Friday, July 03, 2020

Hiding the medical truth

 In the US, death investigations aren’t necessarily overseen by qualified professionals. In most US states, officials who oversee autopsies are not required to have a medical degree. The departments responsible for investigating suspicious deaths often lack funding and oversight, and work closely with – if not under the supervision of – law enforcement. As a result, many deaths at the hands of police are never reported as such, or are minimized by diagnoses that blame the victim’s heart disease or mental illness rather than an officer’s boot or bullet.

A group of physicians and psychiatrists signed a letter condemning the system wherein “autopsy reports are manipulated to bury police violence”.
“Black people are suffocating under the weight of anti-Black hatred. They cannot breathe,” their message, published in Scientific American, reads. “And even as they gasp for air, structural gaslighting operates to deny the truths of the causes of their suffocation.”
The process – a crucial element in the US criminal justice system – is regulated by a patchwork of often confounding, quirky rules and norms. While death inquiries in some communities are directed by medical examiners with medical degrees and board certification, most are overseen by coroners, who don’t necessarily have specialized training.
Only four states – Kansas, Louisiana, Minnesota and Ohio – require their coroners to be physicians, and only 16 states have laws specifying training requirements for the function.
In some communities the job is an elected position. In many it is directly tied to the sheriff’s department. In the state of Georgia, the mayor of any town with 5,000 or fewer residents is officially authorized to also serve as the coroner – and vice versa. Many county coroners in the state are funeral home directors and the position often allows morticians a first crack at selling funeral services to families. Pastors, handymen and plumbers have also been elected to the position.
In Colorado, where coroners are elected in all but one county, the only requirement to run for the office is a high school diploma and US citizenship.
In cases of unnatural deaths, many local governments require autopsies to be performed by trained forensic pathologists. But ultimately it’s often the coroner – and not the pathologist – who decides whether to sign off on the final death reports.
That has been a consistent issue in most California counties, where the chief coroner and sheriff are one and the same. In 2017, two medical examiners employed by San Joaquin county in California resigned, alleging that the sheriff-coroner Steve Moore pressured them to change their autopsy results for deaths in police custody.
Efforts to fully disentangle death investigators from police in California have failed. A bill to simply keep law enforcement out of pathologists’ exam rooms when they were investigating deaths in police custody failed, and another to require large California counties to establish an independent medical examiner’s office was vetoed in 2018.
“There’s just real egregious conflicts of interest in investigating officer-related deaths, across the country,” said Justin Feldman, an epidemiologist at New York University who studies police violence. That is one reason officer-related deaths are underreported, he said.
In cases where victims are choked, beaten or Tasered by law enforcement, investigators have even more leeway in how they might characterize the cause of death. Often, these deaths are described a result of “excited delirium” – a controversial diagnosis that is not recognized by the American Psychiatric Association, the American Medical Association or the World Health Organization. People with excited delirium are said to gain “superhuman strength” and become aggressive under the influence of drugs such as cocaine and methamphetamine. When they interact with law enforcement, they are said to struggle and collapse, essentially killing themselves.
The Hennepin county medical examiner’s autopsy of George Floyd listed the cause of death as “cardiopulmonary arrest complicating law enforcement subdual, restraint, and neck compression”. 
“Cardiopulmonary arrest just means death,” said Dr Roger Mitchell, the chief medical examiner of Washington DC. “It means his heart stopped beating – that’s a very technical way of saying it – due to neck compression..., we know that George Floyd’s intoxication, or George Floyd’s heart condition, played absolutely no part in his death.”
 Floyd’s autopsy listed several underlying health conditions, including heart disease and hypertension, and included a toxicology report that found levels of “cannabinoids, amphetamines, and fentanyl/metabolites” in his system – even though none of those factors appear to have caused his death.
Dr Jennifer Tsai, an emergency medicine physician at Yale said, “there’s character assassination in this process in describing the medical facts. “This is a pattern we see over and over again,” Tsai said.

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