Interview Dr. Vincent DiMaio

[Why did you become a forensic pathologist?]

Every day is different. There are different situations, and it's intellectually stimulating. My choice was to practice regular pathology and look through a microscope eight hours a day or be intellectually stimulated every day.

Now, I know there's decomposed bodies involved and that, but there's a price that you pay for anything. But it's intellectually stimulating.

You get used to the decomposed bodies?

A forensic pathologist for more than 40 years, DiMaio retired as the medical examiner of San Antonio in December 2006. He says that novels and television shows have given Americans a false impression of the state of death investigation in America, which he describes as "mediocre." This is the edited transcript of an interview conducted on June 20, 2010.

• Highlights
• The worst places to die …
• … and the states with good systems
• Why we don't have enough forensic pathologists
• Implementing national standards for death investigation would be relatively easy
• What can a forensic pathologist actually tell you about a death?

Of course you do. You get used to everything in the end.

You see, a lot of these people will say after, like, [Hurricane] Katrina -- and they said, "Well, we need psychologists to treat the people who have been stressed." And they were talking about the medical personnel. And my thought was: Anybody who's been in forensic pathology going [on] a couple of years, you don't need psychological counseling. You've gotten out of the business if you can't handle the psychological stress.

So you get used to everything in the end.

Given your years in the business, could you describe the state of forensic death investigations in this country?

It varies from excellent to absolutely lousy. It depends. As a general rule, medical examiners' offices are all right. Some are better than the others. Some have major problems.

The major problem in this country is the coroner system, in that essentially what you're doing is electing somebody with no medical experience, and then by his election, he somehow acquires all this medical experience. It's absurd. It's a specialty in medicine. Just like I would not go out and deliver babies or do neurosurgery, so it's a specialty, and you train a number of years.

And what many people don't understand -- it's not only just the performance of an autopsy involved in forensic pathology, but on what bodies should you perform the autopsy? If you don't select the right cases, you're going to miss cases. The first step in forensic pathology is to select your cases, so you cast this net out and you bring in all the fish. And then you start examining and seeing which one you want to handle. That sounds crazy, but --

You mean [that it's] like going to the fish market and seeing if the eyes are clear?

Right. ... But what happens is, if you don't have the training, you don't know what cases to bring in. You don't know what cases need an autopsy. You do not know the extent of the autopsy. And you don't know how to put everything together to make a ruling. ...

You just don't wheel in a body and do an autopsy. First of all, you want to find out what the circumstances leading up to and surrounding the death are, and then you decide whether to do an autopsy and the extent of the autopsy.

And then you'll order certain tests -- maybe examination of weapons, maybe toxicology tests. And then, based on the circumstances leading up to and surrounding the death and the autopsy and the laboratory tests, you make a decision as to what the cause and the manner of death is.

Now, some attorneys I know will say: "Well, you're getting influenced by the investigation. You should just do the autopsy." ... Forensic pathologists, medical examiners, are like any other physician. ... What physicians do is they take a history. They ask you why did you come to the office, what your symptoms are. That's what the forensic pathologist does, only his patients don't talk to him. So he gets a report on the circumstances leading up to and surrounding the death, and then he decides what the exam is going to involve and whether any tests are necessary.

Now, it's always best if your investigative personnel report directly to you, because the medical examiner's approach to a death is different than the police officer's approach. So good medical examiners' offices have their own investigators; then they have board-certified forensic pathologists; and then they have their own toxicology section. ...

And it's going to cost you. It's going to cost you about $2.25 to $2.50 a person in your community per year, which is probably less than what you pay for a Coca-Cola in a movie theater. That's what, at this, time roughly the price of a good medical examiner's office is.

[Why are autopsies particularly important in police shootings?]

This is a police shooting. Everybody in our present society gets suspicious. There may be civil litigation. To do the autopsy is not only good for the family and the public; it's also for the police officer if he's an honest individual. So what you want to do is you want to conclusively determine what happened and what the injuries were, and not a year later or two years later end up in court somewhere arguing about what really happened.

Now, based on your description, what's the state [of] forensic investigations in this country? …

Mediocre. And I say mediocre not because they're not good offices, but there's also a lot of bad offices, and they kind of balance out. ...

You're saying that overall, your profession, the business you're in, is mediocre?

No. Medical-legal investigation is mediocre, and the reason is that there are large areas of the country where medical-legal investigation is very poor and doesn't even involve physicians.

When you have a well-funded office working under good standards and employing board-certified forensic pathologists, you will have a good medical-legal office.

But how many are there? The majority of the offices in this country are not even medical examiner offices. There's maybe, I don't know, 300 medical examiner offices in the United States. And then there's all the coroner systems. And then in some areas there's inadequate funding of the office and a lack of understanding by the politicians of what the office is supposed to do and how it's supposed to operate.

You know, they go in, and they say, "Well, there was a survey done a few years ago, and 10 percent of the offices didn't have X-ray." Now, think about that: They don't have X-ray. The X-ray is a 19th-century device, and these offices didn't have X-rays?

Well, we found they didn't have refrigeration.

Right. And they didn't have scales. ... The problem is, there is not an appreciation that this is a science that has to be funded correctly. ... Do you know how much a roll-on commercial scale costs? What is it, $400, $600? You can go to the really top digital things, maybe $800 to $1,000? You don't have that.

And they haven't any standards. They employ people who are not qualified. Let's talk about board certification. Can I?

Sure.

OK. What does board certification mean? It means that an individual who has an M.D. degree trains in a medical specialty for a number of years. Then after successfully completing this training, this individual then takes an examination, both written and practical, and passes it. And at that time, this individual is recognized by other doctors as a specialist in the field. Now, all he has done by taking the examination is demonstrated that he has minimum knowledge of the field.

Yet there are people out there practicing who aren't board-certified, who can't pass their board exams. What does it mean? It means that they have not demonstrated they have minimum knowledge of the field. And these people get hired. The courts recognize them.

Now, I'm a pathologist. I'm board-certified in anatomical and clinical pathology and forensic pathology. Suppose I wanted to do hospital pathology. If I went to a hospital and tried to get a job, the first thing the hospital is going to ask me is, "Are you board-certified in anatomical [and] clinical pathology?" And if I say no, most hospitals will say: "Thank you. Goodbye."

But you can get a job in a medical examiner's office, in a coroner's office in many areas, because the political entity running the office either does not understand the importance or doesn't care. And it's often doesn't care. They have a set amount of money, and they're going to hire somebody; they're going to fill the slot. And if the person's not fully qualified, well, so what? Doesn't concern them.

The dead don't vote. The dead don't vote. Now, of course, when they get their million-dollar lawsuits, then they fire the person. They say, "Ah, we'll fire him." And that's how they solve the problem. They haven't solved the problem. And so this goes on.

To those people watching, it sounds like there's some places in the United States you probably should die and some places you probably don't want to die.

That's correct. That's correct. It was recognized. The newspaper in Omaha, Neb., ran a series of articles about two years ago or so, and they said that they had the worst medical-legal system in the United States. And so the way I think they solved it was they gave a little extra training to their non-physician personnel. This didn't solve the problem. Everyone just kind of made believe they did a little something, and then they walked away. ...

A lot of entities recognize their problems, but they don't really care.

Like where? What are you talking about? Which places?

Nebraska. How about Massachusetts? It has a medical examiner system that ricochets from disaster to disaster. New Jersey has an interesting medical-legal system which is so bizarre I haven't yet been able to figure it out.

What do you mean?

They have cheap medical examiners, and then they have apparently county examiners who really don't report to the chief medical examiners, and it's all under the attorney general's office, which is an absolute conflict of interest.

Go to California. You have sheriff-coroners, so if somebody dies in the jail, the case is handled by their coroner's physicians. Well, that's a little conflict of interest. But some say: "Well, I don't do it. I let the coroners in the adjacent county do it, and then we switch over." Well, still there's obviously a conflict of interest. Now, it may be all legitimate, but there's an obvious projection that there is a conflict of interest, and it's going to cause distrust. ...

Let me ask you again about New Orleans. In New Orleans, the coroner is elected, but he employs board-certified forensic pathologists, he tells us, and he listens to what they say.

OK. Then what job is he doing? What are you paying him for?

He says that he plays a special role in the community, both in terms of having a bedside manner -- he's an OB/GYN -- but also has some social skills in interpreting results for the community, and that also, given the number of tragedies he's had to deal with -- from repeated, let's say, police violence combined with Katrina and other disasters -- he plays a much more important general public role that's beyond what just the cause of death is.

Oh. What he's saying then, he hires people as forensic pathologists who are incompetent to interact with other people. I mean, actually, he's insulting his personnel.

The problem, basically, is this is a nice little thing that coroners put out, or they say, "Well, we're administrators." ... Administrating a medical examiner's office is not that difficult. You just use a lot of common sense, and you hire good people, and things generally work out. My administrators over the years have -- I think one had a college degree; the others had high school degrees. They were great administrators working under me, and they handled a lot of the day-to-day, very simple administration. ...

The coroner system was a wonderful system for the 10th century. That's when people couldn't read, and you walked around barefoot and lived in little huts. But this is the 21st century, and medical-legal work should be on a scientific basis, employing scientists.

So the solution is get rid of the coroners?

Not only is it my idea, but it's the idea of the federal government, who did the investigation and found out that there is no justification for the coroner system anymore.

You're talking about the National Academy of Sciences [NAS]?

Right. I mean, one of their main recommendations was to do away with the coroner system and replace it [with] the medical examiner system. What you're doing is putting medical-legal investigation on a scientific basis and not a semi-scientific-political basis. ...

One of the worst groups of coroners are those who have M.D. degrees and are not forensic pathologists because they think that the M.D. degree entitles them to be experts in every branch of medicine. So I'm not impressed by coroners with M.D. degrees. Actually, coroners who don't have M.D. degrees are often better than those that do.

Because there's a presumption?

Yes. And everybody in the public thinks, well, they have to know what they're talking about, OK? I've got an M.D. degree. Do you want me to deliver your daughter's baby? Do you want me to do brain surgery on you? I understand the concepts. I guess I could take a couple of courses. But would you really want me to do that?

OK. Dr. [O'dell] Owens, who is the coroner in Cincinnati, the president of the International Association of Coroners and Medical Examiners [IAC&ME], he says there are a lot of "coroner haters" out there. ... And his question is: "OK, what's the basis? Who is on their committee? Judges, forensic scientists, two medical examiners, but no coroners." So this was a report, he's saying, that was biased from the beginning.

That's nice. What it was was a committee of scientists. Maybe they don't consider coroners scientists. I mean, he's got an M.D. degree, but most coroners don't.

What are the qualifications to be a coroner in many places? Usually it's to be over 18 or over 21 and to be a resident of the county. Do you have to be able to read or write? I apologize for insulting coroners on that. What I mean is that this group was organized to make a scientific evaluation of the medical-legal systems as well as the crime labs, and so you're going to have scientists on the committees. You're not going to have politicians.

People who are elected.

Yes. They're called politicians, all right?

But he points out that in Ohio, to be a coroner, you have to be a medical doctor and that his predecessors in this office were almost routinely forensic pathologists --

Right.

-- and that his office is accredited by every accreditation organization that exists today.

And?

And that he's all in favor of high standards. He's just saying you're being completely unrealistic saying you want to get rid of 2,000 coroners. There are only 400, apparently, or 450 practicing forensic pathologists in the whole country.

I love that. Well, first of all, let me say something about coroner systems. There are actually some excellent coroner systems, but the bulk of the coroner systems are not very good, OK? So that's my answer to that. ...

The reason that you have an inadequate number is that there are no positions and structures. You know, if there are job openings, people will go into it. And the other problem is, for many years, the medical-legal systems have been so poorly financed that the salaries were not competitive, and the facilities were terrible. ...

If you have poor facilities and low pay, you're not going to attract people. And lots of people find forensic pathology interesting, physicians. But then they say, "Well, I'm going to have to work for a coroner who can overrule my decisions for political reasons, who thinks I should do 600 autopsies, and that's three times the recommended number. Why should I go into this field?" ... You'll attract more people if it's a scientific field. And so, you know, build it, and they'll come. ...

The report that you're citing says that we have to create a national accreditation system, we have to train more forensic pathologists, possibly set up a national institute, do a program of subsidizing the medical training, etc.

Right. And it's going to be very easy. And here's why it's easy. Number one, let's take certification. We have an established certification procedure that dates back to the early part of the 20th century. There have been certification of forensic pathologists since, I believe, it's either 1957 or 1959, OK? So we have certification. We have programs to train them just like any other branch of medicine. So there's no problem with certification.

What about accreditation of offices? The National Association of Medical Examiners [NAME] has an accreditation program, has accredited 70 offices -- 69 in the United States, and it's accrediting the medical examiner's office in Singapore as well. So we have an accreditation.

Now, people will say, "Well, if we eliminate the coroner system, we don't have enough forensic pathologists to occupy the positions." And the answer is yes, you're right, if you eliminated them all in one day. But it's not going to work that way. It's going to take years. ...

And the other thing is, you have a lot of coroners who really aren't necessary. Suppose you take a state with 50 counties; you'll have 50 coroners. Do you really need 50 coroners? Couldn't you make regional offices or a state office? ... And then you have just one chief medical examiner in each office. So you might have just one chief for the state or four chiefs for the state. And then you bring the cases in, and you perform autopsies not in every county, but in a group of counties. One office, so you don't duplicate. You don't duplicate the investigators or the doctors and the coroners.

Well, here's what Dr. Owens says to that, to what you've just said: "I don't think it's realistic that someone's going to put that kind of money in forensic pathologists when you need more family practitioners right now based on the new health care bill. That's just not realistic. I'm not sure that you're going to get 1,000 forensic pathologists -- they say that's what we need -- when there are less than 500 now."

Well, my answer for that is twofold. One, you're going to eliminate all those coroners, so their salaries are going to become available, right? Two, you're going to eliminate multiple facilities and have maybe one or two facilities, so you're saving money there. And you're talking one Coca-Cola a year per person. ... And you save money in the long run in trials, both criminal and civil. And you produce a quality product, you might say. ...

Well, he's for board-certified forensic pathologists. He's for all the standards. Again, what he's saying is, don't throw the baby out with the bathwater. And furthermore, the office of coroner, he would say, insulates him from political pressure because he serves a set term of four years. ...

Yeah. But to be re-elected, he has to get the people's vote, which means he can't offend them because he's still a politician.

And here's the other thing, is how often do you think people go to the polls and say, "Oh, I'm going to vote for Mr. Jones because he's a good coroner"? I'm sure most of his votes come when they pull either the straight Democratic ticket or the straight Republican ticket. ...

In Texas they don't really have coroners, except for the major cities, which are medical examiners' offices. In the counties they have justices of the peace, and they're kind of like a coroner, but they don't have investigators or offices to keep bodies and things like that.

And it's very interesting that I've talked to a number of them, and I say, "Would you be in favor of eliminating this duty from you?" And they said, "Yes!," because they know they're not doing a good job, and they would rather have medical examiners' offices or regional medical examiners' offices. And I think eventually Texas is going to go over to regional medical examiners' offices. It's just that nobody has taken the time to write the bill because most justice of the peaces don't care. And they would rather have a scientific system.

The evaluation of Dr. Owens and [Orleans Parish coroner] Dr. [Frank] Minyard and other coroners that we've spoken with is that what you -- in a sense, the ivory-tower forensic pathologist -- see as a problem the rest of society doesn't. The politicians don't see it that way. This idea of change is just not going to happen. There's no drumbeat for change.

Oh, yeah. They're right. The problem basically is most politicians don't care, because, as you said before, the dead don't vote, except in Chicago. And a lot of people don't even know the difference. You know, they see TV and CSI and the medical examiner, and they think that's how it really is.

I mean, how often do people have contact with medical examiners' offices and coroners' offices? And even then, how do they know when it's screwed up? I mean, when you look at a case as a forensic pathologist and you say, "Oh, oh, there's no scientific basis for this decision. It's just complete garbage," and then you have a family looks at it, and it's typed on this neat paper, and there's this official seal, and they say, "I guess they know what they're doing," you can wrap garbage in pretty paper and nice ribbons, but it's still garbage.

And you're saying they're producing garbage every day?

I'm saying in this country, many medical-legal death investigation offices are producing garbage, yes. ...

If you were to go to the best in this country, where would it be?

Best offices in the United States, I think, are Miami; Maryland; New Mexico; San Antonio, which I set up; Houston. And there's a lot of other good offices besides them. ... Cleveland is one; Cincinnati is another. ...

The National Academy [of Sciences] study and some of the things that you have advocated basically call for national standards, national institutes; if you will, federal control. Is there much of an appetite these days for getting rid of local control?

No. And I don't think you have to have federal control. It's kind of like accreditation of offices and even accreditation of hospitals. What happens is the federal government just lets private groups do it.

And with physicians and medical examiner systems, it's so easy, because everything there is already there. I mean, we already have a certification method for forensic pathologists. It's in place. It's been in place since 1959. So they put it in place, what, more than 50 years [ago].

And for accreditation of the offices, we have that, too. So you don't really need that. You're not going to have to set up any federal agency to do this. ...

The way to accomplish this is simple. If you have an office that is accredited and employs only certified forensic pathologists, then they're eligible for grant money. People who have offices that are not accredited, that do not have certified forensic pathologists, aren't eligible. So there is a carrot to be had if you go along with this accreditation and certification.

... If you were to explain this to the average person out there, why is this important? I'm going to be dead, so what do I care?

Well, it is important. What happens if you don't wear seat belts? What about putting children in the front seat, where there's an airbag? How do you know these things are effective? Or who's even thought about these things? It depends upon forensic pathology to a certain degree.

Everybody thinks, you know, just about police agencies, but also, like, epidemics of drugs that are killing people. You have suicide. Is there a problem in the community? Is it in teenagers? All of a sudden you're having these teenagers dying, drugs. Defective cribs -- you hear all the time about crib recalls. Why? Because children die, which falls into the medical-legal field.

And then you have homicides. You have the people who are serial killers who walk away. You have innocent people in prison. And so all this falls under the medical-legal community.

Insurance -- suppose the cause of death is incorrectly labeled. You can't get insurance. Or the insurance company will pay. Or the person was killed because the working conditions were improper. This is all medical-legal.

People would say: "Oh, well, they're dead. That doesn't affect them." Yes, it does. It affects the public all the time. It's just that people just kind of assume somehow things happen magically and don't understand the significance of the medical-legal offices' functions.

So you're saying that the investigation of the dead and the cause of death is critical to saving our lives?

It is. It's critical for -- well, here, let me give you an example. In the early '70s, some papers came out having to do with deaths of children in a family, and the papers came out of the pediatric community. And they said essentially that if you had a family with multiple children who were just dying, that this was all somehow related to genetics and that these were all natural deaths.

Well, I was a forensic pathologist, and I was shown that paper. And I looked at it, and I said, "These are serial murders." A parent was just killing kid after kid after kid in the family. And the pediatric community got outraged. ...

The pediatricians were saying this was natural, the deaths of these children in one family repeatedly? Genetic in some fashion?

They were saying like that, yes.

And you're saying it was murder.

Right. ... Finally, there's a book called The Death of Innocents. It describes this. All of a sudden it came out that there really were serial murders, and then people went back -- there was a woman in, was it Philadelphia, who had murdered six or eight children over 20 years; that was in Chicago had killed six. And actually, a lot of these people, when they started going back and confronting them, they cut a deal.

And the most famous case was the one they turned around was -- they went to a woman and said that you had smothered all your children. And her answer was: "That's not true. Only the last four. The first one was natural." Something to that effect, she said. And this had been going on for years. And the regular medical community didn't understand. The forensic pathology community all knew they were serial murders. ...

The National District Attorneys Association [NDAA] says that this [NAS] report and what it's implying and, in some cases, what it's stating outright is going to undermine criminal prosecutions.

I think most of their problems have to do with the crime laboratory and not the medical-legal systems. But listen, if you convict someone based on unscientific evidence which is passed off as scientific, aren't you subverting the justice system, or you free somebody on the basis of bogus science? ... In the long run, if you have well-established scientific standards, it's better for the legal system and the justice system of this country.

But isn't the implication of the report that many of the standards -- that your office probably used, that your lab may have used to present evidence to testify about its reliability -- hasn't really been tested, doesn't have a scientific basis, and maybe you're going to have to go back and look at a lot of your testimony in the past?

No. I don't think it's going to affect medical very much, because most of all, medical is presented as not absolute. You say, "It's my opinion that," and you give your conclusion. There are actually standards for the performance of autopsy now.

There are now standards? There weren't standards before?

That's right. I was actually one of the proponents of establishing standards for how to perform an autopsy.

You mean people just did whatever they wanted to do?

Let's say they didn't always do what they should have done, OK? Now there are standards. Now, some offices even now don't follow the standards. And the standards aren't that difficult.

Wait a second now. When you, the forensic pathologist, get up on the stand and say, "In my opinion," the jury's sitting there and saying, "Well, he's got these standards, and he's got this scientific basis," it's not so definite? You'd say, "Be a little skeptical"?

Depends. Depends on what the case is. It's not like DNA. All you can do is you give, you know, in all medical probability. The only area of forensic pathology, I think, that may go after to a degree is toxicology, which involves laboratory analysis. And if your office has accreditation by the American Board of Toxicology, I wouldn't worry. Some of the toxicology done is not very good.

Let me get to your question. All forensic pathologists know some things are absolute and some things are not. If you ask me about the time of death, I would say: "Well, looks like he's been dead maybe a day, but I can't say for sure. You know, plus or minus a day or two." And that's what the science is. So if you ask a forensic pathologist, and he's an honest individual, he'll tell you what the defects in the system are. ...

Now, if the man has a contact wound of the head with a 12-gauge shotgun, I could say conclusively, "He died instantly." But if he's got a through-and-through bullet wound of the frontal portion of the brain with a .22, I would say, "Under most circumstances, a person like that loses consciousness immediately, but in some instances they don't." That would be my testimony. You have to grade it. You can't give statistical probabilities. ...

What do you say if an experienced attorney -- particularly in cases involving custody and police violence -- a civil rights lawyer says that in the jurisdiction, they regularly get a second autopsy if the coroner's office in that jurisdiction is involved?

That means they don't trust the coroner.

Or they don't trust the forensic pathologist also, who worked [for] them.

Right, right. Honestly, we have always told people when they discussed a second autopsy -- we've actually let them use our facility and use our personnel to aid their doctor ... -- we don't worry about it. If you do a good job, you do not worry about a second autopsy. The only time you worry about a second autopsy is if you're doing a lousy job. ...

What is the CSI effect?

The CSI effect is an unrealistic expectation of the public that scientific tests can conclusively prove either the innocence or guilt of an individual. It also assumes that in every crime there will be such evidence.

Now, in rape, where you have semen -- yes, that's 100 percent. If you had a rape and the guy did not ejaculate, obviously it's not going to be 100 percent because you don't have the evidence. So people think that there's always conclusive evidence, and they also think that the tests are done in about an hour, which is not realistic.

Does it give undue importance to, let's say, what you or someone who walks into a courtroom and is a forensic expert says to the jury?

I don't think so. I think it actually undermines, because if I go into the trial, and they said, "Well, how long has he been dead, doctor?," and [they're] used to, "Well, you know, he's been dead an hour plus or minus 15 minutes," and I say, "Well, one day or two, maybe three at most," and "Well, would this have instantly killed him?," "Well, probably, but there's always a possibility that he might not have died immediately," they look at you, and they say, "Well, he must be incompetent because he's not like the people on TV."

So I think it actually undermines the scientific processes as they actually exist, because if you have honest people and they give honest answers, it's not like on TV.

But the Innocence Project testimony [PDF] that they have or that they've demonstrated would say that not always honest people are testifying in a scientifically accurate way in important cases.

I am absolutely shocked -- shocked -- that that occurs. Look, you're dealing with people, and there's the concept of original sin, that everyone is created with a defect.

And the whole thing is that not everybody is objective; not everybody is ethical. And there's nothing you can do about it except to expose these people when you find out about it and have them removed. But the problem is some of these people are very popular, like a certain dentist who always made a positive identification on bite marks. And he was very popular, wasn't he?

You're talking about Mississippi?

Right. And of course there have been a lot of problems with Mississippi. It's like they had an individual doing 1,000 autopsies a year. You can't do that. I mean, I was in a situation one year where I had to do a little over 350 because two people had quit. I had to go back and read everything four or five times because I was making mistakes. ...

There are 17 counties in the Northern California coroner system. They contract out to a group of forensic pathologists privately who were doing well over 500 a year each. What does that say to you?

You can't do work that way. For accreditation, the maximum number is 325, and I think it should be actually lowered to 300. The recommended number of forensic autopsies to a person doing forensic autopsies full-time is 250. You can go up to about 300 and 325 and get away with it, OK?

What do you mean, "get away with it"?

Not make mistakes, OK? Once you start hitting around 350, you will make mistakes. You'll get tired, and you'll say, "Oh, I forgot to examine his eyes," or, "Oh, was the gunshot wound on the right or the left? Let me go take a look at the body again." What happens is if you do more than, say, about 350 autopsies, you're going to make mistakes. It's inevitable.

And if you're traveling around a state doing it, and you're doing it in funeral homes and different locations --

Right. And that's the other thing: You should not do forensic autopsies in funeral homes. You should do it in proper facilities. ...

The National District Attorneys Association says that they are offended by the recommendation to separate medical examiners from law enforcement.

I'm not offended in the least. ... I don't think medical examiners' offices should work for police agencies or under the jurisdiction of a district attorney or a state's attorney. I think there's an obvious conflict of interest. ...

District attorneys, law enforcement and the police, coroners or medical examiners, they all see each other every day, they deal with the same problems in many ways, difficulties. They're trying to get safety for the community, take the bad guy off the street.

See, I disagree with you. And I'll tell you why.

Medical examiners don't want to take bad guys off the street?

No. Two comments on that. Number one, in most medical-legal systems, homicides account for maybe 10 or 12 percent of the cases. Homicides are not the bulk of our cases. ... They're probably the smallest group that we get. The largest group are natural deaths; then come accidents; then come suicides; and then all the way at the bottom are homicides. And most homicides are fairly cut and dry, you know?

And you know, the thing is, you're always going to have police groupies, OK? But the average medical examiner is totally objective. They've got no horse in the race. ...

The only places that I know of where the forensic pathologists work under the jurisdiction of a crime lab are Georgia; I believe, I'm not sure, Alabama; and then you have the sheriff-coroner system in California.

But they work with them; we assume they see them all the time. They're the ones who bring the bodies in.

Oh, well, most times, no. As I stated before, homicides constitute a very small portion of our cases. And it depends on your community. Some of the communities, we never even see the police. They send us the reports, and that's it.

Why is working for the defense OK?

... Essentially, the forensic pathologist's mission is the truth. It's not supposed to be for the police or against the police or for a family or against a family. You're supposed to be impartial and tell the truth. And that's why, when I was practicing as a medical examiner, I was glad to talk to the defense. I had absolutely no problem talking to the defense.

And that's why, in my private time, I would do work for defense attorneys. Now, sometimes what I told them they didn't want to hear, and sometimes what I told them they wanted to hear. But I didn't care, because I was telling them the truth.

Is the truth sometimes ultimately your gut feeling about a situation?

It should not be. ... There's a difference about having a feeling about a case and giving a scientific opinion or testimony in the case. You may think a person is guilty, but you cannot slant your evidence; you cannot slant your testimony to accomplish their conviction.

But there's a degree of uncertainty in this business.

Yes. But what you do is you testify to the scientific findings, not to what you feel emotionally. The time of death -- you say, "Oh, it's one day, unless it's two or three." You don't say, "Well, I know he's got an alibi three days ago, and so I'll just say one day," OK? You have to tell the truth. ...

The National Academy of Sciences has tried to eliminate coroners since 1928.

Right.

What's the odds on it happening now?

Maybe my grandchildren will see it. Honestly, it's one of these fights that's going to take generations to eliminate, because most people don't care, unfortunately. It will take generations. ...

This report is not going to probably have that significant an impact on eliminating coroners. They're going to be eliminated for, I think, financial purposes, because actually medical examiner systems on a regional basis are cheaper, and situations where something is done that is so bad everyone says, "We've got to fix the situation." ...