December 07, 2017
Area(s) of Interest: Advocacy Gynecologic Oncology
From medical staff independence to the corporate bar, the California Medical Association (CMA) and its county medical societies have long stood for and protected physician autonomy and independence. CMA strongly believes medical decision makers should be insulated from influence by laypersons who may not have patients’ best interests at heart.
“Physicians have a professional and ethical obligation to place the patient’s interest foremost, even in death,” says CMA President Theodore M. Mazer, M.D. “Allowing non-physicians to influence the practice of medicine in any way, shape or form, puts all patients at risk, and greatly diminishes the quality of care we can provide to our patients.”
In one area of California, this issue recently made national headlines when San Joaquin County’s longtime Chief Medical Examiner, Bennet Omalu, M.D., and forensic pathologist, Susan Parson, M.D., resigned over what they describe as a “routine practice” of interference from Sherriff-Coroner Steve Moore.
Moore, according to Dr. Omalu, regularly interfered with death investigations and used his political office to protect law enforcement officers in cases of persons who died while in custody or during arrest.
“The Sheriff does whatever he feels like doing as the coroner, in total disregard of bioethics and standards of practice of medicine,” wrote Dr. Omalu, best known as the doctor who identified chronic brain damage as a major factor in the deaths of NFL player, and the subject of the movie “Concussion.”
Dr. Parson’s allegations included Sheriff Moore "forcefully taking over physician scheduling to inserting himself into how Dr. Omalu and I perform our medical duties with attempts to control and influence our professional judgment and conclusions."
Dr. Omalu and Dr. Parson—with the support of CMA and the San Joaquin County Medical Society (SJCMS)—are now calling on San Joaquin County to immediately separate the Coroner’s Office from the Sheriff’s Office in order to guarantee the autonomy and independence of forensic pathologists and other physicians for the interest of the common good of the people of San Joaquin County.
“CMA salutes and supports physicians who uphold professional standards over outside forces,” says Dr. Mazer.
Immediate action must be taken to bring back public trust and integrity to the Sheriff’s Office and the Coroner’s Office in San Joaquin County. Dr. Omalu and Dr. Parson have said once the autonomy and independence of the San Joaquin County Coroner’s Office can be guaranteed, they will both consider withdrawing their resignations and returning to their jobs.
"Physician independence is paramount to avoid improper influence on the practice of medicine," said R. Grant Mellor, M.D., SJCMS president. "We urge the proper authorities to conduct a full investigation."
Physician independence is particularly critical in today’s health care environment, with major market consolidations that threaten to put profits and other non-medical-care considerations before the patients.
Under current California law, a county coroner does not have to be a licensed physician or pathologist. In fact, in 50 of California's 58 counties—including San Joaquin County—the sheriff also serves as coroner.
Sheriff-Coroner Moore’s actions—which have allegedly included pressuring the medical examiner to classify officer-involved deaths as accidents rather than homicides—border on the unlicensed practice of medicine, says Dr. Omalu.
“What is happening at the San Joaquin County Sheriff-Coroner’s Office is eroding the trust the public, every patient and every family place on the physician to provide the highest standards and quality of care without any perceived or real influence, bias or control of professional judgment,” said Dr. Mellor.
The issue of diminished public trust in the autopsy process is not new.
In fact, following another high-profile case in Ventura County, State Senator and physician Richard Pan, M.D., and State Senator Hannah-Beth Jackson jointly authored a bill in 2016 to ensure autopsies are conducted only by licensed physicians and that forensic autopsy reports are accurate and unbiased. The original bill language would have required licensed physicians to review and sign their approval for any post-mortem examination or autopsy conducted by a coroner or deputy coroner. If there was a dispute between the coroner and the reviewing physician, the original language would have required a separate qualified pathologist to make these determinations.
The final legislation (signed by Governor Brown) was amended, however, to remove language that would have explicitly prevented coroners and law enforcement officials who are not medical professionals from overruling a manner of death finding by a medical examiner or forensic pathologist. The new law, which took effect January 1, 2017, upheld the sheriff-coroner’s authority to decide the manner of death, but added a requirement to do so “in consultation with” the forensic pathologist who performs the autopsy.
“The facts in this latest case demonstrate that the law has to be improved so that law enforcement officials cannot interfere with the professional judgment of medical examiners and forensic pathologists to further their own agenda,” says CMA General Counsel and Senior Vice President Francisco Silva.
CMA urges San Joaquin County officials to take immediate action and will continue to stand with physicians against attempts to improperly influence the practice of medicine.