Dead Wrong

Dr. E. Paul Smith, like most people who have spent a lot of time in school, likes to display his credentials on his office wall. But it’s not his master’s degree in public administration that hangs in the spacious office at the Sacramento County Morgue, nor the doctorate in public administration that followed it. Perhaps those are in a drawer somewhere, or hanging in his living room.

Instead, Smith displays a number of certificates that attest to his training as a law enforcement officer. There’s a certificate of completion of the Sheriff’s Reserve Academy on the wall, and another plaque that proves he is a certified range master, qualified to teach others how to shoot firearms.

For Sacramento County Coroner Paul Smith, the most important credentials may be those hanging from his belt: his shiny gold badge and Glock pistol. At age 56, with the shortest possible bristle of silver hair, wearing a black shirt and slacks, his gun and badge on his hip, E. Paul Smith looks every bit the experienced cop. It is an unusual bearing for someone who has never collared a criminal and whose job is essentially a medical one—determining how people have died.

Of course, Smith is neither a medical doctor nor an actual cop—he is the coroner, a high-level administrator in county government. Technically he is a sworn peace officer, as all of his predecessors have been. But unlike the coroners before him, Smith acts and looks the part.

He has experience as a hospital administrator, a job he did for 20 years. This was followed by a seven-year stint as the county director of Correctional Health. It was there—overseeing the health services for jail inmates—that his interest in law enforcement began.

The county Board of Supervisors appointed Smith to be coroner three and a half years ago and to run the department that investigates about half of all deaths that occur in the county each year. Some 6,000 cases, which fall into nearly two-dozen categories—including all homicides and accidental, suspicious or unexplained deaths—fall under the coroner’s jurisdiction. At the heart of the department are its forensic pathologists, highly specialized doctors who perform all of the autopsies, determine the cause of death and, if necessary, testify to their medical findings in court. The other main component of the Coroner’s Office is the group of 14 deputy coroners. They are not doctors, but have some training in death investigation, and prepare reports detailing the death scene.

Although the work of the Coroner’s Office is critical to local law enforcement agencies, most of the cases it investigates never end up in court. Since investigators spend every day determining what is killing Sacramento citizens, the Coroner’s Office serves a vital public health role. For example, the department might be the first government agency to see evidence of a new outbreak of some disease.

The trend, in California and all over the country, has been for coroner departments to place greater emphasis on their scientific and medical missions, and to downplay their origins as law enforcement agencies. Smith, by contrast, has reversed the trend and required his employees to act more and more like police. “Every system needs to have its vision questioned. That’s what I’m doing now,” said Smith.

His vision is a nightmare to many in the medical community who think Smith is a wannabe cop whose preoccupation with guns and badges is undermining one of Sacramento County’s most crucial public health functions.

He has ordered his deputy coroners to carry guns whenever they go to a death scene, something his predecessors had never done. And Smith has sought more control over the highly trained forensic pathologists who perform all of the department’s autopsies. This has sparked complaints from doctors that Smith, who has no real medical training, is interfering with medical decisions. In one troubling case, Smith shocked public health officials when he overruled a forensic pathologist’s recommendation that a routine autopsy be performed on a dead infant—an autopsy the doctor said was necessary to rule out child abuse.

Smith has since fired that doctor and the entire contracting group of four forensic pathologists who previously performed the county’s autopsies. In their place, Smith has tried to implement a system in which forensic pathologists are county employees, under more intense supervision by the coroner.

To complicate matters, the doctors Smith has hired have come with a troubling history. One recently resigned his position as medical examiner in Flagstaff, Arizona, after revelations that he had a drug problem and was subsequently indicted for prescription drug fraud. The other hire is vice president of a group of forensic pathologists that recently had one of its doctors barred from performing autopsies in Sonoma County, after questions about that doctor’s credibility led a judge to throw out a high-profile murder case.

There’s also been a rash of inmate deaths at the Sacramento County Jail that have raised disturbing questions about how the coroner investigates cases of people who have died in custody.

Smith’s tenure as coroner has ignited a debate about whether cops or doctors ought to have control over the way the county investigates deaths, and has led some in the medical community to call for a whole new system.

Smith had an experience in 1994 that changed his life. He was 50 years old when he completed the Sheriff’s Reserve Academy. It was there that he learned how to cultivate a “command presence,” an awareness and way of carrying oneself that is particular to law enforcement officers. He brought his command presence to the job of coroner and along with it a number of new rules that reflect his interest in police work.

Smith purchased new SIG Sauer pistols for all of the deputy coroners in his department. He instituted a policy of having an armorer—someone responsible for acquiring and inspecting guns—and two range masters in the department, something his predecessors had never done. Smith also is now looking into ways to get authority for coroners’ vehicles to use flashing lights and sirens.

Although deputy coroners in Sacramento are now tested three times a year on their shooting skills, none are required to continue their education in death investigation, beyond a two-week course in Southern California.

Smith said the emphasis on guns and weapons training was necessary because the county was subject to great liability. In the past, deputy coroners, as sworn peace officers, could carry guns. Some did and some didn’t, but there was no procedure in place to make sure they were being tested at the shooting range. If something extraordinary happened, and a coroner did shoot someone, the department would be in serious legal trouble once it was revealed that the deputy hadn’t qualified in years. Smith said, however, that none of his deputies has ever drawn their weapon, but insisted it might happen. A couple of deputies have been assaulted with fists, he said. But he also admitted that no coroner should be at a crime scene without an armed police officer or sheriff present.

Many jurisdictions solve the liability problem more directly: coroners simply don’t carry weapons. In Yolo County, not one of the deputy coroners carries a gun. There, deputy coroners must have a master’s degree in forensic science to be hired, according to Chief Coroner Mary Koompin-Williams. That requirement is far more stringent than Sacramento’s. Here deputy coroners are only required to attend a certified Police Officer Standards and Training program, and to complete a basic death investigation course.

Nor do they carry guns in Fresno County. When asked whether his death investigators there carried weapons, Fresno County Coroner Dave Hadden laughed. “I think it’s silly for coroners to carry guns. Who are they going to shoot? Somebody’s bereaved relatives? In 23 years [as coroner] I’ve never had a deputy coroner come back and tell me they wished they had a gun.”

Hadden is an elected coroner, a job that requires no more qualification than being able to read and write and being at least age 18. But Hadden, who has served as coroner for 23 years, is in fact a pathologist. He is stepping down this year, and the most qualified candidate running for his office is a veterinarian. That worries Hadden, who believes a medical doctor—preferably a trained pathologist— ought to oversee the day-to-day operations of any death investigation agency. In those counties that have coroners instead of medical examiners, the deputy coroners are technically law enforcement officers. But Hadden and others say that law enforcement definition of the job is really a holdover from an archaic system, one that dates back to the Middle Ages, and doesn’t reflect the proper role of modern death investigation agencies. It is backward, said Hadden, to accentuate guns and police work over medical and scientific training. “It’s completely the wrong emphasis.”

Right now, there are two basic models for death investigation agencies in California—the coroner and the medical examiner model. The coroner system varies widely depending on which county you are looking at, but all are mutations of the sheriff-coroner model that has been in America since its beginnings. In most rural and smaller California counties, the sheriff is still the coroner. On paper at least, this creates an inherent conflict of interest, especially if someone dies in police custody, which is why many counties have some form of independent coroner. In fact, many of the larger metropolitan areas, San Francisco and Los Angeles for example, have switched over to a full-fledged medical examiner system. The department is under the direction of a bona fide doctor and therefore should be independent of undue influence from law enforcement agencies. That trend is more pronounced in other parts of the country, and in some cases entire states have switched over to the medical examiner model.

Sacramento is somewhat unique for a large metropolitan area in that it hasn’t switched over to the medical examiner model. Critics say the coroner system is inherently flawed because it gives a layperson undue influence over what should be strictly medical decisions.

Still, by many accounts, the Sacramento Coroner’s Office has functioned fairly smoothly over the last three decades, since the county coroner began contracting with independent forensic pathologists in the late 1960s to handle all of the department’s autopsies. For the past 12 years—until January 1 of this year—all forensic pathology had been performed by a group called Northern California Forensic Pathology (NCFP).

The Sacramento coroner himself has historically been little more than a well-paid bureaucrat, and the office was seen as a political plum handed to those administrators who were nearing the end of their careers. Because peace officers enjoy better retirement benefits, and the county coroner is nominally a peace officer, Smith’s predecessors enjoyed healthy retirement packages, without having to become too involved in the grisly details of autopsy and death investigation.

NCFP’s president, Dr. Robert Anthony, and the other forensic pathologists in the group were considered very good doctors, and by all accounts provided the county excellent service. Anthony did have a reputation for his brusque manner and short temper, but despite apparent personality flaws, the coroners largely deferred to him.

But when Smith became coroner three and a half years ago, he decided the department needed some changes. He felt the Coroner’s Office was sorely lacking in the area of “customer service,” the customers being the District Attorney’s Office and the Sheriff’s Department in particular. A more direct line of command, he argued, would ensure that doctors worked more closely with law enforcement, and would help the entire operation run more smoothly.

As Smith puts it, “It’s the difference between being able to say ‘Doctor, you shall do it,’ versus ‘Doctor, will you please do it?’ ”

Although Smith repeatedly emphasized the need for “control” over the day-to-day operations of the department, he quickly added that he would never interfere with the medical decisions of any forensic pathologist.

But the notion of control over forensic pathology didn’t sit well with the doctors at NCFP.

“Yes, it’s nice to have control,” said Dr. Greg Reiber, one of the former NCFP doctors who left when Smith terminated the group’s contract. “But it is better to have control when you know what you are doing.” There were occasions when Smith didn’t know what he was doing, said Reiber, and exerted his control anyway.

For example, Smith may have interfered with medical decisions when he overruled Reiber in a controversial case involving an infant who had apparently succumbed to sudden infant death syndrome (SIDS). Reiber, who was the forensic pathologist reviewing the case, said an autopsy should be performed, as a matter of course, to rule out child abuse or an unknown disease. But Smith said no.

According to Smith, there were no outward signs of child abuse, or disease, and the family objected to having an autopsy performed on religious grounds. A doctor at UC Davis signed the death certificate as SIDS and, despite Reiber’s objection, Smith closed the case.

The problem is, according to Reiber and other doctors, SIDS cannot, by definition, be determined without an autopsy. Reiber said he has seen several cases in the past that came in looking like SIDS but turned out to be child abuse. The SN&R asked several coroners and medical examiners, in Sacramento and other cities, about the SIDS diagnosis and they all strongly stated that an autopsy in most instances should be performed on a dead child.

In regard to the SIDS case, Sacramento County Public Health Officer Dr. Glennah Trochet fired off a letter to Smith saying she was “alarmed” at the lack of an autopsy in the case. “The standard accepted around throughout this country is that an autopsy is required in order to diagnose SIDS. This is an absolute requirement, not an option.”

Trochet’s letter also mentioned “other changes that appear to be taking place in the Coroner’s Office and are of concern to me as Public Health Officer for Sacramento County.”

Trochet declined to be interviewed about any concerns she had with the Coroner’s Office. Oddly, it was the coroner, Paul Smith, who telephoned to tell the SN&R that Trochet would not comment. A follow-up call to Jill Estroff, spokeswoman for the county Department of Health and Human Services, confirmed that it was true—Dr. Trochet did not want to comment, but Estroff also said she wasn’t sure why the call had come from Smith.

Smith’s decision to forego an autopsy may have been questionable and might have given ammunition to those who want to see an end to the lay coroner system, but he did act within his authority under state law.

“I respect their professional judgment, but they are not the coroner,” said Smith.

Reiber said that is exactly the problem. Simply by virtue of being coroner, Smith was able to override a medical decision where he had no expertise. In other words, “He made a medical decision based on the fact that he has a gun and a badge.”

Back in Fresno, Dr. Hadden said he has heard of the termination of NCFP’s contract in Sacramento County, and claimed the county now might have a hard time attracting qualified pathologists. He has been trying to fill positions in his department, at salaries about $20,000 higher than what Sacramento County is offering. “And we still can’t find anybody,” said Hadden. Qualified forensic pathologists are in short supply all over the country. Not many people want to go into the field, for the obvious reason that all of their patients are dead. But also because the pay relative to the years of medical training they undergo is very low compared to other fields.

Last September, when Smith announced his plan to terminate NCFP and make forensic pathologists county employees, he immediately heard from doctors around the state, telling him it wouldn’t work. Smith may find it doubly hard to hire quality doctors if they fear interference coming from the coroner, particularly one who has no medical training and an appetite for control.

Dr. Boyd Stevens, medical examiner for the city and county of San Francisco, wrote that doctors were likely to chafe under the system Smith sought to impose. “Without autonomy for physicians to regulate their professional work, there is an increasing likelihood of unrest,” wrote Stevens.

Fearing difficulty in hiring new doctors, the county Board of Supervisors asked Smith to delay full implementation of his plan until this summer. Unfortunately for Smith, he had already told NCFP to be out by January 1, and Anthony balked at his request to stick around another six months. Smith found himself scrambling to find new doctors.

One of the doctors Smith has hired to replace the NCFP group is Dr. Mark Super, currently vice president of an outfit called Forensic Medical Group (FMG), a contract group similar to Anthony’s NCFP. Super’s group just got some bad press in Sonoma County after officials there barred one of FMG’s doctors from performing autopsies after questions about his credibility sank the district attorney’s case against a physician accused of murdering his wife. The Sonoma County DA was quoted in a newspaper as saying that anybody from that medical group is suspect “based on the track record.” A Sonoma County deputy district attorney, Greg Jacobs, softened that statement when he spoke to the SN&R, saying he wouldn’t necessarily anticipate any problems with autopsies performed by Dr. Super.

“Certainly, we weren’t treated well. But I wouldn’t throw the whole group out,” said Jacobs. (Super did not return a call from the SN&R for comment.)

Then there’s the hiring of Curt Rollins.

The first thing you notice about Dr. Curt Rollins’ office is the stuffed animal heads—a deer and boar that Rollins killed back home in South Carolina. Then there’s pictures of him with various trophies from fishing and hunting trips, including one of a smiling Rollins decked out in camouflage and face paint crouched with a hunting bow over a slain deer. Incongruously, there is also tacked to his bulletin board a kitschy illustration of a smiling, well-coiffed man holding a shot glass of liquor underneath the words “Rehab is for Quitters.”

Until last year, Rollins was the medical examiner for Coconino County, Arizona.

In March 2001, sheriff’s deputies responded to reports of gunfire and a possible burglary in progress at Rollins’ house, although Rollins said he was out of town at the time. Rollins said when officers arrived they discovered his live-in boyfriend had attempted to commit suicide by injecting an overdose of cocaine.

The deputies searched Rollins’ home, and found an empty bottle of Demerol and other prescription-only narcotics. They also removed several of Rollins’ personal journals, which indicated an on-and-off history of drug abuse, and an addiction to Demerol. Ultimately the grand jury handed down a 10-count indictment against Rollins, including prescription drug fraud, theft and illegal possession of narcotics.

Rollins said many of the charges were basically trumped up because, in conservative Coconino County, the sheriff wanted him out because he was gay. “The sheriff basically said ‘he’s not working here if he’s a faggot.’

“It was a witch hunt from the word go,” he added.

In the end, the prescription drug fraud indictment didn’t stick, and his journals were not allowed as evidence, but Rollins did plead guilty to illegal possession of narcotic and drug paraphernalia, and entered a drug diversion program, culminating in five months in a treatment center in Atlanta. He is now given random urine tests once a week. And he knows that if he slips up even once he will lose his job.

When asked if he is confident that he won’t relapse, Rollins said “confident” wasn’t the right word. “I don’t want to be arrogant or cocky about it. I get up every morning and say please help me, and I go to bed every night and say thank you.” Rollins added that the quality of his work has never been an issue, in Coconino or Sacramento counties.

But given all of the baggage that Rollins came with, why would Smith hire him?

“If there had been 15 applicants who were as qualified as I am, I don’t think they would have taken me,” said Rollins.

But there weren’t 15 applicants, and there probably won’t be. The supply of forensic pathologists is short.

For now, Rollins isn’t being allowed to perform autopsies in any cases that are likely to wind up in court. If he does, he is likely to be attacked by defense attorneys in highly sensitive criminal cases, said Dr. Joseph Masters, a forensic pathologist who previously worked with Sacramento County. “It’s going to cause all kinds of problems in court. I think when either [Rollins or Super] take the stand, a good defense attorney will rake them over the coals,” said Masters.

Curt Rollins was hired in part because Paul Smith already knew him. In fact, Rollins used to work for Dr. Robert Anthony and NCFP several years ago. Rollins said he admitted to having a Demerol problem to Anthony back in 1998. He voluntarily checked himself into an inpatient drug treatment center in Oregon for a three-month program. But he said after only one month, Anthony told him to come back or lose his job. To some extent, he blames Anthony for his later relapse. And he says Anthony has no one to blame but himself for losing the Sacramento County contract.

“The guy [Anthony] is a flaming asshole. He’s the angriest person I have ever seen,” said Rollins of his former boss. Rollins added that Anthony used to go on screaming tirades, throwing things in the office, and had complaints lodged against him for fostering a hostile workplace.

“All of the coroners wanted to get rid of him, but gave up. Paul was the first one to dig in his heels.”

Rollins, who is a former Sacramento sheriff’s deputy himself, said Anthony had a pronounced dislike for law enforcement officers. “He hated cops. He always talked down to them, like, ‘say, don’t you have a donut to go eat?’ ”

It seems as though the personality conflicts between Anthony and Smith were a big part of the reason for the changes. Sacramento County Supervisor Roger Dickinson said the board was aware that the relationship between Smith and Anthony had “deteriorated to the point where it was no longer salvageable.”

But such personality conflicts were never mentioned in the Board of Supervisors’ public meeting when Smith requested the authority to terminate NCFP. Smith has maintained all along that the overall purpose of the reorganization was to improve customer service; he never brought up problems with Anthony. In short, the public may not have been given the real reasons for the changes.

Anthony acknowledged that he can be hard to work with, and said he sometimes shows his frustration in inappropriate ways. But he said the real issue is that Smith didn’t like having his judgment questioned.

“They want people who aren’t going to question how things are being done. We said you can’t have non-medical people making medical decisions. But Paul Smith doesn’t brook anyone speaking up. It’s a classic case of ‘if you don’t like the message, shoot the messenger,’ ” said Anthony.

The end result of all the upheaval in the Coroner’s Office is that the county now has one doctor who is capable of performing autopsies on cases that are likely to end up in court. Six months ago it had three. And it is not clear that the criminal justice “customers” of the coroner’s department were clamoring for a change in the first place.

According to the sheriff’s spokesman, Sgt. James Lewis, the changeover has been a wash. He said the Sheriff’s Department couldn’t comment about whether the Coroner’s Office was dysfunctional before the changes, or it had improved since then. “It’s been business as usual.”

The District Attorney’s Office isn’t entirely pleased with the changes, particularly with the potential problems posed by hiring Rollins. Things worked well when NCFP had the contract, said district attorney spokeswoman Robin Shakely. “There were not any problems from our perspective, and we are a huge customer of their services,” said Shakely. She noted that the DA’s Office was also concerned about whether quality pathologists would be available in the future. “It’s hard to find doctors of the caliber of Drs. Reiber and Anthony.”

Shakely said it was too early to tell whether Curt Rollins would be a problem to county prosecutors, but said the decision to keep Rollins off sensitive cases was made with the DA’s input. “That was their concession to our concerns.”

It’s not surprising that Anthony and Reiber would be critical of Smith. After all, they lost a contract worth hundreds of thousands of dollars. But the coroner’s changes have gotten the attention of many in the medical community.

The firing of NCFP and the hiring of their replacements are a serious concern, said Dr. Richard Ikeda, who sits on the county Child Death Review Board and has been a vocal critic of Smith’s administration. Bluntly, Ikeda said Smith’s tenure has been an ‘atrocity.”

Getting rid of NCFP when quality forensic pathologists are in short supply, then bringing on doctors with excess baggage, said Ikeda, are undermining the department’s credibility. ‘It’s just sloppy thinking. It just proves that Paul Smith doesn’t know what he is doing.” He believes it is only a matter of time before the coroner’s department makes a major mistake on a homicide or other sensitive case.

‘When the first bad case blows up in their face, I’m going to be the first one there to say I told you so,” said Ikeda.

Ikeda and others in the medical community are also concerned that Smith was recently reappointed director of the county’s Correctional Health Department, which means he is responsible for the health of the inmates at the county jail. If someone dies in the jail, and they do fairly often, Smith is responsible for the investigation of their deaths. In other words, one department that Smith runs is responsible for investigating another department that Smith runs. The actual autopsies are done by forensic pathologists from San Joaquin County, but there is more to a death investigation than just an autopsy.

Administratively at least, there appears to be a conflict of interest, according to the Sacramento Medical Society, an independent group which reviews some of the jail health programs. In September of last year, the Medical Society sent a letter to county officials complaining, ‘there were several other logical choices [of administrator] that would have avoided potential conflicts.”

Smith denied there’s any conflict and dared anyone to challenge his ethics in handling investigations into jail deaths. That challenge may happen. The jail has seen an unusually high number of deaths recently, including the high-profile suicide of accused killer Nikolai Soltys. Although Soltys was autopsied in Stockton, the death scene investigation was performed by Sacramento County coroners. Tommy Clinkenbeard, Soltys’ attorney from the Sacramento Public Defender’s office, meanwhile has called for an investigation into the suicide and the quality of health care at the jail. Last week he asked the Sacramento County grand jury to conduct an independent investigation into the suicide. Clinkenbeard said he believes Soltys should have been taking psychiatric drugs, but wasn’t, and should have been on a closer ‘suicide watch.” Both of these precautions, he said, were ultimately medical issues, and the responsibility of Paul Smith. Clinkenbeard wants the grand jury to look at the conflict of interest issue as part of any Soltys investigation.

‘The Sacramento coroner should not have done the investigation. He is investigating a death that he is ultimately responsible for,” said Clinkenbeard.

Smith’s apparent affinity for the trappings of law enforcement only raise more questions about the coroner’s ability to do a truly independent investigation of the rash of jail deaths in recent months.

Independence and autonomy are at the very core over the debate over who—doctors or cops—should control a government agency’s investigation into the deaths of its citizens. The debate likely would have occurred in Sacramento at some point, but Paul Smith’s style and philosophy now provide a strong catalyst.

To Dr. Joseph Masters, Paul Smith and his impact on the Coroner’s Office underscore the danger of having a lay coroner, and the need to move to a medical examiner system. Any lay coroner system where doctors are public employees ‘places control of a scientific professional activity and control of medical and medico-legal decisions with administrators who may have no knowledge, education or training in any medical, legal or forensic science.” Smith has interfered in ways, said Masters, that he would not have tolerated when he became one of the first forensic pathologists to work for the county, over 30 years ago.

'I didn’t want to get involved in this,” explained Masters. ‘But I think a serious mistake has been made.”