Schenk: This is episode 80 of the Nursing Home Abuse Podcast: Requesting a public autopsy in Georgia.
The Nursing Home Abuse Podcast is dedicated to providing news and information to families whose loved ones have been injured in a nursing home. Here are your hosts, Georgia attorneys Rob Schenk and Will Smith.
Schenk: Welcome to the show. I’m Rob Schenk.
Smith: And I’m Will Smith.
Schenk: Another interesting topic on the show today, something that hopefully the audience, the viewer, the listener, the reader will find useful. We’re going to be talking today about public autopsies, that is autopsies done by…
Schenk: …by state agencies, the medical examiner’s office, when they go down, how they go down, that type of thing. To help us guide us through this conversation, we have another guest. We have Gene Proctor, the Georgia coroner for Floyd County. We have 100-and…
Smith: 159, 155 – I always forget the exact number, but it’s like 155 counties.
Schenk: There are 155-ish counties in Georgia, and this gentleman that’s our guest today, Gene Proctor, is the coroner for Floyd County, which is located where, Will?
Smith: Northwest Georgia, so past Carrollton. I think it’s somewhere on the Alabama border.
Schenk: Yeah, definitely on the Alabama border. But can you tell us a little bit about Mr. Proctor?
Smith: Sure. So Gene Proctor has been directly involved in public safety for over 40 years now. He’s been active in all areas of service and holds two college degrees, one is an associates in science and the other is a B.A. in homeland security and emergency management.
He’s been in active in the fire service and EMS for many years. He retired as a paramedic supervisor after almost 30 years and has recently retired as the battalion chief of Fire and Rescue Services. He has worked as deputy coroner and chief deputy coroner for 10 years and was appointed as the coroner when the sitting coroner could not complete his term in office. He has currently been the chief coroner for one year.
Schenk: And Gene, welcome to the show.
Gene: Thank you. Glad to be here.
Schenk: All right. So Gene, we wanted to have you on the show today because many of our clients, they have loved ones who have passed away either in a nursing home or after having been transferred from a nursing home to a hospital, and they have questions about the laws surrounding autopsies, when the government is supposed to perform them, things like that. But from a general standpoint, Gene, can you tell us what a public autopsy is and what the purpose of it is?
Gene: Okay, the purpose of an autopsy is a fact-finding mission to discover the cause and manner of death and it’s for when you’re not sure what the cause or manner of death is. For instance, one reason for doing an autopsy is potential drug overdose, whether it’s intentional or accidental. That way with an autopsy, we can use those toxicology and do investigations on the inside of the body to make a determination of the actual cause and manner of death in that patient.
Schenk: And so how is your office alerted that an autopsy may need to be done? Is it the law enforcement that does that job or the family members?
Gene: Well it can be any of the above. Anybody can request a coroner to come out and investigate a death. Any death that’s outside of a hospital setting that is not under hospice would come under coroner’s jurisdiction, or if they’re in a nursing home. That’s one area where there is discrepancy. If it’s a nursing home death and we’re already in charge of that nursing home, we’ll pronounce that patient and they’ll sign death certificates and send it off to the funeral home. And a lot of times, unless the family alerts us to a situation at that nursing home, then we don’t know there was a certain situation there. We would not know to go and investigate it, pull medical records and potentially to an autopsy on that patient to find out what the cause and manner of death was on our own.
Smith: Got you. So a lot of that is slipping through the cracks potentially, I guess.
Gene: Yes, it is, which to me has always been an issue and a problem. I feel like it’s probably simply an issue of monetary stance for state and local government because by law, the coroner and deputy coroners are paid a per diem per case that we work, which is set forth by the General Assembly in the State of Georgia, and it’s $175 per case. That doesn’t matter if that case takes you one hour to work or if it takes you 60 hours to complete, you’re getting $175 for that case.
Smith: That’s insane.
Schenk: Yeah, I didn’t realize it was like that. So you kind of touched upon this. What are the instances in which it’s mandatory that the coroner’s office do an autopsy? I understand if there’s a suspected murder, if there’s a suicide, but what about – and I guess we’re getting into that deficit – our clients sometimes that there’s a possibility of abuse when they pass at a nursing home and an RN signs a death certificate. Would that have been something that would have automatically come under your jurisdiction?
Gene: It should have. If there are any signs or indications of elder abuse or anything, that’s one of the things that we really like to look for in a case that’s coming through. We don’t like the idea of those cases getting by us. It’s the way – it’s been a real, real hard process of getting changed within the state. We have effected a lot of good change in the state, but we still have a long way to go. The nursing home system, basically once you’re entered into that nursing home system, you removed your rights from outside intervention. The family members though, if they request a coroner’s visit on the person that is deceased, then we will come and investigate that case. We’ll come do a case file and investigate it and do everything we can to make a determination. Of course not all cases are going to be abuse and not all cases are going to go for autopsies.
Medical statuses is a huge thing we have to look at – was this person’s life actually viable to continue or were they in the process of dying, and what caused that process? Did somebody speed it up or was it just carrying through in its natural state? That’s why in my office, I require myself and all my deputies, we investigate every case as if it’s a homicide, a criminal case. And if you investigate them that way and disprove anything, then you come out with a good judgment.
Schenk: Gene, let’s back up from a logistical standpoint. So the family, they’re not satisfied that the RN signed the death certificate and there’s not going to be an autopsy, and they want to contact you to get that done. Take me through that process from the phone call to the autopsy. Where are people involved? What documents do you need? What permissions do you need to get, that kind of thing, if any?
Gene: Okay. By law, if they contact us, then we answer to the public in every county. There’s a thing in three counties in the state now that aren’t under the coroner’s system and they went under the medical examiner’s system, which to me is far, far less personal. We have the availability as coroners and medical examiners as the Georgia Bureau of Investigation. We have forensic death investigators there that are certified forensic pathologists, and their sole purpose is to make a determination of criminal activity with a death. But anyone can call the coroner of the county that the person resides in and they can initiate a coroner’s case.
Schenk: Okay, and so then tell me about then what the – I guess once you’ve made a finding, is that made public? Do you share it with the family? Where does it go from there, your report?
Gene: Okay, by law and most people don’t realize that with HIPAA, anybody’s medical files and things are kept totally in the secret. Upon a person’s death, those records are actually no longer covered under HIPAA. They can be obtained by people. An autopsy report is available. It’s part of public record. It’s kept in the office. People can request a copy of an autopsy by contacting the coroner that actually ordered that autopsy report.
Smith: Got you.
Gene: And it will provide them a complete description of the autopsy, the findings, toxicologies and anything else that are done in there. If there’s blood alcohol, which we do those on all the autopsies – we do blood alcohol, toxicology to see if there’s prescription drugs, illicit drugs or whatever in their system, and then we’ll have the autopsy findings. All that is compiled by the medical examiners and back to GBI and then translated back to us. We have a computer system throughout the state that we can access and pull this information up and be able to pull it up for families and whoever’s interested in it and release it.
Schenk: So depending on the conclusion in the report, I’m assuming that would get passed to law enforcement if they suspect abuse and in worst cases, murder, but I’m assuming that’s how it would work.
Gene: Right. If it comes back that those indicators show that there’s criminal activity involved, whether it’s abuse, drugs, it doesn’t matter what, then they’re immediately going to contact the coroner that ordered that autopsy and it’s up to that coroner to contact the presiding police agency and let them know. And we also have agencies like Adult Protective Services and things and DFCS that would have to notify also.
Schenk: Right. And so you mentioned a little earlier that it’s a flat fee of $175 for it whether the autopsy takes an hour or 60 hours.
Schenk: What’s the average time that your autopsy takes?
Gene: Well our autopsies are done by the Georgia Bureau of Investigation in Atlanta. We call them, arrange it, most of the time we get the individual sent down either that day or the next day, and then the day after, generally they have the autopsy completed. They won’t have the findings, but they will have the autopsy completed and then the person will be released to the funeral home of that individual’s choice.
The findings of the autopsy, if it’s – say I’ve pulled this before I started talking to you, I pulled the results off the GBI computer where I have cause and manner of a homicide that was here. I’ve got the cause and manner of death, but I will not have the complete autopsy results until the toxicology is cleared. A toxicology takes most of the time between three months or four months to get from GBI, and that’s because of the extensive process they use to process things.
Smith: Got you.
Gene: They go through in such an intricate manner – they pull sections from different areas of the body and it sends a different layout and then we can get a group concurrence of those findings. That way we know everything is exact in the findings that are coming back.
Schenk: So the gross exam can be pretty quick, but the actual labs is what takes the weeks and weeks and months and months.
Gene: Right. The gross exam, normally within 48 hours, the body will be released. It depends on the caseload at the GBI crime lab at that time, of course, but generally within 48 hours, that body is released to go back to the family. And like I said, it can take several months to get all the findings back because once they findings come back and they go back to the labs and that medical examiner and pathologist, they have to sit down and interpret all those findings and values that he’s gotten in and write a complete report on them, and that’s what’s issued to the coroner.
Schenk: So you mentioned that there are coroner’s offices in every county but three counties. What are the three counties that have the medical examiner?
Gene: Cobb County…
Schenk: I think DeKalb County is…
Gene: Clayton and DeKalb, I believe.
Gene: And Fulton – I’m sorry, there’s four. Fulton.
Schenk: And why is that? What’s your understanding of why that’s the case?
Gene: Well they initially, at one time it was put into mandate that they wanted every county with a population excess of 100,000 people to go into the medical examiner’s system. That was the logic from a long time back. They thought it was so much better. But it’s so expensive to do. It’s very, very cost prohibitive for a local agency to be able to handle that kind of a load.
Schenk: So every county except for those four are sending the individuals for autopsy to the GBI, but the medical examiner’s offices in those county are actually doing the autopsies in those four counties. Am I understanding that correctly?
Gene: That’s correct. That’s correct. They hire their own pathologist and maintain their own lab facilities and how they do them in their counties, that’s up to them. But coroners throughout the state are governed by the Senate and Congressional seats of the state. We’re under the control of the government in the state of Georgia because coroners are elected. We’re an elected position. The deputy coroners that work under us are appointed positions and they work at the luxury of the coroner.
Schenk: Going back to all the logistics of it, what’s the window of time that a family has to alert your office to conduct a public autopsy?
Gene: Well it used to be that you could kind of hold off a while on it if you wanted to because so many people did burials. As long as the body has not been embalmed, we can still take that body and do it. Even if that body has been embalmed, we can still get some fair results off of it, but not really good determination factors will be there once that body is embalmed. Of course, if it’s cremation, there’s nothing left to examine.
Schenk: It’d be hard.
Gene: Yeah, right now in the last reports that I’ve got in the state of Georgia, we’re sitting at close to 60 percent in cremations compared to burial.
Schenk: Oh wow. So okay, so then tell me about – what if a family doesn’t want an autopsy done, even if it’s mandatory under the law? Is there an exception for religious reasons or just personal reasons? Is there a way around it?
Gene: No, there’s not. Really, I haven’t encountered any actual religious reasons for someone not wanting an autopsy. I have had some people who didn’t want it because they didn’t want to put their family member’s body through that, but if it is – one, it’s mandated by law, such as a pediatric death – anyone 17 years of age or younger – if there’s anything that happens to them, there’s a 99 percent change they’re going for an autopsy. Any case that’s going to be criminal activity, they’re going for an autopsy. Any case where I can’t make a determination of what was the cause or manner of death in an individual, doesn’t matter the age, I’m going to send them for an autopsy.
Schenk: So you’re overseeing the autopsies only in Floyd County then, is that right?
Gene: Yes sir. Yes sir.
Schenk: Okay. And then tell me about the process – do you testify later in criminal or civil cases with regards to the findings?
Gene: Oh yes sir, yes sir. Anything that a coroner does from beginning to end is a legal document. It’s classified as an open, legal document. What I do most of the time, if I’ve got suspicions on something, if the individual’s been in the hospital, a nursing home, whatever, it doesn’t matter, as a coroner, your constitutional office, which carries the same rating as a district attorney, sheriff of a county, a judge, so I can actually write – the coroner of a county can actually write their own subpoenas to secure records. And I write a number of subpoenas every month to retrieve records so I can make the determinations on the cause and manner of death in a lot of these people.
Schenk: So medical records, so you’re subpoenaing hospitals and nursing homes?
Gene: Right. Right.
Schenk: Okay, I see. So can you walk us through what does the report look like? Is it 50 pages? Is it pictures? What are we looking at?
Gene: With the autopsy report?
Schenk: Yes sir.
Gene: The autopsy report usually comes back. It will range in size. It depends on the study that’s being conducted. Most of them that they release out are about 10 to 15 pages.
Schenk: I see.
Gene: There are no pictures. If you want pictures and a more extensive report, you can actually get those through the medical examiners, but you have to subpoena the medical examiners and bring them into court to get that.
Smith: Got you.
Schenk: Do you have an understanding between the difference of public and private autopsy in your experience? Is the public autopsy as good or the same quality as the private autopsy?
Gene: Actually the public autopsies, what we do through the Georgia Bureau of Investigation, are probably a lot better and a lot more extensive than what a private autopsy will be. Private autopsy will go in and look usually for one variable. And with the public autopsy, like what we do through the Georgia Bureau of Investigation, they’re going in with an open mind and looking for every variable possible. It’ll be a complete study from head to toe on that individual. Private autopsies in court, a lot of times from what most of the forensic pathologists say won’t hold up because a pathologist doesn’t carry the weight that a forensic pathologist does in making the determination in the cause and manner of death.
Schenk: Can you tell us, for the listener, Gene, what the difference is between a forensic pathologist and a pathologist?
Gene: A regular pathologist is one that – a pathologist would dissect into the body after someone, say, has had a heart attack, a myocardial infarction. They would go in, go to the heart. They would take the heart out, weigh it, dissect it, look and find where the clot was and make the determination that, yup, this was the clot that caused the death.
A forensic pathologist would take that same patient and do the same, get the heart, get the heart out, dissect it, weigh it and then they would find the clot that caused the problem or the irritable foci that caused it to have the arrest. And then they would go a step farther and say, “What caused this clot to be here in the first place?” Were there drugs involved? Was it too much medication? Too little medication? Was it an injury of some type that caused this to happen? Did they get hit in the leg two weeks ago and they had a clot that hit there and then that clot turned loose and come up to the heart and caused EMI? That’s the very, very basic difference between a forensic pathologist and a regular pathologist.
Schenk: Much more thorough in starting from eliminating causes rather than trying to justify a cause.
Gene: Exactly. And there are a lot more expensive to hire and keep on payroll too.
Schenk: So let me ask you this then. Would there be any reason why, maybe not your office, but another county coroner office would have a tendency to decline autopsies by families who have members that have died in nursing homes? Is there somebody – is there a reason to say, “Well this doesn’t meet the strict definition of the law?” in other words?
Gene: Well the coroner has that ability. Once a coroner is contacted about a case, we will take that case, investigate it out and make the determination of yes, it needs autopsy, or no, it doesn’t. We’ll turn around and call the GBI in Atlanta and speak with them down there and talk to a forensic pathologist down there about the case, and they have the final say so about yes or no they’re going to do that autopsy.
Gene: That way, if they say that they’re not going to do it, then the burden is on them then. If they don’t want to do it and we know that something’s wrong, then the burden is passed across to them and they have to prove right or wrong at that point.
Schenk: Is there anything in your experience that’s a borderline case or a bright line case for an autopsy with regard to someone who’s passed in a nursing home? Does it require that there’s bruising on the face or there’s a broken bone? Like what automatically triggers and what needs to be investigated more in your opinion?
Gene: Well anytime you’ve got someone in a nursing home or any type of care facility, they should be, the family should be vigilant in watching for changes in that person, in that individual. Have you noted bruising in the patient? Have you noticed on the shoulders and arms? Are there marks that look like pressure marks for hands and fingers? Do their legs look like they’ve been pulled on, marks on their ankles, on the legs? Are there slap marks on them? All of that should be taken into consideration. And don’t be ashamed. Check that patient’s bottom. Find out have they been laying in dirty diapers if they’re bedridden. To me, these are all travesties that happen to the senior public and sometimes not the senior public in those, and to me the caregivers in that industry need to be held responsible for their actions.
Schenk: Sure. Sure. Well Gene, we really appreciate this information. Like I said before off air, we have a lot of listeners out there that are looking and searching for this information so we’re really glad you were able to take some time out of your day to come on the program with us.
Smith: Yes sir, absolutely.
Gene: I’m more than glad to help. I’ve enjoyed speaking with you. If anybody would like to contact me that has questions, which you can contact your local coroners through going on the web, going on the Internet and looking under Georgia Coroners Association, and every coroner and deputy coroner in that state will be listed on that website, and you have a phone number there where you can have a contact to get in touch with them. If you have any trouble with that, anyone is more than welcome to contact me. They can call my office.
Smith: And how would they go about doing that? We’re going to put up the Coroners Association on the screen and any other numbers you want to give us.
Gene: Okay. If they would like to contact me and I can help them with anything like that, they can call my number in my office – 706-314-1328.
Schenk: Great. All right, Mr. Proctor, we thank you very much for being on the show, sir.
Gene: Thank you very much for having me and I really enjoyed speaking with you guys today.
Smith: Yes sir, thank you.
Schenk: Have a good day.
Gene: All right, bye-bye.
Schenk: Yeah, it’s very important for families to fight for the autopsy if their loved one passes under those types of circumstances, if there’s a suggestion of neglect or abuse. It’s mandatory under Georgia law that an autopsy be done, so contact Gene, contact your county coroner or your medical examiner if you’re in those four counties.
Smith: Yeah. And here’s something interesting. In preparing for this, I looked into the word “coroner,” and it actually comes from the same word as “crown,” as in the Crown of England, so the royal family, because it started around the Norman conquest in 1066 in England, and when they developed the different articles for the royalty and for the government, one of the agencies was the coroner’s office. And originally their job was to deal with not only certain financial issues, like if somebody found a cove of treasure, also known as a treasure cove, then the coroner’s office would deal with that, or if there were suspicious deaths, the coroner’s office would deal with that. Nowadays, that is transformed with somebody who deals almost, in the United States at least, exclusively with death, so it’s interesting.
Schenk: That was interesting.
Smith: Yeah, I can tell.
Smith: I just thought it was interesting. The word “coroner” comes from a Latin word from “crown,” so it’s the same etymologically as the word “crown.”
Schenk: What year was the Norman Invasion?
Schenk: In what famous battle? Some say the most important battle of Western civilization?
Smith: I can’t remember. It’s William the Conqueror.
Schenk: The Battle of…
Schenk: The Battle of Hastings.
Schenk: At any rate, I think that’s about it, unless you have more about the root of the word “coroner.”
Smith: No more. No more. But the cat’s out of the bag, so I guess that’s what matters. And speaking about the cat being out of the bag, August 18th is International…
Schenk: August 8th.
Schenk: Which is Wednesday, is International Cat Bag Day.
Smith: Well International Cat Day.
Schenk: It’s not International Cats Out of the Bag Day?
Smith: No. I was using that as a segue. Anyways…
Schenk: Got you. Anyways, that’s it for this episode. You can get a new episode every Monday morning. You can watch us on our YouTube channel or check us out on the website, which is NursingHomeAbusePodcast.com – you can check us out wherever you download your audio or MP3s from, Spotify, Stitcher, iTunes, Podcast Puppy, wherever that is. And then you can read it. You can read the transcript. If you’re in a hurry, it’s much quicker to read, at least in some people’s cases. My mom reads really fast. You can also actually on a lost of these apps hit the two-times speed button, two-times speed button and listen really fast, so that might be something you really do.
Smith: Or just go read it on the website.
Schenk: Or just click stop at this point instead of having to go fast on this one. But anyways, we thank you very much for your attention and with that, we’ll see you next time.
Smith: See you next time.
Thanks for tuning into the Nursing Home Abuse Podcast. Nothing said on this podcast either by the hosts or the guests should be construed as legal advice, nor is intended to create an attorney-client relation between the host or their guest and the listener. New episodes are available every Monday on Spotify, iTunes, Stitcher or your favorite podcast app, as well as on YouTube and our website, NursingHomeAbusePodcast.com. See you next time.