The Role of the Medical Examiner with Bill Pellan

In this episode John McQueen interviews Bill Pellan of the District 6 Medical Examiner’s office.

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SOURCE: EDMUND D. FOUNTAIN | Tampa Bay Times http://goo.gl/vjfAmn


Transcript:

John McQueen:  Welcome to Anderson‑McQueen’s radio show, “Undertakings.” I’m John McQueen, President and Owner of Anderson‑McQueen Funeral Homes. On this show, we undertake those subjects that you want to know about.

Remember, if there is a specific topic you would like us to talk about or if you have questions you would us to ask one of our upcoming guests, please email them to radio@andersonmcqueen.com. We always do our best to include everyone’s request, if at all possible.

Our topic today is understanding the role of the medical examiner. Our special guest today is Bill Pellan with the District Six medical examiner’s office, who will help us in undertaking this worthy subject. Bill, welcome.

Bill Pellan:  Thank you.

John:  Being in the funeral business for as long as we have, we’ve obviously interacted with medical examiner’s office many times. We get a lot of questions from families that we meet that want to know what all’s involved with the medical examiner or if someone needs to go to the medical examiner for an autopsy, when the death occurs or things like that.

As we get started, can you tell us a little bit about yourself and what brought you into this field, as well as what the primary duties are in your role here at the medical examiner’s office?

Bill:  Yeah, sure, I’d be happy to. Well, my name is Bill Pellan. I’m currently the Director of Forensic Investigations with the District Six medical examiner. We cover both Pinellas and Pasco County, that’s the jurisdiction of this medical examiner’s office.

I’m originally from Moline, Illinois, where I grew up and started working in funeral service there, working for a family owned funeral home in that area and moved to South Florida in 1992, where I, again, worked in funeral service for a few years and then started working with the medical examiner office in Palm Beach County, where I worked there as a forensic investigator and then moved to Pinellas County in 2000, where I’ve been working since.

Like I said, the Director of Forensic Investigations. Basically, I oversee the day‑to‑day operations here at the medical examiner’s office and that includes death investigations, the autopsy process, if there is an autopsy, and all of the administrative functions of the office.

John:  Great. I’ve enjoyed the tour you gave me here today. I know you mentioned you do both Pinellas County and as well as Pasco County. Obviously, you have the office here in Pinellas County. Can you tell us a little bit about how you handle things from Pasco County?

Bill:  Sure. Pasco County, the county themselves, they do not have a facility for the medical examiner in their county. They actually contract with Pinellas County to use the Pinellas County facility, which is where we’re at today.

All of the decedents that fall under medical examiner jurisdiction in Pasco County are transported here to Pinellas and that’s where we do our examinations and autopsies, if necessary, here at the Pinellas location.

John:  Great. Can you tell us a little bit about, maybe a typical day here at the medical examiner’s office?

Bill:  Yeah, sure. Deaths are reported to our office 24 hours a day. We have investigative staff that reviews the circumstances of the death and determines jurisdiction.

The investigators may respond to a death scene and conduct a scene investigation there along with law enforcement. The decedents are then transported to our office where, in the morning, our staff comes in and does what we call, “decedent process,” where they take photographs of the decedent.

Make documentation as to injuries and traumas and such to the body. They’ll take fingerprints. They’ll take x‑rays and get everything ready for the pathologist who actually performs the autopsy and examination. Then autopsies and examinations are done in the late morning time. Those are completed. The decedents are then prepared and readied for release to funeral homes.

John:  I know you mentioned both investigators, as well as your autopsy technicians. About how may investigators and technicians do you have here?

Bill:  We have six forensic investigators. One of those six is our chief investigators who oversees the immediate supervision of the investigative staff.

We have eight forensic technicians, which handle the decedent transportation and handle the decedent processing. They assist our doctors during the autopsy process and then release the remains to funeral homes, as well, afterwards.

Then, we have…six…I had to count because I lose track. We have six forensic pathologists. Out of that six, one is our chief medical examiner who is appointed by the governor, and then we have five associate medical examiners that work at his discretion, and all six of our pathologists are board‑certified in forensic pathology.

John:  I think I heard recently that that’s something that is rare in the United States, being board‑certified forensic pathologists.

Bill:  Yeah. There’s actually, I guess you could say, a shortage of board‑certified forensic pathologists in the country. I think there’s somewhere around 350 or 400 practicing board‑certified forensic pathologists in the entire country, so for us to have that standard here that all of our doctors are board‑certified is really good.

John:  It speaks volumes for how great this facility runs.

Bill:  Thank you.

John:  Speaking of pathologists, and medical examiners, and all of that, one of the things we hear quite often, or families will ask us, or even sometimes the police say, “The coroner’s going to be involved in this case,” or, “The coroner’s not going to be involved in the case,” but as I understand it, there’s a difference between a coroner and a medical examiner. Can you elaborate a little bit on that for us?

Bill:  Yeah. That’s a great question because we hear that a lot as well, and I hear that terminology used frequently as well. A coroner is a position and a term that is and has been used for many years, and I think most parts of the country at one point had coroners that handled the death investigation type procedures, where through time it’s progressed to where some of those coroner jurisdictions have been replaced with medical examiner jurisdictions.

A coroner is an elected position, so any person that receives enough votes could be a coroner, they’re elected to be a coroner, and they may or may not have any medical background, they may or may not have any type of law enforcement, or forensic, or investigative background, and they are elected by the voters.

Where a medical examiner is a physician that typically has education, and training, and experience in forensic pathology, where they are appointed that position by some type of government entity, whether it be individually by county or whether it be by the state, as it is in Florida, where the governor appoints the medical examiner for the district.

That’s the difference. The State of Florida is a medical examiner state where we do not have coroners in Florida. Every inch of the state is covered by a medical examiner.

John:  Over the years growing up, and I’m sure you’ve probably seen this too, having been in the funeral business and now at the medical examiner’s office, but I can remember watching television shows on TV.

One that comes to mind as you were talking about that was the old show, “Quincy, ME,” and it just popped back into my mind that he was supposed to be a medical examiner, but, I don’t know if you recall, his station wagon he would show up at the scenes with would say, “Coroner,” on the side, so I guess sometimes maybe even Hollywood gets it wrong.

Bill:  Yeah, I think you’re right.

John:  Another question that many of our families will oftentimes ask us is, “How does the medical examiner determine if they are going to investigate a death?” Can you share with us some of the reasons why maybe you might take on a case?

Bill:  Sure. We follow Florida law, so when the State of Florida developed the medical examiner system around 1975 was when that occurred, they developed a section in the Florida statutes for the medical examiner, and within that section of the law, it defines those deaths that require reporting and investigation by the medical examiner.

Basically we have an outline or a guide in the law that mandates that we become involved, and it does give us the authority then to become involved, and those deaths are typically deaths involving non‑natural circumstances, or when someone dies suddenly when they’re in apparent good health, or if the dead is somehow suspicious in some way.

Some circumstances that that would include would be deaths involving an accident, trauma‑related deaths, drownings, drug overdoses, suicides, of course homicide cases, any deaths involving police custody, or in jail, or prison. Those are the types of deaths that we deal with, so primarily non‑natural‑occurring diseases.

John:  Obviously I know part of your job here, or your team’s job, is to take care of doing the autopsies and things as needed, so how many autopsies does your office perform in a year?

Bill:  Last year, for calendar year 2013, we performed a total of 1,090 autopsies for both Pinellas and Pasco counties.

John:  That’s a lot of autopsies.

Bill:  It is, and it takes a good staff and a lot of people to make that happen. That breaks down, if you’re interested, Pinellas County, it was 690 autopsies, and Pasco County, it was 400.

John:  Does your office perform autopsies on every person that is under your jurisdiction or do you, in a way, pick and choose which ones you do them on?

Bill:  That’s a good question, and that question does come up frequently, where people want to know if an autopsy’s going to be performed and does it have to be. Basically we do not autopsy everybody that we have jurisdiction over investigating their death. For example, last year we investigated about 1,800 deaths, so as you can see, out of that 1,800, we autopsied a little over 1,000 of them.

We make that determination based on circumstances, so depending on the circumstances of the death will dictated or mandate whether or not we must or should do an autopsy.

John:  Is there any time that like if a family didn’t want an autopsy, would you not do one?

Bill:  Yeah, absolutely. We try to honor the family’s wishes, so if a family expressed objections to us with regard to the autopsy, we’ll try to do whatever we can to honor their wishes, and if at all possible we can avoid the autopsy, accomplish the job that we have to do under the law, and not impact or influence the criminal justice system, then by all means we will honor their wishes and not do the autopsy.

John:  That’s a really nice thing, to be able to try to help honor their wishes. It’s a difficult time for them to be going through things at that. I know many times families tell us that’s one of their worries, that mom or dad’s going to have an autopsy done or things like that.

Bill:  Yeah. We can’t always honor it, but certainly if we can avoid it, we will.

John:  I know nowadays it seems like more often than not, many times when autopsies are performed, it seems like we get a lot of what are called caused‑pending death certificates, where they’re awaiting the final cause, so what might cause that to be the case?

Because many times families ask us, “Am I going to be able to use this death certificate for anything and when will I finally know what the cause is?” In fact, many times they’re coming into make funeral arrangements with us the day after the death occurred and they’re already asking me if we know what the cause is yet, which, obviously as you know, having been in the funeral business, we don’t.

When might you issue a cause‑pending death certificate and how long does it take then to finally get that final cause?

Bill:  There are some circumstances of death where after we perform the autopsy, we do not either have a cause of death that is able to be determined following the autopsy or there may be other circumstances involved that we have to perform testing in order to rule certain things out.

An example of that may be a death that may be related to drugs, so in order to find out if a certain drug or toxin played a role in the death, we have to run toxicology analysis, and that oftentimes takes anywhere from 30 to 45 days on the early end up to 90 days or maybe even slightly longer before we get those results back.

Unfortunately, that means that the death certificate is basically a pending death certificate at that point, the cause of death is pending, and we’re aware of the fact that that may cause some problems with families that are needing that death certificate so that they can get life insurance benefits paid to them, so that they can take care of all the many expenses, and even the day‑to‑day expenses, that they may be having. We try to move that along as quickly as possible to get that done for the family.

John:  You mentioned sometimes you’re unable to determine a cause of death. How often does that happen and what do you do in that instance?

Bill:  It’s uncommon that we would not be able to determine the cause of death after autopsy and after testing, and analysis, and such, but it does happen from time to time. Typically this may occur in infants where the circumstances are not real clear as far as what was occurring with the sleep environment of an infant, where the cause or the manner of death may be undetermined.

Then also it can occur when we’re investigating a death involving remains that are skeletonized, where the only thing remaining is the skeleton and the skeleton itself does not provide an indication of cause of death, so at that point we don’t have the organs to examine, we don’t have the fluids available to run analysis on the fluids, and therefore we’re missing those key components and it may result in an undetermined cause of death at that point.

John:  I know sometimes also, I would assume along that same lines, sometimes you’re unable to determine who the individual is and it’s unidentified remains. What happens in a case like that if you have unidentified remains, Jane Doe, let’s call it, and you’re never able to determine who they are? What ultimately happens with the remains at that point?

Bill:  That does happen. Again, it’s rare, thankfully enough. We do our best and we try very, very hard to identify everyone so that we can at least give that closure and notification to the family as to what happened with their loved one.

When we do have someone unidentified, there’s a whole process of gathering physical evidence and forensic evidence from the remains to be able to have that available for comparison later. That would include fingerprints and dental, X‑rays and chartings, and samples for DNA analysis, a DNA profile, and all of that.

Then the remains, if the remains are not skeletonized, the remains are then buried in a local cemetery at the county’s expense, and in the event that they are identified later, then the family would have that option to be able to move those remains to a different cemetery, or do whatever they would like with them, and if the remains are skeletonized then we retain those remains here at the medical examiner’s office, and we retain them here indefinitely or until they’re identified.

John:  Interesting. Let’s shift gears just a little bit. You’re well aware of this. Here in Pinellas County, in our area, we have a very high cremation rate, so obviously on death certificates, we’re required to get the medical examiner’s approval before we can do a cremation. Why does the medical examiner have to improve death certificates in the case of cremation?

Bill:  It is a fairly large part of the work that we do here. As you indicated, there’s a high cremation rate here in this area. Florida law, the same law that provides us the authority to investigate deaths, and mandates that we investigate deaths, that same section of the law also requires that before a person is cremated, the medical examiner must approve that cremation.

I think the original intent behind creating that law is that cremation is very final, and they wanted to create a mechanism in place where someone looked at that death, and looked at the cause of death, and the circumstances, and makes sure that no one ever needs to see those remains again.

The medical examiner does all of that, reviews the cause of death and the circumstances, and then either approves the cremation or initiates an investigation into the death, and then ultimately will approve the cremation after the medical examiner’s had a chance to look at the remains and the cause of death.

John:  If I recall, about the time some of that came around, I think there was a high‑profile case I think brought out some of this. As I recall, Michael Jordan’s father was found dead in his car, I believe, on the side of the road, or somewhere, like in Mississippi, and think they may have even had a coroner, not a medical examiner, but he was cremated that same day, so it made it very tough to ever go back and investigate that whole situation. Is that right?

Bill:  Yes. I do remember hearing about that, and circumstance like that is unfortunate for the family because there are a lot of unanswered questions, and this section of the law, hopefully it prevents that, and I think in combination with a section in the law requiring funeral directors to wait a certain time period before cremation can take place.

Again, it prevents that from someone dying, and then being immediately cremated, and destroying evidence, either intentionally or not, and then not providing an opportunity to answer those questions.

John:  Again, as we’ve both said, it’s a high cremation rate here in Pinellas County, and in Pasco County too. How many death certificates does your medical examiner office approve each year for cremation?

Bill:  It’s an incredible amount. Actually, it’s the highest in the state by far. The only other area that comes close to the cremation approvals we do here, they approve less than half of what we do. Last year, for example, in 2013, our office performed 13,426 cremation approvals between the two counties. Almost 9,300 of those were in Pinellas County and then a little over 4,000 were in Pasco County.

John:  That’s a lot of death certificates to have to review the cause of death and make sure there’s nothing wrong with it.

Bill:  Yeah, it certainly is. It’s a lot of work that happens here.

John:  That brings up another issue that I had heard recently, was that maybe there was some legislation that had been proposed here in Florida to possibly eliminate the cremation approval or the cremation approval fees, and if that were the case, how do you think that might affect the families that we serve or the public well‑being, for that matter?

Bill:  I think it’s a little disturbing to hear that that’s even being considered, with the elimination of that requirement of the statute. I think it’s really a step backward if they do that. There are actually some states that recently enacted that requirement because they saw the benefit of it.

The example that you give with Michael Jordan’s father is a classic example of what could happen should there not any longer be a requirement to perform that cremation authorization.

It also helps not only from detecting crimes that may have occurred and wrongdoing with remains, I think it also helps the families too to make sure that that death certificate is certified correctly, because that can affect insurance benefits, and that’s one thing that the cremation approval process does, as many death certificates are not completed correct, and we then get that done so that the death is certified appropriately.

John:  In your role here that you’ve been here for quite some time now, and I know you handle a lot of cases and have seen a lot of things, can you share with us what might be your most memorable case?

Bill:  Yeah. I think some of the most memorable cases are the persons that are initially unidentified that we are able to identify. That gratification to be able to provide family members of the deceased information as to what happened to their loved that.

Sometimes these families have been searching for their loved one for years, wondering what happened, and to be able to do that, and give them that information and that closure, I think is some of the more memorable cases that we handle.

John:  That’s interesting. It’s like even in the funeral industry, I know for us, many times people will ask us, “What’s the toughest thing you have to do?” or, “What gives you the greatest gratification?”

Like yourself, when we have a death that families experience is a traumatic death, it’s always gratifying to us that we’re able to return the remains to an appearance that the family is able to come in and see them one last time, and be able to say their goodbyes, and know that we’re offering them closure too, like yourself, so we’re very similarly related here in this part of the world.

Bill, tell us, have you been involved in any cases that received national exposure, and if so, how did that affect the case or affect your office and the work that you do?

Bill:  Our office was involved with a death of an individual that was in what was called a persistent vegetative state. Her name was Terri Schiavo, and that whole circumstance and process leading up to her death had a lot of attention nationally, certainly here locally it did, nationally a lot of attention.

Then when she passed, our office was involved, primarily at the direction of the state attorney, to perform an autopsy and do an investigation to see if we were able to gather any information that may answer some questions surrounding her situation.

That was certainly different for our office whereby we had a lot of coordination with the police agencies on even removing her and getting her transported here to our office because of all of the people, and there was some tension involved with that whole circumstance, and then we had media here where we actually held press conferences the day that she died.

We held a press conference just to explain what we were going to do, and that we were involved, and what the process was going to be, and then we held a press conference after everything was done, after the autopsy report was complete, and of course that involved many, many cameras, and microphones, and things like that that typically we don’t deal with on a daily basis.

Then, of course, the security and such involved, where we actually had law enforcement people here at the building 24 hours a day, making sure that there were no issues with anything.

It was quite an experience. It overloaded our phones a little bit and was actually the first time that we posted an autopsy report out on our website, on the Internet, for everyone to be able to access, to cut down on the number of people calling, wanting copies of that. They could just go to the website, download it, and take care of it on their own.

John:  Was that something for the general public or was that something for law enforcement, or other governmental type agencies, or…

Bill:  It actually was for the general public. All of the work that we do here is public record, so autopsy reports are public record. There are some exemptions or some exceptions. Deaths that are under active criminal investigation are not releasable under public record, autopsy photographs are not releasable to the general public, but for the most part, autopsy reports are public record and could be released to the public.

John:  I never knew that. I always thought probably HIPAA laws and things like that prevented any of that from being released except to the family, maybe, but that’s interesting to know.

Tell me. You’ve seen a lot. You’ve been through the trenches a lot. Is it really like on TV?

Bill:  No. Really it’s not at all glamorous like you may see on TV. Much like when I first thought about going into funeral service, I thought that, “Wow, this is really a great profession. They have nice, big cars, they’re always clean, they wear nice clothes, and that’s what I want to do,” and then I learned that, boy, there are a lot of long days, and long hours, and weekends, and holidays and middle‑of‑the‑night sleep disruptions.

Very similar with the medical examiner’s office, they portray it on TV that it’s much more glamorous.

The other thing is that on television, cases are solved within minutes or within the hour of the show, and analysis, and testing, and such, you get those results back within minutes. In reality, it’s days, or weeks, or months before those things are all wrapped up.

John:  Sure. Hollywood does a great job or taking what we do on an everyday basis and making it fit that 60 minute segment.

Bill:  Exactly.

John:  One last question before we go because I really appreciate you coming on today. I don’t want to take up your whole day but what’s something about our medical examiner’s office here that you would really like the general public to know about?

Bill:  I think knowing that our primary goal is to properly certify deaths. We follow the statute and the guidelines set forth there to do that but I think it becomes a little bit more personal where we try to get these deaths certified correctly to help families with insurance purposes to identify certain trends, such as recently in Florida, we’ve been in the spotlight a little bit over the prescription drug epidemic.

The medical examiners are playing a key role in that because they identify these deaths being cause by certain drugs and then enforcement and attention can be made to those areas where we’re seeing the deaths. We really try to speak for the decedent, if you will, when we handle these death investigations.

The other thing is I’m really proud of our office that we have accreditation by the National Association of Medical Examiners. There’s a little over 70 offices worldwide that have this accreditation and we are one of those.

Of course, as I mentioned before, all our doctors are board certified in forensic pathology. I think it’s something to be very proud of and the people that really benefit, I think, are the citizens that we serve and their families, and the law enforcement community that we help during their investigations. They’re the ones that really benefit.

John:  Bill, I can definitely tell you that having dealt with the medical examiner, personally, myself, having been a funeral director for 30 years now here in Pinellas County, that you guys do a great job. I didn’t know all the outstanding accreditations and things you had until today.

I can tell you, in my opinion, you all do a wonderful job. I appreciate you taking the time out of your busy schedule today to sit down and share a little bit of your knowledge with our listeners and let them know what happens behind the scenes at the medical examiner’s office.

For all those of you out there listening today, I want to thank you for listening to the Anderson‑McQueen Funeral Home radio show, “Undertakings.”

Our next show will be about understanding Jewish funerals when you’re not Jewish. So we’re going to explore some of the customs of the Jewish funerals and also give us an understanding if you’re not Jewish, like I am not, then when I do attend a Jewish funeral, what exactly do I do?

We’re going to be interviewing one of our local rabbis and we think that you’ll find it to be a very interesting topic. Remember to email us those questions and show ideas to radio@andersonmcqueen.com and I’m John McQueen. I thank you for listening.

Bill, once again, thank you for participating today.

Bill:  Certainly. Thank you for the opportunity.

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