MEDICAL EXAMINER OFTEN WORKS WITH LITTLE INFORMATION

It wasn't too long ago that Dr. Michael Zaricor, a Farmington pathologist, was planning to get out of the autopsy business.

The reason, he says, is that some counties don't send along sufficient information about the scenes of death with the bodies to be autopsied.

"Sometimes the bodies are dropped off here with no information at all," he said. "All I've got is a body."

He was quick to point out that he has had "no trouble whatsoever" with Cape Girardeau County's law enforcement agencies or Coroner John Carpenter, and he won't say which counties failed to provide adequate information.

The autopsy itself can determine the cause of death, such as a gunshot wound, Zaricor said. But the details from the scene help determine the manner of death, such as whether the gunshot wound occurred as a homicide, suicide or accidental.

"It's the most important part of the investigation," he said.

Zaricor, who performs autopsies for counties throughout Southeast Missouri and the surrounding areas, said he changed his mind after officials with the Missouri Highway Patrol agreed to help oversee investigations.

In January, when Cape County assumes first-class county status, state statutes mandate abolishing the county coroner's office and hiring a medical examiner.

Sen. Peter Kinder, R-Cape Girardeau, is sponsoring a bill that would allow Cape County the option of retaining the coroner's post. The bill was approved last week in the Senate and has been forwarded to the House of Representatives for action.

Kinder and county officials say hiring a full-time medical examiner would put too great a financial burden on the county without offering any additional services.

"The difference is $150,000 for a medical examiner compared to my base salary of $7,500 plus an additional $500 for taking training every year," Carpenter said.

Zaricor said reports from death scene investigations are "not uniform across the region."

Zaricor and other pathology experts say what is needed is mandatory training in death scene investigations for county coroners across the state. The Missouri Coroners and Medical Examiners Association is working on legislation to that effect, Carpenter said.

State statutes do not currently require any training, although the coroner is legally responsible for determining whether a death should be investigated by law enforcement and whether that investigation should include an autopsy.

Dr. Mary Case, who serves as medical examiner for St. Louis County and several surrounding counties, said, "I certainly believe that more training is needed and I certainly believe there are standards that should be applied to that training."

Case would like to see the state develop a system of training, testing and certifying county coroners and other death scene investigators.

St. Louis University's School of Medicine, with which Case is affiliated, currently offers a basic 40-hour death investigation course attended by "thousands of people from all over the country," Case said, as well as more advanced continuing education.

Scott Amick, who has been Scott County coroner for 12 years, said the state association long has pushed for increased training and higher professional standards.

Case also wants to see a regional system of medical examiner's offices established across the state.

Rural counties can't afford to build morgues and retain full-time medical examiners, she said, but several counties can team up and share costs and resources.

"That's not a bad idea, but you're still going to need someone at the local or county level who does what we do," Amick said.

Carpenter and other coroners now serve the same role that would be filled by investigators in a medical examiner's office, determining whether a death can be classified as suspicious and whether an autopsy is warranted.

That determination is where training is crucial, said Mary Fran Ernst, director of medical-legal training for St. Louis University's School of Medicine.

"If the death investigator gives them good information, that's the critical point that determines whether or not an autopsy is warranted," Ernst said. "We don't do an autopsy every time. They're too expensive."

She gave this example:

An 88-year-old woman dies at home in bed. The police are notified of the death and learn the woman had a long history of heart disease and recently underwent heart surgery.

While at the scene, investigators notice a bruise on the woman's temple. Family members report she fell down the stairs a day or two before, striking her head.

At that point, investigators can order an autopsy to determine if the woman died of heart disease or the head injury as a matter of medical curiosity, Ernst said.

Further investigation may reveal other details along the way. If it turns out the woman recently designated a caregiver as the beneficiary of a large life insurance policy or signed over all her assets, a full-scale criminal investigation may be warranted, she said.

Carpenter said he generally orders 15 to 20 autopsies per year at a cost of $2,000 to $2,200 each. Autopsies are mandatory in violent deaths, and state law requires investigations of all deaths involving children 18 and under with no known critical health problem.

"Normally you have a suspicion or a gut feeling before you even call for an autopsy," he said. "The autopsy surgeon never leaves their office; they send investigators out. Down in Cape Girardeau County, the investigator is the coroner, and he takes that information to the autopsy surgeon."

If a regional system of medical examiners is set up, Amick said, "you're probably going to see more autopsies than you would have in our case now. Every family has the option to request one at their own expense. Most counties just don't want to start doling out that kind of money."