"The Mississippi medical examiner system doesn't exist, except in name only." So says Dr. Vincent DiMaio, a renowned forensic pathologist, and author of the guiding textbook for medical examiners. And he isn't alone. Talk to forensic pathologists across the country about how the state of Mississippi conducts its forensic autopsies and you'll get chuckles, exasperated sighs and indignation. What you'll be hard-pressed to find, however, is anyone outside the state who thinks things are being done properly.
Here's how it works: Each county in Mississippi elects a coroner to take the lead in conducting death investigations. The job requires no prior training, medical or otherwise - only a high school degree. If a death appears to have been caused by criminal activity, the coroner will consult with the local district attorney. Between the two of them, they'll then refer the body to a private medical examiner for an autopsy. If a crime did occur, that medical examiner will likely then be asked to testify at trial.
The system creates some troubling incentives. It encourages prosecutors and coroners to send bodies and the fees that come with them to medical examiners they trust. Critics say it undermines the notion of an adversarial criminal justice system. Medical examiners who have a financial incentive to keep prosecutors and coroners happy end up testifying against indigent defendants who can't afford to hire their own experts to review the state expert's work.
At the center of all of this is a Rankin medical examiner Dr. Steven Hayne, the man who over the last 20 years has come to dominate Mississippi's autopsy business.
Hayne has testified in court and in depositions that he personally does between 1,200 and 1,800 autopsies per year. That range breaks down to three to five autopsies per day, assuming Hayne works every day of the year, with no time off for weekends, holidays, sick time, or personal vacations. For much of his career, Hayne has juggled this astonishing workload while also holding two administrative jobs at a local hospital and at a research facility - jobs he's said could take up to an additional 50 hours of his time each week. Hayne also testifies in court 2-4 times per week all over the state of Mississippi. Because of these other commitments, Hayne has done most of his autopsies at night and on weekends. Until only recently, he did them in a funeral home owned by Rankin County Coroner Jimmy Roberts.
According to the National Association of Medical Examiners, a single doctor should try to do no more than 250 autopsies per year. After 325, the group will no longer certify a doctor's practice. "You can't do it," says Dr. Vincent DiMaio of Hayne's workload. "After 250 autopsies, you start making small mistakes. At 300, you're going to get mental and physical strains on your body. Over 350, and you're talking about major fatigue and major mistakes."
Hayne maintains that such standards are arbitrary, and don't account for his own work ethic. When questioned about his workload in a 2003 deposition, Hayne answered that he's simply an extraordinary physician. "If you want to compare me with the average forensic pathologist, I think it's an insult to me," he said.
After The Wall Street Journal published an article I wrote about Hayne earlier this month, Hayne told a Jackson television reporter that he isn't the only doctor in his practice who performs autopsy examinations, implying that these 1,200 to 1,800 autopsies are actually split between two or more physicians. That may well be the case today (Dr. Hayne didn't respond to my requests for an interview), but I have several depositions over the last 15 years where Dr. Hayne explicitly explains that he is indeed the only doctor in his practice licensed to perform autopsies (he has assistants, but they aren't permitted to perform the actual autopsy).
Mississippi law actually requires a board-certified, salaried state medical examiner to oversee how autopsies are meted out, and to be sure that qualified, certified medical examiners are conducting them. But that position has been vacant since 1995. The last two people to hold the office tried to impose some professional standards and clean up the system. Both left the office on bad terms after butting heads with Dr. Hayne and his supporters. The state Legislature has refused to fund the office since.
The ironic thing is that Dr. Hayne was once considered for the position. He was rejected because he isn't board certified in forensic pathology by the American Board of Pathology, as required by state law (Hayne told the Jackson TV reporter this month that he is board certified, but "couldn't remember" the name of the group that certified him). Yet, by keeping the office vacant and allowing coroners to shop autopsies to freelancers, Hayne has become Mississippi's de facto state medical examiner, anyway.
Dr. Hayne's peers have found plenty of flaws in his work over the years. In 2003, for example, Dr. Harry Bonnell, a medical examiner in San Diego who sits on NAME's ethics committee, sent an unusually harsh letter to a criminal defense attorney after reviewing one of Hayne's autopsies. Bonnell described Hayne's conclusions as "near-total speculation," the quality of his report was "pathetic," and Hayne's failure to obtain specimens from the body and perform toxicology reports "borders on criminal negligence."
Dr. Stephen Pustilnik, now a medical examiner in Texas, reviewed an autopsy Hayne performed in 1998 and found that many of the internal organs Hayne claimed to have examined in the autopsy report hadn't been touched. Pustilnik describes Hayne's autopsy in that case as "near complete malpractice."
So why do Mississippi's coroners and district attorneys keep using Hayne? Critics say it's because they can rely on Hayne to come up with the conclusions they need to secure convictions. Ken Winter, president of the Mississippi Association of Chiefs of Police and former director of the state's crime lab, says that prosecutors have told him over the years that Dr. Hayne is an "excellent witness." But Winter adds, "There's a lot more about being a professional and doing a good job than being an 'excellent witness.'"
Dr. Leroy Riddick, a well-respected medical examiner in Alabama who has opposed Hayne at trial in the past, is more blunt. "All of the prosecutors in Mississippi know that if you want to be sure you get the autopsy results you want, you take the body to Dr. Hayne," he says. J.D. Sanders, former police chief for Columbus, Miss., has tried for years to draw attention to Dr. Hayne's practices. "Prosecutors love him, because he'll testify to whatever they need him to testify to," he says.
Sanders then offers a sobering thought: "There's no question in my mind that there are innocent people doing time at Parchman Penitentiary due to the testimony of Dr. Hayne," he says. "There may even be some on death row." Winter says he's just as concerned that Dr. Hayne's deficiencies may have wrongly classified homicides as suicides or accidents, or otherwise allowed guilty people to go free. Hayne has also testified in hundreds of civil cases over the years, including medical malpractice and torts cases.
At a minimum, Dr. DiMaio says, Mississippi should require that any medical examiner doing criminal autopsies meet the minimum professional standards outlined by NAME. That's a start. But Mississippi also needs to begin undoing the damage the current system has created. Unfortunately, that may mean revisiting what could be thousands of cases over the years in which Dr. Hayne and others like him have testified.
Radley Balko is a senior editor for reason. This article orginally appeared in the Jackson Clarion-Ledger.