"In Mississippi, the Cause of Death Is Open to the Highest Bidder"

Over the last year, I've written several articles about how embattled Mississippi medical examiner Dr. Steven Hayne has corrupted the state's criminal justice system. But he's also done plenty of damage to the state's tort system, particularly in the area of medical malpractice. I touched on this a bit in my article from last October (see "The Case of the $37,000 Edit"). Mississippi's medical malpractice and tort defense attorneys are particularly critical of Hayne. They also tend to be the attorneys who give Hayne the most aggressive grillings in depositions.

One medical malpractice attorney based in Jackson told me last fall, "I don' t know why the ACLU or NAACP didn't go after this guy a long time ago. Dr. Hayne's incompetence has only cost my clients money. I can't believe this man's testimony is putting people in prison."

Dr. Roger Weiner is a cardiologist in Clarksdale, Mississippi. He moved to Mississippi from Philadelphia, Pennsylvania several years ago to start a new practice.

In January 2005, an elderly man named Thomas Harrell had a heart attack, collapsed, and died during a visit to Dr. Weiner's office. According to Weiner, Harrell had several life-threatening ailments, including lung cancer and advanced heart disease. Because Harrell hit his head during his fall, Dr. Weiner ran a CAT scan, just to make sure Harrell's fall didn't contribute to his death. The scan was negative. The head injury was minimal, and wasn't a factor in Harrell's death. Harrell died of a heart attack, and Weiner filled out a death certificate listing "congestive heart failure" due to "coronary heart disease."

Weiner says he was a bit shocked, then, when several weeks later Coahoma County Coroner Scotty Meredith filed a second certificate listing "closed head trauma" as Harrell's cause of death. Attached to Meredith's second death certificate was a letter from Dr. Steven Hayne stating there was "no question" that closed head trauma is actually what killed Harrell.

Weiner did some investigating, and found that despite the certainty with which Hayne agreed with Meredith's findings, Hayne had never actually examined Harrell's body. He issued his diagnosis based only on the observations of Meredith, the county coroner, a man with no medical training.

Weiner and the hospital he worked for were cleared early on of any liability in Harrell's death. Yet Weiner decided to fight to restore Harrell's original death certificate—he says out of principle. "Lots of money can exchange hands over a cause of death determination," Weiner told me in a phone interview. "I wanted to make sure it exchanged hands for the right reasons. Everyone down here knows about Dr. Hayne. Tens of millions of health insurance dollars have gone to plaintiff's lawyers down here because of him."

Weiner wouldn't speculate as to why Meredith would have wanted to change Harrell's cause of death. But other malpractice attorneys I've talked to, while asserting that they have no knowledge about this specific case, say an official cause of death that's listed as an accident can be much more lucrative on a life insurance policy than a death by natural causes.

The case eventually reached the Mississippi State Supreme Court on the matter of whether the local chancery court had the jurisdiction to amend the death certificate, or whether as the county coroner, Meredith's determination of cause of death should be the final say. The court ruled in Weiner's favor, and ordered the chancery court to hold an evidentiary hearing to determine who was right about why Harrell died.  Oddly, after pursuing the case to the state Supreme Court, Meredith dropped the case after that ruling.

A couple of weeks ago, I was able to reach Meredith over the phone to discuss the case.

"I took a second look at Mr. Harrell at the request of his family," Meredith told me.

I asked, "And then you called in Dr. Hayne to look at the body?"

"No. Dr. Hayne never examined the body."

"How could he have been so conclusive about the cause of death if he never saw the body?"

"He agreed with my assessment."

"And do you have any medical training?

"Yes."

"You do?"

"Yes."

"Actual medical training, or death investigation training?"

"I have death investigation training."

"And most of the death investigation training for Mississippi coroners is done by Dr. Hayne, right?"

"A lot of it, yes."

"The CAT scan on Mr. Harrell was negative, wasn't it?"

"Yes."

"So Dr. Hayne took the word of a coroner with no medical training over the word of an MD, and changed the cause of death without ever examining the body himself?"

"He trusted my investigation."

"Why did you withdraw your death certificate after the state supreme court ruling? You could have had an evidentiary hearing on the cause of death in chancery court, and you and Dr. Hayne could have made your case there."

"After speaking with the family, we decided to drop the matter."

"But you fought it all the way to the state supreme court. If your diagnosis was correct, why drop it rather than face an evidentiary hearing?"

"Like I said, I talked to the family, and they asked me to drop the case."

Dr. Weiner wouldn't comment on Meredith specifically, but says more generally that with the aid of Dr. Hayne, Mississippi's county coroners and plaintiff's attorneys are defrauding doctors, hospitals, and insurance companies out of millions of dollars (Hayne was recently sued by one hospital insurer, though I haven't been able to determine how that case was resolved).

"In Mississippi, the cause of death is open to the highest bidder," Weiner told me.

Hayne charges three times as much for private autopsies as he does for state autopsies; he also charges about three times his normally hourly rate for trial testimony and preparation.

This brings us to another problem: Public defenders in Mississippi are notoriously underpaid. For all but a few, it's a part-time position. Cities and counties typically pay less than $10,000 per year to their designated public defender. Consequently, most of the state's public defenders make their actual living in private practice, many as plaintiff's attorneys. When they need an autopsy done in a medical malpractice or wrongful death case, Hayne's often the only game in town.

Hayne, then, has managed to position himself as the lifeline for both law-and-order district attorneys and more left-leaning plaintiff's attorneys, many of whom are also their town or county's designated public defender.

I should add, here, that I've met several dedicated, hard-working public defenders in Mississippi who have done all they can to rid the state of Hayne. But those people tend to be full-time defense attorneys. It isn't difficult to see the conflict of interest problems when the same medical examiner on whom you depend to make your living in your private practice is also giving overtly pro-prosecution testimony in your criminal cases, for which you're only paid a few thousand dollars per year. Why risk angering Hayne in a criminal case when it may come back to bite you in the cases where you make your livelihood?

It goes a long way toward explaining why Mississippi's defense bar hasn't taken a more aggressive stand against Hayne over the years. On the other side, Hayne's favor with the state's district attorneys and politicians may help explain why no one took a hard look at him when the state passed a comprehensive tort reform package a few years ago.

He seems to have created a nice little niche for himself.