Is there a doctor in the house?

Some experts criticize elected coroner system, which requires no medical experience

Dr. Carol Huser was La Plata County’s coroner for 10 years until retiring last week. Huser is a forensic pathologist, but state law does not require a coroner to have a medical degree, a fact that has sparked debate about whether a coroner system is better than a medical examiner system. Enlarge photo

SHAUN STANLEY/Durango Herald

Dr. Carol Huser was La Plata County’s coroner for 10 years until retiring last week. Huser is a forensic pathologist, but state law does not require a coroner to have a medical degree, a fact that has sparked debate about whether a coroner system is better than a medical examiner system.

Colorado is living in the past when it comes to death investigation.

It’s not quite the Middle Ages, but the state’s coroner system is “archaic,” said Dr. Mike Dobersen, a forensic pathologist who is coroner in Arapahoe County.

“This state really needs to step up its death-investigation system,” he said. “It has been around for a long time. The reason that it persists is because the coroners, in a lot of cases, are very politically connected.”

The outdated nature of the system became apparent recently in Southwest Colorado. Dr. Carol Huser, who served as La Plata County coroner for nearly 10 years, retired Friday, leaving residents without a full-time forensic pathologist.

“The people of this area have been extremely lucky to have somebody as qualified as her for so long,” said 6th Judicial District Attorney Todd Risberg. “She’s been a huge help to all law enforcement in the area.”

Coroners investigate and determine cause of death in a variety of situations, including when the death is unnatural, unintended, unexpected, violent, suspicious or when the death occurs on the job or in jail custody.

In Colorado, most counties elect a coroner. The only job requirements: They must be 18 or older, eligible to vote, have lived in the county for at least one year and can’t have any felony convictions.

No medical training is required, which means nearly anyone can serve as coroner, from lawyers to funeral home directors.

“Every time I give a talk and tell people that, I wish I could take a picture of the horrified looks on their faces,” Dobersen said.

Coroners decide when an autopsy is necessary and certify the manner of death, whether it’s natural or homicide. But forensic pathologists perform autopsies, and several forensic pathologists who also serve as coroners in the state say they are the experts who should have the power to determine when an autopsy is needed and how to certify the cause of death.

Death investigations shouldn’t be run by someone who is elected by popular vote, Dobersen said. Rather, they “should be run by somebody who is qualified and has the proper training.”

He added: “The problem is these are lay people with very little medical training that are investigating deaths and making medical decisions with no medical backgrounds.”

Colorado is one of about 10 states with a coroner system. The others have moved to a medical-examiner system, in which doctors have the final say about cause of death.

Weighing a professional opinion

Most coroners in Colorado are well-intended and do a fine job at death investigations, said Dr. Robert Kurtzman, a forensic pathologist who lives in Grand Junction and plans to commute to La Plata County once a week to perform autopsies in Huser’s absence.

But their lack of formal medical training means certain details can go overlooked when determining whether to perform an autopsy, he said.

“Our training really is heavily weighted toward interpretation of injuries,” Kurtzman said. “If you look at the pattern of an injury and the distribution of an injury, that equates to the mechanism by which the injury was sustained. And you really have to look at all injuries carefully to determine whether they’re consistent with the reported circumstances or inconsistent with the reported circumstances.”

Forensic pathologists are a bit leery working for elected coroners with less medical training, Huser said.

A medical examiner system more accurately portrays the professional field of medicine, she said. If someone has a bellyache, a surgeon examines the patient to determine whether an appendix needs to be removed, not an office assistant, she said.

“It’s the professionals who make the decisions, who perform the examinations and tests, who interpret the results, who decide on and take the appropriate actions,” she said.

As the only forensic pathologist living in Southwest Colorado, Huser was a logical choice for voters in La Plata County. There are only about 500 board-certified forensic pathologists in the nation and fewer than 20 in Colorado.

Because she is leaving midway through her term, county commissioners selected someone to fill the remainder of her term. They received several applications, including one from a forensic pathologist in West Virginia, but state law requires coroners to live in the community they serve for one year.

“No practitioner of any profession would move someplace and live there for a year hoping they might, after a year’s residence, get a job,” Huser said.

Commissioners instead selected Jann Smith, who has served as chief deputy coroner for 5˝ years but has no medical degree.

“She has worked hard, she deals extremely well with the bereaved and other agencies, and I think she’ll do a fine job,” Huser said.

Tricky geography

Medical examiner systems can take on many different forms. Some states, including New Mexico, have a statewide medical examiner’s office that oversee all death investigations and perform all autopsies. Others are a hybrid system, in which some counties have medical examiners and others have coroners.

Some states have drawn districts, for example, along judicial boundaries, with a forensic pathologist assigned to each district.

About half the states retain coroners in some form, said Dr. Randy Hanzlick, a board-certified forensic pathologist in Atlanta who has written several articles about death-investigation systems and the conversion of coroner systems to medical examiner systems.

“Just about any permutation that you can think of exists,” he said.

Even in Colorado, some communities have modified the coroner system to resemble a medical examiner system, including Denver.

“It’s a travesty for a big metropolitan area to be run (as a coroner system),” said Amy Martin, chief medical examiner in Denver. “For a small, rural county, maybe that is the best way. But for a metropolitan area, that is the Dark Ages.”

Like other forensic pathologists interviewed for this story, Martin said the requirements to serve as coroner are too minimal.

“It’s just horrific when you consider what the coroner has to do,” she said.

Newly elected coroners receive a crash course about their duties, but “to expect someone with just 40 hours of education to suddenly have the necessary skills to pronounce and certify death in some very complex cases is somewhat unreasonable, but that’s exactly what we have,” Martin said.

Colorado is challenging because of its geography, which can make it difficult to transport bodies from rural communities – for example Durango to Denver, a six-hour drive – to be autopsied.

That is why Dobersen advocates a regional medical examiner system, perhaps divided along judicial districts or other boundaries, with a forensic pathologist in each district.

The state would pick up the tab instead of counties, he said.

“This is where it gets tricky because, obviously, nobody wants to pay for anything anymore,” Dobersen said.

At what cost?

Forensic pathologists are divided about whether it would cost more to switch to a medical examiner system.

The answer depends largely on the makeup of the system, including the number of districts, employees and offices.

Huser said the state is overpaying for death investigations under a coroner system.

Colorado taxpayers spend $18 million to $20 million per year on death investigations, Kurtzman said. That is equal to about $3.50 per resident in the state per death. The national average is close to $2, he said.

In addition, Colorado taxpayers pay vastly different amounts depending on which county they live in. Residents pay $2.72 per autopsy per capita in Arapahoe County compared with $34.32 per autopsy per capita in Mineral County, based on an independent study done from April 2010 to July 2011. An autopsy costs between $725 and $2,000, depending on how much individual forensic pathologists charge. (Huser charged the lowest rate in the state.)

The disproportion is largely a result of population base. Residents in rural counties that have to hire a contract forensic pathologist are charged at a higher rate, she said.

“I think people in the rural counties would be (ticked) off to learn they are paying $5, $10, $30 a head for a service some other county people are paying $2 for,” Huser said.

Martin agreed the county coroner system is more expensive and less effective.

Many forensic pathologists provide fee for service to communities that don’t have a pathologist employed by the county, she said. The fees can vary greatly, and if a small county has a busy year, it can bust the budget, she said. A medical examiner system has fixed costs, and it doesn’t matter as much how many autopsies are done, she said.

“There’s a lot of self-interest in keeping the system the way it is,” Martin said. “I’m not going to elaborate more than that.”

Dr. Patrick Allen, president of the Colorado Coroners Association, disagrees that the coroner system should go.

Rural communities are unlikely to have a forensic pathologist because there is not enough workload, said Allen, who is a forensic pathologist and coroner for Larimer County. Elected coroners serve a vital role in overseeing death investigations and determining whether autopsies need to be done, he said.

For the most part, the state’s elected coroners do a good job, he said.

“Whether we have a coroner system or a medical examiner system in the state, right now, the problem that Durango and Southwest Colorado is facing is going to be the same once Dr. Huser leaves. The same void occurs,” he said.

Legislation introduced

To switch to a medical examiner system would require a change to the state’s constitution.

Rep. Rhonda Fields, D-Aurora, introduced legislation last year to create a task force to study the state’s coroner system and recommend changes. The proposal, which was opposed by the Colorado Coroners Association, died in committee.

“It was our feeling that the outcome of that committee was predetermined,” Allen said. “I think it’s been shown that the coroner system is going to be cheaper than a medical examiner system at the state level.”

Fields said she plans to reintroduce her legislation next year.

“I wonder if our current structure is adequate for our state,” she said. “We need to look at rural areas; we need to look at metropolitan areas. It has to be something that works well for the entire state. We’re just doing some research right now to determine what might be a best practice that we could implement.”

In June 2005, Fields’ 23-year-old son was shot and killed at an intersection in Aurora.

“I understand the role of the coroner,” she said. “Whenever there’s a death investigation, the coroner plays a critical role in solving the merits of that murder.”

When someone needs a doctor, they insist on a specialist who knows every detail of the human body, Dobersen said.

“But when someone dies, and there are legal implications, we’re not very cognizant about entrusting our loved one to someone who is medically qualified,” he said.

shane@durangoherald.com

Dr. Carol Huser displays tools she uses performing autopsies. Enlarge photo

SHAUN STANLEY/Durango Herald

Dr. Carol Huser displays tools she uses performing autopsies.

Hooks on a door hold aprons for Dr. Carol Huser and any guest who might attend one of her autopsies. Enlarge photo

SHAUN STANLEY/Durango Herald

Hooks on a door hold aprons for Dr. Carol Huser and any guest who might attend one of her autopsies.

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