Forensic files 

Don’t call it an autopsy service and please don’t call it CSI: San Antonio. The Bexar County Medical Examiner’s office is staffed with trained physicians who are board-certified forensic pathologists. They investigate traumatic and sudden deaths and it may take months — not one hour — to wrap up your loved one’s case.

Dr. Randall Frost, chief medical examiner, compares his duties to how local law enforcement might respond to different calls. “It may be a quick 10-minute write-up on a fender-bender or it may be a long, involved, vehicular-homicide investigation,” said Frost, 49, who has worked at the department for 10 years.

The medical examiner’s office must investigate deaths within 24 hours of hospital or jail admission, suspicious or unnatural death, suspected suicide and death of children younger than six. Not every demise has to be shrouded in drama, however. The office also investigates natural deaths that occur under a physician’s care — but with an unclear cause — and those who die without a doctor’s care.

Considering the demands from the state, it’s safe to say the Bexar County office is busy. “We don’t take requests from family members,” Frost said.

The 43-person staff consists of six physicians, nine medical investigators, and eight toxicologists. In 2006, the team investigated about 9,200 deaths and, of those, only 14 percent required autopsies. “The fact is, a lot of people don’t like the idea of having an autopsy done on their loved one, so we’re not going to do one unless it’s absolutely necessary,” Frost said. The staff determines the majority of deaths by less-invasive means: external exams, medical records, blood tests, and interviews with witnesses and caregivers.

The local news is Frost’s first briefing of the day. He’ll hear of an accident or homicide and know he’ll see the deceased later at work. He can usually tell if it will be a busy day, but not every case makes the news. “Sometimes you hear of nothing and the morgue is overflowing,” he said.

Medical examiners across the country have seen a steady increase in their business over the past 30 years, partly due to a 1971 ruling by the Joint Commission on Accreditation of Healthcare Organizations which eliminated a longstanding rule requiring hospitals to have a 20-percent
autopsy rate to receive accreditation. In the 1960s, hospitals averaged about a 40 percent autopsy rate, according to the Centers for Disease Control and Prevention. That rate dropped to 7 percent by 1996, and it is assumed by those in the profession to be even lower now. “It’s one of the great problems we have right now — hospitals getting out of the autopsy business,” Frost said.

Consultating on out-of-county deaths is also bumping up the Bexar County medical examiner’s business. Texas has an old rule on the books that allows only counties with more than one million people to have medical examiners. So of 254 counties statewide, only 12 have medical examiners. Otherwise, justices of the peace investigate and determine causes of death. “It’s terribly
archaic and dangerous,” Frost said. “It badly needs to be changed, but I don’t know if that is going to happen in my lifetime.”

The justices of the peace in about 35 surrounding counties may call on Frost’s team to assist in a case. However, the medical examiner doesn’t have the same authority to investigate the death as he would if it occurred in Bexar County. He can perform an autopsy and a few other examinations, but he can’t subpoena people, obtain medical records, or hold an inquest. “We can’t force anything,” Frost said. “ The JP can certify the death as we suggested or totally ignore what we have to say.”

Forensic pathologists are a rare breed within the medical community. “We’re on the fringes of medicine,” Frost said. They don’t interact with patients, deal with insurance companies, or risk lawsuits. They are not trying to save lives. “The rest of medicine is geared toward treatment,” Frost said. “We are geared toward diagnosis and putting the puzzle together that eluded other physicians.”

In addition to medicine, forensic pathology spans many disciplines: anthropology, ballistics, toxicology, and meteorology. This variety drew Frost to the field. “I’ve always been more of an eclectic person instead of the super-specialist,” he said.

And one must be able to digest the sight, smell, and feel of death. “There are a lot of physicians who don’t like seeing the darker, seamier side of life,” Frost said of those who rotate through as residents and never return.

After all Frost witnesses on the job, he takes a few precautions in life, including avoiding peak hours when San Antonians may be intoxicated: “I don’t drive between the hours of 10 p.m. and 6 a.m. unless I absolutely have to.”

The general population, he says, exaggerates the stress involved with his profession. “(Forensic pathology) selects for people who can handle (the subject matter), divorce themselves from it, and look at it dispassionately.”

And many people ask him about the fancy tools they assume he must use. But his response is: “We use our eyes, hands, and a good knife.”


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