October 22, 1996 in Nation/World

Proposal Closes Coroner’s Office, Lets Panel Pick Medical Examiner Introduced Amid Amend Controversy, Measure Would Replace Elected Official With Appointed Expert

By The Spokesman-Review
 

Probably no death investigator since “Quincy” has racked up as much TV time as Dexter Amend.

They know him in Seattle. In Atlanta. In Las Vegas.

After two years as Spokane County coroner, Amend has been featured in newspapers such as The New York Times and on TV shows such as “Dateline” for his controversial statements on homosexuality and morality.

For death investigators nationwide, Amend has become a lightning rod in the debate over who is better to determine causes of death - a coroner or a medical examiner.

“This is a small society of people,” said Dennis McGowan, chief investigator for the Fulton County medical examiner, which covers Atlanta. “I’ve already heard some murmurs about change taking place up there.”

Voters can’t get rid of Amend, who has two years left in his four-year term, but they can ensure he’s the last Spokane County coroner.

They’ll decide Nov. 5 whether to ditch the position in favor of a medical examiner appointed by the county commission.

Coroners are elected officials who serve as administrators. They don’t have to be doctors. They do not perform autopsies but decide when one is necessary. Because they are elected, coroners sometimes are seen as free of political influence, accountable only to the voters.

Medical examiners are appointed. They often are highly trained forensic pathologists who do their own autopsies, but they aren’t necessarily trained administrators.

The ballot measure doesn’t say how a medical examiner would operate in Spokane County. If it passes, commissioners would establish the system over the next two years or appoint a board to do so.

Proponents hope a medical examiner would be free of political influence, reporting to the county Health District or a panel of law enforcement officials rather than county commissioners.

Almost everyone agrees a medical examiner would cost taxpayers more money perhaps hundreds of thousands of dollars - to pump up Spokane’s low autopsy rate and pay for higher salaries and new positions.

Amend, 77, a retired urologist, refused repeated requests for an interview about the ballot measure.

After meeting with county commissioners last month, he said a coroner can deal better with grieving families than a medical examiner can.

Not according to some families.

Amend, a twice-elected coroner, has drawn criticism for offending grieving families with questions about masturbation, sodomy and alcoholism. The accuracy of his death certificates has been questioned. His decisions have run against the advice of law enforcement and the forensic pathologist who performs most of Spokane’s autopsies.

Taxpayers have paid more than $70,000 to defend Amend against five lawsuits, a recall effort and a state challenge to his medical license.

“All the problems with Amend underscore the need for a medical examiner,” said Jan Monaco, spokeswoman for the Spokane County Medical Society, which pushed for the measure. “It’s 1996. The science of forensic investigation has changed by leaps and bounds.”

But some of Amend’s biggest critics don’t favor scrapping the system. Barbara Lampert, who helped lead the failed recall effort, argued that a full-time medical examiner would not earn his or her keep, considering the county’s small number of homicides.

‘No system’ in Spokane

Accurate death investigations are essential to understand the health of a community.

They ferret out wrongdoing and disease trends. They create a statistical picture. They’re also essential for insurance claims, for a family’s health history and for criminal and civil matters.

“Death investigation is just extremely important to a community,” said Dr. John Howard, Pierce County medical examiner. “The problem is it’s kind of overlooked. It’s overlooked unless it’s your family member. People don’t want to think about death.”

Death investigators nationwide say a county should have a recognized system of reviewing deaths - regardless if a medical examiner or a coroner is in charge.

“Spokane has no system,” said Dr. George Lindholm, the forensic pathologist who performs most of Spokane County’s autopsies. He’s also a leading contender for any medical examiner post.

“There isn’t anybody in county government who can tell you when there’s going to be (an autopsy) or there isn’t.”

Eight months ago, Amend said he requests autopsies in cases of possible violence, suspected unnatural death, accidental death, sudden infant death syndrome and homicide as well as for all people under 40 who had no apparent medical reason for death.

This month, Amend told commissioners he asks for autopsies in all homicides, in vehicle accident fatalities with more than one vehicle or more than one passenger, in suspicious deaths of children, in all people under 18, in 96 percent of accidents, in aircraft accidents, in institutional deaths, any time liability is a possibility and if the victim didn’t have a significant family medical history or a primary doctor.

“They’re poor criteria,” said King County Medical Examiner Dr. Donald Reay. For example, Reay said, by not calling for at least partial autopsies on all suicides, the coroner could miss a homicide disguised as a suicide.

County spends more on animal control

Amend operates on a financial shoestring, most coroners and medical examiners agree.

The county spends less on the coroner’s office than it does for animal control. Commissioners recently gave Amend another $90,000, bumping his budget to about $430,000 for this year.

Last year, Amend was criticized for trying to save money by ordering fewer autopsies than recommended. This year, he already has ordered more autopsies than in all of 1995.

Still, he performs fewer autopsies than the national average.

“But what’s the man to do when he doesn’t have enough funding to run the office?” Lindholm asked.

Nationally, death investigation offices spend an average of $1.50 per county resident, statistics show.

King County, with a medical examiner budget of about $1.7 million, spends about $1.08 per resident. In Pierce County, the cost is about $1.90 per resident. The Clark County coroner’s office in Vancouver, Wash., spends about $1.57 per resident.

Even after the recent budget boost, Amend’s office spends about 98 cents per resident.

Under a medical examiner system, Spokane County’s death investigation budget likely would balloon because of higher salaries, possibly more staff and probably more autopsies. Meeting the national per-resident rate would cost Spokane County about $660,000 a year.

The top dog’s salary definitely would increase, experts said. Amend makes $48,658 a year. Medical examiners around the state earn from $98,178 to $148,457 a year.

The number of workers probably would jump, experts also said. Besides Amend, Spokane County now pays for two full-time and seven part-time positions in the coroner’s office.

In comparison, the Pierce County medical examiner’s office has 15 full-time and two part-time positions. The Clark County coroner’s office, which covers a county of about 291,000 people, employs five full-time and three part-time workers.

Spokane County Commissioner Phil Harris, a notorious budget hawk, estimates that a medical examiner would cost the county $400,000 more a year.

No one’s even talked about how the county would cover the extra cost, said Budget Director Marshall Farnell.

Still, the coroner’s office under Amend may be no bargain.

Five grieving families have filed $3.2 million in lawsuits against him and the county, already racking up more than $23,000 in county legal bills.

More taxpayer money has been spent trying to defend Amend’s medical license, which he doesn’t even need to be coroner. Amend has racked up more than $28,000 fighting the state’s effort, and the county is footing the bill.

Opponents failed at a recall effort, which cost taxpayers almost $19,000 in legal fees.

Defenders of the coroner system say it can work well. Ron Flud, coroner of Clark County, Nev., which covers Las Vegas, said the system lets a trained administrator make decisions.

Lindholm also said the coroner system can be effective - if properly managed and given enough money and staff. Dumping the coroner for a medical examiner without other changes in the system won’t help, he said.

“The devil’s in the details,” he said. “In one sense, I’m a little scared of the bill. If they just change the name on the door, I guarantee that’s a recipe for disaster. It’s no better than what we have now.”

, DataTimes MEMO: This sidebar appeared with the story: MEDICAL EXAMINER The ballot measure would replace the Spokane County coroner with a medical examiner once Dexter Amend’s term expires or he leaves office. The medical examiner would be an appointed forensic pathologist, as opposed to the elected coroner who doesn’t have to be a doctor.

This sidebar appeared with the story: MEDICAL EXAMINER The ballot measure would replace the Spokane County coroner with a medical examiner once Dexter Amend’s term expires or he leaves office. The medical examiner would be an appointed forensic pathologist, as opposed to the elected coroner who doesn’t have to be a doctor.


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