Legislative leaders drop proposal to require medical examiner to personally review autopsies of young children, baffling supporters

Sameer Sabir and Nada Siddiqui photographed in the neighborhood where they lived when their 1-year-old daughter, Rehma, was found unresponsive after spending the day with her nanny, Aisling McCarthy. Sabir said the budget proposal is "an insult to the memories of dead children."Suzanne Kreiter/Globe Staff

Facing opposition from Governor Charlie Baker’s administration, Massachusetts legislative leaders dropped from its state budget plan language requiring that the state’s chief medical examiner personally review and approve all autopsies of children younger than 2.

The omission surprised the measure’s proponents, who said it would inject a level of accountability into an office that has faced repeated criticisms in recent years for its handling of young children’s deaths.

The budget proposal, which lawmakers sent to Baker on Monday, calls for the medical examiner’s office to receive a multimillion-dollar budget increase at a time when it has sharply reduced how often it conducts autopsies under its chief, Dr. Mindy J. Hull.

“I am baffled,” state Representative Marjorie C. Decker, a Cambridge Democrat who pushed the measure in the House, said of its failure to survive budget negotiations. The medical examiner’s “budget has continued to grow and balloon, yet the chief medical examiner herself continues to rebuff or not want any role of accountability.”

Hull personally signed a letter to Decker last year that raised concerns about the measure and emphasized the responsibilities she already handles.

“I’m trying to understand: What is so controversial about holding the chief medical examiner accountable?” Decker said.

The House passed the measure in April as part of its budget proposal, requiring that Hull sign off on any rulings or revisions made by those performing autopsies in her office on a child under the age of 2.

Lawmakers had lobbied for the requirement alongside Sameer Sabir, whose 1-year-old daughter Rehma died in 2013 after she was found unresponsive while in the care of her nanny. What caused her death became the subject of a fierce, years-long legal dispute.

Her nanny, Aisling Brady McCarthy, was initially charged in Rehma’s death after the medical examiner handling the case, Katherine Lindstrom, ruled Rehma’s death a homicide by blunt force trauma. But weeks before the case was set to go to trial, Lindstrom reversed her findings, ruling that the child’s death was inconclusive, possibly caused by a brain bleed of unknown cause. Her ruling prompted prosecutors to drop the murder charges.

After House and Senate leaders entered closed-door talks last month to reconcile differences, Baker’s public safety secretary, who oversees the medical examiner’s office, urged them not to include the House language in their final agreement.

In a June 15 letter, Secretary Terrence M. Reidy argued that while Hull, a certified pathologist, worked in the office for a decade before her promotion in 2017, she serves “far more in an executive role than a medical one.” He also suggested the statutory change could have “unintended consequences” if Hull’s successor isn’t as experienced.

Reidy said the office last year also implemented a policy that any medical examiner assigned to the death of a child 2 or younger present their proposed findings “to a conference of several peers” that includes Hull or her deputy chief medical examiner.

“In our opinion, there is no person better equipped to accurately determine the cause and manner of a death than the assigned medical examiner who conducts a comprehensive death investigation,” Reidy wrote in the letter, a copy of which was provided to the Globe.

When a deal on a $52.7 billion budget proposal emerged Sunday — and lawmakers quickly ushered it to Baker’s desk less than 24 hours later — the requirement was not included.

The characterization that Hull shouldn’t play a role in approving such sensitive cases frustrated the measure’s supporters. With a $413,626 base salary, last year she made more than any other executive branch employee and anyone on the state payroll outside the University of Massachusetts system, a level of pay, they argue, that should also invite more responsibility.

“She has been vociferously opposed to it. Given she’s the highest paid official in the state, it’s an insult to the memories of dead children,” Sabir said in a phone interview Tuesday. “Maybe she doesn’t want to take on that accountability. The chief executive should lead and not lock themselves away into a room.”

A spokeswoman for Hull declined to comment beyond Reidy’s letter.

Legislative leaders have historically considered conference committee discussions confidential, making it difficult to determine why a proposal, particularly within a massive $52 billion spending bill, doesn’t survive negotiations.

But Decker appeared to lay blame on leaders in the Senate, writing on Twitter that she was “really disappointed that the [Senate] chose not to include” the language.

Senate budget officials on Tuesday did not respond to her comment.

“I don’t see this as the end of the discussion,” said state Representative Aaron Michlewitz, the House budget chairman and the chamber’s lead negotiator. “We’re going to continue to have to find a pathway to getting this done.”

The medical examiner’s office budget has grown rapidly in recent years, from nearly $9.7 million during fiscal year 2018 to $12.9 million last year. Under the budget the Legislature approved, it stands to receive more than $16.9 million this fiscal year. That would mark a roughly 75 percent jump in five years.

Under Hull, state officials have touted dramatic improvements in turnaround times in producing autopsy reports, making enough progress for the office to secure full accreditation for the first time in 2018 and recently having it extended to 2025.

At the same time, the agency’s autopsy rate is one of the nation’s lowest levels among similar offices. In each of the past three years, the medical examiner’s office performed autopsies in 26 to 27 percent of cases, trailing its counterparts in other states who, on average, performed them 38 percent of the time, the Globe has reported.

And through the first half of last fiscal year, autopsies accounted for slightly less than one quarter of the office’s caseload.