Some medical examiners in Texas have relied on the work of medical school interns, unlicensed doctors and others with questionable expertise -- even for complex capital murder cases, according to a newspaper report Wednesday.
The Fort Worth Star-Telegram found that some offices used physicians who repeatedly failed certification exams or were disciplined for poor work. Growing caseloads and a shortage of licensed forensic pathologists could be prompting offices to relax qualification standards.
"Justice becomes secondary when too many bodies come into the morgue every day and when too few people are doing the autopsy," Dr. Stephen Pustilnik, Galveston County chief medical examiner, told the newspaper.
The National Association of Medical Examiners suggests that a forensic pathologist with no administrative duties should not exceed 250 autopsies per year. When a pathologist performs more than 350 per year, flagrant mistakes and misjudgments result, according to the group.
Records indicate the workload far exceeds those standards in some counties.
Dr. Ray Fernandez, chief medical examiner of Nueces County, said he handled 387 autopsies in 2008, despite the county's hiring of a part-time pathologist to help. He said he doesn't want to do more than 350, but the workload is unrelenting.
In a 2005 audit, Travis County's two pathologists may have handled an average of more than 500 cases each.
The state requires only a license to practice medicine for medical examiners. Dr. Randall Frost, Bexar County chief medical examiner, said they should be certified in anatomic and forensic pathology.
Otherwise, "that's like graduating from medical school and immediately going in and doing a heart transplant," he said.
American Board of Pathology records obtained by the Star-Telegram showed that the chief medical examiners of two counties, Dr. Corrine Stern of Webb County and Dr. Paul Shrode of El Paso County, were not certified.
A telephone call to Stern's Laredo office from The Associated Press was not answered Tuesday evening. No home telephone number for her was found. Shrode has told El Paso County officials that he plans to obtain certification.
In Harris County, a forensic pathologist on the medical examiner's staff lacks required board certification. The doctor "has amply demonstrated his expertise during his tenure, and the requirement for certification has been waived for him," spokesman Dan Morgan told the Star-Telegram.
Another Harris County pathologist, an assistant deputy chief of the medical examiner's office, was reassigned to administrative duties after his medical license lapsed. Morgan said the pathologist will return to his regular duties, including autopsies, after renewing his license.
Some counties have hired interns for training with the understanding that they take certification exams and have special permits.
In Dallas County, a trainee's autopsy on Marquette George helped convict Daniel Clate Acker, George's boyfriend, of capital murder. A federal court is reopening the case after a defense pathologist found "15 points of error" in the autopsy, the Star-Telegram reported.
The Dallas County medical examiner's office concluded that George was dead before her body was pushed from the truck. Dr. Glenn Larkin, a former Pennsylvania medical examiner who reviewed the case for the defense, concluded that George probably died from hitting the truck and the ground.
Acker's defense attorney contends that George died when she jumped from the moving truck.
Dr. Jeffrey Barnard, Dallas County chief medical examiner, declined comment on the case.
Frost, the medical examiner in Bexar County, said most medical examiners agree that there should be a strict limit on the number of autopsies a pathologist can perform. Some offices in Texas are "doing case after case after case, and are doing them very poorly," he said.
Others believe caps could dissuade medical examiners from doing complete autopsies.
Donald Lee, executive director of the Texas Conference of Urban Counties, an advocacy group, said strict limits would cause costs to soar. "Without strict limits, we can get it done, and we have gotten it done," he said.