'Concussion' Doctor Omalu Quits as Coroner; Claims Interference

Alicia Ault

December 11, 2017

Charging interference by the county sheriff that resulted in delayed autopsies, autopsy procedures performed by unlicensed personnel, and potentially fraudulent death classifications, famed "Concussion" pathologist Bennet Omalu, MD, has resigned as chief coroner of San Joaquin County, California, following in the footsteps of a colleague who stepped down earlier.

"The Sheriff does whatever he feels like doing as the coroner, in total disregard of bioethics, standards of practice of medicine, and generally accepted principles of medicine," said Dr Omalu in a memo to the San Joaquin County Board of Supervisors.

Dr Omalu told Medscape Medical News that he is speaking up because "this is about striving to uphold the truth." He said his faith guided his science. "My only motive is the Gospel of John, Chapter III, verse 21," he said. That biblical passage reads: "But whoever lives by the truth comes into the light, so that it may be seen plainly that what they have done has been done in the sight of God."

Dr Bennet Omalu

The sheriff's office shares death investigation duties with the medical examiner's office — a working arrangement that Dr Omalu, and colleague Susan Parson, MD, a forensic pathologist, said had to end if they were to continue working for San Joaquin County.

Both the California Medical Association (CMA) and the San Joaquin Medical Society (SJMS) have called on the San Joaquin County Board of Supervisors to make the coroner's office independent. "Recent events at the San Joaquin County Sheriff-Coroner's Office threaten to erode the trust that every patient and every family place on physicians to provide the highest standards and quality of care without any perceived or real influence, bias or control of professional judgment," wrote SJMS President R. Grant Mellor, MD.

"Physicians have a professional and ethical obligation to place the patient's interest foremost, even in death," said CMA President Theodore M. Mazer, MD. "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."

But separation of the offices may be an uphill battle. According to Dr Mellor, under current California law a county coroner does not have to be a licensed physician or pathologist, and in 50 of California's 58 counties, the sheriff also is the coroner.

In San Joaquin County — which recorded 5308 deaths in 2016, of which 2703 (50.9%) were reported to the Coroner's Office, leading to 515 full autopsies — the relationship became highly contentious. By law, only a licensed physician can determine the cause of death, and "the Coroner is charged with determining the manner of death (how the death occurred; ie natural, accident, suicide, homicide or undetermined) after consultation with the licensed physician," wrote Dr Parson in her letter of resignation.

She said that although she has worked in other Sheriff-Coroner's offices, "I was not prepared for the distressing and obstructionist actions and behaviors of Sheriff Steve Moore."

Changing Officer-Related Death Cases

Moore was first elected Sheriff-Coroner in 2006. Now in his third term, he's up for reelection in 2018. Dr Omalu is best known for having first identified chronic traumatic encephalopathy in professional football players, and was the subject of the 2015 movie, "Concussion." He began working for the San Joaquin County's Sheriff-Coroner's office in 2007. Dr Parson joined in September 2016.

Dr Omalu said that problems with Moore began almost immediately. "Sheriff Steve Moore ran the office like a dictator and intruded upon my autonomy and independence as a physician," wrote Dr Omalu in a memo submitted to the board of supervisors. "He ran the coroner's office as a sheriff's office, which went against the law regarding consolidated offices."

He said he chose to stay on, believing that he could still make a difference. In May 2017, he began documenting Sheriff Moore's alleged interference. In August, for instance, one of the sheriff's agents called Dr Omalu and asked him — a year after the case had closed — to change the manner of death from homicide to accident because it was an officer-involved death. The man suffered traumatic brain and spinal cord injury during arrest, wrote Dr Omalu. "I was shocked," he said.

The tipping point came in October, when Dr Omalu learned that his ruling of "homicide" in one case had been changed to "accident" by the Sheriff's office. "On this day, I was convinced it was time for me to leave the Sheriff's office as a physician-employee," wrote Dr Omalu.

Moore, in a comment posted on the Sheriff's office Facebook page on December 6, said that he was "sad to learn that Dr Bennet Omalu has resigned." He said that he had never interfered with forensic investigations. "I would never try to control, influence, or change the opinions of Dr Omalu or any pathologist working on a case, but I still have the responsibility of making the final determination," he said.

Hands Cut Off for "Identification"

Both Dr Omalu and Dr Parson noted their distress over what came to be a repeated scenario: Autopsy technicians were directed on multiple occasions to cut off the hands of the deceased, ostensibly to send them to a state department of justice lab for the purposes of identification.

"At no point ever is it appropriate, or legal, for anyone other than a licensed forensic pathologist (or qualified technical personnel under the supervision of a licensed forensic pathologist) to make any incision, obtain any sample, or remove a part of a body for purposes relating to death investigation, as California law stipulates that only a licensed physician may perform an autopsy," said Dr Parson, in her memo. She noted that if such incisions or procedures were forced on the patient — even if deceased — the licensed medical professional "may be held liable for committing the criminal offense of battery."

Dr Parson added, "I am not an attorney, however, it seems that when the Coroner, or his designee, decides to remove parts of a body from non-coroner cases, that may violate the California government code and be classified as the unlicensed practice of medicine by a non-physician." 

Dr Omalu said he was concerned that removing hands from bodies could jeopardize his license, his privileges, and his credibility. "Removing the hands of a body is not part of a standard autopsy protocol and should only be performed on special cases, when justifiably indicated," wrote Dr Omalu.

In the cases he reviewed, he saw no reason for needing the hands for identification, he said.

Moore said in his Facebook post that hand removal is needed in rare cases. When all other methods of identification "are not available or cannot be utilized, the Coroner's Office will remove a digit or a hand and send it to the California Department of Justice to be processed at their lab." he added, "At all times, the decedents' families are in our thoughts."

Both Dr Parson and Dr Omalu also alleged sloppy investigations, delays in bringing deaths requiring autopsies to their attention, and a willful interference in the work and scheduling of the coroner's office.

"The Sheriff has been hell-bent on taking over the scheduling of physicians and determining when and how physicians will work or not work for no other reason but to have control of the physicians," said Dr Parson.

"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," said California Medical Association General Counsel and Senior Vice President Francisco Silva, in the organization's statement.

Sheriff Moore and his office were offered the opportunity to comment further, but did not reply by time of publication.

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