Medical examiner’s office goes under the microscope

The grim work of medical examiners has exploded into a pop-culture fascination in recent years, fueled by television shows such as “CSI,” “Law and Order” and their many spinoffs. Dr. Al Robbins, Dr. Elizabeth Rodgers and other fictional crime-solvers in powder-blue lab coats were welcomed into American living rooms, bone saws and all.

But ask most local residents the name of the real-life forensic pathologist in charge of investigating all violent, unnatural, suspicious or unexplained deaths here, and they’ll likely give a blank stare.

Pierce County Chief Medical Examiner Dr. Thomas Clark has an indispensable job for which he’s well compensated – his salary of $236,320 sits alone atop the county payroll.

He works largely behind the scenes, partly because the M.E. is an appointed position. That means voters don’t see a name on the ballot every few years, unlike Thurston and the more than two thirds of Washington counties that have coroners instead of medical examiners.

If Clark’s name does ring a bell, it’s probably because it appeared in prominent news reports in the TNT last week. He’s the subject of a whistleblower complaint, and a $5 million legal claim against the county, for alleged vindictive and contemptuous actions toward subordinates.

He’s also accused of emphasizing organ collection to an extent that some employees felt inappropriate, even unethical.

Clark has some hard work ahead, and despite the independence of his office, he will need outside help and oversight doing it. For starters, he must instill complete confidence that he can fulfill both vows in his office’s mission statement: “facilitating the recovery of organs and tissue to benefit the living, while providing thorough, consistent, impartial, and independent medicolegal death investigations.”

These twin goals are not incongruous, but they can be tough to manage. In 2014, when Clark invited the SightLife eye bank to move into his building in a groundbreaking partnership – still the only one in Washington – Clark recognized the challenge: “For all of us there's that conflict of potentially reducing the information we get from an autopsy by having allowed organ procurement to occur before the autopsy,” he said at the time.

The whistleblower contends this potential conflict has now metastasized into something real.

Among the allegations: forensic shortcuts being taken to allow faster collection of donor parts, and grieving families feeling pressured to sign over their loved ones' tissue.

In an interview Friday, Clark expressed confidence that he’s balancing the dual mission well. Sheriff Paul Pastor and County Executive Pat McCarthy also said they have no concerns about how the M.E. handles death investigations. And an outside review prompted by the whistleblower complaint found no evidence that forensic responsibilities have been compromised.

But the report does point to an office that has fractured after moving to in-house tissue collection – a big cultural shift.

Nobody questions that organ donation is a heroic act that saves and improves lives. Nearly 124,000 people in the U.S. were on a waiting list in 2014 for a life-saving organ, with six people added every hour.

M.E.s often hold the key to time-sensitive organ collection; up to 70 percent of potential donors come through their offices, according to the National Association of Medical Examiners. Working in cooperation with Clark’s staff since 2014 has helped SightLife and two other nonprofits recover corneas, skin, bone, heart valves and other donor material before bodies have “timed out.”

SightLife says Pierce County donors provided corneas for 1,167 sight-restoring transplants in 2015, with 28 percent of those made possible through the M.E’s office.

Clark didn’t immediately warm to the idea when he was appointed M.E. in 2010. After McCarthy hired him from North Carolina, he learned about a 2008 Washington organ donation law that said coroners and medical examiners “shall cooperate” with organ and tissue donation groups. He said he proceeded to meet that mandate in a way he considered most effective: by letting those groups recover tissue on site, but independent of his staff.

“We don’t have anything to do with recoveries,” he said Friday. “ We don’t push them, we don’t perform them. We are merely permissive.”

The whistleblower report leaves little doubt that Clark has displayed poor people skills during the transition, toward members of his 15-person staff, the public-safety profession and the public. He acknowledged Friday that he has a “direct communication style” that might come across as “abrupt.”

This style is understandable, to a point, in light of the detachment necessary for professionals to survive in this line of work. But Clark’s status as an unelected official demands vigilance from those who are elected. McCarthy – and whoever succeeds her as executive next year – must ensure Clark follows through on a performance improvement plan. Clark said he welcomes the help.

In the meantime, the unrest in his office should by no means discourage anyone from signing up to be an organ donor. It doesn’t take a forensic pathologist to understand that out of death springs the precious gift of life.