Saturday, January 20, 2018

Impact from the state medical examiner fallout

The state of Montana’s recent contract cancellation of a long-time notable Billings forensic pathologist will have direct impacts on Stillwater County.
As of July 1, Dr. Thomas Bennett was no longer authorized by the state to conduct autopsies for county coroners under the authority of an associate state medical examiner.
Stillwater is one such county that has relied on Bennett’s services in that capacity for years. Under a reorganization of the State Medical Examiner’s Office, a state medical examiner will hire two deputy examiners, one of which will work out of Billings.
But until that staff is in place, Stillwater County will have to send any autopsies needed to Rapid City, S.D., which is approximately a six-hour drive one way.
“The state says that they will reimburse the counties for any cost over the normal costs. Includes travel and autopsy cost,” said Stillwater County Sheriff Cliff Brophy, who is also the coroner.
As explained by Brophy, all autopsies ordered by a coroner must be done by an authorized forensic pathologist.
Deaths that occur unattended or when the individual is not under a doctor’s (or hospice) care must be reported to the coroner, who then decides if an autopsy is needed.
All deaths that occur while in the custody of law enforcement require an autopsy. Additionally, an autopsy must be done before the death of a child can be ruled as SIDS related, said Brophy.
Other deaths commonly subject to autopsy include accident and crime victims. (see box for further explanation).
Brophy said Stillwater County averages six autopsy cases per year, with that number sometimes hitting as high as 10.

Serious Concerns Prompt Contract Cancellation
Montana Attorney General spokesman John Barnes provided the following background for the News regarding Dr. Bennett’s relationship with the state:
In 1998 Dr. Bennett was designated as an associated medical examiner by the state’s chief medical examiner, which allowed county coroners to utilize him instead of having to send cases to the state crime lab in Missoula.
Each county paid Dr. Bennett for his services and he was neither a state employee nor a state contractor.
“Last year it came to the attention of the Attorney General’s Office that there were problems with this system. Ambiguities in the pertinent statutes, a lack of standardization and collaboration amongst Dr. Bennett and the state’s two on-staff medical examiners in Missoula, and a long-running personal rivalry between the Billings and Missoula medical examiners made it clear that the system in place for the last 16 years simply hasn’t worked,” wrote Barnes in an email to the News.
In order to get past the long history of “a lack of accountability, and in order to provide the best possible service” the AG’s Office determined a different system was needed that provided for “smooth operational conditions, as well as clear lines of communication, collaboration, and supervision amongst the state’s medical examiners,” wrote Barnes.
Under the new system, in addition to a state deputy medical examiner stationed in Billings, there will be a state morgue, which “dovetails with the work we did with the legislature to establish a satellite crime laboratory in Billings.”
Barnes also wrote that the AG’s Office will be asking the 2017 Legislature to correct the statutory flaws that helped create a dysfunctional system.

Death Investigations

Deciding if a death investigation should involve an autopsy is a matter of circumstances, law, jurisdictional procedure and sometimes money.
Stillwater County Sheriff Cliff Brophy, who also serves as the coroner, offers the following guidelines:
•Each jurisdication has its own procedure, but certain deaths require an autopsy by law. One such death is when it occurs while in law enforcement custody.
•Homicides are always autopsied.
•In general, deaths that have two or more possible explanations should be autopsied. Brophy said an example of this would be a person found deceased in a lake. Did they suffer a heart attack? Did they drown accidentally? Were they struck by a watercraft -- either by accident or intentionally?
Brophy said another example would be someone found deceased in a vehicle that had minimal damage, which happened recently in Stillwater County. Did they die as a result of injuries sustained in the crash? Did someone kill them and then stage the car accident? Did they die of a natural cause, such a heart attack or other medical condition, and then crash the car?
Other circumstances include if the only witness to the death had a motive.
“If a jurisdiction has lots of funds, then an autopsy in each case is prudent for statistical data and medical knowledge gained from knowing exactly what process caused the death,” said Brophy.
Working under Brophy as deputy coroners are Undersheriff Chip Kem, Chief Investigator Woody Claunch, Deputy Randy Smith and Terry Nystul.