The needs of the living sometimes compete with those of the dead when it comes to organ donations and investigating homicides and other deaths.
Both must be dealt with quickly after someone dies, and if care isn’t taken, one can interfere with the interests of the other.
Some say that in almost all cases the dead can be given justice, while also being donors for the living.
Pierce County’s chief medical examiner, Dr. Thomas Clark, came under scrutiny after one of his employees made a whistleblower complaint in August, alleging he was putting organ donations above death investigations.
An outside review commissioned by the county found that while Clark placed a high emphasis on facilitating donations, he didn’t compromise the office’s ability to do its job.
The Seabold Group, a Seattle consulting firm, wrote the report, which was given to The News Tribune by attorney Joan Mell, who represents whistleblower Melissa Baker.
Baker, alleging Clark has retaliated against her for speaking out, recently filed a claim against the county seeking $5 million in damages.
“The evidence overwhelmingly supports the allegation that Dr. Clark’s actions in the workplace are perceived as arrogantly vindictive, and in some cases deliberately cruel,” the Seabold Group report said.
As for the office’s procedures regarding organ donation, the investigation found they made some medical examiner staff members and law enforcement detectives uncomfortable.
The staffers and detectives told the outside investigator they feared that the access donation groups had to bodies could interfere with cases.
“A few ME investigators expressed uneasiness at the lengths to which the ME’s office was going to facilitate the (organ donation) process, making it seem to one like a ‘chop shop,’ ” the report said.
Nevertheless, the report found the procedures did not seem to hurt death investigations.
‘THIS IS WORKING VERY SMOOTHLY’
The medical examiner’s office is charged with investigating sudden, unexplained, suspicious and violent deaths in the county. That means figuring out cause of the death and the manner.
Law enforcement agencies use the office’s autopsy findings and evidence gathered from the deceased person in criminal investigations.
In recent years, the medical examiner’s office has worked with outside procurement groups, providing access to bodies for organ-recovery efforts.
Clark, who has been the county’s medical examiner since 2010, explained the office’s relationship with the groups to The News Tribune during a recent tour of his facilities at 3619 Pacific Ave. in Tacoma.
The donor organization that works most closely with the medical examiner’s office is the Seattle-based nonprofit SightLife, whose focus is on recovering corneas for replacement surgeries.
SightLife plays another important role in the state’s donor community: coordinating logistics for other donation groups whose technicians recover other types of organs.
SightLife started renting a small office in the medical examiner’s building in 2014. That’s when Clark started making changes in policies and procedures to increase donations.
Sherry Anderson, partner relations manager with SightLife, does administrative work out of the office.
“It isn’t about every family saying yes to donation,” she said. “It’s the option. It’s the choice that empowers a grieving person.”
In 2013, before Clark started focusing on donations, SightLife had three donors who came from the medical examiner’s office, out of 884 deaths over which it had jurisdiction.
In 2015, after Clark made procedural changes to increase donations, 326 donors came through his office out of 1,027 that the office had jurisdiction over.
The organs are recovered in the building’s autopsy suite area. In the case of corneas, the recovered tissue then is taken to SightLife’s lab to ensure it’s fit for donation. The tissue then is shipped to a surgeon to be transplanted.
No medical examiner employees take part in the process.
Clark said he is happy with how the arrangement has been going.
“Right now, this is working very smoothly,” he said. “The quality of our death investigations has not suffered.”
Probably the biggest procedural change he’s made in the office is to do the autopsy in two parts, Clark said.
The first involves an external exam of the body by a medical examiner employee to look for wounds and document height, weight and other details about the body.
After the exam, technicians with SightLife or other organ groups are allowed to recover what they can from the body. That can be corneas, a heart valve, other tissue or a combination. Other organs, such as the heart or kidneys, can be donated only in a hospital setting.
After the recovery is done, the autopsy is completed, often the next day.
In cases of potential conflicts between the goals of the death investigation and an organ donation, it’s usually possible to make a plan that doesn’t require either side to compromise, Clark said.
If needed, his office will restrict what can be donated, though that is seldom necessary, he said.
For instance, the medical examiner’s office might decide the area around an organ must be left intact for the death investigation, or that the person’s clothing needs to be undisturbed.
Even in that same case, Clark noted, the person’s corneas might still be an option for donation.
“There’s really no reason that you can’t have it all,” Clark said.
SHARING THE BODY
Clark said he initially was hesitant to partner with SightLife.
“At first, I said no,” he said. “It was a little bit scary.”
For many years, Clark said, those in his field resisted cooperating with organ-procurement agencies because of worries that donations could hamper death investigations or potentially affect criminal prosecutions.
He said he eventually came to see how arrangements could be made to serve both the dead and the living.
Early in his conversations with SightLife, Clark said, it became clear his office and the donation groups need access to a body at the same time, and they both need it quickly.
“We could miss something because we didn’t get access to a body quickly enough,” he said. And for organs to remain viable, they need to be recovered quickly, too.
It took months to figure out how to make shared access work, he said. For one thing, communication was streamlined using a shared database to ensure everything is done in time, he said.
As soon as a medical examiner’s investigator gets information such as the name, date of birth and location of the body, it and a brief summary of what happened is put in the database.
A SightLife employee will see that immediately and then check to see whether the person is registered as an organ donor. If so, the person’s medical records are reviewed, and family is contacted.
The decision on whether to go ahead with a donation is noted in the database for the investigator to see. That cuts out phone calls back and forth that used to take more time, Clark said.
He thinks both sides have gotten more efficient in other ways, and noted that none of the changes has cost the county any money.
For instance, his office now has easy access to medical records, which can aid in determining how someone died. It used to take days to get medical records, which meant investigations took more time, Clark said.
“It’s not common for medical examiners to have access to medical records,” he said. “We’re way ahead of the curve on that.”
SightLife contributed to that change, he said, by helping the county contact local hospitals, which led to training on federal privacy regulations, and then access to the records.
Part of working together means SightLife and the medical examiner’s office come across ways to help each other on cases, as well.
“Sometimes they find something that’s relevant to us,” Clark said. “Sometimes we find something that’s relevant to them.”
And, he said, they’re still finding new ways to interact.
Clark said he recently discovered corneas can be better preserved if investigators take the time to elevate the decedent’s head, lubricate the eyes and tape them shut.
SightLife now supplies the saline solution and tape for that to be done.
The organization sometimes helps find family members of the person who has died. Clark said its workers occasionally leave investigators notes that state something like: “I found a relative, here’s a phone number.”
LAW ENFORCEMENT LEADERS SAY SYSTEM WORKS
The outside report stemming from the whistle-blower complaint said it appeared Clark had changed his office’s procedures concerning organ donations without the input of staff members or law enforcement officials.
Clark told The News Tribune he did consult his employees and local police leadership.
“They also recognize that this is a service to the family,” he said of law enforcement. “No one has really objected.”
Sheriff Paul Pastor said he asked his detectives recently about the changes.
“They’ve indicated to me that they do not have a problem with Dr. Clark’s methods, and it has not gotten in the way of proceeding with collection of evidence for cases,” the sheriff said.
“Certainly, in dealing with evidence in serious crime cases, in homicide cases, we do need to take care. At the same time, I think that organ donation is a good thing.”
Lakewood police Chief Mike Zaro said he knew of no cases the new procedures had hurt.
“We are not aware of any Lakewood investigations that were negatively impacted by the actions of Dr. Clark,” he said in a statement.
A Tacoma Police Department statement from spokeswoman Loretta Cool, on behalf of the Criminal Investigations Division, was of a similar vein.
“We are in constant communication with Dr. Clark and his staff regarding our investigations and have no concerns regarding the quality or completeness of the work they perform,” it said.
“As death investigators, we share a mutual understanding of the need for forensically sound death investigations as well as an understanding of the important role organ donation plays in sustaining life.”
The Seabold Group’s report included two allegations about recent cases from Clark’s office. In one instance, a detective asked for fingernail scrapings from a stabbing victim, and was told the hands had already been washed.
In another, staff members said a tarp that had been wrapped around a body contained maggots. It was shaken out in the parking lot at Clark’s instruction.
Whistleblower Baker said the tarp should have been sifted through for evidence, instead. Another staff member interviewed said that sort of thing usually would have been done where organs now are recovered in the autopsy area.
‘WE ALL AGREE THAT WE CAN DO THIS’
Ask medical examiners and coroners elsewhere how they deal with organ donation, and the answers vary.
“If you were to sit down with 10 forensic pathologists, you’re going to have different opinions on how that takes place,” Thurston County Coroner Gary Warnock said about whether and when to allow homicide victims to be donors.
“Some pathologists will say: ‘If this is a homicide case, absolutely not.’ No one will touch that body until they get to it on the day of autopsy, because they don’t want anything disturbed and they want to see it as is.
“That’s just a matter of opinion from one pathologist to another. Some pathologists will say: ‘Sure, go for it.’ ”
Kitsap County, for instance, does not allow organ donations from homicide victims.
“We maintain a very good relationship with (organ-procurement groups), and we want to continue to do so, but not at the expense of losing evidence in a homicide,” Coroner Greg Sandstrom said. “For other cases, I think absolutely they should be allowed to go ahead with the family’s permission.”
King County allows organ donation in homicides, but on a case-by-case basis, such as in Pierce County.
“The challenge is to try to maintain some balance between what we do, in death investigation, and what is a service to the community in terms of facilitating organ and tissue procurement,” King County Chief Medical Examiner Dr. Richard Harruff said.
“... With a reasonable approach from trained professionals, we can certainly sort out what is acceptable and what is not. The investigation takes the priority, but there is certainly an opportunity for donation in just about any type of circumstance, including homicide.”
While many procedures vary among offices, King, Thurston and Kitsap counties handle some matters the same way — and differently — from how Clark operates.
For example, they don’t rent office space to the organ groups, though some allow them to recover donations in their facilities.
And, unlike in Pierce County, they put bags on the hands of all homicide or suspected homicide victims to preserve trace evidence.
“Generally, we bag all the hands as an operational policy,” said Harruff of King County. “I can’t say what decision Pierce County would make, but bagging the hands is sort of a standard thing to do.”
Warnock and Sandstrom said their offices do it, too.
The action is taken in Pierce County when a detective asks that the hands be bagged, or when the medical examiner’s office thinks it’s necessary, such as a close-contact assault.
But the office no longer does it for all homicides.
“Most cases don’t have any trace evidence,” Clark said about the change in policy. “It was wasted effort on our part.”
By taking out that step, he said it’s made both the death investigation and procurement processes more efficient.
The access that organ groups have to bodies in Pierce County is another difference from other offices.
The part of the building where bodies are stored is monitored by cameras, and the security system records all entries to that area, Clark said. SightLife technicians, who undergo background checks, use their badges to get into that space, which leaves a records, he said.
In Kitsap, recovery technicians must be accompanied by someone in the coroner’s office when they visit.
Thurston County gives recovery technicians keycard access to where bodies are stored, but all homicide victims or suspected homicide victims are in locked body bags, Warnock said.
Harruff’s office is a division of the King County Health Department, which has additional privacy regulations.
Only staff members have access to the autopsy area and where bodies are kept. Recovery technicians take the body elsewhere to retrieve organs, as opposed to getting full access to the King County facility.
Harruff said he does not have concerns about Clark’s procedures.
“These are all responsible agencies that are working together to meet the needs of the community and provide a high level of death investigation,” he said.
“I haven’t heard any complaints that they’re not. ... We all agree that we can do this (facilitate organ donations) without compromising investigations.”
COMES DOWN TO ETHICS
After The News Tribune left a message with the International Association of Coroners & Medical Examiners about organ procurement, former president John Fudenberg returned the call.
He said concerns about organ donations interfering with law enforcement efforts is overblown.
“There’s no case that I’m aware of where procurement affected the prosecution of a death-related to a criminal offense,” he said.
Fudenberg is the coroner in Clark County, Nevada, where his office leases space to an organ-procurement group.
Though unfamiliar with Clark or Pierce County’s setup, Fudenberg said he liked the basics he was told about the work being done here to partner with organ-donation groups.
“My opinion is that it’s perfectly fine to do that,” he said. “For them to accept money and lease a space, that’s more than appropriate, provided they’re acting ethically and making ethical decisions. ...
“It sounds like they are doing everything right. They are going above and beyond to allow procurement, and that’s very unusual.”
The shared database, in particular, made sense and sounded progressive, he said.
“The bottom line is, either you’re ethical or you’re not,” he said. “It can be a very good thing for saving lives.”
In 2015, SightLife played a role in more than 6,600 people — 1,049 of them Washington state residents — being able to see again.
The non-profit eye bank — which recovers corneas, makes sure they’re fit for donation and distributes them — started in Seattle in 1969, and today has 225 employees.
Some of the workers are recovery technicians, who remove the corneas for donation.
In doing the procedure, the technicians — under a requirement from by the federal Food and Drug Administration —take down a medical and social history of the person, which is done by calling their family.
If the person is not a registered donor through the state Department of Licensing, SightLife contacts the family to ask permission for the donation.
Its technicians also get medical records, and physically inspect the body to look for any conditions that might make the person ineligible as a donor.
A blood sample is taken and tested for HIV and other diseases.
After the corneas are removed they’re taken to SightLife’s lab, where they’re checked for damage or other problems. If they meet criteria, they’re packed in an ice container and sent to a surgeon to be transplanted.
Medicare and private insurance companies reimburse SightLife for the recovery, processing, distribution of the corneas, and for managing the donation system.