Editorial Note: Although every effort has been made to insure the accuracy of the material in this presentation, the scope of the material covered and the discussions undertaken lends itself to the possibility of minor transcription misinterpretations.

PRESENTATION BY
Dr. Lakshmanan Sathyavagiswaran, MD
Chief Medical Examiner - Coroner, Los Angeles County

Topic: The Role of the Medical Examiner-Coroner in Los Angeles County

February 3, 2005


Chairman Philibosian introduced Dr. Lakshmanan Sathyavagiswaran and welcomed him to the Commission.

Board Direction

Dr. Sathyavagiswaran addressed the Commission about the role the Medical Examiner-Coronerís Office plays in Los Angeles County and how technology significantly assists them in their work.

Medical Examiner/Coroner in Los Angeles County

Dr. Sathyavagiswaran pointed out to the Commission that the Los Angeles County Coronerís Office serves a population of over 10 million covering 5003 square miles with a staff of investigators and support staff. In their capacity this Office services 52 different law enforcement agencies within the County. There are only 3 other similarly structured independent medical examiner/coronerís offices in California: San Diego, San Francisco, and Ventura.

In 1956, the people of Los Angeles County voted a Charter amendment that the Coroner should be both a Forensic Pathologist and a Medical Doctor and would be called Chief Medical Examiner-Coroner. In 1990, the Board of Supervisors felt that it was too much responsibility for this position to be responsible for both the administrative and the professional duties within the Department. As a result they split the department with the administrative portion being the responsibility of Mr. Anthony Hernandez as the Director of the Department of the Coroner. Dr. Sathyavagiswaran, as the Chief Medical Examiner-Coroner, carries out the statutory mandated functions of the Coroner for the County and reports directly to the Board of Supervisors. The 210 staff includes 26 Deputy Medical Examiners and 31 consultants from various disciplines such as neuropathology, odontology, anthropology, and archeology who report directly to him. The remaining staff is divided into 4 divisions: Operations which includes Investigations, Forensic Support, and Decedent Services; Laboratory which includes the criminalists, toxicologists, and evidence control; administrative & support staff; and public services which includes certification, transcription, and subpoena control.

The Function of Medical Examiner-Coroner

There are approximately 70,000 deaths in Los Angeles County a year. Approximately 25,000 of these deaths many of which are not considered to result from natural causes become Coroner cases. The Coroner is the agency that determines the cause of death and the manner of death (suicide, accident, murder, etc.) for purposes of specifying such on a death certificate. An autopsy could be performed as part of this investigation. The scene investigation is also a crucial element in the process. Since the Coroner does not have the number of medical staff needed to go to every scene investigation, the department sends investigators to function as ďthe eyes and earsĒ of the medical examiner with the purpose of collecting information on the circumstances of the incident. Other aspects of the Coronerís Office include: the identification of the victim, notification to next-of-kin, preserving personal property, issuing the final cause of death for the death certificate and finalizing the protocol or autopsy report.

One of the Medical Examinerís roles is to report to Consumer Product Safety Commission any products that have caused injury or death as a direct result of its use. Dr. Sathyavagiswaran cited an example of a case involving a 10 month old infant who died at daycare. The forensic pathologist identified signs of asphyxia. It was determined after further investigation that the cause of death was the child being trapped after the crib collapsed from a faulty side-rail mechanism. After reporting his findings, the U.S. Consumer Product Safety Commission issued a ďClass AĒ recall of over 11,000 of these portable cribs from the market. As a result, he and his staff had received an award for identifying this problem.

Another case highlighted by Dr. Sathyavagiswaran was one involving an abused child and her subsequent death. Trained professionals such as forensic scientists played a key role in matching the suspect weapon to injuries on the victim through the use of technology such as a Scanning Electronic Microscope (SEM). The Coroner was able to prove this case in court which led to the conviction of the suspect. Dr. Sathyavagiswaran mentioned other technologies they posses, such as the Live Scan Technology (which helps with rapid identification through fingerprints). The office received an award from the Product & Quality Commission for the use of this tool.

His final case example involved the accidental death of a 12 year old boy. Through autopsy, microscopic, and toxicology studies utilizing a new instrument called the GCMSMS, the blood tested positive for Dichlorofluromethane-R22 (Freon). The child had inhaled this gas while re-inflating (by mouth)a plastic chair that had been previously inflated with a canister containing R-22. In closing he noted that there are a small percentage of cases where no cause of death can be determined. Hopefully in a few years these cases can use new scientific advances and instruments to determine the cause. Dr. Sathyavagiswaran wanted the Commission to know that the Medical Examiner-Coronerís Office always practices cost effective forensic medicine and new technologies that are a key to efficiency.

Commissioner Questions

Commissioner Thompson noted that when he was with the County Board of Supervisors that they had a great experience with the Coronerís Office. When dealing with deaths in the Ethiopian Jewish Community the Cornerís Office was sensitive to their needs. Many people arenít aware that itís a Jewish practice to bury the dead as quickly as possible. He thanked Dr. Sathyavagiswaran for expediting these cases. Dr. Sathyavagiswaran thanked the commissioner and commented that the Coronerís Office tries to do this for all religions by expediting these cases to help the families and these communities move forward.

Vice-Chair Ikejiri asked about the current annual budget. Dr. Sathyavagiswaran responded that it is $18.4 million. The Office had gone through some budgeting and staffing difficulties in the early 1990ís which resulted in the loss of technical staff that is not easily replaced. Mr. Janssen and the County Board of Supervisors have brought the Coronerís Office back to a reasonable budget level over the past 5 years. This level of funding has enabled the office and the lab to become fully accredited and post certified.

Commissioner Hill asked what was the most difficult official accreditation to get? Dr. Sathyavagiswaran explained that it was The National Association of Medical Examiners. This organization sets the standards for medical examiner accreditation which require that the office meet all of the requirements that they set for staffing and case-loads. Not all medical examiners offices receive this accreditation.

Chairman Philibosian inquired into the activities of the Coronerís novelty store? Dr. Sathyavagiswaran joked that Halloween is the busiest time for the novelty store and that the revenue they receive from the store varies from month-to-month.

Chairman Philibosian thanked Dr. Sathyavagiswaran for devoting his time to a very informative and interesting presentation.

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