ROBERT SIEGEL, Host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.
MICHELE NORRIS, Host:
Two years ago, a blue ribbon panel created by the National Academy of Sciences raised a red flag about a lack of mandatory standards for autopsies. It also expressed concern over a lack of oversight for coroners and medical examiners. The panel recommended that the goal of every state should be to move away from a coroner system which is not based in medicine.
SIEGEL: States, it said, should also hire board-certified forensic pathologists and put them to work as medical examiners.
NPR: Death Investigation in America.
Y: Medical examiners.
D: Well, let me show you our CT scanner.
SANDRA BARTLETT: I'm standing with Dr. Ross Zumwalt, as he shows off his state-of-the-art medical examiner's office in Albuquerque.
D: In fact, we're doing the baby now.
BARTLETT: It serves all of New Mexico.
D: This is such a pleasure to work in this spacious operating room type atmosphere.
BARTLETT: Zumwalt says his new CT scanner will ensure he doesn't miss anything in that last examination. This high-tech X-ray machine takes pictures from several angles at a time.
D: We would like to put everybody through the CT scanner.
BARTLETT: The lab has nine bodies to be examined and autopsied this day. At the morning meeting, cases are described and then assigned to the forensic pathologists.
U: Four-eight-seven-five is a 19-year-old female who was the restrained driver of a Ford Taurus, was traveling southbound on Coors(ph). She went to make a U-turn and apparently she was T-boned by a Hummer.
BARTLETT: Zumwalt's Albuquerque facility is one of the best in the country, not just because of the new building and its modern equipment, but also because he has enough staff to investigate and autopsy all sudden or violent deaths.
D: My assistant is drawing blood from the femoral vein for toxicology.
BARTLETT: Zumwalt says where you die makes a difference, especially when your death is unexpected or suspect.
D: It's certainly incredible to think that just the space of a few yards may mean the difference between competent death investigation and incompetent death investigation. But there may be areas where on side of the border, you have a statewide medical examiner and competent death investigation, the other side of the border may be a small county coroner with few resources and little training.
BARTLETT: As we investigated across the country, we found it's not necessarily the poorer states or those states with smaller populations that fail to provide adequate death investigations.
(SOUNDBITE OF MACHINERY)
BARTLETT: And the mistakes piled up over the years, all over the state.
NORRIS: They're just some baby pictures. These, the ones later on, that kind of bring back some nice memories of...
BARTLETT: Scott Arnold is spreading out a collage of photos, showing him with his sister, Ann.
NORRIS: That's the two of us. We were in a marching band together.
BARTLETT: Arnold lives in Gloucester, about an hour's drive from Boston. In 2003, his sister, Ann Goyette, was badly burned in a house fire.
NORRIS: The police did say to my father that there were two victims, one had died. So we knew it was serious.
BARTLETT: At the hospital, doctors told him they'd put Ann into a coma.
NORRIS: She was in a oxygen tent, you know, a full face mask with tubes down her throat.
BARTLETT: After almost a week, Arnold and his father were told Ann was out of the coma and talking.
NORRIS: So off we went, walked into the unit and there was the girl who we didn't recognize - I'd never met her before - sitting up in bed. And I looked at her and I don't know why, but I said, Ann? And she says, no, my name is Susan. And my father kind of collapsed.
BARTLETT: Even when funding began to improve in 2004, the problems continued. The most recent audit in April of 2007 describes the office as being on the verge of collapse.
D: Yes, I think that was an exaggeration. I didn't sense that.
BARTLETT: Dr. Henry Nields is now the acting chief medical examiner. He worked in the office in the late '90s, before leaving for a job in New York. He came back to Boston in 2006.
D: I mean, I had only been here less that a year. But it didn't feel like it was on the verge of collapse.
BARTLETT: John Grossman is Massachusetts' undersecretary of forensic science and technology. He oversees the medical examiner's office. Grossman says the firing show he's serious about ending the mistakes.
NORRIS: The real problem at the end of Dr. Nields' predecessor term was that he covered it up. And as often the case, the cover-up is worse than the crime. He was fired for cause.
BARTLETT: Dr. Henry Nields became Zane's boss after this incident.
D: Yeah, I don't - I don't know the specifics of the case. There are, as I'm sure you know, there are African-Americans who are relatively light-skinned. So I can't say that that was the case, in this particular case. I don't know.
BARTLETT: Nields says all that is in the past.
D: Well, the place has already been fixed to some extent. You know, I hate to come back to the money thing but we certainly need more funding to be at the level where I would like to be, and I think it's a better place today than it was yesterday.
BARTLETT: Sandra Bartlett, NPR News.
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