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Post Mortem
Death Investigation in America

Interview P. Michael Murphy

“People expect us to have DNA back in 20 minutes or that we're supposed to solve crime in 60 minutes with three commercials.”

You're the coroner?

That's correct.

You elected?

I am not elected. ... I'm appointed by the county commissioner. I work directly for the citizens. ... Many medical examiners are also appointed. It's similar to a police chief. Sheriffs are elected; police chiefs are appointed. ...

Most coroners are elected in the United States?

I would venture to say the vast majority are. ...

But you're a stand-alone, independent coroner's office?

P. Michael Murphy

The coroner for Clark County, Nev., Murphy's office was the inspiration for the television drama CSI. "CSI has done some great things for medical-legal death investigations," he tells FRONTLINE. "It's also caused some problems." He was the only coroner asked to testify for the National Academy of Sciences study and describes the recommendation to abolish coroners as "the nuclear approach." This is the edited transcript of an interview conducted on June 9, 2010.

We are.

Do you operate a crime lab?

We do not.

So the crime labs belong to the law enforcement agencies?

Correct.

And you have to send everything out for toxicology and so on?

Our toxicology is not done in-house. It's done by a national laboratory. Histology is also done that way. We do that for economy of scale, as a result trying to get the biggest bang for our buck. ...

And you're not a doctor?

I am not. Very clearly, I'm not a doctor.

You are a coroner, by background?

Law enforcement.

You sign death certificates?

I do.

And do you have any other functions other than determining the cause of death?

I don't determine cause of death. By statute in our jurisdiction, cause of death, which is the medical reason why someone ceases life, is determined by a physician. ...

Manner of death is the method by which someone dies. There are only five: accident, homicide, suicide, natural and undetermined. And so I would have the ultimate responsibility of determining manner of death. But again, because of the volume of work that we do in our office, that is the vast majority of the time done specifically by the physician of record on the case.

We have five forensic pathologists that work for us in our office. And I see myself as being very similar to a hospital administrator. My job is to make sure that everybody has what they need to get their job done.

But then you are told by them what the cause of death was, and you just simply sign off at that point.

It's a little more complicated than that. We have a QA process, quality assurance. We do several things during that process to make sure that it's not just one person looking at the case. The medical doctor of record will review it with the second physician in our office. We have a lot of policies and procedures that are in place, and protocols.

But if you're asking me, does a physician of record, a forensic pathologist, say to me, "This person died of this cause," and then recommends a manner or says, "This is the manner," yes, we would review that. That would be put on a death certificate. But I have the authority to sign death certificates that they have done that on. So the signing of the death certificate is the official process, but it will also show the doctor of record. ...

Do you have any other functions as the coroner?

I do. We have several processes in our office. One is the forensic process, which includes our forensic pathologist. Then, we have an administrative section, ... and then we have an investigative process. So I oversee a part of that. I have an assistant coroner that assists me. We have about 75 full- and part-time folks. And I do respond personally to any death that involves two or more persons in Las Vegas, some high-profile issues involving either death at the hands of law enforcement or a law enforcement officer, something of that nature.

You have a unique inquest system related to law enforcement, right?

We do. Very unique. I don't know that anybody does it the way we do.

And what is it? ...

... What happens is that, if a death occurs at the hands of law enforcement, an inquest is called, and a jury of seven plus an alternate are called together. The district attorney's office makes a presentation of facts. It is not an adversarial process. The officers come in and testify. It's usually very shortly after the death. ... This is usually within six to eight weeks. ...

There are only three verdicts that can come back. It's very similar to a grand jury, but it's open to the public. And those three verdicts are justified, that the officer was doing what he had a justifiable right to do; ... excusable, that he was doing something that he had a lawful right to do, but he was not using deadly force, the death is excused; or criminal, the fact that he was doing something outside of the color of law and that he should be criminally prosecuted.

Has any officer been criminally prosecuted as a result?

... We have not had a criminal verdict come back in the inquest process.

In 30-odd years?

That's correct. But I have to tell you, one of the reasons is that, if there is clearly criminal action that has been taken by law enforcement, the DA will charge almost immediately, so there's no reason to have an inquest. ...

One of the other unique things that I noticed is that there are 14,000 deaths or so a year in Clark County.

Just a little under that, but yeah, we'll use that number as a kind of a reference.

You have some involvement or see 68 percent of those people who die in the county in a given year?

Yes.

That's pretty high.

I think it would actually be appropriate to say that we're going to have some involvement. We're going to touch in some form or fashion. Now, we may triage that literally by a phone call, speaking to medical professionals or something of that nature. When that all boils down to what we're actually going to bring through the door, it's about 3,200 to 3,800 cases a year.

OK. And that 3,200 to 3,800, so that's still a relatively high percentage compared to a lot of other --

I don't know that that's true. I think the responsibility of our office is to determine what happened, or at least whether what happened is a result of any criminal nature and that type of thing. And so, of those 3,200 to 3,800 that come through the door, half of those will receive a full autopsy. The other half may have only what's known as a medical examination, an external examination. But it's the responsibility of that forensic pathologist to do that. ...

So I have to ask you this question. Las Vegas, Clark County, famous for CSI.

Correct.

Does your operation look like CSI?

It does not.

Do you operate like CSI?

We do not.

What do you think of CSI?

I think that it's a double-edged sword. I think that CSI has done some great things for medical-legal death investigations. It has brought what we do from the shadows, where people really didn't want to know and didn't care what we do to the bright light of day. I think that, anytime that happens, that's, generally speaking, a good thing.

It's also caused some problems. And some of those problems are, people expect us to have DNA back in 20 minutes or that we're supposed to solve crime in 60 minutes with three commercials.

It doesn't happen that way. The Clark County Office of the Coroner/Medical Examiner [CCOCME] is responsible for the decedent and dealing with the family. We have no responsibility to the crime scene. We have no responsibility to the bad guy. We represent the deceased. That's our job, and that's what we do.

So you don't really solve crimes.

We do not. It is not our job to solve crimes.

So you're not really CSI?

No, we're not. Never professed to be. ...

[Does the CSI effect] give a jury a sort of biased view of representatives of your office or scientific crime analyst who appears at trial quite a bit of credibility that they actually know these things with a certainty?

I think for everything it gives you, it probably takes away, because once they find out you can't do all the things they know on TV, the pendulum swings back in the other direction. And there are those that you would talk to in the industry that would probably tell you it's been much more of a detriment than it has been a positive. ...

... What's the most misleading part of [CSI]?

That one person does everything. That's number one. I'd probably follow it up with that everything can happen as quick as they make it happen.

You don't have that kind of equipment, do you?

It's drama. It's TV. It's not real life. ... I don't know if anybody else has told you this in these interviews. Everybody feels like we're in the death business. The truth is, we're in the life business. We deal with the families that are left behind as a result of death, and we have as much responsibility to deal with them as we do with the deceased. ...

The National Academy of Sciences study, ... you contributed testimony to it.

Yes sir. I was invited to do that, and I did.

You support its recommendations?

Not in its entirety.

What do you object to?

I guess one of the things I'd have to say is the elimination of the coroner office per se. It was a pretty broad stroke. I don't know that the medical examiner community is prepared at this point to have that happen, because there's not enough of them out there. ... I had a vacancy in our office for almost 18 months looking for a medical examiner.

Most people don't understand that process. In the budget process, you put in for it. You get it. The budget isn't approved until May or June. Then you try to get your folks. Well, by then, in the medical world, they've already made what they call match. So in January, they find out where they want to go. In February and March, they hear about it, so you're already behind the curve.

The other thing is that depending on who you talk to, there are different numbers out there. There may a couple of hundred vacancies in the United States at any given time, and there may be 25 or 30 that come out of programs nationally and internationally for forensic pathologists. So there's a huge demand, and there's very little supply.

Why is that?

I guess it depends on who you talk to. Maybe the salaries aren't what they think they should be. I don't know that forensic work is everybody's cup of tea. The forensic pathologists that I talk to absolutely love medicine. ... I don't know that they necessarily love patients, so that might work out pretty well for them. But I would tell you that I think it takes a special person.

I have people ask me all the time, how do I do what I do? I consider it an honor and a privilege to do what I do, to be a part of people's lives in some of their most intimate moments.

One coroner we interviewed said simply, "We're underfunded, need more forensic pathologists; we need more equipment." I said, "Well, how come you don't have it?" He said, "The dead don't vote."

They're not supposed to. No, the dead don't vote. I think what we need to remember is that the people only need us when they need us. ... When they need us, they want us to do our job, and then they want to kind of put that away if they could. They spend a lot of time trying to put away this terrible experience that they've just gone through. ...

I think that we do a very special job. Is it underfunded? We're in budget cuts right now. Everybody's in budget cuts. Las Vegas is no different than anybody else. We're hurting. The foreclosure rate's huge. There's been a devalue of property. All these things are going on. We're going to feel that same crunch as everybody else.

But we've never been at the top of the budget food chain. I'm not telling you that the county mothers and fathers haven't given us what we needed, but you're not always going to get what you need. There's not going to be any fluff to begin with. And that's because, you know, parks and kids and preventative programs, those are always going to take a front seat. ...

But I think it's my responsibility as administrator to look at alternative ways to fund projects. We partner with the Organ Procurement Organization for some rental space. We have developed a special program about how that will be done, and we have a team called a first team that responds to a hospital when there's a need to gather forensic evidence that might be lost during a procurement process. They fund that. We have put a dollar on death certificates for a training budget. You have to look at alternative ways to create funding. That's what my job is. My job is to provide the resources for the people to do their job.

So a vital function, determining cause of death, which also has a big public health aspect to it --

It can, yes.

-- already underfunded, according to almost everyone we talk to, is going to go through even deeper cuts.

I think we're going to feel the cuts. We've been very fortunate that our cuts haven't been quite as deep as some others because we haven't had a lot to cut. We're very proud of the fact that, when a body comes to our office, from the time it arrives to the time it leaves is about 24 to 30 hours. That's not necessarily the case [elsewhere] in the United States.

And we're very cognizant of how important it is for that to happen so that families can proceed with their grieving process. ... If we can continue to see cuts, we may have to make some adjustments on what those turnaround times are. The question will be, is that acceptable to the public? And then the powers that be will have to decide if that's acceptable. ...

You testified before the National Academy of Sciences committee. But there's a big complaint that coroners were not part of that -- except you.

Correct. ... I was the only one that was invited. I think I was invited because at that time, I was the president of the International Association [of Coroners and Medical Examiners (IAC&ME)]. I made some very poignant statements in that. I was asked to review it while it was still in draft form. I sent my comments in. They're all done anonymously.

I really don't see that my comments made any impact. ... I said that coroners in the United States vary from a hybrid office, such as ours, to the guy that's a part-time tow-truck driver or a full-time tow-truck driver and a part-time coroner.

One of our recommendations was the creation of a coroner college, for lack of a better description, so that we could further educate the coroners in the United States, so that they knew when they were in over their head and they know when it's time to call in a forensic pathologist. And that forensic pathologist should be used in death investigation. ...

What they're talking about is standardizing the system and trying to provide the country at large with a standardized system with values, accreditation and get rid of all of this kind of uneven and, at times, unreliable system.

My response to that would be, in theory, that's a great idea, and it could work. But the first thing you're going to have to do is make sure you have enough forensic pathologists. And if you don't have that, I think the system would start to crumble. ...

I'm more of a person that says let's be inclusive, not exclusive, and let's raise everybody up. Let's don't just raise up a certain group of people. So I found it to be a little narrow in its scope.

And I think that there are other solutions out there. Now, if you were to say to me 30 years from now or 40 years from now or 50 years from now, would that be the ideal system, it might be a better system. But when we're dealing with these processes, we need to deal with today, tomorrow and next year and year after. ...

You say you support the idea of a coroners' college.

I do.

Would you support the idea of a national center to promote forensic medicine that assisted in educating people so that there would be enough forensic pathologists educated in the United States and produced, let's say, over the next 10 years or however many years it would take, so you could move toward a more professional system nationwide?

I wouldn't have any problem with that. I would tell you, though, that I think there's a problem that they didn't address in the NAS report that I addressed in my presentation, and that is that coroners are a constitutionally elected officer in many states. As a result of that, I don't think that there's an appetite, generally in the public and certainly in the political arena, to eliminate elected offices. I think there's actually -- it's the opposite direction.

We've looked at some things in Clark County thinking that it would be better to have certain positions not elected. That has met with huge resistance and is not considered to be a direction that our state wants to go.

I also think that there is some appetite in the United States that more federal is not necessarily better, that more local government control is better.

And so you're going to have to match a lot of things. And it's a daunting task. And I want you to know the camel's nose is through the tent. I'm not saying that's a bad thing. I'm just telling you that I don't see it changing in the near future.

Your successor as head of the international association [Dr. O'dell Owens] ... said ... that a lot of these recommendations were promoted by what he called "coroner haters." Are there people out there who hate coroners?

I think that you have to always look at why someone, what their motivation is for whatever their opinion is about something. I think that there is a percentage of forensic pathologists that certainly don't like having a layperson, such as myself, have any supervision responsibility over them.

But I can tell you that that model works well in hospitals all over the United States, that the administrator of the hospital is oftentimes not a physician.

But the administrator of a hospital doesn't sign off on the diagnosis.

Well, and you've got to remember, I don't sign off on the diagnosis. I sign off on the manner of death. ... It is my opinion that the manner of death is investigative in nature, very similar to what police officers do every day, and that the cause of death is medical in nature.

But in most jurisdictions, at least with the coroners we've talked to, they sign off on the cause of death.

When I sign, both cause and manner is there. But by statute in the state of Nevada, the physician has to establish cause of death. And I'm going to tell you, I'm not going to agree with you. We're going to have to agree to disagree. I'm not going to agree with you that, in most jurisdictions, the coroners are establishing both cause and manner. I'm going to tell you that I think some of them are. But I'm going to tell you I think there are some systems like ours. ...

OK. So can I say, in sort of summary, that really what you object to in the National Academy of Sciences study is their call for the elimination of coroners, but that much of what else is in there, in recommendations and in conclusions, you agree with.

... I think the NAS report did a good job of capsulizing or capturing some issues that need to be addressed in the forensic community. ... I think that they looked at what, for lack of a better description, was almost like a nuclear option in reference to dealing medical-legal death investigations in the United States.

And I think that is a very long-term process. What I was hoping would happen is we would also look at some of the short-term and medium-range solutions and that it's not just an off-with-their-head kind of attitude, that let's do more to professionalize what's done in America. Isn't that what we're all here to do, to do a better job?

Well, I'm representing sort of all sides. ... One of the subjects they raise, which we've heard other medical examiners raise here who we've talked to, is that there is a perception of bias in coroner systems where someone with a law enforcement background can be the person signing off and running an office. ... So their recommendation is that the coroner office should be run by a doctor, preferably a forensic pathologist, and it's stand-alone. And it's more appropriate for it to be, let's say, in a department of health than seen as an arm of law enforcement.

... I want to be clear that I am not concerned as much about who's running the office as their integrity, their business experience and their abilities. So to make the argument we're partnered with law enforcement, first of all, we happen to be independent. Some agencies are partnered, and saying that that's the reason that we shouldn't do something -- I could make the exact same argument by saying that physicians are partnered with the medical community. So using your analogy, would they, in fact, not be more biased toward the medical community if there was a problem? ...

A number of the medical examiners we talked with, and just looking at history, the National Academy of Sciences has been trying to eliminate coroners since 1928. One of the people here at the conference said, "Well, this report, that's what it's all about: Get rid of coroners."

Probably so. I think someone did make a presentation at this conference where they kind of gave a timeline, and it did go back into, I think, 1928. That's absolutely correct. Doctors don't want coroners, specifically a majority of the forensic pathologists.

Who does want coroners?

Evidently the citizens do, or you wouldn't have them.

Were you surprised when you read the report?

The NAS report? A little bit, yes.

About the elimination of coroners?

I didn't know whether that was going to come out at that particular moment, but that's certainly been something that I know the National Association of Medical Examiners [NAME] has pushed forward for a number of years. ...

I think the thing that kind of set me back a little bit was the idea that you asked me to come testify, and then you didn't take any of my recommendations. I'd kind of like to see [them] at least give it some consideration. But that's their decision. My testimony is on record. ...

What do you think about these online accreditation services that provide sort of a sheepskin for people online by taking a test online?

I think that some of that can serve a purpose to bring up, to raise educational levels. Do they carry the same weight? I think it depends on what you're talking about and what were the requirements.

Forensic medical examination certification online.

When we're talking about forensic medical examination, now we're talking about what should be a licensed physician. No, I don't think so.

But people with those kinds of certifications testify in court.

And I think it's the responsibility of the courts to vet those people and for the jury to make a decision. Do I support that? No, I don't necessarily support that.

So you agree with the medical examiners that we've interviewed who have said this is horrifying to them --

I can see that being a huge concern for them, sure.

-- forensic pathologists who say, "My testimony goes up against somebody who got certified online as a forensic science expert."

You know what? In fairness to them, let me say that I believe that, as a result of -- you asked me earlier about the CSI effect. I think as a result of the CSI effect, there has been this onslaught, for lack of a better description, of folks that want to have forensics as a part of their name because of -- maybe it ties them to some type of funding, or it does something for them. So I think that's happened. Yeah, I would agree with them about a lot of that.

But -- and I think part of what the NAS report was trying to say -- if we want to come back full circle on this, I think part of what they were trying to say is that there needs to be more oversight into the process and that we can do it better. ...

And then -- I guess what I was trying to get to before -- I was surprised reading the report and in subsequently reading in general how disorganized the system is, I know you've already said many things in the United States are like that. We have, like, 30,000 law enforcement agencies, I know, and they have different standards. We have 28 different intelligence agencies who have different computer systems, who --

Thank you for making my case.

-- are not compatible, right?

Right. Well, I won't say not compatible. They struggle with compatibility.

Well, I know at the counterterrorism center, they've got to click back and forth between them in order to see -- and movies like Enemy of the States comes up on the screen, right? Or what CSI does, right?

Sure.

They get the DNA, and they get the picture at the same time, right?

Yeah. They get a lot of things at the same time.

Exactly. But I think people out there assumed, almost everyone we've talked to, that the person in charge of a death investigation in the United States, wherever you are, is at least a doctor, if not a pathologist; if they know what a forensic pathologist is, a forensic pathologist. I think that there's really not a lot of knowledge out there that coroners can be a building contractor or a former law enforcement officer.

Was there a question there?

People don't know, right?

I'm going to tell you that I think the vast majority of people don't have a real good knowledge of what's done in reference to death investigations. If I use what you've asked me, that the majority of the people that deaths are overseen by physicians, the short answer to that is they are because [they're overseen by] physicians in hospitals. Of those 14,000 deaths we talked about in Clark County, remember, we're going to bring right around 3,000 of those to our office.

Those other deaths are overseen by a licensed physician in the state of Nevada. And the licensed physician signs the death certificate, which is the physician of record. So the vast majority of people think that a death is overseen by a physician. They are, by the physician of record.

Those other deaths that are questionable in our jurisdiction are overseen by forensic pathologists. If you were to ask the average citizen, "Who is a forensic pathologist?," we work hard to tell people what they do and who they are.

But I would say that most people don't know who that is. Why would they need to know that? They don't know until they get faced with a tragic situation.

[Data] related to medical examiners and coroners are basically based on a 2004 study by the Department of Justice. There aren't any up-to-date annual statistics about what's going on.

Right. Much of the statistical information that's gathered in the United States in reference to death is done by two groups: law enforcement, because they deal with death; and the other would more than likely be the reporting of death certificates in the CDC, Center[s] for Disease Control [and Prevention], through the reporting of death certificates. Much of that information happens [that way].

And that's important public health information.

Yes, sir.

And it's done by, in some cases, offices that are less qualified than others.

I think that's true in almost every field.

Yeah. But in a wide variety.

I can't argue that. I'm not trying to argue that.

I mean, there are coroners in South Carolina who, until Michael Jordan's father was discovered and then cremated because they didn't have a refrigerator, didn't have any refrigeration for bodies.

I'm sure that there are offices that do not have refrigeration.

And the Los Angeles coroner tells us that there is -- to our surprise, that the center of homicide in Los Angeles is nursing homes, that they don't have enough investigators, enough ability to go into nursing homes to look at the way people die. And that's a huge problem. That's one of the better offices in the country. So a part of this in our reporting is that there's a lot going on that nobody sees --

Or wants to see.

What do you mean, wants to see?

Our business is one that people only use when they absolutely need it. And many people are very put off by the whole death process. So the systems that we have right now and the changes that will come will be as a result, in my opinion, of an internal change by us that are in the business.

And it's one of my responsibilities to bring forth these issues to the powers that be, to our taxpayers, to our citizens. And they'll tell me if I'm doing it correctly. And I will recommend to them the things that we need to do, and they count on us to do it appropriately. And we work very hard to do that.

So are there problems with the system? Absolutely. There's problems with every system. I mean, you know, we could sit here all day long and come up with "what ifs" and scenarios. I could talk about good journalism, bad journalism, good reporting, bad reporting. ...

Can we do better? Absolutely. Should we do better? Certainly. Are we trying to work toward that? That's exactly what this whole process was about this week and our reason for being there.

Can you do it with a nuclear approach? That's what I'm going to call the NAS report in some respects, at least in reference to my purview within the coroner-medical examiner field.

They want to blow the whole thing up?

I think they want to say, wipe all this out, and go this direction. And I'm going to tell you that I think there's a Chinese proverb that says be careful what you ask for. I don't think the system could function without the coroners at this particular time. ...

In some of the reporting that we've done, we've been told the coroners and medical examiners, you are the first line of defense for biological attack, for infectious diseases that may become rampant, for drug overdose problems, drug interaction problems, and the possibility that the helpless -- our relatives, for instance, who may in nursing homes -- are also at risk and that the resources are not there in this country to bring that under control and to monitor it appropriately.

... We're a part of the safety net. And there are several folks that are involved in that process, appropriate health care folks that are doing a really good job. There's monitoring processes within hospitals and hospice organizations and health care facilities. You have fire and EMS [emergency medical services] folks that are out there every day, and they report things. You've got law enforcement that do it.

And we are sometimes the safety net. We go out on a call that's reported to be a natural death, and our death investigator gets there and calls the police and [says]: "We've got a problem. You need to get out here."

But there's a lot of checks and balance that are set up, at least in our jurisdiction, to try to make sure that we kind of safety-net each other to do everything we possibly can to make sure that we're doing it as good as we can.

Now, is that across the nation? Some places are better at it than others, and some places have more resources than others. ...

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Posted Feburary 1, 2011

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