The state’s chief medical examiner announced a major shift on Tuesday in how his office handles cases in which forensic pathologists retract their findings on the cause of death — a move that follows controversial rulings that derailed murder trials.
At an occasionally heated meeting of a state panel that oversees the medical examiner’s office, Dr. Henry Nields, the chief of that office, said when associate medical examiners want to revise a death certificate, the case must now be reviewed by him or his deputy chief, Dr. Kimberley Springer.
Nields said he was also receptive to having a mandatory review when an associate medical examiner declines to change a finding in a case that has been contested.
Nields maintained, however, that even if he disagrees with a pathologist’s conclusion, the final decision rests with the associate medical examiner who initially handled the case, a point that provoked debate among members.
The announcement came as the Medicolegal Investigation Commission — a panel largely representing law enforcement, the defense bar, and the medical community that is appointed by the governor — applied pressure on the medical examiner’s office to have greater transparency in its handling of death investigations. The commission also wants the medical examiner to research practices in other parts of the country, including the handling of recent controversial “shaken-baby” cases.
Cape and Islands District Attorney Michael O’Keefe, a member of the Medicolegal Commission, agreed to work with the medical examiner’s office to survey other offices about how they operate, including issues of communication and how final decisions, or revisions, are made.
As some members of the medical examiner’s office defended the agency’s overall work, Dr. Gerald Healy, a physician on the panel, urged them to be open-minded amid calls for change.
“You’ve got to be careful about perceived arrogance,” he said.
The medical examiner’s office has come under scrutiny for how it decides the manner of death in cases, especially those involving infants. In separate cases in the past two years, three associate medical examiners first ruled that infants died because of abusive head trauma, triggering criminal charges. Then, many months later they revised the manner of death to “undetermined” — following intervention by defense attorneys. Two of the murder cases were then dropped, and one has been seriously undermined.
A Globe report in August examined those cases, finding that the office gives extraordinary power to its 12 medical examiners to rule how people died, with little mandatory oversight by the chief medical examiner and virtually no legal mechanism for critics, including family members, to appeal.
The medical examiner’s office has had no set policy on how and when to re-examine cases, and the chief medical examiner and his deputy do not generally review results from routine autopsies. They also have no set standards on the level of certainty that a medical examiner must have before ruling on a cause or manner of death.
At Tuesday’s meeting, Nields emphasized that, even under his new review policy, the final ruling rests with the associate medical examiner, prompting Berkshire District Attorney David Capeless to suggest that Nields may be surrendering his powerful role to intervene in such disputed cases.
“Isn’t that your responsibility, Henry?”
Capeless, who is also president of the Massachusetts District Attorneys Association, referred to the way that state prosecutors’ offices are run, with the final word regarding whether a prosecution goes forward residing with the district attorney. Capeless suggested that an associate medical examiner’s ruling on the cause of death becomes a proxy for the entire medical examiner’s office.
“I don’t mind stepping on toes,” Nields told Capeless. “But you can’t order someone that that can’t be your opinion.”
Nields later told the Globe that he cannot help it if the public — or jurors — perceive the signature on the death certificate to be something more than the opinion of one state forensic pathologist.
Defense attorney Randy Chapman and other commission members suggested the work of the medical examiner’s office might be too hidden.
Chapman also emphasized that any organization can learn from surveying how other top medical examiner’s offices operate, provoking a reaction from one associate medical examiner sitting in the conference room.
“I think you’re assuming we’re not one of those offices,” said Dr. Mindy Hull, one of two members of the medical examiner’s office on the panel. She has also been the focus of controversy over her suicide ruling in an 82-year-old Belmont man’s death, which has been contested by his family.Patricia Wen can be reached at email@example.com. Follow her on Twitter @globepatty.