathologists in Northern California and elsewhere in the nation has led to the growth of private for-profit forensics companies. Forensic Medical Group (FMG) is one of those companies. FMG, which employs five doctors, conducts all the autopsies for Colusa, Contra Costa, Sonoma, Sutter and Yolo counties, and provides pathology services to nine other counties, covering 21,000 square miles in Northern California.

While some of the doctors hired by FMG are well respected among peers in their field, the firm has been criticized for hiring pathologists who were fired from previously-held government positions. Critics also complain that the large number of autopsies performed by FMG, and the fact that they are spread out over such a large area, result in substandard performance even from otherwise competent pathologists. FMG doctors examine around 2,500 bodies a year – more than the San Diego County medical examiner and more than double the number of autopsies conducted by the Riverside County coroner.

“You can’t do that many cases well,” observed Dr. John Pless, a retired Indiana University forensic pathology professor and director of the National Association of Medical Examiners. “You just cannot do it. I don’t care who you are or what you’ve got working for you. You’re going to miss things, there’s no question about it.”

Dr. Brian Peterson was the long-standing president of FMG before leaving four years ago to become chief medical examiner in Milwaukee. He said his work schedule at the company was formidable.

“I can remember one time driving up to Humboldt County, and that was a five-hour drive, to do three autopsies including an infant and drive back the same day to be at work in the morning,” said Peterson. “It was wear and tear.”

Experts recommend that a doctor perform no more than 250 autopsies annually, and warn that exceeding 325 a year causes exhaustion and increases the possibility of errors. And that is assuming the bodies are all in the same place, not that doctors have to drive for hours to get to them. [See: PLN, Jan. 2011, p.1]. FMG doctors conduct at least 300 autopsies a year and some have a hectic work schedule that exceeds 400 annually.

That demanding schedule sometimes leads to mistakes. For example, Dr. Kelly Arthur, one of FMG’s owners, autopsied the wrong body in Sonoma County in 2006. Instead of a 51-year-old victim of a fatal car crash, she examined a 73-year-old man who died of heart disease. After a technician alerted her to the mistake, Arthur acknowledged that in her rush she had skipped routine safeguards designed to prevent such errors.

Also, Peterson acknowledged hiring Dr. Thomas Gill in 1998 when he was FMG’s president. Gill had been fired by the Indianapolis coroner for drinking on the job and misdiagnosing several cases.

“My thinking at the time was, ‘If I don’t give this guy a chance, who will?’” Peterson reminisced. Gill was rehired by FMG in 2007, but they let him go in December 2010.
Maybe he shouldn’t have been given another chance. Mistakes by forensic pathologists can literally be a matter of life and death; their mistakes might let a murderer go free or send an innocent person to prison. Though of course, the mistakes they make seem to only result in wrongly convicting the poor.

That’s what happened to Corbin Easterling, whose wife died in the cold waters of San Pedro Bay in October 2004 after their Jet Ski became disabled two miles from shore. Easterling was rescued after nineteen hours. He had managed to pull himself onto the watercraft and was shaking uncontrollably, yet still clinging to his wife’s life vest trying to keep her afloat.

Current FMG president Dr. Gregory Reiber found bruising on the torso, neck, mouth, arms and legs of Easterling’s wife, murky water in her lungs and foam in her airways. He ruled the death a homicide, speculating that her husband had pushed her head under water. Yet he also said that some of the bruises occurred after death and none indicated a struggle.

Easterling spent 18 months in jail charged with murdering his wife; his defense team convinced the Sonoma County district attorney’s office to send the autopsy file to another pathologist, who found that hypothermia could have been the cause of death. A third doctor agreed the death may have been an accident. The charges were dropped and, in 2006, FMG changed its findings to indicate accidental death, not homicide. Easterling died of a methamphetamine overdose 11 months later.

“It was so horrible,” said Richard Jevarian, Easterling’s father-in-law, referring to the effect the case had on the family. “This makes or breaks the lives of anyone who’s involved with this.”

Marin County stopped using FMG in 2008 after the county coroner found problems with the company’s work. In one case, an FMG doctor described a woman’s ovaries as being “unremarkable” in an autopsy report. Which was in itself remarkable, since her ovaries had been removed decades before.

Why would private pathology companies conduct an excessively high number of autopsies, thus increasing the possibility of error, when forensics experts recommend an annual limit of 250 autopsies per doctor? In short, money. FMG charges up to $1,250 for a full autopsy and $600 for external examinations; other private pathology firms charge up to $2,500 per autopsy. Thus, such companies have an incentive to maximize the number of autopsies they perform even when that approach may increase the chance of mistakes being made.

Indeed, lives are at stake when autopsies are shoddily performed. Perhaps that is the best argument against privatizing such an important governmental function and subjecting it to the profit-driven motives of corporate capitalism. After all, the government owes the duty of seeking justice to the living as well as to the dead.

Sources: San Francisco Chronicle, Pro Publica, PBS, NPR, California Watch

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