Moving to restore the tarnished credibility of the San Diego County coroner's office, the county has hired a nationally known forensic pathologist to oversee all autopsies, laboratory work and other medical duties in the troubled agency.
Dr. Ronald L. Rivers, who established the state medical examination system for Montana, is to begin work April 1 as San Diego County's first chief of forensic pathology, a position described by many as the closest thing to a full-fledged county medical examiner.
"The way this system is going to work, he is directly responsible for everything medical," Coroner David Stark said after the announcement Wednesday. "I'm technically his supervisor, yes. But in practice, it is not my plan to interfere with his medical judgment."
Rivers' appointment to the $95,000-a-year job is viewed as a critical step toward restoring confidence in the coroner's office, which has been accused of conducting faulty autopsies and thus jeopardizing law enforcement and criminal justice in the county.
Lawyers and pathologists have cited cases in which the coroner's office failed to notice bullet wounds, lost evidence and misinterpreted injuries in autopsy reports--crucial documents that can help decide a person's guilt or innocence in court.
Observers predicted Wednesday that Rivers' hiring will enable the office to recruit better-qualified pathologists, improve cooperation with specialists at UC San Diego and enhance the credibility of autopsy reports and pathologists testifying in court.
"It'll mean that the autopsies will be done correctly and that the abnormalities present in patients will now be identified correctly," said Dr. Paul Wolf, a UCSD professor of pathology and director of autopsy at the VA Medical Center in La Jolla.
Wolf and others also noted that Rivers' new position is "the closest thing" to a medical examiner system--the system used in other populous counties in California in which a medical doctor runs the office, signs all death certificates and has the final say on cause of death.
Critics of the coroner's office--including defense lawyers, pathologists and some public officials--have argued over the last two years that the best way to reform the agency would be to convert from what they describe as an outmoded coroner system to the more modern medical-examiner system.
There were indications Wednesday that Rivers' hiring might be a step toward such a system.
"If and when we want to go to a full medical examiner's office, a person with all the credentials will already be in place," said Norman Hickey, chief administrative officer for the county, who announced the appointment.
"In the meantime, hiring Rivers will give us a person capable of being a medical examiner," said Supervisor Susan Golding, a principal advocate of overhauling the office. Regardless of his title, she said, "We have the expertise we need."
Some attorneys, too, praised the appointment.
"I think that everybody agrees that the label is less important than whether the job is being done," said Elisabeth Semel, past president of the Criminal Defense Bar Assn. "The concern isn't what we call it but whether the . . . proper quality controls are being enforced."
Rivers' duties will include supervising five full-time staff pathologists, whom he will help hire to take the place of the one part-time pathologist and five independent pathologists who now do autopsies on a fee-for-service basis.
Rivers will also be in charge of about 10 forensic technicians and autopsy assistants who work in the coroner's examining room, and 10 more lab workers who specialize in histology and toxicology, Stark said.
As for Stark, he will remain the titular head of the office and the administrative chief, in charge of 12 secretaries, clerks, typists and administrative support staffers, and the 15 deputy coroners who serve as medical investigators at the scene of death.
"While technically someone has to be the department head for administrative purposes, for functional purposes he's in charge of all the medical activities within the office," said Stark, who is 57 and has headed the office since 1978.
Stark said Rivers might even be the one to sign the death certificates that officially state a person's cause of death--an especially sensitive function that has become an issue in the debate over whether or not the county needs a medical doctor running the office.
"I would personally prefer that he sign the death certificate," Stark said. "The important thing behind the whole situation is who's making the medical decisions. My answer to that, very firmly, is Dr. Rivers."
Rivers, 55, is originally from California but was hired in 1980 by Montana Atty. Gen. Mike Greely to serve as the state's first medical examiner, overseeing the death-investigation system then conducted by 56 sheriffs and elected local coroners.