Stiff medicine

Doctors, not cops, should run the department that conducts autopsies and issues death certificates in Sacramento County. That’s the conclusion reached in a report by the Sacramento County grand jury following its probe of the troubled county coroner’s office.

The No. 1 problem, according to the grand jury, is that Sacramento County has clung to an outdated coroner system, in which the coroner is nominally a law-enforcement officer and need not have any medical credentials.

The jury found that the system, and recent organizational changes by County Coroner Paul Smith, undermines the autonomy of doctors who investigate deaths and perform autopsies.

“There should be clear separation of scientific medical decisions from non-qualified individuals, agencies and political interests,” the report concludes.

Noting that death investigation is primarily a public- health function, the jury recommended that Sacramento scrap the coroner system in favor of a more modern medical-examiner system in which the department head would be required to be a doctor, preferably a forensic pathologist.

The report was cheered by those in the medical community, who long have urged Sacramento officials to join other major urban areas in the state by adopting an independent medical-examiner model.

“That’s something the medical society here strongly supports, particularly in a county as large and sophisticated as Sacramento,” said William Sandberg, executive director of the Sierra Sacramento Valley Medical Society, an affiliate of the California Medical Association. “It really ought to afford an opportunity for [the board] to have a serious discussion about moving to the medical-examiner model.”

It is not clear, however, whether the board will seriously discuss making changes or will continue to brush off criticism of the coroner’s office as it has throughout the past two years.

Many of the problems listed in the grand-jury report were examined at length by SN&R last year (see “Dead Wrong”; SN&R Cover; March 14, 2002). Then, critics of Smith complained that he had interfered with medical decisions when he was not qualified to do so and had sought tighter control over pathologists at the expense of their medical autonomy.

Then, as now, the board appears to be sticking by the current regime.

“All the grand jury has done is talk to some people and gather some correspondence and say, ‘Here’s our opinion.’ There’s nothing new in there that I can see,” said County Supervisor Roger Dickinson.

Ditching the coroner system would require an amendment to the county charter, and that in turn would require approval by the Sacramento County Board of Supervisors to place a measure on the ballot for voters to decide—no small matter, given the complicated nature of the issue.

Supervisor Roger Niello said he’s open to the idea but skeptical. “I’m from Missouri on this one. ‘Show me,’” that a medical-examiner system would be better than the current model, he said.

In fact, the board is not required to do anything as a result of the report, other than submit a written response to the grand jury by September 30. Dickinson said he anticipates that the response will be continued support for the coroner and the coroner system.

That’s too bad, said Sandberg, adding that it wouldn’t be the first time the supervisors missed an opportunity to make needed reforms.

For example, Sandberg said, his organization strenuously objected to placing the coroner in charge of health services for inmates of the Sacramento County Jail and argued that having an agency provide medical services to inmates and investigate their deaths was a clear conflict of interest.

The board, however, deferred to Smith and allowed him to keep control of correctional health services. The grand-jury report notes that only after a rash of inmate suicides—which brought intense scrutiny, and lawsuits, to bear on the county’s handling of jail health—did the supervisors put the correctional health program under control of the Sheriff’s Department.

“Typically, the board of supervisors doesn’t respond to anything until it becomes a disaster,” said Sandberg.