Unraveling the autopsy expertise of Texas medical examiners

By Eric Henrikson

AUSTIN (KXAN) — "Can you imagine having to understand every disease that can occur in the human body?" asked Gary Procop, a doctor and president of the American Board of Pathology, when discussing the process of death investigations.

In Texas when a person dies, a couple of different people can perform a death investigation: a justice of the peace or a medical examiner.

Medical examiners are in short supply. The National Association of Medical Examiners or NAME says there are around 750 practicing in the nation. Only 14 of 254 counties in Texas employ a medical examiner , while the rest rely on a justice of the peace.

While a justice of the peace receives training to conduct death investigations , this elected official has no required medical education or expertise.

A medical examiner has to undergo nearly a decade of study before they can officially determine cause and manner of death – through autopsy.

"In our minds, that's why a board-certified forensic pathologist is the best person to do a complex death investigation because they have this broad training," Procop explained and gave an example.

"If you had a complicated case with somebody actually trying to cover up a murder and make it look like a suicide, something like that. You'd really want to have somebody who is trained in that subspecialty," he added.

Medical examiners also follow guidelines established by NAME. These guidelines include the process a medical examination must follow and how to determine cause of death.

The full investigation includes multiple steps, including examining a crime scene, establishing a medical history, analyzing both the external and internal parts of the body and even testing blood for poisons.

"There's a lot to learn, (including) every cause of death and every manner of death," Procop said.

Procop and the Travis County Medical Examiner said that a death investigation is a science – something Danny Wescott, the director of the Forensic Anthropology Center at Texas State University, agrees with.

"It's an individual case, but you're using scientifically or validated methods to investigate that case, and so that's what makes it a science," Wescott said.

NAME provides guidelines, but the investigators also work with statistical confidences and not absolutes.

"If I say that the individual is female, I'm not just saying it's female. I could actually give you how confident I am in that. So I could say, you know, 'In this case, I'm, like, 95% sure that this individual would be a female,' versus just — it's like 50-50 guess," Wescott said.

A justice of the peace does not have to conduct a death investigation, but they can always call in help. Many rural counties will contract out their investigations to bigger counties that have medical examiner offices. They can also ask for forensic anthropologists.

"It's not uncommon for me to get a photograph from a justice of the peace that says, 'We just came onto the scene. There's bones. Is it human?'" Wescott said.

Wescott said his team frequently works with justices of the peace as well as medical examiners when bones need to be examined, helping during a body recovery and performing death investigations on skeletal remains.

Medical examiners are "used to working with soft tissue, and so we usually get involved when... the body is badly decomposed or... skeletonized," Wescott said.

"As far as I know, I never had seen a justice of the peace that wouldn't call somebody in that they think is an expert," Wescott said.

Procop hopes this is true for justices across Texas.

"If an area can only afford a justice of the peace or a coroner, then you really would want to make sure that that individual knew when to call for help," he said.

When a justice contracts an autopsy from another county, it can cost at least up to $4,700 to perform the death investigation per body, according to a KXAN analysis of county audits in Texas. That money comes straight out of the county's budget.

KXAN's Richie Bowes, Josh Hinkle, Robert Sims and Kate Winkle contributed to this report.