PEARL, MS (Mississippi News Now) - Mississippi's state crime lab examines hundreds of bodies every year and calls those procedures autopsies.
However, some medical experts don't, because of what's actually being done in some instances behind closed doors.
"I have complained and was told I have no choice in how they do things," said Sunflower County Coroner Heather Burton. "That's not my call."
Burton said what's happening at the state crime lab troubles and frustrates her.
"They're doing external autopsies where they draw tox, take an x-ray, and look at medical records, and not cutting them, not doing a full examination to determine what was going on," Burton said. "I don't like it at all."
As coroner, Burton gets called anytime someone dies, and must determine whether something suspicious happened or a person's death appears unnatural.
"When we see something in the field that tips us off, there's a reason we sent them to the crime lab," Burton said. "We don't need to get something back saying, 'We're not cutting them. They have a history of cancer. That's what they died of.' People who have terminal cancer can be murdered. They can."
When family members get the results of the investigation, Burton said they often believe the cause of death from the state crime lab isn't accurate at all.
"They think we're trying to cover something up when we're not getting results back, when we're not getting full autopsies, and they leave us coroners from each county to have to answer the family as to why they're not," Burton said.
Mississippi's Crime Laboratory has two forensic pathologists on staff qualified to investigate, on average, more than 1,400 deaths that come through the facility each year, according to director Sam Howell.
That means each pathologist ends up conducting upwards of 600 autopsies a year, more than twice what's recommended by the National Association of Medical Examiners.
Experts believe those higher case loads mean it's more likely that medical examiners will make mistakes and eventually burn out.
Howell said state funding that takes effect July 1 will allow the crime lab to hire three additional pathologists.
Mississippi has had problems hiring for these positions in recent years because the salaries here aren't as competitive as they should be.
"When a family is grieving over the death of their loved one, they don't care how many medical examiners are down there. They want the right answer. They want to know what happened, not what could possibly have happened," Burton said.
Burton said these visual examinations began under Dr. Mark LeVaughn, the state's chief medical examiner.
On March 28, two weeks before this story aired, 3 On Your Side asked Department of Public Safety communications director Warren Strain for interviews with Dr. LeVaughn and Howell.
Strain responded two days later, saying they were working on it.
Despite multiple emails sent to him since that time, Strain didn't respond again until April 11, the airdate of this investigative piece.
"Dr. LeVaughn is one of two DPS pathologist (sic) and does not have the spare time at this moment for a formal interview due to the number of autopsies the lab has to process, reports that are associated with the procedures and Dr. LeVaughn's court schedule," Strain wrote.
He then offered to answer questions via email.
In response, we sent a detailed list of questions which have not yet been answered.
You can read them for yourself at the end of this article.
When contacted directly, Howell declined our request for an on-camera interview as well, citing Strain's approval was needed before that could happen.
Howell did, however, answer a few of our questions through email and a phone call.
How many of Mississippi's autopsies were actually visual examinations?
Howell told us they'd have to go through each of the 1400-plus annual cases to find that out, meaning they don't have an exact count.
"As far as procedures for external examinations, there is nothing specific in writing since every case is different," Howell said in response to a WLBT public records request.
He did, however, justify the practice of visual, or external, examinations as being appropriate in certain cases.
"Externals may be performed in some cases like motor vehicle accidents to assist coroners with documentation techniques such as forensic photography and digital x-rays that they may not have access to, in addition [to] collection of appropriate samples for toxicology," Howell said in the April 9 email. "In these instances, the pathologists can assist in the thorough examination where the cause and manner of death is known."
"I think that's important to make clear that a visual examination in the right circumstance, is absolutely the right thing to do in many cases," said UMMC pathologist Dr. Timothy Allen.
Dr. Allen said whether a medical examiner does a visual examination or a full autopsy should be based on the circumstances surrounding that death, but he would not be more specific than that.
Allen also told us there is no blanket rule here: these procedures, and which to choose, should be handled on a case-by-case basis.
"A forensic pathologist's role is to look at each case individually, and make a determination independent of anything else as to what needs to be done in that specific circumstance," Dr. Allen said.
Could the state crime lab's backlog of pending cases, which varies from county to county, be the reason for these visual examinations?
In Sunflower County alone, Burton's still waiting on completed autopsy reports in 51 cases.
Some of those date back to 2014.
Burton said she asked why she got a body examined through external means only.
"Because they were too understaffed," Burton said.
The cost of an autopsy in Mississippi also serves as a sense of frustration for Burton and others in the state.
State law sets the price at $1,000 per completed autopsy, paid to the crime lab.
"My county is not getting what they're paying for, and the families may not be getting the correct answers that they need," Burton said.
How many deaths in her county were visually examined?
Burton estimated more than half: 60 percent.
State law also requires certain deaths to be examined regardless of condition: deaths that affect the public interest, including the death of anyone incarcerated.
"I think that probably 98 percent of what I send from Parchman is not cut. That's very scary," Burton said.
Many of those deaths could be of natural causes, Burton said, but she also knows what goes on behind the walls of Mississippi's prisons.
After all, there's a reason state law requires all of those deaths be investigated.
"I don't care if they're in Parchman or the local hospital. That's somebody's brother, father, son. They deserve answers just like anybody else does," Burton said.
To her knowledge, every one of her county's homicide victims had a full autopsy.
There's also a word game in play here, too, according to Burton: she doesn't believe visual examinations should be considered autopsies.
That's also shared by famed New York forensic pathologist Dr. Michael Baden, who told 3 On Your Side that a visual, or external, examination cannot be considered an autopsy at all.
During our interview with Dr. Allen, he was also careful not to use the expression "visual autopsy".
If visual examinations aren't autopsies from a medical standpoint, would they be considered autopsies under state law?
The state of Mississippi makes no distinction.
The word “autopsy” is loosely defined under Section 41-37-1 of the Mississippi Code, meaning it’s hard to tell if these visual examinations meet that definition.
However, sections of state code that refer directly to the state medical examiner and procedures concerning deaths of prisoners offer no definition for autopsy, meaning it’s even more vague.
Burton said that law needs to be far more specific -- for families all over Mississippi -- because they're paying for it.
"Please make a change and require full autopsies be done, full autopsies be sent, and not a one-page cause of death. That's not an autopsy report. That's nothing more than a death certificate," Burton said.
In response to Strain's April 11 email, here are the questions we asked Strain to pass along to Dr. LeVaughn in order to better understand situations and conditions at the state crime lab, as well as autopsy procedures.
As we get answers to these, we will update accordingly.
- How do you make a determination on external examinations versus full autopsies? Are there any rules you follow, i.e., "if foul play is suspected, we usually perform full autopsies to get a more thorough outcome."
- We were told by one coroner that the vast majority of bodies that come back from Parchman are not cut. Is that effective when so many other factors could be in play?
- How many of your autopsies annually are actually external examinations? Can you ballpark a percentage?
- There's criticism by coroners and some lawmakers that the state crime lab is performing external examinations simply to address the backlog of cases, because external examinations are typically faster. How would you respond to that?
- It's our understanding the Legislature appropriated more money this year, which would give you the ability to hire more pathologists, but it may not be enough to be competitive among other states with lower case volume. How crucial is funding to your operations?
- Should a coroner be charged the same flat price for an external examination as they are a full autopsy? Why or why not?
- Some medical experts, including forensic pathologist Dr. Michael Baden, contend that visual examinations -- or external examinations -- are not autopsies at all, meaning they shouldn't be listed as such on death certificates or used in cases where state law requires autopsies. What would you say to that?