Donald T. Reay M.D. [Cobain's Cheif ME]

Donald T. Reay, M.D.

President 1987-88

Chief Medical Examiner, King County, Seattle, Washington 1969-1999

I had no intention of pursuing a medical career in forensic pathology. When I received my draft notice to report for induction into the US Army, I was in an internal medicine program as an intern with a special interest in hematology. While in medical school, I had been performing basic research in the pathology of copper deficiency anemia in swine that required autopsies on pigs. With my draft notice, I sought a reserve commission in the USAF that allowed me to complete an AP/CP residency in pathology before active duty. Because of my research in medical school, the American Board of Pathology gave me one year of credit so I was eligible for certification after three years of pathology residency. I had a vacant year before military service and I chose to investigate what forensic pathology was all about. I sought a year of training in forensic pathology, a specialty about which I knew nothing.

There were not many programs available for training in forensic pathology; however, I was fortunate to be accepted by Dr. Lester Adelson for a year of training with him and his staff at the Cuyahoga Coroner’s Office in Cleveland, Ohio. What a marvelous experience! I was totally captivated by Dr. A’s intellect and dedication to forensic pathology. He had a unique perspective about the importance of death investigation and the value of good forensic pathology to the community. In addition to Dr. A, I had stimulation from my contact with Dr. Irving Sunshine who was the toxicologist at the Cuyahoga office. Oliver Schroeder, professor of law at Case Western Reserve, would occasionally drop by to kibitz with Dr. A and I relished their exchange. The year in Cleveland had transformed my perspective on the practice of pathology and remained as an inspiration for me to pursue a career in forensic pathology.

My interest in forensic pathology was further stimulated by my assignment to the Armed Forces Institute of Pathology (AFIP) when I entered active military service after leaving Cleveland. It was my good fortune to be assigned to the forensic pathology unit at the AFIP that was under the capable leadership of Dr. Charles Stahl. Although the unit was under the titular head of Colonel Pierre Fink, it was Charlie who became my friend and mentor. Through his quiet style, Charlie emphasized the value of careful death investigation in the military and years later the Department of Defense (DOD) wised up and established the Military Medical Examiner as it exists today. It has Charlie’s fingerprints all over it. I learned much from Charlie about effective administration.

As I was completing my tour at the AFIP, Dr. Richard Froede arrived at the Institute to begin his year of forensic fellowship. Dick was regular Air Force and knew much about the military. He and I became friends and he became my military advisor. Dick and his family had spent several years in England with the Royal Air Force (RAF) on an exchange program and enjoyed it. I was curious about the program and became interested since I still had my father’s relatives in Durham, England where my father was born. The program sounded interesting since I had become aware that a forensic pathologist, Group Captain Ken Mason, was on staff and was involved with aircraft accident investigation. Although my duties would be those of a surgical pathologist, I welcomed the opportunity to be exposed to a new dimension of pathology.

I arrived at the Institute of Pathology and Tropical Medicine in RAF Halton to do my duty for two years. Despite the culture shock, I had numerous opportunities to accompany Ken on a variety of investigations, including a hovercraft and commercial airline accident investigation. Ken was a most gracious mentor and advisor during my time in England. His dedication to forensic questions was stimulating and I was allowed to perform autopsies during many of the accident investigations for which he was responsible. This experience was most valuable.

When I returned to the U.S., I was assigned to a USAF hospital laboratory as director of laboratories. I had wondered whether I could regain my early interest in surgical and laboratory pathology. As I performed hospital pathologist duties, I became aware that I mostly enjoyed performing autopsies and, in particular, if there were forensic questions about the case. I knew then that I must search out a full-time position in forensic pathology. In December of 1973, I left the USAF and my family and I set out for Seattle, WA to seek a new experience.

In 1969, Seattle-King County had converted its 1899 coroner’s office into a Medical Examiner appointed by local county government. I came to Seattle naïve about creating a new agency out of embedded traditions and customs with nepotism throughout. I came to Seattle with Dr. Patrick Besant-Mathews, who was to take over the administrative/executive functions while I would concentrate my activity on autopsies and death investigation. Patrick was more naïve than I was about county government and running an agency that was tethered to the past. In 1969, there was a desire by county government to have a medical examiner and dispose of the elected coroner but this was done without enabling legislation in the county charter except that the medical examiner would be in the Department of Public Health and perform autopsies. I didn’t realize that nothing had been done except change the nameplate on the door. I hadn’t paid attention to such issues since money had been set aside to construct a new facility at the Harborview trauma center.

The School of Medicine Department of Pathology at the University of Washington had agreed to regular faculty positions for ME pathologist staff and promote resident rotations in forensic pathology. The staffing of the office was structured so that there were 22 Investigators (deputy coroners), 3 office staff, 1 toxicologist tech, and 2 pathologists to perform about 900 autopsies per year. I had energy then and I was content to perform autopsies with enthusiasm although the facility was a converted surgical suite at an old hospital. This was the time I created a rough design for roll-around autopsy tables since we were using old hospital trolleys with cutting boards balanced on the body. The concept has been developed in many new autopsy facilities with roll-around autopsy tables and stations. Although the conditions were primitive, I was content doing autopsies and responding to homicide death scenes.

However, things did not go well. There was staff resistance to reconfiguring office positions in order to generate quality autopsy reports and create other important administrative functions. After two years, Dr. Besant-Matthews resigned and I was left to put things together. The new facility was completed and that was a boost to morale. I was fortunate to create an administrative position that designed enabling legislation accepted by county government along with policy and procedure documents. With retirements, positions were reclassified in line with job functions and union negotiations. The process was slow but there was good support by different Directors of Public Health during my 26 years as Medical Examiner.

The state of Washington has 39 counties and Seattle-King County was the first to make the transformation from a coroner to a medical examiner system. Gradually the major population counties made the transformation much like Seattle-King County. The less populated counties have still retained the elected coroner or a coroner-prosecutor. The elected coroners were suspicious of me since there had been discussions by the state medical society of establishing a state ME like neighboring Oregon. I was less than enthusiastic about such overtures since I had become aware of political forces with which I had to deal at the county level. I had become more politically astute over the years and such issues meant money.

Because there was a desire to improve death investigation statewide, the governor established a Forensic Investigation Council and I was appointed as a member and eventually became chairman. I was very aware of what was needed to improve death investigation in Seattle-King County that would also improve death investigation throughout the State of Washington. To allay the fears of the coroners, I sought to establish a quality toxicology laboratory that would benefit all jurisdictions. Funding was accomplished by a death certificate surcharge and I offered to support the coroner’s need for pathologists to perform autopsies by having our fellow available to perform autopsies when needed. Fortunately, our fellows agreed to this arrangement that required an additional year and the success of establishing the state toxicology program was done with their cooperation. I felt like the typical politician pulling this off. It was necessary to do it, if death investigation were to advance in the State of Washington. Forget the State ME. It will never happen.

We always struggled with a shortage of pathologists to perform autopsies. Fortunately, the medical school pathology residency program provided residents to rotate for forensic experience. In the early eighties, we applied and received approval to have a recognized fellowship training program. Over the years and until my retirement in 1999 we always had a fellow, usually from the University of Washington Medical School pathology program, who joined us for a year or sometimes two years. Many continued on in forensic pathology, and a few who have been active in NAME are John Howard (recent president) and Greg Schmunk. It was always a delight to work with the fellows since they were both challenging and a joy to see them develop forensic skills. I constantly found myself using Dr. A’s aphorism that “you do an autopsy with your head and not your hands.” Generally within three months, you could assess whether or not the fellow understood the issues.

I have always had a desire for investigative work whether it is a laboratory bench or an autopsy table. As in years past, forensic pathology is unique because the autopsy dissection and interpretation still remain the same. Yet there is a need to understand and discover new information about why people die. Death in infancy is still perplexing. Deaths in custody deserve careful scrutiny. I had the occasion to study neck holds used by law enforcement as a common method of restraint. The impetus for my work to understand what happens was prompted by autopsy observations in two victims of law enforcement restraint. The benefit of having a facility in a medical center is that there are cardiologists, radiologists, anesthesiologists, etc., and if approached, are willing to assist in reasonable investigative studies. We were able to design and utilize clinical instruments in our investigation of neck holds. Similarly, in evaluating the effects of hog-tied restraint we used resources borrowed from clinicians. Judicial hanging studies were performed on victims utilizing the latest radiological techniques.

In any major ME office, abundant epidemiological data is collected that can provide a wealth of information. I had the good fortune of working with a medical resident assessing the risk of firearms in the home. The study achieved national attention. In forensic pathology, funds for research are limited or non-existent but autopsy observations can provide an opportunity to seek answers about what causes injury and death. I still have some studies I would have liked to have performed if animal material was available. To those beginning their career in forensic pathology, I suggest that you look first then see. There are still questions that need answering.

I end this memoir with a tribute to NAME. My association with NAME starts in the 1970s when NAME first developed Inspection and Accreditation. My memory is that the Seattle-King County ME office was one of the first offices to be officially inspected and accredited. Joe Davis did us the honors and I was pleased to have Joe spend time with us. He is one of the icons of forensic pathology. It was with Joe’s encouragement that I became active in the organization. It was my good fortune since this introduced me to George Gantner, an early driving force in the organization. I was on the board of directors for about eight years and then was president-elect in 1987. Jim Bell, president at that time, died and I assumed the office of president sooner than expected. Jim was a strong advocate for Inspection and Accreditation and I am sure he would be pleased with the growth of the program. When George Gantner died in 1988, I then became pro-tem secretary/treasurer. Both Jim and George were such stalwarts in the organization and I truly missed their advice and counsel during those years. Over the years NAME has been an important organization for me since it has allowed me the opportunity to develop cherished friendships. Since retirement in 1999, I look back to my years in forensic pathology as a rewarding and satisfying experience. I would do it all over again.

Donald T. Reay M.D.